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12 Ostlin P, George A, Sen G: Gender health and equity: the intersections; in Evans T, Whitehead M, Diderichsen F, et al eds): Challenging Inequities in Health: from Ethics to Action. New York, Oxford University Press, 2001.

13 Cylus J, Hartman M, Washington B, et al: Pronounced gender and age differences are evident in personal health care. Health Aff (Millwood) 2011;1:153–160.

14 Bryant T, Leaver C, Dunn J: Unmet healthcare need, gender, and health inequalities in Canada. Health Policy 2009;91:24–32.

15 Sanchez NF, Sanchez JP, Danoff A: Health care utilization, barriers to care, and hormone usage among male-to-female transgender persons in New York City. Am J Public Health 2009;99:713–719.

16 Ng N, Kowal P, Kahn K, et al: Health inequalities among older men and women in Africa and Asia: evidence for eight health and demographic surveillance system sites in the INDEPTH WHO-SAGE study. Glob Health Action 2010;27: 3.

17 Boerder S, Santana D, Santillan D, et al: The ‘so what’ report: a look at whether integrating a gender focus into programs makes a difference to outcomes. 2004. http://www.who.int/gender/documents/SoWhatReportSept.05.pdf (accessed May 15, 2011).

      Paula R. DeCola, RN, MSc

      Pfizer Inc.

      235 East 42nd Street, MS 219-9-11

      New York, NY 10017 (USA)

       Tel. +1 212 573 7473, E-Mail [email protected]

      Social and Biological Determinants in Health and Disease

      Schenck-Gustafsson K, DeCola PR, Pfaff DW, Pisetsky DS (eds): Handbook of Clinical Gender Medicine.

       Basel, Karger, 2012, pp 18–36

      ______________________

A Global War against Baby Girls: Sex-Selective Abortion Becomes a Worldwide Practice

      Nicholas N. Eberstadt

      American Enterprise Institute, Washington, D.C., USA

      ______________________

      Abstract

      Over the past three decades the world has come to witness an ominous and entirely new form of gender discrimination: sex-selective feticide, implemented through the practice of surgical abortion with the assistance of information gained through prenatal gender determination technology. All around the world, the victims of this new practice are overwhelmingly female - in fact, almost universally female. The practice has become so ruthlessly routine in many contemporary societies that it has impacted their very population structures, warping the balance between male and female births and consequently skewing the sex ratios for the rising generation toward a biologically unnatural excess of males. This still-growing international predilection for sex-selective abortion is by now evident in the demographic contours of dozens of countries around the globe - and it is sufficiently severe that it has come to alter the overall sex ratio at birth of the entire planet, resulting in millions upon millions of new’missing baby girls’each year. In terms of its sheer toll in human numbers, sex-selective abortion has assumed a scale tantamount to a global war against baby girls.

      Copyright © 2012 S. Karger AG, Basel

      Initial Signal in China

A regular and quite predictable relationship between total numbers of male and female births is a fixed, biological characteristic of human populations. The discovery of the consistency, across time and space, of the sex ratio at birth (SRB) for human beings is one of the very earliest findings of the modern discipline of demography. Medical and demographic research subsequently identified some differences in SRB that correspond with ethnicity, birth order, parental age, and other factors [1–3], but such differences were always quite small; until the 1980s, the SRB for large human populations tended to fall within a narrow range, usually around 103-106 newborn boys for every 100 newborn girls and centering not above 105. Until the 1980s, exceptions to this generality were mainly registered in small populations and attributable to chance.

Table 1. The ever-increasing gender imbalance in China. Reported SRBs and sex ratios of the population age 0-4 years: 1953-2005 (boys per 100 girls)

Year of census or survey	Sex ratio of births	Sex ratio of the population age 0-4
1953	–	107.0
1964	–	105.7
1982	108.5	107.1
1990	111.4	110.2
1995	115.6	118.4
1999	117.0	119.5
2005	118.9	122.7
Sources [46; Chinese Academy of Social Science, unpubl. data]. Reprinted with permission.

The modern phenomenon of biologically unnatural increases in the SRB was first noticed in the 1980s - in China, the world’s most populous country. In 1979, China promulgated its forcible antinatalist ‘One Child Policy’ [4]. This program continues to be enforced to this day, albeit with regional and temporal variations in severity [5]. In 1982, China’s national population census - the first to be conducted in nearly two decades - reported an SRB of 108.5, a striking and disturbing demographic anomaly. Initially, researchers surmised that this abnormal imbalance might be in large part statistical artifact, under the hypothesis that Chinese parents might be disposed to conceal the birth of a daughter so as to have another chance for a son, given the birth quotas associated with the ‘One Child Policy’.¹ However, successive Chinese population censuses registered ever-higher SRBs. By the 2005 ‘mini-census’ (1% intercensal survey), China’s SRB approached 120 - and the reported nationwide sex ratio for children under 5 was even higher (table 1).² Over the last two decades some discrepancies and inconsistencies among Chinese data sources - census numbers, vital registration reports, hospital delivery records, and school enrollment figures - have been identified

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