Sexual Health and Gender Equity Reform in Taiwan
By Tzu-Ying Lii
Many Asian societies have become known for a notorious unwillingness to discuss sexual health, sexual education or gender equity in public. This has led to increasing personal and public health problems for many Asian and Asian-American people, including higher rates of abortion and elevated risk of cancer due to lack of early diagnosis, and conflicts with Western styles of medical treatment. However, a case study of Taiwan’s recent gender equity and sexual health education reforms reveals that conservative, traditional Asian societies may still be open to policy change that is influenced through such channels as Western media and increased Western immigration. It is likely that Taiwanese public policies have shifted toward liberalization due to growing interconnectivity with the Western world, providing a useful model for other Asian societies and for Western doctors through which to provide culturally-sensitive medicine.
Cultural conservatism surrounding and preventing effective sexual education in Taiwan is not a new issue. As a public health matter, sexual education and gender equity are crucial components of healthy populations, having been credited with decreasing sexually-transmitted disease infection rates, lowering pregnancy and abortion rates and improving chances of cervical and breast cancer survival by encouraging and allowing for early diagnosis. Sexual health has been an issue since the 1900s in the West and has surfaced periodically in the East (including Taiwan and other nations) as well. Studies in Taiwan dating as far back as 1986 report general concern among Taiwanese adolescents and teenagers on the lack of useful, relevant education regarding sexuality and sexual health, 1 and the rate of teenage pregnancy in Taiwan is the single highest in Asia. 2 However, until recently, the Taiwanese government and educational system had done little to rectify the situation.
But, since the beginning of the 21st century, drastic changes in overall gender politics and sexual education regulations have been suggested and implemented at an unusually high rate compared to past Taiwanese history. Alongside gender equity laws, the development of new, more relevant sexual education programs for students is fast emerging as a major, contentious issue in Taiwan. With the implementation of mandatory sex education programs in schools and the development of national sex education textbooks, sexual health and gender equity has become a national hot topic. This suggests a significant turning point in the public health history of Taiwan in which the once-glacial pace of gender and sexual health reform has suddenly increased at an exponential rate. What caused this recent liberal development in a society widely known to be conservative? Investigation of the current primary sources that are tracking this new and very contemporary issue reveals that it has been impacted by many of the same trends that are affecting other countries around the world: those of increased exposure to the media, Westernization, and immigration. Not only have these been the major sources of influence, but they are all traceable to the 1980s, when Taiwan began to liberalize – not only lifting martial law in 1987, but also loosening immigration laws and strengthening diplomatic international relations. These socio-political forces, building up power gradually, have initiated the beginnings of a powerful reform movement in the public health policies of Taiwan.
Tradition in Chinese Culture
The seeds of this development are discernible in the overarching historiography of the issue when read closely for overall trends. Three decades and a generation ago, historians focused mainly on Chinese 3 and other Asian-American sex education and sexual health statuses as an area of worry, problematized by historical immigration patterns and conservative cultural values. As Charlotte Furth observed in a series of oral histories obtained in 1986, ancient Chinese texts and practices encouraged Taiwanese women to be modest, self-sacrificing and unwilling to speak of “indecent” subjects, including their own sexual health.4 As longstanding, unchallenged cultural values, they exhibit themselves even today in Asian women’s reluctance to discuss private health or undergo sexual health exams for the embarrassing fear of being seen as immodest and loose. 5 These values have been blamed for putting Asian and Asian-American women at higher risk for undiagnosed cervical and breast cancer, and indeed for complications of undiagnosed sexually-related diseases in general. 6
These cultural traditions were maintained through the result of historically giant waves of immigration that resulted in particular social conditions. Bertha Mo’s 1992 article “Modesty, Sexuality, and Breast Health in Chinese-American Women” made specific note of the tight-knit Chinese communities, known as Chinatowns, formed by Chinese immigrants to the United States, which gave them the opportunity to keep their cultural values extant and untainted by Western ideas. 5 This assertion is further supported by Dr. Linda Tom’s analysis of Chinatowns as “cultural enclaves,” in which it would have been quite possible for new immigrants to retain all their old customs, visit their own doctors and maintain their own beliefs. 7 Not only did these patterns of immigration apply to Chinese, but to other Asian groups as well, as written by Barbara Yee: as a result of massive waves of immigration from Vietnam, Laos and Cambodia in the 1970s, certain “geographic locations… became magnets for Southeast Asian refugees” because of pre-established social infrastructure such as family relatives, Asian supermarkets and the availability of work to non-English speakers. 8 Such conditions gave Asian immigrants, and especially Chinese immigrants, the opportunity to keep alive their own cultural values.
