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China

How China's Race To Boost Low Birth Rates Is Backfiring With Teenage Pregnancy

In an attempt to counter an aging population, China announced its "three-child policy" last year. It has also cracked down on sex education and contraception. The move has meant that abortion is often the only option for Chinese girls and women in the post-family planning era.

Woman walks down the street in China

China now encourages women to have three children to boost low birth rates.

Qiliu Zhao

In 2018, the phrase "family planning" disappeared from the names of Chinese State Council ministries and commissions. Three years later, China announced the "third-child policy", allowing one family to have up to three children.

The same year, a public service gynecology clinic serving teenagers in Xi'an was asked to move from the premises provided by the local family planning department, and was no longer invited to host contraceptive education outreach activities. Anqin Zhou, the founder of the clinic, understood clearly that the government was taking contraception much less seriously than before. She was even asked, "Why are you still talking about contraception now that we are encouraging childbirth?"

But alongside the current indifference to contraception is the troubling question of teenage abortion in China.



Due to differences in statistical quality, there is no credible figure for the abortion rates for China's teenage population. In Mainland China, the term generally refers to the age range of 15 to 24 years old. Officials have admitted to the media that teenagers have become one of the main groups having abortions in China. The number of teenage abortions is approaching four million each year, accounting for 40% of all abortions.

From family planning to encouraging fertility, knowledge of contraception, which should be provided to teenagers as a basic sexual and reproductive information service, is being deliberately ignored.

First abortion at 15

Xiaoyun Wang had her first abortion when she was 15. She was six months pregnant. At that time, she had just finished junior high school. Now 21 years old, she has had three abortions. Guo Zhao, a girl who came to work in Xi'an at the age of 13, also underwent an induced abortion when she was less than 16. Now the 22–year–old has had a total of five abortions.

Xiaoyun Wang's and Guo Zhao 's stories are still happening to different generations of young girls in China, hidden among the millions of abortions that are performed each year. The lack of sex education is not enough to explain the contradiction between the low age of abortion and the low willingness to have children at the right age as China moves from family planning to encouraging childbearing. Perhaps it is time to acknowledge the fact that from girls to young women, decisions involving sex have never been entirely in their hands — only the choice to have an abortion is in their hands.

Wang and Zhao both had their abortions while they were in committed relationships. They said that they are not those kind of "easy girls", but rather they are in disadvantaged positions when convincing their boyfriends to use condoms. As far as abortion is concerned, Wang considers herself to have absolute autonomy. "Because the belly is mine and not yours, you just provided a thing."

When underage girls are pregnant, the family would usually expect the girl to give birth to the child, who would be raised by the grandparents, while the young couples could get married when they are of legal marriage age. But in reality, the love between the underage couples would usually wear out after the child was born. In those cases, the children would usually go with the father, as girls would have difficulties getting married with children around. In this case, abortion is usually the first option the girls can turn to.

"Because the belly is mine and not yours, you just provided a thing."

Both Wang and Zhao believe that abortion is "humiliating", as it means that they have had sex, and not only that, they have gotten themselves pregnant. Zhao believes that if girls could not have an abortion, they would suffer a lifetime of damage. "Giving birth to a child means the end of your life." If she can have an abortion, there is still hope to her life. "You're still fine, you can still be normal, right?"

When asked on whether having an abortion is just a personal choice, with no judgment of right or wrong, Zhao replied, "Why should I not be ashamed? If you do this kind of thing, how can you have the face to tell others?" This shame lurks in every Chinese girl, whether it be Guo Zhao, who has had five abortions, or those who only had one. For a well-educated interviewee, it is still a shame to be pregnant before marriage, so even though she has married her boyfriend from university, neither parent knows about their one abortion before.

A woman with the Chinese flag

Chinese girls are rarely taught about contraception.

Todd Lee/ZUMA

Missing sex education

In Chinese society, whether at home or at school, girls are always reminded not to fall in love early, not to have sex, and not to get pregnant from an early age. But the necessary education on contraception is always absent.

"Giving birth to a child means the end of your life."

Anqin once asked a girl who had had three abortions why she would not choose from so many effective forms of contraception. The girl listened in awe and told her, "I only need contraception when I get married." In the general public's perception, contraception methods such as IUDs are only suitable for married and fertile women, and birth control rings can also cause pain and illness. Even though birth control rings are now more sophisticated, the damage to the body has long since been drastically reduced.

This is the result of China's nearly 40–year family planning policy and its avoidance of sex education for teenagers. "The demand for sexual and reproductive services among contemporary adolescents is higher than at any other time in history, and the existing medical system is clearly not ready for it."

With the case of the two girls who experienced multiple abortions, it is clearly not that they are ignorant of contraceptive knowledge. Ruby Lai, a research assistant professor at Linan University in Hong Kong, offered the explanation that one should think outside of public policy. "Authorities and doctors say you should insist on using condoms, but the problem is that it is not how it works in intimate relationships. This is where public health policy fails."

Women's choices

Between 2013 and 2017, Lai conducted field research on the abortion among unmarried women in Hong Kong and China. Her interviewees were mainly adult, with regular partners and jobs, and part of the mobile population. The girls' knowledge about contraception was indeed very low, but Lai's more important finding was that their ability and leverage to negotiate sex and contraception in intimate relationships was actually very limited, especially when they thought they were in a formal relationship that might lead to marriage.

Lai said that when the girls leave their hometowns to work in the city, where their boyfriends are the closest relatives, they often live together to save on rent. "If he makes some request for intimacy, it's OK not to say yes once, and if you don't say yes every time, he will question you, 'Why not again?' 'Do you really love me?'"

According to the results of Ruby's research, the interviewed girls were mostly 20 and 21 years old when their first abortion occurred, while they were mostly 19 and 20 years old when they had their first sexual intercourse. The median timing of the two events largely overlapped. This means that their first pregnancy also occurred immediately after their first sexual encounter.

In public discourse, girls who have had multiple abortions are also portrayed as being very unconcerned or careless about sexuality and pregnancy. "It doesn't matter how old they are, they face the same difficulties and stigma of 'having promiscuous sex without being married, being indiscreet, and even getting themselves pregnant'." In her research, Lai found that attitudes and fears about unmarried pregnancy have largely not changed, whether the women are 16 or 26.

"Especially with the topic of gender and the body, we very often personalize the issue, why aren't individuals doing a good job? If the individual could do it right, there would be no such social problems. But how individuals deal with intimacy, gender and body relationships is a problem for the whole social structure. It's important that we help individuals, but changing the culture of sexuality, the culture of gender, the culture of intimacy in a society is not something that individuals can do."

For Wang and Zhao, they have moved on from their abortion experiences. Wang said that she is no longer interested in having a short-term relationship, but would follow the conventional path of getting married, getting pregnant, and giving birth to a baby when she meets "someone nice". While for Zhao, she describes her perception now as "loving myself and letting the experience (of abortion) go." But to her, long-acting contraception must be done in a way that does not affect future fertility, but also provides a form of protection for herself. In her opinion, this is a choice that women can give their bodies on their own. This is because neither male consent nor male involvement is required.

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