Cablegate: China's Attempts to Address Gender Imbalance Problem

DE RUEHBJ #0035/01 0102316
R 102316Z JAN 10




E.O. 12958: N/A

REF: A) BEIJING 0017 B) 08 BEIJING 2808 C) 08 BEIJING 2795

1. (SBU) SUMMARY: Abnormally high sex ratio at birth (SRB) and
excess female child mortality both contribute directly to the sex
ratio imbalance in China. Social consequences of this imbalance
include an estimated excess of over 30 million unmarriageable males,
a potentially destabilizing force that threatens to cause unrest in
the most economically marginalized areas, and could lead to
increased gender violence through demand for prostitution and
trafficking in girls and women. While there is general agreement on
sex-selective abortions and post-natal discrimination as the leading
causes of China's abnormally high sex ratio imbalance, these actions
are motivated by the interaction of a strong cultural preference and
pressure for sons with China's strict birth limitation policy.

2. (SBU) SUMMARY CONTINUED: While the government has made reducing
the gender imbalance an urgent priority, sources indicate that the
long term deadlines set for normalizing the sex ratio may be further
delayed. Controlling prenatal sex identification and sex-selective
abortions has been a leading strategy in managing the sex ratio
imbalance. Since 2006, China has also broadened its efforts to
include more comprehensive and coordinated approaches to better
address the root causes of the problem. However, government efforts
to reduce the sex ratio imbalance have thus far steadfastly avoided
any major changes to its birth limitation policy. END SUMMARY.

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

3. (SBU) The long term consequences of China's high sex ratio
imbalance are worrisome to China's social planners. The abnormally
high sex ratio imbalance can lead to social problems that follow
from a shortage of women to marry. An April 2009 British Medical
Journal study analyzing the sex ratio for China's population under
the age of 20 found that there are over 32 million more males than
females, triggering a series of stories in the domestic and
international media about the problem of China's "bare branches," or
young men who cannot find partners. According to population
experts, women will be able to marry up and out into wealthier and
more urban areas, so the problem of excess males will be felt most
acutely in the poorest and most marginal regions, possibly
compounding other social and economic discontent. Former Director
of China Population and Development Research Center (CPDRC) MA Li
told ESTHOffs that there is currently no strategy to deal with the
"bare branches" phenomenon, but since the problem is "far off," the
priority now is to reduce the sex ratio imbalance at birth. (NOTE:
CPDRC is the main research arm of the National Population and Family
Planning Commission (NPFPC) and assists the NPFPC in strategic
planning feeding into their Five-Year Population Development Plans.
Ma is also a long-standing Deputy in the National People's Congress
(NPC) and a member of NPC's Education, Science, Culture and Health
Committee. END NOTE)

(SBU) Gender equity advocates also speculate that the growing
imbalance could lead to more serious gender discrimination and
gender violence. Increased demand for sex workers and shortage of
women to marry could lead to more trafficking of girls and women for
future brides or the sex industry.


4. (SBU) Both government and non-governmental sources have noted the
increasing willingness of the government to discuss the sex ratio
problem openly. In a November 30 meeting with the CPDRC, former
Director MA Li described to ESTH officers the gradual opening up of
the problem to public discourse. According to Ma, after years of
treating the sex ratio imbalance as a "secret" problem, the
government publicly acknowledged the problem for the first time in
2002 and made sex ratio data publicly available in 2004. Especially
since 2006, when the government made the gender imbalance problem a
national priority, there has been a high level of domestic and
international attention paid to and research conducted on the issue,
including open discussion of previously sensitive subjects such as
sex-selective abortion and the link to China's social policies.

5. (SBU) In recent separate meetings with United Nations Population
Fund (UNFPA) and United Nations Children's Fund (UNICEF), UNFPA's
Deputy Representative Mariam Khan and UNICEF's Chief of Plans of
Action and Promotion of Child Rights Lisa Ng Bow both characterized
a growing readiness by the government to examine disaggregated data
by gender as a major shift, on key indicators like infant and child
mortality. This is significant because these are indicators for
which China is showing considerable progress overall, but when
disaggregated by gender, show serious disadvantage to girls in child
survival. (REF A)

