Connect with us

Backgrounder

Binging and Purging as Online Trend: From China’s “Big Stomach Stars” to “Vomit Bars”

China’s ‘Big Stomach Stars’ are all the rage – but is it really just harmless entertainment?

Manya Koetse

Published

on

Skinny girls that eat a week’s worth of food in one sitting: Chinese binge-eating vloggers are all the rage recently. But behind their cute image and happy fans, there are darker online discussions tying them to self-induced vomiting – something that is promoted in China’s so-called ‘vomit bars.’ How innocuous is this social media extreme-eating trend?

Mimi Zhang (aka Mizi Jun 密子君) has over seven million fans on her Weibo page. She regularly hits the top trending lists on Chinese social media, and even has her own online fanclubs.

Unlike previous rising Chinese social media stars such as Papi Jiang, the 26-year-old Mimi from Chongqing did not become an online celebrity because of her comic skills or acting talent, nor for her singing voice or dance moves. Mimi Zhang became famous for eating 8 lb (4 kg) of rice in one sitting, during an eating challenge in 2016.

Mimi eating 8lb (4 kg) of rice in one sitting.

By now, Mimi is one of China’s most successful ‘Eating Broadcasting’ hosts. Also called ‘Big Stomach Star Eating Livestream’ (大胃王吃播) or ‘Livestream Eating Vlogging’ (吃播女博主) in China, it is an online video genre in which hosts will consume extremely large amounts of food.

BJ The Diva during one of her livestreams.

In South Korea, it is known as the ‘mukbang‘ phenomenon, and the craze started there some years earlier, peaking in 2016. ‘Eating Broadcasting’ stars such as Kinoshita Yuka (video) and BJ The Diva (video) already had their moments of fame on the internet in South Korea, Japan, and beyond, but the genre only recently has become a real hype on Chinese social media.

 

Binging on Camera

 

Looking at the number of views and subscribers from YouTube to Twitch, or on platforms such as Kuaishou or Douyin, the ‘Eating Broadcasting’ genre obviously has millions of fans worldwide.

This online movement is innocuous in many ways. According to experts, people enjoy watching others eat because they feel a social connection, or want to stimulate their own appetite – it is one of the reasons why the craze is also dubbed ‘social eating.’

For many, the genre is simply entertaining; hosts often eat unconventional dishes, they are descriptive with taste, play around with their expressions, take on challenges, talk, and make funny sounds while eating.

Chinese food vlogger Duoyi (大胃王朵一) eats some skewers…

But what if ‘social eating’ becomes ‘binge eating’? How harmless is the genre if it shows skinny women eating excessive amounts of food, inadvertently promoting unhealthy eating habits and unrealistic standards?

Extreme binging on camera: eating noodles- not from a bowl, but from the back of a delivery car.

Along with Mimi Zhang, ‘Big Stomach Mini'(@大胃mini) is one other among many Chinese livestreamers that has achieved online stardom by eating large amounts of food. The 24-year-old reportedly is 1,70 m. tall and only weights 47 kilograms (103lbs), yet recently managed to eat a staggering 17 kg (35 pounds) of meat (video).

‘Big Stomach Mimi’

More and more, netizens are starting to connect these live-streamers to a habit of purging. Ongoing rumors suggest a supposed connection between binge streaming and vomiting.

Recently, various accounts claimed that Mimi Zhang used to have an account (using the name ‘Little Mi 360’ 小密360) on an online forum where people, mainly women, encourage each other to binge and purge.

 

China’s “Vomit Bar” (催吐吧) Community

 

China’s so-called “Vomit Bars” (催吐吧), online forums focused on binging and purging, have formed a hidden community on Chinese internet for years.

The phenomenon already came to light in 2012, and started to receive news media attention within China in 2015 and 2016. Most of the bigger online forums got shut down in 2017, however, after rumors circulated that a member of a ‘Vomit Bar’ had reached such a low weight that her organs failed and she passed away.

Example post from a ‘vomit bar’: 158 cm tall and 37 kg weight, but still wanting to lose.

Nevertheless, the online community consists of thousands of people, mainly women aged 14-40. A previously well-known forum on Baidu (now shutdown) had around 50,000 members called ‘rabbits’ (兔子) and over 5,5 million posts.

A “Vomit Bar” forum.

Since then, there are still some scattered forums, and a special Android app called ‘Meet Like Rabbits’ (相识于吐), where users can share their experiences and tips on message boards. On WeChat’s group chats, members of the community have more freedom to talk in private with less risk of being shut down.

