Contraception 85 (2012) 563 – 569

Original research article

History of the Chinese Family Planning program: 1970–2010☆

Cuntong Wang⁎
School of Social Development, Central University of Finance and Economics, Beijing, 100081, China
Received 12 October 2011; revised 20 October 2011; accepted 21 October 2011

Abstract

Background: China launched a nationwide family planning program offering birth control methods and family planning services in the
1970s. Promotion of the widespread use of long-term contraceptive methods has been one of the program's core strategies. This paper
reviews the history of China's Family Planning Program at the national level from 1970 to 2010. Special attention is paid to the history of
contraception policy.
Study Design: This study provides an overview of the last four decades of the Chinese Family Planning Program. Programmatic goals
are highlighted during different time periods, with special attention being paid to the role of contraceptive use and the history of
contraceptive policy.
Results: The Chinese Family Planning Program has experienced several transitions. It has evolved from the 1970s period of moderate policy,
represented by wan, xi, shao (late marriage and childbearing, birth spacing and limited fertility), through the strict one-child policy of 1979
to the early 1990s. From the mid-1990s to the present, a relatively lenient policy has been in force, characterized by client-centered
informed choice.
Conclusions: The success of the Chinese Family Planning Program has long been heavily dependent on policies advocated by the central
government, including programs promoting contraception to reduce fertility rates. The Program also depended on a logistical support system,
including organizational safeguards and free provision of contraception and family planning services.
© 2012 Elsevier Inc. All rights reserved.

Keywords: Family planning program; Contraceptive policy; History; China

1. Introduction of population in 1949 to 20 per thousand in 1952. The total

fertility rate (TFR) 1 in 1949 was 6.14 [1].
Throughout history, the Chinese people have believed However, more frequent pregnancies and births restricted
“the more sons, the more blessings.” Chinese people, women's freedom. So the Central Government Administra-
especially those who farm, traditionally prefer early tion Council (now called the State Council) approved the
marriage, early childbearing and large families. After the “Regulation of Contraception and Induced Abortion”
foundation of the People's Republic of China in 1949, the prepared by the Ministry of Health in August 1953. The
central government initially encouraged people to have more state began to promote contraception, supplied contracep-
children, providing material incentives and strictly limiting tives and rendered abortion legal. The goal of emancipating
the use of sterilization and induced abortion. Married couples women from the burdens of high fertility was prominent in
did not plan births, giving rise to an accelerated population campaigns to promote the use of contraceptive methods. The
increase. The natural growth rate rose from 16 per thousand program was initially implemented on a small scale and

☆ 1
Funding: 211 Program (3rd) of the Central University of Finance and Total fertility rate (TFR), equal to the number of births a woman would
Economic & the Projects of the National Social Science Foundation of have at the end of the reproductive years if she were to bear children at
China (10CRK012). prevailing age-specific fertility rates while living throughout the reproduc-
⁎ Tel.: +86 10 62288651; fax: +86 10 62289259. tive period (excluding illegitimate births but based on all women of
E-mail address: [email protected]. reproductive age whether married or not).

0010-7824/$ – see front matter © 2012 Elsevier Inc. All rights reserved.
doi:10.1016/j.contraception.2011.10.013
564 C. Wang / Contraception 85 (2012) 563–569

