China

OVERVIEW

China has abundant private and public health care options. Contraceptives are available without a prescription, though foreign pills are limited to four main brands. Emergency contraceptives are also available without a prescription, practically all of which are Chinese brands, so you won't be able to find ellaOne in pharmacies. STI/STD tests are common and, if you are a foreign worker seeking a visa, they are required. Abortion is incredibly common in China, as well, which is considered the "abortion capital of the world," and it's legally permitted for up to 6 months of gestation.

In China, the public hospitals are the cheapest options. But they may be more inefficient and rudimentary in terms of services and facilities, and English-speaking may be limited. The private hospitals will, of course, cost more. But they may provide a more useful service to foreign visitors if they do not speak any Chinese.

Note that laws in Hong Kong and Macau differ from mainland China. Please check out these pages for details.

Contraception (Birth Control)

General Note: There are many types of contraceptives, also known as "birth control," including IUDs, oral contraceptives, patches, shots, and condoms, etc. If you would like to view a full list, click here.

Laws & Social Stigmas

Contraception, also known as "birth control," is legal and widely available in China. No prescription is needed and there are no known age restrictions. It is estimated that 84.6% of Chinese women in marriages or in unions use some form of contraceptive, with 39.6% using IUDs, 33% using female sterilization, 4.3% using condoms and 1.7% using the pill. It was also found that 6.9% used male sterilization. Furthermore, China appears to use more condoms than any other country in the world. Due to the One-Child Policy, contraceptives have been strongly encouraged by the government for decades, so there is practically no social stigma regarding its use for married couples. Premarital sex has been a social taboo for decades. Yet social views are progressively changing, especially for younger generations. At family planning offices, women receive free contraception and prenatal classes.

As reported by US China Daily, "'For young people, they are not covered by the family planning program because they are not married, so they fall through the cracks in terms of sex education and contraceptive access,' says Joan Kaufman, Distinguished Scientist at the Schneider Institutes for Health Policy at Brandeis University. 'They can certainly purchase birth control at drug stores, but it is harder for them access services from China’s free family planning program.'"

What to Get & Where to Get It

Yasmin birth control pills purchased in China

Marvelon, a common birth control brand found in Thailand

In China, you don't need a prescription to purchase birth control. However, if you do want to consult with a doctor beforehand, you can typically schedule an appointment with a doctor at a Western hospital for 600-700 yuan or with a Chinese doctor for much cheaper.

When you go into a Chinese pharmacy, ask for 避孕药 (pronounced "bì yùn yào"), which translates to "contraceptive pill." You can also say 节制生育 (pronounced "jíe zhì shēng yù"), which means birth control, but it refers to all birth control, including condoms, IUDs, etc. There are four main oral contraceptives in mainland China, all of which are combined pills (contain both estrogen and progestin). According to SmartShanghai, "even if you go to a foreign-operated hospital like United Family or Parkway Health, chances are you won’t find more than these brands at their pharmacies."

Here's the brands:

• Marvelon (mā fù long 妈富隆): 1.5 mg desogestrel + 30 micrograms ethinylestradiol
• Mercilon (měiyì bì, 美意避): 1.5 mg desogestrel + 20 micrograms ethinylestradiol
• Yasmin (yōu sī mín, 优思明): 3mg drospirenone + 30 micrograms ethinylestradiol
• Diane-35 (dá yīng sān shí wŭ, 达英-35): 2mg cyproterone acetate + 30 micrograms ethinylestradiol

If you are interested in getting an IUD in China, here's a personal account of the experience. This woman got her IUD at Xinhua Hospital in Shanghai (insertions are done on Monday, Wednesday, and Friday at 1pm, as of September 2014). For additional recommendations for clinics to fit the IUD, check out the "Gynecological Exams" section.

Warning: Some pharmacies in China have reportedly sold fake pills. So, if possible, try to purchase from a larger, well-known pharmacy.

Costs

In 2015, here were the prices for some birth control pills: Diane-35 (69rmb), Yasmin (138rmb), Marvelon (23rmb) and Mercilon (68rmb).

