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

Dear BMJ Editors

I enjoyed reading your seminal 2009 article, "China's excess males, sex selective abortion, and one child policy: Analysis of data from 2005 national intercensus survey".

This topic is of great significance for Asia, especially Indian Subcontinent and China, where the problem of sex-selective abortions and resultant abnormal male/female sex ratios can have severe social, cultural, economic and even Geo-political ramifications.

BMJ has been one of the leaders and trail-blazers in putting the glare on this heinous barbarism seeping well into the 21st century.  I commend you for your efforts.  The authors of this article are clearly tenacious researchers, experienced professionals with vast knowledge base.

The Prevailing Orthodoxy: However, it is the attempt by the authors of this article to link low fertility with abnormal m/f sex-ratios that I find suspect, poorly referenced and completely at odds with hard evidence. To support my contention I would like to make following comments on the article:

On Page-1, 2nd column, line 9-13 the authors assert: "The highest sex ratios are seen in countries with a combination of preference for sons, easy access to sex selective technology, and a low fertility rate..." To support the assertion, the authors go all the way back to a 1995 (14 years prior) reference (Number-7) by two Korean authors, who blame low-fertility for abnormal sex-ratios. 

Despite the fact that the article was accepted for publication as late as 27^th November, 2008, the authors ignore Korea's own population statistics from 1990 to 2007 which completely contradict this "high-sex-ratio due to low fertility" assertion.

South Korea has all 3-ingredients: A son preference culture, easy access to sex selective technology, and a low Total-Fertility-Rate (TFR). In 1990, Korea's TFR was 1.6 babies/woman (equal to China's TFR in 2009), when the m/f sex-ratio was at its highest (116.5) recorded value. However, from 1990 to 2007, as TFR declined from 1.6 to 1.25 babies/woman, the m/f sex-ratio also normalized from 116.5 to 106.2.

The evidence is clear: from 1990 to 2007, as TFR declined, sex-ratio also normalized in South Korea. It is hard to believe that the authors were not aware of or did not have access to highly detailed Korean data before finishing their 2009-BMJ article. Detailed Korean statistics are readily available online too. For a more recent comprehensive reference see here.

Challenging the Orthodoxy: Why would the authors ignore Korean data from 1990-2007 and go all the way back to a 1995 reference to support an obsolete narrative?  The reader is wrongly led to believe that low-TFR is one of the 3-causes responsible for high sex-ratios, when the evidence from Korea clearly confirms the opposite.

Further, Page-1, 2^nd column, line 13-16 says, "In the era of one-child policy, the fact that the problem of excess males in China seems to outstrip that of all other countries is perhaps no surprise".  But the data that follows, contradicts these assertions.  Looking at Figures-1 and 2 side by side, one immediately realizes that deviating from strict One-Child-Policy OCP (type-1), to "medium" OCP (Type-2), worsens the sex ratios not improves them.

Still further on Page-5, 1^st column, line 26-30 the authors write, “In both South Korea and parts of India, where overall sex ratios are high, the sex ratio increases dramatically for second and higher order births…” But does it for South Korea? Facts clearly show that in the 7-years preceding the article, the sex ratios for 2^nd order births were 106 (2007), 106 (2006), 106.5 (2005), 106.2 (2004), 107 (2003), 107.3 (2002), 106.4 (2001) and sex ratios for 1^st order births were 104.5 (2007), 105.7 (2006), 104.8 (2005), 105.1 (2004), 104.9 (2003), 106.5 (2002), 105.5 (2001). The difference between the sex-ratios of 1^st and 2^nd Order births can hardly be considered dramatic! Moreover, for all 7-years except 2002, the sex ratios for 2^nd order births are within the 103-107 range, considered normal by the authors themselves. 

