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Published in final edited form as: Asian Popul Stud. 2019 Nov 14;15(3):319–336. doi: 10.1080/17441730.2019.1671015

Is banning sex-selection the best approach for reducing prenatal discrimination?

Monica Das Gupta 1
PMCID: PMC8153244  NIHMSID: NIHMS1066815  PMID: 34046078

Abstract

Pressure to ban prenatal sex-selection has grown with rising sex ratios at birth in some countries. Governments feel pressured to act, and bans seem an immediate step they can take. However, such bans have been in place for some time in South Korea, China, and India and the available evidence suggests they are difficult to implement and have limited impact. This is indicated most clearly in the Chinese census data, which throw light on the mixed effects of a very intensive effort to implement the ban.

Studies show that bans on sex-selection have negative consequences for unwanted girls and their mothers. By contrast, studies show that other policies — including mass messaging and measures to increase gender equity — show fairly quick impact in reducing son preference and increasing parental investment in girls. Such policies can permanently lower son preference and sex-selection, while also improving girls’ life-chances.

Keywords: Sex-selection, abortion, son preference, gender equity, East Asia, South Asia

Pressure to ban the use of modern technologies for sex-selection has grown in response to concern about rising sex ratios at birth in societies with a cultural preference for sons. Such bans have been in place for some time in countries such as China, South Korea and India, and countries in the South Caucasus and the Balkans which have high sex ratios at birth are under increasing pressure to impose such bans (Council of Europe, 2011, 2014).

Governments feel the need to do something about sex-selection, and bans seem an immediate step they can take to address this especially egregious manifestation of gender discrimination. However, bans may not be the most effective or humane way to reduce sex-selection. There is limited evidence that bans have much impact, and studies show that unwanted girls and their mothers are at increased risk of maltreatment in the household. By contrast, studies indicate that measures that seek to alter people’s norms are effective at enhancing gender equity, thereby reducing the demand for sex-selection.

This paper draws on evidence from studies spanning several areas of research, which, taken together, shed light on which policy interventions seem most effective at improving girls’ life-chances. This includes evidence from studies that examine (a) whether unwanted girls and their mothers are maltreated in the household (Section 2); (b) whether bans help improve sex ratios at birth (Section 3); and (c) whether other measures such as media advocacy, and laws to increase gender equity, help increase parental investment in daughters and reduce the son preference that underlies sex-selection (Section 4).

Most of the quantitative studies cited are based on rigourous evaluations, where the authors were able to create a counterfactual from the available data in order to test the impact of a policy. However, there are no rigourous evaluations of whether sex-selection bans improve sex ratios at birth, except in the case of India. For this reason, the findings of a study of the 2010 census data from China are discussed, which throw light on the results of an intensive effort to implement the ban, and illustrate how difficult they are to implement.

1. Bans against Sex-Selection

The content of laws banning the use of technologies of sex-selection differs between countries and over time (Mohapatra, 2013). They may prohibit prenatal sex-detection and/or sex-selective abortion, and may also apply to the period before conception. While most bans impose penalties on those providing sex-selection services, some also punish those who seek these services. All these types of bans seek to limit prenatal sex-selection, and are referred to here as bans on sex-selection.

1.1. What types of bans are in place?

Bans on sex-selection for non-medical reasons are in place in most East Asian and South Asian countries with high child sex ratios. They are also in place in many developed countries (Darnovsky, 2009). This paper discusses the bans in South Korea, India, and China, which have been in place for some decades.

In 1987, the South Korean government prohibited testing to identify the sex of a fetus, and providers could be punished by imprisonment for up to three years or a fine of up to $10,000 (Sung, 2012, pp 297–8). In 1990, the Ministry of Health and Social Affairs suspended the medical licenses of eight physicians convicted of performing the tests – an action that was widely reported in the media (Westley, 1995). The effort to enforce the ban increased further in 1994. As South Korea is a small country with a tightly-regulated health sector, it is far easier to implement such bans than in China and India. In 2008, the Constitutional Court ruled the ban on sex-detection unconstitutional, on the ground that it infringes the rights of health providers and parents.1

