Linfen Red-Ribbon School, the only special school for HIV-infected children in China, sparked a social media storm in early June when Shanxi Daily reported that its students would take their national exams in a special exam room, instead of taking it at the standard local exam site together with other students.
The Red Ribbon School was established in December of 2011, and has since been included in the national education system. The Institute offers free food, dorms, medical services, and psychological treatment for its 33 students, who come from all over China.
China’s national college exam, better known as the gaokao (高考), is the National Higher Entrance Examination. For most students, it is the most important exam of their life.
The Red Ribbon School received official authorization to let 16 of its students take the national exam within the school premises. The students have lived and studied at the Institute since 2004. All prerequisites for the official exam, including CCTV and surveillance equipment, have now been installed in two designated gaokao rooms. There are separate rooms for candidates in liberal arts and science.
The idea for the special exam site was originally suggested by Guo Xiaoping, the school’s headmaster. People with HIV often still face severe stigma and discrimination in China. “It is unrealistic to prevent all discrimination in modern-day society,” Guo said in an interview with the Shanxi Daily: “Some people might object to taking tests together with our students. It was my proposal to set up a separate place for them, and it was then approved by the education and exam council. The establishment of this examination site is of major significance.”
But not all netizens agreed on the helpfulness of separate exam rooms, and it triggered wider debates on the existence of the school itself. One Chinese web user objected: “’Red-Ribbon school’? Giving the school this name is like screaming from the rooftops ‘these kids are sick!’ This institution is unprecedentedly wicked rather than meaningful.”
Another person ridiculed the exam arrangements, pointing out that it reinforced discrimination instead of eliminating it.
There are also many people who approve of the school; but also because they are worried about their own ‘safety.’ On the Weibo page of Chinanews, the comment that received the most ‘likes’ explained a concerned parent’s perspective: “Would you feel safe knowing your kid is playing with those HIV-positive children? They are so little and don’t know how to protect themselves. Something might happen that leads to contact with blood.”
“I bet that half of the comments here are just out of political correctness. To be honest, I don’t want to live with HIV-students in the same college because I’m afraid that I might have some dangerous physical contact with them without even knowing it.”
There are also Weibo commenters who support headmaster Guo Xiaoping. “He’s a great man who quit his job as the president of the Linfen People’s Hospital to devote himself to building this school to help HIV-infected kids receive a proper education. It is really unfair to talk badly about such a kind old man and these poor children.”
In 2014, over half a million (501,000) of China’s population were reportedly living with HIV. Although the number of HIV cases is relatively low in China, this has also intensified existing stigmas and fear (see this 2009 study on stigma and discrimination among people with HIV in low HIV-prevalence contexts).
HIV-infected children in China are often forced to drop out of school because of poverty, discrimination, and poor health. In 2014, the 8-year-old HIV-infected Kunkun made headlines when he was banished from his village for the ‘safety’ of his neighbors. He later found a new home at the Red Ribbon school.
Sixth Tone recently reported that many workers with Chinese Hepatitis B seek body doubles to pass health checks in the workplace to avoid discrimination. Similar practices also occur with HIV carriers. Taboos surrounding the disease are so strong that some Chinese doctors still fear treating HIV/Aids patients, despite anti-discrimination rules.
Looking at the many comments on Chinese social media about the facts and falsehoods about HIV/Aids, it is clear that there is still a long road ahead for HIV awareness in China – especially because sexual education is still a controversial topic.
Through an open letter online, one of the students of the Red Ribbon School also gave their view and final say on the matter. They wrote: “I just want to go to college, achieve my dreams and pay back those who love me. The nearer the gaokao is, the heavier my heart feels. So many questions have been troubling me: whether I will be accepted to a university, if the teachers will accept me as a normal student, and whether my classmates will study and live with me.”
