Appendix A

Selected Testimonies Coerced Abortion and Sterilization Cases in Tibet

Case #1

Name: Tsering
Occupation: Farmer
Sex: Female
Region: Eastern Tibet
Date of Interview: October 1994
Source: Personal account

Case Study:

Tsering was the victim of forced abortion and sterilization by local birth control officials in her rural village in Tibet. Having lost one child as the result of beatings and imprisonment the authorities fined her severely for falling pregnant again and then insisted on an abortion followed by sterilization. She lives with the guilt of killing her unborn child and recounts the stories of other women like her who were coerced into sterilizations.

Testimony:

"I was 19 years old when I married. My father basically decided and I was told that I had to stay with my husband and he would be good to me".

"First of all I had a couple of miscarriages and then my first baby grew ill and died. The second baby also died. This happened when my husband escaped (he was sentenced to 13 years for being a counter-revolutionary) and I was interrogated. I was beaten. While they were hitting me I dropped my child and she died. The third child lived.

"When my next child was born we had to pay a fine of 3000 yuan ($US600) in a lump sum, plus a female yak and a dzomo. My husband was doing good business so we could afford it, but other people couldn't pay and had to borrow off each other. Most women agreed to have the abortion since they didn't have the money to pay the fine. The authorities told us:`If you can't pay the fine, your house will be locked up and given to the government'. After my second daughter I had another child. We were supposed to pay the fine within three months but the child died of pneumonia before three months had gone by.

"While my husband was in prison I worked on the farm and local Chinese authorities came and gathered us. I was sterilized. I had already had more children than the official limit.

"Women were told they could only have a second child two years after their first one was born and after that they were sterilized. Before being sterilized,I told the leaders that I didn't want to do it. Then I had a discussion with my husband and he said that he had heard that it wasn't painful to be sterilized. Moreover, during meetings they would tell me that I had enough children:`Don't you have enough problems going around borrowing money to pay for the child?' They would make you feel ashamed.

"Actually, after my third child I became pregnant again and this time I had an abortion. During my pregnancy the authorities told me: `If you don't listen to us now and get an abortion we will put you in prison'. I don't know whether they would have really done that or not. There were no women in prison because of this. Women were too scared and since they couldn't pay the fines, they went and got themselves sterilized.

"Since my husband and I wanted to stay together I felt it was better to be sterilized to avoid committing another sin.The one who carried out the operation was Chinese but the nurse was a Tibetan. Actually they gave me an anesthetic but I could still feel what they were doing. I was tied to a bed. The lady said: `We're not doing anything much to you'. The nurse was just doing her job; she didn't say much.

Some women had contraceptive pills and others had some kind of iron ring in the opening of their uterus, but they had to get checked all the time. Some of them did get pregnant even when they took the pills or had this ring. Then the child would have to be aborted.

"After the operation I could take care of myself because we were pretty well off, but I know of cases where women did not have enough care or money and some died. My friend died one or two months after she was sterilized; we knew each other well and met almost every day. She was bleeding a lot. She was from Chags-skad-sham. This happened in 1988. I know of four or five other women who died also.

"After the operation I had heart problems because I worried and sometimes I wished I hadn't had the sterilization. I talked to my husband but he didn't understand. I couldn't give love and I couldn't be nice to my children. Even the warmth of my body had gone. I felt cold and empty inside. I did talk to other women about it but there was nothing much we could do. I also went to the doctor and he said this was something which all of us would have to bear; even the Chinese.

"Other women also felt the same. Many of them were not properly operated on but I was lucky because I knew someone at the hospital and because of that I was treated better. I was able to stay a bit longer but I know many women who didn't have these connections. They had a much worse time. Some of them had pain; they couldn't drink a lot or they had problems urinating. Chinese women got the same treatment. I know a Chinese woman who could not pay the fine for having an extra child and escaped to Lhasa.

"But the experience of having an abortion or sterilization is not the same for Chinese and Tibetan women. In some ways Chinese woman are treated better. They have better jobs and they don't have to work as hard. Actually I don't know many Chinese. They came to our village but would not stay there - they would come and go. I did not have much interaction with Chinese people..."

Case #2

Name: Name withheld at interviewee's request.
Occupation: Farmer
Sex: Female
Region: Amdo
Date of Interview: April 1994, in India.

Case History:

At the time of the interview, the interviewee and her husband had recently arrived in India. The interviewee underwent sterilization after giving birth to her third child. They left Tibet when they couldn't pay the annual fine for having a third child. Their residence permit ("themtho") was only valid for their own village.

