New Progress Made in Promoting Quality of Care in China's 
Reproductive Health and Family Planning Services since ICPD

Date:   Speech by Mme. Zhang Yuqin, Vice Minister of State Family Planning Commission of China at Cairo, Egypt, November 8, 1998

Source:   State Family Planning Commission

Subject:    reproductive health, family planning, quality of care

Mr. Chairman, Ladies and Gentlemen,

I am very happy to participate this year's conference in Cairo as the representative of China, which is a member state of the Partners in Population and Development. I think it is of special significance to have the conference here in Cairo, because the International Conference on Population and Development in 1994 was also held here. And at that conference, many new concepts and approaches were put forward in its Programme of Action, with the main points being: To stress an integrated approach in addressing the population problem, that is, to combine population with economic, social, resource and environmental factors so as to achieve a sustainable development, to affirm the idea of reproductive health which includes family planning, maternal and child health care, safe motherhood, and sexual health, to regard as part of the reproductive health and family planning programs and the protection of the reproductive rights of married couples or individuals so as to satisfy their needs for reproductive health, rather than take the fulfillment of demographic target as the goal and objective of programs, to emphasize the principle that all couples and individuals have the right to decide freely and responsibly on childbearing and the methods of family planning, to oppose the use of coercion, the use of induced abortion as a means of family planning, and the use of quotas and targets, and to point out that the implementation of the recommendations contained in the Programme of Action is within the sovereign right of each county, and therefore should be consistent with national laws, policies, development priorities and macro - population goals, should show full respect for different religions and ethical values, and cultural backgrounds of its people, and should be conformity with the universally acknowledged international human rights.

The Chinese government delegation headed by Peng Peiyun, a former State Councilor and Minister in - charge of the State Family Planning Commission of China, attended the conference, and through discussions, and based on the principle of seeking common grounds while laying aside differences, the conference finally reached agreement on the Programme of Action. Since then, based on the principles laid out in the Programme of Action and the specific conditions of China, the Chinese Government, has seriously summed up its past experience in family planning as well as the successful experiences of other countries, and formulated a whole series of principles and policies as well as follow-up measures which have yielded remarkable results. We have not only managed to maintain a low birthrate, but actually succeeded in its steady reduction, thus creating a congenial population environment for our reform and opening - up, and our socio-economic development. We have also persistently taken the all- round development of human beings, which is the central concern of all our efforts, as the ultimate purpose of everything we do. We have combined our efforts for family planning with the efforts to lift the poor out of poverty, develop rural economy and help the peasants realize a moderately prosperous life through hard work and form happy families. We have also tried hard to meet the growing needs of the people who have reached the childbearing age for reproductive health and family planning so as to improve physical as well as mental health of women and increase their awareness of the importance of family planning.

Let me here discuss some of the new achievements of our country in the fulfillment of our plans on family planning, reproductive health, and quality services since the last International Conference on Population and Development:

I. Quality services for women at child-bearing age on family planning and reproductive health.

Since the beginning of this decade, China has entered a period of low - birthrate, low - death rate, and low population increase. The total fertility rate of women has dropped to a level lower than the replacement level in 1997, China's natural population increase rate was 10.06 ‰. However, although our population increase rate has already dropped to about half of other developing countries, and has already become a low birthrate country, the burden of the annual population increase (The annual net increase is over 13 million) on the nation's social and economic development remains extremely heavy. This is partly because of the big population base (1.243 bi1lion in 1997), and partly because of the limited coverage of quality family planning services and reproductive health services which still can not meet the requirements of people. Therefore, to implement the resolutions of ICPD, the Chinese Government has decided, while stabilizing the present low birthrate, to focus the family planning efforts on the all - round development of the people and on providing quality services for people at child - bearing age, change the entire approach and the work mechanism to pay more attention to the well - being and vital interests of married couples at the child - bearing age, and combine the population control and family planning with the effort to protect women's legal rights and improve their reproductive health. Starting from 1995, the State Family Planning Commission of China lunched pilot projects in some counties from 6 provinces including Jiangsu, Zhejiang and Shandong and in 5 cities including Shanghai, Tianjin and Nanjing on family planning quality services. The main purposes of the projects are:

The campaign to offer quality services on family planning and reproductive health is guided by the principle that "human beings are the key factor and women at child - bearing age are the focus of our attention". In our mind, we must understand the active role of people in family planning. In work method, we must stress the importance of combining government guidance with people's voluntariness and participation so that government plans and policies can be carried out without neglecting people's interests and needs. In form, emphasis should be on the comprehensive way of handling the population and family planning problem. In content, it should cover the whole period from the inception of puberty to the end of the childbearing age, should include men's needs and participation, and should also include a wide range of aspects such as marriage, bearing and rearing healthy children, contraception, and reproductive health. The whole purpose is to shift the focus of our efforts from merely controlling people's child - birth in the past to the present emphasis on comprehensive quality services and mass participation, combining publicity and education, service and scientific management.

Up to the present moment, reproductive health quality service is being offered in about 300 counties, towns and prefectures. About 94% of China's counties and 80% of its townships have established FP service stations to offer family planning technical service. Our efforts have attracted the attention of the international community and won its warm support. With the help of the Ford Foundation, for example, the Population Council and Michigan University have joined their efforts with the State Family Planning Commission of China on the implementation of the international cooperative projects for providing family planning quality services in China.

