In 1988, the first human baby conceived through in vitro fertilization (IVF) technology in mainland China was born at the Peking Medical College Third Hospital in Beijing. The Chinese media soon celebrated the IVF achievement for its scientific modernity, as well as for its indigenous design, which was deemed suitable for Chinese infertile women. By tracing the project director Zhang Lizhu's professional, social, and technological experiences as the IVF project proceeded at the Third Hospital, I examine the sociopolitical justifications of the project and the technological strategies of the final IVF design. Sociopolitically, state funding for IVF in the mid-1980s, a time of governmental promulgation of the one-child policy, was predicated upon melding eugenic motives into the IVF program as a rationalization for fertility treatment. Technologically, what was claimed to be “indigenous” IVF design was actually a technical shortcut to quick success contrived to bypass challenging protocols established in developed countries. The case reveals that the IVF project and its representations in the reform era, though predominantly characterized by a sociotechnical pragmatism, still carried a hint of Maoist romanticism that celebrated worker innovation and indigenous self-reliance. Zhang's IVF program thus offered a pivotal transitional process through which the sociotechnical imaginaries of biomedical reproductive modernity began to form in 1980s China.
On 10 March 1988, the first baby conceived through in vitro fertilization (IVF) and embryo transfer technology in mainland China, Zheng Mengzhu, was delivered through cesarean section at the Peking Medical College Third Hospital. The media celebrated the event as a major breakthrough in China's long march toward medical and technological modernization. News reports praised the leading gynecologist of the IVF team at the Third Hospital, the woman doctor Zhang Lizhu (张丽珠, 1921–), for her persistence in trying to persuade extreme advocates of population control to fund IVF research and for being highly ingenious in creating an indigenous IVF method particularly suitable to the Chinese population. Some of these news reports compared Zhang with the goddess Guanyin, who in Buddhist legends grants children to devout female believers, a religious metaphor that highlighted the benevolence of the novel biomedical intervention (Meng 1988; Niu 2010).1
As the director of the IVF research group at the Third Hospital and a major research gynecologist within the group, Zhang played an important role in the final success of the project. Like IVF developments in other national contexts, however, the IVF project in China was certainly not due to a single individual but had involved a range of actors and factors that included sociocultural supports, funding agencies, patients, other doctors, and nurses. In addition, amid the general glorification of its humane and innovative aspects, these news reports did not adequately explain how the IVF innovation team evolved amid the various political, technological, and material opportunities and constraints of the reform era. The Third Hospital's IVF research program took place during a time when state reform and myriad social changes presented competing priorities and opinions regarding reproduction and reproductive technologies. For example, although IVF's high-tech prospects fitted well with the nation's endeavors toward comprehensive modernization, its development had received criticisms because the use of IVF might increase births. In addition, directly after the Cultural Revolution, the Chinese biomedical system did not immediately have sufficient material or technological resources to match rekindled national ambitions for science and technology. Fully addressing how the IVF program was justified, funded, and carried out requires the unpacking of the various layers of the making of Chinese IVF.
This article follows the experience of Zhang as a gynecologist who worked with flesh-and-blood patients, as an applicant for the then newly available, “peer-reviewed” national research funds, and as a scientific investigator who strived to achieve. Through the multifaceted experiences of this one female researcher, this article depicts the technological, sociocultural, and governmental resources that simultaneously enabled the IVF program and molded its fulfillment. Zhang's experiences were particularly illuminating because of her active roles in mediating and negotiating among patients' interests, state ambitions with regard to scientific advancements, and medical solutions constrained by limited local expertise. I show that, at the sociopolitical level, the state funding decision regarding IVF had resulted from acts of realignment of the interests of infertile women, state goals regarding population control and eugenics, and a national drive for scientific achievements. Regarding the technological design, I argue, a rationalized risk-taking was pivotal to the success of Zhang's program. Although the team had extensively studied the scientific literature on the already established IVF setup in England, the project was carried out without foreign advisers. How much to replicate and how much to innovate were open-ended questions. The final IVF design diverged significantly from established protocols and was a result of medical compromises to take full advantage of local expertise in surgery, which was later dubbed the “indigenous method.” The full story shows how IVF technological transfer from more developed countries to China was not one of unmodified, unidirectional imports. Rather, the process reflects how reproductive technologies were remade and reimagined in the contexts of Chinese reform in the 1980s.
The case demonstrates a range of sociotechnical imaginaries of Chinese IVF, along with considerably detailed processes of its technological construction. Historians of technology have noted that innovative technological designs are often flexible at the outset, and their eventual fixation requires explanations that go beyond technological advantage, which is often unjustly taken for granted (Pinch and Bijker 1987: 40–46). In terms of introducing new technology, the “system builder” is considered most active as critical decision maker, while existing local technological styles are particularly important in shaping the eventual design of a new adoption (Hughes 1987: 57, 68). For integrating the social and the technical aspects, Sheila Jasanoff and Sang-Hyun Kim have described “collectively imagined forms of social life and social order reflected in the design and fulfillment of nation-specific scientific and technological projects,” which they called “sociotechnical imaginaries” (2009: 120). The concept was invented to guide scholars in examining how political and social priorities made the interpretation and implementation of the same technology different in different sociopolitical contexts. The concept offers a productive angle from which to examine the case of IVF in China. As I will show, the ambitions of scientific modernity, patrilineal reproductive traditions, socialist sovereignty, mass science practices, and quasi-postcolonial binary discourse in between the “Western” and the “indigenous” all left unmistakable imprints on Chinese IVF in the 1980s.2
Progressive endeavors in science and technology during the reform era of China have attracted a number of scholarly inquiries.3 Some works rightly point out that there was a wide gap between high aspirations for development, as shown through aggressive policy statements and financial stimuli, and the challenges of implementing and translating these ambitions into real changes. Yeu-Farn Wang (1993: 100–114) has shown that the establishment of research planning and funding commissions that took account of expert opinions and allowed greater freedom for scientists and technicians in choosing research topics were focuses for the Chinese Communist Party in the early 1980s. These state measures generally increased the autonomy of scientific experts and consolidated the realignment of experts with party leaders but also brought in a range of actors whose diverse interests contested the existing policy. The mission-oriented “key projects” (攻关项目) that the IVF project belonged to were precisely such products of combining expert proposals with important social and state needs.
Regarding the role of experts in altering research and policy direction, different arguments have been offered. Cong Cao's sociological studies on the members of the Chinese Academy of Sciences confirmed the importance of scientific elites in advising research and policy during the reform era but also showed limitations of such a role (2004: 187–89). H. Lyman Miller (1996), on the other hand, suggested that scientific experts continued to constitute one of the most important democratic revolutionary forces since the May Fourth era. Case studies that examine the relationship between scientific experts' sociopolitical stance and the contents of their research in twentieth-century China are relatively few, with exceptions such as the famous case of Fang Lizhi's astrophysics and its political implications. In this regard, Zhang's IVF research provides a way to probe the intimate relationships between experiences of working with patients, with high-tech biomedicine, and with party officials during the reform era, all from the point of view of a medical expert.