Testimony:

"Three of my sisters and I have been sterilized after family planning was introduced. I don't know exactly when the authorities started the policy. At first we could have three children, but for a few years we are have only been allowed to have two children. Many women in my area have been sterilized or have had abortions. In the beginning the sterilization/abortion policy, operations were carried out in the nearest hospital, but these days birth control teams carry out the operations in our village.

"There are many Chinese Muslims in my area. The birth control policy for Chinese women is exactly the same as for us Tibetans. The Chinese women hate the policy as much as we do. I know that women in China itself are allowed to have only one child. The policy in our area is less strict. Still I feel that the policy is much more dangerous for us than for the Chinese. There are so few Tibetans and so many Chinese. Besides, many Tibetans are monks and nuns.

"When I was pregnant with my third child Chinese officials came to my house many times to try to convince me to have an abortion. They told me that I was not allowed to have a third child and that I should go to hospital when I was about five months pregnant to have an abortion injection. I became very frightened and decide to leave my home until the baby was due. I was afraid I would be forced to have an abortion if I stayed at home. I went to stay with my mother in another village. During the months I stayed with my mother the officials who had told me to get an abortion came to my home about ten times. They asked my husband where I was. When he said that he didn't know where I was they slapped him in the face, kicked him and beat him with sticks. They threatened to arrest him if he didn't tell them where I was and if I didn't turn up. They carried pistols and hand-cuffs.

"When the baby was due I went home. About one month after the delivery the officials came to my house again and threatened that they would take away all our possessions and arrest my husband. When we said we would pay the annual fine of 500 yuan until the child was 15 years old, they didn't take our possessions, nor did they arrest my husband. They ordered me to come with them to hospital. I was given an injection in my spine. It was meant to anaesthetize me, but in fact I could feel exactly what the doctors were doing. The operation was very painful. There were four beds in the surgery room. I saw with my own eyes how they injected pregnant women with very long needles. They injected the head of the baby with some kind of poison. Later these women had miscarriages in hospital. I saw many foetuses in the toilets. I saw how they were eaten by dogs. The parents weren't allowed to keep the foetus unless they paid the medical bill for the operation. These bills were so high that nobody could pay them. After the sterilization operation I stayed in hospital for three days. Then I went home. I felt very weak and stayed in bed for about a month. For three months I couldn't work. Ever since the operation I have had a lot of pain in my kidneys. If I drink a lot my kidneys hurt.

"The reason that the Chinese officials are so keen to have all women with two or more children sterilized is that they have to fulfill an annual quota. If they can't fulfill this quota they are fined. This happened to a Chinese Muslim. He was a leader. According to the quota between 70 and 100 women per village have to be sterilized or aborted every year. The precise number depends on the size of the village. These days the family planning teams come to the villages and carry out the operations locally. In my village there are very few young children. Some women who had only one child were sterilized. The only women who are not hassled by the family planning teams are unmarried women without any children. The reason that some women with only one child were sterilized is that the family planning teams had to fill up the quota. As far as I know, hardly any women have appealed to higher authorities against these illegal sterilizations. They are so afraid that they keep quiet and go along with the orders of the family planning teams. D. was detained for 20 days when his wife refused to be sterilized. She had two children. Only when she finally consented to be sterilized did they release her husband.

"We paid the annual fine of 500 yuan for three years. It became increasingly difficult for us to save enough money for this fine. Moreover we didn't get a "themtho" for the third child, which meant that the costs for this child were much higher. After three years we decided to leave our village and to try to avoid the fine by going somewhere else. The problem was that we didn't have a residence permit for other places. We couldn't stay in the same place for long. As soon as the local authorities found out that we came from another place, we had to leave. We decided to try and go to India..."

Case #3

Name: Anonymous
Occupation: Birth Control Operative (1986)
Sex: Male
Region: Kanze (Ganze) Kham
Date of Interview: Conducted in India in March, 1990
Source: TIN Doc.T8 (BB)

Case History:

T8(BB) is a Tibetan man from Dartsedo who was trained first as an accountant and then as a birth control operative. In 1985, after two months training, he was sent to work on birth control programs in a rural area of Kanze.

Testimony:

"I was put to work in the birth control hospital, as the Chinese needed a Tibetan educated by them to carry out this work. This hospital was mainly dealing with abortions and sterilizations. The officer running my department told me that as I had experience in many fields, had been educated by the Chinese government and could speak Chinese, I was the sort of young and energetic person they would need to work in the new department. But before joining this department I was previously trained for two months to be able to carry out that kind of work.

"I was trained in the same district. From 1983 until 1985 the Chinese government launched an abortion and sterilization program. During that period a lot of directives were issued regarding this program. I had to study these documents during my two months' training. After this training I was sent, in 1985, to a sub-district to work.

