Editing One-child policy (section)

=== Contraception and sterilization ===
[[File:Futu-north-0057.jpg|thumb|Propaganda slogan on a building at [[Yangxin County, Hubei]], reading "an [[Copper IUD|IUD]] after the first child, [[tubal ligation]] after the second"]]

Since the 1970s, the [[Intrauterine device|intrauterine device (IUD)]] has been one of the most widely promoted and practiced forms of contraception. It was the primary alternative to [[Sterilization (medicine)|sterilization]]. As directed, the IUD was medically implanted into women in their child-bearing years to prevent pregnancies, thus out of order births. In the 1980s, women either had to receive an IUD after giving birth to their first child, or the husband would have to undergo a vasectomy.<ref name="Cai2018">{{Cite news |last=Cai |first=Tiwen |date=2018 |title=Left in the Dark on Contraception, Young Chinese Seek Abortions |agency=Sixth Tone |url=http://www.sixthtone.com/news/1002188/left-in-the-dark-on-contraception%2C-young-chinese-seek-abortions}}</ref> Between 1980 and 2014, 324 million Chinese women received IUDs and 108 million were sterilized.<ref name=":16">{{Cite book |last=Greenhalgh |first=Susan |title=Governing China's Population, From Leninist to Neoliberal Biopolitics |date=2005 |publisher=Stanford University Press |isbn=9780804748797 |pages=257}}</ref> By law, the IUD was placed four months after the delivery of the first child. It was only medically removed after permission to conceive is granted by the community based upon various laws and policies on childbirth quotas.<ref name="Johnson2016">{{Cite book |last=Johnson |first=Kay Anne |title=China's Hidden Children, Abandonment, Adoption, and the Human Cost of the One-Child Policy. |date=2016 |publisher=[[University of Chicago Press]]}}</ref> Despite this, some [[Midwife|midwives]] illegally removed the device from their patients.<ref name="White1994">{{Cite journal |last=White |first=Tyrene |date=1994 |title=Two Kinds of Production: The Evolution of China's Family Planning Policy in the 1980s |journal=[[Population and Development Review]] |volume=20 |pages=137–158 |doi=10.2307/2807944 |jstor=2807944}}</ref> This led to IUD inspections, ensuring that the IUD remained in place.<ref name="Huang1989">{{Cite book |last=Huang |first=Shu-min |title=The Spiral Road, Change in a Chinese Village through the Eyes of a Communist Party Leader |date=1989 |publisher=Westview Press |location=[[Iowa State University]]}}</ref> Permanent legal removal of IUDs happens once a woman reaches [[menopause]].<ref name="Jiang2016">{{Cite journal |last1=Jiang |first1=Quanbao |last2=Liu |first2=Yixiao |date=2016 |title=Low fertility and concurrent birth control policy in China |journal=The History of the Family |volume=21 |issue=4 |pages=551–577 |doi=10.1080/1081602X.2016.1213179 |via=[[Taylor & Francis]] |doi-access=free}}</ref> In 2016 as means of loosening restrictions and abolishing the one-child policy, the Chinese government now covers the price of IUD removals.<ref name="Sivelle2005">{{Cite news |last=Sivelle |first=Kristina |date=2005 |title=Chinese women and their contraceptive choices |agency=China Daily |url=https://www.chinadaily.com.cn/english/doc/2005-01/18/content_410003.htm.}}</ref>