Since the birth of Louise Brown in 1978, feminist scholars and those from the field of science, technology, and society have offered a large number of works that tackle anthropological, sociological, and ethical issues revolving around the use of assisted reproductive technology.4 Feminist scholars have both criticized IVF as a male-dominated exploitation of women and also pointed out that IVF could be used in ways that liberate and empower women and redefine kinship (Corea 1985; McNeil 1992; Franklin 1997; Bonaccorso 2008). With emerging scholarship on the uses of IVF in non-Western contexts in the 1990s, it became clear that IVF technology had been perceived and used within different geopolitical regions in locally distinct manners, engaging religions, demography, class issues, perceptions of infertility, and nationalism in different ways from the European and American scenarios. A simple globalization framework thus became inadequate to capture the range of culturally specific responses, innovations, and constraints on IVF uses and interpretations. This article touches upon various wider concerns of this large body of literature, including infertility and population size, local medical traditions and styles, and scientific nationalism (Inhorn and Birenbaum-Carmeli 2008). Regarding the first cases of technological fulfillment and successful IVF delivery in particular geopolitical regions, Daphna Birenbaum-Carmeli (1997) has shown that the media narrative of the first case in Israel centered on a Zionist understanding and representation of both Israeli pronatalism and hierarchical gender relations. Aditya Bharadwaj (2000, 2002), in contrast, offers a contested story about the priority of test-tube baby making in India that displays strong competition between medical establishments and their recruitment of media attention. The IVF story in China echoes both works in terms of how IVF developments replicated existing cultural concerns about infertility and strengthened medical authority instead of female patients' best interests. A new dimension that this article adds to this wider body of literature is not only to pluralize IVF stories in their global context but also to unpack the constructiveness and historicity of the technological design itself, down to the details of how eggs for IVF were retrieved in 1980s Beijing, showing the depth and extent to which local conditions reshaped the technology.
The primary sources for this case study include policy documents, news reports, scientific publications, memoirs, Zhang's own autobiographical materials, and interviews with Zhang and her colleague gynecologist Liu Ping. Many of Zhang's autobiographical materials were written throughout her career and were reprinted in her autobiographical anthology. Historians have been wary of acts of self-fashioning, improvisation, and fabrication in such a genre, and I have triangulated Zhang's own accounts with reports and interviews from others (Gordon 1988; Staiger 2013). Yet, for certain experiences, such as her studies abroad, only Zhang's own accounts are available. Readers should be aware of the possible traces of self-embellishment that remain due to the intrinsic limitation of the sources.
In this article, I first review Zhang's professional development as a medical researcher in the United States and a practicing gynecological doctor in Britain and later in Mao's China. I show that although Zhang became interested in cutting-edge biomedical developments during the early days of her training, her highly self-reliant, minimalistic technological style developed only through years of clinical practice in Maoist times and in rural areas. Next, the processes of Zhang's initiation of and justification for IVF research for state funding are discussed, which invoked the term eugenics in order to offset potential opposition from supporters of population control. In the next section, I describe the technological design of Zhang's IVF strategy, which used invasive open pelvic surgery. I highlight clues that indicate that such a design was not used simply, as Zhang claimed, because of the particular tuberculosis patterns among infertile Chinese women. I argue that the highly celebrated “indigenous method” was in reality designed as a shortcut to success. Finally, I assess the significance of Zhang's IVF design by reflecting upon historical resonances found in China's booming assisted reproductive technology industry at present. Although this article focuses on Zhang's experience, it by no means suggests that Zhang was the only figure important to the IVF story: the purpose of focusing on Zhang is to pinpoint, with sufficient detail, how Chinese doctors' earlier experiences both domestically and abroad in the twentieth century shaped not only how medical work operated on a daily basis but also how China adopted novel technology in the 1980s.
A Gynecologist's Coming of Age in Mao's China
Zhang Lizhu was born in 1921 in Shanghai. Her father, Zhang Yaozeng (张耀曾, 1885–1938), was a prominent lawyer and a major drafter of the 1912 Provisional Constitution of the Republic of China that advocated free speech and the containment of presidential power. Zhang would later recall that her father's dream was to advance Chinese society through “progressive change” (jinhua, the same term as “evolution” in Chinese) (Zhang 2008: 8). With her father's vision that women and men should be granted equal opportunities, the young Lizhu enjoyed an education that few Chinese girls at the time had access to.
In 1937, Zhang finished high school intending to study aeronautical engineering at the National Central University in Nanjing in order to meet the urgent national need for aircraft construction during the Sino-Japanese War. Yet she could not go because the university soon moved to the inland city of Wuchang. She remained in Shanghai and at the beginning of 1938 entered the Pennsylvania Medical School at the Shanghai St. John's University, where she trained with gynecologist Wang Yihui.5 In 1944 she obtained her doctoral degree in medicine. After two years of intern work at Shanghai West Hospital, she went to the United States to pursue her postdoctoral studies. She first studied gynecological endocrinology and anatomy at Columbia University and New York University. She then attended the Johns Hopkins University Medical School to study gynecological pathology and surgery with a specialization in early diagnosis of gynecological cancers.
At Johns Hopkins, Zhang modified the Papanicolaou test (pap or “smear” test) that was used for screening malignant and premalignant cells in cervical fluids for detection of uterine cancer. In a published review on the Papanicolaou test, she listed extensive scientific experience as a prerequisite for making a proper diagnosis, noting that “the test is reliable in the hand of a competent cytologist. However it takes time, experience, and skill for such a training” (Leslie and Chang 1948). This research widened Zhang's job prospects in the West, and in 1949 she was hired as a resident gynecological physician by the Marie Curie Hospital in London, a small hospital specializing in gynecological cancers. In October 1950, she passed the British national examination for gynecological physicians and obtained the Diploma of the Royal College of Obstetricians and Gynecologists.