The app for online purging community.

Members of the online ‘purging community’ are called ‘rabbits’ since the Chinese word for rabbit, tuzi (兔子), sounds similar to the word for ‘purging’ (tu 吐), and also because they eat all day, just like rabbits.

The main goal of these online forums is to share tips and tricks on how to lose weight by purging, while still binging on food. People also post photos of their binges or body, and share their hopes and fears in losing weight. “The way it is now, I could maintain a weight of around 46 kilograms,” one ‘rabbit’ writes: “I think it’s fat. My heart is filled with panic. I can only vomit.”

Netizens taking part in the ‘vomit bar’ community sharing photos of their binge food.

Newcomers ask others about best ways to vomit, and some people who say they’ve been binging and purging for years share experiences about their painful stomach and tooth decay.

Doctor Ma Yongchun (马永春) from Zhejiang Tongde Hospital since long has been warning people that these kind of online forums are harmful. She told iFeng news that the so-called ‘rabbits’ get caught up in a vicious cycle of binging and purging, and in doing so are developing serious eating disorders that can become life-threatening.

 

Eating Disorders in China

 

The Chinese ‘rabbit’ community could perhaps be compared to the Western ‘pro-ana‘ phenomenon, an online movement where people promote the behavior related to the eating disorder anorexia nervosa.

But there is one major difference; the ‘pro-ana’ community is connected to the term ‘anorexia’, suggesting that users of such forums are somewhat aware their behaviors are a sign of an actual eating disorder.

In these Chinese online communities, however, there seems to be a lesser acknowledgment that the cycle of binging and purging is one that belongs in the realm of a psychological disorder. Although people do complain that they feel they can no longer stop their irregular eating pattern, they talk more about their stomach aches and ulcers than they actually talk about suffering from an eating disorder.

This perhaps relates to the fact that there is little general awareness about eating disorders (ED) in China. Although there are no official statistics on the occurrence of bulimia, anorexia, or other ED in China, previous studies have found levels similar to Western countries (Tong et al 2014).

What various studies over the past years have also established is that there are major differences between Western countries and China in how eating disorders manifest themselves, suggesting they are not culture-bound but culture-reactive (Getz 2014, 749; Pike & Dunne 2015).

Because EDs are (1) traditionally conceptualized as a “Western mental health issue,” because (2) there is a social stigma attached to mental health issues in general in Chinese society, because (3) there is little general awareness on EDs, because (4) there is a lack in Chinese healthcare facilities specialized in EDs, and because of (5) various cultural factors (e.g. a very strong food culture), Chinese patients are more prone to talk about their problems in the form of somatic symptoms such as an extreme (dis)taste for food or abdominal problems, than in the form of a psychological problem (Getz 2014, 746-750).

 

Growing Awareness?

 

Recently, Chinese media slowly seem to be promoting more awareness on eating disorders. The American video “I became Anorexic for Instagram” has gone viral on Chinese social media over the past month, as it was posted by various state media channels on Weibo.

Among thousands of reactions, many said: “It seems that this kind of disease doesn’t occur much in China – we have too many tasty food!” Others said: “I want to lose weight too – I want an eating disorder like this!”

But there are also more and more people who are tying the rise of China’s online unhealthy eating trends to more serious issues. “These girls who eat so much [on camera] do not just have big stomachs, they actually puke in order to eat so much. I don’t find it entertaining to watch them anymore,” one netizen (@有兔劳劳) says.

“I now find it sad to watch these ‘big stomach stars’ (大胃王),” another person says: “They definitely vomit – it’s impossible for one person’s stomach to hold so much food.”

“What’s up with all these ‘big stomach stars’ recently? It’s not something they were born with, or something they were trained in doing; they are like those ‘rabbits’ and it is a disease, it’s bulimic. I don’t want to support them anymore by watching how they harm themselves,” another commenter writes.

Meanwhile, China’s binge-eating online stars seem to be unaffected by the online rumors that connect them to unhealthy trends and eating disorders.

This week, Mimi Zhang has posted her latest video in which she finishes a total of 15 desserts, while ‘Big Stomach Mini’ has posted a new video in which she eats, amongst others, 250 skewers of meat.

For some commenters, there is no issue at all: “She just has a great appetite.”

Are you suffering from an eating disorder and need help? For information on eating disorders and how to help if you are worried about someone, Beat (UK) or ANAD (US) has advice for sufferers, friends and family.

