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Prenatal sex selection – When prenatal testing can threaten social harmony

China has an imbalance in the sex ratio resulting from selective abortion of female fetuses. Predictions that it may result in social disharmony are eventuating sooner than expected – but the problem is different to the one that was anticipated. Stolen girls have become increasingly valuable commodities in a cruel trade. A 2½ girl is feared kidnapped after she went to the shop around the corner. She vanished; her heartbroken mother and father fear she was kidnapped (1).

As many as 20,000 children and young women are reported kidnapped every year. This is said to be increasing. Only a handful of cases are solved. Many girls are bought by farmers who want wives for their young sons when they come of age, or by men who want a child bride without a dowry. Police raided one village & found that babies were being raised for sale and families were acting as brokers for other peasants who wanted to sell off “surplus” infants (1). 

China’s one child policy is one of the most controversial social policies ever implemented (2). But even before the policy was imposed, China saw a reduction in family size as a result of social and economic developments. Between 1970 and 1979, before the one child policy was introduced, the fertility rate decreased from 5.9 to 2.9; since 1995 it has stabilised at around 1.7 (2). The policy is largely responsible for the current imbalance in the sex ratio. Sex-selective abortion accounts for most of the excess males (3); another major factor is that in some provinces a second child is allowed if the first is a girl resulting in sex ratios reaching up to 146 males per 100 females (4). In 2005 China had more than 32 million excess males under the age of 20, and over 1.1 million excess males were born that year (5).

The problem is similar in India. In the state of Punjab in 2001, there were 799 girls born for every 1000 boys (6). Abortion is legal in India but aborting a fetus because of its sex is not. A doctor and his assistant who offered patients "sex-selective" abortions in the northern state of Haryana, India, were sentenced to two years in prison for performing a gender determination test.

The American College of Obstetricians and Gynecologists (7), and many others, oppose doctors agreeing to requests for sex selection that are for personal and family reasons; their grounds include concern that such requests may ultimately support sexist practices. But there is disagreement. Some argue in favour of allowing sex selection – boys and girls are simply different and they contend that this difference matters to different families in different ways (8); others believe that there is no justification for denying parents the right to choose the sex of their prospective children (9).

In western countries prenatal sex preference tends to be related to couples wishing to balance the family sex ratio. Even immigrants from countries where sex selection is prevalent do not tend to request it – they no longer have the economic necessity to have a boy. There is therefore minimal risk of sex selection causing an imbalance in the sex ratio in western societies.  In Asian countries sex selection is usually related to a cultural and economic preference for males; hence when prevalent results in a sex imbalance.

Solutions to the Chinese unbalanced male to female ratio include promoting the principle of equality between men and women and enforcing prohibitions on prenatal sex identification techniques for nonmedical purposes. Young Chinese women need encouragement to have no preference for one sex over the other. Campaigns to protect women and children from being kidnapped also require strengthening. (5). 

Korea was the first country to report very high male to female sex ratios at birth. From the mid-1990s there was a public awareness campaign warning of the dangers of such distortion, combined with strictly enforced laws forbidding sex selection technology. This led to a decline in the male to female ratio from 116:100 in 1998 to 110:100 in 2004 (2); China needs to learn from the South Korean experience.

The sex ratio in China may be improving. Zhu and colleagues (4) report a decrease in the male to female ratio for the 2005 cohort, which may indicate the beginning of a reduction in the unbalanced sex ratio for the future.  

There can be reasonable disagreement regarding the acceptability of prenatal sex selection in western societies – even if legalized numerically it is likely to remain a small issue hence not risking social consequences. But it presents a major problem in at least some Asian societies: an altered sex ratio might be expected to cause significant disruptions in some predictable and some unpredictable ways. As affected nations grapple with possible solutions, there may be grounds to hope that the final result of addressing the issue might be improved status for women.

1 Michael Sheridan in Kunming, CHINA   From The Sunday Times   May 31, 2009
Kidnappers swoop on China’s girls

2 Editorial: Ratio of males to females in China. BMJ 2009;338:483

3 LaFraniere S   Chinese Bias for Baby Boys Creates a Gap of 32 Million. N Y Times April 10, 2009

4 Wei Xing Zhu,  Lu L, Hesketh T China’s excess males, sex selective abortion, and one child policy: analysis of data from 2005 national intercensus survey BMJ   2009;338:b1211

5 Zeng Yi et al., "Causes and Implications of the Recent Increase in the Reported Sex Ratio at Birth in China," Population and Development Review, 19: 2 [June 1993], p. 298.
6 Ghosh R. Ethical conflict among doctors in India: a cause of high female foeticide. Acta Pædiatrica 2009; 98; 403-404

7  ACOG Committee Opinion No. 360: Sex selection Obstet Gynecol. 2007;109:475-8

8 Savulescu J. Sex selection: the case for. MJA 1999; 171: 373-375

9 Dahl E. Procreative liberty: the case for preconception sex selection Reprod Biomed Online. 20037:380-4

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