II. Advocate man's participation in the family planning and give sexual health education to teenagers.

Since the ICPD and WWC, the Chinese government as a whole, and its State Family Planning Commission, Ministry of Health and the All Women's Federation of China have all been vigorously advocating the idea that man should bear a greater responsibility in reproductive health and contraception and that man and woman being equal, family planning is as much the husband's business as the wife' s. The State Family Planning Commission of China has launched a campaign in the villages of 9 provinces to encourage people to make an informed choice of contraceptive methods. And in Jilin, Sichuan and Yunnan, it has started a project to encourage "male participation", popularize no - scalpel vasectomy or chemical vas occlusion for male sterilization and the use of condom for male contraception with fairly good results. Today in terms of contraceptive measures, male sterilization accounts for 10.2%, female sterilization for 39.5%, IUD for 42.5%, oral pills for 2.8%, condoms for 3.8% and others for 1.2%.

In recent years, teenager sex and premarital sex have shown a tendency to increase steadily. So the government has tried to give instructions on puberty and sexual health through 3 channels;

First, it addresses the problem to the whole society through the mass media. With the joint efforts of the various departments in charge of family planning, public health, education and science and technology, it has given all kinds of presentations, talks, and TV panel discussions on sex education, it has also set up a hot line to the radio station through which listeners could hear "whispers" on sex education and advice on STD prevention. In some coastal cities, there has been an intense publicity effort to prevent and control STDs and HIV/AIDS. Second, it has asked high schools to offer courses on population such as physiology, sex physiology, sex psychology, and sex morals. Third, it has established the non - government Sex Science Association and learned societies like association on sexuality research, given the initiative of such NGOs as the China Family Planning Association, and the China Association for Healthier Births and Better Child - rearing a full play.

III. Pay special attention to the improvement of population quality (in terms of health and education).

Since 1949, thanks to the government's efforts, great achievements have been made in the improvement of the nation's labor quality The infant mortality dropped from 200 ‰ before 1949 to 31.4 ‰ in 1995. Congenital malformation and mentally retarded occurrence has also been on the decline. But our population quality still faces many problems and new challenges. In some poor and remote mountainous areas, the maternal mortality rate and infant mortality rate are several times higher than the nation's average. Moreover, the damage done to women in pregnancy or at child - birth, fetus and infants by environmental pollution, occupational diseases, virus from urticaria etc. has not yet brought under control. In fact, the damage from drug abuse, STDs and HIV/AIDS is on the increase. Also, in mountainous and poor areas, especially in areas inhabited by minority groups, marriage among close relatives is still practiced resulting in a high morbidity of hereditary diseases.

The Improvement of population quality in terms of health and education is an integral part of our country's population policy. Since the beginning of this decade, family planning organizations have been set up all over the country. Today, there are over 2,300 family planning service centres at the county level, and 31,000 at the township level, with a total work force of 120,000 to offer technical services. They are all working hard at the grassroots level, going to every village and every household, instructing peasants in the scientific knowledge of family planning and contraception, bearing and rearing better children and reproductive health, and giving medical care for women and children concerning childbirth, birth control and infertility.

In February 1997, the Work Committee on Women and Children of the State Council of China called a meeting to discuss how to improve population quality. All related authorities in charge of public health, family planning, civil affairs, labor environmental protection, handicapped people's association, and women's association attended the meeting.

After the meeting, the Ministry of Health drafted a "Proposal on How to Improve Population Quality ", in which the present situation on population quality is analyzed, the chief goals are set for improving the situation, specific targets to be achieved are given, principles to be followed are laid down, and specific requirements and policies and measures are all clearly defined for cities and relatively well-developed rural areas, underdeveloped rural areas, poor remote areas and minority group areas respectively. The "proposal" pointed out that by 2000, the high rate of birth defects leading to handicap and deformity must be reduced by a large margin as compared to the beginning of the 90s, the brain damage caused by the lack of iodine of women during pregnancy and breast - feeding of the baby must be eliminated and the physical conditions and intellectual abilities of the babies must be improved.

Moreover, in these years, the State Family Planning Commission of China has also tried hard to combine family planning with the development of the community, carry out experiments on community development in rural areas aimed at encouraging women's participation in social and economic activities so as to improve their economic and social status, combining the improvement of women's health, and maternal and child health care with the increased consciousness of women for the need of family planning. We have also launched the "Project Spring Buds" in poor areas to help little school girls continue their studies at school. In their activities, the Chinese government has paid special attention to giving NGOs' initiative a full play it has tried hard to involve NGOs in family planning or in the supervision over family planning at various levels of the government.

At the beginning of this year, our country set the goal for the next 50 years in population and family planning, which includes specific programs for population control, population quality (In terms of health and education) improvement, reproductive health services for married couples of child- bearing age and the transformation of operational mechanism in family planning. From now on, the Chinese government will make a greater effort to implement the Programme of Action adopted by the ICPD and World Women's Conference, and together with the other members of the Partners on Population and Development, will welcome the arrival of the 21st century with still greater contributions in family planning and reproductive health.

Thank you, Mr. Chairman!