Today in China, there are around one million abandoned children, and that number is growing by ten thousand per year. According to Nathan Vanderklippe in his article for The Globe and Mail, as many as 98% of these children are disabled, left behind by parents who are unable or unwilling to care for them. Some of these children are handed over to the welfare system while others are left to die. Many children do not survive abandonment, or the health conditions that they were abandoned for, but those who do are placed in understaffed and underfunded orphanages where few will ever be adopted. Mandatory prenatal screenings and widespread baby hatches have been proposed to solve this tragedy, but how effective are they?
This problem is wicked, difficult or impossible to solve due to the complexity of the system and the lack of predictable intervention outcomes. Child abandonment directly impacts one million children, and indirectly impacts 1.4 billion more individuals. It is perpetuated by a dearth of accurate information, apathy and conflict between stakeholders, a traditional and conservative culture, and financial and logistical constraints.
There have been various proposed solutions to the problem of child abandonment that target different nodes in the causal model. One proposed solution is the expansion of orphanages in China to accommodate more children and give these children better services. Another is loosening adoption regulations to facilitate domestic and international adoptions. Diao Jiayi, in her article for Beijing Today in 2015, stated that Chinese government has introduced baby hatches to receive unwanted children. All of these solutions aim to receive more abandoned children. Another set of solutions is aimed at reducing the creation of abandoned children in China. Mandatory prenatal screening programs can give parents the power to make an informed decision about whether or not to bring a child into the world, while community outreach programs provide financial support and stigma reduction for parents of disabled children (Douglas County School District 2016). The Chinese government introduced a new two child policy in 2016, which eliminates the state-imposed penalties of having a second child.
One proposed solution to the problem of child abandonment is a mandatory prenatal screening program. Prenatal screening encompasses all tests done on a fetus during pregnancy to diagnose medical conditions as early as possible. This includes tests like ultrasounds, amniocentesis, blood testing, and genetic sequencing (Huang 2012, 173). These tests allow parents to seek timely medical intervention, make the decision to terminate, and prepare psychologically in the case that their child has a medical condition. Around the world today, prenatal screening has been used to detect genetic conditions and birth defects of varying severity such as Tay-Sachs disease, Down syndrome, and cleft lip.
Prenatal screening technologies were first developed in China in the 1960s but their implementation was suspended due to the chaos caused by the Cultural Revolution. Genetic counseling services began operating in the 1970s, with the establishment of cytogenetic laboratories across the country. The first instance of molecular genetic diagnosis was performed in Shanghai during the mid-70s. In the 1990s, many institutions began to establish genetic laboratories, and tests for over 20 genetic disorders became available. As prenatal diagnosis grew in popularity, the Ministry of Public Health convened a national conference on prenatal diagnosis in 2000 and began regulating the practice with the implementation of “The Regulation on Management of Techniques for Prenatal Diagnosis” on May 1, 2003. These new regulations made the public health system the provider of prenatal diagnostic services (Tao, Wang, Zhao, and Zhong 2013, 379-390).
Currently, all third tier hospitals, defined as those with more than 500 beds and specialist services, and most maternal and children’s hospitals perform karyotyping and genetic counseling. Preconception tests are free for everybody, and a portion of prenatal screening services are covered by the national social health insurance. However, very few people actually use these services. The paper “Genetic services and testing in China” points to lack of governmental support, shortage in technical personnel, financial difficulties, and lack of public awareness as reasons why this service is not being fully utilized. Without governmental support, more advanced services such as molecular genetic diagnosis are rendered illegal and can only be carried out in academic non-clinical settings. In China, there is no specific program for the purpose of training medical genetic professionals, and thus these professionals must be trained or recruited from overseas (Tao, Wang, Zhao, and Zhong 2013, 379-390). Health insurance implementation in China is still not universal, and in a country where much of the population is involved in agriculture but virtually all good hospitals are in metropolitan areas, traveling to and from hospitals and paying for genetic tests is not feasible for many. As well, the divide between urban and rural populations mean that rural populations are often less educated and less aware of the benefits of prenatal screening.
There are some drawbacks to prenatal screening. One of the biggest issues concerns the ethics of giving parents the ability to terminate pregnancies based on disabilities that their children may have. Critics argue that doing so is akin to genocide, but in China, the value system is much less concerned about the ethics of abortion. In many other countries, there is an ongoing debate about abortion of Down syndrome fetuses, but this debate is non-existent in China, where around 95% of mothers expecting a child with Down syndrome choose to abort and can abort up until the 9th month of pregnancy (Koetse 2016). As well as ethical concerns, there are more practical drawbacks to prenatal screening. A prenatal test may give false positive or false negative results, and the use of more invasive screening practices such as amniocentesis increases the risk of miscarriage or injury to an otherwise healthy fetus. Finally, since parents are theoretically not allowed to know the sex of their child before birth, due to fears of sex-selective abortion, more instances of prenatal diagnosis give parents more chances to find out the sex of their baby (Hesketh, Lu, and Zhu 2011, 1374-1377).
