The data was immediately published by the People’s Daily Chinese. A month later, it came out in the English version of the paper, and since then it has been making the rounds of the Western press, with the predictable apocalyptic spin.  Within China, however, the article has failed to spark any significant debate, even though the subject wasn’t censored. It is already positive that the authorities speak openly of this problem, but clearly a different approach is needed to raise awareness and find solutions.

With the help of my sister, pediatrician Dr. Madariaga, I have been comparing data from different primary sources outside and inside China. The CASS data coming from China official statistics turns out to be very consistent with previous outside sources, like the often quoted BMJ study. It is also the most pessimistic of all, and the most politically credible, as the patriotic CASS can hardly be accused of anti-CCP bias.

What follows is my analysis of the existing research from a different perspective. Not to do projections on the future, but to see what these numbers tell us of the Chinese today, and what solutions can be found. The results are shocking, read and judge by yourself:

The Story: A Very Common Occurrence

Today, almost 20% of the pregnancies that happen in China are manipulated using the simple method of ultrasound scan to determine gender, followed by abortion in case it is a female.

Most first time pregnancies are natural, with only a few percent points of manipulations. This makes sense, as the 2nd trimester abortions necessary for sex selection are not without risk for the mother’s reproductive capacity. Most families prefer to assure the first descendant, knowing that if it is a girl they will get a second go anyway.

However, about 50% of the first birth parents (the same 50% who had a girl?) decide to go for a second one. It is here that the gender manipulation happens massively. Around 30% of these families manipulated their pregnancy using the method described, with some provinces like Anhui showing a rate of up to 50% manipulations for second births.

This shows that sex selective abortion is not a minority problem practiced by a few rogue parents. It is a very common occurrence, with large parts of the population and the health sector taking part in it. In spite of the illegalization of ultrasound scans for sex detection in the 90s, it is obvious that a large part of the doctors are colluding with the public to ignore the law. In short, in most parts of China practicing sex selective abortion is extremely easy and extremely common. Practically anyone can do it.

Among these depressing results, here is a positive note: The very fact that the practice is so widespread would mean that government information campaigns can have a very important effect if they are done seriously. On the other hand, supervision and control campaigns are condemned to fail, although some particular measures might be applicable. More on this in “Conclusions” below.

The Numbers

Here is the basis data for the story above. I have used several research papers shown in references. In particular, the research done by the British Medical Journal in 2005 has been one of the most useful. Where possible, I have used the CASS paper because it is more recent, and the data (from the 2009 Statistical Yearbook) should be statistically sounder.

According to CASS, among the registered children below 4 years old, there were 123.26 males per 100 females. It is known that the expected value is around 105/100 females, therefore:

1– According to this ratio, there should be around 117 girls born with those 123 boys. 17 girls are missing, these are pregnancies that have been selectively aborted (about 7% of the total 240).

2- However, to get rid of that 7% of female fetuses, it means that around 14% of the pregnancies actually used ultrasound scans with the intention of aborting. Of this 14%, approx half were male and they proceeded, half were female and they aborted.

3- The ultrasound+abortion properly performed should give close to a 100% success. However, due to the illegality of the method and the lack of resources in many areas of China, I have introduced an efficiency E of 90%±10 to cover errors, cheats, late diagnostics, etc.

Following the steps above, we get the following general formula for the percentage of manipulated pregnancies N, where X is the male/100females ratio, and E is the success rate of sonography+abortion.

N = [(X*100/105 - 100)/(X*205/105)]*205/100E = [(X-105)/X]/E

With this simple formula we can estimate the number of manipulated pregnancies in the different cases provided by the BMJ study (this data is from 2005, for registered births. It is more conservative data than the CASS 0-4 year olds). Here are the numbers I obtain for different cases:

Confidence: Because of the different sources, it is hard to estimate overall confidence parameters. I have taken the following assumptions, and the intervals should be close to the 95% confidence range:

• Natural ratio is 105±2 with a very high confidence rate.
• The Statistical Yearbook table gives 2 decimals precision.
• The BMJ data gives confidence levels of 95%.
• I have taken the E as 90%±10, to cover even the most conservative case where there is a 100% efficiency in the system.

