Recently several international media, including The Economist, have reported a strong decline in China’s suicide rates over the past decade. These numbers are based on a 2014 study by Hong Kong University, estimating the average annual suicide rate for 2009-2011 at 9.8 per 100.000, a staggering drop since the 1990s, when China had estimated suicide rates of up to 32.9 per 100.000. The numbers are indeed astonishing; not only are they unique regarding their significant drop in suicide rate, they are also uncommon in the light of China’s economic growth. According to sociological views on suicide (based on the ideas of Durkheim), urbanization and modernization usually lead to a lack of interaction and cohesion within society, causing an increase in suicide rates. It has been the opposite for China, where a significant increase of economic development has gone hand in hand with a drop of suicide rates.
“Since 2000, the suicide rate in rural areas has grown steadily. It’s not too much to describe it as ‘extremely serious.'”
While media report about China’s lowering suicide number, there are also alarming reports about an increase of suicide amongst elders in China’s rural areas. Sociologist Liu Yanwu has stated that “the suicide rate in rural areas has grown steadily”, and that “it’s not too much to describe it as ‘extremely serious'” (Women of China 2014).
Are there less or more suicides in China? The reports are confusing. Former China Daily columnist Patrick Mattimore has called out to (western) media to question the conclusions of studies with vague research methods, warning that covering trending ‘China stories’ can actually give bad science the center stage (Mattimore 2014).
“Occasionally, the Western media fasten onto a “Chinese” story giving credence to bad science.”
A great part of the dispute on China’s suicide rates can be accounted to unrepresentative government data. The Chinese government has not officially published the PRC’s suicide numbers since 1999. The latest World Health Organization (WHO) data on suicides in China also dates back to 1999, when they reported an average rate of 13.9 per 100.000. This number is still not agreed on. In 2000, the former chief of China’s Ministry of Health already admitted that the average suicide rate from 1995-1999 was actually 22 per 100.000; a much greater number than originally reported to the WHO (Zhang 2014). In a 2002 report in Lancet, the number of suicides in the late 1990s was estimated at an annual 23 per 100.000 (Philips et al 2002, 835).
Blogger Zhang Debi stresses that in order to have clear statistics of a country’s suicide statistics, there must be an accurate system of mortality data – something that has been lacking in China. The 1999 ‘13.9’ rate was based on 21 provinces, 36 cities and 85 counties, composed of 57% of urban population. This has distorted the numbers, Zhang says, because it it has become widely acknowledged that China’s countryside suicide rate is higher than that of the urban areas. The number was later adjusted by the Global Burden of Disease (GBD) to 30.3, then the WHO readjusted it to 32.9 – more than twice the rate originally reported by China’s Ministry of Health.
No matter what report one believes, the suicide numbers in China have indeed dropped, although it might not be the staggering 58% drop. The benefits of China’s economic growth are believed to have caused the drop in suicides, especially amongst women in rural areas.
“The statistics make China unique when it comes down to suicide rates”
The statistics make China unique when it comes down to suicide in two ways: (1) it has a higher rate of suicide amongst women, whereas the rest of the world sees more men than women committing suicide, and (2) it has seen a drop in suicides during economic development, whereas it commonly is the other way around.
Suicide is the leading cause of death for women in rural areas in China. The most important factors are considered to be stress, possibly related to the strong patriarchal family structures, and the readily available pesticides: a widespread way of committing suicide in the countryside (WHO 2009). China’s economic development has created more opportunities for this group of women, who now find more freedom in moving to urbanized areas, getting educated and finding employment.
So can we expect the declining trend in suicide to continue in the years to come, and find a ‘happy ever after’? The Hong Kong University report suggests a more gloomy conclusion. Although the growing modernization and urbanization has done much good for countryside women, economic developments have a downside for rural older adults, who are suffering from more stress levels due to China’s rapid socioeconomic changes- causing a heightening suicide group for that group (Wang et al 2014, 929). Sociologist Liu has called the phenomenon a “sick suicide trend,” giving finances, bad health, and loneliness as the three major reasons for the suicide cases of old people in the countryside (Lu 2014). The recent developments suggest that suicide will remain a hot topic in ‘China stories’ in the years to come.
– by Manya Koetse
Lu Chen. 2014. “Elderly Suicide Rapidly Increasing in China’s Countryside.” Epoch Times (August 10) http://www.theepochtimes.com/n3/863657-elderly-suicide-rapidly-increasing-in-chinas-countryside/ (Accessed online August 14, 2014).
Mattirmore, Patrick. 2014. “Must question the conclusions of studies that offer vague research methods.” ContraCosta Time (August 9) http://www.contracostatimes.com/opinion/ci_26296468/guest-commentary-must-question-conclusions-studies-that-offer (Accessed online August 14, 2014).
Phillips, Michael R, Xianyun Li, Yanping Zhang. 2002. “Suicide rates in China, 1995–99.” Lancet 359: 835–40.
