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Mitigating China’s skewed sex ratio at birth

To: All China Women’s Federation; the National Population and

Family Planning Commission of P.R. China

From: Xintong Hou

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I. The policy problem: skewed sex ratio at birth and the son preference culture

From the mid-1980s, despite huge socio-economic development and continuing

improvement in women’s status, China’s SRB started to rise, from 106 in 1979, 111 in

1990, 117 in 2001, to 121 in 2005. According to the result of 2005 National Census,

in 2005 males under the age of 20 exceeded females by more than 32 million in

China, and more than1.1 million excess births of boys occurred. And according to the

2010 Chinese census, the sex ratio at birth (SRB) has climbed during the past three

decades to an alarming 118 boys born for every 100 girls and this ratio may keep

worsening in the reproductive age group over the new two decades without

regulation.

National figures conceal wide local differences with some rural areas showing ratios

as high as 140. Although sex ratios were outside the normal range for almost all age

groups in almost all provinces, the highest ratios were seen in the centre and south of

the country, in the highly populous provinces of Henan, Jiangxi, Anhui, Guangdong,

and Hainan.

These overall figures also conceal dramatic differences in SRB by birth order. The

ratio rose very steeply for second and higher order births in cities 138 (132 to 144),

towns 137 (131 to143), and rural areas 146 (143 to 149), although the numbers of

second order births in cities were low. These rises were consistent across all

provinces, except Tibet, with very high figures for second births in Anhui (190, 176 to

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205) and Jiangsu (192, 174 to 212).

Undoubtedly, the widely-distributed persistently imbalanced sex ratio at birth is a

serious gender problem that will affect China’s social-economic development since it

will hurt both females and males with low social status, such as poor rural young men.

This is also a development problem since sex ratio imbalance is one of the challenges

to address Millennium Development Goals 3-gender equality. It is a result of

undermining women’s reproductive rights and may confront China with huge social

risks in its future development and pose severe threats to social stability and security

of China and even the world.

For women, the skewed sex ratio is itself the result of women discrimination while it

again worsens women’s status even more. By sex selective abortion, postnatal

discrimination against women becomes prenatal discrimination. The shortage of

women will lead to increasing bride trafficking, abductions, rape and kidnapping of

women and those unwanted girls who are born and remain unregistered will most

likely have less access to education and health care, leading to higher mortality risks

and fewer chances in life.

For men, as boy babies grow up, many will be unable to find wives. These low-status,

unmarried young males will suffer both physically and mentally, And if male-

preferring behaviors continue unabated, the future seems to offer only a vicious circle:

a male-centered society produces social behavior that generates a male surplus; that,

in turn, leaves scores of frustrated bare branches, whose anger and sense of betrayal at

being urged to seek fulfillment in husbandhood and fatherhood and yet not being able

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to match those patriarchal expectations will prompt them to either lawless or state-

sponsored violence, which in turn will lead to more militarization, which legitimizes

and rewards male centeredness.

Theoretically, the SRB is the highest where there is a combination of strong son

preference, a small family culture and an easy access to sex-selective abortion. In

china, it has reached a consensus that the rising SRB is attributed directly to sex-

selective abortion due to accessible type-B ultrasonic devices under the background of

socio-economic transformation and demographic transition especially rapid fertility

decline. Besides, the one child policy also helps to skew the SRB of second and

higher birth order. However, the fundamental reason is the deeply-rooted son

preference culture. For one thing, old Confucian ideas embedded in traditional

practices still have profound impact. For another, the poor social security system in

rural areas and not-yet-developed way of production justify son preference culture

even from a realistic perspective. As a result, there is still a minority of people,

particularly rural people insist choosing sex-selective abortion to ensure male

offspring, and thus causing the distorted SRB.

II. Case Comparison

UNFPA & WPC Support to Community mobilization and people driven response to

prevent sex selection and arrest child sex ratio decline Project

This three year project, with idea of adopting holistic and integrated approach to

address the child sex ratio imbalance in India, was funded by UNFPA and

implemented by Women Power Connection, a national NGO that acted as a nodal

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agency. Under the guidance of an advisory committee (AC) and following a

meticulous selection process, WPC also selected 32 state-level NGOs from 11 states

(See table 1 at Appendix) for implementing the project and provided them with the

fund. The partner agencies were given 24 months, from May 2009 to April 2011 for

implementing the program.