The students of the Red Ribbon Schools will be taking their exams on June 7 and 8. One 19-year-old Weibo netizen wishes the students the best: “As a Linfen resident, this moves me to tears, and I am proud of Linfen. All these keyboard warriors need to shut up and stop discriminating. You can’t deprive these students of their rights. I wish them all the good luck for their exams!”
Additional editing by Manya Koetse
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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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Online Doctors and Counting Steps: Top 5 Chinese Health & Fitness Apps
These are the popular health & fitness apps used by Chinese netizens.
Ttracking psychical activities and sharing them with friends on social media is something that has become more popular in China, with other types of apps in the health and fitness categories also gaining in popularity.
In a series of five articles, What’s on Weibo is providing some insights into what apps are currently popular in mainland China. After the categories news apps, mobile gaming, and short video & livestreaming, we will now highlight some of the more popular apps in the category of health and fitness.
We made our selection based on the data from the Android app stores Tencent, Baidu, Huawei, and Zhushou360. We tried our best to give you a representative overview of a variety of apps that are currently most used in China, but want to remind you that these lists are by no official “top 5” charts.
Here we go!
#1 Keep 自由运动场
Keep (literally: Free Sportsground 自由运动场) is currently the most popular health and fitness app in the Chinese Apple store. Keep first appeared in 2015, and has since grown to become the country’s biggest online sports community. Following their success, Keep has also expanded its businesses outside of the online world and now have their own KeepLand Gyms.
Keep is a very all-round app. When first using the app, users have to answer a number of questions concerning their health, age, motivation to exercise, level of experience, and preferred sports. Once the user has answered all the required questions, the app is ready for use.
The app’s main page is called ‘workout’ and is divided into different workout categories. Per category, the user can find many different exercises, including (video) explanations and duration of the workout sessions. For certain endurance sports such as running and cycling, the app will also track the user’s route and speed.
Based on the measured activity, the app will recommend new exercises. Besides workouts, there are also classes you can follow and challenges to take on.
But becoming healthier takes more than exercising alone. Therefore, the app also incorporated a food page, providing its users with diet advice, recipes, and calorie info.
The app also has its own shop selling sports clothes and attributes, food supplements, and other trendy merchandise. For those who share their personal results on social media platforms, such as WeChat, get discounts in the app’s webshop.
Last but not least, the app also has a ‘community space’ where users can share their experiences and find support.
#2 Meet You 美柚月经期助手
Meet You is the English name of this app, that is literally called ‘Beautiful Pomelo Menstruation Tracker’ (美柚月经期助手), with the pomelo being a fruit that symbolizes prosperity, good luck, and positivity. The app is a multifunctional period tracker for all women but is mainly focused on women who are trying to get pregnant, who are pregnant, or who already have children. Meet You promotes its app as a way to “make Chinese women even more beautiful and healthier.”
The most important page of Meet You is the personal main page. On this page, users can keep a record of their menstruation cycle, their day-to-day mood, weight, possible illnesses, bowel movements, use of anticonception, eating habits, etc.
Based on all this data, the app will analyze their current state of health, and recommend certain news articles and other reads that match the user’s preferences.
Additionally, users can also share their experiences and knowledge through the in-app ‘communities.’ The app has a number of communities focused on specific topics, such as Make-up Time, Love To Travel and Skin Care Beauty Salon.
Of course, there is also a shopping page, which, without doubt, is an important part of the app’s revenue model.
Meet You was first launched in 2013 by the Meiyou Information Technology Company, based in Xiamen. Throughout the years, the company launched several other apps all focused on women. Currently, Meet You has over 200 million users, of which 7 million were daily active users according to their own website. And according to a report by Jiguang, Meet You was the second most favored app among female mobile users in 2018.
#3 Qin Baobao 亲宝宝
Qin Baobao is an app to provide childcare information for pregnant woman and families with children up to the age of six. The app was first launched in 2013 by Hangzhou Xingwang Technology. Five years later, in 2018, the app had succeeded in reaching more than 100 million registered users, according to the company’s website.