In India a 1994 Act (effective as of 1996) banned healthcare providers from providing sex determination during pregnancy except for sex linked genetic conditions.2 In 2002, the law was amended to include sex-selection at the time of conception. It imposed stringent punishments for medical practitioners as well as for clients practicing sex-selection — the woman herself being assumed to have acted under familial pressure and innocent unless proven otherwise.3 Ultrasound tests were only permitted under severely limited conditions and doctors required to maintain detailed records justifying each ultrasound test.4 Ultrasound equipment had to be registered. The 2002 amendment also gave the authorities extensive powers of search and seizure, and legal redress against such actions was explicitly denied if the authorities had acted “in good faith”.5 Implementation of these laws has been somewhat haphazard as described below, and perhaps exacerbated the potential negative consequences of the bans.

In China, a ban on sex-selective abortion was passed in 1994, and further tightened periodically from 2001 onwards (Li, 2007). In the mid-2000s, the Chinese government tried to vigorously implement the ban, as described in Section 3.

However, these bans can be difficult to implement in settings like China and India, where abortion is legal and the technology that permits sex-detection is available legally for routine medical purposes such as antenatal care. In South Korea abortion is illegal under a 1973 law except in cases of rape, incest, some birth defects and medical conditions, or to save the life of the mother (United Nations, 2002). The sanctions for health providers include imprisonment or fines (United Nations, 2002). However, the law is clearly lightly implemented, since abortion rates are very high: in 2005, there were about 0.79 abortions per livebirth.6

1.2. Bans can reduce access to safe reproductive health services

Making abortion or sex-selective abortion illegal may force people to pay more for abortions, and resort to using providers with less training and equipment. This can have adverse consequences for women’s health. This is not easy to document rigorously given the difficulties of collecting reliable data on abortions in developing countries, let alone data that permits comparing the cost and health implications of legal versus illegal abortions.

Perhaps the best estimates of the impact of abortion bans on maternal mortality ratios are from Romania, where the Health Ministry kept high-quality data. Maternal mortality rose sharply after the ban was imposed, and fell precipitously when it was lifted (David and Wright 1971, p.208; Serbanescu, Morris, Stupp and Stanescu, 1995, p.84). Data from the Romanian Health Ministry indicate that abortion-related deaths accounted almost entirely for the drop in maternal mortality ratios after the ban was lifted and women no longer needed to resort to illegal abortions (Serbanescu, et al 1995, p.84).

Reports from India indicate that efforts to implement the ban on sex-selection have caused confusion and fear amongst medical practitioners, as well as pharmacists who sell medical abortifacients. Indeed, the 2003 revision of the sex-selection ban in India gave a range of authorities sweeping powers of search and seizure with little scope for redress.7 The effect was reportedly exacerbated by sting operations by journalists and activists, and by police visits to clinics (without any basis of reports of illegal action). Although court convictions under the law are few (UNFPA, 2010a), providers feel randomly threatened and may become increasingly reluctant to provide soundscan and abortion services that are in fact legal, affecting women’s access to safe abortion and the full range of antenatal checks. The price of abortion has reportedly risen. The chaotic situation created confusion about the law, leading the government to attempt to clarify the law by issuing a pamphlet (MOHFW, 2007).

This is analogous to the findings of evaluations of bans on alcohol and drugs in the United States (reviewed in Miron and Zwiebel, 1995), that the alcohol ban raised the price of alcohol and reduced its quality regulation, affecting consumers’ health. This review also found that studies of the ban on drugs in the United States indicate that enforcement is costly, and weaken legal protections against unreasonable searches and seizure of assets.

2. Negative Effects of Sex-Selection Bans on Unwanted Girls and their Mothers

Many studies show that bans on sex-selection have a negative impact on the life-chances of unwanted children and their mothers. Aside from affecting women’s reproductive rights, sex-selection bans also force women to face their families’ displeasure at having unwanted girls.

Having unwanted daughters can affect how a woman is treated within the home. That women may suffer maltreatment in their households if they are forced to bear unwanted female children is highlighted by Article 22 of China’s 2002 Population and Family Planning Law, which simultaneously prohibits sex-selection and the maltreatment of baby girls and their mothers (Li, 2007, Appendix Table 1). An extreme example of this is the burning of a woman and her two little girls by her husband’s family in Vietnam (Phan, 2014).

