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8
Adolescent Transitions to Adulthood in Reform-Era China

Emily Hannum and Jihong Liu




This chapter traces evidence about adolescents’ pathways into adulthood in China over the past two decades of market reforms, focusing on the realms of education, work, family, and health. We draw together information from policy documents, reports, secondary research, and aggregate and individual-level data from a variety of sources. Evidence shows that on average, the market reform period has benefited many aspects of adolescent and young adult life. Education has increased and adolescent labor has decreased in the reform period. The average age at marriage is high, and rose in the 1990s, enough that marriage is unlikely to compete directly with educational opportunities except at the highest levels of education. Low fertility rates suggest that women’s childrearing responsibilities may compete less with other opportunities in China than in many less developed countries.

The benefits of improved standards of living have been shared across social groups, but social and economic inequalities continue to mark the youth life course. While wealthier urban youth are beginning to experience problems with overnutrition, some rural youth still face nutritional deprivation. Suicide rates are dramatically higher among rural youth and young adults, especially young rural women. Wealthier adolescents and those in urban areas are more likely to be in school than their poor rural counterparts, and thus enjoy significant advantages in a labor market that increasingly rewards credentials. The mark of rural poverty is clear in the elevated likelihood of rural youth participating in the labor force, in the high percentage of working youth employed in agriculture, and in the large-scale youth and young adult migration into urban settings. Finally, social changes



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The Changing Transitions to Adulthood in Developing Countries: Selected Studies 8 Adolescent Transitions to Adulthood in Reform-Era China Emily Hannum and Jihong Liu This chapter traces evidence about adolescents’ pathways into adulthood in China over the past two decades of market reforms, focusing on the realms of education, work, family, and health. We draw together information from policy documents, reports, secondary research, and aggregate and individual-level data from a variety of sources. Evidence shows that on average, the market reform period has benefited many aspects of adolescent and young adult life. Education has increased and adolescent labor has decreased in the reform period. The average age at marriage is high, and rose in the 1990s, enough that marriage is unlikely to compete directly with educational opportunities except at the highest levels of education. Low fertility rates suggest that women’s childrearing responsibilities may compete less with other opportunities in China than in many less developed countries. The benefits of improved standards of living have been shared across social groups, but social and economic inequalities continue to mark the youth life course. While wealthier urban youth are beginning to experience problems with overnutrition, some rural youth still face nutritional deprivation. Suicide rates are dramatically higher among rural youth and young adults, especially young rural women. Wealthier adolescents and those in urban areas are more likely to be in school than their poor rural counterparts, and thus enjoy significant advantages in a labor market that increasingly rewards credentials. The mark of rural poverty is clear in the elevated likelihood of rural youth participating in the labor force, in the high percentage of working youth employed in agriculture, and in the large-scale youth and young adult migration into urban settings. Finally, social changes

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The Changing Transitions to Adulthood in Developing Countries: Selected Studies in the reform period raise important concerns about behavioral health issues, especially sexual health and smoking. THE CHANGING CONTEXT OF ADOLESCENCE IN CHINA The transition to markets in China in the late 1970s marked the beginning of a political focus on promoting economic modernization and growth. In rural areas, the transition meant decollectivization of agriculture and implementation of the household responsibility system, in which farmland and resources were contracted to individual households whose earnings were linked to output.1 In urban settings, the privatization of state-owned enterprises and the emergence of a labor market were important elements of growth-promoting reforms. Reforms brought unprecedented growth and poverty reduction, but also rising economic inequality and a deteriorating social safety net.2 Reforms in the education and health sectors decentralized administration and finance, increasing the diversity of services and the costs to individuals. Layoffs and unemployment heightened the economic insecurity of urban residents in the wake of labor reforms. Rural residents faced rising costs for education and health in the context of new pressures for self-sufficiency in agriculture. These changes have dramatically modified the context of adolescence over the past two decades. For many of China’s youth, the market reform period has improved living standards and increased life choices in education, work, and family formation. However, adolescents and young adults face new risks as a result of diversified choices, and disadvantaged groups continue to experience problems characteristic of youth in developing countries, such as difficulty obtaining access to basic nutrition, health, and education. The experiences of China’s youth are significant in the global context, as 18 percent of the world’s 15- to 24-year-old youth reside in China, as do 21 percent of the total youth population in developing countries (see Table 8-1). This chapter outlines major reform-era patterns and trends in adolescents’ pathways into adulthood, focusing on the realms of education, work, family, and health. The chapter is structured as follows: after briefly intro- 1   Experiments with such contracting began in 1978, and by 1983 nearly all of China’s farmers had adopted the responsibility system (Lin, 1988; Powell, 1992). 2   For example, World Bank estimates indicate that the number of people living in poverty declined from 398.3 million in 1985 to 269.3 million in 1995; the head-count index for the same period fell from 37.9 to 22.2 percent (World Bank, 1997). At the same time, recent household income surveys indicate that interprovincial income inequality increased markedly between 1988 and 1995; the urban-rural gap in income and living standards remains large, by some estimates wider than anywhere in the developing world (Carter, 1997; Khan and Riskin, 1998).