"But my job at that time was not to carry out sterilizations or abortions. My first work was taking a local census. I had a team working with me and we had to go around villages to try and find out how many families were living there, the age of each person, and list all this information. We had to report on each woman between the ages of 15 and 45, as they were considered fertile. In 1986 I started to report on my investigations, then the abortions and sterilizations began. Experts (specialist doctors) from the Tibet Autonomous Region came to this hospital to work.

"There were 13 in the team and I was their leader. I had to take the main responsibilities. There was no quota but there was a "Win Jin" (directive) which came from the Central Government and was then transmitted to the district level. These directives were based on information passed to officials by the teams visiting villages. Then the Chinese officials would decide who should receive abortions. A woman with three children would have the fourth child aborted. But there were cases of women with only one child receiving abortions; in those cases the main consideration was the time span between the first child and the new pregnancy.

"When it was a couple, they had the choice of whether the woman or the man should be sterilized. The Chinese had different methods of sterilization or abortion. I have been taught how to sterilize a man. It does not take long, about 15 minutes. It is just an injection in the testicles. The Chinese have a new chemical called "San du yie"; you just inject this very thick substance to sterilize a man or woman. They first experienced it in Tibet. To sterilize women, they injected each ovary. They also had birth control methods like IUD; often because of lack of hygiene, these insertions were followed by infections. I once witnessed the birth of a still-born baby with an huge head and an IUD stuck in his neck. I was eyewitness to cases of abortion as I worked as an interpreter for a Chinese doctor.

"There were two methods of abortion. One was the case of a woman who already had two children and was pregnant with a third. The doctor removed the five to six months old baby from the womb, and then killed the foetus with an injection. There was also another more common method to abort which I witnessed. First water was removed from the womb by syringe. Then medicine was given to the mother to deliver the baby still-born. I first saw this method of abortion in June 1986. Hygiene was very poor. We had no other precautions than washing the instruments which were used with boiled water. Two women came back a few days after having an abortion with infections. One of them became paralysed. Another woman with post-abortion infection was found to have scissors in her womb. The scissors had been used to stop hemorrhage when the woman was bleeding excessively after her abortion.

"I witnessed more than 2,000 men and women being sterilized in a district of about 40,000 inhabitants. In the village where I was working, we sterilized 163 people out of a population of 4,953 in just one week in June 1986. [If the person selected for sterilization did not come to the hospital,] then he or she was fined from 1,500 to 1,800 yuan; it depended on the condition of the family.

"In my sub-district, during June and July 1986, I personally witnessed about 13 cases of abortion where the doctor extracted the baby from the womb. The second method was more frequent and less painful; I saw about 50 cases of women aborted by taking the water out of the womb during this same period of two months.

"The latest pregnancy I have seen terminated was at seven months. After that they generally did not abort. They fine the woman. But I remember once that they aborted a woman who was more than seven months pregnant..."

Case #4

Name: Anonymous
Occupation: Cook
Sex: Female
Region: Lhasa
Date of Interview: 1990 in India
Source: TIN Doc.T2(BB)-B

Case History:

The interviewee is a woman from a former noble family in Lhasa. She was working as an assistant cook in a small government office dealing with Chinese migrants. Her husband was a driver in another department. She left Tibet in 1989.

Testimony:

"I've had three abortions. I had my first abortion when I was 30 years old. I already had two children and at that time my husband was just about to get a promotion in his office. If we had kept the child my husband would not have been promoted and we would have had to pay a fine, because I was pregnant without permission from the Chinese administration. So we decided to abort.

"Before the Chinese enforced their birth control policy in 1982 there was no limit on Tibetan births. Now, as office staff, you only have the right to have two children.

"A woman from Ba, between Kham and Amdo, injected a thick yellow fluid into my stomach...About 10 or 11 hours after the injection the child was born. The sensation was the same as normal birth, but the child came out dead.

"I had no local anaesthetic. Just after the delivery they checked that there were no complications and then told me to leave the hospital. I had no other medical treatment.

"After three months I got pregnant again, even though I was taking the Pill, once a day, after the first abortion. I went to the People's Hospital after 40 days. This time they used another method of abortion. I had to lie down and without any anaesthetic, the doctor scraped inside my womb with a kind of spoon. It lasted about twenty minutes, and then I went home.

"After the second abortion I changed the pill brand but it still did not prevent me from getting pregnant again. I again went to the People's Hospital when I was about 40 days pregnant. They used the same method of abortion. After, I asked the doctor to fit me with an IUD because I had no confidence in the Pill. I was aware of the possible risk, as they are made of iron and get rusty. I heard that this happens sometimes. After having this IUD, I lost a lot of weight and have very heavy periods with dark blood and pus."