The project had three broad objectives: ensuring reduction in demand for pre-birth sex

selection practices; curbing supply of facilities which encourage sex selective

abortions; and creating pressure groups within states for effective monitoring of

implementation of the 2004 PCPNDT Act which aims to prevent gender-based sex

selection. Interventions were taken from three sides: demand, supply and

implementation. On the demand side, people were educated and influenced in a

manner that discourages them from seeking sex-determination services, on the supply

side, interventions were designed to ensure that the medical community and service

providers do not indulge in practices that promote sex-selection; and on the

implementation side, those who make up the implementation side-the authorities and

state representatives-were sensitized so that they can discharge their duties in

effective implementation of the PCPNDT Act.

In order to achieve the goals, WPC developed a four-fold model: a) lobbying and

advocacy at the State and National levels; b) building capacity of the existing and new

groups to take up this issue; c) creating a network of civil society organizations; and

d) institutionalizing the process for sustainable interventions. It actively discussed the

sex ratio issue and the PCPNDT Act at any event organized in states to generate a

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large audience. Information regarding the project and the issue was also sent

periodically through the WPC newsletter, while communication material was

distributed among the organizations 2000 members. It also conducted State level

advocacy workshops in Bihar, Gujarat, Orissa, Maharashtra, Uttarakhand and

Haryana to enhance communication between NGOs, media and the concerned

government officials.

There are several strengths of the design of this project. First, at the very beginning of

the project, from June 2009 to August 2009, WPC project team conducted 9

orientation workshops for all the partner agencies, during which they were briefed of

the project background and shared their respective implementation plans. And since

the workshops were also attended by the concerned government officials who shared

the initiative taken up by the government in respective states, the workshops turned

out to be a good interface between the government and the implementing partners.

Second, WPC offered regular monitoring visits and on site capacity building to the

partner agencies throughout the whole project. WPC project team had undertaken

regular monitoring visits with UNFPA consultants to assess the work being done at

the ground level by the state-level NGOs. Each of the partner agencies were assessed

on their performance and were classified into three categories as strong, moderate and

weak. Twenty one partner agencies which were rated moderate and weak were further

evaluated by UNFPA officials and retrained during the project. Third, partner

agencies were given the flexibility to design their particular activities based on

different context of each state. Finally, experience sharing workshops were also

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organized twice in the project life cycle which turned out to be a useful platform

where the partners collectively addressed the constraints in implementing the project

and worked out mechanisms towards accomplishing the common goal. But there were

also three main weaknesses of the project: limited capacity of some partner agencies

or capacity disparity between partner agencies, limited time span and tight budget

($28,000 one-time grant for one year for each state-level NGO).

As a result, the outcomes and outputs of the project were mixed. On the one hand, the

major outcomes and outputs of the project prove the project’s future potential. For

community mobilization, at the end of the project, through various interventions,

partner organizations reached out to 5.5 lakh households from 1260 villages in 410

Gram Panchayats /69 blocks spread across 51 districts in 11 states. For building

political support, State-level advocacy workshops were organized in 7 states in the

project period, and a formal state level network on this issue has been formed in four

states: Maharashtra, Gujarat, Bihar and Uttarakhand. All the IPs conducted advocacy

workshops in their respective districts which have been an interface between

government, civil society, media, experts etc. Steering committee/core groups were

formed in each of those states where there are three or more partner NGOs, with the

objective of working towards mainstreaming the issue in other programs run by the

government. And since partner agencies were asked to mainstream the issue in their

existing project for sustaining the project outcomes beyond the project period, the

project is highly sustainable. On the other hand, there were outcome divergences both

between States and within States due to capacity disparity between partner NGOs. For

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example, in Gujarat, besides collecting data on the implementation of the Act and

presenting it to the state governments, not much was done. The partner NGO Chenta

did not cover any district or block. Besides, due to fund shortage, some planned

activities were not able to be enforced by partner agencies at state level.

