Women's health in China

Last updated

Women's health in China refers to the health of women in People's Republic of China (PRC), which is different from men's health in China in many ways. Health, in general, is defined in the World Health Organization (WHO) constitution as "a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity". [1] The circumstance of Chinese women's health is highly contingent upon China's historical contexts and economic development during the past seven decades. A historical perspective on women's health in China entails examining the healthcare policies and its outcomes for women in the pre-reform period (1949-1978) and the post-reform period since 1978.

Contents

In general, women's health in China has seen significant improvements since the foundation of People's Republic of China in 1949, witnessed by improvements in multiple indexes such as Infant Mortality Rate(IMR), Physical Quality of Life Index (PQLI), etc. [2] However, due to traditional Chinese ideology on gender inequality and complexities of Chinese political system, challenges in terms of many aspects of women's health, such as reproductive health and HIV/AIDS, are still mounting.

History of Women's Health in China

Late Qing dynasty

In the late 19th century, Chinese reformers began call for the modernization of childbirth based on Western scientific medicine. [3] :104 These debates intensified when May Fourth Movement reformers began criticizing the role of the traditional midwife for what they described as its backwardness and feudal superstition. [3] :104

Nationalist China

In the 1920s, the Nationalist government drafted a national program of maternal and infant health care which built off the ideas of the May Fourth reformers and other concepts of medical modernization which were developing around the world. [3] :104

China lacked medical infrastructure and modern-style medical personnel, and the Nationalist program therefore focused on professionalizing midwifery with different regulations for rural and urban areas. [3] :104–105

Pre-reform PRC (1949-1978)

After the 1949 founding of the People's Republic of China, the country established its first public healthcare system, the Cooperative Medical Scheme (CMS), which focused on the needs of the country's huge rural population. [4] The CMS was a three-tier system: barefoot doctors, township health centers, and country hospitals. In the end of the 1970s, over 90% of rural villages had set up cooperative medical schemes (CMS). [5] The implementation of CMS has seen significant improvement in population health in China, including female health. [6] Studies by Mei-yu Yu et al. found that the female Infant Mortality Rate (IMR) declined from 170 per 1000 in 1953 to 136 in 1957, and female average life expectancy at birth rose from 44.8 in 1949 to 67.1 in 1975. [2] Contrary to the Chinese census, Banister's studies have shown that female IMR is higher than male IMR in China at least since 1975. [7] Mei Yu-yu et al. believed that such a discrepancy in IMR between female and male could be a result of preference for sons in traditional Chinese ideology, which may cause abandonment, unequal treatment or violence against female infants. [2]

In the PRC's early years, traditional midwives came to be viewed as dirty and unscientific. [8] The government sought to expand hospital infrastructure and to replace traditional midwifery with modern techniques approved by the newly-established socialist health authorities. [3] :105 In urban areas, women increasingly gave birth at hospitals. [3] :105 In rural areas, women continued to give birth with the aid of local midwives, including those certified by the government who had taken a short-term course on new birthing methods. [3] :105 By 1959, over 750,000 midwives were retrained with some modern medical practice, but only 5,300 were fully modern trained midwives. [9] With China's program of barefoot doctors, perinatal practitioners were often older women. [10] Their work was effective, with much of the 1950s and 1960s population boom resulting from the decline in infant mortality. [10]

By the late 1970s, most rural areas had a developed but low-tech childbirth infrastructure, with local teams of certified lay midwives worker with barefoot doctors. [3] :105 Rates of hospital births increased significantly in China as a whole, with most home births occurring in rural areas. [3] :105

Economic reform (1979–present)

During Reform and Opening Up, China 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). [5] 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, those same policies have led to decentralization and privatization of healthcare. [5]

In the 1980s, the necessity of rural home births continued to be reflected in health care regulations. [3] :106

Beginning in the 1990s, the China received significant foreign aid to improve its hospital and medication equipment, in part due to major international public health campaigns like the United Nations Safe Motherhood Initiative and the Millennium Development Goals Program. [3] :106 China also allowed public hospitals to finance technological upgrades through fees charged to patients. [3] :106

Hospitals births were made compulsory. [3] :106–107

Health and dormitory life

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. [11] These industries lend themselves to dormitory living. These dormitories are filled with migrant workers, none of whom can stay in the urban areas without being employed. [12] Young women have become the most prevalent demographic for migrant work, making up over 70% of those employed in the garment, toy, and electronic industries. [12] 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 seem to be easily replaceable.[ citation needed ]

