Six years ago I met Han Bingbing (寒冰冰) in a Beijing bar, and I was intrigued by her right away. My friends told me she was a well-known post-operation transsexual who had a successful career in the fashion and entertainment industry, and called herself “China’s Number One Transsexual Beauty” (“中国第一变性美女”). We started talking, and Han invited me to come on her online talkshow the next day.
During our noodle lunch afterwards, we spoke about her life. The seemingly advanced emancipation of Chinese transsexuals surprised me. Mainland China is not exactly known for its excellent fundamental rights, yet here I was speaking to a radiant girl who had her male-to-female sex change in 1999, and now was not only officially a woman in body and on paper, but had also become the mother of her own adopted child. She was independent, successful, and seemingly happy and free.
“Mainland tabloids have entered a phase of fascination with transsexuals.”
Over a decade ago, China Daily wrote that “Mainland tabloids have recently entered a phase of sudden fascination with transsexuals.” With the rise of social media, ‘transgenderism’ has still remained a recurrent topic in Chinese media and on social media sites like Sina Weibo.
Earlier this week, pictures of a Lithuanian male-to-female transgender woman became trending on Chinese social media, where the 21-year-old woman was praised for her beauty and ‘female elegance’ (image below).
Many Chinese transgenders have stepped into the limelight to share their story with the public – such as Chen Lili (陈莉莉), who was the first transsexual woman to attempt to compete in the Miss Universe contest, or Liu Xuanyi (刘炫怡), “China’s first online transsexual celebrity”, or transgender opera star Bian Yujie (边玉洁).
Although there is a nuanced difference between ‘transgender’ and ‘transsexual’ in English (‘transgender’ being an umbrella term for those whose identity does not conform to what is associated with the sex they were born with, and ‘transsexual’ referring to those who transition from one sex to another, Medical Daily), there is no such nuance in common Chinese language, where both would be translated as ‘bianxing‘. ‘Bianxing’ (变性) literally means ‘change sex’, and a transgender or transsexual would be referred to as a ‘bianxingren‘ or ‘change-sex-person’.
China’s most famous transgender woman probably is Jin Xing (金星), a dancer, director and actress who formerly was a colonel in the People’s Liberation Army dance troupe and underwent sex change surgery in 1995. Years ago, Jin Xing stated that she was “quite pleased” with the way in which Chinese people have dealt with her transsexuality, and that she had “experienced no discrimination” (Canada 2000). With over 6 million followers on Weibo, the dance star is very popular on China’s social media. She now has her own talk show, simply called The Jin Xing Show, which is received well by netizens.
Zhang Kesha (张克莎), who had a sex change surgery in 1983, has written a book about her experience as a transgender called ‘A Woman’s Dream’ (女人梦). She has become famous for being the first transgender in China to undergo a sex change surgery. Han Bingbing has also been open about her story, even sharing the price of the operations that turned her into “an ordinary girl”: she spent 200,000 RMB (over 30,000 US dollars) on them.
And there are more who openly discuss transgenderism. Earlier this year, famous Chinese sexologist Li Yinhe stated on her Weibo blog that she had been living together with her female-to-male transgender partner for 17 years. Her revelation lead to online discussions about transgender people, raising awareness about different gender identities within China.
“China may be surpassing the U.S. in its tolerance and acceptance of transgender people.”
With so much exposure on transgenderism in China’s (social) media, the topic can hardly be called a taboo anymore. It is now possible for Chinese transgenders to undergo surgery, change their gender in their official ID, and get married. Some even report that “China may be surpassing the U.S. in its tolerance and acceptance of transgender people.”
Indeed, it is striking how many transgenders are present in China’s popular culture, and how accepted they are by the public. Virtually all of China’s well-known transgenders are artists, dancers or performers. It is perhaps no coincidence that transgender performance has been an important part of Chinese entertainment for centuries (Kile 2013).
“China has an estimated 400,000 transgender people.”
But beyond the limelight, the situation of transgenders in China is less rose-colored. Although China has an estimated 400,000 transgender people, the numbers of the two main centres for sex change operations reveal that no more than 800 transgender patients underwent surgery in the past 30 years, suggesting that many patients have gone to private clinics or foreign countries for their sex change (Jiang et al 2014).
Sex reassigning surgeries are not covered by medical insurance in China, and are very costly. The basic surgery starts at 50,000 RMB (7900 US dollars), while the average annual salary of a Chinese worker is 28,752 RMB (around 4540 US dollars). Besides the price, the guidelines on sex change provided by the Chinese Ministry of Health are also a hurdle to many. For example, the patient must get approval by family members and obtain proof of clean criminal records (ibid., 2014).
Earlier this week, the difficulty of Chinese bureaucracy concerning sex reassignment became painfully clear when Sichuan News reported that a Chinese transgender who underwent surgery in Thailand returned to China, only to find out she could not officially change her gender on paper (read her story).
