A Global War Against Baby Girls: Sex-Selective Abortion Becomes a Worldwide Practice

A GLOBAL WAR AGAINST BABY GIRLS: SEX-SELECTIVE ABORTION BECOMES A WORLDWIDE PRACTICE

Nicholas Eberstadt, Ph.D.[1]

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Abstract

Over the past three decades the world has come to witness an ominous and entirely new form of gender discrimination: sex-selective feticide, implemented through the practice of surgical abortion with the assistance of information gained through prenatal gender determination technology. All around the world, the victims of this new practice are overwhelmingly female—in fact, almost universally female. The practice has become so ruthlessly routine in many contemporary societies that it has impacted their very population structures, warping the balance between male and female births and consequently skewing the sex ratios for the rising generation toward a biologically unnatural excess of males. This still-growing international predilection for sex-selective abortion is by now evident in the demographic contours of dozens of countries around the globe—and it is sufficiently severe that it has come to alter the overall sex ratio at birth of the entire planet, resulting in millions upon millions of new “missing baby girls” each year. In terms of its sheer toll in human numbers, sex-selective abortion has assumed a scale tantamount to a global war against baby girls.

Initial Signal in China

A regular and predictable relationship between total numbers of male and female births is a fixed, biological characteristic for the human populations (as it is for other species of mammals). The discovery of the consistency, across time and space, of the sex ratio at birth (or SRB—sometimes also referred to as the “secondary sex ratio”) for human beings was one of the very earliest findings of the modern discipline of demography.[2] Medical and demographic research subsequently identified some differences in SRB that correspond with ethnicity, birth order, parental age, and other factors.[3] But such differences were always quite small; until the 1980s, the SRB for large human populations tended to fall within a narrow range, usually around 103 to 106 newborn boys for every 100 newborn girls (103-106 by conventional denotation) and centering around 105. Until the 1980s, exceptions to this generality were mainly registered in small populations, and attributable to chance.

The modern phenomenon of biologically unnatural increase in the sex ratio at birth was first noticed in the 1980s—in China, the world’s most populous country. In 1979, China promulgated its “One Child Policy,” a compulsory and at times coercive population control program which has continues to be enforced to this day (albeit with regional and temporal variations in severity).[4]  In 1982, China’s national population census—the first to be conducted in nearly two decades—reported an SRB of 108.5, a striking and disturbing demographic anomaly. Initially, researchers surmised this abnormal imbalance might be in large part statistical artifact, under the hypothesis that Chinese parents might be disposed to conceal the birth of a daughter so as to have another chance for a son, given the strict birth quotas so often decreed by the “One Child Policy.”[5] But successive Chinese population censuses registered ever-higher SRBs. By the 2005 “mini-census” (1% inter-censal survey), China’s SRB approached 120—and the reported nationwide sex ratio for children under 5 was even higher (see Table 1).[6] Although there remain some discrepancies and inconsistencies among data sources (e.g. census numbers; vital registration reports; hospital delivery records; school enrollment figures; and so on) concerning China’s SRBs and child sex ratios over the past two decades,[7] there is absolutely no doubt that shockingly distorted sex ratios for newborns and children prevail in China today—and that these gender imbalances have increased dramatically during the decades of the One Child Policy.

Chinese census data outline the basic geo-demography of China’s imbalanced sex ratios at birth. For the country as a whole, SRBs since 1982 have consistently been lowest for China’s cities, and highest for rural areas; in China’s 2005 “mini-census,” reported SRBs were roughly 123 for rural areas, 120 for towns, and 115 for cities.[8] But there are major SRB variations within China at the regional level; as of 2005, only three provinces reported essentially “normal” SRBs, while many more reported SRBs of 125 or more, with two provinces reporting levels in excess of 130 (see Figure 1). The geography of China’s gender imbalance is further highlighted by a county-level breakdout of sex ratios for young children in the year 2000 (see Figure 2). As may be seen, sex ratios are essentially ‘normal’ (105 or lower) in much of Western China and along parts of the country’s northern border—areas where non-Han ethnic minorities predominate—while unnatural gender imbalances characterize virtually the entirety of the Han-majority areas in China’s east and south. There are tremendous variations in the extremity of the condition within this Han expanse: a number of inland and coastal areas stand out as epicenters of the problem, and are marked by concentrations of counties, each encompassing millions or tens of millions of people, wherein child sex ratios of 150 or greater prevail. Demographers Christophe Z. Guilmoto and Sebastien Oliveau describe these radical-imbalance areas as “hot spots”[9]—and since the phenomenon has diffused across China’s population over the past three decades, Figure 2 may be regarded as the map of a rising national epidemic.   

