Cablegate: Understanding China's Rising Sex Ratio Imbalance

DE RUEHBJ #0017/01 0060746
R 060746Z JAN 10




E.O. 12958: N/A


1. (SBU) SUMMARY: China's sex ratio at birth (SRB, the number of
male births to 100 female births) reached 120.56 in 2008, marking a
continued and dramatic rise in the gender imbalance since the 1980s.
Across all of China's provinces and municipalities, only Tibet now
has a normal SRB. The underlying cause of the sex ratio imbalance
is a strong cultural preference for sons exacerbated by a strict
birth limitation policy, leading to both prenatal and postnatal
discrimination against girls that results in widely practiced sex
selective abortion and excess female infant and child mortality.

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2. (SBU) From a near normal SRB of 107.6 in 1982, China's national
average SRB rose to 116.9 in the 2000 population census, triggering
the country's first public acknowledgement of the sex imbalance
problem in 2002. (NOTE: A natural sex ratio at birth is between 103
and 107. END NOTE) The SRB rose to 118.58 in 2005 and has continued
to creep up each year since then, reaching a high of 120.56 in 2008
(National Statistical Bureau/NSB).

3. (SBU) In recent years the sex ratio imbalance has spread
nationwide. According to the 2000 census data, seven
provinces--Inner Mongolia, Heilongjiang, Guizhou, Qinghai, Ningxia,
Xinjiang, and Tibet, had normal or near normal SRBs of less than
108. By the 2005 inter-census, however, only Tibet still showed a
normal SRB of 105.15. (NOTE: Tibet has the most permissive family
planning in China with no birth limitation policies for Tibetans
residing within the Tibet Autonomous Region (TAR). END NOTE) The SRB
also has increased across both high-income and low-income

4. (SBU) In all regions, the overall SRB conceals dramatic
differences in SRB by birth order. For example, in families where
the first child is a girl, the sex ratio imbalance for the second
child is much higher. In 2005, the national average sex ratio for
first births remained close to normal at 108.41. The sex ratio
imbalance for second births was 143.22 and for third births 152.88.
For second order births, nine provinces had SRBs of over 160; for
third order births, sixteen provinces had SRBs of over 160 and among
those four, Beijing, Anhui, Jiangxi and Guizhou had SRB of over 200.

------------------- ----------------

5. (SBU) While the gender imbalance in China has been receiving much
attention by international press and academics in recent years,
there is some indication that the magnitude of the imbalance may be
peaking, at least as a national average. For example, the sex ratio
for children under age five showed a small decline from 2007 (123.6)
to 2008 (123.3), as did the sex ratio imbalances for second and
third births from 2000 to 2005 (for second births from 151.9 down to
143.2 and for third births from 160.3 down to 156.4). Some
demographic experts speculate that these indicators could signal an
emerging turnaround in the gender imbalance.

6. (SBU) Professor LI Shuzhou, from the Institute for Population and
Development Studies at Xi'an Jiaotong University and Deputy Leader
of the Experts' Advisory Group to the National Care for Girls
Program Office, recently shared with ESTHOff a 2009 study he
co-published on the "missing girls" phenomenon. His cohort analyses
of the sex ratio of children under age five using census data
(collected every five and 10 years) from 1990 through 2005 show that
in over half of China's provinces and municipalities, the child sex
ratio reached a peak in either 1995 or 2000. In some regions, the
sex ratio has continued to fluctuate around that peak, while seven
regions--Beijing, Inner Mongolia, and the provinces of Liaoning,
Zhejiang, Fujian, Shandong, and Guangxi--have seen a decline in the
gender imbalance, either from 1995 through 2005, or from 2000 to

7. (SBU) In a November 30 meeting with population experts at the
China Population and Development Research Center (CPDRC), the main
policy research arm of China's National Population and Family
Planning Commission (NPFPC), Professor GUI Jiangfeng also opined
that the national average SRB must be nearing its peak. He
explained that because ultrasound is already in pervasive use for
the purposes of prenatal sex selection, continued increases in the
SRB imbalance are unlikely to occur. Professor LIU Zhongyi, another
expert from the CPDRC present at the meeting, suggested that there
also may be a natural rebalancing of the sex ratio as society begins
to feel the pressure of the missing girls.


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8. (SBU) Strong traditional preference for sons is seen as the root
cause of China's skewed sex ratio. A patrilineal family system has
resulted in a dominant male status in property inheritance, family
succession, and ritual duties. Additionally, patrilocal marital
customs--where the wife leaves her own family and joins her
husband's and where sons, not daughters, take care of parents as
they age--add the practical need for sons to ensure old age security
to an already long-standing cultural bias in favor of males.
Whereas previously families could ensure the family had sons simply
by having more children, China's implementation of a strict family
planning policy to slow population growth, beginning in 1979,
ensured that rural families, facing constraints in the number of
children they could have, would almost always prefer to have sons.

-------------- ------------------------------ ------------

9. (SBU) Prenatal sex selection, legally banned in China but still
widely practiced, is largely acknowledged as the primary enabler for
China's abnormally skewed SRB. The steady rise in the sex ratio
across all birth cohorts trends with the increasing availability of
ultrasound as a tool for prenatal sex determination. First used in
the early 1980s, ultrasound technology had reached rural townships
by the mid-1990s and is now cheap and accessible even to the rural
poor. Abortion is also widely available due to the family planning
infrastructure established to implement China's strict birth
limitation policy (REF A).

