China's excess males, sex selective abortion, and one child policy: analysis of data from 2005 national intercensus survey

doi:10.1136/bmj.b1211

Published 9 April 2009, doi:10.1136/bmj.b1211
Cite this as: BMJ 2009;338:b1211

Research

China’s excess males, sex selective abortion, and one child policy: analysis of data from 2005 national intercensus survey

Wei Xing Zhu, professor¹, Li Lu, professor and head of department², Therese Hesketh, senior lecturer³

¹ College of Law, Political Science and Public Administration, Zhejiang Normal University, Jinhua, Zhejiang 310347, China, ² Institute of Social and Family Medicine, Zhejiang University, Hangzhou 310016, China, ³ Centre for International Health and Development, University College London, London WC1N 1EH

Correspondence to: T Hesketh t.hesketh{at}ich.ucl.ac.uk

Objectives To elucidate current trends and geographical patternsin the sex ratio at birth and in the population aged under 20in China and to determine the roles played by sex selectiveabortion and the one child policy.

Design Analysis of household based cross sectional populationsurvey done in November 2005.

Setting All of China’s 2861 counties.

Population 1% of the total population, selected to be broadlyrepresentative of the total.

Main outcome measure Sex ratio defined as males per 100 females.

Results 4 764 512 people under the age of 20 were included.Overall sex ratios were high across all age groups and residencytypes, but they were highest in the 1-4 years age group, peakingat 126 (95% confidence interval 125 to 126) in rural areas.Six provinces had sex ratios of over 130 in the 1-4 age group.The sex ratio at birth was close to normal for first order birthsbut rose steeply for second order births, especially in ruralareas, where it reached 146 (143 to 149). Nine provinces hadratios of over 160 for second order births. The highest sexratios were seen in provinces that allow rural inhabitants asecond child if the first is a girl. Sex selective abortionaccounts for almost all the excess males. One particular variantof the one child policy, which allows a second child if thefirst is a girl, leads to the highest sex ratios.

Conclusions In 2005 males under the age of 20 exceeded femalesby more than 32 million in China, and more than 1.1 millionexcess births of boys occurred. China will see very high andsteadily worsening sex ratios in the reproductive age groupover the next two decades. Enforcing the existing ban on sexselective abortion could lead to normalisation of the ratios.

© Zhu et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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