Case #5

Name: Tashi Dolma
Occupation: Doctor (1989)
Sex: Female
Region: Amdo
Date of Interview: 1990 in India.
Source: TIN Doc.T17 (BB)

Case History:

Tashi Dolma was a doctor of western Medicine in Gonghe (Gungho in Tibetan), in Hainan (Tsholho) in Qinghai (Amdo). The eldest of nine children, she was trained at a medical school in Xining from 1980-83. She was 26 years old when interviewed. She has one child, born in 1986.

Testimony:

"When I got married in 1984, I was 22. From a medical point of view, the best time for giving birth is from 23 to 25. Thinking of the well-being of ourselves as well as our undelivered child, we ran everywhere and with our best efforts eventually we were able to get a permit.

"I conceived a child in 1985 and delivered on March 10, 1986. We wished she had been born the previous year but could only give birth to a child after getting permission from the office where you are working, and from the regional and the district offices implementing the Government's birth planning policies. It had taken two years to get the pass. We had to bribe, pay money and use back-door connections to get the permission to have the child. Altogether we paid 300 yuan, and gave cigarettes and alcohol. Normally you need to wait four-five years and do not have to pay, but there are people who have already waited for more than five years because their turn has never come up. I know of cases like that.

"When my daughter became three years old, we decided to have another child. But this time, there was no way to get a birth permit. So, all our family decided to pay 1,700 ($US340) yuan for a birth permit and we got it. The Chinese Government has decreed that a fine must be paid by anyone who gives birth to an additional child going against their birth control planning. Each regional office decides the amount of money to be paid in such a case and in our Tsholho region the fine was 1,700 yuan.

"On October 1988, the second child was conceived. My boss in the office came to know about it after two months. Because of my vomiting it became obvious. She would visit me almost every day and used all means to try to convince me to have an abortion. I did not listen to her at all and made it clear to her that I would certainly give birth to my child. My Chinese boss, Ms. Hong Haphun Yin, head doctor of the Pharmacology Section, told me: `Go home and think well. Return to work after you have thought well. You should do the abortion soon'. "I simply let the time pass and after some time I went to see her. I told her that I would like to have the child and would pay any amount of money as a fine. She became furious and warned me: `If you do not want to listen and insist on going your own way, do it. Paying the fine is just a small matter. You will be punished by the Chairman. From your salary you will be given only 30 percent to live on and it will never be increased. Your child's name will not be registered. He or she will therefore not be allowed to go to nursery or school. Both of you could be dismissed from your jobs'.

"We did not know that it was such a serious matter or that there were as many regulations as my boss pointed out to me. We thought it would be alright to pay the fine and that we could then have our child. Initially, I even though that she was simply frightening me. But later I learnt that there were clear-cut, finalized documents on such matters which are circulated to officials, but were never announced to the public. Under such repressive conditions, I had no choice but to have an abortion.

"At that time the child in my womb was already two months and twenty-four days old. With a few more days I could have already crossed the three month child abortion period. The best time for child abortion ["ringong liuchan"] is between 45 to 50 days. But my child was already 84 days old so the only way to do an abortion was through the "sbug jog bu dbyung" ("chaguan ringong liu chan") technique. It causes a lot of bleeding and pain.

"First they insert a sort of flexible rubber tube with a pointed end into the cervix. There is no medicine in this. They leave this inside for 24 hours. Because it stimulates the birth canal, which opens up slowly and gives way to the flow of blood, a lot of bleeding starts after two hours. After one day they take it out. It has become bigger inside so it is easier for the knife to get inside. They insert an instrument which has a sort of long handle with a knife at the end. They put this inside and start to move it around, cutting the fetus in pieces. Then it is very easy to extract.

"The fetus then has been reduced to many small pieces and is removed by using a sort of compressor, with a pressure of around 200. The fetus is sucked into a sort of container which is then thrown away. This method is commonly used for abortion.

"On January 3, 1989, at 4 pm, my Chinese boss asked doctor Tao Ye Tain of the Birth Planning [unit] to insert a tube into my cervix. This was at my own hospital. Beside of the lack of proper medical equipment to do that, I was not even given anaesthesia and thus experienced excruciating pain at the time. She was unable to finish the insertion until at 4.30pm. She was a Chinese doctor from Qinghai, who had completed her midwife training at the Kokonor Provincial Health Care School. That was her field of specialization. Before that she was a nurse at the Gynecology and Maternity Ward of the Tsholho Regional Hospital. She was later transferred to the Go-ten Hospital's Birth Planning Section.

