No government program has cut so deeply into Chinese society nor inspired such strong resistance in 35 years of Communist rule as the struggle to trim China's population.
Chinese leaders consider their policy of "one couple, one child" a fight for national survival, the chief prerequisite of modernization. Publicly, they claim to rely on the powers of persuasion and education, exercising a policy of voluntary consent. They point to declining birth rates and happy one-child couples as symbols of success worthy of the United Nations' first family planning award given jointly to China and India in 1983.
But a closer and longer look reveals a very different picture. China, to be sure, is curbing its population growth, but its success is rooted in widespread coercion, mass abortion and intrusion by the state into the most intimate of human affairs.
"The size of a family is too important to be left to the personal decision of a couple," Minister of Family Planning Qian Xinzhong explained before resigning last year.
"Births are a matter of state planning, just like other economic and social activities, because they are a matter of strategic concern," he said. "A couple cannot have a baby just because it wants to. That cannot be allowed if China is to stabilize its population and keep it from doubling and redoubling as it might."
The one-child policy was launched in 1979 as the centerpiece of an ambitious plan to contain China's population at 1.2 billion by the year 2000. China now has a population estimated at 1,038,000,000 -- 22 percent of humanity -- and has just 7 percent of the world's arable land.
Loosely enforced at first, the policy was tightened in 1982 after population growth rates began to climb. Since then, the state has strictly required intrauterine devices for all women with one child and sterilizations for one member of every couple with two or more children.
Cutting the growth rate of 1.15 percent in 1983 -- less than half the 1970 level -- these regulations are credited officially with preventing millions of births yearly.
For all its statistical gains, however, the one-child policy is piling up heavy costs in broken lives and is tearing at the fabric of Chinese society.
China is a society dominated by peasants who live off the land and strive for big families as a matter of economic necessity -- the more children, the more hands to till the soil. To them, birth control is a threat, which many actively counter. They hide pregnant women. They secretly remove IUDs. They falsify sterilization certificates. And they physically attack officials.
Every year, millions of Chinese defy authority and have more children despite jolting penalties -- heavy fines, dismissal from jobs and loss of farmland, housing and economic benefits -- that leave them farther behind in China's march to modernization. Yet at least one-quarter of the 15 million to 20 million babies born in China every year are unapproved.
Faced with strong popular resistance, Peking resorts to even stronger measures. To this struggle, it brings the full powers of a totalitarian state, operating without fear of political opposition. There is no check on official abuse, no outlet for human rights complaints and no forum for public debate of the policy.
What emerges from more than 200 interviews spaced over three years with officials, doctors, peasants and workers in almost two-thirds of China's 29 main subdivisions is the story of an all-out government siege against ancient family traditions and the reproductive habits of a billion people.
The story offers a glimpse of China usually hidden from foreigners but painfully familiar to most Chinese -- a world of government-sanctioned infanticide, of strongarm sterilizations and of abortions performed at a rate as high as 800,000 a year in a single province.
It is a harsh milieu, in which houses are razed and valuables seized as the penalty for birth control violations, in which women are forced to wear intrauterine devices as the price of compliance.
While the policy works smoothly in many parts of China, local officials eager to please the central government often resort to excess. The Dark Side of Family Planning
Nowhere is this dark side of family planning more evident than in Dongguan, a bucolic patch of Guangdong Province in southern China. Here, abortion posses scoured the countryside in the spring of 1981, rounding up women in rice paddies and thatched-roof houses. Expectant mothers, including many in their last trimeseter, were trussed, handcuffed, herded into hog cages and delivered by the truckload to the operating tables of rural clinics, according to eyewitness accounts.
Dongguan had been engulfed by an intense birth control campaign known as "high tide," engineered by local officials to bring birth control offenders in line with the one-child policy.
In 50 days, 19,000 abortions were performed -- almost as many as the county's live births in all of 1981.
Dongguan's "high tide" -- details were confirmed in interviews here after initial reports in Hong Kong -- dramatizes the least cited but most frequently observed form of birth control in China: abortion.
Any mother who becomes pregnant again without receiving official authorization after having one child is required to have an abortion, and the incidence of such operations is stunning -- 53 million from 1979 to 1984, according to the Ministry of Public Health -- a five-year abortion count approximately equal to the population of France.
In 1983 alone, the number of abortions nationwide -- 14.4 million -- exceeded the combined populations of the District of Columbia, Maryland, Virginia, West Virginia and Delaware.
Visits to rural south China produced evidence of more than five abortions for every birth in places such as Duan Fen commune of Guangdong Province.
Although abortion was criminally punishable as murder in China as late as the 1950s, it is dispensed today without debate over moral questions.