Ethnographic studies from China, India, and South Korea indicate that, while son preference is high, women may be insecure and/or maltreated if they have unwanted daughters. This is indicated, for example, in an interview with a woman who bore children in the 1970s in South Korea:

“Although my first child was a son, my mother-in-law was very angry with me because the next three were daughters. Although I cooked rice for the family, my daughters and I were allowed only to eat millet. Feeling very guilty about bearing three daughters in a row, I felt I should be very obedient to my mother-in-law. I would wake up very early and do all the domestic work, work on the rice fields, feed the animals, and then weave until late into the night…. After my second daughter was born, she sent me off to work in the kitchen and the rice fields within days of the birth, not allowing the normal period of rest. My third daughter died.” (Das Gupta, Jiang, Xie, Li, Chung, and Bae, 2003, pp.172–3).

This effect is found in rigourous quantitative studies. An analysis of national survey data from China finds that women with first-born sons are significantly better-nourished and have a larger role in household decision-making than those with a first-born daughter (Li and Wu, 2011). Similarly, a study in India finds that women whose first child is a girl have poorer health outcomes than those with a firstborn boy, and are at higher risk of severe physical domestic violence starting soon after the birth (Milazzo, 2018).

Evidence from diverse settings indicates that the practice of prenatal sex-selection improves the life chances of those girls that are born, since more of them are actively wanted.8 This is reflected in lower excess female child mortality after birth, and greater investment in their health and schooling.

A rise in prenatal sex-selection was found associated with a sharp decline in excess female mortality after birth in Taiwan (Lin, Liu and Qian, 2014), and Kalsi (2015) finds this also associated with improvements in girls’ tertiary education in Taiwan. In both cases, the improvements were sharpest among higher birth order girls, the group among which unwanted girls had earlier predominated. The authors conclude that greater investments are made in children who are actively wanted.

In India, Hu and Schlosser (2012, 2015) find that an increase in prenatal sex‐selective abortion is associated with improved anthropometric indicators for girls relative to boys. Anthropometric outcomes are affected not only by nutritional intake, but also by the caloric drain of fighting infections and lowered ability to process nutrients. Thus the findings on improved anthropometric indicators are consistent with the large body of evidence from East and South Asia that unwanted girls (especially those of higher birth order) are given less access to medical care when they are ill (Asfaw, Lamanna and Klasen, 2010; Li, Zhu, and Feldman, 2004).

Yet this is not an unmixed improvement. Like the studies above, Anukriti, Bhalotra and Tam (2018) find that sex-selection reduced gender gaps in parental investment in their children’s health and substantially improved girls’ survival prospects in India. However, they also found that this came at a cost: for every three aborted girls, one additional girl survived to age five.

In assessing policy choices, it needs to be remembered that access to modern technologies is not required to achieve sex-selection. Unwanted girls suffer excess mortality after birth, especially if the family already has a girl, as shown repeatedly in studies in East and South Asia.9 Very high child sex ratios have been reached in the past through postnatal selection (Das Gupta and Li, 2007, Figure 1). Studies across East Asia and South Asia find that parents try harder to seek good medical care if their son is ill, compared with daughters.10 This is recognized by China’s 2002 law prohibiting postnatal sex-selection, which also bans abandoning, maltreating, or discriminating against baby girls (Li, 2007, Appendix Table 1).

Figure 1. Sex ratios at birth, China and South Korea, 1980–2010.

Figure 1.

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Sources:

South Korea: Korean Statistical Information Service), Statistics Korea, http://kosis.kr

China: 1980–2007 from Das Gupta, Chung and Li (2009: Figure1), 2008–09 from the National Bureau of Statistics of China (2009, 2010), and 2010 from the 2010 census (long form, as also for 2000 — see note for Figure 3 on the long and short forms).

