First stop: Zwelethemba, South Africa

Zwelethamba is a township located an hour and a half away from Cape Town. But first off, let me give a bit of history about Zwelethemba and townships. During apartheid, the people of South Africa were divided into three groups: black, colored and white people. Townships were created during apartheid and were where many of the black and colored people were relocated to. Often, these townships were created in areas that had poor land and poor natural resources, such as gold or diamond mines. Even though apartheid was abolished in 1994, townships are still mostly inhabited by black and colored people and perhaps only time will tell if this demographic distribution will change.

My immediate impression of Zwelethemba was that it was nice cozy little town that reminded me a little bit of the US due to the English on all the signs and also of India with the dirt roads and trash on the side of the road. However, the people are incredibly welcoming and hospitable. My host family in Zwelethemba consisted of Mama Eunice, her daughters Thully and Annelin/Phelesa (English/Xhosa name) and Thully's daughter Cecil. Mama Eunice's mission was to make us feel at home and I have to say, she definitely succeeded and completed exceeded my expectations, but I will share more about that in my next post.

China Country Paper

In each country, we have to write a paper on a topic of our choice at the end of our stay. If you are interested, here is my China country paper:

International Honors Program Health and Community Spring 2008
China Country Paper:
Traditional Chinese Medicine’s Approach towards Sex, Contraception, Abortion and Integration with Western Medicine

Traditional Chinese medicine (TCM) began when Shen Neng, who lived around 2700 B.C., tested the medicinal effects of 360 plants on his own body.[1] Since then, it has evolved in many ways. While traditional Chinese medicine was once used for contraception and abortion purposes in China, it has mostly been replaced by biomedicine over the past century. However, TCM still plays a supportive role for Western abortions and is widely used for post-abortion care in China. To investigate this topic, I will examine traditional Chinese medicine’s perception of sex and contraception and its methods of abortion. We will then explore reasons behind the rising incidence of abortion from a economic, cultural and political perspective and the evolving integration of TCM with Western medical abortions.

Traditional Chinese Medicine’s Perception of Sex and Practice of Contraception

Traditional Chinese medicine has its roots in Taoist thought.[2] Taoism envisioned a duality in life, including two seemingly opposite but complementary forces called yin and yang. The yin force is associated with passivity, darkness, coldness, contraction, flexibility and femininity, while the yang force is associated with activity, light, heat, expansion, rigidity and masculinity. According to TCM, disease and deterioration of health occur when the yin and yang are unbalanced. TCM thus aims to balance the yin and the yang with the use of medicinal remedies, eating habits and sexual activity to counteract an “excess” or “deficiency” of yin or yang.[3]

The main function of sexual intercourse in traditional Chinese medicine is to “nourish the yin, [and] supplement the yang.”[4] TCM-believers are therefore often hesitant in practicing certain Western methods of contraception that would interfere with their seminal and vaginal fluids, as they believe that this interference will cause ill health. One manifestation of this belief is in the lower numbers of males than females that undergo sterilization. For example, in one Tientsin hospital, 14,000-15,000 tubal ligations were performed in comparison with 4,000-5,000 vasectomies over the course of a few years.[5]

The most common contraceptive method advocated by traditional Chinese medicine is the “urethral pressure method,” which involves the suppression of ejaculation by the male[6]. This ancient technique is even mentioned in several government birth control pamphlets as a birth control method.[7] It is based on the idea that ejaculation leads to the loss of germinal essence, or ching. Ching, when refined into chi (one’s life force or vital energy) can help to maintain the body’s yin-yang balance. If the man can successfully conserve his limited supply of ching, the female yin will be nourished by being “stirred up” and the yang will be supplemented by the man’s re-absorption of the vitalized yang ching back into his system.[8]

A less common method involves the use of secretions from the internal organs of a rare animal called she xiang. The organ is worn in a small pouch over the stomach area of the female so that the pouch is in contact with the female’s skin. The pouch has a strong fragrance due to the she xiang’s secretions. Due to national policy to protect the she xiang, only 1000-2000kg of the she xiang’s secretions is sold annually on the international market. This method is therefore seldom used due to the expensive and rare nature of the secretions. In addition, there are concerns that its effectiveness as a method of contraception is not documented.[9]