Emergency Contraception (Morning After Pill)

Important Notes: Emergency contraception may prevent pregnancy for three days (72 hours) and sometimes five days (120 hours) after unprotected sex. Take EC as soon as possible after unprotected sex. If you don't have access to dedicated EC, oral contraceptives can be used as replacement EC, but remember the following: 1) Only some contraceptives work as EC 2) Different contraceptives require different dosages and time schedules to work as EC 3) You must only use the first 21 pills in 28-day packs and 4) They may be less effective than dedicated EC. For general information on emergency contraceptives, click here and here.

Laws & Social Stigmas

In China, emergency contraception is available without a prescription. It can be purchased at pharmacies.

What to Get & Where to Get It

In Chinese, the morning after pill is 避孕药 (pronounced "bìyùn yào"). If you go into a Chinese pharmacy, the pharmacist will probably ask if you want birth control pills for "every day" or "just one time." The "just one time" pills are emergency contraception/morning after pills.

Dedicated EC (Anti-Progestin)

Take 1 pill within 120 hours after unprotected sex:

Fu Nai Er (10 mg), Fu Nai Er (25 mg), Hou Ding Nuo (10 mg), Hou Ding Nuo (25 mg), Hua Dian (10 mg), Hua Dian (25 mg), Si Mi An (10 mg) and Si Mi An (25 mg)

Take 2 pills within 120 hours after unprotected sex:

Bi Yun (12.5mg)

Dedicated EC (Progestin Only)

Take 1 pill within 120 hours after unprotected sex:

An Ting (1.5mg), Bao Shi Ting (1.5 mg), Dan Mei (1.5 mg), Hui Ting, Jin Xiao (1.5 mg), Jin Yu Ting (1.5 mg), Ka Rui Ding and Xian Ju (1.5 mg)

Take 2 pills within 120 hours after unprotected sex:

Ai Wu You (0.75 mg), An Ting (0.75mg), Bao Shi Ting (Postinor-2, 0.75mg), Dan Mei (0.75 mg), Hui Ting (0.75 mg), Jin Xiao (0.75 mg), Le Ting (0.75 mg), Yi Ting (0.75 mg), Yu Ting (0.75 mg)

Oral Contraceptives used for EC / Progestin-Estrogen Combined

Take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later:

Levonorgestrel Pill

Costs

In 2015, Yu Ting (毓婷 / Yùtíng) was 36rmb and Postinor (左炔诺孕酮 / Zuǒ quē nuò yùn tong) was 49rmb.

Sexually Transmitted Infections (STIs/STDs)

Important Notes - Learn about PEP and PrEP: If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click here. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click here.

Laws & Social Stigmas

While many people in China have not had an STD test, all foreigners who plan to work in China (under the Z Visa, R Visa, etc.) must take an STD test. Here's an example of the final medical certificate you may receive when applying for a visa. If someone is found to have HIV/AIDS, syphilis or gonorrhea through their tests, their STI status must be reported to the national surveillance system, as stated by the Law of the People's Republic of China on Prevention and Treatment of Infectious Diseases. This data is used to monitor STI rates. Since 2010, China no longer restricts HIV+ people from visiting the country. But it is difficult to completely verify this information, so if you are HIV+, according to HIVTravel: "do not declare your status on the visa application form. Historically, people declaring their status truthfully have been denied entry." Furthermore, you may want to look into anonymous testing facilities or self-testing kits. If you are found to be HIV+, you will not be allowed to attain any residence or work permits in China. However, if you are infected with other STIs, like chlamydia or herpes, your status will probably not be reported. See a discussion here about herpes and status reporting in China. Also, check out this general discussion about medical checkups and Chinese residence/work permits.

Historically, Chinese STI rates have grown in the last few decades. In the 1950s, China launched mass campaigns to reduce STI rates and prostitution. However, Chinese society began to liberalize in the 1980s, bringing about urban development, increased nightlife entertainment, and increased sexual activity outside of marriage. During this period, STI rates grew. For example, syphilis, which had been eliminated in the 1960s in China, came back -- and, as found in 2011, it was one of the most common STIs in China. Furthermore, the estimated number of people living with HIV in China rose from 350,000 in 2001 to 770,000 in 2009. Overall, HIV/AIDS prevalence is low in China. But certain areas are more heavily affected and, in 2009, AIDS became the leading cause of death among infectious diseases.

