In China, Morning After Comes with New Aftermath: Adam Minter

Since China’s so-called “one child” policy began in 1979, cheap, easy and anonymous birth control has been tantamount to a government-guaranteed right. Chinese pharmacies have long made birth control pills and emergency contraceptives -- also known as the “morning after pill" -- available without a prescription.

But on Dec. 21, in a move that shocked Chinese citizens, the local Food and Drug Administration of Fuzhou, the capitol city of Fujian Province, abruptly issued an order requiring its pharmacies to acquire "real name registration" -- the names, phone numbers and government identification numbers -- of women seeking emergency contraceptives.

By Jan.1 , this otherwise local issue had become that rarest of things in modern China: an open, national dialogue on a citizen's right to privacy.

Emergency contraception is popular in China. In  a 2009 online survey conducted by the China Population Communication Center, nearly half of the 40,000 women questioned said they preferred emergency contraceptives to other forms of birth control.

By far, the most popular form of emergency contraceptive is levonorgestrel, a synthetic hormone designed to be taken in pill form within 72 hours of unprotected sex. The dose delays ovulation, prevents fertilization or prevents implantation of a fertilized egg. (In the U.S., the most popular brand name for levonorgestrel is Plan B One-Step, available without prescription to women at least 17 years old.)

If levonorgestrel was the only compound used as an emergency contraceptive in China, the city of Fuzhou may never have issued its now infamous order. But mifepristone -- a steroid best known in the West as RU-486 or the "abortion pill" -- is also available, in small doses, as an emergency contraceptive without a prescription. The problem, from the government’s point of view, is that women can technically buy enough doses of mifepristone to induce an abortion at home.

Until recently, Chinese women had little reason to do such a thing. Abortion -- surgical and drug-induced-- is legal, widely available and socially acceptable in China. What is neither acceptable nor legal, however, is sex-selective abortion, that is, aborting an unborn female with the hope of later conceiving a male. Yet the practice is so common it produced a gender ratio in 2010 of 118 boys to 100 girls in China; the natural human ratio is 105 to 100. New genetic tests allow expecting parents to determine the sex of a developing child as early as seven weeks into a pregnancy, the same period within which  mifeprestone  is designed to work.

Wu Xingfa, the director of Fuzhou’s FDA, said  in an interview with Xinhua, the Chinese state news agency, last week:

As several emergency contraceptive pills contain mifepristone, which can be used as an abortifacient, some private clinics have used them to abort girls because a boy was the preference.

Last August, China’s National Family Planning Commission, the People’s Liberation Army General Logistics Department and the Public Security Bureau, which is China’s chief law enforcement agency, launched a new campaign against non-medical sex determinations and sex-selective abortions. According to Xinhua, the campaign, set to last until March 2012, seeks to “raise awareness of gender equality, to severely punish those involved in cases of non-medical sex determinations and sex-selective abortions, and to strengthen monitoring.”

Fuzhou’s regulation requiring everyone to register who  purchases emergency contraceptives is seemingly in that spirit. But curiously, the  new rule  makes no distinction between mifeprestone and levonorgestrel, though the latter is for use only in the immediate days after sex, when even if a woman has conceived it would be impossible to know the sex of the developing baby.

Thus, rather than inspire a conversation about sex-selective abortion and its deleterious effect on China's demographics, the Fuzhou rule has provoked a national discussion about the costs and benefits of a right to privacy. Many are questioning, with reasonable suspicion, what pharmacies -- and the Party -- will do with a register of people who have bought emergency contraceptives.

Of the many newspaper commentaries on this issue, none was more eloquent or cited than the Dec. 31 piece by a columnist using the pseudonym "Si Yi," published in Gaungzhou's highly independent Southern Metropolis Daily:

Real name registration implies discipline. It’s a general understanding that sex and procreation are private acts. Forcing you to register means forcing you to disclose sex and reproductive behavior to an individual or institution. Of course, this is a kind of humiliation and penalty.

The essay connected the registration requirement for contraceptives to the new requirement that Chinese microbloggers register their real names with their microblogging accounts:

The freedom to be anonymous is an important component of civil liberty. Citizens have the right to make comments anonymously on the condition that their opinions don't violate the law; citizens have the right to have sex anonymously on the condition that both parties are consenting adults; in the same way, citizens also have the right to purchase contraceptives anonymously no matter her situation. Essentially, the freedom to be anonymous is the freely made autonomous right of individuals in their personal sphere. Government authority can't over-expand or over-spread in front of this kind of right and freedom.

On Sina Weibo, China’s leading microblog, Fuzhou’s regulation was one of the top 20 trending topics for almost two weeks, generating more than 3 million posts -- most of which were highly skeptical of the Fuzhou FDA’s competence.

The novelist Wo Dan tweeted:

I believe the real-name registration requirements imposed by Fuzhou are well-intentioned. However that can't overcome their simplicity and crudeness. Those who purchase emergency contraceptives are usually lovers who used condoms and women who are sexually assaulted and have to take medicine. Shouldn’t their rights be respected?

Many commentators and microbloggers argued that the policy will lead to a disastrous increase in surgical abortions as women,  especially minors, decline to  seek emergency contraceptives because they are too embarrassed to sign their names to a government register. “It will inevitably increase the unwanted pregnancy and abortion rates, harming the physical and mental health of teenagers,” tweeted Kong Xiangyi, a Beijing technology entrepreneur.

Other netizens on Weibo argued that the registration requirement will create a black market for emergency contraceptives in Fuzhou. Xia Tian, a journalist with the Daily News in Shanghai, used his Sina Weibo account to speculate, referring to a popular brand of levonorgestrel tablets:

I expect there will be scalpers selling them. Outside the gate of a small and cheap hotel, a man will linger and approach nervous couples to ask: "Do you need Yuting? No registration required!"

Far from dissuading other municipalities from enacting similar legislation, Fuzhou seems to have been a pioneer. Two other city governments in Fujian Province have recently introduced emergency contraception regulation, ensuring that women in that southern corner of China will have to work harder to protect their privacy from an overreaching government.

(Adam Minter is the Shanghai correspondent for the World View blog. The opinions expressed are his own.)

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