A Study of Sex Selective Abortion in China
Written by Julen Madariaga on May 13th, 2010In the 2010 Social Blue Paper, published last December by the Chinese Academy of Social Sciences, there was a very interesting piece hidden among the 330 pages of socio-economic analysis. Under the title “Population problems China should pay attention to between 2011 and 2015″, this article contained some of the newest and most negative data to date about the important problem of gender imbalance [1], published by an official PRC source.
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
NOTES:
- for a simple introduction to the problem of gender imbalance in China and its potential consequences you can read this article from the Economist [↩]
César said:
土木坛子 said:
panda said:
jocilene said:
Keji said:
13
PM
This has great analysis. I take issue with your section “Abortion in China: The holocaust”:
”
You are stepping into a minefield here. If you believe that abortion is intrinsically evil, then the reasoning for why this happens is irrelevant. People who make this moral judgement are usually Christian and see the world through a certain “filter”. The people who take this position may or may not be scientists…most are not though. And their identity or occupational status as “scientist” also has no relevance to the morality of abortion and a woman’s right to control her own body.
People who do not look upon abortion as “evil” may (and many probably do) think that sex-selective abortion is “wrong”. I include myself among this group. But that does not mean that people who have abortions on the basis of the fetus’s sex are evil people.
[Reply to this comment]
13
PM
Yes, I realize I am stepping into a minefield with this section, but I needed to write it because it is an essential part of understanding WHY so many Chinese families take this option.
My point is simple: if you consider aborting for gender selection evil, then most other abortion cases should be evil as well.
Whether the abortion was motivated by gender selection or by time selection (ie. I don’t want it now, I want to study Uni, etc.) there is no difference from an ethical/religious point of view. Both are cases of humans artificially modifying the natural course of life to suit their personal preferences.
Obviously, in the aggregate, the problem of Sex Selection is more serious. But from the point of view of each individuals practicing it (individuals already used to unconditional abortion rights, and largely unaware of the aggregate consequences) it is difficult to see any moral problem.
PS. Regarding the “scientific” with quotation marks, I stick to my guns. It is not particularly directed to religious people, but to anyone who practices Social Science with an agenda.
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14
AM
“As for the murder/abandonment option, it simply does not make any ethical or practical sense for any Chinese families to do this today. If only because the ultrasound method is much better in any cost/risk calculation.”
I would also consider that many people who look for male pregnancies are from the countryside, which is much more prone to sex-selection as they are both poor and rural -boys stay, girls leave, much more traditional than urbanites (where it seems the concientization campaigns and medical control has have some results). Rural areas, and inland provinces are the places where most of the Chinese low income population concentrates; as sex-selection scans are illegal, they must come with an extra price, so those doctors, nurses… will do them risking their job or reputation.
Many orphanages are in the countryside, some operated (and helped -Shanghai International Catholic Community among them) by religious organizations. They are full of girls, and some boys with some kind of handicap, even light ones. I asked some Catholic sisters why did they open an orphanage -that takes a lot of effort in resources -they are quite poor- and material management. Her answer was simple: people started to leave girls and boys at our convent door, thinking that we, catholics will not kill or mistreat them, and will care for them. After a few cases we had to organize and establish an institution with the proper resources and structures to take care of them.
Inner China is, still, quite another world…
[Reply to this comment]
Julen Madariaga Reply:
May 14th, 2010 at 4:08 pm
Rural areas, and inland provinces are the places where most of the Chinese low income population concentrates; as sex-selection scans are illegal, they must come with an extra price, so those doctors, nurses… will do them risking their job or reputation.
Probably there is an extra cost, might be more than the 100 USD I estimated. But you should not overestimate the risk for the doctor. It is practically impossible to prove his illegal act. He can do a scan alleging other reasons, and pass the gender info with a blink. The only possible way to catch a doctor doing this is to have a policeman acting as undercover agent… I wonder how many 3month pregnant policewomen are available for the mission! : )
Many orphanages are in the countryside, some operated (and helped -Shanghai International Catholic Community among them)
I am not denying the existence of murders or abandonments, I have corrected my phrasing to make this clearer. My only point is that these cases account for a tiny fraction of my >1 million missing girls per year. Even if only a 10% of the missing girls are abandonments, there would be at least 1,000,000 orphan girls accumulated in the last 10 years, and 100,000 more coming every year. This would require a whole army of your catholic nuns, it just doesn’t make sense.