With the founding of the People's Republic of China in 1949, the domestic enthusiasm for building a new socialist China attracted many scientists studying abroad to return. By 1949 about five thousand Chinese nationals were studying in the United States, and among them several hundred chose to return within that same year (Wang 2010). For some time, the US and British governments encouraged Chinese students to return. But the outbreak of the Korean War in 1951 catalyzed a British prohibition of such returns. In 1951, Zhang was able to perceive Londoners' increasing animosity toward the newly established communist regime. London was not a major destination for Chinese medical students during the first half of the twentieth century, and Zhang felt quite alone in dealing with such animosity (Zhang 1999). Intuiting that, if she did not try to go back to China, the chance of returning would be bleaker in the future, she managed to obtain a “departure permit” to Hong Kong and there transferred ships to head for the mainland. Onboard she met several other returning Chinese scholars, among them Tang Youqi (唐有祺, 1920–), who had recently received his PhD in chemistry from the California Institute of Technology. One year later, they married (Zhang 2008: 10).6
In 1951, Zhang worked briefly in Shanghai before moving to Beijing to join her husband. Working at the Peking Medical College First Hospital, she was said to have brought a Western style to the classroom. Students were initially amazed that she never stumbled over a single English word while speaking or teaching and were impressed by her elegant yet “exotic” American manners in greeting people and dressing for the occasion. However, Zhang's intended research in cervical cancer met with frustration: in a country where malnutrition and associated endocrinal problems preoccupied medical concerns, she was overwhelmed by patients suffering from ailments due to poor living conditions, and she seldom encountered cancer patients. Her scientific interest and expertise in gynecological cancer lacked sufficient research subjects or public interest to continue (Zhang 2008: 10–14).
In 1958, Zhang was appointed the director of the gynecology and obstetrics department at the newly founded Peking Medical College Third Hospital. At this time, it was reported, a great number of female students studying at the eight colleges in Beijing were not menstruating regularly. In 1960, the director of the Beijing Health Bureau communicated with Zhang over concerns about the problem. Zhang tested some of these female students' hormonal levels by measuring the effects of their urine extracts on the uterine weight of sexually immature female mice.7 Since the results showed these students still maintained some level of luteinizing hormone secreted by the anterior pituitary gland, she concluded that these young women's menstrual cessations were not related to intrinsic problems of the ovary but were due to abnormal signaling of the hypothalamus, which regulates the anterior pituitary gland. She inferred that intense physical labor and malnutrition during the famines of the late 1950s had caused a temporary stoppage of menstruation—what physicians call “secondary amenorrhea.” She predicted that normal menstrual cycles would return once these students' nutritional situation improved. Her prediction proved to be correct when the normal cycles returned in 1962 after the famines had ended. Her 1960 study on students' amenorrhea became the starting point of Zhang's series of endocrinological studies. She continued to investigate related topics during the 1960s and 1970s, including changes in ovary function after tubal ligations, how different hormones interact to maintain early pregnancy, and the measurement of changes in hormones and their receptors in normal and aberrant menstrual cycles (Zhang 2008: 10–14).
Zhang's investigative and clinical life was frequently interrupted amid the continuous political turmoil of Mao's China. Zhang's foreign-seeming manners and her previous studies in the West were singled out as suspicious during the antirightist campaigns in the late 1950s. During the Cultural Revolution, Zhang was attacked both verbally and physically because she and her work were considered to be bourgeois and reactionary. In 1965, she was moved to Tong County for one year to serve the peasants and to be “reeducated.” There she taught “barefoot physicians,” performed cesarean sections on women and pigs, and treated long-neglected gynecological complications among peasants. From 1966 to 1970, she was demoted and assigned daily janitorial work at the Third Hospital. She was frequently summoned to the dining hall to confess her alleged crimes in bringing medical devices from imperial England and in establishing a bourgeois cervical outpatient clinic. During this time, nurses were in charge of the surgical work. Sometimes, when Zhang was on janitorial duty and passed the operating theater, the perplexed nurses would secretly consult her for ideas about difficult medical conditions (Zhang 2008: 10–14).
Rationalizing IVF for State Funding
The end of the Cultural Revolution in 1976 and the establishment of the office of Deng Xiaoping marked a sharp transition of state focus away from class struggle toward economic development. Realizing the vital importance of science and technology for industry, Deng's office sought not only to reverse the devastation caused by the Cultural Revolution but also to reform the system of scientific research away from the Soviet model. This new scientific ambition was directly illustrated in an economic reform program beginning in the mid-1970s called the Four Modernizations, which included modernization in industry, agriculture, national defense, and science and technology. Scientific experts' suggestions were said to be valued, and these ideas were sometimes openly discussed at the governmental level, especially regarding how China's scientific system should be reorganized (Wang 1993: 101–24). One new approach to reorganization was to commercialize some aspects of technological development, connecting them with the changing domestic and international market and liberating them from purely state-oriented interests. For basic research, the reforms established an “individual responsibility system” whereby institutions and programs were to be held accountable for research outcomes. A peer-review system for competitive funding selection was initiated and experimented with. Public science-funding agencies, such as the National Natural Science Foundation, were also established (State Science and Technology Commission 1987: 423–27). These initiatives in changing the funding and operational mechanisms of science resonated with the economic reform program's larger goal of opening up various sectors of Chinese society to capitalist market forces and internationalization.
Yet a thoroughgoing Westernization was decidedly not the party's goal for the reforms: Deng explicitly expressed that he was against total Westernization during and after the stormy 1980s, when various intellectuals and groups of college students advocated democracy, anticorruption measures, and free speech as exemplified by several Western countries (Hayhoe 1993: 35). Although Deng's office tried to depoliticize science in the wake of the Cultural Revolution and effectively put an end to an extremely populist “mass science” approach, it nevertheless encouraged experts to learn from the people and to use native creativity. The term native creativity was not explicitly defined but was indicated in the new constitution adopted by the Fifth National People's Congress in February 1978. Article 12 stated:
The State devotes major efforts to developing science, expanding scientific research, promoting technical innovation and technical revolution and adopting advanced techniques wherever possible in all departments of the national economy. In scientific and technological work, we must follow the practice of combining professional contingents with the masses, and combining learning from other countries with our own creative efforts. (italics added)
With the sea change in state policy regarding the sciences, Zhang was able to establish an endocrinology laboratory at the Third Hospital in 1978 and started to train the first batch of graduate students in 1979. With her students and colleagues, she published an analysis of the anesthetic effects of acupuncture as seen in the ovarian cyst surgery she had performed during the previous decade, as well as articles about her continuing research on the endocrinology of amenorrhea.8 In 1980, as a Chinese national delegate, Zhang attended the World Conference of the United Nations Decade for Women in Copenhagen, Denmark. She was sent to the conference primarily to disseminate information about China's public health measures and the recent one-child policy (Zhang 2008: 17). However, as a medical researcher who had trained in the West but had been cut off from the global frontier of research for some time, during the conference Zhang also learned a great deal about new reproductive technologies developed in other countries and became intrigued. At the time, the 1978 birth in England of Louise Brown, the first human baby born through IVF and embryo transfer technologies, was still an international sensation. A successful case of IVF in Australia soon followed in 1980, and the birth of the first American test-tube baby, Elizabeth Jordan Carr, took place the following year (Henig 2004).
