“MAKE YOUR SKIN WHITE AND PURE.” The poster has been slapped up in a bus stop. The rain-soaked paper, partially torn away, shows the faded face of a smiling Chinese woman. “QUICK AND SAFE ABORTIONS.”

It’s an odd juxtaposition. For an American, abortion calls up bitter divisions, and doesn’t usually go hand-in-hand with beauty treatments. But here in China it’s second-billing to a skin crème.

Chinese and American women both deal with contraception on a regular basis.  While their choices might look statistically similar, their reasons differ greatly.  Abortion has been a part of China’s one-child policy since 1979, coupled with contraceptive use, family planning, counseling, and incentives for families with fewer children. Consequently, Chinese women address their reproductive health differently than Americans.

Different approaches to contraception

Chinese and American women both have high rates of contraceptive use. According to the Guttmacher Institute, 62% of American women ages 15-44 currently use contraceptives of some kind. United Nations statistics state that 83% of married Chinese women use contraceptives.

Photo: flickr.com

The difference is not whether or not women use contraceptives, but in the methods and motivations behind their use. Chinese women generally seem to favour long-term birth control methods. “A majority of contraceptive users in China rely upon one of three methods, the IUD, female sterilisation or male sterilisation,” note U.N. statistics.  By encouraging women to plan for a single child, the Chinese government has emphasised more permanent contraceptive solutions. A 2004 study through the Guttmacher Institute tracked the effects of family planning on women’s lives. Over 90% of the women interviewed used an IUD or sterilisation. The top-down regulations mean that women plan ahead, thinking about how to limit pregnancy in the future.

In contrast, American women prefer the pill. This is no surprise; long associated with women’s liberation, the pill gives a feeling of individual control. The Guttmacher Institute found that 63% of sexually active American women use a reversible method of birth control, such as the pill, the ring, the patch and condoms.

Abortion and the role of the Chinese woman in society

For Chinese women, reproductive choices are inevitably tied in with family obligation.  After marriage, a woman’s primary role is that of child bearer and caretaker. While these attitudes have shifted slightly in the last few years, they remain a part of the cultural fabric. Women feel pressure to please not only their husband, but parents and in-laws, by producing children. 

The younger generation has begun to chafe against the traditional roles. These modern women want careers, incomes, houses and a role in China’s economic future. For these women, such goals seem incompatible with marriage and its inevitable corollary, childbearing.

For both Chinese and American women, abortion often becomes a necessary decision in family planning. In China, “25 percent of women of reproductive age [have] had at least one abortion, as compared with 43 percent in the United States,” notes a study discussing the long-term effect of China’s one-child policy. The Guttmacher Institute puts the percentage at around 33.3% for American women at age 45. Despite the comparable statistics, abortion is framed very differently in the U.S. and China.

Abortion law in America hinges around the idea that the U.S. government doesn’t have jurisdiction over a woman’s body. Roe vs. Wade drew a line between the personal and the public; the issue involves the autonomy of individual women. In fact, American women have much less contact with their government regarding their reproductive choices than Chinese women do. The monoliths of religion and women’s liberation overhang the legal debate, casting a moral shadow over the issue.

In contrast, China’s women don't see abortion as a “values” problem. Instead, abortion is framed by the twin issues of population and development. Americans who have never lived in one of China’s crowded, competitive cities cannot understand the role that population pressure plays. China’s survival depends on controlling an explosive population. For Chinese women, pregnancy is not only personal, but also national – an idea emphasised by the stringent family planning laws.

Economic development is another factor. Given better economic opportunities, women seem to be pursuing education and career with greater enthusiasm, and limiting childbearing. Notes the 2004 Guttmacher study:

Women did not view family planning in a vacuum, but related it to the country's economic situation…women saw family planning as a means of helping women (and men) take advantage of China's improved economic situation by not being tied down or having too many children to feed and clothe.

As China develops, it’s clear that women’s decisions are based on factors that improve their own personal lives.

Fears of encouraging premarital sex and its consequences

Most Chinese women receive birth control from the family-planning programme. The programme has clinics and workers all across the country; their target is primarily married women. A series of interviews conducted by the Shanghai Institute of Planned Parenthood Research showed that most family-planning workers “were ambivalent about the provision of sexual and reproductive health services to unmarried young people.” China retains a cultural reticence to acknowledge sex outside of the family structure.

This all sounds familiar to Americans. Recently, Texas Governor Rick Perry has found himself under fire for mandating HPV (human papilloma virus) vaccines for young girls. The vaccine prevents cervical cancer, but conservatives argue that the vaccine actually encourages women to engage in premarital sex. A similar argument has been used to discourage sex education in American public schools.

Chinese traditional attitudes mirror American conservatives. The Shanghai Institute study found that “[Family-planning workers] from Hebei and Henan clearly felt, for example, that provision of contraceptive services was contrary to traditional Chinese values and would mislead unmarried young people and increase the incidence of premarital sex.” It is considered inappropriate to provide sexual information to unmarried girls. Chinese friends tell me that sex education in school is perfunctory and anatomical, if it happens at all.

These attitudes mean that young, single Chinese women often don’t have the education or resources to access regular contraception. And yet, according to a study by Fudan University in Shanghai, in “both urban and rural Shanghai, 69% of unmarried women had sexual activity before their marriage.” Some use condoms – such as the perfectly named Jizzbon – but others use no birth control at all. A 2001 study of unmarried female migrant workers found that most sexually active migrant women 16-25 don’t regularly use contraceptives.

Because they lack access to services, and because out-of-wedlock pregnancy is both culturally and legally questionable, most single women abort unintended pregnancies.  The Fudan University study found that in six of seven cities, “20% or more of [unmarried] women had a history of induced abortion.” In urban and rural Shanghai, between 86-96% of all unwanted pregnancies reported in the study were aborted. Clearly, a service gap exists for unmarried women.

Across the globe, two societies frame issues of sexual health in very different ways.  But the core issues are the same: whether or not to have children, how many, and when. Too often, both cultures sling sexual stereotypes. It behooves women to look at each other’s reproductive choices in context. When it comes down to it, every woman has to make the same difficult decisions. And whether we eat with chopsticks or a fork seems have a big role in determining how and why we make those choices.

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Keywords: contraception in China women views on contraception and abortion in China sexual education in China abortion in China