It seems contradictory that a country could have one of the highest rates of family planning and contraceptive use in the world, yet have high (and rising) abortion occurrences each year as well. This, however, is exactly the situation that China currently faces. Spending time studying Public Health in China, I was able to tour the Reproductive Center of the Peking University Hospital and witness first-hand the unique way in which China tackles reproductive and sexual health.
Because of the One Child Policy, married people have plenty of access to family planning services and contraceptives. Young and unmarried people, on the other hand, are not given this same access. They are engaging in more premarital sex but with limited knowledge about the topic, leading to an increased number of abortions, as well as sexually transmitted infections (STIs). In fact, according to Jim Yardley in an article in the New York Times, “unmarried women, including teenagers…constitute a majority of [abortion] cases in Shanghai and parts of Beijing…And many of these women are having multiple abortions.” Why does this unusual dichotomy exist? Many see the explanation as the clash between traditional views and current practices.
Traditional Chinese culture is deeply rooted in Confucian values, with a central emphasis on family. People were married at young ages, most often in arranged matches, and sex was seen as a means to an end: producing children. Because of these traditional values, sexual and reproductive health, especially outside the confines of marriage, are not subjects openly discussed. There is a lot of embarrassment and misinformation clouding the topic, leaving many people confused and unequipped to make educated decisions.
Without shedding traditional values, China has become modernized and more liberal as it has opened up to the rest of the world. This is reflected in the more sexually liberal lifestyles of youth and shifting attitudes toward sex and reproduction. Millions of young unmarried people have moved to the cities since the 1980s, putting distance between themselves and their families, and in Yardley’s view, more distance between rural traditional views and values.
Education, however, has not kept up with these social changes. A 2009 United Nations Population Fund study found that over 50% of individuals participating in premarital sex do not use any form of birth control. Although viewpoints are changing, core social institutions still do not consider youth to be sexually active, discussing sex only in the context of married heterosexual couples. The increase in youth sex education has been slow and minimal, mostly emphasizing abstinence and the anatomical and physiological facts of human reproduction, but ignoring other forms of “safe sex” practices. With the lack of education and information available, youth are often engaging in sexual activity without knowledge and awareness of sexual health. Sex is rarely brought up, and when it is, the main idea is abstinence.
While touring the Reproductive Center of the Peking University hospital in July of 2013, I asked a young, single, female doctor about birth control use among young people, specifically oral methods. Although she happily discussed pregnancy and abortions a minute earlier, my question caused her hesitation. Her response was that people don’t really use birth control, besides some people who use condoms, because they were afraid it would affect their fertility later in life. After her half-hearted answer she moved on to the next question, eager to change the subject. Even a doctor in a big city seemed confused on the subject. Topics concerning contraceptive measures and alternatives to abstaining are rarely mentioned, so youths are not equipped with the services or knowledge to protect themselves from pregnancies and STIs.
This issue has gone beyond the individual problem and become a public health concern, and it remains unclear what the exact solution should be. However, it is certain that something needs to be done to halt and hopefully reverse this alarming upward trend of abortions, STIs, and other health risks that result from young people involved in sexual activity without understanding the concerns and effects of their choices.