Communist China was founded in 1949 after the Japanese occupation and a long and devastating civil war. Initially the Government instituted a strong pronatalistic policy encouraging child-bearing by means of child subsidies, and prohibiting contraceptives, abortions and sterilizations 9102. This policy was relaxed in 1953, and contraceptives and abortions under certain conditions became available. In 1957, as part of the government's first birth control campaign, legal access to abortion was made easier 11.

The dramatic peak in fertility observed in 1962 led the government to change its policy and family planning in densely populated urban areas was promoted. The Cultural Revolution halted this program, but in 1973 the first antinatalistic population policy was launched: overpopulation was considered a threat to modernization and development. The 1973 policy used approaches such as education to individual women and couples, provision of models of reproductive behavior, and improvement of contraceptive and abortion services 12. The policy promoted delayed marriage, long intervals between births, and a two-child family.

The 1973 policy was strengthened in 1975 defining population growth targets and introducing locally-managed collective birth plans 13. In 1979 a one-child policy, which previously already had been experimented in some provinces, was introduced to the whole country. In addition to the requirement of one child per couple it set national targets (population less than 1.2 billion and population growth zero in 2000). A new separate vertical service structure (family planning, FP) was formed to implement the policy and monitor it; until 1979 family planning had been a part of health care and was organized at the local level. In 1981, the State Family Planning Commission (currently called the National Population and Family Planning Commission, the equivalent of a "Population Ministry") was formed to coordinate the activities. In 1982, family planning, aiming at reducing population growth, was included in the Constitution as a basic state policy 2. Since 1981, the marriage law has explicitly required couples to practice family planning 14. The family planning policy did not become a national law until 2001, and each province produced its own regulations on the basis of national guidelines 15.

The one-child family policy led to forced family planning and opposition. This and the economic reforms of the early 1980s, which reduced the state's control, led to a more permissive policy in 1984 allowing modifications at the provincial level, usually around the rules of having a second child. In the late 1980s, clear provincial rules were demanded. The new regulations 161718192021222324252627 focused, in addition to higher order births, on preventing early-age marriage and childbirth, and on reducing the high rate of induced abortions 28.

In the 1990s, population policy stressed stability, and only small modifications in population targets at the provincial level were made. Contraception was promoted instead of abortions, and emphasis was placed on improving regular services instead of conducting separate campaigns. High contraceptive use rates were achieved. The importance of integrating population policy into general social and economic planning was acknowledged, and the question of an aging population became an important consideration 29.

Currently, different provinces have different rules 302. The commonest provincial rule for rural areas is "two children if the first is a girl". But some provinces have adopted "two children with a four-year interval" 2. In the case of minority groups, more children are allowed. For cultural reasons very few children have been born outside marriage, and most women marry 31 and have their first child shortly after the marriage. Contraceptives are now available free of charge and are commonly used.

For a pregnancy to be "legal" (i.e. approved by secular authorities), the woman has to have permission for it from the population authorities. The family planning regulations and the 2001 law define legal (authorized) births, i.e. what is allowed 32, and "illegal" (unauthorized) pregnancy (or birth following such pregnancy) must be logically concluded as the opposite. The regulations stipulate incentives, but disincentives to avoid illegal pregnancies are defined at a lower level, mostly by county FP committees. Whether the pregnancy is legal depends on whether the pregnancy history of the parents qualifies them to have a (new) child, and whether the child quota laid down in the yearly plan of the village or workplace is full or not. The rules vary from one area and workplace to another. The process of determining legality may include the issuing of a formal certificate from the local family planning authority. The description from two urban areas 33 shows that getting the permission may be complicated and is not a formality.

The Chinese family planning regulations do not include the concept of an "illegal child" (i.e. a child born out of an "illegal pregnancy"), and the law prohibits discrimination against children born outside marriage 34. However, children from illegal pregnancies may not be registered or treated equally until their parents pay the fines imposed as punishment. Especially in urban areas registration with the local authority is required for medical care, schooling and employment. The use of incentives and disincentives in the population policy implementation has varied by time and place, and it is likely their impact has declined over time due to the large social changes, such as growth of private housing in cities, shrinking of state sector enterprises and internal migration. One incentive from 1988 is the "one-child certificate" which is a contract between a couple and the local government. It gives parents who agree to have only one child certain economic rewards, such as a monthly stipend, free obstetric care, increased maternity leave, highest priority in education and health care for the child, preferential treatment when one is applying for housing, and a supplementary pension 153035. Disincentives for violators include losing housing and school benefits or having to pay higher fees and fines. Fines, currently called extra tax, may be substantial: according to one source, they amount to 10–20 % of a family's annual income; and according to another, they exceed the average annual income 35. Qian 28 reports fines of 2.5 times the village's per capita income. Payment period and how actively the fines are collected have varied by place 15.

