LOOKING at her slim and playful son, Zhang Yingju, like many other women in her village, cannot help but recall the boy's five older siblings. All of them died in early infancy of a genetic disease.

Living in Zhaiwa village of Sankeshu Township, in Guizhou Province of southwest China, the 44-year-old housewife and her husband Meng Renjun, both of the Miao minority, went through heart-wrenching experiences trying to have a son.

Like most of their 1,300 neighbors, Zhang and Meng live on rice and corn grown on about 0.3 hectares of farmland, after Meng ended his migrant worker career and came back from Shenzhen, Guangdong Province, a few years ago when "the market got tough." Their eldest daughter just turned 20 this year.

In rural China, almost every family prefers boys over girls as the males are more valuable assets in farming and carrying on family names. Ethnic minorities in China are allowed to have more than one child, particularly when the first is a daughter. But from 1990 to 1998, the couple saw five of their six children die. Only the eldest daughter, born in 1989, lived.

"We had no idea what went wrong at the time," Meng says. "We hired the midwives, and my wife gave birth to them all at home, just like everyone else in the village did. It worked with our first daughter."

But the five babies died less than one year after each was born, says Zhang, as she turned her head and stared blankly at the ground.

The desperate couple even resorted to hiring a witch to "exorcize the evil spirits" in the hope of a healthy baby, which, of course, proved to be useless.

Meng's family was not the only one in the village that suffered. Their neighbor, a 72-year-old woman who refused to be named, says she gave birth to nine children decades back, but only one lived.

Continuous attempts did not dampen Zhang's hope of getting a boy. Their fate changed when a rural family planning consultant walked into their cottage. Hearing of the five deaths, the government-backed consultant offered Zhang a free heath check in 1998.

"Even before the medical check-up, I suspected the babies' deaths might be associated with my health," says Zhang who only completed elementary education. "But I had no way of finding out."

"The consultant asked me, with eight other women in the village suffering similar problems, to have a thorough check at a family planning health center," says Zhang.

"Previously, villagers seldom went to hospitals for check-ups or deliveries. Scissors, some hot water, some salt water and a self-trained midwife, then you are ready for delivery at home," she says.

"Everybody thought it was embarrassing to go to hospital. You know, you have to take off your clothing in front of strangers ..." says Zhang who was encouraged by her more accepting husband to overcome embarrassment and have her first ever gynecological examination in 33 years.

In the Kaili family planning health center, Zhang was found to be a typical victim of Rh disease, one of the causes of hemolytic diseases in newborns that can destroy the red blood cells of the foetus, and cause severe anemia in newborn children. In the worst cases it can result in stillbirth.

Family planning service

The genetic disease does not kill their first babies, but the antigen substance the mothers gain in the first delivery can be lethal to later babies. Zhang was given two shots of anti-Rh antibodies in 1998. Just one year later, she gave birth to a healthy boy in July 1999.

The couple named the boy as Jisheng, the Chinese words for "family planning."

"He's 10 years old now, and he is top of the class," says the senior Meng as he pats the boy's shoulders.

"We have very high expectations of him now," he says. "I cannot tell you how much we appreciated the family planning service."

The Mengs are not the only couple to benefit from effective family planning services, ranging from contraception, pre-pregnancy tests, pregnancy checkups, early intervention for birth defects and after-delivery consultations.

The Guizhou Provincial Family Planning Commission reveals it helped prevent birth defects for more than 4,000 newborns in 2008.

"Guizhou Province registers a birth defect rate of about 1.9 percent, much higher than the national average of 1.3 percent," says Liao Changhui, head of the commission.

With more than 28,000 babies being born each year in Guizhou with birth defects, Liao says: "We really have a tough job."

"A lot of people do not understand what we do. They still think family planning is all about stopping people from having more children," he says. "Family planning is keeping the population at a controllable level, while improving the overall quality of a gender-balanced population."

In order to improve the quality of the population, the family planning commission provides free check-ups for pregnant women to encourage them to come to the hospitals or health centers, so that possible birth defects can be spotted as soon as possible, he says.

As well, fees for a delivery at a family planning health center in the city can be covered by the rural cooperative medical system, so they don't have to pay a penny, he says.

"With our education and favorable policies in the rural areas, more villagers understand that child delivery in hospitals is far safer than at home, and they are now willing to come to hospitals for checkups during pregnancy, something never tried or even heard of by their parents' generation," Liao says.

"More than 83 percent of the pregnant women in Kaili now give birth to their babies in hospitals or certified health centers, up from a mere 30 percent at the beginning of this century. It's much safer. Family planning is a great plan for the families," he says.

But Liao acknowledges that there are other issues concerning family planning worth paying attention to, such as the imbalanced sex ratio.

Guizhou now has a sex ratio of 117:100. The figure is expected to top 120:100 in 10 years, Liao says.

One fundamental reason, he says, is the social inequality between males and females - males are considered more valuable and more dependable when parents turn older in a society which long neglected a sound rural social welfare system.

The Guizhou provincial government now subsidizes parents, who have only one child or two daughters, with a monthly pension fund worth 300 yuan (US$44).

"If we don't make things better soon, there will be more serious problems," Liao says.