But in viewing the larger historiographical trends on the topic, one major pattern appears: that of the move toward liberalism. Thirty to forty years ago, when studies of Chinese and Asian sexual education and sexual health first began to appear, the rendered focus was on problematic cultural values and histories, as just described. However, gradually, historians have come to focus two very important changes: not only the younger, newer generation that has appeared in the last two decades, but on a growing impetus for reform and social, grassroots-oriented restructuring. Where once the steady conservatism of Chinese and other Asian-American populations was in the spotlight, it is now the younger and more liberal populations that have taken center stage. Additionally, this generation is not content to maintain the status quo, but has decided to call for social change, achieving at least a notable degree of success. The study of this development in public health has important implications, answering questions such as, how can cultural obstacles be overcome in providing public health and medical treatment? How can cultural sensitivity be maintained while these obstacles are being overcome? And what are the most effective ways of overcoming these obstacles?
Setting Itself Apart
Because the United States is a country of immigrants, the answers to these questions have significant value for public health and medical professionals. While many immigrant groups have been absorbed into mainstream practices of health and medicine, Chinese and Asian-American groups continue to present somewhat of an issue in terms of adequate sexual health, screenings and comprehensive sexual education, despite the appearance of a newer, reform-oriented generation. After all, centuries of conservative culture are not so easy to wash away. Thus, it is obvious why the case of Taiwanese public health and sexual education reform is so intriguing: why and how, in a traditional state still governed by a huge bureaucracy of conservative Asians, has reform come about? This paper seeks to answer that question by addressing the impact of Taiwan’s political leanings toward America and the West, the influx of foreign media and of immigration.
Public health and sexual education reforms in Taiwan are especially interesting because they are tied directly to Western and American public health infrastructure. In Taiwan’s growing bid for independence and to cut historical and political ties with Mainland China, it has sought to redefine its politics and educational system apart from China, basing its policies on Western strategies. In a report entitled “NationBuilding and Curriculum Reform in Hong Kong and Taiwan,” researchers Christopher Hughes and Robert Stone from the London School of Economics remarked that there is a very close relationship between educational policies and national image. Prior to the 1980s, before the major split in Sino-Formosan relations, Taiwan had focused on pro-Chinese “morality, culture [and] national consciousness.” However, the establishment of the pro-independence Democratic Progression Party and increasing pro-independence social agitation in the late 1980s forced a great degree of change in Taiwanese educational attitudes, which began progressively to move away from ties to China and toward Western practices. 9 The nine years of education required by the Ministry of Education for each Taiwanese child provides a great length of time in which to shape his or her beliefs. Therefore, the gradual liberalization of Taiwanese curriculum to include sex and gender education is highly revealing of general trends in Taiwanese society and legislature, evincing the information that is deemed “important to society” at any point in time.
Ties to Western Ideology
More and more, such important information has come to be based on American and Western ideology as Taiwan becomes a part of the world economy. The Ministry of Education’s website publishes a set of guidelines each year for its administrative goals, and recent guidelines prove extremely indicative of such a trend. One new goal for 2009 reads, “Launch gender equality education to ensure respect for life,” 10 while other objectives discuss international cooperation and licensing and the preparation of Taiwanese students to become competitive players on the international stage. Clearly, Taiwan is seeking to establish itself in the global arena, which must, if China is excluded for its field of vision, be established mainly in the West. This drive to Westernize its educational strategies is seen not only in reforms such as holistic college admissions processes (a recent change from a purely standardized-testing based system) but also in the introduction of more modern, radical sexual education policies.
The introduction of the Gender Equality Education Act in 2004 not only serves as a good example of reform, but is reflective of the thesis of this paper – that there was a sudden change of social attitudes in Taiwan in the early 21st century due to Western influence. The law was the result of agitation that had begun as early as the 1980s by feminist groups, but was not drawn up as formal legislation until 2000, and is most commonly associated with the women’s rights movements: not only for provisions that protect women against sexual assault and harassment, but also legislate gender equity training in schools that must include sex education. 11 It was formally passed in the Legislative Yuan in 2004, only after careful study of Western social structures by the Taiwan Gender Equity Education Association, which had been founded in 2002 for the specific purpose of developing such gender equity programming. 12 The TGEEA took several trips to study Western countries that included Sweden and Canada and participated in an international conference on women’s rights before drafting a national set of sexual education teaching materials for Taiwanese teachers to use in schools. Thus, the influence and impact of Western countries on Taiwanese sexual health education policies is evident.
