Child survival, protection and development in China发布时间:2012-06-29Jiemin Zhang  IMPROVEMENT OF CHILDREN’S HEALTH AND EDUCATION

  Since its establishment, the People’s Republic of China has made significant stride in child development, gaining universal recognition for its success in improving child health and education

  The Chinese government has always been concerned with and attached to the importance of survival, protection and development of children. “Improvement of the quality of the whole nation begins with children” is a fundamental policy in our construction of socialist modernization. A national coordinating committee that oversees children and women’s development programmes has been formed by the State Council and similar coordinating agencies have been set up in every province, autonomous regions and municipality. The 1990 World Summit for Children endorsed the “World Declaration on the Survival, Protection and Development of Children” and the “Plan of Action for Implementing the World Declaration on the Survival Protection and Development of Children in the 1990s”. Soon after that, the National Committee took the lead in drafting “The National Programme of Action for Child Development in China in the 1990s” within several months.

  Owing to the leadership of the Chinese Government and efforts of the people China has made a significant stride in child development under the condition that economy is still not well developed. For children under five the mortality rate has been brought down to 42/1,000. Maternal mortality rate has been reduced to 94.1/100,000 in 1989 from 1500/100,000 in 1949. At the same time, child communication coverage has reached 85% at the country level in 1990. There are complete three-tier health net works in most areas. According to the sample survey of nine provinces in 1987, the ratio of urban community with health facilities is 80.9%, and those with health care workers but no health facilities is 7.5%; the ratio of villages with health facilities is 56.3%, and those only with health workers is 36%. Pro-school education has been extended to 19.72 million children in 1990 from 130,000 in 1946, and the number of kindergartens has risen form 1,300 to 172,000 in the similar period. Kinder-garden enrollment rate of 3-6 children is 30%. 80% of them are in large and middle cities. In rural areas, one-year pro-school education has been universality in some economically better-developed areas.


  Most of our children live a happy life with their parents. Living conditions are continuously improved, and children’s physical and mental development is raised day by day

  At present, there are 370 million children below the age of 14 years in China. According to the investigation of 2,347,000 children in 1987,228,200 children have both parents and 217,400 children live with their parents, i.e. 92.6% of all children investigated. Generally speaking, the family economic standard is the material basis for children’s health growth.

  Since implementation of the policy of reform, national economy has developed rapidly, people’s living standard is getting higher and higher. In 1991, the average income of urban residents is 1570 yuan per year, increased by 3.2 times that of 1987; and the average income of rural residents is 710 yuan per year, increased by 3.8 times that of 1987. Together with the increases in income, living conditions of the people have been improved. Living space in urban areas increased from 4.2 square meters per person in 1978 to 8.5 square meters per person. In rural areas, it increased from 8.1 square meters per person to 16.1 square meters per person. Changes in the economic condition enable families own household electric appliances which are beneficial for parents to enlighten their knowledge and for children to develop their intelligence. Expenses for entertainments, books and magazines and for medicine also increased accordingly. Children are able to enjoy a happy life and grow healthily in a harmonious family; they enjoy the protection of government and society, which are concerned to provide them better health condition and education opportunity. The infant mortality rate has been brought down from 200 per thousand live birth in 1949 to 51.05 per thousand in 1986 (monitoring figure). The incidence of four diseases that affected the health of Chinese children have decreased in varying degrees. Rickets is a common malnutritional disease among Chinese children.

  According to a 1977-1983 survey in 26 provinces, autonomous regions and municipality of more than 180,000 children under 3 years, average rickets rate was 40.7%. In recent years, owing to nationwide preventive measures by vitamin D, the rate was reduced to 26.7% in 1987. According to the investigation in 9 provinces in 1987, the low body weight ratio in our country is 15.3%, malnutrition is 0.5%, developmental delay is 14.1%, wasting is 1.0%. All these figures are lower than most of the developing countries.