By Manya Koetse

References (online references linked to in text)

Getz, M.J. 2014. “The Myth of Chinese Barbies: Eating Disorders in China including Hong Kong.” Journal of Psychiatric and Mental Health Nursing 21: 746-754.

Pike, Kathleen M., and Patricia E. Dunne. 2015. “The Rise of Eating Disorders in Asia: a Review.” Journal of Eating Disorders 3:33. Available online https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-015-0070-2 [17.1.18].

Tong, J., Miao, S., Wang, J. et al. 2014. “A Two-stage Epidemiologic Study on Prevalence of Eating Disorders in Female University Students in Wuhan, China.” Social Psychiatry and Psychiatric Epidemiology 49(3): 499-505.


Directly support Manya Koetse. By supporting this author you make future articles possible and help the maintenance and independence of this site. Donate directly through Paypal here. Also check out the What’s on Weibo donations page for donations through creditcard & WeChat and for more information.

 

Spotted a mistake or want to add something? Please let us know in comments below or email us.

©2018 Whatsonweibo. All rights reserved. Do not reproduce our content without permission – you can contact us at info@whatsonweibo.com.

image_print

Manya Koetse is the editor-in-chief of www.whatsonweibo.com. She is a writer and consultant (Sinologist, MPhil) on social trends in China, with a focus on social media and digital developments, popular culture, and gender issues. Contact at manya@whatsonweibo.com, or follow on Twitter.

Advertisement
Click to comment

Leave a Reply

Your email address will not be published. Required fields are marked *

Backgrounder

“Opposing Dog Meat Consumption Is Hypocritical” – Weibo Users Respond to Anti-Dog Meat Protests in South Korea

Eating dog meat is a personal choice, many commenters argue.

Manya Koetse

Published

on

Man eating dog meat during anti-dog meat protest; image via https://udn.com/news/story/6812/3928149

Last week’s anti-dog meat protests in South Korea have triggered discussions on Chinese social media on the status quo of the dog meat industry in China. An overview of the sentiments on social media and the background of dog eating in the PRC.

South Korea’s dog meat industry made headlines on Friday after protesters in Seoul, joined by actress Kim Basinger, called for an end to the decade-old dog meat trade in the country.

Not far from the protesters were farmers who raise dogs that are sold to restaurants. They brought steamed dog meat and ate it with kimchi (featured image).

In China, where the eating of dog meat has a long history, the Seoul protests triggered some discussions on social media.

The hashtags “Hundred People Gather in South Korea to Stop the Eating of Dog Meat” (#韩国百人集会呼吁停食狗肉#) and “Big Protest in South Korea against Eating of Dog Meat” (#韩国大规模抗议吃狗肉#) received over 83 million views.

In South Korea, the overall demand for dog meat has plummeted over the years. Earlier this month, one of the largest dog meat markets in the country, the Gupo dog meat market, was shut down. In November of 2018, Seongnam city already demolished South Korea’s largest dog slaughterhouse.

Friday’s protesters hope to shut down dog meat trade in the country completely. The latest protests have put the thorny issue of the dog meat industry back in the limelight.

 

HYPOCRITICAL PROTESTS?

“I don’t eat dog meat, but I don’t oppose it.”

 

On Chinese social media site Weibo, hundreds of netizens expressed their opinion on the matter, that has been a hot topic in China for years.

According to polls from the past and present, the topic of dog meat in China is clearly a divisive one.

But over the past few days a seeming majority of commenters on Weibo spoke out about the issue in a remarkably similar way, with thousands of netizens highlighting one issue in the matter: hypocrisy.

“I won’t oppose to the eating of dog meat,” one person writes: “Because if I support the anti-dog meat movement today, then tomorrow it will turn against the eating of cows, then the eating of pigs, and then the eating of fish..”

Many people on social media agree with this point of view, arguing that no matter one’s personal ideas about dog meat, condemning the dog meat practice in specific would be hypocritical: “Pigs are so cute, why do we eat pigs then?” many say, with others arguing: “Aren’t cows also spiritual animals?”

Dog meat restaurant in Jilin.

“I also raise dogs, I also love dogs,” another commenter says: “But I think that if they legally breed dogs for the dog meat [industry], then we have no right to prevent them from doing so.”

“I don’t eat dog meat, but I don’t oppose it, as long as it’s legal it’s ok,” with others writing: “I am opposed to the eating of any living creature.”

