Three steps away from government
Founded in early 1980, when China's strict birth control policies were beginning in earnest, and largely funded by government ever since, the China Family Planning Association (CFPA) appears at first sight to be no more than a 'non-government' instrument to further state policies and objectives. Indeed, the Association affirms that its first goal is 'to complement the government in implementing state family planning policies, laws, regulations and programmes', and its cadres list 'demographic education' among its activities in rural areas - propagandising the message that China needs fewer children, and that fewer children mean greater family prosperity.
Yet this organisation, which claims to have branches in 70% of China's villages and no less than 83 million members, also states that it is firmly opposed to any form of coercion in family planning, and has earned international regard for its role in improving reproductive health services, and demanding greater accountability of government officials.
Liu Liqing, Deputy Director of the Public Affairs Department, feels that non-government status makes it easier for the Association to work with groups that are not reached by the State Family Planning Commission hierarchy. For example, state family planning services remain geared almost exclusively to married couples, although experimental or casual sexual relationships are becoming more common, especially among young people in urban areas, and some people now choose to live together without marrying. The Association believes that in some cities by the late 1990s more than half of induced abortions were performed on unmarried women. The CFPA has therefore ventured into adolescent reproductive health services, providing information and counselling and selling contraceptives in a number of major cities.
The Association is now starting work with Marie Stopes International on a UNFPA funded information and outreach project in several universities in Beijing, and middle and vocational schools in Shanghai's Minghan district. As part of the Beijing project, condom vending machines have been installed in Haidian district, where most of the city's colleges are concentrated. The Association is also developing a joint project with the Seattle based NGO, PATH (Program for Appropriate Technology in Health), aimed at young people in ten Chinese cities. PATH has several years experience of working in China as an implementing agency of previous UNFPA funded projects.
Women migrants, whether married or not, generally lack access to reproductive health services, and this is an area that some city Family Planning Associations have begun to address with specific programmes. (The national Association is very decentralised: local groups are largely responsible for raising their own funds and deciding their own programmes). Urban centres run by local Associations in sixteen cities meanwhile offer to all comers a wide range of services including reproductive health care classes, physical checks and screening, sale of (both Western and Chinese) medicines to treat reproductive tract infections, and sale of contraceptives (including 'morning after' pills).
Liu Liqing stresses that as well as being open to unmarried people and migrants, these centres aim to offer 'comprehensive' services of high standards, meeting the client's right to make informed choices and receive quality care. As such, the centres have been important laboratories for testing the 'client centred' approaches that the State Family Planning Commission is apparently now inclined to endorse and adopt.
At the same time, and largely shaping the growth of these services, the Association has for several years pursued what it calls 'democratic participation and supervision' (minzhu canjia minzhu jiandu). This phrase describes a cluster of advocacy activities that 'started informally during the late 1980s as some grassroots FPAs grappled with their constituents' practical problems and began forwarding public demands to local governments.' (1997 Annual Report, page 14.)
On the 'democratic participation' side, local FPAs have, through surveys, discussion groups and telephone hotlines, actively sought and documented public views on state family planning services, and passed these on to government. In a parallel process, the Association has translated, published, discussed and distributed seminal, international documents on reproductive rights and health; and it has also drawn up its own guidelines, in the form Provisional Regulations Governing the Democratic Participation and Supervision of Family Planning Associations.
On the 'supervision' side, the Association has encouraged local groups to act as watchdogs of family planning officials, setting up suggestion boxes and complaint lines where people can report cases of clinical malpractice, or abuse of power. A 1996 report commissioned by the British government commended the Association's contribution to 'rooting out corrupt or unfair officials, and representing grass-roots views in both family planning and development.'
This work has been supported by the International Planned Parenthood Federation (IPPF), of which CPFA is a full member. IPPF has been a major funder of the national Association, providing grant aid that rose to USD 1 million in 1996. This has since been gradually reduced, to USD 500,000 this year, roughly matching the central government contribution. Another longstanding international partner has been the Ford Foundation, which supported the establishment of counselling and service centres, advocacy and improved outreach activities in reproductive health and HIV/AIDS. The California based Public Media Center has also provided assistance for publications and 'information, education and communication' materials.
Because of the decentralised nature of the Association, local activities vary considerably, ranging from re-employment projects for laid off women, to establishing early childhood development classes.
In rural areas, village level family planning associations operate more like clubs or discussion groups, although in some townships free services and contraceptives are available. But a major thrust of work in rural areas has been income generation and training for women through a 'Happiness Project' undertaken in collaboration with the China Population Welfare Foundation(CPWF).
This was registered in 1987 and, according to Secretary General, Miao Xia, initially its main activity was awarding 'Population Prizes' to individuals who had done outstanding work in the field of 'population welfare'.
The joint Happiness Project was launched in 1995 and has so far raised more than CNY 100 million (USD 12 million) in donations from individuals, enterprises and schools. This has funded over 300 local programmes (in 27 provinces) that combine skills training, reproductive health education and microfinance schemes. Loans ranging from CNY 1,000 to CNY 3,000 (USD 120 to USD 360) have been made to more than 65,000 women, at a 3% rate of interest. According to Miao Xia, average repayment rates are 70% - 80%, and have been as high as 90% in some project areas.
Projects are implemented mainly by local volunteers, with management support from family planning associations. CPWF has only a small national staff, and the organisation's main contribution to Happiness Project has been in fundraising. It is, however, now embarking on a 'Grass Roots Project' to provide information and consulting services to farmers through a county level computer network.
The Foundation is also beginning to work in two new areas of 'population welfare,' at opposite ends of the human age range. It is building a retirement home, and hoping to develop other projects to support older people; and it is collaborating with the Half the Sky Foundation, established in the United States by parents who have adopted Chinese children, to improve conditions for early childhood development in a number of orphanages. As part of a 'grandma programme,' CPWF has helped orphanages to identify volunteers who can spend time playing with and stimulating the young children, and the two Foundations are now looking into the possibility of pre-school teacher training programmes for care staff.
Further from government, and more focused on the (albeit broadly construed) field of reproductive health, is the Yunnan Reproductive Health Research Association. Attached to Kunming Medical College, this is not just a research group, as it also engages in advocacy based on experience gained both in field research and in pilot project management.
From its founding in 1994, the group has adopted a multi-sectoral and interdisciplinary approach to reproductive health, welcoming social scientists into terrain which, in China, has been dominated by medics on the one side and family planners on the other. According to Director, Zhang Kaining, it took a long time and a great deal of debate for the group's founding members to achieve a shared conceptual framework for analysing and understanding reproductive health issues, but this process was itself greatly enriching.
In fieldwork, as well as traditional survey research the group has used and adapted techniques such as participatory rural appraisal, asking women to identify and articulate their own concerns, health problems and needs. Although simple, such an approach is still quite radical in China, where useful knowledge is generally felt to reside only with experts and officials.
Reproductive tract infections have been one focus of the group's research and intervention efforts. As well as playing a leading role in several studies of RTIs, the group has developed and piloted health education materials which rural women themselves helped to design.
In Shuangbai county, where it was involved in training courses for women doctors, the Association promoted the practice of combining in one individual the roles of village level family planning worker, maternal and child health worker and Women's Federation representative. Detailed prior research had suggested that this was the most effective and practical way of achieving a more unified approach to reproductive health.
In Luoping County, the group is working with the local Women's Federation on a project which combines a women's microfinance scheme with health care and education activities.
In addition the Association has published several books drawing together Chinese experiences in reproductive health, and has translated selected international literature and distributed this widely within China.