GEOG @ GSAL
Saturday, 5 December 2015
Sunday, 29 November 2015
Monday, 9 March 2015
China's quiet revolution in reproductive health
With a population of 1.3 billion, much of it crowded into the eastern third of the country,
Zhang Xinhua, an attractive woman in her early 30s, sits on a bench outside the small family planning service station in the tiny
Though most of Qinghai Province ,
where Zhang's village is located, consists of hilly, semi-arid grasslands, this
is farming country. Close to 60 per cent of the entire population of five
million lives and works on just three per cent of the provinces land area. The
treeless hills around the village have been cultivated continuously for some
3000 years. Every square metre of soil that can bear crops has been put to the
plough. The entire landscape is a checkerboard of wheat, maize and vegetable
fields.
Zhang's one-hectare farm grows mostly wheat
and some vegetables for household consumption. The land is fertile and produces
more than enough to feed the family, two adults and three children. During
surplus years, she can even put some money in the bank. Still, Zhang's life is
not easy. Her husband injured his back in an accident and is unable to perform
most of the heavy work that must be done on a farm. Zhang does most of the farm
work herself, with help from two of her three children. The third child, a boy,
is afflicted with epilepsy and is enrolled in a special school. Her other son
and daughter pitch in to help with chores after school.
Despite her difficulties, Zhang is optimistic
about the future. She has advantages some of her neighbours do not. Zhang is a
high school graduate and is literate. Many
women in her village, especially those belonging to the Hui minority which are
predominately Muslim, did not even get a chance to pass through grade school.
Traditionally, Muslim women were not educated and in some villages female
illiteracy is as high as 60 per cent. Zhang values her daughter as much as her
two sons and intends to keep all of them in school as long as possible. "I
want them all to go to the university, if they have the aptitude and
interest," she explains in a clear, even voice. "I want my children
to make a living with their heads, not their hands."
Birth quotas
Zhang has come to the clinic for a routine
checkup. "With a handicapped child and a crippled husband, life is
difficult," she says matter-of-factly. "So I decided to switch to
Norplant [a long-term injectible]. I do not want any more children." Now
she is looking forward to the extra time so she can concentrate on raising her
three children and make some extra money by selling vegetables and sewing
clothes. Thanks to the upgrading of the clinic's services, including access to
a complete array of contraceptive choices and better counseling, Zhang can now
get most of the services she needs at her local community clinic, services she
used to get only at the county hospital, an hour each way by bus from her home.
This out-of-the-way family planning clinic is
part of a silent transformation in China 's reproductive health
services. In 32 counties in 22 of the country's provinces, the State Population
and Family Planning Commission, working closely with the Ministry of Health and
the China Family Planning Association (an NGO) has abandoned birth quotas and
targets for family planning acceptors. At the same time, the services in family
planning clinics and primary health care centres have been upgraded. Women and
men now have more freedom of choice when selecting contraceptive methods, including
wider access to alternatives such as condoms, pills and injectibles.
This ground-breaking initiative was made
possible by a $14 million pilot project funded by United Nations Population
Fund (UNFPA). Before this project was launched the most common family planning
methods in these counties, as in the rest of the country, were limited to two
methods: an IUD after the first child and often sterilization after the second.
The quality of reproductive health services has been improved significantly through
an expanded training programme for health care providers, the provision of
modern diagnostic equipment and supplies and better interpersonal counseling,
which includes informed consent.
Dr. Song Hou Qin, the physician in charge of
the Qinghai Provincial Family Planning Commission, is enthusiastic about the
results of the project in Datonghui
County , an area of some
1,000 farming villages tucked away in the hills about 40 kilometres north of
the provincial capital of Xining .
"We chose this county as one of the project sites because it has a fairly
mixed population; 45per cent consists of various minorities, with 55 per cent
Han Chinese," she points out. "As a result, we have a significant
number of Muslims, as well as Buddhists and some Christians. In addition, the
county is rural and needs better services, and the provincial and local
governments strongly support this effort."
Quality care
As part of the implementation strategy, Datonghui County has strengthened its capacity to
deliver quality reproductive health services to more women and men. "We
have trained our local family planning service providers, giving them better
face-to-face counseling techniques," explains Dr. Song. "We also
designed and distributed more focused IEC [Information, Education and Communication]
materials, aimed at the needs and concerns of local women, and we are making
full use of new technologies to improve the quality of reproductive health
care, including better pre-natal, post-natal and peri-natal services and
attended births for all women."
