3- aos/ta : 13 X 
 
 CHINA'S FAMILY PLANNING PROGRAM: 
 INPUTS AND OUTCOMES 
 
 by 
 
 Judith Banister 
 
 and 
 
 Christina Wu Harbaugh 
 
 Center for International Research 
 
 Bureau of the Census 
 Washington, D.C. 20233-3700 
 
 CIR Staff Paper 
 No. 73 
 
 June 1994 
 
Digitized by the Internet Archive 
 
 in 2012 with funding from 
 
 LYRASIS Members and Sloan Foundation 
 
 http://archive.org/details/chinasfamilyplanOObani 
 
CIR STAFF PAPER 
 No. 73 
 
 CHINA'S FAMILY PLANNING PROGRAM: 
 INPUTS AND OUTCOMES 
 
 by 
 
 Judith Banister 
 
 and 
 
 Christina Wu Harbaugh 
 
 Center for International Research 
 
 Bureau of the Census 
 Washington, D.C. 20233-3700 
 
 June 1994 
 
11 
 
SUMMARY 
 
 Certain aspects of China's family planning program have been well documented, for 
 example, the fertility targets, annual birth rates and total fertility rates, the parity distribution 
 of reported births, data on the contraceptive use rate and contraceptive mix, and the rationale 
 for the methods used in the program. But a surprising range of information has been completely 
 unavailable or very difficult to locate. The main purpose of this report is to fill in as many of 
 those missing pieces as possible, so that interested observers can more fully comprehend the 
 organizational structure, chains of command, staffing, financial aspects, and means of delivery 
 of each kind of birth control technique in the People's Republic of China. 
 
 Another purpose is to assess what aspects of China's family planning program are 
 relevant elsewhere and might provide an example for other countries to follow. We note that 
 China has the world's only required family planning program, so far as is known, which lessens 
 the applicability of some aspects of the China model in countries where the government is 
 unwilling or willing but unable to pursue required family planning. Yet by looking closely at 
 the ways that China's family planning program operates, we have discovered some lessons 
 relevant to family planning programs elsewhere. 
 
 Population Trends and Dynamics 
 
 This report begins with an overview of demographic trends in China in recent decades. 
 Mortality has improved dramatically in the four decades since the PRC was founded, and a life 
 expectancy at birth of about 67 years has been achieved. The death rate is low and 
 
 in 
 
approximately constant, and the infant mortality rate is low but, based on our analysis of survey 
 data from 1988, has not improved further since about 1977. 
 
 The report documents the steep drop in fertility in China during the early 1970s, and the 
 fluctuations in the total fertility rate between 2 and 3 births per woman at least through 1991. 
 Reviewing the main proximate determinants of fertility, the report notes that almost all Chinese 
 women marry and have children. The age at marriage for women rose in the 1970s under 
 government pressure, reducing the birth rate in the bargain. But a drop in the regulated 
 minimum marriage ages caused a surge of marriages in the early 1980s that increased the birth 
 rates and total fertility rates 1 in the 1980s. Since 1987 the average age at first marriage for 
 women has risen again, temporarily depressing both these measures of fertility. 
 
 According to a 1988 survey, 71 percent of married women of reproductive age in China 
 were practicing family planning. Of those couples, 91 percent were using modern, passive birth 
 control methods that, once implemented, require no incentive on the part of the couple to avoid 
 childbearing. These effective means of birth control are backed up by abortion, sometimes 
 voluntary and at other times mandated by the authorities as a "remedial measure" when women 
 become pregnant without permission. Of those pregnancies in China that do not spontaneously 
 abort, about one-third end in induced abortion. 
 
 l The total fertility rate is the sum of age-specific birth rates of a hypothetical cohort of 
 women over their reproductive span, or the number of children women would have in a lifetime 
 if women lived their entire fertility lifetime with current, constant fertility rates, ignoring 
 mortality. 
 
 iv 
 
Family P lanning Personnel and Expenditures 
 
 After providing an overview of China's major population policies over time, the report 
 compiles and estimates figures for China's national, provincial, and per capita family planning 
 "operational" budgets. It shows that the core national family planning budget doubled in real 
 terms from 1978 to the late 1980s, and that further doubling is being projected by the central 
 government. The report documents what is and is not covered in that formal budget, and 
 provides the main components and total cost of the PRC family planning program in 1985, 1987, 
 and 1989. For each of these years, the actual costs of China's family planning program were 
 about four times the size of the "operational" budget. By 1989, China's family planning 
 program cost just over one U.S. dollar per capita (at the official exchange rate), or almost US$6 
 for each married woman of reproductive age. The main category of costs in China's family 
 planning program is the incentives paid to couples who pledge to have only one child. 
 
 Fertility Interventions and Their Effectiveness 
 
 China's family planning policy is successful, in that people are in general bearing fewer 
 children than they would prefer to have. But government control of fertility in China is far from 
 absolute. The peak of Government intervention in 1983 was accompanied by a popular reaction, 
 which prompted the authorities to temporarily ease the requirements of the program. Some 
 provinces have acquiesced to the rural demand for two children per couple, and in 16 such 
 provinces, rural people are restricted to one child if the firstborn is a son, but allowed two births 
 if the first child is a daughter. The one-child policy, while followed in the cities, has had to be 
 modified in the countryside. 
 
Future Prospects 
 
 If the count of young children was complete in the 1990 census, one can estimate that 
 the total fertility rate in the late 1980s dropped to about 2.4 births per woman in 1988 and 1989 
 and further to around 2.2 in 1990. If babies and children were undercounted, then fertility was 
 slightly higher. There is evidence of further reduction in the TFR to an estimated 1.9 births per 
 woman in 1992. The report argues that a continuing unstable equilibrium can be expected in 
 the 1990s, with Chinese authorities trying to hold fertility below the level desired by the people, 
 and each year millions of women attempting to carry unauthorized pregnancies to term. Fertility 
 per woman might remain steady under this scenario, or decline slightly under the impact of 
 continuing urbanization and further reduction of fertility among the minority groups. It is also 
 possible that changes in China's government policies could result in less vigorous support of the 
 current approaches to family planning, in which case fertility would rise. 
 
 Because of sharp changes in mortality and fertility in previous decades, China's age 
 structure is not smooth. China has already experienced a drop in the number of children 
 entering school, due to the fertility decline of the 1970s. The age structure now has a bulge of 
 people in the late teens and early twenties, who are already at peak childbearing ages or soon 
 will be. Hence, further reductions in the birth rate will be difficult for most of the nineties. 
 
 During the late 1990s, however, the numbers of people in their teens and early twenties 
 will decline, which will begin to ease the upward pressure on the birth rate and will reduce the 
 numbers of people entering the labor force. This could help to reduce urban unemployment, 
 which in China is a phenomenon concentrated among young adults. The report traces the aging 
 
 VI 
 
of China's labor force in the early decades of the coming century, and finally the aging of the 
 population, especially the urban population, by mid-century. 
 
 Relevant Lessons from China's Family Planning Program 
 
 For countries with voluntary family planning programs, we show that China provides an 
 example of a poor developing country that has tapped domestic resources to fund a relatively 
 effective family planning program. What is required is a government with the will to promote 
 family planning and the capacity to implement a family planning program. Judging from 
 Chinese experience, an advanced economy is not a requirement. 
 
 The PRC experience also suggests that the amount of money spent on family planning 
 is not the only determinant of success in controlling fertility. We note that China's family 
 planning program is not static, but adapts over time to changing circumstances, often by making 
 organizational changes rather than just throwing money at it. While there is waste in China's 
 family planning program, there are also attempts to contain costs while still getting the 
 government's desired results. 
 
 The China model is also relevant to other countries with regard to the legalization of all 
 forms of birth control. China also demonstrates that a poor country can manage to provide free 
 birth control operations and supplies. The use of international assistance to build the factories 
 that produce contraceptives helps China to do that. 
 
 The PRC experience also demonstrates that it is unwise to believe data on acceptors or 
 births when they are reported by family planning workers or local officials. China has shown 
 the importance of conducting independent censuses and surveys to give better estimates of 
 
 vu 
 
fertility and family planning use. Similar data constraints and requirements exist in many other 
 countries. 
 
 The paper concludes by noting that the required elements of China's family planning 
 program, and the significant incentives and disincentives, are expensive in both financial and 
 social terms. A country that desires to copy the best of the China model might try to minimize 
 these costs while adopting many of China's practical methods for motivating couples to practice 
 family planning and for delivering birth control supplies and operations to the people. 
 
 vui 
 
PREFACE 
 
 The Center for International Research conducts economic and demographic studies, some 
 of which are issued as Staff Papers. A complete list of these papers is included at the end of 
 this report. The use of data generated by the U.S. Bureua of the Census precludes performing 
 the same statistical reviews the Bureau does on its own data. 
 
 This study was prepared as a background paper to a larger World Bank study on 
 Population Issues in Asia by Warren C. Sanderson and Jee-Peng Tan (1993). We would like 
 to express appreciation to them for providing us with this opportunity to analyze the 
 organizational and financial aspects of China's family planning program in order to assess its 
 relevance for other developing countries. We would like to thank Andrea Miles for her 
 assistance with tables, graphs, and maps, and Richard Turnage for design and creation of the 
 maps. The analyses and opinions expressed in this report are those of the authors alone, do not 
 represent the policies of the U.S. Government or the U.S. Bureau of the Census, and should not 
 be attributed to the World Bank or its affiliated organizations. 
 
 Comments and questions regarding this study should be addressed to Marc Rubin, 
 Eurasia Branch, Center for International Research, Bureau of the Census, Washington, D.C. 
 20233; telephone (301) 763-4020. 
 
 IX 
 
CONTENTS 
 
 Summary iii 
 
 Preface ix 
 
 Contents xi 
 
 I. Introduction 1 
 
 A. Required Family Planning 1 
 
 B. Determinants of Fertility in China 3 
 
 n. Population Trends and Dynamics 5 
 
 A. Fertility Trends, 1950-1991 5 
 
 B. Proximate Determinants of Fertility in China 11 
 
 a. Marriage 13 
 
 b. Level and Efficiency of Contraception 20 
 
 c. Abortion 25 
 
 d. Breastfeeding 29 
 
 C. Mortality and Health 29 
 
 D. Migration 33 
 
 HI. China's Family Planning Goals and Policies 35 
 
 xi 
 
IV. China's Family Planning Budget 37 
 
 A. Aggregate Family Planning Operational Budget 37 
 
 B. Provincial Per Capita Operational Budget Expenditures 39 
 
 C. Complexity of China's Family Planning Financial Accounting 47 
 
 D. Components of the PRC Family Planning Operational Budget 54 
 
 V. Estimated Spending on Family Planning in China 57 
 
 A. Public and Private Provision of Services 63 
 
 B. Family Planning Personnel and Facilities 66 
 
 a. Family Planning Cadres and Workers 66 
 
 b. Density of Family Planning Delivery 68 
 
 c. Remuneration for Family Planning Workers and Staff 76 
 
 C. Contraceptive Supplies 81 
 
 D. Costs and Provision of Birth Control Surgery 86 
 
 E. Bonus for One-child Certificate and One-child Health Care 90 
 
 F. Penalties for Unauthorized Children 97 
 
 G. Utilization of Fines for Births Outside the Plan 100 
 
 H. Expenses for IEC 101 
 
 I. Expenditures on Family Planning Scientific Research Projects 104 
 
 J. Expenses for Equipment, Fixed Assets and Capital Construction 107 
 
 VI. Foreign Assistance for Family Planning 108 
 
 Xll 
 
VII. Overview of Interventions and Their Effectiveness Ill 
 
 A. Ideal Family Size Ill 
 
 B. Current Limits to Fertility Reduction in China 113 
 
 VIII. Future Prospects 116 
 
 A. Future Fertility 116 
 
 B. Future Population Size and Growth 117 
 
 C. Future Shifts in Age Composition 118 
 
 D. Urbanization and Its Implications 119 
 
 E. Implications of China's Fertility Level 121 
 
 V. Conclusions 123 
 
 APPENDICES 
 
 Appendix A: Family Planning Expenditures in China's National Budget 131 
 
 Appendix B: Organizations and Personnel Involved in the Family Planning 
 
 Program 135 
 
 Appendix C: Text of 1983 Regulation on Family Planning Operating Funds 141 
 
 Appendix D: China, Maternal and Child Health Network 147 
 
 Appendix E: Operational Expenditures for Contraceptive Supplies and 
 
 Devices: Components and Bases for Expenditure Calculation 155 
 
 Appendix F: Utilization of Fines for Births Outside the Plan 159 
 
 Appendix G: Funds for Building and Equipping China's Family Planning 
 
 Service Stations 161 
 
 Bibliography 165 
 
 xiii 
 
TEXT TABLES 
 
 Table 1: China, Nationwide, Urban, and Rural Total Fertility Rates, 
 
 1950-1990, As Reported 7 
 
 Table 2: Marital Status of China's 1988 Population 14 
 
 Table 3: China, Women's Mean Age at First Marriage, 1950-1981 17 
 
 Table 4: Contraceptive Mix in China, 1982-1988 22 
 
 Table 5: Reported Birth Control Operations in China, 1971-1990 24 
 
 Table 6: China, Abortion rates, 1971-1989 26 
 
 Table 7: China, Reported Causes of Pregnancies that Ended 
 
 in Abortion, 1979-1982 28 
 
 Table 8: China, Family Planning Operational Expenses, 1978-1990 38 
 
 Table 9: China, Family Planning Expenditures Per Capita, 1988 and 1989 40 
 
 Table 10: China, Reported and Planned Per Capita Family Planning 
 
 Expenditures by Various Provinces 45 
 
 Table 11: Costs of Family Planning in Shanghai County, 1979-1983 49 
 
 Table 12: China Estimated Family Planning Expenditures, 1985, 1987, 
 
 and 1989 58 
 
 Table 13: Estimated Wages for Full-time Family Planning Employees 
 
 in China, 1985 and 1987 74 
 
 Table 14: Total Full-time Family Planning Cadres and Estimated 
 
 Annual Wages 75 
 
 Table 15: Basic Situation of Contraceptive Supplies and Devices 
 
 Control Stations in China 84 
 
 Table 16: Well-Equipped County Level Family Planning Service Stations 
 
 in China, 1989 87 
 
 Table 17: China, Estimated Expenditures for Birth Control Measures, 
 
 1980-1989 91 
 
 xiv 
 
Table 18: One-child Incentive Program: Monthly Payment and 
 
 One-time Bonus 92 
 
 Table 19: China, Foreign Aid in the Population Field 109 
 
 FIGURES 
 
 Figure 1 : China Nationwide, Urban and Rural Total Fertility Rates, 
 
 1950-1990, As Reported 8 
 
 Figure 2: China, Pattern of Childbearing 12 
 
 Figure 3: China, Mean Age at First Marriage for Women, 1950-1981 18 
 
 Figure 4: China, Provincial Fertility Level and Per Capita 
 
 Family Planning Operational Expenditures, 30 Provinces 42 
 
 Figure 5: China, Provincial Fertility Level and Per Capita 
 
 Family Planning Operational Expenditures, 29 Provinces 43 
 
 Figure 6: Organization of the National Family Planning Program 
 
 (Central Level) 51 
 
 Figure 7: Organization of the National Family Planning Program 
 
 (Provincial and Local Level) 52 
 
 MAPS 
 
 Map 1. People's Republic of China i 
 
 Map 2. China, Reported Crude Birth Rates by Province, 1990 Census 6 
 
 Map 3. China, Reported Annual Per Capita Family Planning 
 
 Operational Expenditures by Province, 1989 44 
 
 xv 
 
APPENDIX TABLES 
 
 Table D.l: China, Maternal and Child Health Expenditures 
 
 by Province, 1987 148 
 
 Table D.2: China, Rural Part-time Public Health Personnel, 1965-1989 150 
 
 Table D.3: Public Health Organizations at the Village Level in 
 
 the Rural Areas in China, 1985-1989 153 
 
 xvi 
 
I. Introduction 
 
 The People's Republic of China (PRC) is the world's most populous country. This 
 country alone has 27 percent of the total population of developing countries and 37 percent of 
 the Asian population. 2 So China looms large in any assessment of trends and prospects for the 
 population of Asia. The PRC is seen as a success story because it has achieved unusually low 
 fertility for a low-income country, partly through its family planning program. This study 
 catalogs the inputs to China's family planning program and the outcomes, to the extent that this 
 is possible given limits on data availability. Then it assesses the extent to which China's family 
 planning policies and programs are relevant to other developing countries. 
 
 A. Required Family Planning 
 
 The family planning program of the PRC is unique in one important way which weakens 
 the relevance of the China model for other low-income countries faced with rapidly growing 
 populations. At the moment, so far as is known, the PRC is the only country where the 
 government attempts to control, for each woman and couple, the age of marriage, timing of 
 pregnancy, type of birth control method, number of years between births, and total number of 
 
 2 Based on assessments of each country's population size in 1993, conducted at the Center 
 for International Research, U.S. Bureau of the Census. 
 
 i 
 
births. 3 These limitations are not completely enforceable everywhere in China, but they are 
 surprisingly effective, in part because the PRC has a highly organized political system that 
 affects people's daily lives on a routine basis and regularly monitors women's birth control use 
 and menstrual cycles. 
 
 The Chinese government does indeed try to increase genuine demand for family planning 
 services through its publicity and educational work, and by providing easy access to birth control 
 devices and operations. But in addition, the government mandates the use of the birth control 
 techniques provided. The family planning program in China has the following important 
 components: 
 
 —strong political commitment 
 -convenient availability of supply points 
 -a range of available contraceptive technology 
 -government reimbursements to providers 
 —free birth control techniques for users 
 —strong reinforcing social institutions 
 -powerful incentives and penalties 
 
 3 For details see Banister, 1987, 147-226; Hardee-Cleaveland and Banister, 1988; Aird, 
 1990. 
 
B. Determinants of Fertility in China 
 
 Many scholars have tried to determine what proportion of China's fertility decline has 
 been caused by the family planning program, and what portion by socioeconomic development. 
 They use statistical techniques that have proved useful for this assessment in other countries. 
 They show that provinces, subprovincial areas, or individual couples with lower fertility usually 
 have more developed socioeconomic characteristics (higher education, more urbanized, higher 
 income, lower mortality, better quality of life, more industrialized), while those places or 
 couples with higher fertility tend to have more backward socioeconomic characteristics. Some 
 analysts then attribute most of the differentials in fertility to socioeconomic development 
 differentials, and finally imply that the family planning program is not that important in causing 
 China's fertility decline. 
 
 Such analyses ignore the fact that China's family planning program is more controlling 
 or "stronger" in urban areas than rural, in advanced areas than poor areas, and that the family 
 planning program more strongly affects educated people with higher incomes, who have more 
 to lose from the penalties than do poor peasants. Besides, the explicit family planning policies 
 require advanced areas and couples to stop at one child, but allow backward areas and rural or 
 minority couples two or three children. Therefore, the differentials in fertility are caused in part 
 by big differences in how the family planning program is implemented. 4 In the PRC, 
 socioeconomic variables are highly associated with family planning variables. The 
 
 4 For further detail, see Peng, 1989. 
 
multicollinearity problem is so severe that one cannot separate out the causes. The better 
 analyses have therefore concluded that in China, socioeconomic development and the family 
 planning program have been mutually reinforcing in bringing about fertility decline. 5 
 
 Analyses that focus on explaining the differentials in fertility among provinces or 
 localities usually ignore the important fact that fertility almost everywhere in China, no matter 
 how poor and backward, has declined during the last decade or two. The total fertility rate 
 (TFR) has dropped from around 6 births per woman to 4 or below, just about everywhere. 6 
 In advanced areas, this early phase of the fertility decline happened or may have happened 
 spontaneously, without much effect from the family planning program. 7 In backward areas, this 
 fertility decline was very likely caused by the family planning program. In China, what the 
 analyst needs to explain is not only the remaining differentials in fertility, which are significant 
 from region to region, but also the remarkable convergence of fertility across the whole 
 socioeconomic spectrum. For example, one study showed that in several provinces, fertility 
 differentials in the early 1970s that were related to differences in education and literacy had 
 largely disappeared by the end of the decade under the impact of China's family planning 
 program. 8 
 
 5 See, for example, Poston and Gu, 1987. 
 
 •^The major exception is Tibet, where the Tibetan minority constitutes 95 percent of the 
 civilian population, family planning has only recently been introduced, and the TFR is still 
 reported to be 4.8 births per woman. China 1990 Census, 1991, 4, 17; Zhaxilangjie and Zang, 
 1991, 6. 
 
 7 Lavely and Freedman, 1990. 
 
 "Freedman etal., 1988. 
 
In conclusion, while it is hard to measure, there is little doubt that China's family 
 planning program has been very effective in lowering fertility. Socioeconomic development has 
 certainly played a part in bringing about China's fertility decline. For instance, many millions 
 of families have probably chosen to have fewer children in response to the sharp drop in infant 
 and child mortality, the improved societal position of women, increased education and literacy, 
 industrialization, and urbanization. China's lowest birth rates are found in the more urbanized 
 and developed provinces of the northeast, north, and eastern areas along the coast (Map 2). 
 Higher birth rates are seen in the less developed, mostly inland provinces, and the highest birth 
 rates are in minority group and economically backward provinces. But the role of the family 
 planning program in initiating fertility decline and sustaining low fertility should not be 
 underestimated. 
 
 n. Population Trends and Dynamics 
 
 A. Fertility Trends, 1950-1991 
 
 The PRC has experienced a profound fertility transition during the last several decades. 
 As shown in Table 1 and Figure 1, women had over 6 births apiece on average during the 
 middle years of the 1950s. The fertility of the urban nonagricultural population was also high, 
 but was already below that of rural women. 
 
Table 1: China, Nationwide, Urban, and Rural 
 Total Fertility Rates, 1950-1991, 
 As Reported 
 
 Year 
 
 National 
 
 1950 
 
 5.81 
 
 1951 
 
 5.70 
 
 1952 
 
 6.47 
 
 1953 
 
 6.05 
 
 1954 
 
 6.28 
 
 1955 
 
 6.26 
 
 1956 
 
 5.85 
 
 1957 
 
 6.41 
 
 1958 
 
 5.68 
 
 1959 
 
 4.30 
 
 1960 
 
 4.02 
 
 1961 
 
 3.29 
 
 1962 
 
 6.02 
 
 1963 
 
 7.50 
 
 1964 
 
 6.18 
 
 1965 
 
 6.08 
 
 1966 
 
 6.26 
 
 1967 
 
 5.31 
 
 1968 
 
 6.45 
 
 1969 
 
 5.72 
 
 1970 
 
 5.81 
 
 1971 
 
 5.44 
 
 1972 
 
 4.98 
 
 1973 
 
 4.54 
 
 1974 
 
 4.17 
 
 1975 
 
 3.57 
 
 1976 
 
 3.24 
 
 1977 
 
 2.84 
 
 1978 
 
 2.72 
 
 1979 
 
 2.75 
 
 1980 
 
 2.24 
 
 1981 
 
 2.63 
 
 1982 
 
 2.86 
 
 1983 
 
 2.42 
 
 1984 
 
 2.35 
 
 1985 
 
 2.20 
 
 1986 
 
 2.42 
 
 1987 
 
 2.58 
 
 1988 
 
 2.52 
 
 1989 
 
 2.35 
 
 1990 
 
 2.31 
 
 1991 
 
 2.07 
 
 Urban 
 
 Rural 
 
 5 
 4 
 5 
 5 
 5 
 5 
 5 
 5 
 5 
 4 
 4 
 2 
 4 
 6 
 4 
 3 
 3 
 2 
 3 
 3 
 3 
 2 
 2 
 2 
 
 00 
 72 
 52 
 40 
 72 
 67 
 33 
 94 
 25 
 17 
 06 
 98 
 79 
 21 
 40 
 75 
 10 
 91 
 87 
 30 
 27 
 88 
 64 
 39 
 
 1.98 
 1.78 
 1.61 
 1.57 
 1.55 
 
 37 
 15 
 39 
 58 
 34 
 22 
 21 
 24 
 
 1.36 
 
 5 
 5 
 6 
 6 
 6 
 6 
 5 
 6 
 5 
 4 
 4 
 3 
 6 
 7 
 6 
 6 
 6 
 5 
 7 
 6 
 6 
 6 
 5 
 5 
 4 
 3 
 3 
 3 
 2 
 3 
 2 
 2 
 3 
 2 
 2 
 2 
 2 
 2 
 
 96 
 90 
 67 
 18 
 39 
 39 
 97 
 50 
 78 
 32 
 00 
 35 
 30 
 78 
 57 
 60 
 96 
 85 
 03 
 26 
 38 
 01 
 50 
 01 
 64 
 95 
 58 
 12 
 97 
 05 
 48 
 91 
 32 
 78 
 70 
 48 
 77 
 94 
 
 — Not available. 
 
 Notes: Data for 1950-1981 are from China's 
 1982 one-per-thousand-population fertility 
 survey. Data for 1982-1987 are from China's 
 1988 two-per-thousand-population fertility 
 survey. Data for 1988-1990 were estimated by 
 Zhao Xuan from China's 1990 census and 1990 
 annual survey of population change. Figures for 
 1988-1991 were reported by the State Family 
 Planning Commission. 
 
 Sources: China 1982 Fertility Survey, 1984, 
 159-173; China Family Planning Yearbook, 1990, 
 195; Zhao, 1991, Table 1; China Population Today, 
 1992, 8. 
 
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During the famine of China's Great Leap Forward which began in 1958, the total fertility 
 rates of urban and rural women dropped approximately in half due to starvation-induced 
 subfecundity. As soon as food supplies were restored to barely adequate levels, the fertility 
 level rose in 1962 and reached an unprecedented peak of compensatory childbearing in 1963. 
 