Another major problem is employment discrimination. Within the arts and entertainment, transgenderism is commonly accepted, but in everyday life, transgender individuals are often discriminated, as they are considered “abnormal” or even “disgusting” by many. Especially female transgenders who identify as male will encounter discrimination, even from within the LGBT community (Jun 2010, 351-352).
The difficulty in finding a job leads many to work in the entertainment industry. “Many transsexuals have to work in she-male shows to make money,” Han Bingbing tells China Daily.
I saw Han Bingbing again this year, at Beijing Fashion Week, after our initial meeting in 2009. She had cut off her hair and was now a blonde, wearing a pearly pink dress that showed off her sexy cleavage. She was doing fine, and life had been treating her good, she told me, before her manager came round to take her to her next appointment. Transgender China is well-off within the spotlights. But there is a lot of room for improvement behind the limelight.
* Thanks to Pei Yuxin (裴谕新) for her input on this article.
*Available online sources have been directly linked within this article.
Canada: Immigration and Refugee Board of Canada. 2000. “China: Treatment of transsexuals who have undergone a sex change operation, particularly in Hong Kong (1997-2000).” Refworld (4 April). http://www.refworld.org/docid/3ae6ad4e10.html [11.08.15]
Jiang, Hua, Xian Wei, Xiaohai Zhu, Hui Wang, and Qingfeng Li. 2014. “Transgender Patients Need Better Protection in China.” The Lancet 384 (9960). Elsevier Ltd: 2109–10. doi:10.1016/S0140-6736(14)62372-2.
Jun, Pi. 2010. “Transgender in China.” Journal of LGBT Youth 7 (May 2013): 346–58. doi:10.1080/19361653.2010.512518.
Kile, Sarah E. 2013. “Transgender Performance in Early Modern China.” Differences: A Journal of Feminist Cultural Studies 24 (2): 130-149.
Hore, B. D., F. V. Nicolle and J. S. Calnan. 1973. “Male Transsexualism: Two Cases in a Single Family.” Archives of Sexual Behavior 2 (4): 317–21.
Jun, Pi. 2010. “Transgender in China.” Journal of LGBT Youth 7 (May): 346–58.
Ruan, F. F., V. L. Bullough and Y. M. Tsai. 1989. “Male Transsexualism in Mainland China.” Archives of Sexual Behavior 18 (6): 517–22. doi:10.1007/BF01541677.
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Over a Third of China’s Babies Are Delivered via C-Section – The National Health Commission Wants to Change That
Fear of pain is a major reason for nonmedical cesarian deliveries on maternal request.
In 2018 the percentage of deliveries by cesarean was 36.7% in mainland China, according to the latest Report on Women’s & Children’s Health (中国妇幼健康事业发展报告) that was launched by the National Health Commission on May 27.
This means that together with Hong Kong, Taiwan, Brazil, Egypt, and Turkey, the People’s Republic of China (PRC) now has the highest C-section rates in the world.
A World Health Organization report from 2010 estimated that 46% of Chinese babies were delivered via C-section. In 2017, another study found that this percentage was incorrect, although some urban and wealthier regions in China, such as Shanghai, did see C-section (CS) rates as a high as 68% (Black & Bhattacharya 2018, 1; McNeil 2017).
China’s CS rates have recently become a hot topic in Chinese newspapers and on social media. On May 27, the National Health Commission of the People’s Republic of China held a Beijing news conference in which Qin Geng (秦耕), the director, announced that more actions will be taken to encourage natural childbirth among Chinese women.
These actions will, among others, include stricter regulation of cesarian section operations and the provision of more support and pain relief for laboring women, as well as a higher hospital income for natural births. The National Health Comission hopes to significantly reduce the number of unneccesssary C-sections without medical indication in this way (Beijing News 2019; Caijing 2019).
Since 1985, the international healthcare community has considered 10-15% to be “the ideal rate” for C-sections, of which the highest percentage are those CS deliveries with medical indications that can actually save the lives of mothers and babies.
Although the worldwide rates for CS deliveries have increased throughout the years, there is no evidence for the benefits of nonmedically indicated C-sections for women or children, according to the World Health Organization.
This is not the first time Chinese authorities try to combat the country’s high CS rates. After reports by the World Health Organization from 2010 and 2015 pointing out the potential hazards of unnecessary C-sections, there have been various state efforts to reduce the number of nonmedical cesarian surgeries.
Besides the introduction of free prenatal education classes, these efforts included monitoring public hospital CS rates and removing bonuses or cutting portions of a hospital’s income once their CS rates reached a certain threshold (e.g. 40%) (Wang 2017, 3). These government initiatives seem to have had effect: the country’s C-section growth rates have slowed down, but were not decreasing yet.
