May 13, 2007
Face of Abortion in China: Young, Single Woman
By JIM YARDLEY
QINGDAO, China — At an abortion
clinic in this seaside city, a young woman sat in the recovery room with an IV drip in one hand and a cellphone in the other. She was 22 and worked as a nurse. Her boyfriend, an information technology specialist, sat nearby. They both knew the routine: It was her second abortion in 18 months.
In the waiting room, a few other unmarried couples watched a DVD of a hit Chinese movie until they were called. The clinic, one of the few in China that focuses on reproductive health for single women, performed 65 abortions in March. Of those women, 42 were having at least their second abortion. One woman had her sixth.
Young and single is not the usual profile of a woman having an abortion in China. Far more often, abortion has been associated with married women complying, voluntarily or not, with the country’s one-child policy. But as society has rapidly changed, so has the face of abortion.
Unmarried women, including teenagers, are now having a rising number of abortions, and even constitute a majority of cases in Shanghai and parts of Beijing, according to academic studies and health experts. And many of these women — migrant workers, urban professionals, students and prostitutes — are having multiple abortions.
“We can see it beginning in larger cities and the smaller cities, even down to the developing counties,” said Gu Baochang, a leading scholar on family planning policy at Renmin University in Beijing. “More and more abortions are for unmarried women. It is a very clear trend.”
For this new generation of single women, who have grown up in a China increasingly unmoored from the values, and inhibitions, of traditional culture, the rising abortion numbers are rooted in many factors. While the Chinese government has focused on policing the reproductive lives of married women, it has paid far less attention to educating single women about sex, partly because of cultural resistance.
Health experts say that many single women lack even a basic understanding about reproductive health and contraception. At the same time, premarital sex, once rare, is now considered common, particularly in urban areas. So as more single women are having sex, despite often knowing little about it, they also are having more abortions.
“There is a blind spot in sex education in China,” said Xu Jin, director of the clinic, which is run by Marie Stopes International, a nonprofit group that provides sexual and reproductive information and services. “We are here to fill the hole in the system.”
Public hospitals, which are found across China, are the busiest abortion providers. Prices vary, depending on location. Ms. Xu said abortions at public hospitals in cities like Beijing might average 500 yuan, or about $65. These hospitals are usually impersonal and crowded, and some operating rooms are equipped to perform more than one abortion at once.
Health experts in China say safety is usually not a problem. However, Ms. Xu noted that young women who have multiple abortions are more susceptible to certain health problems, including infertility. A recent survey of 8,846 single and married women who had undergone abortions at 10 hospitals in Beijing found that 36 percent had had more than one abortion within six months.
For single women, confidentiality is a major concern. A single, pregnant woman faces enormous social stigma and shame and has few options beyond abortion. Single motherhood is almost nonexistent, and unmarried pregnant women rarely carry a pregnancy to term in order to place a child up for adoption.
Profiteering private hospitals and clinics, some nicknamed “quack” hospitals, are now marketing abortion services, as well as treatment for sexually transmitted diseases. These hospitals advertise heavily with promises of strict confidentiality. But sensational, even fraudulent, advertising has become so rampant — “Painless Abortions!” or “The Model Abortion for a New Generation!” — that last November the government banned advertisements for abortion and 11 other types of medical treatment. Still, the ads continue to surface in some newspapers. And private clinics distribute fliers on university campuses, even offering student discounts.
Young women, meanwhile, are often confused and searching for information. Hotlines have become popular, and one group of teenagers and young women formed an online instant messaging forum, Women Tribe.
In April, an 18-year-old was chatting with other members, describing pain and possible complications right after she had taken an abortion pill. “I don’t have the guts to go the hospital,” she said, uncertain if the pill had worked. “I’m afraid the baby is still there.”
“You should go immediately,” answered another member, Yingying. “You should not be embarrassed. The last time I went to the hospital, a lot of women were doing this.”
Such personal stories also appear in Chinese newspapers and on Web sites. “College Student Knows Nothing About Contraception and Had Four Abortions in Six Years!” a headline on the popular Web portal, Sina.com, declared recently.
Abortion inside China became a controversial political issue outside China after the introduction of the country’s family planning policy in 1979. The policy, which limits most urban families to one child, had an immediate impact: Abortion rates soared in the early 1980s, and then again in 1990, when enforcement was tightened. International criticism quickly followed.
In response, China has gradually shifted its approach, even if family planning policy remains mostly unchanged. Family planning officials say they emphasize maternal care and contraception.
