June 13, 2003

Safe Sex in China

This is Ming Ming's second abortion. She arrived at the Sichuan Province Mother-Child Clinic in Chengdu, the capital of Sichuan, at 8 am. After squirming through the crowd of girls surrounding the nurses and making her appointment, she sat down with 13 other young women on the small green plastic chairs outside of the operating room.

This antechamber consists of cold concrete, hard plastic, one dying plant in the corner, several doors leading into crowded nurse's offices and one big sliding glass door in front of which a pile of small shoes waits to be sifted through by groggy and stiff young women staggering out of the operating room.

Outside through an open iron gate sit the men, talking loud into their cell phones, reading the paper, chatting about business good naturedly or just staring off into space. Every few minutes one of them lights up a smoke.

Ming Ming glimpses the extremely pointy and thin heels that are very popular these days with young Chinese women along with dirty white sneakers most likely belonging to a student. There is also a pair of dusty, clunky black heels and her own brown loafers.

Her boyfriend waits with her for a few minutes in the antechamber, but after receiving a few inquisitive stares from the other women waiting for their appointment, he scuttles through the gate and waits with the other men.

She was hoping for the best hospital in Chengdu.

Last time, she paid 660 RMB and went through an assembly line process in which she was put to sleep, operated on and then allowed to lie in bed for a few minutes before being forced out to make room for the next girl. The whole process took less than thirty minutes.

This time, she chose a hospital near her home, a well-known mother-child clinic. When she became pregnant, she chose this hospital for her check-ups. Ming Ming's boyfriend accompanied her on the first few visits and was impressed by the kindness of the staff and the clean, warm environs.

Pictures of mothers and their children lined the wooden walls of each separate room, the waiting room was within arm's reach of most of the patient's rooms, so her boyfriend could talk with Ming Ming while she was behind the curtain with the doctor. Posters advertising lamaze training interested him and he wrote down the number.

They almost decided to keep the baby, but the accidental pregnancy brought with it too many financial and emotional burdens for the young couple, so Ming Ming made another appointment, this time not in the pregnancy ward, but across the parking lot, where the abortions take place.

The abortion clinic is older, dirtier, colder and much more crowded than the newer pregnancy ward.

"I remember looking at the fathers-to-be and their nice clothes and expensive cell phones," says her boyfriend Ma. "I think everybody noticed we didn't belong. Our parents weren't there and I was the youngest man in the ward."

In the abortion clinic's waiting room, Ming Ming and Ma fit right in: young, "repeat offenders" with no family around to support them.

Does Population Control = Safe Sex?

China has faced a lot of flak over its family planning policies, specifically the one-child policy initiated by Deng Xiao Ping meant to curtail population growth – the type of growth explosion Mao hoped for in the 1950s and 1960s, the type of explosion that could lead to crucial food, water, employment and space shortages as Vaclav Smil discussed in his book, China's Environmental Crisis.

According to official Chinese estimates, the one-child policy cut China's population growth by 330 million people. But that success has been ignored by much of the international community due to draconian state-sponsored measures to enforce the policy, including state permits for child-births, forced abortions and sterilizations and hefty fines for offenders.

The reality of the situation in China, especially in the mid to late 1980s, is much different from the reality US President George Bush and the New Religious Right held up to support cutting UN Population Fund (UNFPA) aid by $34 million last year.

Ming Ming has a sister and a brother, both younger. Ming Ming's mother refused to have an abortion and instead paid a fine of 10,000RMB ($1,200) for her second child and 10,000 for her third child.

Chengdu native Xiao Li, studying in Chongqing and waiting for her third abortion, also has a younger brother, for which her parents paid a fine of 5,000RMB.

The sterilizations and forced abortions – mostly carried out in the countryside where peasants can't afford the fines – are a thing of the past in the cities. The policy was never made national law and was subject to local conditions. Which meant the one-child policy was enforced to a degree the populace could tolerate, and not much more. Many families in the countryside have more than one child and minority groups were never subject to the policy.

Abortions cost as little as 500 RMB these days, even less in the countryside, so state-sponsored enforcement of abortion is not as necessary now as it was 15 years ago when the Chinese middle class was virtually non-existent.

