Bringing out a second edition of Tears of Silence was made necessary by the tightening repressive conditions inside Tibet, the further control over Tibetan people's rights and the recent focus towards women's issues and gender inequalities building up to the 1995 United Nations Fourth World Conference on Women (FWCW), being hosted by China in Beijing. Furthermore, with the conclusions drawn from the International Conference on Population and Development (ICPD) held in Cairo in September 1994 and the United NationsSocial Summit for Development held in Copenhagen in April 1995, the issues of reproductive rights and women's health have attained even greater global attention and the particular situation of Tibetan women living under Chinese occupation bears significant reference to these issues.

In updating this report, certain changes have been made. This revised edition contains updated information on new Chinese policies and laws that have come into practice since the Cairo Conference, and new information that has been made available to the Tibetan Women's Association (TWA) on restrictive reproductive practices within Tibet, all of which have significant relevance to the violation of women's fundamental human rights occurring in Tibet.

The 20-year Programme of Action of theCairo Population Conferencepromotes an eight-point plan designed to achieve an integrated balance between global resources, growth and human rights. In particular this plan: applies basic human rights principles explicitly to population policies and programs; rejects coercion (including incentives and disincentives), violence, and discrimination; and reasserts that all people have the right to good quality health care. The Cairo Declaration also: calls for and defines reproductive and sexual health care that provides good quality, comprehensive information and services (including safe abortion where not against the law) for all, including adolescents. These policies endorsed by theCairo Conference reinforce the recommendations of the Tibetan Women's Association to end the coercive practices of population control and violations of women's reproductive rights in Tibet.

A submission by worldwide non-governmental organizations to the United Nations Commission on the Status of Women held in New York in April 1995, as the final preparatory meeting to the United Nations Women's Conferencehosted by Beijing, also identifies inequalities in women's health care and reproductive rights as fundamental obstacles to the empowerment and advancement of women this century. The recommendations of the submission highlight areas of concern that include; discrimination, sexual violence, education and access to information, and the implications of social and political factors that inhibit women's reproductive freedoms and health. Given the polemic inside Tibet and the restrictions on Tibetan women's rights (reproductive, educational, social and political) the resolutions agreed upon for elevating women's status must be viewed realistically within the political context of Tibet.

The non-governmental submission for theBeijing Conference asks governments to take primary responsibility to ensure that gender hierarchies and restrictions of women's fundamental rights are eradicated and that the international community properly addresses the problems inhibiting women's growth and private and public freedoms. The Tibetan Women's Association requests this same international community that supports and endorses the agendas of these important global conferences, to consider the relationship of Tibetan women to the authority that decides their reproductive health for them; to consider the conditions under which Tibetan women are forced to comply with a system that severely limits their fundamental freedoms; and to consider the force and absence of choice that accompanies these actions.

The Tibetan Women's Association calls upon the international community, women's organizations, governments and non-governmental agencies to fully implement the strategies and recommendations of the United Nations fora concerning population issues and women's issues. The documented coercive practices of population control in Tibet bear particular relevance to the agendas of these global meetings. Without significant sanctioning of these recommendations endorsed by the participants across the global community, these same recommendations are rendered invalid. By proposing fair, universal accountability for the future health of women worldwide, the international attendees of these events must be prepared to address the situations of women whose circumstances are politically implicated.

The situation of Tibetan women is representative of a gender imbalance, a power imbalance and a social and political imbalance. While the women of the world are identifying their needs, suggesting alternatives and requesting platforms for change, the issues facing Tibetan women today should be examined in the light of these conclusions. This report aims to demand that the fundamental human rights of Tibetan women, their right to reproductive health, choice and freedom be returned unconditionally to them.

May 20, 1995
President
Tibetan Women's Association
Mcleod Ganj
Dharamsala
INDIA

One such convention is that of the United NationsConvention on the Status of Women which in 1979 adopted the Convention on the Elimination of Discrimination Against Women, known as CEDAW . All forms of this Convention came into force in 1981. China has already ratified this Convention.

Article 14.2(b) of CEDAW states the need to have access to adequate health care facilities, including information, counselling and services in family planning". While another article 16.1(e) of the same Convention states that "women have the same rights to decide freely and responsibly on the number and spacing of their children and to have access to the information, education and means to exercise these rights".

China also became signatory to theAgreement on the Abolition of Discrimination of Women which was a result of the First World Women's Conference in Mexico in December, 1979. Under Article 16 of the above-mentioned agreement, China undertakes to carry out "all suitable measures for the abolition of discrimination against women in family matters", especially "the right to free and responsible decision about the number and age difference in children to be had." But the opposite is practiced in Tibet and no doubt in the People's Republic of China.

A resolution regarding the upliftment of the status of women was passed by the Third World Conference on Women in Nairobi, Kenya, in 1985 as Nairobi Forward Looking Strategies For The Advancement of Women (NFLSAW). The strategies were adopted by consensus of the 157 countries represented at the Conference. They were also adopted without a vote by the 40th session of the United Nations General Assembly in Resolution 40/108 in December, 1985. All conferences leading up to the Fourth World Conference on Women in Beijing in September, 1995 will focus on these strategies.