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The Changing Transitions to Adulthood in Developing Countries: Selected Studies TABLE 8-1 Population of 15- to 24-Year-Olds, 2002   Total World Total Percentage of: Less Developed Country Total World 1,112,549,895 — — More developed countries 164,122,595 15 — Less developed countries 948,427,300 85 — China 202,484,007 18 21 NOTE: Census Bureau definitions of “More Developed” and “Less Developed” are employed here. SOURCE: U.S. Bureau of the Census (2002). ducing data sources, we discuss educational policies and the changing educational opportunities available to adolescents. Next, we discuss youth employment and the changing economic backdrop in which employment occurs. We then provide an overview of family formation changes, considering marriage and childbearing. Finally, we consider persisting and new health issues facing adolescents. We close the chapter by synthesizing patterns and trends in each of these domains, placing them in the context of broader social changes in reform-era China. DATA SOURCES We draw on a variety of sources of information. To document policies, we employ reports and policy documents issued by Chinese government offices and a variety of secondary sources, including English- and Chinese-language analyses of economic and social policy problems in the reform era. To trace patterns and changes empirically, we draw on several sources of aggregate data, including census data from the National Statistical Bureau of China, demographic data from the U.S. Census Bureau International Data Base, education data from the United Nations Educational, Scientific, and Cultural Organization (UNESCO) Institute for Statistics, and education, marriage, and health data from the United Nations Millennium Indicators and the United Nations Common Database. To investigate attitudes about sexuality, we employ tabulated survey data from the 1997 National Reproductive Health Survey (Jiang, 2000). Finally, where possible, we complement aggregate data with our own tabulations of individual-level data on education, employment, and marriage from adolescent and young adult cohorts in the 1989 and 1997 waves of the China Health and Nutrition Survey (CHNS), a multipurpose panel survey conducted by the Chinese Academy of Preventive Medicine and the Institute of Nutrition

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The Changing Transitions to Adulthood in Developing Countries: Selected Studies and Food Hygiene, in collaboration with the Carolina Population Center at the University of North Carolina.3 EDUCATION For adolescents, some of the most fundamental shifts in the reform period have occurred in the realm of education. On the eve of market transition in the late 1970s, China’s education system was oriented around the political goal of eliminating class differences in society. With the transition to markets in the late 1970s and early 1980s, the focus shifted to economic modernization, and this new orientation was clearly reflected in educational reforms aimed at efficiently producing an appropriately skilled labor force.4 A complex hierarchy of programs varying in length, quality, curriculum, and financial base supplanted the egalitarian structure of the Cultural Revolution education system. Classrooms moved away from a focus on egalitarianism and class struggle, instead emphasizing quality, competition, individual talents, and the mastery of concepts and skills important in the development of science and technology (Broaded, 1983; Kwong, 1985; Lin, 1993). Vocational education was reinstated, with the intention of making education provide labor market skills and skills relevant to rural living circumstances (Tsang, 2000; UNESCO, 1998). Higher education, shut down completely for 6 years at the start of the Cultural Revolution, was reinvigorated due to recognition of its critical role in supplying the high-level personnel and scientific expertise needed for national development (Tsang, 2000). Most recently, attention has turned to molding the education system to better stimulate critical thinking and creativity perceived to be necessary for the new economy. Learner-centered teaching approaches and the so-called “quality education” (suzhi jiaoyu) reforms are intended to develop the abilities of the 3   The CHNS used a multistage, random cluster process to draw a sample from eight geographically diverse provinces, which differ by level of economic development, public resources, and |health indicators. The provinces covered were Liaoning, Jiangsu, Shandong, Henan, Hubei, Hunan, Guangxi, and Guizhou in 1989. Liaoning was replaced by Heilongjiang in 1997. Counties in each of these eight provinces were stratified by income level and randomly selected based on a weighted sampling scheme. In addition, the provincial capital and a lower income city were selected. Villages and townships within the counties and urban and suburban neighborhoods within the cities were selected randomly. Overall, the sample consisted of 32 urban neighborhoods, 30 suburban neighborhoods, 32 towns, and 96 villages. For more details, see http://www.cpc.unc.edu/projects/china/. In this study, we excluded Liaoning (in 1989) and Heilongjiang (in 1997) from the analysis. 4   Education laws continue to exhibit this orientation. The Education Law of 1995 and the Education Plan for the 21st Century of 1999 confirmed the priority placed on education as a strategic area for social and economic development (UNESCO, 1998; Ministry of Education, 1999).

