To the Editor: Hesketh and colleagues (Sept. 15 issue)1 providean interesting survey of the effects of the infamous Chineseone-child policy after 25 years. However, I was somewhat takenaback by the authors' editorial statement that "relaxation ofthe policy can be considered only if fertility aspirations aresuch that a baby boom will not result." Certainly, this is thesame sort of argument that tyrannical regimes have given forcontinuing their oppressive policies, from apartheid and dictatorshipsto the oppression of women and just about any other human-rightsviolation through history. The policy of one child per familyhas been a terrible violation of the personal rights of millionsof Chinese women. All that is necessary for the draconian policyto be removed, not just "relaxed," is for the Chinese governmentto make the decision to stop such repressive measures and startdealing with the problems posed by an expanding population throughmoral means. I am disappointed to see the "ends justify themeans" logic endorsed and unchallenged on the pages of a respectablemedical journal.
Thomas R. Jackson, M.D. Ireland Army Community Hospital Fort Knox, KY 40121
References
Hesketh T, Lu L, Xing ZW. The effect of China's one-child family policy after 25 years. N Engl J Med 2005;353:1171-1176. [Free Full Text]
The authors reply: We agree that the one-child policy is a violationof the human right to reproductive choice, as we acknowledgein our article. It is precisely for this reason that it is socontroversial. But we should not judge the Chinese by Westernstandards. Few Chinese see the policy as a human-rights violation.Most (though not all) accept it with equanimity, even in thecities where the one-child rule is enforced. This is perhapsless surprising when one considers the overcrowding in Chinesecities, the pressures of child care with two working parents(as is usually the case), and the high cost of raising children.
The Chinese authorities would argue that the policy has contributedto improvements in human rights by lifting more than 200 millionpeople out of poverty and by raising living standards for themajority of the population. In an increasingly interdependentworld, where available natural resources per capita are decreasing,the Chinese government should perhaps be applauded for havingthe courage to take unpopular measures to control populationgrowth.
Therese Hesketh, Ph.D. Institute of Child Health London WC1N1EH, United Kingdom t.hesketh{at}ich.ucl.ac.uk
Zhu Wei Xing, M.P.H. Zhejiang University Hangzhou 310006, China
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