Use of Traditional Chinese Medicine in Abortion

Traditional Chinese medicine’s approach to abortion usually involves the use of herbal medicinal remedies rather than surgery.[10] For example, dried asparagus lucides soaked in alcohol are sometimes used as cervical dilators to induce uterine contractions for abortion purposes. According to one study, even after using this method 84 times, there were no adverse effects, such as infections.[11]

China’s Ministry of Health issued a directive in 1955 to integrate traditional and Western medicine, including using Western medicine’s reductionist approach to reduce medicines to their basic, essential ingredients.[12] The same approach is now being used in traditional Chinese abortion medicine. For example, tian hua fen or the powdered root of the Trichosanthes Kirilowii plant has been used “for hundreds of years to induce premature abortion” and “facilitate the expulsion of the placenta.”[13] After researching this ancient Chinese abortion remedy, investigators at the Shanghai Institute of Organic Chemistry recently found a chemical called tricosanthin that is effective in inducing late-pregnancy abortions. Today, it has been successfully synthesized and used on at least one million women for abortion purposes.[14] This isolation of active chemicals in TCM herbal remedies mirrors a similar trend in Indian Ayurvedic medicine. In addition, both TCM and Ayurveda have begun to be marketed in pill form, as is common in Western medicine.[15] For example, a famous brand-name pharmacy Tong Ren Tang in China is marketing TCM in pill form and in Tanzania, “ready-made Chinese medical patent formulas which allow for speedy consumptions” are already available for sale.[16][17] This has led to a change in perception towards TCM. For example, Wu Yingkai, a doctor who received his medical training in the United States, felt that the reevaluation of TCM has been valuable and changed his perception of it from being “rubbish” to a field that deserves “a place in medical care.”[18]

Impact of Economics, Culture and Politics on Abortion

The incidence of abortions has increased significantly in the past few decades due to a number of factors: the cultural and economic opening-up of China’s markets, the one-child policy, and traditional values of morality associated with virginity. For example, the national abortion ratio was below 200 per 1,000 live births in 1973. By 1982, the ratio had risen to 584 per 1,000 live births. In fact, between 1978 and 1979, at the time when the one-child policy came into effect between 1978 and 1979, the abortion ratio grew almost 50%. This trend has been found amongst both married and unmarried women.

As a result of the cultural and economic opening up of China’s markets since 1980, the Chinese people have increasingly been exposed to goods and cultural values from outside. These developments have influenced Chinese people, particularly China’s youth, to develop a more liberal attitude towards sex. For example, it has allowed revealing clothes, such as “spaghetti straps,” and soap operas that show physically intimate and romantic scenes to be imported into China.[19] As a result of the appeal of romantic love and the increasing acceptance of close intimacy between lovers, China’s youth has been more adventurous in its exploration of love and sex than previous generations, effectively leading to an increase in premarital sex.[20]

This exploration of love and sex has led to a cultural clash with traditional values amongst unmarried women. In China, virginity, particularly amongst women, has always been highly valued. This can be illustrated by wedding costs. The amount of money spent by the groom on his bride depends, to a large extent, on whether the bride is a virgin. For example, in Wuhan in 1985, the average male worker spends three years’ wages to get married. In rural Tongxi, a marriage can cost 4,000 RMB in 1985 while the average family income is 1,900 RMB. The high wedding cost is rationalized by traditional Chinese culture which dictates that an extravagant wedding would ensure that the bride or groom does not “lose face” and would instead honor his or her “family prestige.”[21] However, if the woman is not a virgin upon marriage, her wedding costs are not borne by the groom but are instead shared between the groom and the bride. The frequency and value of betrothal gifts given after engagement also decrease if the woman is not a virgin. As the frequency and quality of gifts is apparent to everyone in the community, other people can easily see the bride’s “purity,” contributing to the pressure from women’s families and communities to not engage in premarital sex.[22] Thus, women are often torn between the increasing liberalization of attitudes towards sex amongst their generation and the traditional values emphasized by their families and communities. As a result of this conflicting mentality, if unmarried women become pregnant, there is great incentive for these women to terminate their pregnancies, effectively increasing the incidence of abortions.

