[Paleopsych] TLS: Throw-away babies

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Throw-away babies
http://the-tls.co.uk/archive/story.aspx?story_id=2087590&window_type=print
    Frank Dikotter
    12 January 1996
    The growth of eugenic policies and practices in China

    The People's Republic of China recently passed eugenic legislation to
    prevent what are called "inferior births" from becoming a burden on
    the state and society. As Chen Muhua, Vice-President of the Standing
    Committee of the National People's Congress and President of the
    Women's Federation, declared: "Eugenics not only affects the success
    of the state and the prosperity of the race, but also the well-being
    of the people and social stability." Although such ideas have long
    been discredited in the West on both ethical and scientific grounds,
    eugenic laws in China have been implemented at the provincial level
    since 1988, while first drafts of the present national law were made
    some time ago. As a development which potentially endows medical
    authorities with the power to grant or deny life to millions of
    children, its medical, ethical and political implications deserve to
    be more closely scrutinized than has so far been the case.

    Whether or not all the allegations made by the Channel 4 programme
    Return to the Dying Room will stand up to closer scrutiny, it is
    beyond doubt that the increase over the past few years in the number
    of children suffering from minor accidents of birth who are abandoned
    is closely related to the spread of eugenic ideas in China.

    The control of the "quality" of births is thought in China to be as
    important as the control of "quantity": both have regularly been
    heralded as the twin goals in the regulation of reproduction since
    Deng Xiaoping came to power in 1978. The new eugenics law, which came
    into effect in June 1995, is not a random addition to the arsenal of
    regulations aimed at the control of the population's fertility, but an
    intrinsic part of population policies which has been in the making for
    over a decade.

    The term "eugenics", it should be emphasized from the outset, is not
    without its particular problems: there is generally no consensus as to
    what precisely constitutes "eugenics" or what characterizes its
    relation to contemporary genetics. Conflicting definitions of the term
    often reflect broader political positions, and its use in Europe
    generally expresses fears about direct government programmes. In
    China, the term used since the 1920s literally translates as "science
    for superior birth". In contrast to the West, China made no attempt
    after the Second World War to distinguish between "eugenics", a
    concept identified with Nazi policies, and "genetic counselling",
    meant to make medical information about reproductive health accessible
    to responsible individuals. A closer look at the recent legislation
    reveals both positive efforts to improve the accessibility of genetic
    counselling and worrying signs of official efforts to curb individual
    rights in the name of a genetic imperative.

    The 1995 law, renamed "Maternal and Infant Law" after protests against
    a preliminary draft entitled "Eugenics Law", supports the systematic
    "implementation of premarital medical checkups" in order to detect
    whether one of the couple suffers from "serious hereditary", ven-ereal
    or reproductive disorders as well as "relevant mental disorders" or
    "legal contagious diseases"; it suggests that those "deemed unsuitable
    for reproduction" should become celibate, or undergo sterilization or
    abortion in order to prevent "inferior births". The law explicitly
    points to voluntary sterilization and individual choice; the question
    is what importance will be given to "individual choice" in a regime
    that has never hesitated to imprison citizens who disagree with
    official policy, or to use military force to suppress dissent, as it
    demonstrated in Tiananmen Square in June 1989.

    In particular, one wonders what weight will be given to the
    "individual choice" of people defined as "mentally ill" and others
    deemed "unfit" by medical authorities and local cadres, and how these
    "choices" could be respected without the necessary legal framework. It
    is easy to slip from voluntary sterilization to compulsion, and one
    fundamental difference between genetic counselling and eugenics is
    precisely that the former informs families of potential risks; whereas
    the latter instructs them whether or not to bear children. The
    coercive implementation of birth-control programmes so far indicates
    that eugenic legislation will be carried out without any respect for
    couples' wishes.

    The second most troublesome aspect of Chinese eugenic legislation is
    that the right to reproduce, or even the right to exist, is determined
    by ill-defined and misguided ideas about "genetic fitness". There is a
    lack of a clear definition of what constitutes or should be
    considered, for instance, a "severe" handicap. Down's syndrome and
    hydrocephalia are often given as examples of "severe inherited
    diseases", but so are haemophilia, mucopolysaccharidosis or even
    diabetes; it has been suggested that foetuses which are found to be
    affected by any of these disorders by a DNA test after the first four
    months of pregnancy should be "instantly aborted".

    No definition is provided for the terms "mental retardation" and
    "mental illness", often referred to in official statements and eugenic
    legislation. There is a wide range of mental disabilities, many of
    which are only partially understood, and few forms of mental illness
    have been clearly demonstrated to have a genetic cause, yet political
    and medical authorities do not hesitate to prescribe sterilization for
    those judged to be "retarded".