 During the 1960s, China's fledgling family planning program reached the urban 
 population. 9 Pressure began to be placed on urban couples to sharply limit their number of 
 births. Barrier methods of contraception and intrauterine devices were produced and provided. 
 Urban fertility had declined steeply by the mid-1960s. After a slight reversal during the Cultural 
 Revolution of the late 1960s, the urban total fertility rate continued its downward trend under 
 tight fertility restrictions, falling below three births per woman in the early 1970s. Urban 
 fertility in China dropped below replacement level in 1974, and under the impact of the one- 
 child limit launched in 1979, urban women have had a total fertility rate (TFR) of only 1. 1-1.6 
 births every year since (Table 1 and Figure 1). 
 
 Rural fertility was very high in China during the 1960s. But in the early 1970s, one 
 province after another, prodded by the central government, implemented a campaign of "later, 
 longer, fewer," requiring couples to marry at older ages, wait longer between births, and stop 
 childbearing at a smaller completed family size than in the past. The campaign was carried out 
 at the local level under the guidance of the pervasive political and economic structure that 
 
 9 Aird, 1972; Banister, 1987, 147-152. 
 
 9 
 
reached effectively into most villages. It was very successful. Rural fertility dropped from 6.4 
 births per woman in 1970 to about 3.0 in 1978. 
 
 During the 1980s, the rural fertility level fluctuated between 2.5 and 3.3 births per 
 woman, according to the data in Table 1. China's rural population has resisted the one-child 
 
 policy, and the authorities have responded by showing some flexibility in enforcement. 
 
 Major fertility trends in the 1980s and early 1990s were a decline in China's total fertility 
 rate to 1985, then a rise peaking in 1987, and an apparent decline in fertility since then. The 
 gap between urban and rural fertility is still wide. 
 
 During the 1970s, as China's population shifted from an almost noncontracepting 
 population to one with highly controlled fertility, the pattern of childbearing by age of women 
 shifted too. In the years through 1970, women began bearing children in their late teens, and 
 in the ages 23-25, one-third of the women at each age each year had a baby. Fertility continued 
 high for women in their late twenties, thirties, and early forties, in what is called a "broad peak" 
 fertility pattern. But by the early 1980s, births were highly concentrated in the early and mid- 
 twenties, and childbearing ceased for most women by the early thirties. China's "narrow peak" 
 fertility pattern of today is typical of East Asian populations at low levels of fertility. Births to 
 Japanese women are similarly concentrated, though peaking at older ages than in China. 
 
 10 
 
As shown in Figure 2, by 1979 births were infrequent to women in their teens and the 
 peak fertility level was at ages 25 and 26. But during the next three years, there was a strong 
 shift of childbearing to younger ages of women. The age- specific fertility of women in their 
 early twenties rose, and fertility peaked at ages 24 and 25, but cessation of childbearing also 
 happened at younger ages than before. The trend continued, and by 1987 childbearing started 
 slightly younger than in 1982 and peaked at age 23, with fertility dropping off rapidly in the late 
 twenties. This extreme concentration in the age-specific fertility pattern means that the number 
 of women in their twenties has great effect on the crude birth rate. If China's age structure 
 happens to have a dearth of women in their twenties, the birth rate will tend to be lower, but 
 if there is a bulge in the age structure, this will put upward pressure on the birth rate. 
 
 B. Proximate Determinants of Fertility in China 
 
 The "proximate determinants of fertility" are the intermediate behavioral and biological 
 factors through which social, economic, and environmental variables affect fertility. 10 In this 
 report we will concentrate on the following proximate determinants of fertility in China: 
 
 -proportion who ever marry 
 
 -marital disruption and remarriage 
 
 -mean age at first marriage for women 
 
 -prevalence of contraception 
 
 -methods of contraception 
 
 10 For discussion see Bongaarts and Potter, 1983, ix, 1-20, 24-28, 52-77. 
 
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—use-effectiveness of the leading contraceptive techniques 
 -incidence of induced abortion 
 —frequency and duration of breastfeeding 
 
 a. Marriage 
 
 Historically, China had a typical Asian pattern of early and universal marriage. 11 
 According to data from the 1988 fertility survey, it is still true that almost everyone eventually 
 marries, as shown in Table 2. Women enter rapidly into marriage, starting before age 18. At 
 age 21, almost half have already married, and at 25, 92 percent of women have married. By 
 their early thirties, 99 percent of women have married. Men marry a year or two older than 
 women on average. Eventual marriage for men is about as universal as possible, given the 
 comparative dearth of women in China because of historical female infanticide, selective neglect 
 of girls, and high maternal mortality in the past. 12 (China's censuses counted 107.6 males per 
 hundred females in 1953 and 106.6 in 1990.) Divorce is infrequent. Small proportions of 
 people are widowed while still in fecund childbearing ages. Remarriage is common for those 
 divorced or widowed in young adulthood or middle age. Therefore, a very high proportion of 
 China's adult population in their twenties, thirties, and early forties is married and "at risk" for 
 childbearing. 
 
 "Barclay etal., 1976, 609. 
 12 Banister, 1984. 
 
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In China, it is not only customary for everyone to marry, but also customary for every 
 couple to have one or more children. For example, data from China's 1988 fertility survey 
 showed that, of Chinese women who married from the early 1940s through 1986, 97.4 percent 
 had borne at least one child by midyear 1988. 13 Primary infertility is extremely low in China, 
 and couples rarely choose to be childless. 
 
 In the PRC, the universality of marriage and the ubiquity of childbearing within marriage 
 tend to bring about higher fertility than in countries where many never marry and many more 
 never bear any children. At the same time, universal marriage and universal childbearing have 
 important positive effects on individual and family welfare that should not be overlooked. For 
 example, very low fertility in Western countries is caused by many never marrying and many 
 marrying but not having children; a result is that a large proportion of the elderly adult 
 population has no spouse and/or no children. Family financial and emotional support for the 
 elderly is impossible if there is no family. In China, however, very low fertility still leaves 
 almost every aged man or woman with at least one surviving son or daughter or daughter-in-law, 
 particularly now and in the future with mortality so low. Because of these Chinese cultural 
 characteristics, the future aging of the population in combination with continuing low fertility 
 may not cause as acute a crisis as we might otherwise predict. 
 
 "China 1988 Fertility Survey, 1990, 197-198. But some women may have reported adopted 
 children as their own, if they themselves were childless. This would cause an underestimate of 
 primary infertility. 
 
 15 
 
In a system with universal marriage and very little childbearing outside of marriage, 
 mean age at first marriage for women is an important predictor of length of generation. 
 Changes in the age at first marriage also have strong effects on the birth rate. In China there 
 was a slow increase in the mean age at first marriage for women from age 18.7 in 1950 to age 
 20.2 in 1970, then a sharp increase in mean first marriage age to 23.1 years in 1979 under the 
 government's strong late marriage requirements of the 1970s (Table 3 and Figure 3). As 
 marriage age rose in the 1970s, this helped to depress the birth rate each year. From 1970 to 
 1979, average age at first marriage for rural women rose from 19.9 to 22.6~an increase of 2.7 
 years—and for urban women from 22.3 to 25.5 years—rising 3.2 years. 
 
 In response to a reaction against required late marriage, and for various demographic and 
 social reasons, China's government revised the marriage law in 1980, lowering the regulated 
 minimum marriage age to 20 for females and 22 for males. 14 Female mean age at first 
 marriage quickly dropped 1.3 years by 1984; this phenomenon occurred in both urban and rural 
 areas. Birth rates rose because of the bunching of first and then second births to young people 
 of several different cohorts marrying at the same time. Total fertility rates also rose at the 
 beginning of the 1980s and again after the middle of the decade; part of these apparent increases 
 in fertility is attributable to the drop in marriage age and surge of marriages. 15 The 
 government responded by trying to reinstitute some restrictions on early marriage. Mean age 
 
 14 Details in Banister, 1987, 152-165. 
 15 Coaleetal., 1991. 
 
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 16 Figures and generalizations in this paragraph are from Li Jingneng and Guo Yang, 1991, 
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 data. 
 
 ,7 Peng Peiyun, 1993, 1. 
 
 19 
 
b. Level and Efficiency of Contraception 
 
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 reproductive age (defined as ages 15-49) in China. As of 1982, according to the nationwide 
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 Half the couples practicing family planning were using intrauterine devices (IUDs), another 35 
 percent had one partner sterilized, and an additional 8 percent were using the birth control pill. 
 Only 6 percent of users depended on less effective methods such as condoms, diaphragms, 
 spermicides, rhythm method, withdrawal, or folk remedies. 
 
 The PRC family planning program relies very heavily on passive methods of birth 
 control. 19 For a couple to successfully prevent conception using the pill, or barrier methods, 
 or withdrawal, or rhythm, at least one of the partners must be motivated to avoid pregnancy. 
 But in China, high proportions of couples are required by the government to postpone the next 
 birth longer than they wish or cease childbearing before they have their desired number of 
 children. Therefore, the Chinese family planning program puts great emphasis on sterilization 
 and intrauterine devices. Once a person is sterilized, that individual and his or her spouse will 
 no longer have unauthorized conceptions or births. Once an IUD has been inserted into the 
 
 18 Qiuetal., 1984, 140. 
 
 19 Discussed in Lavely, 1989, 68; and United Nations ESCAP, 1991. 
 
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uterus, especially a PRC-made IUD with no string attached, it is difficult for a woman to get 
 it out and have an unauthorized pregnancy. 
 
 Required sterilization was made an explicit nationwide policy in late 1982 for most Han 
 Chinese (not minority group) couples who had two or more living children. 20 The policy was 
 carried out throughout most of China during 1983, resulting in 21 million sterilizations that year, 
 up from 5 million in 1982, as shown in Table 5. By the end of the year, over half the couples 
 in China with two or more living children had one partner sterilized. 21 The policy caused a 
 distinct shift in the contraceptive mix. Table 4 shows that by year-end 1983, sterilization made 
 up half the contraceptive practice in the country. IUD use was down to 41 percent of users. 
 As of the end of 1983, reliance on these passive birth control techniques had risen; couples 
 using tubal ligation, vasectomy, and the IUD constituted 91 percent of all contraceptive use, up 
 from 86 percent a year earlier. There has been hardly any change in the level and pattern of 
 contraceptive use in China as a whole since yearend 1983. According to the 1988 fertility 
 survey, 71.2 percent of married women of reproductive age were practicing contraception in 
 1988, of whom 91 percent were using passive methods (Table 4). 22 
 
 20 Banister, 1986a, 142-157. 
 
 21 According to the 1982 census, of women in China 15-49, 120.4 million had 2 or more 
 living children. China 1982 Census, 1985, pp. 482-483. A very small proportion of these 
 women were no longer married, so there were slightly fewer than 120.4 million married women 
 with 2 or more living children. By the end of 1982, as shown in Table 4, 62.4 million couples 
 had one partner sterilized. Because sterilization after only one or no child is very infrequent in 
 China, we assume that all couples with one partner sterilized had 2 or more living children. 
 Therefore, by the end of 1983, about 52 percent of couples with 2 or more living children had 
 one partner sterilized. 
 
 ^LiHonggui, 1991, 10. 
 
 22 
 

 
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In general, the birth control methods used in China are modern and highly effective. A 
 successfully performed sterilization is essentially 100 percent effective in preventing conception 
 or fertilization by the woman or man sterilized. Given the low incidence of divorce and 
 widowhood in the childbearing years, this translates into effective prevention of further 
 childbearing by the couple or either member of the couple. 
 
 During the 1970s, IUDs used in China were all made in China (mostly without 
 international assistance) and were of mediocre quality. There were frequent problems with 
 excessive bleeding, expulsion, and pregnancies with the IUD in place. During the 1980s, the 
 United Nations Population Fund gave China "turnkey" factories that produce high quality copper 
 IUDs. During 1989, Chinese IUD factories produced 42 million IUDs, of which over 8 million 
 (20 percent) were of the high quality copper type. 23 
 
 Use-effectiveness of IUDs in China is low compared to international standards, United 
 States experience, or even in comparison to the Philippines. 24 We do not know what 
 proportion of the IUDs inserted each year are the high-quality copper variety. If we assume that 
 the entire 8 million copper IUDs produced in 1989 were used in the family planning program 
 the same year, then almost half of the IUDs inserted that year would still have been those of 
 poorer quality with high failure rates. One Chinese source says that China's steel single ring 
 IUD, still commonly used in China today, has the highest failure rate among all types of IUDs, 
 but it is inexpensive, and hence remains in widespread use. 25 
 
 "China Family Planning Yearbook 1990, 120. 
 
 ^Details in this paragraph from Wang, Weng, and Zhang, 1991. 
 
 "Ibid. 
 
 24 
 
Chinese birth control pills are reported to be of high quality by international standards 
 and have a low estrogen dose suitable to oriental (and other) women. Some other devices, such 
 as condoms, have improved in quality over time because of international assistance providing 
 factories for contraceptive production. 26 
 
 Contraceptive effectiveness in China is enhanced by the easy availability and free 
 provision of birth control techniques to married couples. If one method is not suitable for a 
 particular couple or causes unpleasant side effects, Chinese authorities are happy to supply an 
 alternative technique free of charge. 
 
 c. Abortion 
 
 As shown in Table 5, during the 1970s through 1978, there were about 5 million induced 
 abortions per year in China. The number jumped to 8 million in 1979 with the introduction of 
 the one-child policy. Annual abortions increased greatly in the early 1980s, peaking at 14 
 million in 1983 with an explicit nationwide policy to abort all unauthorized pregnancies. Since 
 then, abortion has continued to be a strong element of the family planning program, and the 
 number of reported induced abortions has fluctuated between 9 million and 13 million per year. 
 The number of abortions per thousand live births in China increased during the 1970s to 271 in 
 1978, jumped to 378 with required abortions in 1979, and to 550 in 1980 (Table 6). The peak 
 was in 1983, with 725 abortions performed per thousand live births, and since then the ratio has 
 
 26 For an overview of contraceptive quality in China, see Banister, 1987, 171-175. 
 
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been 380-509 induced abortions per thousand births. In the 1980s, of those pregnancies that did 
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techniques were illegal or unavailable, as in many countries of the world. For example, abortion 
 rates were much higher in the Soviet Union and countries of Eastern and Central Europe than 
 in China. 27 
 
 d. Breastfeeding 
 
 Breastfeeding also affects fertility because it tends to suppress fecundity after childbirth, 
 especially if the baby derives all of its nourishment from breast milk. In rural areas, 
 breastfeeding is still the norm, but in urban areas bottle-feeding and mixed feeding are taking 
 over. A survey in the mid-1980s found that of Chinese babies 4 months of age, 70 percent were 
 exclusively breastfed in rural areas but only 43 percent in urban areas. By 6 months, the 
 proportion of babies fed only breast milk was 60 percent in rural and 34 percent in urban areas. 
 Mixed bottle and breastfeeding has less of a contraceptive effect on the mother; 20 percent of 
 rural infants and 30 percent of urban infants received both bottle and breastfeeding. 28 
 
 C. Mortality and Health 
 
 China historically had very high mortality, even in places where warfare was not raging, 
 and health conditions were poor. 29 During the 1950s, the new Communist government attacked 
 
 ^Henshaw and Morrow, 1990, 78. 
 28 UNICEF, 1989, 49. 
 29 Barclay etal., 1976. 
 
 29 
 
most diseases and causes of death with vigor, bringing about a steep reduction of the death 
 rate. 30 After a serious famine brought about by policy mistakes of the Great Leap Forward, 
 that caused 30 million excess deaths in 1958-1961, the country resumed its health improvements 
 and mortality reduction. By the early 1970s, the population had achieved a life expectancy of 
 over 60 years. Mortality improvements have continued since then but have been slower. Life 
 expectancy in 1990 was about 66 years for males and 68 years for females. 31 
 
 Infant mortality in China reportedly declined for both sexes until about 1977, then leveled 
 out at around 40 infant deaths per thousand live births, according to the fertility survey of 1988. 
 Male infant mortality was reported to be slightly higher than female in most years. 32 The lack 
 of continued improvement in infant mortality may have been caused in part by aspects of the 
 economic reforms that have been in effect since 1978. For example, dismantling of the rural 
 collective structure and weakening of the welfare system might have affected maternal and child 
 health care in ways that halted further reductions in infant mortality. 
 
 A disturbing recent trend has been a rise in the enumerated sex ratios of successive 
 cohorts of children born since 1978 and throughout the 1980s. The 1987 one percent sample 
 
 ^Details in Banister, 1987, 51-120. 
 
 ^Reconstructed and adjusted at the Center for International Research, U.S. Bureau of the 
 Census, using data from the 1982 and 1990 censuses, the 1988 fertility survey, and other 
 sources. Center for International Research (forthcoming). China's reported mortality data show 
 higher life expectancies, but that is because deaths are not completely reported among infants 
 or elderly people. 
 
 32,, China's infant mortality declines in past forty years," China Population Newsletter . June 
 1989, 11, 18. 
 
 30 
 
census and the 1990 census both found that there were 1 10 boys per hundred girls ages 0-4. By 
 the 1990 census, the sex ratios were 1 12 boys per hundred girls at infancy and age 1, 1 10 at age 
 2, 109 at age 3, 108 at ages 4 and 5, etc. 33 The problem may simply reflect underenumeration 
 of girls, but this explanation is losing ground in light of the fact that the elevated sex ratios of 
 particular cohorts have now been traced through several surveys and censuses. 34 It appears that 
 most of the missing girls are not alive, which may suggest rising female infant mortality in the 
 1980s. In addition, about half of the missing girls appear to be accounted for by sex-selective 
 abortion. 35 
 
 Compared to most developing countries, infant mortality in the PRC is low and has been 
 for at least two decades. Data on the mortality of children above infancy in China are still 
 weak, but we can discern important trends. Between the early 1970s and 1981, age-specific 
 mortality of children above infancy, that is at ages 1-4 and 5-9, was approximately cut in half, 
 and the death rate among those 10-14 also greatly improved. 36 There has been continuing 
 dramatic improvement in child mortality above infancy in the 1980s. 37 One possible 
 explanation for the extraordinary gains in child mortality that seem to have happened in the late 
 
 33 China 1987 Sample Census, 1988, 135; China 1990 Census 10 Percent Sample Tabulation, 
 
 1991, 93. 
 
 "Banister, 1992, Table 2. 
 
 35 Based on hospital records of about 1.2 million births per year, by 1990 the sex ratio at 
 birth in China had risen to 109.1 males per 100 females born. For details see Zeng Yi et al., 
 
 1992, 9. 
 
 "Banister, 1986b. 
 ^Banister, 1992. 
 
 31 
 
1970s and the 1980s is that the steep fertility decline of the early and mid-1970s allowed families 
 and society to focus resources and health care on the smaller numbers of children per couple. 
 Another contributor was the massive national infant and child immunization program funded by 
 the World Health Organization and UNICEF, which began in 1978 and continues today. 38 
 
 There are important effects of China's low and improving mortality on fertility. Low 
 infant and child mortality can lead to reduced fertility since parents know that their children are 
 likely to live. By now, Chinese parents may realize that each newborn child is unlikely to die 
 soon. This tends to increase the willingness of parents to settle for fewer births than they would 
 have insisted upon in the past. 
 
 But reduced mortality also has effects that might raise fertility. Marriages are rarely 
 disrupted by premature death, so couples tend to complete their childbearing before either dies; 
 all else being equal, this tends to increase fertility. Similarly, China's reasonably good health 
 conditions raise fecundity in comparison to the past. It was probably China's vastly improved 
 morbidity and mortality conditions that brought about China's peak fertility levels of the 1950s 
 and 1960s. 39 Mortality declines and health improvements tend to increase fertility and 
 
 38 UNICEF, 1989, 33. 
 
 39 In the beginning of the 1950s, Chairman Mao Zedong announced that promotion of birth 
 control was a genocidal plot to wipe out the Chinese people. During the early Great Leap 
 Forward period starting in 1958, he made famous ideological statements that more people means 
 not only more mouths, but more important, more hands. This concept comes from Marxism's 
 labor theory of value. Such words by Mao encouraged high fertility in the 1950s and 1960s. 
 
 32 
 
population growth, which in turn increases the need for fertility control techniques and the 
 likelihood that couples will be willing to use them. 
 
 D. Migration 
 
 For three decades until the late 1970s, China's population was extremely immobile except 
 for government-directed moves to border provinces or new industrial bases. The fixed location 
 of the vast majority of the population was controlled by the population registration system and 
 rationing. This system facilitated family planning, contraceptive delivery, and official control 
 of fertility. In rural areas, the livelihood of the long-term residents was controlled by the village 
 production teams under the people's communes. When local authorities demanded compliance 
 with fertility targets, it was difficult for people to resist. 
 
 China's economic reforms, initiated in 1978, have allowed greater population movement. 
 Individuals are now permitted to leave their location of permanent registration and travel for 
 days, weeks, or months for economic reasons, such as transport services or retail trade 
 activities. People also may move "temporarily" to a town, city, or another rural location for 
 business or other reasons. Because food is now plentiful, it can be bought in free markets 
 without ration tickets. Increased numbers of permanent moves are also being allowed today. 
 
 The "floating" population, that is people away from their location of permanent 
 residence, has recently been estimated at between 50 and 80 million, constituting about 4-7 
 
 33 
 

 percent of China's total population. However, migration and temporary movement are still 
 difficult because of transport bottlenecks and occasional official discouragement at destination. 40 
 
 Increased migration has begun disrupting the system of regular monitoring of women's 
 contraceptive status, menstrual record, and pregnancies. There have been numerous newspaper 
 articles, radio broadcasts, videos, journal articles, speeches, urgent circulars, and regulations 
 complaining that the fertility of female members of the floating population is out of control. 
 These sources state that many women leave their villages on some pretext—for example to care 
 for an ailing relative- to complete an unauthorized pregnancy, or they leave home with their 
 husbands to live in a makeshift slum on the outskirts of a city and have numerous "illegal" 
 children. These women are known in PRC literature as the "excess birth guerrillas." One 
 Chinese source stated: "According to statistics of the relevant department, the births to the 
 floating population throughout the country constitute 10 percent of the total number of births; 
 furthermore, they are births outside the plan." 41 Thus, a major focus of family planning effort 
 in China at present is to attempt to control the fertility of the mobile population. 
 
 '"'For example, in the 1982-1987 period, only 2.9 percent of China's population made a 
 permanent or long-term (6 months or longer) move. China 1987 Sample Census, 1988, 677. 
 
 41 Chen Bowen, 1989, 3. 
 
 34 
 
III. China's Family Planning Goals and Policies 
 
 China's family planning program has been motivated in part by official concern about 
 adequately feeding the population. During the period of agricultural reform since 1978, food 
 production increases have far outpaced population growth. However, the government's 
 population policies are still based on China's earlier population/food impasse that had been 
 caused in large part by the traumatic economic policy failures of the previous three decades. 
 China's leaders are not convinced that food security has been achieved. Besides, agricultural 
 production, distribution, and storage problems are not all solved, and prime agricultural land is 
 still being lost to development, so the government continues to be concerned about keeping up 
 the per capita food supply as population keeps on growing. 
 
 Essentially, the Chinese government since about 1970 has attempted to lower the birth 
 rate and population growth rate each year as much as possible. China's Constitution and 
 Marriage Law as revised in the early 1980s state that couples are required to practice family 
 planning. Provincial regulations, which have the force of law, specify the detailed requirements 
 for residents of each province. There is pressure for late marriage and a limited number of 
 children per couple. 
 
 China adopted a one-child policy in 1979, which it has attempted to implement ever 
 since. This policy has been highly successful in the cities and urban towns, both because urban 
 
 35 
 

 
 people are more amenable to having only one child than are rural people, and because 
 government control is more effective in urban areas. Rural people have resisted the one-child 
 policy, and China's government has backed off to a two-child policy or a "one-and-a-half-child 
 policy" for the rural areas of most provinces. The latter policy imposes a one-child limit on 
 those couples with a firstborn son, but allows a second birth to those couples with a firstborn 
 daughter. 
 
 Married women are monitored regularly by village, neighborhood, and workplace family 
 planning personnel to achieve compliance with the regulations. Before conceiving a baby, 
 couples must secure official permission to do so. According to China's fertility survey of 1988, 
 the proportion of all births in the country that were "planned," which means authorized ahead 
 of time by the authorities, rose from 51 percent in 1980 to 58 percent in the first half of 1988. 
 This increase was probably due partly to greater forcefulness of the program, partly to changed 
 attitudes favoring smaller families, partly to the rapid fertility decline among the minority 
 population, and partly to the relaxation of the one-child limit in most rural areas. In 1988, the 
 proportion of births that were pre-approved was 94 percent in cities, 57 percent in urban towns 
 ("zhen"), and 52 percent in the countryside. 42 
 
 42 LiHonggui, 1991, 10. 
 
 36 
 
 
IV. China's Family Planning Budget 
 
 A. Aggregate Family Planning Operational Budget 
 
 Sporadic figures relevant to total state budgetary expenditures for family planning have 
 been reported in various Chinese sources. It is not an easy task to put these figures in orderly 
 form since some of the reported figures are discrepant. By piecing together information from 
 different sources, we created Table 8 with some reported figures and some reconstructed figures 
 for the total state budgetary expenditures for family planning operations for the year 1978 and 
 for years from 1980 to 1990. 
 
 Table 8 shows that family planning operational expenditures have been increasing every 
 year. After conversion of the values into 1990 constant yuan, it is clear that total real 
 expenditures in 1990 were 2.5 times as much as in 1978. In addition, real per capita 
 expenditure has doubled in just over a decade. 
 
