On June 30, 2022, six days after the United States Supreme Court overturned Roe v. Wade, the Chinese foreign ministry’s then-spokesperson Zhao Lijian was asked to comment on the decision at a press conference. He responded that “(t)he conditions of women’s rights in the U.S. indicates [sic] once again that the country is in no position to claim itself as a ‘human rights defender.” On February 20, 2023, in a 4,000-word treatise titled “U.S. Hegemony and Its Perils,” the Chinese government once again highlighted U.S. attitudes to abortion, citing former president Donald Trump’s 2017 decision to withdraw U.S. funding for the United Nations Population Fund on abortion-related grounds as evidence that Washington “[puts] its domestic law above international law.” (The decision was reversed in early 2021 under President Joe Biden.)
By condemning reproductive policies in the U.S., China seeks to brand itself as an international champion of gender equality. However, abortion access is rocky terrain in China. People within and outside the country recall the forced abortions that were performed in service of the one-child policy, which was in place from around 1980 to 2015. But since the early 2000s, a range of local restrictions on women’s access to abortion have been introduced. These measures include banning or requiring government approval for abortions after 14 or 18 weeks of gestation. The motivation for these restrictions is not religion, as in the U.S., but a desire to curb sex-selective abortions. Though some regions in China relaxed their abortion policies after the one-child policy was scrapped in 2015, others introduced restrictions, and did so with fervour, as sex ratios remained highly skewed in favour of male children.
The backlash against these more restrictive policies exposes an emerging tension in Chinese society: while the male-dominated government seeks to assert its vision of social governance as superior on the global stage, domestically it is contending with apathy, frustration, and occasionally outright rebellion from many of the country’s women, who face a remarkably complex fight for abortion access.
The abortion issue in China falls at the crossroads of policy, traditional culture, and medical misinformation sponsored by state propaganda. In the post-one-child era, the Chinese state faces a different kind of demographic crisis: a rapid drop in birthrates and a contracting population. Fewer children means a smaller labour force in the decades to come, posing a grave threat to China’s industrialization, urbanization, and ability to become a high-income nation. Beijing may well feel motivated to reduce abortions to increase the number of births; but in doing so, it enmeshes its political objectives with Chinese women’s reproductive freedom.
The origins of the 14-week ‘ban’
China has one of the world’s most male-heavy sex ratios: about 115 men per 100 women. Preference for boys is deeply ingrained in traditional Chinese culture, especially in central and southern China, where having many children, especially boys, is historically highly revered. During the one-child policy, families that desired boys often sought illegal means to determine their unborn fetus’s sex and abort females.
Since the early years of the one-child policy, central and local governments have imposed regulations to curb the practice of sex-selective abortion. The country’s first legislative attempt at banning sex-selective abortions came into effect in 2003. The ‘Provisions on Prohibiting Fetal Sex Identification for Non-medical Needs and Sex-Selective Pregnancy Termination’ (‘Provisions’) required that any procedures to terminate a one-child-compliant pregnancy after 14 weeks of gestation be approved by a county-level family planning bureau. But there are also non-legislative means for limiting abortion access. For example, national insurance coverage of abortion procedures differs greatly across cities and provinces. In general, medically necessary abortions and abortions done to comply with family planning regulations are more likely to be covered, while voluntary abortions, especially abortions requested by unmarried patients, are rarely covered.
During the following decade, many regions tightened restrictions. The city of Guangzhou, for example, made no reference to abortion in its first family planning regulation in 2001. However, a revised version in 2005 made getting government approval for an abortion mandatory: “For pregnancies conceived in line with the ‘Guangdong Provincial Regulations on Population and Family Planning’ and where emergency situations are not applicable, requests for induced abortions should be supported by a certificate of approval issued by a family planning department at or above the county level.” In 2013, in its third revision of the family planning policy, Guangzhou added some exceptions: unmarried women and those who are fewer than 14 weeks pregnant were exempt from seeking government approval for abortions.
Since these policies were implemented during the one-child era, there is good reason to believe that certifying bodies rarely barred citizens from abortions. However, these regulations, while largely failing to curb sex selection, had two important effects. First, they emboldened the family planning bureaucracy. And second, they entrenched institutionalization of the procedure. Specifically, abortion, along with much of reproductive care in China, became its own special class of medical procedure regulated by state and societal objectives, instead of a private decision between a doctor and a patient. Professor Liang Hongxia of China’s Southwest University of Political Science and Law, using data from Hunan, Liaoning, and Anhui provinces, showed in a 2018 journal article that 14-week abortion restrictions had no observable impact on sex ratios among newborns.