  Disabled children are getting more and more attention and protection, but the basis of special education is still weak

  According to the results of a 1987 sample survey of disabled persons, the total number of disabled children is 8,173,500,i.e. 2.6% of the whole number children. Among them, the number of visual disabled children is 182,300, i.e. 2.2% of the total number of disabled children (including 30,000 low visual children), 620,000 physical handicapped children, i.e. 7.6% of the total number of the disabled children; 14,000 mental handicapped children, i.e 0.17% of all the disabled children; 1,160,000 deaf children, i.e. 14.2% of the whole number of disabled children; 5,390,000 mentally retarded children, i.e. 65.94% of the whole number of disabled children, 807,000 multiple disabled children, i.e. 9.9%of the whole number of disabled children. Mentally retarded children living in cities are 4%, in towns 14%, but in the county it is 82%. The more remote and deeper mountain areas, the higher rate of disabled children. Congenital defects is 19 per thousand of the new born. In China, disabled children are getting more and more attention from the government. In March 1988, the China Disabled Persons Federation (CDPF) was set up, and in cooperation with the States Education Commission (SEdc), Ministry of Civil Affairs (MCA) and Ministry of Public Health (MOPH), etc. nine governmental ministries formulated “Proposal on Developing Special Education”, “Law on Protection of Disabled Persons” and gradually a work system on Chinese Disabled persons’ cause has been set up, and the disabled persons’ federation at county level has been established. In 1991, the Federation and other departments formulated the “Eight-Five Year Programme of Rehabilitation of Disabled Children”, and set forth the priorities of disabled children in the 1990s, i.e. prevention of disability and rehabilitation and protection of disabled children. However, the basis of our special education is very weak. The enrollment rate of deaf children is 5.15%, that of the blind children is 2.7%, and that of the mentally retarded is 0.33%, So, to develop special education is a key task in our popularization of primary education


  China is a country with a vast territory and a huge population, embracing 56 ethnic nationalities including the Han nationality. Owing to disparities in the historical development and among different regions, the development of the society in various aspects are very uneven. The population process involves complicated biological and physiological processes, and the external social, material and cultural conditions of life affect the survival, protection and overall development of children. Hence, there exist great differences between the big cities and developed towns on the one hand and the outlying broad countryside and mountainous areas on the other, while the level of development of children in big cities and developed towns compares favorably with that of the developed countries in the world. So our problem now is how to promote development in the whole country. The main issues in the development may be elaborated as follows.


  The rate of breast-feeding is on the decline. Owing to various factors in the past decade, the breast-feeding rate has reduced steadily in the big cities, and the trend is spreading gradually to medium and small cities. According to a survey of 20 provinces and municipalities in 1986, the average rate of breast-feeding of 4 month-old babies was 43% in urban areas and 70% in rural areas, while that of the big cities is much lower, with 13.8% in Beijing and 12.7% in Shanghai.

  Insufficiency of high quality weaning food for babies: A survey revealed that there were more than 35 million young children below the age of 5 years, but the current output of milk, milk products and milk substitutes could supply only 1.6 million children, constituting merely 5% of the total need. Furthermore, the baby foods available on the market are limited in variety and low in protein content, which could not meet the need of the growing babies. In fact, low quality baby food might cause retardation in growth and development, poor immunity against diseases and some nutritional deficiency diseases among children, such as anemia, rickets, etc.

  Lack of scientific knowledge of feeding of the parents: Along with improvement in the living standard of the family, a large number of obese children have emerged, evidently due to indulgence of the parents and irrationally dietary composition. An epidemiological survey of 167,065 children of 0-7 years of age in 9 cities revealed that the rate of obese children reached 91%. Low rate of breast-feeding and undue supplementary solid foods and early weaning among bottle-fed babies also constitute the patterns of feeding that lead to childhood obesity.

  Anemia, rickets and decayed teeth are also outstanding problems among children in the cities.