Finally, there is one important correction to your comment: The areas where the problem of Sex imbalance is most acute do not correspond to areas of lowest incomes. Look at the numbers and map of the BMJ. Rich provinces like Guandong and Zhejiang are among the most affected. I can tell you from my own visits that in those provinces even the peasants are relatively well off. It looks like it is not culture, but rather widespread availability of Ultrasound scan that makes the difference.
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kailing Reply:
May 15th, 2010 at 6:39 am
@Julen Madariaga, Up to now I have no army of Catholic sisters, and they are simply a part, you have to add the Protestant institutions, the buddhist ones, and then, the big bulk of the Government run institutions. Then another fraction may be in the girls that are buy/sell in the market… plus those given in adoption to foreign couples… Each one of these items by itself do not make a million, but all together may account for some of the missing figures.
And of course I agree, the big difference is the ultrasound; it definitely brought down the number of abandoned infants due to pre-selection, and the worst mix is in relatively well-off rural areas where tradition and money coexist, Anhui being an example. Probably as development continues its way in, more inland provinces will add to the ultrascan trend.
About what you say: “It is practically impossible to prove his illegal act. He can do a scan alleging other reasons, and pass the gender info with a blink. The only possible way to catch a doctor doing this is to have a policeman acting as undercover agent… I wonder how many 3month pregnant policewomen are available for the mission!” I agree, but even though the doctor blinks the eye… How is the procedure for abortion in China? I mean, you just go and say I want to abort, or you need to present some paper indicating the fetus have some problem, or you just say it is your second Child, or maybe “underground” abortion clinics… because this may be also one of the reasons for the problem. Abortion in China may be in need of some regulations, so that doctor who just blink the eye are not enough.
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15
PM
“Abortion in China may be in need of some regulations, so that doctor who just blink the eye are not enough.”
- That is precisely one of my main points. OK, this is just secondary research and I haven’t been checking the situation on the ground. But judging by the all the information I have found, AND the amazing number of abortions that are happening, I can only conclude that abortion in China is as simple as walking to the hospital and paying 600RMB.
I will do a little follow up to this post next week. I think it is really important info, and I haven’t found any analysis from this perspective on the internet. I have even new numbers proving that more than half of the families that already have a girl manipulate the pregnancy. And this is National average.
Do you realize the significance of this? It means that, of the people that would be particularly interested in having a boy (ie. those who already had a first girl) MORE THAN HALF of them actually manipulate the pregnancy.
In other words, the practice is so extremely common among the concerned couples, that it is not even a large minority, but A MAJORITY that is doing this. This includes families of policemen, cadres, army people, etc. so the doctors can be sure that they are protected.
Every Chinese person I have told this refuses to believe me, but I am reviewing my numbers once and again, and I can’t see there is any mistake. Myself, until last week I was convinced this Sex Selection was a minority problem, I didn’t imagine so many people were involved!
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17
AM
This is definitely a serious problem, and something the extant policy has failed to address effectively. I have a friend who recently had a son, and after their ultrasound their doctor asked them if they wanted to know the sex. His wife knew this was illegal, and the doctor said yes, “I can’t tell you whether the child is male or female. However, it has a penis.”
Abortion controls and education both seem like they could help, but I wonder how likely they are to actually happen (and be effectively enforced on local levels, especially in places far from the capital).
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17
PM
Hi, thanks for your anecdote. It illustrates very well the reasons behind the problem: it is impossible to control spread of information with a ban. It is already difficult when it comes to complex IP, let alone when the info is just one bit.
Regarding the difficulty to be enforced: sure, I don’t say they are easy. I just say they are the ONLY ways I can think of, prohibition is simply impossible to implement.