Parity Specific Imbalance

Further light is cast on the epidemiology of Chinese SRB imbalances by patterns of parity-specific SRBs—that is to say, sex ratios at birth by birth order—since 1982 (see Figure 3). Significantly, SRBs for firstborn Chinese children have remained relatively low and were actually in the biologically ‘normal’ 105 range until the early 1990s. For higher-parity births, on the other hand, SRBs from the late 1980s onward have been stratospheric—biologically impossible—and continued to rise until the year 2000, at which time the SRB for higher parity births exceed 150. (Higher-parity SRBs reportedly declined somewhat between 2000 and 2005—but as of 2005 nonetheless amounted to 143 for second births and to 156 for third births.) At one point, researchers hypothesized that the emerging gender imbalance in China was primarily a consequence of the spread of the Hepatitis B virus, which is known to skew SRBs in favor of male babies in maternal carriers[10]--but clearly that theory cannot account for the extraordinary and continuing disparities between first births and higher-order births in China. Instead, it is by now widely recognized that these gender disparities are the consequence of parental intervention—namely, mass feticide, through the agency of medically induced abortion and prenatal gender determination technology.  Chinese parents appear to have been generally willing to rely upon biological chance for the sex outcome of their first baby—but with increasing frequency they relied upon health care technology and services to ensure that any second- or higher-order baby would be a boy.[11]

The critical health service elements in this tableau are China’s universal and unconditional availability of abortion conjoined with access to reliable and inexpensive obstetric ultrasonography. According to Chinese researchers, in 1982 diagnostic ultrasound scanning devices were available in health clinics in about one sixth of Chinese counties; over half of Chinese counties had them by 1985, and virtually all had them by 1990.[12] By the year 2000, sex-selective abortion had become astonishingly commonplace in China: rough calculations for that year suggest that no less than half of the nation’s higher-parity female fetuses were being aborted, and that well over half of all abortions were female fetuses terminated as a consequence of prenatal gender determination. In effect, most of contemporary China’s abortions are thus intentional female feticides.

Drivers of Imbalance

Though Western sensibilities may be inclined to attribute the national embrace of mass female feticide to “backwardness” or “backward” thinking in China, important basic facts are uncomfortably inconsistent with that proposition. For one thing, abnormal sex ratios appear to be almost entirely a Han phenomenon within China—and China’s Han are better educated and more affluent than the country’s non-Han minorities. Second, although SRBs are lower in urban than in rural China, these differences may have less to do with education and income than with fertility levels. After all, fertility levels are decidedly lower in urban than in rural China, meaning that a significantly smaller proportion of babies born in China’s cities are hyper-male higher parity births. Third, China has enjoyed a historically extraordinary surge of development and prosperity over the very years that SRBs and child sex ratios have been rising. Between the 1982 and 2005 censuses, China’s reported adult (15+) female illiteracy rate dropped from 25%  to 4%, and over roughly that same period mean years of schooling for Chinese women rose by nearly 50%, from 5.4 to 8.0.[13]  Moreover, China’s estimated per capita income jumped nearly five-fold between 1982 and 2005,[14] while the fraction of the population living in extreme poverty (as defined by the World Bank) plummeted from roughly 75% in 1981 to roughly 15% in 2004.[15] Despite continuing political restrictions and state-administered censorship, China is also vastly more open to the outside world today than it was in the early 1980s (as attested by statistics on everything from international trade, investment and finance to travel and communications).[16] China’s increasingly unnatural sex ratios for babies and children and its growing army of “missing girls” must therefore be regarded a feature—indeed, a defining feature—of “globalization with Chinese characteristics.” (Note, incidentally, that Beijing outlawed prenatal sex determination in 1989,[17] and criminalized sex-selective abortion in 2004[18]--yet these legal strictures have obviously been ineffective despite the Chinese state’s considerable police powers.)