The authors then continue with this theme on Page-6, 1^st column, Lines 6-13: "The policy implications are clear: changing the regulations in force in type-2 provinces, which permit most couples a second child after a female birth, could help to reduce the sex ratio. Indeed some commentators have gone further: now that the fertility rate is below replacement, some have recommended that all couples should be allowed two children irrespective of sex..."

This statement clearly shows the authors' bias towards relaxing one-child policy, and even phasing it out.  But this conclusion contradicts the message from article's Table-3, Figure-1 and 2, that Strict OCP (type-1) leads to less abnormal m/f sex-ratios, whereas medium OCP (type-2) worsens them.

The authors did not even consider a more accurate conclusion that Strict OCP (type-1), if implemented across the entire territory of China where medium OCP (type-2) is currently enforced, might help normalize sex-ratios at birth, resulting in a better outcome for China compared to what the article shows. 

A Pattern of Bias and Contradictory Statements:  Going back 3 years, another BMJ 2006 article titled "Family size, fertility preferences, and sex ratio in China in the era of the one child family policy: results from national family planning and reproductive health survey", feeds similar obsolete assertions to the reader.

On Page-3, Ist column, line 18-onwards, the authors doubt their own convictions and then sensationally assert that "It is not clear how much these demographic changes are due to the one child policy. Many countries are seeing decreases in fertility rates, and neighbouring east Asian countries have some of the lowest total fertility rates in the world: 1.38 for Japan, 1.04 for Singapore, and 0.91 for Hong Kong. Thus the fertility rate may have continued to fall from the 2.9 seen in 1979 even without the one child policy."

That Hong-Kong and Singapore are tiny SAR-City and City States respectively, with 100% Urban population is conveniently ignored. China's scale, cultural-social heterogeneity, and enormous administrative complexity is simply in another dimension. China is 11 times larger than Japan, 270 times larger than Singapore, and 192 times larger than Hong-Kong, an astounding difference in scale.

The authors continue further, "Likewise many other Asian countries that have declining birth rates and traditional preferences for male babies are seeing serious sex imbalances: 1.19 for Taiwan, 1.18 for Singapore, 1.12 for South Korea, and 1.20 for parts of northern India. Even without the policy, sex selective abortion would be likely to continue, although it would probably be less common."

No data or evidence is provided to support the assertion as to how "without one-child-policy", sex-ratios would be less abnormal. Later, after 3 years, the authors' own 2009-BMJ article clearly proves this assertion to be weak.

Also, the authors omit the fact - as discussed before - that after 1990 in Korea, as TFR declined, m/f sex ratios normalized. Also omitted is the fact that there is a wide difference in TFR as well as population scale between North-India (>3-babies/woman) and Taiwan/Singapore. That North India faces rampantly high m/f sex ratios despite "High" TFR does not register on Authors' minds.

In the final paragraph of 2006-BMJ article, the authors write, "...A relaxation in the policy could be considered in the near future.... It is unlikely that a baby boom would result, and such a change in policy might help to correct the abnormal sex ratio."  No convincing data or evidence is provided to support the sex-ratio speculation. Again the evidence from 2009-BMJ article (Figure 1+2, Table-3) clearly shows that strict-OCP results in less abnormal sex-ratios, and medium OCP policy worsens the sex-ratios.

Venturing a little bit outside BMJ, the authors make similar assertions in a PNAS 2006 article titled "Abnormal sex ratios in human populations: Causes and consequences". On 2nd page, Ist column, lines 38-41, they write, "However, it is the combination of sex-selective technology and a small-family culture that has caused the highest sex ratios."

But hard Korean evidence till 2006 which completely contradicts these assertions is ignored. The authors further claim while discussing Table-2, "The sex ratio across birth order is well illustrated by data for South Korea during the highest sex ratio years of the late 1980s and early 1990s (see Table 2). These data show that South Koreans sex-select even in their first pregnancy..." However, the data in Table-2 clearly shows that Koreans do not sex select in their first pregnancy. Sex-ratios for 1st births is 106(1980), 104(1989), 106(1992), 106(2001) in same Table-2. According to authors' own admission, 103-107 m/f sex ratios are considered normal.

