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Reform in China's Population Program: a View from the Grassroots

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Reform in China's Population Program: a View from the Grassroots Reform in China's Population Program: A View from the Grassroots Diana Szatkowski Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy under the Executive Committee of the Graduate School of Arts and Sciences COLUMBIA UNIVERSITY 2015 ©2015 Diana Szatkowski All rights reserved ABSTRACT Reform in China's Population Program: A View from the Grassroots Diana Szatkowski Having largely achieved the goal of “controlling population quantity,” and faced with slowing economic growth, serious demographic problems, and the changes brought about by the deepening marketization of Chinese society, China’s central-level leaders have, in recent years, turned their attention to the lesser known twin objective of their population policy, “improving population quality.” To this end, they have introduced program reform aimed at improving the quality of services. They have adopted an eclectic approach to program reform, drawing selectively on global discourses and practices on sexual and reproductive health and rights and at the same time relying on their own model of experimental governance, namely, conducting “pilot experiments” in carefully selected sites. Developments at the central-level have been a subject of scholarly attention, but until now, relatively little attention has been paid to grassroots implementation, making it difficult to assess the degree to which practice has in fact changed. This dissertation examines how global discourses and practices on sexual and reproductive health and rights, articulated in global forums and consensus documents, have been taken on, interpreted, and experienced by people at the grassroots level in China. It is based principally on six months of fieldwork, July - December 2009, in Deqing, a rural county, located in the northern part of Zhejiang Province, in the Jiangnan region of China. Deqing is a pilot site for the introduction of “client-centered” approaches to implement the population program. Data were derived from participant observation, analysis of documents, semi-structured interviews with 17 local-level providers working at the county, township, and village-levels in clinical and administrative capacities, and 17 married women of reproductive age residing in three townships. I documented many innovative approaches that the local program developed to promote “quality service” and its various components, such as “information,” “choice,” and “rights,” as they understood them. I also found that the range of services that the program now provides extends well beyond birth planning and that in addition to its core demographic, married women of reproductive age, the program now targets new populations including those that have been a focus of global attention in recent years such as migrants and adolescents. For the populations that the program targets, migrants being a notable exception, the mode of governance has begun to shift from direct to more indirect means, the latter being considered a more efficient way to implement the program in the current environment. Unlike earlier efforts to “control population quantity,” which were often forcefully implemented and fiercely resisted, efforts to “improve population quality,” have received a warm reception by providers and clients alike in Deqing. While there are some continuities, overall, the changes that have been introduced are an explicit departure from past practice. Taken together, these findings contribute to ongoing debates regarding the dynamics and effects of globalization. Table of Contents LIST OF FIGURES, TABLES, AND BOXES ............................................................... viii ACKNOWLEDGEMENTS ............................................................................................... ix DEDICATION ................................................................................................................... x INTRODUCTION: ............................................................................................................ 1 CHAPTER ONE: Deqing ................................................................................................... 5 Section 1.1: Deqing County Overview ............................................................................ 5 Section 1.2: Three Townships ....................................................................................... 14 CHAPTER TWO: Research Questions ........................................................................... 23 CHAPTER THREE: Literature Review .......................................................................... 25 Section 3.1: One-Child Policy ....................................................................................... 25 Section 3.2: Globalization ............................................................................................. 29 Section 3.3: Governmentality ....................................................................................... 31 CHAPTER FOUR: Population and Development ............................................................ 35 Section 4.1: Global Discourse on Population and Development .................................. 35 Section 4.2: China’s Population Policy and Program ................................................... 38 CHAPTER FIVE: Problems ............................................................................................ 46 Section 5.1: China’s Population Problems .................................................................... 46 Section 5.2: Problems in Program Implementation ....................................................... 53 CHAPTER SIX: Methodology ......................................................................................... 55 Section 6.1: Prelude to Field Work .............................................................................. 55 i Section 6.2: Fieldwork .................................................................................................. 62 CHAPTER SEVEN: Program Reform in China ............................................................... 73 Section 7.1: The Experimental Model .......................................................................... 73 Section 7.2: The “Working Mechanism” ..................................................................... 74 Section 7.3: Technical Service ..................................................................................... 75 Section 7.4: Information, Education, and Communication .......................................... 80 Section 7.5: Informed Choice of Contraceptives .......................................................... 88 Section 7.6: Administrative Measures .......................................................................... 94 Section 7.7: Rights Protection .................................................................................... 100 CHAPTER 8: Expending the Scope of Services and Target Clients in Deqing ............. 106 Section 8.1: Implementing the Healthy Baby Plan ..................................................... 106 Section 8.2: Managing the Migrant Population .......................................................... 119 Section 8.3: Promoting Adolescent Reproductive Health Education ......................... 133 Section 8.4: Integrating Gender Perspectives ............................................................. 141 Section 8.5: Perfecting Population Policy .................................................................. 145 CONCLUSION ............................................................................................................... 149 BIBLIOGRAPHY ........................................................................................................... 157 APPENDIX I ................................................................................................................. 169 APPENDIX I I ................................................................................................................ 179 ii LIST OF FIGURES, TABLES, AND BOXES Figures Figure 1. Mountainous area in the western part of Deqing................................................. 6 Figure 2. Wetland in the middle of Deqing County............................................................ 6 Figure 3. Map of Deqing County ........................................................................................ 7 Figure 4. Piano factory in Piano Township ..................................................................... 16 Figure 5. Storage containers for wine at a factory in Piano Township ............................ 16 Figure 6. Bringing the freshly cut logs down from the bamboo forest ............................ 19 Figure 7. Bundling the bamboo ........................................................................................ 20 Figure 8. A man making a bamboo basket with his son ................................................... 20 Figure 9. Quality of Care (QOC) pilot sites ...................................................................... 45 Figure 10. China Total Fertility Rate (TFR) 1950-2009.................................................. 47 Figure 11. China Population Pyramid 2000-2056 .......................................................... 49 Figure 12. China Sex Ratio at Birth (SRB) 1970-2008 ................................................... 51 Figure 13. The “Working Mechanism” ............................................................................ 75 Figure 14. Floor map of the County Technical Service and Guidance Station (floor
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