Facts and Details

BIRTH CONTROL IN CHINA

birth control poster Some 70 percent of all women in China use contraception (compared to 2 percent in Cameroon and 83 percent in the United Kingdom). In ancient China, women were told that consuming mercury heated in oil would prevent them from having babies. It may have worked because mercury can kill a fetus--and a mother too.

The Shengyubiao was a conception calendar--based on a woman’s age in lunar months and the month of conception--used by women to give birth to a child of a specific sex. The whole concept had long been dismissed as a superstition and an old wives tale but in the early 2000s, Italian researchers found that conception dates can in fact affect the sex of a child.

Puberty tends to start earlier as countries develop and children's diets improve; in China, the starting age has fallen from about 14.5 in the 1970s to 12 ½ years old. Meanwhile, the average marriage age has edged up, from 20 in the 1970s to 22 now, extending the time that many young people can be sexually active but unmarried. Li Shuzhuo, a demographer at the Institute for Population and Development Studies in Xian, says it is clear that there has been a big shift from post-marriage to pre-marriage abortions. [Source: Alexa Olesen Associated Press, January 10, 2011]

Good Websites and Sources: Birth Control in China elizabethinchina.com blog ; Population and Family Planning unescap.org; Illegal Births, Legal Abortion ncbi.nlm.nih.gov ; China.org article China.orh ; Family Planning info asianinfo.org ; Forced Abortion /buyhard.net46.net ; Links in this Website: POPULATION IN CHINA Factsanddetails.com/China ; ONE-CHILD POLICY IN CHINA Factsanddetails.com/China ; PREFERENCE FOR BOYS Factsanddetails.com/China ; THE BRIDE SHORTAGE IN CHINA Factsanddetails.com/China

Family Planning in China

Alexa Olesen of Associated Press wrote: “The mainland's family planning network is enormous and efficient, a virtual population control army that promotes contraception and meticulously logs births, abortions and sterilizations - but it focuses mainly on married couples.” [Source: Alexa Olesen Associated Press, January 10, 2011]

The manager at one family-planning clinic told AP that she has wanted to tell young people how to use pills and condoms properly when she lectures at high schools and colleges, but administrators often force her to stick to dating etiquette and menstruation. "They don't want me to mention contraception," she says. "They are afraid I will corrupt the students." [Ibid]

Birth Control Methods in China

Intra-uterine devices (IUDs) are the most common form of birth control in China. Contraceptive methods (2001): 1) IUDs (intrauterine devices, 46 percent); 2) female sterilization (38 percent); 3) male sterilization (8 percent); 4) condoms (8 percent); 5) pills and injections (2 percent); 6) other (1 percent).

A typical Chinese woman uses no birth control until she has her first child, then she uses and IUD until the child passes the age of high mortality, or she has a second child and then is sterilized. Birth control is generally free.

More and more couples are relying on the pill, which has only become widely available in the last decade; IUDs usually have their strings cut so mother can't fish them out; and living five to a room as many Chinese do is in itself considered a form of birth control. Many abortions in China occur after contraceptive failure. An effort is now being made to give women access to better-quality foreign IUDs, condoms and Norplants. The abortion pill RU486 is legal in China.

Contraceptive pills are available over the counter in China at the drugstore but often they don’t work because they are not properly or perhaps are counterfeit. It is not clear why they did not work, though clinic staff say some women do not realise they must be taken every day without fail.

Many Chinese villages without adequate medical facilities have "Family Planning Service Stations," where women can get ultrasound checks and birth control pills. Charts on the walls of these small clinics record the number of women who have been sterilized, who have been given IUDs or birth control pills, who are infertile, who have just given birth and who have permits to have babies. The ultrasound devices used at these clinics are made by a Chinese-Canadian joint venture. They cost about $1,000 and are carried in a box that looks like a small overnight suitcase.

Sterilizations and IUDs are widely promoted and subsidized, but only for married women. The needs of unmarried women tend to be overlooked and more of them are having sex as attitudes about casual sex become more liberalized.

Birth Control Quotas in China

Population control promotion In rural areas, village chiefs and local officials are given a quota for the number of children born. To meet their quotas local officials often force women to have abortion or sterilizations or falsify data.

Prospective mothers have to be a certain age before they are given "birth license" to have a child. Under age women who are pregnant often go into hiding to avoid having an abortion. Women in families with one child are often fined when they become pregnant.

Teenage girls who give birth each year: 1 percent (compared to less than 1 percent in Japan, 5 percent in the United States and 16 percent in Nicaragua).

