women's health in china women's health in china 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". 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. 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. 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 pre-reform china (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 devotes much attention to meeting the needs of the country's huge rural population. the cms was consisted of 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). the implementation of cms has seen significant improvement in population health in china, including female health. 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. contrary to what chinese census has manifested, banister's studies have shown that female imr is higher than male imr in china at least since 1975. 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. in the prc's early years, traditional midwives came to be viewed as dirty and unscientific. by 1959, over 750,000 midwives were retrained with some modern medical practice, but only 5,300 were fully modern trained midwives. with china's program of barefoot doctors, perinatal practitioners were often older women. their work was effective, with much of the 1950s and 1960s population boom resulting from the decline in infant mortality. economic reform (1979–present) since 1978 china has been systematically moving away from a socialist economy and toward a capitalist system. with the intention to increase efficiency and improve standards of living, china has 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). 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 at breakneck pace, those same policies have led to decentralization and privatization of healthcare. women's health in china is among the most prevalent casualties of this economic transformation. 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. 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. 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. 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. 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. 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. while those changes did allow china to achieve unprecedented economic growth, the privatization of many industries also forced china to reform its healthcare policies. 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. 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. 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. 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. 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 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. 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. 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. 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. between the late 1970s and the late 1990s, the chinese government transfers for health expenditure fell by 50% and are continuing to fall. 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. 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. 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. women's health outcomes 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. 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. 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