    In 1988, the Standing Committee of the National People's Congress of
    Gansu Province passed the country's first law prohibiting mentally
    retarded people from having children. The law was directed at people
    whose condition was either inherited or a consequence of marriage
    between close relatives, and it decreed that they would not be allowed
    to marry until they had undergone sterilization surgery. Those who
    were married before the promulgation of the law would also be
    sterilized, and pregnant women diagnosed as suffering from mental
    retardation were required to have their pregnancies terminated. It
    remains to be established how many women have been forced to undergo
    sterilization or forced abortion in Gansu following this provincial
    law, but the crucial point is that the government has only recently
    started to recognize that a lack of iodine, rather than "defective"
    genes, is at the root of many mental-health problems in the
    countryside. This example indicates the human cost of the confusions
    which are frequently made in China between the dietary, environmental
    and genetic factors of population health.

    Such problems are compounded by a lack of discussion of the benign
    nature or relatively easy therapeutic treatment of some of the
    diseases that are represented as grave threats to social welfare. In
    general, both medical literature and official legislation rarely focus
    on specific cases in which the unique circumstances of individual
    cases need to be taken into account. Discussions about the ethical
    implications of eugenic laws, moreover, are hampered when such terms
    as "ethical" and "human" are viewed with suspicion in a socialist
    regime that dismisses such values as "bourgeois".

    Even in those rare cases of a demonstrable one-to-one correspondence
    between a gene and a defect, sterilization will not always reduce its
    incidence in the population. If an undesirable genetic trait is
    recessive or polygenic, sterilization is an entirely utopian measure,
    in particular since a person with such a hereditary disability is more
    often than not the offspring of normal parents. For example, to rid
    the "gene pool" in Britain of the recessive form of PKU, a metabolic
    disorder which can lead to mental deficiency, as Lionel Penrose
    calculated over half a century ago, 1 per cent of the British
    population would have to be sterilized. The absence of clear
    definitions of health and ill-health in eugenic legislation in China
    logically entails that every single individual's reproduction should
    be controlled, since all human beings are the bearer of some sort of
    "defective" gene.

    This indicates that the reasons for promoting such legislation may
    have more to do with politics than medicine, as it gives enormous
    power to local cadres and medical experts, a suspicion confirmed by
    the insertion of a clause in the 1995 law which notes that it is
    sufficient for a doctor merely to "suspect" a pregnant woman of foetal
    abnormality to recommend diagnostic tests and possibly the termination
    of pregnancy. Eugenic measures, furthermore, are constantly justified
    in the name of future generations. Abstractions like the "race",
    "future generations" and the "gene pool" are raised above the rights
    and needs of individuals and their families, just as claims about "the
    state", "the revolution" or "the party" have been used in the past in
    the political repression of population.

    How are these eugenic policies initiated? In the case of birth-control
    programmes, it has been suggested that hard-line policies generally
    emerged from a small group of high functionaries, while relaxations
    and accommodations were negotiated at local level by family-planning
    personnel and by specialists in research institutes. Similarly, it
    might be hypothesized that eugenic policies are resisted by the
    population at large.

    Li Peng, a high official who was also directly involved in the events
    in Tiananmen Square, is certainly one of the most open and active
    supporters of eugenics. ("Idiots breed idiots" is perhaps one of his
    most notorious public statements.) Many of the officials behind the
    promotion of eugenic legislation, in particular Peng Peiyun, head of
    the State Family Planning Committee, Chen Muhua, Chairperson of a
    Eugenics Symposium in 1989, and Chen Minzhang, the Minister of Public
    Health, all have close ties with Li Peng, confirming the impression
    that eugenic policies are supported by a small fraction of
    conservative party officials. It would be wrong, however, to suggest
    that these policies are being effectively opposed at grass-roots
    level; there is ample evidence to suggest that eugenics is supported
    by specialists and medical authorities throughout much of the country.

    As in Nazi Germany, the eugenic ideas of senior bureaucrats have found
    widespread support in research institutions and among population
    specialists, many of whom have been put into powerful positions of
    responsibility after decades of official ostracism before the reforms
    initiated by Deng Xiaoping. It would be equally misleading to think
    that research circles retain some independence from the government.
    The close relationship between research institutions and government in
    China is well known, while formal government control and informal
    personal networks contribute to the integration of research with
    government policy.

    Eugenic legislation, furthermore, thrives on social prejudice, in
    particular, folk models of inheritance which see disorders as running
    in family lines. The one-child family policy has effectively prepared
    the terrain for a better acceptance of eugenic legislation among large
    sectors of the urban population; many families which are allowed to
    have one child only are keen to avoid "defective" births themselves. A
    prolific medical discourse has responded to the general public's
    concern for healthy offspring, a virtuous child or even a genetically
    improved line of descent.

    Numerous pamphlets of scientific vulgarization thus dispense advice on
    the art of engendering a prodigy child, suggesting that the eugenic
    vision of the government is shared to a great extent by a population
    which is anxious to avoid "inferior births".

    The lack of any effort to establish guidelines on what constitutes a
    "birth defect" is compounded by social prejudice, in particular the
    cultural preference for a son; a female embryo might be considered a
    defect in itself. Although the government has issued a ban on tests to
    determine the sex of an embryo, it should not surprise us that the
    number of abandoned female children with minor defects, such as a
    harelip or a cleft palate both only require a minor surgical operation
    to be corrected has soared over the past few years. Tens of thousands
    of children are born with minor genetic illnesses every year, and many
    are abandoned by their parents.

