The cause of the concern about induced abortion is our previous push < < uncontroversial sex teaching materials are not good teaching materials > >-China has 13 million abortions every year, Ranked first in the world. Even on the platform of Clove Garden, which has 2 million practicing doctors, this data also makes people gasp. As we deepen, we find more striking data and scenes:
A 17-year-old girl with a history of 7 abortions, a private clinic where she advertised abortions in a pregnancy test stick;
Among the women who have had abortion, 45% of the repeated abortion time intervals are only 0.5-1.5 years. 13.5% had more than 3 abortions.
The telephone number of a 3A hospital for follow-up and contraceptive education after abortion was marked as harassing telephone number.
The proportion of women under the age of 25 in abortion is 47.5%, and the proportion of these women who have never given birth is 49.7%.
Abortion is the complex and main theme in youth movies, with advertisements everywhere, while sex education is like a scourge.
Here, there is no religious reverence for life, but there is a distortion of relevant information driven by profit. In addition, due to historical and cultural reasons, due to timing or fate, various contraceptive methods, in this land, have not found a suitable soil…
Don’t want to go in the second place
A medical student drew the abortion room where he worked for me. The three rooms were connected in a string. The waiting room, the operating room and the rest room were long and narrow. There was a registration table at the entrance and two operating tables in the operating room.
[It’s a, uh, place where you don’t want to go in once and you don’t want to go in twice? ]
[Pale, pale? ]
[No, the ground is gray, the granite of old-fashioned hospitals, cold but not as sterile as other operating rooms… Another point is that due to structural reasons, people in the waiting room can see nurses coming out of the operating room to treat sucked embryos. I can’t imagine what those people (waiting for surgery) will think in their hearts.]
It is a second-tier city medical college affiliated hospital, the daily abortion operation volume is about 7 or 8 units in the off season, and there will be more than 10 units in the peak season. The so-called peak season usually occurs after the May Day, National Day and other small long holidays.
At 12: 30 noon, the family planning clinic of a 3A hospital in Shanghai, the doctor is still on duty. Because most of the pre-judgment did not have an outpatient service at noon, there were not many people queuing outside the clinic, but the patients in front of the doctor were one by one, in an endless stream, and from time to time someone probed in from the open door, there was no privacy here.
At noon, I met a little girl with neat bangs and short front and long back hair from Japanese cartoon books timidly describing [illness] to the doctor: [Well… I am pregnant]. The girl’s face shrank again into the lamb woolen collar. The age column on the medical record said 18. The doctor sighed and confirmed to her: [Don’t want it, think it over? ] The girl nodded desperately… … …
The doctor told me, [This kind of faltering, Not much, After all, you will come only after you think it over.] In the clinic whose name has a special meaning in China, Patients can be roughly divided into two categories, 45 years old under the flow of people, 45 years old over to take ring. The former of the crowd and mainly divided into two categories, embryos died need to clear the palace, embryos live well but not suitable for birth. It was a Tuesday, the hospital’s painless abortion operation has been about next Monday.
Behind Ten Million Abortions
The reason for paying attention to induced abortion is that our previous push < < uncontroversial sex teaching materials are not good teaching materials > >. China’s 13 million annual abortion operations have hot eyes of many people, and have also caused more complaints, such as the younger age of patients and repeated abortion.
There is also an obstetrician’s message, [once there was a G12P1 on the night shift, and everyone laughed at me for not waking up when I was handed over in the morning]-the so-called G and P are gynecological terms, G is gravidity, i.e. Pregnancy, P is parity, childbirth, G12P1 is 12 pregnancies, once childbirth.
Another obstetrician said that she had seen a 17-year-old girl with 7 pregnancies and 0 births-7 pregnancies and 7 miscarriages.
For the well-known 13 million, The source of this data, Wu Shangchun, who has a bright voice, A researcher from the Institute of Science and Technology of the National Population and Family Planning Commission explained on the phone: [That’s 1990 data.] During that period, both the health system including hospitals and maternal and child health hospitals and the family planning system with family planning service stations could perform abortion operations. Due to statistical reasons, it was difficult for outsiders to obtain an accurate total from their respective data, and why did they choose this data? Because it has a clear source, [this is the data quoted by Chinese obstetrics and gynecology.]