 The budget reported in Table 8, however, does not include all the actual spending in 
 China's family planning program. For example, incentive payments to couples who pledge to 
 stop at one child are not included in the operational budget, yet this is a big portion of family 
 planning expenditures in some localities. In order to estimate a more complete set of figures 
 for genuine expenditures in China's family planning program, it is necessary to first try to learn 
 what is paid for out of "family planning operational expenses" and what is excluded from this 
 
 37 
 
Table 8. China, Family Planning Operational Expenses, 1978-1990 
 
 
 
 
 
 
 
 In 
 
 mill: 
 
 ions 
 
 
 
 
 In mi 
 
 llions of 
 
 of 
 
 constant 
 
 
 
 Total 
 
 current 
 
 yuan 
 
 1990 yuan 
 
 
 
 population 
 
 
 
 
 
 
 
 
 Year 
 
 in 
 
 millions 
 
 Total 
 
 Per 
 
 capita 
 
 Total 
 
 Per 
 
 capita 
 
 1978 
 
 
 956 
 
 198 
 
 
 .2 
 
 542 
 
 
 
 .6 
 
 1980 
 
 
 981 
 
 330 
 
 
 .3 
 
 778 
 
 
 
 .8 
 
 1981 
 
 
 994 
 
 (389) 
 
 
 .4 
 
 878 
 
 
 
 .9 
 
 1982 
 
 
 1,008 
 
 446 
 
 
 .4 
 
 925 
 
 
 
 .9 
 
 1983 
 
 
 1,022 
 
 (527) 
 
 
 .5 
 
 991 
 
 
 
 1.0 
 
 1984 
 
 
 1,033 
 
 (624) 
 
 
 .6 
 
 1,024 
 
 
 
 1.0 
 
 1985 
 
 
 1,045 
 
 745 
 
 
 .7 
 
 1,076 
 
 
 
 1.0 
 
 1986 
 
 
 1,058 
 
 803 
 
 
 .8 
 
 1,080 
 
 
 
 1.0 
 
 1987 
 
 
 1,073 
 
 852 
 
 
 .8 
 
 1,032 
 
 
 
 1.0 
 
 1988 
 
 
 1,088 
 
 1,004 
 
 
 .9 
 
 1,096 
 
 
 
 1.0 
 
 1989 
 
 
 1,105 
 
 (1,214) 
 
 
 1.1 
 
 1,275 
 
 
 
 1.2 
 
 1990 
 
 
 1,134 
 
 1,380 
 
 
 1.2 
 
 1,380 
 
 
 
 1.2 
 
 Notes: Figures for 1978, 1980, 1982, 1985-1988, and 1990 were 
 reported in current Chinese yuan. Figures in parenthesis were 
 derived from reports about the percent increase in the family 
 planning operational budget from a previous year. To get rid of the 
 problem of annual inflation, we used China's official GNP price 
 deflators for 1978-1990 and calculated the expenditures in constant 
 1990 yuan. 
 
 Sources: 1978, 1985-1988 - China Finance Statistics, 
 1950-1988, 82. 
 1980, derivation of 1981 estimate - China Family 
 
 Planning Yearbook 1986, 263. 
 1982 - Yang Deqing, 1990, 33. 
 1990 - Cao Jingchun, 1991, 29. 
 
 1983, derivation of estimate - China Family 
 Planning Yearbook 1988, 95. 
 
 1984, derivation of estimate - China Family 
 Planning Yearbook 1986, 248. 
 
 1989, derivation of estimate - China Family 
 
 Planning Yearbook 1990, 143. 
 China Statistics Abstract 1991, 3, 6. 
 
 38 
 
nationwide formal budget. (The detailed information regarding family planning expenditures in 
 China's national budget is discussed in Appendix A.) 
 
 B. Provincial Per Capita Operational Budget Expenditures 
 
 Table 8 shows that real per capita expenditures in China's family planning operational 
 budget doubled from 1978 to 1989-1990, to 1.2 yuan per capita per year across the whole 
 population. Of course, if the total budget were compared to only the adult population of 
 childbearing ages, the calculated expenditures per capita for reproductive-age adults would be 
 more than twice as large. 
 
 For 1988 and 1989, expenditures from the family planning operational budget have been 
 reported by province. The total expenditures by the provinces (Table 9) fell short of total 
 national family planning operational budget expenditures (Table 8) by 163 million yuan in 1988 
 and 197 million yuan in 1989. This difference each year probably represents expenditures at 
 the national level for the State Family Planning Commission and other items not specific to any 
 province. 
 
 Table 9 shows that most provinces spend close to 1 yuan (0.8-1.2 yuan) per capita each 
 year in family planning operational expenses. Guangxi Province in the south has unusually high 
 per capita spending, and Hainan in the south as well as Tibet have unusually low per capita 
 expenditures; the reasons for these disparities are unclear. This family planning budget 
 
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increased in most provinces from 1988 to 1989, with the greatest percent increase in the 
 minority nationalities region of Xinjiang. 
 
 Figure 4 is a scattergram created to determine whether there is any relationship between 
 the fertility level and the family planning operational budget in each of China's provinces. 
 Figure 5 is the same graph with the extreme case of Guangxi Province excluded. Some might 
 expect, for example, that China's family planning program would focus family planning funds 
 on those provinces with highest fertility, while others might argue that unusually high per capita 
 expenditures on family planning in a province might bring about and therefore be correlated with 
 low fertility. Neither of these hypothesized relationships is evident. The points in Figures 4 and 
 5 appear to be random. Map 3 shows per capita family planning operational expenditures by 
 province for 1989. 
 
 For China's Eighth Five- Year Plan, which covers 1991-1995, many provinces plan to 
 increase their budgets for family planning. The national guideline is that financial expenditures 
 devoted to family planning ventures at all levels should gradually rise from around one yuan per 
 capita to two yuan per capita. 43 Table 10 illustrates the 1990-1991 level of per capita spending 
 on family planning in various provinces and the projection by each province as to when it will 
 reach target funding. 
 
 43 Xinhua report, 1991, 33-36. 
 
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44 
 
Table 10: China, Reported and Planned Per Capita Family Planning 
 Expenditures by Various Provinces 
 
 Province 
 
 1990-1991 
 
 Period of the Eighth Five-Year-Plan 
 1991 1992 1993 1994 1995 
 
 Beijing 
 
 Tianjin 
 
 Hebei 
 
 Shanxi 
 
 Inner Mongolia 
 
 Liaoning 
 
 Jilin 
 
 Shanghai 
 
 Jiangsu 
 
 Fujian 
 
 Jiangxi 
 
 Shandong 
 
 Guangdong 
 
 Hainan 
 
 Sichuan 
 
 Shaanxi 
 
 Gansu 
 
 Xinjiang 
 
 1.48 
 1.00 
 
 1.28 
 1.00 
 1.30 
 .99 
 .71 
 2.00 
 1.16 
 
 1.78 
 
 1.40 
 
 .80 
 
 1.50 
 
 1.22 
 
 2.00 
 
 1.30 
 
 1.42 
 
 2.00 
 
 2.00 
 2.00 
 
 2.00 
 
 2.50 
 
 1.50 
 
 2.00 
 2.00 
 
 2.00 
 2.00 
 2.78 
 2.80 
 2.00 
 
 2.50 
 
 Sources: Zhongguo renkou bao (China Population), Feb. 4, 
 1991, 1; May 17, 1991, 1; May 20, 1991, 1; 
 June 10, 1991, 1; June 28, 
 1991, 1; July 15, 1991, 1; 
 July 22, 1991, 1; July 26, 
 1991, 1; Aug. 5, 1991, 1. 
 
 Zhongguo tongji xinxibao (China Statistical 
 Information Daily), June 24, 1991, 1. 
 
 1991, 1; July 5, 
 
 July 19, 1991, 1; 
 1991, 1; July 29, 
 
 45 
 
The data in Table 10 suggest that each province has some autonomy in determining the 
 size of its own input into the family planning program. By the same token, each locality also 
 has enough autonomy to decide what proportion of its family planning funds to allocate to 
 various projects. For example, in 1987, Beijing Municipality decided to spend more money in 
 its IEC (information, education and communication) program. Therefore, it made a 122 percent 
 increase to its 1986 amount spent on IEC. 44 Meanwhile, Yingshan County of Hubei Province 
 in 1987 decided to spend 30.3 percent of its budgetary expenditure in its IEC program. 45 
 According to Jiangxi's 1989 report, 22 percent of its 1989 budgetary expenditure was for IEC 
 service station expenditures, 4.2 percent was for single-child insurance, 0.4 percent was for 
 contraceptive supplies, 0.5 percent was for staff training expenditures and 23 percent was for 
 other expenses. 46 
 
 The provincial Communist Party committee can set the standard for desired per capita 
 funds for family planning operational expenses to be raised by departments at lower levels. 
 Hebei Province provides an example. In order to solve the problem of insufficient funds for 
 family planning operational expenses, the standing committee of the Hebei provincial Party 
 committee in 1986 decided that funds must be raised by the towns and townships. A certain 
 amount per capita was set by the Party committee for the towns and townships. In order to meet 
 the quota, either the town/township enterprises had to contribute a portion of their retained 
 
 "China Family Planning Yearbook 1988, 150-151. 
 45 China Family Planning Yearbook 1988, 198. 
 "China Family Planning Yearbook 1990, 265-266. 
 
 46 
 
earnings or profits or the public themselves were asked to pay from their own pockets. The 
 funds raised would be used to pay wages and other operational expenses such as IEC, training 
 and other activities for family planning. By the end of 1987, 132 counties in Hebei had started 
 the fund-raising. By 1989, 1 15 out of 139 counties and cities in Hebei had reached the standard 
 for counties set by the provincial Party committee and the provincial government, that is, the 
 standard of 0.5 yuan per capita raised for family planning operational expenses. Then, after the 
 provincial authorities increased the goal for townships and villages to one yuan per capita, a total 
 of 32 million yuan was raised. 47 
 
 C. Complexity of China's Family Planning Financial Accounting 
 
 The budget for family planning operational expenditures represents only part of the actual 
 spending on China's family planning program. Local governments, factories, offices, military 
 units, clinics, women's associations, family planning associations, village committees, and 
 neighborhood committees gather funds through taxation or required levies or from their regular 
 income. They then disburse the funds locally for desired or mandated spending on family 
 planning. Very little information has been reported on the amounts of these family planning 
 expenditures. 
 
 47 Figures in this paragraph from China Family Planning Yearbook 1988, 155; China Family 
 Planning Yearbook 1990, 221. 
 
 47 
 
The multi-layered structure of family planning expenditures may contribute to the paucity 
 of reported family planning financial figures. A table from a study conducted by Shanghai 
 County on the costs of family planning from 1979 to 1983 illustrates the complexity of the costs 
 of its family planning program (see Table 11). Shanghai County may be unique and not 
 representative of most of China, but this accounting offers a glimpse of the family planning 
 budget in one of China's most developed and urbanized counties, adjacent to the city districts 
 of Shanghai. 
 
 Table 1 1 shows that entries of family planning expenditures include not only wages for 
 full-time and part-time family planning workers, and expenditures for running offices, providing 
 contraceptive supplies and devices, providing free birth control surgery, and purchasing 
 equipment and instruments, but also the cost of the one-child incentive program. Table 1 1 also 
 indicates that on average the one-child incentive program accounts for 80 percent of the total 
 cost of the family planning program in Shanghai County. 
 
 The next question we may logically ask is who is paying for all the listed expenses. We 
 then face an even more complicated aspect of family planning funding. 
 
 Responding to the report of the meeting attended by directors of family planning 
 committees nationwide, Premier Li Peng said in February, 1989, "...money spent for family 
 planning expenditures is not much. It will be better for each province and each unit to cope with 
 its own expenditures. Expenditures occurring in the locality should be taken care of by the 
 
 48 
 
Table 11: Cost of Family Planning in Shanghai County, 1979-1983 
 (In current yuan) 
 
 Items 
 
 1979 
 
 1980 
 
 1981 
 
 1982 
 
 198. 
 
 Full-time workers 
 
 Part-time workers 
 
 Reimbursed fees for birth control surgery 
 
 Sick leave for birth control 
 
 Bonus leave for later marriage 
 
 Bonus leave for delayed pregnancy 
 
 Post-sterilization special nutrition allowance 
 
 Post-IUO failure, abortion special nutrition allowance 
 
 One-child family monthly payments 
 
 One-child family contract one time bonus 
 
 One- child nursery and kindergarten fees 
 
 One-child primary and middle school tuition 
 
 Contraceptive supplies 
 
 Family planning office expenses 
 
 Family planning operational expenses 
 
 Equipment purchase 
 
 Other expenditures 
 
 Funds allocated from upper level government 
 
 Total 
 
 15,890.11 
 
 16,654.61 
 
 20,002.64 
 
 20,173.16 
 
 23,786.9: 
 
 77,144.67 
 
 87,941.16 
 
 90,934.51 
 
 100,417.23 
 
 118, 428. 9< 
 
 23,783.14 
 
 28,121.94 
 
 27,267.19 
 
 35,626.40 
 
 52,542.2: 
 
 41,462.31 
 
 107,772.81 
 
 108,091.21 
 
 153,972.61 
 
 335, 683. 4< 
 
 
 
 109,669.90 
 
 78,924.33 
 
 78,005.3' 
 
 
 
 75,978.22 
 
 237,089.00 
 
 208,645.81 
 
 310.00 
 
 180.00 
 
 690.00 
 
 1,530.00 
 
 2,400.0( 
 
 60.00 
 
 825.00 
 
 1,630.00 
 
 2,715.00 
 
 6, 610.01 
 
 55,520.00 
 
 774,832.00 
 
 1,523,538.00 
 
 2,454,060.00 
 
 3, 206, 670. 0( 
 
 161,805.00 
 
 451,940.00 
 
 262,270.00 
 
 402,290.00 
 
 222, 360. 0( 
 
 32,776.00 
 
 267,072.00 
 
 515,712.00 
 
 660,648.00 
 
 810.624.0C 
 
 3,623.00 
 
 12,361.00 
 
 17,653.00 
 
 25,364.00 
 
 30.440.0C 
 
 33,027.00 
 
 24,871.38 
 
 24,910.99 
 
 30,924.62 
 
 32,298.9? 
 
 
 4,342.69 
 
 6,884.46 
 
 6,362.41 
 
 6.700.6C 
 
 
 
 443.09 
 
 4,411.32 
 
 5,847.8 
 
 
 
 625.50 
 
 7,263.85 
 
 3.147.0C 
 
 20,138.80 
 
 6,131.64 
 
 4,900.22 
 
 13,524.07 
 
 26,691.4: 
 
 2,764.69 
 
 16,588.18 
 
 21,757.50 
 
 50,669.60 
 
 30.996.9C 
 
 468,304.72 
 
 1,799,634.41 
 
 2,812,958.43 
 
 4,285,965.60 
 
 5, 201, 879. 4J 
 
 Items 
 
 1979 
 
 Percent of total 
 1980 1981 1982 
 
 198: 
 
 Full-time workers 
 
 Part-time workers 
 
 Reimbursed fees for birth control surgery 
 
 Sick leave for birth control 
 
 Bonus leave for later marriage 
 
 Bonus leave for delayed pregnancy 
 
 Post-sterilization special nutrition allowance 
 
 Post-IUO failure, abortion special nutrition allowance 
 
 One-child family monthly payments 
 
 One-child family contract one time bonus 
 
 One-child nursery and kindergarten fees 
 
 One-child primary and middle school tuition 
 
 Contraceptive supplies 
 
 Family planning office expenses 
 
 Family planning operational expenses 
 
 Equipment purchase 
 
 Other expenditures 
 
 Funds allocated from upper level government 
 
 3.39 
 
 .93 
 
 .71 
 
 .47 
 
 .4< 
 
 16.47 
 
 4.89 
 
 3.23 
 
 2.34 
 
 2.2! 
 
 5.08 
 
 1.56 
 
 .97 
 
 .83 
 
 1.0 
 
 8.85 
 
 5.99 
 
 3.84 
 
 3.59 
 
 6.4! 
 
 .00 
 
 .00 
 
 3.90 
 
 1.84 
 
 1.51 
 
 .00 
 
 .00 
 
 2.70 
 
 5.53 
 
 4.0 
 
 .07 
 
 .01 
 
 .02 
 
 .04 
 
 .0! 
 
 .01 
 
 .05 
 
 .06 
 
 .06 
 
 .1: 
 
 11.86 
 
 43.05 
 
 54.16 
 
 57.26 
 
 61.64 
 
 34.55 
 
 25.11 
 
 9.32 
 
 9.39 
 
 4.27 
 
 7.00 
 
 14.84 
 
 18.33 
 
 15.41 
 
 15.58 
 
 .77 
 
 .69 
 
 .63 
 
 .59 
 
 .59 
 
 7.05 
 
 1.38 
 
 .89 
 
 .72 
 
 .62 
 
 .00 
 
 .24 
 
 .24 
 
 .15 
 
 .13 
 
 .00 
 
 .00 
 
 .02 
 
 .10 
 
 .1' 
 
 .00 
 
 .00 
 
 .02 
 
 .17 
 
 .0< 
 
 4.30 
 
 .34 
 
 .17 
 
 .32 
 
 .5 
 
 .59 
 
 .92 
 
 .77 
 
 1.18 
 
 .6 
 
 Total 
 
 100.00 
 
 100.00 
 
 100.00 
 
 100.00 
 
 100.0 
 
 Note: *This appears to be a residual spending category which is paid for by a subsidy from higher levels, 
 in the list of expenditures because it was reported this way by Shanghai County. 
 
 We have left it 
 
 Source: Gao Ersheng et al., 1990, 274. 
 
 49 
 
locality and expenditures occurring in the military should be taken care of by the military. As 
 to how to cope with the problems, please discuss among yourselves and come up with your own 
 solutions." 48 Premier Li Peng's speech indicates that financing the costs of family planning in 
 China is, to a great extent, the responsibility of provinces and localities. 
 
 Certain aspects of China's family planning program are extremely decentralized. On the 
 one hand, the central government as well as the provincial governments stipulate family planning 
 policy as well as guidance and allocate a certain amount of family planning funding. On the 
 other hand, each locality, down to village teams, assumes responsibility for carrying out the 
 policy and for raising funds for different projects. 
 
 China's family planning organizations are set up like a pyramid, similar to other organs 
 of political power in China. At the top of the pyramid is the State Family Planning 
 Commission, and at the bottom are the peasant small groups, neighborhood small groups, and 
 the workshop or section teams. The attached Figures 6 and 7 show this complicated 
 organizational structure. 
 
 The family planning program in China is a team project. Besides the family planning 
 commission, committees, divisions and offices at all levels, numerous other government 
 ministries and departments also involve themselves in this program to make it successful. In 
 
 
 ^China Family Planning Yearbook 1990, 7-8. 
 
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 52 
 
addition, there are seven public family planning and population institutions directly under the 
 administration of the State Family Planning Commission and two affiliated population social 
 groups. (The detailed information regarding the relevant organizations is included in Appendix 
 B.) 
 
 The complexity of the decentralized sources for funding family planning costs in China 
 is described in the following overview: 
 
 Multiple sources of support for the family planning program exist at all 
 organizational levels. These include the State Family Planning Commission; 
 other central government ministries including Public Health, Social Welfare and 
 Education; factories, cooperative stores, the military, railways, educational 
 institutions~in sum, any organization employing people; town/townships 
 (formerly communes), as distinct from the above; direct unreimbursed 
 expenditures of private individuals (to a minor extent); and extensive services by 
 unpaid volunteers. Responsibility for financial support of the family planning 
 program is shared by the government and the communities. The central 
 government finances the costs for all contraceptive supplies and surgical services, 
 but communities shoulder most of the financial responsibility for the program's 
 operation and payment of incentives. 49 
 
 The number of "communities" financing the family planning program as of 1989 included 
 governments of 30 provinces, 151 prefectures, 447 cities, 1,919 counties, and 55,764 rural 
 villages and towns as well as 746,432 village neighborhood committees. 50 Family planning 
 funds are also provided by 2,251 birth control service stations at the county level and 20,552 
 
 49 Neumann and Chang, 1988, 121. 
 
 ^China Statistical Yearbook 1990, 3; China Rural Statistical Yearbook 1990, 27. 
 
 53 
 
service stations at the village/ town level, 51 as well as 102,300 state-owned industrial 
 enterprises and 1,747,000 collective industrial enterprises. 52 In one way or another, these 
 organizations are involved in the financial activities supporting family planning. 
 
 There are millions of organizational units involved in paying for China's birth planning 
 program. Most of them lack well- trained accountants and modern office equipment such as 
 computers and software to account for the expenditures. Nevertheless, the PRC has an extensive 
 year-end reporting system from lower to higher administrative levels that has been in use for 
 decades. It would be possible to compile expenditure data for the birth control program up the 
 administrative hierarchy, or carry out a specialized survey on current sources of funds. 
 Unfortunately, a systematic accounting is not available, in contrast to the availability of detailed 
 data on health expenditures that are regularly published by the government. 
 
 D. Components of the PRC Family Planning Operational Budget 
 
 China's Family Planning Yearbook 1990 reported that the budget called "family planning 
 operational expenditures" mainly derives from budgetary allocations from finance departments 
 at all governmental levels. 53 What is and what is not covered by the budgetary expenditures 
 allocated by the Ministry of Finance for family planning operational expenses was spelled out 
 
 51 Lan Qing, 1990, 1. 
 52 China Statistical Yearbook 1990, 409. 
 "China Family Planning Yearbook 1990, 143. 
 
 54 
 
in a regulation issued in 1983. (See Appendix C for detailed clauses of the regulation). 54 This 
 regulation stipulates that the budget for family planning operational expenditures covers expenses 
 for contraceptive supplies, birth control surgeries, office operational expenses (including staff 
 training, attending meetings, travel, office equipment, propaganda materials), purchasing small 
 instruments for birth control service stations, and wages for the full-time family planning cadres 
 in the rural villages and urban neighborhoods. 
 
 On the other hand, the 1983 regulation specifies that costs of birth control surgeries for 
 workers and staff of state-owned enterprises or of military personnel and dependents are not 
 covered by the operational expenditures; they are paid for out of the free medical care to which 
 these people are entitled, and out of the enterprise and defense budgets. Furthermore, the 
 regulation states, family planning organizations at county level and above are designated as 
 administrative organs, and their staffers are to be designated as administrative personnel; the 
 wages and other expenses of these organizations are supposed to be paid out of administrative 
 expense budgets separate from the family planning operational budget. The regulation also 
 stipulates that the work units of the parents of an only child should assume the responsibility for 
 the one-child health fund. However, no further details concerning the one-child incentive 
 program were discussed in this regulation. 
 
 If we compare the cost components of the family planning program in Shanghai County 
 as listed in Table 11 with components listed in the 1983 national regulation (Appendix C), we 
 
 "Compilation of PRC Public Health Laws, (1981-1983), 1985, 500-503. 
 
 55 
 
discover that Shanghai County accounts for its expenses on the one-child and birth control 
 incentive program in much greater detail. It is obviously costly to cover all these expenses such 
 as sick leave for birth control, bonus leave for later marriage and delayed pregnancy, post- 
 sterilization special nutrition allowance, abortions following IUD use, abortion special nutrition 
 allowance, one-child family monthly payments, one-child family contract one-time bonus, one- 
 child nursery and kindergarten fees, and one-child primary and middle school tuition. According 
 to the 1983 regulation, the budgetary operational expenditures do not cover the above-mentioned 
 expenses, and Shanghai County's experiences show that state-owned and collective enterprises 
 are shouldering these expenses. 55 In order to determine the aggregate level of family planning 
 spending in China, all the items mentioned in the 1983 regulation and in Table 11 ideally should 
 be taken into consideration. 
 
 In addition, even though the 1983 regulation is by far the most detailed regulation 
 regarding family planning funding that appear to be available, directives on capital construction 
 for family planning programs, maternity and child health care (MCH) and foreign aid were not 
 included in this regulation. These three categories are relevant to family planning programs and 
 expenditures but usually discussed and handled separately. In later sections of this paper, these 
 three categories are also addressed. (Detailed information regarding the maternal and child 
 health network in China is included in Appendix D.) 
 
 55 For details see Gao et al., 1990, 270-271. 
 
 56 
 
V. Estimated Spending on Family Planning in China 
 
 Because the available information is reported in fragments and in scattered sources, it is 
 difficult to estimate how much of the family planning program resources (money and personnel) 
 goes to supplying birth control techniques, how much goes to IEC work, and how much is used 
 for the one-child incentive program. 
 
 It would be helpful if China's other provinces would follow the Jiangxi Province example 
 and present at least a brief report as follows: In 1989, family planning operational expenditures 
 reported by Jiangxi Province totaled 36,568,000 yuan, among which 36 percent was applied to 
 free or discounted birth control surgical fees (13, 164,480 yuan), 13.9 percent went to grass-roots 
 level staff and administrative expenditures (5,082,952 yuan), 22 percent was applied to IEC 
 service station expenditures (8,044,960 yuan), 4.2 percent went to single-child health care 
 (1,535,856 yuan), 0.4 percent went to contraceptive supplies (146,272 yuan), 0.5 percent was 
 allocated for staff training expenditures (182,840 yuan) and 23 percent was applied to other 
 expenses (8,410,640 yuan). 56 However, no other family planning financial report can be found 
 that provides even this much detail. 
 
 In order to derive a more realistic figure for the true costs of China's family planning 
 program, we have attempted in Table 12 to estimate the costs of each major type of expense 
 
 '•Our calculation based on information from China Family Planning Yearbook 1990, 265- 
 266. 
 
 57 
 
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Notes for Table 12: 
 
 Some of the figures in this table are directly reported, while most are estimated from 
 other available information. The derivation of figures on wages for full-time family planning 
 personnel in 1985 and 1987 is shown in Table 13. Our estimated monthly average wage in 1985 
 is 140 yuan; in 1986, 180 yuan; and in 1987, 121 yuan. We use the average of these three 
 average wages, 147 yuan, to estimate the 1989 figure. 
 