Paragraph 159 of NFLSAW states that all governments should ensure that fertility control methods and drugs conform to adequate standards of quality, efficiency and safety. This should also apply to organizations responsible for distributing and administering these methods.

Despite their ratification ofCEDAWand six other UN human rights instruments, and agreement to the adoption of the Nairobi Resolutions by the UN, China continues to violate aspects of these accords on the grounds of sovereign rights. In his statement, Mr. Cui Tiankai of the Chinese delegation, at the preparatory conference of the International Conference on Population and Development (1992), said that different countries are faced with different circumstances. That their levels of economic development, political systems, natural endowment and cultural and religious traditions differ considerably from each other. He maintained it is only logical for countries to formulate their own population policies, objectives, programmes, priorities and measures and this is their sovereign right, which should be respected without any outside interference. However, given the forced occupation of Tibet, these population policies need to be revised with respect to fundamental human rights and choices of the Tibetan people.

All women's conferences leading up to the Fourth World Conference on Women (FWCW) in Beijing in September 1995, including the International Conference on Population and Development (ICPD) held in Cairo in September 1994, place continued emphasis on these strategies to ensure the rights of women. The location of the Fourth World Women's Conference in China, where internal violations of human rights of both Chinese and Tibetans are well documented, will bring the issue of reproductive rights into sharp focus once again.

Birth Control Policies Within the TAR

Officially the "one family, one child" policy covers only "nationalities" in China with over 10 million members. Tibet, with a population of 6 million, should therefore be exempt from this policy. However, in 1982, the Beijing authorities issued a national directive on birth control, which said of the minority:

Although the policy towards the national minorities may be appropriately relaxed according to the actual situations, family planning must be encouraged among the national minorities.

However, that policy of relaxation appears in practice to mean that implementation is delayed and the full policy is introduced by stages.

The Central Committee and the State Council responsible for propagating family planning and control of population growth stated that "family planning should be practiced among minority nationalities to raise the economic and cultural levels of minority areas and to improve national quality."A national conference on family planning among minority nationalities was convened jointly by the State Family Planning Commission and the State Nationalities Affairs Commission in 1993 to formulate relevant policies and measures.

China's current national birth control policy states that Tibetan "minority" women are allowed to have two children, while Chinese women are allowed to have only one child. In order for a Tibetan or a Chinese woman to have a child, she must be married and between the ages of 25 to 35. A Tibetan woman desiring a second child must wait four years before becoming pregnant again. Women who become pregnant outside of these parameters must have an abortion and/or be sterilized, or face severe social and economic sanctions.

In urban areas, Tibetan women "cadres" (employees in the government's administration) are strongly encouraged to have only one child like the Chinese women. A Tibetan nurse named Chimi who had worked for three years at Lhasa People's Hospital, explained China's family planning policy for urban Tibetans. According to her "Tibetan women are allowed to have two children, but if they have one this is considered best. In public meetings that everyone is required to attend, women are told that it is best to have one child. If they are sterilized after the first child, praise will be given for being a good citizen." She continued that "sterilization is done automatically on women delivering their second child at Chinese hospitals."

Since 1982, China has passed several regulations for the adoption of birth control policies in the Tibet Autonomous Region. One of the more significant regulations is the 1985 TAR regulations, entitled Established Guidelines Relevant to Granting Birth Permits which allowed urban Tibetans two children and Chinese one. An urban Tibetan cadre could have a third child if the first two were of the same sex. The guidelines provided a confusing image of the state of the policy at that time, avoiding any mention that extra children were banned or that anything at all was forbidden. Under these regulations, couples were required to obtain a permit for giving birth from the local authorities, implying but not stating that a birth without a permit is not allowed. The Tibet Information Network (TIN), an independent human rights monitoring agency, suggests that the ambiguities of the 1985 document stemmed not from an attempt at concealment but from the gradual approach with which the authorities were trying to introduce legislated birth control into Tibet. This gradualism is fundamental to Chinese policy towards non-Chinese, especially the Tibetans.

On 29 May, 1990, Xinhua announced that the Tibetan Regional Government was preparing to introduce birth control regulations throughout the Tibet Autonomous Region, as had already happened in Tibetan areas outside the TAR. Chinese officials began to place more emphasis on the notion that birth control was as necessary for Tibetans and other nationalities as it was for Chinese.Additional Birth Control Regulations were passed for the TAR in 1992. Issued on 8 May, 1992, these regulations further defined the terms of administration and fiscal management of the policy. These changes reflect the increased emphasis on rewards and punishments to "encourage" late marriages, delayed births and births at long intervals, preferably of only one child, but in no case of more than three.

