Married women in the hospital's "family planning department": from "abortion" to "fetal protection"

Doctor Chen Suwen's office is pink.

The curtains are pale pink, the popular science notices on the wall are dark pink, and the precautions on the table, the door sign at the door, and the guiding arrow on the ground are all pink.

For three decades, the tall buildings outside the window of the consultation room have been lined up, and the willow trees in the courtyard have grown higher and higher, but the pink clinic of the family planning department in the hospital has stood still and Chen Suwen and the department have become an anchor, guarding a refuge ship belonging to women.

Here, family planning doctor Chen Suwen accepts women from different eras, different ages, different identities, backgrounds, personalities, and concepts. Around her, these women do not have to feel ashamed or afraid of being seen, and can loudly discuss the difficulties and anxieties in the face of childbirth.

During most of the consultation, Chen Suwen would quietly listen to the women's talks, carefully give treatment advice, and then gently and firmly tell them: "Don't worry, take your time." ”

On the small refuge ship of the family planning department, Chen Suwen found that with the changes in education, birth policies, and population, the thoughts, ages, and demands of women who came to the ship were also changing.

Younger girls came to her for abortion surgery, older women came to her to "save the pregnancy", abortion procedures became more and more complicated, more and more women suffered from various complications, and women who wanted to "put on birth control" also re-entered the clinic with the opening of the policy.

In recent years, the focus of the family planning department has also changed, from "abortion" to "fetal protection". Chen Suwen also felt that the meaning of the word "family planning", which had been with him for 30 years, had become different. It is no longer a specific noun with the color of the times, but closer to the original meaning of the word: "When it is time to give birth, we must eugenics and childbearing, and at the same time, we must choose a correct and appropriate birth interval." ”

Nowadays, more and more women are more eager to take the initiative of childbirth into their own hands. Chen Suwen always thinks that maybe "family planning department" is also the time to change the name.

Married women in the Family Planning Department after the two-child policy

This is not the first time Chen Suwen has met this gray-haired mother.

At the end of March, Beijing is in early spring. The afternoon sun was warm and bright, slanting through the translucent pink curtains, through the mother's hair, and on the stacks of medical records and medical bills in front of Chen Suwen.

Chen Suwen greeted the mother through the mask and asked, "How is the daughter?" ”

"It's been 8 weeks." The mother replied, a smile streaming from the corners of her eyes.

Chen Suwen lowered his head and continued to look at the medical order. Her patient was not the gray-haired mother, but her daughter, a young pregnant woman, who was not present. The expectant mother had experienced two abortions and finally became pregnant two months ago, but she was so anxious that she did not dare to go to Chen Suwen's clinic alone. She could only let her mother register instead of her and deliver the test results to Chen Suwen.

She told the mother to let her daughter get more blood supplements, and then come for a check-up, and told her to tell her daughter not to be afraid, she would stay with them until the baby was born.

Chen Suwen specializes in infertility treatment. In 2020, the "three-child policy" was introduced, and many married women who needed repeated abortion surgery because of fetal arrest began to appear in her office more frequently.

Most of these women are over 35, the oldest is 44, and some even have a child. Almost all of them are at high risk – with the exception of sub-health problems and chronic diseases associated with age, almost half of them choose caesarean section when they first give birth. The scarred uterus caused by the caesarean section reduces the ability of these women to re-conceive, increases the risk of pregnancy location, and turns what was originally a "simple" day surgery into a "high-risk miscarriage".

But that doesn't make them give up. In Chen Suwen's office, she has visited too many married women who have had repeated abortions. She remembers the most time, a patient who had six miscarriages and still wanted to "try again."

After repeated failures, each woman has similar symptoms, but at the end of the consultation, Chen Suwen will be asked: "When can I start trying to get pregnant again?" Hearing her answer was that after at least 3 months, even with thick N95 masks, these women could not hide the disappointment on their faces.

Anxiety, in the consultation room of the family planning department, is the common "enemy" of Chen Suwen and married women.

In addition to repeated miscarriages and increased surgical complexity, the age of women who come to the clinic has also begun to polarize - younger and younger unmarried women have unwanted pregnancies and line up to find Chen Suwen for abortion surgery: "Twenty years ago, the youngest abortion patient I saw was 14 years old, but in recent years, I have even seen 11-year-olds. ”

Mothers who are getting older, even suffering from chronic diseases, are beginning to prepare for pregnancy, stop the fetus, and seek "fetal preservation surgery", and the age "fault" in the middle is getting bigger and bigger.

Not only in Chen Suwen's department, but also in the flow room of another gynecological hospital in Beijing, young girls in their early 20s lined up for abortion surgery; In the reproductive center on the other side, couples in their 50s are still trying to do IVF, trying to get on the last train and "have another one".