In recent years, the quotas and rules have been relaxed. Women can make their own decisions about birth control and the government is relying more on education rather than forced abortions and involuntary sterilizations.

Sterilization in China

Married women using birth control who are sterilized (1988): the United States (36 percent); China (35 percent); India (31 percent); Britain (23 percent) and the Netherlands (15 percent). Sterilization campaigns in China are usually held the same time every year—in November and December—when woman are needed in the fields to tend crops.

Women who have reached their limit of children are supposed to get sterilized. There have been reports of forced sterilizations of handicapped people and even women who missed an IUD check-up. Women have died form infections caused by botched sterilizations ordered by the government after the woman had a second child.

In 1988, a law was passed in Gansu Province that required people with an IQ of less than 49 to be sterilized. Other provinces have passed similar laws. The 1994 Maternal Infant Health Care Law, originally known as the Eugenics Law, stipulates that couples undergo a premarital examinations and urges doctors to "take steps" to "prevent childbearing" through sterilization if there is a genetic problem or one of the parents is severely handicapped.

In an international study, doctors were asked if "reducing defective genes" was one of their goals. All the respondents in China said yes, while only 5 percent in the United States agreed.

Abortion in China

Abortion has been legal in China since 1953, although sex-selective abortions were banned starting in 1994. China was the first country to approve mifepristone, the abortion-inducing drug also known as RU-486, and by the late 1990s it was widely available — by prescription and on the black market — all across China. [Source: Mark McDonald, New York Times, July 30, 2009]

Abortions at registered clinics in China cost about $88. Wu Shangchun, a research official with the National Population and Family Planning Commission, told China Daily that about 10 million abortion-inducing pills are sold annually in China. “ [Ibid]

China has mobile abortion clinics—vans equipped with a bed, body clams, suction pumps and other tools used to perform abortions. Among the other heroic deeds performed by a pilot, one Chinese newspaper reported, was the fact that he "persuaded his wife, pregnant for the first time, to have an abortion."

The government estimated that 9.2 million abortions were performed in 2008, up from 7.6 million in 2007. But the count only includes those done at hospitals. State media has reported the total could be as high as 13 million. If accurate, that would give China one of the highest abortion rates in the world.

Alexa Olesen of Associated Press wrote: “The country legalized abortion in the 1950s, but it did not become common until the government began enforcing a one-child limit to stem population growth. From fewer than five million abortions a year before 1979, the number jumped to 8.7 million in 1981, a year after the policy was launched. It peaked in 1983 at 14.4 million before coming down as Beijing relaxed the policy to allow rural couples a second child if their first was a girl. An aggressive, and often coercive, prevention campaign also reduced abortions. In 1983 alone, authorities steril ized 21 million people and fitted 17.8 million women with intrauterine devices. The next year, abortions declined sharply to 8.9 million.” [Source: Alexa Olesen Associated Press, January 10, 2011]

"It used to be that Chinese women only had an abortion if the foetus had birth defects or if they got pregnant after having their first child," an anaesthesiologist told AP. "Society is different now. It's much more open, too open actually, and puberty is starting much younger, but schools and parents are not discussing these things with the kids." [Source: Alexa Olesen Associated Press, January 10, 2011]

High Number of Abortions in China

According to government data released in August 2009, 13 million abortions a year are performed in China, mostly on single young women. The true figure is thought to be much higher. The numbers included only abortions performed at hospitals and did include those done at unregistered rural clinics, where a lot of abortions are performed, or medication-induced abortions. According to the data about 10 million abortion pills are sold every year and half the women who get abortion used no contraception. [Source: China Daily]

Even the official figure shows a marked increase in Chinese abortions, based on statistics from 2003, the last year for which reliable data are available. In a joint report, the World Health Organization and the Guttmacher Institute put the number of abortions in China at 9 million, out of a total of 42 million worldwide that year. “ [Source: Mark McDonald, New York Times, July 30, 2009]

The rate of abortion in China — about 24 abortions for every 1,000 women between the ages of 15 and 44 — is far from the world’s highest. Russia has by far the highest rate at 53.7 per 1,000, according to the United Nations Population Division. Some two million abortions are performed each year in Russia, which has a population of 142 million. China’s population is 1.3 billion. “ [Ibid]

“More than eight million induced abortions are performed in China every year, 50 percent of them not being the woman's first, according to a survey, Xinhua News Agency reported.The more abortions a woman has, the more likely she is to suffer from diseases caused by abortions, said Cheng Linan, an expert with the Chinese Medical Association. About 88 percent of the infertile women in China have experience of abortion. [Source: Chen Yingqun, China Daily, September 27, 2011]

The rate of miscarriage for those who have repetitive abortions is 2.5 times that of women who have never had an abortion, and their rate of premature delivery is 5.44 times that of women who have had one abortion.