Two thousand kilometres to the southeast the
small farming village
of Mudun is tucked away
deep inside the rice growing region of Fujian Province .
Ye Jianzhen, a petite women with round cheeks and raven hair, sits in her
living room explaining how her life has improved over the past decade. She is
34 years old and the mother of a charming, intelligent 8-year-old girl - the
only child in the family. Ye is part of a growing chorus of voices heard among
younger Chinese women that having a child is the important thing, no matter
whether a boy or a girl.
"I was delighted to have a girl
child," she says in a quiet, steady voice. "A girl is just as good as
a boy," she adds emphatically. "I want her to achieve as much as she
can in life, and hopefully since she is intelligent and does well in school she
will have a chance to go to the university." Ye didn't get beyond the 9th
grade before being forced to dropout to help with farm chores.
Like Zhang, Ye lives in one of the 32
counties in China
that have eliminated family planning targets and quotas. Ye does not want
another child because she wants to give her daughter opportunities that she did
not have, coming as she did from a family of four children, three of them boys.
"My life has been confined to this village, but it is my hope that my
daughter will acquire skills that will take her away from here and open up a
world of opportunities for her."
With the family's fortunes on the rise,
thanks to two rice crops a year and the success of her husband's small business
shipping oranges to neighbouring provinces, Ye is looking forward to more
disposable income. One of the first things she intends to buy: "a new
computer for my daughter, with Internet access, so she can benefit from the
global information revolution."
Ye is now using pills, instead of an IUD. She gets a check up three times a year at her local clinic to make sure that her family planning method is working properly and is counseled on other contraceptive methods; services the old system did not provide. "Before we were not given a choice of contraceptive methods," she shrugs. "This has all changed because of the new policies. The services are much better and tailored to my needs."
Ye is now using pills, instead of an IUD. She gets a check up three times a year at her local clinic to make sure that her family planning method is working properly and is counseled on other contraceptive methods; services the old system did not provide. "Before we were not given a choice of contraceptive methods," she shrugs. "This has all changed because of the new policies. The services are much better and tailored to my needs."
One-child choice
It's a similar story for Zhang Qingying and
her husband Lu Hao, living in Deqing
County , in Zhejiang Province . Unlike other regions, efforts
to improve the quality of reproductive health care began here in 1995,
following the International Conference on Population and Development (ICPD) in Cairo . Since 1998 when
Deqing joined UNFPA's 32 county pilot programme, it has become a showcase for
quality service delivery for the entire country.
Qingying and Hao are both busy professionals
(school teachers) in their late 20s and have one child, a gifted six-year-old
boy named Yihui. Even though the couple could have another child, since both
come from one-child households, they do not want another child. "It is a
difficult enough job raising one child," confesses Qingying.
"Besides, with two children you don't have as many options and
opportunities available. We want to concentrate our efforts on giving Yihui the
best possible future."
Qingying is delighted with the services
provided by her local family planning clinic. "The counselors are well
informed, friendly and courteous," she says, "and the doctors are
very professional, very competent." However, she is not taking any
contraceptives. "I don't like pills," she says blushing slightly,
"so my husband uses condoms."
Empowering women
Condom use in China is soaring, especially in
urban areas. In Deqing, a full 10 per cent of family planning acceptors use
condoms; in Shanghai
and other large cities over 20 per cent do so.
Condom use is on the increase mainly for two
reasons: the success of publicity campaigns to prevent sexually transmitted
infections (STIs) and HIV/AIDS, and because Chinese women are being empowered
in their personal and professional lives.
"We have certainly empowered women in
this county," affirms Shao Huimin, Director of the Deqing Family Planning
Bureau. "Most women here work and earn their own money. Three of our four
government bureau directors are women, along with two deputy governors,"
she points out proudly. "In addition to comprehensive improvements in
services, we have educated local politicians to be gender sensitive, included
services for youth, introduced sexuality education in secondary schools and
reached out to other partners."
An energetic, engaging woman in her early
50s, Shao has worked in the health and family planning fields her entire adult
life. "Thanks to UNFPA's catalytic assistance, we have made tremendous
progress in a short period of time," she states. "We now get around
60,000 visitors a year from all over China , as well as foreign
countries. Most are family planning experts who come mainly to see our
facilities and seek advice and guidance on best practices and lessons
learned."