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The Changing Transitions to Adulthood in Developing Countries: Selected Studies FIGURE 8-1 Mean years of schooling by birth year, 25- to 54-year-olds, China Health and Nutrition Survey, 1989 and 1997. whole child, and to stimulate critical learning (Tsang, 2000). Additional reforms designed to develop locally relevant curriculum are also under way. Educational opportunities have increased dramatically in the years since the establishment of the People’s Republic in 1949. Using data from the 1989 and 1997 China Health and Nutrition Surveys, Figure 8-1 shows mean years of education by birth year for men and women ages 25 to 54 in both years.5 The year that each cohort would have reached age 15 is also labeled on the graph. The figure shows dramatic increases in mean years of schooling for men and women reaching age 15 through the latter years of the Cultural Revolution in the mid- to late 1970s. For example, mean years of schooling for women rose from about 2 years for women age 15 in 1951 to more than 8 years for those age 15 in 1978. Cohorts coming of age in the early years of market transition experienced slight dropoffs in years of schooling. This downturn is not fully understood, but often attributed to some combination of push factors—shutdowns of low-quality rural junior high schools as part of the upgrading that occurred in the early reform years and rising educational costs—and pull factors—the new economic opportunities that followed agricultural decollectivization in the reform period (see Hannum, 1999a and 1999b, for discussion). Following the downturn in the early 1980s, the reform period has seen an expansion of educational access. Table 8-2 shows aggregate educational 5   Data points shown in Figures 8-1, 8-2, 8-4a, and 8-4b are based on 3-year moving averages.

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The Changing Transitions to Adulthood in Developing Countries: Selected Studies indicators that extend further into the reform period. Panel A shows gross enrollment ratios, or total enrollment in a level of education, regardless of age, expressed as a percentage of children in the officially-designated age range corresponding to that level of education in a given school year. At the primary level, gross enrollment ratios are over 100 throughout the reform period for girls and boys. At the secondary level, enrollment ratios were around 54 for boys and 37 for girls in 1980, around the time of the start of reforms. Consistent with Figure 8-1, ratios dropped through the mid-1980s. However, by the mid-1980s, the downturn ended. By 1997, enrollment ratios were 74 percent for boys and 66 percent for girls. Tertiary enrollment ratios have expanded since 1980, from 2.5 percent for boys and 0.8 percent for girls in 1980, to 7.3 percent for boys and 3.9 percent for girls in 1996. Although gross enrollment ratios are useful for temporal and gender comparisons, they do not have clear implications regarding levels of education, because of the lack of consistence of numerators and denominators.6 Other measures not plagued by this problem similarly show rising access to education for adolescents after the mid-1980s. From 1988 to 1995, primary to secondary transition ratios rose from 62 percent to 88 percent, with girls only about 3 to 4 percentage points behind boys (see Table 8-2, Panel B). In 1987, only 3 percent of male youth ages 15 to 24 were illiterate, compared to nearly 1 in 10 female youth. By 2001, only 0.8 percent of male youth and 3.3 percent of female youth remained illiterate (see Table 8-2, Panel C). Data from the China Health and Nutrition Survey also indicate improvements in the 1990s in adolescents’ access to schooling. Focusing on CHNS adolescents, among those who were 12 to 18 years old in 1989, 61.0 percent of males and 55.9 percent of females were enrolled in school (see Table 8-3). By 1997, the figures were 74.6 percent for males and 74.2 percent for females. Average years of school completed were also greater in the 1997 sample cohorts than in the 1989 sample cohorts (see Table 8-4). In 1989, mean years completed were 7.0 for boys and 6.8 for girls. By 1997, corresponding figures were 8.0 and 8.0. While the long-term trend has been expansion of access, certain concerns have arisen about social disparities in access, especially to a 6   Gross enrollment ratios often overestimate enrollment rates due to enrollments of children outside of official age ranges. They are also affected by repetition rates. They are commonly employed, however, because they are much more widely available than other, preferable measures such as net enrollment ratios. Net enrollment ratios, which have age-eligible children in both the numerators and denominators, are available for China only at the primary level, for the years 1988 to 1996. These ratios are above 90 percent throughout the period. A gender gap that favored boys by about 6 percentage points in 1988 diminished to zero by 1995 (see UNESCO, 2002).