China’s unnatural long-term rise in SRBs emerged under a draconian state-run population control program. But coercive family planning programs are neither a necessary nor a sufficient condition for widespread female feticide. This much is evident from SRB trends in East Asia’s four “Little Tigers”: Hong Kong, Singapore (more specifically, Singapore’s ethnic Chinese), South Korea, and Taiwan. All of those societies maintain voluntary family planning programs---nevertheless, each of them has registered disturbing increases in SRBs in the era of unconditional abortion and widespread access to inexpensive obstetric ultrasonography (see Figure 4).  In all four of these affluent and highly educated populations, SRBs approaching the dawn of the 21^st Century were a biologically impossible 108 or higher—and just as in China, SRBs were typically lowest (often ‘normal’) for the firstborn babies and suspiciously elevated for all higher-parity births[19], a tell-tale sign of parental intervention through sex-selective abortion. Like China, these “Little Tigers” all had laws on their books proscribing prenatal gender determination and/or sex-selective abortion that did not forestall subsequent increases in their sex ratios at birth. Of all the “Little Tigers,” South Korea reached the most demographically disfiguring heights: an SRB of well over 114 in the early 1990s, not to different from China’s at that time. But South Korea’s SRB declined steady thereafter, and by 2009 was according to official state statistics a practically ‘normal’ 106[20]--a matter to which we shall return.

One commonality to China, and the four “Little Dragons” would be a Confucian cultural heritage, which places an imperative on continuing a family’s lineage through the male heir as a metaphysical key to greater universal harmony virtue and harmony. It is noteworthy that Japan—an East Asian society without a strong Confucian tradition, but with easy access to abortion and obstetric ultrasonography and with very low fertility rates, just as in China and the four “Little Tigers”—has always reported a sex ratio at birth well within biological human norms.

As it happens, however, a strong Confucian heritage is not a unique identifier of societies at risk of mass female feticide. In Southeast Asia, Vietnam—a society with a strong Buddhist tradition—now evidences strong indications of rising SRBs.[21] Like China and the “Little Dragons,” Vietnam is a sub-replacement fertility society with easy access to abortion, and an increasing diffusion of ultrasound technology.[22] Between 1999 (according to data from annual sample population surveys) and 2009 (the year of the country’s latest population census), Vietnam’s sex ratio at birth appears to have risen from about 105 to over 110. As in China and the “little Dragons,” SRBs are markedly elevated for higher order births (especially for third or higher births).  Vietnam’s upsurge in SRBs, it may be observed, coincided with a period of rapid material advance (between 1998 and 2008, per capita output is estimated to have jumped by 80%[23]), and positively correlates with prosperity within Vietnam today, with the country’s lowest SRBs registered by the poorest income quintile and the highest registered by the most affluent. Like China and the “Little Dragons,” Vietnam also has laws on the books that make sex-selective abortion nominally illegal.

By this point in our discussion, a consistent etiology of unnaturally high SRBs (the female feticide that underpins them) can be described. These phenomena appear to arise from a collision of three forces: 1) local mores that uphold a truly merciless preference for sons; 2) low or sub-replacement fertility trends, which freight the gender outcome of each birth with extra significance for parents with extreme gender bias; and 3) the availability of health services and technologies (easy and affordable abortion and prenatal sex diagnostics) that permit parents to engineer the sex composition of their families—and by extension, of their societies.