"On January 4, at 10.00 am, Dr. Tao did an operation on me- the abortion. Because of the previous day's tube insertion in my womb, the surgery became a little easier. First she inserted the instrument ("gua shao") into my uterus, stirred and destroyed the child inside. And then in order to remove the afterbirth completely, she scraped out the uterus in a clockwise direction twice. It took about three minutes. Then she turned on the sucking machine and inserted the tube into my uterus. The fetus was sucked out along with the uterus lining. Because my child was slightly bigger than others [bigger pieces of flesh] often blocked the opening of the tube. The surgery took about half an hour. But an innocent being was mercilessly killed in that way.

"No words have the power to express the excruciating pain I experienced during the operation. Over 85 percent of the women workers have to undergo the same torture and excruciating pain of surgery like me. It is even more tragic to remove a child of six to seven months from a womb.

"There was no medical treatment afterwards. You have to leave immediately after receiving the operation. You get 15 days off from work and miss your allowance. You have to pay for the treatment, about 17 yuan and 80 mao, to the hospital. You can stay for a night in the hospital but I went to my house.

"I do not know what has been damaged inside me and I think this method is used on many people. My physical and mental well-being have been badly affected. After the abortion I was not well. I had a period twice a month, sometimes for 15 days at a time. At the Delek Hospital [in India] they said that I have anaemia as a result..."

Appendix B

Excerpts from Birth Control Regulations

1) Excerpts from "The Temporary Method for the Management of PLanned Birth in the Tibet Autonomous Region." (Draft, Version 1) 8 May, 1992.

Source: TIN Documents on Birth Control, March, 1994.

Chapter 1. General Rules

Article 1. It is a basic State policy of our country to practice planned birth. In order for population growth to comply with economic and social development, according to relevant regulations provided in the PRC Constitution, PRC National Autonomy Law and PRC Marriage Law, we drafted this method, bearing in mind the reality of our region.....

Chapter 2. Late Marriage, Late Births and Controlling Births

Article 5. We must advocate and encourage late marriage. Chinese who marry three years later then the legal marriage law is [are considered to have had] a late marriage. Married women who give birth to their first child at the age of 24 is [are considered to have had] a late birth. Tibetan and other minorities within the region who marry three years than the legal marriage age provided in the PRC marriage law supplementary rules provided by the TAR is [are considered to have had] late marriage, while Tibetan and other minority women who have had their first child at the age of 22 [are considered to have had] a late birth.

Article 6. Those who comply with these birth conditions should themselves apply, taking their residential certificates and certificates of pregnancy, to the special planned birth cadres in the work unit above the level of country to which the women's residential permit belongs. They should go to the local city [area] Planned Birth Administrative Management Department to ask for a "birth certificate"...

Article 8. Tibetan cadres and workers and their families who are township residents, who residential certificates are in their work units within the region, can have two children with an interval between. The second birth must be more then three years after the first. Third births must be strictly controlled...

Article 9. In the heart of the agricultural and nomadic areas, we must focus on education and propaganda, cooperation and providing services. We must advocate fewer births and births at intervals, and further stress that couples that already have three children no longer give birth. We must start by trying out propaganda work, and then gradually widen the scope [of the movement] on that basis...

Article 12. We must stick to contraception as the main method and widely combine a mixture of planned birth measures. The Government should offer contraceptive medicine and equipment free of charge under the plan. Couples of childbearing age must implement effective contraceptive methods and extra-plan pregnancies must be dealt with by appropriate methods...

Chapter 3. Management

Article 14. Government offices and industries and other work units must take planned birth, late marriages and late births as an important test for promotion. They must put forward and evaluate models and advance workers according to the same standards. Whenever a cadre or worker is transferred to another work unit, his/her planned birth situation must also be put on file.

Article 15. Each area [city] and country must establish a planned birth leading group and officers equipped with specially trained cadres.

Article 16. Each level of the Planned Birth Administrative Management Department is the functional department which is mainly responsible for the planned birth work of the People's Government at the same level. It is responsible for the realizing the implementation of the relevant planned birth policies, rules and supervising the execution of planned birth rules and population plans...

Article 18. The planned Birth Management Office of the xiang [town] people's government and of the neighborhood office is responsible for the following work:

(1) propagating and carrying out relevant planned birth policies, methods, rules and regulations;

(2) propagating information on population, planned birth, quality births and quality upbringing;

(3) distributing contraceptive medicine, guiding, helping and supervising the couples of child bearing age to implement contraceptive methods;

(4) providing rewards and penalties according to the scope of its responsibilities;

(5) carrying out statistical work on planned birth;

(6) carrying out the other planned birth management and service work...

Article 21. Planned birth statistics must be strictly carried out in accordance with the PRC statistic law. No work units or individuals should make false statements, falsify or alter statistical figures...