Married women are still having abortions, some voluntarily, others reluctantly, to avoid the heavy fines levied for having a second child. Some women, particularly in rural areas, choose to abort a female fetus because of cultural preferences for a son.
Family planning officials have tried to stop such “sex selective” abortions and also deny that married women, as a group, are forced to have abortions to meet population quotas. In 2002, China passed a law prohibiting coercive or forced abortions. But human rights abuses can still occur. In April, villagers in southwest China accused local officials of forcing dozens of women to have abortions to meet family planning quotas.
Over all, though, family planning officials and Chinese health experts say the number of married women having abortions is going down, even as the numbers for unmarried women are going up.
Ministry of Health statistics recorded a peak of 14 million abortions in 1990. The latest numbers, for 2005, showed 7.1 million abortion cases in that year. The United States, by comparison, had 1.29 million abortions in 2002, according to the Guttmacher Institute.
Experts say the official Chinese figures are probably incomplete because they do not include private hospitals or women who use abortion pills. One recent Chinese study predicted that there could be as many as 13 million abortions every year, though no explanation of how the study arrived at that number was provided.
National abortion statistics do not break out married and unmarried women. But family planning officials say the abortion rate is dropping among married women partly because more than 80 percent of married women with a child are using long-term contraception like IUDs, or have been sterilized to comply with the one-child policy.
By contrast, millions of young, unmarried women have flocked to cities since the 1980s, a journey for migrant work that often severs them from their families and more conservative rural values.
Urban women, meanwhile, are waiting longer to marry, if not to have sex. A study in Shanghai found that 69 percent of single women had premarital sex. Seven other studies in various cities found that between 20 percent and 55 percent of the single women surveyed had undergone at least one abortion.
“All the time, my colleagues say they are seeing young girls who have had five or six abortions,” said one doctor who has performed abortions at a public hospital in eastern China for nearly two decades. “Many people consider abortion as a contraception method, especially the young girls. Sometimes when I’m around the city in shopping malls, I recognize the girls.”
Another doctor, Deng Jun, who runs a counseling program at Beijing No. 2 hospital, says that single, pregnant women comprise almost one-third of her clients. One afternoon in mid-April, Dr. Deng was between appointments when a black telephone rang on her desk. It was a hotline for single women.
“You have a pregnancy problem?” Dr. Deng asked. “Where are you?”
“Gansu,” the caller answered, naming one of the poorest provinces in western China.
“How old are you?” Dr. Deng continued.
The woman had had sex twice in early March and had taken a morning after pill. Her period had come on March 17. She had not had sex since then but it was late April and her period was late. She was worried. Dr. Deng offered reassurance: no sex, no pregnancy.
“All the kids are good kids,” Dr. Deng said later. “It’s not like they are morally bad. There is just a lack of sex education. The government is doing more slogans than action.”
Ru Xiaomei, a deputy director with China’s National Family Planning Committee, said government efforts were “on the right path.” But she agreed that much work remained on sex education. She said the government was very concerned about the rise in the number of pregnancies and abortions among unmarried women.
“We don’t say we have done very well, or perfectly,” she said in a recent interview. “The whole society is concerned.”
Here in Qingdao, a gracious city on China’s east coast, the Marie Stopes clinic opened in 2003, the first nongovernment clinic of its kind in China. Since then, Marie Stopes has opened a clinic in Nanjing and has plans for several others.
Ms. Xu said a major objective of the clinic was to provide reliable information about contraception and sex education to young women. Her staff regularly conducts classes on contraception and sex education for women at local factories, hotels and restaurants.
Ms. Xu said many rural girls did not use contraception for fear of offending their boyfriends. One woman came into the clinic for repeated abortions as she kept changing boyfriends. Another woman, a former prostitute, came to the clinic for her last abortion but could not remember if it was her sixth or seventh.
“When I think of my past, I just think of it as a time when I was young and made mistakes,” said the prostitute, who insisted on using a pseudonym, Yang Rui, that is popular with many local prostitutes. “I made some money and had fun. I’m not saddened by it but I just want to move on and live an ordinary life.”
Abortion, though, seems increasingly common for lives that are ordinary. The nurse and her boyfriend, the I.T. specialist, said they planned to marry one day. She said many of her friends, ordinary young women like herself, also had had abortions. It was not uncommon.
“Young people think if they are not married or are not having a regular relationship,” she said, “then they can just have an abortion.”
Lin Yang contributed.