Although shortly after on 3^rd-Page lines 9-19, the authors do mention Korean government and media efforts to combat sex-selective abortions, resulting in sex-ratio normalization from 1998 to 2004, there is no mention that during the same time, Korean TFR was further declining from low to even lower.

My personal impression is that the authors have a strong bias towards linking abnormal sex-ratios with low-TFR which is completely contradictory to available evidence from South Korea.  

However, in fairness to authors, they are not alone in perpetuating the orthodoxy of high sex-ratios due to son-preference, easy access to sex selective technology, and a low-TFR. There are many other prominent demographers who do not give Korea the coverage it deserves since it challenges the prevailing orthodoxy with a competing, more powerful narrative, “As TFR declines from low to lower, abnormal Sex-Ratios can dramatically normalize even in the presence of sex-selective technology as well as strong tradition of son-preference culture”.  Vigorous and sustained government, media, civil society activism is necessary.

Direct Consequences of Obsolete Assertions: When these assertions - in the light of clear contrary evidence - are published they are rapidly amplified and sensationalized by international media to influence the public opinion, creating a climate of panic and outrage. This can lead to misinformed public agitation for policies which are based on obsolete assertions to begin with. This can also lead to anxiety, political instability and even armed conflicts.

If China phases out or relaxes its OCP, and instead of moving towards a South Korea like low-TFR and normalized m/f sex-ratio, experiences a higher-TFR and/or higher m/f sex-ratio, it will be tragic for China, Asia and the World.

The Only Cause: Low-TFR did not cause abnormal sex-ratios in Japan or Thailand (still 66% rural), because there was no son-preference culture. There is only one cause: Son preference culture. Low-TFR, whether imposed by government and/or socio-economic transformation, cannot be a cause for high m/f sex ratios if there is no son-preference culture to begin with.

Broader Consequences: Large parts of Southern-Asia below 45-degree latitude with 4.1-Billion people are suffering from severe malnutrition, low human development, land, water and food shortages as well as pollution and climate change. The immense toll on people is in part due to high population density, massive overpopulation and unsustainable birth rates.

For instance, 90% of China's 1.35 Billion people are concentrated in just 40% of its landmass, so that China's effective population density is similar to Japan, a highly overpopulated country. Japan wisely implemented policies to achieve and maintain low-TFR along with minimal immigration.

If abnormal m/f sex-ratios are carelessly blamed on low-fertility and low-fertility policies are not implemented in Asia and Africa there could be severe aggravation of water, soil, food, energy and development problems in future due to scarce and finite resources.

With political tensions rising, manpower of these two giant countries- India and China - can be mobilized for wars and imperial conquest. India and China have a history of over 2200 years of imperialism and colonialism.  China's imperialism since the Han dynasty in Korea, Vietnam, Myanmar and Central Asia; India's Imperialism in Central Asia and South-East Asia during Northern Mauryan/Karkota and Southern Chola Empires, respectively.

Asia and Africa are giving birth to 73.5 Million babies/year and 37 Million babies/year respectively, whereas Europe-Russia and North-America are making only 7.5-Million babies/year and 4.5 Million babies/year respectively.  Instead of taxing, regulating and extracting development funds from the highly indebted-West, low-fertility policies need to be implemented in Asia and Africa so they can enjoy TFR similar to 21st century South Korea for a sustainable and greener future.

Even Vietnam, a low-income country has seen recent TFR of 1.84 babies/woman. This means even poor countries with sincere efforts can achieve sustainable lower-fertility targets.

Conclusion: We must learn from Korea's sterling example that with declining fertility rates, sex ratios can normalize, become healthier and the practice of female genocide in womb can be conquered. Moreover, obsolete assertions should not be permitted in research and public discourse.

Best wishes

Andy Maheshwari