ICRW the Men and Gender Equality Policy Project (MGEPP)

The Men and Gender Equality Policy Project (MGEPP) was a multi-year (2007-

2011), multi-country project coordinated by ICRW and Instituto Promundo.

Participating countries were Brazil, Chile, Croatia, India, Mexico, South Africa and

Tanzania. Via formative qualitative and quantitative research, its objective was to

provide policymakers and program planners with data and feasible strategies to

achieve large-scale change in men’s attitudes and behaviors relating to sexual and

reproductive health, gender-based violence, fatherhood, maternal and child health as

well as to raise awareness among them the need to engage men in these policy areas

to better foster gender equality.

Project activities included: a) a multi-country scan of policies for the degree to which

they seek to include men from a gender perspective, presented in the publication What

Men Have to Do with it: Public Policies to Promote Gender Equality; b) the

International Men and Gender Equality Survey (IMAGES), a quantitative household

survey carried out with men and women in seven countries in 2009-2011, initial

results of which are presented in the publication Evolving Men: Initial Results from

the International Men and Gender Equality Survey (IMAGES); c) the Men Who Care

study consisting of in-depth qualitative life history interviews with men involved in

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non-traditional care giving roles in five countries, presented in the publication Men

Who Care: A Multi-Country Qualitative Study of Men in Non-Traditional Care giving

Roles; and d) advocacy efforts and dissemination of the findings from these different

components via various formats, including a video produced by documentary

filmmaker Rahul Roy. The IMAGES and the What Men Have to Do with it policy

research were the most important components of the project.

The International Men and Gender Equality Survey (IMAGES) is a comprehensive

household questionnaire on men’s attitudes and practices--along with women’s

opinions and reports of men’s practices--on a wide variety of topics related to gender

equality. From 2009 to 2010, household surveys were administered to more than

8,000 men and 3,500 women ages 18 to 59 in Brazil, Chile, Croatia, India, Mexico

and Rwanda. These countries represent different geographic regions where advocacy

efforts relate d to engaging men in gender equality, many of those in collaboration

with civil society groups, are underway. Topics included health practices, parenting,

relationship dynamics, sexual behavior and use of violence. After the survey, a report

was published. The report provided an initial comparative analysis of a) men’s socio-

demographic status, including employment status and employment-related stress; b)

men’s self-reported attitudes and practices, along with women’s reports of men’s

behaviors on some of these practices, related to relationship dynamics, parenting and

involvement in childbirth, health practices, violence, and transactional sex; and c)

men’s reported knowledge and attitudes toward existing gender equality policies.

Findings from the IMAGES are: a) gender attitudes of men matter since men’s

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attitudes about gender—whether they believe in a set of norms related to men and

women being equal—are consistently associated with their practices; b) men are

generally positive about gender equality. In all the countries, with the possible

exception of men in India, men did not see gender equality as a “zero-sum game”

where gains for women mean losses for men; c) education is an important factor

contributing to men’s more gender-equitable attitudes and practices; d) childhood

experiences matter, affirming the need to engage men in gender-equitable practices in

the lives of children; and e) there is a need to move beyond a superficial

understanding of gender equality toward addressing the structural but changeable

factors that underpin it.

The What Men Have to Do with It policy research-- currently under way in Brazil,

Cambodia, Chile, China, Croatia, India, Mexico, South Africa and Tanzania, with

additional countries still joining--provides insights on how to achieve large-scale

impact in promoting more cooperative and equitable relations between women and

men, reducing gender inequities and calling attention to men’s gender-related

vulnerabilities. The research suggests the need for comprehensive gender equality

policies, including: a) education policies, including early childhood education; b)

public security policies, encompassing the armed forces and the police and

incarceration policies; c) human rights policies that guarantee legal protection and

equality for women and men, including specific groups of vulnerable men; d) health

policies that implement adequate prevention targeting women and men based on

gender-specific needs and realities; e) HIV/AIDS and sexual and reproductive health