Since the Chinese government announced an end to its one-child policy in 2015, lowering cesarean sections rates has become a more urgent matter, as Chinese couples are now allowed to have a second child.
Although various studies from mainland China and beyond challenge the idea that nonmedical C-sections are less ‘safe’ than vaginal births for single deliveries, this risk changes when a woman who previously had a CS section plans another pregnancy: multiple cesarean sections are associated with additional risks including CS scar rupture and abnormal placental invasion (Biler et al 2017, 1074; Black & Bhattacharya 2018, 2; Liu et al 2015, 817).
Why So Many C-sections in China?
But why does China have such a high cesarian delivery rate at all? Since the early 1990s, mainland China saw a more dramatic rise in CS rates than, for example, the USA; from less than 10% (with only 3.4% in 1988), China went to one of the highest in the world (Hellerstein 2011; Wolf 2018, 13).
The answer to why this is, is not so straightforward and relates to socio-economic changes as well as cultural factors that come into play.
One reason is that there is a general belief in the ‘safety’ of cesarian births that influence women’s choices for a (nonmedical and planned) C-section (Black & Bhattacharya 2017, 2).
An insightful study into this matter is that of researcher Eileen Wang (2017), who found that anxiety about giving birth and fear of pain is also a major reason for nonmedical cesarian deliveries on maternal request, especially considering that only a minority of Chinese women are given any form of pain relief during labor. Besides traditional concepts, this is also because China faces a shortage of anesthetists and because obstetricians are not always well-informed to prescribe other forms of pain medication (2017, 5).
As noted by Wang, epidurals are denied to laboring women not just because anesthesiologists are too busy, but also because of various other factors: different from a scheduled C-section on their agenda, they are not always available during nighttimes and in weekends to administer anesthesia to women in labor, do not have the time to monitor a patient for hours during labor (whereas a cesarean could be done in an hour), or were not even trained to administer epidurals (2017, 5).
According to Wang, the concerns about labor pain result in more requests for C-sections, both before and during labor. With relatively low awareness and availability of labor pain relief methods many Chinese women simply opt for a C-section as a way to control their pain.
But there are also other factors that contribute to the relatively high rate of women requesting C-sections for nonmedical reasons. One of them is the importance placed in the astrological calendar: having a baby on that one ‘lucky day’ or within that ‘lucky year’ is considered enough reason to plan a cesarian birth for many Chinese families.
In early 2015, ahead of the Chinese New Year, many women rushed to the hospital to make sure their baby was born in the Year of the Horse (2014) as the Year of the Goat (2015) was coming up. There is an old Chinese saying that nine out of ten people born in the Year of the Goat are incomplete and will suffer from great misfortune throughout their life (“十羊九不全”).
Another factor that leads to more cesareans on maternal request relates to the existing concerns among women that vaginal delivery will affect their figure or sex life (Wang 2017, 2).
Responses on Chinese Social Media
Since the Beijing news conference of May 27, the hashtag “Reducing Unnecessary Cesarean Section Surgery” (#减少非必需剖宫产手术#) has taken off on Chinese social media.
“What do you call ‘unnecessary cesarian’?” one of the most popular comments said: “Isn’t it that so many women in labor choose to have a C-section because natural childbirth is too painful?”
Other commenters also called for a normalization of pain relief in labor, saying that the high percentage of C-sections lies in the fact that Chinese women lack access to “wútòng fēnmiǎn” (无痛分娩) or “painless birth,” meaning vaginal delivery with pain relief.
Some Weibo users also stress that women should have the freedom of choice on how they wish to give birth, saying: “C-section or natural should be my own choice” and “If you leave me no choice I might as well not give birth at all.”
Multiple commenters write: “The lower the C-section rate, the higher the suicides,” referring to an incident that occurred in Shaanxi in 2017 when a pregnant woman committed suicide by jumping from the fifth floor of the hospital after she was allegedly denied a CS delivery.
Other Chinese netizens also complain about the fact that it seems to be men who are promoting the new policies to combat the high C-section rates, writing: “Isn’t there a way to have them suffer the pain of labor instead?”
In her study, scholar Eileen Wang also argues that the lack of pain relief is one of the major issues that should be addressed by policymakers who are hoping to reduce the number of C-sections in China. Further improving the childbirth experience by, for example, integrating a midwifery model, is also essential in making natural childbirth more attractive for Chinese women, Wang argues.
For now, many hospitals in China are still offering C-section “packages”: some prices start at RMB 5800 ($840) for a C-section, other hospitals have packages that start from RMB 88,000 ($12,741) including a three-day hospital stay in a private room.
“It’s a pregnant’s woman body, so she should decide how she wants to deliver her baby,” one commenter on Weibo writes: “It should be a woman’s right to decide.”