Enforcement of the population policy has been pursued via the Communist Party and the State Family Planning (FP) Commission, both of which have a functioning vertical structure. The FP structure extends downwards from the State FP Commission to province, city, district (urban) or county (rural), street/township, and finally to neighborhood FP / village FP committee. FP service centers at the county and township level have taken over some services previously provided by local health services 15. The FP organization has good connections to women's voluntary organizations 35. In the 1990s, there were an estimated 300 000 FP officials, and hundreds of thousands of part-time FP workers in villages, called "cadres" (lay-people working part time for local authorities) 2. Parallel to the hierarchical structure of civil servants, there is the party organization, and the leaders of the party at each level share the decision making with leaders of the civil servant departments. Cadres are usually also members of the Communist Party.

Implementation of the family planning policy has been taken seriously and extensive and ongoing ideological education activities involving authorities and cadres were introduced. Education has been provided on both, general and individual level. Individual women are persuaded to comply with the rules, as care and control are provided by the same individuals 33. Educational programs address the general good: the importance of the population policy for the society. Yearly population plans, including numbers of births and the organization of FP services, are developed by local authorities, and state and municipal workplaces. Data collection is organized by cadres. Villages in rural areas and workplaces in urban settings take collective responsibility, and sign a contract to make the plan for targets and enforcement 3336.

In rural areas, an extensive system has been created at the village and district level to ensure constant surveillance of contraceptive use and pregnancy status of all married women at reproductive age. It is common for married women to be requested to visit an FP station every two or three months for pregnancy testing, allowing for early pregnancy detection.

In cities, family planning officials and cadres within workplaces have a central function. The surveillance of contraceptive use may be more common than surveillance of pregnancies, as fear of loosing a job may motivate women not to have an illegal pregnancy 33. Alongside education, accessible services, incentives, disincentives, and the surveillance of all married women at reproductive age, a "personal responsibility system" was introduced in the early 1990s to guarantee that the local birth plan is followed 153635. Under this system, the heads of both the FP and Party committees at each level are personally responsible for ensuring that the targets are met and the rules are followed. If deviations occur, the officials may be subject to penalties, including the withholding of monetary bonuses, the loss of promotion and dismissal. This has resulted in false reporting and financial negotiations with an official's constituency to compensate for financial losses 1536.

Until 1953, induced abortion was available only on the basis of protecting a woman's or her existing children's health; in addition abortions had to be performed early and a physician's certificate was required 11. In 1957, abortion was made available at a woman's request within the first 10 weeks of pregnancy and each woman was allowed one abortion per year. The 1979 abortion law abolished most restrictions, and set 28 weeks of gestation as the upper limit for legally performing abortions 37. Some provinces have made their own laws stipulating the place and performer of the abortion 12.

Whether a woman ends up having an abortion depends on the strength of her and her family's wish to have a further child, and her acceptance of abortion and the population control norms. It seems that the population at large is permissive towards abortion 38 (Table 1). In our study, conducted in a rural setting in Anhui Province, the outcome of pregnancies varied considerably according to the legal status of the pregnancy 8.

The number of abortions increased rapidly after the introduction of the 1979 population policy. Some reports suggest that women may have been forced to have an abortion if an illegal pregnancy occurred 39. Applying pressure to undergo sterilization was apparently even more common 40. However, there are reports that forced abortions are uncommon nowadays 40414243. The temporary concealment of pregnancies and children lessens the pressure of having an unwanted abortion. Hidden children are usually registered later, sometimes as immigrants.

An unnatural sex ratio at birth, i.e. more baby boys than girls, has been reported from China at least since the early 20^th century. The excess of male babies declined considerably between 1936 and 1960 44, and increased from the mid-1970s onwards 454446. The sex ratio at birth is higher in rural than in urban areas 4647, and the variation by province is large 344448. It has been shown that the higher parity is, the higher is the sex ratio, especially if there are no previous sons 344950. The unnatural sex ratio at birth can be the result of sex-selective abortions, hiding and/or not reporting baby girls, or of extra deaths among newborn girls 8343338. Previously hiding of baby girls might have been the main cause for the high sex ratio at birth, as indicated by a higher numbers of girls at later ages as compared to births. However, as shown in our study in one rural county in Anhui province [our unpublished data], sex selective abortions may have become an important reason for the high sex ratio at birth.

Fetal sex determination is illegal in China and health professionals performing it are penalized 3438. The first regulation against fetal sex determination was issued by the national health ministry in 1989, and the content repeated in the 1995 law on maternal and child health care. The 2002 FP law explicitly refers to the ban of using ultrasound and other technologies to determine fetal sex. Abortions on the basis of a child's sex are illegal, and if detected the parents' right to have a second child is lost. Ultrasound scanning is now widely available 3438, and the various regulations against its use for fetal sex determination indirectly hint that such use has occurred. Many other Asian countries and regions, including South Korea, Taiwan, Hong Kong, Singapore and Thailand have experienced a remarkable decline in fertility from the 1950s to 1990 [see e.g. 519]. With the exception of Singapore, these countries had no other explicit population policies except for the promotion and wider provision of family planning services (Table 2).

