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Remembering San Mao – the Bohemian Writer That Captured the Hearts of Millions of Chinese

27 years after her suicide, bohemian writer San Mao still strikes a chord with Chinese netizens.

Manya Koetse

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Renowned author and world traveler San Mao (三毛) was one of the first Chinese mass media celebrities. Exactly 27 years after her passing, Weibo netizens collectively commemorate her free spirit, inspirational life, and tragic death.

In a time when Beijing’s first fast-food restaurants opened their doors, people were hooked on Teresa Tang’s sweet voice, and television sets entered Chinese living rooms, pirate editions of books by the wildly popular Chinese author San Mao first started spreading all over mainland China.

Before this time in the late 1980s, the female author was already a celebrity in Taiwan and Hong Kong since the 1970s; not just because of her many books, newspaper columns, song lyrics, and public lectures, but also because of her free, cosmopolitan, and “legendary” life that captured the imagination of many Chinese eager to look beyond their own borders.

Researcher Miriam Lang (2015) describes San Mao as “one of the first mass media celebrities in the Chinese-speaking world” (440).

On January 4th 2018, the 20th-century writer became a trending topic on social media when various media commemorated her. Chinese state media outlet People’s Daily dedicated a post to the iconic author on Weibo, titled “Today, we cherish the memory of San Mao.”

People’s Daily writes:

She was born in Chongqing, moved to Taiwan, studied in Spain, and settled in the Sahara. All of her life she pursued freedom and touched the hearts of many with all of her words. Her love-story with Jose stirred people’s emotions. Her mother said that maybe her life was not perfect enough for her, but we now know that her life-long pursuit of her dreams has already become romantic legend. Today, in 1991, writer San Mao committed suicide.”

Besides that the post itself attracted thousands of comments and was shared nearly 3800 times, many other media outlets and netizens also posted their own commemorations to the author on Weibo. One post by the Communist Youth League received more than 100,000 comments on January 4th.

“She was the first author I really loved,” one person comments: “Whether she was in the Sahara or Madrid, the way she describes her love has become like a little gemstone in my own life.”

 
A Woman Writer Named Chen, Echo, and San Mao
 

San Mao is known as the wandering writer. Throughout her life, she moved from place to place; a life pattern that already started forming in the early years of her childhood.

San Mao was born in Chongqing, China, in 1943. Her parents, mother Miao Jinlan and father Chen Siqing, named their little girl Chen Mao Ping (陈懋平). Chen, however, later preferred to be called Chen Ping, and gave herself the English name of ‘Echo’ to honor her painting teacher. Once she started writing, she used the pen name San Mao (三毛), which is how she came to be remembered.

Chen Ping aka San Mao during her time in the Sahara.

San Mao’s early years took her from wartime Chongqing via Nanjing to Taiwan, where the 6-year-old girl had trouble fitting in at school. She preferred reading books over doing schoolwork, and while she read literary classics such as Don Quixote at an early age, she failed in mathematics and received low grades.

After a teacher at her Taipei school embarrassed her in front of her classmates by drawing a ‘0’ grade on her face and making her parade around, she refused to continue her classes there and was home-schooled by private tutors and her own father, who was a lawyer (Chen 2007).

San Mao as a young girl.

After studying Philosophy at the Chinese Culture University in Taiwan, the 20-year-old San Mao set out to broaden her horizons and moved to Spain, where she enrolled at the University of Madrid. It was the start of her bohemian lifestyle, that brought her from Spain to Germany, from the Sahara Desert to the Canary Islands, and from Central and South America back to Taiwan.

San Mao experienced many adventures but also had to face many difficult times. Her first great love whom she was to be married to, a German teacher 19 years her senior, died of a heart attack when San Mao was 26 old.

Chen Ping aka San Mao with her good friend Father Barry Martinson, a Jesuit priest.

Ten years later, her Spanish husband Jose Maria Quero Y Ruiz, whom San Mao lovingly called ‘He Xi’ (荷西) and with whom she had spent six years in the desert, tragically died during a diving accident.

San Mao and her Spanish husband ‘He Xi’ (荷西).

Miriam Lang, in her study of San Mao (2015), describes her as “unusual for a woman of her time and place”; she traveled far from home, married a non-Chinese man, and remained childless. Nonetheless, Lang notes, San Mao was also traditional in that she represented herself as a “happy housewife” while married, and expressed conservative feminine values in her books (443).

San Mao and Jose.

Although San Mao published her first book at the of 19, she did not really gain fame until the release of her first book The Stories of the Sahara (撒哈拉的故事) in 1976. This work revolves around San Mao’s personal experiences in the Sahara desert together with her husband Jose (Ying 2010, 162).

 
An Unhappy Ending
 

In the decade following her husband’s death, San Mao first set out on a 6-month journey to America but then traveled less and finally settled in Taiwan in 1982, where she started teaching literature and creative writing at the Chinese Culture University.

San Mao in the US.

Being a celebrity, her classes were always packed – students lined up to attend her lectures.

In 1989, she first visited mainland China again since her childhood, where she started working on the screenplay of Red Dust, a love story set during the Sino-Japanese war. Although the film eventually received much acclaim – even winning the prize for Best Film at the Golden Horse Awards of 1990 – San Mao received criticism for creating a “too positive picture” of the leading male character, who was perceived to be a traitor to the Chinese nation (Lang 2015, 442).