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The Changing Transitions to Adulthood in Developing Countries: Selected Studies TABLE 8-2 Selected National Education Indicators, 1980-2001 Year A. Gross Enrollment Ratiosa B. Transition Ratiosa Primary Secondary Tertiary Primary-Secondary Male Fem. Male Fem. Male Fem. Tot. Male Fem. 1980 121.0 103.7 53.9 37.4 2.5 0.8 — — — 1981 122.5 102.4 46.7 31.7 2.7 0.9 — — — 1982 124.2 102.5 42.7 29.3 — — — — — 1983 125.6 103.9 41.9 29.1 2.7 1.0 — — — 1984 130.8 108.5 43.6 30.9 3.2 1.3 — — — 1985 132.0 113.9 46.3 32.6 3.9 1.7 — — — 1986 134.0 117.5 48.8 35.9 4.1 1.9 — — — 1987 134.0 118.9 51.3 37.9 4.0 2.0 — — — 1988 133.3 119.8 52.0 38.8 3.9 2.0 62.3 — — 1989 132.2 120.7 52.8 39.0 3.9 2.0 67.8 — — 1990 129.6 120.3 55.3 41.7 3.9 2.0 70.2 — — 1991 125.7 118.5 58.1 45.2 3.8 2.0 75.3 — — 1992 121.9 115.8 61.1 48.5 4.0 2.1 74.2 — — 1993 119.1 114.5 61.6 51.7 5.0 2.6 78.8 80.4 76.9 1994 118.3 115.2 65.2 56.4 — — 87.6 89.0 86.0 1995 118.3 116.6 69.5 61.8 — — 87.9 89.4 86.3 1996 120.0 119.6 72.5 65.1 7.3 3.9 — — — 1997 122.5 123.0 73.7 66.2 — — — — — 1998 — — — — — — — — — 1999 — — — — — — — — — 2000 — — — — — — — — — 2001 — — — — — — — — — aUNESCO, Institute of Statistics (2002). bUnited Nations Millennium Indicators (2002). cUNESCO, Institute of Statistics (2002). high-quality education. These concerns are in large part attributable to changes in education finance in the reform period. Major components of reform era education policy were the decentralization of the administration and finance of primary, secondary, and tertiary education and the privatization of costs (Lofstedt, 1990; Tsang, 2000). Currently, the central government runs and finances certain institutions of higher education; more typically, provincial, county, township, and village governments respectively take responsibility for schools at the tertiary, upper secondary, lower secondary, and primary levels (Tsang, 2000, p. 13). This finance structure has increased the regional disparities in funding

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The Changing Transitions to Adulthood in Developing Countries: Selected Studies C. Literacy Ratesb   D. Program Typec Ages 15-24 Secondary: % in: Tertiary: % in: Male Fem. Gen. Educ. Educ. Humanities Soc. Sci. Nat. Sci. Med. Sci. Other — — 97.0 29.3 5.7 3.7 48.2 12.3 0.8 — — 96.9 24.9 6.0 4.5 51.2 12.4 0.9 — — 96.3 24.6 5.8 6.1 48.5 14.2 0.8 — — 93.8 25.4 6.2 7.4 48.6 11.6 0.8 — — 92.5 25.1 7.0 8.8 48.0 10.3 0.8 — — 91.1 23.8 8.2 10.6 46.7 9.3 1.4 — — 90.4 24.4 7.7 11.2 46.8 9.2 0.7 97.0 90.2 89.9 24.7 6.7 11.2 47.3 9.4 0.7 97.2 90.8 88.8 24.6 6.4 12.0 46.9 9.4 0.7 97.3 91.3 87.9 24.6 6.1 12.4 46.5 9.7 0.7 97.4 91.9 87.5 24.3 5.8 12.6 46.8 9.9 0.7 97.6 92.4 87.2 24.5 5.6 12.5 46.8 10.0 0.6 97.8 92.9 86.6 24.2 5.7 13.1 46.6 9.8 0.6 98.0 93.4 85.3 22.8 7.5 25.1 36.9 7.1 0.6 98.2 94.0 84.5 16.4 6.4 9.4 53.2 8.9 5.6 98.4 94.5 84.2 — — — — — — 98.5 94.9 84.1 — — — — — — 98.7 95.3 83.7 — — — — — — 98.8 95.7 — — — — — — — 99.0 96.1 — — — — — — — 99.1 96.5 — — — — — — — 99.2 96.7 — — — — — — — for schools, and has increased family educational expenditures needed even for compulsory education.7 Government concerns about these problems are evident in equity-oriented policies instigated throughout the reform period. For example, although implementation was tied to regional economic development levels, the Law on Compulsory Education of 1986 designated 9 years of education—6 years of primary 7   In poor areas, the lack of government resources has strained the ability of local communities to finance high-quality public education. In general, the government budget finances only teachers’ wages. Other costs must be covered from local resources, including specially raised earmarked funds collected from households, collective contributions, school-generated revenues, or fees charged directly to students (Hannum and Park, 2002).