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. [12] 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 private space allotted is behind 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 a highly restrictive environment. [12] While those changes did allow China to achieve unprecedented economic growth, the privatization of many industries also forced China to reform its healthcare policies.[ citation needed ]

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. [13] 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. [14] 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. [14] 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. [14]

WTO membership (2001-present)

While China's entry to WTO was presumed to further motivate its economic development and improve its market structure, it has also been worried that joining WTO will worsen China's labor surplus because over-hired labor in state enterprises [15] may be deemed "inefficient" once China entered global market. Moreover, studies have shown that the workforce in China was made of only 40% women but 60% of those laid off were women, which demonstrated that women are much more vulnerable to these effects than man. [16]

Statistics obtained in 2008 have shown that males enjoy higher physical well-being than females. However, it is not addressed if the situation could be related to China's changing economy in any ways. [17]

By the 2010s, the practice of home birth had ended through the practice of subsidizing rural hospital deliveries and banning rural midwives from practicing. [3] :107

Healthcare policies

Health systems in China have changed considerably during the 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, which left many Chinese citizens uninsured having to pay for their care out of pocket with cash.[ citation needed ] Under China's new trade policies brought on by membership to the WTO, China's open market was exposed to foreign competition. This led to the import of better drugs and more expensive medical equipment, which in turn gave way to higher cost of care. This priced out many Chinese who were in dire need of medical attention.[ citation needed ]

Between the late 1970s and the late 1990s, the Chinese government transfers for health expenditure fell by 50% and are continuing to fall. [14] 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. [13]

In addition to bearing gender disadvantage, rural women suffer even more from insufficient healthcare due to increasing spatial disparity in China. Based on studies by Xiaobo Zhang et al., healthcare facilities have been significantly scarcer in rural areas. In 1980, hospital beds and healthcare personnel per 1000 people in cities were 4.57 and 7.82, respectively, compared to 1.48 and 1.81 in rural areas. Such disparity has grown over years. [18] Moreover, infant mortality rate in rural areas has been significantly higher than in cities, with the gap reaching 2.1 in 2000. The ratio of female to male IMR increased dramatically from 0.9 to 1.3 over the same period. More seriously, female IMR in rural areas rose from 34.9 to 36.7 in the period of 1990–2000, as families in rural areas often have a stronger boy preference. [19] [20]

Women's health outcomes

Reproductive health

Prenatal health

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 to 2007 only 38 or 39 percent of women are getting the reproductive examinations that they need. [14] 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. [14] 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.[ citation needed ]

Abortion in China is legal and generally accessible. [21] Abortions are available to all women through China's family planning programme, public hospitals, private hospitals, and clinics nationwide. [22] In August 2022, the National Health Commission announced that it would direct measures toward "preventing unintended pregnancy and reducing abortions that are not medically necessary." [23] Those measures include encouraging reproductive education and improving support measures in the areas of taxation, insurance, education, with encouragement for local governments to boost infant care services and family friendly workplaces. [23]

The National Health Commission also announced that assisted reproductive technology will be gradually included in the national medical system. [23] IVF is expensive in China and has not been accessible to unmarried women. [23]

Labor and delivery

The rate of cesarean sections began to sharply increase in China in the 1990s. [3] :101 This increase was driven by the expansion of China's modern hospital infrastructure, and occurred first in urban areas. [3] :101 The rise in cesarean deliveries has also resulted in social critique of the medical establishment over the medical necessity of performing cesarean sections. [3]

Postnatal health

The tradition of "doing the month" or "sitting the month" (Chinese :坐月子; pinyin :Zuò yuèzi) has significant influence on women's postnatal health in China. Denoted as "postpartum confinement" in western scholarship, it is a series of everyday practices from special diet to restrictive activities meant to help postnatal women to recover from the trauma of birth. It is believed that such practices can help women restore their "harmonious equilibrium" in body and therefore prevent certain diseases later in their lives. [24] Especially in Hong Kong, mother and baby sometimes "sit the month" in special clinics. [25]