Street posters in Lhasa in 1993 advertised the policy with slogans such as: "Control the Population and Create a Civilized Nation." Such campaigns were not new. Similar posters have been visible in eastern Tibet for nearly a decade. As early as 1987, a partial policy of birth control existed in some areas of Tibet. The leading Chinese demographer Zhang Tianlu, wrote in 1987 that in the TAR, Tibetans and other workers were allowed a third child "only in special cases".

Birth Control Policies Outside of TAR

Vast regions of Kham and Amdo constitute parts of Tibet which do not fall under the officially recognized TAR. Most of Kham is today incorporated into Sichuan Province, and most of Amdo is incorporated as regions of Qinghai and Gansu Province. There are reports that population control campaigns are more intense in the Tibetan prefectures outside of the TAR. The official Chinese media has acknowledged that in Tibetan areas outside of the TAR " the family planning policy... is quite different from that in Tibet [TAR]".

The prefectural governments in these regions officially permit farmers and nomads to have three children and Tibetan cadres to have two. "Unconfirmed reports from the area around Lake Kokonor (Qinghai) however, suggest that since 1988 Tibetan cadres have been permitted only one child and other Tibetans only two." This means that for cadres, there is no "relaxation" of the policy applied to the Chinese.

Similar to the regulations on birth control laid down for the TAR, there are also regulations laid down for each of the regions outside of the TAR. For example, in 1982 the Gonghe (Gungho in Tibetan) county issued a series of regulations entitled< The Supplementary Regulations for the Implementation of Planned Birth in the Gonghe County. Compared to other regulations, it seems far more aggressive, strict and uncompromising. The birth prevention operations are described six times as "imperative" for those who have had an extra child, and the rules say that after 1991 "no excuses or pretext will be entertained as any reason for staying or postponing the operation any further." Paragraph six of the Gonghe Regulations states that from 1 January, 1991, apparently for the first time, farmers and nomads would be included in the birth control policy and would be limited to two or three children with a gap of at least four years between births.

The Gonghe District policy presented to the district people's government at Gonghe on 25 January, 1991 was published as document No.90 and brought into force by a notification dated 24 June, 1992. It states that since 1984 the regional government has advocated and carried out the policy of two children per couple among the cadres, workers and the staff of enterprises and residents in towns and cities.

The important account provided by Tashi Dolma, a Tibetan doctor from Tsolho (Hainan in Chinese) in a region of Amdo, suggests that by 1988, in some areas outside the TAR there were indications that the one-child policy would be extended to certain categories of Tibetans. After fleeing to India, Dr.Tashi remarks: "Since 1988, government people are allowed one child and non-government people, two. No specific reason was announced for this policy".

The report was confirmed by another woman doctor from the same area who fled a year later. She maintains that by 1991 the one-child policy had been extended not just to Tibetan cadres but to Tibetans in villages as well. This extension of the one-child policy to Tibetans in Amdo seems to have been followed soon afterwards by the authorities in Kham. A Tibetan who worked as a nurse in 1992 in a "xiang" or township hospital (the name of the township has been withheld by TIN to protect the woman from repercussions) in Ngapa prefecture, Amdo told TIN in an interview in India that from 1982 to 1990 the limit for Tibetans in Ngapa was two children, but since 1990, she said, Tibetans could have only one child. At the same time the fine for an extra child was increased to 7000 yuan ($US1400), which is equal to about eight years' income for an average farmer.

Punishment for breaching "birth planning" regulations are not just limited to monetary fines. An important sanction is the deprivation of children born "out of plan", as the Chinese put it, from residence cards (sometimes referred to as ration cards). This means that these children will experience difficulties in obtaining state-provided schooling, housing, basic foodstuffs, medical treatment and travel. It may also deny them such political rights as exist in relation to voting and citizenship.

In Ganze (Kanze in Tibetan), in Kham (a Tibetan prefecture within Sichuan Province), the birth control regulations under the supplementary regulations of the Ganze Tibetan Autonomous prefecture concerning Planned Birth Methods and Marriage Law implemented on 1 July, 1989, showed that planned birth restrictions were in force well before 1990. Chapter Four, Article 23 of this law states that those who give birth without permission will be deprived of their single-child benefits and privileged treatment, and of their single-child certificates and their welfare fees. According to one villager from near Derge, part of Ganze prefecture, women who want more than two children "have to pay a fine of 1000 yuan ($US200). If they can't pay, then they must go to the hospital to have an abortion". Tibetan cadres who exceed the limit would be reduced to a lower rank and lose their rights to any bonus payments, as well as their right to stand for election to the Congress.

In 1991, the Ganze Tibetan Autonomous prefecture issued a booklet for internal distribution called "The Collection of Planned Birth Documents, No. 5". In this booklet, the committee lays down the necessity of strengthening the work of planned birth and strictly controlling population growth and also talks about the procedure for birth control in the Ganze Tibetan Autonomous prefecture. The general rules of the procedure state that "ideological education must be the main method of implementing planned birth and must also be assisted by necessary administrative and economic methods." On restricting births they stress that births must take place according to the plan.

