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In 1979, China made it illegal for couples to have more than one child. This law remained in place until 2015, when it was relaxed to allow two children. According to the Chinese government, the policy prevented 400 million births, thereby staving off mass starvation. But at what cost? In One Child Nation, a documentary film that won the U.S. Grand Jury Prize at the Sundance Film Festival this year, directors Nanfu Wang and Jialing Zhang provide a harrowing answer.

The film is framed by Wang’s personal experiences growing up in China’s Jiangxi Province. Surrounded by propaganda glorifying one-child families, Wang didn’t question the policy until she became pregnant herself, long after she’d left China. Struck by an intense desire to “protect the life [she] was carrying,” Wang began to wonder how mothers fared in a country that restricted their ability to do so. In One Child Nation, Wang returns to her hometown to gather firsthand accounts of life under the policy, beginning with her own family.

With astonishing frankness, her interviewees recount the horrific means by which the policy was enforced. A former village chief explains that if families violated the policy, he would “demolish their homes or take their possessions." Women were sterilized against their will and forced to abort if they conceived. “In those days, women were abducted by government officials, tied up, and dragged to us like pigs,” recalls an 84-year-old midwife, before making a chilling admission: “I’ve done a total of between 50,000 to 60,000 sterilizations and abortions. I counted this out of guilt, because I aborted and killed babies. Many I induced alive and killed. My hands trembled doing it.”

New abuses arose after the government legalized international adoption in 1992. Family planning officials abducted newborns and sold them to orphanages. Because officials withheld this information and gave adopting couples fabricated stories, it is all but impossible for adoptees to find their biological families—and vice versa.

A burden on women and girls

The brutality of the one-child era extends beyond its implementation. Guided by a rigid cultural preference for males, many parents aborted female fetuses or abandoned them as newborns for a second chance at having a son. Wang doesn’t have to go far to find proof of this, discovering that her aunt and uncle left her newborn cousin on a meat counter in a marketplace, hoping that someone might rescue her. She died two days later when no one did. Recounting the tragic decision, Wang’s uncle explains that his mother threatened to commit suicide if he did not give her away. “I thought I could save her life by giving her away,” he explains, “But she ended up dead.”

Near the end of the film, Wang asks her grandfather to explain his culture’s preference for males. He responds that a son is necessary to carry on the family name. Wang interjects with a question that could be directed not just at her grandfather but at the entire nation: “What about women?” She’s met with a momentary but significant hesitation, fittingly emblematic of the lack of consideration given to women in a policy that affected them more than anyone else. Women suffered the physical toll of forced abortions and sterilizations. Women were disproportionately aborted, killed, abandoned, and separated from their families. Women paid the emotional cost of a policy that made protecting the life inside them a criminal act.

One Child Nation covers a lot of ground, a reflection of the enormity of the policy and its sprawling effects. The film also provides numerous takeaways: the power of propaganda, the danger of complacency in the face of injustice, the perils of putting the interests of a nation before the dignity of its people. More than anything, though, One Child Nation highlights the gendered-skewed burden of population control—and the tragic irony of ignoring the interests of women on an issue that, by the nature of biology, is so distinctly feminine.

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