This chapter demonstrates the interplay between domestic and international ideas about birth control and abortion in Republican China (1912–1949). Eugenic discourses linking individual health to national strength and modernity gained currency in the early 1920s. Margaret Sanger’s visit to China in 1922 further fueled elite preoccupation with using contraception to improve the “quality” of the population, while reformers called for an end to social ills, such as abortion, child abandonment, and infanticide. Mirroring the blending of Chinese and foreign eugenic thought, the medical language used to describe birth control merged a primarily traditional Chinese medical discourse with Western and Japanese scientific terminology. Despite their prominence in intellectual circles, many of the high-level arguments for and against birth control had little direct impact on everyday reproductive practices.

Like their predecessors, Communist officials initially placed strict restrictions on birth control and abortion, encouraging high fertility rates. Focusing on the early years of the People’s Republic from 1949 until the Great Leap Forward, this chapter shows that even in this constrained environment, literature on sex and birth control continued to be published, promoting disparate narratives on sexuality and fostering diverse local contraceptive practices. The need to more fully mobilize women’s labor led to a gradual loosening of birth control limitations. Yet, the availability of information about sex, as well as access to birth control, abortions, and sterilizations, differed dramatically according to location, class, and education level.

During the Cultural Revolution (1966–1976) and the Sent-Down Youth Movement (1968–1980), the latter bringing millions of urban youth to the countryside, the city and the countryside converged in unprecedented ways. Focusing on the period from 1966 until the establishment of the One Child Policy in 1979, this chapter uses rare court records, medical guides, and memoirs to analyze the evolving tensions among national directives, local policy implementation, and grassroots sexual realities. Although the deployment of minimally trained “barefoot doctors” helped integrate state-led family planning into the rural healthcare system, local authorities used the court system to arbitrarily police abortions. By creating unprecedented opportunities for sex among unmarried youth with limited access to prophylactics, the state paved the way for the contemporary reliance on abortion as a primary tool for family planning.

The epilogue addresses the question of what can be ascertained from studying sex and reproduction in the longue durée. As demonstrated by the enduring reliance on abortion as birth control, family planning remains deeply gendered with women shouldering much of this burden. The persistence of eugenic ideas and the state’s intrusive but uneven policing of sexuality have been features of Chinese history since the early twentieth century. Despite ongoing changes in fertility policies, attitudes toward contraception and perceptions of what constitutes the ideal family remain diverse.

In the wake of the Great Leap Forward, the State Council ordered the establishment of community family planning programs. Taking up the call for “birth planning,” officials sought to weave birth control into the local cultural fabric through plays, exhibitions, and focus groups while countering the traditional preference for large families. Yet, resource shortages, contradictory messages from the state about the efficacy of traditional medicine, and individual distrust or dislike of birth control continually undermined efforts to more systematically monitor and control reproduction. In this context, contraceptive practices involved ongoing negotiation among diverse actors: provincial and local birth planning authorities, as well as individuals and their families.

Chapter 2 focuses on the praxis of birth control and abortion during the Republican era. Although sterilization and abortion were criminalized, contraception was neither explicitly endorsed nor banned. Yet, at times, local police cracked down on those who sold or consumed these products. In spite of the law, a wide range of contraceptive and abortive techniques were available to women in urban China. Grounded in folk practices, traditional Chinese healing, and Western medicine, abortion was the most prevalent form of fertility regulation that appeared in the historical record. Tiaojingyao – patent drugs and homemade herbal decoctions that blurred the line between abortifacients and emmenagogues designed to induce regular menses – were also particularly common, and by their nature, difficult to police.

Chapter 6 traces the One Child Policy’s lifespan from its introduction in 1979 until its replacement with the Two Child Policy in 2015. I show that the extent to which the One Child Policy was actually enforced and the ways in which it was received differed significantly in Shanghai, Tianjin, and Luoyang. For some couples, particularly those in more economically developed cities like Shanghai and Tianjin, the policy simply affirmed personal convictions that smaller families are more economical and allow children to have better educational opportunities. In smaller cities like Luoyang, however, policy violations were more common as family size – as well as the existence of a male heir – remained more important than the opportunities allocated to those children. This chapter also interrogates the renewed interest in eugenics among parents wishing to “optimize” the qualities of their one and only child, as well as the limited scale and scope of sex education, a trend that exacerbated the reliance on abortion as premarital birth control.

Li Xiaoping was a credit officer at a small bank branch and a married woman. One day in 1956, Chen Xu, the director of a nearby military camp, visited the bank. Soon after meeting, the two began having an affair. However, when Chen professed his love to Li and asked her to leave her husband for him, she refused. Not long after, Li realized she was pregnant and that Chen was the father. Knowing that adultery was punishable by law and an out-of-wedlock pregnancy provided the most indicting evidence of infidelity, Li decided to abort the fetus using a method she had heard about that involved consuming quinine tablets. Today quinine is used to treat malaria, but for much of the twentieth century taking an overdose to deliberately terminate a pregnancy was relatively common in China and other parts of the world.1 Though not technically banned at the national level, local authorities frequently charged and convicted people who underwent, performed, or facilitated home abortions.2 Knowing this, Li had to convince her doctor to prescribe quinine for another illness. In the end, she successfully aborted the pregnancy, and the affair was not discovered for another two years.3