In the eyes of Cheng Linan, the sixth chairman of the Family Planning Branch of the Chinese Medical Association, this is inseparable from economic pressure: "35~40-year-old couples, the family economy is stable, at this time may want to have another child." But most of them are only children, there are four elderly people, the work pressure is high, how can they want to have more children? ”

Even though more and more married women are prone to abortion, resulting in abortions, a large proportion of married women who choose abortions are still because they "do not want children". Chen has seen many of these women, most of whom have become pregnant with unexpected children because of failed or ineffective contraception.

Therefore, the lack of corresponding sex education for married couples has become an important issue in the current relaxed birth policy.

According to the World Health Organization, between 2010 and 2014, there were more than 56 million abortions performed annually worldwide, 73% of which were married women. The "2006~2016 China Fertility Status Report" pointed out that the increased risk of induced abortion after two births means that the contraceptive needs of women after giving birth to two children have not been met.

When Chen Suwen asked the married women what method of contraception they used, one of them replied that it was in vitro contraception.

Chen Suwen said very directly: "You yourself know that this cannot be called contraception," she frowned, "It's not safe at all." ”

The young married woman was silent for a moment and asked her, "What kind of abortion can not hurt the uterus?" Chen Suwen replied bluntly: "Birth is the least harmful to the uterus." ”

This "North Drift" woman is married and has one child. Before that, she had also had an abortion operation. Her busy life and work made her unable to raise her second child, so she decided to miscarry.

She asked Chen Suwen if she could "medicinal flow", and Chen Suwen told her that for some reason, the hospital did not provide "medicinal flow" for the time being. The efficiency of this method is not as high as people expect, and the "flow is not clean", which is easy to cause complications. "We often admit patients with incomplete drug flow in the hospital," Chen said.

She listened, thought for a while, made an appointment with Chen Suwen for next week's operation, and repeatedly confirmed that "it must be Director Chen who will perform the operation at that time" before leaving the consultation room with confidence.

"One-stop tire protection service"

Chen Suwen's focus gradually became "tire protection".

This starts earlier. In the early days, the family planning department was brilliant, but now it is the department that most gynecologists are reluctant to choose, and some people simply and crudely call it "abortion". If obstetrics is about welcoming a new life, family planning marks the "failure", "loss", and even "ending" of a young life.

But now, like other family planning doctors, Mr. Chen's focus has become on "how to treat women who have had repeated abortions, miscarriages and infertility."

"I always tell people that I don't just do abortions." Chen Suwen said, "I am helping them relieve their fertility anxiety, according to women's self-will, to decide whether life will come to the world, or fulfill their dream of becoming a mother." ”

In Chen Suwen's consultation room, most of them are "repeat customers". Chen Suwen can name everyone and understand their pregnancy experience. From the day these women had abortions after abortion, Chen Suwen's "one-stop fetal protection service" had begun.

From checking the cause of fetal arrest after surgery, to conditioning, treating the uterus, to guiding preconception examination, eugenics and childbirth, and finally re-pregnancy, fetal buds and fetal heartbeats, Chen Suwen participated in every part of it. Every woman who walked out of the family planning department with her stomach straight up and entered the obstetrics department next door was called a successful "graduation" by her.

Chen Suwen will treat these women like children. She would call them "baby" and "darling" during her consultation; Will talk to them in a discussing, coaxing tone. She will also carefully explain to them the principle of each step of the diagnosis and treatment plan: "Don't worry, only if the disease in the womb is cured first, can you slowly get pregnant." ”

She also never advises women who want to have children to give up. A thin, fair-skinned young woman told Chen that she had anemia, had a child by caesarean section and now wanted a second one. After three abortions, she looked confused and a little desperate. Chen Suwen told her to have confidence, "Many people have been protecting their babies with me, and they can't say give up until the end." ”

The causes of tire arrest are complex and diverse. In addition to chronic diseases and caesarean sections, repeated miscarriages experienced in the past are also one of the important causes of fetal arrest. Cheng Linan believes that due to the lack of sex education, many women do not know how to use contraception, and even use "abortion" as one of the means of contraception, and once pregnant, they will go to abortion. Now, when these women want to have children, the complications of repeated abortions in the past can easily cause them to have an abortion.

Clinically, a woman who has had two or more induced abortions in her lifetime is called "repeat abortion". "Analysis of the Change Trend of Induced Abortion Level and Related Factors among Women of Childbearing Age in China" pointed out that there are about 99 million unwanted pregnancies in the world every year, of which 56% end in miscarriage. According to the global annual number of abortions is estimated at 55.9 million, the number of abortions per 1,000 women of childbearing age aged 15~44 is about 35.

In China, after the comprehensive "two-child" policy, the number of induced abortions is still huge, with more than 9 million abortions per year, of which about 50% are repeat abortions, and the average number of repeated abortions of those who have children is 1.171 (1.098-1.249) times that of infertile people. It is expected that in the next few years, the total number of Chinese abortions will stabilize at about 9.7 million per year, and the abortion rate will be about 27 per thousand.

