'There's adverts for abortion clinics on the subway, but never for condoms'

Medical insight on sex education in China from Dr Neil Schmid

China’s at a tipping point when it comes to contraception and sex education, warns Dr Neil Schmid, Beijing chief of sexual health charity DKT International

China has the highest overall contraceptive prevalence rates in the world: 88 percent of women of reproductive age (15-49) use contraceptives. But that official figure is highly problematic: it’s unrepresentative of sexual activity across the Chinese populace for the fundamental reason that it excludes unmarried women and all men, married or unmarried. So it’s a highly gendered measurement of what constitutes normative contraceptive use. And in China, that concept forms the basis of the entire family planning policy as well as access to and, crucially, knowledge of all contraceptive methods.

The upshot of this situation is that married women bear the brunt of contraceptive responsibility, men don’t, and those outside of married couples – namely 249 million people – are largely ignored in terms of sex education and general public discourse on all the contraceptive methods available. I want to address these inequalities and other sexual health concerns by promoting condom use among youth and by providing both women and men with additional contraceptive options.

At the moment, the Government’s family planning policy favours IUDs [intra-uterine devices] and sterilisation for married women, and these two methods currently amount to roughly 50 percent and 30 percent respectively (a whopping 80 percent combined) of all contraceptives used by that group. The legacy of this system is that because all these procedures were, and still are, done in Government-controlled clinics, contraceptive choices have been highly limited. Not having a variety of choices means that information about other contraceptives isn’t necessary, and both institutions and parents are thus never obliged to develop the knowledge and concern to communicate different options. Also, hormonal contraceptives such as the pill, implants and injections don’t generally appeal to Chinese women because they often believe that hormones disrupt the body’s balance. An unfortunate result of the lack of short-term contraceptives among younger, unmarried women is that multiple abortions are relatively common and there’s frequent misuse of emergency contraceptives such as the morning after pill. If used excessively, both of these methods can affect fertility in the long term. Finally, there’s a social conservatism that feeds into these larger patterns: you’ll often see adverts for abortion clinics in the Beijing subway, but you would never, ever see an advert for a condom.

Today’s Chinese youth have enormous amounts of freedom, access and mobility that their parents never had. Enablers range from rapid urbanisation to apps like Momo, billed as ‘the magical tool to get laid’, which were completely unthinkable among their parents’ generation. Where the State was once revolutionary in addressing citizens’ reproductive and sexual health needs, it’s now turned a conservative eye to the changes affecting its population.

The negative results are a rapid increase in unwanted pregnancies, abortions and STIs. Over 50 years ago, syphilis was virtually eliminated from China by Government initiatives. Now an epidemic rages, with an average of more than one baby per hour being born with congenital syphilis in China. And unfortunately that’s only one of multiple STIs which are increasingly rampant across the population. As important and useful as IUDs and hormonal contraceptives might be in preventing unwanted pregnancies, they do nothing to stop the ever-growing spread of sexually transmitted diseases.

DKT International runs extensive programmes addressing sexual health in China. Visit www.dktinternational.org for more details.


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