Women's health in China

Women's health in China refers to the health of women in People's Republic of China (PRC), which is different from men's health in China in many ways. Health, in general, is defined in the World Health Organization (WHO) constitution as "a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity". However, due to traditional Chinese ideology on gender inequality and complexities of Chinese political system, challenges in terms of many aspects of women's health, such as reproductive health and HIV/AIDS, are still mounting.

History of Women's Health in China

Late Qing dynasty

In the late 19th century, Chinese reformers began call for the modernization of childbirth based on Western scientific medicine. The CMS was a three-tier system: barefoot doctors, township health centers, and country hospitals. In the end of the 1970s, over 90% of rural villages had set up cooperative medical schemes (CMS). Studies by Mei-yu Yu et al. found that the female Infant Mortality Rate (IMR) declined from 170 per 1000 in 1953 to 136 in 1957, and female average life expectancy at birth rose from 44.8 in 1949 to 67.1 in 1975. Mei Yu-yu et al. believed that such a discrepancy in IMR between female and male could be a result of preference for sons in traditional Chinese ideology, which may cause abandonment, unequal treatment or violence against female infants. The government sought to expand hospital infrastructure and to replace traditional midwifery with modern techniques approved by the newly-established socialist health authorities. With China's program of barefoot doctors, perinatal practitioners were often older women. Their work was effective, with much of the 1950s and 1960s population boom resulting from the decline in infant mortality. may be deemed "inefficient" once China entered global market. Moreover, studies have shown that the workforce in China was made of only 40% women but 60% of those laid off were women, which demonstrated that women are much more vulnerable to these effects than man.

Statistics obtained in 2008 have shown that males enjoy higher physical well-being than females. However, it is not addressed if the situation could be related to China's changing economy in any ways.

By the 2010s, the practice of home birth had ended through the practice of subsidizing rural hospital deliveries and banning rural midwives from practicing. Moreover, infant mortality rate in rural areas has been significantly higher than in cities, with the gap reaching 2.1 in 2000. The ratio of female to male IMR increased dramatically from 0.9 to 1.3 over the same period. More seriously, female IMR in rural areas rose from 34.9 to 36.7 in the period of 1990–2000, as families in rural areas often have a stronger boy preference.

Women's health outcomes

Reproductive health

Prenatal health

One of the aspects of women's health to suffer the most as the economy shifts to a free market system is reproductive health. As health firm privatize those firms are less likely to provide free preventative health, and as a result they have discontinued the practice of providing regular reproductive health examinations. Due to this from 1997 to 2007 only 38 or 39 percent of women are getting the reproductive examinations that they need. Abortions are available to all women through China's family planning programme, public hospitals, private hospitals, and clinics nationwide. In August 2022, the National Health Commission announced that it would direct measures toward "preventing unintended pregnancy and reducing abortions that are not medically necessary." Those measures include encouraging reproductive education and improving support measures in the areas of taxation, insurance, education, with encouragement for local governments to boost infant care services and family friendly workplaces. This increase was driven by the expansion of China's modern hospital infrastructure, and occurred first in urban areas. Especially in Hong Kong, mother and baby sometimes "sit the month" in special clinics.

Researchers debate whether the tradition is helpful or dysfunctional. Shu-Shya Heh et al. have found that "doing the month" makes women less likely to develop postnatal depression, because they perceive high social support from their family. Other studies have also shown that certain elements of the custom jeopardize postnatal women's health, such as lack of exposure to sunshine or imbalance of nutrition.

HIV/AIDS

HIV in China has been on the rise as well rising from 15.3% in 1998 to 32.3% in 2004. This sharp rise is due to the lack of recognition and education, as for years in HIV was considered a western disease that would not affect the Chinese population and because of this rhetoric China found itself ill-equipped to deal with the social and health issues relating to HIV. During 1999–2008, the proportion of women infected with HIV doubled compared to the previous decade. During 1999–2008, the proportion of women infected with HIV doubled compared to the previous decade. Also, STI rates, as a marker of infection rate of HIV/AIDS, are also on the rise in China for the past few decades, and young women in migration or commercial sex industry are particularly vulnerable to STI.

Eating disorders

Studies have shown a high level of body dissatisfaction among young women across China. Like other parts of the world, reported eating disorder symptoms are also significantly higher for females than males. Among various predictors, perceptions of social pressure and teasing play a significant role in impacting young women's weight-related concerns. Sing Lee et al. have found that women's concern with body fat is more severe in developed areas such as Hong Kong. Some interpret prevalent eating disorders among women as a side effect of the societal modernization in China.

Suicide

China accounts for 30% of the world's suicide and it is the only country where women have a higher suicidal rate than men. According to Pin Qing's study, approximately 56% of women who committed suicide worldwide were Chinese. Some explanations state that prevailing gender discrimination in China is a main cause of high female suicide. Many traditional concepts of Chinese society, such as an emphasis on women's domestic and reproductive role, all put women at a vulnerable position. In August 2017, the 26-year-old pregnant woman, surnamed Ma, jumped from a hospital window, after she was not allowed to receive C-section by her husband's family. The family declined Ma's request to receive C-section because they believe the procedure would make it harder for her to give birth to a second child. The incident has stirred hot debate about women's status within households and ongoing propaganda on two-child policy.

In recent years, however, female suicidal rate in China has decreased significantly, from 26.1 per 100,000 to 15.7 per 100,000 in 2000. The female to male suicide rate decreased from 1.2 to 0.96 in urban areas. Paul S. F. Yip attributes such progress to rapid modernization during the 1990-2000 decade, which involves great improvement in the standard of living, education, etc.

It is also important to note that the rural suicidal rate is three-fold the urban rate in China, and the decrease in female suicide rate is much less significant in rural areas. Liu Meng's field studies in rural China indicated that women sometimes use suicide as a means of rebellion in their private space, a way to achieve the influence and power that were unattainable in their lifetime. Such is related to the more extreme forms of patriarchal oppression in rural areas.

Intimate Partner Violence

According to studies by William Parish et al. in 2004, 19% of female respondents in China reported experience of intimate partner violence while 3% of their male counterparts reported such. The study showed that duration of the relationship and low socioeconomic status both have a positive correlation with the occurrence of male-on-female violence, and respondents from inland or Northern China are also more frequently found to experience such violence.

Experience of intimate partner violence was found to exert serious adverse impact on women's physical and mental health. Multi-country studies by Henrica A F M indicated that 19-55% women who experienced intimate partner violence were actually injured by their partner and they are exposed to significantly higher risk of mental illness such as emotional distress.