Researchers debate whether the tradition is helpful or dysfunctional. Shu-Shya Heh et al. have found that "doing the month" makes women less likely to develop postnatal depression, because they perceive high social support from their family. [26] Other studies have also shown that certain elements of the custom jeopardize postnatal women's health, such as lack of exposure to sunshine or imbalance of nutrition. [27]

HIV/AIDS

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. [28] 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. [28] 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. [28] This uninformed perception of AIDS victims was particularly damaging to women and homosexuals as they were perceived as the carriers of this disease.[ citation needed ]

A recent sign that catches increasing attention is the rise in new infections among women compared to men. Recent estimates by the Chinese Ministry of Health and the Joint United Nations Programme on HIV/AIDS shows that the ratio of reported infections went from 5 men to 1 woman during 1995–1997 to 4 men to 1 woman by 2001. [29] During 1999–2008, the proportion of women infected with HIV doubled compared to the previous decade. [30] During 1999–2008, the proportion of women infected with HIV doubled compared to the previous decade. [30] Analysis by Population Reference Bureau attributes such rise primarily to three aspects: physical vulnerabilities of women, soaring sexually transmitted infection (STI) rates in China, and women's social vulnerability in China. [29] Durin99-2008, the proportion of women infected with HIV doubled compared to the previous decade. [30] Specifically, unprotected sex exposes women to a risk of HIV infection of 2-4 times higher than for men due to the biological structure of women's vagina. [31] Also, STI rates, as a marker of infection rate of HIV/AIDS, are also on the rise in China for the past few decades, and young women in migration or commercial sex industry are particularly vulnerable to STI.[ citation needed ]

Eating disorders

Studies have shown a high level of body dissatisfaction among young women across China. Like other parts of the world, reported eating disorder symptoms are also significantly higher for females than males. Among various predictors, perceptions of social pressure and teasing play a significant role in impacting young women's weight-related concerns. [32] Sing Lee et al. have found that women's concern with body fat is more severe in developed areas such as Hong Kong. Some interpret prevalent eating disorders among women as a side effect of the societal modernization in China. [33]

Suicide

China accounts for 30% of the world's suicide and it is the only country where women have a higher suicidal rate than men. According to Pin Qing's study, approximately 56% of women who committed suicide worldwide were Chinese. Some explanations state that prevailing gender discrimination in China is a main cause of high female suicide. [34] Many traditional concepts of Chinese society, such as an emphasis on women's domestic and reproductive role, all put women at a vulnerable position. In August 2017, the 26-year-old pregnant woman, surnamed Ma, jumped from a hospital window, after she was not allowed to receive C-section by her husband's family. The family declined Ma's request to receive C-section because they believe the procedure would make it harder for her to give birth to a second child. The incident has stirred hot debate about women's status within households and ongoing propaganda on two-child policy. [35]

In recent years, however, female suicidal rate in China has decreased significantly, from 26.1 per 100,000 to 15.7 per 100,000 in 2000. The female to male suicide rate decreased from 1.2 to 0.96 in urban areas. Paul S. F. Yip attributes such progress to rapid modernization during the 1990-2000 decade, which involves great improvement in the standard of living, education, etc. [36]

It is also important to note that the rural suicidal rate is three-fold the urban rate in China, and the decrease in female suicide rate is much less significant in rural areas. Liu Meng's field studies in rural China indicated that women sometimes use suicide as a means of rebellion in their private space, a way to achieve the influence and power that were unattainable in their lifetime. Such is related to the more extreme forms of patriarchal oppression in rural areas. [37]

Intimate Partner Violence

According to studies by William Parish et al. in 2004, 19% of female respondents in China reported experience of intimate partner violence while 3% of their male counterparts reported such. The study showed that duration of the relationship and low socioeconomic status both have a positive correlation with the occurrence of male-on-female violence, and respondents from inland or Northern China are also more frequently found to experience such violence. [38]

Experience of intimate partner violence was found to exert serious adverse impact on women's physical and mental health. Multi-country studies by Henrica A F M indicated that 19-55% women who experienced intimate partner violence were actually injured by their partner and they are exposed to significantly higher risk of mental illness such as emotional distress. [39] [40]

See also

Related Research Articles

<span class="mw-page-title-main">Infant mortality</span> Death of children under the age of 1

Infant mortality is the death of an infant before the infant's first birthday. The occurrence of infant mortality in a population can be described by the infant mortality rate (IMR), which is the number of deaths of infants under one year of age per 1,000 live births. Similarly, the child mortality rate, also known as the under-five mortality rate, compares the death rate of children up to the age of five.

