Confucius taught that not having children was the height of filial impiety. On the Internet you can get some sense of what that means. One person quoted by Reuters wrote on one chat line: “My parents threatened to never see me again or even to commit double suicide if I don’t have a baby soon...Many coworkers look at me like a jerk, an impotent, or a sick person, just because I’ve been married for two years and have no child yet.”

In the Mao era infertility treatments other than herbal remedies didn’t really exist. Today if you have enough money, many of the treatments available in the West are also available in China. The first fertility clinics opened up in the late 1990s. Now demand is so high there are almost 200 of them. Some couples seek treatment to have twins or triplets as way of getting around the one-child policy.

Despite an official ban on surrogate mothers, women offer their service for between $5,000 and $12,000 depending on the surrogates education and physical qualifications, with the highest prices earned by those with college degrees.

Enforcement of the surrogate mother laws enacted in 2001 is weak. There are brokers, middlemen and agencies who help match infertile couples that desperately want a child with women who are willing to be surrogates. There have been some cases of surrogate women impregnating themselves with the sperm of a donor after being paid about $10,000. In a typical case an agency who works out the surrogacy is paid $20,000 and the surrogate mother receives $10,000.

Healthier Births and “Preventing Birth Defects”

According to the Encyclopedia of Sexuality, published in the early 1990s, every year in China, 13 infants per 1,000 are found to suffer from physical defects. The death rate is 26.7 per 1,000 and the deformity rate is 35.7 per 1,000. Most are the victims of inbreeding and such hereditary diseases as some mental illnesses, hemophilia, and chromosome defects. This is a big burden to society and the families that have a child with a serious birth defect. In the early 1980s, the concept of healthier birth, or prevention of birth defects, had already become an important component of China’s policy of population control. In 1986, the Ministry of Health and the Ministry of Civil Administration stipulated that a medical examination would be a national requirement for marriage approval.[Source: Zhonghua Renmin Gonghe Guo, Fang-fu Ruan, M.D., Ph.D., and M.P. Lau, M.D. Encyclopedia of Sexuality =]

Gansu province is one of the poorer provinces in China. Out of its population of 23 million in million in the early 1990s, more than 260,000 were mentally retarded. This became a very severe social burden for the province. In 1988, Gansu province adopted a law to force persons who have severe hereditary or congenital mental retardation (I.Q. 1) to be sterilized before marriage, or abort any fetuses conceived, in order to prevent severe birth defects. From January 1989 to June 1991, 6,271 mentally retarded persons were sterilized. Later, several other provinces, including Fujian, Guangdong (Canton), Henan, Liaoning, and Sichuan, adopted the same law. Premier Li Peng and Ms. Peng Peiyun, the minister in charge of the State Family Planning Commission, have spoken out in support of this local law.” The sterilization of mentally retarded persons later became national law. =

In January 1994, a new family law went into effect that banned sex-screening of fetuses and forbade couples carrying serious genetic diseases to have children. Marriage was prohibited for persons diagnosed with diseases that “may totally or partially deprive the victim of the ability to live independently, that are highly possible to recur in generations to come, and that are medically considered inappropriate for reproduction.” A list of the applicable diseases was published shortly after the law went into effect (Reuters 1994). =

Caesareans Preferred Over Natural Birth in China

Tom Hancock of AFP wrote: “As an automatic piano chimed a wedding march, new mother Wang Dan walked down a red carpet towards a hospital room called the "White House", minutes after giving birth in a candlelit water pool. The suite is adorned with an enormous rococo style sofa and a Mona Lisa portrait, and 28-year-old Wang, who gave birth to a son, said: "I wanted to stay in the White House because it's large and well decorated." But Wang's presidentially-themed chamber at Beijing's Antai hospital -- an expensive private facility aimed at the capital's wealthy middle class -- was not the only unusual thing about the birth of her first child. In a country where most urban professionals choose caesarean sections, she stands out for choosing to give birth naturally.” [Source: Tom Hancock, AFP, January 3, 2013 ^*^]

“The proportion of Chinese mothers choosing caesareans more than doubled in less than a decade, from around 20 percent in 2001 to above 46 percent in 2008 -- and approaching two-thirds in cities, according to the latest World Health Organization figures for the country. Across Asia caesarean rates have reached "epidemic levels", it said in a 2010 report. Experts say that caesareans are necessary in many cases when a mother or baby has a health condition which would make a natural birth risky, but that the risks of elective operations are often greater than the benefits. ^*^

