Handbook of Clinical Gender Medicine. Группа авторов

8]. However, there is absolutely no doubt that distorted sex ratios for newborns and children prevail in China today - and that these gender imbalances have increased dramatically during the decades of the ‘One Child Policy’.

Chinese census data outline the basic geo-demography of China’s imbalanced SRBs. For the country as a whole, SRBs since 1982 have consistently been lowest for China’s cities and highest for rural areas. In China’s 2005 ‘mini-census’, reported SRBs were roughly 123 for rural areas, 120 for towns, and 115 for cities [6]. However, there are major SRB variations within China at the regional level; as of 2005, only three provinces reported essentially ‘normal’ SRBs, while many more reported SRBs of 125 or more. Two provinces reported levels in excess of 130 (fig. 1). The geography of China’s gender imbalance is further highlighted by a county-level breakout of sex ratios for young children in the year 2000 (fig. 2). As may be seen, sex ratios are essentially ‘normal’ (105 or lower) in much of Western China and along parts of the country’s northern border - areas where non-Han ethnic minorities predominate. Higher-than-normal gender imbalances are seen in China’s east and south populated primarily of the Han majority. There are tremendous variations in the extremity of the condition within this Han expanse: a number of inland and coastal areas stand out as epicenters of the problem and are marked by concentrations of counties, each encompassing millions or tens of millions of people, wherein child sex ratios of 150 or greater prevail. Demographers Guilmoto and Oliveau [10] describe these radical-imbalance areas as ‘hot spots’. This phenomenon has diffused across China’s population over the past three decades and figure 2 may be regarded as the map of a rising national epidemic.

      Parity-Specific Imbalance

Further light is cast on the epidemiology of Chinese SRB imbalances by patterns of parity-specific SRBs - that is to say, SRBs by birth order - since 1982 (fig. 3). Significantly, SRBs for firstborn Chinese children have remained relatively low and were actually in the biologically ‘normal’ 105 range until the early 1990s. For higher-parity births, on the other hand, SRBs from the late 1980s onward have been stratospheric - biologically impossible - and continued to rise until the year 2000, at which time the SRB for higher-parity births exceeded 150 (higher-parity SRBs reportedly declined somewhat between 2000 and 2005 - but as of 2005 they nonetheless amounted to 143 for second births and to 156 for third births). At one point, researchers hypothesized that the emerging gender imbalance in China was primarily a consequence of the spread of the hepatitis B virus, which is known to skew SRBs in favor of male babies in maternal carriers [11] - but clearly that theory cannot account for the extraordinary and continuing disparities between first births and higher-order births in China. Instead, it is by now widely recognized that these gender disparities are the consequence of parental intervention through the agency of medically induced abortion and prenatal gender determination technology. Chinese parents appear to have been generally willing to rely upon biological chance for the sex outcome of their first baby - but with increasing frequency they relied upon health care technology and services to ensure that any second-or higher-order baby would be a boy.³

Fig. 1. China’s reported SRB by province, 2005 (boys per 100 girls). Source [20].

Fig. 2. Reported child (age 0-4 years) sex ratio in China by county, 2000. Source: Guilmoto and Oliveau [10]. Reprinted with permission.

Fig. 3. China: Reported SRBs by birth order (parity), 1982-2005. Sources [9, 16–20]. Reprinted with permission.

The critical health service elements in this tableau are China’s universal and unconditional availability of abortion conjoined with access to reliable and inexpensive obstetric ultrasonography. According to Chinese researchers, in 1982 diagnostic ultrasound scanning devices were available in health clinics in about one sixth of Chinese counties; over half of Chinese counties had them by 1985, and virtually all had them by 1990 [14]. By the year 2000, sex-selective abortion had become commonplace in China: rough calculations for that year suggest that no less than half of the nation’s higher-parity female fetuses were being aborted and that well over half of all abortions were female fetuses terminated as a consequence of prenatal gender determination. In effect, most of contemporary China’s abortions are thus intentional female feticides.

      Drivers of Imbalance

Though Western sensibilities may be inclined to attribute the SRB imbalances to ‘backward’ thinking in China, important basic facts are uncomfortably inconsistent with that proposition. For one thing, the abnormal sex ratios appear to be almost entirely a Han phenomenon within China, and China’s Han tend to be better educated and more affluent than the country’s non-Han minorities. However, it should also be noted that SRBs are lower in urban than in rural China. However, these differences may be more related to lower fertility levels in urban areas than to levels of education and income since lower fertility levels tend to be associated with lower SRB imbalances in comparison to those seen with higher-parity births. Further, the rise in SRB imbalances has been occurring during a time when China has enjoyed a historically extraordinary surge of development and prosperity. Between the 1982 and 2005 censuses, China’s reported adult (15+) female illiteracy rate dropped from 25 to 4%, and over roughly that same period the mean years of schooling for Chinese women rose by nearly 50%, from 5.4 to 8.0 [15–20]. Moreover, China’s estimated per capita income jumped nearly five-fold between 1982 and 2005 [21], while the fraction of the population living in extreme poverty (as defined by the World Bank) plummeted from roughly 75% in 1981 to roughly 15% in 2004 [22]. These advances have also been occurring during a time when, despite continuing political restrictions and censorship, China has been becoming vastly more open to the outside world than it was in the early 1980s. China’s increasingly unnatural sex ratios for babies and children and its growing army of ‘missing girls’ must therefore be regarded as a feature - indeed, a defining feature - of ‘globalization with Chinese characteristics’. It is worth noting that Beijing outlawed prenatal sex determination in 1989 [23] and criminalized sex-selective abortion in 2004 [24] - yet these legal strictures have obviously been ineffective in reversing this cultural phenomena. China’s unnatural long-term rise in SRBs emerged under a state-run population