Intended for healthcare professionals


Sex selection in China sees 117 boys born for every 100 girls

BMJ 2002; 324 doi: (Published 25 May 2002) Cite this as: BMJ 2002;324:1233
  1. Ted Plafker
  1. Beijing

    Chinese demographers are warning that the nation's social fabric could unravel under pressure from an increasingly skewed sex ratio in newborns. According to figures published this month in state run Chinese media, 116.86 boys are born for every 100 girls in China. The numbers mark a worsening of a trend that began more than 20 years ago but that officials have only recently begun to face.

    Data from the 2000 census showed wide regional differences in the ratio. Normal ratios of between 102 and 106 boys per 100 girls were seen in some areas, but ratios were grossly skewed elsewhere, especially in China's more prosperous provinces. The ratio ran to 130.30 in Guangdong and 135.64 in Hainan.

    As in other Asian countries, notably India and South Korea, the Chinese have a strong traditional preference for male children, especially in rural areas.

    Knowing that daughters will marry out of the family, people want at least one son to carry the family name, help work the land, and, later, care for elderly parents.

    Since the 1970s, when China instituted its strict birth control policy, couples have sought ways to guarantee a son. Many have put baby girls in orphanages or kept them unregistered so that they might try again for a son.

    Cases of infanticide have also been reported, but experts say these are too rare to have any significant impact on the ratios.

    Instead, most experts—Chinese and foreign alike—blame the sex gap on the increased availability of ultrasonography throughout China and easy access to abortion for couples who want to use it as a method of sex selection.

    Cheap and simple ultrasound machines have been manufactured in China for nearly 10 years and can now be found at even the smallest of rural clinics and hospitals. Despite a raft of national and local laws banning the use of ultrasonography for sex selection, the practice is widespread.

    “It's a simple question of economics,” says Ma Yingtong, a demographer with the Population Advisory Committee of China's State Family Planning Commission.

    “Having a son is very important to people and they will gladly pay to get what they want.”

    Joan Kaufman, a US expert on Chinese population issues, notes that ugly consequences are already being felt, with the emergence of a “bride market” in which young women are kidnapped and sold into forced marriages in areas that lack women.

    “This imbalance is one of the key demographic problems with the one child policy, and it is starting to tip the scales against that policy,” said Dr Kaufman, of the Radcliffe Institute for Advanced Studies at Harvard University.

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