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The Changing Transitions to Adulthood in Developing Countries: Selected Studies TABLE 8-3 Enrollment Rates,a Youth Ages 12-18 Characteristic 1989 1997 N Male Female P-Value N Male Female P-Value Total 1,991 61.0 55.9 0.02 1,494 74.6 74.2 NS Age   12-13 522 93.1 92.7 NS 413 96.2 96.0 NS 14-15 582 77.4 68.9 0.02 442 85.9 83.5 NS 16-17 581 38.3 31.3 NS 407 64.7 58.9 NS 18 306 17.2 16.1 NS 232 33.9 42.9 NS P-value   0.00 0.00     0.00 0.00   Urban-rural residence   Urban 465 68.5 62.6 NS 406 84.1 82.8 NS Rural 1,525 58.7 53.9 NS 1,088 71.0 71.1 NS P-value   0.01 0.02     0.00 0.00 NS Household head’s education   None 374 51.1 43.6 NS 134 63.4 59.6 NS Primary 940 58.5 55.2 NS 511 70.6 68.2 NS Junior high 509 67.9 61.1 NS 544 75.8 78.4 NS Senior high+ 160 74.7 75.4 NS 285 88.7 83.3 NS P-value   0.00 0.00     0.00 0.00   Number of consumer items ownedb   Missing 54 83.3 58.3 0.04 40 88.0 80.0 NS Lowest quartile 409 54.4 49.7 NS 338 69.1 60.5 NS 2nd quartile 665 56.7 50.2 NS 480 70.6 69.4 NS 3rd quartile 588 64.8 60.6 NS 281 74.8 81.5 NS Highest quartile 275 70.3 67.2 NS 355 83.3 87.2 NS P-value   0.00 0.00     0.01 0.00  

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The Changing Transitions to Adulthood in Developing Countries: Selected Studies School-age children in householdc   One 361 44.4 48.7 NS 468 71.4 74.5 NS Two 795 65.0 54.9 0.004 654 76.0 74.2 NS Three or more 835 65.5 59.3 NS 372 77.1 73.9 NS P-value   0.00 NS     NS NS   Province   Jiangsu 205 62.8 61.3 NS 145 75.0 81.5 NS Shandong 218 63.1 51.3 NS 185 81.4 68.2 0.04 Henan 321 58.7 45.6 0.02 202 67.6 77.3 NS Hubei 249 67.7 52.8 0.02 231 71.8 72.9 NS Hunan 249 62.9 66.7 NS 232 77.9 75.2 NS Guangxi 310 55.9 55.0 NS 264 75.7 74.2 NS Guizhou 438 59.8 59.8 NS 235 73.2 72.2 NS P-value   NS 0.01     NS NS   Relationship to household head   Own child 1,858 60.9 55.7 0.02 1,382 73.7 73.8 NS Otherd 133 62.9 59.2 NS 106 86.4 80.9 NS P-value   NS NS     0.03 NS   aCalculations were based on the question, “Are you currently in school?” bBoth the 1989 and 1997 surveys asked, “Does your household or do any household members own the following electrical appliances or other goods?” To reflect economic changes over time in China, several new items were added in the 1997 survey. Regardless of small differences in the lists of consumer items in the two waves, we summed up the ownership of all items for each household, then grouped all households into quartiles. cThis refers to the number of children who are under 18 years old at survey date in each household. dOthers include grandchildren, siblings, other relatives, and other nonrelatives (one “spouse” was included in 1989). NOTE: NS: P-values are not significant at 0.05 level. P-values are results from chi-squared tests of independence. P-values listed to the right of enrollment rates result from tests of gender by enrollment (within categories of the listed characteristic, if applicable). P-values listed below enrollment rates are within-gender chi-square tests of enrollment by the listed characteristic. SOURCE: China Health and Nutrition Survey.