Chlamydia is the most common bacterial STI in China today. In 1999-2000, a study found that 2.1% of men and 2.6% of women were infected. The highest rates were found among female sex workers (infection rate of 16-18%). As for gonorrhea, while it is common for high-risk groups, rates have gone down over the past decade. Some studies show especially high herpes rates for pregnant women.

In China today, there is often strong social stigma regarding STIs/STDs. In a 2008 study of Shanghai migrant women, over 50% agreed that people who acquired HIV through drugs or sex deserved it. Yet only 3.7% had ever been tested for HIV. In 2016, another study concluded that "people who contracted HIV from 'blameless' routes (e.g., with stable partners) may have less stigmatized experience compared to people who contracted HIV from 'blamable' routes (e.g., injecting drug use, sex with sex workers).

What to Get & Where to Get It

Chinese words for STDs/STIs:

"I want to do an AIDS test": Wǒ xiǎngzuò àizībìng jiǎnchá 我想做艾滋病检查

Gonorrhoea: Lìnbìng 淋病 Syphilis: Méidú 梅毒 Chlamydia: Yīyuántǐ 衣原体 Herpes: Pàozhěn 疱疹 HIV/Aids: Àizī bìngdú/Àizībìng 艾滋病毒 / 艾滋病 Hepatitis B: Yǐxíng gānyán 乙型肝炎

Testing Facilities

• You'll typically pay a fee for a bundle of STD tests at public Chinese clinics. But you'll be charged an extra fee if you also want an HPV test.
• Please visit the city pages, like the Shanghai or Beijing pages, for specific clinics. Just search for the city on the site.

Support

• Shanghai Sexual Health Website: "Sexual Health Shanghai is dedicated to providing easy access to sexuality information, education, mutual support, counseling, therapy, healthcare, products and other resources for people who are living shanghai. There are many ways to find what you need through navigation or search tools on the top. You can call our supporting hotline at 021-5108 2260 or send email to info@shshanghai.com for any Health Relevant information which you need to know, but can not find in this site through your research."

Costs

If you choose to go to a public clinic, prices will be cheaper. However, anonymity is not guaranteed. Overall, expect to pay anywhere from 300-1000 RMB for the consultation and between 100-800RMB per test.

Medications & Vaccines

Laws & Social Stigmas

While you'll find many medications in China, overseas prescriptions are typically not valid. Also, hospital pharmacies only accept prescriptions from their own doctors. China has strict laws regarding medicine imports, as well, which makes foreign/western medicines rather expensive. In the past, it was reportedly very common buy antibiotics at Chinese pharmacies with no prescription, though is increasingly less common. If you don't speak Chinese, be sure to bring a Chinese translation of the medicine you want, as the specific brand may not be available in China. For a list of recommended pharmacies, check out the "Contraception" section.

If you are interested to learn more about pharmacies in China, here's an account written by a pharmacy student, visiting China from the United States.

What to Get & Where to Get It

Here's the name of one yeast infection medication in China: 按此看中文.

Menstruation

Note: In addition to pads and tampons, you can also use menstrual cups and menstrual underwear for your period. To learn more about menstrual cups, click here. To learn more about menstrual underwear, click here.

Laws & Social Stigmas

In China, pads are much more common than tampons. For an online discussion on this trend, click here and here.

What to Get & Where to Get It

Pads and pantyliners are more popular than tampons with locals. You'll be able to find tampons (usually with no applicators, like OB) at international stores, like Watson's and Auchan. Sometimes tampons are placed on higher shelves, so make sure to look thoroughly. As for menstrual cups, there are no known sellers of major brands (DivaCup, MoonCup, LadyCup) in China, so it's best to buy them online.

Gynecological Exams

Pregnancy

Laws & Social Stigmas

For decades, China had the "One Child Policy" in place. However, citizens who were ethnically non-Han Chinese, or if they were sole children (and lived in certain provinces), or if they lived in certain rural areas, did not need to follow the policy. There were certainly many reported negative effects of this policy, including the gender disparity in births and preference of boys over girls, the difficulty in adoption, unregistered children, birth tourism, and the overall secrecy and financial difficulty suffered by families who had more than one child, among many other issues. However, the policy also helped improve the quality of life for many women in Chinese society, as well, many of whom held a lower status in the household and were unable to seek educational and work opportunities due to the pressure to bear and support many children.

