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". The circumstance of Chinese women's health is highly contingent upon China's historical contexts and economic development during the past seven decades. A historical perspective on women's health in China entails examining the healthcare policies and its outcomes for women in the pre-reform period (1949-1978) and the post-reform period since 1978. In general, women's health in China has seen significant improvements since the foundation of People's Republic of China in 1949, witnessed by improvements in multiple indexes such as Infant Mortality Rate(IMR), Physical Quality of Life Index (PQLI), etc. 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. These debates intensified when May Fourth Movement reformers began criticizing the role of the traditional midwife for what they described as its backwardness and feudal superstition.
Nationalist China In the 1920s, the Nationalist government drafted a national program of maternal and infant health care which built off the ideas of the May Fourth reformers and other concepts of medical modernization which were developing around the world. China lacked medical infrastructure and modern-style medical personnel, and the Nationalist program therefore focused on professionalizing midwifery with different regulations for rural and urban areas.
Pre-reform PRC (1949-1978) After the 1949 founding of the People's Republic of China, the country established its first public healthcare system, the Cooperative Medical Scheme (CMS), which focused on the needs of the country's huge rural population. 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). The implementation of CMS has seen significant improvement in population health in China, including female health. 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. Contrary to the Chinese census, Banister's studies have shown that female IMR is higher than male IMR in China at least since 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. In the PRC's early years, traditional midwives came to be viewed as dirty and unscientific. The government sought to expand hospital infrastructure and to replace traditional midwifery with modern techniques approved by the newly-established socialist health authorities. In urban areas, women increasingly gave birth at hospitals. In rural areas, women continued to give birth with the aid of local midwives, including those certified by the government who had taken a short-term course on new birthing methods. By 1959, over 750,000 midwives were retrained with some modern medical practice, but only 5,300 were fully modern trained midwives. 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. By the late 1970s, most rural areas had a developed but low-tech childbirth infrastructure, with local teams of certified lay midwives worker with barefoot doctors. Rates of hospital births increased significantly in China as a whole, with most home births occurring in rural areas.
Economic reform (1979–present) During Reform and Opening Up, China implemented far-reaching reforms: decollectivization and land tenure reforms, promotion of township and village enterprises (TVEs), state sector reforms, and policies to encourage foreign direct investment (FDI) and trade liberalization. These policies were implemented as China moved to a market economy and were furthered in order to insure their membership to the World Trade Organization (WTO). These policies are hailed by many as being highly successful, producing massive economic growth while raising the standard of living by reducing poverty. China has taken a gradual and highly regulated approach to its transformation, and while China started its transformation earlier than other socialist countries. it is still undergoing that transformation. These measures have led to much growth, and as China continues to increase its GDP, those same policies have led to decentralization and privatization of healthcare. In the 1980s, the necessity of rural home births continued to be reflected in health care regulations. Beginning in the 1990s, the China received significant foreign aid to improve its hospital and medication equipment, in part due to major international public health campaigns like the United Nations Safe Motherhood Initiative and the Millennium Development Goals Program. China also allowed public hospitals to finance technological upgrades through fees charged to patients. Hospitals births were made compulsory.
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