“Eating dog is not illegal, why all this sentimental nonsense? Why don’t you also defend chickens, ducks, geese, pigs, sheep, and cows?!”

“As long as they’re not abused, I don’t see a problem with it.”

“Dog meat is tasty,” one commenter from Zhejiang writes: “I like it, although I rarely eat it. I don’t see a problem with it, it’s a personal choice.”

 

SHORT OVERVIEW OF DOG EATING IN CHINA

“To them, dog meat was just like any other meat.”

 

The tradition of dog eating in China can be traced back as far as the Shang Dynasty (ca. 1558 to 1046 BC), when dog meat was considered a delicacy for the upper class.

Later on in Chinese history, during the Han Dynasty (202 BC-220 AD), it became more and more common until the practice saw a general decline, especially in northern China, during and after the tenth century (Li et al 2017, 513-514).

Despite the rising and declining popularity of dog meat throughout China’s history, the practice of eating dog has never completely disappeared, particularly in southern China.

In a book on China from 1878 by John Henry Gray, the author notes the popularity of restaurants serving dog and cat meat in ‘Canton’ (Guangzhou):

I do not think (..) that I exaggerate in saying that there are no fewer than twenty such places in Canton. Each restaurant contains only one public apartment. The approach to this dining-room is generally through the kitchen, where cooks may be seen standing in front of slow fires over which the flesh of cats and dogs is being cooked. The flesh is cut into small pieces and fried with water chestnuts and garlic in oil. In the windows of the restaurant dogs’ carcasses are suspended, for the purpose, I suppose, of attracting the attention of passengers” (75).

He further writes:

The flesh of black dogs and cats is generally preferred because it is supposed to possess more nutriment than that of cats and dogs of any other color. At Ying-tong, a suburban district of Canton, a fair is held at which dogs are sold for food; and in one of the streets dogs and cats are daily exposed for sale. The dogs are put to death by strangling, stabbing, or felling with clubs” (76).

Something that has not changed since the days described in Gray’s book is the belief in the medicinal benefits of dog meat.

Dog meat dish, via Sohu.com.

Especially in summer, dog’s flesh is believed to serve as an antidote against summer heat, and to be nutritious and beneficial as a source to enhance male virility or to boost the liver. Even at present, Chinese media promote the eating of dog meat to boost the immune system and help stimulate better blood circulation.

It should be noted that although China has a long history of dog meat consumption, it also has a long history of dog domestication and dog-human comradery. Dogs were pets, guarded the house, used in hunting, and also used in rituals of sacrifice.

Ceramic crouching dog, excavated from Henan burial site, dating from Han Dynasty, 206BC-220AD, Henan Museum.

Most of the 20th century (1900-1978) was a tough time for people in mainland China, and it was a tough time for dogs too. In many times, there was barely enough food to eat, and under Mao’s rule, dogs were considered “parasites” and were outlawed as pets (Coren 2018; Li et al 2017, 514).

Those who kept pets were seen as part of the ‘bourgeoisie,’ and during the Cultural Revolution, pet dogs were reportedly seized and beaten to death in front of their owners (Coren 2008, ch. 21).

Much has changed since those days. Although (stray) dogs, as carriers of diseases and potentially aggressive, are often still considered a drain on society, having a dog as a pet has become much more commonplace in China since the late 1980s and early 1990s.

Eating dog meat has become less popular, especially among young people in China, who have grown up very differently from their parents and have different perceptions of dogs.

Chinese writer Bang Xiao looks back on the first time his mother served him dog meat during Chinese New Year, writing:

For them, dog meat was just like any of the other meats, and coming from a generation who lived through famine and the Cultural Revolution, I was told I should be grateful. For me though, it meant I was eating my own pet Duo Duo. I cried.”

Later on, he writes about his parents:

They weren’t “dog eaters”. They were just people that happened to have a different history that led to different animals being on the menu.

 

THE YULIN DOG MEAT FESTIVAL

“Don’t go, don’t eat it, don’t pay attention to it.”

 

Despite the general unpopularity of dog meat in China, there is one time of the year when the discussions on the practice of dog eating flare up again, and that is during the Yulin Lychee & Dog Meat Festival, an annual event that’s been held over the past decade in the Chinese city of Yulin intended to generate income from tourism (Brown 2018).

Some 10,000 to 15,000 dogs and cats are slaughtered during the 10-day event that starts on June 21st every year. The event attracts hundreds of people every day. There is a restaurant strip and a market where dozens of vendors cook various dog meat dishes in large woks and where live dogs are sold and slaughtered.

