CASE 2:  Medicine and Childbirth

What options would a Chinese woman giving birth have nowadays, compared to a woman during Jizhai’s time? In principle, Chinese women now have a wide range of options for ensuring successful childbirth, as the official Chinese healthcare system includes both modern biomedicine (often referred to as “Western” medicine) and “TCM” (“traditional Chinese medicine”). The biomedical options available in China are like those in developed countries, which include diagnostic and therapeutic technologies (e.g., ultrasound, fetal monitoring devices, and chemical tests) and modern drugs and procedures (e.g., anesthesia, antibiotics, blood transfusion, and caesarian sections), with care given in hospitals staffed by certified medical personnel (e.g., licensed midwives, obstetricians, and anesthesiologists).

TCM is descended from the elite Chinese medicine of yore and derives its fundamental content from ancient Chinese philosophical and medical texts. However, it owes its present form to the political agendas of twentieth-century Chinese reformers and revolutionaries who actively promoted and protected indigenous medicine during China’s long march to modernization. On the one hand, they sought to prove that China’s indigenous healing traditions still had something important to offer a biomedical world, and so they selectively modeled a Chinese medical “tradition,” stripping away elements viewed as “superstitious” while streamlining and standardizing other practices along modern professional lines. At the same time, they promoted the integration of Chinese and Western practices, arguing that the two systems complemented one another. Today, we find not only specialized TCM hospitals but also TCM departments and pharmacies in regular hospitals. During pregnancy, labor, childbirth, and the postpartum period, TCM therapies such as herbs, acupuncture, or moxabustion are commonly used alone or in conjunction with therapies derived from biomedicine. Finally, in recent years, some women-centered childbirth practices from Europe and North America also have begun to spread in China. These include the Lamaze method and the use of “doulas,” who are women who accompany the expectant mother throughout labor and birth, providing advice and emotional support. Such practices were originally promoted in the West by women and practitioners who were disillusioned with modern obstetrics and wanted alternatives that would allow women more control over their bodies and birthing experiences. Studies have shown that such techniques are effective in reducing the rate of complications in labor. Middle- and upper-class Chinese, attuned to world trends, also have started to adopt these practices. Since 2003, one Shanghai hospital has even provided facilities for “water births,” where women deliver their babies while sitting in a warm pool.

Despite this array of potential choices, however, the options actually available to any given Chinese woman differ greatly according to her location and finances. In the early 1990s, for example, the Chinese government reported that while 98% of urban women had access to prenatal care, only 70% of rural women did. Of course, the general problem of healthcare “haves” and “have nots” is not unique to twenty-first century China, but it has become a significantly problematic issue with serious implications for long-term social and political stability. Until 1979, China’s socialist system effectively provided government-sponsored healthcare to its citizens through networks of rural healthcare centers and through urban work units (e.g., companies, schools, etc.) Beginning in the early 1980s, however, the drive for market reforms led the government to decentralize the healthcare system and reduce its funding. The Chinese healthcare system essentially became privatized, with the result that hundreds of millions of people were deprived of affordable healthcare. The pain has been felt most deeply in the rural areas, home to approximately 70% of China’s population, and especially in the less-developed interior provinces. As the government reduced its subsidies, medical personnel and healthcare institutions had to find their own sources of revenue. Selling pharmaceuticals and providing high-tech procedures emerged as the most profitable activities, further increasing healthcare costs, which increased five- to six-fold during the 1990s. As of 2001, the United Nations estimated that in the poorest regions of China, only 6% of women could afford a hospital birth.

Over the past several years, the Chinese government has taken steps to mitigate these widely recognized problems, but it is clear that there will be no quick solutions. As of 2004, the World Health Organization estimated that 83% of all Chinese women were attended by licensed medical personnel (the analogous figure for the US is 99%). Although this represents a significant increase over the past decade, it still means that as many as one in five Chinese births takes place without any expert oversight.

Thus, on one end of the spectrum, we find an upper–middle-class urban woman from China’s economically advanced coastal regions. She expects to give birth in a well-equipped hospital, attended by medical personnel with postgraduate training and access to the latest technology. Coached by a birthing assistant and resting in a ward decorated to look like a family home, she will have all the physical and emotional support she needs to make her birthing experience as comfortable as possible. At the other end of the spectrum is the woman in a rural village, who lives too far from a hospital or cannot afford the fees. She will probably give birth at home. If she is fortunate, she will be attended by an experienced but unlicensed midwife, who is not counted in official statistics of “trained birthing attendants.” She also may give birth alone, or with the assistance of people ranging from her mother-in-law to a local healthcare worker with vocational medical training and a highschool education. Lacking access even to the basic surgical equipment needed to perform an emergency caesarian section, she is at a significantly higher risk of maternal mortality than her urban sisters.

Another vulnerable group consists of female migrant workers, women from the countryside who flock to the cities to earn money. As undocumented workers at the bottom of the socioeconomic ladder, they cannot afford proper medical care and often rely on illegally operated birthing clinics or well-intentioned friends. A survey in Shanghai found that in 2003, migrant women died in childbirth at three times the rate of local residents, which led the municipal government to start establishing subsidized obstetrics clinics. In sum, Chinese women as a group now have more options than at any point in history, but their ability to access these resources can vary widely.

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