For married women, there is a political and social incentive to seek abortions due to the government’s policy whereby couples may only have one child. This policy was implemented in 1978 in an effort to control the spiraling population growth. It effectively decreased the rate of the population’s natural increase between 1970 and 1979 from 25.9 per thousand to 11.7 per thousand.[23] This policy gave women who already had one child social pressure to abort subsequent pregnancies. As one mother noted, when she saw other families with more than one child, she felt that these people were not doing their civil responsibility to help China’s population problem.[24] As a result, abortion is used by married women to comply with the government’s one-child policy.

The Role of Traditional Chinese Medicine in Western Abortion Practices

Western methods of contraception and abortion have gained popularity over methods advocated by traditional Chinese medicine. This trend is partially due to the increasing adoption of Western values as part of China’s modernization, and the general feeling that TCM is “unscientific” and “unreliable.”[25] However, with the government’s support and commitment to the integration of both Chinese and Western medicine, TCM still plays an important role in the increasingly Westernized healthcare market.

For example, traditional Chinese medicine offers a potentially more confidential method of abortion than Western medicine does. At biomedical hospitals, a woman is required to register herself at the hospital to obtain an abortion. This decreases women’s accessibility to safe Western abortions. However, as traditional Chinese medicine plants can be homegrown, it is relatively easy for a woman to have an abortion secretly.[26]

Traditional Chinese medicine is also sometimes preferred over Western medicine as it is cheaper. This is particularly true for unmarried women whose abortions are not subsidized by the government in contrast to married women who can have abortions for free. For example, in a private Western hospital in Beijing, an abortion can cost 800 to 2400 RMB (US$115-345) depending on the type of abortion obtained and whether the abortion used anesthesia.[27] This problem is exacerbated by the expensive costs of pharmaceutical products manufactured in Western countries.[28] On the other hand, plants used as herbal medicine in traditional Chinese medicine are often more cheaply available. One reason for this is because there is less money spent on research in TCM than in biomedicine.

Another example of the integration of traditional Chinese medicine and Western medicine is in the use of acupuncture instead of anesthesia during surgical abortions. Some studies have concluded that acupuncture is “safer and less liable to incur complications” than anesthesia as patients can still be awake during surgery.[29] Acupuncture is also less expensive with anesthesia.

While traditional Chinese medicine can induce abortions, for many people, Western medicine is now the preferred medical system used for abortions, particularly due to fears that traditional Chinese medicine may be “unreliable” because its effectiveness varies for different people.[30] Interestingly, perhaps as a result of this trend, TCM has managed to find a gap in abortion healthcare that is not covered by Western medicine and also fits in with its philosophy to promote general well-being. Today, the use of TCM in post-abortion care has gained popularity and is recommended even by Western medical physicians.[31] Depending on the woman’s body, over 500 different types of traditional Chinese medicines, including lotus seeds and dates, can be used in various combinations to help stop post-surgery bleeding and promote general well-being.[32] Many of the medicines used after abortions are the same as those administered after the delivery of children and the medicine is often taken for a month after abortion or delivery.

Conclusion – A Complementary Relationship Between TCM and Western Medicine?

In traditional Chinese medicine, sex is still viewed as a health-promoting activity and there is a belief that contraceptive methods used should not interfere with the flow of seminal or vaginal secretions. In addition, while herbal medicinal remedies were once used for abortion purposes, these remedies have evolved with the influx and integration of Western medicine ideas and are currently being reduced to their essential ingredients. The number of abortions has increased greatly during the past 40 years due to the cultural and economic opening-up of China’s markets, the government’s one-child policy and the traditional desire for “pure” women. Despite the increasing popularity of Western medicine, traditional Chinese medicine still offers a cheaper and more confidential alternative to Western medicine and is widely used to restore women’s health post-abortion. Perhaps with the integration of medical systems in China, both Western and traditional Chinese medicine will be able to complement each other in many areas of healthcare in addition to abortion and have a harmonious yin-yang relationship that will provide comprehensive care to the community in all aspects of health.