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and rights policies that incorporate gender into program development and reflect an

understanding of how power dynamics, stigma and economic marginalization leave

women and men vulnerable; f) integrated gender-based violence policies that include

primary prevention targeting men and boys; g) livelihoods and poverty alleviation

policies that recognize the roles of men and women, that recognize varied family

configurations; and h) maternal and child health policies and paternity leave policies

that engage men as fathers and caregivers. By examining the country case studies, the

research also suggests some strategies to advancing current policies: a) work with the

women’s movement is fundamental to working with men; b) gender equality and the

inclusion of men in such policies must be framed as a public good with benefits for

all; c) specific issues and events present opportunities for dialogue on engaging men

in gender equality; d) civil society plays an essential role in ensuring implementation;

and e) engage with youth in support of new attitudes for a new generation

Since the objective of the project is to provide evidence base for the necessity to

engage men as well as provide policy makers with feasible strategies to advance

current public policies, it is difficult to assess it though conventional outcome/output

evaluation approach. Neither is it possible to simply label it as successful or failed.

However, it is fair to conclude that the IMAGES and the What Men Have to Do with

it research do offer some insightful findings and strategies for engaging men in gender

equality issues. Over time, the project has the potential to create transformative

change in the laws and policies that govern relationships between men and women.

Comparison and lessons learnt

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The first project targeted the particular imbalanced sex ratio issue. The only country it

concerned was India. In order to address the sex ratio problem, the project focused on

the direct reason—gender-based sex selective abortion and tried to reduce it by

community mobilization, building social network with the civil society, ensuring

effective implementation of existed legal act and building more political support

through advocacy. It combined both bottom-up and top-down approaches and took

into account all the demand, supply and implementation sides of the sex selection. In

general, it was a successful and sustainable project with several great designs. The

only limitations of the project were fund shortage, short time span and limited

capacity of some local partner NGOs. The second project concerned more broad

gender issues and with a focus on more fundamental reason for gender inequality—

social norms, mindset and attitudes. It was unique since it tried to provide policy

makers and program planners both evidence base and strategies for engaging men in

gender inequality. And instead of separating men from women and conceptualizing

men as the problem, the involvement of men suggested by the project also give men

the change to address their own gender-related vulnerabilities. Many findings and

strategies suggested by the survey and research report were consistent with those of

the first project.

So the two projects could complement each other by focusing on both short-term,

direct reason and long-term, fundamental reason for the imbalanced sex ratio

problem. And they all suggest a combination of top-down and bottom-up approaches.

The lessons could be learnt from the two projects are: a) qualitative and quantitative

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research and effective dissemination of research findings is necessary; b) legal action

by itself is not effective in addressing sex selection that are embedded in cultural

beliefs and are influenced by social and economic factors. To become effective, it

must be an integral part of a broad and integrated campaign; c) there is a need for

coalition-building among all national and international stakeholders; d) sustain

political will and support through advocacy and sensitization workshop at both

national and provincial level is vital; e) there is a need to treat gender as relational,

acknowledge the vulnerabilities of both men and women, and to make men more

visible within gender mainstreaming policies; f) technical assistances are also crucial

for the success of interventions; g) education and childhood experience could play a

vital role to make young generation more gender-equitable.

III. Policy Recommendations

First, All China Women’s Federation and the National Population and Family

Planning Commission should work with National Statistic Bureau to conduct

further qualitative and quantitative research on the socio-cultural and economic

roots of the sex selection and determinants may change it to support

interventions against the practice.

Second, the NPAFPC should continue and extend its “care for girl” campaign to

enhance public awareness of gender equality. Social and family pressures to

produce a son are immense. However, a sustained campaign and interventions focused

on bringing about behavioral and social change could substantially alter the situation.

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First Launched in Beijing in 2004, the “care for girl” campaign has become a national

campaign aiming at promoting equality between girls and boys among parents-to-be

and creating a favorable environment for girls' personal development.  It uses public

meetings to inform people about how dire the situation is, explaining how the gender

imbalance could adversely affect their own family in the future. Besides, parents with

daughters are given certain forms of financial assistance like low-interest loans, social

security payments and special consideration for land allocation. Since it has only

operated on a national level since 2006, it’s difficult to tell its impact. But the fact that

the SRB has decreased from 120.56 in 2008 to 117.78 in 2011 may be a positive sign.

