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’ [40] - 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. This phenomenon is now reportedly being witnessed in some women-scarce areas in Asia [41].
Finally, there is the speculative question of the social impact of a sudden addition of a large cohort of young ‘excess males’ to populations sustaining extreme SRBs: depending on 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.7
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 subreplacement 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 - son preference - is perhaps surprisingly difficult to identify in advance. In theory, the 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 1.8 However, 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. Differential infant and child mortality rates arguably offer clues about son preference. Societies where female mortality rates exceed male rates 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. The roster includes much of South-Central Asia (Afghanistan, Bangladesh, Nepal, Pakistan, Turkmenistan, and Uzbekistan), North Africa and the Middle East (Bahrain, Egypt, Morocco, Jordan, Oman, and Yemen), parts of Latin America and the Caribbean (Bolivia, Ecuador, Haiti, Honduras, Nicaragua, and Trinidad and Tobago), and over a dozen countries in sub-Saharan Africa, including the sub-Saharan demographic giants of Nigeria, Ethiopia, and Sudan [44]. If such gender bias in mortality turns out to be a predictor of 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 imbalanced SRBs to normal ratios: South Korea. There is still considerable dispute about the factors involved in this turnaround [45], 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. This was not altogether unlike the way in which nationwide conversations of conscience had helped to stigmatize international slave-trading 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 not occur - have a special obligation to be front and center in this dialogue.
Acknowledgement
The author would like to thank Mr. Dale Swartz and Ms. Kelly Matush for overall research assistance for this chapter, and Ms. Heesu Kim and Mr. Mark Seraydarian for identifying those DHS surveys in which parental gender preferences for the next birth are specified. Ms. Laura Kelly of Battelle provided extremely constructive criticism of an earlier draft. All remaining errors are the author’s responsibility.
Footnotes:
1 Johannson and Nygren [6], for example, concluded that much of the contemporary ‘missing girl’ puzzle in China could be explained by hidden daughters, while also pointing to the likelihood of some sex-selective infanticide.
2 Chinese authorities conducted a national population census for November 2010, but the detailed results from that count are not yet available, and the initial communiqué on that census does not mention the country’s SRB [7].
3 Although China’s population program is known as the ‘One Child Policy’, it does in practice permit the birth of some second, third, and even higher-order babies: for the country as a whole, the total fertility rate (or number of births per woman per lifetime) is estimated by the UNPD as 1.64 for the 2005-2010 period, and by the US Census Bureau International Data Base at 1.54 for the year 2010 [12, 13].
4 According to Vietnam’s Ministry of Health, annual ultrasound tests nationwide rose more than tenfold between 1997 and 2007, i.e. from 1 million to 10.8 million; these data refer to medical imaging for all purposes, not only obstetrics [28].
5 Calculated using ProFamy software [37] as described in Yi, et al. [38].
6 For an overview and evaluation of the growing literature on the relationship between marriage and health, see Wood et al. [39].
7 For a decidedly ‘pessimistic’ but studied assessment of these prospects, see Hudson and den Boer [42].
8 For example: Macro International, a USAID contractor, archives over 200 DHS surveys for 75 countries - but only 7 of these for 4 countries (India 1992/1993, 1998/1999, 2005/2006; Jordan 2002; Pakistan 1990/1991, and Yemen 1991/1992, 1997) contain specific questions on parental sex preference for the next birth. The DHS surveys in question are available
