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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 blog ; Population and Family Planning; Illegal Births, Legal Abortion ; article China.orh ; Family Planning info ; Forced Abortion / ; Links in this Website: POPULATION IN CHINA ; ONE-CHILD POLICY IN CHINA ; PREFERENCE FOR BOYS ; THE BRIDE SHORTAGE IN CHINA

Family Planning, Late Marriage and Contraception 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.” 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." [Source: Alexa Olesen Associated Press, January 10, 2011]

According to the Encyclopedia of Sexuality, published in the early 1990s, all kinds of contraceptive measures, from condom to pill, are available and used in China’s practice of family planning. In 1989, it is estimated that more than 70 percent of couples of child-bearing age are using contraceptives, over 8.8 million males have undergone sterilization injections or operations, including a new reversible sterility operation. For females, the most popular birth control method is the intrauterine devices (IUDs). Used by 60 million women in the country, the IUD accounts for 41 percent of the total contraceptive measures; female sterilization operations constitute 36 percent. Research on a variety of oral contraceptives in the country has also reached advanced levels and these are available to the public. Breakthroughs have recently been reported in the development of medicines for terminating early pregnancy. In 1992, a survey showed that 83.4 percent of married couples have adopted contraceptive practices, 40 percent of them are using IUDs, 39 percent female sterilization, 12 percent male sterilization, 5 percent oral pills, and 4 percent condoms. Infertility due to sexual dysfunctions was common (e.g., more than 25 percent of about 40,000 family planning counseling cases seen in 1984 to 1989), but most were said to be somewhat amenable to medical or herbal therapy. [Source: Zhonghua Renmin Gonghe Guo, Fang-fu Ruan, M.D., Ph.D., and M.P. Lau, M.D. Encyclopedia of Sexuality =]

“Until the recent past, the Chinese people were controlled on the local level by danwei - the unit or institution one belongs to. In order to marry, a couple must have a legal registration and a permit letter from his/her danwei. Usually one’s danwei leader checks one’s age - while the minimum legal marriageable age is 22 for males and 20 for females, “later marriage age” policy stipulates an age of 27 to 28 for males and 24 to 25 for females in order to help in the control of population. A 1991 survey in Nanjing, the former capital of China and the capital of Jiangsu Province, showed that the average marriage age was 27.5 for males and 25.8 for females. In 1949, the average first marriage age for females was 18.57, in 1982 it increased to 22.8 years old. Married women are urged not to have a baby before 25 to 28 years of age, but no later than 30 years of age, in order to achieve the twin goals of later childbearing and healthier birth. =

Birth Control Methods in China

left 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). In the 1980s, contraceptive methods utilized included: diaphragm (50.8 percent), tubal ligation (21.8 percent), pills (7.5 percent), vasectomy (1.2 percent), others (12.3 percent), and none (6.4 percent). Birth control measures used by urban couples included: diaphragms (42.8 percent), tubal ligation (9.4 percent), other mechanical means (18.3 percent), pills (5.9 percent), vasectomy (2.3 percent), other methods (e.g., “safe periods,” coitus interruptus, unknown) (15.5 percent), and none (5.8 percent). [Source: “1989-1990 Survey of Sexual Behavior in Modern China: A Report of the Nationwide “Sex Civilization” Survey on 20,000 Subjects in China: by M.P. Lau’, Continuum (New York) in 1997, Transcultural Psychiatric Research Review (1995, volume 32, pp. 137-156), Encyclopedia of Sexuality ++]

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. China also sells about 10 million abortion pills a year,

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

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.

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Abortion rate by province

Infertility in China Linked to Pollution

Fiona Keating of IB Times wrote: “China's pollution is believed to be a factor in a growing national infertility crisis, with infertility rates rising to 12.5 percent of all adults in China of child-bearing age. Around 20 years ago, the level was at 3 percent, and worryingly, sperm counts have dropped by 80 percent in Chinese men in 80 years. [Source: Fiona Keating, IB Times, February 1, 2014 /+/]

“Across China, over 40 million people have been diagnosed as infertile. A national study of air pollution and how it affects fertility is under way in China. In other investigations, the Chinese Academy of Sciences is looking into the effects of pollutants such as arsenic, plastic solvents and melamine on male infertility. /+/

“While some experts believe that 70 percent of female infertility and 50 percent of male infertility are the result of unhealthy lifestyles, others believe that environmental factors may also play a role. "New chemicals appear in our lives every day, and the problem is that we don't know if these new chemicals will pose risks to our health," Zhang Jun, lead researcher of the infertility study told the South China Morning Post. "So our study will be significant in providing evidence to prove if these chemicals are harmful. And based on that we can make our policies prevent any hazards from such environmental pollution."” /+/

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, 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]

Wealthy Chinese Rent American Wombs

According to IN Times: “Chinese inquiries to agencies that match couples from around the world with American surrogates have risen tenfold since 2012 and are expected to double again in the next two years, according to a Times report. Surrogacy is against the law in China, so many infertile couples are using American agencies. John Weltman, president of Circle Surrogacy, a Boston agency, said that North America was "unequivocally the safest country to do surrogacy in". [Source: Fiona Keating, IB Times, February 1, 2014]

“American surrogacy offered Chinese couples the choice of deciding on the gender of the child, which is illegal in China. In China, there are 34 million more men than women. The American surrogate mother, the so-called "gestation carriers", are mostly working class and come from the rural South or the Midwest. The fee for renting out their wombs ranges from £48,000 to £72,000. "Customers often say that they have consulted doctors and been told that pollution is the cause of the infertility," said one Chinese surrogacy agent.” [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 June 2015

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