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China Health & Science

The “Last Downer”: China and the End of Down Syndrome

With screenings for Down syndrome becoming more advanced, there are less and less babies being born with Down in China every year. Unborn babies with Down syndrome are allowed to be aborted to up to nine months of pregnancy.

Manya Koetse

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New screenings that can predict if an unborn baby has Down syndrome have sparked wide debate across the world – mostly because their results often lead to parents choosing for abortion. The ethical debate that is so alive in many countries seems practically non-existent in China, where Down syndrome is slowly disappearing from society. Unborn babies with Down syndrome are allowed to be aborted to up to the ninth month of pregnancy; 21% of Down-related abortions in China occur during or after the seventh month.

Last month was World Down Dyndrome Day (世界唐氏综合征日, March 21) and next month marks China’s National Disability Day (全国助残日, May 15) – both are occasions when Chinese media pay extra attention to Down syndrome, a disorder that is slowly disappearing from Chinese society.

On World Down Syndrome Day, Chinese state media broadcaster CCTV wrote on its Weibo account: “Currently, medical science does not have effective prevention and treatment methods for Down syndrome, but it can be detected early through prenatal screening. You might have seen this kind of face: mouth slightly open, a blank expression, eyes somewhat wide apart,.. break your prejudices and understand them!” This text is accompanied by different facts about Down syndrome pictured with a cartoon baby on CCTV’s account page (pictured below).

angrbaby

“I’m still nervously awaiting the results of the amniotic fluid test,” one netizen responds to the post: “I hope my baby is healthy and normal.”

On Chinese social media, many expecting mothers express their worries about screening results and the health of their unborn child. But the ethical debate that is so alive in many other countries about Down syndrome screening and abortion seems practically non-existent in China. One Weibo user comments: “In foreign countries, there are many mothers raising kids with Down, because their religion does not allow them to abort the baby.”

 

THE “LAST DOWNER”

“New medical techniques and the ethical questions that come with it have caused ample discussion on Down syndrome in many nations across the world.”

 

Down syndrome (DS) is a congenital disorder caused by a chromosome defect, that exists in all regions worldwide. Children with DS often have an intellectual disability and are also affected physically in their appearance and general health. Down syndrome has an incidence of 1 in 600–1000 live births, differing per country (UN; Wang et al 2013, 273). The disorder was named after John Langdon Down, the British physician who first classified this genetic disorder in 1862. In Chinese, it is known as 唐氏综合征 (Tángshì zònghézhēng) or as 先天愚型 (Xiāntiān yúxíng), the latter literally meaning ‘naturally stupid-type’.

With new techniques, it has become easier for doctors to safely detect whether or not a fetus has Down syndrome. In many countries, women can now choose for first-trimester prenatal screenings that can indicate the likelihood they are carrying a baby with Down syndrome. These tests can be followed up with diagnostic tests, either through amniocentesis (amniotic fluid test) or a DNA blood test, that can give a conclusive answer. If the unborn baby turns out to have DS, parents often have the option to abort it.

These new medical techniques and the ethical questions that come with them have caused ample discussions on Down syndrome in many nations across the world. Denmark introduced national guidelines for prenatal screening and diagnosis as early as 2004, which has led to an all-time low of Danish infants with Down syndrome – 95%-98% of pregnant women choose to abort a fetus with DS (Vice 2015). This means that Down could become something of the past; not just in Denmark, but also in other countries that have followed its example after 2004.

According to anti-abortion media, what is happening in Denmark is a “targeted form of genocide.” In the United States, the test has also become a focus of controversy, as it is intertwined with America’s general debate over abortion.

NRC

The Dutch TV-series “The Last Downer” (sic) explored the gradual disappearance of Down Syndrome. The show was co-hosted by two young adults who were born with DS themselves. Photo via NPO/NRC of TV Show “De Laatste Downer.”