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The Changing Transitions to Adulthood in Developing Countries: Selected Studies TABLE 8-4 Average Years of School Completed,a Youth Ages 12-18 Characteristic 1989 1997 Male Female Male Female Mean SD Mean SD P-Value Mean SD Mean SD P-Value Total 7.0 2.2 6.8 2.6 0.01 8.0 2.2 8.0 2.2 NS Age   12-13 5.4 1.6 5.6 1.7 NS 6.2 1.4 6.3 1.4 NS 14-15 7.1 1.7 6.6 2.5 0.01 8.1 1.4 7.9 1.7 NS 16-17 7.9 2.2 7.6 2.5 NS 9.1 1.9 9.0 1.9 NS 18 7.9 2.5 7.4 3.2 NS 9.3 2.7 9.4 2.4 NS P-value   0.00   0.00     0.00   0.00   Urban-rural residence   Urban 7.9 2.1 8.2 2.1 NS 8.4 2.3 8.7 2.2 NS Rural 6.7 2.1 6.3 2.5 0.00 7.9 2.2 7.8 2.1 NS P-value   0.00   0.00     0.00   0.00   Household head’s education   None 6.5 2.4 6.2 2.9 NS 7.6 2.7 7.2 2.5 NS Primary 6.8 2.1 6.6 2.4 NS 8.0 2.1 7.8 2.2 NS Junior high 7.3 2.0 6.9 2.5 NS 8.0 2.2 8.2 2.0 NS Senior high+ 8.3 2.1 8.2 2.3 NS 8.3 2.1 8.5 2.1 NS P-value   0.00   0.00     NS   0.00   Number of consumer items owned   Missing 6.8 2.3 6.4 2.2 NS 7.2 2.2 8.7 3.3 NS Lowest quartile 6.2 2.2 5.2 2.7 0.00 7.4 2.3 6.9 2.1 NS 2nd quartile 6.8 2.0 6.3 2.5 0.00 7.9 2.1 7.8 2.0 NS 3rd quartile 7.5 2.0 7.5 2.2 NS 8.3 2.0 8.5 2.0 NS Highest quartile 8.2 2.1 8.3 2.0 NS 8.7 2.3 8.9 1.9 NS P-value   0.00   0.00     0.00   0.00  

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The Changing Transitions to Adulthood in Developing Countries: Selected Studies reproductive health issues are recognized as being an important element in the mid- to long-term plan for AIDS control in China (Zhang, 2003). The challenges are exacerbated by ever-increasing numbers of unattached youth and young adults migrating to cities for work; these youth often remain excluded from urban welfare services, such as reproductive health services. A fourth public health problem facing adolescents and young adults that has gained considerable public attention in recent years is suicide. Table 8-11 shows two recently published estimates of adolescent and young-adult suicide rates.30 Panel A shows national urban and rural estimates of suicide rates and the percentage of all deaths from suicide for women and men, for ages 15 to 34 and for all ages. These estimates show that, overall, suicide rates among rural residents were much higher than those of urban residents—about three times as high. Women’s rates were higher than men’s, but the disadvantage faced by women was concentrated in rural areas. Furthermore, among rural populations, the excess suicide among women is larger among the young population than among the whole population. For rural women ages 15 to 34, fully 31 percent of all deaths were attributable to suicide. The rate of suicide for rural women in this age group, at 37.8 per 100,000, was 1.7 times the rate of rural men, 3.5 times the rate of urban women, and 4 times the rate of urban men. The 2001 World Health Report lists suicide as the leading cause of death in 1998 among rural women ages 15 to 34 in China (World Health Organization, 2001, Figure 2.5). Data from 1988, 1990, and 1992 (Panel B) suggest that the peak of rural young women’s suicide rates occurs in the 20- to 24-year-old age range. The most common technique is pesticide ingestion, which accounts for 34.3 to 66.6 percent of all suicides (Ji et al., 2001, pp. 3, 4; Phillips, Li, and Zhang, 2002). Ji and colleagues (2001) observe that this technique is extremely effective because rural health care systems are not equipped to handle pesticide poisoning. The ready availability of pesticides, and the inability of health systems to counteract their effects, may play a role in the excess suicide mortality for young women.31 Contradictory evidence exists about the degree to which depression is a significant risk factor for suicide. 30   Phillips, Li, and Zhang’s (2002) estimates (Panel A) are based on mortality data for 1995-1999 provided by the Chinese Ministry of Health, adjusted according to estimates of unreported deaths, and projected to the corresponding population (pp. 835-836). The authors describe the estimates as “conservative.” Ji’s (1999) estimates (Panel B) were calculated from unpublished Chinese Ministry of Public Health data. These data were collected from each county of China, and therefore represent a national sample. Further details were unavailable (p. 1). There are a number of estimates using data from other sources showing variation in the overall level of suicide prevalence. However, patterns of high rural-urban ratios of suicide and high female-male ratios among rural populations emerge across different studies (see, e.g., Ji, Kleinman, and Becker, 2001; Yip, Callanan, and Yuen, 2000). 31   Ji and colleagues (2001) point out that as many as 80 percent of female suicide attempts among Western women are unsuccessful attempts.

