When China’s government ordered women in her mostly Muslim community in the region of Xinjiang to be fitted with contraceptive devices, Qelbinur Sedik pleaded for an exemption. She was nearly 50 years old, she told officials. She had obeyed the government’s birth limits and had only one child.

It was no use. The workers threatened to take her to the police if she continued resisting, she said. She gave in and went to a government clinic where a doctor, using metal forceps, inserted an intrauterine device to prevent pregnancy. She wept through the procedure.

“I felt like I was no longer a normal woman,” Sedik said, choking up as she described the 2017 ordeal. “Like I was missing something.”

Across much of China, authorities are encouraging women to have more children, as they try to stave off a demographic crisis from a declining birthrate. But in the Xinjiang region, China is forcing them to have fewer, tightening its grip on Muslim ethnic minorities and trying to orchestrate a demographic shift that will diminish their population over generations.

Birthrates in the region have already plunged in recent years as the use of invasive birth control procedures has risen, according to reports by a noted researcher, Adrian Zenz, along with the Associated Press.

It is part of a vast and repressive social reengineering campaign by a Communist Party determined to eliminate any perceived challenge to its rule, in this case, ethnic separatism. Over the past few years, the party, under its top leader, Xi Jinping, has moved aggressively to subdue Uyghurs and other Central Asian minorities in Xinjiang, putting hundreds of thousands into internment camps and prisons. Authorities have placed the region under tight surveillance, sent residents to work in factories and placed children in boarding schools.

While authorities have said the birth control procedures are voluntary, interviews with more than a dozen Uyghurs, Kazakhs and other Muslim women and men from Xinjiang, as well as a review of official statistics, government notices and reports in the state-run media, depict a coercive effort by the Chinese Communist Party to control the community’s reproductive rights. Authorities pressured women to use IUDs or get sterilized. As they recuperated at home, government officials were sent to live with them to watch for signs of discontent. One woman described having to endure her minder’s groping.

If they had too many children or refused contraceptive procedures, they faced steep fines or, worse, detention in an internment camp. In the camps, the women were at risk of even more abuse. Some former detainees say they were made to take drugs that stopped their menstrual cycles. One woman said she had been raped in a camp.

To rights advocates and Western officials, the government’s repression in Xinjiang is tantamount to crimes against humanity and genocide, in large part because of the efforts to stem the population growth of Muslim minorities. The Trump administration in January was the first government to declare the crackdown a genocide, with reproductive oppression as a leading reason. The Biden administration affirmed the label in March.

Sedik’s experience, reported in The Guardian and elsewhere, helped form the basis for the decision by the U.S. government. “It was one of the most detailed and compelling first-person accounts we had,” said Kelley E. Currie, a former U.S. ambassador who was involved in the government’s discussions. “It helped to put a face on the horrifying statistics we were seeing.”

Beijing has accused its critics of pushing an anti-China agenda.

The recent declines in the region’s birthrates, the government has said, were the result of authorities’ fully enforcing long-standing birth restrictions. The sterilizations and contraceptive procedures, it said, freed women from backward attitudes about procreation and religion.

“Whether to have birth control or what contraceptive method they choose are completely their own wishes,” Xu Guixiang, a Xinjiang government spokesman, said at a news conference in March. “No one nor any agency shall interfere.”

‘I Lost All Hope in Myself’

All her life, Sedik, an ethnic Uzbek, had thought of herself as a model citizen.

After she graduated from college, she married and threw herself into her work, teaching Chinese to Uyghur elementary school students. Mindful of the rules, Sedik did not get pregnant until she had gotten approval from her employer. She had only one child, a daughter, in 1993.

Sedik could have had two children. The rules at the time allowed ethnic minorities to have slightly bigger families than those of the majority Han Chinese ethnic group, particularly in the countryside. The government even awarded Sedik a certificate of honor for staying within the limits.

Then, in 2017, everything changed.

As the government corralled Uyghurs and Kazakhs into mass internment camps, it moved in tandem to ramp up enforcement of birth controls. Sterilization rates in Xinjiang surged by almost sixfold from 2015 to 2018, to just over 60,000 procedures, even as they plummeted around the country, according to calculations by Zenz.

The campaign in Xinjiang is at odds with a broader push by the government since 2015 to encourage births, including by providing tax subsidies and free IUD removals. But from 2015 to 2018, Xinjiang’s share of the country’s total new IUD insertions increased, even as use of the devices fell nationwide.

The contraception campaign appeared to work.

Birthrates in minority-dominated counties in the region plummeted from 2015 to 2018, based on Zenz’s calculations. Several of these counties have stopped publishing population data, but Zenz calculated that the birthrates in minority areas probably continued to fall in 2019 by just over 50% from 2018, based on figures from other counties.

In Beijing’s depiction, the campaign is a victory for the region’s Muslim women.

“In the process of deradicalization, some women’s minds have also been liberated,” a January report by a Xinjiang government research center read. “They have avoided the pain of being trapped by extremism and being turned into reproductive tools.”

Women like Sedik, who had obeyed the rules, were not spared. After the IUD procedure, Sedik suffered from heavy bleeding and headaches. She later had the device secretly removed, then reinserted. In 2019, she decided to be sterilized.

“The government had become so strict, and I could no longer take the IUD,’” said Sedik, who now lives in the Netherlands after fleeing China in 2019. “I lost all hope in myself.”

‘The Women of Xinjiang Are in Danger’

The penalties for not obeying the government were steep. A Han Chinese woman who violated the birth regulations would face a fine, while a Uyghur or Kazakh woman would face possible detention.

When Gulnar Omirzakh had her third child in 2015, officials in her northern village registered the birth. But three years later, they said she had violated birth limits and owed $2,700 in fines.

Officials said they would detain Omirzakh and her two daughters if she did not pay.

She borrowed money from her relatives. Later, she fled to Kazakhstan.

“The women of Xinjiang are in danger,” Omirzakh said in a telephone interview. “The government wants to replace our people.”

The threat of detention was real.

Three women told The Times they had met other detainees in internment camps who had been locked up for violating birth restrictions.

The former detainees’ accounts could not be independently verified because tight restrictions in Xinjiang make unfettered access to the camps impossible. The Chinese government has forcefully denied all allegations of abuse in the facilities.

“The sexual assault and torture cannot exist,” said Xu, the regional spokesman, at a news briefing in February.

Beijing has sought to undermine the credibility of the women who have spoken out, accusing them of lying and of poor morals, all while claiming to be a champion of women’s rights.

‘We Are All Chinese’

Even in their homes, the women did not feel safe. Uninvited Chinese Communist Party cadres would show up and had to be let in.

The party sends out more than a million workers to regularly visit, and sometimes stay in, the homes of Muslims, as part of a campaign called “Pair Up and Become Family.” To many Uyghurs, the cadres were little different from spies.

The cadres were tasked with reporting on whether the families they visited showed signs of “extremist behavior.” For women, this included any resentment they might have felt about state-mandated contraceptive procedures.

When the party cadres came to stay in 2018, Zumret Dawut had just been forcibly sterilized.

Four Han cadres visited her in Urumqi, bringing yogurt and eggs to help with the recovery, she recalled. They were also armed with questions: Did she have any issues with the sterilization operation? Was she dissatisfied with the government’s policy?

“I was so scared that if I said the wrong thing they would send me back to the camps,” said Dawut, a mother of three. “So I just told them, ‘We are all Chinese people and we have to do what the Chinese law says.’ “

© 2021 The New York Times Company