India’s Imbalance

Given its history of deadly discrimination against girls and women (through its customs of female infanticide, dowry killings and ritual sati immolation of widows),[24] its pronounced and continuing fertility declines, and its past two decades of very rapid economic growth attended by increasing domestic diffusion of new technologies of every sort, India would seem poised as a likely battlefield in the new global war against baby girls. Sure enough, both SRBs and child sex ratios have risen markedly for the world’s second most populous country since the early 1990s.  According to India’s National Family Health Surveys (NHFS I –III), India’s nationwide SRB rose from around 105 in the 1979/92 to 109 for 2000/06; more recently the country’s National Sample Survey placed the SRB for 2004/06 at 112.[25] According to the India’s population censuses, the nationwide sex ratio for children under 7 years of age rose from 105 in 1991 to 109 in 2011.[26] Geographically, India’s gender imbalances are most extreme in the India’s Northwest (particularly in the states of Haryana and Punjab, where the 0-6 sex ratio is now close 120, or even above 120); in Delhi, India’s capital, the sex ratio for children under 7 is currently a reported 115 (see Figures 5 and 6).  Socioeconomically, SRBs and child sex ratios in India today correlate positively---not negatively—with education, income, and urbanization. Like the aforementioned countries with unnaturally high SRBs, sex selective abortion is illegal in India.

Caucasus Region Imbalance

In West Asia, the Caucasus region has emerged since the end of the Cold War as another front in the global war against baby girls.[27] Between the final collapse of the Soviet Union in 1991 and the year 2000, SRBs in Armenia, Azerbaijan and Georgia all rose from about 105 to about 120. (In the Soviet era, ultrasound diagnostics had been generally unavailable in these countries; inferential evidence—including the increasing general access to ultrasound diagnostic and newly increasing SRBs for higher-parity births, especially third and higher-order births—strongly suggest these countries are subject to the same syndrome observed in so much of East Asia and South Asia.) More recent vital registration system data indicate that SRBs in the Caucasus have declined, but only slightly: to 116 in Armenia and Azerbaijan (as of 2008) and to 112 in Georgia (as of 2004).

Other Countries and Subpopulations

 The ten societies with biologically unnatural SRBs examined thus far represent most of the world’s major religious and cultural traditions: Confucianism, Buddhism, Hinduism, Islam, and Christianity. But these are by no means the only contemporary settings in which evidence of the phenomenon is emerging at a population-wide level (see Tables 2 and 3). Recent vital statistics for places with complete or near-complete registration, and census returns for other places, point to almost twenty additional countries or territories with populations of one million or greater. Other places in Asia with suspiciously high recent SRBs and/or child sex ratios include the Philippines, Brunei Darussalam, Papua New Guinea, Bangladesh, Kyrgyzstan and Turkey. In the Middle East/North Africa, both Lebanon and Libya betray the same disturbing demographic characteristics. In Latin America and the Caribbean, elevated SRBs or child sex ratios are seen in Cuba, Puerto Rico and El Salvador. But it is important to recognize that the phenomenon is also now evident in over half a dozen European countries as well. Albania’s officially reported 2004 SRB was 113. In Serbia and Montenegro—portions of the former Yugoslavia—2008 SRBs were 109 and 108, respectively. And in the nominally Catholic-majority populations of Austria (2008), Italy (200), Portugal (2008) and Spain (2008), SRBs officially reported SRBs were all an anomalous 107.

Biologically impossible SRBs are also now seen in the United States and the United Kingdom—within particular ethnic groups. In America, SRBs of 108 were characteristic of the “Asian-Pacific” population (Chinese-Americans, Korean-Americans, Filipino-Americans, etc) in the 2000 census,[28] and in vital statistics thereafter—populations whose SRBs were within the ‘natural’ biological range a generation ago. In England and Wales, sex ratios at birth for Indian-born mothers have also risen markedly, from 104 in the 1980s to 108 in the late 1990s.[29] In both the USA and the UK, these gender disparities were due largely to sharp increases in higher-parity SRBs, strongly suggesting that sex-selective abortions were the driver. The US and British cases also point to the possibility that sex-selective abortion may be common to other sub-populations in developed or less developed societies, even if these do not affect overall SRBs for the country as a whole.