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The Changing Transitions to Adulthood in Developing Countries: Selected Studies TABLE 8-11 Select Published Estimates of Suicide Rates in China for the 1980s and 1990s Panel A: Mean Annual Rates of Suicide (1/100,000) and Percentage of All Deaths Due to Suicide, 1995-1999 Age 15-34 All Ages Population Group Suicide Rate % of all Deaths Due to Suicide Suicide Rate % of all Deaths Due to Suicide Rural 30.3 20.4 27.1 4.0 Urban 10.2 10.3 8.3 1.5 Women 32.1 29.0 25.9 4.4 Men 20.0 12.1 20.7 2.9 Rural women 37.8 31.0 30.5 4.9 Rural men 22.8 13.1 23.9 3.3 Urban women 10.8 15.8 8.3 1.7 Urban men 9.5 7.4 8.3 1.3 Panel B: Rural Suicide Rates in 1988, 1990, and 1992 (1/100,000) Age 15-19 20-24 25-29 30-34 Population Group   Women   1988 31.7 67.1 34.6 28.3 1990 23.3 47.6 37.3 25.9 1992 18.2 46.3 38.6 27.9 Men   1988 14.1 38.2 23.6 22.8 1990 10.4 22.5 20.3 17.1 1992 9.8 28.4 23.0 19.8 SOURCES: Panel A: Section reproduced from Phillips, Li, and Zhang (2002a, Table 1). Panel B: Section reproduced from Ji (1999, Table 2). Ji and colleagues’ (2001) review suggests that serious depression is not a primary precipitant of suicide, while Phillips and colleagues’ (2002b) national case-control study indicates that a high depression symptom score did significantly raise the risk of suicide. However, scholars agree that social stressors significantly raise the risk of suicide (Ji et al., 2001; Phillips et al., 2002b). Research on call-ins to mental health hotlines suggests that significant stressors, especially for women, include marital problems, pressures of extramarital or premarital affairs, family pressures, and education and employment pressures (Ji, 1999; Ji et al., 2001).

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The Changing Transitions to Adulthood in Developing Countries: Selected Studies Trend data remain sketchy, but certain evidence suggests a decline in suicide rates. Ji’s estimates for rural residents in the late 1980s and early 1990s (Tabel 8-11, Panel B) suggest that suicide rates are declining across time, as 1992 figures were somewhat lower for most age cohorts than 1988 figures. Consistent with this result, a World Health Organization report (2001, Figure 2.4) indicates that age-standardized suicide rates in China dropped by 17.2 percent in the most recent three years for which data were available. However, Phillips, Li, and Zhang (2002a) indicate that an earlier study using comparable Ministry of Health mortality data from 1987 suggests that both the level and the age pattern of suicide were stable, compared with their own results for 1995 to 1999. Regardless of the trend, the scope of suicide in recent years has brought recognition of suicide as a major public health problem. The Ministry of Health, in collaboration with the World Health Organization, held a workshop on suicide prevention in March 2000 that took the first steps toward developing a national suicide prevention program (Phillips, Li, and Zhang, 2002a). Some of the health problems described here—overnutrition, sexual health, and to some degree, smoking—are problems enabled by the rising wealth in China. Other problems, including persisting undernutrition faced by children and youth in poor rural areas and the high suicide rates of young people in these areas, especially women, reflect older issues such as poverty and the social pressures facing young women. SUMMARY The evidence presented here indicates that changes were taking place in the 1990s. Most significantly, youth were delaying transitions into adulthood across major domains of the life course. Figures 8-4a and 8-4b illustrate this point, combining rates of nonenrollment, employment, and marriage by age for females (8-4a) and males (8-4b) ages 11 to 29 in the 1989 and 1997 CHNS samples. These figures illustrate that cohorts coming of age in the latter year transitioned more slowly out of education, into work, and into marriage. Consistent with this story, fertility data also suggest a shift to later childbearing. These shifts can be characterized as favorable, from the perspectives of improving the educational composition of the population, reducing child labor, and promoting slower population growth. However, improved standards of living and norms of social openness associated with market reforms have raised the significance of behavioral health issues, such as smoking and premarital sexual activity. Furthermore, while available evidence suggests that many favorable changes have been shared across social groups, some noteworthy social and economic inequalities continued to mark adolescents’ lives. For example, youth in ur-

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The Changing Transitions to Adulthood in Developing Countries: Selected Studies FIGURE 8-4a Nonenrollment, employment, and marriage, Chinese Health and Nutrition Survey, females, 1989 and 1997. FIGURE 8-4b Nonenrollment, employment, and marriage, Chinese Health and Nutrition Survey, males, 1989 and 1997.