mainly in large cities. However, its implementation was Planning (1984–2011), compiled by the National Population
interrupted by the famine accompanying the Chinese Great and Family Planning Commission of the People's Republic
Leap Forward (1959–1961) [2]. of China (NPFPC) (China Population Publishing House
In the 1960s, China entered its second peak period for Press, Beijing, yearly, from 1984). Data on induced abortion
childbearing [2]. From 1962 to 1972, the annual number of are taken from the China Health Statistical Yearbook (1971–
births in China averaged 26.69 million. The incompatibility 2011), compiled by the Ministry of Health of the People's
between unchecked population growth and planned eco- Republic of China (Peking Union Medical College Publish-
nomic development had become apparent, attracting the ing House, Beijing, yearly, from 1971). These data have
attention of leaders and scholars. China's population policy been used to calculate the prevalence of contraceptive use
began to change. The central government issued a call for and rates of induced abortion using standardization per
family planning and advocated the use of contraceptives. grand-mean centering methods, thus facilitating comparisons
However, due to the lack of a deep understanding of the from multiple data sources.
seriousness of the population problem, the government did Additional data for this article were collected during
not initially develop a clear population policy, and family frequent field visits in China over the past 30 years and from
planning was not carried out effectively [3]. the author's collection of relevant Chinese and Western
During the early 1970s, the birth rate still remained high documents from the 1950s onwards. The author has also
(above 33 per thousand of population) [2]. Concerned about used information from major demographic journals.
the social and economic consequences of continued rapid
population growth, China launched a nationwide family
planning program offering birth control methods and family 3. Results
planning services in 1973 [3,4]. Contraceptive and abortion
services were extended into the rural areas, and there was In the early 1970s, China launched a targeted family
extensive promotion of later marriage, longer intervals planning campaign promoting wan, xi, shao (late marriage
between births and smaller families. and childbearing, birth spacing and limited fertility) in some
In 1979, the Chinese government embarked on an provinces. The program was spread nationwide beginning in
ambitious program of market reform following the economic 1973. At that point, contraception was introduced as the
stagnation of the Cultural Revolution. Rapid growth, main strategy for reducing the fertility rate. Since then, oral
however, put a considerable strain on the government's contraceptives have been provided to married couples free of
efforts to meet the needs of its people. For example, pre-1979 charge; couples obtain the contraceptives from local
contraception and family planning measures failed to limit hospitals [2]. More stringent rules were applied in the cities,
the population to 1.2 billion by 2000, the official target. By where couples were encouraged to delay marriage until the
1979, there was growing concern about China's “carrying age of 25 for women and 28 for men and to have no more
capacity,” the ability of its land, water and other resources to than two children. The rules for those living in rural areas
support a population which had grown from 500 million in were more accommodating, where the minimum age for
1950 to 1 billion [2]. The solution to this problem was sought marriage was set at 23 for women and 25 for men and a
in the one-child policy. Known as the world's strictest family maximum family size was set at three children. Urban and
planning policy, the one-child policy (one-size-fits-all, urban rural couples alike had to abide by a birth-spacing period of
or rural) was introduced in 1979. at least 3 to 4 years [5]. Consequent to these policies, overall
The Chinese government has enacted a variety of policy contraceptive use by married couples increased annually.
measures related to family planning since the 1970s. The However, this family planning policy was still moderate in
Chinese Family Planning Program has remained in place that married couples could freely choose contraceptive
for more than three decades and has caused China's birth methods. The policy was also mild in the sense that family
rate to plummet. As one of the key strategies of the family planning was advocacy based and largely focused on
planning program, various contraceptive methods were education about the use of contraception. Although total
provided in family planning clinics at all levels. Intrauterine contraceptive usage by married couples increased annually,
devices (IUDs) and tubal sterilization were the most it increased on a relatively smaller scale than it would in the
frequently used methods [2]. In 2010, officials claimed early 1980s. Additionally, advances were made in domestic
that over 400 million births have been averted since the or client-controlled contraception technologies. This was
program's inception [4]. especially true for oral contraception technology, in which
considerable progress was made as a result of domestic
research [6,7]. In March 1978, the Chinese government
2. Materials and methods made family planning and population control a basic state
policy and explicitly incorporated it into the Constitution of
The data on TFR and contraception of married women the People's Republic of China.
and men of reproductive age (20–49 years) for this study are In 1979, following the economic stagnation of the
drawn from the Yearbook of China's Population and Family Cultural Revolution, the Chinese government embarked on
 C. Wang / Contraception 85 (2012) 563–569 565

