View source for Sex-selective abortion

{{Short description|Pregnancy termination based on predicted sex}}
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[[File:2012 Birth Sex Ratio World Map.jpg|thumb|300px|World map of birth sex ratios, 2012]]
'''Sex-selective abortion''' is the practice of terminating a pregnancy based upon the predicted sex of the infant. As the practice overwhelmingly targets [[female]] fetuses, sex-selective abortion often specifically refers to female-selective abortion. Sex-selective abortion is closely linked to [[female infanticide]], and is recognized by many human rights organizations as an act of [[violence against women]].<ref>{{Cite web |title=Sex-selective abortions are discriminatory and should be banned |url=https://coe.int/en/web/commissioner/-/sex-selective-abortions-are-discriminatory-and-should-be-bann-1 |access-date=2025-03-20 |website=Commissioner for Human Rights |language=en-GB}}</ref>  

The selective [[abortion]] of female fetuses is most common where male children are valued over female children, especially in parts of [[East Asia]] and [[South Asia]] (particularly in countries such as [[People's Republic of China]], [[India]] and [[Pakistan]]), as well as in the [[Caucasus]], [[Western Balkans]], and to a lesser extent [[North America]].<ref name="Goodkind_1999">{{cite journal | vauthors = Goodkind D |year=1999 |title=Should Prenatal Sex Selection be Restricted?: Ethical Questions and Their Implications for Research and Policy |journal=Population Studies |volume=53 |issue=1 |pages=49–61 |jstor=2584811 |doi=10.1080/00324720308069}}</ref><ref name="Gettis">{{cite book | vauthors = Gettis A, Getis J, Fellmann JD | date = 2004 | title = Introduction to Geography | edition = Ninth | location = New York | publisher = McGraw-Hill | page = 200 | isbn = 0-07-252183-X }}</ref><ref name="czgparis" /> Based on the third National Family and Health Survey, results showed that if both partners, mother and father, or just the father, preferred male children, sex-selective abortion was more common. In cases where only the mother prefers sons, this is likely to result in sex-selective neglect in which the child is not likely to survive past infancy.<ref name="tandfonline.com">{{cite journal | vauthors = Robitaille MC, Chatterjee I |date=January 2, 2018 |title=Sex-selective Abortions and Infant Mortality in India: The Role of Parents' Stated Son Preference |url=https://www.tandfonline.com/doi/full/10.1080/00220388.2016.1241389 |journal=The Journal of Development Studies |language=en |volume=54 |issue=1 |pages=47–56 |doi=10.1080/00220388.2016.1241389 |s2cid=42247421 |issn=0022-0388 |access-date=March 16, 2022 |archive-date=September 3, 2023 |archive-url=https://web.archive.org/web/20230903155434/https://www.tandfonline.com/doi/full/10.1080/00220388.2016.1241389 |url-status=live |url-access=subscription }}</ref>

Sex-selective abortion was first documented in 1975,<ref>{{cite web | vauthors = Hvistendahl M | date = 2 November 2015 | url=https://www.scientificamerican.com/article/china-s-new-birth-rule-can-t-restore-missing-women-and-fix-a-population/| title=China's New Birth Rule Can't Restore Missing Women and Fix a Population| work = [[Scientific American]]| access-date=September 7, 2018| archive-date=January 22, 2019| archive-url=https://web.archive.org/web/20190122123121/https://www.scientificamerican.com/article/china-s-new-birth-rule-can-t-restore-missing-women-and-fix-a-population/| url-status=live}}</ref> and became commonplace by the late 1980s in [[South Korea]] and China and around the same time or slightly later in India.

Sex-selective abortion affects the [[human sex ratio]]—the relative number of males to females in a given age group,<ref name=coevolution>{{cite journal | vauthors = Kumm J, Laland KN, Feldman MW | title = Gene-culture coevolution and sex ratios: the effects of infanticide, sex-selective abortion, sex selection, and sex-biased parental investment on the evolution of sex ratios | journal = Theoretical Population Biology | volume = 46 | issue = 3 | pages = 249–278 | date = December 1994 | pmid = 7846643 | doi = 10.1006/tpbi.1994.1027 | doi-access = free | bibcode = 1994TPBio..46..249K }}</ref><ref>{{cite web |url= http://articles.philly.com/2011-06-21/news/29683905_1_gender-imbalance-fertility-institutes-boys |title= Gender imbalance tilting the world toward men |work= [[The Philadelphia Inquirer]] | vauthors = Gammage J |date= June 21, 2011 |access-date= June 27, 2013 |archive-date= April 9, 2016 |archive-url= https://web.archive.org/web/20160409042515/http://articles.philly.com/2011-06-21/news/29683905_1_gender-imbalance-fertility-institutes-boys }}</ref> with China and India, the two [[List of sovereign states and dependencies by population|most populous countries]] of the world, having unbalanced gender ratios. Studies and reports focusing on sex-selective abortion are predominantly statistical; they assume that birth-sex ratio—the overall ratio of boys and girls at birth—for a regional population is an indicator of sex-selective abortion. This assumption has been questioned by some scholars.<ref name="James_2008" /> Researchers have shown that in India there are approximately 50,000 to 100,000 female abortions each year, significantly affecting the human sex ratio.<ref name="Nandi_2015"/>

Recent studies have expanded the understanding of this issue by quantifying trends in conditional sex ratios (CSRs) among Asian diaspora populations in Australia, Canada, the UK, and the US, showing that sex selection practices have persisted among diaspora communities from 1999 to 2019.<ref>{{cite journal | vauthors = Meh C, Jha P | title = Trends in female-selective abortion among Asian diasporas in the United States, United Kingdom, Canada and Australia | journal = eLife | volume = 11 | article-number = e79853 | date = September 2022 | pmid = 36165452 | pmc = 9514843 | doi = 10.7554/eLife.79853  | doi-access = free }}</ref> Research into the past four decades of sex-selective abortions in China highlights the significant role these practices have played in shaping the country's demographic profile, despite challenges in estimating exact numbers due to underreporting and the controversial level of sex ratio at birth (SRB).<ref>{{cite journal | title=Sex-selective abortions over the past four decades in China | journal=Population Health Metrics | date=2025 | volume=23 | issue=1 | article-number=6 | doi=10.1186/s12963-025-00368-y | pmid=39984920 | pmc=11846193 | doi-access=free | vauthors = Mei L, Jiang Q }}</ref>

According to demographic scholarship, the expected birth-sex ratio range is 103 to 107 males to 100 females at birth.<ref name=unfpa2012>{{cite web | url = http://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/Report_SexRatios_2012.pdf | title = Report of the International Workshop on Skewed Sex Ratios at Birth | archive-url = https://web.archive.org/web/20140611013444/http://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/Report_SexRatios_2012.pdf | archive-date=June 11, 2014 | work = United Nations FPA | date = 2012 }}</ref><ref name=kseb>{{cite journal | vauthors = Kraemer S | title = The fragile male | journal = BMJ | volume = 321 | issue = 7276 | pages = 1609–1612 | date = December 23, 2000 | pmid = 11124200 | pmc = 1119278 | doi = 10.1136/bmj.321.7276.1609 }}</ref><ref name="naturalratio">{{cite journal | vauthors = Chao F, Gerland P, Cook AR, Alkema L | title = Systematic assessment of the sex ratio at birth for all countries and estimation of national imbalances and regional reference levels | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 116 | issue = 19 | pages = 9303–9311 | date = May 2019 | pmid = 30988199 | pmc = 6511063 | doi = 10.1073/pnas.1812593116 | doi-access = free | bibcode = 2019PNAS..116.9303C }}</ref>

== Human sex ratio at birth ==
{{Main|Human sex ratio}}
[[File:Abortion Laws.svg|thumb|400px|The [[human sex ratio]] at birth can vary for natural reasons as well as from sex-selective abortion. In many nations abortion is legal (see above map, dark blue).]]
Sex-selective abortion affects the [[human sex ratio]]—the relative number of males to females in a given age group.<ref name=coevolution /> Studies and reports that discuss sex-selective abortion are based on the assumption that birth sex ratio—the overall ratio of boys and girls at birth for a regional population, is an indicator of sex-selective abortion.<ref name="James_2008" /><ref name= "Junhong_2001" />

The natural human sex ratio at birth was estimated, in a 2002 study, to be close to 106 boys to 100 girls.<ref name=pmid11976243>{{cite journal | vauthors = Grech V, Savona-Ventura C, Vassallo-Agius P | title = Research pointers: Unexplained differences in sex ratios at birth in Europe and North America | journal = BMJ | volume = 324 | issue = 7344 | pages = 1010–1011 | date = April 2002 | pmid = 11976243 | pmc = 102777 | doi = 10.1136/bmj.324.7344.1010 }}</ref> Human sex ratio at birth that is significantly different from 106 is often assumed to be correlated to the prevalence and scale of sex-selective abortion. Countries considered to have significant practices of sex-selective abortion are those with birth sex ratios of 108 and above (selective abortion of females), and 102 and below (selective abortion of males).<ref name=unfpa2012 /> This assumption is controversial, and the subject of continuing scientific studies.

=== High or low human sex ratio implies sex-selective abortion ===
One school of scholars suggest that any birth sex ratio of boys to girls that is outside the normal 105–107 range, necessarily implies sex-selective abortion. These scholars<ref>{{cite journal | vauthors = Hesketh T, Xing ZW | title = Abnormal sex ratios in human populations: causes and consequences | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 103 | issue = 36 | pages = 13271–13275 | date = September 2006 | pmid = 16938885 | pmc = 1569153 | doi = 10.1073/pnas.0602203103 | doi-access = free | bibcode = 2006PNAS..10313271H }}</ref> claim that both the sex ratio at birth and the population sex ratio are remarkably constant in human populations. Significant deviations in birth sex ratios from the normal range can only be explained by manipulation, that is sex-selective abortion.<ref name= "Klausen_2003">{{cite journal |  vauthors = Klausen S, Wink C | year = 2003 | title = Missing Women: Revisiting the Debate | doi = 10.1080/1354570022000077999 | journal = Feminist Economics | volume = 9 | issue = 2–3| pages = 263–299 | s2cid = 154492092 }}</ref>

In a widely cited article,<ref name= "Sen_1990">{{cite book | vauthors = Sen A | chapter = More than 100 million women are missing. | title = Gender and Justice | date = July 2017 | pages = 219–222 | publisher = Routledge }}</ref> [[Amartya Sen]] compared the birth sex ratio in Europe (106) and the United States (105) with those in Asia (107+) and argued that the high sex ratios in East Asia, West Asia and South Asia may be due to excessive female mortality. Sen pointed to research that had shown that if men and women receive similar nutritional and medical attention and good health care then females have better survival rates, and it is the male which is the genetically fragile sex.<ref name=kseb />

Sen estimated [[Missing women of Asia|'missing women' from extra women who would have survived in Asia]] if it had the same ratio of women to men as Europe and the United States. According to Sen, the high birth sex ratio over decades implies a female shortfall of 11% in Asia, or over 100 million women as missing from the 3 billion combined population of South Asia, West Asia, North Africa and China.

=== High or low human sex ratio may be natural ===
Other scholars question whether birth sex ratio outside 103–107 can be due to natural reasons. William James and others<ref name="James_2008">{{cite journal | vauthors = James WH | title = Evidence that mammalian sex ratios at birth are partially controlled by parental hormone levels around the time of conception | journal = The Journal of Endocrinology | volume = 198 | issue = 1 | pages = 3–15 | date = July 2008 | pmid = 18577567 | doi = 10.1677/JOE-07-0446 | doi-access = free }}</ref><ref>{{cite journal | vauthors = James WH | title = The human sex ratio. Part 1: A review of the literature | journal = Human Biology | volume = 59 | issue = 5 | pages = 721–752 | date = October 1987 | pmid = 3319883 }}</ref><ref>{{cite journal | vauthors = James WH | title = The human sex ratio. Part 2: A hypothesis and a program of research | journal = Human Biology | volume = 59 | issue = 6 | pages = 873–900 | date = December 1987 | pmid = 3327803 }}</ref><ref>{{cite journal | vauthors = Bernstein ME | title = Studies in the human sex ratio. 5. A genetic explanation of the wartime increase in the secondary sex ratio | journal = American Journal of Human Genetics | volume = 10 | issue = 1 | pages = 68–70 | date = March 1958 | pmid = 13520702 | pmc = 1931860 }}</ref><ref name = "Meslé_2007">{{cite book | vauthors = Meslé F, Vallin J, Badurashvili I | chapter = A sharp increase in sex ratio at birth in the Caucasus. Why? How? | title = Watering the Neighbour's Garden: The Growing Demographic Female Deficit in Asia | location = Paris | publisher = Committee for International Cooperation in National Research in Demography | date = 2007 | pages = 73–88 |url= http://www.cicred.org/Eng/Publications/pdf/BOOK_singapore.pdf#page=85 |access-date=December 28, 2013 |archive-date=September 17, 2018 |archive-url= https://web.archive.org/web/20180917172708/http://www.cicred.org/Eng/Publications/pdf/BOOK_singapore.pdf#page=85 |url-status=live |isbn=978-2-910053-29-1 }}</ref> suggest that conventional assumptions have been:
* there are equal numbers of X and Y chromosomes in mammalian sperms
* X and Y stand equal chance of achieving conception
* therefore equal number of male and female zygotes are formed, and that
* therefore any variation of sex ratio at birth is due to sex selection between conception and birth.

James cautions that available scientific evidence stands against the above assumptions and conclusions. He reports that there is an excess of males at birth in almost all human populations, and the natural sex ratio at birth is usually between 102 and 108. However the ratio may deviate significantly from this range for natural reasons such as early marriage and fertility, teenage mothers, average maternal age at birth, paternal age, age gap between father and mother, late births, ethnicity, social and economic stress, warfare, environmental and hormonal effects.<ref name="James_2008" /><ref>{{cite journal | vauthors = Graffelman J, Hoekstra RF | title = A statistical analysis of the effect of warfare on the human secondary sex ratio | journal = Human Biology | volume = 72 | issue = 3 | pages = 433–445 | date = June 2000 | pmid = 10885189 }}</ref> This school of scholars support their alternate hypothesis with historical data when modern sex-selection technologies were unavailable, as well as birth sex ratio in sub-regions, and various ethnic groups of developed economies.<ref name=rjhmam>{{cite journal | vauthors = Jacobsen R, Møller H, Mouritsen A | title = Natural variation in the human sex ratio | journal = Human Reproduction | volume = 14 | issue = 12 | pages = 3120–3125 | date = December 1999 | pmid = 10601107 | doi = 10.1093/humrep/14.12.3120 | doi-access = free }}</ref><ref name=tvlkjt /> They suggest that direct abortion data should be collected and studied, instead of drawing conclusions indirectly from human sex ratio at birth.