Article 24. Contraceptive operations must be carried out by the specially trained medical technical personnel at medical work units which have good conditions. The operators must strictly carry out the routine for contraceptive operations and secure the safety if the patient. Individual operators [doctors] must not perform contraceptive operations.

Chapter 4. Rewards and Incentives

Article 25. Women workers from State offices, industries and work units (including contract workers) who practice late marriage and late birth and who have single child certificates will be given the benefit of longer maternity leave; cadres and workers who practice late marriage will enjoy an additional week of marriage leave.

Article 26. Cadres and workers (including contract workers) who have had contraceptive operations will be given the following holidays, subject to evidence produced by the hospitals at the country level or above:

1. Three days off for the insertion of the contraceptive ring, plus one week off from heavy labor;

2. Twenty days off for the remedial method;

3. Twenty three days off for those who both adopt the remedial method and the insertion of the contraceptive ring;

4. Thirty days off for having a tubal ligation of eggs [or sperm];

5. Thirty five days off for both adopting the remedial method for having a tubal ligation of eggs [or sperm];

6. Fifty days off for inducing birth [yincan] in the middle of pregnancy;

7. Sixty five days off for including birth in the middle of pregnancy and having a tubal ligation of eggs [sperm]...

Article 29. Those who receive a single child certificate can enjoy the following treatment:

...3. A single child enjoys priority arrangements with respect to entering kindergarten and going to hospital if other conditions are equal. They also enjoy advantageous arrangements with respect to enrollment at university, in the factories, and the army...

Article 30. Children of minority cadres and workers, such as Tibetans, who comply with the planned birth regulations, who leave the region for clinical treatment with the approval of the hospital and units, will have their travel fees and medical expenses refunded half and half by the couple's work units upon the couple providing the hospital receipts....

Chapter 5. Limitations and Punishment

Article 34. Tibetans and other minority cadres and workers within the region who have extra births will be given the following punishments:

1. For the first extra birth, a penalty fee of 500 yuan will be charged as an extra birth fee [if one member of the couple does not have a stable profession the fee is 300 yuan], and for two neither member of the couple is allowed a promotion, raise, or bonus [including salary awards].

2. For the second extra birth, a sum of 1000 yuan extra birth fee will be charged [if one member of the couple has no stable profession then 600 yuan will be charged]. For three years neither member of the couple will be promoted, be given a raise, or enjoy a bonus [including a salary award] and should not be awarded the status of advanced workers. One member of the couple is also advised to have a sterilization operation.....

Article 38. Those who become pregnant within the region can only be given a birth certificate to have the child registered in their household by providing three items of proof [a witness, the local police station, and work units of the people concerned, or the local neighborhood committee]. Otherwise they will be treated as having an extra birth...

Article 41. Citizens who behave in one of the following ways will be given administrative punishment, and those whose behavior constitutes a crime will be identifies as criminally responsible by the legal department:

...3. Without approval, examining the child's sex, removing contraceptive equipment for others, reconnecting tubes that transport eggs [sperm] for others and preforming a contraceptive operation against the rules, thus causing an accident.....

...7. Doing anything else which violates planned birth...

2) Excepts from the Document of the District People's Government at Gonghe, published by Gonghe People's Government, 1991, No.90.

Source: Human Rights Desk, Department of Information and International Relations, Central Tibetan Administration, Dharamsala, India.

A report on "Policy-Strategy Regarding Leniency on Imposition of Monetary Fines on those Exceeding Planned Limit on Births Per Couple in Our District for those Agreeing to Submit to Birth Prevention Operation" in our district.

A submission for the attention of the District People's Government:

Since birth control was implemented in our district in 1982, we have achieved appreciable results in implementing the "Regulations for implementation of birth control in Qinghai province" and the "Supplementary Regulations for the Implementation of Birth Control in Gungho District." But because of several reasons, there are still households with a large number of members who, because of their stubborn adherence to old customs and traditions, resist birth prevention operations. This continues to render implementation of the policy difficult. In order to achieve all-around results in the implementation of the birth control policy, we have finalized this "Policy Strategy Regarding Leniency on Imposition of Monetary Fine on those Exceeding Planned Limit on Births Per Couple in Our District for those Agreeing to Submit to Birth Prevention Operation". For this purpose, and in order to implement the resolutions of the first meeting of the State Family Planning Commission held in 1991, we submit the following report of policy strategy:

1. Regarding those who from 6 December, 1982 to 31 December, 1988 neither volunteered to undergo birth prevention operation, nor agreed to pay monetary fines, the birth prevention operation will be carried out without exception and on the basis of the number of extra children, monetary fines will be collected before the end of the year 1991. [The fines will be 300 yuan for one extra child, 600 yuan for two extra children, and so on.]