Analogous to the findings of studies of bans on sex-selection, studies of abortion bans indicate that less investment is made in the human capital of unwanted children, affecting their future prospects. Romania offers a “natural experiment”, since a stringent ban on abortions was passed in 1966 and enforced under a strong dictatorial regime, and birth rates doubled the following year. Pop-Eleches (2013) estimates that, controlling for the socio-economic background of the mothers, children born after this ban was imposed had worse educational and labor market achievements as adults. Variation in the timing of abortion legalization across states in the United States also offers “natural experiments” to test the impact of abortion bans, and studies find similar negative impact on children (Gruber, Levine, and Stager, 1999; Rotz, 2013).

The apparent dearth of studies reporting no effect or a positive effect of bans (whether bans on abortion or on sex-selective abortion) on women and children’s life-chances could be because of an absence of such findings. It could also be because, unlike the natural sciences, negative findings tend not to be published in the social sciences.

3. Do Bans on Sex-Selection help normalize Sex Ratios at Birth?

Despite all the negative effects of banning sex-selective abortion, there is a potentially strong argument for the ban if they help normalize sex ratios at birth. Sex-selection is an especially egregious manifestation of low gender equity, and also has other consequences such as a future shortage of brides.

Although postnatal sex-selection has long been practiced in parts of South and East Asia, the new technologies make it much easier for parents to achieve their desired family composition. This is suggested by the rise in sex ratios at birth in the 1980s in China and South Korea, when the technology of prenatal sex-detection became widely available (Figure 1). It is also suggested by the rise in sex-selection when abortion was legalized in Taiwan (Lin et al, 2014).

This argument depends crucially on whether such bans are effective at reducing sex-selection. On the face of it, sex ratios at birth in South Korea and China kept climbing despite the ban imposed in South Korea in 1987, and in China in 1994 (Figures 1 and 2). Estimated sex ratios at birth in India improved after the mid-2000s (UNFPA, 2010b, Figure 1), but these estimates have large sampling errors (UNFPA, 2010b; Kulkarni, 2007) and cannot be seen as clear indication of a trend.11 Randomized evaluation of the bans’ impact is hindered by lack of data, including on the counterfactual of what might have happened in the absence of the ban.

Figure 2:

Figure 2:

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Sex Ratio at Birth and some gender-related policies, South Korea 1970–2010

Sources: Sex ratios at birth from Korean Statistical Information Service.

Policies from Shin (2006, 2014), ILO (1989), Kim (2013), Kim (2004), Chun (2018), Chung and Das Gupta (2007), and Na and Kwon (2015).

The horizontal line indicates an approximately “normal” sex ratio at birth of 106 boys per 100 girls.

Note the peaks in the sex ratio at birth also in 1986 (Year of the Tiger) and 1988 (Year of the Dragon) which are also inauspicious years for girls to be born. As Lee and Paik (2006) show, some of the sharp rise in sex ratios at birth in these years is attributable to shifting the recording of births that take place close to the beginning or the end of inauspicious years, to the neighboring year.

3.1. The available evidence on the bans’ effectiveness at lowering sex ratios at birth

Rigorous evaluation of the impact of these bans is very difficult, given the lack of randomized data for evaluation. Here whatever information can be gleaned is used to assess the effectiveness of the bans. The clearest information is available from India, and from a comparison of trends in China before and after the all-out effort in the mid-2000s, to implement the ban.

Studies of the effectiveness of the ban in India can exploit the fact that the ban was introduced in the state of Maharashtra several years before the national ban, so its impact can be evaluated by comparing trends in the sex ratio in Maharashtra with those of surrounding states. Two studies conclude that the Maharastra ban had a small but significant effect of slowing the pace at which child sex ratios became more masculine. Nandi and Deolalikar (2013) found that the ban raised the child sex ratio (females per 1000 males) by 14–26 points (i.e. between 1.4 and 2.6 percent), while (Nandi, 2015) found that it raised the odds of a female birth by between 0.7 and 1 percent. Several states in the United States have also put such bans in place in view of sex-selection by Asian parents, but a study suggests this has little impact (Nandi, Kalantry, and Citro, 2015).

