The rationale behind the current government policy in promoting birth control in China was that the large population had been a heavy burden to economic growth. Besides, there had not been any important social mechanism that moved against population growth. Excessive "idle" population has facilitated raising young generations. Before rural economic reform, the income distribution in rural areas depended on the number of people in a family. This system apparently had a pro-natal effect. Even after the reform, no significant advantage of having a small family has appeared. As the net flow of wealth from children to parents was still considered positive and the opportunity costs in raising children is relatively low in rural areas, the incentive to produce more children is still present. In urban areas, grandparents may take the responsibility of caring for children for a large number of young couples; therefore, the opportunity costs to these parents may not be significant. Cultural traditions and a distorted low cost of raising children all stimulate population growth. Under such conditions, using an administrative system to implement population policies would be the most effective means of halting population growth. The target of the policy should be the causes of population growth rather than the outcome.
This paper discussed the changes from 1980 to 1987 in the proportion of urban population and the proportion of non-agricultural population in the total population of China. The definition of urban areas developed in 1955 referred to areas with a population of over 2000 with over 50% engaged in non-agricultural occupations. This definition changed in 1964 and in 1983. The current definition is areas with more than 20,000 residents and over 10% non-agricultural population. The urban population grew from 10.6% in 1960 to 19.7% in 1984. Even though there were annual fluctuations, the slow and gradual. From 1980 to 1987, urban population rapidly increased from 19.4% to 46.6%. The most important cause of this growth was a change in the definition of urban areas. This change resulted in upgrades of towns to cities and expansion of city boundaries. Thus, the population of urban areas increased and the proportion of non-agricultural population reduced. The redefinition of urban areas mostly affected the population size of cities in 1983 and of towns in 1984. In 1984, a new regulation was issued on the eligibility of a status changes from an agricultural to a non-agricultural population. As an effect of this new regulation, non-agricultural population increased substantially, but the growth trend showed a subsequent decline due to further policy changes and a return of migrants who failed to established themselves in cities.
The Population Institute of Wuhan University in China conducted a field study on the family planning (FP) program in several cities and counties of Hubei Province in 1989. It was found that a number of aspects of the program were incompatible with what was needed to deal with the eminent population growth. 1) There was a shortage of FP personnel at the grassroots level. Those who were responsible for the FP program were often too busy with other things or did not have sufficient knowledge or experience for the job. 2) Publicity about the government FP policy was inadequate in many local areas. Out of 1,263 women with 2 or more children who responded to the study, only 5.3% had heard about the policy, 26.7% never read about FP and 43.7% never thought about the government birth control policy when trying to become pregnant. 3) Knowledge about birth control methods was in adequate for the needs of the people. 85% of the respondents knew about birth control methods, basically the IUD and female sterilization. Only 14.4% knew about oral contraceptives, 1.8% about vasectomy, and 1% about injectables. Knowledge of the rest of the methods was no more than 1%. Even local FP workers did not know much more. For those women who did not want to use surgical procedures, no alternatives were known. Therefore, no contraceptive method was used, thus unwanted pregnancies occurred. 4) Some methods of FP publicity in rural areas were overly simplistic. To some local FP workers, publicity only meant writing slogans with FP messages on the wall. Quite a few local workers did not know FP policies and regulations. They simply said "You have to pay a fine if you have too many children," making people believe that the FP program was no more than a way to collect money. The information gathered from the survey showed that publicity and education are of great importance to a FP program. They can either help the program implementation or cause adverse effects.
69.1% of women of childbearing age in Qinzhou City, China, are currently using IUDs. A sample survey of 474 women had shown that the level of failure of this contraceptive method was undesirably high. 26.16% of the survey respondents experienced IUD expulsion. The highest was among women in the 25-29 age group (29.15%). It was believed that reported expulsions were most probably user-initiated removals because most women in this age group had already had a child, and they would want to have another child, especially if the 1st child was a girl. The study also showed that the expulsion rate was higher among those women who had had and IUD inserted at a young age. The expulsion rate of women who had the insertion when they were 20-24 was 1.59 times higher than those in the 25-29 age group, and 2.02 times higher than those in 30-35 age group. This suggested that the uterine cavities of younger women with low parity might be more sensitive to foreign objects. Analysis by types of institution where IUD insertion was provided showed that expulsion was over 3 times higher among those who had had an IUD inserted in village clinics than in hospitals at county level and above. This suggested that the skill of service providers and medical facilities may be correlated with IUD expulsion. Village rural doctors usually received less training and may have limited supplies of different sizes of IUDs which contributed to higher rates of IUD expulsion of their patients. A number of recommendations are made for improving the effectiveness of the IUD. It is necessary to strengthen population education among women to increase their commitment to fertility control. Service providers should receive proper training before they can perform IUD insertions. Medical professionals having good attitudes and outstanding performance should be rewarded. Those who helped remove IUDs illegally should be subjected to discipline or legal procedures. Regular examination after IUD insertion should be emphasized to ensure its effectiveness.
Establishment of a system for old age support in rural areas of China is an important aspect to ensure the success of a family planning (FP) program. The necessity of such a system was examined from the following perspective. 1st, children are sources of old age support due to lack of social security and pension systems in rural areas. This had been the key reason motivating some rural farmers to ignore FP regulations and continue to have children. Unless the livelihood of a rural population is ensured in some way, it is difficult to achieve FP program objectives. 2nd, the increasing life expectancy and declining fertility made the population age process occur rapidly, e.g., the population aged 65 and over will increase from 7% at the end of the century to 17% in the 2030s. Living and health care of the old age population at that time would be an important need for the society. 3rd, changes in family patterns from extended to nuclear families have gradually changed the position of old people in the family which made it unfeasible to rely entirely on children for old age support. Several systems of old age support have been suggested. Government and the community should take responsibility for establishing a social security system. The role of the government will be in educating the public on the importance of social security programs, training professionals to work in these programs, formulating laws and regulations on social security, and supporting a social security system through taxation and welfare programs. The communities may help set up the organizational structure and make financial contributions to the social security system. Insurance companies or commercial banks may set up special coverage or saving programs for old age support. The role of children to support parents would still be important for a certain period of time. The current pilot projects on a rural social security system in 270 countries were an important starting point for helping the rural population to reduce the need for children and to reduce the opposition to family planning programs.