James' hypothesis is supported by historical birth sex ratio data before technologies for ultrasonographic sex-screening were discovered and commercialized in the 1960s and 1970s, as well by reverse abnormal sex ratios currently observed in Africa. Michel Garenne reports that many African nations have, over decades, witnessed birth sex ratios below 100, that is more girls are born than boys.<ref name="Garenne_2004">{{cite journal | vauthors = Garenne M | title = Sex ratios at birth in populations of Eastern and Southern Africa. | journal = Southern African Journal of Demography | date = January 2004 | volume = 9 | issue = 1 | pages = 91–96 | jstor = 20853265 }}</ref> [[Angola]], [[Botswana]] and [[Namibia]] have reported birth sex ratios between 94 and 99, which is quite different from the presumed 104 to 106 as natural human birth sex ratio.<ref name="Garenne_2004" />{{rp|95}}

[[John Graunt]] noted that in London over a 35-year period in the 17th century (1628–62),<ref>{{cite journal | vauthors = Campbell RB | title = John Graunt, John Arbuthnott, and the human sex ratio | journal = Human Biology | volume = 73 | issue = 4 | pages = 605–610 | date = August 2001 | pmid = 11512687 | doi = 10.1353/hub.2001.0048 | s2cid = 41810038 }}</ref> the birth sex ratio was 1.07; while Korea's historical records suggest a birth sex ratio of 1.13, based on 5 million births, in 1920s over a 10-year period.<ref>{{cite journal | vauthors = Ciocco A |year=1938 |title=Variation in the Sex Ratio at Birth in the United States |journal=Human Biology |volume=10 |issue=1 |pages=36–64 |url=https://www.proquest.com/openview/202c2e5a18ba5665e9705908fc815948/1 |access-date=May 11, 2022 |archive-date=June 24, 2021 |archive-url=https://web.archive.org/web/20210624081919/https://www.proquest.com/openview/202c2e5a18ba5665e9705908fc815948/1 |url-status=live }}</ref> Other historical records from Asia too support James' hypothesis. For example, Jiang et al. claim that the birth sex ratio in China was 116–121 over a 100-year period in the late 18th and early 19th centuries; in the 120–123 range in the early 20th century; falling to 112 in the 1930s.<ref>{{cite journal | vauthors = Nie JB | title = Non-medical sex-selective abortion in China: ethical and public policy issues in the context of 40 million missing females | journal = British Medical Bulletin | volume = 98 | pages = 7–20 | year = 2011 | pmid = 21596712 | doi = 10.1093/bmb/ldr015 | doi-access = free }}</ref><ref>{{cite book | vauthors = Jiang B, Li S |year=2009 |title=The Female Deficit and the Security of Society |location=Beijing |publisher=Social Sciences Academic |pages=22–26 }}</ref>

=== Data on human sex ratio at birth ===
In the United States, the sex ratios at birth over the period 1970–2002 were 105 for the white non-Hispanic population, 104 for Mexican Americans, 103 for African Americans and Native Americans, and 107 for mothers of Chinese or Filipino ethnicity.<ref name="NCHS" /><ref>{{cite web|title=UN Sex Ratio Statistics|url=https://www.un.org/esa/population/unpop.htm|publisher=United Nations Population Division|access-date=June 29, 2017|archive-date=November 13, 2018|archive-url=https://web.archive.org/web/20181113003456/http://www.un.org/esa/population/unpop.htm|url-status=live}}</ref><ref>{{cite web|title=Sex ratio at birth (per 100 female newborn)|url=http://data.un.org/Data.aspx?q=sex+ratio+birth&d=PopDiv&f=variableID%3a52|publisher=United Nations Data Division|access-date=December 28, 2013|archive-date=June 22, 2018|archive-url=https://web.archive.org/web/20180622004852/http://data.un.org/Data.aspx?q=sex+ratio+birth&d=PopDiv&f=variableID:52|url-status=live}}</ref> In the aggregated results of 56 Demographic and Health Surveys<ref>{{cite web |url=http://www.measuredhs.com/ |title=Demographic and Health Survey |access-date=December 28, 2013 |archive-date=November 14, 2016 |archive-url=https://web.archive.org/web/20161114042446/http://www.measuredhs.com/ |url-status=live | work = Measure DHS }}</ref> in African countries, the birth sex ratio was found to be 103, though there is also considerable country-to-country, and year-to-year variation.<ref name=pmid12617497>{{cite journal | vauthors = Garenne M | title = Sex ratios at birth in African populations: a review of survey data | journal = Human Biology | volume = 74 | issue = 6 | pages = 889–900 | date = December 2002 | pmid = 12617497 | doi = 10.1353/hub.2003.0003 | s2cid = 12297795 }}</ref>

In a 2005 study, U.S. Department of Health and Human Services reported sex ratio at birth in the United States from 1940 over 62 years.<ref name="NCHS">{{cite journal | vauthors = Mathews TJ, Hamilton BE | title = Trend analysis of the sex ratio at birth in the United States | journal = National Vital Statistics Reports: From the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System | volume = 53 | issue = 20 | pages = 1–17 | date = June 2005 | pmid = 15974501 | doi = |url=https://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_20.pdf|publisher=U.S. Department of Health and Human Services, National Center for Health Statistics|access-date=September 11, 2017|archive-date=June 14, 2019|archive-url=https://web.archive.org/web/20190614045635/https://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_20.pdf|url-status=live }}</ref> This statistical evidence suggested the following: For mothers having their first baby, the total sex ratio at birth was 106 overall, with some years at 107. For mothers having babies after the first, this ratio consistently decreased with each additional baby from 106 towards 103. The age of the mother affected the ratio: the overall ratio was 105 for mothers aged 25 to 35 at the time of birth; while mothers who were below the age of 15 or above 40 had babies with a sex ratio ranging between 94 and 111, and a total sex ratio of 104. This United States study also noted that American mothers of Hawaiian, Filipino, Chinese, Cuban and Japanese ethnicity had the highest sex ratio, with years as high as 114 and average sex ratio of 107 over the 62-year study period. Outside of United States, European nations with extensive birth records, such as Finland, report similar variations in birth sex ratios over a 250-year period, that is from 1751 to 1997 AD.<ref name="tvlkjt">{{cite journal | vauthors = Vartiainen T, Kartovaara L, Tuomisto J | title = Environmental chemicals and changes in sex ratio: analysis over 250 years in finland | journal = Environmental Health Perspectives | volume = 107 | issue = 10 | pages = 813–815 | date = October 1999 | pmid = 10504147 | pmc = 1566625 | doi = 10.1289/ehp.99107813 | bibcode = 1999EnvHP.107..813V }}</ref>

Female Selective abortions in Asia are predominantly practiced in areas such as Taiwan, China, and India. The Sex ratio at birth in Asia based on worldwide data is 104 and 107 males per 100 females, which was the accepted norm before sex selective abortion was available. Unfortunately, census results from 2000 are still being reviewed and currently unavailable.<ref name="Miller_2001">{{cite journal | vauthors = Miller BD | title = Female-selective abortion in Asia: patterns, policies, and debates | journal = American Anthropologist | volume = 103 | issue = 4 | pages = 1083–95 | date = December 2001 | pmid = 12769123 | doi = 10.1525/aa.2001.103.4.1083 | jstor = 684130 }}</ref>

In 2017, according to CIA estimates,<ref name="cia.gov"/> the countries with the highest birth sex ratio were [[Liechtenstein]] (125), [[Northern Mariana Islands]] (116), [[China]] (114), [[Armenia]] (112), [[Falkland Islands]] (112), [[India]] (112), [[Grenada]] (110), [[Hong Kong]] (110), [[Vietnam]] (110), [[Albania]] (109), [[Azerbaijan]] (109), [[San Marino]] (109), [[Isle of Man]] (108), [[Kosovo]] (108) and [[Republic of Macedonia|Macedonia]] (108). Also in 2017 the lowest ratio (i.e. more girls born) was in [[Nauru]] at 83.<ref name="cia.gov"/> There were ratios of 102 and below in several countries, most of them African countries or Black/African majority population Caribbean countries: Angola, Aruba, Barbados, Bermuda, Burkina Faso, Burundi, Cabo Verde, Cameroon, Cayman Islands, Central African Republic, Chad, Comoros, Republic of the Congo, Côte d'Ivoire, Djibouti, Eritrea, Eswatini, Ethiopia, Gabon, The Gambia, Ghana, Guinea-Bissau, Haiti, Kazakhstan, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Niger, Puerto Rico, Qatar, Senegal, Sierra Leone, Somalia, South Africa, Togo, Uganda, Zambia.<ref name="cia.gov"/>

There is controversy about the notion of the exact natural sex ratio at birth. In a study around 2002, the natural sex ratio at birth was estimated to be close to 1.06 males/female.<ref name=pmid11976243/> There is controversy whether sex ratios outside the 103-107 range are due to sex-selection, as suggested by some scholars, or due to natural causes. The claims that unbalanced sex ratios are necessary due to sex selection have been questioned by some researchers.<ref name="James_2008" /> Some researchers argue that an unbalanced sex ratio should not be automatically held as evidence of prenatal sex-selection; Michel Garenne reports that many African nations have, over decades, witnessed birth sex ratios below 100, that is more girls are born than boys.<ref name="Garenne_2004"/> Angola, Botswana and Namibia have reported birth sex ratios between 94 and 99, which is quite different than the presumed "normal" sex ratio, meaning that significantly more girls have been born in such societies.<ref name="Garenne_2004" />{{rp|95}}

In addition, in many developing countries there are problems with [[birth registration]] and data collection, which can complicate the issue.<ref name="The consequences of son preference">{{cite journal | vauthors = Hesketh T, Lu L, Xing ZW | title = The consequences of son preference and sex-selective abortion in China and other Asian countries | journal = CMAJ | volume = 183 | issue = 12 | pages = 1374–1377 | date = September 2011 | pmid = 21402684 | pmc = 3168620 | doi = 10.1503/cmaj.101368 }}</ref> With regard to the prevalence of sex selection, the media and international attention has focused mainly on a few countries, such as China, India and the [[Caucasus]], ignoring other countries with a significant sex imbalance at birth. For example, [[Liechtenstein]]'s sex ratio is far worse than that of those countries, but little has been discussed about it, and virtually no suggestions have been made that it may practice sex selection, although it is a very conservative country where [[1984 Liechtenstein women's suffrage referendum|women could not vote until 1984]].<ref>{{cite web | vauthors = Eveleth R | date = 17 September 2013 | work = Smithsonian Magazine | url= https://www.smithsonianmag.com/smart-news/liechtenstein-has-the-most-skewed-ratio-of-baby-boys-and-girls-in-the-world-right-now-8176140/ | title=Liechtenstein Has the Most Skewed Ratio of Baby Boys and Girls in the World Right Now | access-date=December 24, 2018 | archive-date=April 9, 2019 | archive-url=https://web.archive.org/web/20190409045059/https://www.smithsonianmag.com/smart-news/liechtenstein-has-the-most-skewed-ratio-of-baby-boys-and-girls-in-the-world-right-now-8176140/ | url-status=live }}</ref><ref>{{cite web | vauthors = Kircher MM | url=https://www.businessinsider.com/china-gender-ratio-disparity-isnt-words-largest-2015-10| title=The country with the highest gender disparity at birth isn't China| website=[[Business Insider]]| date=October 30, 2015| access-date=December 24, 2018| archive-date=July 24, 2019| archive-url=https://web.archive.org/web/20190724200553/https://www.businessinsider.com.au/china-gender-ratio-disparity-isnt-words-largest-2015-10| url-status=live}}</ref> At the same time, there have been accusations that the situation in some countries, such as [[Georgia (country)|Georgia]], has been exaggerated.<ref>{{cite web | url=https://eurasianet.org/georgia-data-glitch-distorts-abortion-picture | title=Georgia: Data Glitch Distorts Abortion Picture | work = Eurasianet | access-date=December 24, 2018 | archive-date=April 9, 2019 | archive-url=https://web.archive.org/web/20190409045056/https://eurasianet.org/georgia-data-glitch-distorts-abortion-picture | url-status=live }}</ref> In 2017, Georgia' sex ratio at birth was 107, according to CIA statistics.<ref>{{cite web | url=https://www.cia.gov/library/publications/the-world-factbook/fields/2018.html | title=The World Factbook | work = Central Intelligence Agency | access-date=May 17, 2016 | archive-date=October 16, 2013 | archive-url=https://web.archive.org/web/20131016065003/https://www.cia.gov/library//publications/the-world-factbook/fields/2018.html }}</ref>

=== Data reliability ===
The estimates for birth sex ratios, and thus derived sex-selective abortion, are a subject of dispute as well. For example, United States' CIA projects<ref name=cia>{{cite web | url = https://www.cia.gov/library/publications/the-world-factbook/fields/2018.html | archive-url = https://web.archive.org/web/20070613003045/https://www.cia.gov/library/publications/the-world-factbook/fields/2018.html | archive-date = 13 June 2007 | title = Sex Ratio | work = The World Factbook, CIA, US Government | date = 2013 | quote = Note: Sex ratio of 1.26 is same as 126 boys per 100 girls }}</ref> the birth sex ratio for [[Switzerland]] to be 106, while the Switzerland's Federal Statistical Office that tracks actual live births of boys and girls every year, reports the latest birth sex ratio for Switzerland as 107.<ref>{{cite web | url = http://www.bfs.admin.ch/bfs/portal/en/index/themen/01/06/blank/key/02/01.html | archive-url = https://web.archive.org/web/20081118222403/http://www.bfs.admin.ch/bfs/portal/en/index/themen/01/06/blank/key/02/01.html | archive-date = 18 November 2008 | title = Births and deliveries | work = Federal Statistical Office, Switzerland | date = 2013 }}</ref> Other variations are more significant; for example, CIA projects<ref name=cia /> the birth sex ratio for [[Pakistan]] to be 105, United Nations FPA office claims<ref>{{cite web | url = https://www.unfpa.org/webdav/site/global/shared/documents/Guilmoto_Revised_presentation_Hanoi_Oct2011.pdf | title = Sex Ratios | archive-url = https://wayback.archive-it.org/all/20120604063319/https://www.unfpa.org/webdav/site/global/shared/documents/Guilmoto_Revised_presentation_Hanoi_Oct2011.pdf | archive-date=June 4, 2012 | vauthors = Guilmoto CZ | work = UNFPA | date = 2011 | page = 13 }}</ref> the birth sex ratio for Pakistan to be 110, while the government of Pakistan claims its average birth sex ratio is 111.<ref>{{cite web | url = https://www.census.gov.pk/index.php | title = Sex ratio at birth – National and Regional Census Data | archive-url = https://web.archive.org/web/20170513014654/http://www.census.gov.pk/index.php | archive-date=May 13, 2017 | work = Pakistan Census | date = 2013 }}</ref><ref>{{cite web | url = http://www.dawn.com/news/641175/gender-imbalance-pakistans-missing-women | title = Gender Imbalance: Pakistan's Missing Women | archive-url = https://web.archive.org/web/20131230232222/http://www.dawn.com/news/641175/gender-imbalance-pakistans-missing-women | archive-date = December 30, 2013 | work = Dawn | location = Pakistan | date = 2013 }}</ref><ref>{{cite news |title=Abandoned, Aborted, or Left for Dead: These Are the Vanishing Girls of Pakistan |url=https://www.theatlantic.com/international/archive/2012/06/abandoned-aborted-or-left-for-dead-these-are-the-vanishing-girls-of-pakistan/258648/ |work=The Atlantic |date=June 19, 2012 |access-date=March 11, 2017 |archive-date=January 19, 2019 |archive-url=https://web.archive.org/web/20190119174455/https://www.dawn.com/news/641175/gender-imbalance-pakistans-missing-women |url-status=live }}</ref>

The two most studied nations with high sex ratio and sex-selective abortion are China and India. The CIA estimates<ref name=cia /> a birth sex ratio of 112 for both in recent years. However, The World Bank claims the birth sex ratio for China in 2009 was 120 boys for every 100 girls;<ref>{{cite journal | vauthors = Ebenstein AY, Sharygin EJ |title=The Consequences of the 'Missing Girls' of China |journal=The World Bank Economic Review |date=2009 |volume=23 |issue=3 |pages=399–425 |doi=10.1093/wber/lhp012 |hdl=10986/4508 |url=http://documents.worldbank.org/curated/en/498661468221674913/pdf/776250JRN020090UBLIC00Missing0Girls.pdf |access-date=March 10, 2020 |archive-date=October 10, 2016 |archive-url=https://web.archive.org/web/20161010125250/http://documents.worldbank.org/curated/en/498661468221674913/pdf/776250JRN020090UBLIC00Missing0Girls.pdf |url-status=live }}</ref> while United Nations FPA estimates China's 2011 birth sex ratio to be 118.<ref name=unfpaaugust2012 />

For India, the United Nations FPA claims a birth sex ratio of 111 over 2008–10 period,<ref name=unfpaaugust2012 /> while The World Bank and India's official 2011 Census reports a birth sex ratio of 108.<ref name=teconomist /><ref>{{cite web | url = http://www.censusindia.gov.in/2011census/population_enumeration.aspx | title = India Census 2011 Provisional Report | archive-url = https://web.archive.org/web/20140208004957/http://www.censusindia.gov.in/2011census/population_enumeration.aspx | archive-date=February 8, 2014 | work = Government of India | date = 2013 }}</ref> These variations and data reliability is important as a rise from 108 to 109 for India, or 117 to 118 for China, each with large populations, represent a possible sex-selective abortion of about 100,000 girls.
[[File:國軍臺中總醫院院徽.jpg|thumb]]
Bias is due to the unreported births in hospitals which makes a slight difference on the data they report vs the census. If parents obtain sex testing before birth, and abortion was made and it was based on female fetus, it is more likely for the abortion to happen in the hospital for safety purposes and would have been reported. With no comparative data with hospitals vs nonhospital births the length of biased would be unable to determine opposed to those countries where most hospital births occur and are actually reported.<ref name="Miller_2001"/>

