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March 3rd, 2019

 I still remember back in the 90s about at least one evening news segment that demonstrated the integration of Traditional Chinese Medicine (TCM) in China's Western medical practice which featured the famous shot of a heavily pregnant woman in childbed serenely pincushioned with acupuncture needles. This was meant to exemplify a way of giving birth naturally without the perceived harm of analgesics, apparently perfected by TCM practices. At the time, Malaysia was also seriously looking into developing its indigenous medical traditions, including TCM. Local Chinese medical halls and chains from mainland China had just started coming in with modernised methods of medicine preparation. Herbs were powdered and precisely served in capsule form, no laborious double-boiling required. Single-use aseptic acupuncture needles now guaranteed hygiene. TCM doctors were real doctors in white coats, sparkling practices and spoke science...along with humours. 

I'm going to start by saying that immune-boosting as a quality is an exceptionally subjective value. TCM runs off the idea that the whole body is an interconnected system, and so its treatment is designed to right any perceived imbalances. I've heard it couched as a form of preventative healthcare, less active than proactive. This is the direct opposite of using acupuncture in childbirth, which counts as an active intervention. So as a symbol of the miraculous powers of TCM, it's a pretty loud example. 

But childbirth and its resultant pain is possibly one of the most subjective things to measure. We now know with the proliferation of doulas, midwives and focus on "traditional/natural births" without any of the "unnatural" painkillers, additives and flavourings that a mother's level of comfort during the birthing process is a major contributor to pain. It makes sense. The leg spreaders at an OB/GYN are awkward. It's not a comfortable position for any living creature to have a pap smear in, never mind give birth, which is why there's advocacy for letting women move around, even sit up during labour. That still doesn't mean they won't need an epidural (and some studies do seem to show there's less tearing with painkillers involved because there's less strenuous pushing). It just means that childbirth sounds like exactly the sort of messy, personal experience that it is.

Full disclosure: I have zero interest in children. I'm sure it's a difficult job with no manual. I don't think I'm the right type of person for it for a variety of reasons. It's not what I'm looking for in life to grow as a person. So why am I fascinated with this topic where it intersects with women's personal agency? Because you can't talk about the full rights of women as citizens without taking into account their control over their own reproductive health. This very much includes whether they want to have children or not, when and how. Particularly, how we talk about and perceive women having children often hints at how our culture perceives women in general.

Traditional Chinese Medicine is rooted in a deeply patriarchal culture. Note that I didn't say "historical". The PRC recently stopped its punishing one-child policy, which at its worst included forced late-term abortions and outright human rights abuses that it has never fully acknowledged. They did this because the PRC, like Japan, is faced with a rapidly ageing population and not enough young people to help support it within the next few decades. The PRC's birth rate has effectively plummeted below the replacement rate. This has real effects on its ability to sustain economic growth. Coupled with sex-selective abortions, an unanticipated effect of its one-child policy and a society that favours sons, it also has a burgeoning gender imbalance problem. It's now pretty clear that a lot of young men won't be able to find partners. Idle men cause unrest, no matter how hard the PRC exports them to build roads in other countries en masse. More than anything else, improved economic and educational opportunities for its population is the best birth control as it is anywhere else. After a whole generation of single children have grown up and started families themselves, there's less interest in having more than one child. While it isn't a trend strictly for just the PRC, the PRC does have the unique situation where actual government policy actively tries to turn off then turn on when its population can breed. Unsurprisingly, the women whose lives this policy affects are unamused.

That's how I found this fascinating paper on a study of Cesarean sections in Shanghai, which looks at the surprisingly feminist reasons why mothers opted for C-sections even with education on the merits of vaginal birth. It turns out that up until recently, China had one of the highest C-section rates in the world. In a push to improve maternal and infant mortality, the country undertook a drive to medicalise births, i.e. move all childbirth into hospitals while de-certifying and eventually criminalising home births and traditional mid-wives, at the same time promoting vaginal births over C-sections at all costs. Giving birth in a hospital amidst specialists was considered safer, with more guarantee of the baby's health. During the one-child policy era, when women worked with the perception they had only one shot at delivering a "quality child" (that's the exact phrase in the study, which I find absolutely brilliant at describing the kind of ultra-competitive environment East Asian children are born into), that meant it was even more important for that one child to be born with guaranteed health. Remember: the PRC doesn't do things in half measures.

A strained and sprawling public health system was now pushed to deliver babies like a well-oiled machine. That's not unique to the PRC, but the implementation kind of is. It sounds like, based on the paper, the system understood vaginal births meant improved infant well-being, but lacking the manpower and medical resources (specifically, anesthesia), just decided to make do with childbirth pain. That's horrifying on many levels for any modern medical system. Nowhere in this paper were there any acupuncture needles, by the way. Instead, two patriarchal values were clearly in force: that childbearing pain is a necessary evil for all women (it can't be helped!), and women who complained were weak-willed (motherly martyrdom is a defining trait of the good mother).

The uncommonness of epidurals, or even knowledge that epidurals were possible, meant that women saw C-sections as the only obvious choice to receive pain relief during childbirth and analgesics post-partum. The study hospital had a birthing ward closed to family members, leaving women effectively alone on a bed. This is a system where, not only was vaginal birth coerced, but the doctors and nurses in charge were often openly unsympathetic and even critical of women who disagreed. Pregnancy and childbirth education wasn't even the prerogative of the OB/GYN, as optional public classes were held twice a week in the hospital.

All of this is terrible but enlightening reading. There's a lot more to unpack in there, including classist ideas of which women are more naturally equipped to withstand pain, a parallel to how women of colour in the US are (wrongly) perceived to handle pain better. Once you get to the part about how women who lived through the Cultural Revolution or from the provinces can all eat their share in bitterness and thus have less worthy pain than the wealthy and educated, it becomes incredibly surreal. 

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