A doctor from Nanchang, Jiangxi Province, has stirred controversy online for sharing photos of supposed bribes for medicine. In September of this year, the man shared photos on his Weibo account (@Tao韬GT) of cash money, writing: “I have received 5500 yuan [±840$], again, as a commission for medicine sales. I’m happy, now I can go shopping again, it’s good to be a doctor, ha.”
The post did not attract attention until earlier this week, when netizens exposed the issue on Weibo. It then made headlines in various online newspapers such as The Paper, Sohu News, and Sina.
“Bribery in hospitals is a common occurrence,” some netizens responded to the controversy: “At least this man is honest about it.”
Healthcare corruption is a much-discussed problem in China. In 2013, Quartz reporter Lily Kuo wrote that it is common for pharmaceutical firms in China to bribe doctors and hospitals to prescribe their medicine or buy their medical equipment, as low-paid doctors and nurses depend on these bribes and sales at hospital pharmacies for a large part of their income.
On Weibo, many commenters express similar sentiments regarding the Nanchang doctor, saying that it is not so much this man, but the system that is the problem. “He just tells the truth. Nowadays all hospital accept bribes”, one commenter wrote. “It would be more newsworthy if he did not accept bribes,” one person joked.
Other Weibo users suggested the Nanchang doctor purposely posted the photo to raise awareness on corruption in Chinese hospitals.
The doctor in question, however, claims he never really received bribes and that he was just making foolish jokes on Weibo. The photo of the cash money was not even his, he says, but just an image he found on search engine Baidu.
According to Chinese media outlet The Paper, the doctor was employed at the emergency department of the Nanchang Second Hospital. The hospital’s management confirmed that the man has been dismissed this week since the controversy erupted and that the case is under investigation.
“At the time, my relationship had just ended and I was feeling down and depressed,” the man wrote on his Weibo account on December 26: “I posted that because I was venting and being ironic about myself. After posting that, there were no comments on it for three months, and I thought nobody had seen it so I did not pay attention to it anymore. Who would have thought it would come out like this today, I’m so depressed. I’m left to suffer the consequences of my own actions.”
A day later, the man also wrote: “I acknowledge my mistakes. I was foolish and immature. My frivolous remarks have created much disturbance. No matter what work I will do in the future, I will face it with a mature, rational, and positive attitude. This is a lesson I’ve learned for life.”
Many netizens, however, care more about the bigger issue behind this post than the man’s apologies. One person wrote: “He was just talking rubbish and boasting, but medicine commissions are in fact a tumor in the medical industry.”
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Coca Cola Introduces “Ocean Plastic Bottles” to Combat Marine Waste Problem
Coca Cola’s innovative ocean plastic bottles have become top trending on Weibo.
As Coca Cola introduced the world’s first bottles made from recycled ocean plastic waste this week, the topic has risen to the top trending on China’s Sina Weibo.
As reported by Business Insider, Coca Cola has released 300 sample bottles showing the potential of its new technology that is able to transform lower-grade recycables into high-quality food packages.
The Coca Cola bottles were produced using 25% recycled marine waste, collected by volunteers and fishermen during 84 beach cleanups in Spain and Portugal, the report says, with the company’s long-term goal being to have all its plastic bottles be made from 50% recycled plastics by 2030.
Coca Cola will start to use more recycled plastic for its bottles from 2020 on.
With the topic now having reached 140 million views on Weibo, many people are discussing the issue. The majority of commenters applaud the environment-friendly initiative, but there are also some who say they fear the bottles would somehow contain “more pollutants” or start to “taste like the ocean.”
Others write they do not necessarily want to drink Coca Cola, but would like to obtain one of their ‘ocean plastic’ bottles as a collector’s item.
The Chinese news reports about the new Coca Cola initiative raise awareness on the problems of how plastic waste in oceans jeopardizes marine life.
“Environmental problems require immediate action,” one Weibo users writes: “A good company will take on the responsibility to do something.”
Some 200 billion plastic bottles are sold in China every year – many of them are already being recycled. Coca Cola, however, will reportedly be the world’s first company to use ocean plastic waste for its bottles.
Coca Cola is an important player in the Chinese beverage market; the company has introduced more than 60 products under 20 brands within mainland China.
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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