Eugenics and "Quality Control"

In October 1994 China introduced a national law known as The Maternal and Infant Health Care Law, to be implemented in China in June 1995, in which the government reserves the right to control marriages and births according to their perception of the health of the parents and infant, that is, to avoid "breeding" of inferior quality. The law specifically mentions that it would use sterilization, abortion and bans on marriage to prevent people from passing on mental disabilities and disease to their children.

The law requires that people suffering from mental or physical illnesses defer their marriages, and those who elect to marry outside of these specifications are subjected to forced contraceptive measures such as sterilization or ligation. Article 10 states:

When either one of the couple is diagnosed to have a serious disease, which is medically deemed unsuitable for reproduction, the doctor should explain the situation and offer medical opinions to the couple. The couple may marry if they agree to take long-lasting contraceptive measures or give up child by undergoing ligation.

This would include children of political prisoners interred in psychiatric hospitals that could be subjected to sterilization due to what the State perceives to be a family history of mental illness.

Women who have already given birth to children with mental or physical disabilities will be automatically subjected to medical examinations to determine whether they will be permitted to conceive or give birth again. Similarly, foetuses are examined for hereditary diseases and are aborted accordingly. However little evidence exists to suggest that the couple are consulted extensively during the passing of these decisions, and that medical conclusions are drawn from the most basic of testing procedures. That the State can determine what is considered a "healthy" and "able" parent is a reality based on political implications rather than existing medical conditions.

Eugenics policies had already been written into law at the provincial level in several areas of China, and with the introduction of this law, this has transgressed to the national level making birth control with eugenic intent a powerful means of population control with extreme ramifications. However the law also makes provisions for alternative "rule-bending" of such restrictive reproductive legislations by decreeing:

Provincial, autonomous regional and municipal governments should formulate rules for the implementation of the premarital medical check-up in the light of their respective actual conditions.

This statement clearly allows the regional birth control representatives complete freedom in interpreting on who and when the drastic reproductive restrictions will be executed. For Tibetans considered wholly as part of the "autonomous region", this legislative loop-hole spells greater restrictions on sexual and reproductive freedom, according to the directives issued by local birth control teams, unanswerable to higher authorities.

A new rationale developed by Chinese politicians to explain the application of birth control restrictions to smaller nationalities was the "population quality" argument. There are persuasive indications that the eugenics policy is aimed specifically at the non Chinese nationalities to whom the argument of over population or "population quantity" does not apply.

The Minister of Public Health, Chen Minzhang, who introduced the draft legislation, singled out "births of inferior qualities" among "the old revolutionary base, ethnic minorities, the frontier and economically poor areas", as constituting a major burden on the State, implying that they were the focus of attention. The "revolutionary base" areas and the border areas are mainly populated by non-Chinese.

In May, 1990 the Chinese authorities announced, without providing any sources or evidence, that there were 10,000 mentally handicapped people in Tibet.This, they declared, was a sign of inferior population quality, and efforts therefore had to be made to improve the quality of Tibetan stock. There have been cases where sterilizations have taken place on women with conditions unlikely to be passed on to their offspring.

The 1992 TAR regulations have since been redrafted in the light of such eugenic considerations. "Population quality" is added as one of the objectives of planned birth policy.

Some refer to the aspect of "population quality" as a reason for the introduction of birth control, "the fewer but better births" is the official slogan.

Surgical Procedure - Abortion

Methods of birth control available to Tibetan women are primarily surgical: abortion and sterilization. Access to painless methods of preventing birth and pregnancy is almost unheard of, minimally discussed in official propaganda and largely absent from family planning legislation and policy directives. Although there is stated access to other methods of contraception (including The Pill, intra-uterine devices, and condoms) the language of birth control policy documents clearly indicates that abortion and sterilization are the main methods through which the policy is implemented. Chinese authorities do not make any attempt to consider contraception and contraceptive education as a serious alternative to the use of surgical controls.

Tibetan women forced to undergo abortion and/or sterilization are given reasons that they are too young or too old to have children, too poor or unemployed, unmarried or unfit. Reports of coercive abortion in the 1980's helped provoke a cut-off of financial support from the United States for Chinese family planning programs.

Two types of birth control teams operate in Tibet. While birth control units in Chinese hospitals implement birth control policies for Tibetans living by a hospital, mobile birth control teams carry out birth control regulations for Tibetans living in rural villages and nomadic areas. Both teams have a monetary incentive to perform abortions and sterilizations on as many women as possible. The more names the doctors collect, the more money they get from their government, and from the women who are charged for the operation. In June and July 1990, just after the announcement of the shift of focus in the TAR to the rural areas, birth control teams were active in certain areas of the countryside. For example in one case publicized by the authorities 1,467 women were operated on by the planned birth teams in three counties of the Lhasa Municipal Area.

Abortion appears to be the major form of birth control in Tibet. Those contraceptives that exist are widely seen as dangerous and ineffective, with low medical standards of manufacture and insertion. According to a Tibetan paramedic who had worked in a rural area of Ganze before 1990, "they also had birth control methods like IUD: but often, because of lack of hygiene, these insertions were followed by infections. On one occasion, two women came back after having an abortion with infections; one of them became paralyzed."