The national ‘Provisions’ were comprehensively revised in 2016 and the 14-week clause was removed. Regional authorities followed suit: Guangzhou, for example, removed all references to government approval for abortions in its most recent revision of the local family planning regulation in 2018. However, these same ‘Provisions’ tightened regulations around medical abortions. In addition to reiterating the 2003 ban on retail sales of abortion-inducing medications, the 2016 update further specified that medical abortions may only be performed under the supervision of medical professionals affiliated with institutions authorized to perform surgical abortions. This contravenes recommendations from the World Health Organization as well as international researchers, who find that medical abortions can be self-administered safely in the early phase of pregnancy.
In 2018, Jiangxi province in eastern China attracted widespread attention when it instituted strict restrictions on abortion. Any patient who is allowed to have another child but wishes to terminate a pregnancy after 14 weeks of gestation must prove that the procedure is medically necessary and obtain signatures from three doctors. Many Chinese ‘netizens’ say the policy displayed government disregard for women’s reproductive freedom, and that it felt like whiplash after decades of the one-child policy: “Back then [the government] wouldn’t let [women] give birth when they are eight-months pregnant, and now they wouldn’t let people have abortions after three months!”
Abortion, medical misinformation, and misogyny
In 2019, a now-banned Weibo user named “Feminist Knight” (@女权女侠) shared a viral post detailing regional policies restricting access to abortion after 14 weeks of pregnancy, arguing that “Chinese women's loss of abortion rights began a long time ago.” The user faced furious attacks by anti-feminists, who argued that the “anti-China” post drew false equivalence between local policies that discourage sex selection and American human rights violations.
The case is illustrative of the minefield advocates face in contemporary China’s internet environment, in which it is difficult to critique domestic social policy without facing ethnonationalist accusations of disloyalty. Conservatives and state censors regard feminist rhetoric and LGBTQ+ activism as “Trojan horses” that make China vulnerable to Western influence. This environment has prevented comprehensive, unbiased debates on domestic abortion policies.
In the United States and Europe, contemporary anti-abortion movements are inextricably tied to religion, and particularly Christianity. Since China is perceived as deeply secular, Western commentators often assume that the abortion debate is devoid of moral or ethical dilemmas. In fact, female social media users in China are often candid about their complicated emotional experiences with abortion. In a 2022 question thread titled “Do girls who have had abortions regret it?” posted on Zhihu, China’s Quora, and viewed more than 579,000 times, the top-voted response reads, “Every girl who has ever had an abortion regrets it.” The person who posted this statement was a university student who said she had two abortions. She said she experienced “chronic health issues” ever since the termination of her first pregnancy in middle school.
The user shared that throughout her middle school and high school years, she was in a sexual relationship with a much older man. She writes that she had received no sex education before meeting him. The man paid for her first abortion, but when she became pregnant again, he initially refused to pay and threatened to reveal their relationship publicly. Eventually, the man found a private clinic where the procedure could be done relatively cheaply, at less than C$400 (2,000 Chinese yuan). The user says that after the relationship ended, she learned about Buddhism through internet communities, which convinced her that she made an “unforgivable mistake” in deciding to abort her fetuses.
This anonymous Zhihu user’s story, while not representative of most abortion seekers in China, nonetheless reflects a variety of factors essential to the abortion discussion in China. Even when abortion is fully legal, the legal system, health-care institutions, and social stigma limit access. Chinese law does not explicitly grant minors the right to consent to their own medical treatments. To avoid being held liable, public hospitals usually only perform abortions on underage patients if they are accompanied by parents or guardians. Young women who do not want to inform their parents of their pregnancies thus visit private clinics, some of which charge sky-high fees and are unscrupulous in their medical practices.
These young women are also not well equipped to prevent pregnancy to begin with. Sex education is often severely lacking in Chinese schools, and when young people seek out information online, they encounter rumours, horror stories, and misleading narratives. The paucity of reliable information is particularly egregious given the relatively high rates of abortion in China. A study published in the British Medical Journal found that between 2015 and 2019, China had the second highest rate of unintended pregnancy termination in East and Southeast Asia. Due to these statistics, cultural beliefs (including theories from traditional Chinese medicine and folklore), and a lack of gynaecological literacy, many in the country have come to believe the myth that Chinese women are increasingly infertile due to frequent abortions.
