Women's health in China
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Health is more than our physical condition, and according to the World Health Organization (WHO), standard healthcare is a fundamental right. The preamble to the WHO constitution reads “health is a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity". According to the capabilities approach pioneered by Amartya Sen and Martha Nussbaum, health is a capability to be promoted by governments in a gender equitable manner. A historical perspective on women's health in China entails examining the healthcare system and its health outcomes for women and men in both the pre-reform period (1949-1978) and the reform period since 1978, particularly the period after China joined the World Trade Organization (WTO) in 2001.
- 1 Economic conditions
- 2 Healthcare policies
- 3 Women's health outcomes
- 4 See also
- 5 References
- 6 Further reading
- 7 External links
Pre-reform China (1949-1978)
In 1952 the Chinese government set up a public healthcare system that was financed by the central government. The system covered civil servants, soldiers, and social sector employees and a labor insurance program financed by employers which was meant to cover laborers. In the end of the 1970s, over 90% of rural villages had set up cooperative medical schemes (CMS). Those CMS programs set up by one or two villages were able to finance "barefoot doctors" and medical equipment to support those villages' populations. These programs favored the urban population but, in all, the health of the entire population was improved. Women's access to care improved as the number of clinics for mothers and children increased, causing a marked improvement in China's health indicators. Life expectancy increased from 39 in 1949 to 68 in 1978; infant mortality rate decreased by 83%; and maternal mortality rate decreased by just under 94%.
Economic reform (1979–present)
Since 1978 China has been systematically moving away from a socialist economy and toward a capitalist system. With the intention to increase efficiency and improve standards of living, China has 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 at breakneck pace, those same policies have led to decentralization and privatization of healthcare. Women’s health in China is among the most prevalent casualties of this economic transformation.
When China joined the WTO in 2001, the conditions for membership were steep: China agreed to lower tariffs from 24.6% in 1997 to 9.4% by 2005 and to abolish all quotas and discriminatory taxes in industrial sectors. Those adjustments were agreed upon with the assumption that China would open up its markets to international trade. When international trade began to thrive, women struggled to find their place in this new and changing economy. Neither women nor men were guaranteed work, so unemployment became rampant. As the Chinese markets moved to efficiency. many workers were made redundant. Those redundancies affected women far greater than men; the workforce was made up of only 40%, yet 60% of those laid off were women.
Health and dormitory life
The economy was changing; as the market opened new employment opportunities for women became available. Those new opportunities were primarily in the service and textile industries. The number of Chinese women working as of 2007 was 330 million which is now 46.7% of the total working population, the majority of these women are working in the agricultural or industrial sectors with a high concentration working in the garment industry. These industries lend themselves to dormitory living. These Chinese dormitories are not a new institution; similar systems have emerged in the east and west, and are primarily associated with industrialization. These dormitories are filled with migrant workers none of whom can stay in the urban areas without being employed. Young women have become the most prevalent demographic for migrant work and make up a very large portion of migrant work, making up over 70% of those employed in the garment, toy, and electronic industries. These women now called dagongmei are typically short term laborers who are contracted for a short period of time and at the end of their contracts they either find more work or are forced to return home. That type of labor contract leaves these dagongmei with very little bargaining power as they are seemingly easily replaced and mobility is almost nonexistent. The dormitory life in China leaves women with little to no home space independence from the factory: all of the women’s time spent traveling from home to work is eliminated and working days are extended to suit production needs. Sick days and personal health are of little concern in these dormitory settings. Women will often neglect their own health out of fear of retribution from factory supervisors. Furthermore, as shown in the documentary "China Blue" if a woman becomes pregnant while working she will be either fired or forced to quit shortly after her baby is born because she will not be able to meet her work responsibilities. In 2009 alone over 20,000 Chinese dorm workers became ill while living in these dorms the majority being young women. While living in dormitories women migrant workers' time is not their own. As they become assimilated into the factory life they are almost completely controlled by the paternalistic systems of these factory owners and managers. Hygiene and communicable diseases become a threat to health as women live in rooms of 8-20 people sharing washrooms between rooms and floors of the dormitories. The only privacy one is allotted is space inside the curtain that covers an individual’s bunk. Male and female workers are separated and there are strict controls placed on the sexual activity of both. These conditions pose a great threat to not only the physical but also the mental health of these women workers being away from their home and placed in an environment where total control is place on them by the factories. While those changes did allow China to achieve unprecedented economic growth, the privatization of many industries also forced China to reform its healthcare policies.
