There is one aspect of health interventions influencing economic growth that has not attracted as much attention as it should have. And that relates to the problem of unbalanced sex ratios that prevail in some parts of the world, particularly China, India and (to a smaller extent) South Korea.
While many countries around the world have a small imbalance in their juvenile sex ratios for biological reasons (e.g., there is a biological tendency for more male than female babies to be born to compensate for the slightly higher risk of mortality among male relative to female infants), the imbalance in countries such as China and India is acute, and is indicative of prenatal sex selection by parents – the tendency of parents to abort female fetuses based on prenatal ultrasounds. For instance, the sex ratio at birth was only 893 female births per 1,000 male births in China and India and 885 in South Korea (as compared to 980 for Kenya and South Africa and 952 for Cambodia and Mexico).
In India, the juvenile sex ratio (often defined as the sex ratio among children aged 0-6 years) has been falling secularly over the last 3-4 decades – from 964 females per 1,000 males in 1971 to 927 in 2001. The phenomenon has become more pervasive over time, and has spread to states such as Orissa, Gujarat, Maharashtra and Tamil Nadu that historically had more balanced sex ratios than the northern states. Indeed, every major state in the country other than Kerala saw its juvenile sex ratio decline between 1991 and 2001. In China, too, the problem has become more acute over time. A study based on a survey of over 5 million children in China found that among children born between 1985 and 1989, there were 926 female births for 1,000 male births. But, among children born between 2000 and 2004, the number had fallen to 806. Thus, in both countries, the situation appears to be worsening.
The unbalanced sex ratio reflects a strong cultural preference among Indian and Chinese parents for sons over daughters. The low and declining birth/juvenile sex ratio in these countries is a matter of grave policy concern, not only because it violates the human rights of unborn and infant girls but also because it deprives the countries of the potential economic and social contribution of these ‘missing women.’ Some estimates have put the number of ‘missing females’ (i.e., unborn or prematurely dead girls) as high as 100 million in the two countries. It is almost impossible to value the economic output foregone by the loss of these women, but it is likely to be very large. While women still earn less than men in labor markets around the world, there is increasing evidence that the pecuniary returns to female schooling are in fact greater than those to male schooling. There is little doubt that the growth rate of the Chinese and Indian economies would have been greater had the ‘missing’ women been born and integrated into these economies.
What can be done about this problem? Clearly, outlawing prenatal sex-determination tests and sex-selective abortions is an obvious policy response – one that has already been attempted in both countries. Unfortunately, laws banning sex-determination tests have done little to stop sex-selection abortions from taking place, as enforcement of these laws is weak, and there are loopholes in the law that allows clinics and doctors to continue to perform sex-determination tests. The root cause of imbalanced sex ratios is the strong preference for sons among parents, and unless this attitude changes, outlawing sex selection tests is unlikely to achieve much.
It might seem that improving literacy and schooling among women might reduce the parental preference for sons. However, here, too, the evidence is not encouraging. There is disturbing evidence from India which points to a worsening of the juvenile sex ratio with increased female education and literacy. Why the perverse effect? A possible explanation has to do with the negative effect of female literacy on fertility. Educated women tend to have fewer children than less-educated women, and, in the context of a strong son-preference culture, the lower levels of fertility lead to greater pressure on couples to have boys instead of girls. This relationship between fertility decline and lower juvenile sex ratios has also been observed in South Korea and China.
In addition, it is important to recognize that one (although not the only) reason for son preference is that, historically, inheritance laws in both countries have favored sons over daughters. While both countries now do not restrict women’s access to parental property, customary practices which consider sons the natural heirs of land are still prevalent in much of rural China and India. India only recently (in 2004) removed the discriminatory provisions of earlier legislation and allowed parents to bequeath their property to their daughters.
What is needed in both countries to combat the scourge of low juvenile sex ratios is a package of interventions that includes stricter enforcement of equal inheritance laws, economic incentives for parents to have daughters and educate them, and an educational curriculum at the primary and middle school levels that highlights the importance of equal treatment of boys and girls in the family. Even with such a package, it will take years for attitudes to change and for the practice of prenatal sex selection and neglect of the girl child to end. One thing is clear, however. Unless China and India manage to reverse the decline in the birth/juvenile sex ratio that has been going on for decades, their demographic transition and economic transformation will remain incomplete.