The number of abortions in China declined slightly after peaking in 1995. Since then, the number of abortions for policy reasons has become less and less. Instead, more and more women have taken to the abortion table for personal reasons.
In the latest medical yearbook, the number of abortions in 2014 and 2015 was more than 9 million. According to WHO data, the number of abortions worldwide from 2010 to 2014 was about 56 million, that is to say, China accounted for one sixth of the world’s abortions.
In Shanghai’s 3A hospital, which needs to make an appointment almost a week in advance, the relevant medical staff revealed that the number of induced abortions in the hospital has not increased significantly in the past five years. However, the current situation is still worrying according to several important indicators. Several important characteristics of abortion in China include: the younger age of the population and the high proportion of repeated abortions.
At the Nanjing Center of Maristep, an international organization specializing in reproductive health services for unmarried adolescents, head nurse Liang Li told me about the youngest patient they met:
About 16 years old, junior high school, the little boy accompanied the little girl, after the Spring Festival with New Year’s money to do abortion, and 16 or 17 years old, the mother accompanied…
She also talked about a girl who still puzzled her-twenty-two or three years old, Dress up in fashion, He went to their clinic for four abortions in two years. [After the first operation, We did contraceptive science popularization. About two months after the operation, she came again, and we told her that you would affect the future. When you want children, it would not be easy to conceive a healthy baby. But after a short time, she came again. Every time she came, she would say: You didn’t say I couldn’t conceive, look at me pregnant again, I came again…]
The head nurse is over forty, She laughed with curved eyes and affinity. She had a son who went to high school, but her face was puzzled when she told the story. She really couldn’t understand-[We don’t mean we can’t conceive, we can conceive, but it’s hard to say whether the child can stay in your womb and whether you can give birth to a healthy baby.]
Finland has collected data on more than 300,000 registered primiparas from 1996 to 2008. The results show that people with a history of induced abortion have a high risk of perinatal death and extremely premature delivery (less than 28 weeks), and the risk of extremely premature delivery is related to the number of induced abortions. The more the number of abortions, the higher the probability of extremely premature delivery of children.
The data on abortion has always been vague, and the government has not published any data on the proportion of married and unmarried, age composition ratio, repeated abortion rate, etc. Based on literature summary, Wu Shangchun and his colleagues found that the age of abortion women is obviously younger:
The proportion of women under the age of 25 in abortion is 47.5%, and the proportion of these women who have never given birth is 49.7%.
55.9% of the women did not undergo abortion for the first time.
45% of repeated abortions have a time interval of only 0.5-1.5 years.
13.5% had experienced more than three abortions.
There has never been a minimally invasive abortion.
When we want to look for a doctor who is good at induced abortion in the doctor’s database, But found a difficult problem, No doctor will write abortion in his own [expertise]. Yao Xiaoying, chief physician of the Family Planning Department of Fudan University’s Affiliated Obstetrics and Gynecology Hospital, briefly explained the cause of this phenomenon: [It’s a minor operation, which does not reflect the level of diagnosis and treatment]. Yao Xiaoying entered the family planning department in 2001. In her brief introduction, she only mentioned [family planning-related surgery] very implicitly.
And how do those girls who get pregnant unexpectedly choose the abortion hospital?
A girl who accompanied her best friend to have an abortion chose [the hospital on the medical card in the pregnancy test stick]-stuffing a medical card in the pregnancy test stick is one of the illegal promotion forms of some private abortion clinics.
The hospital is not far from the residence, To register in the afternoon, Surgery at night, It ended at 8: 30 p.m. A girl born in 1991 chose a small clinic in the next county. [It was 2009, the summer vacation after my college entrance examination. We went to a small clinic in the next county because we couldn’t do it nearby. The advantage was that it was cheap. At that time, we didn’t have the capital to choose whether it was suitable or not. It was unreliable. For me, the only thing I could do was to complete the operation within the scope of economic affordability.]
A person who passed through the post-90s generation twice told me that in 2013, she went to the local public hospital for the first time when she was pregnant unexpectedly. Her attitude was cold, but she was at ease and cheap, and it cost more than 1,000 yuan. In the winter of 2015, she had a second unexpected pregnancy and wanted to go to the public. As a result, the queue time was too long and the pregnancy reaction was especially uncomfortable. She went to a very expensive private clinic with a very good attitude. After the abortion, she was diagnosed with cervical erosion (a physiological phenomenon that no longer exists in medical textbooks and is considered to be over-treated). She made an extra LEEP knife, which cost more than 4,000 in total.