But more than the confidence numbers, the consistency of all the different sources over time strongly backs these results. The  interval on BMJ 1st birth makes this information hardly usable, but for the rest of the lines in the table, the results are significant beyond doubt. In particular, the 2000 census, the BMJ paper and the CASS all confirm main line: Almost 20% of the total pregnancies are gender manipulated.

Unregistered, Adopted, Infanticides and Others

One of the main objections that can be done to this data is that those 7% girls missing from the census 0-4 year olds are not all due to abortion, but to unregistered births (including infanticides, abandonments and children just kept out of the law). Certainly, some part of the N values I am giving corresponds to these occurrences, but it is so small as to be insignificant in the statistics.

Many children from unregistered births trickle back into the stats in the following years, as they register for immunization or schooling purposes. Surprisingly, in all the reference studies we see the sex ratios for 1-4 year olds (and even the 5-9yo) are higher than those of births, showing that late registrations tend to be more boys than girls. This causes the sex ratios at birth used in BMJ to be lower than the 0 to 4 year old values of CASS.

In a country like China it is inconceivable that significant numbers of people live their lives unregistered beyond childhood. To affect the statistics significantly, there would need to be millions of roaming “phantom” girls that have never been asked their IDs, and there would be at least some trace of this.

As for the murder/abandonment option, it simply does not make any ethical or practical sense for any Chinese familiy to do this today. If only because the ultrasound method is much better in any cost/risk calculation. This is the main reason to believe the ultrasound+abortion hypothesis accounts for the practical totality of my missing girls: it is by far the easiest way to do it for any Chinese family.

Sex Selection: How it happens

Form practicing specialists I obtained the information that at 15 weeks of pregnancy it is possible to determine the gender by ultrasound at almost 100% precision. Some research shows that this can be done even as early as 10 weeks, but let’s take the conservative assumption of 15 to account for the technological/legal situation in China. Even with this assumption, there is still largely the time to do a sex selective abortion.

In fact, according to this study by the WHO, virtually all 2nd trimester abortions in China are performed using medical methods. Induction with mifepristone and misoprostol for 10–16 weeks’ gestation, and intra-amniotic administration of ethacridine lactate for of >16 week’s gestation are routine methods in clinical practice in China.

So it is easy to figure out how this works. An ultrasound scan around week 15, followed by a drug induced abortion the same week, probably performed (and billed) by the same doctor for no more than 100$ the whole package. It is unlikely that doctors get much more than that, due to the available resources of the rural population, and the existence of competition. Virtually very hospital and consultation has ultrasound scans, and the numbers speak of a burgeoning sex selection industry.

Abortion in China: The holocaust

There are about 13 million abortions practiced in China every year, for a total of 18 million births. Almost 10% of the total abortions are motivated by gender selection.

Some Western “scientists” like to call this a holocaust of little girls, and they use it to expose the evil of the Chinese system. But we have to look at the problem more closely to understand how it happens, and why so many Chinese families are supposedly “evil”.

Nowadays abortion is freely available in China, and there are no defined time limits for access to the procedure. Sex selection is forbidden in theory, but in practice there is no way to know the motives of a person requesting an abortion. Certainly, sex selective abortion is a massive problem in the aggregate, but from the point of view of a single individual, it is not necessarily more “wrong” than other cases of abortion.

In fact, from a purely ethical point of view, it is not clear that most common reasons for abortion are any sounder than gender selection. Many Chinese peasants practicing this have serious economic and subsistence reasons to prefer a boy. How does this compare with other common cases, such as: because the time is not convenient, because the parents want to study, because they just couldn’t be asked to use contraception.

People with religious or ethical beliefs have all the right to call this a holocaust. But in all honesty they should include in the count most of the 13 million of Chinese abortions, as well as most of the abortions practiced in the West. Or is the destruction of a fetus any less wrong when its gender is not known?