In March 2019, the app was the third most popular app in the category Health and Fitness in the Chinese Apple Stores.
Qin Baobao is mainly focused on using technology to help families to better care for their young children. The app’s functions can be divided roughly into two parts. One part is focused on the improvement of children’s health and general well-being, and the other part is about recording the child’s development and sharing joyful moments with friends and family.
To help parents in taking care of their young children, the app provides functions such as soothing music and a knowledge database of age-appropriate foods.
There are also recipes for baby food, tips on how to make your child eat well, advice on what to do when your child is sick, and a Q&A forum.
The other part is all about documenting the growth of the child. Through texts, pictures, and videos, the precious first years of a child’s life can be safely stored and shared with friends and family.
What makes the app more attractive than other social media, according to the company’s statement, is that the app respects its users’ privacy and allegedly won’t be using the uploaded data for other purposes.
#4 Ping An Good Doctor 平安好医生
Ping An Good Doctor is a health care and medical consultation platform and part of the Ping An Healthcare and Technology Company.
Ping An Good Doctor was launched in 2015 and has become more popular since. In 2018, the number of registered users reached 265 million, of which nearly 54.7 million were monthly active users, according to their own website.
The app is a portal for medical consultation, something which is not easily available to everyone in China. The app provides four types of services: the family doctor, the consultation hall, medical bibliography of the doctors, and a ‘health community.’
The so-called family doctor service provides a one-on-one, private, real-time (paid) consultation between a user and a doctor. Online ‘patients’ can also talk to doctors in the ‘consultation hall,’ but this service is not private nor one-on-one.
The app certainly cannot replace an actual doctor’s appointment; not only does the virtual environment make it impossible to do a physical checkup, but the doctors also can not give any prescriptions to their ‘patients.’ The app does allow users to make an appointment with a doctor at an actual hospital through its appointment booking service.
Besides the medical consultation functions, the app also includes a catalog of China’s top-notch doctors. Through the app, users can request (offline) consultation or other services from these doctors. The compiled list of doctors is also a way to get insight into the different specialisms of different hospitals and doctors throughout the country.
The last feature of the app is the health community. In this area, all users can read articles about how to keep healthy, how to treat diseases, etc.
To provide all of these services, Ping An Good Doctor allegedly employed 1196 medical personnel in its in-house medical team, signed contracts with an additional 5,203 renowned external doctors, and partnered with over 3000 hospitals and over 15.000 pharmacies by the end of 2018.
#5 Yodo Run 悦动圈
The final app in this list is Yodo Run by the Shenzhen-based Rejoice Sports Tech Company. Yodo Run is one of China’s leading social health and fitness recording apps that strives to stimulate users to adopt a healthy lifestyle.
Through Yodo Run‘s advanced automatic step counting and GPS algorithm, the app can record various exercise patterns such as walking, running, fitness, and cycling. This way, users can keep track of their day-to-day movements. But that is not all that the app provides. The app also includes exercise schedules, video tutorials and a list of music.
To make sure people keep using the app, Yodo Run gives away tens of thousands of money packages every day. There are awards for reaching small goals, such as making 500 steps on your first day as an app user. But there are also awards that are more difficult to earn, such as long-term goals or when you partake in competitions or challenges.
But for those who are not using the app as a way to earn something extra, the app found another way to stimulates its users to exercise. And this is where Yodo Run differentiates itself with many other sports apps.
Yodo Run has a strong focus on bringing people together to exercise. To enable this, Yodo Run has the right tools to actively stimulate people to go out and meet others with a shared passion for exercising. According to their own website, the app has enabled people to unite in more than 500,000 “sports groups”, of which 10,000 are actual real-time running groups, spread over more than 300 cities worldwide.
The app is available in both Chinese and English.
- Top 5 of China’s Most Popular Live Streaming and Short Video Apps
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