Bibliography
Chan, Leonard. "A Brief History of Chinese Herbs and Medicine." Bulletin of the Torrey Botanical Club 66.8 (Nov. 1939): 563-568.

Ching, C. C. "The One-Child Family in China: The Need for Psychosocial Research." Studies in Family Planning 13.6/7 (June-July 1982): 208.

Edwards, James W. "The Concern for Health in Sexual Matters in the 'Old Society' and 'New Society.'" The Journal of Sex Research 12.2 (May 1976): 88-103.

Elderly Retired Park-User. Personal Communication. Beijing Public Park. 26 Mar. 2008.

Hsiang-Yang, H. “hi-Huo Sheng-Yu Chih-Shih Wen-Ta (Questions and Answers on Planned Parenthood Information).” Peking: Jen-Min Wei-Sheng Ch'u-Pan She: 1973

Hsu, Elisabeth. "'The medicine from China has rapid effects': Chinese medicine patients in Tanzania." Anthropology & Medicine 9.3 (2002): 291-313.

I-Hsueh, C. (A Basic Explanation of Chinese Medicine). Ed. by Hopeh New Medical College Ministry of Education. Peking: Jen-Min Ch'u-Pan She, 1974.

Jiang, W., China Academy of Chinese Medical Sciences. 12 Mar. 2008.

Keng, Y. “Tan-Tan Chi-Hua Sheng-Yii (A Talk on Planned Parenthood)”. Tientsin: Tientsin Jen-Min Ch'u-Pan She: 1964.

Koo, Linda C. "A Journey Into the Cultural Aspects of Health and Ill-Health in Chinese Society in Hong Kong - The Importance of Health and Preventive Medicine in Chinese Society." Health and Preventive Medicine in Chinese Society 11.2 (Feb. 1989): 51-58.

Miles, Andy. "Tian Hua Fen, An Integrative View." Dr. Pan's Clinic of TCM. 10 Aug. 2007. 30 Mar. 2008 .

Nurse in Abortion Clinic. Personal Communication. Beijing Wu Zhou Women’s Hospital. 24 Mar. 2008.

Ren, Xu. Personal Communication. China Academy of Chinese Medical Sciences. 24 Mar. 2008.

Ren, Xu. Personal Communication. China Academy of Chinese Medical Sciences. 29 Mar. 2008.

Russell, Cristine. "Chinese Medicine: Old & New." Science News 116.17 (Oct. 1979): 292-295.

Tien, H. Yuen. “Sterilization, Oral Contraception, and Population Control in China.” Population Studies 18.3 (Mar. 1965): 215-235.

Tsa-chih, C. Chinese Journal of Surgery 14: 1 (Jan. 1966); summarized in JPRS, No. 36,889 (9 Aug. 1966).

Tsao, H. Unpublished paper. “International Honors Program Health and Community Spring 2008 – India Country Paper: How has the practice of Ayurveda changed between ancient (1000 B.C.) and modern (20th century) times?”, Mar. 2008.

Zhang (Housewife in Beijing). Personal Communication. 21 March 2008.

Zhou, Xiao. "Virginity and Premarital Sex in Contemporary China." Feminist Studies 15.2 (Summer 1989): 279-288.