 

In the Netherlands, a TV show revolving around ‘the end of Down syndrome’ was recently aired on national television. The series, that was titled ‘The Last Downer’, explored what society loses if Down syndrome disappears. It also talked about the ethical, social and psychological consequences of having a child with Down syndrome. ‘The Last Downer’ also triggered debate, as some critics deemed that it was too much in favor of the pro-life movement.

 

DOWN SYNDROME IN CHINA

“21% of abortions related to DS in China take place after the 28th week of pregnancy.”

 

In China, it is estimated that 1 out of 700 infants are affected with Down syndrome. Although this percentage is relatively low compared to other countries, it is an enormous figure nevertheless due to China’s huge population (Deng et al 2015, 311).

China’s Ministry of Health has promoted nationwide prenatal screenings for birth defects since 2003 (312). As pointed out in recent Chinese research, there has since been a sharp increase in the percentage of prenatal diagnosis and consequential birth termination (Deng et al 2015, 315).

The detection of Down syndrome through prenatal diagnosis in China went from nearly 13% in 2003 to over 69% in 2011 – with urban women having better access to early screenings and diagnosis than women living in the more rural areas of China. Around 95% of women terminate their pregnancy after learning the baby has DS, which is close to similarly high numbers in countries like Denmark or Hungary.

What is different in China, is that abortions can take place up to the ninth month of pregnancy.* In nearly 80% of the cases where the DS diagnosis led to abortion, this termination took place before 28 weeks. In the other cases, the pregnancy was terminated later than 28 weeks; meaning that 21% of abortions related to DS take place after the 28th week of pregnancy (ibid. 2015, 315).** In, for example, the Netherlands, abortion can take place up to 24 weeks of pregnancy, which is determined as the moment after which a fetus would be able to survive outside the uterus. Denmark allows for abortions to take place until the 12th week of pregnancy.

Chinese doctors encourage screening more strongly when pregnant women are older. According to current regulations in China, pregnant women aged 35 or above will be suggested to have an amniocentesis test directly, and, as research points out, “most Chinese women opt to abort fetuses with malformations” (Deng et al 2015, 316). Overall, the prevalence of prenatal diagnosis of DS and the number of related abortions is higher in urban areas than in China’s rural areas due to better medical facilities in cities. This also suggests that the majority of babies with DS are now born in the countryside, where parents do not always have access to the medical care they need.

 

ABORTION IS OKAY

“Bright-pink advertisements on ‘painless abortions’ depict smiling women, butterflies and flowers.”

 

On Weibo, many netizens share their experiences with prenatal screening. One pregnant woman says the test has cost her 191 RMB (±30 US$), another netizen responds: “In my hometown, these screenings are free of charge!” Another Weibo user shares her anxiousness: “I’ve been worrying about this Down screening all week,” she writes on April 21st. The following day, she replies to the comments with crying emoticons.

Although the screenings are a big issue on Chinese social media, the ethical question of the abortions is seemingly not. This might relate to the fact that abortion is not as contentious in China as it is in many other countries.

Pregnancy termination became quite common in China during the 20th century in relation to the one-child policy. By now, China has the highest abortion rate in the world. According to the National Health and Family Planning Commission, 13 million abortions are carried out in China every year. The actual number is probably much higher, as the official number does not include the abortion numbers from private clinics, nor the estimated 10 million induced abortions per year through medicine (Xinhua 2014), nor the numbers of sex-selective abortions– a practice that has officially been illegal since 2004.

The prevalence of abortions in China has led to a booming industry focused on abortion procedures. Bright-pink advertisements on ‘painless abortions’ depict smiling women, butterflies and flowers.

beaqueen

Some even promise that the abortion will be over within ‘a dreamlike three minutes’ (for more on this read: Glamorous & Painless – China’s Booming Abortion Industry). Although China has a painful past when it comes to forced abortions, the personal choice for abortion is not as controversial as it is in many countries where the Down syndrome detection debate is more alive.

abortion

“I’m drinking fresh rosedew after my abortion,” one netizen writes: “It’s good for my cold womb.”

