Rise in abortions marks a changing society in China

By Jim Yardley

QINGDAO, China: At an abortion clinic in this seaside city, a young woman sat in the recovery room with an intravenous drip stuck in one hand and a cellphone held in the other. She was 22 and 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, 42 women were having at least their second abortion. One woman had her sixth.

Abortion is legal and widely accessible in China, yet the usual profile is of married women complying, voluntarily or not, with the one-child policy. But as Chinese society rapidly changes, so has the face of abortion.

More young, single women are having abortions and even constitute a majority of those getting abortions in Shanghai and parts of Beijing, according to academic studies and health experts.

Many of these women - migrant workers, urban professionals, prostitutes and students - are having multiple abortions. For this new generation of single women, who have grown up as sexual mores have steadily loosened in China, abortion rates have risen as Chinese society has become more transient and unmoored from the values, and inhibitions, of traditional culture.

"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. "

The trend is also the product of an unexpected disconnect. While the government has focused intently on policing the reproductive lives of married women, it has paid far less attention to educating single women about sex, partly because of societal resistance to the topic. As a result, premarital sex, once rare, has become common in China, even as many young men and women lack even a basic understanding of contraception and reproductive health.

"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 remain the busiest abortion providers in China. They are usually impersonal and overcrowded - some operating rooms are equipped to perform more than one abortion at a time - but health experts in China said safety was usually not a problem.

However, Xu noted that young women who have multiple abortions are more susceptible to problems like infertility, hemorrhaging, endocrine diseases and endometriosis. A recent survey of 8,846 single and married women at 10 hospitals in Beijing found that 36 percent had had more than one abortion within six months.

Confidentiality is a major concern for single women. Some are embarrassed to go to a public hospital for fear that doing so could attract unwanted attention from the authorities. Profiteering private hospitals and clinics, some nicknamed "quack" hospitals, are now marketing abortions as well as treatment for sexually transmitted diseases. Fraudulent or misleading advertising became so rampant - "painless abortion operations!" or "the model abortion for a new generation!" - that in November the government banned ads for abortion and 11 other types of medical treatment.

Despite the ban, abortion ads are still common in some provincial newspapers. And in May, students at one university in southern China discovered advertising fliers for "painless abortions" covering the walls of classrooms and dormitories. One ad promised a "student discount."

Young women, meanwhile, are often confused and searching for information. Hot lines have become popular. One group of teenagers and young women formed an online instant-messaging forum, Women Tribe. In April, an 18-year-old girl was chatting with other members, describing pain and possible complications after she took an abortion pill to end a pregnancy. "I don't have the guts to go the hospital," the woman, who called herself Shuang'er, wrote, 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."

Similar stories, if less graphic, appear in Chinese newspapers and 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. This month, two Shanghai newspapers described a spike in teenage abortions in city hospitals that coincided with a recent weeklong national holiday.

Abortion inside China has long been a controversial political issue outside China. In the early 1980s, abortion rates soared after China introduced its family planning policy limiting most urban couples to one child. In 1990, another spike in abortions coincided with tightened enforcement of the policy.

In 2002, China passed a law prohibiting coercive or forced abortions. Officials said family planning efforts should emphasize maternal and child health. But human rights abuses can still occur. In April, local officials in southwest China reportedly forced dozens of women to have abortions to meet family planning quotas.

The big picture, though, suggests contradictory trends. Married women are still having abortions, for various reasons. Some do so to delay the birth of a first child; many others do so to avoid the fines and pressures that come with a second child. But family planning officials and Chinese health experts say the number of abortions among married women is falling, even as the numbers for unmarried women are going up.

The Chinese Ministry of Health statistics recorded a peak of 14 million abortions in 1990. The latest numbers showed 7.1 million abortion cases in 2005. (The United States, by comparison, had 1.29 million abortions in 2002, according to the Guttmacher Institute.) Experts say the latest Chinese figure is probably incomplete, since it does not include private hospitals or women who use abortion pills at home. One recent Chinese study estimated that there could be as many as 13 million abortions a year, though no explanation was provided.

National statistics do not differentiate between 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, in order to comply with the one-child policy.

By contrast, millions of young, unmarried women have flocked to cities since the 1980s, a journey that often severs them from their families and more conservative rural values. Urban women, meanwhile, are waiting longer to marry, but not for sexual relationships. A study in Shanghai found that 69 percent of single women had premarital sex. Seven other studies in various cities found that between 20 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."

Lin Yang contributed to this article.