Reasons Why Caesareans Are So Common in China

Tom Hancock of AFP wrote: “China's caesarean rate is "definitely too high", said Shenlang Tang, a researcher into Chinese healthcare at Duke University in the US, adding that "the key factor is hospital financing". China has made huge strides in maternity care over the past decades, slashing its newborn death rate by almost two-thirds since the mid-nineties, largely by promoting hospital births. But Chinese hospitals receive little government funding and generate almost half their incomes from selling operations such as caesareans, with other revenues coming mainly from diagnostic tests and medicines. "The price of caesarean section based delivery can be up to three or four times that of a natural birth... which helps the hospital generate more revenue," Tang said.[Source: Tom Hancock, AFP, January 3, 2013 ^*^]

“China's "one child" family planning policy also plays a role, as parents with more money to invest in their only childbirth are more likely to splash out on the procedure, which they see as safer, Tang said. "There are a lot of perceptions that if you have natural delivery it will affect your sex life," he added. ^*^

"Our major problem is that pregnant women in China are very scared of pain," Antai's director Chen Fenglin told AFP. "We found that even water birth couldn't reduce our patients' fear, which is why we introduced hypnosis," he said. Chen doubts China's caesarean rate will fall significantly, because of the financial incentives hospitals face. "No matter how much you promote natural birth, it's ultimately a matter of economics," he said. ^*^

Promoting Natural Birth in China

Tom Hancock of AFP wrote: “Some local governments in China have launched campaigns to promote natural birth, he said, but there is no clear central government policy on the issue. In an attempt to encourage women to choose a natural birth, the Antai hospital offers water births and teaches expectant mothers hypnosis techniques to deal with the pain of labour. It also charges just as much for natural childbirth as it does for a caesarean, removing incentives for doctors to promote the operation.[Source: Tom Hancock, AFP, January 3, 2013 ^*^]

“A red carpet runs from Antai's delivery room towards a series of recovery suites, including the western-themed White House, a room aimed at Muslims called the "Islamabad Palace," and a chamber inspired by Mongolian warlord Genghis Khan. "Parents hope that their child can grow up to be an emperor or princess, or a president, so the rooms give the parents a beautiful dream," said Chen, who says his hospital has carried out more than 2,000 water births. ^*^

“An automated piano outside the delivery room plays a wedding march when mothers walk past with their newborn baby. "We want to express that a birth is as joyful as a wedding," Chen said. Its innovations have proved a hit with mothers such as Wang Dan, who are willing to pay its hefty fees. "I felt really happy when the wedding music played, because some people are in a lot of pain after giving birth, but I was simply excited," she said, adding that she did not use an anaesthetic. But downstairs from Antai's water-birth suite, the hospital's doctors are still busy performing caesareans. ^*^

Breast-Feeding in China

China's rates of breast-feeding are among the world's lowest. Only about 28 percent of Chinese infants younger than 6 months are breast-fed exclusively, well below the global average of about 40 percent, according to UNICEF China. Didi Tang of Associated Press wrote: “Health experts say breast-feeding is the best source of nutrition for newborns, increasing babies' immune systems and reducing their chances of obesity in adulthood. They also say breast-fed children have higher IQs and are less likely to have chronic diseases such as diabetes.” [Source: Didi Tang, Associated Press, August 9, 2013 +|+]

“Breast-feeding rates in China began to drop in the 1970s with the introduction of baby formula and hit a low in the '80s, according to a study by Dr. Colin Binns of Australia's Curtin University and his Chinese colleagues published in the International Breastfeeding Journal in 2009. "Probably because of aggressive marketing of imported baby milk powder, people thought the baby formula was more nutritious," said nurse Yang Xiaoping, a 24-year veteran of Tiantan Hospital's maternity ward.+|+

“China's exclusive breast-feeding rates might have declined in recent years, Dr. Robert Scherpbier, chief of health and nutrition for UNICEF China, said. However, data that would make the trend clear are not available. Many Chinese workplaces give new mothers no way to nurse. Urban mothers usually get no more than four months of maternity leave. Women from the countryside who move to the city to work leave babies with grandparents who have no choice but to use powdered formula. +|+