 

THE HARDSHIPS OF DOWN CHILDREN IN CHINA

“Giving a child with Down syndrome up for adoption is very difficult, as China’s DS children are generally deemed ‘unadoptable’.”

 

Besides the fact that abortion is considered relatively uncontroversial in China, the high rate of abortions for DS-diagnosed babies might also relate to the fact that disabled children face many difficulties in China due to stigmatization and practical hurdles.

Raising a handicapped child is a heavy burden for many parents in China, who receive little government support and often do not have the means to make sure their child gets the medical care and education they need. This means that abandoning the child sometimes is the only solution for parents to make sure their child is taken into an institution (Yoxall 2008, 25).

downer

Giving a child with Down syndrome up for adoption is very difficult, as China’s DS children are generally deemed ‘unadoptable‘. Until recently, it was legally not possible to adopt a child with Down within China. Since this has now changed, international organizations like the Bamboo Project help parents who want to adopt a child with Down syndrome from China.

 

SCREENINGS FOR DOWN: ANXIETY & CONFUSION

“If your baby has Down syndrome, you can’t keep it – you do understand this, don’t you?”

 

In China’s urban areas, first-trimester screenings for DS (唐氏筛查) through a blood test have become practically mandatory. Some clinics have 100% screening guidelines for all of their patients, but do ask parents to sign for consent first; other hospitals simply proceed to include the test with general pregnancy check-ups without any permission.

Screening procedures differ per hospital and can be confusing for expecting mothers: “Today my doctor told me that because I am already 35, I should do an amniocentesis test,” one netizen writes on Weibo: “but the blood test in my first trimester indicated I had low risk of having a baby with Down. I’m very confused if I should do it or not.”

China’s screening procedures and prevalent attitudes on how to deal with a baby that possibly has DS can be shocking to some. A 31-year-old Dutch mum named Anna (alias), who lives in Shanghai, recently shared her experiences on Facebook. Anna, pregnant with her second baby, writes:

I was unable to come on Facebook for some time due to problems with my VPN. During this period, I’ve come across something that I loathe even more than China’s internet censorship. “They’ve tried calling you but you didn’t pick up,” the Chinese nurse tells me while looking up from a form, as she points me to an examination room. I walk in, and ask the doctor what’s going on – I vaguely remember a ‘standard’ blood test (..) – “‘You have an increased risk for a child with a mental disability,’ the doctor straightforwardly tells me. ‘Excuse me?’ – I ask her to repeat her sentence. ‘The child might be retarded,’ she tells me.

Anna writes: “In the Netherlands, the availability of prenatal tests for Down syndrome has caused quite some controversy earlier this year. It is not allowed for doctors to proactively encourage women to do this test unless there’s an increased risk for them to have a child with an intellectual disability – because they are above the age of 40, for example. But this is not the case in China, where every pregnant woman, no matter her age, is tested for heightened risk through blood screening. I ask the doctor what the test results are, since I’m only 31. ‘Well, that’s not like being 21 anymore, now it is?’ she snarls at me.”

Anna explains that the results of her blood test showed there was a 1-in-200 chance her baby had Down syndrome. After informing Anna about this, the doctor says: “You can choose if you now want an amniocentesis or a DNA test. The first is more expensive and needs to be done in a private clinic, here’s an information leaflet, just think about it.”

She chooses to do the DNA test, which is safer for mothers and their unborn babies than the amniocentesis. She says: “I was initially just shocked to hear there was an increased risk for me to have a child with a disorder, but it also bothered me that the initial screening was done without my consent. I ask the doctor what happens if my baby turns out to have Down syndrome. ‘Then you can’t keep it,’ she gives me a piercing look: ‘You do understand this, don’t you?’

Anna writes: “She advised me to timely book a possible abortion, but that the procedure would be possible until 32 (!) weeks.” Anna receives the DNA test results a week later through text message, and her baby shows no signs of abnormalities. Despite her relief, she feels uncomfortable about the intrusive way in which her prenatal screening and its possible outcome was handled.

