The Chinese government’s decision to end the decades-old one-child policy will probably complicate an already difficult situation for China’s left-behind children — those left at home in rural areas when their parents migrate to cities in search of work — since it will increase their number and demands for their care. According to statistics from the All China’s Women’s Foundation, one in five children nationally — an estimated 61 million children — grow up without one or both parents.

Rapid economic development in many countries has forced millions of workers to emigrate from rural areas to cities in search of employment. This is particularly evident in the case of China, where over the past generation over 270 million Chinese laborers have left the country’s poorer inland provinces to find work in coastal towns and cities. This is considered the largest human voluntary migration ever.

The left-behind children suffer the consequences of their parents’ migration. It is estimated that 70 percent of these left-behind children don’t get to see their parents annually. Only a third of the left-behind children see their parents once or twice a year, usually during the Chinese New Year, and many don’t even get a phone call for a year which makes them feel unloved and isolated from their parents.

The children left at their parents’ homes are usually left in their grandparents’ care, in situations that are not usually the most convenient for the development of the children. At other times, they may be even kept under the care of their great-grandparents or other relatives who can shelter and feed them. If the children left behind suffer from some health problems it presents a dire dilemma on how to deal with them due to the extra care they need.

Children’s well-being and education suffer as a result of this situation. Lack of parental figures to order their lives can lead to rebellious children who may also get depressed and who may even become involved in criminal activities. This is why the situation of left-behind children is a matter of considerable uneasiness among government officials and the public at large.

To better protect the well-being and healthy development of the children left behind the government issued a regulation on Jan. 1. According to it, the guardian of a child shall be disqualified if he or she fails to fulfill their responsibility for more than six months. This period, however, should be shortened to only a month to make this regulation more effective, since considerable damage can be caused to a child uncared for during the six month period.

Many left-behind children carry the burden of loneliness. Growing Home, a Chinese non-governmental organization, found in a study that left-behind children were more introverted than their peers and more vulnerable to being bullied at school. They also manifested higher levels of anxiety and depression than their peers. Many among them said that they didn’t even remember what their parents look like.

The psychological consequences on the mental health and proper development of left-behind children are underscored by professionals such as Tong Xiao, director of the China Institute of Children and Adolescents. “The kids will have big issues with communications. Their mental state and their development might suffer,” he said.

Many left-behind children’s grandparents are often illiterate and, as a consequence, the children’s education may be affected. The All-China Women’s Federation reports that a quarter of the grandmothers who were looking after small children never attended school, while most of the rest had only primary education.

Some of the left-behind children have siblings, since the one-child policy was slightly more relaxed in the countryside. This presents an additional problem, however, since the second child in many cases cannot be registered and lack even the most basic rights, such as going to school, having medical attention or even having a library card. The future for these children (called “black children”) is very dire and requires immediate attention.

The Chinese government has to confront a very difficult situation brought about in part by its decision to implement the one-child policy in 1979 to slow down the population rate. The best and most immediate course of action is the creation by the government of a multidisciplinary task force including anthropologists, doctors, social workers, demographers, psychologists and politicians who can determine how to meet the most urgent challenges.

Dr. Cesar Chelala has traveled twice to China on U.N. health-related missions.

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