The deficiency and non-availability of acceptable contraceptive methods in Tibet is only one of the reasons why abortion is a more common practise. The authorities, for a start, had stated a preference for the "combined method" a term which is believed to mean combining abortion with contraception.It appears that the combined method includes sterilization as a subsequent element. There are frequent first-hand accounts by recent arrivals in India of abortions being carried out. One recent arrival, who had four abortions before she left Tibet for India in 1989, told TIN how she had been given an injection in Lhasa "when I was five months pregnant, they aborted my child at the Main People's Hospital in Lhasa. After this injection, the child came the next day stillborn."

While working as a nurse at the Lhasa People's Hospital, Chimi noted that women "nine months pregnant are injected in the abdomen to induce abortion. If delivered alive, the fetus is also injected so it will die." In China, it is legal to inject women nine months pregnant to induce abortion, and to kill infants still in the birth canal with a lethal injection.

Dr. Tashi Dolma - an obstetrician - from Amdo (Qinghai) had undergone an abortion herself. When Dr. Dolma became pregnant for the second time, the head of her hospital told her to have an abortion or lose her job. She had the abortion. It is important to note that despite her relatively high status she says that she had no idea that she could be sacked or be liable to any other sanctions apart from fines for births "out of plan". The detailed regulations concerning punishment are kept secret, and it appears that only summaries are published.

Sterilization - the Preferred Method

Even if abortion is the most frequent form of birth prevention in Tibet, the official literature focuses on the simpler and much surer solution of sterilization. Sterilization is advised and there is an implicit preference for sterilization in all the current regulations. In the internal commentaries on the Ganze "procedure", it is stated clearly that sterilization is the preferable option in remote areas, a directive which lends some credibility to Tibetan recent arrivals accounts of rural sterilization campaigns. There is no doubt that teams are sent out to the countryside for birth control blitzes, and that these included mass sterilizations from as early as 1986.

In 1990, the local radio station in Qinghai announced that "over 87,000 women had been sterilized, about ten percent of women of child-bearing age." It was unclear whether these operations had been voluntary, but the same broadcast announced, "effective and forceful measures have also been adopted to strengthen family planning work." Furthermore, Gansu Radio on 7 May, 1990 reported that 63,000 men and women had been sterilized as a result of a two-month long campaign.

Chinese explanation that sterilizations have been confused with antisyphilis injections and treatment has been contradicted by the western doctors when examining women who have undergone sterilization. Dr. Diana Gibbs of London supports this statement. Some of the reasons given by women for yielding to sterilization include inability to pay fines that exceed yearly incomes, and coming under pressure to obey the Chinese rules.

Each district in Tibet has a birth control office which deals with the operation of the birth control policy. The mobile birth control teams travel from village to village, plan a target and take women by force to the hospital for sterilization. The surgery is performed without anaesthesia and proper post medical care.

A monk named Tashi described a mobile birth control team that came to his village in Amdo in 1987. Tashi recalls, "I watched a mobile birth control team set up their tent next to my monastery. First the villagers were informed that the team had arrived, and that all women had to report to the tent or there would be grave consequences, like fines of 1000 yuan ($US200) to women who did not comply. The team also said that sterilization was part of a world constitution; women all over the world have this done. The women who went peacefully received medical care. Women who resisted were rounded up by the police and taken by force. No medical care was given."

Infanticide - The Unknown Method

Infanticide is also a commonly reported practice. Many women have reported giving birth to healthy children only to have the hospital staff inform them their babies are stillborn. The mothers will often hear their child's first cries before it is taken away, injected and killed. This is often done when women seek medical assistance for the birth at a public hospital but do not have the requisite birth document. In many instances the woman is also sterilized without knowledge or consent.

Three Tibetan women interviewed in exile in India, described how a relative or acquaintance of theirs had delivered a healthy baby, only to have the nurse kill it with a lethal injection in the "soft spot" (fontanelle) on the head. Cases of infanticide are considered abortion under Chinese law.

Use of Force To Effect Birth Control Policies

Physical Force

There is considerable evidence to suggest that coercion is used to enforce birth control policies in Tibetan prefectures and regions. In particular, the Gonge regulations (see Chapter III -Birth Control Policies Outside of the TAR) imply a use of force to carry out the birth control policies. In addition the Ganze Regulations (as also outlined in Chapter III) prescribe compulsory abortion and the TAR Regulations (Chapter III - Birth Control Policies Within the TAR) demand compulsory sterilization for births `out-of-plan'. The TAR regulations also claim the right to compulsory abortion for people with hereditary diseases and for unregistered "floating" couples of any nationality who have had a child out of plan and have failed to return to their registered area.It is quite clear that the birth control policy in China is not educational but legislative, and it is impossible to have a legislative system without the threat of force, at least in the final instance.