To add insult to injury, in addition to repeat miscarriages, these women are now generally over 35 years old. Cheng Linan said that the proportion of fetal arrest will increase with age, "At that time, women under the first wave of the one-child policy wanted to get pregnant in a hurry, and we saw many pregnant after the age of 40 or even 45 in the clinic, half of whom were embryos with poor embryo development and were prone to fetal arrest." ”

An obstetrician and gynaecologist recalled that he knew a woman who wanted a second child at the age of 45, and "fought hard to get pregnant, and then miscarried." The obstetrician and gynecologist remembers crying "so badly" that she never became pregnant again.

Let "family planning" return to its original meaning

More and more women have come to the family planning department to "go to the ring".

"Upper ring" refers to the placement of an intrauterine device in a woman's uterus, commonly known as a "birth control ring". In the narratives reported by many Chinese in recent years, the "birth control ring" is the shackles of women's bodies under the one-child policy. Many young and independent daughters brought their mothers into the hospital and removed the birth control ring that had been buried in their bodies for many years, symbolizing that two generations of women would jointly regain their own body and reproductive sovereignty after many years.

But with the advancement of women's self-awareness and the popularization of sex education, the symbolic meaning of "upper ring" and "taking ring" has been diluted, replaced by its practical meaning - it is no longer linked to the times and policies, but returns to its essence as an economical and efficient contraceptive method for women to choose.

Compared with women who have been forced to "go to Ring" and ignore it for more than ten years, Chen Suwen believes that women who take the initiative to "go to Ring" now are sensitive to their physical condition, but it is a manifestation of increased awareness of contraception and sex education. "When they finish their birth plan, they use a long-acting and rational form of contraception," she said. Everything is manageable and planned.

There is also the need to return to the original meaning, and the "family planning department". In the past two years, Chen Suwen has always received calls from others, asking her if the department is about to disappear if the birth policy has been relaxed, which makes her feel helpless.

In China, the four words "family planning" have a distinct sense of the times, which are the product of specific birth policies, making people always think that "family planning" is equivalent to "abortion" and "birth control".

This is not the case. In foreign countries, for a long time, "family planning" refers more to the birth arrangement within a family - choosing the appropriate birth interval, birth time, eugenics and childbirth, each family is different.

In the United States, the Planned Parenthood Association is also known as the Planned Parenthood. Under China's one-child policy, this strongly intervened family birth arrangement is almost completely uniform: "After giving birth to a child, all families have the same plan, which is to terminate the pregnancy." ”

But now, Mr. Chen thinks, people's perception of the term "family planning" may need to change. The family planning department itself may be called another way - "we can call it 'reproductive regulation', or 'fertility regulation', to help people who want to use contraception to contraception, and to help people who want to have children." This is also in line with the mainland's current birth policy. ”

In addition, just as "family planning" focuses on the "family", the responsibility for "family planning" also needs to fall on the family, not solely on female birth control.

Cheng Linan believes that men's family planning responsibilities have always been absent, "Perhaps many areas are patriarchal, but in the field of contraception and childbirth, it is preference." ”

In terms of birth control, birth control for women is more accessible, while doctors and institutions that actually provide birth control for men are rarer. On social media, you can always see some men who want to get a ligation and go around looking for andrologists, but no one can do it.

In fact, over the past 50 years, the contraceptive methods available to men have hardly changed compared to women. Currently, the only contraceptive methods available to men are condoms and vasectomy sterilization. Women, in addition to tubal ligation, can also use a variety of contraceptive measures such as birth control devices, subcutaneous implantable contraceptive injections, oral contraceptives, and long-acting contraceptive injections.

This inequality of reproductive responsibility between the sexes is also reflected in obstetrics and gynecology. Although pioneering ideas in obstetrics and gynecology encourage men to participate in obstetrics and reproductive health, some delivery rooms or obstetrics and gynecology departments still sometimes say "Men stop" or "Family stops" at the door.

Many clinicians believe that this is to protect women's privacy and psychological safety during examinations, but on the other hand, some experts believe that it also limits men's participation in family reproductive health decisions, resulting in insufficient awareness of birth trauma such as miscarriage and fetal arrest.

Among the patients Chen Suwen received, a young girl once asked her: Can you not write on the leave slip that you take leave because of a miscarriage? The patient found Chen Suwen on the afternoon of a working day. The girl is a white-collar worker with delicate manicures, sunglasses, and curly hair.

She told Chen Suwen that her boss was a man and did not know how to explain the miscarriage: "I can only tell him that he has a flu during this period and will have to rest for ten days." ”

Written by Zhang Yuxiao

Li Lin and Yan Yucheng are responsible editors

This article was first published on the WeChat public account "Eight Points Jianwen" and may not be reproduced without authorization