2. Regarding those who had, on whatsoever criteria, one or two extra Children from 1 January, 1989 to 31 December 1990, and who failed to undergo the birth prevention operation or to pay the monetary fines, the operation will be carried out without exception before the end of the year 1991. A certificate of confirmation evidencing the operation must be shown. This will be followed by leniency to the extent of 600 yuan for those having one extra child and 400 yuan having two extra children out of a total fine of 900 yuan. In case of those who have already agreed to have birth prevention operation but submitted to it only in the following year, leniency will be shown to the extent of 500 yuan for those having one extra child, and 300 yuan for those having two extra children out of a total fine of 900, and birth control prevention operation will be carried out unconditionally.

Regarding those having three or four extra children who have neither submitted to birth prevention operation nor paid the monetary fine, birth prevention operation must be carried out without exception and, in addition, the entire amount of 900 yuan fine will be collected without any concession.

3. Regarding those who from 6 December, 1982 to 31 December, 1990, on whatever basis or criteria, had violated the birth limit per couple and who had already agreed to pay the fine but had not yet had the birth prevention operation, the birth prevention operation will be carried out before the end of 1991 or, in any case, within the year 1992, and no excuses or pretexts will be entertained as any reason for staying or postponing the operation any further.

4. From 1 January, 1991 onwards, the birth control policy will be strictly implemented and in the case of those exceeding the limit, the birth prevention operation will be carried out within the year and the fine of the whole amount of 900 yuan will be collected.

5. In the case of staff and technicians, Document No.126 of 1990 of the District People's Administration ["A Supplementary regulation for enforcement of birth control policy in order to prevent population increase in our district"] will be fully implemented. Whoever violates the birth control policy by having extra children will be operation upon within the year to prevent further childbirth and no concessions will be granted.

6. From 1 January, 1991 onwards, countryside and pastoral areas and townships will be brought under the birth control policy. As per the provisions of Chapter Four of "Regulations for implementation of birth control in Qinghai province", each couple will be entitled to have two to three children. However, if a birth takes place within the period of less than four years from the time of having the previous child, a fine of 300 yuan will be imposed [even if the birth is otherwise within the limited number].

7. The above policy strategy will be implemented from the time of it's announcement.

As no reasons have been sen to find fault with the above policy strategy report, the district administration calls on all concerned officers under and within it to implement it fully.

By the Birth Control office of Gonghe District, 25 January, 1991. (Original document in Chinese).

Extracts from Chinese Laws: Mother and Child

Law on maternal, infant health care aims "to improve the quality of births" - adopted at the 10th meeting of the Eighth National People's Congress Standing Committee on 27th October 1994.

Chapter 1. General principles

Article 1. This law is formulated according to the constitution to guarantee the health of mothers and infants and to improve the quality of births.

Article 2. The State provides essential conditions and material equipment to the development of undertakings for maternal and infant health care, so that mothers and infants have access to medical and health care services. The State supports undertakings for maternal and infant health care in outlying and poor areas.

Article 3. People's governments at all levels exercise leadership in the work of maternal and infant health care. The undertakings for maternal and infant health care should be incorporated into the programme for national economic and social development.

Article 4. The State Council's Public Health Administration is in charge of the national work for maternal and infant health care, gives guidance to administrations at different levels and areas in light of their respective conditions and conducts supervision and administration of such work around the country.
Other relevant departments of the State Council should, within their functions and duties, coordinate with the Public Health Administration in promoting the work of maternal and infant health care.

Article 5. The State encourages and supports education and scientific research in the field of maternal and infant health care, promotes advanced and practical technology for maternal and infant health care and popularizes scientific knowledge about maternal and infant health care.

Article 6. Organizations and individuals with outstanding performance in the work of maternal and infant care and outstanding achievements in the scientific research in maternal and infant care should be rewarded.

Chapter II. Premarital health care

Article 7. Medical and health care organs should offer premarital health care services to citizens.
(1) premarital hygienic guidance: education in knowledge concerning sex hygiene, reproduction and hereditary diseases;
(2) premarital hygienic consultation, offering medical opinions on marrying, health care for child bearing and other problems;
(3) premarital and medical checkups on men and women preparing for marriage to discover diseases likely to affect their marriage and reproduction.

Article 8. A premarital medical checkup should include examinations for the following diseases:
(1) serious hereditary diseases;
(2) legal contagious diseases;
(3) relevant medical disorders.

After the premarital medical checkup, the medical and health care organ should issue a certificate on the premarital checkup.

