This compilation brings together a diverse array of manuscripts focused on sexual and reproductive health in China. Given the resurgence of syphilis in China and the on-going sexual revolution, this topic is timely and has important implications for public health policy. The book describes the sexual and reproductive health shift away from a state-heavy, compulsory approach and towards a more progressive, client-centred approach. While the book reads more like a series of related essays rather than a coherent whole, there are several insightful pieces that represent new thinking on these old topics. The compilation focuses mostly on Chinese language sources, combining primary and secondary data analysis. The authors merge their own empirical experience alongside theoretical underpinnings to articulate how sexual and reproductive health has evolved over the past 30 years. The analysis focuses more on the side of smaller scale micro-processes and observations (e.g., local programmes) rather than how to scale things up or connect locally successful programmes into regional or national models.
The impetus for changing sexual and reproductive health services in China has come both from the larger international reproductive health community and domestic Chinese leadership. Many chapters cited the International Conference on Population and Development in Cairo (1994) and the World Women's Conference (1995) as watershed events that dramatically altered the landscape of sexual and reproductive health. Each of these conferences mobilized support for key stakeholders (NGOs, youth, women) involved in sexual and reproductive health. The increased support for these groups helped to catalyze innovative family planning programmes, training workshops, and technical meetings to implement these new approaches. Subsequent reviews of these two conferences in China have re-examined progress and served as rallying points to energize further implementation. However, as the book well demonstrates, there were earlier domestic trends in China that had a profound influence on the development of sexual and reproductive health services. The majority of the decrease in fertility in China during the 1970s preceded the formal “One Child Policy,” instead representing a reaction to the “later marriage, fewer children, longer spacing” campaign. Both the long history of family planning organizations and women's organizations in China have domestic origins that are explicated in Zhenzhen Zheng's excellent chapter “Women's empowerment in reproductive health in China – searching and practice.”
The chapter devoted to non-governmental involvement (“The growth of China's sexual and reproductive health NGOs: thirty years in review,” by Guosheng Deng and Ying Ji) is a welcome addition to the book. The breadth and depth of non-governmental organization involvement in sexual health service delivery have markedly increased in the past ten years, albeit with a number of constraints. NGOs in China are both quantitatively less common and qualitatively closer to the government than in many other parts of the world. Despite these constraints, Chinese NGOs continue to play a key role in piloting novel sexual and reproductive health programmes, liaising with community groups, and marshalling support from abroad.
There are several weak areas that could be improved in this book. First, further empirical evidence about how new theories and perspectives have resulted in fewer unwanted pregnancies or averted sexually transmitted diseases would be useful. Many of the important new concepts described in the book have only been piloted in small settings and not scaled up beyond the local level. Second, a broader discussion of homosexuality in China is critical for interpreting sexual and reproductive health in China. While several chapters mention this trend in passing, a more thorough discussion of homosexuality in the context of sexual and reproductive health is warranted. Gay culture in China has a long history, but high-quality sexual health services for homosexual men are lacking across China. Third, an education perspective focused on the current content and future needs for sex education in China would be another key area that was not well covered. Unfortunately for many youth in China, the evolution of sexual and reproductive health services has not been accompanied by comprehensive sexual education programmes.
Sexual and Reproductive Health in China is an important and timely reminder of the progress in sexual and reproductive health made thus far and the work that remains ahead. The book would be especially useful for medical or graduate students undertaking research in this field, China scholars interested in reproductive health, or those involved in implementation of sexual/reproductive health programmes. The editor and authors should be commended for their contribution to understanding sexual and reproductive health in China. More research and critical discussion are needed to move forward sexual and reproductive health in China.
