Chinese women and their contraceptive choices
In recent decades, a better global understanding of birth control techniques has contributed to women's development and gender equality.
Research by the United Nations Population Fund published in 2003 indicates that the use of contraception in China is almost universal ¨C at 83 percent.
China, in fact, leads the world in the use of contraception. However, that does not reflect the whole picture.
China's family planning policy is aimed mainly at married women, and it emphasizes long-term or permanent methods of contraception.
A study conducted in 2004 by the Medical Center of Fudan University in Shanghai and the International Health Research Group found premarital sex among China's urban youth was becoming more common.
It also found that the abortion rate among unmarried women was alarmingly high. The use of contraception such as condoms or the contraceptive pill remains low, which accounts in part for the high abortion rate among China's young women.
The Fudan University report concluded "there is a large unmet need for temporary methods of contraception in urban areas of China."
'It Won't Happen to Me¡¯
"I'm scared," said 22-year-old Beijing resident Li Chen. She's been dating her boyfriend for two years, and says she is in love with him. She is pregnant, but is not married and acknowledges she is not ready to be a mother.
She is facing one of the most difficult decisions a woman ever has to make "I'll have an abortion. There's no other way," she said.
Neither Li nor her boyfriend had been using contraceptives. She, like many women, thought she would not get pregnant. "I'm very sad. I want to have children one day, and I love my boyfriend. This is our first baby. It's special. I¡¯m so sad I have to terminate the pregnancy," she said.
Li has not told her family she is pregnant; only a friend and her boyfriend know about her condition. Li is scared and she feels she is alone. But she isn't, as countless other women in urban China are in the same situation.
Every Woman's Choice
China has a decades-long history of family planning. The Chinese Government, since 1979, has encouraged the "one-child" policy to control population growth (rural families and ethnic minorities are permitted to have two children) and contraception has been widely available.
The State Family Planning Commission has established Family Planning Centers in cities, towns and rural communities. The National Family Planning and Reproductive Health Survey (2001) conducted by the Family Planning Commission found 80.1 percent of the villages surveyed had a family planning clinic and 99.3 percent had at least one professional family planning worker.
As a result, China has become the world leader in contraceptive usage. This report found sterilization was the most prevalent method of contraception in China. More than 200,000 people were covered in the survey and results indicated approximately 38.1 percent of women and 7.9 percent of men are sterilized in China.
The IUD, or intrauterine device, was the next most popular form of contraception; 45.6 percent of women used the device. The research indicated a mere 5.1 percent of Chinese used condoms, and, surprisingly, just 2.1 percent of Chinese women used contraceptive pills.
It is important to note, however, these statistics did not take into account the difference in choices of contraception made by younger people and people after they had a child.
Liu Liqing, chief representative of Marie Stopes China, a leading reproductive healthcare charity, commented "In the unmarried group, condom and contraceptive pill usage is much higher than the national average. But the statistics are mainly for married people, so you can't say for sure how much higher."
"The survey shows that long-acting methods still dominated the contraceptive methods used by most couples of childbearing age," the report says, demonstrating a preference for long-term and permanent methods of contraception in Chinese family planning policy.
The high rate of sterilization in China can best be understood when put in context, which includes the "one-child" policy.
"In the rural areas, after the first child, a woman is encouraged to use an IUD. After the second child, she will likely be sterilized," said Liu. Sterilization is an effective, and inexpensive way to guarantee long-term contraception.
In light of the almost-universal contraception usage, and the prevalence of the irreversible permanent methods of contraception, why are so many Chinese women having abortions?
The abortion rate in China is about 28 percent, only slightly higher than the 25 percent rate in the United States, 2 but it is still surprisingly high considering the high usage rate of permanent forms of contraception.
Research conducted by the Medical Center of Fudan University in Shanghai and the International Health Research Group found unmarried women in China's cities were more likely to have abortions than married women elsewhere in the country.
The research team analyzed statistics compiled from eight studies, seven of which were conducted in China¡¯s urban areas. The researchers used statistical data collected from the pre-marital examinations of more than 17,000 women.
Such exams were compulsory, prior to October 2003, for all couples in China wishing to get married. The research indicated, in some areas of China, the abortion rate among unmarried urban women was as high as 55 percent, and "Four of the seven studies reported that, among those unmarried women who had induced abortion, some of them had two or more induced abortion."
The Contraceptive Pill
About seven percent of Chinese that use contraception choose to use temporary forms of contraception, such as contraceptive pills and condoms. That is quite low. In recent years, the Chinese Government has recognized the importance of promoting the use of condoms in the fight against human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS).
Therefore, especially among those who have access to such information, condom usage is improving, most especially among youths. In other countries the pill is the most popular form of contraception, indicates Population Reports, the quarterly journal published by the Johns Hopkins Population Information Program.
In the United States, 80 percent of women born after 1945 have used the pill. In Western Europe 50 percent of married women use the pill. 3 It is considered a safe, reliable form of temporary contraception.
However, the pill has a bad reputation in China said Liu: "The once-a-month, high-dosage version of the pill was introduced to China during the 1980s, as part of the country's family planning policy. Unfortunately, it had more side effects than the newer, low-dosage daily version that is popular today."
