Like many laowai, when I came to China, I brought a stash of Western medications, afraid that I wouldn’t be able to get Pepto-Bismol, Tylenol, Sudafed or my oral contraceptives in the land of Eastern (read: herbal, and for me, completely ineffectual) medicine and fake prescription drugs. However, after a while it becomes unsustainable to keep flying back and forth with my own in-suitcase pharmacy. Not to mention bringing a year’s supply of medication is risky as the expiration dates on pills sold in the States are likely to lapse while you’re waiting to use them in China. The situation lead me to finding alternative tummy settlers, depending on different decongestants, and more notably, scheduling my first OBGYN appointment in China.
Prescriptions for oral contraceptives in the States are only written after a doctor has given the patient an exam that must be repeated annually. Pap smears, breast exams and basic questions regarding a woman’s risk for contracting STDs are a minimum for any yearly gynecological exam. While vaguely unpleasant, almost of us accept that that putting our feet in metal stirrups for twenty minutes every year is an uncomfortable yet necessary evil and keeps us healthy and safe.
My trip to the Beijing clinic was completely different. Even though it was a very professional foreign-run clinic, staffed by foreign doctors, when I walked in and started addressing my concerns about switching over to Chinese methods of contraception, I felt more knowledgeable than the staff about my options for birth control. There were no questions about my medical history, no conversation about self-screening every month for lumps in my breasts, no encouragement to engage in safer sex practices, and certainly no encounter with a speculum – and yet I still left with a new pack of pills, which, though different from what I had previously taken, was still a brand name I recognize and trust.
As I was telling my usually very-westernized Chinese friend about the experience at the clinic, she acted surprised that I would want pills that would alter my body chemistry when there were other methods of contraception available. She pointed to the withdrawal and rhythm methods of family planning, which she believes are the methods most commonly used by women in China (an opinion seconded by a different Chinese friend). Somewhat ironically, I was getting this advice from a woman who was four months into a surprise pregnancy.
A second conversation with my matronly neighbor about family planning in a post-Mao era revealed an extremely common attitude towards abortion: if it helps maintain the one child policy then who are we to question? As someone accustomed to a steady stream of differing views on abortion from all sides of the political and social spectrum, this docile perspective was shocking. Here in China, state suppression of any group that organizes outside of state sponsored channels – from the breaking up student groups in Tiananmen Square in 1989 to the banning of Falun Gong in 2001 and 2002 – extends to include any anti-abortion groups that might arise. This is not really in fear that a group will undermine the one child policy, but is instead based on a larger fear of any non-government sponsored group that might gain a significant following.
I myself am unapologetically pro-choice, but the idea that abortion is just another method of birth control scares me. Consequently, when I saw that the state-run China Daily had published an article detailing Chinese abortion statistics, I was surprised that the Party would allow something so sensitive to be published so close to the nation’s 60th anniversary, even in their laowai-placation publication.
According to the China Daily, and the data on which it based its article, there are over 13 million abortions performed on the Mainland each year, the highest proportion of those procedures (62%) being performed on unmarried women in their twenties. The report also revealed that the number of women under 18 who are undergoing the procedure is increasing.
It is important to keep these numbers in perspective though instead of engaging in pointless China-bashing: China’s abortion rate is high, but it is less than half of Russia’s. Between the ages of 15 and 44, 2.4% of Chinese women have an abortion whereas 5.37% of Russian women undergo the procedure. On the other hand, in the same age range, the abortion rates in Western countries are significantly lower than China’s. In the UK the rate is only 1.8% and in the U.S. estimates based on national trends put it at approximately 2%.
The article in the China Daily quoted Wu Shangchun, a division director of the National Population and Family Planning Commission’s technology research center, as saying that research shows nearly half of the women who received abortions had not used any form of contraception. This is very disturbing, but what more, a study done in 2004 and published in the International Journal of Gynecology Obstetrics summarized their findings as follows:
Of 4547 unmarried young women seeking an abortion, 33.0% reported having had one previous induced abortion. Of those who had had more than one abortion, only 29.7% used a contraceptive method at their first sexual intercourse after the procedure; and of the 446 women who chose contraception, 41.3% used the traditional methods of withdrawal or rhythm. Although 65.0% of the young women had used condoms at least once, only 9.6% did so consistently and correctly; 47.7% of the current pregnancies were associated with nonuse of any contraceptive, and 52.3% were related to contraceptive failure.
So not only are Chinese women not using protection, but even after they discover the consequences of unprotected sex in the form of an unwanted pregnancy ending in termination, only 9.6% of those women reported that they were using condoms regularly.
If these numbers seem large, notice that even the pro-government China Daily admits that these numbers are much lower than the real number of abortions being performed in China. The only abortions which were considered in this study were official procedures carried out in state-registered facilities, despite the fact that unofficial, unregistered clinics all over the country perform the procedure for less money and with less stigma attached.