Use of wet nurses -- women who breast-feed other families' children -- also is on the rise. These women are sought out by young mothers who don't want to use formula but cannot produce enough milk of their own or worry about the impact of nursing on their figures. "It's been growing at 20 percent every year," said Jia Xixian, an agent in the southern Chinese city of Shenzhen who helps clients find wet nurses.” +|+

Marketing of Baby Formula in China

China is one of the world's largest markets for baby milk products. China's infant formula market has grown from about $1 billion in 2002 to $9 billion this year, according to UNICEF. That is forecast to rise to $13 billion by 2015. Rising rates of obesity among Chinese children also might be linked to use of infant formula, said Binns. [Source: Didi Tang, Associated Press, August 9, 2013 +|+]

Foreign brands are particularly popular because of scandals about contamination of domestically made products. Demand for domestically produced formula has fallen dramatically since 2008, when melamine-tainted milk powder left six babies dead and more than 300,000 sick. The incident seriously damaged consumer confidence in local firms and led to international competitors gaining market share. [Source: Wall Street Journal, Reuters, October 29, 2013]

The demand for foreign brands has also jacked up prices. A can of Karicare Gold 3 infant milk powder from Nutricia, a unit of Danone, retails in New Zealand and Australia for around $19. In China, the official Nutricia store on the online Taobao Mall sells one can for 190 yuan ($31).

Didi Tang of Associated Press wrote: “Dairy companies energetically promote formula. Free samples are widely available in maternity wards despite laws prohibiting the practice. Advertising encourages parents to see it as helping children become stronger and smarter. A report this year by Save the Children, a British charity, said 40 percent of the Chinese mothers it interviewed had been contacted directly by salespeople for baby food companies. Binns said, "They are bombarded with baby formula ads, and the mothers want the best for their children," he said.[Source: Didi Tang, Associated Press, August 9, 2013 +|+]

Baby Formula Scares in China

Didi Tang of Associated Press wrote: “Parents who could afford it switched to more expensive imported formula after six babies died in 2008 and thousands were sickened due to Chinese-produced milk that was tainted with the industrial chemical melamine. But confidence in foreign supplies was shaken this week after Beijing ordered a recall of formula from Fonterra Co-operative Group after the New Zealand supplier said it might be tainted with bacteria that can cause botulism. The recall has sent shockwaves through New Zealand. The dairy industry is a key part of the country's economy, and China is its biggest milk export market. [Source: Didi Tang, Associated Press, August 9, 2013 +|+]

"The risks of formula feeding are increasingly clear to the Chinese public,"Dr. Robert Scherpbier, chief of health and nutrition for UNICEF China, said in an email this week. His comment came after China's government ordered a recall of formula imported from New Zealand because of contamination fears. "How many infant formula crises do we still need to convince mothers and policy makers that breast is best?" Scherpbier said. +|+

Encouraging Breast-Feeding in China

Didi Tang of Associated Press wrote: “Health workers and the government are trying to revive the practice of breastfeeding, and a drumbeat of safety scares over commercially produced milk is giving them new leverage. Visitors to Internet forums for new parents are posting comments about the benefits of breast-feeding and the potential hazards with formula. [Source: Didi Tang, Associated Press, August 9, 2013 +|+]

China's Cabinet has announced a goal of raising that to at least 50 percent by 2020. Official initiatives include a joint effort by UNICEF and the government's National Center for Women's and Children's Health to encourage Chinese employers to add rooms for new mothers to breast-feed in hopes of encouraging the practice. "Breast-feeding is safe, universally available and free," Scherpbier said. "So there is no reason why mothers should use infant formula when they can breast-feed."+|+

“Tiantan Hospital encourages breast-feeding by putting mothers and their newborns in the same room instead of putting infants in a nursery. The nurses' station has pamphlets promoting breast-feeding, and diagrams on the walls of patient rooms show postures for nursing. Each morning, nurses using dolls show mothers how to breast-feed in one-on-one sessions. "No mother can get it right on their first try, so our nurses always adjust postures by hand to make sure they do it right," Yang said. Elsewhere, many Chinese hospitals fail to encourage breast-feeding. +|+