<span class="mw-page-title-main">Health in China</span> Overview of health in China

Health in China is a complex and multifaceted issue that encompasses a wide range of factors, including public health policy, healthcare infrastructure, environmental factors, lifestyle choices, and socioeconomic conditions.Although China has made significant progress in improving public health and life expectancy, many challenges remain, including air pollution, food safety concerns, a growing burden of non-communicable diseases such as diabetes and cardiovascular disease, and an aging population. In order to improve the situation, the Chinese Government has adopted a series of health policies and initiatives, such as the Healthy China 2030 program, investment in the development of primary health-care facilities and the implementation of public health campaigns.

Health equity arises from access to the social determinants of health, specifically from wealth, power and prestige. Individuals who have consistently been deprived of these three determinants are significantly disadvantaged from health inequities, and face worse health outcomes than those who are able to access certain resources. It is not equity to simply provide every individual with the same resources; that would be equality. In order to achieve health equity, resources must be allocated based on an individual need-based principle.

<span class="mw-page-title-main">Healthcare in Pakistan</span> Overview of the health care system in Pakistan

The healthcare delivery system of Pakistan is complex because it includes healthcare subsystems by federal governments and provincial governments competing with formal and informal private sector healthcare systems. Healthcare is delivered mainly through vertically managed disease-specific mechanisms. The different institutions that are responsible for this include: provincial and district health departments, parastatal organizations, social security institutions, non-governmental organizations (NGOs) and private sector. The country's health sector is also marked by urban-rural disparities in healthcare delivery and an imbalance in the health workforce, with insufficient health managers, nurses, paramedics and skilled birth attendants in the peripheral areas. Pakistan's gross national income per capita in 2021 was $4,990 and the total expenditure on health per capita in 2021 was Rs 657.2 Billion, constituting 1.4% of the country's GDP. The health care delivery system in Pakistan consists of public and private sectors. Under the constitution, health is primarily responsibility of the provincial government, except in the federally administered areas. Health care delivery has traditionally been jointly administered by the federal and provincial governments with districts mainly responsible for implementation. Service delivery is being organized through preventive, promotive, curative and rehabilitative services. The curative and rehabilitative services are being provided mainly at the secondary and tertiary care facilities. Preventive and promotive services, on the other hand, are mainly provided through various national programs; and community health workers’ interfacing with the communities through primary healthcare facilities and outreach activities. The state provides healthcare through a three-tiered healthcare delivery system and a range of public health interventions. Some government/ semi government organizations like the armed forces, Sui Gas, WAPDA, Railways, Fauji Foundation, Employees Social Security Institution and NUST provide health service to their employees and their dependants through their own system, however, these collectively cover about 10% of the population. The private health sector constitutes a diverse group of doctors, nurses, pharmacists, traditional healers, drug vendors, as well as laboratory technicians, shopkeepers and unqualified practitioners.

The healthcare reform in China refers to the previous and ongoing healthcare system transition in modern China. China's government, specifically the National Health and Family Planning Commission, plays a leading role in these reforms. Reforms focus on establishing public medical insurance systems and enhancing public healthcare providers, the main component in China's healthcare system. In urban and rural areas, three government medical insurance systems—Urban Residents Basic Medical Insurance, Urban Employee Basic Medical Insurance, and the New Rural Co-operative Medical Scheme—cover almost everyone. Various public healthcare facilities, including county or city hospitals, community health centers, and township health centers, were founded to serve diverse needs. Current and future reforms are outlined in Healthy China 2030.

<span class="mw-page-title-main">Healthcare in China</span> Overview of the health care system in China

Healthcare in China has undergone basic changes over the twentieth century and twenty-first century, using both public and private medical institutions and insurance programs. As of 2020, about 95% of the population has at least basic health insurance coverage.

<span class="mw-page-title-main">Health in Kenya</span> Health status and problems in Kenya

Tropical diseases, especially malaria and tuberculosis, have long been a public health problem in Kenya. In recent years, infection with the human immunodeficiency virus (HIV), which causes acquired immune deficiency syndrome (AIDS), also has become a severe problem. Estimates of the incidence of infection differ widely.