== Prenatal sex discernment ==
{{Main|Prenatal sex discernment}}
[[File:Sex determination ban.JPG|thumb|left|Sign in an Indian hospital stating that prenatal sex determination is not done there and is illegal]]
[[File:Boy.JPG|thumb|Ultrasonography image showing the fetus is a boy]]
The earliest post-implantation test, [[cell free fetal DNA]] testing, involves taking a blood sample from the mother and isolating the small amount of fetal [[DNA]] that can be found within it. When performed after week seven of pregnancy, this method is about 98% accurate.<ref>{{cite journal | vauthors = Devaney SA, Palomaki GE, Scott JA, Bianchi DW | title = Noninvasive fetal sex determination using cell-free fetal DNA: a systematic review and meta-analysis | journal = JAMA | volume = 306 | issue = 6 | pages = 627–636 | date = August 2011 | pmid = 21828326 | pmc = 4526182 | doi = 10.1001/jama.2011.1114 }}</ref><ref>{{cite news |url=https://www.bbc.co.uk/news/health-14457670 |date=August 10, 2011 |title=Baby gender blood tests 'accurate' | vauthors = Michelle R |newspaper=[[BBC News Online]] |access-date=June 20, 2018 |archive-date=July 23, 2017 |archive-url=https://web.archive.org/web/20170723122740/http://www.bbc.co.uk/news/health-14457670 |url-status=live }}</ref>

[[Obstetric ultrasonography]], either transvaginally or transabdominally, checks for various markers of fetal sex. It can be performed at or after week 12 of pregnancy. At this point, {{frac|3|4}} of fetal sexes can be correctly determined, according to a 2001 study.<ref name=mazza>{{cite journal | vauthors = Mazza V, Falcinelli C, Paganelli S, Contu G, Mantuano SM, Battafarano SD, Forabosco A, Volpe A | title = Sonographic early fetal gender assignment: a longitudinal study in pregnancies after in vitro fertilization | journal = Ultrasound in Obstetrics & Gynecology | volume = 17 | issue = 6 | pages = 513–516 | date = June 2001 | pmid = 11422974 | doi = 10.1046/j.1469-0705.2001.00421.x | s2cid = 37709826 | doi-access = free | hdl = 11380/741241 | hdl-access = free }}</ref> Accuracy for males is approximately 50% and for females almost 100%. When performed after week 13 of pregnancy, ultrasonography gives an accurate result in almost 100% of cases.<ref name=mazza />

The most invasive measures are [[chorionic villus sampling]] (CVS) and [[amniocentesis]], which involve testing of the chorionic villus (found in the placenta) and [[amniotic fluid]], respectively. Both techniques typically test for [[Chromosome abnormality|chromosomal disorders]] but can also reveal the sex of the child and are performed early in the pregnancy. However, they are often more expensive and more dangerous than blood sampling or ultrasonography, so they are seen less frequently than other sex determination techniques.<ref>{{cite journal | vauthors = Young C, von Dadelszen P, Alfirevic Z | title = Instruments for chorionic villus sampling for prenatal diagnosis | journal = The Cochrane Database of Systematic Reviews | volume = 2013 | issue = 1 | article-number = CD000114 | date = January 2013 | pmid = 23440775 | pmc = 7050982 | doi = 10.1002/14651858.CD000114.pub2 }}</ref>

Prenatal sex determination is restricted in many countries, and so is the communication of the sex of the fetus to the pregnant woman or her family, in order to prevent sex selective abortion.
In India, prenatal sex determination is regulated under the [[Pre-conception and Prenatal Diagnostic Techniques (Prohibition of Sex Selection) Act]] 1994.<ref>{{cite web|url=http://pndt.gov.in/writereaddata/mainlinkfile/File53.pdf|title=The Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994: Answers to Frequently Asked Questions | work = Center for Enquiry Into Health and Allied Themes (CEHAT) | publisher = Ministry of Health and Family Welfare |access-date=June 7, 2017|archive-date=March 3, 2016|archive-url=https://web.archive.org/web/20160303201506/http://pndt.gov.in/writereaddata/mainlinkfile/File53.pdf}}</ref>

;Availability
China launched its first ultrasonography machine in 1979.<ref name= "Junhong_2001" /> Chinese health care clinics began introducing ultrasound technologies that could be used to determine prenatal sex in 1982. By 1991, Chinese companies were producing 5,000 ultrasonography machines per year. Almost every rural and urban hospital and family planning clinics in China had a good quality sex discernment equipment by 2001.<ref name = "Junhong_2001">{{cite journal | vauthors = Junhong C | year = 2001 | title = Prenatal Sex Determination and Sex-Selective Abortion in Rural Central China | journal = Population and Development Review | volume = 27 | issue = 2| page = 260 |doi=10.1111/j.1728-4457.2001.00259.x}}</ref>

The launch of ultrasonography technology in India too occurred in 1979, but its expansion was slower than China. Ultrasound sex discernment technologies were first introduced in major cities of India in the 1980s, its use expanded in India's urban regions in the 1990s, and became widespread in the 2000s.<ref name=maydrgermany>{{cite journal | vauthors = Akbulut-Yuksel M, Rosenblum D |date=January 2012 |ssrn=1989245 |title=The Indian Ultrasound Paradox |journal=IZA Discussion Paper |issue=6273 }}</ref>

==Africa and the Middle East==
Sex selective abortion based on son preference is significant in [[North Africa]] and the [[Middle East]].<ref name = "Goodkind_2015">{{cite book |doi=10.1016/B978-0-08-097086-8.31038-8 |isbn=978-0-08-097087-5 |chapter=Sex Selective Abortion |title=International Encyclopedia of the Social & Behavioral Sciences |year=2015 | vauthors = Goodkind D |pages=686–688 }}</ref><ref>{{cite book |doi=10.1016/B0-08-043076-7/02151-3 |isbn=978-0-08-043076-8 |chapter=Family Systems and the Preferred Sex of Children |title=International Encyclopedia of the Social & Behavioral Sciences |year=2001 | vauthors = Basu A, Das Gupta M |pages=5350–5357 }}</ref><ref name="The consequences of son preference"/>

== Asia ==
The total numbers of "missing women" are about 11.9 million and 10.6 million in [[China]] and [[India]] respectively, out of 23 million world-wide, according to a 2019 study.<ref name="naturalratio"/> Given that the total number of recorded abortions is much lower than that, some dispute those numbers.

=== China ===
{{Further|Son preference in China|Missing women of China|Female infanticide in China|List of Chinese administrative divisions by gender ratio}}
[[File:G106-Dajipu-to-Daye-hills-0068.jpg|thumb|250px|A roadside slogan calls motorists to crack down on medically unnecessary antenatal sex identification and sex-selective pregnancy termination practices. ([[Daye, Hubei]], 2008)]]
[[File:PRC family planning don't abandon girls.jpg|thumb|250px|Roadside sign in Danshan Township, which reads "It is forbidden to discriminate against, abuse or abandon baby girls"]]
China, the most populous country in the world, has a serious problem with an unbalanced sex ratio population. A 2010 BBC article stated that the sex birth ratio was 119 boys born per 100 girls, which rose to 130 boys per 100 girls in some rural areas.<ref name="news.bbc.co.uk">{{cite news| url=http://news.bbc.co.uk/2/hi/asia-pacific/8451289.stm| title=China faces growing sex imbalance| date=January 11, 2010| access-date=December 15, 2017| archive-date=October 16, 2018| archive-url=https://web.archive.org/web/20181016195046/http://news.bbc.co.uk/2/hi/asia-pacific/8451289.stm| url-status=live}}</ref> The Chinese Academy of Social Sciences estimated that more than 24 million Chinese men of marrying age could find themselves without spouses by 2020.<ref name="news.bbc.co.uk"/> In 1979, China enacted the [[one-child policy]], which, within the country's deeply patriarchal culture, resulted in an unbalanced birth sex ratio. The one child policy was enforced throughout the years, including through [[forced abortion]]s and [[forced sterilization]]s, but gradually loosened until it was formally abolished in 2015.<ref>{{cite news| url=https://www.bbc.com/news/world-asia-34665539| title=China to end one-child policy| work=BBC News| date=October 29, 2015| access-date=June 20, 2018| archive-date=November 21, 2016| archive-url=https://web.archive.org/web/20161121005729/http://www.bbc.com/news/world-asia-34665539| url-status=live}}</ref>

When sex ratio began being studied in China in 1960, it was still within the normal range. However, it climbed to 111.9 by 1990<ref name = "Junhong_2001" /> and to 118 by 2010 per its official census.<ref>{{cite web | url = http://news.xinhuanet.com/english2010/china/2011-08/16/c_131052436.htm | title = China's sex ratio declines for two straight years | archive-url = https://web.archive.org/web/20150222173509/http://news.xinhuanet.com/english2010/china/2011-08/16/c_131052436.htm | archive-date=February 22, 2015 | work = news.xinhuanet.com | location = Xinhua, China }}</ref><ref>{{cite report | vauthors = Kang C, Wang Y | title = Sex ratio at birth. | work = Theses collection of 2001 national family planning and reproductive health survey. | date = 2003 | pages = 88–98 }}</ref> Researchers believe that the causes of this sex ratio imbalance are increased female infant mortality, underreporting of female births and sex-selective abortion. According to Zeng et al. (1993), the most prominent cause is probably sex-selective abortion, but this is difficult to prove that in a country with little reliable birth data because of the hiding of "illegal" (under the One-Child Policy) births.<ref name=zengyi93>{{cite journal | vauthors = Yi Z, Ping T, Baochang G, Yi X, Bohua L, Yongpiing L | year = 1993 | title = Causes and implications of the recent increase in the reported sex ratio at birthin China | journal = Population and Development Review | volume = 19 | issue = 2| pages = 283–302 | doi=10.2307/2938438| jstor = 2938438 }}</ref>

These illegal births have led to underreporting of female infants. Zeng et al., using a reverse survival method, estimate that underreporting keeps about 2.26% male births and 5.94% female births off the books. Adjusting for unreported illegal births, they conclude that the corrected Chinese sex ratio at birth for 1989 was 111 rather than 115.<ref name=zengyi93 /> These national averages over time, mask the regional sex ratio data. For example, in 2005 [[Anhui]], [[Jiangxi]], [[Shaanxi]], [[Hunan]] and [[Guangdong]], had a sex ratio at birth of more than 130.<ref>{{cite web | vauthors = Branigan T | url = https://www.theguardian.com/world/2011/nov/02/chinas-great-gender-crisis | title = China's Great Gender Crisis | archive-url = https://web.archive.org/web/20230901175527/https://www.theguardian.com/world/2011/nov/02/chinas-great-gender-crisis | archive-date=September 1, 2023 | work = The Guardian, UK | date = November 2, 2011 }}</ref><ref name=Hesketh />

Traditional Chinese techniques have been used to determine sex for hundreds of years, primarily with unknown accuracy. It was not until [[ultrasonography]] became widely available in urban and rural China that sex was able to be determined scientifically. In 1986, the Ministry of Health posted the Notice on Forbidding Prenatal Sex Determination, but it was not widely followed.<ref>Ministry of Health and State Family Planning Commission.1986. "Notice on strictly forbidding prenatal sex determination," reprinted in Peng Peiyun(ed.), 1997, Family Planning Encyclopedia of China. Beijing: China Population Press, p. 939.</ref> Three years later, the Ministry of Health outlawed the use of sex determination techniques, except for in diagnosing hereditary diseases.<ref>Ministry of Health. 1989. "Urgent notice on strictly forbidding the use of medical technology to perform prenatal sex determination," reprinted in Peng Peiyun (ed.), 1997, Family Planning Encyclopedia of China. Beijing: China Population Press, pp. 959–960.</ref> Individuals or clinics that violated the ban on prenatal determination at the request of the mother were subject to financial penalties, and the ban was repeatedly affirmed in the 1980s, early 1990s, and early 2000s.<ref>{{cite book | vauthors = Rodriguez SM |url= |title=Reproductive realities in modern China: birth control and abortion, 1911-2021 |date=2023 |publisher=[[Cambridge University Press]] |isbn=978-1-009-02733-5 |location=Cambridge, United Kingdom |page=191 |oclc=1366057905}}</ref> However, many people have personal connections to medical practitioners and strong [[son preference]] still dominates culture, leading to the widespread use of sex determination techniques.<ref name="Junhong_2001" />

Hardy, Gu, and Xie suggest sex-selective abortion is more prevalent in rural China because son preference is much stronger there.<ref name="Xie">Hardee, Karen, Gu Baochang, and Xie Zhenming. 2000. "Holding up more than half the sky:Fertility control and women's empowerment in China,"paper presented at the Annual Meeting of the Population Association of America, March 23–25, Los Angeles.</ref> Urban areas of China, on average, are moving toward greater equality for both sexes, while rural China tends to follow more traditional views of gender. This is partially due to the belief that, while sons are always part of the family, daughters are only temporary, going to a new family when they marry. Additionally, if a woman's firstborn child is a son, her position in society moves up, while the same is not true of a firstborn daughter.<ref name="Junhong_2001" /> Families in China are aware of the critical lack of female children and its implication on marriage prospects in the future; many parents are beginning to work extra when their sons are young so that they will be able to pay for a bride for them.<ref name="Junhong_2001" />

[[File:Sex ratio at birth in mainland China.png|thumb|450px|Birth sex ratios have dramatically changed in China since the implementation of the [[One-Child Policy]].]]
In a 2005 study, Zhu, Lu, and Hesketh found that the highest sex ratio was for those ages 1–4, and two provinces, Tibet and Xinjiang, had sex ratios within normal limits. Two other provinces had a ratio over 140, four had ratios between 130 and 139, and seven had ratios between 120 and 129, each of which is significantly higher than the natural sex ratio.<ref name="Hesketh">{{cite journal | vauthors = Zhu WX, Lu L, Hesketh T | title = China's excess males, sex selective abortion, and one child policy: analysis of data from 2005 national intercensus survey | journal = BMJ | volume = 338 | issue = 7700 | pages = 920–923 | date = April 2009 | pmid = 19359290 | pmc = 2667570 | doi = 10.1136/bmj.b1211 | jstor = 20512658 }}</ref>

The birth sex ratio in China, according to a 2012 news report, has decreased to 117 males born for every 100 females.<ref>{{cite web|url=http://www.china.org.cn/video/2012-03/31/content_25036729.htm|title=China sees decrease in male-to-female birth ratio gap - China.org.cn|website=www.china.org.cn|access-date=October 23, 2019|archive-date=February 18, 2019|archive-url=https://web.archive.org/web/20190218122734/http://www.china.org.cn/video/2012-03/31/content_25036729.htm|url-status=live}}</ref> The sex ratio peaked in 2004 at around 121, and had declined to around 112 in 2017.<ref>{{cite web | vauthors = Somaia P, Islamiah Zahroh R, Bohren M |date=March 11, 2020|title=Where are all the missing girls?|url=https://pursuit.unimelb.edu.au/articles/where-are-all-the-missing-girls|access-date=September 12, 2020|website=Pursuit|language=en|archive-date=February 15, 2022|archive-url=https://web.archive.org/web/20220215134155/https://pursuit.unimelb.edu.au/articles/where-are-all-the-missing-girls|url-status=live}}</ref> The ratio was forecast to drop below 112 by 2020 and 107 by 2030, according to the National Population Development Outline by the State Council.<ref>{{cite web|title=Report: Sex ratio to balance out by 2030 - China - Chinadaily.com.cn|url=https://www.chinadaily.com.cn/china/2017-01/27/content_28064356.htm|access-date=September 12, 2020|website=www.chinadaily.com.cn|archive-date=February 15, 2022|archive-url=https://web.archive.org/web/20220215134205/https://www.chinadaily.com.cn/china/2017-01/27/content_28064356.htm|url-status=live}}</ref>