Mother Breast-Feeding her Baby in China

Didi Tang of Associated Press wrote: “With her 1-day-old son propped against her in a hospital bed nursing, Qi Wenjuan says she has no desire to feed her child with infant formula. "I don't trust baby formula," the first-time mother said, lying in the maternity ward of Beijing's Tiantan Hospital. "There are too many quality problems." Qi, however, is in the minority in China, where most newborns are fed — sometimes exclusively — with infant formula within the first six months of their lives. [Source: Didi Tang, Associated Press, August 9, 2013 +|+]

“Qi breast-fed her baby for the first time shortly after birth. "I let him find the nipple, and he found it instinctively," Qi recalled. "There was a little pain, but I could take it. It was an oddly nice feeling, and all of a sudden I felt like a mother and that I could not be separated from the child." A tiny bolster propped up the newborn as Qi described what she saw as other benefits of breast-feeding: It saves money and will help her recover from childbirth, and she believes it will help the baby to grow better. +|+

“But Qi, an intensive care nurse at the same hospital, worries about what will happen when she returns to work about four months from now. "I think it will be more troublesome to feed him after that," Qi said. +|+

China Tightens Rules on Baby Formula to Promote Breast Feeding

In October 2013, reported “The Chinese government will tighten rules again on makers of infant formula to promote the use of breast feeding, banning pictures of children on packaging and formula companies from promoting their wares in hospitals. The new rules state that infant feed should bear labels promoting the use of breast feeding and have no pictures of children, the official Xinhua news agency said, citing a notice from the food and drug watchdog, health ministry and State Administration of Industry and Commerce. [Source: Reuters, October 29, 2013 ==]

“International guidelines, used in China, say doctors should promote breastfeeding unless there are medical reasons not to, but new mothers are often pressured to use formula, in the belief that it is better than breast milk. Hospitals and other medical facilities can receive no gifts or inducements from formula companies, which cannot push their products inside them, it said. Violators will face punishment. ==

“Separately, the food watchdog will step up requirements ensure milk powder is safe, according to a draft law published by the government. Formula manufacturers will have to report the raw materials, ingredients and labels of their products to food safety administrations, and will not allow them to contract production out, or repackage products under other labels, the draft states. China also plans to tighten restrictions on the publication of news about food safety issues to prevent the spread of untrue information which could cause alarm, according to the draft. Organizations and individuals "must not fabricate or spread phony food safety information", the draft said. "The news media must ... be objective, and fairly report on food safety issues." ==

Reuters reported: “Corruption is widespread in the health care system, fuelled in part by low salaries for doctors and nurses. State television last month said Danone SA had bribed hospital staff to give its milk powder to newborn babies, allegations which the French group investigated immediately. China is a magnet for foreign infant milk formula makers, with the $12.4 billion market expected to double by 2017. But foreign firms have come under pressure amid a crackdown on pricing and as authorities look to consolidate the dairy sector and promote breast feeding. In August 2013, the National Development and Reform Commission fined a group of mostly foreign milk powder producers, including Danone, a total of $110 million for price-fixing. Japan's Meiji Holdings Co Ltd, Nestle and Zhejiang Beingmate Scientific Technology Industry and Trade Co Ltd were also implicated, but escaped punishment for cooperating with the investigation. Meiji said it would pull out of China's baby formula market, the first international firm to do so following the pricing crackdown.

Chinese Dealers Strip Shelves of Baby Formula Worldwide

Melanie Lee of Reuters wrote: “For many Chinese and expatriates living in China going to Hong Kong or overseas for holidays, the shopping list includes diapers and infant formula, and they buy in bulk. In March, Hong Kong passed a law that classified milk powder as a restricted export, alongside items like rough diamonds, mandating that anyone without a license caught exporting more 1.8 kilograms. about two cans of milk powder, will be fined or jailed. Security guards patrol shops at Hong Kong's international airport to make sure the rule is not broken. In Britain, shops are rationing sales of baby milk after Chinese visitors and bulk buyers cleared their shelves to send the goods to China. Boxes of baby milk costing around 10 pounds ($15) in Britain are on sale on Chinese websites for up to three times as much. [Source: Melanie Lee, Reuters, July 6, 2013 |::|]