 There were reported to be one million part-time family planning workers in 1985 and 
 1989. We went through all provincial reports in China Family Planning Yearbook 1988 to come 
 up with the 1987 figure of 834,000 part-time family planning personnel. We then use 7 yuan, 
 10 yuan and 13 yuan per month for the part-time workers' allowance for these three years. This 
 is a rather conservative estimate. In Panshi County of Jilin Municipality, Jilin Province, part- 
 time family planning workers are paid 420 yuan per year plus 5 yuan allowance per month. In 
 addition, newspapers and magazines frequently urge the authorities to increase the allowance for 
 family planning workers to keep up with inflation and to keep the workers highly motivated. 
 
 The number of contraceptive distributors was reported by administrative level for 1989. 
 For 1985 and 1987, we use reported numbers of provinces, prefectures, counties, 
 towns/townships and villages. We then assign 7 workers to the provincial level in each 
 province, 3 to each prefecture, 2 to each county, and 1 to each lower level unit. Five yuan per 
 month for allowance is used in 1985 and 8 yuan per month for allowance is used in 1987 and 
 1989, as mentioned in the unpublished document from Yunnan Provincial Family Planning 
 Committee issued on July 3, 1986. 
 
 Figures for estimated expenditures for continuing users, reimbursed fees for birth control 
 surgery, and cost of procuring contraceptive supplies are derived from Table 17. 
 
 According to Shanghai County data (Table 1 1), the total family planning office expenses 
 of 1980 to 1983 was equivalent to 5 percent of the total of full-time and part-time wages for the 
 same period of time. We therefore use 5 percent of the total of full-time and part-time wages 
 in 1985, 1987, and 1989 to estimate the family planning office expenses for the corresponding 
 year. 
 
 According to the report in the China Population Newsletter of April 1990, the Chinese 
 government had invested 78.26 million yuan in core funding for IEC work for the previous five- 
 year period. For various kinds of mass media devices, we estimate the costs of production as 
 300 yuan per TV film, 3 yuan per book, .08 yuan per pamphlet, 0.5 yuan per periodical, 1 yuan 
 per picture book, .08 yuan per poster, 5 yuan per hanging chart, .25 yuan per newspaper and 
 1 yuan for other objects to obtain our estimates for IEC expenditures in 1985, 1987, and 1989. 
 
 59 
 
It was mentioned by Mr. Wu Jingchun, Deputy Director of the State Family Planning 
 Commission, in his September 26, 1989 speech that the average expenditure in family planning 
 research is 4 million yuan per year. We use this figure for 1985 and 1987. For 1989, we have 
 a more detailed report on expenditures for purchasing scientific research equipment. 
 
 Scattered figures are found in the family planning yearbooks reporting expenditures on 
 equipment purchased for family planning service stations at all levels and for contraceptive 
 distribution stations. We only use the incomplete figures available for each year. 
 
 Figures on a special fund for family planning capital construction are available for 1985 
 and 1989. We are not able to find data for 1987. 
 
 Short-term training sessions are given for family planning personnel at various levels. 
 We have scanned the family planning yearbooks and use the reported figures for the number of 
 sessions given and for numbers of participants. We estimate the cost at 30 yuan per participant 
 per training session in 1985, 1987 and 1989. 
 
 Figures for single-child family monthly health subsidy and single-child family contract 
 one-time bonus are derived from Table 18. 
 
 For the number of single children attending nursery and kindergarten for free, we 
 compute the total of children ages 0-5 in 1985, 1987, and 1989 using data from Table 18 on 
 single-child certificates issued each year. We then assume that half of these children attend 
 nursery and kindergarten while the other half are cared for at home. Twenty-four yuan per child 
 per year is used for our estimates for single-child nursery and kindergarten fees, as given in the 
 computation of the cost for the single children attending nursery and kindergarten for free in 
 Shanghai County. 
 
 For the number of single children attending primary and middle school with all fees 
 waived, we compute the total of children ages 6 in 1985, 6-8 in 1987 and 6-10 in 1989 whose 
 parents have signed the one-child certificate, using data from Table 18. We then use 38.5 yuan 
 per child per year for our estimates for expenditures of single-child primary and middle school 
 tuition. This figure is based on a 1988 Xinhua report that each school pupil in the rural areas 
 of Hubei Province paid an average of 38.5 yuan in tuition in the previous year. 
 
 We compare our totals in Table 12 with figures in Table 8 to obtain the annual ratio of 
 our estimated costs for the family planning program to the reported family planning operational 
 budget. 
 
 60 
 
Sources for Table 12: 
 
 Table 8; Table 11; Table 13; Table 17; Table 18; 
 
 Yu Changhong, 1990, 18; 
 
 Jan Wong, 1990, A.9; 
 
 Xue Baosheng, 1990, 62-64; 
 
 Zhang Faying, 1990, 16; 
 
 Gao Ersheng, et al. 273; 
 
 China Family Planning Yearbook 1986, 48, 241, 256, 259, 323, 333; 
 
 China Family Planning Yearbook 1988, 67, 114; 
 
 China Family Planning Yearbook 1990, 123, 134, 146-147, 163-165; 
 
 China Rural Statistical Yearbook 1986, 3; 
 
 China Rural Statistical Yearbook 1988, 3; 
 
 China Statistical Yearbook 1986, 3; 
 
 China Statistical Yearbook 1988, 3; 
 
 Public Health Yearbook 1988, 112; 
 
 Xinhua News in China Daily, June 4, 1988, 3. 
 
 Unpublished document from Yunnan Provincial Family Planning Committee issued on July 3, 
 
 1986. 
 
 61 
 
incurred in the program. More detailed data are available for 1985, 1987, and 1989 than for 
 any other years. In Table 12, available evidence from China is used to assign a cost to each 
 expenditure category in yuan, then added up the total expenditures. Subsequent sections of this 
 report document certain expenditure categories in greater detail, for example, wages for family 
 planning workers, costs of birth control surgery and supplies, and single-child incentive 
 expenses. 
 
 According to our estimation, the total cost of China's family planning program in 1989 
 reached 4.55 billion yuan. Expenses for wages of full-time and part-time family planning 
 workers accounted for about 13 percent of the total; expenses for the one-child incentive 
 program and rewards comprised about 72 percent of the total cost; expenses for reimbursed 
 contraceptive surgery and supplies accounted for 1 1 percent; and all but one of the remaining 
 categories accounted for less than one percent each. It is interesting to find that expenses for 
 IEC (information, education, and communication) accounted for less than one percent of the total 
 program costs while the expenses for the one-child incentive program made up seven tenths of 
 the total costs. 
 
 The number of married women of childbearing age in China totaled 212 million in 1989. 
 We thus calculated that the family planning expenditure for these women was 21 current yuan 
 per person in 1989. Applying the 1989 official exchange rate, we converted the yuan into US 
 dollars and obtained the figure of US$5.71 in family planning expenditures for each married 
 
 62 
 
woman of reproductive age in China in 1989. Applied to China's total 1989 population, the per 
 capita cost was 4 yuan or US$1.08 for the family planning program. 
 
 A. Public and Private Provision of Services 
 
 In China, the family planning program is almost 100 percent provided by the public 
 sector. However, from 1990 on, drug stores in medium-sized and large-sized cities, as well as 
 hospitals, maternal and child health stations and other medical clinics were supposed to start 
 retailing contraceptive pills and devices. In addition, some supply and marketing cooperatives 
 in relatively prosperous rural areas also are setting up pilot points to retail contraceptive 
 supplies. 
 
 This small private component of China's family planning program developed only 
 recently. For public convenience and in order to eliminate waste, a pilot project for retail sale 
 of contraceptive pills and devices was initiated in 1986. It proved to be highly effective. 
 Beginning in May 1987, 132 drug stores in Beijing started selling contraceptive supplies and 
 devices at the manufacturer's price (cost of production, unsubsidized by the family planning 
 delivery system) instead of providing them free. 57 In November 1988, a "Circular on 
 Strengthening the Production and Supply of Contraceptive Pills and Devices" was jointly issued 
 by the State Family Planning Commission, the Ministry of Finance, the Ministry of Chemical 
 Industry, the Ministry of Commerce, and the State Pharmaceutical Administration. The circular 
 
 "China Family Planning Yearbook 1988, 150. 
 
 63 
 
instructed that the dual-track system which combines planned and free-of-charge allocation of 
 contraceptive pills and devices with retailing in the market (the retail price is 15 percent higher 
 than the factory listed price) be widely adopted. 58 The circular called for all drugstores, 
 hospitals and supply and marketing cooperatives throughout the country to retail contraceptive 
 drugs and devices. According to incomplete data, by the end of 1989, there were 5,548 
 drugstores, 2, 195 hospitals, 1,802 supply and marketing cooperatives as well as more than 3,000 
 other kinds of organizations in China selling contraceptive drugs and devices. In all, 1.2 million 
 sets of contraceptive supplies and devices were distributed through this arrangement. 59 
 
 The only "non-governmental" organization which is active in the family planning program 
 is the China Family Planning Association (CFPA). The Association is led by paid full-time 
 family planning cadres who steer the organization to follow government policy. Beijing Review 
 presented a brief description of CFPA as follows: "The China Family Planning Association, a 
 non-governmental organization, has 500,000 grass-roots branches and a membership of 20 
 million. In co-ordination with the relevant government departments, the association plays an 
 active role in pushing forward the work of family planning." 60 A 1990 article stated that "By 
 the end of September, 665,000 branches had been established with more than 28.1 million 
 members.... The CFPA is a nationwide non-governmental organization composed of retired 
 workers, medical staff and representatives of such mass organizations as the women's federation 
 
 "Office of Contraceptive Supplies and Devices, State Family Planning Commission, 1989, 
 2. 
 
 59 Song Yixia, 1990, 1. 
 "'Cheng Gang, 1990, 20-22. 
 
 64 
 
and the youth league. It was formed to assist the government by raising public awareness of 
 family planning issues." 61 By July 1991 the number of CFPA branches had reportedly 
 exceeded 700,000 and the number of members totaled more than 35 million. 62 
 
 Even though the CFPA is classified by the government as a non-governmental 
 organization, financially it is assisted by the State Family Planning Commission and family 
 planning offices at other levels of government. The Commission issued a circular in October 
 1989 regarding giving energetic support to CFPA. This circular gave important impetus to the 
 establishment of the CFPA. The family planning personnel offices in numerous provinces and 
 cities report that they provide paid personnel to the CFPA at provincial and local levels. 63 At 
 least part of the working expenses of these Associations has thus been met. The budget of the 
 China Family Planning Association "mainly relies on subsidies from the relevant government 
 departments, donations from individuals and social groups, and aid from international 
 organizations." 64 The CFPA should thus be considered a part-public, part-private effort. It 
 must adhere to official family planning policies. According to the statistical data from the end 
 of 1989, the CFPA above the county level in China was staffed with 4,796 full-time paid official 
 and 96, 185 part-time staff. In some areas, even the CFPA at the township level was staffed with 
 
 "Staff Reporter, China Daily, Nov. 22, 1990, 3. 
 62 Wang Shoudao, 1991, 1,2. 
 "China Family Planning Yearbook 1990, 316. 
 "China Family Planning Yearbook 1986, 64. 
 
 65 
 
personnel specially designated for the CFPA task. 65 It was reported that by November 1990, 
 CFPA at all levels had full-time workers and staff numbering about 5,500 persons. 66 
 
 B. Family Planning Personnel and Facilities 
 
 a. Family Planning Cadres and Workers 
 
 Since China has a vast territory, it is difficult to establish a comprehensive family 
 planning network, especially in the rural areas. During the 1980s, staffing of the system 
 expanded. Yet the numbers of paid personnel appear small for a population of over one billion. 
 
 The total number of full-time family planning workers and staff (often referred to as 
 "cadres") increased from 44,878 in 1979 to 134,671 in 1985. The average annual increase rate 
 was almost 20 percent. By the end of 1987, the number of cadres working in the family 
 planning system totaled 142,157 persons (not including Tibet and the units directly under the 
 State Family Planning Commission). 67 The total family planning cadres in China account for 
 about 0. 1 percent of the total salaried workers and staff in the country. According to the 
 circular issued on November 14, 1989, the State Personnel Office agreed to increase the number 
 
 65 China Family Planning Yearbook 1990, 316. 
 
 "Li Xiangdong, 1990, 2. 
 
 67 This figure does not agree exactly with the total in Table 13 because they are from 
 different sources and because this total excludes some subcategories. Yang Ming, 1989, 1. 
 
 66 
 
of authorized personnel of the family planning committees at the prefecture level and at the 
 county level by 8,000 administrative cadres. 
 
 Full-time family planning workers and staff may involve themselves in different tasks 
 such as administration, IEC work, scientific research, contraceptive supplies distribution, or 
 technical and medical service. In 1985, the number of administrative cadres in family planning 
 work totaled 7,698, managerial cadres at the local level totaled 76,777 and cadres with special 
 skills or classified as "professional" totaled 40,837. 68 By 1987, the number of cadres 
 shouldering administrative responsibilities totaled 33,012, managerial cadres at the local level 
 totaled 87,937 and cadres with special skills or classified as professional totaled 25,93s. 69 
 
 According to a 1990 report in The Globe and Mail . China has 150,000 full-time birth 
 control workers and one million part-time ones on the state payroll. 70 However, in one of her 
 1990 speeches, Madam Peng Peiyun, the Minister of China's State Family Planning 
 Commission, reported that China had 180,000 full-time family planners at or below the county 
 level. 71 
 
 ^China Family Planning Yearbook 1986, 244-245. 
 •"China Family Planning Yearbook 1988, 70. 
 70 Wong, 1990, A9. 
 71 Yu Changhong, 1990, 18. 
 
 67 
 
The provinces have some discretion in deciding what proportions of family planning 
 cadres should be allocated to what categories of tasks. For example, regulations for Jiangsu 
 Province family planning guidance institutes (stations) stipulate that their personnel should be 
 distributed as follows: administrative and odd-job personnel should account for 15 percent of 
 the total, IEC personnel should make up 20 percent, and public health technicians at the county 
 stations (including contraceptive supplies and devices managerial personnel) should comprise 65 
 percent. 72 
 
 b. Density of Family Planning Delivery 
 
 A passage in China's 1989 Public Health Yearbook indicated that up to December 1987, 
 according to incomplete statistical data, 2,076 service stations at the county level (accounting 
 for 89 percent of the total counties) were established in 28 provinces in China. The number of 
 workers and staff totaled 22,600 persons. Among these, medical and technical personnel 
 accounted for 62 percent; IEC personnel made up 14 percent and contraceptive supplies 
 managerial personnel accounted for 9 percent. 73 
 
 By the end of the seventh five-year plan period (year-end 1990), the number of service 
 stations at the county level and at the towns and townships below the county level totaled 2,203 
 and 25,345 respectively, accounting for 92 percent and 47 percent respectively of the targeted 
 
 ^ShenZhihe, 1991,2. 
 ^China Public Health Yearbook 1989, 157. 
 
 68 
 
total service stations to be established. 74 In China's political structure, a township used to be 
 a rural people's commune. The population of a township is approximately 19,000 and the 
 population of a village averages close to 1,200. 75 The population in townships and villages, 
 of course, varies from place to place. The prosperous townships and villages tend to be more 
 populous. 
 
 In China's 1990 Family Planning Yearbook , a passage stated that according to 1989 
 incomplete data from 28 provinces, the number of service stations established at the county level 
 totaled 2,251. Among the total employees, the medical, technical and contraceptive supplies 
 managerial personnel accounted for 67 percent. This total of 2,25 1 county-level family planning 
 service stations accounted for 93 percent of the targeted total service stations to be established 
 in order to provide adequate service to rural counties. In addition, the number of professionals 
 at the county level was reported to be 16,386 persons, though it was not clearly defined what 
 are their specialties and what percentage they occupied in the total. 76 It was reported that 
 China had invested 557 million yuan to build the 2,251 county-level family planning service 
 clinics. The main functions of these county-level clinics include publicizing family planning, 
 providing birth control techniques, and training family planning workers. 77 In one of her 1990 
 
 74 Song Yixia, 1991, 1. 
 
 75 Figures estimated by the U.S. Census Bureau based on the rural population reported in 
 China's 1990 census and the number of township governments and village neighborhood 
 committees reported in China Rural Statistical Yearbook 1990, 27. 
 
 76 China Family Planning Yearbook 1990, 134, 203. 
 
 ^Xinhua news in English, Nov. 9, 1990. 
 
 69 
 
speeches, Madam Peng Peiyun of the State Family Planning Commission reported that family 
 planning stations (or posts or rooms) were available in 90 percent of China's counties, 30 
 percent of China's towns/townships and a few villages. 78 
 
 The number of family planning service stations in towns, townships and villages is 
 considered inadequate. This is a problem which has been addressed in many discussions. The 
 Vice Mayor of Jixi Municipality in Heilongjiang Province pointed out this problem after a 
 survey was done on family planning in the rural areas of the municipality. He stated, "Family 
 planning organizations of towns, townships and villages cannot meet demand. Of the 25 towns 
 and townships in the municipality, only 10 have their own family planning assistant. The 
 overwhelming majority of the villages do not have full-time family planning cadres." 79 The 
 same problem was stressed by the People's Daily in 1991. An editorial urged that "it is 
 necessary to resolve to form a family planning work team at the grass-roots level characterized 
 by a good state of mind and a correct workstyle and with professional knowledge and 
 management ability; to speed up the establishment of family planning networks covering 
 counties, townships, and villages; and to strengthen the numbers of family planning personnel 
 of various villages and work groups so that there are always some people at the grass-roots level 
 in charge of the various tasks related to family planning." 80 
 
 78 Yu Changhong, 1990, 18. 
 79 Wang Yuehua, 1990, 70. 
 
 8 Renmin ribao April 29 editorial, 1991, 31. 
 
 70 
 
Family Planning Associations in the rural areas help to ameliorate the shortage of 
 personnel and service stations at town, township, and village levels. The family planning 
 program in China emphasizes outreach efforts. A goal of the program is to take family planning 
 messages and supplies to the households. When there is a perceived need or official requirement 
 for a woman to go to a family planning service station or to a hospital, she is often accompanied 
 by family planning personnel or advocates. Many China Family Planning Association branches 
 invite retired and on-the-job doctors in the township clinic to answer questions on hygiene, sex 
 and heredity and health care for women and children. In addition, many CFPA members are 
 good at consulting and persuasion. It was reported that by July 1991 the number of China 
 Family Planning Association branches in the town/township and village levels totaled more than 
 600,000. In other words, the CFPA has been established in 90 percent of counties, 80 percent 
 of towns/townships and 70 percent of villages in China. 81 Therefore, the CFPA expands the 
 effectiveness of the service stations at or below the county level. 
 
 Today in China more effort is focused on the local level. The leading cadres of the 
 family planning program are required to spend time with the people at the grass-roots level (one- 
 fourth of the year for state family planning cadres, one- third of the year for the provincial and 
 prefectural family planning cadres and one-half of the year for the county family planning 
 cadres). They are expected to go door-to-door talking to people, to understand their problems 
 and to educate them. 82 
 
 81 Yang Hongyu, 1991, 1, 
 82 Peng Peiyun, 1991, 8. 
 
 71 
 
By 1988 the majority of town, township, and neighborhood family planning offices were 
 staffed with one to two full-time family planning cadres. 83 Family planning tasks in most 
 administrative villages and urban neighborhood committees are supervised by local 
 administrative leaders. Sometimes, part-time personnel (who have other full-time jobs) are hired 
 to shoulder specified family planning tasks. The grass-roots level of the hierarchy of the family 
 planning structure is natural village teams. These are teams in the administrative villages 
 grouped by their nature (such as households targeted for family planning or groups of women 
 of childbearing age). Each team has a team motivator to promote the family planning activities. 
 The actual door-to-door work is done by these motivators. 84 It is believed that a motivator for 
 every 10 households in a village is most effective. 85 
 
 To guarantee the timely distribution of contraceptive supplies and devices requires an 
 effective work force assigned to the task. It was reported that by the end of 1989, the number 
 of workers and staff managing contraceptive supplies at the provincial level totaled 236 persons; 
 at the prefectural level, 1,380 persons; at the county level, 4, 102 persons; and at the township 
 and village levels they totaled 1,029,000 persons. 86 
 
 "Peng Zhiliang, 1990, 385. 
 
 •"China Family Planning Yearbook 1986, 58. 
 
 85 Family Planning Committee of Yi district in Zaozhuang City of Shandong Province, 1991, 
 2. 
 
 •"China Family Planning Yearbook 1990, 120. 
 
 72 
 
Apparently China's leaders have become aware of the importance of having well-trained 
 statisticians in the family planning staff. By the end of 1988 the number of statisticians 
 (classified as administrative staff) at the provincial, prefectural and county level family planning 
 committees is reported to be 4,424 persons. These statisticians work at the department, division 
 or office of statistical regulation, policy stipulation, science and technology, or finance. The 
 number of statisticians who work for family planning committees at the provincial level totaled 
 154 persons, an average of 5 persons per province; at the prefectural level, these totaled 735 
 persons, an average of 2 persons per prefecture; at the county level, these totaled 3,535 
 persons, averaging 1-2 persons per county. 87 
 
 Financial resources, service stations, and personnel are unevenly distributed and may be 
 highly concentrated in certain localities. For example, in Family Planning Yearbook. 1988 it 
 was reported that in 1987 there were more than 90,000 towns/townships in China. However, 
 the number of full-time family planning cadres at the town/township level totaled only slightly 
 more than 70,000 and only about 20 percent of the towns/townships were staffed with full-time 
 cadres. 88 
 
 The PRC had 135,000 full-time family planning cadres in 1985, which rose to 148,000 
 by midyear 1987 (Table 13). Table 14 shows the much more detailed data available for 1986 
 on the distribution of full-time family planning cadres by province. The data show that out of 
 
 "China Family Planning Yearbook 1990, 78. 
 88 Family Planning Yearbook 1988, 127. 
 
 73 
 
Table 13: Estimated Wages for Full-time Family Planning Employees in China, 
 1985 and 1987 (In current yuan) 
 
 Job functional structure 
 
 1985 
 
 Number of 
 employees 
 
 Estimated 
 
 wage bi 1 1 
 
 per year 
 
 Administrative cadres 
 Leading cadres 
 Administrative cadres in general 
 
 Specialist cadres 
 
 Rural, town, urban neighborhood full-time cadres 
 
 Other cadres 
 
 Total 
 
 1,853 
 
 6,893,160 
 
 5,845 
 
 11,923,800 
 
 40,837 
 
 98,008,800 
 
 76,777 
 
 96,739,020 
 
 9,359 
 
 12,690,804 
 
 34,671 
 
 226,255,584 
 
 Job functional structure 
 
 1987 
 
 Number of 
 employees 
 
 Estimated 
 
 wage bill 
 
 per year 
 
 Administrative cadres 
 
 Ministry and committee level 
 
 Office and bureau level 
 
 Department level 
 
 Other administrative cadres 
 Specialist cadres 
 
 Rural, town, urban neighborhood full-time cadres 
 Other cadres 
 
 Total 
 
 5 
 
 21,300 
 
 145 
 
 400,200 
 
 1,968 
 
 4,014,720 
 
 30,894 
 
 35,960,616 
 
 25,935 
 
 62,244,000 
 
 87,937 
 
 110,800,620 
 
 900 
 
 1,220,400 
 
 47,784 
 
 214,661,856 
 
 Notes: Since we do not have clear information on the ranking of the 
 administrative cadres and skill levels of specialist cadres, we arbitrarily 
 assign amounts for their basic wages. Going through various pay scales for 
 different job descriptions, for 1985 and 1987, we use 355 yuan, 310 yuan, 
 230 yuan, 170 yuan, and 97 yuan per month for the administrative cadres 
 at various levels, 200 yuan per month for specialist cadres, 105 yuan per 
 month for rural, town, urban neighborhood full-time cadres and 113 yuan 
 per month for other cadres. 
 
 Sources: China Family Planning Yearbook 1986, 244-245. 
 China Family Planning Yearbook 1988, 70. 
 Cao Xu et al., 1987, 568-597. 
 
 74 
 
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China's 147,000 full-time family planning cadres, only 308 worked at the national level for the 
 State Family Planning Commission, 105 more worked at the central level in other units, 2,278 
 worked for the military, 38,000 ran the program at the provincial or county or municipal levels, 
 34,000 worked for industrial and related enterprises, and 75,000 worked in villages and 
 neighborhoods. These figures do not include the part-time family planning workers and the 
 unpaid workers organized by the China Family Planning Association, but may include some or 
 all of the full-time paid cadres working for the CFPA. 
 
 c. Remuneration for Family Planning Workers and Staff 
 
 Wages for the workers and staff of the family planning departments include wages and 
 bonuses for full-time family planning personnel, fees for part-time family planning personnel, 
 and family planning service fees. Wages and benefits for the full-time family planning cadres 
 of villages in the rural areas and of neighborhoods in the urban areas are supposed to be covered 
 by the family planning budgetary expenditures. 
 
 According to the 1983 regulation, family planning departments at county or higher levels 
 are regarded as administrative organizations. Personnel in these organizations are included in 
 the billets for administrative personnel. Expenses incurred by these organizations are covered 
 by the budget allocated for administrative operational expenses instead of family planning 
 operational expenses. 
 