At home, economic improvements during the reforms made it possible for infertile couples in China to reach out for fertility treatment. In the early 1980s, the Third Hospital received an influx of infertile patients, predominantly women, seeking help. Zhang received a number of letters from women detailing the distress they experienced by virtue of being infertile. They pleaded for help.9 For women who could afford to visit the Third Hospital, Zhang offered examinations and found that blockage of the fallopian tubes was a common cause for infertility. Some of the blockages resulted from past tuberculosis and had little chance of being successfully treated through conventional surgical methods (Anonymous 1978). In 1982, she began to make tentative efforts toward developing IVF techniques (Zhang 2008: 37).
Zhang was not the only Chinese gynecologist to become interested in IVF research at the time. In Hunan province, Lu Guangxiu (卢光琇, 1939–) had since 1980 been testing IVF technology in mice at the Hunan Xiangya Hospital. She and her father, Lu Huilin (卢惠霖, 1900–1997), an eminent medical geneticist, established the first sperm bank in China in 1981. In 1982, using cryopreserved sperm, Lu Guangxiu successfully induced a human pregnancy through artificial insemination (Liu and Gu 2006). In Beijing, He Cuihua (何萃华), a gynecologist who had learned laparoscopy techniques from the American gynecologist Jordan M. Phillips in the late 1970s, had just returned from an IVF study trip in Singapore. She was at the time making efforts in perfecting her laparoscopic operations for IVF development at the Peking Union Medical College Hospital (Batt 1992). Around 1984, these three female gynecologists started to communicate and to consider applying for funding from the Chinese Ministry of Health.10
With superb professional credentials and a goal of world-class technological achievements, the three were nevertheless concerned about how the Ministry of Health would perceive the appropriateness of the project when the central government was making the one-child policy more stringent and was mobilizing intensive family planning campaigns. Established in 1979, the one-child policy became implemented in more forceful ways during the early 1980s to fulfill the goal of the Sixth Five-Year Plan (1981–85) to confine the population growth rate to below 13 per 1,000. The state initiated a massive sterilization campaign in 1983, in which couples with two or more children were required to undergo sterilization (Greenhalgh 2003: 165). It is understandable that Zhang, Lu, and He perceived that time as especially precarious for proposing a technological development with the potential of increasing population growth, a situation later recalled by colleagues and other acquaintances.11 I myself was told that one physician in Zhang's team, Li Meizhi (李美芝, 1932–), suggested that the application for state funding should emphasize the preservation of the early embryo instead of the fertility treatment aspects of IVF.12 In their final application, the project was titled “Eugenics: The Protection, Preservation, and Development of Early Embryos” (Science and Technological Bureau 1991: 833–35).
The three hospitals at which Zhang, Lu, and He were working jointly proposed the newly titled IVF project to the Ministry of Health in 1984. The funding was granted in 1986 with the establishment of the National Natural Science Foundation (NNSF), modeled on the US National Science Foundation and with the goal of experimenting with a peer-review mechanism. The standard general award was 30,000 yuan over three years (Hamer and Kung 1989: 9–12). For the whole IVF project, the three hospitals were granted about 100,000 yuan (approximately US$29,000) in total. It was later incorporated into the Seventh Five-Year Plan as a major medical project under the category of Family Planning and Eugenics (China Editorial Board 1988: 86–87).
It might appear odd that the NNSF funded assisted reproductive technologies and eventually included the research program in the state's five-year plan amid China's most intensive campaign for population control.13 The allowance of IVF funding was by no means a bureaucratic slip or gesture toward liberal technological developments; rather, it was consistent with the overarching reform discourse on development and on controls of both the quality and quantity of the population. My interviewees told me that the officials and reviewers at the NNSF were definitely fascinated by the “eugenic” aspect of the high technology proposed, such as the selection of the best-quality embryos in the petri dish. Yet two other factors probably also made the reviewers more sympathetic to the project: the changing social and cultural niche of reproductive women and the accentuation of individual reproductive needs, paradoxically catalyzed by various family planning campaigns in the 1980s.
First, as the economic reforms deepened in the 1980s, women's societal role began to be repositioned from a primarily productive force in a socialist society to reproductive and nurturing entities within families. This new social image of women rationalized the female urge for reproduction and problematized the lack thereof. During the 1980s, large numbers of women quit professional work or agricultural labor to “return to the kitchen.” In rural areas, the early 1980s witnessed the redistribution of communal lands to individual families and remade the family as the primary productive unit. Rural families could now decide what to do with their assigned land and divided the labor among family members. In cities, close connections between factories and market dynamics led to an increasing focus on efficiency and intensified competition in the workplace. Working women who took care of family members or children experienced greater pressure and often could not compete with the new labor force rushing into cities from rural areas. Some of them voluntarily withdrew from professional life (Summerfield 1994).
As more women performed social functions primarily within families, the resurgence of traditional values after the Cultural Revolution helped to strengthen a patrilineal view. Popular magazines and pamphlets that aimed to guide family life reframed the ideal image of women from female communist soldiers who were no different from their male counterparts during the 1970s to educated, modernized, yet feminine daughters, mothers, and workers in the 1980s.14 Emphases on domestic roles, along with demographic attention to reproduction, have directed the “panoptic gaze” of the state toward women's intimate realm of family life (Foucault 1980; Anagnost 1988). Infertile women, whether functioning within a family or subjected to patrilineal views at the workplace or in society at large, became increasingly sensitized to their reproductive responsibilities and were rendered vulnerable to criticism (Handwerker 1993, 102–12; Evans 2002).15 These trends were reflected in the letters written by infertile women to Zhang after 1980: thousands conveyed the distress associated with infertility, such as depression, guilt, unharmonious marriages, complaints and pressure from mothers-in-law, threats of divorce, and occurrences of wife beating (Handwerker 1993: 160–65; Zhang, Li, and Wang 1993). Interestingly, as Lisa Handwerker has shown (1998: 183–85) and as I discuss further below, family-control policy did not alleviate such reproductive pressure but, in fact, normalized the need for one child per family and even accentuated it through bringing women's reproductive functions under state-level regulation. Other scholars have also shown that the availability of a range of new reproductive technologies at times exacerbated the pressure on infertile women and created an additional social burden for involuntary childlessness (Handwerker 1995; Dyer et al. 2002).
