Theses Doctoral

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

Szatkowski, Diana

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.

Geographic Areas


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More About This Work

Academic Units
Sociomedical Sciences
Thesis Advisors
Cohen, Myron L.
Ph.D., Columbia University
Published Here
February 6, 2015