In December 2016, researchers at the [[University of Kansas]] reported that the missing women might be largely a result of administrative under-reporting and that delayed registration of females, instead of abortion and [[infanticide]] practices. The finding questioned the earlier assumptions that rural Chinese villagers aborted their daughters on a massive scale and concluded that as many as 10 to 15 million missing women hadn't received proper birth registration since 1982.<ref>{{cite web | vauthors = Steger I |url=https://qz.com/848715/its-a-myth-that-china-has-30-million-missing-girls-because-of-the-one-child-policy-a-new-study-says |title=It's a myth that China has 30 million "missing girls" because of the one-child policy, a new study says |work=Quartz |date=November 29, 2016 |access-date=April 29, 2023 |archive-date=April 29, 2023 |archive-url=https://web.archive.org/web/20230429225829/https://qz.com/848715/its-a-myth-that-china-has-30-million-missing-girls-because-of-the-one-child-policy-a-new-study-says |url-status=live }}</ref><ref>{{cite news |url=https://www.washingtonpost.com/news/worldviews/wp/2016/11/30/researchers-may-have-found-many-of-chinas-30-million-missing-girls/ |title=Researchers may have 'found' many of China's 30 million missing girls |newspaper=Washington Post |date=November 30, 2016 | vauthors = Denyer S |access-date=April 29, 2023 |archive-date=July 29, 2023 |archive-url=https://web.archive.org/web/20230729003039/https://www.washingtonpost.com/news/worldviews/wp/2016/11/30/researchers-may-have-found-many-of-chinas-30-million-missing-girls/ |url-status=live }}</ref> The reason for underreporting was attributed to families trying to avoid penalties when girls were born, and local government concealing the lack of enforcement from the central government. This implied that the sex disparity of the Chinese newborns was likely exaggerated significantly in previous analyses.<ref name="shi_kennedy">{{cite journal| vauthors = Shi Y, Kennedy JJ |date=December 2016|title=Delayed Registration and Identifying the "Missing Girls" in China|journal=The China Quarterly|volume=228|pages=1018–1038|doi=10.1017/S0305741016001132|issn=0305-7410|doi-access=free}}</ref><ref name="cnn_161201">{{cite web |url=https://edition.cnn.com/2016/12/01/asia/china-missing-girls/index.html |title=Study finds millions of China's 'missing girls' actually exist |website=CNN |date=December 1, 2016 | vauthors = Jozuka E |access-date=April 29, 2023 |archive-date=April 2, 2023 |archive-url=https://web.archive.org/web/20230402034411/http://edition.cnn.com/2016/12/01/asia/china-missing-girls/index.html |url-status=live }}</ref><ref>{{cite web | vauthors = Zhuang P |title=China's 'missing women' theory likely overblown, researchers say |url=https://www.scmp.com/news/china/policies-politics/article/2050444/chinas-missing-girls-theory-likely-be-overblown-study |website=South China Morning Post |date=November 30, 2016 |access-date=April 29, 2023 |archive-date=December 15, 2019 |archive-url=https://web.archive.org/web/20191215011815/https://www.scmp.com/news/china/policies-politics/article/2050444/chinas-missing-girls-theory-likely-be-overblown-study |url-status=live }}</ref> Though the degree of data discrepancy, the challenge in relation to sex-ratio imbalance in China is still disputed among scholars.<ref>{{cite journal |url=https://www.cambridge.org/core/journals/china-quarterly/article/abs/missing-girls-or-hidden-girls-a-comment-on-shi-and-kennedys-delayed-registration-and-identifying-the-missing-girls-in-china/61E21855F8A1D958660973841BBC46FD |title=Missing Girls or Hidden Girls? A Comment on Shi and Kennedy's "Delayed Registration and Identifying the 'Missing Girls' in China" |journal=The China Quarterly |issue=231 |date=2017 |pages=797–803 | vauthors = Cai Y |volume=231 |doi=10.1017/S0305741017001060 |s2cid=158924618 |access-date=April 29, 2023 |archive-date=April 29, 2023 |archive-url=https://web.archive.org/web/20230429232049/https://www.cambridge.org/core/journals/china-quarterly/article/abs/missing-girls-or-hidden-girls-a-comment-on-shi-and-kennedys-delayed-registration-and-identifying-the-missing-girls-in-china/61E21855F8A1D958660973841BBC46FD |url-status=live |url-access=subscription }}</ref><ref>{{cite web |url=https://www.newsecuritybeat.org/2017/01/chinas-missing-girls-along/ |title=Have China's Missing Girls Actually Been There All Along? |website=New Security Beat |date=January 9, 2017 | vauthors = den Boer A, M Hudson V |access-date=April 29, 2023 |archive-date=April 29, 2023 |archive-url=https://web.archive.org/web/20230429232050/https://www.newsecuritybeat.org/2017/01/chinas-missing-girls-along/ |url-status=live }}</ref>

=== India ===
{{Further|Female foeticide in India}}
[[File:2011 Census sex ratio map for the states and Union Territories of India Boys to Girls 0 to 1 age group.svg|thumb|200px|left|A map of India's child sex ratio, 2011.]]

A research by [[Pew Research Center]] based on Union government data indicates foeticide of at least 9 million females in the years 2000–2019. The research found that 86.7% of these foeticides were by [[Hindus]] (80% of the population), followed by [[Sikhs]] (1.7% of the population) with 4.9%, and [[Muslims]] (14% of the population) with 6.6%. The research also indicated an overall decline in preference for sons in the time period.<ref>{{cite news | vauthors = Kaur B |title=Foeticide: More 'Missing' Girls Among Hindus Than Muslims in Last Two Decades, Official Data Shows |url=https://thewire.in/women/india-missing-girls-sex-ratio-infanticide-pew-analysis |access-date=September 6, 2022 |work=[[The Wire (India)|The Wire]] |date=September 6, 2022 |archive-date=September 6, 2022 |archive-url=https://web.archive.org/web/20220906121635/https://thewire.in/women/india-missing-girls-sex-ratio-infanticide-pew-analysis |url-status=live }}</ref>

India's 2001 census revealed a national 0–6 age child sex ratio of 108, which increased to 109 according to 2011 census (927 girls per 1000 boys and 919 girls per 1000 boys respectively, compared to expected normal ratio of 943 girls per 1000 boys).<ref>{{cite news|url=https://timesofindia.indiatimes.com/india/Sex-ratio-worsens-in-small-families-improves-with-3-or-more-children/articleshow/50989227.cms|title=Sex ratio worsens in small families, improves with 3 or more children|website=[[The Times of India]]|date=February 15, 2016|access-date=May 14, 2018|archive-date=December 25, 2018|archive-url=https://web.archive.org/web/20181225051046/https://timesofindia.indiatimes.com/india/Sex-ratio-worsens-in-small-families-improves-with-3-or-more-children/articleshow/50989227.cms|url-status=live}}</ref><ref>{{cite web | url = http://www.census2011.co.in/p/glance.php | title = India at Glance – Population Census 2011 – Final | archive-url = https://web.archive.org/web/20140108025228/http://www.census2011.co.in/p/glance.php | archive-date=January 8, 2014 | work = Census of India, Government of India | date = 2013 }}</ref> The national average masks the variations in regional numbers according to 2011 census—Haryana's ratio was 120, Punjab's ratio was 118, Jammu & Kashmir was 116, and Gujarat's ratio was 111.<ref name=cc2011>{{cite web | url = http://www.actionaidusa.org/sites/files/actionaid/child_sex_ratio_-_presentation_by_census_commissioner.pdf | title = Child Sex Ratio in India | archive-url = https://web.archive.org/web/20131203181227/http://www.actionaidusa.org/sites/files/actionaid/child_sex_ratio_-_presentation_by_census_commissioner.pdf | archive-date=December 3, 2013 | vauthors = Chandramouli C | quote = Registrar General & Census Commissioner, India | date = 2011 }}</ref> The 2011 Census found eastern states of India had birth sex ratios between 103 and 104, lower than normal.<ref name=tec2011>{{cite web | url = http://articles.economictimes.indiatimes.com/2011-03-31/news/29365989_1_ratio-males-girl-child | title = Census of India 2011: Child sex ratio drops to lowest since Independence | archive-url = https://wayback.archive-it.org/all/20120718173236/http://articles.economictimes.indiatimes.com/2011-03-31/news/29365989_1_ratio-males-girl-child | archive-date = July 18, 2012 | work =  The Economic Times, India }}</ref> In contrast to decadal nationwide census data, small non-random sample surveys report higher child sex ratios in India.<ref>{{cite web | url = http://india.unfpa.org/drive/SRBBooklet.pdf | title = Trends in Sex Ratio at Birth and Estimates of Girls Missing at Birth in India | archive-url = https://web.archive.org/web/20121021182934/http://india.unfpa.org/drive/SRBBooklet.pdf | archive-date=October 21, 2012 | work = UNFPA | date = July 2010 }}</ref>

The child sex ratio in India shows a regional pattern. India's 2011 census found that all eastern and southern states of India had a child sex ratio between 103 and 107,<ref name=cc2011 /> typically considered as the "natural ratio." The highest sex ratios were observed in India's northern and northwestern states – [[Haryana]] (120), [[Punjab, India|Punjab]] (118) and [[Jammu and Kashmir (union territory)|Jammu & Kashmir]] (116).<ref name=ci20012011>{{cite web | url = http://censusindia.gov.in/2011-prov-results/data_files/india/s13_sex_ratio.pdf | title = Child Sex Ratio 2001 versus 2011 | archive-url = https://web.archive.org/web/20140928131054/http://censusindia.gov.in/2011-prov-results/data_files/india/s13_sex_ratio.pdf | archive-date=September 28, 2014 | work = Census of India | publisher = Government of India | date = 2013 }}</ref> The western states of Maharashtra and Rajasthan 2011 census found a child sex ratio of 113, Gujarat at 112 and Uttar Pradesh at 111.<ref name=ci20012011 />

The Indian census data suggests there is a positive correlation between abnormal sex ratio and better socio-economic status and literacy. Urban India has higher child sex ratio than rural India according to 1991, 2001 and 2011 Census data, implying higher prevalence of sex selective abortion in urban India. Similarly, child sex ratio greater than 115 boys per 100 girls is found in regions where the predominant majority is Hindu, Muslim, Sikh or Christian; furthermore "normal" child sex ratio of 104 to 106 boys per 100 girls are also found in regions where the predominant majority is Hindu, Muslim, Sikh or Christian. These data contradict any hypotheses that may suggest that sex selection is an archaic practice which takes place among uneducated, poor sections or particular religion of the Indian society.<ref name=cc2011 /><ref name=wbhindia />

[[File:India Male to Female Sex Ratio 1941 1951 1961 1981 1991 2001 2011.png|thumb|250px|The male to female sex ratio for India, based on its official census data from 1941 through to 2011. The data suggests the existence of high sex ratios before and after the arrival of ultrasound-based prenatal care and sex screening technologies in India.]]
[[File:6th Earl of Mayo.jpg|thumb|200px|[[Richard Bourke, 6th Earl of Mayo]], who was [[Governor-General of India]] at the time of the [[Female Infanticide Prevention Act, 1870]].]]

Rutherford and Roy, in their 2003 paper, suggest that techniques for determining sex prenatally that were pioneered in the 1970s, gained popularity in India.<ref>{{cite report | vauthors = Retherford RD, Roy TK |title=Factors affecting sex-selective abortion in India and 17 major states |date=2003 |hdl=10125/3488 | work = National Family Health Survey Subject Reports | volume = 21 | publisher = International Institute for Population Sciences, East-West Center Program on Population | location = Mumbai, India Honolulu, Hawaii, USA }}</ref> These techniques, claim Rutherford and Roy, became broadly available in 17 of 29 Indian states by the early 2000s. Such prenatal sex determination techniques, claim Sudha and Rajan in a 1999 report, where available, favored male births.<ref>{{cite journal | vauthors = Sudha S, Irudaya RS | title = Female demographic disadvantage in India 1981-1991: sex selective abortions and female infanticide | journal = Development and Change | volume = 30 | issue = 3 | pages = 585–618 | date = July 1999 | pmid = 20162850 | doi = 10.1111/1467-7660.00130 | s2cid = 33446683 }}</ref>

Arnold, Kishor, and Roy, in their 2002 paper, too hypothesize that modern fetal sex screening techniques have skewed child sex ratios in India.<ref name=Arnold>{{cite journal | vauthors = Arnold F, Kishor S, Roy TK | year = 2002 | title = Sex-Selective Abortions in India | journal = Population and Development Review | volume = 28 | issue = 4| pages = 759–785 | doi = 10.1111/j.1728-4457.2002.00759.x }}</ref> Ganatra et al., in their 2000 paper, use a small survey sample to estimate that {{frac|1|6}} of reported abortions followed a sex determination test.<ref>{{cite book | vauthors = Ganatra BR | date = 2000 | chapter = Abortion research in India: What we know, and what we need to know | veditors = Ramasubban R, Jejeebhoy SJ | title = Women's Reproductive Health in India. | location = New Delhi | publisher = Rawat Publications }}</ref>

The Indian government and various advocacy groups have continued the debate and discussion about ways to prevent sex selection. The immorality of prenatal sex selection has been questioned, with some arguments in favor of prenatal discrimination as more humane than postnatal discrimination by a family that does not want a female child. Others question whether the morality of sex selective abortion is any different over morality of abortion when there is no risk to the mother nor to the fetus, and abortion is used as a means to end an unwanted pregnancy.<ref>{{cite journal | vauthors = Kumar D | year = 1983 | title = Male utopias or nightmares? | journal = Economic and Political Weekly | volume = 13 | issue = 3| pages = 61–64 | jstor = 4371751 }}</ref><ref>{{cite journal | vauthors = Gangoli G | year = 1998 | title = Reproduction, abortion and women's health | journal = Social Scientist | volume = 26 | issue = 11–12| pages = 83–105 | doi=10.2307/3517661 | jstor = 3517661 }}</ref><ref>{{cite journal | vauthors = Goodkind D | year = 1996 | title = On substituting sex preference strategies in East Asia: Does pre-natal sex selection reduce post natal discrimination? | journal = Population and Development Review | volume = 22 | issue = 1| pages = 111–125 | doi=10.2307/2137689 | jstor = 2137689 }}</ref>

India passed its first abortion-related law, the so-called Medical Termination of Pregnancy Act of 1971, making abortion legal in most states, but specified legally acceptable reasons for abortion such as medical risk to mother and rape. The law also established physicians who can legally provide the procedure and the facilities where abortions can be performed, but did not anticipate sex selective abortion based on technology advances.<ref>{{cite web |title=Medical Termination of Pregnancy Act 1971 – Introduction |work=Med India |date=October 20, 2013 |url=https://www.medindia.net/indian_health_act/the-medical-termination-of-pregnancy-act-1971-introduction.htm |access-date=December 26, 2018 |archive-date=April 10, 2019 |archive-url=https://web.archive.org/web/20190410020324/https://www.medindia.net/indian_health_act/the-medical-termination-of-pregnancy-act-1971-introduction.htm |url-status=live }}</ref>

With increasing availability of sex screening technologies in India through the 1980s in urban India, and claims of its misuse, the Government of India passed the [[Pre-Conception and Pre-Natal Diagnostic Techniques Act, 1994|Pre-natal Diagnostic Techniques Act (PNDT)]] in 1994. This law was further amended into the Pre-Conception and Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) (PCPNDT) Act in 2004 to deter and punish prenatal sex screening and sex selective abortion. The impact of the law and its enforcement is unclear. However, research shows that there was about a 0.7%-1% increase in female births after the PNDT Act was passed in 1994. Unfortunately, this data was not significant.<ref name="Nandi_2015">{{cite journal | vauthors = Nandi A |date=October 2, 2015 |title=The Unintended Effects of a Ban on Sex-Selective Abortion on Infant Mortality: Evidence from India |journal=Oxford Development Studies |language=en |volume=43 |issue=4 |pages=466–482 |doi=10.1080/13600818.2014.973390 |s2cid=154284754 |issn=1360-0818  }}</ref> [[United Nations Population Fund]] and India's National Human Rights Commission, in 2009, asked the Government of India to assess the impact of the law. The Public Health Foundation of India, an activist NGO in its 2010 report, claimed a lack of awareness about the Act in parts of India, inactive role of the Appropriate Authorities, ambiguity among some clinics that offer prenatal care services, and the role of a few medical practitioners in disregarding the law.<ref name=wbhindia /> At the start of passing this act, women were still able to travel across borders to continue having sex-selective abortions. This was until the national PNDT was passed in 1996.<ref name="Nandi_2015" />

The [[Ministry of Health and Family Welfare]] of India has targeted education and media advertisements to reach clinics and medical professionals to increase awareness. The Indian Medical Association has undertaken efforts to prevent prenatal sex selection by giving its members ''Beti Bachao'' (save the daughter) badges during its meetings and conferences.<ref name=wbhindia />

