China’s transformation into an economic superpower is often framed in terms of production output, technological advancement and infrastructure. What is often missing is another kind of production – that of workers. Dr Gonçalo Santos has been tracing the transformation of birth in China as it moved from the home to the hospital and became increasingly subject to biomedical interventions. THE LABOUR OF GIVING BIRTH It’s not called labour without reason. The effort of pregnancy and giving birth, and then raising children, has been termed ‘reproductive labour’ by social scientists like Dr Gonçalo Santos of the Department of Sociology and Hong Kong Institute for the Humanities and Social Sciences, who is leading a research group on the technologies of reproductive labour in East Asia with colleagues at the University of Chicago and Smith College. “The work of reproductive care doesn’t get the attention of something like the One Belt One Road project. But workers are the foundations of those projects, and as feminists have long noted, in addition to asking questions about workers, we also have to ask questions about the work that is involved in producing workers,” he said. In China, that work has undergone profound changes in a very short time period. As recently as the 1980s, half of all babies were still born at home. Today, most are born in hospitals – and fully one-third by caesarean section (C-section). Dr Santos has been a witness to the transformation, which has been driven by government policy, technology, and changing moral and social dynamics. His work started in the late 1990s, when he undertook fieldwork in rural areas where most people still delivered at home. He saw villagers grapple with the one-child policy, which was also pushing people towards hospital births where it was easier to keep track of numbers. “Women were giving birth in secret places and relying on village midwives. Birth became heavily politicised and people tried to negotiate with the state at various levels over the right way to give birth, where to give birth, whether to follow state prescriptions,” he said. There’s a sense that they want to escape the natural birth experience,” Dr Santos said, “and there is nothing wrong with that.” From zero to 100 in a generation Women are also giving birth at a later age, sometimes with the help of assisted reproduction technology – factors that increase risk and thus lead doctors to advise C-sections. Families have reason not to oppose C-sections, too. Although they must pay for births even in public hospitals, the government subsidises at least half the cost. Dr Santos believes these subsidies will become unsustainable in the long run and, for this reason, the government is curbing the growth in C-section rates through investment in maternal care and punitive measures against hospitals. A ‘wellness culture’ that favours natural birth is also on the rise among the urban middle classes, although not yet to the extent seen in Japan, where it started much earlier. “In China and some East Asian societies, there has been a compressed modernity – a story of emerging economies that went from zero technology in a biomedical sense to benefitting from all these highly-sophisticated technologies within practically the space of one generation. They have leapfrogged without the middle layer and didn’t form a culture of natural birth in the process,” he said. Such a culture is only now starting to take hold under the influence of global discourses of ‘wellness’ and traditional Chinese medical wisdom. Women should have as much choice and information as possible about giving birth, he added – something that scholars can contribute to through research. █ Not strictly a medical issue The state prevailed, marking a dramatic shift in how babies were born and who was involved in the process. Birth was no longer managed by local networks of midwives and female relatives, but shifted to hospitals and biomedical professionals, including obstetricians who, until the past decade or so, were mostly men. “However, birth is not strictly a technical, medical issue. It should be seen from a holistic perspective that allows for the social and cultural dimensions to be taken into consideration, too,” Dr Santos said. These dimensions are evident in China’s high caesarean rate of at least 35 per cent of all births, one of the highest in the world. Doctors and hospitals, pregnant women and their families each have their own reasons for favouring C-sections. (And note: all three are involved in providing informed consent for birthing procedures in China – it is not just a matter between a woman and her doctor.) Hospitals are more likely to favour C-sections because they are more profitable and can be planned – an important consideration given many hospitals are understaffed. Doctors are more likely to favour them because their training is in handling complications and applying the techniques they learn, rather than waiting out the unpredictability of a natural birth. Many women regard C-sections as easier than natural delivery. Their mothers and grandmothers were better prepared for the physical trials of labour because they often engaged in hard physical work, but people today live more sedentary lives, particularly in urban areas. “For most women working in the new China, reproduction is a chore and it’s often perceived as a burden – as something to be afraid of. For most women working in the new China, reproduction is a chore and it’s often perceived as a burden – as something to be afraid of. Dr Gonçalo Santos The University of Hong Kong Bulletin | May 2019 Cover Story 03 | 04
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