 76 
 
Economic units in China are required to pay the salaries of family planning cadres 
 assigned to their work force. According to regulations, most factories, mines, schools, people's 
 groups, enterprises and military organizations have established offices staffed with full-time 
 family planning workers or personnel with specially designated responsibilities. Many medical 
 schools and hospitals even establish family planning scientific research institutes. By 1987, there 
 were 13 such institutes. Enterprises with a certain number of workers and staff are required to 
 support certain numbers of full-time family planning personnel. For example, in Chongqing 
 City, Sichuan Province, enterprise units generally have established family planning offices. As 
 a rule, enterprises with more than 1,000 employees should establish a family planning office, 
 which is an independent second-level office. Enterprises with more than 500 staffers should 
 support one family planning cadre; enterprises with more than 1 ,000 staffers should support two 
 to five cadres; enterprises with more than 5,000 employees should support five to seven cadres; 
 and enterprises with over 10,000 staffers should support no fewer than seven family planning 
 cadres. 89 Enterprises are required to shoulder the wages and benefits for these workers. For 
 another example, Anshan Steel and Iron Company has a full-time family planning team including 
 six assistant statisticians, one assistant doctor and two doctors in charge. 90 
 
 In China, the real problem area of family planning funding lies at the grass-roots level. 
 Family planning workers at the town/township level and village level in particular often 
 complain about their low pay. The following two examples illustrate this pattern. First, Hou 
 
 89 Family Planning Committee of Chongqing City, 1991, 19. 
 ^Su Xiaogang, 1988, 1. 
 
 77 
 
Zhiying has been a cadre working on family planning in Shandong's Linyi County for more than 
 20 years. Today, she is still earning only 21 yuan a month. In comparison, the average family 
 planning cadre in the townships and towns nationwide was earning 62.8 yuan in 1987, and even 
 then, that wage level was below the national average for cadres. Second, in some localities, 
 such as Shandong's Yishui County, family planning cadres do not have workers' insurance or 
 health care, nor do they receive bonuses or subsidies. 91 The Deputy Director of the State 
 Family Planning Commission, Mr. Chang Chongxuan in his March 8, 1986 speech pointed out 
 that "family planning cadres at the village level (including the neighborhood committee) should 
 be paid reasonable fixed wages or be compensated for the work time they lose while working 
 in the family planning program. In any case, they should be paid reasonably. In addition, each 
 locality should come up with an appropriate way to handle the payment in accordance with local 
 conditions. " n 
 
 Indeed, various methods and pay scales are practiced in different localities. Following 
 are some examples. (1) In Fujian Province, the family planning cadres at the town/township 
 level are paid at step one of the floating wage scale (which means that part of the wage and 
 bonus of the cadres will be determined by their periodic performance evaluation). 93 (2) Shimen 
 County in Hunan Province pays its family planning workers as administrative personnel plus 9 
 yuan per month for the family planning post allowance. Those who have been in a family 
 
 9, Chu Hsiaoyang, 1991, 80-81. 
 
 ^China Family Planning Yearbook 1987, 23. 
 
 93 Zhang Haihong et al., 1989, 1. 
 
 78 
 
planning position for a consecutive five years with outstanding performance are paid at the scale 
 of deputy village director. 94 (3) Lu County in Sichuan also pays its full-time village family 
 planning workers step one of the floating wage scale plus some equipment such as a bicycle, 
 raincoat, etc. equivalent to 30 yuan worth of labor insurance per year. 95 (4) Yuxi City in 
 Yunnan pays the town/township family planning workers 30 to 60 yuan per person per month 
 plus an 8 yuan allowance for operational expenses. Any additional payments are subsidized by 
 the revenue of the town/township enterprises. Meanwhile, the contraceptive supplies distributor 
 in the town/township family planning system is paid 30 yuan per month. This expense is 
 covered by the budgetary revenue of the city government. In addition, some contraceptive 
 supplies delivery persons in the towns and villages are subsidized 5 to 8 yuan per month. The 
 expense is covered by the enterprises run by the townships or villages. 96 (5) In Shandong, 
 more than 10,000 persons receive 15 yuan per month for the family planning post allowance. 
 More than 2,700 persons were hired as family planning specialists and professionals. 97 (6) 
 From 1985 in Sichuan, the city government of Chongqing City agreed that cadres at the county 
 and lower levels would be paid a floating post allowance. From 1990, the floating post 
 allowance was changed into a post allowance. Each part-time family planning staff in the post 
 got a 15 yuan monthly allowance. 98 (7) In 1989 in the Huayuan Road Neighborhood 
 
 *Peng Yueli, 1989, 2. 
 
 95 Wei Junshi and Kang Jiang, 1988, 2. 
 
 ^Unpublished document from Yunnan Provincial Family Planning Committee issued on July 
 3, 1986. 
 
 ^Sun Nianjiu, 1991, 1. 
 
 98 Family Planning Committee of Chongqing City, 1991, 20. 
 
 79 
 
Committee of Beijing's Haidian District, certain elderly women who made up the patrol party 
 to check on the birth control, menstrual, and pregnancy status of their neighbors were paid 40 
 yuan a month. 99 
 
 The above examples illustrate how complicated the methods and sources of wage 
 payments can become. We can best estimate the expenditures for wage payments by using the 
 total reported figures for family planning staff at all levels and then multiply them by the 
 standard pay scale for all positions for the years 1985-1987 (see Tables 13 and 14). 
 
 Since many family planning workers and staff are paid on the floating wage scale, their 
 monthly income (wage and bonus) is determined by their performance evaluation. That is to 
 say, whether or not there are births outside the local official birth plan in their assigned areas 
 affects their income. In the rich areas, most workers have other sources of income so they are 
 less concerned about their wage and bonus from family planning work. Furthermore, well-off 
 peasants in the rich areas can afford to bribe family planning workers in order to obtain 
 permission to have births outside the plan. On the other hand, the only income for family 
 planning cadres in the poor areas may be their wages and bonus. The threat of a cut in their 
 income if they do not meet the required family planning targets might motivate them to attempt 
 strong measures to prevent unapproved births. 100 
 
 "Chu Hsiaoyang, 1991, 82. 
 100 Chu Hsiaoyang, 1991, pp. 85-86. 
 
 80 
 
C. Contraceptive Supplies 
 
 Under the "contracted responsibility system" of contraceptive supplies and devices, the 
 managerial cadres and staff at the contraceptive supplies and devices distribution stations are 
 rewarded bonuses at the end of the year if they have guaranteed the public timely supplies of 
 contraceptives and economized on expenditures. The cadres and staff are thus encouraged to 
 control costs and provide better distribution of supplies. The people need to obtain the 
 contraceptive supplies and devices in a timely manner so they can avoid accidental pregnancy. 
 The system is said to be well received by family planning committees and offices at all levels 
 as well as by the public and has proved to be very effective. 
 
 In January 1974, the Ministry of Commerce, the Ministry of Public Health, the Ministry 
 of Chemical Industry, and the Family Planning Leading Team of the State Council jointly issued 
 a circular to announce that 14 various kinds of contraceptive pills and supplies would be 
 provided free of charge and door to door delivery of contraceptive supplies would be provided. 
 As a result, 90 percent of the contraceptive supplies and devices were provided to the public via 
 door to door service and 10 percent were given out through various health station clinics, 
 markets or drugstores. According to a joint circular issued in 1980, to cover their management 
 fees the commercial departments may charge the family planning departments 2 percent of the 
 total cost of contraceptive supplies and devices purchased and delivered. 101 
 
 101 For details see Historical Experience of New China's Preventive Medicine, 1990, 327; 
 China Family Planning Yearbook 1986, 21 ; Office of Contraceptive Supplies and Devices, State 
 Family Planning Commission, 1989, 2. 
 
 81 
 
The system of "overall funds rationing and price-settled allocation" was tried out in 1982 
 and 1985 and improved in 1986. The main purpose of the system is to more effectively and 
 economically manage contraceptive supplies and devices. A contract is signed between the State 
 Family Planning Commission and provincial family planning committees at all levels. Under 
 this system, the State Family Planning Commission calculates and approves the contracted base 
 amount for expenditures on contraceptive supplies and devices for each participating province. 
 Such provinces are thus delegated the financial responsibility for economizing on the cost of 
 contraceptive supplies and devices. A new base for calculating contracted expenditures of 
 contraceptive supplies and devices was stipulated in 1986 and it was fixed for a period of three 
 years. All provinces which adopted the contracted responsibility system after 1986 applied the 
 new contracted base for their contraceptive supplies and devices; provinces adopting the system 
 before 1985 continued to use the old base. The base of contracted expenditures on contraceptive 
 supplies and devices was adjusted in 1989 and the base was fixed for a period of three years 
 beginning in 1990 (more detailed explanation of the calculation of base amount and the 
 components of the contracted expenditures on contraceptive supplies and devices is in Appendix 
 E). By the end of 1989, all of the provinces except Tibet had adopted the new system of 
 contract and responsibility. 102 
 
 In order to reduce transfer links, speed up the allocation and guarantee timely supply of 
 condoms to users, a system was adopted for direct allocation of condoms from manufacturers 
 
 102 For details see China Family Planning Yearbook 1986, 45-49; China Family Planning 
 Yearbook 1990, 120-122. 
 
 82 
 
to the family planning departments at the prefectural and municipal levels, instead of going 
 through commercial departments. In August 1988, the State Family Planning Commission and 
 the State Pharmaceutical Administration jointly published "The Circular on Overall Direct 
 Allocation of Contraceptive Pills and Devices" calling for initiation of direct allocation of all 
 kinds of contraceptive pills and devices starting in 1989 in order to link manufacturing and sales 
 together. m 
 
 China has developed a vast distribution network to get contraceptive supplies and devices 
 to the users. The National Center for Contraceptive Supplies and Devices, which is in charge 
 of the eight distribution centers in China, purchased contraceptive supplies and devices worth 
 98 million yuan and transferred from warehouses into distribution channels contraceptive 
 supplies and devices worth 90 million yuan for the entire nation in 1990. 104 In the urban and 
 rural areas, stations and warehouses were established to distribute and store pills and other 
 supplies. According to statistical data in the 1990 Family Planning Yearbook , the number of 
 personnel involved in managing contraceptive supplies and devices total more than one million 
 (see Table 15 for details). These personnel are not included in the data on full-time family 
 planning cadres. 
 
 103 Public Health in the People's Republic of China 1989, 78. 
 104 ZhangHong, 1991, 1. 
 
 83 
 
Table 15: Basic Situation of Contraceptive Supplies and Devices Control Stations in China 
 (As of Year-end 1989) 
 
 
 
 
 
 
 
 
 Township 
 
 
 
 
 
 Provincial 
 
 Prefecture 
 
 County 
 
 village 
 
 Items 
 
 
 Unit 
 
 Total 
 
 level 
 
 level 
 
 level 
 
 level 
 
 Authorized personnel 
 
 person 
 
 
 4,573 
 
 272 
 
 1,352 
 
 2,949 
 
 
 Actual 
 
 person 
 
 
 1,034,718 
 
 236 
 
 1,380 
 
 4,102 
 
 1,029,000 
 
 Building space 
 
 square 
 
 meter 
 
 237,083 
 
 14,549 
 
 86,570 
 
 135,964 
 
 
 Built space 
 
 square 
 
 meter 
 
 196,817 
 
 10,049 
 
 67,168 
 
 119,600 
 
 
 Warehouse 
 
 square 
 
 meter 
 
 87,670 
 
 6,400 
 
 38,797 
 
 42,473 
 
 
 Under construction 
 
 square 
 
 meter 
 
 40,266 
 
 4,500 
 
 19,402 
 
 16,364 
 
 
 Veh i c I es 
 
 each 
 
 
 419 
 
 44 
 
 256 
 
 119 
 
 
 Vans 
 
 each 
 
 
 145 
 
 18 
 
 76 
 
 51 
 
 
 Big truck 
 
 each 
 
 
 61 
 
 13 
 
 47 
 
 1 
 
 
 Mini truck 
 
 each 
 
 
 213 
 
 13 
 
 133 
 
 67 
 
 
 Other equipment 
 
 each 
 
 
 1,160 
 
 136 
 
 371 
 
 653 
 
 
 Forklift truck 
 
 each 
 
 
 4 
 
 2 
 
 2 
 
 
 
 
 Wheelbarrow 
 
 each 
 
 
 232 
 
 39 
 
 96 
 
 97 
 
 
 Air conditioning 
 
 each 
 
 
 874 
 
 65 
 
 254 
 
 555 
 
 
 Computers 
 
 each 
 
 
 50 
 
 30 
 
 19 
 
 1 
 
 
 Source: China Family Planning Yearbook 1990, 123. 
 
 84 
 
Most contraceptive supplies used in China are produced in the country. In 1989, China 
 produced 2.9 billion oral pills, 834 million condoms and 42 million IUDs. 105 
 
 From 1979 to 1989, the United Nations Population Fund (UNFPA) invested altogether 
 US$21 million in assisting the production of contraceptive supplies. The amount mainly was 
 spent on purchasing modem production machinery, introducing advanced technology, and 
 training family planning workers. The assistance increased the quantity of production as well 
 as improved the quality of contraceptives. It provided high efficiency and safer contraceptive 
 supplies and devices for the family planning program in China. Factories receiving assistance 
 from UNFPA have the capability to meet 20 percent of the nation's demand for contraceptive 
 supplies. 106 A specific example is the Second Pharmaceutical Factory in Nanjing which, with 
 assistance from UNFPA, has reached international quality standards. The total investment in 
 this factory was 13.7 million yuan, among which US$2 million was allocated from UNFPA to 
 import advanced machinery from the United States, Great Britain, Italy, Japan and Germany. 
 Currently this factory is able to produce 1 billion oral contraceptive pills per year, which is 
 enough to supply the annual dosage for 3.5 million women of childbearing age. 107 This 
 accounts for almost 40 percent of the 9.2 million women who used oral pills and injections in 
 1989. 108 
 
 105 China Public Health Yearbook 1990, 159. 
 106 YeLiqi, 1991, 6. 
 
 107 Chen Naian and Zhang Jian, 1989, 1. 
 ,08 China Family Planning Yearbook 1990, 390. 
 
 85 
 
D. Costs and Provision of Birth Control Surgery 
 
 Those contraceptive operations that can be performed at county family planning clinics 
 are carried out there. By the end of 1989, of the 2,251 county-level family planning service 
 stations in China, 798 were equipped to carry out all kinds of birth control surgery, 171 could 
 do 70 percent of the required operations, 292 could perform 50 percent, and 418 could carry 
 out 30 percent. When a clinic can perform only some of the contraceptive operations, these are 
 likely to be the simplest and safest procedures, namely IUD insertions, legal IUD removals, and 
 first-trimester abortions using vacuum aspiration. Table 16 shows the provincial distribution of 
 fully equipped county family planning clinics; in most provinces there is only one such clinic 
 per one or two million population. In that case, most birth control operations would still be 
 carried out in hospitals. 
 
 The contracted responsibility system was adopted for contraceptive surgery as well as 
 contraceptive supplies. Fees for registration, examination, medicine, hospitalization, and post- 
 surgical treatment when people receive various kinds of birth control surgery (IUD, vasectomy, 
 tubal ligation and abortion) are covered by the family planning operational expenditure budget. 
 Fees for treatment of complications following birth control surgery are also covered by the 
 family planning operational expenses upon the determination of a birth control surgery 
 technology advisory team above the county level. 
 
 86 
 
Table 16: Well-Equipped County Level Family Planning 
 Service Stations in China, 1989 
 
 
 
 Total number 
 
 
 Number 
 
 of counties in 
 
 Province 
 
 of stations 
 
 the provinces 
 
 Beijing 
 
 4 
 
 8 
 
 Tianjin 
 
 2 
 
 5 
 
 Hebei 
 
 63 
 
 128 
 
 Shanxi 
 
 34 
 
 93 
 
 Inner Mongolia 
 
 26 
 
 72 
 
 Liaoning 
 
 41 
 
 38 
 
 J i I i n 
 
 14 
 
 26 
 
 Hei long jiang 
 
 29 
 
 54 
 
 Shanghai 
 
 4 
 
 9 
 
 J i angsu 
 
 29 
 
 51 
 
 Zhejiang 
 
 29 
 
 52 
 
 Anhui 
 
 26 
 
 63 
 
 Fuji an 
 
 27 
 
 56 
 
 J i angx i 
 
 29 
 
 75 
 
 Shandong 
 
 43 
 
 78 
 
 Henan 
 
 44 
 
 104 
 
 Hubei 
 
 27 
 
 50 
 
 Hunan 
 
 33 
 
 78 
 
 Guangdong 
 
 38 
 
 76 
 
 Guangxi 
 
 29 
 
 76 
 
 Hainan 
 
 5 
 
 16 
 
 S i chuan 
 
 96 
 
 169 
 
 Guizhou 
 
 22 
 
 75 
 
 Yunnan 
 
 20 
 
 114 
 
 Tibet 
 
 
 76 
 
 Shaanxi 
 
 30 
 
 86 
 
 Gansu 
 
 28 
 
 67 
 
 Qinghai 
 
 6 
 
 37 
 
 N i ngx i a 
 
 7 
 
 16 
 
 X i n j i ang 
 
 13 
 
 71 
 
 Total 
 
 798 
 
 1.919 
 
 Total of county service stations 
 Stations with 100% capability 
 Stations with 70X capability 
 Stations with 50* capability 
 Stations with 30X capability 
 Stations not accounted for 
 
 
 Percent of 
 
 umber 
 
 the total 
 
 2,251 
 
 100 
 
 798 
 
 35 
 
 171 
 
 8 
 
 292 
 
 13 
 
 418 
 
 19 
 
 572 
 
 25 
 
 Sources: China Family Planning Yearbook 1990, 134, 146. 
 China Statistical Yearbook 1990, 3. 
 
 87 
 
On the other hand, according to the 1983 regulation, expenses for birth control surgery 
 and treatment of post-surgical sequelae for the staff of state administrative units, political parties 
 and groups, and people's organizations should be covered by "operational expenses for free 
 medical care;" for workers and staff, and their direct dependents, of state-owned and urban 
 collective enterprises, these operations and treatments should be covered by the enterprises' 
 "welfare funds for workers and staff;" in the military, expenses for birth control surgery and 
 treatment of post-surgical sequelae received by officers and other military personnel, workers 
 and staff and their dependents should be charged as "national defense expenses." These 
 regulations mean that the health coverage provided for urban, official, and military workers is 
 required to include payment for the full cost of birth control operations and follow-up. 
 
 Because a large portion of the expenses for birth control surgery in China is covered by 
 the system of free medical care, many hospitals and clinics tend to overcharge the medical 
 reimbursement system for these birth control operations. For example, some areas in Shanxi 
 Province reportedly charged 40 yuan, 50 yuan or "even 80 yuan" for surgical sterilization. The 
 medical coverage scheme was also billed for extra charges for various items which patients 
 might not have received at all in their operation. 109 Madam Peng Peiyun of the State Family 
 Planning Commission pleaded in her October 20, 1988 speech that the charge for contraceptive 
 surgery should cover only the cost and that material prices departments should provide 
 supervision to prevent wanton charges for the surgery. 110 
 
 109 Fan Zhigang and Zhang Xiaosen, 1989, 1. 
 110 Peng Peiyun, 1990, 1. 
 
 88 
 
Some areas in Yunnan, Guizhou, and Sichuan provinces report that they are 
 overburdened by the increasing expenditures for birth control surgery. Since 1986, Guizhou has 
 practiced the contracted responsibility system and used the poll method to compile its base for 
 surgery reimbursement. Due to the inflation of prices and hospital charges, there is an 8.08 
 million yuan difference between the actual amount required for reimbursing birth control 
 surgeries and the smaller amount allocated by the contracted responsibility system in 1989. In 
 Yunnan Province for five years in the late 1980s, family planning operational expenditures grew 
 29 percent a year on average. However, due to the rising cost of each surgery, Yunnan still 
 could not keep up with the increased costs of the birth control operations. m Therefore, 
 Yunnan's family planning department fell heavily in debt to the public health department every 
 year. In addition, it was reported that many provinces owe their public health departments up 
 to 10 million yuan for tubal ligation surgery fees. 112 
 
 The above-mentioned examples illustrate the need for improved financial management 
 
 and a better system for covering the actual expenditures occurring from birth control surgery. 
 
 These reports also reveal that provincial and lower level governments are shouldering the 
 
 majority of the expenditures. As Madam Peng Peiyun pointed out in her 1989 report, 
 
 Insufficient funding, especially the insufficient funding for birth control surgery expenses, 
 has become a serious obstacle in promoting family planning. Party and political leaders 
 at all levels should actively help the family planning departments solve this problem. In 
 accordance with the current financial management system, budgetary expenditures mainly 
 rely on local financial departments at all levels. At the same time, the central 
 
 in Wan Qinghua, 1989, 1. 
 112 Zhu Li, 1989, 39. 
 
 89 
 
government will subsidize the expenditures as it sees fit.... Family planning departments 
 at all levels should vigorously reflect the relevant situation to the local party and political 
 leaders as well as to the financial departments and strive by every means to obtain more 
 of the budgetary family planning expenditure. These departments also have to control 
 charges for birth control surgery. They should strictly forbid the unreasonable increase 
 of prices or unreasonable charges for services. 113 
 
 Total expenditures for birth control surgeries and supplies have not been reported, so the 
 data in Table 17 reflect our estimates, based on the assumptions given. 
 
 E. Bonus for One-child Certificate and One-child Health Care 
 
 In order to encourage each couple to stop childbearing after one child, the Chinese 
 government has set up incentive programs to reward couples who sign a pledge to have only one 
 child. The rewards include one-child welfare subsidies, one-time bonuses for couples signing 
 up for the "one-child family" program, free medical care, free nursery and kindergarten for the 
 only child, and deduction of tuition fees for the only child's elementary and high school 
 education. While certain rewards are suggested or mandated, the actual spending on rewards 
 depends on the capacity of each locality or unit to pay for the benefits. Total expenditures 
 nationwide are estimated in Table 18. 
 
 113 China Family Planning Yearbook 1990, 34. 
 
 90 
 
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Table 
 
 18: One-child 
 
 Incentive Program, 1979-1989 
 
 
 
 
 
 
 
 Number 
 
 One-time 
 
 
 Reported 
 
 
 
 Number 
 
 of couples 
 
 bonus for 
 
 
 state-owned 
 
 
 
 of couples 
 
 who received 
 
 one-child 
 
 
 enterprises 
 
 
 Current 
 
 holding 
 
 one-child 
 
 pledge 
 
 Single child 
 
 one-child 
 
 
 users of 
 
 one-child 
 
 certificates 
 
 (40 yuan 
 
 health care 
 
 incentive 
 
 Year 
 
 contraceptives 
 
 certificates 
 
 that year 
 
 per couple) 
 
 expenditures 
 
 expenses 
 
 1979 
 
 93,586,000 
 
 6,101,000 
 
 6,101,000 
 
 244,040,000 
 
 366,060,000 
 
 
 1980 
 
 100,740,000 
 
 11,433,000 
 
 5,332,000 
 
 213,280,000 
 
 685,980,000 
 
 210,000,000 
 
 1981 
 
 104,993,605 
 
 14,481,166 
 
 3,048,166 
 
 121,926,640 
 
 868,869,960 
 
 270,000,000 
 
 1982 
 
 114,048,641 
 
 19,529,612 
 
 5,048,446 
 
 201,937,840 
 
 1,171,776,720 
 
 400,000,000 
 
 1983 
 
 124,525,921 
 
 24,767,858 
 
 5,238,246 
 
 209,529,840 
 
 1,486,071,480 
 
 550,000,000 
 
 1984 
 
 132,482,469 
 
 28,174,429 
 
 3,406,571 
 
 136,262,840 
 
 1,690,465,740 
 
 550,000,000 
 
 1985 
 
 139,235,627 
 
 29,445,965 
 
 1,271,536 
 
 50,861,440 
 
 1,766,757,900 
 
 610,000,000 
 
 1986 
 
 145,889,724 
 
 30,508,417 
 
 1,062,452 
 
 42,498,080 
 
 1,830,505,020 
 
 700,000,000 
 
 1987 
 
 154,665,987 
 
 32,304,790 
 
 1,796,373 
 
 71,854,920 
 
 1,938,287,400 
 
 800,000,000 
 
 1988 
 
 166,337,498 
 
 34,430,315 
 
 2,125,525 
 
 85,021,000 
 
 2,065,818,900 
 
 940,000,000 
 
 1989 
 
 172,693,228 
 
 35,467,087 
 
 1,036,772 
 
 41,470,880 
 
 2,128,025,220 
 
 1,070,000,000 
 
 Notes: The figure for "Number of couples who received one- child certificate that year" is 
 really the net increase in the total number of certificate-holders. Net increase = new recipients 
 of certificates minus couples who have a second child and thus lose the certificate, minus couples 
 with one-child certificates who age out of childbearing ages. 
 
 The one-time bonus for couples making the one-child pledge was reported to range from 30 to 50 
 yuan in different provinces. Therefore we have assumed the average is 40 yuan per couple. 
 The health care subsidy for the child of couples holding one-child certificates is about 5 yuan 
 per month. 
 
 The right-hand column shows the escalation in one-child incentive expenses met by China's 
 state-owned enterprises. These are a portion of the total nationwide expenditures on 
 one-child bonuses, single child health care expenditures, and other one-child incentives. 
 
 Sources: Table 14; 
 
 China Family Planning Yearbook 1986, 375, 378, 381, 388, 405, 416, 426; 
 
 China Family Planning Yearbook 1987, 402; 
 
 China Family Planning Yearbook 1988, 287; 
 
 China Family Planning Yearbook 1990, 386; 
 
 Gao Ersheng et al., 1990, 273; 
 
 China Labor Wages Statistical Yearbook 1990, 402-403. 
 
 92 
 
First, a couple who applies for and is issued the one-child certificate is reportedly eligible 
 for a one-time bonus. The bonus is reportedly between 30 and 50 yuan and varies from 
 province to province. 
 
 Reported regulations from many provinces say that the only child should receive a health 
 care allowance from the day the child is born till the child reaches 14 years of age. The 
 allowance usually runs from 5 yuan to 7 yuan per month (some areas pay only 2.5 yuan per 
 month). 
 