The process of abortion-uterine expansion, attraction and curettage, doctors are most afraid of, one is uterine perforation, the other is incomplete abortion, especially the former, because the latter may need curettage again, and the former may directly endanger life.
At the entrance of the flow room, Yao Xiaoying showed me various types of silver-shining palace expansion rods, straws used to connect negative pressure suction, and scrapes with sharp circles.
She said, [There is no so-called minimally invasive abortion in unreliable advertisements, and things must be sucked out. If they cannot be sucked out, there will be problems of long bleeding time and large residual opportunities.]
In Maristep, doctors will receive training from London headquarters to operate manual negative pressure aspirator (MVA) for abortion, which is considered to be relatively safe in the world. As a result, many private clinics in online advertisements use this as a gimmick and claim to provide [Maristep abortion with painless and safe palace].
That’s impossible, The surgery they provide is definitely different from our standard procedure], Liang Li analyzed to me, [Maristep’s abortion is only under local anesthesia, without pain, and according to the operation specifications, no curettage is required. As long as the embryo is sucked out, if there is still decidua residue, they will fall off by themselves, and there may be continuous intravenous bleeding. However, if it is a high-priced private clinic, in order to appear clean, they will definitely scrape the intima clean…]
In < < only doctors know > >, Dr. Zhang Yu of Concorde Hospital described the pain of the whole abortion process:
With the [use] of this pain-induced abortion at the beginning, By sucking the embryo and the placenta under negative pressure, Often it is not very painful, The next step is a complete curettage of the uterine cavity. The scratching was drawing to a close, That is, near the myometrium, It will cause a sharp pain from the lumbosacral region to the heart and brain. The woman who has been biting her lips with forbearance on the bed, At this time, most people can’t help shouting. After embryos and other pregnant objects are removed, The uterus contracted rapidly, Doctors will find that, The straw that entered and left the uterus smoothly was now firmly sucked by the contracted uterus. At the same time, The curette scratches the myometrium, The unique feeling transmitted to doctors through metal instruments, It is called [muscular sound], similar to the sound and touch of fingernails scratching directly on rough walls. Uterine contraction, [cry] and [muscular sound] are the three major factors that urge doctors to stop in time. However, in recent years [painless abortion], without [cry] on the abortion bed, uterine contraction and [muscular sound] are not so obvious under general anesthesia…
In Yao Xiaoying’s hospital, There is a special nurse in charge of telephone follow-up after flow. It is a post-abortion care program called PAC, The hospital will make regular phone calls to communicate with the patients about their recovery, mental state and psychological status after the abortion within 6 months after the abortion. As well as carrying out contraceptive education again. However, this phone call is not easy to make, and the loss of patients is very serious. Some people simply registered fake numbers, while others refused to answer hospital calls. [On some platforms, our follow-up numbers were simply marked as harassing calls.]
In China today, There are not many cases of direct death and disability caused by abortion, but complications after abortion are not uncommon. These complications are mainly reflected in the impact on reproductive health, especially the weakening of female fertility, that is, some girls will lose the ability to become mothers without realizing it when [the dream lasts for three minutes and the troubles disappear].
In a CCTV program on induced abortion in 2015, the camera was extended to the Hysteroscopic Center of Fuxing Hospital, where the girls cried until they nearly fainted because they found that they had lost their ability to be mothers.
Intrauterine adhesion is one of the causes of infertility, [cervical adhesion is itself a complication of negative pressure aspiration, and about 80% to 90% of people with cervical adhesion have undergone induced abortion,] Wu Shangchun explained.
Among the complications of induced abortion, there are various diseases with infertility as the outcome-tubal obstruction, intrauterine adhesion…
As a cause of disease, Induced abortion often leads to a series of reproductive system diseases through a complex etiological chain. Common, such as secondary infertility or premature birth of newborns, etc. And because it is not easy for people to pay a return visit, it is difficult for us to obtain accurate data on the number of abortions and the incidence rate of certain complications in China. Even, we are not clear about the incidence rate of these complications in China alone and whether there is a trend of increasing year by year.
