The conflict over the political status of Tiber[1] has damaged China 's relations with the West. Serious accusations have been made about human rights abuses and religious persecution. One of the most consistent of the charges has been that the Chinese government practices coercive family planning in Tibet by imposing strict birth limits and forcing women to undergo abortions and sterilizations.

A highly critical report was jointly submitted to the United Nations in 1998 by the International Committee of Lawyers for Tibet, the Women's Commission for Refugee Women and Children and the Tibetan Centre for Human Rights and Democracy. Based mainly on refugee accounts, it paints a horrific picture of repressive birth control in Tibet, including forced abortions, sterilizations and huge fines and penalties. An example of the many charges is:

The Mission interviewed a male health worker who had fled Chushul in 1997.He described policies that included the summoning of October 1994,every women who had already had two children was summoned for sterilization (about 300), but due to lack of personnel, only 84 could be sterilized at that time. A woman who disobeyed the summons was subject to a fine. For office workers the fine was deducted from the paychecks. Farm women who could not lost their land.[2]

These charges are vigorously denied by the Chinese government and Chinese researchers[3]. Are such reports, then, accurate depictions of life in contemporary Tibet? Is the Chinese government really forcing Tibetans to undergo unwanted abortions and sterilizations to achieve state-set birth limits, and if not, what if the reproductive life of Tibetan villagers really like? We designed and conducted a study to fill this gap in knowledge by examining reproduction, child mortality and contraception on site among a large sample of women living in diverse areas of Tibet.

Research Methods

The data presented here were collected from November 1997 to August 2000 as part of a four-year study on the impact of China's reform policies on rural Tibet. Conducted in collaboration with the Lhasa-based Tibet Academy of Social Sciences. Based on government income statistics, the authors extensive experience and prior contacts in rural Tibet, 13 villages[4] were selected from four rural townships(xiang) in three counties (xian) in two of Tibet's seven prefectures[5] (see Table 1). In order to obtain a mix of cultural situations, we selected villages located in the two major sub-cultural areas of central Tibet (U and Tsang). Similarly, to obtain a mix of economic situations, we chose two townships (Kartse and Norgyong) that were situated neat county seats and could therefore be expected to have greater educational and economic opportunities. And two located relatively far from county seats (Tsashol and Mag). Official statistics on county-level per capita income in Tibet give some indication of the range of variation represented by the research sites. Of the study' s three counties, Panam ranked 17th out of Tibet's 73 counties, Lhundrup ranked 47th and Medrogungka ranked near the bottom at 66th.

　　

Multiple research methods were utilized, including a lengthy household survey, in-depth interviews, informal interviews, focus groups, observation and local records. In addition, a separate, fertility/ family-planning survey was administered to all women aged 18 or older living in these areas[6]. Follow-up interviews were conducted in cases where the initial responses were unclear or inconsistent. All of our fellow researchers and interviewers were ethnic Tibetans. and all of the interviews were conducted in Tibetan. The authors selected the research sites themselves and developed the research questions. No information was censored by the Chinese government and no provincial or local government officials accompanied the researchers while they did their fieldwork. Repeated visits were made to all the research sites and the researchers had complete freedom of movement while there. They could visit villagers whenever they wished without having to make prior arrangements. Interviewees were not subject to questioning by local officials after their interviews with us. Finally, the content and conclusions of this paper were not in any way "vetted".

The reproductive component of the study included all 1,749 women aged 15 and older in the study villages. Table 2 presents the distribution of women in the study by five-year age categories. Of these women, 51.2 per cent were married, 2.8 per cent were divorced, 8.9 per cent were widowed and 36.4 per cent were married，　unmarried. Marriage among teenagers was rare-only 2.5 per cent of women aged 15-19 had married; whereas 40.8 per cent of women aged 20-24, 69.2 per cent of women aged 25-29 and 78.5 per cent of women aged 30-34 had married. The median age of the sample was 34 and the average household size was 7.1 people.

　　

Tibetans traditionally practiced monogamy, polygyny and various forms of polyandry, and continue to do so. Polygyny in a marriage in which a husband has two of more wives. Polyandry is a marriage in which two or more males (usually. But not always, brothers), share a bride. Of the 1, 060 ever-married women, 81.6 per cent were married monogamously, 15.8 per cent were involved in some form of polyandry and 1.9 per cent were married polygynously. The mean age at first marriage was 22.8 years (standard deviation =3.9, with a range from 14 to 41). Consistent with this relatively late age at first marriage, the age at which the first child was born was also relatively late at 23.6 years (standard deviation = 4, with a range from 15 to 44).

Fertility

Female fertility will be an important indicator of whether family-planning programs are coercive in Tibet--high fertility will clearly be inconsistent with strict and repressive family planning. Tables 3 and 4 present fertility data collected during the detailed reproductive history interviews that were conducted with all women. Table 3 reveals that the mean number of live births for all women aged 40-44 and 44-49 was 4.6 and 5.2, respectively.