So the In the NPAFPC should continue the campaign and in the future, more modern

communication technology, such as commissioning videos and TV spots and creating

web site could be adopted to reach larger and more diverse audiences.

Third, ACWF and the NPAFPC should take the initiative to build coalition of

main stakeholders, including government officials, academicians, health

workers, the media, international donors and NGOs. The coalition should engage

in information-sharing and networking to develop strategies for combating sex-

selective abortions as well as provide support for related activities and advocacy.

Most importantly, the coalition should form a national advocacy strategy to make sure

that advocacy and behavior change interventions, undertaken by different

stakeholders, are synergistic, coordinated and non-contradictory. The advocacy

strategy should present short-, medium-, and long-term goals to address the issue from

a perspective of gender equality.

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Fourth, ACWF should work with local partner NGOs to ensure law enforcement

through community mobilization. China has outlawed the practice of sex

identification of fetuses and sex-selective abortions since 1995. However, there is

always a gap between the law and its enforcement. As a semi-official national NGO,

ACWF should work with local partner NGOs to ensure the law enforcement.

Selection of local partner NGOs should be cautious and based on various criteria,

including the child sex ratio of the area for which the program was proposed and

experience of the organization in working on issues concerning health/gender. Partner

NGOs should be given the flexibility to design specific intervention activities based

on local context. In general, activities could include: forming village or community-

level monitoring group, forming women’s coalition group, sensitizing police, doctors

and local government officials.

Fifth, ACWF and NPAFPC should work with the Ministry of Education to

mainstream gender equality into school education. According to the IMAGES,

using the education system, particularly secondary education, can be an important

locus for doing even more with girls and boys to promote gender equality. So school

curriculums should be examined for stereotypical views about boys and girls. And

since childhood experiences matter, preschool should recruit more men to work in

childcare, remove gender stereotypes from early childhood educational materials and

toys. Parents should also be sensitized on gender equality. For example, fathers should

be encouraged to involve in child care and domestic work.

Sixth, the two agencies should bring about and sustain commitment of top-level

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leadership to embed the constructive engagement of men into public policy,

through the passage and enforcement of laws, the funding of policy priorities, and

through working with key stakeholders to lead to society-level change in gender

norms. To be specific, such change could be achieved through: a) long-term

investment in reaching boys and young men in their formative years; b) far more

attention to scale-up and to bringing about structural and policy changes necessary to

promote change on a large scale; c) policy initiatives in which gender equality is

established as a new social norm; and d) research that assesses the impact of legal and

policy changes on men’s behaviors and norms.

Finally, the two agencies should also provide technical assistance to ensure the

success of interventions. Such technical assistance include adequate fund, before and

during intervention capacity building for unqualified partners based on regular

monitoring and evaluation, and consulting services.

My recommendations do not include reform the one child policy because although it

does skew the SRB for the second and higher order birth, it is not the fundamental

reason for sex selection. As my analysis has attributed the skewed sex ratio at birth

mainly to the son preference culture, the focus of my recommendations is therefore

moving the gender biased son preference culture by changing women, men, girls’ and

boys’ attitudes and behaviors that may reinforce it. Admittedly, it will take a long time

to achieve this and ACWF and the NPAFPC should implement both short-term and

long-term, bottom-up and top-down interventions by engaging national and

international stakeholders as well as women and men all together.

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References

Therese Hesketh., Li Lu., Zhu Wei Xiang (2011). The Consequences of Son

Preference and Sex-Selective Abortion in China and Other Asian Countries, Briefing

paper, Canadian Medical Association or its licensors.

Chi Zhou., Xiao Lei Wang., Xu Dong Zhou., Therese Hesketh (2012). Son preference

and sex-selective abortion in China: informing policy option, International Public

Health, vol.57, pp. 459-465.

