Handbook of Clinical Gender Medicine. Группа авторов

nor a sufficient condition for widespread female feticide. This much is evident from SRB trends in East Asia’s four ‘Little Tigers’: Hong Kong, Singapore (more specifically, Singapore’s ethnic Chinese), South Korea, and Taiwan. All of those societies maintain voluntary family planning programs - nevertheless, each of them has registered disturbing increases in SRBs in the era of unconditional abortion and widespread access to inexpensive obstetric ultrasonography (fig. 4). In all four of these affluent and highly educated populations, SRBs approaching the dawn of the 21st century were a biologically impossible 108 or higher - and, just as in China, SRBs were typically lowest (often ‘normal’) for the firstborn babies and suspiciously elevated for all higher-parity births [25], a tell-tale sign of parental intervention through sex-selective abortion. Like China, these ‘Little Tigers’ all had laws on their books proscribing prenatal gender determination and/or sex-selective abortion that did not forestall subsequent increases in their SRBs. Of all the ‘Little Tigers’, South Korea reached the most demographically disfiguring heights: an SRB of well over 114 in the early 1990s, comparable to China’s at that time. But South Korea’s SRB declined steadily thereafter, and by 2009 it was according to official state statistics a practically ‘normal’ 106 [26] - a matter to which we shall return.

Fig. 4. SRBs reported in East Asia, 1980-2005 (3-year averages). Source: Shuzhuo [9]. Reprinted with permission.

      One commonality to China, and the four ‘Little Tigers’, would be a Confucian cultural heritage, which places an imperative on continuing a family’s lineage through the male heir as a metaphysical key to greater universal virtue and harmony. It is noteworthy that Japan - an East Asian society without a strong Confucian tradition but with easy access to abortion and obstetric ultrasonography and with very low fertility rates, just as in China and the four ‘Little Tigers’ - has always reported an SRB well within biological human norms.

As it happens, however, a strong Confucian heritage is not a unique identifier of societies at risk of mass female feticide. In Southeast Asia, Vietnam - a society with a strong Buddhist tradition - now evidences strong indications of rising SRBs [27]. Like China and the ‘Little Tigers’, Vietnam is a subreplacement fertility society with easy access to abortion and an increasing diffusion of ultrasound technology.⁴ Between 1999 (according to data from annual sample population surveys) and 2009 (the year of the country’s latest population census), Vietnam’s SRB appears to have risen from about 105 to over 110. As in China and the ‘Little Tigers’, SRBs are markedly elevated for higher order births (especially for third or higher births). Vietnam’s upsurge in SRBs, it may be observed, coincided with a period of rapid material advance (between 1998 and 2008, the per capita output is estimated to have jumped by 80% [27, 28]), and positively correlates with prosperity within Vietnam today, with the country’s lowest SRBs registered by the poorest income quintile and the highest registered by the most affluent. Like China and the ‘Little Tigers’, Vietnam also has laws on the books that make sex-selective abortion nominally illegal.

      By this point in our discussion, a consistent etiology of unnaturally high SRBs (the female feticide that underpins them) can be described. These phenomena appear to arise from a collision of three forces: (1) local mores that uphold a truly merciless preference for sons; (2) low or subreplacement fertility trends, which freight the gender outcome of each birth with extra significance for parents with gender bias, and (3) the availability of health services and technologies (easy and affordable abortion and prenatal sex diagnostics) that permit parents to engineer the sex composition of their families - and, by extension, of their societies.

      India’s Imbalance

India has a history of discrimination against girls and women through its customs of female infanticide, dowry killings, and ritual sati immolation of widows [29]. It has recorded pronounced and continuing fertility declines, and its past two decades of very rapid economic growth have been attended by increasing domestic diffusion of new technologies of every sort. With this as a backdrop, India would seem poised as a likely battlefield in the new global war against baby girls. Sure enough, both SRBs and child sex ratios have risen markedly for the world’s second most populous country since the early 1990s. According to India’s National Family Health Surveys (NFHS I-III), India’s nationwide SRB rose from around 105 in 1979/1992 to 109 for 2000/2006; more recently the country’s National Sample Survey placed the SRB for 2004/2006 at 112 [30]. According to India’s population censuses, the nationwide sex ratio for children under 7 years of age rose from 105 in 1991 to 109 in 2011 [31]. Geographically, India’s gender imbalances are most extreme in India’s northwest. In the states of Haryana and Punjab, the 0-6 sex ratio is now close 120, or even above 120, while in Delhi, India’s capital, the sex ratio for children under 7 is currently a reported 115 (fig. 5, 6). Socioeconomically, SRBs and child sex ratios in India today correlate positively - not negatively - with education, income, and urbanization. Like the aforementioned countries with high SRBs, sex selective abortion is illegal in India.

Fig. 5. India: reported sex ratios for children ages 0-6 years by state, 2001 versus 2011. Source: Census of India [31].

      Caucasus Region Imbalance

In the Soviet era, ultrasound diagnostics had been generally unavailable in West Asia within the Caucasus region. However, inferential evidence, including the increasing access to ultrasound diagnostic and newly increasing SRBs for higher-parity births, strongly suggests that these countries are subject to the same syndrome observed in so much of East Asia and South Asia. Since the end of the Cold War this area has arisen as another front in the global war against baby girls [32, 33]. Between the final collapse of the Soviet Union in 1991 and the year 2000, SRBs in Armenia, Azerbaijan, and Georgia all rose from about 105 to about 120. More recent vital registration system data indicate that SRBs in the Caucasus have declined, but only slightly: to 116 in Armenia and Azerbaijan (as of 2008) and to 112 in Georgia (as of 2004).

Fig. 6. Reported child (age 0-6 years) sex ratio in India (reaggregated subdistricts), 2001. Source: Guilmoto and Oliveau [10]. Reprinted with permission.

      Other Countries and Subpopulations

The ten societies with biologically unnatural SRBs examined thus far represent most of the world’s major religious and cultural traditions: Confucianism, Buddhism, Hinduism, Islam, and Christianity. However, these are