an ambitious program of market reform. Sweeping economic early and mid-1980s. This figure had remained virtually
changes were introduced in an officially sponsored transition unchanged since then, ranging from 1.0 in the most highly
from a centrally planned economy to a socialist market developed and urbanized provinces such as Beijing,
economy. At the time, China was home to a quarter of the Shanghai and Tianjin, to 2.0 in Xinjiang, where ethnic
world's people, who occupied just 7% of world's arable minorities account for more than 60% of the total
land. Two thirds of the population was under the age of 30 population [12].
years, and the baby boomers of the 1950s and 1960s were In the years 1980 to 1983, the one-child policy was
entering their reproductive years. Concerned about the mainly enforced through “shock drives” (tu ji) such as
social and economic consequences of continued rapid intensive mass education programs and abortion–steriliza-
population growth, the government viewed strict population tion campaigns at the end of each year. The mandatory long-
containment as essential to economic reform and to an term contraceptive policy was further strengthened through
improvement in living standards. However, the family so-called “mass mobilization campaigns” (qunzhong
planning measures implemented from 1970 to 1979 were yundong) 3 to advocate “one-size-fits-all” in rural and
regarded as incapable of limiting the population to 1.2 billion urban areas [13]. At its core, the policy depended on
by 2000, the official target. The central government believed virtually universal access to contraception and abortion
that such a large population size coupled with a weak without charge. In December 1982 and early 1983, circulars
economic foundation would seriously block the progress of distributed by the central government called for mandatory
the “four modernizations” in China [2]. Thus, a major policy IUD insertion for women with one child, abortion for
revision was in order at the Second Session of the Fifth unauthorized pregnancies and sterilization for couples with
National People's Congress in 1979: the strict rule of one two or more children [2]. For the majority of married
child per family, urban or rural. The following year, the couples, no contraceptive choice was available, and little
Communist Party of China (CPC) Central Committee issued education was provided about their reproductive health
an open letter calling for CPC and Communist Youth League rights. Indeed, 80% of women in a recent large study said
members to have only one child in a bid to improve lives. they had no choice and just accepted the method recom-
The letter argued that more children would consume more mended by the family planning workers [14]. Women
money and food and hinder the improvement of living proceeding with an unapproved pregnancy were known to be
standards within families. It further argued that unchecked reluctant to use antenatal and obstetric services because they
population growth would affect the “accumulation of funds” feared they would face pressure to have an abortion or fines
for the nation's modernization drive [8]. In essence, the for violating the one-child policy [2]. There was heavy
“open letter” was not only advocacy for the one-child policy, reliance on long-term contraception, with sterilizations and
but a special, mandatory order to conduct a family planning IUDs together accounting for more than 90% of contracep-
program alongside a planned economy. With this official tive methods used since then.
introduction of the mandatory one-child policy, China These policies were further enforced via a system of
entered a new era of “slam the brakes” population control. incentives for compliance, such as preferential policies in
The government noted, however, that “the population educational opportunities, health care, housing and job
growth problem might relax in three decades” [2,9]. assignments. Disincentives for lack of compliance were also
The one-child policy consisted of a set of regulations implemented, including fines and loss of access to education
governing the approved size of Chinese families. These and other privileges [15]. Pointed and directed family
regulations included restrictions on family size, late marriage planning slogans were posted in most rural areas, e.g.,
and childbearing, and the spacing of children (in cases in “rather adding ten cemeteries than adding one birth”
which second children were permitted). For most urban or (ningtian shizuo fen, butian yige ren) and “an unplanned
rural residents, the policy was strictly enforced, with few birth will result in birth control surgery” (gaiza buza, fangdao
exceptions. The exceptions included families in which the wuta; gailiu buliu, bafang qianniu). A few provinces, such as
first child had a disability or in which both parents worked in Sichuan and Shandong, implemented “mass sterilization
high-risk occupations (such as mining) or were themselves campaigns,” in which sterilization was mandatorily per-
from one-child families (in certain areas) [2,10]. Addition- formed after just one birth [8]. In 1983, an estimated
ally, the State Family Planning Bureau 2 drew up an official 87,989,893 sterilizations and 14,370,000 induced abortions
indicator of the maximum completed fertility called for by were performed nationwide, and the sterilization (46.33%)
the family planning policy [11]. The commission set an and the induced abortion rates (56.07%) peaked during the
average of 1.2 children born per woman nationally in the

3
Mass mobilization campaigns (qunzhong yundong) were defined as
2
The State Family Planning Bureau was renamed as the State Family “… government-sponsored efforts to storm and eventually overwhelm
Planning Commission (SFPC) in 1981 and again renamed as the National strong but vulnerable barriers to the progress of socialism through intensive
Population and Family Planning Commission of the People' Republic of mass mobilization of active personal commitment.” These campaigns
China (NPFPC) in 2003. advocated the “one-size-fits-all” approach in rural and urban areas.
566 C. Wang / Contraception 85 (2012) 563–569