In November 2007, MacPherson estimated that 100,000 abortions every year continue to be performed in India solely because the fetus is female.<ref name=macpherson /> Women may further be subject to violence for birthing daughters over sons. In 2016, [[Murder of Anu Bansal|Anu Bansal]] was murdered by her husband after giving birth to another daughter. She was burned to death.<ref>{{Cite news |date=2022-07-29 |title=Bulandshahr: India girls who wrote letter with blood get justice |url=https://www.bbc.co.uk/news/world-asia-india-62344788 |access-date=2025-04-22 |work=BBC News |language=en-GB}}</ref>

===Pakistan===
{{Main|Female infanticide in Pakistan}}
[[File:Pakistan (orthographic projection).svg|thumb|[[Pakistan]] has a tradition of sex selection. Similarly with India, the tradition of [[dowry]] plays role.]]
For Pakistan, the United Nations Population Fund, in its 2012 report estimates the Pakistan birth sex ratio to be 110. In the urban regions, particularly its densely populated region of Punjab, report a sex ratio above 112 (less than 900 females per 1000 males).<ref>N Purewal (2010), "Son Preference, Sex Selection, Gender and Culture in South Asia", Oxford International Publishers / Berg, {{ISBN|978-1-84520-468-6}}, page 38</ref> Hudson and Den Boer estimate the resulting deficit to be about 6 million missing girls in Pakistan than what would normally be expected.<ref name=hudsonboer /> 

In 2017, two Pakistani organisations discovered large cases of infanticide in Pakistani cities. This was led by the Edhi Foundation and Chhipa Welfare Foundation. The infanticide victims were almost all were female infants. The reason given by the local authorities were poverty and local customs, where boys are preferred to girls. However, the large discovery in Karachi shows that many of the female infants were killed because of the local clerics, who ordered that out-of-wedlock babies should be disregarded. This is due to the fact that fornication is a major sin in Islam, although it is also ''[[haram]]'' (forbidden) to kill an innocent soul, which babies and children fall under.<ref name="thenews.com.pk">{{cite web | url=https://www.thenews.com.pk/print/309162-karachi-becoming-a-killing-field-for-newborn-girls | title=Karachi becoming a killing field for newborn girls | access-date=May 8, 2020 | archive-date=February 17, 2022 | archive-url=https://web.archive.org/web/20220217224111/https://www.thenews.com.pk/print/309162-karachi-becoming-a-killing-field-for-newborn-girls | url-status=live }}</ref> In fact, [[Muhammad]] explicitly banned the killing of female infants, as it was a custom in [[Pre-Islamic Arabia]].<ref>{{Cite journal |last1=Tasgheer |first1=Aqsa |last2=Ishfaq |first2=Muhammad |date=October 17, 2021 |title=Female Infanticide in Pre-Islamic Arab Society: A Quranic and Historical Perspective |url=https://www.researchgate.net/publication/361885912 |journal=Al-Qawarir |volume=3 |issue=1 |page=6 |via=ResearchGate}}</ref>

{{Blockquote|From January 2017 to April 2018, Edhi Center foundation and Chhipa Welfare organisation have found 345 such new born babies dumped in garbage in Karachi only and 99 percent of them were girls.

"We have been dealing with such cases for years and there are a few such incidents which shook our souls as much. It left us wondering whether our society is heading back to primitive age," Anwar Kazmi, a senior manager in Edhi Foundation Karachi, told The News.

Edhi Foundation has found 355 such dead infants from the garbage dumps across the country in 2017; 99 percent of them were identified girls. And Karachi has topped in this notorious ranking with 180 cases in 2017. As many as 72 dead girls have been buried in the first four months of this year by Edhi Foundation alone in the metropolitan city. The given data is just tip of the iceberg as Edhi foundation maintains the data of those cities where it provides services.<ref name="thenews.com.pk"/>}}

=== South Korea ===
{{Further|Sex-selective abortion in South Korea}}

Sex-selective abortion gained popularity in the mid-1980s to early 1990s in [[South Korea]], where selective female abortions were commonplace as male children were preferred. Historically, much of Korea's values and traditions were based on Confucianism that dictated the patriarchal system,<ref name="Chun_2009">{{cite journal | vauthors = Chun H, Das Gupta M |title=Gender discrimination in sex selective abortions and its transition in South Korea |journal=Women's Studies International Forum |date=March 2009 |volume=32 |issue=2 |pages=89–97 |doi=10.1016/j.wsif.2009.03.008 }}</ref> motivating the heavy preference for sons. Additionally, even though the abortion ban existed, the combination of son preference and availability of sex-selective technology led to an increasing number of sex-selective abortions and boys born.<ref>{{cite journal | vauthors = Lee J, Smith JP | title = Fertility behaviors in South Korea and their association with ultrasound prenatal sex screening | journal = SSM - Population Health | volume = 4 | pages = 10–16 | date = April 2018 | pmid = 29349269 | pmc = 5769124 | doi = 10.1016/j.ssmph.2017.10.003 }}</ref> As a result, South Korea experienced drastically high sex ratios around mid-1980s to early 1990s.<ref name="Chun_2009" /> However, in recent years, with the changes in family policies and modernization, attitudes towards son preference have changed, normalizing the sex ratio and lowering the number of sex-selective abortions.<ref name="Chun_2009" /> With that being said, there has been no explicit data on the number of induced sex selective abortions reportedly performed due to the abortion ban and controversy surrounding the topic. Therefore, scholars have been continuously analyzing and generating connections among sex-selection, abortion policies, gender discrimination, and other cultural factors.

===Other Asian countries===
Other countries with large populations but high sex ratios include [[Vietnam]]. The United Nations Population Fund, in its 2012 report,<ref>{{cite book | url = http://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/Sex%20Imbalances%20at%20Birth.%20PDF%20UNFPA%20APRO%20publication%202012.pdf | title = Sex Imbalances at Birth: Current trends, consequences and policy implications | archive-url = https://web.archive.org/web/20131230232549/http://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/Sex%20Imbalances%20at%20Birth.%20PDF%20UNFPA%20APRO%20publication%202012.pdf | archive-date=December 30, 2013 | publisher = UNFPA | isbn = 978-974680-3380 | page = 20 }}</ref> claims the birth sex ratio of Vietnam at 111 with its densely populated [[Red River Delta]] region at 116.

[[Taiwan]] has reported a sex ratio at birth between 1.07 and 1.11 every year, across 4 million births, over the 20-year period from 1991 to 2011, with the highest birth sex ratios in the 2000s.<ref>{{cite journal | vauthors = Lee IW, Lai YC, Kuo PL, Chang CM | title = Human sex ratio at amniocentesis and at birth in Taiwan | journal = Taiwanese Journal of Obstetrics & Gynecology | volume = 51 | issue = 4 | pages = 572–575 | date = December 2012 | pmid = 23276560 | doi = 10.1016/j.tjog.2012.09.012 | doi-access = free }}</ref> Sex-selective abortion is reported to be common in [[South Korea]] too, but its incidence has declined in recent years.<ref>{{cite web|url=https://www.unfpa.org/sites/default/files/resource-pdf/regional_analysis.pdf|title=Sex-ratio imbalance in Asia: Trends, consequences and policy responses|access-date=October 23, 2019|archive-date=January 17, 2018|archive-url=https://web.archive.org/web/20180117194644/https://www.unfpa.org/sites/default/files/resource-pdf/regional_analysis.pdf|url-status=live}}</ref><ref name="The consequences of son preference"/><ref>{{cite journal | vauthors = Vogel L | title = Sex-selective abortions: no simple solution | journal = CMAJ | volume = 184 | issue = 3 | pages = 286–288 | date = February 2012 | pmid = 22271910 | pmc = 3281151 | doi = 10.1503/cmaj.109-4097 }}</ref> As of 2015, South Korea's sex ratio at birth was 1.07 male/female.<ref name="cia.gov">{{cite web | url=https://www.cia.gov/library/publications/the-world-factbook/fields/2018.html | title=The World Factbook — Central Intelligence Agency | access-date=May 17, 2016 | archive-date=October 16, 2013 | archive-url=https://web.archive.org/web/20131016065003/https://www.cia.gov/library//publications/the-world-factbook/fields/2018.html }}</ref> In 2015, [[Hong Kong]] had a sex ratio at birth of 1.12 male/female.<ref name="cia.gov" /> A 2001 study on births in the late 1990s concluded that "sex selection or sex-selective abortion might be practiced among Hong Kong Chinese women".<ref>{{cite journal | vauthors = Wong SF, Ho LC | title = Sex selection in practice among Hong Kong Chinese | journal = Social Science & Medicine | volume = 53 | issue = 3 | pages = 393–397 | date = August 2001 | pmid = 11439822 | doi = 10.1016/s0277-9536(00)00306-3 }}</ref>

Recently, a rise in the sex ratio at birth has been noted in some parts of [[Nepal]], most notably in the [[Kathmandu Valley]], but also in districts such as [[Kaski District|Kaski]].<ref name=pmid23674444>{{cite journal | vauthors = Frost MD, Puri M, Hinde PR | title = Falling sex ratios and emerging evidence of sex-selective abortion in Nepal: evidence from nationally representative survey data | journal = BMJ Open | volume = 3 | issue = 5 | article-number = e002612 | date = May 2013 | pmid = 23674444 | pmc = 3657664 | doi = 10.1136/bmjopen-2013-002612 }}</ref><ref>{{cite news|url=http://www.ageing.ox.ac.uk/blog/2016-Gender-Inequality-Nepal-BLOG|title=Gender inequality in Nepal: How can we tackle sex-selective abortion?|newspaper=Oxford Institute of Population Ageing|access-date=November 2, 2016|archive-date=September 15, 2019|archive-url=https://web.archive.org/web/20190915085341/https://www.ageing.ox.ac.uk/blog/2016-Gender-Inequality-Nepal-BLOG}}</ref> High sex ratios at birth are most notable amongst richer, more educated sections of the population in urban areas.<ref name=pmid23674444/>

== Europe ==
Abnormal sex ratios at birth, possibly explained by growing incidence of sex-selective abortion, have also been noted in some other countries outside South and East Asia. According to CIA, the most imbalanced birth sex ratios in Europe (2017) are in Liechtenstein, Armenia, Albania, Azerbaijan, San Marino,  Kosovo and Macedonia; with Liechtenstein having the most imbalanced sex ratio in the world.<ref name="cia.gov"/>

=== Caucasus ===
[[File:Caucasus topographic map-en.svg|thumb|250px|Topography of the [[Caucasus]],  a region at the border of [[Europe]] and [[Asia]], situated between the [[Black Sea|Black]] and the [[Caspian Sea|Caspian]] seas]]
The [[Caucasus]] has been named a "male-dominated region", and as families have become smaller in recent years, the pressures to have sons has increased.<ref>{{cite web | vauthors = Forestier-Walker R | date = 22 June 2015 | url=http://www.aljazeera.com/news/2015/06/azerbaijan-pressured-sex-selective-abortions-150621124644074.html | title=Azerbaijan pressured over sex-selective abortions &#124; News | work = al Jazeera | access-date=October 5, 2016 | archive-date=April 9, 2019 | archive-url=https://web.archive.org/web/20190409102453/https://www.aljazeera.com/news/2015/06/azerbaijan-pressured-sex-selective-abortions-150621124644074.html | url-status=live }}</ref> Before the [[dissolution of the Soviet Union]] in the early 1990s, the birth sex ratio in Caucasus countries such as [[Azerbaijan]], [[Armenia]] and [[Georgia (country)|Georgia]] was in the 105 to 108 range. After the collapse, the birth sex ratios sharply climbed and have remained high for the last 20 years.<ref name = "Meslé_2007" /> Armenia, Georgia, and Azerbaijan have seen strongly imbalanced birth sex ratios in the first decade of the 21st century.<ref name=teconomist>{{cite news | url = https://www.economist.com/news/europe/21586617-son-preference-once-suppressed-reviving-alarmingly-gendercide-caucasus | title = Gendercide in the Caucasus | archive-url = https://web.archive.org/web/20170914204741/https://www.economist.com/news/europe/21586617-son-preference-once-suppressed-reviving-alarmingly-gendercide-caucasus | archive-date=September 14, 2017 | newspaper = The Economist | date = September 13, 2013}}</ref> In Georgia, the birth sex ratio for the years 2005–2009 was cited by ''[[The Economist]]'' to be about 120, a trend ''The Economist'' claims suggests that the practice of sex-selective abortion in the Caucasus has been similar to those in East Asia and South Asia in recent decades.<ref name="teconomist"/>

According to an article in ''The Economist''  the sex ratio in Armenia is seen to be a function of birth order. The article claimed that among first born children, there are 138 boys for every 100 girls.<ref name="teconomist"/> Overall, the birth sex ratio in Armenia exceeded 115 in some years, far higher than India's which was cited at 108.<ref name=teconomist /><ref>{{cite journal | vauthors = Michael M, King L, Guo L, McKee M, Richardson E, Stuckler D | title = The mystery of missing female children in the Caucasus: an analysis of sex ratios by birth order | journal = International Perspectives on Sexual and Reproductive Health | volume = 39 | issue = 2 | pages = 97–102 | date = June 2013 | pmid = 23895886 | doi = 10.1363/3909713 | doi-access = free | jstor = 41959961 }}</ref><ref name="Bongaarts_2013">{{cite journal | vauthors = Bongaarts J |title=The Implementation of Preferences for Male Offspring |journal=Population and Development Review |date=June 2013 |volume=39 |issue=2 |pages=185–208 |doi=10.1111/j.1728-4457.2013.00588.x }}</ref> While these high birth sex ratios suggest sex-selective abortion, there is no direct evidence of observed large-scale sex-selective abortions in Caucasus.<ref name= "Meslé_2007" />

According to latest CIA data, the 2017 sex ratio in the region is 112 for Armenia, 109 for Azerbaijan, and 107 for Georgia.<ref name="cia.gov"/>

=== Southeast Europe ===
An imbalanced birth sex ratio has been present in the 21st century in the [[Western Balkans]], in countries such as [[Albania]], [[Republic of Macedonia|Macedonia]], [[Kosovo]] and [[Montenegro]]. Scholars claim this suggests that sex-selective abortions are common in southeast Europe.<ref name=czgparis>{{cite web | url = http://www.demographie.net/guilmoto/pdf/research%20note%20on%20BM%20in%20SE%20Europe4.pdf | title = High Sex Ratio at Birth in Southeast Europe | archive-url = https://web.archive.org/web/20150923213506/http://www.demographie.net/guilmoto/pdf/research%20note%20on%20BM%20in%20SE%20Europe4.pdf | archive-date = September 23, 2015 | vauthors = Guilmoto CZ | publisher = CEPED, Université Paris-Descartes | location = France | date = 2012 }}</ref><ref>{{cite web | vauthors = Stump D | date = 2011 | url = http://www.assembly.coe.int/CommitteeDocs/2011/ASEGAselectionprenatalee.pdf | title = Prenatal Sex Selection | archive-url = https://web.archive.org/web/20170421051847/http://www.assembly.coe.int/CommitteeDocs/2011/ASEGAselectionprenatalee.pdf | archive-date=April 21, 2017 | work = Committee on Equal Opportunities for Women and Men | publisher = Council of Europe }}</ref><ref>{{cite journal | vauthors = Verropoulou G, Tsimbos C | title = Differentials in sex ratio at birth among natives and immigrants in Greece: an analysis employing nationwide micro-data | journal = Journal of Biosocial Science | volume = 42 | issue = 3 | pages = 425–430 | date = May 2010 | pmid = 20361419 | doi = 10.1017/s0021932009990599 | s2cid = 22202092 }}</ref> As of 2017, according to CIA estimates, Albania's birth sex ratio is 109.<ref name="cia.gov"/> According to Eurostat and birth record data over 2008–11, the birth sex ratios of Albania and Montenegro for that period were 112 and 110 respectively.<ref name=unfpaaugust2012>{{cite web | url = http://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/Sex%20Imbalances%20at%20Birth.%20PDF%20UNFPA%20APRO%20publication%202012.pdf | title = Sex Imbalances at Birth: Current trends, consequences and policy implications | archive-url = https://web.archive.org/web/20131230232549/http://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/Sex%20Imbalances%20at%20Birth.%20PDF%20UNFPA%20APRO%20publication%202012.pdf | archive-date=December 30, 2013 | work = United Nations FPA | date = August 2012 }}</ref> In recent years, Montenegrin health authorities have expressed concern with regard to the significant imbalance between the number of male and female births.<ref>{{cite web | vauthors = Tomovic D | work = BalkanInsight | url=http://www.balkaninsight.com/en/article/gender-selection-raises-concerns-in-montenegro| title=Abortions of Girls Cause Male Surplus in Montenegro| date=September 18, 2014| access-date=June 7, 2017| archive-date=November 15, 2017| archive-url=https://web.archive.org/web/20171115082656/http://www.balkaninsight.com/en/article/gender-selection-raises-concerns-in-montenegro| url-status=live}}</ref> However the data from CIA in 2017 cites the birth ratio for Montenegro within the normal range, at 106.<ref name="cia.gov"/> In recent years, the birth registration data for Macedonia and Kosovo indicate unbalanced birth sex ratios, including a birth rate in 2010 of 112 for Kosovo<ref name=unfpaaugust2012 />{{rp|23}}  As 2017, CIA cited both Macedonia and Kosovo at 108.<ref name="cia.gov"/>

== Americas ==

=== United States ===
As in other countries, sex-selective abortion is difficult to track in the United States because of lack of data.