Second, local resistance to the one-child policy through various means gave voice to citizens' desire to fulfill their basic reproductive rights. Stringent implementation and coercive sterilization programs in 1983 gave rise to a number of disturbances at local levels and were criticized internationally as the cause of increasing female infanticide (White 2000). Under these pressures, in 1984, the Chinese Communist Party repudiated a rigid implementation of the one-child policy and added flexibility to revised terms.16 By then, it was clear among policy officials and social workers that satisfying the minimum reproductive needs of families was essential for social stability. After all, state regulations on family planning never discouraged the first birth in healthy couples.17 In certain cases, the practice of family planning campaigns even highlighted the value, and oftentimes the imperativeness, of the first birth. For example, the “birth permit” automatically issued to married childless women of reproductive age every year was often interpreted as a state authorization for the imperative first birth. Unwittingly, the one-child policy intensified the focus on the one child each family was obligated to have. As one woman who was interviewed by anthropologist Handwerker (1993) stated, it was really a “you-must-have-a-child policy.” Thus, although developing assisted reproductive technology might have seemed contradictory to the central government's endeavors to curtail the population, the technological facilitation of the first birth could be naturally incorporated into the rationale of the one-child policy and seen as benevolent, even progressive to some extent, in offsetting the inhumane aspects of the sterilization campaigns.18
The enterprise of the one-child policy actually also had the aim of improving population quality by limiting births and assuring more resources and education per capita.19 Used in the three hospitals' grant proposal, the term yousheng (优生), which means “good birth” and is often translated as “eugenics,” has been widely and profusely used in documents and pamphlets aimed at disseminating knowledge about family planning and maternal and child health.20 By the early 1980s, Family Planning and Eugenics had become an established category for organizing state research programs.
In 1985, at an expert committee convened by the NNSF on the IVF program, researchers discussed the prospects for using IVF technology to avoid aberrant embryos and to select embryos with desirable genetic traits, and these prospects attracted the attention of NNSF officials.21 At the time, selection of embryos in the petri dish through detailed genetic analysis was not available in China. The suggestion of embryo selection was more a far-fetched gesture than a grounded research plan. However, set against an ethos of scientific modernization, such a depiction of IVF understandably might gain nods from officials. By using the term eugenics in the title to emphasize the potential of IVF technology for improving the quality of the next Chinese generation and to avoid direct reference to fertility treatments, Zhang and her collaborators intentionally aligned their funding application with the state's goal and sidestepped potential conflict. By juxtaposing IVF with programs of contraceptive and sterilization technologies under the category of Family Planning and Eugenics, the NNSF also achieved a harmonization between the party's sovereignty over the Chinese population and the value of social welfare attached to individual fertility treatment. An added promise was that the IVF research program could also impart scientific modernity to age-old reproduction.
Trying IVF: “Western Machines” versus “Indigenous Methods”
The negotiations among scientific, individual, and state priorities regarding reproduction did not end with the initiation and funding of IVF research. The achievement of IVF on a clinical front also involved efforts to redesign the technological procedure established in England to accommodate the material, technoscientific, and epidemiological circumstances of 1980s China. Elsewhere, I have documented more completely the technological explorations and designs through which the Peking Medical College Third Hospital learned about egg morphology, designed proper media for fertilization, and imported chemicals and tools from abroad (Jiang 2011a). This section focuses on the particular technological solution to egg retrieval, since it proved to be the most challenging part of the investigation and was later interpreted as the invention of an “indigenous method.”
Since 1982, Zhang had explored ways to retrieve eggs for IVF from infertile patients, who often had obstructed or distorted fallopian tubes. The then standard ovum retrieval procedure established in clinics in Britain involved laparoscopy, a telescopic system that could be inserted into the abdominal cavity through a small incision near the umbilicus to facilitate diagnosis and keyhole surgery. With the aid of the laparoscope, IVF clinics in England could retrieve ova from patients without as much pain or inconvenience as with regular abdominal surgery.22
Zhang, in her initial consideration of this method, investigated what she could see under the laparoscope at places such as the Peking Union Medical College Hospital, where He Cuihua was performing surgery with the aid of laparoscopy on a daily basis. Zhang nevertheless found the laparoscope difficult to operate. Indeed, operating a laparoscope required extensive training and a good deal of experience, which was impossible to grasp in a short time.23 In order to use a laparoscope to retrieve eggs, it is necessary for the whole surface of the ovary to be directly exposed to the laparoscope. For many infertile patients, this prerequisite was hard to achieve. Doctors and nurses often could not clearly see the internal structures of ovaries because scar tissue or adhesions resulting from past tuberculosis blocked the ovaries from view. Consequently, the laparoscope could not easily be adapted to retrieve eggs from women with tuberculosis-related infertility.24
Frustrated by the finesse required to operate the laparoscope, Zhang started to consider open pelvic surgery as an alternative for retrieving eggs, a procedure that she later called intraoperative or laparotomy ovum pickup (Zhang et al. 1990). At the time, open pelvic operations were routinely carried out at the Third Hospital and were uniformly preferred for gynecological problems that needed surgery. In the early 1980s, sterilizations under the aegis of the family planning campaign, surgery for removing cysts or tumors from the pelvic areas, and infertility treatments targeted at removing blockages from fallopian tubes all involved abdominal operations at the Third Hospital. Not only were its procedures familiar to Zhang, but open pelvic surgery also exposed a patient's ovaries to the physicians' eyes, which greatly increased the chances of precise egg retrieval. Since many of the women scheduled for open pelvic surgery were also infertile due to their ailments, Zhang reasoned, it might make sense to try to retrieve eggs from these patients' ovaries during the operation after the original surgical task was finished, in the hope of developing IVF treatments using their eggs.25
Zhang had little certainty of being able to retrieve eggs successfully at this stage of research. Very few patients with whom she discussed the idea consented to her proposal of egg retrieval as an additional step after surgery. For the patients who did agree, Zhang extrapolated the time of ovulation from their menstrual cycles and scheduled surgery immediately before.26 After the primary surgical treatment that each patient had needed was complete, she scrutinized the surface of the ovary and used her hands to feel for any area that stood out from the surface. After finding a protrusion that she supposed was generated by a maturing, swollen ovarian follicle, Zhang would quickly insert an aspiration needle and extract the follicular liquid. The liquid would later be meticulously examined to identify the egg within (Niu 2010).
At that time, Zhang had in fact never seen a human egg under the microscope, and her only references were pictures of pig eggs from an embryology textbook (South Weekly 2008). To identify human eggs from follicular fluid, Zhang consulted Liu Bin (刘斌, 1937–), an embryology professor working at the Laboratory of Histology and Embryology at Peking Medical University. Liu had studied mouse IVF in the late 1970s with the prominent mammalian embryologist Jacques Mulnard at the Université Libre de Bruxelles in Belgium (Alexandre 1992). While studying there, Liu had made a film that captured the development process of the mouse embryo in vitro, and he brought the film back to Beijing. Zhang, Liu, and the IVF team at the Third Hospital watched the film frequently and discussed how human eggs would behave compared to the mouse embryo. In Liu's video, the fertilized mouse egg went through rounds of cell division to the four-cell, eight-cell, and eventually the blastocyst stage. With information from this video and from images of human eggs published in the scientific literature, Liu and Zhang examined collected follicular fluids and isolated human ova from them in 1984 (Anonymous 2009).