Reasons for the High Number of Abortions in China

The number of abortions has risen dramatically with the one-child policy. Statistics for the country as a whole are difficult to come by. But there is some regional data. In surveys conducted in Shanghai in 1987 and 1991, some 47 percent of married women questioned had at least one abortion; and more than third (36.8 percent) of those who had abortions had at least two. Abortions are performed even after the sixth month of pregnancy if the babies are "outside the plan." [Source: U.S. News and World Report]

Officials blamed a low level of sex education among young people for the widespread use of abortion in China. More than 70 percent of callers to a pregnancy phone line at a Shanghai hospital knew almost nothing about contraception, China Daily reported. Only 17 percent were aware of venereal diseases, and less than 30 percent knew that HIV/AIDS could be transmitted sexually. “ [Source: Mark McDonald, New York Times, July 30, 2009]

Sex is no longer considered taboo among young people today, and they believe they can learn everything they need from the Internet, Yu Dongyan, a gynecologist, told the paper. But it doesn’t mean they’ve developed a proper understanding or attitude toward it. “ [Ibid]

A Chinese cultural preference for sons, combined with the state’s longstanding one-child policy, has resulted in a widening use of gender-selective abortions and an imminent generation of excess men, according to a recent report in the online British Medical Journal. There are now 32 million more Chinese boys than girls under 20, the researchers found, an imbalance that is expected to widen over the next 20 years. “ [Ibid]

Nearly half of the women who had abortions had not used any form of contraception, Wu said. About 60 percent of the women who have abortions are between 20 and 29 years old, and most are single. “ [Ibid]

Views on Abortion in China

Alexa Olesen of Associated Press wrote: “ Chinese can be brutally frank when it comes to abortion. Many feel a foetus is not a person until after it is born - an attitude Beijing sociologist Li Yinhe associates with the country's once-high infant mortality rate. Frequent miscarriages and infant death hardened families to the point that babies were not traditionally named until 100 days after birth, she said.” [Source: Alexa Olesen Associated Press, January 10, 2011]

"Luckily, in Chinese culture people generally feel that before the actual birth, you do not yet have an actual person, so we have cases of induced abortion at seven and eight months along," Li said. "I think this is to China's advantage from a population control point of view ... China has absolutely no need for the so-called `right to life' argument, no need to introduce ideas about abortion as murder and so on." [Ibid]

The mainland's few anti-abortion campaigners are usually Buddhists or Christians. But their activities are low-key because the government keeps a tight rein on grass-roots organizations and religious groups. [Ibid]

More Young Women Getting Abortions in China

The abortions rate among young, single women is rising. Alexa Olesen of Associated Press wrote: “Official figures show abortions are increasing, and the media and experts say many, if not most, of the abortion-seekers are young and unmarried. That is a change from the past, when abortion was used mainly to enforce the government's one-child-per-couple limit.[Source: Alexa Olesen Associated Press, January 10, 2011]

“Many blame the trend on newly liberal attitudes towards premarital sex and on lagging sex education. Bureaucratic red tape and social stigma deter single women from having a child on their own, and laws bar women from marriage until they are 20, making teen pregnancy virtually unheard of . These factors and a lack of stigma surrounding abortion, or "artificial miscarriage", as it's known, have helped make it a relatively cheap, widely available option for birth control. Today, students are clearly a client base: the Beijing Modern Women's Hospital offers a government-subsid ized "Safe & Easy A+" discount abortion package at 880 yuan ($135). Others advertise in college handbooks.” [Ibid]

"The moral outrage over having a child before marriage in our society is much stronger than the shame associated with abortion," said Zhou Anqin, the manager at the clinic in Xian, which performs about 60 abortions each month, mostly on students aged 24 or younger. [Ibid]

A United Nations-funded survey of 22,288 Chinese aged 15-24 by the Peking University Population Research Institute in 2009 found that two-thirds were accepting of premarital sex but that most "had very limited levels of sexual reproductive health knowledge." The survey found 22 per cent had had sex before; of those, more than 50 per cent used no contraception during their first sexual encounter. [Ibid]