For South Korea, there are no rigorous evaluations of the impact of the ban on prenatal sex-detection, since it was implemented countrywide. From 1987, health providers who broke the law on prenatal sex-detection were subject to stringent sanctions, and sanctions were enforced from 1992.12 Yet as late as 2002 there were as many as 1.41 boys per girl born at birth order 3+,13 suggesting continued access for those remaining desperate for a son. The ban was finally lifted in 2008,14 and there was no rise in sex ratios at birth.15

A multiplicity of other factors helped reduce son preference and sex-selection in South Korea (Figure 2). First, the country underwent a blistering pace of socio-economic change from around 1960, with the traditional social fabric torn apart by rapid industrialization and urbanization, as well as rapid increases in women’s schooling and incorporation into the paid labourforce.16 By 1996, South Korea had become a member of the OECD. Second, a slew of legal changes increased gender equity, including successive changes to the Family Law that culminated in allowing women to pass on the family name; laws requiring that women fill a specified proportion of electoral candidacies; and a law to underpin gender equality in employment.17 Third, the expansion of state pensions and national health insurance eroded the need to depend on sons for old age support.18 The legal reforms and social insurance programs took time to build up, but they added to the overall social transformation of Korean society. Fourth, intensive media campaigns against son preference were launched in the 1970s to discourage high fertility by people seeking to have sons, and in the 1990s to discourage sex-selection.19

This rapid social and economic transformation lowered son preference in South Korea before sex ratios at birth started falling in the mid-1990s. Between 1985 and 1994, the percent of women reporting that they “must have a son” fell from 48% to 26%, and then fell further to 10% by 2006 — before the ban on sex-detection was lifted in 2008.20 Recent surveys show that people increasingly prefer to have a daughter, because they provide more tender loving care to their parents, than sons (Chun, 2018). Countries such as China and India have also passed gender-equal laws, tried to implement bans on sex-selection, and used media advocacy to enhance gender equity and reduce son preference. However, these are large heterogeneous countries in which new social norms spread slowly compared to a small homogeneous country like South Korea.21 Their pace of social and economic transformation is also much slower than in South Korea — even in the case of China, where social insurance programs are still works in progress, and GDP per capita is still far from OECD levels.

The government of China made by far the most vigorous effort to implement the ban on sex-selective abortion, with an intense push as part of its Care for Girls program. This program has been studied by Guo, Das Gupta and Li (2016). The program was piloted from 2003 in one county in each of 24 provinces, and implemented nationally from 2006. Several government departments were given responsibilities in implementing the campaign, including those for family planning, health, education, and police, and organizations such as the Women’s Federation.

For implementing the ban on sex-selective abortion, women pregnant with their second child were specially monitored during their pregnancy by local family planning workers, as most of those allowed a second child under the family planning policy were couples whose first child was a girl and would thus be under greater pressure to ensure that their second child was a boy. Until then, the sex ratio at birth had been close to normal for first births but had risen sharply at second birth. Focusing on second pregnancies also made the workload of the implementers tractable, since only a quarter of births in the 2000 census were second births.

Stringent sanctions were put in place for those found practicing sex-selection. Private clinics would be fined and have their equipment confiscated, and the whistle-blower rewarded. Doctors in public hospitals would lose their job. Local officials would be sanctioned for underperformance. In areas which permit a second birth, couples found to be conducting sex-selection would be denied permission to try again for a second child. A large number of cases were investigated and punished.22

The 2010 census of China allows a look at the effect of these intensive efforts. The “long form” data are used, since they give the breakdown of sex ratios by birth order. The overall sex ratio at birth remained essentially stable between the censuses of 2000 and 2010, indicating that access to sex-selection remained despite the ban (Figures 1 and 3). The estimated sex ratio at birth has fluctuated around 120 boys per 100 girls since the late 1990s (Figure 1), both before and after the intervention.

Figure 3: Sex Ratio at Birth by birth order, China 1982–2010.

Figure 3:

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Source: Guo, Das Gupta, and Li (2016), derived from the full censuses of China of 1982, 1990, 2000 and 2010.

Note: The 2000 and 2010 censuses collected data in both a “short form” and a “long form”. The data from both these forms indicate that the overall sex ratio at birth remained essentially stable, rising minimally in both cases. The data here are from the “long form”, as data on sex ratios at birth by birth order were only available from these.