After the initial success of egg retrieval, more patients became willing to try Zhang's suggested procedure in the hope of eventually getting pregnant. With her newly gained confidence, Zhang started to use human chorionic gonadotropin to induce superovulation and scheduled surgery at thirty-two to thirty-three hours after injecting the hormone. With a steady supply of eggs, in October 1985 Zhang's team successfully fertilized a human ovum in vitro and brought it to the four-cell stage (Anonymous 2009).
In 1986, the funding of 30,000 yuan from the NNSF kicked in, though this was still a meager sum for such a costly project, and Zhang's team tried various methods to save research funds. They tried making culture media from scratch and recycling culture dishes, as well as other tools. After testing various compositions, Zhang realized that the purity of some of the necessary chemicals available in China was not satisfactory for culturing human embryos in vitro. She thus began to contact acquaintances and relatives in the United States and England to ask them to bring certain chemicals to China. When her few aspiration needles became blunt with prolonged use, Zhang had them sharpened in a nearby watch repair shop. The team also realized that they did not have adequate equipment for safely transferring the four-celled embryos developed in vitro from Liu's laboratory to Zhang's operating theater at the Third Hospital. With Zhang's expertise and confidence that she could operate under a variety of conditions, they moved the whole operating facility to Liu's laboratory and conducted embryo transfer on site.27 From February to December 1987, Zhang operated on at least forty-four infertile women for egg retrieval alongside their surgical treatment for other illnesses (Zhang and Zhao 1990).
One day in May 1987, Zheng Guizhen (郑桂珍), a female elementary school teacher from a rural area of Gansu province, visited Zhang. With blocked fallopian tubes caused by a past tuberculosis infection and eager to obtain her own biological offspring even if this meant higher risk, Zheng made a perfect candidate for Zhang's IVF program. Ten months later, at thirty-nine years of age, Zheng gave birth to China's first test-tube baby, Zheng Mengzhu (郑萌珠) (Jiang 2011a).28
The detailed narrative of the birth of Zheng Mengzhu was widely disseminated in the Chinese media. In these reports, Zhang's open pelvic egg retrieval was praised as an ingenious native design that the established Western technology could not match.29 In interviews, Zhang rationalized her strategy of using open surgery to retrieve eggs as being particularly suited to a Chinese demography of tuberculosis-related infertility. She stated that one-third of her patients had suffered from tuberculosis in the past and that their ovaries could not be observed with the laparoscope. Open surgery made sense for tuberculosis-related infertility, Zhang reasoned, because the physician could remove excess adhesions and effusions in the patient to treat associated pelvic disease during the same operation as for ovum retrieval. Even if the eggs could not be obtained through such surgery, the doctor could at least ameliorate the patient's pelvic conditions.30
Although she operated on patients with fallopian tubes blocked due to a variety of causes, including endometriosis, or due simply to “unknown reasons,” Zhang talked more about tuberculosis during interviews with the media (Zhao and Zhang 1988). In the 1990s, China had a large population of tuberculosis carriers, who had a 10 percent chance of developing active tuberculosis in their lifetime, and the number of active tuberculosis patients was over 5 million in 2000 (Tang and Squire 2005). Female genital tuberculosis is common in developing countries, usually leading to infertility, yet it has been poorly diagnosed (Simon et al. 1977; Anonymous 2005). It was believed that tuberculosis-related infertility was not treatable by conventional surgery, whereas other causes of infertility potentially stood a chance of being addressed without IVF.31 Whether Zhang was justifying her invasive method for egg retrieval to the media by intentionally hiding part of the truth is a tricky question. Yet even if it were true that Zhang operated only on tuberculosis-related infertility patients, the fact that two-thirds of infertile Chinese women did not fall into the tuberculosis-related category runs counter to any claim that bypassing laparoscopy was simply a strategy to accommodate Chinese infertility patients overall. I have shown that mastering the operation of laparoscopy was a technical challenge for the IVF team at the Third Hospital. In this light, open pelvic surgery for egg retrieval was probably an expediency designed to quickly achieve IVF with the limited technological resources at hand.
The use of open pelvic surgery did seem to matter to the success of Zhang's IVF program. In 1985 and 1986, several foreign experts were invited to Beijing and Guangzhou to try to achieve IVF-facilitated pregnancies for infertile Chinese patients. They tried around twenty cases using laparoscopy-assisted IVF, but no pregnancies resulted (Daqing Daily 2008). Among the three hospitals funded by the NNSF, the only one that insisted in using laparoscopy to retrieve eggs, the Peking Union Medical College Hospital, lagged behind and did not have any successful cases during the 1980s.
The question remains as to what made the team at the Third Hospital adept and flexible in navigating the technological strengths and resources at hand. As Zhang's experience prior to the 1980s shows, working through nearly four decades in Mao's China cultivated a medical and scientific style that relied more on her individual skill than on established protocols and led Zhang to take higher circumstantial risks with greater technical flexibility. From 1951 to the early 1980s, Zhang had changed her medical research direction several times according to changing state circumstances and priorities, transferring from cancer research to endocrinology and then to the study of IVF. During the Cultural Revolution, Zhang had to adapt to the minimal medical equipment and aseptic measures available in indigent areas and rely on her own knowledge and skill in dealing with diseases, some of which were life-threatening. These experiences in her professional life nurtured Zhang's preference for flexibility and creativity in solving technical issues rather than the following of established rules.
However, Zhang and her team members, along with the journalists reporting on the events, all seemed to prefer using a language of indigenous ingenuity to capture the IVF technical design instead of describing it as simply a technological adaptation, even though the imagined indigenousness of her method was at best a distorted caricature. In fact, the development of open pelvic gynecological surgery was linked to the foundation of modern US medical schools during the late nineteenth century and was unmistakably Western (Fleming 1954). In addition, after the first successful IVF pregnancy, Zhang soon introduced the noninvasive ultrasonic transvaginal ovum retrieval technology that gynecologists in the West at the time had started to use (Zhang et al. 1990). Ultrasound-guided egg retrieval proved to be feasible under the technical conditions at the Third Hospital and soon replaced the open pelvic method. If one were to follow the logic of the indigeneity argument, it would be necessary to describe Chinese IVF after 1988 as the readoption of Western machines and the loss of an original Chinese character, but this would be an absurd way to portray these events. The representation of Zhang's IVF strategy as indigenous, rather, reflected a collective wish for national scientific self-reliance and, perhaps, for Zhang, a nostalgic longing for the recent medical past in which physicians' creativity and adaptability were paramount in successfully dealing with patients, diseases, and precarious social conditions.