By Manya Koetse
Biler, A., Ekin, A., Ozcan, A., Inan, A. H., Vural, T., & Toz, E. 2017. “Is It Safe to Have Multiple Repeat Cesarean Sections? A High Volume Tertiary Care Center Experience.” Pakistan Journal of Medical Sciences 33(5): 1074–1079.
Black, Mairead & Sohinee Bhattacharya. 2018. “Cesarean Section in China, Taiwan, and Hong Kong— A Safe Choice for Women and Clinicians?” PLOS Medicine 15(10): 1-3.
Caijing. 2019. “卫健委：全国剖宫产率为36.7% 积极推广分娩镇痛.” Caijing , May 27 http://economy.caijing.com.cn/20190527/4591594.shtml [5.31.19].
Hellerstein, Susan Celia. 2011. “Cesarean Delivery in China Analysis of Cesarean Deliveries Without Indication.” The American College of Obstetricians and Gynecologists: 20s.
McNeil, Donald. 2017. “Study Finds Lower, but Still High, Rate of C-Sections in China.” New York Times, Jan 9 https://www.nytimes.com/2017/01/09/health/c-section-births-china.html [6.2.19].
Wang, Eileen. 2017. “Requests for Cesarean Deliveries: The Politics of Labor Pain and Pain Relief in Shanghai, China.” Social Science and Medicine (173): 1–8.
WHO. 2015. “WHO statement on caesarean section rates.” World Health Organization, April https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/ [6.2.19].
Wolf, Jacqueline H. 2018. Cesarean Section – An American History of Risk, Technology, and Consequence. Baltimore, Maryland: Johns Hopkins University Press.
Featured image by Sohu News.
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What Are Weibo’s “Super Topics”?
Explaining Weibo’s “Super Topics”
Over the past year, Weibo’s so-called “Super Topics” (超级话题) have become more popular on the social media platform as online spaces for people to connect and share information.
Weibo’s “super topic” function has been around since 2016. The function allows Weibo users to create and join interest-based content community pages that are online groups separated from the main Weibo space. One could perhaps compare these Weibo Super Groups to ‘mega-threads’ or ‘subreddits’ on Reddit.
These are the most important things to know about Weibo’s Super Topics:
#1 A Super Topic is Not the Same as a Hashtag
Similar to Twitter, hashtags make it possible for Weibo users to tag a topic they are addressing in their post so that their content pops up whenever other people search for that hashtag.
Different from Twitter, Weibo hashtags also have their own page where the hashtag is displayed on top, displaying how many people have viewed the hashtag, how many comments the hashtag is tagged in, and allowing users to share the hashtag page with others.
A Super Topic goes beyond the hashtag. It basically is a community account where all sort of information is shared and organized. People can ‘follow’ (关注) a Super Topic and can also ‘sign in’ (签到).
On the main page of every Super Topic page, the main subject or purpose of the super topic is briefly explained, and the number of views, followers, and posts are displayed.
A super topic-page can be created by any Weibo user and can have up to three major hosts, and ten sub-hosts. The main host(s) can decide which content will be featured as essential, they can place sticky notes, and post links to suggested topics.
#2 A Super Topic Is a Way to Organize Content
Super Topic pages allow hosts to organize relevant content in the way they want. Besides the comment area, the page consists of multiple tabs.
A tab right underneath the main featured information on the page, for example, shows the “sticky posts” (置顶帖) that the host(s) of the page have placed there, linking to relevant information or trending hashtag pages. Below the sticky notes, all the posts posted in the Super Topic community are displayed.
One of the most important tabs within the Super Topic page is called “essential content” (精花), which only shows the content that is manually selected by the host(s). This is often where opinion pieces, articles, official news, or photos, etc. are collected and separated from all the other posts.
Another tab is the “Hall of Fame” (名人堂), which mainly functions as a reference page. It features links to the personal Weibo pages of the super topic page host(s), links to the Weibo pages of top contributors, and shows a list of the biggest fans of the Super Topic. Who the biggest fan of the page is, is decided by the number of consecutive days a person has “checked-in” on the page.
#3 Super Topics Are a Place for Fans to Gather
Although a Super Topic could basically be about anything, from cities to products or hobbies, Super Topics are often created for Chinese celebrities, video games, football clubs, or TV dramas.
Through Super Topic pages, a sense of community can be created. People can be ranked for being the most contributive or for checking in daily, and comment on each other’s posts, making it a home base for many fan clubs across China.
The host(s) can also help somebody’s page (e.g. a celebrity account) grow by proposing them to others within the group.
Super Groups are ranked on Weibo based on their popularity. This also gives fans more reason to stay active in the group, making their Super Topic top ranking within their specific category (TV drama, food, photography, sports, games, etc).
What makes the Super Topic group more ‘private’ than the common Weibo area, is that people posting within the Super Topic can decide whether or not they also want their comment shared on their own Weibo page or not. If they choose not to, their comments or posts will only be visible within the Super Topic community.
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