10. (SBU) Although both prenatal sex identification for non-medical
reasons and sex-selective abortion are technically illegal as
stipulated in the 1994 Law on Maternal and Child Health and later
reaffirmed by the 2002 Law on Population and Family Planning, all of
Post's sources consulted in recent weeks underscored the difficulty
of enforcing these prohibitions. The burden of proof is
challenging, the implementing regulations vague, and the penalties
and sanctions largely ineffective as deterrents. In a November 20
meeting with ESTHOffs, Professor HU Yukun of Peking University's
(PKU) Institute of Population Research described the prevalence of
private and underground clinics that openly advertise the
availability of "quick and painless" abortion services. She noted
that proving an abortion has been carried out based on sex selective
criteria and not on government sanctioned family planning grounds
remains nearly impossible.

11. (SBU) Abortion studies and data are limited in China, but one
2008 doctoral dissertation carried out at Renmin University on sex
ratio includes a section on abortion, analyzing data on 12,000 to
18,000 cases occurring each year from 2000 to 2006. The nationwide
study found the average sex ratio of aborted fetuses over the
six-year period to be 72.5 male to 100 female (meaning nearly 50
percent more aborted female fetuses), with this sex ratio at the
lowest in 2006 at 64.9 male to 100 female. A separate 2005 study on
sex-selective abortion in rural Henan province published by the
California Center for Population Research at the University of
California, Los Angeles, examined data from 1,056 rural women and
followed 2,362 total pregnancies. The results showed 18 percent of
the pregnancies were aborted and, among the terminated pregnancies,
35 percent were reported as due to "undesired gender." The sex
ratio of the live births was 116.9.

--------- ------------------ ---------------

12. (SBU) Although overall infant and child mortality has declined
considerably in China in the 30 years since economic reforms began,
the plight of girls after birth relative to boys has worsened. In a
normal population, the under age five mortality rate typically is
higher for males than for females, which counteracts the natural
higher number of boys born and leads to a more balanced (or lower)
overall male-female sex ratio of children under age five than at
birth. However, in China, while the sex ratio imbalance at birth
has been increasing each year, reaching 120.56 in 2008, the overall
2008 sex ratio of children under five was even higher, at 123.26,
likely due to excessively high post-natal female child mortality.

13. (SBU) In meetings on November 19 with Lisa Ng Bow, UNICEF
China's Chief for Plans of Action and Promotion of Child Rights, and
on December 4 with Mariam Khan, UNFPA's Deputy Country
Representative, ESTHOff learned that the strong preference for sons
over daughters in China continues to be reflected in the neglect and
mistreatment of girls. Bow and Khan noted that while infanticide
now only occurs in extreme cases, gender inequities in girls' access
to food, nutrition, and medical care still exist, which lead to
higher female infant mortality. Government sources concurred. As
former Director MA Li and population experts from the CPDRC

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explained in a November 30 meeting with ESTH officers, the neglect
of girls is most frequently seen in access to urgent medical care,
especially in the immediate period after birth.

14. (SBU) Academic research findings support the idea that biases
against girls leading to childhood mortality in China is highest in
the first year of life, and perhaps even the first days of life.
Professor LI Shuzhou's "missing girls" study (same as in paragraph
5) found the male-female ratio of mortality rates for children less
than one year old has been steadily dropping over the last thirty
years and in 2005 was the farthest below parity among children under
five, at 80 boy deaths to every 100 girl deaths, even though in
normal populations, male children typically have a slightly higher
mortality rate than female children. A 2006 study by Fudan
University's Professor WU Zhuochun that followed a cohort of 3,697
pregnancies from 20 rural villages in Anhui province from pregnancy
registration through seven days after birth found not only a sex
ratio at birth of 159, but also that the likelihood of death for
girls was almost three times that of boys during the first 24 hours
of life.

-------------------- -------------------------

15. (SBU) A common question is how much preference for sons and the
pressure of China's one-child policy have caused families not to
report first born girls so they may try again to have a boy, a
phenomenon which would explain some of the sex-ratio imbalance in
reported births. There is disagreement as to the degree
underreporting of girls has exaggerated the gender imbalance.
NPFPC's Care for Girls Leadership Committee gave a presentation on
sex ratio in 2008 that acknowledged underreporting probably does
exist but cited adjusted findings for the SRB of 115 in 2000 and 118
for 2005, only slightly lower than that yielded in census studies.
Professor ZHAI Zhenwu, Director of Renmin University's Population
and Development Studies Center (PDSC) argues that the underreporting
is more severe; his 2009 study comparing population data with later
education enrollment data for the same cohort determined that
China's sex ratio imbalance, while serious, is in reality five
points lower than the census data would indicate. CPDRC's Ma
stressed to ESTHOff at their recent meeting that the government had
studied the issue of underreporting carefully and determined it has
not been a major contributor to the abnormal sex ratio. She
explained that their studies had also found common underreporting of
boys by parents who wanted to have a second child, regardless of the
sex of the first child.

16. (SBU) UNFPA's Khan agrees with Ma's view on underreporting and
noted told ESTH Off that she has heard discussed the idea of local
governments granting "amnesty" for unregistered children to
encourage parents to register them so that a clearer picture of the
sex ratio problem can emerge. Khan was however unaware of any
locality where an amnesty of this type has been implemented.

17. (SBU) COMMENT: Although some experts anticipate that the sex
ratio imbalance may be peaking, because the growing pressure of
"missing girls" could become a destabilizing social force, the
government must make normalizing the imbalance a more urgent policy
priority. To bring the imbalance under control, China must not only
control the means of prenatal sex selection now so commonly (if
illegally) practiced, but must also target and transform a
deeply-rooted cultural son preference and bias against girls. END


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