New Internationalist

Girls not allowed

October 2013

Prenatal sex selection is an unfolding tragedy. Vanessa Baird assesses the damage done - both personal and global.

Pawan Kumar/Reuters
Choosing boys over girls in China and India has already skewed the global average sex ratio at birth to a biologically impossible level. Pawan Kumar/Reuters

There’s a moment in the documentary film ‘It’s a Girl’ that is at once chilling and heart-rending.

A woman smiles nervously as she starts to describe the methods she used to kill her eight new-born baby daughters.

Then she puts her hand up to her own neck, to indicate strangulation – and it’s almost as though she were doing it to herself. Which, in a way, she was.

We soon learn that several other women in her community in rural Tamil Nadu admit to similar measures to provide their husbands with a son.

Such brutal customs are rare in India today, sociologists say, and confined to certain isolated communities.

A far greater number of baby girls die more slowly – from neglect. Hence the shocking statistic: an Indian girl aged between one and five is 75 per cent more likely to die than a boy. It’s the worst under-five gender differential in the world.

But far more common than letting girls die today is another form of sex discrimination – making sure that girls aren’t born at all.

Skewing the world

Foetal imaging technology became widely available in the 1980s. Expectant parents in China and India, the planet’s most populous countries, were able to know the sex of the baby in the womb. And if they did not like what they saw, they could abort and try again.

The result of their choices: more boys. Many, many more boys. It is estimated that in China alone there will be 30-40 million more boys under the age of 19 by 2020 than girls. That’s equivalent to all the boys in the US.

Naturally, it also means far fewer girls. The latest global UN estimates are that 117 million females are missing.3 In other words, women and girls who would be alive now were it not for sex selection before birth or neglect and infanticide after. Imagine the entire female populations of Britain, Canada, Australia, Spain and France – all gone.

'Sex selection is a rampant, multibillion dollar industry. That's what keeps it going...'

Normally, 105 boys are born for every 100 girls. Boys being biologically weaker, nature seems to adjust by ensuring more are born. This ratio is pretty consistent, with anything over 107 beginning to look dodgy. But because of all the skewing that has already occurred, 107 is the world average today – impossible in purely biological terms.

China is the worst offender, with around 118 boys born to every 100 girls; India records a national average of around 111, though in some northwest states the disparity is more extreme.

It’s not just an Asian problem. Several European countries, including Azerbaijan, Armenia, Georgia and Albania, are having many more male births than they ought, due to sex selection. Azerbaijan, at around 116 boys to every 100 girls, has the second-worst sex ratio at birth in the world. And there are signs of distortions in Western Europe and North America, too.


This hasn’t happened overnight; there were warnings. Back in 1990 economist Amartya Sen published a seminal paper claiming that millions of women were ‘missing’. At that time he blamed female infanticide and neglect. It took a while for analysts to detect the role that prenatal sex-selection was playing.

During the next decade, more warnings were given, but little was done at a policy level to address the problem. Now academics are busy calculating, and speculating upon, the future impact of so many surplus males – on health, crime, relationships, family life, social harmony, global security.

Some economists had ventured that the status of women would improve as a result of their ‘scarcity value’. The opposite appears to be happening, as females are increasingly viewed as a commodity, a resource, to be bought and sold.

Trafficking (much of it forced) of girls and women into China has become a multibillion dollar business with demand rising (see ‘Blue Dragon to the rescue’ on page 26). Child marriage, still common in India, is now making an appearance in China, too – there are reports of parents kidnapping girls to raise as partners for their sons.

Nita Bhalla/Reuters
This young woman has been bride-trafficked to Uttar Pradesh, an Indian state with one of the worst shortages of girls and women. She has been repeatedly raped by her husband's brothers, who cannot find wives. Nita Bhalla/Reuters

High levels of sexual violence in Asia – especially gang rapes in India – have led to media speculation that ‘female shortage’ might be a factor. Easier to ascertain is the violence, physical and emotional, that women in India may be subjected to at the hands of their in-laws if they refuse to take a sex test or abort a female foetus.

This issue has been thrust into the limelight by a Delhi doctor, Mitu Khurana. Highly unusually, she has brought criminal charges against her husband – a surgeon – his mother, his brother and two hospital staff. She alleges that, when she was pregnant with twin daughters, she was deliberately fed food she was dangerously allergic to after she refused an illegal sex test, which hospital staff then subjected her to without her consent. The case is currently going through the Indian courts.