The China Daily also pointed out that the figures included in the study also did not include pregnancies terminated through use of the morning after pill, which has been sold in China since 1998. According to that same study, approximately 10 million doses of the morning after pill are sold in China every year.
But even if we agree that those numbers underestimate the real abortion rates in China, there is no information about the reasons behind these abortions. More specifically, are these abortions carried out to ensure that a family’s sole child be a son?

Translation: “if there are equal numbers of girls and boys, only then will there be a harmonious society.”
Figures for sex-selection abortions vary widely, but while the government may allow the China Daily to report on the basic breakdown of abortions had on the Mainland, the topic of gender selection abortions remains unmentionable. The PRC recognized the population imbalance created by the one child policy, in combination with the Chinese emphasis on the importance of sons, and so the central government has been discouraging sex selection with an extensive PR campaign declaring “男女平等” – that men and women are equal. To this end, the Chinese government has taken it one step further, by disallowing pregnant women to know the sex of their baby before birth. Women in Hong Kong on the other hand, can know the sex of their children, and that has my coworker dreaming of a little girl dressed in pink, searching for affordable air fare so she can get a reading from an ultrasound.
So, why have the Chinese been depending so heavily on abortions instead of taking methods to protect themselves from an unwanted pregnancy? The China Daily cited a lack of knowledge regarding sex and contraception, misinformation about sex and contraception, and lingering cultural taboos.
If abortion is one product of a hush-hush attitude towards sex in Chinese culture, it is not the only one. A survey done by a Shanghai hospital “found that less than 30 percent of callers to a hotline knew how to avoid pregnancy,” but that only 17 percent of callers were aware that venereal diseases exist, much less how they are transmitted. Even more troubling, more than 70 percent did not know that HIV is spread through unprotected sex.
Among women my age, sex certainly seems to be an unfit topic of conversation. When I broached the subject with a Chinese friend, she blushed while asking why I would want to know such things before quickly trying to change the subject. A far cry from the Carrie Bradshaws of New York, sex in this city, from my experience, is not something that is discussed openly. If women are too timid to talk about sex among themselves, then it is hard to imagine that when a woman’s partner tries to beg-out of using a condom, she will have the strength to prioritize her own sexual health by telling him to get a condom or get out.
It’s not like the Chinese are completely bereft of sex education, but most Chinese schools offer only a basic introduction to sex and contraception, one that focuses on the biology of the act. One first-grader came home and showed his uncle his text books, only for his uncle to discover what exactly sex-ed looks like at that age. Colorful illustrations of testicles and condoms wearing sunglasses and graphic diagrams of both a penis and a vulva. It’s very detailed – aside from neglecting to label the clitoris, which perhaps reflects the seriousness of the culture’s gender bias – but it seems like it would be overload for children that age. Starting early is a very good thing, but it does need to be age appropriate. When a four year old asks his Mommy where babies come from, she doesn’t need to launch into a diatribe describing a woman’s fallopian tubes. A six or seven year old deserves more details, but I still think a full blown examination of the inner workings of both male and female bodies is a little sophisticated for a child of that age. Reading about human biology at age seven could certainly never replace a conversation about loving, consensual relationships or safer sex practices, both of which can be made appropriate for any age.
In many cases, Mainland students receive education about the emotional elements of sex only after they reach college. In a world where (according to a study compiled by Durex in 2007, “The Global Face of Sex”) we are losing our virginities at an average age of 19, starting proper sex education then can only spawn emotionally damaging and unhealthy sexual experiences. Even in China, where that average is 22 years old, many people come into this information too late to put it to good use.
When the adults in their lives shirk away from talking about sex with their children, many Mainland teens turn to the internet as their primary point of reference. However, due to Beijing’s anti-pornography campaign, sites are often blocked indiscriminately, whether the content is entertainment or education. As the experts who edit Wikipedia pages demonstrate, misinformation is often indiscernible from the truth to an unknowledgeable reader. Not to mention, as I found out from my trip to the Beijing clinic, it seems that many women are not getting the information they need from their doctors, either.
After looking at this data, the Chinese agree that China’s sex education needs to undergo some changes, but many Mainlanders remain concerned that continuing sex education programs would encourage children to experiment with sex at even younger ages. Parents are afraid that encouraging conversation about the way to protect yourself both physically and emotionally would in essence condone the act. Ever heard that argument before? If we are fully disclosing the consequences of engaging in sexual activity in age appropriate increments, raging hormones can at least be tempered by information.
However the only way we could expect parents to have these conversations with their children is if we can start having these conversations amongst ourselves. If we can’t talk about the methods of birth control we’re using or that funny rash with our closest friends, how are we ever meant to educate our children? Because these numbers clearly demonstrate that old wives tales and knowledge garnered from sketchy internet sites are hardly helping women and men make informed decisions about their sexual wellbeing. Only when we can stop giggling like schoolgirls at the mention of condoms can parents pass down information that will help their children avoid unnecessarily poor sexual experiences and unwanted pregnancies.