"It's more humane to kill children before they are born than to bring them into a society of too many people," said Xu Fangling, a birth control official who helped direct the Dongguan campaign. "If you consider the serious difficulties overpopulation creates for people living today, the moral problem of abortion isn't too serious."
Nor is the timing of abortion usually a factor. Many are performed in the last trimester of pregnancy -- 100,000 in Guangdong last year, or 20 percent of the province's total abortions -- and some as late as the ninth month. Officials say it often takes that long to get reluctant women to clinics.
Doctors normally terminate late-term pregnancies by injecting an herbal drug into the womb, killing the fetus and inducing labor -- a kind of induced stillbirth. The dead fetus is usually expelled in 24 hours.
In the Inner Mongolian capital of Hohhot, however, hospital doctors practice what amounts to infanticide by a different name, according to a Hohhot surgeon, who would not allow his name to be used for fear of reprisal. After inducing labor, he revealed, doctors routinely smash the baby's skull with forceps as it emerges from the womb.
In some cases, he added, newborns are killed by injecting formaldehyde into the soft spot of the head.
"If you kill the baby while it's still partly in the womb, it's considered an abortion," explained the 33-year-old surgeon. "If you do it after birth, it's murder."
He said the practice began in 1981 after hospitals in Hohhot passed a new regulation banning births of second children except in the case of ethnic Mongolians, who are treated more leniently under a national minorities policy. For everyone else, he said, "the second child cannot come out alive. The doctor has the obligation to prevent it."
A doctor who ignores the regulation risks losing his job, he said. He estimated that hundreds of babies die this way in his hospital every year.
"You get used to it," said the surgeon, explaining how doctors react. Sitting in the corner of a coffee shop during the interview, he lifted a cup and said, "It's like drinking coffee. At first, it's bitter. But after a while you don't notice the taste.
"I've done it myself."
Similar practices have been reported from other urban centers. A former hospital patient in the northwest city of Urumqi said that she saw women in labor being wheeled into a large room marked "abortion ward."
A medical student in Canton who worked in a hospital gynecology ward in 1982 told foreign visitors that pregnant women were required to present birth authorization cards before admission to the delivery room. He said doctors who were under orders to abort all unauthorized pregnancies often strangled or smothered newborns.
While abortion is justified officially as a necessary expedient, its high incidence is considered an embarassing breakdown of a system carefully crafted to prevent unplanned pregnancies.
China's family-planning work is backed by the full organizational might of the Communist Party, which extends its influence to every factory, neighborhood and village. Every Chinese belongs to a "unit" -- workplace or rural governing body -- and every unit has a birth control committee headed by party officials. These officials have enormous power over the lives of their charges. Almost all decisions require their approval -- who earns bonuses, who gets housing space, who grows cash crops, who has a chance to study, who marries and who has children.
When Peking gave local party chiefs responsibility for family planning, it added a powerful lever to assure compliance. Then, to fortify the resolve of these officials, it added financial incentive. In most parts of China, local officials earn cash bonuses only if their units observe birth control limits.
With a financial stake in low births, officials put a high premium on prevention. They carefully plan new births for their unit, requiring written applications from any couple wanting to have a child and matching requests with quotas that trickle down from Peking.
The primary target of their work, however, is couples who already have two or more children. At least one parent is required by the state to undergo sterilization, and local officials use methods ranging from cash rewards to coercion to get those eligible to the operating table. Almost always the woman bears the responsibility.
Official statistics show a high level of success: 31 million women and 9.3 million men were sterilized between 1979 and 1984, totaling almost one-third of all married, productive couples in China.
A national sterilization drive last winter boosted annual sterilizations for 1983 to an extraordinary 16.4 million for women and 4.4 million for men, according to the Public Health Ministry -- exceeding the total number of such procedures in the previous five years.
Most sterilizations in rural areas are done collectively in "high tides" organized by local officials to coincide with the visit of roving surgical teams who operate in improvised facilities or cold, austere clinics equipped with little more than board and bucket.
A roundup in frigid northern China near the Mongolian border illustrates how the process works.
The campaign, which was described by a participating doctor, began in November 1983, when officials from every commune in the county searched their records for women under the age of 45 who had two or more children. Then they broadcast their names over public loudspeakers and set dates by which each had to report to the clinic for surgery.
There was a warning to potential evaders: a loss of half of their state land allotment, a fine of $200 -- equal to about a year's income -- and a late fee of $10 for every day they failed to report.
Several couples initially defied the warning but were quickly brought into line. Officials went to their homes, confiscated valuables, such as sewing machines and building materials, and threatened to sell them within three days unless they submitted to the operation.
The surgical team left in early January after completing its goal of 16,000 sterilizations in two months, according to the doctor.