Gender imbalance is not great news for all those ‘surplus’ boys either. By 2020 an estimated 24 million young Chinese males will face the prospect of life on the shelf. The poor or less well-educated are most likely to be affected. ‘It’s a tragedy,’ says French demographer Christophe Z Guilmoto, ‘in societies that marginalize unmarried men as failures and where there is no model of the fun-loving bachelor.’

Why boys?

In places with seriously distorted sex ratios at birth, parents almost invariably select in favour of boys. Tradition is often given as the reason for this intense son preference.

In China, for example, girl aversion is often put down to the Confucian custom that family name and property can only be passed down the male line. In India, Hindu culture is most strongly associated with son preference. Traditionally, the son provides for his parents when they grow old – and beyond. Only a son can perform the funeral rites that will aid passage into the afterlife. Women, meanwhile, are expected to abandon their own kin on marriage and become part of their husband’s family.

Guilmoto, who has spent two decades studying skewed sex ratios, warns against making generalizations. But he has detected some common basic determinants. Countries where skewing has been most extreme are those where there has been rapid economic growth. In these places technology for diagnosing the sex of the foetus has become widely available and affordable. They are also places where fertility has plunged, with people having far fewer children than their parents had.

In a nation like India, economic growth has produced an appetite for consumerism that appears to mesh with traditions deeply harmful to girls and women.

Photographer and gender activist Rita Banerji is founder of the 50 Million Missing campaign in India. She pulls no punches when she says that in India sex selection is essentially ‘greed based’. Because dowry is paid by the bride’s family, and is often a large portion of family wealth, ‘every son is a way of getting money in’ whereas every daughter represents an outflow of wealth from the family.

For Banerji, dowry, prenatal sex selection and female infanticide are part and parcel. ‘The minute dowry enters a community, everyone becomes greedy for it. It becomes a way of thinking, “Okay, this is a way of getting a huge amount of money”.’

The female, she adds, ‘becomes a resource pawn in this patriarchy – you can buy her, sell her, kill her, keep her. However you want. It’s like with any resource.’

Like India, the Eastern European countries with skewed sex ratios have also embraced free market capitalism with gusto while bearing far fewer children. This, in itself, does not lead to sex selection, but combined with intense son preference it does. If you have just two children there is a 25 per cent chance that you will end up without a son – no joke in a patriarchal society fixated on male offspring.

China’s one child policy, in place since 1979, is often blamed for female infanticide and high levels of sex selective abortion. But according to China expert and paediatrician Therese Hesketh, the policy has had only a marginal impact on the sex ratio. ‘It is not clear that lack of a policy would help,’ she says. Indeed, the data shows that sex selection is highest in areas where people have been allowed to have a second child if the first is a girl.

The law and the A-word

Sex selection is now illegal in at least 36 countries. But in those where son preference has the biggest global impact enforcement of the law is weak or non-existent. In China there is no enforcement. ‘Hospitals with suspiciously high rates of female foetuses being aborted could be investigated but are not,’ says Hesketh. ‘For some reason the higher echelons just don’t do it.’

In India, Banerji sees a more sinister complicity: ‘Sex selection is a rampant, multi-billion dollar industry that everyone – the lawmakers, the law implementers, doctors and medical companies – is benefiting from. That’s what keeps it going. The law in India is so blatantly violated it’s as good as having no law.’

Sex selective abortion is a tricky area for feminists: a woman’s right to choose has become a tool of misogyny.

She adds that British and Norwegian Indians come to India to get sex selective terminations because the rules are more stringently applied in Britain and Norway. And when a leading official in the north Indian state of Haryana tried to set up a sting operation to catch law-breaking doctors he was persecuted by colleagues for trying to implement the law.

Others point out that the bans are unenforceable. Ultrasound tests are a regular feature of pregnancy management; the sex of the foetus can be disclosed without a word being said. The abortion can take place in a separate clinic; a reason other than the sex of the foetus can easily be given.

There is also concern that attempts at tough enforcement could restrict women’s legitimate and hard fought-for right to abortion.

Sex selection is tricky area for feminists: a woman’s right to choose has become a tool of misogyny. In the absence of a strongly articulated feminist position on the subject, in the US the issue has been effectively hijacked by the pro-life lobby.