In April 2013, AFP reported; “Blamed for empty shop shelves from Europe to Australia, networks of baby formula traffickers are shipping milk powder to Chinese parents fearful of local products, and working ever harder to meet demand.Chinese parents haunted by scandals involving poisoned baby milk will pay premium prices -- three or four times as much as domestic brands -- for formula from Europe, where stores are limiting sales in the wake of the shortages.Even the Chinese buyers are complaining. "Its getting harder to find milk powder, for each box I have to walk further," said a woman surnamed Shao, who lives in Germany and advertises baby formula online.She is one of a small army of vendors working from homes across Europe, emptying shelves and causing shops to impose limits on purchases. [Source: AFP, April 12, 2013 ***]

“China's equivalent of eBay, Taobao, has more than 4,000 listings for milk powder products from Germany, with a similar number from Britain and nearly 3,000 from France."I started off sending the powder to family and friends," said Shao, a stay-at-home mother who says she makes a "small amount" from the business."Mothers usually order six to eight boxes at a time, because it takes a month to arrive and they want to keep a constant supply," she told AFP.Other vendors contacted by AFP ran larger-scale operations, with one Chinese company owner surnamed He boasting that he employs 10 German staff. Demand is driven by memories of a 2008 scandal over Chinese baby formula tainted with the industrial chemical melamine which killed six children and affected more than 300,000 others. Distrust was fortified last year when another domestic manufacturer's formula was found to be contaminated with carcinogens, despite official pledges to clean up the industry.Breastfeeding rates in China are low -- only 28 percent according to a 2012 UNICEF report -- due to time limits on maternity leave and aggressive marketing of formula. ***

“But buyers are sceptical of any products sold in China, including foreign brands packaged for the Chinese market. China is "by far" the world's largest market for formula, says consumer research group Euromonitor."Chinese young parents perceive international brands, especially imported brands in original packaging, to be healthier," said analyst Vera Wang. The Chinese websites charge hefty mark-ups, sometimes approaching 100 percent, on the retail price, such as German brand Aptamil advertised at around 220 yuan (35) for a 600g (21 ounce) box.Shipping fees can double those prices again, while customs checks and import duties in China can add another 30 percent, according to Chinese reports. In contrast, a central Beijing supermarket sells Chinese-made Yili formula at 150 yuan for 900g. ***

“The rising Chinese demand has led to shortages across Europe.One German exporter posted a picture of empty supermarket shelves online writing: "I counted with the shop manager, there were eight meters of empty shelves... all bought by Chinese people."German media have seized on photos of shop shelves stripped bare, with Bild, Europe's highest circulation newspaper, announcing in January: "Angry mothers stand in front of empty Aptamil shelves... because Chinese buy up our milk powder!"Milupa, which makes Aptamil, apologised for the shortages, citing "exports to Asia" as the reason."We don't encourage these exports and we don't sell to Asia. These customers buy directly from German supermarkets," it said on its website. Closer to mainland China, anger about visitor purchases in Hong Kong saw the city ban travellers taking out more than 1.8 kilograms of formula, with banners at the border warning of HK500,000 (US64,000) fines and two-year jail sentences for offenders. European stores have also begun to limit sales, with German pharmacy chain DM banning customers from buying more than three boxes of Aptamil at a time.In Britain, major supermarket chains are reportedly limiting customers to two cans of formula per day at manufacturers' requests, with Milupa's parent company Danone saying the move was to prevent bulk-buying for "unofficial exports to China". *** “A Chinese customer was recently forced out of a branch of a British supermarket after staff said he had bought more than 100 boxes of formula in a single week, according to the 21st Century Business Herald, a Chinese newspaper.In Australia, a major run on Karicare formula reportedly linked to an influx of Chinese tourists over Christmas saw some supermarkets and pharmacies introduce rationing and purchase limits in January. In Germany, a vendor based near Frankfurt echoed others across the country when he told AFP: "It's becoming much harder to buy milk powder. Last time I went shopping I could only buy 12 boxes, so I've stopped trading."But Shao said the shortages and restrictions would not stop her."If one supermarket is sold out, I'll walk to another," she said. "I do it for the mothers, and for the children. As a mother myself, I know how important milk powder is."” ***

