Many youths still ignorant about sexual health, He Na and Xie Chuanjiao report from Qingdao, Shandong province.

Failed contraception leads to having a baby: That's the gist of the young man's sign as university students promote spreading information about preventing pregnancy on World Contraceptive Day, Sept 26, in Qingdao, Shandong province. [Photo/ China Daily]

Matron Feng Shuang arrives every morning at the Qingdao You&Me Adolescent Health Service Center about 9, half an hour ahead of opening.

No one waits at the door while she unlocks it, but as soon as it opens three or four young women hurry in to the waiting room.

"Our center provides services for young people, and the majority of customers are here for induced abortion. They often wait in nearby shops for fear they'll be recognized," Feng said.

The center is operated by Marie Stopes International China, a nongovernmental organization that is one of the largest global providers of information on family planning and sexual health.

Oct 20 was an ordinary Thursday. Just after 9 am, four patients were already sitting on the green sofa. Two looked like schoolgirls, with satchels over their shoulders.

"When will the doctors come?" asked one in a white sports suit.

"Soon," Feng said with smile as she asked them to sign in. The register was just a few days old, but it was already half-full.

Xu Jin, director of the center, said the staff doesn't ask for identity certificates for the sake of patients' privacy. Most customers provide real information, she said, but some tell lies.

"We meet girls wearing thick makeup and claiming they're in their early 20s," she said, "but from experience we can easily tell they are much younger."

The center provided services to 46,283 people from 2003 through 2010. Seventy percent of them were 15 to 24 years old.

"More and more younger faces are coming for induced abortions than in the first several years. And the proportion of students and migrant workers is on the rise," Xu said.

More students

"The youngest girl I did an operation on was only 15. A middle school student only one year older than my son," said Wang Lingwei, one of three doctors at the center.

The girl was wearing school clothes that day and blood had stained her pants, Wang said. They helped clean her up and asked her to return the next day, on an empty stomach. She was about two months' pregnant.

"The girl said she got drunk in a bar during a friend's birthday party and did not know what happened. She didn't know who the father was," Wang said.

"She came early the next morning, with her mother following closely. The mom yelled and wanted to slap her. The girl kept silent, without uttering a word, until the operation was finished," Wang said.

"She's really a child," Wang said. "How does a small girl like her without any sexual knowledge become a mother?"

"Most people take for granted that premarital pregnancy students must be bad students, but our experience says no," Xu said. "Many of our student customers are from key middle schools and well-known universities.

"They can be called good students for performing well in their studies, but they really lack even basic sexual knowledge."

More migrants, too

The center induced more than 900 abortions last year, and it wasn't the first time for half the patients. Dr Wang said she has quite a few repeat customers.

One woman, who is 22, has had eight abortions in five years.

"Her uterus has been seriously damaged. If she continues to have the operation, she may easily lose the ability to be a mother in the future," Wang said.

"But the woman told me both she and her boyfriend are migrant workers from Henan province and work in a shoe factory. The money they earn can't make both ends meet every month, let alone raise a baby."

As Wang was talking, a young woman came out to the waiting room after her operation. The color drained from her face.

"It's my second time to have an induced abortion," she said. "The first was in August."

She said she is 23, from Baishan in Northeast China's Jilin province, and she sells men's clothing in a mall near the health center.

"There are quite a few customers like her," said Xu, the center's director. "These girls came from afar to Qingdao and are working as waitresses, sellers, workers, and some even as prostitutes in places of entertainment. This poorly educated group has poor access to sexual knowledge."

That knowledge should include the use of contraceptives. (Actually using them appropriately is a separate, often difficult issue.) Birth-control pills, the rhythm method and condoms are the primary methods used in China.

Pills can be highly effective; rhythm is not. Condoms aren't much more successful, but they offer protection from disease.

Coastal Qingdao is not unique in its premarital pregnancies and abortion rate. A road in Daxing district, Beijing, is called Abortion Street because of its numerous illegal clinics. Many factories are situated nearby, and most of the workers are young women.

"We often cooperate with some migrant workers at factories to provide free physical checkups and to popularize sexual knowledge, and we receive a warm welcome. We found that they really have no access to sexual knowledge," Xu said.

"We also selected some girls from each factory to be health ambassadors. We provide regular free training and hope they will influence the people around them."

Wang Yu is such an ambassador. "I was once a worker in a shoe factory," she said, "and I saw a roommate give birth in the dormitory. The girl never behaved like she was pregnant and we did not know she was pregnant until the baby was born.

"It sounded like she did not know, either. We were all shocked. We don't know what happened to her next, for she left the factory without telling anyone."

As an ambassador of the clinic, Wang has expanded her knowledge and often makes speeches to factory workers, which has developed her leadership skills. She has moved up from an ordinary worker to deputy director of a department.

An uneasy feeling

Dr Wang has worked at the center for five years and has performed more than 3,000 abortions. Eight a day, on average.

The first two weeks after summer and winter holidays are high-incidence periods, with 20 to 30 percent more abortions. Apparently, young people have more time to spend together and more opportunities for sex during the holidays.

If these young people received some sex education and took the right measures before and after sexual relations, the doctor said, maybe they would not suffer the operation and the harm it does to physical and mental health.

"I am used to the work rhythm here," Wang said, "but the increasing number of young people coming in for abortions and the younger faces really make me uneasy."