While the vast majority of parents in the United States do not practice sex-selective abortion, there is certainly a trend toward male preference. According to a 2011 [[Gallup poll]], if they were only allowed to have one child, 40% of respondents said they would prefer a boy, while only 28% preferred a girl.<ref>{{cite web | vauthors = Newport F | title = Americans Prefer Boys to Girls, Just as They Did in 1941. | work = Gallup | date = June 23, 2011 | url = https://news.gallup.com/poll/148187/americans-prefer-boys-girls-1941.aspx }}</ref> When told about prenatal sex selection techniques such as sperm sorting and in-vitro-fertilization embryo selection, 40% of Americans surveyed thought that picking embryos by sex was an acceptable manifestation of reproductive rights.<ref name=Jesudason>{{cite news| vauthors =  Jesudason S, Shenker-Osorio A|work=The Atlantic|date=May 31, 2012|access-date=November 3, 2013|url=https://www.theatlantic.com/politics/archive/2012/05/sex-selection-in-america-why-it-persists-and-how-we-can-change-it/257864/|title=Sex Selection in America: Why It Persists and How We Can Change It|archive-date=November 13, 2013|archive-url=https://web.archive.org/web/20131113003835/http://www.theatlantic.com/politics/archive/2012/05/sex-selection-in-america-why-it-persists-and-how-we-can-change-it/257864/|url-status=live}}</ref> These selection techniques are available at about half of American fertility clinics, as of 2006.<ref>{{cite web | title = Half fertility clinics allow parents to pick gender | url = https://www.nbcnews.com/health/health-news/half-fertility-clinics-allow-parents-pick-gender-flna1c9438434 | via = Msnbc.com | agency = Associated Press | date = 21 September 2006 }}</ref> However, other studies show a larger preference for females. According to the Parliamentary Office of Science and Technology, 80% of American couples who wanted to get gender selection wanted girls over boys.<ref>{{cite journal|journal=Postnote|title=Sex Selection|url=http://researchbriefings.files.parliament.uk/documents/POST-PN-198/POST-PN-198.pdf|date=July 2003|issue=198|publisher=Parliamentary Office for Science and Technology|access-date=September 6, 2020|archive-date=December 25, 2021|archive-url=https://web.archive.org/web/20211225170832/https://researchbriefings.files.parliament.uk/documents/POST-PN-198/POST-PN-198.pdf|url-status=live}}</ref>

A study of the 2000 United States Census suggests possible male bias in families of Chinese, Korean and Indian immigrants, which was getting increasingly stronger in families where the first one or two children were female. In those families where the first two children were girls, the birth-sex ratio of the third child was 1.51:1.<ref>{{cite news | url=https://www.nytimes.com/2009/06/15/nyregion/15babies.html?_r=2&pagewanted=1&hp | title=U.S. Births Hint at Bias for Boys in Some Asians | work=The New York Times | vauthors = Roberts S | date=June 15, 2009 | access-date=May 23, 2010 | archive-date=October 18, 2018 | archive-url=https://web.archive.org/web/20181018184143/https://www.nytimes.com/2009/06/15/nyregion/15babies.html?_r=2&pagewanted=1&hp | url-status=live }}</ref>

Because of this movement toward sex preference and selection, many bans on sex-selective abortion have been proposed at the state and federal level. In 2010 and 2011, sex-selective abortions were banned in [[Oklahoma]] and [[Arizona]], respectively. Legislators in [[Georgia (U.S. state)|Georgia]], [[West Virginia]], [[Michigan]], [[Minnesota]], [[New Jersey]], and [[New York (state)|New York]] have also tried to pass acts banning the procedure.<ref name=Jesudason />

== Other countries ==
A 2013 study<ref name="Bongaarts_2013" /> by [[John Bongaarts]] based on surveys in 61 major countries calculates the sex ratios that would result if parents had the number of daughters and sons they want. In 35 countries, claims Bongaarts, the desired birth sex ratio in respective countries would be more than 110 boys for every 100 girls if parents in these countries had a child matching their preferred gender (higher than India's, which The Economist claims is 108).<ref name=teconomist />

== Estimates of missing women ==
[[File:Number of 'Missing Women' in the world, OWID.svg|thumb|Number of 'Missing Women' in the world, Our World in Data.<ref>{{cite web |title=Search |url=https://ourworldindata.org/search?q=missing+women |website=Our World in Data |access-date=December 5, 2022 |archive-date=December 5, 2022 |archive-url=https://web.archive.org/web/20221205114536/https://ourworldindata.org/search?q=missing+women |url-status=live }}</ref>]]
Estimates of implied missing girls, considering the "normal" birth sex ratio to be the 103–107 range, vary considerably between researchers and underlying assumptions for expected post-birth mortality rates for men and women. For example, a 2005 study estimated that over 90 million females were "missing" from the expected population in [[Afghanistan]], [[Bangladesh]], [[China]], [[India]], [[Pakistan]], [[South Korea]] and [[Taiwan]] alone, and suggested that sex-selective abortion plays a role in this deficit.<ref name="Gettis" /><ref name=hudsonboer>{{cite journal | vauthors = Hudson VM, Den Boer A | title = Missing Women and Bare Branches: Gender Balance and Conflict | journal = Environmental Change and Security Program Report | date = 2005 | issue = 11 | pages = 20–24 | url = http://kar.kent.ac.uk/11409/1/WW-missingwomen-05.pdf | archive-url = https://web.archive.org/web/20181103175820/https://kar.kent.ac.uk/11409/1/WW-missingwomen-05.pdf | archive-date=November 3, 2018 | series = ECSP Report }}</ref> For early 1990s, Sen estimated 107 million missing women, Coale estimated 60 million as missing, while Klasen estimated 89 million missing women in China, India, Pakistan, Bangladesh, Nepal, [[West Asia]] and [[Egypt]].<ref name= "Klausen_2003" /> Guilmoto,<ref name=czg /> in his 2010 report, uses recent data (except for Pakistan), and estimates a much lower number of missing girls, but notes that the higher sex ratios in numerous countries have created a gender gap – shortage of girls – in the 0–19 age group.

{| class="wikitable sortable"
|-
! '''Country''' !! '''Gender gap'''<br />0–19 age group (2010)<ref name=czg /> !! % of [[Minor (law)|minor]]<br />females<ref name=czg /> !! '''Region''' !! '''Religious situation'''{{synthesis inline|date=February 2023}}
|-
| [[Afghanistan]] || align="right"|265,000 || align="center"|3.0 || South Asia || [[Religion in Afghanistan|Mostly Islam]]
|-
| [[Albania]] || align="right"|21,000 || align="center"|4.2 || Southeast Europe || [[Religion in Albania|Religiously diverse]]
|-
| [[Armenia]] || align="right"|35,000 || align="center"|8.4 || Caucasus || [[Religion in Armenia|Mostly Christianity]]
|-
| [[Azerbaijan]] || align="right"|111,000 || align="center"|8.3 || Caucasus || [[Religion in Azerbaijan|Mostly Islam]]
|-
| [[Bangladesh]] || align="right"|416,000 || align="center"|1.4 || South Asia || [[Religion in Bangladesh|Mostly Islam]]
|-
| [[China]] || align="right"|25,112,000 || align="center"|15.0 || East Asia || [[Religion in China|Religiously diverse]]
|-
| [[Georgia (country)|Georgia]] || align="right"|24,000 || align="center"|4.6 || Caucasus || [[Religion in Georgia (country)|Mostly Christianity]]
|-
| [[India]] || align="right"|12,618,000 || align="center"|5.3 || South Asia || [[Religion in India|Religiously diverse]]
|-
| [[Montenegro]] || align="right"|3,000 || align="center"|3.6 || Southeast Europe || [[Religion in Montenegro|Mostly Christianity]]
|-
| [[Nepal]] || align="right"|125,000 || align="center"|1.8 || South Asia || [[Religion in Nepal|Mostly Hinduism]]
|-
| [[Pakistan]] || align="right"|206,000 || align="center"|0.5 || South Asia || [[Religion in Pakistan|Mostly Islam]]
|-
| [[South Korea]] || align="right"|336,000 || align="center"|6.2 || East Asia || [[Religion in South Korea|Religiously diverse]]
|-
| [[Singapore]] || align="right"|21,000 || align="center"|3.5 || Southeast Asia || [[Religion in Singapore|Religiously diverse]]
|-
| [[Vietnam]] || align="right"|139,000 || align="center"|1.0 || Southeast Asia || [[Religion in Vietnam|Religiously diverse]]
|}

== Disparate gendered access to resources ==
Although there is significant evidence of the prevalence of sex-selective abortions in many nations (especially India and China), there is also evidence to suggest that some of the variation in global sex ratios is due to disparate access to resources. As MacPherson (2007) notes, there can be significant differences in gender violence and access to food, healthcare, immunizations between male and female children. This leads to high infant and childhood mortality among girls, which causes changes in sex ratio.<ref name=macpherson />

Disparate, gendered access to resources appears to be strongly linked to socioeconomic status. Specifically, poorer families are sometimes forced to ration food, with daughters typically receiving less priority than sons.<ref name= "Klausen_2003" /> However, Klasen's 2001 study revealed that this practice is less common in the poorest families, but rises dramatically in the slightly less poor families.<ref name= "Klausen_2003" /> Klasen and Wink's 2003 study suggests that this is "related to greater female economic independence and fewer cultural strictures among the poorest sections of the population". In other words, the poorest families are typically less bound by cultural expectations and norms, and women tend to have more freedom to become family breadwinners out of necessity.<ref name= "Klausen_2003" />

Increased sex ratios can be caused by disparities in aspects of life other than vital resources. According to Sen (1990), differences in wages and job advancement also have a dramatic effect on sex ratios. This is why high sex ratios are sometimes seen in nations with little sex-selective abortion.<ref name= "Sen_1990" /> Additionally, high female education rates are correlated with lower sex ratios (World Bank 2011).<ref>World Bank, Engendering Development, The World Bank, (2001)</ref>

Lopez and Ruzikah (1983) found that, when given the same resources, women tend to outlive men at all stages of life after infancy. However, globally, resources are not always allocated equitably. Thus, some scholars argue that disparities in access to resources such as healthcare, education, and nutrition play at least a small role in the high sex ratios seen in some parts of the world.<ref name= "Klausen_2003" /> For example, Alderman and Gerter (1997) found that unequal access to healthcare is a primary cause of female death in developing nations, especially in Southeast Asia. Moreover, in India, lack of equal access to healthcare has led to increased disease and higher rates of female mortality in every age group until the late thirties (Sen 1990). This is particularly noteworthy because, in regions of the world where women receive equal resources, women tend to outlive men (Sen 1990). Women outlive men in all but 2 countries.<ref>{{cite journal | vauthors = Austad SN, Fischer KE | title = Sex Differences in Lifespan | journal = Cell Metabolism | volume = 23 | issue = 6 | pages = 1022–1033 | date = June 2016 | pmid = 27304504 | pmc = 4932837 | doi = 10.1016/j.cmet.2016.05.019 }}</ref>

Economic disadvantage alone may not always lead to increased sex ratio, claimed Sen in 1990. For example, in sub-Saharan Africa, one of the most economically disadvantaged regions of the world, there is an excess of women. So, if economic disadvantage is uncorrelated with sex ratio in Africa, some other factor(s) may be at play.<ref name= "Sen_1990" /> More detailed analysis of African demographics, in 2002, suggests that Africa too has wide variation in birth sex ratios (from 1.01 in Bantu populations of East Africa to 1.08 in Nigeria and Ethiopia).<ref name=pmid12617497/> Thus economic disadvantage remains a possible unresolved hypothesis for Africa as well.

== Reasons for sex-selective abortion ==
According to the 2012 report of the United Nations Fund for Population Activities on sex imbalances at birth, there are three preconditions for sex-selective abortion.<ref name="UNFPA">United Nations Fund for Population Activities (UNFPA). Sex imbalances at birth: current trends, consequences and policy implications. United Nations: Bangkok, Thailand; 2012.</ref> First, the practice should be feasible with the availability of abortion methods and prenatal sex-screening technologies (e.g., [[obstetric ultrasonography]], [[cell-free fetal DNA]], [[amniocentesis]]).<ref name="UNFPA" /><ref name="Hohmann_2014">{{cite journal | vauthors = Hohmann SA, Lefèvre CA, Garenne ML | title = A framework for analyzing sex-selective abortion: the example of changing sex ratios in Southern Caucasus | language = English | journal = International Journal of Women's Health | volume = 6 | pages = 889–897 | date = October 20, 2014 | pmid = 25349481 | pmc = 4208631 | doi = 10.2147/IJWH.S66333 | doi-access = free }}</ref> Second, changing the sex composition of children should be advantageous to the parents and the family. A variety of socioeconomic factors can account for this sex preference such as inherence rules, patronymic transmission, dowry systems, social preference of family composition.<ref name="UNFPA" /><ref name="Hohmann_2014" /> Third, sex-selective abortion should be necessary because of low or decreasing fertility. Given the existence of the social benefits associated with sons, the need for having sons while maintaining a limited number of children is intensified by low fertility.<ref name="UNFPA" /><ref name = "Goodkind_2015" /> Low fertility can be a result of social norms of family size, rising marginal costs of an additional child, or birth control policies.

Some demographers question whether sex-selective abortion or infanticide claims are accurate, because underreporting of female births may also explain high sex ratios.<ref>{{cite journal | doi=10.2307/1972351 | title=The missing girls of China: a new demographic account | vauthors = Johansson S, Nygren O | jstor=1972351 | year=1991 | volume=17 | issue=1 | journal = Population and Development Review | pages=35–51}}</ref><ref>{{cite journal | vauthors = Merli MG, Raftery AE | title = Are births underreported in rural China? Manipulation of statistical records in response to China's population policies | journal = Demography | volume = 37 | issue = 1 | pages = 109–126 | date = February 2000 | pmid = 10748993 | doi = 10.2307/2648100 | s2cid = 41085573 | doi-access = free | jstor = 2648100 }}</ref> Natural reasons may also explain some of the abnormal sex ratios.<ref name="James_2008" /><ref name=rjhmam /> In contrast to these possible causes of abnormal sex ratio, Klasen and Wink suggest India and China's high sex ratios are primarily the result of sex-selective abortion.<ref name= "Klausen_2003" />

=== Socioeconomic reasons for son preference and daughter aversion ===

==== Cultural preference ====
[[File:Burying Babies in China (p.40, March 1865, XXII).jpg|thumb|200px|Burying Babies in China (p.40, March 1865, XXII). There is a long tradition of [[female infanticide in China]].<ref name=Offering1865>{{cite journal|title=Burying Babies in China|journal=Wesleyan Juvenile Offering|date=March 1865|volume=XXII|page=40|url=https://books.google.com/books?id=1VwEAAAAQAAJ|access-date=December 1, 2015|archive-date=April 11, 2024|archive-url=https://web.archive.org/web/20240411212316/https://books.google.com/books?id=1VwEAAAAQAAJ|url-status=live}}</ref>]]
[[File:Infanticide-ganges.jpg|thumb|200px|Infanticide committed by throwing an infant into the [[Ganges river]]]]
The reason for intensifying sex-selection abortion in China and India can be seen through history and cultural background. Generally, before the [[information era]], male babies were preferred because they provided manual labor and continuation of the family [[Lineage (anthropology)|lineage]]. Labor is still important in developing nations as China and India, but when it comes to family lineage, it is of great importance.