<span class="mw-page-title-main">Health in Mali</span> Overview of health in Mali

Mali, one of the world's poorest nations, is greatly affected by poverty, malnutrition, epidemics, and inadequate hygiene and sanitation. Mali's health and development indicators rank among the worst in the world, with little improvement over the last 20 years. Progress is impeded by Mali's poverty and by a lack of physicians. The 2012 conflict in northern Mali exacerbated difficulties in delivering health services to refugees living in the north. With a landlocked, agricultural-based economy, Mali is highly vulnerable to climate change. A catastrophic harvest in 2023 together with escalations in armed conflict have exacerbated food insecurity in Northern and Central Mali.

<span class="mw-page-title-main">HIV/AIDS in Lesotho</span>

HIV/AIDS in Lesotho constitutes a very serious threat to Basotho and to Lesotho's economic development. Since its initial detection in 1986, HIV/AIDS has spread at alarming rates in Lesotho. In 2000, King Letsie III declared HIV/AIDS a natural disaster. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) in 2016, Lesotho's adult prevalence rate of 25% is the second highest in the world, following Eswatini.

Various issues in medicine relate to lesbian, gay, bisexual, and transgender people. According to the US Gay and Lesbian Medical Association (GLMA), besides HIV/AIDS, issues related to LGBT health include breast and cervical cancer, hepatitis, mental health, substance use disorders, alcohol use, tobacco use, depression, access to care for transgender persons, issues surrounding marriage and family recognition, conversion therapy, refusal clause legislation, and laws that are intended to "immunize health care professionals from liability for discriminating against persons of whom they disapprove."

<span class="mw-page-title-main">Health in Ghana</span>

In precolonial Ghana, infectious diseases were the main cause of morbidity and mortality. The modern history of health in Ghana was heavily influenced by international actors such as Christian missionaries, European colonists, the World Bank, and the International Monetary Fund. In addition, the democratic shift in Ghana spurred healthcare reforms in an attempt to address the presence of infectious and noncommunicable diseases eventually resulting in the formation of the National Health insurance Scheme in place today.

<span class="mw-page-title-main">Healthcare in Ghana</span>

Healthcare in Ghana is mostly provided by the national government, and less than 5% of GDP is spent on healthcare. The healthcare system still has challenges with access, especially in rural areas not near hospitals.

<span class="mw-page-title-main">Health in Bangladesh</span>

Bangladesh is one of the most populous countries in the world, as well as having one of the fastest growing economies in the world. Consequently, Bangladesh faces challenges and opportunities in regards to public health. A remarkable metamorphosis has unfolded in Bangladesh, encompassing the demographic, health, and nutritional dimensions of its populace.

<span class="mw-page-title-main">Missing women</span> Fewer women than expected in a population

The term "missing women" indicates a shortfall in the number of women relative to the expected number of women in a region or country. It is most often measured through male-to-female sex ratios, and is theorized to be caused by sex-selective abortions, female infanticide, and inadequate healthcare and nutrition for female children. It is argued that technologies that enable prenatal sex selection, which have been commercially available since the 1970s, are a large impetus for missing female children.

Botswana's healthcare system has been steadily improving and expanding its infrastructure to become more accessible. The country's position as an upper middle-income country has allowed them to make strides in universal healthcare access for much of Botswana's population. The majority of the Botswana's 2.3 million inhabitants now live within five kilometres of a healthcare facility. As a result, the infant mortality and maternal mortality rates have been on a steady decline. The country's improving healthcare infrastructure has also been reflected in an increase of the average life expectancy from birth, with nearly all births occurring in healthcare facilities.

<span class="mw-page-title-main">Health care access among Dalits in India</span>

Achieving Universal Health Care has been a key goal of the Indian Government since the Constitution was drafted. The Government has since launched several programs and policies to realize ‘Health for All’ in the nation. These measures are in line with the sustainable development goals set by the United Nations. Health disparities generated through the Hindu caste system have been a major roadblock in realizing these goals. The Dalit (untouchables) community occupies the lowest stratum of the Hindu caste system. Historically, they have performed menial jobs like - manual scavenging, skinning animal hide, and sanitation. The Indian constitution officially recognizes the Dalit community as ‘Scheduled Castes’ and bans caste-based discrimination of any form. However, caste and its far-reaching effects are still prominent in several domains including healthcare. Dalits and Adivasis have the lowest healthcare utilization and outcome percentage. Their living conditions and occupations put them at high risk for disease exposure. This, clubbed with discrimination from healthcare workers and lack of awareness makes them the most disadvantaged groups in society.