The Sociotechnical Imaginaries of Chinese IVF Then and Now
How could Zhang's IVF research program be justified at a time of state population control and eventually become celebrated for adapting to the underdeveloped technological conditions at the Third Hospital? The several rounds of sociotechnical negotiations that I have depicted are probably the key to the answer. Embedded in the initiation and fulfillment of Chinese IVF in the 1980s were the reform government's reconception of what counted as good socialist state building and as good citizens of current and future generations, as well as researchers' visions of what is good medicine in relation to state-regulated reproduction. These reconceptions were expressed in the policies, social norms, and technological strategies that constituted a package of sociotechnical imaginaries for Chinese IVF in the 1980s. These operated so powerfully at the time that seemingly contradictory governmental and individual imperatives on reproduction could be melded into apparent harmony, while Zhang's design and other countries' technological routines were portrayed by way of a very matter-of-fact indigenous/Western contrast.
As Sigrid Schmalzer points out (2014, forthcoming), the celebration of indigenous science, and specifically the discourse on tu (“indigenous” in Chinese), originated from the communist revolutionary Yan'an period and reemerged during the Great Leap Forward era in the late 1950s as Mao began to pull away from Soviet influences. Although official policy advocated a combination of the Western and the indigenous in developing science and technology, it is often the case that only when the indigenous component appeared superior were its scientific fruits trumpeted. Zhang's IVF research was one of these cases that smacked of the Yan'an spirit of self-reliance that Mao's era embraced wholeheartedly, a symbolic capital that Zhang and her interviewers could easily invoke in the 1980s with recent memories of the 1960s and 1970s.32
The use of a Maoist style of worker innovation to achieve high-technology success during the opening-up and reform era may seem counterintuitive, but the IVF case was not the only developmental case that mined the technological and cultural resources of the Mao era. Although the blunt ideology of mass science to the exclusion of scientific elites was effectively eliminated during the early 1980s, because training scientific expertise and forming new networks required time, immediate achievements in science and technology often still relied on research networks and styles formed during the Cultural Revolution. One telling example is the successful artificial synthesis of yeast alanine transfer RNA in 1981 by the “824 Project.” The project was initially formed in 1967, based on the idea of “nationwide alignment” (quanguo da chuanlian 全国大串连) and involving more than sixty young scientists. The basic organization and research arrangement of the group continued into the reform era (Zou and Xiong 2009: 305–47). Another instance is the China Study, one of the largest epidemiological studies of nutrition conducted in the early 1980s, that was inspired by and involved a group of scientific personnel mobilized initially to compile an atlas of cancer rates in different provinces as a response to the premier Zhou Enlai's fatal bladder cancer (Campbell and Campbell 2006: 69–108). How historians should assess developments in science and technology during the Cultural Revolution and their legacy in the reform era is an emerging and provocative topic that recent modern Chinese history scholarship has now begun to tackle (Wei and Brock 2013). As Rudi Volti points out (2013: 337, 341), in many scripts on the triumph of mass science and technology during the 1960s and 1970s, recurring failures were often ascribed to technologies originally imported from foreign countries, while their fixes often involved worker innovations based on more rudimentary materials and technological settings. To what extent such indigenous worker innovations continued in scientific and technological developments in the reform era is still an open question, yet the IVF case and the examples mentioned above show that traces of “worker innovation” styles were still pivotal to some of the technoscientific advances of the 1980s.
Yet the 1980s was a time of transition, and in the 1990s the Chinese IVF industry boomed and its practices changed character (China Daily 2005). The socialist romanticism seen in Zhang's IVF design was replaced by standardized protocols and commercialized practices. The pragmatically creative medical style Zhang mastered is no longer the staple of Chinese IVF. As the Third Hospital started to produce IVF babies, to use Zhang's words, “in a manner of the assembly line,” Zhang herself became concerned about the current practice of IVF. She has complained that it gives little consideration to the individual causes of infertility, while the overly routinized assessment of patients often passes new clinical data by without careful recording and analysis. In addition, she has also worried that such practice could reduce doctors' creativity.33 For IVF, the time for Zhang's style has passed, yet it would be interesting to examine whether the creative style that Zhang longed for still exists in other emerging areas of biomedical research in China, such as the therapeutic development of embryonic stem cells.
The caveats behind the rationale for the one-child policy and the proposed eugenic aspects of IVF research have manifested in recent years as well. State regulations prohibit the use of IVF for multiple births and ban the use of surrogate mothers (Chinese Ministry of Health 2001). Misconceptions about the eugenic aspects of IVF have hung on for rural patients, with some thinking they would get a baby from a test tube or could get an improved baby that was more intelligent or stronger. One husband asked the doctors: “If I pay more, can I get a better-looking and smarter kid?” (Handwerker 2002; Anonymous 2009).
The alignment of the governmental control of population with the developmental goal of reproductive technology and an admixture of a socialist romanticism and a pragmatic style of technological practice all manifested in Zhang's Chinese IVF research program. The program captured a foundational moment for Chinese reproductive modernization. It happened at a time when numerous possibilities for scientific developments were becoming available, while there were also a great number of inconsistencies to be ironed out, values to be chosen, and strategies to be taken. Such a sense of potential characterized many aspects of social and political life in 1980s China. What was suggested by medical experts, what was taken into account by the state, and what was eventually celebrated all have much to say about how high technology and reproduction were positioned relative to one another in the Chinese reform era. Its vestiges remain in today's IVF practices and policies and form an essential part of the longer story of how reproduction became high-tech in late twentieth-century China. In many celebratory memoirs, news reports, and television programs, one quote from Zhang has often been chosen as an epigraph. Reading from a noncelebratory angle, that quote may also work well as a conclusion to this article: “When a doctor is facing a patient, she is interacting with the whole of society.”
I wish to thank Jane Maienschein and Zuoyue Wang for introducing this interesting topic at the outset and for discussions along the way. The manuscript has benefited from comments and editorial suggestions from Maienschein, Angela Creager, Erica O'Neil, and the editors of this journal, especially Wu Chia-Ling and three anonymous referees, as well as from discussions with Sigrid Schmalzer, Benjamin Elman, Christine Luk, and Gongcheng Jiang. The Embryo Project Encyclopedia at the Center for Biology and Society, Arizona State University, provided crucial financial support for research in Beijing, and the D. Kim Foundation for the History of Science and Technology in East Asia provided a fellowship that allowed time for writing. Hearty thanks go to Xiong Weimin and Sun Chengsheng, who have hosted my research visits at the Institute for the History of Natural Sciences, Chinese Academy of Sciences, and to Zhang Lizhu and Liu Ping, who kindly granted interviews. My gratitude also goes to Jennifer Liu, Christine Luk, and Xuan Geng for the workshops, conference panels, and class lectures they organized that offered opportunities to discuss this project at earlier stages.
For a comparison with the Zionist representation of the pioneering IVF doctors in Israel, see Birenbaum-Carmeli 1997.