Shanghai centre
Just 200 kms to the northeast of Deqing lies Shanghai , home to 17
million people. Not surprisingly, China 's largest metropolis is
another centre of excellence in the new approach to reproductive health
services. Even small, neighbourhood reproductive health stations come equipped
with a reception area, counseling rooms, a private examination room, a library
and a complete range of contraceptive supplies. Additionally, many sell baby
supplies, including high-tech cribs that sport built-in toys and a variety of
gadgets, even a sleep monitor.
"We provide a complete array of services
for reproductive health, family planning and baby care under one roof,"
points out Zhang Yunxia, Director of the Da Pu Qiao Street Reproductive Health
Station in the centre of Shanghai .
"Our doctor, a highly popular gynecologist, comes twice a week at posted
times to give examinations and provide special counseling if necessary. We also
have a regular counselor here everyday to answer questions and give
advice."
Pointing to a young woman with the doctor,
Zhang says, "this lady came in for a routine health examination, only to
discover that she has a reproductive tract tumour. The doctor is setting up an
appointment with the local hospital right away so she can get a complete array
of tests." Before the emphasis on quality of care, this station did not
offer such comprehensive services. "It's one more reason why we see dozens
of clients a day here," confirms Zhang. "Even nearby university
students drop in to get information, borrow tapes on various reproductive
health issues, get advice and help themselves to our free condoms."
This centre, like all others in the city,
hands out dozens of pieces of literature and hundreds of condoms every week.
All municipal buildings in Shanghai
sport condom dispensers - anyone is free to take as many as they need. But,
astonishingly, even apartment buildings now have condom dispensers in discreet
locations. As a result, STIs have dropped dramatically in many parts of the
city. "It's September," says Zhang, "but we haven't had one case
of an STI yet this year in our centre."
Extended impact
The impact of UNFPA's programme in China has been
remarkable.. Based on the results and impact of the 32 county pilot project,
the State Population and Family Planning Commission has extended the quality of
care package of services to another 880 counties, one-third of the country's
total. Though these counties will still have birth quotas and targets, at least
initially, the Commission is counting on being able to keep fertility rates
down by providing a wider choice of contraception, improved care and better
counseling, based in informed consent.
The Fund's pilot project has not only helped
establish client-centred services, including informed choice, as hallmarks of
the Commission's approach to reproductive health, it has "opened the eyes
of many officials and politicians regarding population issues in general and
family planning in particular," notes one population expert from Beijing.
UNFPA's efforts have helped "change fundamental attitudes towards these
issues," he says.
"Of course we still have old guard
politicians in this country who want draconian population laws, but this
initiative has demonstrated that you can have voluntary family planning
programmes that work; without quotas, without targets and most importantly
without increases in the population."
Lower population growth rates remain a top
priority for the Chinese government, which views the issue as one of crucial
importance for the future of the country. "Anyone who has visited China will see
right away how important it is to limit population growth," observes a
former World Bank economist and diplomat, stationed in Beijing from 1998 until 2002. "China has a
population of close to 1.3 billion people, with 94 per cent of them living in
the eastern third of the country. Imagine that many people all crammed together
east of the Mississippi River in the United States ,
and you get a picture of how crowded this country is by comparison."
Fewer children
Even so, the one-child family is not a
universal policy. In fact, the average number of children per family in China today is
close to two. There are plenty of exceptions to the rule.
In rural areas couples can have two children:
if the first baby is a girl, if both husband and wife are only children, if the
parents of the wife had two girls and no boys, and if both husband and wife are
from rural areas. Ethnic minorities can have up to three children and Tibetans
have no limits on family size.
Perhaps most importantly, the new strategy
"reflects major changes in Chinese society," states Baige Zhao, the
dynamic, English-speaking Vice Minister of the State Population and Family
Planning Commission in Beijing .
"China
is in transition from a state-planned to a free market economy; from a largely
rural, traditional society to a modern, urban one." These underlying
changes are also driving people's decisions to have fewer children.
"Our efforts to deliver client-centered,
quality reproductive health services to more people, including access to a full
range of contraceptives," she observes, "must be seen in the context
of the economic and social forces at work. UNFPA came in with the right
strategy at the right time."
The right strategy at the right time has allowedChina 's reproductive health
revolution to take off. Ru Xiao-mei, Assistant Counsel of the State Population
and Family Planning Commission, underscores what this transition means:
"we are no longer preaching population control. Instead, we are
emphasizing quality of care and better meeting the needs of clients. It's a
service-based approach, not a demographic-based approach."
