In Reply Dr Barrows takes issue with some of the positive aspects of the one-child policy that were outlined in our Viewpoint.
First, we agree that fertility reduction is not ipso facto positive. However, for low- and middle-income countries, the inverse relationship between fertility rate and wealth is well established.1 In China, the reduction in average family size did contribute to poverty reduction. It is well recognized that the policy has contributed to demographic imbalance, and our Viewpoint addressed this problem. Concerns about the increase in the aging population are the reason that the policy has been progressively eased.
Hesketh T. China’s One-Child Policy—In Reply. JAMA. 2016;315(21):2350. doi:10.1001/jama.2016.2195