An essential assumption that prenatal screening is based on is that parents and babies will benefit from early knowledge of medical conditions that the fetus may have, and they will choose to act on that information. This may be in terms of psychological preparation, early medical intervention, or the power to terminate pregnancy. Another assumption that prenatal screening is based on is that these tests are accurate and provide correct results at a much higher frequency than false positive or negative results.
Another proposed solution to the problem of child abandonment in China is the widespread institution of baby hatches. A baby hatch is a place where a parent can give up their child anonymously and safely. Baby hatches were recently reintroduced, following the decline of foundling wheels, and are used in many countries today such as Germany and Japan (Hubpages 2015). One of the reasons why baby hatches are used is to prevent parents from infanticide, because they have no other options. In China, baby hatches are secluded one room structures containing an incubator and a bed. Parents bring their children to the hatches, place them in the bed or incubator, and press a button. After they leave, care workers arrive to pick up the children and bring them to orphanages (Diao 2015).
In 2014, China introduced 25 baby hatches across the country, with plans to expand to another 18 locations the next year. However, many of these hatches were inundated with children. Guangzhou’s hatch received 80 infants during the two week span of the Lunar New Year holiday, and some other hatches had to shut down indefinitely because there were not enough resources to care for the children (Kubin 2014).
Baby hatches operate under the assumption that they reduce the incidence of infanticide and that children and parents would be better off if the children were left at a baby hatch. It is also assumed that children receive superior treatment if they are left at a baby hatch, than if their parents were to keep them. Finally, for baby hatches to continue to operate, parents must not abuse them, and hatches must be able to increase their capacity to keep up with the number of children they receive.
In China, child abandonment is punishable by up to five years in prison, and those whose children have died due to abandonment can be charged with homicide. However, it is very hard to track down these parents, as they go to great lengths to conceal their identities. Leaving a child in a baby hatch is legal, and due to the high rate of children being turned in at newly opened baby hatches, critics have argued that the government has decriminalized child abandonment and encouraged more parents to abandon their children, even children they may be fully capable of caring for (Ripley 2015). Baby hatches also violate a child’s right to know their biological parents, and sometimes may violate the rights of one parent who did not consent to the surrender of the child (Asai and Ishimoto 2013, 9). Finally, children who are left at baby hatches currently have no legal protections and face an uncertain fate once brought to the Child Welfare Office (Kubin, 2014).
Both of these solutions have strengths and weaknesses. Prenatal diagnosis provides important information in order to benefit children and parents concerning early medical intervention and psychological preparedness before the birth of the child. They also help parents avoid the stigma of having an unwanted or disabled child. The power to make an informed decision about termination is both a strength and a weakness of the solution, as this may reduce infanticide in sick babies, but can also be interpreted as genocide of children with medical conditions. On the flip side, prenatal tests, though largely accurate, can produce false results, and more invasive practices may cause miscarriages. Baby hatches save the lives of children who might not make it otherwise, a potentially more ethical solution than abortion, but they are costly, inefficient, and unsustainable. Though baby hatches reduce the abandonment of children, they do not provide a more permanent solution for the orphans they take in.
In order to create a solution to the problem of child abandonment, many different stakeholders need to be satisfied. Children who are abandoned need to be given food, shelter, education, and medical care until they become adults. They also want emotional comfort and security. Thus, children with the potential to be abandoned will tend to choose the second solution, because it offers them a greater chance of survival. The parents of these abandoned children need assistance to care for their children, and do not want to undergo the psychological trauma of giving them up. They are predicted to lean more towards prenatal screening, as it is less expensive and psychologically distressing than the alternative of having a child and giving it up. Charitable organizations that take in these children want fewer of them in their centres, either through less abandonment or more adoption, and need more funds, personnel, training, supplies, and governmental approval to continue operations. They are also predicted to prefer mandatory prenatal screenings, as this will reduce the number of children overall that end up in their centers, freeing their resources to give to others. The government wants fewer children born overall to mitigate overpopulation, but also wants people that are currently living in the country to be productive members of society. The government is also predicted to prefer mandatory prenatal screenings, because the country is overpopulated already and prenatal screening will cost less in the long run than welfare for individuals with medical conditions. Finally, the wider Chinese society has less interest in this issue but does not want to be burdened by supporting others financially. The public is predicted not to have a preference for either solution, because they are not as directly involved and may have different viewpoints concerning the ethics, costs, and benefits of the two solutions.
A successful solution should be able to target the causes of the problem as effectively and comprehensively as possible. In my opinion, it is most important for a successful solution to satisfy abandoned children, parents of children with the potential to be abandoned, charitable organizations responsible for the welfare of orphans, and the government, as these stakeholders’ responses will determine the success of the program, and less important to satisfy the Chinese public, because it is too big of a group with many diverse opinions. In addition, I believe that this solution should be created with traditional Chinese values in mind, as these beliefs are key to understanding and overcoming the last mile problem.