The Economist. 2014. “A dramatic decline in suicides – Back from the edge.” The Economist (June 28) http://www.economist.com/news/china/21605942-first-two-articles-chinas-suicide-rate-looks-effect-urbanisation-back (Accessed online August 14, 2014).
Wang, Chong-Wen, Cecilia L.W. Chan and Paul S.F. Yip. 2014. “Suicide Rates in China from 2002 to 2011: an update.” Social Psychiatry and Psychiatric Epidemiology 49(6): 929-941.
Women of China. 2014. “Wave of Suicides among China’s Rural Elderly Residents.” Women of China (August 12) http://www.womenofchina.cn/html/womenofchina/report/175054-1.htm (Accessed online August 14, 2014).
World Health Organization. 2009. Women and health: today’s evidence, tomorrow’s agenda . WHO Report (November) http://www.who.int/gender/documents/9789241563857/en/ (Accessed PDF online August 14, 2014).
Zhang Debi. 2014.“中国自杀率陡降”让人惊异 [The amazing drop in China’s suicide rate]” (In Chinese). 今日话题 [In Touch Today] (July 6) http://view.news.qq.com/original/intouchtoday/n2846.html (Accessed August 14, 2014).
Zhang Lie, Jing Jun et al 张 杰 景 军. 2011. “中国自杀率下降趋势的社会学分析 [Social Analysis of China’s Drop in Suicide Rate]”.中国社会科学 [China Social Sciences] (5).
Zhang, J.J. Ma, C. Jia, J. Sun, X. Guo, A. Xu, W. Li. 2010. “Economic growth and suicide rate changes: A case in China from 1982 to 2005.” European Psychiatry(25): 159–163.
(FYI: the woman in the picture was saved.)
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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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What Are Weibo’s “Super Topics”?
Explaining Weibo’s “Super Topics”
Over the past year, Weibo’s so-called “Super Topics” (超级话题) have become more popular on the social media platform as online spaces for people to connect and share information.
Weibo’s “super topic” function has been around since 2016. The function allows Weibo users to create and join interest-based content community pages that are online groups separated from the main Weibo space. One could perhaps compare these Weibo Super Groups to ‘mega-threads’ or ‘subreddits’ on Reddit.
These are the most important things to know about Weibo’s Super Topics:
#1 A Super Topic is Not the Same as a Hashtag
Similar to Twitter, hashtags make it possible for Weibo users to tag a topic they are addressing in their post so that their content pops up whenever other people search for that hashtag.
Different from Twitter, Weibo hashtags also have their own page where the hashtag is displayed on top, displaying how many people have viewed the hashtag, how many comments the hashtag is tagged in, and allowing users to share the hashtag page with others.
A Super Topic goes beyond the hashtag. It basically is a community account where all sort of information is shared and organized. People can ‘follow’ (关注) a Super Topic and can also ‘sign in’ (签到).
On the main page of every Super Topic page, the main subject or purpose of the super topic is briefly explained, and the number of views, followers, and posts are displayed.
A super topic-page can be created by any Weibo user and can have up to three major hosts, and ten sub-hosts. The main host(s) can decide which content will be featured as essential, they can place sticky notes, and post links to suggested topics.
#2 A Super Topic Is a Way to Organize Content
Super Topic pages allow hosts to organize relevant content in the way they want. Besides the comment area, the page consists of multiple tabs.
A tab right underneath the main featured information on the page, for example, shows the “sticky posts” (置顶帖) that the host(s) of the page have placed there, linking to relevant information or trending hashtag pages. Below the sticky notes, all the posts posted in the Super Topic community are displayed.
One of the most important tabs within the Super Topic page is called “essential content” (精花), which only shows the content that is manually selected by the host(s). This is often where opinion pieces, articles, official news, or photos, etc. are collected and separated from all the other posts.
Another tab is the “Hall of Fame” (名人堂), which mainly functions as a reference page. It features links to the personal Weibo pages of the super topic page host(s), links to the Weibo pages of top contributors, and shows a list of the biggest fans of the Super Topic. Who the biggest fan of the page is, is decided by the number of consecutive days a person has “checked-in” on the page.
#3 Super Topics Are a Place for Fans to Gather
Although a Super Topic could basically be about anything, from cities to products or hobbies, Super Topics are often created for Chinese celebrities, video games, football clubs, or TV dramas.
Through Super Topic pages, a sense of community can be created. People can be ranked for being the most contributive or for checking in daily, and comment on each other’s posts, making it a home base for many fan clubs across China.
The host(s) can also help somebody’s page (e.g. a celebrity account) grow by proposing them to others within the group.
Super Groups are ranked on Weibo based on their popularity. This also gives fans more reason to stay active in the group, making their Super Topic top ranking within their specific category (TV drama, food, photography, sports, games, etc).
What makes the Super Topic group more ‘private’ than the common Weibo area, is that people posting within the Super Topic can decide whether or not they also want their comment shared on their own Weibo page or not. If they choose not to, their comments or posts will only be visible within the Super Topic community.
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