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Health is more than our physical condition, and according to the World Health Organization (WHO), “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.” The preamble to the WHO constitution reads “health is a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity”. An Introduction to the Human Development and Capability Approach: Freedom and Agency. Ch. 10: 228-245.. Economic reforms, healthcare reforms, and reproductive health are important health concerns for women in China. Taking the WHO’s standard a step further and using Martha Nussbaum’s capabilities approach one can now determine the equability of women’s health in China

Economic reform
Since 1978 China has been systematically moving away from a socialist economy and toward a capitalist system. With the intention to increase efficiency and improve standards of living, China has implemented far reaching reforms: decollectivization and land tenure reforms, promotion of township and village enterprises (TVEs), state sector reforms, and policies to encourage foreign direct investment (FDI) and trade liberalization. These policies were implemented as China moved to a market economy and were furthered in order to insure their membership to the World Trade Organization (WTO) (2). These policies are haled by many as being highly successful, producing massive economic growth while raising the standard of living by reducing poverty. China has taken a gradual and highly regulated approach to its transformation and while China started its transformation earlier than other socialist countries China is still undergoing that transformation. These measures have led to much growth; and as China continues to increase its GDP at break neck paces those same policies have led to decentralization and privatization of healthcare (2). Women’s health in China is among the most prevalent causalities of this economic transformation. In 2001 China joined to the WTO in 2001 the conditions for membership was steep: China agreed to lower tariffs from 24.6% in 1997 to 9.4% by 2005 and to abolish all quotas and discriminatory taxes in industrial sectors. Those adjustments were agreed upon with the assumption that China would open up its markets to international trade (6). When international trade began to thrive, women struggled to find their place in this new and changing economy. Both women and men where no longer guaranteed work once the market opened up unemployment became rampant. As the Chinese markets moved to efficiency many workers were made redundant. Those redundancies effected women far greater than men, the workforce made up of 40% women however, 60% of the layoffs ended up being women (5). The economy was changing; as the market opened new employment opportunities for women became available. Those new opportunities were primarily in the service and textile industries. The number of Chinese women working as of 2007 was 330 million which is now 46.7% of the total working population, the majority of these women are working in the agricultural or industrial sectors with an high concentration working in the garment industry (3). These industries lend themselves to dormitory living.These Chinese dormitories are not a new institution; similar systems have emerged in the east and west, and are primarily associated with industrialization (9). These dormitories are filled with migrant workers all of whom cannot stay in the urban areas without being employed (9). Young women have become the most prevalent demographic for migrant work and makeup a very large portion of migrant work making up over 70% of those employed in the garment, toy, and electronic industries (9). These women now called dagongmei are typically short term laborers who are contracted out for a short period of time and at the end of their contracts they either find more work or are forced to return home. That type of labor contract leaves these dagongmei with very little bargaining power as they are seemingly easily replaced and mobility is almost nonexistent. The dormitory life in China leaves women with little to no home space independence from the factory all of the women’s time spent traveling from home to work is eliminated and working days are extended to suit production needs (9). Sick days and personal health are of little concern in these dormitory settings. Women will often neglect their own health out of fear of retribution from factory supervisors. Furthermore as shown in the documentary “China Blue” if a woman becomes pregnant while working she will be either fired or forced to quit shortly after her baby is born because she will not be able to meet her work responsibilities. In 2009 alone over 20,000 Chinese dorm workers became ill while living in these dorms the majority being young women (http://www.waronwant.org/overseas-work/sweatshops-and-plantations/china-sweatshops). While living in dormitories women migrant worker’s time is not their own as they become assimilated into the factory life they are almost completely controlled by the paternalistic systems of these factory owners and managers. Hygiene and communicable diseases become a threat to health as women live in rooms of 8-20 people sharing washrooms between rooms and floors of the dormitories. The only privacy one is allotted is space inside the curtain that covers an individual’s bunk. Male and female workers are separated and there are strict controls placed on the sexual activity of both. These conditions pose a great threat on not only the physical but also the mental health of these women workers being away from their home and placed in an environment where total control is place on them by the factories(9). While those changes did allow China to achieve unprecedented economic growth the privatization of many industries also forced China to reform its healthcare policies. Another factor that limits women’s capabilities to access healthcare is their relative low wage compared to men. China promotes itself as having almost no gender bias when it comes to wages yet we see that compared to men women are making less money. The Chinese government touts there “equal pay for equal work” mantra, however, women find that their work in the textile industries are not equal to the work done in industries requiring “heavy” labor so in the end women make less than men because they are perceived as not being able to do the “heavy” work (5). This inequitable pay leaves women more vulnerable and with less capability to pay for their individual healthcare when compared to men. While 49.6% of women are uninsured demonstrating that there is not much disparity between uninsured men and women (1). The lack of insurance does not affect men and women equally as women needs tend to be greater in order to provide care for child birth, family care, and security (1). Social security coverage has also been a factor as only 37.9% of those receiving social security are women; again this becomes an issue as elderly women are unable to pay for their growing health costs. As the cost of healthcare increases due to deregulation of trade and privatization, research has shown that the conditions mentioned above have greatly reduced women’s capability to access healthcare in China (1).

