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Who is to blame for high death rates in orphanages?

Chinese orphanages are not deliberately exterminating the children in their care, Kay Johnson writes, but are dealing with the terrible consequences of an epidemic of abandonment caused by the state's population policies.

The recent Human Rights Watch report on Chinese orphanages, Death by Default,has received widespread publicity and strikingly little criticism, except from a predictably defensive and closed Chinese government and adoption agencies understandably fearful that their international adoption programs will be shut down or slowed as a result of this bad press. Adoptive parents who have visited orphanages and seen things that contradict the Human Rights Watch report have generally been dismissed as naive.

I am an adoptive parent, but I am also an academic who has studied China for over two decades. I have been studying the problem of infant abandonment and orphanages in China for several years. I am no apologist for the Chinese government; my previous publishing record makes that clear. Given my knowledge and continuing research on this topic, I do not find the basic assertion of the Human Rights Watch report convincing--that there is a state policy of extermination and intentional abuse of abandoned children in Chinese state-run welfare institutions.

Human Rights Watch bases its assertion on two pieces of evidence. First, it has strong evidence of abuse in one such institution--the Shanghai Children's Welfare Institute--from the late 1980s until 1993, when the institution underwent a significant overhaul, which the report asserts was "cosmetic." Second, it has statistics from the Chinese Civil Affairs authorities for several provinces in 1989-1990 indicating that mortality in welfare institutions that care for abandoned children was between 50 and 80 percent.

Without much further evidence, Human Rights Watch puts these two pieces of shocking information together in a tight causal relationship, concluding that they are proof of "widespread atrocities" and a national policy, carried out in hundreds of local institutions across China, to reduce the population of abandoned infants by the "routine murder of children through deliberate starvation."

My research leads me to reject this sweeping thesis. Of course I have not investigated the hundreds of institutions that care for the escalating population of abandoned, primarily female, infants in China, but nor has Human Rights Watch. The only new evidence the report brings to light is about Shanghai. I have no independent knowledge of the Shanghai orphanage, which may indeed have seen terrible abuses, just as some mental institutions in my own state of Massachusetts did in the 1970s. But I have learned a great deal about several other major Chinese child welfare institutions, and several smaller ones, in different locations in China. Nothing I have seen in their records, in my visits or in extensive interviews has led me to believe that they have practiced the policy alleged by Human Rights Watch.

I learned about the escalating problem of abandonment and of the tragically high mortality rates among abandoned children five years ago when I made repeated visits to a large state orphanage in central China. I found the staff and management of the orphanage to be surprisingly open, given my intrusive presence and endless, pointed questions. I was allowed free roam of the place, without any concern about unannounced visits. Although I was visibly upset at times by what I learned, the staff, sometimes reticent, never attempted to hide or give me a misleading impression of conditions at the institution.

The explanation for the high mortality rates involved numerous factors, most beyond the control of the orphanage staff. First, a very high percentage of the infants were extremely ill on arrival. Over 50 percent suffered from congenital disabilities, many of which were in themselves terminal or life-threatening.

The act of abandonment was itself life-threatening; many infants who were born without disabilities, such as my own daughter, were brought to the brink of death from malnutrition, exposure and illness before they reached the orphanage. While birth parents may not intend it, or allow themselves to contemplate the fact, abandonment of a fragile human infant is all too often tantamount to infanticide.

Furthermore, many children are abandoned precisely because they are extremely ill. When dying children were left in hospitals by parents who ran away in order to avoid bills they were probably unable to pay, the hospital authorities routinely brought the terminally-ill children to the orphanage to die. In effect the orphanage served as a hospice. It was the orphanage that was left to deal with the problems that no one else would shoulder, neither birth parents nor other institutions. In most cases these tragic problems represent the negative consequences of population policies, policies that have been internationally-supported and praised for their "success," even as China has been periodically condemned for their inevitable, horrible consequences. A double bind if there ever was one.

In the institutions I investigated, there were neither funds nor staff to provide the kind of intensive medical treatment and individual, round-the-clock care that many infants required. Human Rights Watch scoffs at these reasons for high mortality in Shanghai and all of China, but this is wrong. There simply were not funds to provide extraordinary medical treatment to children who were unlikely to survive. But expensive medical care was provided for those most likely to benefit from it.

