By Frederika Whitehead
Awareness among China's 161 million 15-24-year-olds is poor, while sex education and services are said to be inadequate.
China has a lot of work to do if it wants to provide adequate sexual health services for its 161 million 15- to 24-year-olds. A recent report funded by the United Nations Population Fund (UNFPA), found shockingly low levels of awareness about sexual health among its young people. Experts in the field have confirmed that the policies for providing these services either aren't in place or are not being enacted.
The UNFPA-funded report says that "at present there is no policy relating specifically to the sexual and reproductive health of youth in China".
And although it is mandatory for sex education to be taught in Chinese schools, some people working in sexual health say provision is woefully inadequate. "Chinese schools are supposed to teach sex education but they don't allocate enough time – they prefer to focus on academic subjects – they might give it only one hour, one session," says Wang Chen from the charity Prevention Through Education (PTE).
Lily Liu Liqing, country director for Marie Stopes International in China, agrees: "Officially it is available in middle schools [catering for 13-15 year-olds] but if you look closely the content is very limited, and it is centred around physical development. The sexes are usually taught separately. They will tell the boys about wet dreams and the girls about periods but they won't talk to them about contraception. They won't talk to them about the wider issues, they don't cover relationships, STIs [sexually transmitted infections], LGBT [lesbian, gay, bisexual and transgender] etc. It's just the mechanics. They do explain what HIV is but only in a very limited way."
Awareness of sexual health matters is very poor. Only 4.4% of the Chinese youth surveyed for the UNFPA report were able to answer all three of the following questions correctly: Can a woman get pregnant the first time she has sex? Masturbation causes serious damage to health – true or false? Abortion affects a woman's future pregnancies – true or false?
Despite mandatory emphasis on HIV in school sex education, the same survey also found ignorance about basic facts relating to HIV transmission. While 95% of youth had heard of HIV, when they were asked five questions such as: "Can a healthy-looking person have HIV?" or "Does using a condom reduce the risk of getting HIV?" only 14.4% of the young people polled answered them all correctly.
Another frequent complaint was about the lack of data collection. Few reliable national statistics are collected, charities say.
The national rates of teenage pregnancies, abortions, or STI infections are all unknown, which makes it difficult for agencies working with young people to ask for more assistance.
"Generally speaking we don't have reliable statistics," says Liu .
"This is the first thing we are really keen for the government to do," says Wang . "Young people are more interested in sex now than they were in the past. Abortions are very common. Many things seem to be on the increase but the data just isn't available."
While advice and sex education is largely unavailable, abortions are easy to come by. Young people can walk into almost any clinic and get an abortion. China's Population Communication Centre reported that more than13m abortions were carried out in China last year. Of these 65% are said to have been performed on unmarried women aged between 20 and 29. Fifty percent of the women had used no form of birth control, and 50% had undergone an abortion at least once in the past. In China, women are classified as married or unmarried and there is little provision for young women who are sexually active before marriage. Government programmes target married women, who are often put on long-term contraception.
"In every clinic you can see young people queuing up for abortions. Some of them are even in their school uniforms," says Wang. "We desperately need better statistics so that we can get an idea of the scale of this problem and work out how to tackle it."
There is little or no confidential advice available in most regions. If young people want advice, they will talk to their friends or seek information online. Their reliance on "unregulated and informal sources" is cited as the reason for their "low awareness" of sexual health in the UNFPA report.
PTE runs an online counselling service that allows young people to logon and go into a chat room with experienced counsellors to discuss their problems.
In China Marie Stopes focuses all of its efforts on young people, it also has a website that offers advice and runs extensive peer-to-peer education programmes.