What does it mean that the Chinese on the edge of the cliff and the state is about to intervene?

In the first week of the Year of the Tiger, document No. 1 released by the China Family Planning Association caused an uproar on social media.

This also surprised the parties. This is the "2022 Work Points of the China Family Planning Association" issued before the Spring Festival, which was paid attention to by the media after the festival and appeared in the spotlight.

Controversial is Article 9, which mentions "special actions to intervene in abortion among unmarried people to reduce unintended pregnancies and abortions among adolescents".

Especially under the cliff-like decline in the birth population and the continuous low willingness to have children, it has caused public concern - "Is this going to restrict abortion surgery?" ”

From 2014 to 2019, the number of Chinese workers who miscarried hovered around 9.5 million. Last year, 10.62 million people were born in China. That is to say, the gap between the number of abortions and the number of births may be only more than 1 million.

With the unoptimistic data, coupled with the New Deal of "intervention in the flow of people", how will the "intervention" be carried out? How to "intervene"? To whom is "interfering"? For several days, the public's questioning has continued.

When we asked many parties for verification, a number of relevant experts told Eight Points Jianwen that it is impossible for China to restrict the flow of people, and the sunshine and standardized flow of people will not be cut off.

"China cannot limit the flow of people"

A number of experts have given a reassuring pill: on the mainland, abortion as a basic right of women has a clear legal basis.

"On the mainland, the flow of people complies with the provisions of policies and laws and is a basic right of women on the mainland." Yuan Xin, vice president of the Chinese Society and professor of economics at Nankai University, pointed out to Eight Points that some countries where "abortion is illegal" are related to local laws, religion, culture and other factors, and abortion is also included in the laws of these countries.

On the mainland, the illegal abortion mentioned at the policy and legal levels is strictly prohibited as "artificial termination of pregnancy that is not medically necessary to select genders".

Yuan Xin stressed that the main prohibition on the mainland is the abortion of sex selection of fetuses, as well as underground illegal abortion institutions. "The aim is to protect women's reproductive safety."

Since abortion is not restricted, what exactly does it mean to intervene in abortion?

"The first step is to avoid unintended pregnancies." Wu Shangchun, a researcher at the Institute of Science and Technology of the National Health Commission and a doctoral supervisor, told Eight Points Jianwen.

In other words, it is to do a good job of contraception, popularize contraceptive knowledge, conduct sex education, and avoid unwanted pregnancies.

After the three-child policy, some people also misunderstood contraception. Zou Yan, a researcher and chief physician of the Science and Technology Research Institute of the National Health Commission, told Eight Points Jianwen that many people will ask, is it not to encourage fertility, why should contraception be promoted?

"Scientific contraception and the three-child policy are not contradictory, in the 30-35 years of women's fertility period, women should avoid the occurrence of unintended pregnancy and subsequent abortion, especially for unmarried young people, in order to reduce the adverse impact of abortion on their future fertility." After the three-child policy, the reasonable birth planning of each family, the appropriate birth spacing for each postpartum period (at least 2 years of birth spacing, avoiding re-pregnancy within 1 year after childbirth) is conducive to the health of the mother and her children, so contraceptive services are very important. Zou Yan said.

"In addition, there is currently about 9 million people flowing every year, if this group of women have missed the opportunity of contraception, they need to use abortion surgery as a remedy, and the most important thing is to ensure women's reproductive safety and life safety." Yuan Xin emphasized.

In this document, special emphasis is placed on "intervention in abortion among unmarried people". Many experts pointed out that this is strongly related to the increase in unmarried people and young women among women who have aborted in the mainland in recent years.

Chen Suwen, director of the family planning department of Beijing Obstetrics and Gynecology Hospital, told Eight Point Jianwen that in her more than 30 years of clinical experience, the changes she has felt are particularly obvious.

In recent years, the youngest woman Chen Suwen has treated is only 11 years old; 20 years ago, most of the abortions were married women, but in recent years, most of them are unmarried women, and there are not a few high school and college students. "Especially before and after the holidays, it is the peak period of abortion."

Chen Suwen said that in such a situation, if women are given obstacles in abortion surgery, it is very easy to cause tragedies.

When the abortion channel of the sun is blocked, the abortion operation is very easy to go to the underground "black clinic", and the safety of abortion surgery will not be guaranteed.

Although there are no conditions or real possibilities at the level of legal and policy makers that limit abortion, it is important to be extra vigilant that policies must be implemented in various places to avoid losing shape.

A scholar who has been engaged in population work for many years told Eight Points That a certain eastern city had planned to introduce a relevant draft to strictly control abortion. "When several of our scholars learned about it, they strongly opposed it, so they did not make the trip." The scholar stressed that the experience of foreign countries is enough to prove the harm of restricting the flow of legal people, forcing the flow of people, and the operability in real life is extremely poor.

Therefore, many experts have also called for the introduction of detailed rules for intervening in abortion as soon as possible, clearly conveying the bottom line that "China cannot restrict abortion".

It is a miscarriage operation, not a sterilization procedure

In Yuan Xin's view, it is urgent to intervene in abortion.

The flow of more than 9 million people is a serious devastation to the health of Chinese women, especially young women, not only that, but young people and premarital abortion are related to the future fertility of the country. "From the perspective of protecting women, such a huge flow of people, of course, to intervene, to carry out reproductive health knowledge dissemination, technical support, emergency services, humanistic care and psychological comfort, which has nothing to do with fertility rates."

