The Dark Road by Ma Jian, a Chinese author and artist living in London, is set in contemporary rural China and is, as the title suggests, dark. It is disturbing and thought-provoking but compelling.

Meili is a peasant girl, who lives with her husband and young daughter in a remote village, in the heart of his family, surrounded by the traditions of their people. He has standing as the village schoolteacher. All will change in their efforts to give Kongzi, her husband, the son he desires so desperately in order to maintain his family line. In the face of the brutally enforced one-child policy, they run away, with a ripple of repercussions felt by themselves, family and the rest of the village. The book charts their efforts to forge a life for themselves and their daughter as they try to fulfil Kongzi's need for a son. Meili, as she matures, sees her own ability to control her fertility as the secret of her ambition to make a better life for herself and her family: it provides a potent accent to the book's overarching condemnation of state control of population.

The description of the traumas suffered by the little family are uncompromising. The language is simple – perhaps as a result of the translation – but hauntingly beautiful in places. The ‘keywords’ at the start of each chapter – reminiscent of a scientific abstract or a child's reading book – struck a discordant note for me. The underpinning dialogue between Meili and her successive unborn children, I think is intended to convey that at heart she remains a simple, spiritual country lass, despite her increasing but superficial sophistication. She is strong, and battles through the terrors of her life, but one knows from the beginning that she will not win.

For me, as a clinician working in contraception and sexual health, the casual inhumanity of the medical staff enforcing the one-child law is the abiding horror of this novel. It makes it both a deeply uncomfortable and unforgettable read. Did I enjoy the book? I am not sure. Would I recommend it? Without a doubt.