Nestlé Cuts Baby-Formula Prices in China

In July 2013, Swiss food company Nestle and French rival Danone said would cut the prices of some infant nutrition products in China, following a Beijing investigation into possible price fixing and anti-monopoly violations by foreign companies. John Revill of the Wall Street Journal wrote: “The Swiss food company said it would cut prices in its Wyeth Nutrition line of baby products by an average of 11 percent and freeze prices on all new products for the next year. The move comes as China's National Development and Reform Commission, the country's top economic planning body, investigates foreign companies that sell infant formula and other baby nutrition products for potential price fixing. [Source: John Revill, Wall Street Journal, July 3, 2013 <=>]

“Nestlé said it is cooperating with the investigation and decided to change some of its sales and marketing practices following the inquiry. "To meet the NDRC concerns with respect to the affordability of infant formula to the Chinese consumer, and provide quality products at appropriate and affordable prices, Wyeth Nutrition decided to implement a price reduction of key products from July 8th 2013 through 2014," the company said. The average reduction will be at 11 percent with the biggest single product price reduction at 20 percent, the company said in a statement. <=>

“Chinese state media reported on Tuesday that the government is investigating Abbott Laboratories, Mead Johnson Nutrition Co., Danone SA and Netherlands-based Royal FrieslandCampina NV, as well as Wyeth, which Nestlé bought for about $12 billion last year. The probe also includes Biostime International Holdings Ltd., a Chinese importer of European formula powder, according to the Communist Party mouthpiece the People's Daily. <=>

Foreign Companies Jack Up Prices on Infant Goods

Melanie Lee of Reuters wrote: “Sophie the Giraffe is a teething toy taking over the world one baby mouth at a time. The toy, handmade in France from Malaysian rubber sap, is the rage for parents of toddlers the world over, including China. But the knobby chew toy is priced around $30 in China, nearly three times the price in France. It's not a shock for Chinese parents, who have long lived with imported baby products that are sharply more expensive than elsewhere in the world. [Source: Melanie Lee, Reuters, July 6, 2013 |::|] “Several other products aimed at infants and toddlers appear to be exorbitantly priced in China. Import duties are only a part of the reason, experts say - much of the premium for imported infant products can be ascribed to fears that locally made goods may be contaminated. Chinese parents, who are mostly only allowed to have one child, simply do not want to take the risk of possible contamination in local baby products. |::|

Foreign companies know this and many take advantage. "Brands have been able to get away with this just because of the fear factor about buying unsafe products," said Benjamin Cavender, principal analyst at China Market Research Group. "If you look at how consumers spend their money, they are disproportionately willing to spend money on anything that their child will be eating or what will be touching their child's body." |::|

“When it comes to children, the fear of domestic goods goes beyond food to items like toys and diapers. Many local toys have been found to have toxic levels of substances like lead, arsenic and mercury. Sophie the Giraffe retails for about 8 euros ($10.33) on Amazon's French website. Under Chinese law, Sophie would face an import duty of 10 percent if imported as a rubber item and a value-added-tax (VAT) of 17 percent. If it is imported as an animal toy, there is no import duty but the VAT still applies. Transport and distribution costs would also apply. Shanghai Tongzhen Trading Co. sells the toy for $27 on Chinese e-commerce platform Jingdong Mall.

Cai Junfang, a Shanghai woman who has a two-month old baby girl, says she manages the high prices by breastfeeding and using local diaper brands. "The prices of imported baby goods are indeed very high," said Cai, adding that the quality of imported goods was however generally better than domestic products. But when it comes to her baby's milk formula, she's not taking chances."There has been too much media exposure on the domestic formula safety. The most important thing is my baby's health," she said.

Image Sources:

Text Sources: 1) Encyclopedia of World Cultures: Russia and Eurasia/ China , edited by Paul Friedrich and Norma Diamond (C.K.Hall & Company, 1994); 2) Liu Jun, Museum of Nationalities, Central University for Nationalities, Science of China, China virtual museums, Computer Network Information Center of Chinese Academy of Sciences, ~; 3) Ethnic China *\; 4) \=/; 5), the Chinese government news site | New York Times, Washington Post, Los Angeles Times, Times of London, Lonely Planet Guides, Library of Congress, Chinese government, Compton’s Encyclopedia, The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Newsweek, Reuters, AP, AFP, Wall Street Journal, The Atlantic Monthly, The Economist, Foreign Policy, Wikipedia, BBC, CNN, and various books, websites and other publications.

Last updated July 2015

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