When the policy was abolished in 2015, China did so because "they have too many men, too many old people, and too few young people. They have this huge crushing demographic crisis as a result of the one-child policy. And if people don’t start having more children, they’re going to have a vastly diminished workforce to support a huge aging population."

Abortion

Important Note: There are two main types of abortions: medical (also known as the "abortion pill") and surgical (also known as "in-clinic"). For medical abortions, you take a pill to induce abortion. For surgical abortions, a procedure is performed to induce abortion. For general information about medical and surgical abortions, click here.

Laws & Social Stigmas

In China, abortion is fully legal. While most women receive abortions in their first or second terms, abortion is legally permitted for up to six months of gestation. This legality can be found in Criminal Code of China, enacted by the National People's Congress on 1 July 1979. All general reasons for an abortion are permitted, including: to save the life of the woman, to preserve physical health, to preserve mental health, rape or incest, fetal impairment, economic or social reasons, and available on request. The methods of abortion vary, depending on the length of the pregnancy. For early pregnancy, the vacuum aspiration technique is used. Second trimester abortions require an in-hospital procedure performed by a physician. The government of China provides abortion services as a public service. Once women receive an abortion, they are entitled to paid sick leave for 14 days (if the abortion took place in the first trimester) or 30 days (if the abortion took place in the second trimester). In some parts of the country, if the woman receives an IUD or sterilization after her baby's birth, paid sick leave is extended.

Today, China is considered the "abortion capital of the world," and it records 13 million abortions performed each year. But, historically, this was not always the case. In the early 1950s, abortion was only permitted under special circumstances, such as: medical concerns if the woman continued the pregnancy, spacing of children (i.e. if too close together), or if the woman had problems breastfeeding due to another recent birth. In all of these cases, a joint application of the couple and certification of the physician was required. In 1957, the Public Health Ministry liberalized abortion laws, removing requirements for age, number of children or certifications. Yet the government did not want to fully endorse abortion, and they hoped that they could chiefly stress contraceptives as a means of population control. For these reasons, the laws at the time only allowed abortions once a year within 10 weeks of pregnancy.

As the birth rate continued to grow in China, the government decided to include family planning into their economic planning. In 1976, during the time of Mao's death, the government introduced the "Later, Longer, Fewer" (Wan-Xi-Shao) campaign. This campaign encouraged people to start families after establishing solid careers ("later"), to space children 3-4 years apart in age ("longer") and to have less children ("fewer"). The campaign was considered rather successful, and China saw a substantial decline in birth rate.

In 1979, China replaced the "Later, Longer, Fewer" campaign with the One-Child Policy. This policy, which required that families should have only one child, was meant to last for only one generation. However, it became a general policy in China, lasting until 2015. Many Chinese citizens were not required to comply with the policy. During this time, free contraceptives were made available. There were some cases of forced abortions. By the 1990, it was found that 85% of women of reproductive age were using contraceptives, which was comparable to developed nation rates. The most common forms of contraceptives were IUD, female sterilization and male sterilization. Yet, after many Chinese women removed their IUDs, they did not typically find a substitute contraceptive, resulting in pregnancy. Overall, the majority of abortions in China today (70%) are estimated to follow "contraceptive failure."

Today, nine in ten Chinese women with premarital sexual experience have had an abortion. It's estimated that over 50% of abortion patients are under 25 years old. While China's liberal laws can partially explain these numbers, cultural factors also play a role. According to statistics collected by the China Population Control Center, 75% of children have never spoken to their parents about sex. Furthermore, half of Chinese young people find sexual health information from pornography or adult forums, which offers a limited window health practices. It was found that, even among university students, 45% did not know how to avoid pregnancy. Meanwhile, advertisements for "pain-free" abortions can be found throughout China. This leads to a cultural climate in which sexually-active young people are neither informed nor publicly conversing on safe sex practices, and where they may quietly seek out abortions that they're told are "pain-free" or "easy."

For a real testimonial on getting an abortion in China, click here.

Advocacy & Counseling