Ming Ming and Xiao Li are both students. Their boyfriends are students. Xiao Li had her first abortion at 16, with her first long time boyfriend. Ming Ming's boyfriend Ma works various odd jobs and borrowed 500RMB to help pay for the abortion. Xiao Li's boyfriend refused to pay, so she borrowed money from her uncle – telling him it was for school.

The amount is so small, that neither girl is worried about paying the money back. Xiao Li is headed to Shenzhen to work in 4 months and Ming Ming has a office job at an English School.

No Coordinated Efforts?

Ironically, the cut in funding for the UNFPA hinders that organization's efforts to nip the problem in the bud: lack of sexual education in China, which translates into rampant unsafe sex.

Earlier this year, China's State Family Planning Commission revealed that Chinese men buy approximately three condoms per year and 30 to 40 percent of these condoms are defective. Combine this with a widespread perception amongst the populace that AIDS and other STDs come from foreign countries and/or foreigners, that abortion is a quick and relatively cheap solution to pregnancy and many Chinese women find themselves waiting in stuffy, crowded rooms for their turn to "go under the knife" or receive a shot of antibiotics.

Small private shops selling "Adult Products" abound on the streets of Chinese cities and towns, selling (presumably defect) condoms as well as other paraphnelia. Small "clinics" specializing in the treatment of STD's are also growing in number. Many of these clinics are outfitted with the latest antibiotics and equipment – various forms of tetracycline can be given to patients intravenously while they sip herbal teas and are admonished to stay away from alcohol and, especially in Sichuan, hot peppers.

There are a variety of reasons why girls like Xiao Li and Ming Ming do not use condoms. China is opening up very quickly and perceptions are changing very fast, but for a girl to buy contraceptives of any sort – be it pills, or a shot or condoms – will still send the rather prolific Chinese rumor mill spinning away, resulting in a loss of face, presumed or actual.

Also, Durex condoms at the local Ito Yokado, a Japanese department store, sell for 30RMB for a package of 12 condoms. Conversely, a package of locally produced, rather untrustworthy Jizzbons sell for 5RMB a package of 10.

Also, abortions are cheap and there is no shortage of hospitals that can do the surgery. Ming Ming was back to work a day after her abortion. Xiao Li went back to Chongqing and resumed studies two days later – after a few tears and a little blood and pain, life resumes. Perhaps Chinese women have become accustomed to the process.

There are no reliable statistics on the number of women who have multiple abortions, but Dr. Zhang Li Rong of the Sichuan Mother-Child Clinic says the abortion clinic performs 15 abortions on average every day between the hours of 8 am and 12 pm.

Chinese men, although continuously being exhorted by the state to pull their share, still refuse to buy condoms. A lack of sexual education and tradition are the largest factors preventing the men from pulling their share.

A bar-goer in Chongqing who frequents the brothels often, is married and has a girlfriend scoffs at the use of condoms.

"There is no feeling," he says. "Besides, Chinese girls are very clean and I can always make them get an abortion."

These sentiments will result in an explosion in cases of chlamydia and HIV , according to a report in the March 12 edition of the Journal of the American Medical Association. Roughly 10 percent of Chinese men visit prostitutes, states the study.

Prostitutes are starting to catch on.

In brothels across Chengdu, prostitutes are now using disinfectant pads as well as condoms with almost every customer. But the misconception that pads can kill AIDS and other STDs still hampers the development of a safe-sex culture.

One prostitute in Chengdu mentioned that certain customers she has "a good feeling" about may eschew the use of a condom while declaring in the same breath that all foreigners must use condoms, as she is afraid of AIDS.

The Aftermath

These matters of disease don't concern Ming Ming or Xiao Li that much. They both have steady, reliable partners. Ming Ming has almost completely forgotten her ordeal at the clinic, which left her eyes glazed and her knees wobbly. She is still bleeding a little, two weeks after the operation and her stomach hurts.

But she laughs and her bright eyes flash as she and her boyfriend discuss the use of condoms in the future. They both swear that they will be much more careful.

"But if I get pregnant again, I am going to keep the baby," she declares. Ma just looks at her and shrugs.

–Sascha Matuszak

(Also ran in South China Morning Post on May 31, 2003)

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Sascha Matuszak is a teacher living and working in China. His articles have appeared in the South China Morning Post, the Minnesota Daily, and elsewhere. His exclusive Antiwar.com column (usually) appears Fridays.

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