Made in China

Eugenics" is a term with many meanings - some of them beneficial. However, most people in western nations today think of eugenics as a coercive social programme enforced by the state for the good of society and there have been lots of articles and books exploring the troubled history of western eugenics.

Since China announced the Maternal and Infant Health Care Law in 1994, the international scientific community has expressed widespread concern about some of its eugenic content. There has, however, been little international discussion of the history of eugenics in China, particularly about what eugenics means to Chinese people and medical professionals, and why eugenics there is alive and well.

Imperfect Conceptions aims to fill this gap. The overall message is that China's eugenics law is a precipitation of medical knowledge of birth defects and genetic diseases that demonstrates how Chinese assumptions about the relationship of the individual to society shape attitudes towards procreation, cultural, social and economic views of population and disability, and the trend towards socialistic nationalism from late imperial China to the People's Republic. This message is to some extent in line with the results of an international survey on ethics and genetics conducted in 37 nations including China, published by myself and D. C. Wertz in western scientific literature.

In the chapter titled "Imperfect conceptions", Frank Dikötter explains the patrilineal model of descent, where a baby is viewed as the culmination of his or her ancestors and is held responsible for the health of all future generations. According to Chinese traditional medical theories, pregnant women had to make every effort to maintain a balance of Yin (negative) and Yang (positive) and a harmony of Five Elements (metal, wood, water, fire and earth) in their body, so as to have a healthy and intelligent baby. All three Chinese teachings thought that a woman's behaviour and attitude directly affected the well-being of her baby. A deformed or retarded child was viewed as a the result of a moral failure by the parents.

Dikötter then discusses, in "Defective genes", the development of modern western medicine in the period of the Republic of China, and explores how medical professionals, social reformers and politicians attempted to use their knowledge of eugenics and genetics to solve social problems. He correctly notes that, like many developing countries today, because China had serious social problems of poverty, illiteracy, malnutrition, high infant mortality, poor medical services, short adult life expectancy and war, Chinese medical authorities had little interest in the eugenic improvement of the population.

In the chapter on "Inferior births", Dikötter provides a panoramic view of the social and media environment, as well as the political and economic forces, in which the first Chinese eugenics law was born. But I do not think he gives a full account of why most Chinese medical professionals support the law. As I have argued in The Lancet , this is most likely due to their exposure to the huge population of China, the large number of people with disabilities and parents' great desire to have a healthy child, as well as the effects of the government's one-couple, one-child policy and the lack of expertise in and funding for systematic research into the ethical, legal and social aspects of genetics in China - in addition to their lack of knowledge of the history of western eugenics.

Overall, Imperfect Conceptions includes material that is not available elsewhere, making it a valuable reference book in the field of Chinese eugenics.

Xin Mao is a cancer cytogeneticist, section of cancer genetics, Haddow Laboratories, Institute of Cancer Research, University of London.