Yulin, image via 轉角國際udn Global

Although the voices of those people protesting the festival seem to grow louder year on year, the dog meat festival continues. It is not illegal, and its economic benefits have become of crucial importance for many in the city of Yulin.

Vendor selling dog meat at the Yulin festival.

A 2016 media survey held among 2000 people from various ages and places in China found that 64% of the people opposed to the festival, 52% thinks that dog meat should be banned in China, and 70% said they had never had dog meat themselves.

“Don’t go, don’t eat it, don’t pay attention to it. When there’s no business, the killing will stop,” one Weibo commenter suggests.

 

A MURKY MARKET

“There does not seem to be a Chinese dog meat market that is both cruel-free and completely legal.”

 

Apart from Yulin, the eating of dog meat is barely a celebrated tradition in China anymore.

For a What’s on Weibo article from 2015, we could still find 122 restaurants listed as ‘dog meat’ specialty restaurants in the city of Beijing on restaurant site Dianping. But at present, Dianping no longer publicly lists any restaurants when searching for ‘dog meat’ specialty places (note that there still are restaurants serving dog meat, but they might not be listed due to controversy or for fear for activists).

China’s biggest e-commerce websites sell different herb mixes for dog stews or dog meat hotpots (see tweet below), but the market could hardly be called thriving.

Yet, despite all those people on Chinese social media saying that eating dog meat should not be a problem for those who still want to eat it, China’s dog meat market does actually have a problem.

China has no law that bans the eating of dogs; eating dog meat is a personal freedom. But what makes the issue murky and troublesome is that China actually has no large-scale legal dog farms, nor legal dog slaughterhouses.

The very few dog farms in existence in China would never be adequate to provide the meat for the industry in southern China, let alone for the estimated 10,000+ dogs slaughtered in Yulin every year.

It is therefore not clear where the dogs that are used for their meat in China come from. Are they stray dogs? Are they stolen from the streets? And if so, would this not be considered illegal (Brown 2018; Cao 2014; Yan 2015, 46)?

Every now and then scandals appear in the media of restaurants slaughtering and killing dogs that were actually people’s pets (for example, this scandal in Jilin in 2018 or in Chengdu this year).

Another issue making the dog meat market a problematic one is the cruel treatment of the dogs.

China has seen countless of food scandals over the years, and some of them involve the selling of poisoned dog meat. As a result, many people have a general distrust in (frozen) meat products and want to make sure they are consuming good quality meat.

Dog meat markets such as Yulin, therefore, often sell living dogs. They are virtually like ‘wet markets’ for dogs, where those who want to eat dog meat can do so with the assurance that the meat they are eating is fresh and safe. The dogs are slaughtered at the spot or are sold alive for home consumption (Brown 2018).

Image via BBC.com.

The process of being transported, being displayed in tiny cases in the summer heat, and being killed in often cruel ways all add to the enormous stress and pain the animals at the live dog market are suffering.

China currently has no laws from the perspective of animal welfare to minimize the pain and suffering during transport, the selling, or at the point of slaughter (Brown 2018).

For the aforementioned reasons and more, festivals such as the Yulin Dog Meat one are getting more controversial year on year, with more and more Chinese calling for a boycott and a ban.

 

DISTORTED DISCUSSIONS

“If you eat dog meat of unknown origin, you might be participating in the killing of someone else’s pet.”

 

As the discussions on dog meat in China are ongoing following the South Korea protests, one blogger posted a survey asking netizens if they support the eating of dog meat.

Despite the many commenters who also defend the practice of dog eating, a majority of 67% percent among the 32.000 participants said they do not support it as “dogs are our friends.”

A recurring sentiment expressed on Chinese social media on the issue is that there essentially is nothing wrong with eating dog meat – and that it would be hypocritical to only oppose to eating dog without also opposing eating sheep, cows, chickens, and so on – as long as it is legal, and as long as the dogs are not stolen, poisoned, or abused.

But that’s the whole issue at hand: all those things are in fact happening in the dog meat industry today. It is difficult to discuss the eating of dogs based on the hypothetical assumption that these things are not occurring.

Consumers are not buying (frozen) meat from legal dog farms and certified dog slaughterhouses, they are mostly buying living dogs or dog meat from unknown origins, and the process of selling and slaughtering often goes hand in hand with cruel treatment.

