Preventing teenage pregnancy in China

by Cesar Chelala

NEW YORK — Parallel to its economic revolution, China is now undergoing a sexual revolution, particularly among youth, that is having far-reaching consequences on their health and quality of life. The response to this challenge will determine how, or whether, young people can overcome serious problems.

Since feudal times, sex has been a taboo subject in China. Even today, despite significant progress in many areas, many Chinese, particularly the older generations, consider sex as something shameful or dirty and refuse to talk about it. Young people differ greatly from their parents in their opinion about sexual activity. At the same time, boys and girls are becoming sexually mature at a younger age and are becoming sexually active earlier.

An increasing number of Chinese adolescents engage in premarital and unprotected sexual activity. As a result, there has been a parallel increase in unwanted pregnancies and abortions, as well as in sexually transmitted infections (STIs), including HIV/AIDS. China is now in the early stages of a major HIV/AIDS epidemic.

It is estimated that China now has more than 240 million people between 15 and 24, and every year 20 million more people enter adolescence. This constitutes an important segment of the population whose need for information — particularly with regard to sexual matters — should be addressed.

A survey conducted by the State Family Planning Commission among 7,000 people between 15 and 49 found that 89.2 percent of the respondents in cities and 74.6 percent of those in the countryside agree that high schools should offer sex education courses. However, only in recent years have the first textbooks on sex education been published and distributed in schools.

Many women resort to abortion when confronted with unwanted pregnancies. It is estimated that the rate of underage pregnancies is growing, and the age at which adolescents become pregnant is lower than in previous years. In some hospitals, up to 40 percent of the abortion operations performed are on unwed mothers.

Worldwide, 14 million adolescent girls give birth every year, while about 4.4 million girls have abortions. The 2001 edition of “Almanac of China’s Health” reports that approximately 10 million induced abortions are performed annually in China, and about 20 to 30 percent are conducted on unmarried young women.

According to Chinese law, there must be approval from a parent or guardian before an abortion can be performed on a girl under 19. Because of that, many pregnant girls who fear their parents’ reaction go to back-street abortionists or quacks who may put the girls’ lives in jeopardy.

There are some risk factors that increase the probability of pregnancy in adolescents such as family instability, the adolescent pregnancy of a sister, a mother who was pregnant as an adolescent, pressure from friends, low socio-economic level, ignorance of one’s own physiology, incorrect use of contraceptive methods, poor communication with parents, and lack of discussion of sexual problems.

Unwanted pregnancy in adolescents can have devastating effects because it can delay or halt an individual’s personal development. There is a loss of autonomy as one becomes much more dependent on parents, and there is an interruption of group relations as pregnant adolescents cannot continue their school activities or normal labors.

Education continues to be one of the most effective ways of teaching young people how to develop an optimal state of physical and mental health. For this to be effective, though, educational materials on sexual issues must be reviewed periodically and their message adapted to various social and cultural groups.

Because of the taboo role sex has had for so long in Chinese society, some parents themselves should be educated not only on sexual issues but also on how to have a productive and ongoing dialogue with their children so that they keep open the channels of communication.

Open communication is important not only between parents and children but also through the mass media, which can help remove taboos regarding adolescent sexuality, redefine social norms, and thus modify attitudes and behaviors.

There should be constant discussion among parents, teachers and health and social workers regarding programs for adolescents. Young people should be active participants, since they can bring energy and enthusiasm to the design of programs that affect their health and quality of life.

Cesar Chelala, M.D., Ph.D., is the author of the Pan American Health Organization publication “Health of Adolescents and Youth in the Americas.”