The Chosen Few: The Gendered Dimensions of Health Investment under the Chinese One Child Policy

Abstract

In 1980, the One Child Policy (OCP) took effect in China, and parents were limited to having only one child. The policy was an attempt to curb China’s growing population. In 2016, the OCP was repealed as the population growth rate began to slow and government officials feared population decline that would impact the nation’s GDP. Fertility interventions such as the OCP often have unintended consequences, especially in contexts where a strong preference exists for one gender over another. In China, a strong son preference exists, incentivizing parents to invest more in the health of their sons than their daughters, and to take actions to make their one child under the OCP a male child. Under the OCP, far more male children were born than female children as prenatal sex selection allowed parents to abort female fetuses. However, within this study, I find that the female children that were carried to term under the OCP often received relatively higher levels of health investment and experienced more positive health outcomes than female children not born under the policy. Previous literature would suggest that this outcome is because the female children carried to term under the OCP are generally more wanted by their parents than female children not born under the OCP, who may be the siblings of more wanted sons. In my analysis, I use a triple interaction design within both differences-in-differences analyses and event studies to illustrate the nuanced impacts of the OCP on health investment dynamics in China. I find that, male children received more health investment and experienced better health outcomes overall, that those with more siblings often experienced lower investment and worse health outcomes, and that under the OCP, the gap in investment between young boys and young girls became more narrow.