Times Literary Supplement, 12 January 1996

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', venereal 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 overwhelmingly 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 non-procreative 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.