The selective abortion of female fetuses is most common in areas where cultural norms value male children over female children for a variety of social and economic reasons.<ref name="Goodkind_1999" /> A son is often preferred as an "asset" since he can earn and support the family; a daughter is a "liability" since she will be married off to another family, and so will not contribute financially to her parents. Sex selective female abortion is a continuation, in a different form, of a practice of [[female infanticide]] or withholding of postnatal health care for girls in certain households.<ref name="Gupta_2005">{{cite journal | vauthors = Gupta MD | title = Explaining Asia's "missing women": a new look at the data. | journal = Population and Development Review | date = September 2005 | volume = 31 | issue = 3 | pages = 529–535 | doi = 10.1111/j.1728-4457.2005.00082.x }}</ref> Furthermore, in some cultures sons are expected to take care of their parents in their old age.<ref>{{cite journal | vauthors = Mahalingam R | title = Culture, ecology, and beliefs about gender in son preference caste groups | doi = 10.1016/j.evolhumbehav.2007.01.004 | journal = Evolution and Human Behavior | volume = 28 | issue = 5 | pages = 319–329 | year = 2007 | bibcode = 2007EHumB..28..319M }}</ref> These factors are complicated by the effect of diseases on child sex ratio, where communicable and noncommunicable diseases affect males and females differently.<ref name="Gupta_2005" /> In parts of India and Pakistan, there are social norms such as [[purdah]], which stipulate that female seclusion and confinement to the home is necessary. Such practices are prevalent among some Muslim and Hindu communities in South Asia. When females interact with men, or are believed to do so, the "[[family honor]]" is tarnished.

Historically, in many South Asian populations, women were allocated a very low status, evidenced through practices such as [[Sati (practice)|sati]], an ancient funeral custom where a [[widow]] immolated herself on her husband's [[pyre]] or committed [[suicide]] in another fashion shortly after her husband's death.<ref>{{cite journal |doi=10.1017/S1060150300004678 |jstor=25058378 |title=The Sati, the Bride, and the Widow: Sacrificial Woman in the Nineteenth Century |journal=Victorian Literature and Culture |volume=25 |issue=1 |pages=141–158 |year=1997 | vauthors = Gilmartin S |s2cid=162954709 }}</ref><ref>{{cite book | vauthors = Sharma A |title=Sati: historical and phenomenological essays |date=1988 |publisher=Motilal Banarsidass |location=Delhi |isbn=978-81-208-0464-7 |edition=1st | pages = 19–21 }}</ref><ref name=julialeslie>On attested Rajput practice of sati during wars, see, for example {{cite book| vauthors = Leslie J |chapter=Suttee or Sati: Victim or Victor?|page=46|chapter-url=https://books.google.com/books?id=vPdYkFguJ8IC&pg=PA46 | veditors = Arnold D, Robb PG |title=Institutions and Ideologies: A SOAS South Asia Reader|year=1993 |publisher=Routledge|location=London|isbn=978-0-7007-0284-8|volume=10}}</ref> Such societies, in placing almost no value on females, encouraged parents to commit [[infanticide]] of girls or to abandon them. The modern practice of sex-selective abortion is therefore a continuation of other historical practices. During the 19th century, in the Northwest [[British raj|British India]], one-fourth of the population preserved only half the daughters, while other 3/4th of the population had balanced sex ratio. There were 118 males per 100 females. This is comparable to the contemporary sex ratio in the area, now divided between India and Pakistan.<ref>{{cite book|title = Child Survival: Anthropological Perspectives on the Treatment and Maltreatment of Children| vauthors = Hughes NS |publisher = Springer|isbn = 978-1-55608-028-9|year = 1987|page = 99}}</ref>

[[Chinese culture]] is deeply patriarchal. Pre-modern Chinese society was predominantly patriarchal and patrilineal from at least the 11th century BC onwards.<ref>{{cite journal | title=周代男女角色定位及其对现代社会的影响 | trans-title=Role orientation of men and women in the Zhou Dynasty and their effects on modern society | vauthors = Wu X | pages=86–92 | language=zh | journal=Chang'An Daxue Xuebao (Shehui Kexue Ban) | date=2009 | volume=11 | issue=3 }}</ref> There has long been a son preference in China, leading to high rates of female infanticide, as well as a strong tradition of restricting the [[freedom of movement]] of women, particularly upper-class women, manifested through the practice of [[foot binding]]. Although the legal and social standing of women have greatly improved in the 20th century, son preference remains still strong, and the situation was aggravated by the [[one child policy]].

Interpretations of [[Confucianism]] have been argued to contribute to the low status of women. The gender roles prescribed in the [[Three Obediences and Four Virtues]] became a cornerstone of the family, and thus, societal stability. Starting from the Han period, Confucians began to teach that a virtuous woman was supposed to follow the males in her family: the father before her marriage, the husband after she marries, and her sons in widowhood. In the later dynasties, more emphasis was placed on the virtue of chastity. The Song dynasty Confucian [[Cheng Yi (philosopher)|Cheng Yi]] stated that: "To starve to death is a small matter, but to lose one's chastity is a great matter."<ref name="ebrey">{{cite book |url=https://books.google.com/books?id=GDPskRXfl5cC&pg=PA10 |title=Women and the Family in Chinese History |author=Patricia Buckley Ebrey |pages=10–12 |publisher=Routledge |date=September 19, 2002 |isbn=978-0-415-28822-4 |access-date=December 18, 2017 |archive-date=April 11, 2024 |archive-url=https://web.archive.org/web/20240411212314/https://books.google.com/books?id=GDPskRXfl5cC&pg=PA10#v=onepage&q&f=false |url-status=live }}</ref> The "cult of chastity" accordingly, condemned many widows to poverty and loneliness by placing a [[social stigma]] on remarriage.<ref name=Adler>{{cite web | vauthors = Adler JA | title = Daughter/Wife/Mother or Sage/Immortal/Bodhisattva? Women in the Teaching of Chinese Religions | work = ASIANetwork Exchange, vol. XIV, no. 2 | date = Winter 2006 | url = http://www2.kenyon.edu/Depts/Religion/Fac/Adler/Writings/Women.htm | access-date = May 18, 2011 | archive-date = March 20, 2006 | archive-url = https://web.archive.org/web/20060320105840/http://www2.kenyon.edu/Depts/Religion/Fac/Adler/Writings/Women.htm | url-status = live }}</ref>

In modern East Asia, a large part of the pattern of preferences leading to this practice can be condensed simply as a desire to have a male heir. Monica Das Gupta (2005) observes, from 1989 birth data for China, there was no evidence of selective abortion of female fetuses among firstborn children. However, there was a strong preference for a boy if the first born was a girl.<ref name="Gupta_2005" />

==== Dowry ====
[[File:Say no to dowry.jpg|thumb|A social awareness campaign in India against dowries]]
{{Further|Dowry system in India}}
[[File:India - Delhi wedding - 5438.jpg|thumb|200px|left|Wedding gifts for the son of the Imam of Delhi, India, with soldiers and 2000 guests. Large dowries are expected among several populations in South Asia, especially in India and Pakistan.]]
[[Dowry]] is the property that parents of a female transfer at her marriage. Dowry is an ancient practice, that has been common in many cultures around the world, and which is today prevalent especially in South Asia. The custom of dowry is most common in cultures that are strongly [[patrilineal]] and that expect women to reside with or near their husband's family ([[patrilocality]]).<ref>{{cite web| url=https://www.britannica.com/topic/dowry| title=Dowry &#124; marriage custom| date=June 30, 2023| access-date=March 1, 2017| archive-date=July 19, 2019| archive-url=https://web.archive.org/web/20190719020111/https://www.britannica.com/topic/dowry| url-status=live}}</ref>

Kirti Singh states that dowry is widely considered to be both a cause and a consequence of son preference, and this may lead to girls being unwanted, sex selective abortion, [[female infanticide]] or abuse of female children.<ref>{{cite web |url=http://india.unfpa.org/drive/LawsandSonPreferenceinIndia.pdf |title=Laws and son preference in India: a reality check |website=india.unfpa.org |access-date=January 12, 2022 |archive-url=https://web.archive.org/web/20140313094849/http://india.unfpa.org/drive/LawsandSonPreferenceinIndia.pdf |archive-date=March 13, 2014 }}</ref>

The [[dowry system in India]] is a major part of [[Indian culture]] and refers to the durable goods, cash, and real or movable property that the bride's family gives to the bridegroom, his parents, or his relatives as a condition of the marriage.<ref name="Jethmalani_1995">{{cite book|title = Dowry Deaths and Access to Justice in Kali's Yug: Empowerment, Law and Dowry Deaths| vauthors = Jethmalani R, Dey PK |year = 1995|pages = 36, 38}}</ref> Dowry consists of a payment in cash or some kind of gifts given to the bridegroom's family along with the bride and includes cash, jewelry, electrical appliances, furniture, bedding, crockery, utensils and other household items that help the newlyweds set up their home.<ref name="Diwan_1997">{{cite book|title = Law Relating to Dowry, Dowry Deaths, Bride Burning, Rape, and Related Offences| vauthors = Diwan P, Diwan P |publisher = Universal Law Pub. Co.|year = 1997|location = Delhi|page = 10}}</ref> Disputes regarding dowry sometimes lead to [[dowry death]]s.

==== Trivers–Willard hypothesis ====
The [[Trivers–Willard hypothesis]] argues that resource availability affects male [[reproductive success]] more than female and that, consequently, parents should prefer males when resources are plentiful and females when resources are scarce. This has been applied to resource differences between individuals in a society and also to resource differences between societies. Empirical evidence is mixed, with higher support in better studies, according to Cronk in a 2007 review. One example: in a 1997 study of a group with a preference for females was [[Romani people|Romani]] in [[Hungary]], a low-status group. They "had a female-biased sex ratio at birth, were more likely to abort a fetus after having had one or more daughters, nursed their daughters longer, and sent their daughters to school for longer."<ref>{{cite journal | vauthors = Cronk L | title = Boy or girl: gender preferences from a Darwinian point of view | journal = Reproductive Biomedicine Online | volume = 15 | issue = Suppl 2 | pages = 23–32 | date = December 2007 | pmid = 18088517 | doi = 10.1016/S1472-6483(10)60546-9 }}</ref>

=== One-child policy ===
[[File:Danshan Nongguang Village Bulletin board.jpg|thumb|right|200px|The [[one child policy]] in [[China]] has contributed to the imbalanced sex ratios. Image shows a community bulletin board in Nonguang Village, [[Sichuan province]], China, keeping track of the town's female population, listing recent births by name and noting that several thousand yuan of fines for unauthorized births remain unpaid from the previous year.]]
Following the 1949 creation of the People's Republic of China, the issue of population control came into the national spotlight. In the early years of the Republic, leaders believed that telling citizens to reduce their fertility was enough, repealing laws banning [[contraception]] and instead promoting its use. However, the contraceptives were not widely available, both because of lack of supply and because of cultural taboo against discussing sex. Efforts were slowed following the famine of 1959–61 but were resumed shortly thereafter with virtually the same results. Then, in 1964, the Family Planning Office was established to enforce stricter guidelines regarding fertility and it was moderately successful.<ref>{{cite book | vauthors = Henneberger S | chapter = History of the Policy. | title = China's One-Child Policy | veditors = Henneberger S | date = 2007 | url = http://iml.jou.ufl.edu/projects/fall07/Henneberger/History.html | archive-url = https://web.archive.org/web/20100205073709/http://iml.jou.ufl.edu/projects/fall07/Henneberger/History.html | archive-date = 5 February 2010 }}</ref>

In 1979, the government adopted the [[One-Child Policy]], which limited many families to one child, unless specified by provincial regulations. It was instituted as an attempt to boost the Chinese economy. Under it, families who break rules regarding the number of children they are allowed are given various punishments (primarily monetary), dependent upon the province in which they live.<ref>{{cite report | title = History of the One-Child Policy | work = All Girls Allowed | date = 2013 | url = https://www.allgirlsallowed.org/about-us }}</ref>

As stated above, the sex ratios of a province are largely determined by the type of restriction placed upon the family, pointing to the conclusion that much of the imbalance in sex ratio in China can be attributed to the policy. Research by Junhong (2001) found that many parents are willing to pay to ensure that their child is male (especially if their first child is female), but will not do the same to ensure their child is female.<ref name="Junhong_2001" /> Likely, fear of the harsh monetary punishments of the One-Child Policy make ensuring a son's birth a smart investment. Therefore, son's cultural and economic importance to families and the large expenses associated with multiple children are primary factors leading to China's disparate sex ratio.

In 2013, China announced plans to formally change the One-Child policy, making it less stringent. The National People's Congress has changed the policy to allow couples to have two children, so long as one of the partners is an only child. This change was not sparked by sex ratios, but rather by an aging population that is causing the workforce to become increasingly smaller. It is estimated that this new law will lead to two million more births per year and could cause a baby boom in China. In 2015, China officially relaxed its one child law.<ref>{{cite news| url=https://www.bbc.com/news/world-asia-china-38714949| title=China birth rate up after one-child change| work=BBC News| date=January 23, 2017| access-date=June 20, 2018| archive-date=August 19, 2019| archive-url=https://web.archive.org/web/20190819214358/https://www.bbc.com/news/world-asia-china-38714949| url-status=live}}</ref> Unfortunately, many of China's social problems are based on overpopulation. So, it is unclear if this new law will actually lead to women being more valued in Chinese society as the number of citizens increases.<ref>{{cite web |url= http://www.independent.co.uk/life-style/health-and-families/health-news/chinas-one-child-policy-to-change-in-the-new-year-9028601.html |title= China's one-child policy to change in the new year|date=December 29, 2013|work = The Independent|language=en|access-date=October 23, 2019|archive-date=October 23, 2019|archive-url=https://web.archive.org/web/20191023095846/https://www.independent.co.uk/life-style/health-and-families/health-news/chinas-one-child-policy-to-change-in-the-new-year-9028601.html|url-status=live}}</ref>

== Societal effects ==

=== Missing women ===
{{Main|Missing women}}
The idea of "missing women" was first suggested by Amartya Sen, one of the first scholars to study high sex ratios and their causes globally, in 1990. In order to illustrate the gravity of the situation, he calculated the number of women that were not alive because of sex-selective abortion or discriminatory practices. He found that there were 11 percent fewer women than there "should" have been, if China had the natural sex ratio. This figure, when combined with statistics from around the world, led to a finding of over 100 million missing women. In other words, by the early 1990s, the number of missing women was "larger than the combined casualties of all famines in the twentieth century" (Sen 1990).<ref name= "Sen_1990" />

This has led to particular concern due to a critical shortage of wives. In some rural areas, there is already a shortage of women, which is tied to migration into urban areas (Park and Cho 1995).<ref name= ParkCho>{{cite journal | vauthors = Park CB, Cho NH | year = 1995 | title = Consequences of son preference in a low- fertility society:Imbalance of the sex ratio at birth in Korea | journal = Population and Development Review | volume = 21 | issue = 1| pages = 59–84 | doi=10.2307/2137413| jstor = 2137413 }}</ref> In [[South Korea]] and [[Taiwan]], high male sex ratios and declining birth rates over several decades have led to cross-cultural marriage between local men and foreign women from countries such as mainland China, Vietnam and the Philippines.<ref>{{cite news | url=https://www.nytimes.com/2007/02/22/world/asia/22brides.html?pagewanted=all | work=The New York Times | vauthors = Onishi N | title=Korean Men Use Brokers to Find Brides in Vietnam | date=February 22, 2007 | access-date=February 23, 2017 | archive-date=November 4, 2017 | archive-url=https://web.archive.org/web/20171104102845/http://www.nytimes.com/2007/02/22/world/asia/22brides.html?pagewanted=all | url-status=live }}</ref> However, sex-selective abortion is not the only cause of this phenomenon; it is also related to migration and declining fertility.<ref name= ParkCho />