Had there been a policy in 1991, as Human Rights Watch asserts, to limit the population in the orphanage I studied, a short delay in taking my daughter (and a dozen others like her who I saw in early 1991) to the hospital for an intensive and expensive two-week treatment for pneumonia would have resulted in her rapid death. At the time her medical records show that she was a severely malnourished, underweight one month old infant who could have all too easily expired from even a minor infection. Only quick treatment saved her.

I also saw two infants with harelips who had just returned from a medical evaluation and who were scheduled for surgery to correct the problem, making it possible for the orphanage to find adoptive homes in China for them. Obviously, the orphanage staff had to decide carefully how to use scarce funds, and they chose with an eye to getting the most benefit for the children they felt they could help. These were tough choices I would never have wanted to make.

When I first visited this orphanage and a few others, there were virtually no international adoptions being conducted in China and thus no "showcases" for foreign consumption. While this was one of the largest and possibly one of the best-run orphanages in China, its main business was to save as many children as it could within its limited resources and arrange for domestic adoptions. In fact, it had always been able to find domestic adoptive parents for the healthy infants it received and for those it could restore to health. It arranges hundreds of domestic adoptions each year, despite the restrictive qualifications required of adoptive parents--in particular that they be childless and over 35.

Other large orphanages I investigated also emphasized arranging domestic adoptions and were quite successful in doing so. It was only in the early 1990s that the escalating numbers of abandoned children began to strain this orphanage's ability to find Chinese parents for its healthy infants and toddlers and that the long standing "childless" restriction became a serious problem for them.

It was at this point that international adoptions began to open up, bringing a new source of prospective parents as well as an important new source of funds to this and other orphanages. As a result, physical conditions and staffing have improved greatly. Since 1993, this orphanage and others have also benefitted from a campaign, endorsed by Party leader Jiang Zemin (himself an orphan), to "aid and support orphans" which has brought new domestic donations and, most important, medical volunteers from the local hospitals that used to charge the orphanage high prices for medical care. Improvements are strikingly evident here, as in a dozen or more other institutions.

These improvements were not merely "cosmetic." In fact they are precisely the kinds of improvements we would hope for; they provide clear evidence that fees gathered through foreign adoptions are being put to good use.

There is at least one point on which Human Rights Watch and I agree. Liberalizing domestic adoption regulations would quickly help reduce the numbers of children in orphanages. China has a long tradition of adoption and many people would be happy to adopt a daughter. Contrary to widespread belief outside China, contemporary Chinese popular culture increasingly values daughters as a source of emotional support and closeness for parents. Using adoption policy, rigidly codified as law in 1992, as a means to plug up a hole in the dike of the one-child birth planning policy has cruel consequences for the victims of birth planning. A humane adoption policy must put the interests of children who need families first.

Unfortunately, the current sensationalized international criticism of orphanages which locates their problems in a state policy of child murder does little to help those in China who agree that domestic adoption laws should be changed, a position that is argued in numerous popular magazines. Furthermore, such misdirected criticism could hamper the international adoption program which has done so much to help orphanage directors meet the recent crisis that they have had to face.

I strongly believe that blaming civil affairs and orphanage staff, along with an alleged national policy of extermination, for the high mortality rates among abandoned children is not only unfair but incorrect. When I left the orphanage discussed above, I felt extremely critical of the conditions and policies that had created the crisis and the high death rates at the orphanage--the sorely inadequate resources, the understaffing, the lack of help from other institutions, including organs of the central government, and above all the severe campaigns aimed at limiting China's growing population.

But the orphanage staff and the civil affairs bureaucracy in places I have investigated were not responsible for creating these problems. Although I do not doubt that some orphanage workers perpetrate abuse in this under-supervised system, those that I met were mostly hard-working, conscientious and surprisingly open people, who occasionally, in secret and private moments, showed the emotional toll their jobs took on them. I left with admiration for them and a desire to see their work more fully supported.

I only hope the Chinese authorities will not react with defensiveness and churlishness to the Human Rights Watch report. They would be wise to let the unjustified generalizations go by while dealing in earnest with the real problems presented by abandonment, adoption and orphanage care in China.

Kay Johnson, Professor of Politics and Asian Studies at Hampshire College in Amherst, Massachusetts, studies women, family, and village life in China.

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