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Today, a friend sent me a news article by a colleague, Dr Prabhat Jha, who explains the link between behaviour in Canada and his research on the use and abuse of selective abortion in India. This presented the ideal opportunity to reproduce here a paper I wrote recently about the implications of Dr Jha’s landmark finding that there are millions of “missing” girls in India, due to selective abortion. Please note that a more scholarly version of the text below has been submitted to a peer-reviewed journal. Therefore please do not excerpt or cut-and-paste any part of this blog post. However, linking to the post is fine. Thanks.
Implications of India’s Skewed Sex Ratio
In their widely cited 2011 paper, Dr Prabhat Jha and colleagues used publicly available demographic data (the national census and household health survey data) to show that there were likely 4.2-12.1 million selectively aborted girls in India from 1980 to 2010. The authors convincingly suggested that selective abortion was the primary explanation for a steadily declining female-to-male sex ratio in India, which in turn is driven by cultural factors associated with a preference for boy children.
Their paper was not the first to point to a crisis in India’s sex ratio. In 2001, the UN estimated that there were 44 million “missing women” in India. And in 2008, researchers examined hospital delivery data over 110 years to show that India’s national sex ratio fell dramatically after 1980, when ultrasound technology for antenatal sex determination became available. Many regional studies confirm that this trend is truly national.
Similar trends have been famously seen in other countries, especially in China, where the “one child policy” is thought to have resulted firstly in an epidemic of female infanticide, and secondly, after the arrival of antenatal sex determination technologies, in an increase in selective abortions of female foetuses.
Beyond the moral objections to female foeticide is the demographic crisis represented by a severely unequal sex ratio. However, the likely impacts of such imbalance are not well known, nor have they been well considered in the wider health literature. They include:
- Speculatively, a rise in levels of violence amongst unmarried men of reproductive age, as competition for brides increases, although violence always has multifactorial causes. This is because, in affected societies, marriage and paternity are linked to social prestige among men.
- A shortage of marriageable women may lead to a disavowing of lower class or less socially desirable men, causing social strife stratified to the less economically robust classes.
- An expansion of the sex industry, probably involving coercion and trafficking and possibly contributing to higher rates of sexually transmitted infections.
- An increase in inter-generational relationships, most egregiously manifesting as child marriage. In India, child marriage (usually involving young girls and much older men) is already such a serious problem that it has attracted the attention of the Clinton Global Initiative and other global NGOs. Child brides are at greater risk for a host of additional unwelcome experiences, such as reduced educational opportunities, increased economic dependency and greater rates of maternal complication and mortality.
- Parts of India already have a classical history of polyandrous marriage. While polygyny has been popular in many societies historically, polyandry seems to arise more sporadically and in times of resource crisis or bride shortage. Recent trends in Indian fraternal polyandry have arisen from a desire to keep ancestral lands from being divided by marriage. But it is conceivable that such an arrangement might become more commonplace if the sex ratio continues to skew.
- Two possible positive outcomes include a greater tolerance of homosexual relationships and a greater acceptance of cross-class and cross-caste marriages. However, the latter would likely involve unions between powerful men and vulnerable women, which may only serve to exacerbate existing gender tensions and exploitative relationships.
In India, the social drivers for sex selection are both deeply cultural and shallowly economic. Amongst orthodox Hindus, the care for elderly parents is traditionally the domain of the eldest son and his wife. Thus, the economic disincentive for having a girl is reflected in the local saying that raising a daughter is akin to “watering someone else’s garden”. A preference for sons manifests in many agrarian societies in which a male work force is valued for their wage-earning capacity. And the tradition of dowry, originally intended as a vehicle for assuring that a new bride had personal wealth, often in the form of jewellery, in the event that she was widowed or abandoned, has mutated into a form a “bride price”, in which families often go into debt to marry off their daughters. These are all economic disincentives for having girl children.
Interestingly, Dr Jha found evidence that sex selection is most prominent amongst affluent households for whom the economic disincentives are less relevant. For them, it seems likely that a simple and sexist preference for sons is at play, which has at its heart a cultural bias for the social cache and prestige that sons provide. The prime distinction between the affluent and the poor in this sense, then, is that the former can more readily afford expensive sex selection technologies. Importantly, the clustering of the trend in wealthier households also means that India’s vaunted economic expansion, especially in the middle class, is unlikely to assuage the sex ratio situation; indeed, as more families enter the realm of the affluent, it may exacerbate it.
With drivers and incentives for sex selection being social, cultural and economic, policies for addressing the crisis cannot be limited to the medical realm. In Jha’s paper, it is noted that India’s Pre-Natal Diagnostic Techniques Act of 1996, which seeks to penalize the misuse of prenatal sex determination technologies, is largely unenforced. The authors suggest that India’s traditional inability or unwillingness to police private medical practice is the greatest hindrance. The paper’s accompanying commentary recommended better enforcement of existing policies as the appropriate solution. But it is possible that the desire to penalize sex selection, while evident at the policy-making level, has yet to penetrate to the street level, due to the depth and pervasiveness of cultural and economic drivers.
In the words of one researcher, “It is evident that mere legislation… cannot solve this social evil. Moves to address all forms of gender inequality… are needed to strike at the causes for distortion of the sex ratio.” Social change for improving women’s rights, both in India and elsewhere, is required. As noted by another writer, “Nothing can realistically be done in the short term to reduce the current excess of young males, but much can be done to reduce sex selection now”. While official policies have their place, in India no progress will be made unless the social and economic drivers are addressed. For the former, this means public awareness and educational campaigns focusing on the value of girls. And for the latter, it means finding creative solutions to expand employment opportunities for both sexes, and to remake the social welfare infrastructure to limit the expectation of gender-based elder care, inasmuch as such is determined by an expectation of the roles of the eldest son and his wife.
Given the status of India and China as both the world’s fastest growing economies and our most populous lands, the demographic situation faced by both countries is relevant to all of us. To refer to those nations’ skewed sex ratio as a mere crisis is an understatement. Such profound demographic change may prove to be the basis for a host of pervasive social, economic and medical woes manifesting as the present generation of newborns reaches reproductive age.
Comments are welcome.
Update: This paper has been published in the Internet Journal of Public Health