Referencing American Programs
In fact, American social programs are among those specifically referenced as model systems by the Ministry of Education. In 2005, a press conference held by the Legislative Yuan on sex education policies in Taiwan argued for policy reform, the Ministry used the American experience as one of its major argumentative points. Legislative leaders specifically “refer[red] to the United States’ experience” and the US government’s established allocation of more than $50 million a year to usher in a new type of sexual health education that would encourage “responsible and cautious attitudes towards relationship and sex.” 13 The motion sponsored by the press conference was passed. Even when opposition to sexual education programs is the issue at hand, American and Western legislation is often brought into the argument: Li-hua Pan, the vice president of the Millennium Cultural and Educational Foundation, in denouncing a certain explicit illustration suggested for use in national sexual education programs, stated, “It doesn’t fit in, in our country” 14 – thus using the West as a canonical figure in sexual education policies which can be used as a backboard for all new ideas. The very nature of Pan’s argument makes clear that, in legislative debate, Western, and in particular, American, public health programs are considered respectable in Taiwan, and may be used as an authoritative reference point. By divorcing itself from China and seeking political guidance from the West, Taiwan has allowed its policies to gradually become more and more liberal, leading to recent reforms in sexual education and gender equity.
OTHER INFLUENCING FACTORS
But Western legislation and policy are not the only factors that have influenced Taiwanese public health policy. Who brought in these foreign influences to begin with, and what has caused them to have such an enormous and lasting impact? This has been the role of the media, and of immigration – the other two factors in the shift of Taiwanese sexual health education and gender equity health policies. As globalization has progressed and the transmission of information steadily continues to increase in speed and volume, more American ideas have been allowed to enter Taiwanese society, contributing largely to this liberal shift.
Role of the Media
In an article published in mainland China, Xiaoji Zhang, who founded a sexual education center in Beijing, spoke of American media as being the major influence on adolescents’ ideas about sex. Not only the “sex scandal of Clinton splashed across newspaper headlines,” but also American television shows such as Friends and Sex and the City, have become the new “primers on relationships and sex,” according to Zhang.
One of the surveys run by Zhang’s center evinced the fact that 94% of adolescents learn about sex solely through various forms of media, including television, the internet and books, and not from school sexual education programs or parental discussion. 15 Statistics in China cannot be exactly extrapolated to fit the society of Taiwan, but the fact that China, with its infamous firewalls and notoriously tight censorship, is experiencing a notable degree of Western media’s influence on its youth, is extremely significant, and has implications on the amount that is reaching other Asian countries.
Indeed, Western media has been seen as having a discernible and perhaps worrying effect on Taiwanese adolescents. Its all-pervasive power and increasing liberalization have effectively come to play a powerful role in shaping Taiwanese societal attitudes and needs, emphasizing the urgent and crucial lack of gender equity and sexual education. In 2007, it was reported that 15% of elementary school students had watched pornography (a thoroughly Western type of media), compared to 39% by high school and 79% by college; 14 the very fact that such a study was deemed necessary is revealing of the increasing concern felt by Taiwanese culture on liberal media impact. Additionally, the Garden of Hope foundation set up in Taiwan to provide help and information to pregnant teenagers reported that more “teenagers were turning to the [foundation’s telephone] hotline or the web” 16 as a source of information, instead of to their parents, as such resources became more widely available, evincing the sway and availability of informational resources in the 21st century.
Utilizing the Media
Media has proven to be so all-encompassing that sex educators have attempted to utilize it in their favor rather than to try to work against it. In a TGEEA press conference held in 2005, advocates called for teachers to “turn gender news into teachings materials and [thus] provide better sex education.”One of its studies found that, in every single week of the year prior, at least one news story was relevant to sex education, providing evidence of the omnipresence of sexual health issues in Taiwanese society. 17
Legal Changes Influence the System
But while media has always been credited as having great social impact, the lifting of Taiwanese martial law in 1987 and concomitant leniency in allowance of Western influences, as well as the introduction of the internet in the 1990s, has done much to aid the introduction of foreign media in Taiwan. Song-jing Gau, director of one of the new sexual health education curricula developed by the Ministry of Education, described sexuality as “more complicated than ‘monkey see, monkey do,’ as children already know a lot about sex through media.”14 With this foreign media, as in China, has come early sexual precociousness, probably much earlier than that seen in any previous generations, and therefore an urgent need to adjust sexual education programs and gender equity politics in order to address this younger “coming of age.” Clearly media impact, especially that coming from America and the West, has had a powerful influence on Taiwan, opening society up to more liberal ideas and options for reform.