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6. (SBU) Public discourse on the issue has resulted in increased
scrutiny on the impact of China's social policies on its sex ratio.
For example, Professor HU Yukun of Peking University's (PKU)
Institute of Population Research was quick to point out to ESTHOffs
in a November 20 meeting that although the official family planning
policy has loosened somewhat in recent years to allow over half of
families to have a second child if the first one is a girl (known as
the one-and-a-half child policy), a fertility policy conditioned on
the sex of the first child still caters to the cultural preference
for sons and implies that sons and daughters are not equivalent. Hu
explained that the policy worsens the sex ratio imbalance because
not only can families who bear sons not have another child, but many
who have a girl first will likely use sex selection to ensure they
have a boy next. The policy also reinforces the social concept that
girls are inferior to boys. The April 2009 British Medical Journal
study on the sex ratio of China's population under 20 years of age
presented findings showing that one-and-a-half child policy areas
have the highest overall sex ratios. (NOTE: According to China's
national data, the SRB was 120.56 in 2008 (REF A), although the CIA
World Factbook reports an estimated SRB of 110 for 2009, presenting
a less severe picture of China's sex ratio imbalance at birth. For
other areas sharing a common cultural tradition of son preference,
the CIA World Factbook estimates comparable SRB for 2009: 109 in
Taiwan, 108 in Hong Kong, 107 in South Korea, and 107 in Vietnam.

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

7. (SBU) While China has made solving the sex ratio problem an
increasingly urgent priority, the central government has struggled
to meet its own goals for normalizing the sex ratio imbalance. The
current Eleventh Five-Year Plan (2006-2010) and Long Term Plans for
2020 divided strategic gender imbalance goals into three
stages--slowing the rate of increase of the sex ratio at birth by
2010, reducing the imbalance by 2015, and normalizing the sex ratio
at birth by 2020. These goals are a revision of the original
deadline announced by President HU Jintao at the 2004 National
People's Congress, which set a goal of normalizing the SRB by 2010.

8. (SBU) According to CPDRC's Ma, the government may soon be issuing
further revisions in its timeline for normalizing the SRB. Ma
reported that details are still being vetted internally, but CPDRC's
recommendation to the NPFPC will be to set a goal of reducing the
SRB by three points by 2015 and normalizing the SRB by 2030.

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

9. (SBU) Despite the growing pressure to reduce the SRB, CPDRC's Ma
emphatically declared that there will not be a change in the
fundamentals of China's family planning policy and its commitment to
maintaining a low total fertility rate for the long term. Ma did
not, however, dismiss outright the possibility of the birth
limitation policy being loosened over time to a general two-child
policy. NPFPC's Care for Girls Leadership Committee has already
included among its priorities the elimination of birth spacing
restrictions, a key component of China's family planning policy, as
one way to address the sex ratio imbalance. (REF C)

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

10. (SBU) According to Ma, because of China's commitment to its
birth limitation policy, the government has concentrated its initial
efforts on fighting the practice of sex selection. Although she
acknowledged that efforts to control the SRB by prohibiting the use
of ultrasounds for fetal sex identification and sex-selective
abortions have been ineffective and nearly impossible to implement
(REF A), Ma also argued that for now, improving enforcement on these
regulations is all the government can do in the short term. She
added that a lasting solution would not be possible without a
comprehensive social security system and a transformation of
cultural beliefs and customs "which will take years, if not
generations" to achieve.

11. (SBU) NPFPC has been trying for years to criminalize illegal
sex identification and sex-selective abortion (commonly referred to
as the "Two Nons"), which currently are prohibited only under
administrative law. If successful, this would mean jail time for
violators instead of simply fines and suspended licenses. Ma noted
that she has been working on the issue of legal reform related to
sex-selective abortion since its inception and has herself proposed
amendments to the Criminal Code to the National People's Congress
(NPC) dealing with sex-selective abortion each year since 2006. She
explained, however, that attempts to criminalize the "Two Nons" are
likely to continue to fail for two key reasons: 1) because many

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believe that even if successful, the burden of proof will be too
difficult, rendering the law useless, and 2) because many NPC
deputies disagree with the premise, believing that it is a woman or
couple's right to choose whether or not to have a child, for
whatever reason. While Ma feels strongly that enforcing regulations
against the "Two Nons" is the only means of reducing the SRB in the
short term, she also questioned its urgency and speculated that if
China eventually moves to a two-child policy, the prevalence of sex
selective abortions likely would be less and the sex ratio imbalance
less acute. She added, however, that the public also could shift to
using sex selection to ensure one boy and one girl in each family.

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

12. (SBU) In December 2006, the Central Committee of the Communist
Party of China released a key "Decision on Fully Enhancing the
Population and Family Planning Program and Comprehensively
Addressing Population Issues (REF C)," which made "comprehensively
addressing the abnormal sex ratio to avoid negative impacts on
stability of society" a core population and family planning
priority. The "Decision" not only emphasized that sex
identification of the fetus and non-medical sex-selective abortions
are strictly forbidden and called for setting up systems to regulate
access to these services and report offenses, it also broadened
government efforts beyond regulatory controls, to include a more
systemic approach for targeting the root causes of son preference
and bias against girls. Furthermore, SRB was listed for the first
time in 2006 as an indicator in China's annual "Statistical
Communique," allowing the government to track the problem on an
annual basis.