Another foreigner living in Beijing told What’s on Weibo they also were tested for Down syndrome risks in the first trimester of pregnancy at Beijing United hospital without being asked for permission first. Although they were surprised to get the results, they did not react strongly to it as the test turned out to be very low risk.

Although the ethical debate on this issue is generally lacking from mainstream media, one story did make headlines last year when a woman from Hubei was determined to end her pregnancy at 16 weeks because of the Down syndrome screening. The initial blood screenings showed an increased risk of DS, and the woman arranged an abortion – in spite of the doctors convincing her that she should wait for the actual diagnoses screening first. This story also shows how intertwined prenatal screenings and abortion have become.

 

DS IN CHINA: TABOOS AND SOCIAL STIGMA

“I think my sister’s baby has Down syndrome, but I am too afraid to ask her.”

 

Chinese netizens share their experience with Down syndrome on various online message boards. One netizen tells how it is growing up with a brother with Down syndrome. “My brother was born prematurely and was in weak health. The doctor told my parents to just give up on him. But my father refused to give up, because it was a boy, and he thinks boys are worth more than girls. So my brother lived.” The netizen tells how his parents were told by doctors that their child was simply “hopeless”, and that his brother was always teased in school.

On message board Douban, multiple netizens share how doctors encourage couples to have an abortion if their unborn baby is diagnosed with DS.  The discussion of Down on Chinese social media shows that DS is heavily stigmatized and that it is sometimes also considered a taboo.  Some netizens tell about former classmates with Down who were constantly bullied, and one netizen writes: “I think my sister’s baby has Down syndrome, but I am too afraid to ask her.”

Now that rapidly advancing medical techniques have decreased the prevalence of DS in China, chances are that the less common the disorder is, the more stigmatized it will become. It is also probable that over the next one or two decades, if rural areas get better access to medical care, Down syndrome will altogether disappear from China.
downsscreening

For China’s upcoming ‘day for the handicapped’, multiple organizations try to raise more public awareness for Down syndrome. This year, the day will specifically focus on handicapped orphans. For this occasion Chinese media recently wrote about an orphanage in Tianjin, where one-third of all children are Down syndrome babies who were left behind by their parents.

Although the article describes children with DS as little “happy angels”, one Chinese birth clinic seems to think otherwise. In their ad (see image), their message is loud and clear: “Reject children with Down syndrome! Give birth to a healthy baby!” Angels or not, modern-day China seems to have no place for Down syndrome children.

– By Manya Koetse

[rp4wp]

References

Wang, S.-S., Wang, C., Qiao, F.-Y., Lv, J.-J. & Feng, L. 2013. “Polymorphisms in genes RFC-1/CBS as maternal risk factors for Down syndrome in China.” Arch Gyneocol Obstet 288: 273-277.

Deng, C., Yi, L., Mu, Y., Zhu, J., Qin, Y., Fan, X., Li, Q. & Dai, L. 2015. “Recent trends in the birth prevalence of Down syndrome in China: impact of prenatal diagnosis and subsequent terminations.” Prenatal Diagnosis, 35(4), 311–318.

Yoxal, James W. 2008. China’s Social Policy: Meeting the Needs of Orphaned and Disabled Children. Master Thesis, Union Institute & University.

NB: other references are linked to in-text.

* As written by Deng et al (2015): “Following a systemic and standardized diagnostic process, pregnancy affected by severe anomalies such as DS is allowed to be terminated at any gestational age following informed consent” (312).

** According to 2003-2011 surveillance data, study by Deng et al uses data from the Chinese Birth Defects Monitoring Network.

©2016 Whatsonweibo. All rights reserved. Do not reproduce our content without permission – you can contact us at info@whatsonweibo.com.

Manya Koetse is the founder and editor-in-chief of whatsonweibo.com. She is a writer, public speaker, and researcher (Sinologist, MPhil) on social trends, digital developments, and new media in an ever-changing China, with a focus on Chinese society, pop culture, and gender issues. She shares her love for hotpot on hotpotambassador.com. Contact at manya@whatsonweibo.com, or follow on Twitter.