Healthcare Reforms
Health systems in China have changed considerably during transition to a market economy. As the transformation evolved China’s new decentralized government divided responsibility for urban health services between the ministries of Health and Labor and Social Security. As the industrial markets we liberalizing so to were the health system as the new market economy left many Chinese citizens uninsured having to pay for their care out of pocket with cash. (red book) Under China’s new trade policies brought on by membership to the WTO China’s open market were exposed to foreign competition leading to the import of better drugs and more expensive medical equipment. The new drugs and equipment gave way to higher cost of care, pricing out many Chinese whom were in dire need of medical attention. Between the late 1970’s and the late 1990’s, the Chinese government transfers for health expenditure fell by 50% and are continuing to fall (Chen, Standing). The Chinese were spending more on healthcare but the share the state was spending went down from 36.4% of the total health expenditures in 1980 to 15.3 percent in 2003; conversely, individuals contribution increased from 23.2% to 60.2% during the same time period. As mentioned in the economic reforms section women make less on average than men in China this leaving women particularly vulnerable to the rising costs of healthcare. One elderly women interviewed by Liu stated that she knew many older women who when confronted with the prospect of an expensive medical procedure opted to commit suicide rather than burden their families with the cost (5).

Reproductive Health
One of the aspects of women’s health to suffer the most as the economy shifts to a free market system is reproductive health. As health firm privatize those firms are less likely to provide preventative health, and as a result they have discontinued the practice of providing regular reproductive health examinations. Due to this from 1997-2007 only 38 or 39 percent of women are getting the reproductive examinations that they need. HIV in China has been on the rise as well rising from 15.3% in 1998 to 32.3% in 2004. This sharp rise is due to the lack of recognition and education, as for years in HIV was considered a western disease that would not affect the Chinese population and because of this rhetoric China found itself ill equip to deal social and health issues relating to HIV (1). There is also a widening gap between urban and rural women with regards to their respective health indicators. Health indicators show that in 2003 96.4% of urban women vs. 85.6% of rural women visited a doctor during their pregnancy. In urban areas children under 5 had a mortality rate of 14 per 1,000 again vs. 39 per 1,000 so children born in rural China were twice as likely to die before the age of 5. There are also more traditional gender values that reduce women’s access to healthcare. In one study it was shown that the majority of women still are reluctant to seek out medical help for issues concerning their gynecological needs. The unwillingness to get regular vaginal and breast examines has led to severe vaginal infections and late detection of breast cancer (1). Women resist getting these vaginal exams because if they are found to have an infection their identity as a woman is called into question as her role of care giver is reversed and is labeled as a care receiver (1). When infections where found it was reported that women often didn't even think they were suffering from an illness, and it is speculated that they perceived these infections as part of the female condition. These attitudes are common and spread due to poor healthcare systems and health information (1). References: 1.	 Chen, Lanyan and Standing, Hilary. July/October 2007. “Gender Equity in Transitional China’s Healthcare Policy Reforms.” Feminist Economics 13(3-4): 189-212 2.	Berik, Gunseli, Dong, Xiao-Yuan, and Summerfield, Gale. July/October 2007. “China’s Transition And Feminist Economics.” Feminist Economics 13(3-4): 1-33. 3.	Burda, Julien. July/October 2007. “Chinese Women After The Accession To The World Trade Organization: A Legal Perspective on Women’s Rights.” Feminist Economics 13(3-4): 259-285. 4.	Chen, Junjie and Summerfield, Gale. July/October 2007. “Gender And Rural Reforms In China: A Case Study Of Population Control And Land Rights Policies In Northern Liaoning.” Feminist Economics 13(3-4): 63-92. 5.	Liu, Jieyu. July/October 2007. “Gender Dynamics and Redundancy In Urban China.” Feminist Economics 13(3-4): 125-158. 6.	Bloom,Gerald, Lu, Yuelai, and Chen, Jiaying. 2003. “Financing Health Care in China’s Cities: Balancing Needs and Entitlements.” Social Policy Reform In China. Ch. 12: 155-168. 7.	Xin, Gu. 2010 vol. 20. Towards Central Planning or Regulated Marketization? China Debates on the Direction of New Healthcare Reforms.” China’s New Social Policy. Ch. 2: 23-39. 8.	Blomqvist, Ake and Jiwei, Qian. 2010 vol. 20. ”Direct Provider Subsidies vs Social Health Insurance: A Compromise Proposal.” China’s New Social Policy. Ch. 3: 41-71. 9.	Ngai, Pun. July/October 2007. “Gendering the Dormitory Labor System: Production, Reproduction, and Migrant Labor in South China.” Feminist Economics 13(3-4): 239-258. 10.	Ariana, Proochista, and Naveed, Arif. “Health.” Denewlin, Severine, and Shahan, L. 2009. An Introduction to the Human Development and Capability Approach: Freedom and Agency. Ch. 10: 228-245. 11.