[No, there is a special shortage of such data,] Wu Shangchun said.
The only thing we can say accurately may be as a review in the Chinese Journal of Family Planning said: [The more induced abortions, the more complicated the conditions related to secondary infertility in these women, and the less optimistic the pregnancy outcome.]
It’s not mine, is it? I didn’t shoot it in
The World Health Organization (WHO) said: [There is clear evidence that investing in contraception can save lives, promote gender equality and enhance economic development. For every dollar invested in modern contraception and high-quality maternal and newborn health care, there will be a return of about US $120.]
However, in China, at least, more publicity funds are invested in abortion rather than contraception-abortion advertisements are everywhere, but contraceptives cannot be advertised. The reason is very simple, the latter is considered [products related to sex life] and is forbidden to be published.
What are the reasons for the unexpected pregnancy of the patients in the family planning clinic? Yao Xiaoying replied: [It is mainly the lack of sex education and lucky psychology.]
In Zhihu, when it comes to the reason why there is no condom, some girls said, [damaging the atmosphere]; Some boys said, “Passion is coming.” Several girls who had undergone abortion told me that their contraceptive method at that time-safety period or external shooting. Some girls also told me that after she became pregnant, her boyfriend’s first reaction was: “It’s not mine, I didn’t shoot in].
As a matter of fact, even if condoms are used, because it is often difficult to achieve full and effective [perfect] use, their contraceptive effect is very general compared with IUD and contraceptive pills.
Apart from the problem of usage habits, due to historical and cultural reasons, due to timing or fate, various contraceptive methods have failed to find a suitable soil in this land.
Sheung Wan was rated as [that is for mothers’ generation, I don’t use it]. There are also many stories about being forced to take out the ring after menopause, only to find that it has been embedded in the uterus. No one will delve into it. The contraceptive ring actually has a life span, usually 5 to 20 years. In WHO’s recommendation of contraceptive methods, the effectiveness of the ring is tied with ligation, which is the first recommended long-term reversible contraceptive method.
Male-dominated contraceptive methods, such as vasectomy, are very rare here. In 2015, vasectomy accounted for only 0.6% of family planning surgeries in China, compared with 10.8% of couples in the United States and 21% in the United Kingdom that year.
Unlike in the West, behind the development of birth control pills, feminist activists are shouting around for fund-raising. In order to find something that can make sex more free, a woman can match her orange juice every morning or take it conveniently while brushing her teeth without asking the man beside her pillow for advice.
China’s contraceptive research is a national project. The whole research started in the 1960s, with several research groups and sports-style contraceptive research. At that time, the research and development results were named after numbers, such as No.1, No.2 and No.0. Born in 1968, China’s first generation of contraceptives, and No.53 contraceptive was the famous “family visit contraceptive” at that time.
In the United States in the 1960s, a woman kissed a photo published in the newspaper by the inventor of the contraceptive pill. [She was so grateful that this was the first year in her eight years of marriage that she had not been pregnant.]
In China, however, around this strange and mysterious pill, which makes life impossible for children, is panic and doubt about drugs. Hormones, obesity or thrombosis, bad news from various channels can always reach the ears of the target users in China in the first place and accurately.
Yao Xiaoying said: [Thrombosis has a high incidence rate in Europe and the United States, and smokers over 35 years old have a high incidence rate.] Wu Shangchun believed: [These risks mainly come from estrogen. In the current new generation of contraceptives, the dose of estrogen is very low, and the main effective ingredient is progesterone.]
However, none of this can change the fact that in the United States and Britain, the proportion of short-acting contraceptives in contraceptive methods is 16% and 28% respectively, while in China, the proportion of short-acting contraceptives in contraceptive methods is only about 2%.
Compared with the unpopularity of short-acting contraceptives, emergency contraceptives have become unique. According to a survey by Xinkang, in the Chinese contraceptive market in 2015, the share of short-acting oral contraceptives was 26.1%, while that of emergency contraceptives was 69.6%.
[They eat emergency birth control pills like jelly beans, almost every day], which is one of the “strange ideas” of users described to me by the staff of a youth sex education platform.
What is the problem with the emergency contraception? Wu Shangchun believes that [the effect is not as good as short-acting oral contraceptives.]