The effect of the intensive effort was a sharp change in the patterns of sex-selection by birth order (Figure 3). The 2010 census data show a completely new pattern, with a sharp decline in the sex ratio of second births, and a sharp rise in that of first births. Since first births constituted nearly two-thirds of all births in the 2010 census, there was no reduction in the overall sex ratio at birth. Parents were clearly seeking to have a son at the first birth, to avoid the monitoring of second pregnancies,23 and were clearly able to access sex-selection despite the stringent sanctions imposed on providers and clients of sex-selection services.

The vigorous implementation of the ban did succeed in sharply reducing sex-selection amongst the targeted women (those having their second child), but even among second births the sex ratio at birth remained as high as 130 in the 2010 census. This is a somewhat limited achievement given that the entire manpower and apparatus of China’s family planning program was brought to bear on monitoring these pregnancies to avert sex-selection.

Only China has the political and administrative capacity as well as grassroots manpower to even consider such intense effort to avert sex-selection. Yet even there, they focused on a quarter of births, those most likely to be subject to sex-selection. It would be enormously labor-intensive and expensive to monitor every pregnancy in China. The country is focused also on communication and other ways of changing social norms on son preference.

4. What else can Governments do?

A range of other policies is available to reduce son preference, to increase the value of daughters to their parents, and thereby encourage them to invest in their daughters. The impact of some of these interventions has been evaluated, and they indicate that such policies can effect change within quite short periods of time, as discussed below.

4.1. Media advocacy

Much can be done to alter people’s values and behaviors through mass messaging, and a multiplicity of studies show that careful messaging can alter norms quickly. Several of these studies use randomized data, comparing people living in areas with/without access to media or to specific media programs, thereby controlling for potential selection bias within the sample. These findings are summarized below.

Survey data from India permit analysis of the impact of media exposure on son preference, and find a highly significant impact. Some studies have used randomized data on access to media, and find that exposure to television is associated with improvements in several measures of gender equity, including reduced son preference (Jensen and Oster, 2009; Ting, Ao, and Lin, 2014). Many cross-sectional analyses have found that greater exposure to the media is associated with reduced son preference.24 Further, Lin and Adsera (2013) find that in India, mothers with greater media exposure allocate housework more equitably between boys and girls.

Studies have also found significant impact of the media on other aspects of norms and behaviors. For example, studies analyzing “natural experiments” have found significant impacts of radio and television messages on values and behaviors. In Brazil, fertility declined significantly amongst women living in areas covered by the network that broadcasts telenovelas (soap operas) depicting small successful families (La Ferrara, Chong, and Duryea, 2012). A radio soap opera in Tanzania was found effective at increasing contraceptive use (Rogers, Vaughan, Swalehe, Rao, Svenkerud, and Sood, 1999). Data from the United States indicate that the media altered voting behaviour (DellaVigna and Kaplan, 2007). A large number of less rigourous studies based just on analyzing cross-sectional data, have also found that media exposure has a large impact on a wide range of norms and behaviors.

Mass messaging to encourage people to value daughters more equally with sons is widely used in South and East Asia. This is the focus of large public awareness campaigns in China advocating for gender equity and the advantages of having daughters (Zhou, Wang, Zhou, and Hesketh, 2012), as also in India.25 However, no studies evaluating these interventions were found.

4.2. Legal and other measures for gender equity

It is well-known that measures seeking to integrate women more fully into the economic and political mainstream help to improve gender equity, but they also help parents to see their daughters as worth investing in. All these countries have tried a range of initiatives to do this, such as laws on equal inheritance for girls and boys, and efforts to encourage both sons and daughters to care for their parents.26

What is less well-known is that such measures can effect changes quite quickly. Some of these initiatives in India have been evaluated, and find that girls can benefit within a few years. One measure is the expansion of rights to equal inheritance. Variation between Indian states in the timing of this legal change offers “natural experiments” for testing its impact on girls. Deininger, Goyal, and Nagarajan (2013) and Deininger, Jin, Nagarajan and Xia (2018) find that it significantly increased many aspects of investment in daughters --- including schooling, greater access to bank accounts, and more assets brought into marriage. Deininger et al (2018) find that the daughters of women who benefited from the reforms gain even more in terms of education, time use, and health, pointing to a sizeable empowerment effect. Similar results on schooling were found by Roy (2015). Studies differ in their conclusions on the impact on female child mortality on the first generation of daughters: Rosenblum (2015:237) found a slight rise (0.17 to 0.32%) in female child mortality following the reform of the inheritance law, while Deininger et al (2018) found that fewer girls were born but those born had higher survival rates.