I conduct the case study mainly using historical perspectives on the original innovation process and admittedly focus more on the research and research policy aspects and less on the various social and ethical implications of the widening use of assisted reproductive technology in China. However, Lisa Handwerker has provided a range of elegant studies on the profound social impact of the spread of IVF clinics during the reform era (1993, 1995, 1998, 2002). For bioethical and policy issues of reproductive technology in Taiwan, see Wu 2002 and 2012.
For an excellent review of the wealth of scholarship on the issue of assisted reproductive technology, see Thompson 2005, 55–78.
Wang Yihui (王逸慧, 1899–1958) studied surgery at the medical school of the University of Cincinnati in 1926. He later transferred to Johns Hopkins University Medical School for specialty training in gynecology. In 1928, he went back to Peking Union Medical College Hospital and became a pivotal figure in the gynecology department. He was said to be discontented with discrimination toward Chinese physicians by their foreign colleagues, and he left Peking in 1935. In 1937, he started to work at his alma mater, St. Johns University Medical School (Chen and He 1988: 115–17).
Tang has worked on macromolecular crystallography, among other topics, at Peking University since the early 1950s and was made a national academician in 1980. See Wei and Li 2011: 199–202.
Acupuncture-assisted ovarian cyst surgery had been performed at the Third Hospital since 1970. US president Richard Nixon even attended one of Zhang's operations during his 1972 visit to China. Zhang et al. 1981a; Wolpe 1985: 411.
In her anthropological study of the stigmatization of Chinese infertile women in the early 1990s, Handwerker has quoted several such letters that accorded with Confucian patrilineal notions of the female's primary social and familial responsibility in reproduction. See Handwerker 1993, especially 166–69.
It is fair to say that few men practice gynecology in contemporary China. A prevailing distaste for intimate physical contact between opposite sexes in clinics probably provides a partial explanation. The large proportion of female doctors and workers in Chinese gynecology and in IVF research is unique compared with the male-dominated gynecological workplace in England, Australia, the United States, Israel, and India. It is possible that IVF research and clinical practice in China thus had differentially gendered practices, and interested scholars might find that the booming IVF industry in China offers fruitful cases for analysis.
Liu Ping, interview by the author, 29 June 2010, Beijing; Zhang Lizhu, interview by the author, 30 June 2010, Beijing.
Liu interview; also see Wang 2011: 1881–82.
Although it may appear equally unlikely that IVF infertility treatment might significantly increase the Chinese population—a huge denominator to begin with—such concerns were nevertheless expressed in both direct and indirect ways to the doctors at the Third Hospital, while their investigations became increasingly publicized. As Handwerker points out (2002: 304), in the early 1990s fertility treatment doctors had to justify their work both to medical colleagues in other specialized fields and to the general public, because of the perceived conflicts between their work and population control policy.
Covers of the magazine Zhongguo Funv (Women of China) published between 1965 and 1985 showed that depictions of women transitioned from emphasizing worker identity to emphasizing roles within the family.
A saying from Mencius, an important early Confucian scholar, has perpetuated in Chinese society for more than two thousand years: “There are three acts that are considered unfilial; the foremost is not to have offspring.” Although Mencius was harshly criticized and subverted during the Cultural Revolution, the emphasis on the reproductive role of the individual, and especially of women, was never eradicated and reemerged during the reform era. Parallel to the redirection of social attention toward the reproductive role of women, the redirection of the focus of manhood from militant masculinity to sexual desire has been cogently shown in Everett Zhang's studies of the nature of sexual repression in the Maoist era and the evolution of men's medicine during the reform era (2005, 2007).
The revised policy allows, for example, a second birth in rural areas if the firstborn is a female. See Greenhalgh 2008: 299–306.
Even the 1982 governmental document Directions in Furthering the Work of Family Planning, which symbolized the start of a period of the strictest implementation of the one-child policy, encouraged “fewer births” and “good births” instead of “no births.”
The legitimization for the first birth was more explicitly stated in the Population and Family Planning Law enacted in 2001, stating that “citizens have the right to reproduction” in Article 17 and that the state “advocates one child per couple” in Article 18. In the Detailed Rules for the Implementation of the Regulation on the Administration of Family Planning Technical Services issued in the same year, infertility treatment was listed along with fertility and contraception as legitimate family planning services under state regulation.
The vital importance of population quality was premised on the idea that all citizens, through their physical and moral development, shared responsibility for the future of the nation, and this was increasingly invoked in the developmental discourses of the 1980s. See Murphy 2004.
Changing practices of modifying environmental and physical conditions to cultivate offspring with better qualities reaches back to late Imperial China in the sixteenth century. Unlike the counterpart eugenics in the West, the term yousheng brings out quite positive connotations in Chinese. Some scholars in China objected to the translation of yousheng as “eugenics” and proposed instead “healthy birth,” “quality birth,” or “Well-Bear and Well-Rear.” For convention's sake, this article uses eugenics, yet readers should be aware that the Chinese understanding of eugenics has major practical differences from the Galtonian negative eugenics and, with its emphasis on hygiene and obstetrics, is more similar to the medical practices of early twentieth-century France. See Dikötter 1998 and An 2001.
In fact, the partnership between the British developmental biologist Robert Geoffrey Edwards and the British gynecological surgeon Patrick Christopher Steptoe that eventually achieved the first human baby through IVF technology was initially formed because of Steptoe's expertise in laparoscopy, which offered the possibility of transferring gametes from fallopian tubes without excessive trauma. See Jiang 2011b.
Steptoe himself took a long time to convince other gynecologists to extensively use laparoscopy because of the fastidiousness of its technique. In order to train others, in 1967 Steptoe published a whole monograph to describe the use of laparoscopy in gynecology. Edwards and Steptoe 1980: 73–77; Steptoe 1967.
Liu interview; Niu 2010: 28. In a conference held at the University of Illinois, Urbana-Champaign, in November 2010, anthropologist Charis Thompson, who did extensive fieldwork in Chinese reproductive clinics, commented that the US physicians who visited China in the 1980s also reported that they observed excessive amounts of adhesions in the abdominal tissues of Chinese tuberculosis patients.
Liu interview; Zhang interview; Jiang 2011a.
The child's name, Mengzhu (萌珠), literarily means the germination of a pearl, which connotes successful birth of a girl.
One report had the subtitle “Western (yang) Machines Could Not Compete with Indigenous (tu) Method” (Niu 2010: 28).
The emphasis on using an indigenous method was probably unique in IVF innovation compared with other countries that developed IVF after Britain and Australia, although both Indian and Israeli doctors mentioned the hard work and, for the latter, the teamwork of local actors in their representations. See Birenbaum-Carmeli 1997 and Bharadwaj 2002.