It is about time China reduces its rate of abortions, but this is a different problem that has little to do with gender selection.

Why Prohibition is Completely Useless

The Chinese government forbid in the 90s the use of ultrasound for the purpose of gender assignment, in order to curb the growing trend of gender selection. In fact, it is the popularization of cheap ultrasound devices in the 90s, rather than the single child policy, which has been the main driver of the problem.

The problem with ultrasound scans is that they is an important diagnosis tool, and the devices themselves cannot be banned. As we have seen, abortions without a justified reason are not forbidden either. So what IS forbidden? Here is the reason why the law never worked and will never work: what is forbidden is to transmit information.

Information is famously the single most difficult thing to keep under control, and this is the basic element of information, a bit, boy or girl. It can be transmitted with the raising of an eyebrow. Considering the economic incentives, the large number of doctors who have access to the machines, the existing demand, the lack of a social conscience of the problem, the impossibility to prove the crime… one cannot imagine for a moment that this Prohibition can ever have any effect in China.

If the worrying trend shown in the graphs is going to be stopped, it will most certainly not be through prohibition. But see below are some alternative ideas that may work.

Conclusion and Some Ideas for the Government

Unfortunately, most of the articles published about this are concerned with either exposing CCP’s policies, or else drawing spectacular scenarios of the future. The goal of this post is just to analyze the existing research from a different perspective, looking at this serious problem from the side of its protagonists. This is part of my old quest to understand the Chinese people.

By looking at the other side of the problem, we have found some results that are shocking, even for Chinese readers. The reaction of disbelief I have seen in Shanghai friends, as well as the little debate existing on the internet even after an official source wrote about it, all illustrate the the low social awareness of this problem. I hope my results can be useful to increase this awareness, and in the meantime here is my little contribution to figure out effective policies:

1- Communication Campaigns: We have seen banning does not work, and no efforts by the central government is going to change this in the short term. On the other hand, because of the large proportions of the phenomenon in society, a vigorous information campaign is likely to have a strong effect amongst the least convinced of the “selectionist” parents and doctors. A massive long term campaign is needed, including films, adverts, sponsoring television characters, etc. to create a negative perception of gender selection. More importantly, the campaign should highlight the advantages of having a girl in China, which are rapidly growing as the gender imbalance makes females more demanded.

2- Abortion Controls: Nobody can know if the motivation behind an abortion is gender selection or not. But what is sure is that practically all gender selection abortions occur after the 12th (probably 15th) week. In the frame of a general move to lighten the restrictions of the single child policy, the introduction of restrictive conditions for late abortions would  have an important effect in dissuading sex selective behaviors, apart from avoiding risks for pregnant women and other misuses of abortion. This should be accompanied by campaigns to promote contraception to avoid a sudden spike in fertility.

I wish someone inside the Chinese Government reads these points and considers them urgently, for the sake of China and the World. And please, speak about it, let everyone be aware of the problem, encourage debate. Not censoring is already a good step, but active measures should be taken as well to promote discussion. This is a problem that can never be solved by the authorities alone. Involve the people!

If you have some other suggestions, or else some question/correction, please leave them in comments.

References

• China’s excess males, sex selective abortion, and one child policy: analysis of data from 2005 national intercensus survey – BMJ
• Sex Ratios at Birth in China – CEPED-CICRED-INED
• CASS 中国2011-2015年期间需要关注的人口问题 – 2010 Social Blue Paper
• CASS 2010 Blue Paper Index – 2010 Social Blue Paper
• The worldwide war on baby girls – The Economist
• Abortion Laws Around the Word – Pew Forum
• Sonographic early fetal gender assignment, by V Mazza – 2001
• Surgical vs medical methods for second-trimester induced abortion-WHO
• 1 in 5 marriage age Chinese men to remain bachelors… – People’s Daily
• Abortion statistics cause for concern – China Daily
• Statistics China – UNICEF

1. for a simple introduction to the problem of gender imbalance in China and its potential consequences you can read this article from the Economist