    "Rabbit children", suffering from congenitally deformed mouths, and
    "whitoes", as children with albinism are called, are seen to be a
    burden on parents and on the state. Throw-away children, most of them
    girls, end up and die in crowded welfare centres and orphanages. Some
    lucky children are adopted by couples from Hong Kong, Singapore or
    Europe, but the majority remain patients for life. Serious birth
    defects are one of the most tragic and painful challenges any
    individual family can face, and all possible ethical considerations
    and medical options should be carefully considered and openly debated
    in order to reach some sort of consensus. The present eugenic
    legislation does not reflect any consensus; it is imposed by those who
    politically benefit from it.

    The argument that concern with human rights is a typically eurocentric
    activity, and that people in China find authoritarian policies
    relatively more tolerable, disregards the great diversity of cultural
    traditions in China. Some supporters of authoritarian approaches
    underline the sense of discipline which is thought to be inherent to
    "Confucian traditions". Even if one could find evidence for this in
    China's vast cultural heritage, it is not clear how that would compare
    to other cultures which have similarly emphasized the need for
    self-discipline, from Saint Augustine to the Protestant work ethic.
    Reproductive freedom is not the prerogative of a few privileged
    cultures, but an inalienable part of the individual rights which the
    government in China has consistently suppressed ever since it came to
    power in 1949.

    Coercive methods are only possible in non-democratic states, and the
    sterilization programmes used in India during the "emergency period"
    in the 1970s were over-whelmingly rejected when general elections were
    finally held. In China, too, the socialist regime knows that its
    policies would be directly attacked if democratic elections and legal
    freedom existed.

    Eugenics legislation is not only an important part of the population
    policies which have been actively pursued during the Deng Xiaoping
    era; it constitutes a fundamental aspect of a more general attempt to
    regulate the sexuality of each and every individual. Instead of
    distinguishing between individual sexual preferences, lines have been
    drawn between procreative and nonprocreative acts that are
    administered in the name of a higher entity, be it "the nation", "the
    state", or "future generations".

    Non-procreative forms of sexuality in particular pre-marital and
    extra-marital sex are not recognized as legitimate expressions of
    individual desire, but as psychologically disturbed and socially
    deviant acts that should be suppressed in the interest of the nation.
    Medical technologies have been mobilized in the official campaign
    against undisciplined sexuality in young people. It has been reported
    that extreme methods of "scientific control" have actually been used,
    including psychological and medical treatment for young people who are
    thought to suffer from "sexual hyperfunction" and "sexual addiction"
    (one article has recommended the regulation of the level of sex
    hormones for dangerous sex criminals and for sexually active young
    girls).

    The medical consequences of the government's efforts to restrict
    sexuality to a marital context have a direct impact on the
    population's health. To an even greater degree than in the West, for
    instance, HIV/AIDS is represented as a disease caused by sexual
    promiscuity instead of a virus which can potentially be contracted by
    every sexually active person. Until last month, unambiguous and clear
    statements about the protective value of condoms could not be found,
    and the human cost of the systematic campaign of misinformation
    carried out by medical institutions and government officials in China
    still remains to be estimated. Ignorance is already the main reason
    for the spread of sexually transmitted diseases in China. The
    regulation of sexuality in the name of the nation, rather than the
    control of disease for the sake of individual health, has thus been
    the ultimate objective of legal sanctions, social controls and medical
    norms in China ever since Deng Xiaoping came to power in 1978.

    Racial nationalism has also been on the increase in the post-Tiananmen
    era, from the representation of early hominids in China as the
    "ancestors" of the "yellow race" in palaeo-anthropology to the
    identification of the Han as the descendants of the Yellow Emperor in
    serological studies. A few publications in demography have even made
    claims about the "biological fitness" of the nation and herald the
    next century as an era to be dominated by "biological competition"
    between the "white race" and the "yellow race". The mastery of
    reproductive technologies and genetic engineering is seen to be
    crucial in the future battle of the genes, and the government has
    given much support to medical research in human genetics.

    A research team was even set up in November 1993 to isolate the
    quintessentially "Chinese genes" of the genetic code of human DNA. All
    aspects related to reproductive health, in other words, are linked to
    a nationalist agenda in which individuals are seen to be relatively
    insignificant elements of a greater collectivity.

    Whether the regulation of sexuality has replaced ideological control
    as the main tool of repression in the People's Republic is an
    important question which is open to debate. It is beyond question,
    however, that the signs of a drift towards an authoritarian form of
    government guided by biological imperatives have been accumulating in
    China for some time, and anybody with a serious interest in that
    country and its people should consider the implications of that drift
    carefully.

    Frank Dikoetter's book, Sex, Culture and Modernity in China: Medical
    science and the construction of sexual liberties in the early
    republican period, will be reviewed in a future issue of the TLS.