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The Changing Transitions to Adulthood in Developing Countries: Selected Studies ban areas remained more likely to be in school, and thus to enjoy the benefits of education in a labor market that increasingly rewards credentials. The mirror image of this phenomenon is reflected in the elevated likelihood of rural youth to be in the labor force, in the high percentage of working youth employed in agricultural pursuits, and in the rise in youth migration into urban settings. Similar signs of disparity mark education and employment status along socioeconomic lines. Urban-rural and socioeconomic splits are also glaringly evident in the health problems facing China’s adolescents, with youth in some poor rural areas continuing to face basic health problems such as lack of adequate nutrition, while wealthier urban youth are beginning to face health problems associated with youth culture in more affluent settings. The lines of inequality are nowhere more painfully clear than in suicide rates, which are three times higher in the rural youth population, probably reflecting a combination of the poverty-related stressors that poor rural adolescents must cope with on a daily basis and their easy access to potent poisons. For reasons that remain murky, the toll is highest for young rural women. DISCUSSION AND CONCLUSIONS China’s socialist past was characterized by an unusually high degree of policy involvement, using means that were sometimes harsh, to achieve state goals regarding education, job placement, marriage, fertility, and women’s roles. China’s more recent experience of rapid economic development has built on some of the hard-won achievements of these earlier policies to yield many patterns of adolescent transition that are favorable. Youth stay in school longer, and start work later, as time passes. The average age at marriage is high enough that marriage is unlikely to compete directly with educational opportunities, except at the highest levels of education. Low fertility rates, especially at young ages, suggest that women’s childrearing responsibilities compete less with other opportunities than in many less developed countries. Strikingly, in the 1990s, many of these favorable patterns were markedly enhanced. Yet, the institutional legacies of socialism are not always suited to addressing the current problems of adolescents. For example, the traditional system of family planning, oriented toward strict regulation of marital fertility, is working to offer a more service-oriented approach, and to address issues of nonmarital sexual activity among increasingly mobile youth. Nor are the implications of market reforms exclusively favorable. Wealth and the opening of society have led to new concerns about adolescent welfare. Improved standards of living and norms of social openness associated with market reforms have raised the significance of overnutri-

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The Changing Transitions to Adulthood in Developing Countries: Selected Studies tion, sexual health, and to some degree, smoking as adolescent and young adult health problems. Among the new problems facing youth, AIDS has the potential to become a staggering social problem if not successfully addressed in a timely manner. In the area of work, adolescents enjoy much greater chances of achieving high incomes than in the past, but they also face a harshly competitive environment in which the rewards associated with work are more narrowly economic and the tenure of any job obtained is less secure. Further complicating the picture is evidence that, while opportunities have improved across social groups, socioeconomically disadvantaged youth face disproportionate barriers to successful transitions into adulthood.32 In short, successes in improving the lives of many adolescents have brought new challenges, as China’s youth policy makers now serve populations that face increasingly divergent problems. Decision makers in education, labor, family planning, and health now need to adapt services to the needs of urban adolescents and impoverished young rural-urban migrants, while dealing effectively with the older problems facing the rural poor. Their degree of success in this endeavor will bear crucial ramifications for the future welfare of China’s youth and adult populations. REFERENCES Adams, J., and Hannum, E. (2005, March). Trends in children’s social welfare in China: Access to health insurance and education. China Quarterly, 181, 100-121. Arnold, F., and Liu, Z. (1986). Sex preference, fertility, and family planning in China. Population and Development Review, 12(2), 221-246. Banister, J. (1987). China’s changing population. Stanford, CA: Stanford University Press. Bian, Y. (2002). Chinese social stratification and social mobility. Annual Review of Sociology, 28, 91-116. Bloom, G., and Gu, X.Y. (1997). Introduction to health-sector reform in China. IDS Bulletin, 28(1), 1-23. Broaded, M.C. (1983). Higher education policy changes and stratification in China. China Quarterly, 93, 125-141. Brown, D. (2002, July 9). Survey finds China’s AIDS awareness is lacking. Medicine scarce in India, conference is also told. Available: http://www.thebody.com/cdc/news_updates_archive/july11_02/china_aids.html [accessed October 21, 2003]. Carter, C.A. (1997). The urban-rural income gap in China: Implications for global food markets. American Journal of Agricultural Economics, 79, 1410-1418. 32   We note that our indicators may not fully represent the scope of disparities present in important dimensions of education and health care quality. The system of education is absorbing increasing proportions of children and youth, but it is also becoming increasingly stratified in quality as a direct result of economic and education policy shifts in the reform period. Similarly, the public health system is struggling to address persisting and new health problems of adolescents in a context where access to care is much more dependent on ability to pay than in the past.

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