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3 Comments

3 Comments

  1. Avatar

    Colette

    July 18, 2016 at 1:02 am

    In the UK termination for DS is also permitted until 9 months………Lord Shinkwin is trying to change this.

  2. Avatar

    jack

    October 27, 2016 at 3:40 am

    The truth is the chinese and the Japanese are a mongoloid race they were created from the daughters of a man called Lot the nephew of abraham in the bible read the story of Sodom and gomorrah this will tell of Lots two daughters and there plan…the modern day chinese are the moabites and the Japanese are the modern day ammonites,incest causes down syndrome or retardation these two nations are the product of incest…BASTARD babies…truth is hard to accept

    • Avatar

      Anonymous

      December 27, 2016 at 6:11 am

      Please go back to /pol/.

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China Health & Science

Cancer Diagnoses in Young Doctors at Same Lab: About the Zhongshan Hospital Controversy

Within a short time frame, three Chinese young doctors received cancer diagnoses after working in the same laboratory at the Zhongshan Second Affiliated Hospital.

Manya Koetse

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Several medical workers who all worked at the same renowned oncology lab in Guangzhou recently were diagnosed with cancer. Although there are many concerns about whether or not their cancer is related to their working environment, the primary source of public outrage revolves around the handling of the controversy by the affiliated hospital.

Over the past week, a case of three young doctors working in the same laboratory at a renowned Guangzhou hospital being diagnosed with a rare form of cancer has repeatedly become a trending topic on Weibo and beyond.

The hospital involved is the Sun Yat-Sen University’s Sun Yat-Sen Memorial Hospital (中山大学孙逸仙纪念医院) – also known as the Zhongshan Second Affiliated Hospital (中山二院). Founded in 1835, the hospital is known for pioneering in western medical practice. It is also well-known for its cancer treatments and education.

The three medical workers, two breast surgeons and one trainee doctor, all developed cancer just before or in 2023 after working at the Breast Cancer Center (乳腺肿瘤中心实验室). The issue first became a big topic of discussion around the night of November 6 and on November 7, when netizens’ posts started circulating on social media about how several people connected to the oncology lab got diagnosed with cancer.

One of the claims made is that one of the young doctors was expelled from the research team’s WeChat group by the team leader Dr. Su Shicheng (苏士成) upon revealing her cancer diagnosis. This assertion was later confirmed to reporters by the woman’s sister, Lele (乐乐). The staff member involved, Huang Mei (黄敏), is battling pancreatic cancer and she is currently not doing well.

The other researchers, all approximately 30 years old, are suffering from synovial sarcoma and breast cancer.

The topic soon gained traction as people assumed the lab safety at the Zhongshan Hospital must be blamed for the cancer cases. When the research center in question suddenly got dismantled on November 8, the discussions intensified as social media users speculated that the hospital was trying to get rid of evidence.

The hospital denied that the medical workers had contracted cancer due to exposure in the lab environment. Staff members later claimed that the alleged dismantling of the lab on November 8 was already scheduled as part of the fire department’s orders, emphasizing that it was unrelated to the ongoing controversy.

Photos of the lab getting dismantled shared on Weibo.

On November 9, the China Association for Science and Technology (中国科学技术协会) posted on their official social media account, calling for a thorough and professional investigation into the case to uncover the truth.

 
Online Anger and Suspicions
 

Chinese political commentator Hu Xijin (@胡锡进) also posted a lengthy column about the issue on his social media. In his post, Hu critiqued the manner in which Zhongshan Second Affiliated Hospital handled the controversy. Although he also stressed that he did not necessarily believe that the renowned hospital purposely crossed scientific ethics that might have increased cancer risks for students working in the laboratory-if their cancer is indeed related to their working environment,- he argued that the hospital should handle this case with greater transparency.

According to the Shanghai Morning Post (@新闻晨报), the laboratory was first opened in 2009 and has since trained more than 200 students. The three cancer patients have only started working at the laboratory in recent years.