The right strategy at the right time has allowed
Funding tragedy
As the new system takes root throughout the
country, it has not only transformed the way services are delivered, it has
forged new partnerships between the Commission, the Health Ministry and NGOs.
The Maternal and Child
Hospital in Jianou City ,
capital of Jianou
County , about 50
kilometres from where Ye Jianzhen lives, has become a model facility. The
hospital delivers 1,400 babies a year. Moreover, with only three infant deaths
over the past three years - one per year - this achievement has earned it
UNICEF's "Baby
Friendly Hospital "
award.
Dr. Han Xiaoqing, Deputy Director of the
Family Planning Commission of Jianou County, says the hospital's success rests
on four factors, "a good foundation for services, a client-oriented
approach, very affordable fees and close collaboration between the Ministry of
Health and the Commission." Ten years ago," confesses Han, "we
were a self-contained agency, we seldom even spoke to colleagues in the
Ministry of Health, now we work closely with them, as well as other
partners."
Tragically, just asChina 's
new policies are having real impact across the country, UNFPA finds itself the
hapless victim of US domestic politics. UNFPA's mere presence in China has
prompted the Bush Administration to withhold $34 million in Congressional
appropriations for the Fund in 2002 and again in 2003. The excuse provided by
the State Department (speaking on behalf of the White House) was that UNFPA had
violated the terms of the Kemp-Kasten Amendment (to the 1985 foreign
appropriations bill), which states that no agency can receive US funds if it
participates in a program of coercive abortion or sterilization.
Tragically, just as
Monitoring missions
In withholding funds from UNFPA, the Bush
administration not only ignored the findings of over 160 UN monitoring missions
to China over the past decade, they ignored the detailed reports of three major
independent missions fielded over the past two years. In April 2002 three
members of an all-party group of British Parliamentarians visited China , followed
in May by the US State Department's own three-person assessment team. Both
concluded that there was absolutely no evidence to support allegations of
misconduct by UNFPA. The State Department's hand-picked team found "no
evidence that UNFPA has knowingly supported or participated in the management
of a program of coercive abortion or involuntary sterilization in the PRC.
Indeed, UNFPA has registered its strong opposition to such practices."
Another independent mission, organized by
Catholics for a Free Choice, sent a nine member team of faith-based
organization leaders and ethicists to China in September 2003. Their
conclusions were unequivocal: "On the basis of our meetings with Chinese
family planning officials and ordinary citizens, we can say with confidence that
all of the programs with which UNFPA is currently working are committed to
avoiding any practice of forced abortions or involuntary sterilizations."
The sad fact is that the "Bush
Administration has made UNFPA a sacrificial lamb for the religious right in America ,"
says Professor Ronald Green, Chair of the Department of Religion at Dartmouth College and a member of the faith-based
delegation that visited China
in September 2003. "President Bush is pandering to militants on the
extreme right wing of the Republican Party," insists Dr. Green. "It's
crass election politics. These groups not only oppose abortion, they are
against family planning and reproductive health in general. Their positions are
unethical, contradictory and have no basis in reality."
The ironies of the Bush policy are as thick
as treacle. In the first place, not one dollar of American aid went to UNFPA's China
programme; those funds were provided by European donors. This fact seems to
have escaped the attention of religious conservatives, who now seem to be
making US
foreign policy in the field of reproductive health and family planning.
Fewer abortions
A much more poignant testimony to UNFPA's
presence is the plain fact that in the 32 counties where UNFPA's programme is
being implemented, the abortion rate has dropped by an average of 30 per cent.
In Yuzhong county, Gansu
Province , data show an 85
per cent decline in abortions, from 512 in 1997 (before UNFPA assistance began)
to 75 in 2002. Similarly, in UNFPA supported counties, the voluntary
sterilization rate for women under 35 decreased significantly, from 36 to 26
per cent (for the period 1998-2003). Moreover, the overall sterilization rate
for all men and women of reproductive age in these counties is 30 per cent,
nearly the same as in the United
States !
The results of the UNFPA-sponsored programme
are so impressive that high-level officials in Beijing are looking forward to extending the
same package of services to every corner of the country. If the trends hold and
the reforms do spread throughout China , it is conceivable that
quotas and birth targets will become redundant. Underscoring these momentous
changes is the fact that women are being empowered in China through
increasing opportunities for economic and social advancement. Even in the
countryside, most women work. Increasingly, it is economic considerations, not
government decrees, which are keeping one-child families the norm in cities and
towns.