The Demographic Effect

Sex-selective abortion is by now so widespread and so frequent that it has come to distort the population composition of the entire human species: this new and medicalized war against baby girls is indeed truly global in scale and scope. Estimates by the United Nations Population Division (UNPD) and the US Census Bureau’s International Programs Center (IPC)—the two major organizations charged with tracking and projecting global population trends—make the point (see Tables 4 & 5). By the IPC’s analysis, as of 2010 a total of 26 countries or territories (including a number of European, Middle Eastern, and Pacific Island areas not yet mentioned in this chapter) had SRBs of 107 or higher in the year 2010; the total population of the regions said to be beset by unnaturally high sex ratios at birth amounted 2.72 billion, or about 40% of the world’s total population. For its part, UNPD estimates that 24 countries and territories (a slightly different roster from IPC’s, including some additional European, South American, Middle Eastern, Asian and Pacific settings not thus far mentioned) had child (0-4 years of age) sex ratios of 107 or higher for the 2005-2010 period, with a total population for 2010 estimated at 2.68 billion, or about 39% of the world’s 6.8 billion population that same year. The estimated 2010 population for all the places flagged by either UNPD or IPC for unnaturally high SRBs or child sex ratios would amount to 2.83 billion—about 41% of total global population—and if we tally in the other places from Tables 2 and 3whose official demographic statistics report unnaturally high SRBs of child sex ratios, we would have a total of over 40 countries and territories accounting for over 3.3 billion people, or roughly 48% of the world’s total population.

By the reckoning of UNPD, the overall global sex ratio at birth has already assumed biologically impossible heights in the era of sex-selective abortion, rising from 105 in 1975-80 to 107 for 2005-10. By the same token, IPC puts the worldwide under-5 child sex ratio at 107.0 for 2010 (though its global estimates only extend back to the year 2000).

To go by both UNDP and IPC reconstructions of local age-sex structures, today’s unnaturally high SRB and/or child sex ratio societies would have had an aggregate “boy surplus” of over 55 million boys and young men under the age of 20 by the year 2010; and if we assume the SRBs and child/youth sex ratios in these societies should be around 105, the unnatural “girl deficit” for females 0-19 years of age as of 2010 would have totaled roughly 51 million by both UNDP and IPC figures (see Tables 4 & 5). In both the UNPD and the IPC reckonings, the world’s two most populous countries, China and India, would account for the overwhelming majority (48-49m) of the world’s “missing girls” under 20 years of age in our era of sex-selective abortion (although the implied UNPD and IPC totals for China and India themselves differ substantially, in accordance with their assumptions concerning such things as the extent of undercounting of girls). Note, in any case, that irrespective of differences in IPC- and UNPD-based estimates for given countries, these global estimates for “missing girls” under 20 are arguably conservative figures, excluding as they do numerous countries—some of them quite populous—where evidence of unnaturally high SRBs has been emerging from vital registration or national census data.[30]

Social Implications

The consequences of medically-abetted mass feticide are far reaching, and manifestly adverse. In populations with unnaturally skewed SRBs, the very fact that many thousands—or in some cases, millions—of prospective girls and young women have been deliberately eliminated simply because they would have been female establishes a new social reality that inescapably colors the whole realm of human relationships, redefining the role of women as the disfavored sex in nakedly utilitarian terms and indeed signaling that their very existence is now conditional and contingent.

Moreover, enduring and extreme SRB imbalances set the demographic stage for an incipient “marriage squeeze” in affected populations, especially where sub-replacement is reducing the future pool of potential brides. China’s persistently elevated SRBs, for example, stand to transform it from a country where as of 2000 nearly all males (about 96%) had been married by their early 40s to one in which nearly a quarter (23%) are projected to be never married as of 2040, less than 30 years from now.[31] Such a transformation augurs ill in a number of respects. For one thing, unmarried men appear to suffer greater health risks than their married counterparts, even after controlling for exogenous social and environmental factors;[32] a sharp increase in the proportion of essentially unmarriagable males in a society with a universal marriage norm may only accentuate those health risks. In a low-income society lacking sturdy and reliable national pension guarantees for the elderly, a step rise in the proportion of unmarried and involuntarily childless men begs the question of old-age support for that rising cohort. Some economists have hypothesized that mass feticide, in making women scarce, will only increase their “value”[33]—but in settings where the legal and personal rights of the individual are not secure and inviolable, the “rising value of women” can have perverse and unexpected consequences, including increased demand for prostitution and an upsurge in the kidnapping and trafficking of women (as is now reportedly being witnessed in some women-scarce areas in Asia[34])