It was an unusually successful campaign considering the intensity of opposition to sterilization. The very mention of a "high tide" has sent whole villages of eligible women into hiding. To head off a mass exodus last year in coastal Fujian Province, Fuqing County officials reportedly organized late-night "surprise attacks," hustling sleeping women from their beds to 24-hour sterilization clinics.
Another popular dodge is phony sterilization certificates. Couples buy falsified or purloined forms at high prices. When the woman gets pregnant, she pleads for leniency, claiming she was a victim of faulty surgery.
As resistance stiffens, however, so does the penalty for evasion.
When women in a Yellow River community of Henan Province fled in advance of a "high tide" last spring, Xiuwu County officials tore off roofs of their houses and knocked down walls with tractors, according to a Chinese medical staffer who witnessed the wrecking.
Female workers in the sleepy southern port city of Zhanjiang were docked their wages until they reported for sterilization surgery, according to factory hands there. Although 20 women at one candy plant stood their ground and were fired, most gave in to the financial pressure.
"Who dares to oppose the regulation?" asked a 34-year-old mother who had an operation she did not want. "I have three children. Can I afford to feed them without a job?"
Officials are no less forceful in dealing with one-child mothers. They are required by national regulation to have IUDs inserted after their first child is born and strictly forbidden to remove the stainless steel loops.
Other forms of contraception are permitted, including birth control pills and condoms, but statistics reflect the official preference for easier and more reliable IUDs: Of 124 million married women using birth control, 55 percent wear IUDs -- 69 million, which exceeds the total number of IUD users in the rest of the world combined. Automatic IUD Implants
In some city hospitals, doctors automatically implant the devices immediately after a woman gives birth, often without informing the woman or seeking prior consent, according to a Peking gynecologist.
Official prodding substitutes for hospital efficiency in most places, however. Family-planning authorities call on new mothers to stress the need for contraception. There are follow-up visits to "educate" the woman until she possesses an IUD certificate, for which she gets a cash bonus and time off work.
Little choice is given in places such as rural Fujian, where women who refuse IUDs lose their right to grain rations and medical benefits for their first child, according to an overseas Chinese visitor.
Women fitted with IUDs in most of China regularly are shepherded into clinics for X-rays to make sure of proper placing. Up to six times a year, they are stood before decades-old equipment to endure the kind of fluoroscopic examination discouraged in the West for fear of causing radiation damage to ovaries or fetuses. Frequent X-ray exams are considered necessary because of the high failure rate of IUDs, which are often inserted in factory-line fashion without concern for sizing.
Of greater concern to authorities is the problem of surreptitious removals. Women who had submitted reluctantly to IUD insertions pay charlatan doctors to extract them with homemade metal hooks. It is a common occurrence in rural areas, where the so-called "hook wielders" charge as much as $25 for a home "operation," often undoing the family planning work of an entire village in a few days' time.
These "hook wielders" remain popular despite their record of disasters -- hundreds of deaths and injuries reportedly caused by penetration of the uterus and intestines with unsterilized bicycle spokes or bamboo sticks.
For local officials who claim to run voluntary IUD campaigns, the reported incidence of such deviant behavior is contradictorily high: 80 percent of IUD users in some parts of Fujian had their loops removed in 1981; 10,000 extractions were reported in a single county of Sichuan Province between 1980 and 1983.
"These so-called doctors are swindlers who take advantage of the backward desire of peasants to have more children," said Sun Guoliang, vice chief of Sichuan's birth control office.
"There are women who were less than willing in the beginning to have the IUDs put in," he said. "Others may have been willing at first but changed their views after the swindlers told them the loops would make them sterile." In case of contraceptive failure or abuse, however, there are other controls built into the system.
Few unauthorized pregnancies can elude the tight supervision of birth control activists, a phalanx of female members of the party, Communist Youth League and Women's Federation who are deputized by local officials to monitor the reproductive lives of Chinese couples.
These activists, who often are referred to derogatorily as "mothers-in-law" for their meddling ways, each focus on a few couples in every factory, neighborhood and rural hamlet.
They know everyone's contraceptive method. They make daily house calls to remind birth control pill users to take their pills. They issue condoms on request, giving repeated instructions and insisting they be used "two at a time" or be inflated first to test for leaks.
The activists closely watch for signs of pregnancy -- morning sickness, craving for sour food or swollen breasts -- and cultivate informers to report on their neighbors or coworkers.
They keep detailed records of every woman's menstrual cycle, checking to make sure of regularity.
"If it is late, we wait four days," said Yu Caihua, an activist in Zhou Nan County of Shandong Province. "If the woman's period still doesn't come, we take her for a checkup." Monitoring Contraception In the Work Place
Many factories around the country hang up blackboards listing each female worker's contraceptive measure and the day her period arrives. The women are required to place a check mark next to their names after menstruation begins every month. If she fails to report on schedule, her boss will be asked why. The woman is then ordered to take a pregnancy test.