　　

　　

However, since 33 per cent of women aged 20-59 were unmarried, the number of live births to women who were currently married is better indicator of the level of fertility in this population. Table 4 reveals that the fertility of the women in this study was very high both before and during the post-commune period that began in Tibet in 1980. Currently married women aged 40-44, who were at the start of their reproductive period when the new era began, have averaged 5.7 births. Those aged 45-49 and 50-54 averaged 6.5 and 6.9 live births respectively. This level of fertility is comparable with the fertility of indigenous (non-contracepting) Tibetan groups living in northern Nepal: for example. Nyinba women over 43 years of age averaged 6.3 children[7] and Limi women over 53 years of age averaged 6.7 births[8]. This is also comparable to the fertility reported for a group of nomads living in the western part of Tibet where the average for all women aged 50-59 was 5.4 (6.8 for parous women: that is, for those women who had ever given birth)[ 9].

Other indices corroborate this finding of very high fertility during the post-commune period among our respondents. The crude birth rate (CBR), for example, was also relatively high[10]. The study population's CBR of 23.5/1,000 in 1997 was 38 per cent higher than the 17/1,000 CBR for Chine as a whole[11] and 27 per cent higher than the 18.4 CBR for Tibet in 1997[12]. Similarly, as is typical of high-fertility populations, the age structure of this population was young, with 34.1 per cent of the population being under the age of 15[13]. While this proportion was not among the highest in the Third world (e.g., neighbouring Nepal and Bhutan both registered 43 per cent), it was higher than the 26 per cent for China as a whole.[14]

The percentage of live births that were of third birth order or higher is another important indicator. If forced birth control were in place throughout rural Tibet, there should be few of no women of child-bearing age today who have had three, four or more children, since forced abortions and sterilizations would preclude that. However, of the 131 births that occurred in 1997 to the women in our study, 45.4 percent were of third birth order or higher, 31.5 per cent were of fourth order or higher and 20.8 per cent were fifth order or higher. Similarly, 70.1 per cent of the 1,110 parous women had given birth to three or more children, 55.9 per cent had four or more, and 41.4 per cent had given birth to five or more.

Equally indicative of the absence of birth limits since the 1980s is the fact that the fertility of local officials was high. The average number of surviving children for the 20 local village heads, many of whom were Communist party members and lone of whom were Party secretaries, was 5.1 children. Of these 20 officials, 70 per cent had four or more children and 60 per cent had five or more.

These fertility data are inconsistent with the presence of forced birth control in the 14 villages in three counties that we studied, and therefore suggest there is on general program of forced birth control in rural Tibet.

Mortality

The growth rate of a population is function of the difference between fertility and mortality (and, of course, migration). Mortality is also an important dimension of family planning research since reductions in child mortality often are followed some years later by voluntary decreases in birth rates.

As could be expected in a remote area such as Tibet, most of the deaths of children born to women in the study occurred before the age of six. Of the 637 children who had died, 57.7 per cent died in infancy (less than one year old) and 21.8 per cent in early childhood (1-5 years of age). However, on the whole, despite limited access to modern medicines and maternal/child health facilities[15]. Women did not report high infant and child mortality. For example, 65.2 per cent of parous women had no children die, 21.2 per cent had one child die, and only 13.6 per cent had two or more children die.

Table 4 presents the average number of births and surviving children to currently married women aged 20-59 .The mortality among offspring ranged from 7.3 per cent to 15.6 per cent , and the average was 11.6 per cent. In other words, on average, 88.4 per cent of the offspring born to percentage of offspring who died was 12.9 per cent. These results are similar to those of a recent survey of 1,499 Tibetan women that reported a figure of 13.2 per cent[16].

This level of mortality is moderate of low in comparison with indigenous Tibetan populations in northern Nepal who also lack modern health care: for example, in Limi as of 1976, on average 43 per cent of the children born to women had died by the time of the study[17]. Similar findings were reported for the Nyinba of northwest Nepal, Where 54.3 per cent of all children born to women had died[18]. Fieldwork conducted in a relatively poor pastoral nomadic population in western Tibet between 1986 and 1988 also revealed a higher percent of morality, at 26 per cent[19].

These data suggest that the populations investigated in this study have experienced a marked decrease in mortality-but not fertility-as compared with traditional Tibetan societies in Nepal and presumably Tibet in the pre-1959 era. However, relative to other groups in China, the 12.9 per cent mortality rate among the offspring of all women in our sample is high. For example, Chinese statistics for 1990 indicate that child mortality rates for the Han Chinese, Koreans, Mongols and Hui, are only 2.6 per cent, 5.5 per cent, 6.8 per cent and 8.6 per cent, respectively[20].

This combination of high fertility and moderate mortality rates means that women of all ages in our sample had many surviving children. For example, Table 4 shows that the mean number of live births to currently married women aged 20-59 is 4.3, and the mean number of surviving children to these same women is 3.8. Married women aged 40-44, 45-49, 50-54 and 55-50 had, respectively, 5,5.6,6.1 children still alive.

The data therefore reveal that while mortality is higher than among the Han and some other minority groups, a much smaller proportion of offspring die than in traditional Tibetan societies, and married women have far more surviving children than the 2.1 needed for couples to replace themselves in the next generation.

It should also be noted that we found no evidence of higher female than male infant mortality (unlike the case in inland China). Of the 366 infants in our study who died, 33 per cent were female and 55 per cent were male (12 per cent were unidentified by sex). As a result, the study population's sex ratio favoured females slightly (2,805 to 2,778)[ 21]. Similarly, 36 per cent of the deaths among all of the children in our study were female and 52 per cent were male(12 per cent were unidentified by sex).