Wei Xing Zhu., Li Lu., Therese Hesketh (2009). China’s Excess Males, Sex Selective

Abortion, and One Child Policy: Analysis of Data from 2005 National Intercensus

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Woojin Chung., Monica Das Gupta (2007). The Decline of Son Preference in South

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Britt L. Crow (2010). Bare-stick s and rebellion: The drivers and implications of

China’s reemerging sex imbalance, Technology in Society, Vol. 32, pp. 72-80.

Julie Zilberberg (2007). Sex-Selective Abortion for Social Reasons: Is It Ever Morally

Justifiable: Sex Selection and Restricting Abortion and Sex Determination, Bioethics,

Vol. 21 No. 9, pp 517–519.

Rachel Murphy., Ran Tao., Xi Lu (2011). Son Preference in Rural China: Patrilineal

Families and Socioeconomic Change, Population and Development Review, Vol. 37,

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No. 4, pp. 665-690.

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Jade S. K. Au (2002). Gender Selection In China: Its Meanings and Implications,

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AppendixTable 1 List of Partners under WPC-UNFPA Project 2008-2011

SI No.

State Partner Organizations

District covered Block covered

1. Bihar 1. Adithi Vaihsali, Muzzafarpur and Motihari

Bhagwanpur ,Kurhani, Banjariya

2.Gramin Evam Nagar Vikas Mandal

Patna Daniawan, Phulwarisharif

3. Jan Jagran Sansthan

Gaya, Nalanda and Jehanabad

Asthawan, Manpur and Modanganj

4. Jayprabha Gram Vikas Mandal

Rohtas and Bhojpur

Rohats,Tilothu,Sasaram, Shahpur and Bitiya

5. NIRDESH East Champaran Motihari & Bankatwa2. New Delhi 6. Prayatn South West

and SouthOhkla, Vasant Vihar and Najafgargh

7. Action India South, North, Northeast, East District, Southwest,Northwest, South

3. Gujarat 8. Chetna9. Swati Surendranagar

and PatanHalvad, Dhrangadhra

10. The Young Citizens Charitable Trust of India

Mehsana Mehsana, Vishnagar and Unhja

4. Haryana 11. Centre for Social Research

Kurukshetra and Ambala

Ambala Cantt and Thaneswar

12. Haryana Nav Yuvak Kala Sangam

Rohtak Lakhan Majra,Meham and Rohtak

13. PRIA Sonipat

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5. Himachal Pradesh

14. SUTRA Una,Mandi,Kangra, Solan and Sirmor

Una, Gagret, Darang, Chontda, Bejnath, Nalkhanda and Panwata Sahib

6. Maharashtra 15. Vikas Sahyog Pratishthan

Satara and Ratnagiri

Chiplun, Ratnagiri, Koregaon and Karad

16. Yerala Project Society

Sangli Miraj, Walwa and Palus

7. Orissa 17. Orissa Institute of Medical Research and Health Services

Cuttack Nischintakoli

18. Sansristi Nayagarh Nayagarh 2GPs :Badapandusara and Sinduria

19. VHAI Jagatsinghpur Kujanga20. Centre for Action Research

Khorda Tangi

8. Punjab 21. ARPAN Roopnagar Anandpur Sahib and Tehsil Nangal

22. Voluntary Health Association, Punjab

Fatehgargh and Patiala

Sirhind, Khera and Rajpura

23. Ekatra Tarn Taran Tarn Taran9. Rajasthan 24. CECODECON Jaipur, Tonk Chaksu,Niwai

25. EcatBodhgram Naguar Kachuman26. Jatan Sansthan Rajasamand Rajasamand and

Railmagra27. Society for Uplift Rural Economy28. Vihaan Jaisalmer,

Hanumangarh, Ganganagar, Alwar and Jhunjhunu

Jaisalmer and Sam, Hanumangarh, Ganganagar, Kotkasim and Surajgarh

10. Uttar Pradesh

29. Bhartiya Association for Rural Development30. Shramik Bharti Kanpur Nagar Bidhnu31. Tarun Chetana Sansthan

Pratapgarh PATTI

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11. Uttarakhand 32. Rural Litigation and Entitlement Kendra

Dehradun, Haridwar

Vikasnagar, Kalsi, Laksar and Bahadrabad