Chinese health authorities’ interest in curbing the prevalence of abortions stems in part from the emphasis on youshengyouyu (优生优育), which generally means to improve the “quality” of births, a longstanding priority for China’s family planning bureaucracy. This priority is driven by a belief that abortions negatively affect maternal health, and state organs discourage the procedure by exaggerating the risks. A National Health Commission directive on promoting contraception in 2018 said: “Abortion is a remedial measure taken after an unwanted pregnancy. Abortion can cause serious damage to a woman's fertility and reproductive health and may lead to a variety of complications and secondary infertility, with a higher risk of complications and secondary infertility after repeat abortions.”
Decades of large- and small-scale studies, including ones in China, have shown little to no causal relationship between previous abortion procedures and infertility. However, central and local health authorities in China continue to promote the falsehood that abortion is physically damaging to women. A Jiangxi province announcement in 2018, issued in response to media inquiries about its aforementioned abortion restrictions, said that: “We have found in our work that many young people have abortions for unwanted pregnancies due to inadequate contraception, which adversely affects women’s health, and in some cases, even affects their future fertility. The cost is tragic.”
Government directives frame abortion as a self-inflicted tragedy rather than a regularly performed medical procedure. The propagandistic narrative then feeds into a digital landscape rife with both misogyny and profiteering by private medical providers. Vulnerable patients — like the anonymous Zhihu user — are led to believe that they are at fault for seeking health care and are thus further marginalized.
Peering over a demographic cliff
Alarm bells went off when, in August 2022, the National Health Commission’s (NHC) new birth-encouraging plan included a directive to “reduce abortions that are not medically necessary.” The influential U.S.-based feminist scholar Leta Hong Fincher said in the aftermath of the announcement that she expected the Chinese state to restrict abortions for several years. Fincher argues that abortion has long been a political tool for economic and ethnic control in China; in her view, a state that is willing to enforce, and continue to justify, a stance as draconian as the one-child policy would have no qualms denying abortion to serve its economic targets. However, with the extraordinary rise in feminist consciousness over the past 20 years, any attempts at introducing explicit abortion bans in China will likely see enormous public pushback. Simply citing economic need and evoking nationalism are unlikely to resonate with the country’s increasingly independent and politically conscious women.
In November 2022, as part of a wider regulation of the medical market, and citing risks to women’s health, China’s National Medical Products Administration banned two abortion pills from being sold online. One of these – mifepristone – is currently at the heart of a raging debate in the U.S. over access to abortion medications. The Chinese state could lean on the longstanding misinformation and medical myths discussed earlier to justify these subtle, yet still impactful, restrictions on abortion access. The erosion of Chinese women’s reproductive freedom could be accelerated through top-down pressures on the country's medical establishment. The sector is entangled with the state and, as demonstrated during the COVID-19 pandemic, can be easily pressured by central and local authorities to put politics above standards of care.
Article 17 of China’s Population and Family Planning Law states that: “Citizens have the right to reproduction as well as the obligation to practise family planning according to law. Both husband and wife bear equal responsibility for family planning.” Prescribing a “right to reproduction” is a relatively unique feature of China’s legal system, and some researchers say this right could also threaten access to abortion. When the "right to reproduction" clause first came into force in 2002, some hospitals began asking for husbands’ signatures from married women seeking abortions for fear of impugning on men’s right to reproduction. The Supreme People’s Court, China’s top court, later issued a clarification saying that courts "will not support” cases where husbands sue for damages to their reproductive rights after their wives terminate pregnancies. Nevertheless, ‘netizens’ still sometimes share that hospitals ask for spousal consent before proceeding with abortion procedures.
In February 2023, a Chengdu court ruled that termination of pregnancy without spousal consent or “legitimate reasons” constitutes a violation of men’s right to reproduction. The judge’s decision specified three such “legitimate reasons”: the woman has a health condition incompatible with pregnancy, the couple is living separately after a breakdown in the relationship, or the wife has already requested a divorce. The case sets a potentially chilling precedent for abortion rights in China, as it erodes existing precedents and appears to deny married women the autonomy to make decisions about their own medical procedures.
Watch this space for more debate
In the coming years, China’s aging population and contracting labour force will influence the CCP’s public health policymaking. But the politicization of abortion access in China is already here: regardless of the direction in which the country’s overwhelmingly male decision-makers take the country in the wake of the August 2022 proclamation, Chinese women know that their reproductive freedom is contingent upon Beijing’s national economic blueprint.