Chinese Abortion Clinic

Alexa Olesen of Associated Press wrote: “The leaf-strewn road divider in Eternal Peace Road hides a grim secret: numerous tiny foetuses lie in unmarked graves dug by women from the abortion clinic across the street. The staff at the small clinic in the heart of this ancient city of Xian do not bury most of the foetuses - only those that have reached three or four months, when they clearly resemble miniature babies. ‘This big,’ says anaesthesiologist Liu Jianmin, using her thumb and index finger to measure out the length of a lipstick tube. The burials are a gesture of respect for lives cut short, she adds, and the patients are not told.”[Source: Alexa Olesen Associated Press, January 10, 2011]

“The two-storey facility, which opened in 2007, is one of five operated in China by Marie Stopes International, a London-based not-for-profit group that runs hundreds of clinics globally promoting safe abortions, HIV testing and other services. The foetuses that are not buried are discarded as medical waste, as they are in the United States.” [Ibid]

Online adverts and cheery brochures advertise "painless artificial miscarriage", private recovery lounges and post-surgery massage to help shrink the swollen uterus back to normal size. "These kids today have it so easy, they get a pinch and fall asleep, no suffering," says the anesthesiologist, who herself underwent an abortion without pain medicine in 1982, standard practice at the time. "If they felt it, they wouldn't get pregnant again." [Ibid]

Young Chinese Woman Getting an Abortion

Alexa Olesen of Associated Press wrote: “In a ground-floor examination room, a nurse rubs the sonogram wand over Nancy Yin's belly as Yin, 20, stares at the wall, looking away from the image on the machine: a nearly three-month-old foetus with arms, legs and a quick heartbeat. Yin, a student, started having sex with her boyfriend in March. The couple never used contraceptives, she says, because she ‘didn't feel comfortable with it.’ Her parents never talked to her about birth control, nor was it discussed in school. [Source: Alexa Olesen Associated Press, January 10, 2011]

As a nurse checks her blood for signs of infection, Yin seems embarrassed but firm in her decision. "I considered having the baby," she says. "But it's not possible. I am in school and I've got to graduate." Later, Yin leaves with a bag of pills and an abortion appointment three days later. The manager, explains that the pills will kill the foetus and soften Yin's cervix. "It's like preparing the ground before you pull out a sapling," she says. "If you pour water on the ground first, it will loosen the soil and make it much easier." [Ibid]

“Marie Stopes frequently sees repeat customers. Zhang Jie, 22, warms herself by a space heater in the recovery room after her second abortion in two years. A petite woman with blue-tinted contacts, Zhang works as a salesgirl and hopes to open her own fashion shop one day. She says she wants a baby when she is older and has some savings, but not now.” [Source: Alexa Olesen Associated Press, January 10, 2011]

Forced Abortions in China

There have been many reports of forced abortions n China. In some places women must have regular check-ups to make sure they are not pregnant. If they are pregnant they are forced to have an abortion. There have reports of the families of women having their houses torn down and their fields taken away after the women refused to get abortions

Unauthorized pregnancies are sometimes ended with the injection of lethal chemical through the mother's stomach and into the fetus's brain, followed by an abortion. This technique is used even at nine months. If a baby is then born alive, he or she is given an another injection that causes death.

Forced abortions and sterilizations were common in the early days of the one-child policy but were made illegal. Even so the practice continues because failure to meet birth control quotas could spell doom for the careers of local officials.

In the city of Linya in Shandong Province peasants have been forced to have abortions by local government officials worried about meeting their population control quotas. There have been reports of officials who raided homes there and forced couples with two children to undergo sterilizations and women carrying a third child to have an abortion, in some cases days before their due date. See Punishments for Extra Children, One Child Policy.

Sterilization, See Chen Guangcheng, Human Rights

Surrogacy and In-Vitro Fertilization in China

The eight baby story Jonathan Kaiman wrote in the Los Angeles Times, has “unleashed a barrage of editorials in state media about the ethics of surrogacy and in-vitro fertilization.” "This completely topples the traditional meaning of parents," said an editorial in the official People's Daily. One editorial in China Daily denounced surrogacy as the "business of renting out organs." [Source: Jonathan Kaiman, Los Angeles Times, January 19, 2012]

Chinese hospitals have been forbidden to carry out gestational surrogacy procedures since 2001. However, surrogacy agencies seem to be booming in China, as evidenced by a profusion of websites and advertisements offering the service. An estimated 25,000 children in China have been born using surrogate mothers in the last 30 years, according to Southern Metropolis Weekly, a southern Chinese magazine. Procedures typically cost more than $50,000, about 140 times the average monthly salary for a university graduate in Guangzhou.