That has left some women cautious. Chen Meng, 25, a journalist from Tianjin, said, "I don't use the pill because I worry about the side effects. I've heard you put on weight, or it may cause a breast tumor."
A study conducted by the Guangdong Family Planning Science and Technology Research Institute in 1999 revealed another concern women have about the pill: Prolonged use of the pill might prevent pregnancy later in life.
There is no evidence to suggest that taking the pill effects future fertility. The researchers studied the sexual activities of transient workers, and found more than half of the women migrant workers in Guangdong Province had experienced an unplanned pregnancy.
The report highlighted that "Dousing the vagina with water and drinking traditional Chinese medicine, which have a 'cooling effect,' are often their methods of preventing pregnancy."
Every woman has the right to decide what form of contraception to use, but, according to the research by Fudan University, an alarming number of unmarried women do not use contraception.
"A history of premarital pregnancy was sought in two of the seven urban studies. This ranged from 12-32 percent. Several studies commented that most of these pregnancies were unintended, and no contraceptive measures were used."
Another study by the Shanghai Institute of Planned Parenthood in Shanghai compared the contraceptive choices of 7,336 couples, which were made before and after their marriages.
Research found "Only one-third of those exposed to premarital risk of conception were protected by some form of contraception, mostly by withdrawal and periodic abstinence. As a consequence, a majority of these couples conceived, which prompted rapid marriage in most cases, and induced abortion among one-fourth of them."
The study suggested there should be a wider selection of contraceptives, including oral contraceptives to meet couples' needs in Shanghai, and that the family planning program's attention should be focused on sexually active unmarried individuals.
The above two studies indicated an alarmingly high number of unmarried women are not using contraception.
A Sexual Revolution?
China is experiencing a social revolution. Chinese society is changing, opening up, and developing. Not only are ideas and perceptions changing, but so is behavior.
Several decades ago, a Chinese woman would not see her husband before her wedding day; now, some young people in the cities are choosing to live with their partners before they decide to wed. The topic of sex is becoming more open, and sex before marriage is not the taboo it once was.
Mu Zimei has become a symbol of the sexual revolution. She has a website that details her 70-plus one-night stands and offers sex tips, such as how to have intercourse in a car. Sex and the City, the US comedy-drama about the sex lives of four party-goers in New York, can be found in even the smallest DVD shops in China.
According to the research conducted by Fudan University, of the five urban studies which reported sexual activity, the majority of women--from 54 percent in one study to 82 percent in another--said they had sex before marriage.
However, in the one rural study they analyzed, only 20 percent of the women said they had premarital sex. The research, therefore, suggests, the sexual revolution is changing Chinese people's perceptions and sexual habits. Since there seems to be a large modern, urban group of people who are sexually active before marriage, where are they accessing important information about contraception?
"Sex education is quite a new concept in China," said Liu Liqing. Marie Stopes China is working with the Local Education Bureau in Beijing to ensure young people have comprehensive information so they can make responsible choices about sex and contraception.
Liu's organization distributes a user-friendly newspaper, called "You and Me," that provides important information for young people.
The organization also provides teacher-training and support for sex education. "It is still very sensitive. Puberty classes were introduced in the 1970s, but they mainly discuss the physical aspects of puberty and conception. Contraceptives are not talked about," Liu said.
A survey conducted in 2003 by the Chinese Youth and Children Research Center, which involved 5,000 college students across China, indicated a mere 6.6 percent of respondents had received scientific and thorough sex education at the college level. An alarming 36 percent said they had not received any sex education at college.
Vivian Bo, 23, from Beijing, said "I had very little sex education. They told us nothing about contraceptives. In my opinion, it was not sufficient" Added Chen: "I had no sex education at all, either at school or in university."
In recent years, some universities have introduced classes to raise awareness of HIV, AIDS and the use of condoms. Although students have applauded this, the classes still reach a minority of mostly urban students.
China is changing. Views, ideas, perceptions and perspectives are being challenged, adapted and reviewed each day. Nothing in China stands still. Research indicates the sexual habits of China's modern urban youth are also changing.
Sex before marriage is becoming more common, but unmarried Chinese women are still having greater difficulty, compared with married women, in accessing advice and information about contraception.
The result is many young, unmarried women are not protecting themselves against pregnancy and subsequently there is an alarmingly high abortion rate among this group of women.
Regardless of what Li thinks, or how she feels, she is not alone. She is single, pregnant and preparing to have an abortion, simply because she did not have access to information about sex and contraception.
Many women across China are in the same situation. Fudan University's research concluded that "there is a large unmet need for reproductive health services for women prior to marriage in China."
Thanks to the work of the Chinese Government, AIDS awareness agencies and sexual-health promoters, condom usage is increasing across China. But the information is only reaching a lucky, small number of people.
Other methods of contraception, such as the pill, remain in the shadows, clouded by myths and misinformation. Every woman must make her own decision about birth control, based on her own situation, and it will be a great day when every woman in China, whether married or unmarried, has sufficient information to make an educated decision.