Analysis of coercion in China's family planning program is complicated by the excessive use of euphemisms in published documents and discussions. John S. Aird discusses Chinese euphemisms often employed in statements on birth control policy. He states, "the expression, `remedial measures' is a standard Chinese euphemism for mandatory abortion." The euphemism, "technical services" refers to IUD insertions, sterilization and abortion. He concludes that "the Chinese family planning program is profoundly and intentionally coercive."

Economic Force

The use of economic sanctions and rewards to enforce policy is clearly stated in birth control policy regulations. For example in Chapter Four of the TAR 1992 regulations dealing with Rewards and Good Treatments Article 25 states that women workers from State offices, industries and work units who practice late marriage and late births, and who have single child certificates, will be given the benefit of longer maternity leave; cadres and workers who practice late marriage will enjoy an additional week of marriage leave. Article 30 clearly indicates the incentives offered by employers for complying with the specified planned birth regulations; incentives that include having half their travel expenses and medical fees refunded by the work units (upon provision of hospital receipts).

Chapter Five of the TAR 1992 Regulations deals with Limitations and Punishments. Article 34 states that Tibetans and other minority cadres and workers within the region who have extra births will be punished as follows, for the first extra birth, a penalty fee of 500 yuan ($US100) will be charged as an extra birth fee, and for two years neither member of the couple is allowed a promotion, raise, or bonus (including salary awards). For the second extra birth, a sum of 1000 yuan extra birth fee.

Economic sanctions against Tibetan and Chinese women who have additional children include permanent demotions and the potential loss of employment for both parents, as well as fines from 500 to 3000 yuan ($US100-$US600: one to six years' salary). Tibetan women are also given economic incentives to undergo abortion and sterilization.

According to a statement on abortion by Dickyi Dolkar born in Lhasa in 1963 but speaking from exile, she was a nurse at the Lhasa People's Hospital until she escaped to India in 1984. Women are given 100 yuan ($US20) and a blanket if they undergo sterilization, but if a woman has a third child, the child virtually has no right to exist: no ration card to buy food from the government ration shop, no permit or passport to travel, no educational opportunity, no government work and no right to own property. The only stated sanctions described in the 1995 guidelines are fines of 500 yuan for Chinese, 150 yuan for Tibetan cadres, and 100 yuan for Tibetan town-dwellers. The fines are described throughout as a punishment for not observing the stipulated three-year-gap between births; they are not defined as punishment for having a third child.

Statements from four Tibetans, including doctors and rural women consulted for this survey concurred in finding that a very considerable element of force is applied to women, particularly in villages, through the mechanism of fines and administrative sanctions. Particularly where the women are poor, these threats of fines constitute effective force. The women say that they had no option but to agree to undergo an abortion or a sterilization operation. The use of fines as a way to force a woman to accept abortion is a discriminatory weapon.

Other reported penalties include demotion, loss of financial bonuses and disqualification from the right to stand for elected positions."Illegal children" are denied legal papers that give them the right to identity, attend school, own property, travel, participate in legal work, or obtain a ration card. A ration card entitles a child to receive a monthly allotment of Tibetan dietary staples at government stores. Lack of a ration card would mean that basic food such as grain must be bought at non-subsidized prices on the open market.

There are other testimonies of economic force being used to compel Tibetans to yield to abortions and sterilization. One such case is that of a Tibetan woman who worked as an assistant to the cook in a small reception office for people coming from China. Her husband was a driver in a government office. She had an abortion when she was 30 years old. At that time her husband was just about to get a promotion in his office and she comments,"If we had kept the child, my husband would not have been promoted".

Almost all the reports and testimonies of serious incidents of physical force being used to impose birth control seem to emanate from outside of the TAR. The only public protest by Tibetans which has referred to birth control as an issue took place in Rekong (Tongren in Chinese), Amdo (Qinghai). The demonstration, staged in November 1987 mainly by students, called on the Chinese authorities to stop the practice of forced abortion which was happening in rural areas.

The Role of the Quota System in Enforcement

A contributory factor to the use of effective force in the birth control campaigns is the quota system. By this system, each provincial official's performance is assessed. In most areas, doctors are also given quotas for birth control operations that must be reached. The system of quotas and targets were made more strict each year to ensure stronger controls over the lower level officials charged with carrying out birth control policies. The final implementation strategy is decided by the county level authorities, who are in turn answerable to the Party County Committee.

On 26 July, 1988 the central CPC office and State Council Office gave instructions on the present planned birth policy. The instructions to carry out the Sichuan provincial planned birth article stated, for example, "we must adopt strong measures to quickly and effectively carry out planned birth work." They issued an order calling for "target responsibility systems" to be implemented. This was carried out on paper in Sichuan on 10 November 1988, through an order called"Sichuan Provincial People's Government Document No 206" (1988). The provincial government decided to implement the planned Birth Target Management Responsibility System throughout the province from 1989, in order to increase the responsibility of each level of government to do planned birth work well.

The State gave a population control target and point system to Sichuan province, with four items to be examined each year:
1) Number of births;
2) Planned birth rate;
3) Spread of two children (families); and
4) Extra plan pregnancy rate.