Finally, there is the speculative question of the social impact of a sudden addition of a large cohort of young “excess males” to populations sustained extreme SRBs: depending a given country’s cultural and institutional capabilities for coping with this challenge, such trends could quite conceivably lead to increased crime, violence, and social tensions—or possibly even a greater proclivity for social instability.[35]

All in all, mass sex selection can be regarded as a “tragedy of the commons” dynamic, in which the aggregation of individual (parental) choices has the inadvertent result of degrading the quality of life for all—and some much more than others.

What are the prospects for mass sex-selective feticide in the years immediately ahead? Unfortunately, there is ample room for cautious pessimism. Although biologically unnatural SRBs now characterize an expanse accounting for something approaching half of humanity, it is by no means clear that this march has yet ceased.

As we have seen, sudden steep increases in SRBs are by no means inconsistent with continuing improvements in levels of per capita income and female education—or for that matter, with legal strictures against sex-selective abortion. Two of the key factors associated with unnatural upsurges in nationwide SRBs—low or sub-replacement fertility levels and easy access to inexpensive prenatal gender determination technology—will likely be present in an increasing number of low-income societies in the years and decades immediately ahead. The third factor critical to mass female feticide—ruthless son preference—is perhaps surprisingly difficult to identify in advance. In theory,  overbearing son preference should be available from demographic and health surveys(DHS)—such as India’s National Family and Health Survey, which demonstrated that prospective mothers in the state of Punjab desired their next child to be male rather than female by a ratio of 10-to-1).[36] Yet ironically, despite the many tens of millions of dollars that international aid and development agencies have spent on the hundreds of DHS surveys they have supported in low-income countries over recent decades, information on sex preference to date is almost never collected. (Evidently, Western funders of Third World population programs are concerned about the number of babies local parents desire, not their genders.) Differential infant and child mortality rates arguably also offer clues about deadly son preference: societies where female rates exceed male rates (patterns arising from systemic discriminatory mistreatment of little girls) may be correspondingly disposed to prenatal gender discrimination as well. According to WHO 2008 Life Tables, over 60 countries currently experience higher infant or 1-4 mortality rates for girls than for boys: a roster including much of South-Central Asia (Afghanistan, Bangladesh, Nepal, Pakistan, Turkmenistan, Uzbekistan); North Africa and the Middle East  (Bahrain, Egypt, Morocco, Jordan, Oman, Yemen); parts of Latin America and the Caribbean (Bolivia, Ecuador, Haiti, Honduras, Nicaragua, Trinidad & Tobago), and over a dozen countries in sub-Saharan Africa, including  the sub-Saharan demographic giantsof  Nigeria, Ethiopia and Sudan.[37] If such gender bias in mortality turns out to be a predictor sex selection bias, this global problem may get considerably worse before it gets better.

Considerations Moving Forward

There is, however, one country thus far that has managed to return from grotesquely imbalanced SRBs to normal human ratios: South Korea. There is still considerable dispute about the factors involved for this turnaround[38], with many institutions and actors ready to take credit (as the old saying goes: success begets many fathers). Available evidence, however, seems to suggest that South Korea’s U-turn in SRBs was influenced less by government policy than by civil society: more specifically, by the spontaneous and largely uncoordinated congealing of a mass movement for honoring, protecting and prizing daughters. In effect, this movement—drawing largely but by no means exclusively on the faith-based community—sparked a national conversation of conscience about the practice of female feticide--a conversation that was instrumental in stigmatizing the practice, not altogether unlike the way in which nationwide conversations of conscience had helped to stigmatize international slave-trading (now universally held to be an abomination) in other countries in earlier times. The best hope today in the global war against baby girls may be to carry this conversation of conscience to other lands. Medical and health care professionals—without whose assistance mass female feticide could occur—have a special obligation to be front and center in this dialogue.

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References