The World Health Organization (WHO) has defined health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." Identified by the 2012 World Development Report as one of two key human capital endowments, health can influence an individual's ability to reach his or her full potential in society. Yet while gender equality has made the most progress in areas such as education and labor force participation, health inequality between men and women continues to harm many societies to this day.

<span class="mw-page-title-main">Women's health in India</span> Demographic health topic

Women's health in India can be examined in terms of multiple indicators, which vary by geography, socioeconomic standing and culture. To adequately improve the health of women in India multiple dimensions of wellbeing must be analysed in relation to global health averages and also in comparison to men in India. Health is an important factor that contributes to human wellbeing and economic growth.

For years, the census data in China has recorded a significant imbalance in the sex ratio toward the male population, meaning there are fewer women than men. This phenomenon is sometimes referred to as the missing women or missing girls of China. China's official census report from 2000 shows that there were 117 boys for every 100 girls. The sex imbalance in some rural areas is even higher, at 130 boys to 100 girls, compared to a global average of 105 or 106 boys to 100 girls.

Childbirth in China is influenced by traditional Chinese medicine, state control of reproductive health and birthing, and the adoption of modern biomedical practices. There are an estimated 16 million births annually in mainland China. As of 2022, Chinese state media reported the country's total fertility rate to be 1.09. In 2023, there were 7.88 million births.