Despite all of her activities in her later career, San Mao never parallelled the success she had with her stories about the Sahara. In 1990, San claimed she had won a literary prize in Spain for novella written in Spanish, but the work appeared to be non-existent (Lang 2015,442).

In early 1991, San Mao admitted herself to a hospital in Taiwan where she was tested for cancer. The results turned out negative, but San reportedly asked the nurse for a sleeping pill for the night and asked her not to wake her (Chen 2007).

San Mao ended her own life by hanging on January 4, 1991, at Rongmin General Hospital. She was 47 years old.

Father Jerry Martinson, a Jesuit priest who knew San Mao for years as the brother of her close friend Barry Martinson, told UCA News two weeks after her suicide that San Mao “desired to escape from her fame’s pressure and emotional entanglements, and to reunite with Jose (..). His death was a trauma in her life.”

He also said that Antoine Saint-Exupery’s The Little Prince was San Mao’s favorite reading: “At the end of the story, the Little Prince wanted to go back to his planet, reachable only through short suffering.”

Throughout her life, San Mao visited over 54 countries and wrote a total of 26 complete works (Chen 2007; Lang 2015, 442; Huang 2017). An English translation of her work Stories of the Sahara (1976) is expected to be released by publishing house Bloomsbury in 2018.

 
Online “San Mao Fever”
 

The suicide of San Mao generated a new wave of “San Mao fever” in the 1990s. And now, more than two decades after her death, the Chinese celebrity still has major appeal to social media users, who post her quotes, photos, and audio segments.

“How I love San Mao,” one person writes: “Her every word is just immersed with her wisdom.”

But not all commenters are equally positive. Some say that San Mao is representative of a time when Chinese women “blindly followed” western values, adoring foreign men.

For the majority of commenters, however, San Mao is a name that brings out new inspiration or old memories. “Whenever I think about her stories from the Sahara, it just moves me.”

One Weibo user honors San Mao by posting one of her quotes*:

Often, I asked myself, what is distance? Then I heard my own answer, saying that distance is what I desired most in life – that it is freedom.
A freedom far, far away, like the air.
At that moment, I realized that I had slowly released myself from all the things I didn’t need that were binding me to my life. I then thought: I can go to the most remote corners of the earth if that is where my heart wants to go.
It was in that moment, that my freedom had finally arrived
.

If you are interested in this story you might also be interested in reading the story of Li Xianglan, the superstar who was caught between China and Japan during the Second Sino-Japanese War.

The Stories of the Sahara (in Chinese) can be purchased from Amazon:
The story of the Sahara (Chinese Edition)

The complete works of San Mao can also be purchased in Chinese online:
The Complete Works of Sanmao (Chinese Edition)

iTunes also offers The Stories of the Sahara in Chinese:

By Manya Koetse

Sources & References

Chen, Shaoshua. 2007. “San Mao – Taiwan’s Wandering Writer.” Women of China, November 30. http://www.womenofchina.cn/womenofchina/html1/people/writers/8/8989-1.htm [4.1.18].

Huang, Echo. 2017. “The brave, tragic adventurer who inspired generations of Chinese girls to adopt her nickname.” Quartz Magazine, April 24. https://qz.com/963273/the-world-traveling-writer-san-mao-inspired-generations-of-girls-to-adopt-her-nickname-echo/ [4.1.18].

Lang, Miriam. 2015 (2003). In Lily Xiao Hong Lee and A.D. Stefanowska (eds), Biographical Dictionary of Chinese women – The Twentieth-Century 1912-2000. London/New York: Routledge.

Treichel, Tamara. 2013. “The Echo Effect.” Global Times, March 10. http://www.globaltimes.cn/content/767044.shtml [4.1.18].

UCA News. 1991. “PRIEST SAYS WRITER WHO COMMITTED SUICIDE WANTED TO BECOME CATHOLIC NUN.” UCA News, February 21. https://www.ucanews.com/story-archive/?post_name=/1991/02/19/priest-says-writer-who-committed-suicide-wanted-to-become-catholic-nun&post_id=32086 [7.1.18].

Ying, Li-hua. 2010. Historical Dictionary of Modern Chinese Literature. Lanham: The Scarecrow Press.

Images

http://www.baike.com/wiki/%E4%B8%89%E6%AF%9B%5B%E4%BD%9C%E5%AE%B6%5D
http://designblog.rietveldacademie.nl/?tag=mask
http://cq.people.com.cn/GB/365409/c24845560.html
http://www.360doc.com/content/14/0623/15/700274_389097947.shtml
https://www.lemiaunoir.com/san-mao-mujer-escritora/
http://www.sohu.com/a/142240780_767795
http://www.sohu.com/a/130964781_488738
https://elpais.com/elpais/2016/10/25/inenglish/1477405923_390849.html

* “常常,我跟自己说,到底远方是什么东西。
然后我听见我自己回答,说远方是你这一生现在最渴望的东西,就是自由。
很远很远的,一种像空气一样的自由。
在那个时候开始,我发觉,我一点一点脱去了束缚我生命的一切不需要的东西。
在那个时候,海角天涯,只要我心里想到,我就可以去。
我的自由终于在这个时候来到了.”

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.

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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.

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Backgrounder

“Opposing Dog Meat Consumption Is Hypocritical” – Weibo Discussions on Anti-Dog Meat Protests

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

Manya Koetse

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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

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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.

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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.

Manya Koetse

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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.

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