A positive test spells trouble for any woman who already has a child. She is urged to have an abortion, offered a cash bonus and time off from work as a reward. If she refuses, the pressure mounts.
This is where China's family-planning apparatus comes down with full force. It also is the breaking point for many Chinese.
First come the tactics of persuasion played out in what is known euphemistically as "heart-to-heart chats." Several activists visit the pregnant woman at home to explain the need for population control. She is urged to have an abortion for the good of her nation, her community and her family. Husbands and mothers-in-law are recruited for the talks because they often pose the biggest obstacle to abortion.
If she holds her ground, the talks intensify. More officials enter the fray, sometimes eight or 10 at a time. They come for hours every day lecturing, cajoling, pleading. Eventually, the local party chief joins in and the tenor changes. Now the pregnant woman is criticized for resisting and warned of the penalty for unauthorized birth, which varies from place to place but can include loss of farmland, fines of up to $1,000, firing from factory jobs, public censure and the denial of land, medical benefits, grain rations and educational opportunities for the unplanned child.
To increase the pressure for speedy abortion, the woman is charged a penalty, called a "talking fee," of $2 per day in the rural suburbs of Qingdao in east China, according to peasants there.
In coastal Jiangsu Province, she is required to sign a "guarantee" promising to pay any penalty, according to family planning officials there.
Fines begin in the fourth month of pregnancy in factories of Shantou in east Guangdong, where both husband and wife lose 50 percent of their monthly wage -- to be refunded if she finally has an abortion.
Party chief Huang Zhigao of Double Bridge Village in the southwestern province of Sichuan acknowledged the practice of "helping" pregnant women to the clinic if they refuse to go on their own.
As an example, he cited the story of a 32-year-old woman named Li who had a baby girl and became pregnant again in the hope of having a boy. After numerous visits to her home by "persuasion groups" proved unsuccessful, eight activists appeared at her doorstep one morning and told Li, then four months pregnant, "if you don't go to the clinic willingly, we'll take you," according to Huang.
"The woman struggled and started crying when they started taking her by the arms," recalled Huang. "She was dragged about 50 yards and finally gave in."
Activist Zhang Xiujun, who was among those "helping" Li, said, "It took all of us to get her to the clinic."
Huang justified the episode as a necessary "administrative measure." He said Li and another woman who met a similar fate complained that they had been taken against their will, but "they were told there was no way out because they rejected our advice to go willingly."
The large number of Chinese who reject such advice every year indicates less aggressive enforcement or stronger resistance elsewhere.
Many pregnant women hide in the mountains or flee to a relative's village to escape official harassment, practicing what is colloquially known as "childbirth on the run." So many runaways reached the remote, northwestern province of Gansu that a regulation was passed directing local officials to "terminate within a limited time all unplanned pregnancies of women not in their home residential area," according to an internal document.
Those who stay home simply resist the official hectoring, usually passively. In numerous cases, however, the pressure becomes too much and explodes into violence. There have been attacks against the private gardens of activists in Sichuan and Anhui provinces. And there have been physical attacks against officials themselves -- stabbings, clubbings and beatings, according to official news reports.
A Guangdong peasant named Wu Jingqu, who had two children, personally pulled out his wife's IUD and got her pregnant. When the deputy party secretary of his commune visited the couple and pressed the woman to have an abortion, Wu reportedly hacked him to death with a meat cleaver. Wu was executed.
A Shandong activist was hospitalized for two months after she was kicked in the groin and beaten with wooden staves by a man who objected to her urging a pregnancy test for his wife.
"Some peasants accept the idea of birth control easily and some don't," said vice chief Sun of Sichuan. "The activists have to do their work, and the peasants want more children. There are inevitable clashes."
For many peasants who are just starting to prosper under today's flexible economic policies and want more farm hands, the prospect of being fined for having children seems unjust. For local officials, however, the only way to stop unplanned births is to make them prohibitively costly.
At the Double Bridge commune, Huang decided to make a "negative example" of a 29-year-old woman named Meng who fled 200 miles to have her second child at an aunt's home. Huang, who lost his bonus because of Meng's clandestine delivery, took revenge when she returned. He stripped her family of half of the land given by the state for farming, fined her $400 -- almost thrice her annual income -- and denied her the right to grain and cloth rations for the second child.
To sharpen the sting, Meng was forced to make a self-criticism at a mass meeting. Standing before 100 peasants who sat on stools in the village warehouse, she endured what in Chinese terms is a painful loss of face.
"Since then, we haven't had an unapproved second birth," said Huang.
Next: Female infanticide.