 When the child is ready to go to school, the only child is eligible for free kindergarten, 
 elementary school and junior high school. Parents of the only child also expect to receive a 
 better housing assignment and better retirement terms in an urban area and better land allocation 
 in the rural area. 114 
 
 According to the 1983 regulation, the spouses' working units will shoulder 50 percent 
 of the burden of the one-child health care and incentive awards. Couples who have their own 
 business are to obtain their award from the funds of the individual business association allocated 
 from the funds of individual industry and commerce management. For the single child's 
 education, the work units, the Ministry of Education, the Ministry of Social Welfare and 
 township and town committees jointly shoulder the expenses. 
 
 ,14 For details see China Family Planning Yearbook 1988, 22-47; Gao et al. 1990, 273. 
 
 93 
 
Paying each single child 5 yuan per month for health care until the child reaches 14 
 years of age creates a snowball effect (Table 18). The available data on the expenditures 
 allocated for workers and staff working at state-owned enterprises for the one-child allowance 
 and health care indicate that the totals escalated from 0.21 billion yuan in 1980 to 1.07 billion 
 in 1989. 115 Based on the assumption that each couple receives a one time bonus of 40 yuan 
 for obtaining the one-child certificate and each single child gets 5 yuan per month till the age 
 of 14, the number of couples obtaining the one-child certificate each year can be used to get a 
 rough idea how much the one-child incentive program cost each year from 1979 to 1989 (see 
 Table 18). The figures in Table 18 indicate the large amount of money required for this 
 incentive program. 
 
 To meet the rest of the incentive program, state-owned and urban collective enterprises 
 draw their resources from enterprise welfare funds and retained profits. When they run into 
 difficulties, they can, upon the approval of the finance department, obtain supplementary funds 
 by using part of the enterprise management fees. Administrative and operational units such as 
 schools and organizations draw resources from the welfare funds of their workers and staff. 
 When they face difficulties meeting the demand, they are allowed to use money budgeted for the 
 administrative expense or operational expense of the unit. 
 
 On the other hand, rural residents receive their one-child benefits from local public 
 welfare funds. As an alternative, if welfare funds are inadequate, they may be allocated more 
 
 
 n5 China Labor and Wages Statistical Yearbook 1990, 402-403. 
 
 94 
 
contract farm land to till or the required deliveries of crops they grow may be reduced. 
 Hardship areas (independent basic accounting units in which the annual per capita income is less 
 than 50 yuan) are subsidized 50 percent of the cost by the state upon the approval of the county 
 government. This 50 percent subsidy is shouldered evenly by the central and local 
 governments. 116 
 
 Working units and local governments are assuming the major responsibility for supporting 
 the one-child health care program. According to data provided by Shanghai county, the 
 collective units are shouldering more than 90 percent of the cost. Another obvious fact is that 
 costs relevant to one-child benefits (health care, nursery, one-child certificate awards and tuition 
 exemptions) account for a large proportion of the total cost of family planning in advanced areas 
 where high proportions of couples stop at one child. 
 
 In addition, the work units are absorbing the costs for incentives and subsidies given to 
 the recipients of birth control measures. This includes expenses paid for sick leave taken by 
 birth control surgery recipients, expenses for extended marriage and maternity leaves as bonuses 
 for late marriage and delayed pregnancy, and expenses for special nutrition allowances for 
 
 116 For details see China Family Planning Yearbook 1986, 35. The part shouldered by the 
 central government is treated as a special budgetary allocation for that particular fiscal year. 
 The allocated amount for subsidy is computed by the State Family Planning Commission and the 
 Ministry of Finance in accordance with the number of one-child certificates obtained by the year- 
 end of the previous year in the hardship areas multiplied by the average standard amount for the 
 allowance. Each province, municipality, and autonomous region then allocates the sum (the 
 standard allowance of that locality plus the amount of subsidy from finance departments at all 
 levels) to the county level. The family planning department at the county level then takes the 
 responsibility to allocate the amount to the recipient. 
 
 95 
 
recipients of sterilization, IUD, and those women with IUDs who become pregnant and undergo 
 abortions. One could argue that the one-child benefits are just another form of welfare for the 
 workers and staff to make up for their low wages. 117 Therefore, we could classify all these 
 one-child benefits as expenditures of China's family planning program or, alternatively, as 
 societal transfer payments to the single-child families. 
 
 Women employees are eligible for generous maternity and child care benefits under the 
 provisions of the Women's Protection Law of September 1988, especially if they have complied 
 with late marriage, late birth, and one-child policies. The benefits (which include between six 
 months and three years of paid maternity leave) are designed to provide additional incentives to 
 women workers of childbearing age to abide by family planning policies. Ironically, now that 
 employers may exercise greater freedom when hiring employees, the law encourages 
 discrimination against women in the job market. For the profit motivated employer, the high 
 cost of maternity leave and child care benefits argues in favor of hiring men rather than 
 women. 118 
 
 Realizing the heavy burden shouldered by the enterprises, the Chinese government has 
 introduced insurance arrangements specially designed to cover the maternity cost of women 
 
 117 By 1990, the total amount spent by state-owned enterprises for the one-time bonus for one- 
 child pledges constituted about 3 percent of the total expenditures for worker and staff benefits. 
 This was only a small portion of single child benefits, however. China Labor and Wages 
 Statistical Yearbook 1990, 402-403. 
 
 ""Foreign Labor Trends, China, 1989-1990, 9. 
 
 96 
 
workers. Where this insurance system operates, each enterprise is required to contribute 20 
 yuan for each worker each month. After a woman gives birth, the enterprise receives 1,000 
 yuan from the insurance fund to cover maternity fees. Each woman gets birth compensation fees 
 only once in a lifetime as the country encourages one couple to have only one child. 
 
 The system was first introduced by Nantong city in Jiangsu Province in September 1988 
 and it has now spread to 41 cities and counties in 11 provinces. Shanghai, Fujian, Sichuan, 
 Hebei and Heilongjiang as well as Qingdao in Shandong Province and Dalian in Liaoning are 
 mapping out plans to implement the program. 119 
 
 F. Penalties for Unauthorized Children 
 
 Those who choose not to abide by the one-child policy and who have unauthorized 
 children not only forfeit potential benefits but also are penalized. Even though penalties vary 
 from one locality to another, they can be generalized as follows: 
 
 Couples (no matter whether they are state workers and staff, urban residents, or rural 
 residents) with one unauthorized child (including adopting another's child or giving their own 
 child up for adoption) can be penalized 10 percent of their monthly wages for a consecutive 
 seven years; for two unauthorized children, the penalty can be 20 percent of their monthly 
 
 ,19 Xinhua English News, June 26, 1991. 
 
 97 
 
wages for a consecutive fourteen years. 120 Provincial regulations sometimes vary in the 
 amounts of the penalties. 
 
 For couples working in state organizations, neither husband nor wife can apply for a day 
 care subsidy or hardship subsidy, nor can they receive pay increases or quarterly and annual 
 bonuses for three years; they will not be promoted either. In addition, the wife will not enjoy 
 any benefits (pay and other) during her maternity leave. Couples who have received one-child 
 certificates not only have to return the certificates but also have to reimburse the one-child health 
 care allowances and awards they have received. 
 
 For couples who have three children, besides the above-mentioned penalties, either the 
 husband or the wife is strongly encouraged or required to undergo sterilization. There are some 
 provinces and localities, particularly minority nationality areas, where this does not apply. 
 
 Those couples who are permitted to have a second child must return the one-child 
 certificate. They stop collecting all benefits relevant to the one-child program beginning from 
 the month when they obtain approval to give birth to a second child. 121 
 
 ,20 China Family Planning Yearbook 1988, 36-37. 
 121 For details see China Family Planning Yearbook 1988, 22-47. 
 
 98 
 
For the floating population, there is another set of regulations and penalties. 122 We will 
 not detail these in this paper. 
 
 In the urban areas, a higher proportion of couples adopt the one-child policy than in rural 
 areas. One reason is that the resources for all the promised incentive awards are better 
 guaranteed in the urban areas. Another is that most urban residents are state or collective 
 workers and staff who must comply with the one-child policy in order to avoid large penalties. 
 On the other hand, in most of the rural areas, the terms for the incentive awards are not clearly 
 defined and the resources for the awards are not guaranteed. Furthermore, compared with the 
 actual benefits of having unauthorized births, especially boys, the amount of the award is not 
 enough to persuade many of the peasants to abide by the one-child policy. By the same token, 
 the amount of the penalty is too insignificant to prevent prosperous peasants from having births 
 outside the local government's birth plan. 
 
 There are, however, many rural areas in China where the penalties for bearing an 
 unauthorized child are high in comparison to local incomes and are enforced. In such localities, 
 many couples have fewer children than they desire in order to avoid the penalties. 
 
 I22 For details see China Family Planning Yearbook 1987, 34-40. 
 
 99 
 
G. Utilization of Fines for Births Outside the Plan 
 
 There is very little available information on the amounts of money collected as fines for 
 having an unauthorized birth. In some areas the sums are large and their use is not well 
 monitored. Reports often appear in newspapers and periodicals about corruption among family 
 planning cadres, their mismanagement of collected fines and their abuse of excessive birth fines 
 for personal gain (such as luxurious banquets and personal travel). 123 
 
 Fines collected, nevertheless, may be a major financial source for the family planning 
 program. (A few examples of utilization of fines for births outside the plan are included in 
 Appendix F.) There is an interesting example given in a 1989 article to illustrate the budgetary 
 relevance of fines for births outside the official birth plan: 
 
 The birth control rate of Yongan Township of Fengjie County in Sichuan Province 
 reached 100 percent (i.e. no excessive births). However, because this town no longer 
 collected excessive birth fines to supplement its revenue, it faced a severe lack of funding 
 for its family planning operational expenditures. It was not able to pay for such expenses 
 as wages and bonuses for the family planning cadres, cost of medicine, cadres' business 
 trips and training courses. 124 
 
 In localities where the family planning program has obtained increased compliance, fewer 
 unauthorized births occur, which also means that revenue from "excessive birth fines" could 
 
 123 Details see Cheng and Wu, 1989, 54 and Chen, 1990, 61-62. 
 124 Cheng and Wu, 1989, 53. 
 
 100 
 
 
correspondingly decrease. Who then picks up this portion of the family planning budget? 
 Circumstances in the urban areas are quite different from those in the rural areas. 
 
 In urban areas, the majority of married couples are strictly abiding by the "one-child per 
 couple" policy. Measures of compliance such as "planned birth rates" in urban areas are rather 
 high. Therefore, revenue from fines for unauthorized births is nowhere near enough to offset 
 family planning expenditures. 
 
 In rural areas, the situation is quite different. There are towns and villages whose birth 
 control rates reach 100 percent and financial departments at both the county and town/township 
 levels reportedly subsidize these towns and villages. Nevertheless, in most rural areas, many 
 peasants continue to bear unauthorized children. In some places, revenue from collecting the 
 financial penalties for unauthorized births is enough to offset family planning operational 
 expenditures. For example, during the 1980s, a county in Sichuan Province covered about 96 
 percent of its actual expenditures for family planning work by levying fines for unauthorized 
 births. 125 
 
 H. Expenses for IEC 
 
 In order to enhance the understanding of the present young and future generations about 
 demographic matters, China has introduced population education into the curricula of middle 
 
 125 Cheng and Wu, 1989, 53. 
 
 101 
 
schools and institutions of higher learning. These programs promote late marriage and small 
 families. Population research units have been established and demography is now taught in more 
 than 30 universities and colleges. Basic population theory is now taught in most senior middle 
 schools and reproductive physiology and personal hygiene are reportedly taught in all junior 
 middle schools. 126 In order to strengthen population education among young people, UNFPA 
 provided US$5.5 million for population education for a teachers' training program, curriculum 
 design, and sex education materials for high school students. 127 
 
 The Family Planning Yearbook 1986 reported: "In the 1980s, there was new 
 development in the strength of IEC. Along with the opening-up and reform policy, joint 
 research projects on population and family planning were signed with UNFPA. IEC of family 
 planning was one of the joint research items. For the first cycle (1980-1985), the amount 
 allocated to this item was US$8.3 million, accounting for more than 16 percent of the total 
 amount for the joint research project " 128 
 
 Short-term training courses are frequently held for population and family planning 
 officers and field workers with emphasis on basic population theory, general population issues 
 facing China, IEC methods, and birth control procedures so as to make them capable of 
 disseminating knowledge of population and family planning. So far almost all the family 
 
 126 China Family Planning Yearbook 1986, 74. 
 127 YeLiqi, 1991,6. 
 
 128 China Family Planning Yearbook 1986, 323. 
 
 102 
 
planning workers have gone through short-term training courses (with about 500 at the national 
 level, about 2,000 at the provincial level and more than 480,000 at local levels). 129 Besides 
 this, the Nanjing Family Planning Managerial Cadre College was established in 1985, with 
 UNFPA support, to run a 2-year course for family planning managers at provincial and county 
 levels. 130 In addition, from January 1988 to December 1989 a UNFPA project entitled "To 
 Strengthen the Capabilities of the State Family Planning Commission in Policy Stipulation, Data 
 Base Management, Research and Evaluation" was carried out in China. Total UNFPA input for 
 the project was US$1,221,810, 131 
 
 Madam Peng Peiyun in a 1989 speech instructed that each family planning committee at 
 the county level should allocate a certain proportion of its operational expenditures for IEC 
 expenses. In addition, each village can obtain a portion of accumulated public funds and birth 
 fines for IEC expenses. 132 
 
 Ms. Peng Yu, deputy director of the State Family Planning Commission, in a 1989 
 speech suggested that the family planning departments at the provincial level establish a separate 
 communication department with at least two staffers, and that family planning departments at 
 the county level should have one or more full-time or one specially designated part-time cadre. 
 
 129 These figures are based on the incomplete statistical data as of the end of 1987. For 
 details see China Family Planning Yearbook 1988, 67. 
 
 130 For details see China Family Planning Yearbook 1986, 243. 
 
 ,31 China Family Planning Yearbook 1990, 84. 
 
 132 China Family Planning Yearbook 1990, 51. 
 
 103 
 
Each locality should guarantee operational expenses for family planning communication 
 activities." 
 
 I. Expenditures on Family Planning Scientific Research Projects 
 
 A 1983 State Family Planning Commission regulation stipulated that money for research 
 should all be allocated as follows: Of the family planning scientific research budget, research 
 on theory should account for 20-25 percent; research on applications should constitute 60-65 
 percent; research on development should make up 10-15 percent and research on information, 
 3-5 percent. The regulation also stipulates that units at the grass-roots level should change the 
 proportion of the distribution according to their actual conditions and the nature of their research 
 assignment. 
 
 For scientific research projects, four different levels of management are designated: (1) 
 State Family Planning Commission (2) ministry planning committees (3) local planning 
 committees and (4) unit planning committees. The economic management system for scientific 
 research treats each individual research project of the state scientific projects as an accounting 
 unit. Meanwhile, local units can choose their own research projects. However, these units are 
 responsible for their own working expenses. In general, there is no special grant allocated for 
 financial support of local-level family planning research. 
 
 133 China Family Planning Yearbook 1990, 152-156. 
 
 104 
 
Mr. Wu Jingchun, Deputy Director of the State Family Planning Commission, 
 commented in 1989 on the paucity of available funds for family planning research: 
 
 Regarding working expenses for the family planning scientific research projects, after the 
 reform of the science and technology system, the Ministry of Finance allocated all the 
 working expenses regarding scientific research to the Science Commission. Currently 
 the Family Planning Commission in China can obtain two grants to cover the working 
 expenses. One is the special task research grant from the state. The total for this five- 
 year grant is 7.89 million yuan. The other is a project grant from the committees at the 
 ministry level. The annual allocation for this grant is 2.25 million yuan. Therefore, the 
 average total for the grant is about 4 million yuan per year. This is obviously 
 insufficient. The Division of Science and Technology is willing to allocate some funds 
 for research projects. However, more often than not, it is limited by insufficient 
 budgeted working expenses. Family planning committees at all levels perhaps are able 
 to allocate a certain amount for the special research funding by squeezing some funds 
 from their budgetary operating expenditures. 134 
 
 Madam Peng Peiyun in her July 30, 1989 speech also noted: 
 
 You all mention the insufficiency of research working expenses. We can understand 
 your situation. This year the amount that you all requested for your research working 
 expenses totaled 304,000 yuan. However, we are only able to provide you 157,500 
 yuan. Even though this is only half as much as you are asking for, we have to squeeze 
 this sum from our limited budgetary operating expenditure. This year, the state not only 
 has not increased our budget for operating expenses, but will cut the budget by 5 percent 
 in the latter half of the year. Therefore, please do what you can. You may have to 
 downgrade the content and scale of some research projects. Even so, you still have to 
 struggle hard. We hope some day we can obtain a grant for policy research. The 
 government should have allocated expenditures for this kind of research. Nevertheless, 
 working expenses for this kind of research were not included in the budgeted operational 
 expenditures allocated from the state to us. From now on, we will do all we can to 
 obtain the budget. 135 
 
 134 China Family Planning Yearbook 1990, 134. 
 135 China Family Planning Yearbook 1990, 72. 
 
 105 
 
Even though the above statements indicate that the scientific research funds from 
 domestic sources are scarce, the assistance from UNFPA from 1979 to 1989, on the other hand, 
 is rather significant. Over the past ten years, funds from UNFPA helped to establish four family 
 planning scientific research institutes in Beijing, Tianjin, Chengdu and Guangzhou. These four 
 institutes conduct research on contraceptive supplies and devices. They purchased advanced 
 analytical research instruments and equipment (for example, in the past five years, Chengdu 
 imported more than US$600,000 worth of equipment, Tianjin imported US$880,000 worth of 
 instruments, lab materials and books and Guangzhou imported US$490,000 worth of equipment). 
 These institutes have also trained a number of scientists for contraceptive research. 136 
 
 In addition, research grants were awarded by international organizations to many 
 individual institutes and scientists. Since details can be found in Inventory of Population 
 Projects in Developing Countries Around the World. 1989/1990 . we only list a few items as 
 examples. Research grants were awarded to the Shanghai Institute of Planned Parenthood 
 Research ($74,059); and the Family Planning Research Institute of Zhejiang in Hangzhou 
 ($43,905). The World Health Organization in 1989 collaborated with the National Research 
 Institute for Family Planning in Beijing, which received $490,407. Research training grants 
 were awarded to 33 Chinese scientists, the total expenditures under this heading amounting to 
 about $725,300, of which $246,128 were UNFPA funds. 137 
 
 136 For details see Ye Liqi, 1991, 6; China Family Planning Yearbook 1990, 163-165. 
 
 '"Inventory of Population Projects in Developing Countries Around the World 1989-1990, 
 117. 
 
 106 
 
J. Expenses for Equipment, Fixed Assets and Capital Construction 
 
 Capital construction and equipment expenditures for family planning work do not appear 
 to be included in the family planning operational budget. Neumann and Chang point out that 
 "capital expenditures do not enter family planning cost calculations in China, as found in the 
 author's research." 138 
 
 It was stated in Document #37 issued in 1982 that "regarding the construction of service 
 stations, the investment in its capital construction should be financed by the unified funds for 
 the locality and funds raised by the locality while implementing the regulation of the State 
 Planning Commission." 139 
 
 Capital construction for family planning programs may cover the building of family 
 planning clinics at the county level, facilities built for family planning scientific research labs, 
 facilities built for printing family planning information and publications or to store contraceptive 
 supplies and devices, or even houses built as living quarters for family planning personnel. 140 
 Each village, each county, and each province may come up with its own funds. However, 
 expenditures for capital construction investment are mainly special funds allocated annually by 
 the State Planning Commission to the State Family Planning Commission and then to 
 
 138 Neumann and Chang, 1988, 127. 
 ,39 China Family Planning Yearbook 1988, 97. 
 140 For details see China Family Planning Yearbook 1990, 147. 
 
 107 
 
governments at all levels for the specified purposes. According to the 1990 Family Planning 
 Yearbook , the special fund for capital construction investment allocated by the State Planning 
 Commission to the family planning system was 25.5 million yuan in 1989. Of this amount, 
 13.02 million yuan was used for capital construction projects of units directly under the 
 administration of the Family Planning Commission and 12.48 million yuan was used to support 
 local capital construction investment. 141 (The detailed examples regarding the funds for 
 building and equipping China's family planning service stations are included in Appendix G.) 
 
 VI. Foreign Assistance for Family Planning 
 
 A number of international and bilateral donors have contributed money to China for 
 population and family planning; the organizations and funds are compiled in Table 19. The 
 majority of this aid is allocated to projects relating to the production of contraceptives. These 
 include assistance with the setting up of factories for IUD production; funds for increasing 
 production facilities for oral contraceptives; aid for the manufacture of vaginal suppositories and 
 tablet production; funding for the production, testing and packaging of condoms; training 
 programs in contraceptive production and quality control; and support for continuation of 
 NORPLANT introduction into the national family planning program. Great emphasis has also 
 been placed on research and training projects. Many Chinese government agencies, universities, 
 and research institutes are involved in the ongoing projects. Even though we can calculate the 
 total amount donated by UNFPA, WHO, UNESCO, JOICFP, FAO, and other organizations 
 
 141 China Family Planning Yearbook 1990, 147. 
 
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from the reported figures, we cannot draw a clear picture of how these funds are actually 
 applied, and no single agency or institute in China has provided an overall accounting for the 
 utilization of foreign funds. Figures about foreign aid are reported sporadically in family 
 planning yearbooks and various reports; these occasional figures, more often than not, are 
 singled out or treated as special funds in reporting the expenditures for family planning. There 
 appears to be no systematic reporting on foreign aid to the family planning program in China. 
 
 To show the interrelations between foreign aid and Chinese government funding, one 
 report indicates that the Chinese government utilized the US$100 million allocated by UNFPA 
 (1979-1989) to establish 64 joint research projects. To set up a supporting fund, the Chinese 
 side invested about three to five times as much as the amount of foreign aid received. 142 
 
 Much of the money provided by foreign donors is not incorporated into our estimates of 
 China's yearly family planning budgets in Table 12. For example, no category is included for 
 the building and equipping of IUD and condom factories in the budget. Included, however, are 
 the annual costs of buying from the factories the IUDs and condoms needed that year in the 
 family planning program. 
 
 Comparing foreign aid to China in the population field with the total family planning 
 budgets we have compiled in Table 12 illustrates how self-reliant China's family planning 
 program has been. Using the formal exchange rate each year, in 1985 China received US$11 
 
 142 YeLiqi, 1991, 6. 
 
 110 
 
million or 33 million yuan in population assistance. This was equivalent to only one percent of 
 China's 1985 family planning expenditures. In 1987, foreign aid in the population field was the 
 equivalent of one percent, and in 1989, 0.8 percent of our estimated family planning 
 expenditures for China. 
 
 VII. Overview of Interventions and Their Effectiveness 
 
 The PRC family planning program strongly influences the reproductive decisions of most 
 married women of reproductive age in the country. While the program does not always succeed 
 at constraining each woman's fertility to the government's desired one-child limit, it has 
 achieved significant results. In particular, it has gradually lowered fertility expectations and 
 desires for most people. Some couples may desire more children than the government allows, 
 but they might want two or three children instead of six or seven. China's pervasive family 
 planning message has been partially internalized by most people. 
 
 A. Ideal Family Size 
 
 Several surveys have asked respondents about desired number of children. It is clear 
 from their answers that the preference for having two or more children continued into the 1980s 
 in rural and mountainous areas. For example, a small 1981 fertility survey of rural areas in 
 
 111 
 
Hubei Province had these results: "Among 728 [peasants] questioned, only 5 percent want to 
 have only one child, but 51 percent wish to have two, 28 percent wish to have three, and 15 
 percent wish to have four children. In the mountainous areas where traditional ideology is 
 strong, 27 percent want two and 72 percent wish to have three or four." 143 If the survey had 
 given respondents the option of preferring more than four children, the average desired family 
 size would have been higher. 
 
 A government pamphlet reported on a small 1986 survey of urban and rural residents in 
 
 and near three cities in China's urbanized Liaoning Province, conducted by the Liaoning 
 
 Provincial Family Planning Commission. The results were: 
 
 Those who want to have only one child made up 25.2 percent of the urban and 8.7 
 percent of the rural population; those who would like to have another child made up 
 74.4 percent of the urban and 88.9 percent of the rural population; and those who want 
 to have a third child made up 0.4 percent of the urban and 2.4 percent of the rural 
 population. The survey shows that people's viewpoint on childbirth and childbearing is 
 changing into that of having fewer and healthy babies. However, two childbirths still 
 seem to be the most desirable state. 144 
 
 Outside the three province-level municipalities of Beijing, Shanghai, and Tianjin, Liaoning is 
 
 China's most highly urbanized province. City populations in this industrialized area, and 
 
 suburban populations in the near periphery of these cities, would be expected to have about the 
 
 lowest desired family size in China. 
 
 143 Cheng Du, "Hubeisheng nongcun shengyulu diaocha" [A fertility survey in rural areas of 
 Hubei province], Renkou yanjiu [Population Research], 5, Sept. 29, 1982: 31. 
 
 144 China. Facts and Figures: Population and Family Planning . Beijing: Foreign Languages 
 Press, 1990, 11-12. 
 
 112 
 
Based on China's surveys on desired numbers of children, young unmarried or recently 
 married adults strongly prefer to have two children, though larger proportions of these than of 
 older cohorts respond that they want one child. 145 However, family size preferences do appear 
 to be declining over time. 
 
 No matter how many children individual couples want for themselves, most adults in 
 China seem to have accepted and internalized the idea that China has too many people, and that 
 control of population growth is essential. High proportions of respondents in family planning 
 surveys agree that "population should be put under control." 146 More informally, visitors to 
 China get lectures on the problems of over-population from the least educated of rural people, 
 from highly educated urban elites, and from most people inbetween these extremes. 
 