family enforcement by command rather than according to

law and on carrying out state policies on population control
rather than safeguarding individual interests [15,17]. So the
relationship between local governments and their constitu-
encies was tense. Mass protests against the one-child policy
occurred repeatedly. Some family planning cadres and their
family members were even killed in the performance of
official duties related to birth control [2]. This resistance
caused policymakers to reevaluate their decision to impose
the one-child policy nationwide [18].
Faced with widespread peasant resistance, the govern-
ment slightly modified the rigorous one-child policy, first in
April 1984 and then in May 1986, incorporating more
pragmatic content [19]. In rural areas, if the first child was a
girl, the couple was allowed a second birth. Otherwise, only
one child was allowed. Minority nationalities were allowed
to have two births per couple. However, only six provinces
and autonomous regions adopted this policy of allowing
rural couples to have a second child a few years after the
Fig. 1. Total contraceptive prevalence rates, induced abortion rates (%) birth of their first [20]. Following these compromises,
of married women of reproductive age (20–49 years) and TFR in China, China's Family Planning Program began to propagandize
1979–2010. “later marriage and later birth, fewer births and healthier
births” (wanhun wanyu, shaosheng yousheng).
After 1985, the state conducted a series of reforms to
1980s. The TFR dropped from 2.92 in 1979 to 2.42 in 1983 family planning policies. One of these reforms was to
[16] (Fig. 1). A relatively stable mode of contraception was embrace the “three principles” (san wei zhu). Family
established, with one of the most important elements in the planning was to follow three principles: using information,
birth control program being the massive use of program- communication and education. This policy relied on
directed contraception (including induced abortion), to contraception and regular provision of family planning
achieve desired family planning goals. This program services. The central government also established a five-tier
achieved the highest overall long-term contraceptive use in family planning network to effectively implement the birth
the world during the early 1980s. control program. This network was fully funded out of the
Although the one-child policy — and the accompanying national budget and covered the national, provincial,
mass campaign of sterilization and induced abortion — led prefectural, county and township/village levels. These
to a decline in fertility, it also caused a popular uproar and organizations served both urban and rural areas, monitored
ignited strong resistance, especially in China's vast rural contraceptive usage and fertility rates, and provided free
areas. There, two conflicts between the individual and the counseling and contraceptive services for married couples
local government arose. One conflict was the individual [21]. In 1988, China's family planning policies were again
desire for more births, while the local government forced modified, with the one significant change being that couples
individuals to conform to the one-child policy. The other in rural areas with one daughter only were allowed to have a
conflict arose over the questions of contraceptive methods second child after a certain interval (4–6 years). This change
and induced abortion. Individuals did their utmost to avoid was implemented in 18 provinces by the end of 1989 [19]. At
long-term contraception or abortion, accepting short-term the same time, a family planning “one-veto” system (yipiao
contraceptives that still allowed them to control their foujue) for cadres was introduced in some provinces. Local
reproductive methods. Hence, they potentially looked cadres were evaluated on their performance in both
forward to increased numbers of births. At the same time, economic and family planning work, with their family
the local government endeavored to force people to practice planning activity as the top priority for evaluation [15].
long-term contraception or to induce abortion. In addition, In the early 1990s, the central government ceased to rely
family planning workers at the village level tended to be on mass sterilization campaigns and instead promoted IUD
older and less educated. These workers had difficulties in use nationwide. Couples were permitted to have a second
learning the information and service techniques of repro- child without penalty if the first child had a birth defect, if
ductive health and in improving their work style. For one partner in a second marriage had no offspring from the
example, they tended to focus on family planning manage- first marriage and the other partner had only one, if the first
ment rather than reproductive health services and on child was adopted, if a man married into a family in the
completing specific tasks rather than dealing with questions countryside and the bride was the only child, or if the couple
about why individuals violate policies. They also focused on was of an ethnic minority [22]. However, when the
 C. Wang / Contraception 85 (2012) 563–569 567