Wanting girls
Two other important factors are reinforcing China 's shift
to a quality of care, service-based approach. In the first place, "the
small family ethos has become part of Chinese culture," observes Dr.
Ronald Green. "Through public education and civic involvement, Chinese
attitudes towards the family have changed dramatically."
Secondly, younger Chinese women do not have
'a boy bias'. "Our research shows that even in rural areas a preference
for boys is no longer as pronounced as it once was," explains Dr. Zhang
Rong Zhou, Director of the Shanghai
Population Information
Center , an NGO. "The
younger generation has no preferences whatsoever; they value girls as much as
boys." In fact, in Shanghai ,
he points out, "couples now prefer girl children because they cost less
and are easier to raise than boys." As a result, the sex ratio in Shanghai is 105 boys to
every 100 girls, the normal international average. "In other urban areas
the ratio is also beginning to even out," claims Dr. Zhou.
"Centuries of prejudice are not easy to
overcome, especially in the countryside," admits Zhou. "In some rural
provinces the disparity is still striking, but the younger generation in China shares
many of the characteristics of its counterparts in the West: they want a better
life, much smaller families and more opportunities for education, travel and
work." It is these powerful trends that are helping to drive China 's quiet
revolution in reproductive health.
"The demographic profile of China , like its
economic profile, is changing rapidly and so policies and programmes must
adjust to new realities," points out Baige Zhou, the eloquent Vice
Minister of the State Population and Family Planning Commission. "The
policy that we see evolving is more fluid, based on continued improvements in
the provision of client-oriented quality services that meet the needs of modern
families."
She is grateful for the help afforded by
international partners. "We could not have come this far so quickly
without help from the international community. The lesson here is clear,"
she concludes, "if you want to influence Chinese policy, stay
engaged."
Thursday, 5 March 2015
Cities 100 Years Report
The Centre for Cities launched a report on 100 years of cities in the UK and make some interesting observations on how cities have changed. They argue that industrial decline and manufacturing change were not as influential as we may believe. Read on, follow the link here
Friday, 13 February 2015
Fines for Fat Kids - read on
Could fining parents be the solution to the increasing global concern surrounding childhood obesity?
Read this article from the BBC for more details
Read this article from the BBC for more details
Wednesday, 4 February 2015
Brown Agenda UN calls for change to Waste Water
UN Report Calls for Wastewater Focus in Post-2015 Agenda, as 80% of Worlds
Wastewater Discharged Untreated
Pit Latrines Still Used by 1.77 Billion People Worldwide,Sparking Low-income Country Waste Treatment Innovations
Click here for details
Pit Latrines Still Used by 1.77 Billion People Worldwide,Sparking Low-income Country Waste Treatment Innovations
Click here for details
Sunday, 23 February 2014
Decline and Deprivation in the Inner City
Urban decay and decline occur when part of a city falls into disrepair and abandonment. Characteristics of urban decay include high unemployment rates, high crime rates, depopulation, desolate-looking landscapes, abandonment of buildings and split family groups. Urban decay does not have one single cause, but rather a combination of many, including poor urban planning, redlining, poverty, suburbanization and racial discrimination.
Urban decline is the deterioration of the inner city often caused by lack of investment and maintenance. It is often but not exclusively accompanied by a decline in population numbers, decreasing economic performance and unemployment.
Urban deprivation is a standard of leaving below that of the majority in a particular society that involves hardships and lack of access to resources. Places suffering from urban deprivation have visible differences in housing and economic opportunities been the rich living alongside poor people.
Decline and Deprivation in the Inner City
- Poverty
- Pollution
- Crime
- Overcrowding
- Poor housing conditions
- Unemployment
- Racial tension
- Older residents
- Single parent families
- Students
- Poorer families
- Ethnic minorities left behind – formation of ghettos.
Decentralisation increases the problem: -
Movement of businesses out of inner city – unemployment – Dead Heart. Removal of businesses causes a loss of money from the area so there is little money available to invest in improvements.
- increased competition from overseas
- reduced demand
- increased mechanisation and use of technology reducing manpower
- globalisation
TASK
The Causes of Inner City Decline:
Read Section IV in this linked pdf and make notes on:
The Causes and Consequences of Urban Decline.
Use the Barker, Redfern and Skinner textbook 148-153 to support your notes.
Subscribe to:
Posts (Atom)