References

  1. Ariana, Proochista; Naveed, Arif (2009), "Health", in Deneulin, Séverine; Shahani, Lila (eds.), An introduction to the human development and capability approach freedom and agency, Sterling, Virginia Ottawa, Ontario: Earthscan International Development Research Centre, pp. 228–245, ISBN   9781844078066
  2. 1 2 3 Yu, Mei-yu; Sarri, Rosemary (1997). "Women's health status and gender inequality in China". Social Science & Medicine. 45 (12): 1885–1898. doi:10.1016/s0277-9536(97)00127-5. PMID   9447637.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Santos, Gonçalo (2021). Chinese Village Life Today: Building Families in an Age of Transition. Seattle: University of Washington Press. ISBN   978-0-295-74738-5.
  4. Bluementhal, David; Hsiao, William (2005). "Privatization and Its Discontents: The Evolving Chinese Healthcare System". The New England Journal of Medicine. 353 (11): 1165–1170. doi:10.1056/NEJMhpr051133. PMID   16162889.
  5. 1 2 3 Berik, G. N.; Dong, X. Y.; Summerfield, G. (2007). "China's Transition and Feminist Economics". Feminist Economics. 13 (3–4): 1. doi:10.1080/13545700701513954. S2CID   154553158.
  6. Chen, Xiao-Ming; Hu, Teh-Wei (1993). "The Rise and Decline of the Cooperative Medical System in Rural China". International Journal of Health Services. 23 (4): 731–42. doi:10.2190/F8PB-HGJH-FHA8-6KH9. PMID   8276532. S2CID   7625542.
  7. Banister, Judith (1991). China's Changing Population. Stanford University Press.
  8. Lary, Diana (2022). China's grandmothers : gender, family, and aging from late Qing to twenty-first century. Cambridge, United Kingdom: Cambridge University Press. p. 42. ISBN   978-1-009-06478-1. OCLC   1292532755.
  9. Lary, Diana (2022). China's grandmothers : gender, family, and aging from late Qing to twenty-first century. Cambridge, United Kingdom: Cambridge University Press. pp. 42–43. ISBN   978-1-009-06478-1. OCLC   1292532755.
  10. 1 2 Lary, Diana (2022). China's grandmothers : gender, family, and aging from late Qing to twenty-first century. Cambridge, United Kingdom: Cambridge University Press. p. 43. ISBN   978-1-009-06478-1. OCLC   1292532755.
  11. Burda, J. (2007). "Chinese women after the accession to the world trade organization: A legal perspective on women's labor rights". Feminist Economics. 13 (3–4): 259–285. doi:10.1080/13545700701439481. S2CID   154811942.
  12. 1 2 3 4 Ngai, P. (2007). "Gendering the dormitory labor system: Production, reproduction, and migrant labor in south China". Feminist Economics. 13 (3–4): 239–258. doi:10.1080/13545700701439465. S2CID   154431203.
  13. 1 2 Liu, J. (2007). "Gender dynamics and redundancy in urban China". Feminist Economics. 13 (3–4): 125–158. doi:10.1080/13545700701445322. S2CID   154873982.
  14. 1 2 3 4 5 6 Chen, L.; Standing, H. (2007). "Gender equity in transitional China's healthcare policy reforms". Feminist Economics. 13 (3–4): 189. doi:10.1080/13545700701439473. S2CID   153725632.
  15. Dong, Xiao-Yuan (March 2003). "Soft budget constraints, social burdens, and labor redundancy in China's state industry". Journal of Comparative Economics. 31 (1): 110–133. doi:10.1016/s0147-5967(02)00012-4.
  16. Liu, Jieyu (2007). "Gender dynamics and redundancy in urban China". Feminist Economics. 13 (3–4): 125–158. doi:10.1080/13545700701445322. S2CID   154873982.
  17. Shi, Jing; Liu, Meina; Zhang, Qiuju (2008). "Male and Female Adult Population Health Status in China: A cross-sectional national survey". BMC Public Health. 8 (277): 277. doi: 10.1186/1471-2458-8-277 . PMC   2529296 . PMID   18681978.
  18. Zhang, Xiaobo; Kanbur, Ravi (2005). "Spatial inequality in education and healthcare in China" (PDF). China Economic Review. 16 (2): 189–204. doi:10.1016/j.chieco.2005.02.002. hdl: 1813/58074 . S2CID   7513548.
  19. Hesketh, T.; Lu, L.; Xing, Z. W. (6 September 2011). "The consequences of son preference and sex-selective abortion in China and other Asian countries". Canadian Medical Association Journal . 183 (12): 1374–1377. doi:10.1503/cmaj.101368. PMC   3168620 . PMID   21402684 . Retrieved 21 October 2022.
  20. Murphy, Rachel; Tao, Ran; Lu, Xi (2011). "Son Preference in Rural China: Patrilineal Families and Socioeconomic Change". Population and Development Review . 37 (4): 665–690. doi:10.1111/j.1728-4457.2011.00452.x. ISSN   0098-7921. JSTOR   41762376. PMID   22319769 . Retrieved 21 October 2022.
  21. Miller, Claire Cain; Sanger-Katz, Margot (2022-01-22). "On Abortion Law, the U.S. Is Unusual. Without Roe, It Would Be, Too". The New York Times. ISSN   0362-4331 . Retrieved 2022-10-20.
  22. "China's controversial history of abortion needs different cultural lens". South China Morning Post. 2022-06-19. Retrieved 2023-01-01.
  23. 1 2 3 4 Master, Farah; Zhang, Albee (2022-08-16). "China to discourage abortions to boost low birth rate". Reuters . Retrieved 2022-08-16.