13. (SBU) The year 2006 also saw the beginning of several important
national programs that addressed critical social welfare and
security concerns across China. The central government moved toward
full exemption of all tuition and textbook fees and provided a
subsidy for school boarding for compulsory education in western
China, which was later expanded to all poor families nationwide in
2007. According to PKU's Professor HU, this was a "dramatic
triumph" for girls' rights achieved through a social policy
intervention that, almost overnight, removed the practical barriers
to girls from low income families attending school.

14. (SBU) China's broadest family planning subsidy currently is the
Social Support Program (REF B). Implemented nationally in 2006, it
gives a monthly stipend to those who comply with family planning
regulations and is seen as a key step in addressing rural old-age
social security concerns, which has been a key factor driving the
son preference. Hu believes that adequately providing for old-age
social security will over time reduce the reliance on sons for
old-age support and soften the view that daughters are a liability.

15. (SBU) In addition to these social policies that appear to have
improved opportunities for girls, the government in 2006 expanded
nationwide the Care for Girls campaign (initially piloted in 2003 in
24 counties) which includes a range of policies ostensibly tailored
to local conditions to counter gender imbalance. These include
allowing inheritance by females, strategies to crack down on the
"Two Nons," preferential policies to help girls in families without
a son, and advocacy and education to promote cultural change away
from a preference for having sons. Among other preferential
policies such as education, medical, and employment benefits for
girl-only families, some localities have extended the Social Support
Program benefits to include even two-girl families under the Care
for Girls Program, attempting to reinforce the value of girls in
contributing to old age security. A less conventional related
strategy has been the promotion of matrilocal marriage, where the
man marries into the woman's family.

16. (SBU) Another key component of the Care for Girls program has
been the establishment of family planning and reproductive health
services to follow women from pregnancy through postnatal check-ups.
The intent is to encourage better monitoring of pregnancies and
births to improve survival rates, more accurate reporting of births
and deaths, as well as careful regulation and registration of
medicines and abortion services.

17. (SBU) According to UNFPA's Khan, because money for social
programs and services in different sectors is controlled at
different levels of government and mostly funded locally, another
important aspect of the campaign is improved leadership and
coordination on resources across government departments. To
incentivize local leadership to provide more support for Care for
Girls, some provinces have linked local officials' performance
evaluations to improving the sex ratio.

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18. (SBU) Khan also noted that to date, there has been no
comprehensive evaluation of the Care for Girls Program to determine
its results or pinpoint effective strategies. She explained that
while UNFPA's gender advocacy strategy includes sex ratio at birth
as a thematic focus, its programs are not directly part of Care for
Girls. UNFPA has, however, commissioned research focused on
understanding the factors that reduce the sex ratio, including an
ongoing study of seven provinces--Henan, Guangdong, Guangxi, Hainan,
Sichuan, Chongqing and Hunan--that have shown some decline in SRB
since 2007. Khan anticipates that this study will be completed in

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

19. (SBU) In 2008, the NPFPC established a special coordinating
office to deal with the sex ratio issue. The NPCPC convened through
this coordinating office two national conferences on Care for Girls
(in November 2008 and August 2009) that have showcased provincial
efforts in Care for Girls and attempted to motivate provinces to
develop new plans and regulations for reducing the sex ratio

20. (SBU) In preparation for the first National Conference on Care
for Girls in Hainan province in November 2008, eleven provinces
performed research studies on their efforts to manage the sex ratio
imbalance. The conference highlighted in particular the success of
Hainan Province's comprehensive Management and Reporting Model. Five
additional provinces--Henan, Anhui, Jiangxi, Hubei and Hunan--whose
SRBs were among the top ten highest in 2005, were chosen to pilot
Hainan's model in 2009. (NOTE: Hainan Province had the third
highest SRB in 2000 and showed the second greatest reduction in SRB
of any province from 2000 to 2005, when it dropped to tenth. END

21. (SBU) Key characteristics of Hainan's Management and Reporting
Model include increasing coordinated data collection and management
systems to monitor birth and death registrations and data sharing
across the health, public security, and education bureaus to prevent
concealment, omission, and misreporting. "Whole course"
reproductive health service management is stressed, such as
promoting hospital delivery through incentives to mid-wives and
monitoring throughout the pregnancy, child birth, and post-natal
period. Enhanced coordination across public security, family
planning, health, and food and drug safety bureaus was shown to be
necessary for effectively investigating violations of the "Two Nons"
and deaths of baby girls that were not from natural causes.