Article 9. When either one of the couple preparing for marriage is found to be in the infective stage of a legal contagious disease or at the pathogenic stage of a relevant mental disorder during premarital medical checkup, the doctor should offer medical opinions and the couple should postpone their marriage.

Article 10. When either one of the couple is diagnosed to have a serious hereditary disease, which is medically deemed unsuitable for reproduction, the doctor should explain the situation and offer medical opinions to the couple. The couple may marry if they agree to take long-lasting contraceptive measures or give up child bearing by undergoing ligation; this does not apply to those who marriage is prohibited by articles in the "Marriage Law of the People's Republic of China".

Article 11. Should persons undergoing premarital medical checkups, they may apply for a medical technical certification with them.

Article 12. When a couple register their marriage, they should have the certificates of premarital medical checkups or medical technical certification with them.

Article 13. Provincial, autonomous regional and municipal people's governments should formulate rules for the implementation of the premarital medical checkup system in light of their respective actual conditions.

Provincial, autonomous regional and municipal people's governments should set rational charges for premarital medical checkups and grant a reduction or exemption of the charges to people from outlying and poor areas to those who have difficulties paying for the checkups.

Chapter III. Health care during pregnancy and childbirth

Article 14. Medical and health care organs should provide health care services to child-bearing, pregnant and lying-in periods.

Health care services contain the following:

1. Health care guidance for mothers and infants offering medical opinions for conceiving healthy children and for the cause, treatment and prevention of serious hereditary diseases, iodine deficiency diseases and other endemic diseases;

2. Health care for pregnant and lying-in women providing consultation and guidance pertaining to hygiene, nutrition and mental care for pregnant and lying-in women , as well as regular prenatal examinations and other medical and health care services;

3. Foetal health care monitoring and protecting, as well as providing consultation and medical guidance for the growth of foetuses; and

4. Infant health care providing medical and health care services for the growth, feeding and nursing of infants.

Article 15. Medical and health care organs should provide medical guidance for pregnant women having contracted serious diseases or having taken deformity causing substances, whose pregnancy may endanger the life of pregnant women themselves or seriously affect their health and normal growth of foetuses.

Article 16. When a doctor discovers or suspects childbearing couples of contracting serious hereditary diseases, he or she should offer a medical opinion; and the childbearing couples should take appropriate measures based on the doctors opinion.

Article 17. When a doctor discovers or suspects pregnant women foetal abnormality during prenatal examinations, he or she should conduct prenatal diagnosis tests for the pregnant women.

Article 18. When one of the following circumstances id discovered during prenatal diagnostic tests, the doctor should explain the circumstances to both husband and wife and give medical opinion on terminating the pregnancy:
1. Foetuses have contracted serious hereditary diseases;
2. Foetuses have serious deformity; and
3. Due to serious illness, continuation of pregnancy may endanger the life of pregnant women or seriously harm their health.

Article 19. When termination of a pregnancy or ligation is performed on pregnant women, it is necessary to obtain their signature of consent from guardians in the case that pregnant women are legally incompetent. Termination of a pregnancy or litigation performed according to the provisions of this law is free of charge.

Article 20. Before a woman who has given birth to seriously defective infants conceives again, both husband and wife should undergo medical examinations at a medical and health care organ at or above the county level.

Article 21. Doctors and delivery personnel should strictly abide by the relevant operational procedures and should strive to improve delivery techniques and service quality to prevent and reduce injuries during delivery.

Article 22. Pregnant women who cannot reach a hospital should have their babies delivered by midwives using sterilized procedures.

Article 23. Medical and health care organs and personnel engaged in family delivery shall issue infant birth certificates printed and distributed uniformly according to the regulations of the State Council's Public Health Administration; deaths of lying-in women and infants and deformity of new births should be reported to the public Health Administration.

Article 24. Medical and pubic health organs provide physical examinations and preventive inoculations for infants; as well as the step-by-step medical and health care services of screening for diseases of new births and of preventing and curing frequently occurring and common diseases among babies.

Chapter IV. Technical certification

Article 25. Local people's governments at and above the county level may set up medical technical certification organizations to conduct medical technical certification organizations to conduct medical checkups, diagnoses of hereditary diseases and prenatal diagnostic tests.

Article 26. Personnel engaged in medical technical certification must have clinical experience and knowledge of genetic medicine and must posses the specialized technical job title of "doctor-in-charge" or above.
Composite members of medical technical certification organizations shall be nominated by the public. Health Administration and appointed by the people's government at the corresponding level.

Article 27. A withdrawal system is implemented in medical technical certification. Certification of personnel who have conflicts of interests with litigants which may affect the impartiality of certification should be withdrawn.

List of Abbreviations

CEDAW