population showed a slight increase in 1991, the central continued to promote the one-child policy. However, they
government once again strengthened its mandatory sterili- provided married couples with reproductive rights —
zation program, and the prevalence of sterilization reached a including the rights to decide the timing and spacing of
second historic high. Out of 30 provinces, 20 continued to their children if a second one was permitted and to choose
enforce the policy of “mandatory IUD insertion for women contraceptive methods freely. One of the most important
with one child, abortion for unauthorized pregnancies, and articles in the Population and Family Planning Law referred
sterilization for couples with two or more children.” China to a compensation fee. Fines for violations of family
continued to maintain the highest overall contraceptive usage planning regulations, which were widely used in the past,
and prevalence of long-term contraception in the world [23]. were now substituted by a social compensation fee collected
TFR stabilized at around 1.77. through local government and family planning officials. That
In the mid-1990s, the International Conference on fee identified the legal responsibility, in monetary terms, of
Population and Development held in Cairo in 1994 played those who violated the law [22]. In fact, local residents, and
an important role in China's family reorientation. The often the local officials, do not see much difference between
Conference called for a radical shift away from demographic the former family planning fine for unplanned births and the
aims and toward reproductive health and the improvement of new social compensation fee for producing extra children
the situation for women. After the conference, the Chinese [15]. In 2003, the SFPC was also renamed as the NPFPC.
government made commitments to the promotion of Presently, despite the fact that there are still four
women's reproductive health and advanced a client-centered provinces that have implemented IC pilot programs in just
policy of informed choice contraception, known as IC policy a few of their counties, the IC policy has been carried out in
[4]. The IC policy included the provision of updated, most provinces, and married couples now have the right to
scientifically accurate and easy-to-understand information freely choose one of the contraceptive methods according to
on contraceptive methods and standard technical services. their needs [21]. It may be observed that the overall progress
This information was disseminated through education, of the IC policy has changed the long-standing Chinese
communication, training and counseling. Clients were contraceptive management approach of “mandatory IUD
enabled to choose the safest and most effective contraceptive insertion for women with one child, abortion for unauthor-
method that best suited them. Reorientation of family ized pregnancies, and sterilization for couples with two or
planning strategies was also initiated at that time and then more children.”
developed very quickly. Current contraceptive use is more diversified, the induced
First officially identified in 1995 by the State Family abortion rate remains at a low level, and the TFR has
Planning Commission (SFPC), the reorientation of family stabilized at not far below the replacement level (Fig. 1).
planning switched policy implementation from a target- There are an increasing percentage of IUD and short-term
driven to a client-centered approach [24]. In China, the main contraceptive methods in use, and a decreasing percentage of
thrust of this approach included quality of care (youzhi fuwu) male and female sterilization [13]. The Chinese mode of
and informed choice. This policy reorientation was initially contraception seems quite stable, with long-term contracep-
piloted in six selected counties by the SFPC in 1995 [4]. tive use achieving the highest overall global prevalence level
Within the pilot areas, Family Planning Program enforce- during early 1980s [13]. This may be explained, in part, by
ment became increasingly aligned with international repro- the use of incentives. For example, most provinces pay
ductive health standards, and more attention was paid to monetary incentives to encourage married couples to choose
women's contraceptive rights by enabling married couples to long-term contraceptive methods. For example, in 2009,
choose contraceptive methods according to their own needs. couples in Hunan could receive 3000 CNY (China Yuan) for
For example, data tabulation on the sterilization rate and the a male or female sterilization and 1000 RMB for an IUD.
induced abortion assessment indicators were cancelled. Monetary incentives have greatly expanded long-term
Married couples were able to freely select one contraceptive contraception usage. At the same time, the five-tier National
method with the guidance of professional and technical staff. Population and Family Planning Network provides free
The pilot program seemed to be successful and was praised counseling and contraceptive services for married couples
by the masses [25]. It was extended to 100 counties and and monitors contraceptive usage and fertility rates. By
districts in 1997, further to 200 counties and districts at the 2010, the network in mainland China had over 2500 county-
beginning of 1998, and to 300 counties and districts (more level service delivery points, 140,000 technical service
than 10% of all counties) by the end of that year [24]. staff and nearly one million grassroots service providers
Upon entering the 21st century, “Family Planning and volunteers.
Technical Services Regulations” and the “Population and
Family Planning Law” of 2001 became effective on 1
September 2002. As part of the overall efforts of legal reform 4. Discussion
in China, these laws specified the rights and obligations of
Chinese citizens in family planning and provided a legal As reported above, the Chinese Family Planning Program
basis for tackling population issues [15]. These laws has experienced several transitions in contraceptive use
568 C. Wang / Contraception 85 (2012) 563–569

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