 B. Current Limits to Fertility Reduction in China 
 
 During the 1970s, China's expanding family planning drive succeeded in halving the 
 country's total fertility rate from 5.8 births per woman in 1970 to 2.8 only seven years later 
 (Table 1). It appears from this very rapid fertility transition that Chinese couples did not 
 vigorously resist the shift from having six children to bearing only three per couple. 147 In the 
 
 145 Chen and Luo, 1985; SSB, 1987, 2. 
 14<5 Lu Guanghui and Ge Shijun, 1987, 2. 
 147 Banister, 1987, 234; Freedman and Guo, 1988, 135-136. 
 
 113 
 
period since 1977, the Chinese government has: 
 
 -introduced the one-child policy 
 
 -expanded the geographic scope of required abortion and sterilization policies 
 
 -included the minority groups in the program of birth limitation 
 
 -constantly fine-tuned the required and voluntary aspects of the family planning 
 program. 
 
 Yet through 1990, the total fertility rate fluctuated between 2.2 and 2.9 births per woman- 
 hitting a low point in 1980, peaking in 1982, dropping again to a nadir in 1985, peaking again 
 in 1987, and apparently declining again. Some of these fluctuations, as discussed earlier, were 
 influenced by changes in age at marriage. 
 
 Economic, social, and political changes in China since the 1970s have had and will 
 have mixed effects on fertility. China's program of economic reform was launched in 1978. 
 By 1984 most rural people's communes had been dismantled, and rural family households began 
 to have more control over their daily lives, production, income, movement, and family 
 decisions. At the same time as rural cadres lost some of their former stifling control over the 
 lives of villagers, the perceived value of children to rural families may have increased. Now, 
 each child, especially each son, can be expected to provide farm labor to increase family food 
 supply and income from agriculture, or get a nonagricultural job to increase family income, and 
 also provide family welfare support now that the former rural welfare system has been 
 weakened. Analysts from China's State Planning Commission noted this effect of the 1980s 
 agricultural reforms: "It has become a clear advantage to have a large family, especially one 
 
 114 
 
made up of male workers." 148 Greater population movement under the reforms has also 
 diminished the impact of fertility controls. 
 
 But an opposing effect of the economic reforms since 1978 has been to raise people's 
 incomes and living standards enough to make them more vulnerable to the effects of family 
 planning related incentives and penalties. This is especially true when families enter the modern 
 economic sector. For those working for the public sector, financial disincentives for violating 
 family planning regulations are often large in comparison to family income. Most couples with 
 one or both partners working outside agriculture cannot risk the financial hardships that would 
 follow the birth of an unauthorized second child. Successful resistance to the urban one-child 
 policy appears to be infrequent, especially in cities. The main reason that the city total fertility 
 rate has not dropped to 1.0 birth per woman is that some second births are allowed to certain 
 women in cities, for example minority group women, couples whose first child is handicapped, 
 and couples both of whom were single children themselves. 149 
 
 148 Xin and Zhang, 1990. 
 
 149 Certain cities are extreme examples of the success of the one-child policy. For example, 
 Shanghai city districts have claimed a total fertility rate of 1.0 or 1.1 throughout most of the 
 1980s. The 1990 census recorded that 92 percent of all the 1989 births in the whole 
 municipality, including the counties surrounding the city, were first births. Shanghai Population 
 Census Office, Shanghai renkou [Shanghai's Population]. Shanghai: Shanghai Scientific and 
 Technical Press, 1991, 22. 
 
 115 
 
VIII. Future Prospects 
 
 A. Future Fertility 
 
 The government, encouraged by its success in halving the level of fertility during the 
 1970s, shifted to a two-child policy in 1977 and rapidly to a one-child policy in 1979, both 
 policies applicable to urban and rural areas alike. 
 
 Beginning in 1984, the government began sanctioning the concept that rural couples with 
 undefined "special difficulties" would be allowed two children. Since most rural couples were 
 bearing at least two children anyway, the effect of this policy shift was to narrow the gap 
 between government demands and actual rural fertility. The transition back toward a rural two- 
 child policy is still partial—only six provinces allow all rural couples two children. Another 16 
 provinces have adopted a "one-and-a-half child policy," to phrase it awkwardly. To counter 
 strong son preference and discrimination against girls, this policy states that parents of a 
 firstborn son must stop at one child only, while those with a firstborn daughter may have a 
 second child. At last report, seven provinces still have a strict rural one-child limit. 150 
 
 Based on trends in the 1980s, we could project that the one-child policy will be continued 
 in urban areas, while the policy for rural areas will range from one to two children per couple 
 in the near future as it has in the recent past. The likeliest scenario for the 1990s is continuation 
 of the unstable equilibrium between limitations on fertility set by the government and popular 
 
 150 Banister, 1991. 
 
 116 
 
attempts to exceed the birth limit. Recently available information suggests that the government 
 has succeeded in reducing fertility below replacement level by 1992. Therefore most observers 
 are projecting low fertility for the foreseeable future. However, it is possible that required 
 family planning could cease with future shifts in government perspective. If China's family 
 planning program becomes voluntary in the 1990s, fertility is sure to rise. 
 
 B. Future Population Size and Growth 
 
 Though China's fertility is unusually low for a developing country, the population has 
 continued and will continue to grow. Between the 1982 and 1990 censuses, China's population 
 increased at about 1.4 percent a year. The crude death rate is low (now about 7 deaths per 
 thousand population per year) because of comparatively good mortality conditions combined with 
 a young age structure. The crude birth rate remains at 18 births per thousand population per 
 year or higher because of a bulge in China's age structure in the peak childbearing ages from 
 the late teens through the twenties. This upward pressure on the birth rate will ease in the late 
 1990s. 
 
 Judging from the count of young children in China's 1990 census, fertility peaked most 
 recently in 1987 at about 2.8 births per woman but may have declined to as low as 2.2 births 
 per woman in 1990. The TFR may have dropped further to 1.9 births per woman in 1992, 
 based on more recently reported data. We expect some slight fertility decline in the 1990s, 
 unless the requirements of the program ease for political reasons. Factors contributing to a 
 
 117 
 
decrease in fertility would be continuing urbanization and further decline in the fertility level of 
 the minority groups. 151 If China's fertility level declines further to about 1.8 births per woman 
 at the turn of the century, China's population will increase to about 1.26 million by then. 
 
 C. Future Shifts in Age Composition 
 
 China's very sharp fertility decline of the 1970s has already caused some dramatic shifts 
 in the age composition of China's population. By the early 1980s, much smaller cohorts of 
 children began entering primary school. It is a benefit of low fertility that the school system can 
 be relieved of the pressure to continually expand the sheer number of schools, teachers, and 
 classrooms. China is reaping this benefit now. 
 
 Another benefit of low fertility that is imminent in China is a decline in the numbers of 
 teenagers and young adults entering labor force ages. From 1982 to 1990, the 15-24 age group 
 grew from 203 million to 249 million, averaging 2.5 percent annual growth. Such rapid growth 
 made it difficult to expand the numbers of jobs fast enough and control or reduce unemployment 
 in the 1980s. The size of this age group began declining in 1991, a lagged effect of the 1970s 
 fertility decline, and will decrease every year, dropping to 195 million by the year 2000. 
 
 Nevertheless, the size of the broad labor force age group 15-64 will continue growing 
 in the 1990s and beyond, and China will experience the aging of its workforce in the first 
 
 ,5I Banister, 1991. 
 
 118 
 
decades of the coming century. The population in the age group 40-64, for instance, was 31 
 percent of the 15-64 labor force age group in 1990; this proportion will increase to 37 percent 
 in the year 2000, 44 percent by 2010, and 48 percent by 2020. 
 
 China's population as a whole will age in the coming century. The sharp drop in the 
 country's fertility level in the 1970s has brought about a contraction in the population age 
 pyramid at the young ages. The huge cohorts born before the fertility decline now constitute 
 a bulge in China's age structure at the young adult ages. As the large cohorts grow older, they 
 will swell the older labor force age groups, and later the ranks of the elderly. The proportion 
 of the population in the elderly ages 65 and above is projected to constitute about 23 percent of 
 the total population by 2040, up from 6 percent in 1990. 
 
 D. Urbanization and its Implications 
 
 China's population urbanized rapidly in the 1950s, but then the authorities decided to 
 block further urbanization by forbidding most population movement, instituting location-specific 
 food rationing, and requiring millions of urban-born youth to move to the countryside. As a 
 result, the urban population constituted only 17-18 percent of China's total population for two 
 decades. Since the beginning of China's economic reform period in 1978, more rural-to-urban 
 migration and circular migration have been allowed, though significant barriers to movement 
 remain. The urban portion of China's population grew to 21 percent in 1982 and 26 percent in 
 1990. 
 
 119 
 
With greater rural-to-urban migration allowed, some adults use this opportunity to get 
 away from control of their fertility by local authorities at their legal home. Such migrants have 
 moved to "temporary" slum areas outside some cities, where they bear unauthorized children 
 and avoid the population registration system. These children are not "legal," and they may be 
 deprived of schooling and other basic benefits. In the short run, the effect of the migration of 
 these women or couples is to raise their fertility because the couples are evading China's family 
 planning program. However, much of today's rural-to-urban migration tends to hold the fertility 
 of the migrants at a low level as they come under tighter urban fertility restrictions. 
 
 In the long run, rural-to-urban migration is expected to have a net effect of reducing 
 fertility in China. This is not only because fertility controls are more rigid and effective in 
 urban areas, but also because urban conditions are conducive to a low-fertility lifestyle. 
 
 The very low fertility in China's urban areas will bring about more pronounced aging of 
 the urban population than of China's whole population. 152 The fertility level of China's urban 
 population dropped in half in the mid-1960s, and has been below replacement level since the 
 early 1970s. Some of China's leading cities are already concerned about the phenomenon of 
 population aging because the process is already visible there. Some municipal leaders are 
 tentatively suggesting that their cities be allowed to return to a two-child policy as early as the 
 1990s to ameliorate the extreme population aging they themselves forecast. 
 
 l52 Banister, 1989. 
 
 120 
 
E. Implications of China's Fertility Level 
 
 China has had low fertility for two decades. Yet it remains a poor developing country 
 with only minimal unemployment compensation, social security systems, or other welfare 
 programs that might take the place of the family and of grown children in providing support. 
 What has low fertility meant already and what will it mean in such a context? 
 
 The reduction of fertility in China from 6 births per woman to 2 has benefited China's 
 economic development effort by slowing population growth. China's population is still 
 increasing in size and density, and is likely to continue increasing for decades to come, but 
 population pressure on the environment, arable land, job opportunities, urban areas, and open 
 space would have escalated much faster had fertility not declined. 
 
 Low fertility results from, and then reinforces, couples shifting away from emphasis on 
 the number of children they bear toward stressing the "quality" (health, education, career, 
 happiness) of each child. We would expect that the single child of couples that sign the one- 
 child pledge would show great gains in child "quality," because the government has mandated 
 that resources be given these couples and their single child—free schooling, money, health 
 allowances, better housing, better jobs. This must be happening, but it is hard to measure. 
 Most research so far has detected almost no differences between single children and those 
 
 121 
 
children with siblings regarding their personalities, success in school, or how others evaluate 
 them. 153 
 
 As in other advanced East Asian countries, low fertility in China has had and will have 
 mixed effects on family welfare. On the positive side, reduced fertility has meant that the child 
 dependency burdens on the families are lighter than in the past. This has freed up the women 
 in the families for productive and remunerative work, and for other societal involvement outside 
 the home. But on the negative side, nuclear, stem, or joint families are the basic economic units 
 in China, and there are now fewer children to contribute unpaid labor to the family, earn income 
 for the family, support the sick and the elderly, minimize the risk of destitution, give emotional 
 support to other family members, and represent the family in the community. In the future, 
 especially in urban areas where single-child families are the norm, large proportions of families 
 can expect to disintegrate if the only child leaves the immediate area. For older couples or 
 individuals with good pensions, this might not be a problem. But for the urban elderly who 
 qualify for little or no social security, and for most of the rural families, to lose the emotional 
 and financial support of their child or children could be serious. 
 
 Normally, we expect reduced fertility to follow from, and to contribute further to, 
 improved status of women in a society. Women in China have made great gains in comparison 
 to the pre-Communist period, in terms of legal status, involvement in the labor force, education, 
 personal stature, and emancipation from foot-binding and other demeaning customs. Most of 
 
 153 Poston and Falbo, 1989; Falbo and Poston, 1991. 
 
 122 
 
these gains preceded the fertility decline, and many have been enhanced by the low fertility 
 today. But family planning and tight fertility limitation may also have had some negative effects 
 on the status of girls and women. Son preference is strong in China, and when only one or two 
 children are allowed, couples often insist that the only child or one of the two must be a boy. 
 Women are often blamed if their first child is a girl. In addition, it is primarily women who are 
 subjected to the monitoring and pressure associated with required family planning. 
 
 V. Conclusions 
 
 There are numerous lessons that could be drawn from China's family planning program 
 and applied to other developing countries, especially Asian countries. China has shown that, 
 even in a poor country, there are human and financial resources that can be tapped to carry out 
 a strong, self-reliant family planning program. The Chinese government spreads the burden of 
 family planning costs by mandating that each level of government and each enterprise contribute 
 certain numbers of staff or amounts of funds. Other governments could also require or 
 encourage involvement in the family planning effort by units below the central government level. 
 But there must be a functioning government with a will to promote family planning. A well- 
 functioning, modern economy is not required-China is proof of that. 
 
 Another lesson from China is that human ingenuity and flexibility can go a long way 
 toward bringing success in a family planning program. China's family planning program is not 
 static. When some aspects of the program are not working as anticipated, other creative 
 
 123 
 
solutions are tried, then publicized if they work. Often the new strategies involve organizational 
 change instead of, or in addition to, more funds. 
 
 Birth limitation has high priority in China, and the government is willing to spend or 
 mandate the expenditure of considerable sums of money to maximize fertility control. The lack 
 of accountability for how some of the money is spent surely contributes to waste in the program. 
 Yet, we have seen that the Chinese program has tried to contain costs, overcome waste, cut 
 funds for non-essentials, and enlist the assistance of volunteers, pensioners, and other low-cost 
 workers to promote family planning. Other countries might study China's cost control measures 
 to see which ones could be applicable in their situations. 
 
 China got rid of restrictions on abortion, sterilization, and the importation of birth control 
 supplies in the 1950s, and since then all methods of birth control have been legal in the country. 
 In contrast, many other countries in the world have outlawed one or more methods, or have 
 blocked popular access to particular techniques, such as sterilization, abortion, the pill, IUDs, 
 or condoms. It is not impossible to reduce fertility under such constraints, but it is a lot more 
 difficult than in countries like China where all methods are allowed. 
 
 In China, birth control supplies and surgery are given to married couples free of charge 
 and at reasonably convenient locations. At the same time, Chinese leaders have discovered that 
 negative side effects or sequelae of birth control operations give the family planning program 
 
 124 
 
bad publicity, so they have moved to restrict which clinics may provide which operations. 154 
 The cost of providing safe operations at many more locations may also be prohibitive. To 
 achieve maximum accessibility with minimum risk to users is a goal that family planning 
 programs everywhere might find relevant. China's domestically financed system for providing 
 contraceptives and surgery in a network accessible and inexpensive or free to most married 
 people is a model applicable to other countries. 
 
 As a populous developing country, China can take advantage of the considerable 
 economies of scale associated with factory production of condoms, pills, spermicides, and IUDs. 
 A few factories produce all that China needs of each type of contraceptive. It might make no 
 sense for a small country to set up a factory making ten times the IUDs it needs, but 
 coordination among a group of nearby countries could expand the market enough to make a 
 contraceptive production factory worthwhile. Populous developing countries would do well to 
 follow the China example and produce rather than import their own birth control devices, if they 
 are capable of achieving high quality standards and continual quality control. The examples of 
 the poor quality steel ring IUDs that China keeps producing, and the poor quality condoms 
 produced until recently, are not worth emulating. But China's use of international assistance to 
 set up modern factories producing top quality IUDs, condoms, diaphragms, spermicides, and 
 pills is a good model. 
 
 I54 In China, concern for the health of users does not prevent the continuing use of required 
 abortions in all three trimesters of pregnancy, however. 
 
 125 
 
China measures the success or failure of its family planning program not by counting 
 "acceptors" of this or that family planning method, but rather by looking at actual fertility per 
 woman and the actual birth rate. All these measures are imperfect. In China as anywhere, 
 when it is family planning workers who are collecting and reporting the data that measure their 
 own success, the result is that acceptors are overreported and births are underreported. Chinese 
 leaders learned in the early 1980s that such data are not to be trusted. Since 1982, they have 
 carried out several fertility surveys and censuses of exceptional quality. Several times the results 
 of these massive efforts have shown that fertility was higher than previously thought. Such 
 reality checks are needed to overcome the self-deception common in family planning programs. 
 
 China has also demonstrated for other developing countries that desired family size can 
 be reduced from traditional levels even in a poor country where people are illiterate or educated 
 only at a primary level. In the Chinese case, some of this transformation probably came from 
 the compulsory nature of the program, but some also is attributable to the widespread teaching 
 of simple demographics, attempts to educate and persuade, and lots of pro-family planning 
 publicity. 
 
 This report has shown that a considerable proportion of the expense of China's family 
 planning program is associated with the one-child incentives. Such an incentive program is not 
 an essential part of a developing country family planning program, and without it the costs 
 would be much lower. Also, the compulsory elements in China's family planning program add 
 to the expense. To continually monitor women's menstrual and pregnancy and contraceptive 
 
 126 
 
status requires far more time from family planning workers than running a voluntary program 
 would require. 
 
 The China model of family planning is intriguing to many countries because of China's 
 success in achieving low fertility against great odds. Fortunately for these other countries, there 
 is much to learn from Chinese experience in family planning that is applicable to countries 
 without required family planning. 
 
 127 
 
APPENDICES 
 
 129 
 
Appendix A: Family Planning Expenditures in China's National Budget 
 
 In China's national government budget, which includes the budgets of all the provinces, 
 where do family planning revenue and expenditure fit in? In 1964, the State Council approved 
 the "Regulations on Family Planning Budget and Expenditure" and delegated responsibility for 
 supervision of this budget to the Ministry of Public Health and the Ministry of Finance. 1 Ever 
 since, "family planning budget and expenditure" has been listed as a special item in the State 
 budget. In 1970, when Premier Zhou Enlai talked with the staff of the Military Control 
 Commission under the Ministry of Public Health, he emphasized, "Don't mix the Patriotic 
 Public Health Movement with the Family Planning Program. Family Planning should be 
 included in the range of state planning. It is a matter of planning instead of a matter of public 
 health. " 2 Reports in the Family Planning Yearbook state that the financial management of the 
 family planning sector was gradually separated from that of the Ministry of Public Health 
 beginning in 1978. Especially after 1981, when the State Family Planning Commission and 
 committees at the provincial and local levels were established one after another, the financial 
 management work of the family planning program was reportedly improved and strengthened. 3 
 
 'Historical Experience of New China's Preventive Medicine, 1990, 324. 
 2 Historical Experience of New China's Preventive Medicine, 1990, 326. 
 3 China Family Planning Yearbook 1986, 260. 
 
 131 
 
In view of the above statements, we have every reason to expect that a separate section 
 for family planning finance is designated in the state budget report. If we carefully examine the 
 29 categories of China's 1988 budget and expenditure, we find Category 13, entitled Funds for 
 Public Undertakings in Culture, Education and Public Health. 4 In this category, 15 items of 
 working expenses for various activities are listed, including such expenditures as working 
 expenses for the Ministry of Culture and local culture sectors, working expenses for schools at 
 all levels under the Ministry of Education, working expenses for the Ministry of Public Health, 
 and expenditures for free medical care for state organizations. The last item on this long list- 
 appearing almost as an afterthought—is working expenses for the family planning program. 
 
 With this in mind, in China's financial reporting we can expect to find that the budget 
 and expenditures for family planning activities will be covered under the umbrella heading of 
 Funds for Public Undertakings in Culture, Education and Public Health. Indeed, in China 
 Finance Statistics (1950-1988) . the state budget and expenditure allocated for the family planning 
 program for the years 1978, and 1985 to 1988 appears as an entry under this heading. 5 Even 
 in more detailed reports, expenditures for family planning are sometimes indicated but not 
 further broken down into component expenditures. From time to time, scattered financial 
 figures are reported by individual provinces. However, only in the 1990 Family Planning 
 
 4 Dai Genyou, 1990, 360. 
 
 5 China Finance Statistics (1950-1988), 1989, 82. 
 
 132 
 
Yearbook do we find systematic reporting on family planning operational expenses collected 
 from all provinces for 1988 and 1989. 6 
 
 6 China Family Planning Yearbook 1990, 144-145. 
 
 133 
 
Appendix B: Organizations and Personnel Involved in the Family Planning Program 
 
 In August 1989 the State Personnel Office authorized the State Family Planning 
 Commission to establish seven public institutions and two affiliated social groups. 1 These 
 organizations and their authorized personnel levels are as follows: 
 
 Institutions: 
 
 1. Scientific Technology Research Institute under the State Family Planning Commission, 
 with 224 authorized personnel; 
 
 2. China Population Information and Research Center with 1 10 authorized personnel; 
 
 3. China Population Newspaper, with 70 authorized personnel; 
 
 4. China Population Publishing House, with 30 authorized personnel; 
 
 5. China Family Planning Propaganda and Education Center, with 125 authorized 
 personnel; 
 
 6. Nanjing Family Planning Managerial Cadre College, with 180 authorized personnel; 
 
 7. Family Planning Commission Contraceptive Supplies and Devices Service Center, with 
 35 authorized personnel. 
 
 Groups: 
 
 1. China Family Planning Association, with 40 authorized personnel; 
 
 2. China Population Welfare Foundation, with 10 authorized personnel. 
 
 ! China Family Planning Yearbook 1990, 114-115 
 
 135 
 
Regulations were stipulated by the State Family Planning Commission on June 1, 1981 
 regarding departments involved in the family planning program and their responsibilities. 2 The 
 detailed descriptions are as follows: 
 
 (1) State Family Planning Commission: studies and formulates policies, principles, laws 
 and regulations of family planning, supervises their enforcement and provides guidance; with 
 the State Planning Commission works out long-term plans and medium and annual programs of 
 population development and supervises, urges and checks up on their implementation; is in 
 charge of the statistics of birth control work; carries out propaganda of the birth control work 
 at home and abroad; designs and carries out research programs of applied science on birth 
 control techniques under the direction of the general program of medical science research 
 formulated by the Ministry of Public Health; provides technical guidance for family planning 
 and eugenics jointly with departments concerned; advances scientific research on population 
 science; works out plans for the production of contraceptive pills and devices; formulates 
 policies and principles of the management of pills and devices; controls the production of the 
 pills and devices jointly with departments concerned; draws up budget and final accounts of 
 funds for birth control allocated by central finance; maps out relevant projects and handles the 
 investment of capital construction; makes programs and provides guidance for on-the-job 
 training of family planning personnel; strengthens the building of contingent of cadres in the 
 field of family planning; is in charge of international exchange and cooperation in the field of 
 
 2 China Family Planning Yearbook 1986, 22-23. 
 
 136 
 
family planning and population; provides guidance for the China Family Planning Association, 
 Chinese Population Welfare Foundation and social organizations concerned. 
 
 (2) State Planning Commission: is in charge of examining and approving the population policy 
 and making the policy known to each province, autonomous region, and municipality in China; 
 provides supervision and guidance in policy implementation; guarantees the prerequisites for 
 the task. 
 
 (3) State Science Commission: is in charge of examining and approving the regulations on 
 family planning scientific research and making them known to the whole nation; provides 
 supervision and guidance in the implementation of regulations. 
 
 (4) State Agriculture Commission: creates favorable conditions for implementing the guidance 
 and policy of family planning and population planning when stipulating rural economic policy; 
 includes population birth control planning in the production responsibility system while 
 promoting the system in the rural areas. 
 
 (5) State Nationalities Commission: helps stipulate the population policies and guidance relevant 
 to minority nationalities. 
 
 (6) Ministry of Public Health: on the basis of state unified rules and in coordination with units 
 concerned, works out regulations of professional titles and salary quotas for medical workers; 
 
 137 
 
is in charge of plan-making and macro-administration of maternity and child health care; 
 stipulates regulations, rules, and technical standards of family planning; is in charge of 
 supervision and inspection of technical quality, development, and study of new technologies and 
 eugenics. 
 
 (7) Ministry of Chemical Industry, Medicine Administration and Manufacturers: is in charge 
 of organizing the scientific research, manufacture, and supply of contraceptive pills and birth 
 control devices. 
 
 (8) Ministry of Culture: is in charge of organizing the creative writing of literature and other 
 artistic performance to propagandize the family planning program through various cultural 
 formats. 
 
 (9) Ministry of Education: arranges courses to teach puberty psychological hygiene, basic 
 population theory, late marriage and birth control in junior middle schools; to establish 
 population research units and to teach family planning and demography at colleges and 
 universities. 
 
 (10) Ministry of Civil Administration: conducts the propaganda for late marriage and birth 
 control to the youth in the process of marriage registration; provides sound social relief to those 
 urban and rural residents who become disabled due to accidents from inappropriate birth control 
 surgeries. 
 
 138 
 
(11) Ministry of Finance: thoroughly implements the policy to reward fewer births and to 
 restrict excessive births while carrying out the financial tasks; supports and allocates all the 
 necessary working expenses for family planning tasks; supervises financial departments at all 
 levels to strengthen the management of family planning working expenses so that waste can be 
 prevented and eliminated. 
 
 (12) Department of Public Security: is in charge of providing the statistical data from the 
 population registration system for population planning; working with judicial departments to 
 punish those who have violated the family planning regulations. 
 
 (13) State Bureau of Labor: in the process of stipulating planning for hiring and arranging 
 employment, gives priority to the only-child or its parents when two applicants compete with 
 the same qualifications. 
 
 In addition, the All-China Federation of Trade Unions, the Communist Youth League of 
 China and the All-China Women's Federation educate the masses of workers, youth and women 
 to implement the family planning policy. 
 