Various international studies (e.g. here, here, here) have previously indicated that research in biomedical laboratories might involve an increased risk of certain types of cancer among employees.

While some Weibo commenters voice concerns about safety protocols at the hospital lab, the prevailing online anger is more about how the hospital is handling the situation. There is a sense that those involved are being silenced, that evidence is being tampered with, and that there is a special relationship between the lab team leader, Dr. Su Shicheng, and the hospital director, Song Erwei (宋尔卫).

Adding to the suspicions, Dr. Su not only works directly under Song as a deputy director of the Breast Cancer Center but has also co-authored an academic essay with Song’s son, Song Shijian (宋世键). Some people believe they are all covering for each other.

“If they [the hospital] finally holds a press conference, they’d better invite Ms. Huang who was kicked out of the WeChat group!” some commenters on Weibo wrote.

Meanwhile, there is an increased media focus in China on the lab safety protocols at other hospitals as well. With Chinese media outlets interviewing medical students from other institutions, it has come to light that many say they have never actually received formal training regarding lab safety rules (#5位医学生眼中的实验室#, #多数受访学生称未接受实验室安全培训#).

As attention on the Zhongshan Second Affiliated Hospital case intensifies from various fronts, including the public, media, and medical associations, the pressure on the hospital is mounting to provide a clear and transparent response to the situation.

While many might wish for this case to fade away, this storm is not going to blow over anytime soon. Beyond the public’s need for answers, it is the medical workers who are struggling with their illness and navigating through this whirlwind who especially deserve the clarity they need.

“Let’s build up the pressure,” some netizens suggest, trying to keep the case trending.

“I’m so disappointed,” another Weibo user wrote: “I was determined to study medicine since senior high school, but the older I get the more I realize the ugly face behind the healthcare system.”

By Manya Koetse

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©2023 Whatsonweibo. All rights reserved. Do not reproduce our content without permission – you can contact us at info@whatsonweibo.com.

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China Brands, Marketing & Consumers

Tsingtao Brewery ‘Pee-Gate’: Factory Worker Caught Urinating in Raw Material Warehouse

The pee incident, that occurred at a subsidiary Tsingtao Beer factory, has caused concerns among consumers.

Manya Koetse

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A video that has circulated on Chinese social media since October 19 shows how an alleged worker at a Tsingtao Beer factory climbs over a wall at the raw material production site and starts to urinate.

The incident reportedly occurred at the Tsingtao Beer Factory No. 3, a subsidiary of the Tsingtao Brewing Company, located in Qingdao, Shandong.

After the video went viral, the Tsingtao Brewery Company issued a statement that they took the incident very seriously and immediately report it to the authorities, who have started an investigation into the case. Meanwhile, the specific batch in production has been halted and shut off.

The incident has caused concern among consumers, and some commenters on social media wonder if this was the first time something like this has happened. “How do we know this hasn’t happened many times before?”

Others speculate about what might have motivated the man to urinate at the production site. There are those who believe that the man is part of an undercover operation orchestrated by a rivaling company, aimed at discrediting Tsingtao. It’s even suggested that there were two ‘moles’ leaking in this incident: one doing the urinating, and the other doing the video ‘leak.’

Meanwhile, there are voices who are critical of Tsingtao, suggesting that the renowned beer brand has not effectively addressed the ‘pee gate’ scandal. It remains uncertain how this incident will impact the brand, but some netizens are already expressing reservations about ordering a Tsingtao beer as a result.

But there are also those who joke about the “pissing incident,” wondering if Tsingtao Beer might soon launch a special “urine flavored beer.”

By Manya Koetse

Get the story behind the hashtag. Subscribe to What’s on Weibo here to receive our newsletter and get access to our latest articles:

Featured photo by Jay Ang (link).

Spotted a mistake or want to add something? Please let us know in comments below or email us. First-time commenters, please be patient – we will have to manually approve your comment before it appears.

©2023 Whatsonweibo. All rights reserved. Do not reproduce our content without permission – you can contact us at info@whatsonweibo.com.

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