“I don’t oppose to eating dog, but I hate the dog trafficking market,” one person says. Another commenter agrees, writing: “I don’t oppose to the eating [of dogs] that are bred for it, but I do oppose to those who steal other people’s dogs. Most of the dog meat I’ve seen comes from unknown origins. (..) If you eat dog meat that you don’t know the origin of, you might be participating in the killing of someone else’s pet.”

For now, China and South Korea are very different when it comes to their dog meat industries and their (legal) changes. The countries do seem to have one thing in common, which is that the practice of eating dog meat is no longer popular among the younger generations.

This might suggest that as sales are dropping, the dog meat market will shrink and might eventually disappear altogether if there is no interest in it.

“Don’t hype the dog meat festival,” one Weibo commenter writes: “It’s the hype that made it big and that led to more dogs being killed.

This basically reiterates the advice of one of the aforementioned commenters: don’t go, don’t eat it, don’t pay attention to it, and the business will, eventually, die out.

Want to read more? Also see:

20 Facts About Dogs & Dog-Eating in China
The Yulin Dog Meat Festival: 10 Views From Chinese Netizens
Tradition or Abuse? Chinese Views on the Yulin Dog Meat Festival

By Manya Koetse

Want to see more articles such as these? Please donate to keep What’s on Weibo going.

References

Brown. Hannah. 2018. “Yulin Lychee and Dog Meat Festival: A Shift in Focus.” In: Tourism Experiences and Animal Consumption: Contested Values, Morality and Ethics, Carol Kline (eds), Chapter 15. London: Routledge.

Cao Yin. 2014. “Experts: Dog Meat Festival ‘Illegal’.” China Daily (June 16). Online at http://www.chinadaily.com.cn/china/2014-06/16/content_17589087.htm [6.23.16].

Coren, Stanley. 2008. The Modern Dog: A Joyful Exploration of How We Live with Dogs Today. New York: Free Press.

–. 2018. “What Is China’s Current Attitude Concerning Dogs?” Psychology Today, Feb 21 https://www.psychologytoday.com/us/blog/canine-corner/201802/what-is-chinas-current-attitude-concerning-dogs [7.15.19].

Gray, John Henry. 1878. China: A History of the Laws, Manners, and Customs of the People (Volume II). London: MacMillan & Co.

Li, P. J., Sun, J., & Yu, D. 2017. “Dog “Meat” Consumption in China: A Survey of the Controversial Eating Habit in Two Cities.” Society and Animals, 25(6), 513–532. http://doi.org/10.1163/15685306-12341471

Xiao, Bang. 2018. “Chinese New Year: Remembering how I first ate dog meat, and how differences bring us together.” ABC, February 17 https://www.abc.net.au/news/2018-02-17/chinese-dog-meat-eating-linked-to-history-of-famine/9454394 [7.15.19].

Yan Wei. 2015. “Dog Meat Festival: Traditional Custom or Abuse?” Beijing Review (29): 46-47.

Spotted a mistake or want to add something? Please let us know in comments below or email us. Please note that your comment below will need to be manually approved if you’re a first-time poster here.

©2019 Whatsonweibo. All rights reserved. Do not reproduce our content without permission – you can contact us at info@whatsonweibo.com

image_print
Continue Reading

Backgrounder

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.

Manya Koetse

Published

on

Image by Sohu News

China’s National Health Commission wants to lower the nation’s high C-section rates. On Chinese social media, many women argue it should be up to the mother to decide how she wants to give birth.

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.

Qin Geng during the press conference on May 27.

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).

“Giving labor without pain: removing mom’s fear for giving birth” – image by Chinese website http://www.8bb.com/huaiyun/1381.html.

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.

On Weibo, the hashtag page received 340 million views at time of writing. One thread about this topic even received over 28400 comments.

“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

References

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.

Spotted a mistake or want to add something? Please let us know in comments below or email us. Please note that your comment below will need to be manually approved if you’re a first-time poster here.

©2019 Whatsonweibo. All rights reserved. Do not reproduce our content without permission – you can contact us at info@whatsonweibo.com

image_print
Continue Reading
Advertisement
Advertisement

Support What’s on Weibo

If you enjoy What’s on Weibo and support the way we report the latest trends in China, you could consider becoming a What's on Weibo patron:
Donate

Facebook

Instagram

Advertisement

Contribute

Got any tips? Suggestions? Or want to become a contributor? Email us as at info@whatsonweibo.com.

Popular Reads