[1] Chan, Leonard. "A Brief History of Chinese Herbs and Medicine." Bulletin of the Torrey Botanical Club 66.8 (Nov. 1939): 563-568.
[2] Koo, Linda C. "A Journey Into the Cultural Aspects of Health and Ill-Health in Chinese Society in Hong Kong - The Importance of Health and Preventive Medicine in Chinese Society." Health and Preventive Medicine in Chinese Society 11.2 (Feb. 1989): 51-58.
[3] Jiang, W., China Academy of Chinese Medical Sciences. 12 Mar. 2008.
[4] Edwards, James W. "The Concern for Health in Sexual Matters in the 'Old Society' and 'New Society.'" The Journal of Sex Research 12.2 (May 1976): 88-103.
[5] Keng, Y. “Tan-Tan Chi-Hua Sheng-Yii (A Talk on Planned Parenthood)”. Tientsin: Tientsin Jen-Min Ch'u-Pan She: 1964.
[6] Edwards, James W. "The Concern for Health in Sexual Matters in the 'Old Society' and 'New Society.'" The Journal of Sex Research 12.2 (May 1976): 88-103.
[7] Hsiang-Yang, H. “hi-Huo Sheng-Yu Chih-Shih Wen-Ta (Questions and Answers on Planned Parenthood Information).” Peking: Jen-Min Wei-Sheng Ch'u-Pan She: 1973
[8] Edwards, James W. "The Concern for Health in Sexual Matters in the 'Old Society' and 'New Society.'" The Journal of Sex Research 12.2 (May 1976): 88-103.
[9] Ren, Xu. Personal Communication. China Academy of Chinese Medical Sciences. 24 Mar. 2008.
[10] Ren, Xu. Personal Communication. China Academy of Chinese Medical Sciences. 24 Mar. 2008.
[11] Tsa-chih, C. Chinese Journal of Surgery 14: 1 (Jan. 1966); summarized in JPRS, No. 36,889 (9 Aug. 1966).
[12] Tien, H. Yuen. “Sterilization, Oral Contraception, and Population Control in China.” Population Studies 18.3 (Mar. 1965): 215-235.
[13] Miles, Andy. "Tian Hua Fen, An Integrative View." Dr. Pan's Clinic of TCM. 10 Aug. 2007. 30 Mar. 2008 .
[14] Russell, Cristine. "Chinese Medicine: Old & New." Science News 116.17 (Oct. 1979): 292-295.
[15] Tsao, H. Unpublished paper. “International Honors Program Health and Community Spring 2008 – India Country Paper: How has the practice of Ayurveda changed between ancient (1000 B.C.) and modern (20th century) times?”, Mar. 2008.
[16] Hsu, Elisabeth. "'The medicine from China has rapid effects': Chinese medicine patients in Tanzania." Anthropology & Medicine 9.3 (2002): 291-313.
[17] Koo, Linda C. "A Journey Into the Cultural Aspects of Health and Ill-Health in Chinese Society in Hong Kong - The Importance of Health and Preventive Medicine in Chinese Society." Health and Preventive Medicine in Chinese Society 11.2 (Feb. 1989): 51-58.
[18] Russell, Cristine. "Chinese Medicine: Old & New." Science News 116.17 (Oct. 1979): 292-295.
[19] Elderly Retired Park-User. Personal Communication. Beijing Public Park. 26 Mar. 2008.
[20] Zhou, Xiao. "Virginity and Premarital Sex in Contemporary China." Feminist Studies 15.2 (Summer 1989): 279-288.
[21] Zhou, Xiao. "Virginity and Premarital Sex in Contemporary China." Feminist Studies 15.2 (Summer 1989): 279-288.
[22] Zhou, Xiao. "Virginity and Premarital Sex in Contemporary China." Feminist Studies 15.2 (Summer 1989): 279-288.
[23] Ching, C. C. "The One-Child Family in China: The Need for Psychosocial Research." Studies in Family Planning 13.6/7 (June-July 1982): 208.
[24] Zhang. Personal Communication. 21 March 2008.
[25] I-Hsueh, C. (A Basic Explanation of Chinese Medicine). Ed. by Hopeh New Medical College Ministry of Education. Peking: Jen-Min Ch'u-Pan She, 1974.
[26] Russell, Cristine. "Chinese Medicine: Old & New." Science News 116.17 (Oct. 1979): 292-295.
[27] Nurse in Abortion Clinic. Personal Communication. Beijing Wu Zhou Women’s Hospital. 24 Mar. 2008.
[28] Ren, Xu. Personal Communication. China Academy of Chinese Medical Sciences. 24 Mar. 2008.
[29] Russell, Cristine. "Chinese Medicine: Old & New." Science News 116.17 (Oct. 1979): 292-295.
[30] Ren, Xu. Personal Communication. China Academy of Chinese Medical Sciences. 29 Mar. 2008.
[31] Nurse in Abortion Clinic. Personal Communication. Beijing Wu Zhou Women’s Hospital. 24 Mar. 2008.
[32] Ren, Xu. Personal Communication. China Academy of Chinese Medical Sciences. 29 Mar. 2008.