In examining any performance, the total number of points is 100. Those who do not exceed the controlled population number will get 30 points. Those who do not exceed the extra planned pregnancy quota will get 30 points. For every one percent lower than the target for number of births and extra planned pregnancies, an extra point will be added. Each item in the quota will be based on a random sample of 1000 chosen by the Provincial Planned Birth Committee. The threshold for awards is 95. After examination, those whose general marks are above 110 points will be placed in the first class, and awarded 1,500 yuan ($US300). Those with points of 100 and above will be in the second class and awarded 1,000 yuan ($US200), Between 95 and 100 will be in the third class and awarded 500 yuan ($US100), and between 90 to 95 there are no rewards nor punishments. Those teams who receive first class awards continuously for three years will be given the title of "Red Flag Work Unit" and will receive a one-off prize. The necessary funds for such awards will be allocated from the planned birth fund.

Conversely, those who do not fulfill the target will be criticized. A notice of criticism and a written report will be sent to the provincial government if they do not fulfill targets for two years running. Those who are charged with causing a serious loss of population control will be demoted one rank or one grade or even be dismissed completely from their positions. The Ganze regulations repeated the Sichuan wide instructions, but with a discreet modification: the pass mark for Ganze officials was lowered by 5 percent so that the areas could fall to 85 percent of the quota before they would incur punishment.

In April 1991, the Prime Minister of the People's Republic of China, Li Peng, accompanied by the Party Secretary, Jiang Zemin, announced that the responsibility for the quota system, used to encourage population control in certain regions, would be extended across all China and would become the responsibility of local government rather than birth control officials.

By March 1992, the Tibet government was able to report that "family planning personnel in our region have conscientiously implemented the relevant policies and regulations, strictly abided by the limits allowed by the policies, and have done a great deal of work under difficult circumstances".

The pattern of implementation has varied widely from one county to another. However, in all cases the quota system and associated punishments and rewards have led to excessive enforcement, beyond the written dictates of the law. So the quota system acts as a second barrier which has to be crossed after a couple has satisfied the requirements of other stringent limitations on childbirth. The current eighth Five-Year Plan of the People's Republic of China, at least in its internal version, calls for a quota system to be implemented in the TAR as well as other aspects of birth control policy: We must step-by-step implement the birth planning quotas of cities and towns providing the leaders of the birth-planning work with the strength, resources and administrative means.

It should be noted that in addition to the above-mentioned forms of coercion, there is evidence of social and psychological pressures being used to ensure compliance with the policy. One example is the holding of commune family planning meetings. Attendance at these meetings is compulsory for women with a third or subsequent child. These meetings could last for days and women are not allowed to leave the "struggle session", until they can "think clearly" about their pregnancy.

Cultural Survival

Colonialists usually have more resources and education than host populations, which often results in an exploited relationship. The result leads to impoverishment of host populations. At the extreme, "deliberately inflicting on the group conditions of life calculated to bring about its physical destruction in whole or in part", is a violation of theConvention on the Prevention and Punishment of the Crime of Genocide, and International Convention on the Suppression and Punishment of the Crime of Apartheid.

With the implementation of birth control policies in Tibet, plus massive Chinese migration, the Tibetans have become a minority in their own country. It is estimated that between at least four and 20 percent of the population is no longer able to reproduce, with many thousands more subjected to other forms of contraception. If there were no more children born to this sector of the population, [the] Tibetan population could be reduced by as much as 20 percent.

Tibet has a religious tradition of what is described as a "self imposed" population control of between five to ten percent of the population - being monks and nuns. The potential result of these combined factors makes it hard to believe that the population could stabilize, even if large numbers of nomadic Tibetans were allowed four children, as some reports suggest. Therefore, it is likely that the rich Tibetan culture and heritage will succumb under the impact of a diminishing population, strict population control, and Chinese migration.

Changing Demographics In Tibet

In the 1980's, a particularly sinister policy was instituted by China, in the form of population transfer of millions of Chinese into Tibet. The combination of population transfer, and the implementation by stages of a coercive family planning program among Tibetans both in and outside of the TAR, places the very survival of Tibetan culture and population at risk.

The first public indication of Chinese population transfer to Tibet came as early as 1952, issued by Chairman Mao Zedong himself in theDirective on Central Committee of COC on the policies for work in Tibet. Proposing a five-fold increase in the TAR population, he said the TAR: covers a large area but is thinly populated. Its population should be increased from the present two or three million to five or six million.

In May 1984, Radio Beijing reported that, "over 60,000 workers representing the vanguard groups to help in the construction work in the TAR are arriving in Tibet daily." In the summer of 1985, another 60,000 Chinese workers, mainly from Sichuan, arrived in the TAR. To encourage Chinese settlement in Tibet, the Chinese Government offers an array of benefits to its personnel and civilian population. Housing, health care, home leave, cultural and educational facilities are all part of an expensive undertaking to subsidize the Chinese in Tibet. Annual wages for Chinese are 87 percent higher in Tibet than in China. Chinese entrepreneurs receive special tax exemptions and loans at low-rate interest in Tibet, whereas for Tibetans to start an enterprise in their own homeland, even getting the license is reported to be virtually impossible.