Patrick Chan, an obstetrics expert in Hong Kong, said the eight babies are either a result of good luck or extremely aggressive fertilization techniques. "From the sound of it, they just tried to have some kind of baby machine," he said. Chan said multiple births through in-vitro fertilization also carry the risk of severe complications such as premature delivery. "Doctors see twins as a complication of treatment," he said. "We don't intend to create multiples."

Wang Qi, the manager of surrogacy agency daiyunivf.com, said the scandal hasn't affected her business. The agency continues to be overwhelmed with applications from aspiring surrogate mothers, most of them "people who had emergencies and need a large sum of money." Sales, she said, have been "quite good." Wang is unperturbed by the media hype and the government response. "There are so many dark things in society," she said. "The woman caused quite a stir, but wait a few days and you won't hear anything more about it."

Use of Surrogate Mothers On the Rise Among Wealthy Chinese

Aw Cheng Wei wrote in The Straits Times: Surrogacy is illegal in the country, but try telling that to the increasingly wealthy Chinese who are getting others to carry and give birth to their babies. More than 25,000 children were born to surrogate mothers in China over the past three decades, with their births arranged by over 500 unlicensed agencies, according to some estimates. It is a growing phenomenon, said several agencies, some of whom spoke to The Straits Times on condition of anonymity. [Source: Aw Cheng Wei, The Straits Times, May 13 2012]

“In particular, many Chinese want to have a baby during this auspicious Year of the Dragon. Some agencies say their business spiked by some 30 per cent last year over the year before. "Most couples want to have a Dragon baby, so surrogates have to be impregnated the year before," an agency owner in Beijing told The Strait Times. [Ibid]

“A check by The Straits Times also found more than 200 online discussion groups on infertility with a total of about 35,000 members, the majority looking for surrogate mothers. Most couples go through an agency, which acts as a middleman, to connect them with women willing to rent out their wombs. The first of such unlicensed firms opened in 2004. It advertised online to reach infertile couples and recruit surrogate mothers. [Ibid]

“The entire process costs about 300,000 yuan (US$47,534). The agent pockets 20,000 yuan and the surrogate mother, usually recruited from the countryside, is paid around 140,000 yuan. The remaining amount goes to medical expenses such as hormone therapy treatment and the baby's delivery. The surrogate mother typically offers just her womb. A fertilised embryo from a childless couple is placed in her. She is then paid in instalments and gets a bigger payoff once the baby is handed over to the biological parents. This is done to ensure that she fulfils her end of the contract. Customers have the option of caring for the surrogate mother themselves. Otherwise, she will be placed under the agency's care for 3,000 yuan a month, and live in an apartment with a nanny on standby 24 hours a day. [Ibid]

“The growing demand is due to several factors. For one thing, many urban Chinese, like people in developed countries, are marrying later and postponing child birth as work demands and the high costs of city living weigh couples down. Sometimes, vanity is involved: Women, particularly those with careers, simply want to maintain their svelte figures.Older couples are more likely to have problems conceiving, doctors say. One in every eight Chinese couples struggles to have a baby, according to official statistics. This is five times the number compared with 20 years ago. In 2010, 40 million people in China were affected by sterility.A surrogate mother in China has the added bonus of possibly dodging the country's one-child policy, as in-vitro fertilisation creates a higher chance of having twins or even triplets. Twins and other multiple-birth deliveries are exempt from the penalties. [Ibid]

“But locals are not the only ones seeking wombs for rent. The relatively low cost of surrogacy in China has attracted childless couples from overseas too."Americans and Europeans also come to us when they want children," said an agency owner, who has had seven years' experience in the business and seen more than 6,000 successful births. 'It costs twice as much to do the surrogacy process in the US, and the facilities are the same.'

The authorities are trying to crack down on the practice after a woman in southern Guangzhou hired two surrogate mothers to give birth to eight babies, local media said last year. The public attention stemming from the incident and complaints about the exploitation of women's bodies prompted officials in March to call for tighter laws against surrogacy. While the Chinese Health Ministry has banned medical institutions from trading in embryos and assisting in surrogate pregnancies, there are no clear laws against surrogacy services. In 2009, three surrogate mothers were forced to abort their foetuses when they were discovered. [Ibid]

Image Sources: 1) University of Washington; 2) ElizabethinChina blog; 3) Abotion rate map Robert Johnson.

Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, National Geographic, The New Yorker, Time, Newsweek, Reuters, AP, Lonely Planet Guides, Compton’s Encyclopedia and various books and other publications.

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© 2008 Jeffrey Hays

Last updated August 2012