  In the cities, the main problem is care and education for the only children. In our country, it is advocated for one family to have only one child, and the proportion of only children has risen abruptly. According to a survey conducted in 1987, only children constitute 20% of children below the age of 14 years, while in the cities the rate was as high as 43.3%. Surveys and studies in recent years showed that the only children are at an advantage, that the family is better off to provide for their needs, including cultural and recreational opportunities, and the parents have more time and energy to take care of them, which is very important for early childhood development.

  The findings of a survey conducted in Sichuan Province in 1987 showed that 80% only children surpassed the sibling children in height and 90% in body weight. However, in personality and behavioural traits some only children are less conscientious and hardworking, self-centered, spoiled, less independent and persevering. The only children are at a disadvantage in these psychological traits because they have no siblings, and peers are and indispensable factor in the social development of children. In the course of contacts with other children they learn their duties and obligations, the norms of conduct and spirit of cooperation and service to others. Being the only child of the family, they tend to be self-centered. Secondly, the parents tend to spoil their only child with too much attention and indulgence, and thirdly, the inconsistency in the parents’ attitude in educating the child. Therefore, wholesome psychological development of only children is a problem that calls for special attention in the overall development of children, and it has already aroused the general concern of various circles of the society.

  In the countryside, particularly in remote mountainous and less advantaged areas, owing to poor natural condition, frequent disasters, inconvenient communication and weak economic basis and backward social development due to historical reasons, there is high mortality rate and low enrollment rate at school among children. Thus, the problems of survival and care are the priorities to be tackled. Take Yunnan Province for instance, the sample survey in 1987 revealed that infant mortality in rural areas was as high as 98.5%, which is 4.75% higher than the national figure. The immediate reason of high rate of child mortality is poor sanitary condition; in some areas there is lack of water resources, and many places are in need of sanitary drinking water and health and medical facilities. A sample survey conducted in 9 provinces in 1987 revealed that among 226 neighborhood communities in the cities surveyed, 80.9% of them have infrastructure for medical and child health care workers but 11.5% have neither medical care facilities nor health care workers. Among 836 villages surveyed, 56.3% have medical and health care facilities and 12.7% have neither medical and health care facilities nor health care personnel, and 20% in the village in Yunnan province have neither medical and health care facilities nor health care personnel. The coverage of immunization rate of 4 vaccines for 6 diseases (BCG, DPT and measles) was low. Though the immunization rate of the 4 vaccines has reached 85% in the cities, but the rate in the above mentioned rural areas lags far behind. Furthermore, another important reason is low educational level of the parents who have little knowledge of scientific child-rearing.

  As a result of poor economic condition and influence of the circumstances, the enrollment rate at school was low among children, and proper pro-school education was hardly available in these areas. The national rate of preschool attendance among young children is 6.7% in the countryside, but in villages in Yunnan province, the rate of children below 5 years attending kindergarten was 0.9%, and that of minority nationality children was 0.5%; the percentage for 1at-year pro-school education was 3.7%, and for children of Han nationality, the percentage was also quite low, only 18.1%. Though the Law on Compulsory Education has been promulgated for a few years in China, yet there are still considerable number of 6-14 year-old children out of school, and the situation is grave in the above mentioned rural areas. For example, the 1987 statistic of Yunnan Province revealed 29.8% of school-age children were out of school, and the percentage for minority children in rural areas was as high as 42.5%. The reason that so many school-aged children were deprived of the right of education are manifold: inconvenient location of schools, lack of means of transportation, low educational level of the parents who held that it is useless for children to go to school, children were engaged in business and work, girls were discriminated under the influence of feudal ideas and the number of girls out of school was markedly higher than that of the boys, and the last but not least important reason, is difficult economic condition of the family, which constitutes about 12%.

  The fact that so many children are out of school inevitably threatens the enhancement of the cultural quality of our nation and economic development of the country, and our government has attached increased attention to this problem.


  As China had a long tradition of Feudal system, the feudal ideas has exerted pernicious influence and affected people’s behaviour and ideas even till now. They regard children as their personal property and believe in “a true son grow up under the sticks”. They don’t respect their children, beat and scold at will, children’s rights are deprived of education, and forced to go to word and earn money. Children in divorced families are often aroused by their step-parent, and some teacher physically punish students, and adults maltreat youngster…All these phenomena were regarded by some people as neither right nor extremely wrong.