22. (SBU) In addition to the Hainan model, in August 2009 at the
Second National Care for Girls Conference, NPFPC Minister LI Bin
also cited as models Jiangsu and Hebei Provinces, which had both
established a data sharing mechanism between their education and
statistical bureaus in order to gain a clearer picture of the gender
imbalance situation. Minister Li also emphasized needing more
strategies to investigate and prosecute violations of the "Two

23. (SBU) Since the 2008 and 2009 conferences and the national
scrutiny of the gender ratio imbalance, numerous provinces have
revised their regulations to increase coordination, broaden efforts,
and strengthen regulatory controls. In December 2008, Fujian and
Henan Provinces issued new regulations, with Fujian emphasizing
combating violations of the "Two Nons" through linking the family
planning, public security, health, and food and drug safety
departments, tightening controls on abortions after 14 weeks (after
which fetal sex identification is possible), improving registration
of births and deaths, and establishing a public reporting mechanism
for violations, including a 2,000RMB (USD 294) reward to informants
beginning in November 2009. Henan announced a six-month pilot
campaign beginning in March 2009 against the "Two Nons", and cited
specific administrative consequences for public officials who are
found to have "failed to implement policies to control SRB."

24. (SBU) Between July and November 2009, Gansu and Jiangxi
Provinces, and the cities of Shanghai and Shenzhen also announced
changes to their Care for Girls strategies. Shanghai and Gansu
emphasized preferential policies to foster development of girls and
assistance to girl-only households. Shanghai announced on July 10 a
new plan to improve the care and protection of girl children,
including assistance in the form of medical, education and
employment benefits to families with only daughters. In Gansu's
Changning County, rural families with one girl can apply for a
4,000RMB (USD 588) one time award, a 1,600RMB (USD 235) contribution
to their pension savings, and a 20RMB monthly health care stipend.
Two daughter families who initiate sterilization or some other
long-term contraceptive method can receive a 3,000RMB (USD 441)
award from the county government and another 3,000RMB award from the
province, plus an 800RMB (USD 118) contribution to their pension
savings. Shanghai also proposed inter-province cooperation to

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address the needs of its migrant population. Jiangxi's new
provincial plan to manage SRB reflects the Hainan model and
emphasizes improved family planning service delivery, a data
campaign that includes a better birth registration system, and a
rewards system for identifying violators of the "Two Nons." Press
reports in November 2009 profiled Guangming District in Shenzhen,
which as part of their 2009-2010 Care for Girls campaign established
a 2,000RMB (USD 294) reward for information on violators of the "Two
Nons," set up telephone hotlines, neighborhood mailboxes, and an
online reporting system to "mobilize the masses to provide clues,"
and stepped up investigations of practices at private hospitals and
clinics. Since the start of this campaign, the district is reported
to have closed three unlicensed clinics and investigated five
pharmacies for illegal sale of medicine for inducing abortions.

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

25. (SBU) To date there has been no systematic study of gender
imbalance in the migrant population. However, a February 2008
family planning conference in Shanghai reported gender ratio data
that showed differences by residency status. In 2007, the sex ratio
at birth for residents with a Shanghai household registration
(hukou) was close to normal at 107.8, while for permanent residents
it was 115. (NOTE: The "permanent resident" category officially
includes both those with a Shanghai household registration and those
who are documented to have lived in Shanghai for longer than six
months. END NOTE) The sex ratio at birth for the migrant population
temporarily in Shanghai, at 123, was much higher. However, just as
family planning officials have had difficulty monitoring compliance
of migrants with family planning policies and requirements (REF B),
capturing an accurate picture of and managing the sex ratio
imbalance among the migrant population pose similar challenges.

26. (SBU) COMMENT: China has in recent years demonstrated greater
openness in discussing the nature and causes of its sex ratio
imbalance, and increased urgency about addressing the problem. Some
local governments have had some success in managing the problem,
including through providing financial incentives to girl-only
families and improving social policy supports to target the root
causes of the son preference. Furthermore, although China has made
noteworthy progress in reducing infant and child mortality and has
already met its Millennium Development Goals (MDGs) for these
indicators ahead of schedule, the government has of late delayed
goals for normalizing the gender imbalance, perhaps in recognition
that it currently lacks effective short term measures to quickly
reduce the sex ratio at birth. China has acknowledged that removing
barriers to gender equity and promoting the value of girls, as well
as building an adequate old-age social security, are key to
achieving a widespread, lasting solution. Beyond its continued
rhetoric, however, the central government also must provide the
resources necessary for provinces to fulfill their mandates for
delivering services geared toward the care, protection, and
promotion of girls. Local commitment and follow through also must
be strengthened and officials held accountable for humanely reducing
the sex ratio imbalance. END COMMENT.


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