The most widely used alternative to IUDs has been sterilization. As the leading form of contraception in China, sterilization has included both [[tubal ligation]] and [[vasectomy]].<ref name="Kallgren2007">{{Cite journal |last=Kallgren |first=Joice K. |date=2007 |title=Review of China's Longest Campaign: Birth Planning in the People's Republic, 1949-2005 by Tyrene White |url=http://www.jstor.org/stable/20192745 |journal=The China Quarterly |issue=189 |pages=190–192 |doi=10.1017/S0305741006000981 |jstor=20192745 |s2cid=153652778}}</ref> Starting in the early 1970s, massive sterilization campaigns swept across the country. Urban and rural birth planning and [[family planning]] services situated themselves in every community.<ref name="Kallgren2007" /> Cash payments or other material rewards and fines acted as incentives, increasing the number of participants.<ref name="Johnson2016" /> Socially willing participants were considered role models in the community.<ref name="White1994" /> In 1983 mandatory sterilization occurred after the birth of the second or third child.<ref name="White2006">{{Cite book |last=White |first=Tyrene |title=China's Longest Campaign: Birth Planning in the People's Republic," Supplement: The New Politics of Population: conflict and Consensus in Family Planning, 1949-2005 |date=2006 |publisher=Cornell University Press |isbn=978-0-8014-4405-0}}</ref> As the restrictions tightened a few years later, if a woman gave birth to two children, legally she had to be sterilized. Alternatively, in some cases her husband could be sterilized in her place. In other cases, sterilization of surplus children occurred.<ref name="InformationPCR">{{Cite web |last=Information Office of the State council of the People's Republic of China |title=Family Planning in China |url=http://www.china-un.ch/eng/bjzl/t176938.htm. |website=Permanent Mission of the People's Republic of China To the United Nations Office At Geneva and Other International Organizations in Switzerland (1995)}}</ref>

In the early years of the sterilization campaigns, abortion was a method of birth control highly encouraged by family planning.<ref name="Jiang2016" /> With 55 percent of abortion recipients as repeat customers and the procedure easily accessible,<ref name="Jiang2016" /> women had chosen to abort and had been forced to abort because of laws, social pressure, discovery of secret pregnancy, and community birth quotas.<ref name="Johnson2016" /> In 1995, the [[People's Republic of China]] (PRC) warned against abortion as a means of family planning and as a contraceptive. Should an abortion be required, the woman was to have a safe procedure done by a registered physician.<ref name="InformationPCR" /> Despite this, some women even in the 2000s chose or were encouraged to use traditional abortive products such as [[blister beetle]]s, also known as ''[[Mylabris]]''.<ref name="Sommer2010">{{Cite journal |last=Sommer |first=Matthew H |date=2010 |title=Abortion in Late Imperial China: Routine Birth Control or Crisis Intervention? |journal=[[Late Imperial China (journal)|Late Imperial China]] |volume=31 |issue=2 |pages=97–165 |doi=10.1353/late.2004.0009 |pmid=21328808}}</ref> Women would ingest the toxins orally or by means of douching with the hopes of inducing abortion. An overdose could lead to death of the mother and [[fetus]].<ref name="Sommer2010" /> The efficacy of these products has been very low with a high mortality rate. The medical community and PRC have warned against use of these traditional methods.<ref name="Jiang2016" />

The priorities of individual families also played a role in the birth rate. Families debated the social and economic stability of the household prior to conception. Some families chose to follow the single-child limit due to varying social and economic factors such as marrying later, spacing out children, the cost of raising a child, the fines for having multiple children, birth control policies, and the accessibility of contraceptives.<ref name="Jiang2016" /> In addition, those who violated the one-child policy could lose their jobs, their titles, a portion of medical insurance, and opportunities for higher education for the second child; they could also face sterilization and the labeling of the second child as a "black child".<ref name="Johnson2016" /> All of the variables played an important role in couples' decisions on when to conceive, placing their social and economic situation above the desire to bear additional children.

Other examples of contraceptives have included the [[Morning-After pill|morning-after pill]], [[birth control pills]], and [[condom]]s. The morning-after pill has made up 70 percent of oral contraceptives in the Chinese market.<ref name="Cai2018" /> Only seven percent of Chinese women had shared that they use the pill and condom in combination.<ref name="Sivelle2005" /> The Chinese government promoted the use of IUDs and sterilization over the combined pill and condom because PRC authorities questioned the voluntary commitment of the public.<ref name="Huang1989" /> The Chinese government has distributed free condoms at medical clinics and health centers to adults with proof that they are 18 years of age or older. Additionally, the rate{{Clarify|date=June 2023}} and highly debated [[sexual education]] have increased awareness of sex and contraceptive measures among groups of China's young population, further lowering the birth rate.<ref name="Cai2018" />