Although the US has a normal sex ratio at birth, Republican anti-abortion lawmakers this year managed to push through the Prenatal Non-Discrimination Act, under the pretext of defending gender rights. But, according to critics, the law goes beyond banning prenatal gender identification to restricting women’s access to abortion itself. It will allow no exceptions to save the life or health of the mother, nor any medical reasons for sex selective abortions – for example to avoid fatal inherited conditions linked to a particular gender. Doctors will be required to racially profile women seeking terminations and scrutinize their medical choices.

Miriam Yeung of the National Asian Pacific American Women’s Forum is strongly opposed to sex selection but in May this year she joined a broad range of health and reproductive rights bodies to file a legal challenge to the law in Arizona.

‘I would welcome real efforts and real partnerships to fight gender inequity and racial discrimination,’ she commented. ‘But laws like this are not those efforts. If they want to address son preference, the way to do it is not by stigmatizing women and taking away our rights.’

Abortion is the means – not the cause – of sex selection.

But honest regulation of sex selection, however tricky to enforce, is necessary because individual acts are having extremely harmful collective consequences.

Anupam Nath/Press Association Pictures
Violence against girls and women is increasingly reported - and protested against - in India. Anupam Nath/Press Association Pictures

Families need to realize that sex selecting for boys is a crime against girls. And that forcing or coercing women to abort female foetuses is an act of extreme cruelty for which perpetrators will be properly punished.

‘The law and its implementation,’ argues Banerji, ‘is fundamental to changing mindsets.’

Change is possible, as South Korea has shown. It is to date the only country that has managed to bring a highly skewed sex ratio at birth back to normal.

But it will take more than laws to stop the pursuit of son preference.

In the view of Guilmoto, governments have only limited impact when it comes to reproductive and family choices. It is social movements that bring about revolutions.

The big revolution that needs to happen is gender equity in every area – in family life, in law, in the community, in work, in politics, on the street.


In India, rallies protesting violence against girls and women take place with great regularity across towns and cities these days.

Awareness keeps rising. The imperative is to stop sex selection and to end the war on girls it embodies. Women like Mitu Khurana are tackling this in a direct and personal way. Leaving her husband and giving birth to her daughters made her stronger, more confident, she says. She believes she has a duty to speak out for those who cannot and to ‘fight for a better world for my daughters’.

The Indian media, meanwhile, is full of stories about the results of the latest census and comparing how states are doing in trying redress their male to female imbalances. Haryana, one of the states with the fewest girls, has just reported a record take-up of the government’s Ladli scheme which rewards parents of girl children with cash payments and allowances until she reaches 18.

These are just a few strategies, more carrot than stick, that India has been trying out. China has been offering similar up-beat incentives to parents within its Care for Girls programme. Their success, or not, has yet to be properly assessed, says Guilmoto. China and the worst parts of India are modestly improving their sex ratios, he says. Something is working, but we don’t know what yet. In China, for example, the introduction of old-age pensions in 2007 has lessened economic dependence on, and hence need for, sons. But even with rapid improvement – an optimistic scenario – it would take until at least 2050 before adult sex ratios got back to normal.

Some social change will happen perforce, as reality changes. A surfeit of males may prompt societies to acknowledge and accommodate a diversity of family and sexual arrangements. According to surveys of young Chinese urbanites, attitudes towards homosexuality are already becoming more relaxed.

However, there are indications that the sex selection habit is catching on in other parts of the world. Nepal and Pakistan are beginning to show the signs. In the Middle East, private clinics in Beirut and Amman are offering, for those who can afford it, sex selection without abortion, using advanced technologies such as sperm sorting for IVF or pre-implantation genetic diagnosis (PGD). These are the high-profit, booming areas of the industry that offer easier sex selection with less chance of detection. It’s a worrying thought.

Surely if the past two decades have taught us anything, it is that nature, left to its own devices, does sex balancing pretty well. Humans clearly do not.

The girls are back in town...

Lee Jae-Won/Reuters
Lee Jae-Won/Reuters

South Korea was the first to report that its sex balance was getting seriously warped in favour of boys. And the first to do something about it - fast. Read more...

Front cover of New Internationalist magazine, issue 466 This special report appeared in the sex selection issue of New Internationalist. You can buy this magazine or, to get stories like this one through your door every month, subscribe.

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