In June 1987, Deng Xiaoping admitted that the Chinese were being encouraged to move to Tibet because, according to him, the local population "needs Chinese immigrants as the Autonomous Region's population of about two million is inadequate to develop its resources".

There are now 7.5 million Chinese throughout Tibet according to the exile government's figures, as opposed to 6 million Tibetans; this results from three decades of population transfer policies and the ensuing uncontrolled migration of Chinese job-seekers.

As reported by Asia Watch, this pattern of systematic discrimination contravenes the provisions of the United NationsInternational Conventonal on the Elimination of All Forms of Discrimination (CEFD), a covenant to which China acceded in 1981.

The increase of Chinese inhabitants compared to Tibetans has led to a de-facto system of discrimination in such social goods as housing, education and health care facilities. The infrastructure built to accommodate and provide perks and incentives for Chinese cadres, "experts and technicians," and office workers, plus the "Han chauvinism", combined to create a situation of clear-cut discrimination in favor of the incoming Chinese in terms of social services and facilities.

Women's Health at Risk

Health, as defined by the World Health Organization (WHO), is not merely the absence of disease but a condition of physical, social and psychological well-being.It is not only the physical health of Tibetan women which is at stake, but also the psychological impact of policies which lead to having no control over ones own body. Chris Mullin of the Minority Rights Group commented in 1981 that "even to the casual observer, it is evident that the standard of health care is much lower in Tibet than in the rest of China."

In Section 1243 of theUnited States Foreign Relations Authorization Actregarding human rights violations in Tibet by the People's Republic of China, it is stated that "Tibet's economy and education, health and human services remain far below those of the People's Republic of China as a whole". Given the neglect and underdevelopment of the Tibetan sector on the whole, it is unlikely that health conditions have improved since that time. Save the Children Fund/UK and The Woodlands Mountain Institute have both documented widespread malnutrition among Tibetan children and lack of maternal and child health preventive measures, such as immunization campaigns and TB control. World Bank statistics in 1984 showed high infant mortality rates for Tibetans, with a child mortality figure of 150 per thousand in the TAR, as compared to 43 for China.

The issue of abortion and sterilization raises particularly serious concerns for women's health and well-being. Many testimonies report health problems that are attributed to abortion and/or sterilization operations. The operations are often carried out without regard for the health or welfare of the woman, with extremely questionable procedures, with under-qualified medical staff, under poor conditions, and without a woman's consent. The symptoms described are remarkably consistent and include most commonly, backache, loss of appetite with attendant gastric problems, weakness and tiredness. Some report fever and headaches. There are even reports that some women have died or suffered chronic problems as a result of such operations.Following undesirable medical procedures, women receive no follow-up or post-natal care; thus problems often go unattended until they reach a critical and/or fatal stage.

One such testimony describes an abortion technique that involves "inserting electrical devices into the vagina of women who are two to three months pregnant, thereby killing the baby." Another testimony from a Tibetan doctor from the People's Hospital in Amdo describes the process of "Menstrual Termination of Pregnancy" (MTP) which she underwent against her will. It was her second pregnancy and a birth permit had been obtained. Nonetheless the MTP operation was ordered by her Chinese boss. On that day the required appliances were not available at the hospital and no anaesthetic was applied. A rubber tube was inserted for 24 hours causing a loss of blood in the womb. This was claimed to make the operation safer. She reports constant back pain and irregular periods since that time.

Economic Impoverishment

As stated earlier, there are stringent economic sanctions that act as both deterrents and punishments to Tibetans seeking birth permits or who have children above the permissible number. The 1992 TAR Regulations, for example, contain detailed sanctions for Tibetans working in towns. An urban Tibetan couple who have an unauthorized child will be fined at least 500 yuan, about three month's income for a government employee, or a year's income for a member of a farming family. Neither husband nor wife is eligible for promotion, raises, or bonuses for two years. The fine for a second illegal child is 1000 yuan for an employed couple, or 600 yuan for couples with no "stable profession". Therefore, those Tibetans who have "illegal" children are forced to pay fines, irrespective of their income, leading to their economic degradation.

In a 1991 interview reported by TIN, a female villager from Derge in Ganze Prefecture, Sichuan Province, reported undergoing a sterilization operation in 1982, when birth control was first introduced in her village. She gave financial pressures as the reason, "I knew that if I had more children, I would not have the money to pay the fine."

Yet another impact of the birth control policies appears to be the increasing instance of Tibetan women escaping out of Tibet to safely give birth to their children. Elaine J. Cohen (researcher) interviewed a Tibetan woman who had escaped to India and found out that the woman's family had put all their money together to get her safely out of Tibet in order to spare her from being the subject of birth policies in Tibet.