Examining women's health in China

Women in China are now healthier than ever, but as the economy grows and China's culture becomes more westernized, the country faces new challenges due to changing social norms and expectations, say experts in a special collection of articles published by The BMJ .

In nine articles spanning topics and conditions across women's life courses, experts from China analyze the current state of women's health; review achievements and remaining challenges in the contexts of women's empowerment and rights, labor force participation, and family and community dynamics; and make recommendations for promoting women's future health, with a focus on sexual and reproductive health.

Such a focus is necessary because of the immediate context of falling fertility, explain BMJ editors Jin-Ling Tang and Jocalyn Clark in an editorial to launch the collection.

In 2022, the fertility rate in China dropped to 1.1% and for the first time in decades, became lower than the country's overall mortality. In the meantime, the percentage of people aged 65 years or older reached its highest level (14.9%), setting a new challenge for health systems and delivery in the country.

Against this background, an article by Wang and colleagues argues that if China is to return to population growth it needs to acknowledge the realities of parenthood, avoid any violation of women's reproductive autonomy (including lifting restrictions on egg freezing for non-medical reasons), and ensure the safety and health of mothers and their babies.

In another article, Zeng and colleagues argue that increased sexual activity, decreased fertility, and delayed parenthood all require more comprehensive and effective contraceptive services in China.

In addition to a focus on sexual and reproductive health and rights, other articles in the collection examine approaches to deal with the growing burdens of non-communicable disease in women, including screening for cervical cancer and depression after giving birth and strategies for reducing cardiovascular diseases and type B hepatitis infections.

Domestic violence is another serious concern for women in China, which was estimated to affect at least 25% of women in 2023. In their article, Liu and colleagues suggest that mental health workers may have an important role in breaking the silence and helping those affected.

"Promoting women's health in China, as elsewhere, demands that women's rights and status are not overlooked as broader social changes accelerate the wealth and development of a country as large and vital as China," write Tang and Clark.

They say efforts must ensure that girls and women have access to education and leadership opportunities, new digital technologies are harnessed to empower girls and women while safeguarding their well-being, and the impacts of growing challenges like climate change and migration are examined through a gender lens.

Existing inequities between rural and urban women, those in different cultural and ethnic groups, and those across regions and groups of different economic levels must also be addressed before they widen alongside the country's overall wealth and economic gains, they add.

Finally, they say they hope this work contributes to the conversations and analysis of gender equality in China and stimulates more discussion to ensure evidence-based interventions are developed and implemented fairly.