NEJM "perhaps" applauds the one-child policy

The editors' response to this letter is just plain creepy:

China's One-Child Family Policy
To the Editor: Hesketh and colleagues (Sept.
15 issue)1 provide an interesting survey of the
effects of the infamous Chinese one-child policy
after 25 years. However, I was somewhat taken
aback by the authors' editorial statement that
"relaxation of the policy can be considered only
if fertility aspirations are such that a baby boom
will not result." Certainly, this is the same sort
of argument that tyrannical regimes have given
for continuing their oppressive policies, from
apartheid and dictatorships to the oppression of
women and just about any other human-rights vio-
lation through history. The policy of one child
per family has been a terrible violation of the
personal rights of millions of Chinese women.
All that is necessary for the draconian policy to
be removed, not just "relaxed," is for the Chinese
government to make the decision to stop such re-
pressive measures and start dealing with the prob-
lems posed by an expanding population through
moral means. I am disappointed to see the "ends
justify the means" logic endorsed and unchal-
lenged on the pages of a respectable medical
journal.
Thomas R. Jackson, M.D.
Ireland Army Community Hospital
Fort Knox, KY 40121
Hesketh T, Lu L, Xing ZW. The effect of China's one-child
family policy after 25 years. N Engl J Med 2005;353:1171-6.
1.
The authors reply: We agree that the one-child
policy is a violation of the human right to repro-
ductive choice, as we acknowledge in our article.
It is precisely for this reason that it is so contro-
versial. But we should not judge the Chinese by
Western standards. Few Chinese see the policy as
a human-rights violation. Most (though not all)
accept it with equanimity, even in the cities where
the one-child rule is enforced. This is perhaps
less surprising when one considers the overcrowd-
ing in Chinese cities, the pressures of child care
with two working parents (as is usually the case),
and the high cost of raising children.
The Chinese authorities would argue that the
policy has contributed to improvements in human
rights by lifting more than 200 million people
out of poverty and by raising living standards for
the majority of the population. In an increas-
ingly interdependent world, where available nat-
ural resources per capita are decreasing, the Chi-
nese government should perhaps be applauded for
having the courage to take unpopular measures
to control population growth.
Therese Hesketh, Ph.D.
Institute of Child Health
London WC1N1EH, United Kingdom
t.hesketh@ich.ucl.ac.uk
Zhu Wei Xing, M.P.H.
Zhejiang University
Hangzhou 310006, China

(New England Journal of Medicine 2006, 354, 8).