More on Beijing!

Unfortunately, due to the censorship in China, it was quite difficult for me to access my blog. Instead, I will now try to catch up with you on everything that happened in China to the best of my memory while I am in South Africa.

Thoughts/observations/comments:

• Karaoke/K-TV/KTV is huge in China. Everyone loves to sing. Interestingly, my friend made the comment that she has never heard a Chinese with a bad voice and she thinks that it's due to the tonal quality of Mandarin. I personally have not come to any conclusions about this. What do you think?
• Went to the "new socialist countryside" for a few days at the end of our stay in China. I was surprised that the "countryside" was not actually as rural as I thought it would be. Instead, they were little guest houses fully equipped with small dining areas, sleeping areas, and of course, KTV facilities. I did not enjoy the food in the countryside as much as in the urban part of Beijing. The good thing though is that we still had dumplings in the countryside for one meal, so that made up for it! :)
• I didn't realize how many migrant workers there were in Beijing until we heard a talk from a migrant workers' rights worker. The guest lecturer spoke about the severity of occupational health neglect in China and I was so touched that at one point, most of the class including myself and the translator was in tears. One particularly moving story involved a young girl who was around our age who worked in an assembly line in a factory in Shenzhen. The factory doors were locked to ensure that the girls/workers would not steal materials from the factory. Unfortunately, one day, a fire broke out and most of the workers died not from the fire itself, but from suffocation. In memory of his daughter, the girl's father spent a lot of money on the girl's funeral because he said that in his eyes, his daughter was always very obedient to him ("ting hua") and never did anything to anger him. I was enraged that the company that the factory was under got away without any blame. In addition, the Hong Kong manager of the factory got away without any blame while the mainland China manager of the factory only got 10 years in jail. 10 years total amongst 3 people somehow is enough to compensate for the deaths of at least 8 young factory girls. This has really made me wonder about the meaning of justice and the legal system. How just is the law? And to what extent does this question depend on the country and the particular government in place? Is it culture-specific or is justice universal?
• Everywhere, I can see signs of the Olympics, such as through the billboards, television etc. I can really understand why the Olympics can evoke such a great sense of pride from the people. Just during my one month in Beijing, I could already feel the atmosphere that is being built up! I can't wait until the actual games start on 8 Aug 2008 (those of you who are Chinese will understand the auspiciousness of this date 08-08-08, right?). It's amazing how much Beijing has prepared itself for the Olympics, including cleaning up pollution, building more subway lines and drastically reducing public transportation fares for everyone and unifying the transportation system. I really am very very impressed. I hope that the world can see the efforts that are being made and that these improvements can be sustained in China in the long-run.

Places visited:

• Temple of Heaven
• Forbidden City
• Great Wall - a restored section as well as an unrestored section.
• Beihai Park
• The Olympics venue, including the Bird's Nest!!!

All in all, these were all very cultural and historical visits for me and really helped me to connect with China and my culture. It makes me proud to be Chinese and to be able to share the richness of this country with other people. I hope that through the Olympics, more people will have a glimpse of the many traditions and the long history that China has. While I know that the Beijing Olympics 2008 are controversial globally due to a variety of reasons, I hope that the world can just unite in the name of sport and be peaceful during this time. An idealistic thought, I know, but one can still hope. After all, I really think that idealism and big ideas instead of passivity are the beginnings of change.

Capetown, South Africa

Hi, folks. Here I am in Capetown, South Africa. We are 6hrs behind Hong Kong and 6 hours ahead of US EST (Boston). I may not have access to the internet for a whole week. If you want to contact me, please call my cell phone at 27-73-724-5843.