From a technical point of view alone, contraceptive protection measures before and after sexual activity are now very rich and perfect. But who carries out the popularization and education of knowledge? Who provides consulting services? Who provides these contraceptives and technologies? How do young people get this knowledge and stuff? Yuan Xin said that now this road is broken.

On the mainland, the level 7 technical and knowledge service network (national, provincial, municipal, county, township, community, villager group) created by the family planning system in the past can directly deliver reproductive health and family planning knowledge and technical services to thousands of households. But now, the last meter of reproductive health knowledge and technology being passed into the family has been passively divided with the reform of the ministerial system and the evolution of the family planning system and mechanism.

If this step is "lost", the "trouble" will come to Chen Suwen. The term "intervention", in the eyes of clinicians like Chen Suwen, is to standardize surgery, protection and follow-up, and to try to remedy and protect their fertility.

Chen Suwen has spent most of his career dealing with clinical work on family planning. Simply put, it is to give women with different needs to perform abortion surgery according to their wishes.

Every month, 600 to 700 abortion surgeries occur at Beijing Maternity Hospital, and Chen Suwen reports each to the higher-level maternal and child management department, and educates and follows up women after surgery. The first is to ensure that the postoperative situation is stable; second, to ensure the dissemination of contraceptive knowledge and the harm of abortion.

Professor Cheng Linan, former honorary chairman of the Family Planning Branch of the Chinese Medical Association, mentioned that they have carried out Post Abortion Care in the country since 2009. PAC) project to protect women's reproductive health by providing health education for women who require abortion, implementing contraception in a timely manner, and counselling for future births. Because of the accurate positioning, PAC has received good results in avoiding repeated flow of people, especially in a short period of time.

Chen Suwen said that this is to convey a most simple cognition - "I am in charge of my fertility, when I want to have children, I have a good birth; when I don't want to have children, I will avoid the occurrence of unexpected pregnancies." ”

In Chen Suwen's view, "remediation" is very important, and later mission is also more important.

"A woman undergoes an abortion and cannot be sterilized." Chen Suwen stressed.

Chinese stream on the edge of the cliff

According to data released by the National Bureau of Statistics, the net increase in Chinese population in 2021 was 480,000, and the number of births was 10.62 million. More than 9 million abortions were performed, almost at a level comparable to the number of births.

Several respondents also cited concerns about this data, including not only regrets about the more than 9 million unborn children, but also concerns about the health of more than 9 million women lying on the operating table, especially their reproductive health.

Chen Suwen mentioned to Eight Points Jianwen the people who went to his department for abortion surgery: 49% were unmarried and childless, most of them under the age of 25, and 25% of the women were people who had to undergo abortion because of embryo cessation, which is usually a group of people who want to have children but can't.

People who are pregnant but do not want to have children but cannot give birth are becoming the main group of people lying on the Chinese-rate operating table, and the two are statistically inextricably linked, and the probability of the former turning into the latter is worrying.

Chen Suwen also mentioned to Eight Points Jianwen: "We have done statistics, the more times there are abortions, the greater the chance of infertility in the later stage, even if you can have children, the probability of complications during pregnancy, or difficult birth during childbirth will increase significantly." That is to say, multiple and repeated miscarriages are very harmful to future fertility and will have many potential threats. ”

According to a literature-based pooled study by Wu Shangchun and colleagues, 47.5% of women under the age of 25 were in abortion surgery, and 49.7% of these women had never had children; 55.9% of women were not experiencing abortion surgery for the first time; 45% had a repeat abortion interval of only 0.5-1.5 years; and 13.5% of people experienced more than 3 miscarriages.

A 2021 article in the Chinese Journal of Practical Gynecology and Obstetrics summed it up as follows: "Abortion in mainland China has three characteristics: a large number, a high proportion of repeat abortions, and a large proportion of young and unpregnant women." ”

There is no doubt that these large numbers of abortions, especially repeated abortions, are undermining China's already stretched fertility potential.

Among the complications of abortion, there are various lesions that end in infertility - tubal obstruction, uterine cavity adhesions... A review in the Chinese Journal of Family Planning once mentioned: "The more times there are abortions, the more complex the situation associated with secondary infertility in these women, and the less optimistic the pregnancy outcome." ”

According to the "China Reproductive Health Report" released in 2021, the challenges facing the reproductive health of chinese women include: the rapid increase in unmarried abortions, the increase in hidden dangers in reproductive health after marriage; the lack of reproductive health knowledge of the floating population, the high rate of abortion; the change in the concept of marriage and childbearing among adolescents, and the lack of reproductive health education... In the interpretation of relevant data, China Women's Daily bluntly said: "When you want to conceive, you can't get pregnant, but you can't give birth when you want to give birth."

In August last year, Wang Pei'an, secretary of the party group and executive vice president of the China Family Planning Association, mentioned: "Teenagers have become one of the main groups of people with abortion. Nearly 4 million abortions are made annually by unmarried adolescents, accounting for 40% of the total number of abortions in mainland China, of which 19% have multiple abortions. Many problems, such as adolescent abortion, are "leading to an increase in infertility rates and undermining national fertility", and the increasingly serious reproductive health problems of adolescents have posed a "major threat" to the security of the national population.

Li Lin and Li Shanshan wrote

Xu Zhuojun 丨 Responsible editor

This article was first published on the WeChat public account "Eight Points Health" (ID: HealthInsight)

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