 Furthermore, the headquarters of political departments of the Chinese People's Liberation 
 Army (PLA) and the headquarters of PLA logistics departments are in charge of the IEC task 
 for the entire officers and men of the PLA in order to implement the family planning program. 
 
 139 
 
Mass media also play an important role in the whole structure. New China News 
 Agency, People's Daily . Bureau of Broadcasting Operations and TV stations all publicize the 
 family planning guidance and policy of the party and central government. They also are 
 responsible for reporting population and family planning trends and situations. In addition, they 
 introduce updated scientific and technological knowledge of family planning to the people. 
 
 140 
 
Appendix C: Text of 1983 Regulation on Family Planning Operating Funds 
 
 What is and what is not covered by the budgetary expenditures allocated by the Ministry 
 of Finance for family planning operational expenses was spelled out in a regulation issued on 
 January 13, 1983. ' The following list is translated directly from the regulation. 
 
 The scope of family planning operational expenses covers: 
 
 (1) free supplies of contraceptive pills, contraceptive devices and management fees; 
 
 (2) fees for registration, examination, surgery, medicine, hospitalization, and post-surgery 
 treatment when urban residents and rural commune members receive various kinds of birth 
 control surgery; 
 
 (3) fees for treatment of sequelae due to inappropriate birth control surgery received by 
 urban residents and rural commune members are also covered by the family planning operational 
 expenses upon the determination of a birth control surgery technology advisory team above the 
 county level; 
 
 (4) on principle, fees for other surgical operations received by residents and members 
 while they are undergoing birth control surgery are paid by these individuals. However, if a 
 certain individual has difficulty paying the fees, discount of the charge can be granted to this 
 individual upon the approval of the family planning department above the county level. 
 Expenses for the discount will be covered by the family planning operational expenses; 
 
 'Compilation of PRC Public Health Laws, (1981-1983), 1985, 500-503. 
 
 141 
 
(5) fees for birth control surgery received by youth waiting for jobs are also covered by 
 the family planning operational expenses. Those unemployed youth who have joined the job 
 agencies or similar organizations and who are supposedly covered by the public welfare funds 
 of these organizations are still able to be covered by the family planning operational expenses 
 when they have difficulty paying their fees and have obtained the approval of the family planning 
 department above the county level; 
 
 (6) training expenses. Family planning departments above the county level conduct short- 
 term training sessions to train grass-roots key members such as female team leaders and family 
 planning propagandists for family planning work. Expenses for the training sessions such as 
 training materials, office expenses, incidental expenses, meal allowance, travel expenses and 
 other relevant training expenses are covered by the family planning operational expenses. 
 Expenses (such as meal allowance) for family planning surgical team members (like the barefoot 
 doctors in the organizations) who are not workers or staffers of state-owned enterprises should 
 be covered by revenue from the charges for birth control surgery they have provided. However, 
 family planning operational expenses can be used if these revenues are insufficient; 
 
 (7) equipment purchase. Some medical and technical establishments in the communes 
 and brigades have difficulty purchasing the essential surgical equipment to perform the birth 
 control work. Expenditures allocated by the family planning departments above the county level 
 to these establishments to purchase essential, small-scale and specialized equipment for birth 
 
 142 
 
control surgery should be covered by the family planning operational expenses; 
 
 (8) one-child health fund. The family planning operational expenses may temporarily 
 cover the expenses of the one-child health fund for those unemployed persons who are waiting 
 for jobs in the urban areas; 
 
 (9) operating expenses for the full-time family planning cadres of communes (villages) 
 in the rural areas and of neighborhoods in the urban areas. Wages and benefits for these full- 
 time family planning cadres should be the same as that of the cadres in the same commune or 
 the same neighborhood; 
 
 (10) expenses occurring at the family planning department for convening business 
 conferences and meetings, printing materials for family planning propaganda and technical 
 information, holding exhibitions, and giving out awards and certificates of merit are covered by 
 the family planning operational expenses; 
 
 (11) operational expenses for institutions directly under the departments of family 
 planning above the county level. These institutions include family planning science research 
 institutions, family planning propaganda centers, and propaganda and technology advisory 
 stations; 
 
 (12) equipment, instruments, and appliances purchased for family planning work by the 
 family planning department. In addition, expenses incurred from some odd pieces of capital 
 construction which are not too costly will also be covered by the family planning operational 
 expenses. 
 
 143 
 
The following are some other expenditures which are relevant to the family planning 
 program, yet are covered by operational expenses under other departments' expenditures or 
 under different categories. The following list is translated directly from the regulation: 
 
 (1) expenses of birth control surgery and treatment of post-surgery sequelae received by 
 the staff of state organs and institutions, political parties and groups, and people's organizations 
 should be covered by "operational expenses for free medical care"; 
 
 (2) expenses of birth control surgery and treatment of post-surgery sequelae received by 
 the workers and the staff and their direct relatives supported by these workers and staff of the 
 state-owned and urban collective enterprises should be covered by the enterprises' "welfare funds 
 for the workers and staff ; 
 
 (3) in the military, expenses of birth control surgery and treatment of post-surgery 
 sequelae received by officers and men, workers and staff, workmen and their dependents should 
 be covered by the "national defense expenses"; 
 
 (4) each province, municipality and autonomous region has the autonomy to decide 
 whether or not to compensate their workers for their loss of working time while they are away 
 to join short-term training sessions; 
 
 (5) surgical equipment and instruments purchased by the medical organizations and 
 maternity and child health care organizations at and above county level and under departments 
 other than family planning departments should be covered by the operational expenses budgeted 
 for these relevant departments and units; 
 
 144 
 
(6) regarding one-child health fund expenses, the regulation stipulates that both units 
 where the couple works will be respectively responsible for 50% of the total cost, no matter 
 where the couple works or what kind of jobs they are holding. People in the hardship areas 
 (independent basic accounting units in which the annual per capita income is less than 50 yuan) 
 will be subsidized 50% of the cost by the state upon the approval of the people's government 
 at the county level. This 50% subsidy is shouldered evenly by the central and local 
 governments; 
 
 (7) expenditures for family planning conferences convened by party committees or 
 governments of county and higher levels are also covered as administrative operational expenses. 
 Expenditures for propaganda for family planning work conducted by departments and units other 
 than family planning departments and units are covered as operational expenses for those 
 relevant organizations and units; 
 
 (8) family planning departments at county or higher levels are regarded as administrative 
 organizations. Personnel in these organizations are included in the billets for administrative 
 personnel. Expenses incurred by these organizations are covered as administrative operational 
 expenses. 
 
 145 
 
Appendix D: China, Maternal and Child Health Network 
 
 The capability of a certain locality to provide health care to women and children can be 
 evaluated by examining that locality's children's health care service, women's health care service 
 and birth control services. 1 In many cases, maternity and child health care (MCH) and the 
 family planning program are reported side by side as two complementary categories. Though 
 there is a close relationship between the MCH and the family planning program, they are 
 organized under different administrative organizations. MCH is under the Ministry of Public 
 Health while the family planning program falls under the Family Planning Commission. In other 
 words, the expenditures for MCH are covered by the budgetary expenditures for public health. 
 Only in Chinese Health Statistical Digest. 1988 can we find a thorough breakdown for MCH 
 expenditures in each province (Table D.l). Other than that, figures for these expenditures are 
 reported only sporadically. 
 
 In China the number of separate MCH facilities is approximately one per county and 
 county-level municipality. 2 General hospitals also provide MCH services. The township and 
 neighborhood hospitals might be staffed with MCH teams or full-time MCH personnel. Medical 
 staff from the departments of gynecology and obstetrics, internal medicine, or pediatrics would 
 be responsible for some MCH services. Clinics for brigades (which are large villages or groups 
 
 'WangShuo, 1991, 1. 
 
 2 In 1985, China had 1,986 counties and 158 county-level municipalities. In 1989, China had 
 1,919 counties and 262 county-level municipalities. Meanwhile, the number of MCH facilities 
 in China at the county level was 2,724 in 1985 and 2,796 in 1989. 
 
 147 
 
Table D.l: 
 
 China, Maternal and Child 
 Health Expenditures by 
 Province, 1987 
 (In thousands of current 
 Chinese yuan) 
 
 Province 
 
 Total 
 
 expenditure 
 
 133 
 
 f 040 
 
 1 
 
 ,882 
 
 2 
 
 f 446 
 
 9 
 
 F 167 
 
 7 
 
 ,544 
 
 8 
 
 ,605 
 
 6, 
 
 ,902 
 
 7 
 
 ,396 
 
 7 , 
 
 ,304 
 
 1 
 
 ,653 
 
 6, 
 
 ,306 
 
 7 , 
 
 ,423 
 
 5, 
 
 ,979 
 
 4, 
 
 ,195 
 
 5, 
 
 ,194 
 
 9, 
 
 ,473 
 
 8, 
 
 ,454 
 
 9, 
 
 ,964 
 
 10, 
 
 ,013 
 
 6, 
 
 ,466 
 
 10, 
 
 ,901 
 
 15, 
 
 ,832 
 
 3, 
 
 ,667 
 
 8, 
 
 ,755 
 
 2, 
 
 ,084 
 
 4, 
 
 ,640 
 
 3, 
 
 ,838 
 
 1, 
 
 ,993 
 
 2, 
 
 ,513 
 
 2, 
 
 450 
 
 Total 
 
 Beijing 
 
 Tianjin 
 
 Hebei 
 
 Shanxi 
 
 Inner Mongolia 
 
 Liaoning 
 
 Jilin 
 
 Hei long jiang 
 
 Shanghai 
 
 Jiangsu 
 
 Zhe jiang 
 
 Anhui 
 
 Fu j ian 
 
 Jiangxi 
 
 Shandong 
 
 Henan 
 
 Hubei 
 
 Hunan 
 
 Guangdong 
 
 Guangxi 
 
 Sichuan 
 
 Guizhou 
 
 Yunnan 
 
 Tibet 
 
 Shaanxi 
 
 Gansu 
 
 Qinghai 
 
 Ningxia 
 
 Xinjiang 
 
 148 
 
of villages within each township) are sometimes staffed with female barefoot doctors or country 
 doctors who provide MCH services. Some of these clinics have midwives as well (Table D.2). 
 In the urban areas, there are Red Cross clinics and group health stations providing MCH 
 services. Most of their personnel are not specially trained medical personnel. Most of them 
 hold down regular jobs other than working in the clinics. 3 
 
 Data from a recent survey conducted in 13 cities indicate that their annual per capita 
 working expenditures for MCH was only 0.24 yuan. 4 Reports from Inner Mongolia, on the 
 other hand, indicate that in 1987, a special fund of 30 million yuan, about 1.45 yuan per capita, 
 was invested in establishing MCH stations. From 1988 to 1990, governments from the 
 autonomous region, the league cities and the banner counties of Inner Mongolia jointly invested 
 more than 4 million yuan to improve working conditions, equipment and machinery of the MCH 
 stations. In addition, each year the autonomous region squeezed a part of its government budget 
 for housing maintenance and expansion of the MCH stations in the banner county areas. Every 
 year in Inner Mongolia a sum of 100,000 yuan is also allocated for surveys and research on 
 maternity and child health care as well as health education. Currently, the 72 banner county 
 MCH stations all have office space and 54 of them even are equipped with ambulances. 5 
 
 3 Wang Chongyi et al., 1986, 180-185. 
 4 WangShuo, 1991, 1. 
 5 Zheng Zemin, 1991, 1. 
 
 149 
 
Table D.2: China, Rural Part-time Public Health Personnel, 
 1965-1989 (In thousands) 
 
 
 Total 
 
 
 
 
 
 
 rural 
 
 
 
 Female 
 
 
 
 health 
 
 Female 
 
 Of whom, 
 
 percent of 
 
 Midwives 
 
 
 personnel, 
 
 public 
 
 trained 
 
 rural public 
 
 in the 
 
 
 both 
 
 health 
 
 in 
 
 health 
 
 rural 
 
 Year 
 
 sexes 
 
 personnel 
 
 midwifery 
 
 personnel 
 
 areas 
 
 1965 
 
 94 
 
 
 
 
 686 
 
 1970 
 
 1,218 
 
 
 
 
 
 1971 
 
 1,301 
 
 
 
 
 
 1972 
 
 1,230 
 
 
 
 
 
 1973 
 
 1,212 
 
 
 190 
 
 
 
 1974 
 
 1,372 
 
 384 
 
 
 28.0 
 
 524 
 
 1975 
 
 1,559 
 
 502 
 
 334 
 
 32.2 
 
 615 
 
 1976 
 
 1,802 
 
 638 
 
 440 
 
 35.4 
 
 727 
 
 1977 
 
 1,760 
 
 628 
 
 468 
 
 35.7 
 
 755 
 
 1978 
 
 1,666 
 
 582 
 
 410 
 
 34.9 
 
 743 
 
 1979 
 
 1,575 
 
 536 
 
 394 
 
 34.0 
 
 709 
 
 1980 
 
 1,463 
 
 489 
 
 356 
 
 33.4 
 
 635 
 
 1981 
 
 1,396 
 
 443 
 
 342 
 
 31.7 
 
 585 
 
 1982 
 
 1,349 
 
 410 
 
 
 30.4 
 
 550 
 
 1983 
 
 1,279 
 
 371 
 
 
 29.0 
 
 540 
 
 1984 
 
 1,251 
 
 356 
 
 314 
 
 28.5 
 
 524 
 
 1985 
 
 1,293 
 
 342 
 
 294 
 
 26.4 
 
 514 
 
 1986 
 
 1,280 
 
 342 
 
 299 
 
 26.7 
 
 508 
 
 1987 
 
 1,278 
 
 343 
 
 298 
 
 26.8 
 
 488 
 
 1988 
 
 1,247 
 
 310 
 
 291 
 
 24.9 
 
 467 
 
 1989 
 
 1,241 
 
 322 
 
 
 25.9 
 
 445 
 
 Note: The barefoot doctors in 1965 spent their time half and 
 half in practicing medicine and agriculture. It is not clear to us 
 whether the number of female public health personnel who have been 
 trained in midwifery is included in the total number of midwives in 
 the rural areas. 
 
 Source: Zhongcpio funu tongji ziliao 1949-1989, 483; 
 Zhongguo weisheng manjian 1990 (China Public Health Yearbook 1990) , 
 459. 
 
 150 
 
The scope of MCH research and service projects with international organizations is 
 expanding. From 1985 to 1989, a sum of US$15.33 million was given to China's MCH 
 programs through UNFPA, UNICEF and WHO. Through this assistance, 128 counties in 28 
 provinces thus set up health care networks. 6 
 
 In June 1989, the third cycle of the UNFPA aid project was approved. This project 
 covers the period from 1990 to 1994 and the total amount for the project will be US$57 million. 
 The focus of the project will be on the grass-roots level in poor and backward areas in the 
 countryside. Funds for MCH and family planning projects will be US$20.5 million, accounting 
 for 35 percent of the total funding. 7 
 
 In 1990, the number of MCH clinics in China totaled 2,820, including 20 child health 
 care stations. The number of MCH institutes totaled 328 and the number of beds totaled 32,300. 
 In addition, the number of children's hospitals totaled 33 and the number of beds totaled 7,866. 8 
 Birth control operations often are conducted at various MCH institutes. In addition, the MCH 
 network also frequently provides technical guidance and management for family planning. 9 
 
 6 Du Peidian, 1991, 4. 
 
 7 For details see Ye Liqi, 1991, 6-7 and China Public Health Yearbook 1990, 162. 
 "Information Center for Health Statistics, Ministry of Public Health, 1991, 1,3. 
 'Public Health in the People's Republic of China, 1989, 24. 
 
 151 
 
Often in the rural areas, especially in places where the technical capabilities of the county 
 family planning service stations are substandard, birth control surgery is conducted at various 
 hospitals at the county and the town/township level. Data for 1989 showed that the number of 
 hospitals in China at the county and the town/township level totaled 2,241 and 47,523 
 respectively. Meanwhile, the number of medical technicians at these two levels totaled 365,867 
 and 763,426 respectively. 10 Table D.3 illustrates the public health organizations at the village 
 level in the rural areas. These dispensaries have basic equipment and can provide some basic 
 health care, contraceptive supplies and devices, information about birth control and some post- 
 surgical follow up but they do not have the capability to perform any complicated medical 
 treatment. 
 
 10 China Public Health Yearbook 1990, 455-456. 
 
 152 
 
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Appendix E: Operational Expenditures for Contraceptive Supplies and Devices: Components 
 and Bases for Expenditure Calculation 
 
 According to Central Document #7 of 1984, the distribution of contraceptive supplies and 
 the management of expenditures were then being reformed. From 1986 on, any province which 
 applied for and was approved to contract for the responsibility of managing expenditures for 
 contraceptive supplies and devices was obligated to use the new contract system. 1 The details 
 of the system are explained in the following translation from the China Family Planning 
 Yearbook 1986 . 
 
 Contracted operational expenditures for contraceptive supplies and devices include three 
 components: 
 
 (1) Operational expenditures for purchasing contraceptive supplies and devices. The amount 
 is stipulated at 70 percent of the base figure for the contracted expenditures. The State Family 
 Planning Commission controls this component. A contract was signed in accordance with the 
 purchase and allocation plan designed by the State Family Planning Commission and China 
 Pharmaceutical Company at the National Working Conference for Contraceptive Supplies and 
 Devices. As for those provinces and cities which are new participants in the contract 
 responsibility system, the State Family Planning Commission allocates the appropriate funds in 
 advance to the China Pharmaceutical Company for purchase and distribution of supplies and 
 
 'China Family Planning Yearbook 1986, 46-47. 
 
 155 
 
devices. The proportion of allocated funds is calculated according to the quantity of supplies 
 and devices designated for each new province and city by the allocation plan which was drawn 
 up at the working conference and the required expenditure is calculated accordingly. 
 
 (2) Expenditures for business activities. The amount is stipulated at 15 percent of the base 
 figure for the contracted expenditures. The State Family Planning Commission allocates this 
 amount lump-sum to the provinces which sign contracts. The allocated amount is used to cover 
 business expenses related to distributing contraceptive supplies and devices (such as 
 warehousing, transferring, purchasing transportation vehicles and necessary equipment, and 
 maintaining warehouses). 
 
 (3) Floating operational expenditures. The amount is stipulated at 15 percent of the base figure 
 for the contracted expenditures. The State Family Planning Commission holds these funds in 
 escrow. According to the year-end evaluation, those provinces which had met the evaluation 
 standards set in "Measures for Managing the Contraceptive Supplies and Devices" are then given 
 the entire amount of the floating operational expenditures. Those provinces which fail to meet 
 the standards are deprived of part or all floating operational expenditures, depending on the 
 situation. 
 
 As for floating operational expenditures which are given to the provinces at the year-end, 
 two-thirds of the amount should be retained and applied to the following year's expenditures for 
 purchases of contraceptive supplies and devices. The remaining one-third of the amount can be 
 
 156 
 
used for business activities (including business establishment). A small portion of this remainder 
 can also be used as welfare funds or bonuses for family planning workers. The standard and the 
 scope for the bonuses have to conform to the relevant regulations stipulated by the state. 
 
 Once the contracted expenditures are approved, the contract is valid for three years. The 
 methods for calculating the base figures for the contracted expenditures are as follows: 
 
 1. Based on the statistical data as of the end of June 1985, each contraceptive surgery 
 performed prior to that date will be calculated at 0.18 yuan per surgery. 
 
 2. Based on the statistical data of users of contraceptive supplies and devices as of the 
 end of June 1985, users of condoms will be calculated at six yuan per person, and users of oral 
 pills, injections or spermicide will be calculated at an average of three yuan per person. 
 
 3. The sum of the two groups listed above would be used as the base figure for the 1986 
 contracted expenditures for contraceptive supplies and devices. 
 
 157 
 
Appendix F: Utilization of Fines for Births Outside the Plan 
 
 There are various ways that localities utilize the money collected through fines for births 
 outside the official birth plan. The following examples illustrate how the money may be 
 allocated. 
 
 In Xinjiang Province, the excessive birth fines collected from the individual owners of 
 businesses are controlled and managed by the county and city family planning committees for 
 expenditures of the family planning operation. By the end of each year, 10 percent of this fund 
 will be used to reward the advanced units and individuals involved in family planning, business 
 administration, public security or individual labor force associations. 1 
 
 Yibin district in Sichuan Province has a special regulation regarding the excessive birth 
 fine, under which the family planning committee at the prefecture level keeps 5 percent of the 
 money, the county level keeps 20 percent, the district level keeps 5 percent, and the village level 
 keeps 70 percent of the fine. Specific rules were stipulated for the utilization of the fines at the 
 village level. The distribution of the fines is as follows: 
 
 'Xinjiang Family Planning Committee (1988) Document # 15. 
 
 159 
 
5 percent for one-child health care; 10 percent for the hardship family subsidy; 3 percent for 
 incentives for parents with only one child; 25 percent for IEC; 15 percent for routine 
 examination of women; 15 percent for the subsidy for the IEC team members; 10 percent for 
 the subsidy of the grass-roots service stations; 10 percent for the contraceptive operation fees; 
 and 7 percent for other expenses. 2 
 
 Jilin Province spends 10 percent of the collected fines for births outside the plan to 
 subsidize the service stations and service offices below the county level. 3 Fujian Province 
 established a population endowment funded by collecting one to two yuan from each person plus 
 10 percent of the excessive birth fines. 4 Weichang County in Hebei Province also established 
 a population endowment funded by collecting one yuan per person in the rural area plus 60 
 percent of the excessive birth fines. Interest earned from this fund is used to purchase surgical 
 equipment for the 32 town/township family planning service stations, to improve the working 
 conditions of 21 operation rooms, to send 18 staff for one-year further training, and to pay for 
 an additional 360 full-time family planning workers in towns/townships and villages. 5 
 
 2 Cheng and Wu, 1989, 53-54. 
 
 3 Office of Culture, Education, Administration and Finance under the Department of Finance, 
 Jilin Province, 1988, 2. 
 
 4 Fujian Provincial Committee and Provincial Government, 1991, 1. 
 
 5 Wang Zhiqiang, 1989, 1. 
 
 160 
 
Appendix G: Funds for Building and Equipping China's Family Planning Service Stations 
 
 Most of the 2,251 established family planning service stations at the county level in China 
 are in need of additional equipment and instruments. In 1989, a special fund of 36 million yuan 
 was allocated by central finance to subsidize purchases of machinery and equipment for 698 
 family planning service stations at the county level. By the end of 1989, there were altogether 
 798 service stations at the county level that were fully equipped and were capable of performing 
 a variety of birth control operations. However, about 60,000 to 100,000 yuan per station is still 
 required for purchasing necessary equipment for the remaining 1,453 service stations. The 
 planned source for underwriting the expenditures is to obtain two-thirds of the subsidy from 
 central finance and one-third of the subsidy from local finance. The amount will be allocated 
 over three to four years. 1 
 
 Hainan Province raised 500,000 yuan in funds to purchase new instruments for service 
 stations. Of this amount, 300,000 yuan was allocated by the State Family Planning Commission 
 and 200,000 yuan was allocated by the provincial finance department. 2 
 
 'China Family Planning Yearbook 1990, 146-147. 
 2 China Family Planning Yearbook 1990, 287. 
 
 161 
 
In 1989, Shanxi Province spent 2.3 million yuan to purchase and install 6,223 pieces of 
 medical and IEC equipment in 58 birth control service stations at the county level. Of this 
 amount, 1.6 million yuan was allocated by the State Family Planning Commission and 0.7 
 million yuan was allocated by the provincial family planning committee. In addition, county 
 family planning committees invested 0.78 million yuan to remodel these service stations. 3 
 
 In 1989, Gansu Province's investment in family planning capital construction totaled 4.09 
 million yuan. The money was mainly spent on establishing service stations at the prefecture and 
 county levels and in renovating some office buildings and residential buildings. Of this amount, 
 0.5 million yuan was capital construction investment from the provincial level; 0.75 million 
 yuan was renovation investment; 1.47 million yuan was investment from the prefecture level, 
 and 1.37 million yuan was investment from the county level. 4 
 
 In 1989, the national and Sichuan provincial financial departments allocated a special 
 fund of 8.66 million yuan to Sichuan Province family planning operations as a subsidy for 
 equipping and renovating the family planning propaganda and technical service stations at the 
 grass-roots level. In 1989, Sichuan Province also invested 7.868 million yuan in building 
 56,000 square meters of space for family planning project accommodation. Among the total, 
 
 'China Family Planning Yearbook 1990, 224-225. 
 4 China Family Planning Yearbook 1990, 302. 
 
 162 
 
the state invested 0.5 million yuan, the province invested 0.5 million yuan and the family 
 planning department itself raised 6.86 million yuan. 5 
 
 Based on the rule that each level pays one third of the funds, the financial departments 
 at the provincial, prefectural, and county levels in Guizhou Province equally shared the expenses 
 for investment in the capital construction of the family planning IEC and technical advisory 
 institutes (stations) in 1985. 6 
 
 Referring to funding for family planning service stations at the county level, Madam Peng 
 Peiyun, Minister of the State Family Planning Commission, said, 
 
 Construction funds for service stations at the county level, according to the current 
 financial and planning management system, will mainly come from the localities. That 
 is, the county finance department will allocate a little bit more, higher levels will 
 subsidize a little bit more, the county will obtain a portion of the excessive birth fines 
 in accordance with the regulation and the locality will help itself by increasing revenues 
 and economizing on expenditures. 7 
 
 In addition, many advanced instruments were imported from abroad for the family 
 planning program, funded by US$1.61 million from UNFPA for the period 1985-1989. 8 
 
 5 China Family Planning Yearbook 1990, 290. 
 6 China Family Planning Yearbook 1986, 168. 
 7 Peng Peiyun, 1990, 1. 
 8 China Family Planning Yearbook 1990, 165. 
 
 163 
 
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 176 
 
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