And I am optimistic to a certain point. Precisely because the effort has been so poor up to now: there must be a lot of potential to affect the behaviour of those less “hard core” parents - those who were hesitating until the last minute but in the end they went for it, because there was nothing really so wrong about it was there. Of couse, the hardcores will never change, and nothing can be done really to stop them. But I am sure there is a good percentage of softcores.
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4
AM
Just a question on one part of the logic above. Is the problem here the imbalance between abortions of males and females? That problem could be solved by aborting more male babies, then, couldn’t it? If abortion is not wrong, then why should it matter; and if abortion is wrong, why is it important whether the life killed is male or female? Or is the problem not abortion as such, but the sex imbalance and its social impact?
Someone with a logic hangup.
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jzhang Reply:
June 4th, 2010 at 12:38 am
I see this has already been addressed somewhat. Nevermind.
In other news, it’s probably worth reading how forced abortions are sometimes carried out. It’s harrowing, but should be read: http://www.theepochtimes.com/n2/content/view/25235/
[Reply to this comment]
16
PM
Jules,
why don´t you write anymore?
[Reply to this comment]
Julen Madariaga Reply:
June 16th, 2010 at 6:03 pm
@Lucia: Because I am really busy these days at work. I am trying to figure out how to write my blog and keep up with my life at the same time. I will be back as soon as I get this done, thanks for your concern
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19
PM
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.
i am a native chinese ,and as far as i know ,
it is illegal to using the simple method of ultrasound scan to determine the baby’s gender.
but some rich people bribe doctoers to determine the baby’s gender. But this is rare.
[Reply to this comment]
20
PM
Ah, ehm, good..sorry I called you Jules ^^ , Julen
[Reply to this comment]
13
AM
For a college thesis, I looked at the possibility of economic factors in sex-selective abortion in China’s rural regions. While I wouldn’t deem my results conclusive (since Chinese data in general can be a little bit suspect), one of Harvard’s economics professors has a recent paper on this very topic. It seems that the introduction of old-age pensions - ie a social security net - may encourage a less skewed sex ratio. This might be because children are seen as long-term investments in China, whose government still does not provide adequate social security for most of the population, and in rural areas boys are more likely than girls to provide for their parents in old age (and not just in monetary terms - the parents are more likely to reside with the male child later on). This may be less of a factor in the cities, which also have less skewed sex ratios; in my personal experience living in Beijing, the girls are just as likely to care for their parents in old age, though it is possible that women earn less than men on average in China.
Another part is cultural - girls in China don’t carry the family name. Until Chinese people stop caring about extending their name, or children start taking on their mother’s family name, this will be rather hard to change. I agree that education and stricter rules about ultrasound testing are needed, but the latter is too easily subject to bribery (like much of the Chinese healthcare system), and I have my suspicions that we will need a combination of social security, more urbanization, and less cultural sexism (such that saying someone “is a woman” has the same import and gravity as saying someone “is a man”).
I imagine that a large part of the antagonism towards sex-selective abortion isn’t the abortion itself, but the implicit declaration that a girl’s life is worth less than a boy’s. We like to think both men and women are valued equally - both before and after birth - but that hasn’t been the case throughout any country’s history, and it will take time to change. Even with tremendous modernization, traditions and cultural connotations tend to have a lot of staying power.
[Reply to this comment]
pug_ster Reply:
July 23rd, 2010 at 11:25 pm
@Shiyo,
“Until Chinese people stop caring about extending their name, or children start taking on their mother’s family name” Children carrying their mother’s name? In western nations, when does that happen, only when the father is absent, but there is usually not alot of single parents in China.
I do think that the problem is financial in nature, as when parents have the 2nd child, the parents have to pay a heavy tax for it. I think China should lax the rules to having a 2 child policy instead of one.
[Reply to this comment]
2
PM
Hi, I write about sex traders in my second book-You are far away in Chinese.
we should meet up since we both live in shanghai.
We can meet at FCC SH event or we can meet in person.
[Reply to this comment]