  In 1989, when every district, county and township started to set up a special organization committee for protection of juveniles according to the Beijing Provision of Protection of Juveniles, which was implementing in Jan, 1989, many people still turned a deaf ear to it- as a decoration. However in Sept. 1989, when a government cadre openly slapped his son’s classmate on the face, and refused to make an apology, the police authorities openly tries the case, the cadre was punished with 7 days detention according to related regulations. Several days later, and other similar case was punished 15 days detention, and compensated 500 yuan for medical treatment. For the open hearings of these two cases took the Beijing people at surprise, they were enlightened by it and were happy about it. Children are also under the umbrella of legislative protection. And now, they may ring to the Committee for Protection of Juveniles, informing about various ill-treatment of the adults and to seek protection for themselves. The committee for protection of the juveniles is usually made up of leaders from governmental and social organizations such as Labor Union, Youth League and Women’s Federation. By means of coordinating, co-organization and co-operation, it makes up a complete social chain and forms a joint force under unified will of the Provision. Without this kind of organization, detailed provisions is only a piece of mere paper. From Jan, 1989 to Dec,1991, the Committee for Protection of Juveniles at different levels in Beijing received 800 cases of torting and legal consultant 300 cases, and among 101 cases of torting, physical torting constitutes 46%, and educational torting 22.8%. In Sept, 1991, the Standing Committee of the National People’s Congress approved the Law on Protection of Juveniles in P.R. of China, and taking protection of minors’ rights will become the whole society’s conscientious behaviour.


  Under the earnest support of UNICEF, the Child Development Center of China exerts effort to fulfil its proper role as a technical arm to the coordinating committee for work of women and children under the state council.

  Since 1980, with the concern of Executive Director Mr. James Grant, UNICEF has developed active and close cooperation with China in term of financial support, professional consultation and introduction of advanced international experience, which has brought immense benefit to China. In fact, the Child Development Center of China is an outcome of this close cooperation. Right after its establishment, under the leadership of All-China Women’s Federation, CDCC convened the National Conference on Scientific Child-rearing. Since then, with the joint efforts of women’s federation at various levels, nationwide publicity activities have been launched popularising of mental and physical development of children and on scientific childrearing. At the same time, various types of parents’ schools have been set up, such as schools for newly-weds, run by the community or women’s federations, schools for mother-in-laws, for grand-parents, etc, and kindergartens and primary schools also organize their own parents’ schools. Thus, knowledge of scientific childrearing has become a household interest and the general concern of the people.

  Up to the present we have organized training courses and put out publications to popularize “Fact for Life”, and have trained primary health care workers and nursery and kindergarten teachers, covering 30 provinces, municipalities and autonomous regions throughout the country. Meanwhile, in line with actual needs, research projects on stimulation of secretion of breast milk, family self-monitoring of pregnant women, homemade weaning food, etc. have been conducted. The findings of the survey on the physical growth and development of rural children in 10 provinces have been popularized and put into practice. In the course of formulation of the “Programme for Child Development in China in the 1990s”, CDCC has played a consulting and advisory role. CDCC, in its role as a technical arm, shall exert its efforts to promote the realization of the Programme.

  The cause of child development is a systematic conprehensive programme, involving the state, society and every family. To achieve the objectives set forth in the Programme, it relies on a large extent the participation of the community, the parents and broad masses of people. It is indispensable to carry out publicity to arouse the sense of responsibility of the parents and to regard it as their duty to bring up their children with scientific childrearing and to care and educate them properly. The principles of prevention and early intervention should be adhered, and community childcare network should be established. We are confident that with the support of UNICEF and the international community, through our concerted efforts, we shall be able to achieve the objectives set forth in the Programme.

  (Children at risk; NORWAY 1992, selected papers ; zhang tao participed in writing)