Perhaps one reason the media is so pervasive and seems to send such a radical message is that it is no longer targeted directly at a conservative, wholly-Asian population, but rather at a highly migratory, mutable and changing population of immigrants, aliens and American-born Taiwanese. This audience is used to a much more liberal media message, which in turn has begun to influence the traditional Taiwanese population as well.
THE ROLE OF IMMIGRATION
From where does this new foreign audience come? Taiwan’s president, Ying-jeou Ma, has written of the recent great wave of immigration that began in the 1980s, when Taiwan allowed foreign immigrants, spouses and workers to its shores, seeking to redefine itself independently after existing in China’s shadow during the Cold War. 18 This immigration has had a clear and present impact on educational and public health policies, because it affords the Taiwanese a vast new horizon of ideas and options. No longer are the Taiwanese restricted to traditional, conservative ideals; instead, they are surrounded by foreigners who have brought with them the ideology of the West. One example of the burgeoning American population in Taiwan is evident through analysis of student enrollment at Taipei American School, which was instituted as a school for American diplomats and employees in Taiwan. According to the school’s website, in the 1980s, which “witnessed Taiwan’s birth as a dynamic democracy full of economic opportunities,” enrollment has steadily increased, from less than 1,000, to 2,215 students as of the 2008-2009 school year. 19 This increase is surely commensurate with the influx of foreign and American nationals who have moved to Taiwan to take advantage of career and diplomatic opportunities, and have brought foreign and American liberalism with them. This international effect is also reflected in recent guidelines of the Ministry of Education, which specifically mention the preparation of students for international competition, foreign exchange and global participation 10 – all of which involve the education of students in a curricula with an international (and therefore Western) focus.
The impact of immigration has been felt in other areas relating to public health – the high percentage of foreign immigrant spouses that has moved to Taiwan since the 1980s caused the Immigration Act to be “revised [in 2007] in response to concerns about domestic violence,” protecting female immigrants’ rights to stay in Taiwan in cases of domestic abuse. Female immigrant spouses are thus more enabled to protect themselves when in the past they had to suffer in silence or fear deportation. The increased ease and availability of applying for immigration visas has also presented many women with the option of leaving Taiwan for America, as noted by Gina Lee, the director of the Office of Social Work for Modern Women’s Foundation. Lee said that it is widely known that America is the land where women’s rights movements originated, and is seen as a country where “people show women more respect.” 20 The option of emigration has thus given Taiwanese women greater options and freedom for their sexual health, forcing Taiwanese society in general to pay closer attention to its shortcomings in gender equity and turn an eye toward reform.
In consideration of all of these factors, the recent drastic changes in Taiwanese sexual health curriculum and gender equity laws, as part of wide-ranging public health policies to improve women’s health, are perhaps not so inexplicable after all. The dramatic change in Taiwanese foreign policy and governmental structure that occurred in the 1980s provided enough room for such liberal changes to begin to agitate. They were spurred by technological advances that both introduced vast amounts of liberal foreign media and waves of foreign immigrants looking for work to the island, which, in the early 21st century, were finally solidified in legislation by the Gender Equity Education Act. From this act, which proposed mandatory sex education, has come the opportunity to create massive social change in Taiwan, reform sexual education, and provide ever-increasing gender equity to the Taiwanese. A complex mixture of political and social factors which included a split from China, but also, as has been the focus of this paper, an increasing reliance on Western and American public health policies and strategies, has enabled and catalyzed this change to take place. Without American and Western preexisting public health structures and policies, the Taiwanese system could not have reached its current state of greater liberalization. Therefore, the impacts of American and Western public health infrastructure, media, and immigration have played a large role in helping Taiwan to establish its own new system of the 21st century. The growing interconnectivity of the world has forced Taiwan to finally address an old issue, and to rely on preexisting Western policies to overcome and solve these questions of sexual education and gender equity reform. In the larger scheme of global public health, although they have not been discussed here, the strategies that Taiwan has used to implement liberal sexual issue reform can be studied and utilized to improve cultural sensitivity and provide appropriate medical and public health care to Asian populations throughout the West. Thus, the cultural exchange will have come full circle.
1. Bruyas, Dimitri. “New MOE Sex Ed Program Denounced.” The China Post. 15 Dec 2007. 1 Dec 2009.
Subject: Healthcare Policy, Global Health
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