Other types of legal changes also alter gender roles. A number of studies find this is to be the case with a 1993 law in India requiring that one-third of local political representatives (panchayats) should be women. Women have become much more active in local political life following this law (Chattopadhyay and Duflo 2004; Deininger, Jin, Nagarajan and Xia, 2015), and this has weakened stereotypes about gender roles in the public and domestic spheres (Beaman, Chattopadhyay, Duflo, Pande, and Topalova, 2009). Kalsi (2017) finds this reservation is associated with higher female child survival. Moreover, the new role models help raise girls’ aspirations, erasing the gender gap in adolescent educational attainment (Beaman, Duflo, Pande, and Topalova, 2012).

Additional approaches to altering structures of patriarchy have also been tried in East Asia. In 2005, South Korea legislated that women can pass on their family name and assume family headship (Shin, 2006). In 2008, Vietnam passed a similar law (UNFPA, 2011, pp.55–56). These changes imply that women can perform ancestor worship rituals, a concern that had powerfully motivated people to have sons to assure a peaceful afterlife. The impact of these efforts has yet to be evaluated.

4.3. Financial incentives

A direct approach that has been tried in India and China is to offer financial incentives to parents of daughters. Evaluations of two of these programs in India have found them to be quite ineffective (Anukriti, 2015; Anukriti et al, 2018; Holla, Jensen, and Oster, 2007; Sinha and Joong 2009). It would be enormously expensive for governments to significantly offset the costs of raising an unwanted girl. Also, states “compensating” parents for having a girl imparts a negative message on the value of daughters.

Countries with greater resources can also consider broader financial interventions, such as pensions, health coverage, and other measures for social protection and insurance. These help reduce parents’ dependence on sons, though this is not their primary objective. Such programs are being expanded in China, and an evaluation of early stages of a rural old-age pension program indicated that the program had a measurable impact on sex ratios at birth (Ebenstein and Leung, 2010).

5. Conclusions

As new prenatal sex-detection technology spread in South and East Asia, the proportions of “missing girls” rose sharply. These technologies clearly make it easier for parents to achieve their desired family composition, than through postnatal selection alone.

Sex-selection is an especially egregious manifestation of low gender equity, and also has other consequences such as a future shortage of brides. Governments have sought to address the problem by banning access to the technology of prenatal sex-detection, usually accompanied by banning sex-selective abortion. They have also sought to use other more indirect measures to reduce sex-selection, such as media outreach and legislation for gender equity.

Bans on sex-selection are difficult to implement, as illustrated by the experience of China’s intensive campaign in the 2000s to implement such a ban, backed by strong political and administrative support. The effort had two prongs. The first was to detect and punish providers and clients using sex-selection technology. This seems to have had little impact on access to sex-selection, as the overall sex ratio at birth remained unchanged. The second prong was to have the army of grassroots family planning workers monitor women expecting their second child, as they are the most likely to sex-select. This effort reduced the sex ratio at birth at second birth from 152 to 130, but was fully offset by a rise in sex-selection at first birth as people sought to evade the monitoring. It would be enormously costly to expand the pregnancy monitoring to include the first birth — effectively requiring the monitoring of most pregnancies in China.

Other types of intervention that require fewer resources show promise in changing gender norms and reducing the demand for sex-selection. Studies show that media messaging can alter many aspects of behaviors and norms, including son preference. Other studies show that legal changes, such as those making for more equitable inheritance and political representation, can within a few years begin to change gender norms and parental willingness to invest in girls.