Wage discrimination reduces access to healthcare
Another factor that limits women’s capabilities to access healthcare is their relative low wage compared to men. China promotes itself as having almost no gender bias when it comes to wages yet we see that compared to men women are making less money. The Chinese government touts their “equal pay for equal work” mantra, however, women find that their work in the textile industries is not equal to the work done in industries requiring “heavy” labor so in the end women make less than men because they are perceived as not being able to do the “heavy” work. This inequitable pay leaves women more vulnerable and with less capability to pay for their individual healthcare when compared to men. While 49.6% of women are uninsured demonstrating that there is not much disparity between uninsured men and women. The lack of insurance does not affect men and women equally as women needs tend to be greater in order to provide care for child birth, family care, and security. Social security coverage has also been a factor as only 37.9% of those receiving social security are women; again this becomes an issue as elderly women are unable to pay for their growing health costs. As the cost of healthcare increases due to deregulation of trade and privatization, research has shown that the conditions mentioned above have greatly reduced women’s capability to access healthcare in China.
Health systems in China have changed considerably during transition to a market economy. As the transformation evolved China’s new decentralized government divided responsibility for urban health services between the ministries of Health and Labor and Social Security. As the industrial markets were liberalizing so too were the health systems as the new market economy left many Chinese citizens uninsured having to pay for their care out of pocket with cash. (red book) Under China’s new trade policies brought on by membership to the WTO China’s open market were exposed to foreign competition leading to the import of better drugs and more expensive medical equipment. The new drugs and equipment gave way to higher cost of care, pricing out many Chinese who were in dire need of medical attention. Between the late 1970s and the late 1990s, the Chinese government transfers for health expenditure fell by 50% and are continuing to fall. The Chinese were spending more on healthcare but the share the state was spending went down from 36.4% of the total health expenditures in 1980 to 15.3 percent in 2003; conversely, individuals' contributions increased from 23.2% to 60.2% during the same time period. As stated above, women make less on average than men in China thus leaving women particularly vulnerable to the rising costs of healthcare. One elderly women interviewed by Liu stated that she knew many older women who when confronted with the prospect of an expensive medical procedure opted to commit suicide rather than burden their families with the cost.
Women's health outcomes
One of the aspects of women’s health to suffer the most as the economy shifts to a free market system is reproductive health. As health firm privatize those firms are less likely to provide free preventative health, and as a result they have discontinued the practice of providing regular reproductive health examinations. Due to this from 1997–2007 only 38 or 39 percent of women are getting the reproductive examinations that they need. There is also a widening gap between urban and rural women with regards to their respective health indicators. Health indicators show that in 2003 96.4% of urban women vs. 85.6% of rural women visited a doctor during their pregnancy. In urban areas children under 5 had a mortality rate of 14 per 1,000 again vs. 39 per 1,000 so children born in rural China were twice as likely to die before the age of 5. There are also more traditional gender values that reduce women’s access to healthcare. In one study it was shown that the majority of women still are reluctant to seek out medical help for issues concerning their gynecological needs. The unwillingness to get regular vaginal and breast examinations has led to severe vaginal infections and late detection of breast cancer. Women resist getting these vaginal exams because if they are found to have an infection their identity as a woman is called into question as her role of care giver is reversed and is labeled as a care receiver. When infections were found it was reported that women often didn’t even think they were suffering from an illness, and it is speculated that they perceived these infections as part of the female condition. These attitudes are common and spread due to poor healthcare systems and health information.
HIV in China has been on the rise as well rising from 15.3% in 1998 to 32.3% in 2004. This sharp rise is due to the lack of recognition and education, as for years in HIV was considered a western disease that would not affect the Chinese population and because of this rhetoric China found itself ill-equipped to deal with the social and health issues relating to HIV. There was some attempt at safe sex education and access to condoms for sex workers in the 90s but these were largely token gestures and had no real effect. At one point the Chinese government in some provinces went as far as to outlaw AIDS victims from marrying, or serving as teachers and doctors. This uninformed perception of AIDS victims was particularly damaging to women and homosexuals as they were perceived as the carriers of this disease.
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