Shao Haihao, on the other hand, believes that this large dose of progesterone drug [is equivalent to dumping ovarian suppression, and frequent use may lead to premature ovarian failure.]
Shao Haihao is a professor-level senior engineer at the Shanghai Institute of Family Planning Science. Director of the Sustained Release Drug Laboratory of the Drug Development Laboratory, A male scientist who knows more about women’s ovulation mechanism than women. He gestured to me and my surprised female colleagues in the institute to explain the process of contraceptive pill: Starting from the linear axis of the human body, A small amount of progesterone, slightly inhibit ovulation function, inhibit the growth of endometrium, let cervical secretions sticky, sperm is not easy to pass through, thus achieving the purpose of contraception, but almost will not bring what damage to the body. Carry hands, he also talked about contraceptives and endometriosis, that is, the principle of contraceptives to relieve dysmenorrhea.
Shao Haihao’s main research focuses on slow-release subcutaneous implantation-using slow-release technology to regularly and evenly release progesterone implanted in the body within 3-5 years after implantation.
This is an example of flowers inside the wall and incense outside the wall. In Indonesia, which has a population of more than 200 million, there are almost 1.2 million skin burial operations in a year, most of which come from China. In China, with a population of 1.3 billion, there are only about 100,000 subcutaneous implants a year.
The advantages of skin burial are obvious, Long-term reversible and easy to operate, However, its shortcoming is also obvious-intravenous bleeding. Because unlike short-acting contraceptives, which are supplied periodically, Progesterone implanted under the skin will be released continuously and evenly, [When these exogenous progesterones enter, Estrogen in the human body does not respond, causing the intima to fall off before it grows well. The intima is full of blood and falls off as it grows, thus causing intravenous drip bleeding, sometimes throughout the month. About 20% of users will have more or less bleeding, although such bleeding will never have what effects on women’s health.]
Since the 1980s, Shao Haihao has been committed to the research and development of skin burying technology, reducing the number of skin burying needles from six to two, and trying to reduce discomfort reactions such as intravenous bleeding of users. However, the impression of intravenous bleeding caused by skin burying has been planted in the 1990s, and the current technology lacks policy support in China.
Solve
Making abortion services less accessible, for example, can more supporting documents and fewer supply agencies reduce the number of abortions?
A post-90s girl said, “It would be terrible if the flow of people forced a guardian to accompany her.” ] A foreign friend working in a sex education NGO reminded me that in the West there had been cases of abortion with iron wire. And one researcher told me, [after all, the proportion of unsafe people in China is extremely low at present…]
Li Lan, director of the Nanjing Center in Maristep, believes that reducing induced abortion requires not only sex education, but also the creation of a social and cultural environment.
In the West, the birth control pill became a symbol of women’s independence in the 1960s. It laid the material foundation for the hippie culture, rock and roll and the women’s liberation movement. In China, several interviewees mentioned abortion in youth movies. Almost every youth movie has an abortion plot, which makes abortion rather than contraception a factor associated with youth and rebellion.
Li Lan mentioned the unexpected pregnancy of a volunteer girl in her team, [she knows all about what, however, when things happen, she did not take more reliable contraceptive measures.] It is not enough to just tell teenagers the necessity of contraception, more importantly, to improve young people’s coping ability when encountering such situations. At the same time, more institutions can provide accessible contraceptive counseling and services for young people.
In cases of repeated abortions, Hospital education plays a very important role. In a paper, Wu Shangchun expressed her suggestions on this matter: [We should strengthen the research on various forms of induced abortion, and explore the effects of different intervention forms on improving the usage rate, compliance with conventional contraceptive methods and reducing the rate of induced abortion through intervention research, so as to accumulate experience and provide reference models for practical work…]
In this helplessness and helplessness, I often think of a story Liang Li told me: One day, two senior high school students came to their clinic. They said they especially wanted to give it a try, so they came to consult first.
[I didn’t say to let them try or not to try. I just told them, Sex, if you were safe, you wouldn’t get pregnant… Later, The two men seemed to have tried, but they put on their condoms, were not pregnant, and there was no danger of what. Later, both of them were admitted to foreign universities. The two children also specially called back from abroad to thank us for providing the sexual safety consultation when they felt hazy. This changed their lives.]
(Thank you for your help in this article from the youth sex education platform [Qingxing])