Unlike bans, indirect interventions to reduce sex-selection have a positive effect on women’s lives. Bans seek to force women to bear daughters who are unwanted by their families, and thus expose both mother and daughter to harsh treatment in the household. This negative impact is demonstrated in empirical studies in China and India, and also highlighted by the Chinese government simultaneously banning sex-selection and the maltreatment of baby girls and their mothers. Bans are also difficult and expensive to implement, even in settings with such unique political organization and grassroots monitoring capacity as China. In sharp contrast to this, the more indirect approaches help reduce son preference by enhancing gender equity, through interventions such as media messaging and more gender-equal laws. Efforts to alter gender norms and reduce son preference would seem to offer many advantages over bans in effecting a permanent shift away from sex-selection.

Acknowledgements

This study was partly supported by the Eunice Kennedy Shriver National Center for Child Health and Human Development grant R24-HD041041 Maryland Population Research Center.

Footnotes

3

Article 24 of the PCPNDT Act, http://chdslsa.gov.in/right_menu/act/pdf/PNDT.pdf, accessed 12 February 2014.

5

Paras 30–31 of the PCPNDT Act http://chdslsa.gov.in/right_menu/act/pdf/PNDT.pdf, accessed 12 February 2014.

6

This estimate is derived from the number of abortions in 2005 estimated by a survey of health facilities (Ahn, Seol, Lim, Hong, Lee, Park, Kim, and Kim, 2012), and the number of livebirths recorded for that year by the vital registration system (Korean Statistical Information Service), and may be an underestimate since abortions tend to be under-reported. Many other sources also point to the high proportion of pregnancies aborted in South Korea. See for example Choe and Kim (2007) and Sung (2012).

7

Paras 30–31 of the PCPNDT Act http://chdslsa.gov.in/right_menu/act/pdf/PNDT.pdf, accessed 12 February 2014.

8

Park and Cho (1995:75–77) noted that selective abortion reduces unwanted children, improving girls’ life-chances.

9

See for example Choe (1987) on South Korea, Das Gupta (1987) on North India, Muhuri and Preston (1991) on Bangladesh, Li et al. (2004) on China, and Lin et al (2014) on Taiwan.

10

See for example Li et al. (2004) on China; Treleaven, Toan, Le, Diamond-Smith, Partridge and Le (2016) on Vietnam; Chen, Huq, an D’Souza (1981) on Bangladesh; Das Gupta (1987) on Northwest India; and Hazarika (2000) on Pakistan.

11

Given that fertility still has a considerable way to decline in populous parts of north-central India that already manifest sex-selection, Roy and Chattopadhyay (2012) project that India’s overall sex ratio at birth is likely to increase by 2026.

12

Sung 2012: 297–8, Kim (2004: 870–871).

13

Korean Statistical Information Service (kosis.kr/eng/, last accessed March 2015)

15

Korean Statistical Information Service (kosis.kr/eng/, last accessed March 2015).

22

6700 cases were investigated between August 2011 and May 2012, of which 5800 cases had been concluded and about 2400 people punished (Guo, Das Gupta, and Li, 2016).

23

The rise in sex-selection amongst first births cannot be attributed to tighter implementation of the family planning policy, as the estimated Total Fertility Rate changed little during this period: 1.44 in 1999 and 1.37 in 2009 (National Bureau of Statistics of China 2000, 2010).

25

See for example the Meena campaign launched in 1998 (http://www.unicef.org/rosa/media_2479.htm), and the Beti Bachao campaign launched in 2015.

26

Laws on equal inheritance for girls and boys were passed in India in 1956, and strengthened in 2005 (http://www.hrln.org/admin/issue/subpdf/HSA_Amendment_2005.pdf), in China in 1985 (http://www.fmprc.gov.cn/ce/cgny/eng/lsqz/laws/t42224.htm), South Korea in 1989 (Shin 2006).

Laws encouraging sons and daughters to care for their parents include Article 49 of China’s 1982 Constitution (http://english.people.com.cn/constitution/constitution.html), Vietnam’s 2000 law http://chinhphu.vn/portal/page/portal/English/legaldocuments/Policies?categoryId=886&articleId=10001412, and India in 2007 http://dc-siwan.bih.nic.in/senior_citizens_act.pdf.

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