(June 2001) PRB staff recently met with Yu Xuejun, director of the China Population Information and Research Center (CPIRC) in Beijing, to discuss reproductive health in China. CPIRC is a research and educational organization originally established in 1980 by the State Family Planning Commission (SFPC), the state agency that implements China’s population policies.
Yu became CPIRC’s director in 1998 after serving in a variety of positions in the organization beginning in 1991. He has published widely on Chinese demographic topics, with particular emphasis on population aging and economic development. Prior to taking his current position, he conducted post-doctoral research in the Economics Department of Yale University between 1996 and 1998. He holds a B.A. in Economics and a Ph.D. in Population Economics from Beijing University.
PRB: The 1994 International Conference on Population and Development in Cairo is looked upon as a watershed moment in the international population movement, a moment when women’s needs and reproductive health became the top priority. How was the “Cairo consensus” received in China?
Yu: Cairo, along with the World Women’s conference held in Beijing in 1995, made a big impression on the Chinese government. First, look at policy. Soon after these meetings there were changes in birth restrictions, changes that encouraged decentralization. Localities gained more control over birth restrictions and could implement reforms in accordance with local conditions. In general, this meant that more people could have two children. Seven provinces have declared that married couples in rural areas may have two children if either the husband or the wife is an only child. Also regulations concerning individuals who divorce and remarry and then want to have children have been loosened in many cases.
You can also see the change in the tone of government pronouncements. In 1991, the white paper on population policy was full of directives: we must control the birth rate, we must increase birth planning, and so on. The 2000 white paper had a very different feel to it: It stressed quality of care, informed choice, human-centered development, social security, and voluntary participation in reproductive health programs. There is more of a tendency to see population policy in terms of the overall development picture now.
At the grassroots level, things are more complicated. Many local family planning workers did not initially understand these new ideas. So the SFPC headquarters has launched a propaganda campaign to educate local workers about how to take a more demand-driven approach. In many cases, officials have changed their behavior, but their thinking has remained stuck in the past, so this remains a continuing challenge.
There has also been a lot more international exchange in family planning work. There is one program that sends provincial family planning directors from China to other countries for two to three weeks. This allows them to learn about the population policies of other countries, as well as to meet with foreign population experts and learn how other countries view China in this respect.
PRB: What kind of progress has been made in terms of indicators?
Yu: There has been significant progress in some areas. The birth rate has been more stable in the 1990s than in the 1980s, for example. You can also look at contraceptive use in the past few years. Sterilization is less and less common, and less invasive measures are becoming more widespread.
PRB: What are the biggest obstacles to improving reproductive health in China?
Yu: Two things ought to be emphasized here. The first is money, especially in relatively remote villages in the countryside. The SFPC can tell its local branches to do more to improve reproductive health, but without money to implement such changes, there is not much that can be done. The central government has recently increased the amount of money being distributed for this purpose, but I feel that it is still insufficient.
Look at Qinghai province, for example, one of the poorest provinces in China. Less than 50 percent of the local jurisdictions have family planning service centers, places where women can go to receive reproductive health care. The number is supposed to be 100 percent, so there’s clearly a long way to go. The problem is not that family planning workers don’t want to spend money on these service centers, but that there is not enough money to build them.
The second problem is cooperation between the various organizations that are involved in reproductive health. There is the Ministry of Public Health, the Ministry of Finance, Ministry of Civil Affairs, and of course the SFPC. Each of these has a role. Civil Affairs manages marriages, for example, while the Ministry of Finance has to be involved in budgetary issues. Getting all of these players to agree on a common approach is quite difficult.
PRB: What about specific reproductive health problems?
Yu: First, reproductive tract infections (RTIs) are quite widespread in China, and there is still not enough care in this area. Where it is available, it may be only for a limited time. In addition, family planning workers may tell the local women to come to the local clinic to be examined for RTIs, but the feeling is that they are also looking to see if you are pregnant. Women may be afraid to visit the clinic because they think they will get in trouble. Things are changing, however. In the past, women were told when to visit the clinic and were not given a choice about whether or not to go. Today, the voluntary aspect of reproductive health care is being emphasized.
There are other problems as well. Infertility is beginning to receive attention as a problem; in fact, this problem appears to be more widespread than in the past. Another problem is adolescent reproductive health. Traditionally, reproductive health care has focused on married couples, but premarital sex is now on the rise in China. So who manages care in this area? We need to adjust our concept of what reproductive health care is to make sure that everyone is covered.
PRB: What about AIDS?
Yu: AIDS has become more widespread in China in recent years, but it’s a small problem if looked at in terms of the total population. The official published figure is just between 10,000 and 20,000. There are some people who say the real figure is closer to 500,000, and I believe them. Of course, the number of reported cases is much lower than that. People either don’t know they have it or don’t want to make it public. In terms of projections, if nothing is done to stop it, the government estimates the total number of HIV-infected adults could reach 10 million by 2010.
The pattern of HIV infection in China varies quite a bit. In southwest and northwest China, those infected with HIV are mainly drug users, but in central China people carrying the virus are more likely to have been infected while selling their blood to blood merchants; that has become a significant problem in China. Along the coast and in the big cities, sexual transmission of HIV appears to be more common.
The SFPC has a department devoted to information, education, and communication (IEC), and the HIV/AIDS prevention program is being integrated into this work. But there are bureaucratic issues here as well. AIDS is mainly managed by the Ministry of Public Health and the Disease Prevention Bureau, not the SFPC.
PRB: What kind of work is CPIRC doing in the reproductive health area?
Yu: We have several research programs in this area. CPIRC is the executing office of the SFPC for researching quality of care in China. Right now, we have a program funded by the UN Population Fund that is looking at the quality of care in various counties. In addition, we are collaborating with the SFPC office that does IEC work on AIDS to disseminate information about the disease. We may also be involved in the follow-up to the 1997 survey on reproductive health. We hope that will take place this year.
Bingham Kennedy, Jr. is an associate editor at the Population Reference Bureau.