  24. Holroyd, Eleanor (1997). ""Doing the month": an exploration of postpartum practices in Chinese women". Health Care for Women International. 18 (3): 301–313. doi:10.1080/07399339709516282. PMID   9256675.
  25. Lary, Diana (2022). China's grandmothers : gender, family, and aging from late Qing to twenty-first century. Cambridge, United Kingdom: Cambridge University Press. p. 41. ISBN   978-1-009-06478-1. OCLC   1292532755.
  26. Heh, Shu-Shya (2004). "The association between depressive symptoms and social support in Taiwanese women during the month". International Journal of Nursing Studies. 41 (5): 573–579. doi:10.1016/j.ijnurstu.2004.01.003. PMID   15120985.
  27. Strand, Mark; Perry, Judith (2009). "Doing the month: rickets and postpartum convalescence in rural China". Midwifery. 25 (5): 588–596. doi:10.1016/j.midw.2007.10.008. PMID   18276049.
  28. 1 2 3 Kaufman, J. (2010). "Turning Points in China's AIDS Response". China: An International Journal. 08: 63–84. doi:10.1142/S0219747210000051. S2CID   154615367.
  29. 1 2 Thompson, Drew. "China's Growing AIDS Epidemic Increasingly Affects Women". Population Reference Bureau. Retrieved 26 November 2017.
  30. 1 2 3 Lu, Lin; Manhong, Jia; Ma, Yanling (2 October 2008). "The changing face of HIV in China". Nature. 455 (7213): 609–11. Bibcode:2008Natur.455..609L. doi: 10.1038/455609a . PMID   18833270. S2CID   2407257.
  31. Wilkinson, David (October 2002). "Nonoxynol-9 spermicide for prevention of vaginally acquired HIV and other sexually transmitted infections: systematic review and meta-analysis of randomised controlled trials including more than 5000 women". The Lancet Infectious Diseases. 2 (10): 613–617. doi:10.1016/s1473-3099(02)00396-1. PMID   12383611.
  32. Chen, Hong; Jackson, Todd (25 October 2007). "Prevalence and sociodemographic correlates of eating disorder endorsements among adolescents and young adults from China". European Eating Disorders Review. 16 (5): 375–385. doi:10.1002/erv.837. PMID   17960779.
  33. Lee, Sing; Lee, Antoinette (2000). "Disordered eating in three communities in China: A comparative study of female high school students in Hong Kong, Shenzhen, and rural Hunan". International Journal of Eating Disorders. 27 (3): 317–327. doi:10.1002/(SICI)1098-108X(200004)27:3<317::AID-EAT9>3.0.CO;2-2. PMID   10694718.
  34. Qin, P. (2001). "Specific characteristics of suicide in China". Acta Psychiatrica Scandinavica. 103 (2): 117–121. doi:10.1034/j.1600-0447.2001.00008.x. PMID   11167314. S2CID   33382774.
  35. Allen, Kerry (7 September 2017). "Chinese debate medical rights after pregnant woman's suicide". BBC News.
  36. Yip, Paul (2005). "Suicide rates in China during a period of rapid social changes". Social Psychiatry & Psychiatric Epidemiology. 40 (10): 792–798. doi:10.1007/s00127-005-0952-8. PMID   16205852. S2CID   6100606.
  37. Qin, P. (2001). "Specific characteristics of suicide in China". Acta Psychiatrica Scandinavica. 103 (2): 117–21. doi:10.1034/j.1600-0447.2001.00008.x. PMID   11167314. S2CID   33382774.
  38. Parish, William; Wang, Tianfu; Laumann, Edward (December 2004). "Intimate partner violence in China: National Prevalence, Risk Factors and Associated Health Problems". International Family Planning Perspectives. 30 (4): 174–181. doi: 10.1363/3017404 . JSTOR   1566491. PMID   15590383.
  39. Henrica A F M, Jansen; Lori, Heise; Charlotte H, Watts (2008). "Intimate partner violence and women's physical and mental health in the WHO multi-country study on women's health and domestic violence: an observational study". The Lancet. 371 (9619): 1165–1172. doi:10.1016/s0140-6736(08)60522-x. PMID   18395577. S2CID   585552.
  40. Xu, Xiao; Zhu, Fengchuan; O'Campo, Patricia (3 February 2004). "Prevalence of and Risk Factors for Intimate Partner Violence in China". American Journal of Public Health. 95 (1): 78–85. doi:10.2105/ajph.2003.023978. PMC   1449856 . PMID   15623864.
  41. Chen, J.; Summerfield, G. (2007). "Gender and rural reforms in China: A case study of population control and land rights policies in northern Liaoning". Feminist Economics. 13 (3–4): 63. doi:10.1080/13545700701439440. S2CID   154606954.
  42. Bloom, Gerald; Lu, Yuelai & Chen, Jiaying (2003). "Ch 12 "Financing Health Care in China's Cities: Balancing Needs and Entitlements". In by Catherine Jones Finer (ed.). Social Policy Reform in China: Views from Home and Abroad. Ashgate. pp. 155–168. ISBN   9780754631750.
  43. Xin, Gu (2010). "Ch 2 Towards Central Planning or Regulated Marketization? China Debates on the Direction of New Healthcare Reforms". In Zhao Litao; Lim Tin Seng (eds.). China's New Social Policy Initiatives for a Harmonious Society. Vol. Vol 20. World Scientific. ISBN   978-981-4277-73-0.
  44. Åke Blomqvist & Qian Jiwei (2010). "Ch 3 Direct Provider Subsidies vs Social Health Insurance: A Compromise Proposal". In Zhao Litao & Lim Tin Seng (eds.). China's New Social Policy Initiatives for a Harmonious Society. Vol. Vol 20. World Scientific. ISBN   978-981-4277-73-0.

Further reading