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.