Our answer is no and yes. No, considering the fact that the distinction between illegality and strong social disapproval or lack of choice is not a major one, particularly among the poor. Both situations mean lack of choice, particularly if incentives not to have children and disincentives to have them are used. In countries in which religion is a strong social factor, from an individual's point of view the distinction between morals and laws may be hazy, and social and legal control may be hard to distinguish from one another. Population targets, widespread family planning information, easily accessible services and increased sex ratios at birth, are not unique to China. The increased sex ratio in China was not intended, and the comparison with some other Asian countries suggests that when fertility is low in societies favoring men, sex ratios are likely to be high 63.

But yes – China's population policy is distinctive in two ways. Firstly, it has created an efficient system for the regular monitoring of all married women's pregnancy status. This allows early intervention by means of abortion, and constant enforcement of contraception. Secondly, it was designed to apply to all women. Usually, when a society has used legal measures to prevent individual women and couples from having children, it has acted selectively. Grounds have included the assumed health of the future child or the childbearing capabilities of the parents, especially that of the mother. In Europe, the largest group of women to be excluded from childbearing used to be non-married women. Currently, the largest group is very young women.

The answer depends on one's view of who should decide on reproduction. Should it be freely decided upon by an individual / by a woman or whether a society or state should decide. The individualistic approach has been promoted to give women a choice. The proponents of individualism mainly live in countries in which large numbers of births have not been a societal problem. European and North American countries have had pronatalistic population policies, if any. In Western countries, terminating a pregnancy is legally controlled to a greater extent than being pregnant, although abortion laws vary considerably from one country to another 1.

When a society or its leaders feel there are too many people for the society to function well, moral judgment of actions undertaken to restrict the size of the population is influenced by the quality of implementation tools and the grounds for deciding that there are too many people. After 1979, the tools for restricting population size in China did not respect individuals, and at least in some places they were coercive. However, the worst forms, including forced abortions, are believed to have been rare 15. The current national population policy explicitly prohibits coercion 40.

Many Westerners, with their cultural emphasis on gender equity, find sex-selective abortions disagreeable. To our knowledge there are no large-scale studies on Chinese views regarding sex-selective abortions. But a small study by Chu 38 found that even though rural women were undergoing such abortions, they did not think this was right and felt that it represented unfair treatment of girls.

Because it is unknown what would have happened without it, it is difficult to judge. When comparing the development in China to that in South Korea in the 1970s, the comprehensive and resource-intensive one-child family population policy in China did not seem to have been fully successful – the decline in birth rates was not exceptionally large. The 1979 reform of population policy coincided with the rural economic reform, with its shift from collective to private farming ("household responsibility"). This reform may have partly contradicted the aim of restricting and monitoring population growth 51642. The rapid changes in population policy may have confused people and lessened public support. But the aim of ensuring equity in the policy may have softened the criticism: all women and couples are faced with equally harsh requirements. Nathansen's 33 study from an urban area showed that most women resigned to the one child policy, because they accepted the reasons for it, even though their personal wishes may have been different. However, variations in local application and fines have created geographical and social inequity. Yearly fluctuation and unbalanced growth in different decades and generations puts an extra burden on the provision of services such as schools and child care facilities, and social security in old age. The system of personal responsibility, under which meeting the family planning targets is one central achievement indicator for civil servants at different levels, has worsened the quality of population statistics, thus impairing monitoring and predictions.

Sex-specific abortions have been practical in helping families to have at least one son with fewer births. In the short term both, parents and family planning personnel have benefited from this. But in the future, the social implications of fewer women may be considerable in a culture that values marriage. Lack of women is likely to have an impact on prostitution and trafficking of women, and other social problems 50.

This article has mainly analyzed the situation in China as it was up to 2000. China is rapidly changing, and this also applies to its population policy. Since 1994, the population policy has been reoriented. The new official policy emphasizes on quality of services, respect for the individuals, the needs of citizens, and informed choice 65. Reproductive health rather than population control is promoted, as well as cooperation between the family planning system and the health sector. The 2002 FP law prohibits discrimination of baby girls or their mothers. All over the world governments employ various mechanisms to regulate reproduction. Traditional methods of state control include marital laws, making infanticide illegal, protecting children from negligence, and regulating sterilizations and abortions in various ways. Reproduction is socially regulated through religion, morals, values, and laws. Modern technology, with its effective contraceptive methods, possibilities to see and study the fetus, and easier and safer abortion techniques, has made the regulation of childbearing technically easier. A comparison of China, where the state regulates who can be pregnant and, for example, Ireland, where the state regulates who can have an abortion shows how relative norms are in the area of reproduction 137. The case of China leads us to believe that at the societal level there is no shared "world" view on the legal control of reproduction. Whether such a view exists in the context of the values and morals of individual women or families is not a topic of this paper.