=== Trafficking, forced marriage and sex work ===
Some scholars argue that as the proportion of women to men decreases globally, there will be an increase in [[Human trafficking|trafficking]] and sex work (both forced and self-elected), as many men will be willing to do more to obtain a sexual partner (Junhong 2001).<ref name= "Junhong_2001" /> Already, there are reports of women from [[Vietnam]], [[Myanmar]], and [[North Korea]] systematically trafficked to mainland [[China]] and [[Taiwan]] and sold into [[forced marriage]]s.<ref name="Hvistendahl_WSJ">{{cite news |url= https://www.wsj.com/articles/SB10001424052702303657404576361691165631366 |title=The War Against Girls |work=The Wall Street Journal  | vauthors = Last JV |date=June 24, 2011 |access-date=August 7, 2017 |archive-date=September 28, 2019 |archive-url=https://web.archive.org/web/20190928120406/https://www.wsj.com/articles/SB10001424052702303657404576361691165631366 |url-status=live }}</ref> Moreover, Ullman and Fidell (1989) suggested that pornography and sex-related crimes of violence (i.e., rape and molestation) would also increase with an increasing sex ratio.<ref>{{cite book |doi=10.1007/978-1-4684-5631-8_15 |isbn=978-1-4684-5633-2 |chapter=Gender Selection and Society |title=Gender in Transition |year=1989 | vauthors = Ullman JB, Fidell LS |pages=179–187 }}</ref>

=== Widening of the gender social gap ===
As Park and Cho (1995) note, families in areas with high sex ratios that have mostly sons tend to be smaller than those with mostly daughters (because the families with mostly sons appear to have used sex-selective techniques to achieve their "ideal" composition).<ref name= ParkCho /> Particularly in poor areas, large families tend to have more problems with resource allocation, with daughters often receiving fewer resources than sons.<ref name=ParkCho /> Blake (1989) is credited for noting the relationship between family size and childhood "quality." Therefore, if families with daughters continue to be predominantly large, it is likely that the social gap between genders will widen due to traditional cultural discrimination and lack of resource availability.<ref>{{cite book | vauthors = Blake J |title=Family Size and Achievement |date=1989 |publisher=University of California Press |isbn=978-0-520-06296-2 }}{{page needed|date=March 2020}}</ref>

Guttentag and Secord (1983) hypothesized that when the proportion of males throughout the world is greater, there is likely to be more violence and war.<ref name= Guttentag>{{cite book | vauthors = Guttentag M, Secord PF |title=Too many women?: the sex ratio question |date=1983 |publisher=Sage Publications |isbn=978-0-8039-1918-1 }}{{page needed|date=March 2020}}</ref>

=== Potential positive effects ===
Some scholars believe that when sex ratios are high, women actually become valued more because of their relative shortage.<ref name= ParkCho /> Park and Cho (1995) suggest that as women become more scarce, they may have "increased value for conjugal and reproductive functions" (75). Eventually, this could lead to better social conditions, followed by the birth of more women and sex ratios moving back to natural levels.<ref name= ParkCho /> This claim is supported by the work of demographer Nathan Keifitz. Keifitz (1983) wrote that as women become fewer, their relative position in society will increase. However, to date, no data has supported this claim.<ref>{{cite book | vauthors = Keifitz N | chapter = Foreword | veditors = Bennett NG | title = Sex selection of children. | location = New York | publisher = Academic Press | date = 1983 | pages = xi–xiii }}</ref>

It has been suggested by Belanger (2002) that sex-selective abortion may have positive effects on the mother choosing to abort the female fetus. This is related to the historical duty of mothers to produce a son in order to carry on the family name. As previously mentioned, women gain status in society when they have a male child, but not when they have a female child. Oftentimes, bearing of a son leads to greater legitimacy and agency for the mother. In some regions of the world where son preference is especially strong, sonless women are treated as outcasts. In this way, sex-selective abortion is a way for women to select for male fetuses, helping secure greater family status.<ref>{{cite journal | vauthors = Bélanger D | title = Sex selective abortions: short-term and long-term perspectives | journal = Reproductive Health Matters | volume = 10 | issue = 19 | pages = 194–196 | date = May 2002 | pmid = 12369329 | doi = 10.1016/S0968-8080(02)00033-2 | s2cid = 12574519 | doi-access = free | jstor = 3775793 }}</ref>

Goodkind (1999)<ref name="Goodkind_1999"/> argues that sex-selective abortion should not be banned purely because of its discriminatory nature. Instead, he argues, we must consider the overall lifetime possibilities of discrimination. In fact, it is possible that sex-selective abortion takes away much of the discrimination women would face later in life. Since families have the option of selecting for the fetal sex they desire, if they choose not to abort a female fetus, she is more likely to be valued later in life. In this way, sex-selective abortion may be a more humane alternative to infanticide, abandonment, or neglect. Goodkind (1999) poses an essential philosophical question, "if a ban were enacted against prenatal sex testing (or the use of abortion for sex-selective purposes), how many excess postnatal deaths would a society be willing to tolerate in lieu of whatever sex-selective abortions were avoided?"

===Controversies===
There are many controversies surrounding sex-selective abortion. Just like the practice of sex-selective abortion has been criticized, the solutions proposed or enacted by governments have also been criticized.<ref name="nwlc.org">{{cite web|url=https://www.nwlc.org/wp-content/uploads/2015/08/prendafactsheet.pdf|title=Race and Sex Selection Abortion Bans Are Harmful to Women | work = National Women's Law Center|access-date=June 10, 2017|archive-date=October 3, 2017|archive-url=https://web.archive.org/web/20171003225021/https://www.nwlc.org/wp-content/uploads/2015/08/prendafactsheet.pdf|url-status=live}}</ref><ref name="Eklund & Purewal 2017">{{cite journal | vauthors = Eklund L, Purewal N |title=The bio-politics of population control and sex-selective abortion in China and India |journal=Feminism & Psychology |date=February 2017 |volume=27 |issue=1 |pages=34–55 |doi=10.1177/0959353516682262 |s2cid=152171783 |url=https://eprints.soas.ac.uk/23079/1/Bio-Politics-Population-Control-Sex-Selective-Abortion-China-India.pdf |access-date=March 10, 2020 |archive-date=July 31, 2020 |archive-url=https://web.archive.org/web/20200731065129/https://eprints.soas.ac.uk/23079/1/Bio-Politics-Population-Control-Sex-Selective-Abortion-China-India.pdf |url-status=live }}</ref> Eklund & Purewal argued that the response to a patriarchal practice (sex selection) should not be another patriarchal practice (restricting women's reproductive rights), as such a situation creates a cycle: women's social status is lowered, which in turn leads to more sex-selective abortions.<ref name="Eklund & Purewal 2017"/> The association of public discourse on sex-selective abortion with the [[anti-abortion movement]] also complicates the situation.<ref>{{cite journal | vauthors = Mohapatra S | title = False Framings: The Co-opting of Sex-Selection by the Anti-Abortion Movement | journal = The Journal of Law, Medicine & Ethics | volume = 43 | issue = 2 | pages = 270–274 | date = August 2015 | pmid = 26242948 | doi = 10.1111/jlme.12242 | hdl-access = free | s2cid = 33140798 | hdl = 1805/25403 }}</ref> Furthermore, access to safe abortion is seen by some as important from a [[public health]] perspective; in India, although the abortion law is relatively liberal, most efforts are put into preventing sex-selective abortion, rather than adequate access to safe abortion,<ref name="Eklund & Purewal 2017"/> as a result nearly 78% of all abortions in India take place outside of health facilities, with such [[unsafe abortions]] representing the third largest cause of maternal death in India.<ref>{{cite web| url=https://www.indiaspend.com/reduce-stigma-to-make-women-comfortable-accessing-safe-abortions-88950/| title=Reduce Stigma to Make Women Comfortable Accessing Safe Abortions| date=August 7, 2018| access-date=December 25, 2018| archive-date=April 9, 2019| archive-url=https://web.archive.org/web/20190409060749/https://www.indiaspend.com/reduce-stigma-to-make-women-comfortable-accessing-safe-abortions-88950/| url-status=live}}</ref> Another controversy in that of [[population planning]] campaigns such as the [[one child policy]] in China, and efforts from the governments of several Asian countries, including India and South Korea, from the 1970s onward to limit the number of children a family could have, which have intensified the desire to quickly have a son. An article by [[Al Jazeera Arabic|Al Jazeera]] titled "''How Western family planners helped curb the birth of girls in developing countries, the effects of which are felt today''" claimed that it was such population policies (which included [[forced sterilization]]), which were fully supported, even pushed by the West, that contributed to unbalanced sex ratios.<ref>{{cite web | url=https://www.aljazeera.com/programmes/specialseries/2018/11/politics-population-control-181127071333333.html | title=The Politics of Population Control &#124; India | work = al Jazeera | access-date=December 25, 2018 | archive-date=December 24, 2018 | archive-url=https://web.archive.org/web/20181224212605/https://www.aljazeera.com/programmes/specialseries/2018/11/politics-population-control-181127071333333.html | url-status=live }}</ref><ref>{{cite web | vauthors = Hvistendahl M |title=Where Have All the Girls Gone? |url=https://foreignpolicy.com/2011/06/27/where-have-all-the-girls-gone/ |website=Foreign Policy |date=June 27, 2011 |access-date=May 22, 2020 |archive-date=February 25, 2020 |archive-url=https://web.archive.org/web/20200225220814/https://foreignpolicy.com/2011/06/27/where-have-all-the-girls-gone/ |url-status=live }}</ref>

== Sex-selective abortion in the context of abortion ==
MacPherson estimates that 100,000 sex-selective abortions every year continue to be performed in India.<ref name=macpherson /> For a contrasting perspective, in the United States with a population {{frac|1|4}}th of India, over 1.2 million abortions every year were performed between 1990 and 2007.<ref>{{cite web | url = https://www.census.gov/compendia/statab/2012/tables/12s0101.pdf | title = Abortions—Number and Rate by Race: 1990 to 2007 | archive-url = https://web.archive.org/web/20150923235255/http://www.census.gov/compendia/statab/2012/tables/12s0101.pdf | archive-date=September 23, 2015 | work = US Census Bureau, Statistical Abstract of the United States, 2012 }}</ref> In [[England and Wales]] with a population {{frac|1|20}}th of India, over 189,000 abortions were performed in 2011, or a yearly rate of 17.5 abortions per 1,000 women aged 15–44.<ref>{{cite web | url = https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213386/Commentary1.pdf | title = Abortion Statistics, England and Wales: 2011 | archive-url = https://web.archive.org/web/20170328212931/https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213386/Commentary1.pdf | archive-date=March 28, 2017 | work = Department of Health | publisher = UK Government | date = May 2012 | page = 3 }}</ref> The average for the [[European Union]] was 30 abortions per year per 1,000 women.<ref>{{cite web | url = http://www.euro.who.int/en/health-topics/Life-stages/sexual-and-reproductive-health/activities/abortion/facts-and-figures-about-abortion-in-the-european-region | title = Facts and figures about abortion in the European Region | work = World Health Organization | date = 2012 | archive-url = https://web.archive.org/web/20140814103838/http://www.euro.who.int/en/health-topics/Life-stages/sexual-and-reproductive-health/activities/abortion/facts-and-figures-about-abortion-in-the-european-region | archive-date = August 14, 2014 | quote = Summary Note 4 }}</ref>

Many scholars have noted the difficulty in reconciling the discriminatory nature of sex-selective abortion with the right of women to have control over their own bodies. This conflict manifests itself primarily when discussing laws about sex-selective abortion. Weiss (1995:205) writes: "The most obvious challenge sex-selective abortion represents for [[pro-choice]] feminists is the difficulty of reconciling a pro-choice position with moral objections one might have to sex selective abortion (especially since it has been used primarily on female fetuses), much less the advocacy of a law banning sex-selective abortion."<ref>{{cite journal | vauthors = Weiss G | title = Sex-selective abortion: a relational approach | journal = Hypatia | volume = 10 | issue = 1 | pages = 202–217 | date = February 1995 | pmid = 11865874 | doi = 10.1111/j.1527-2001.1995.tb01360.x | s2cid = 27987147 | jstor = 3810465 }}</ref>
As a result, arguments both for and against sex-selective abortion are typically highly reflective of one's own personal beliefs about abortion in general. Warren (1985:104) argues that there is a difference between acting within one's rights and acting upon the most morally sound choice, implying that sex-selective abortion might be within rights but not morally sound. Warren also notes that, if we are to ever reverse the trend of sex-selective abortion and high sex ratios, we must work to change the patriarchy-based society which breeds the strong son preference.<ref>{{cite book | vauthors = Warren MA | title = Gendercide: The Implications of Sex-Selection | publisher = Rowman and Allenheld | date = 1985 | isbn = 978-0-8476-7330-8 }} {{page needed|date=March 2020}}</ref>

Laws against sex-selective abortion, especially those that exist in some [[U.S. state]]s, are controversial, because it is not clear how they can be enforced, and [[pro-choice]] activists argue that such laws are brought by [[anti-abortion movement]] forces who are using this as a [[pretext]] to restrict women's access to safe and legal abortion and to harass doctors who perform abortions: [[NARAL]] states that "For many years, anti-choice lawmakers have tried to ban abortion using every possible reason and excuse –including, now, on the grounds of purported concern about race or sex selection."<ref>{{cite web |url=https://www.prochoiceamerica.org/wp-content/uploads/2017/01/4.-Race-and-Sex-Selection-Abortion-Bans-A-False-Solution-to-the-Real-Problems-of-Racism-and-Sexism.pdf |title=Race- and Sex-Selection Abortion Bans: A False Solution to the Real Problems of Racism and Sexism |access-date=June 10, 2017 |archive-date=March 12, 2018 |archive-url=https://web.archive.org/web/20180312165542/https://www.prochoiceamerica.org/wp-content/uploads/2017/01/4.-Race-and-Sex-Selection-Abortion-Bans-A-False-Solution-to-the-Real-Problems-of-Racism-and-Sexism.pdf }}</ref> There is concern that such bans may put women who seek sex-selective abortions in danger because they may seek unsafe abortions, and that these bans do not address the root cause of sex-selective abortion, including the pregnant women's fear that they or their future daughters will suffer abuse, violence and stigmatization.<ref name="nwlc.org"/>

== Laws, campaigns and policies against sex-selective abortion ==
[[File:Something you wouldn't see in America (cropped).jpg|thumb|Sign in an Indian clinic reading "Prenatal disclosure of sex of foetus is prohibited under law" in English and Hindi]]

=== International ===
The practice of prenatal sex selection has been condemned internationally. It is often seen as a result of discriminatory social views which consider females inferior to males. In 1994 over 180 states signed the Programme of Action of the [[International Conference on Population and Development]], agreeing to "eliminate all forms of discrimination against the girl child".<ref>{{cite web|url=http://www.unfpa.org/webdav/site/global/shared/documents/publications/2011/Preventing_gender-biased_sex_selection.pdf|title=Preventing gender-biased sex selection|publisher=[[UNFPA]]|access-date=November 1, 2011|archive-date=October 11, 2011|archive-url=https://web.archive.org/web/20111011095023/https://www.unfpa.org/webdav/site/global/shared/documents/publications/2011/Preventing_gender-biased_sex_selection.pdf|url-status=live}}</ref> In 2011 the resolution of [[Parliamentary Assembly of the Council of Europe|PACE]]'s Committee on Equal Opportunities for Women and Men condemned the practice of prenatal sex selection.<ref>{{cite web|url=http://assembly.coe.int/Documents/WorkingDocs/Doc11/EDOC12715.pdf|title=Prenatal sex selection|publisher=[[Parliamentary Assembly of the Council of Europe|PACE]]|access-date=November 1, 2011|archive-url=https://web.archive.org/web/20111003133834/http://assembly.coe.int/Documents/WorkingDocs/Doc11/EDOC12715.pdf|archive-date=October 3, 2011}}</ref>

=== By country ===
Many nations have attempted to address sex-selective abortion rates through a combination of media campaigns and policy initiatives.

;Canada
In 2013, Conservative MP [[Mark Warawa]] introduced a motion condemning discrimination against females through sex-selective abortion but which ultimately never came to a vote.<ref>{{Cite news |date=December 5, 2012 |title=MP's motion on sex selection stirs abortion debate |url=https://www.cbc.ca/news/politics/mp-s-motion-on-sex-selection-stirs-abortion-debate-1.1188154 |work=CBC}}</ref> In 2021, Conservative [[Cathay Wagantall]] introduced a private member's bill that would prohibit a medical practitioner from performing a sex-selective abortion. Although the bill was defeated 248-82, a majority of Conservative MPs voted in favour of the bill.<ref>{{Cite web |last=Press |first=The Canadian |date=2021-06-02 |title=Majority of Conservative MPs vote in favour of defeated sex-selective abortion bill |url=https://www.ctvnews.ca/politics/article/majority-of-conservative-mps-vote-in-favour-of-defeated-sex-selective-abortion-bill/ |access-date=2025-07-31 |website=CTVNews |language=en}}</ref>

;USA
The [[United States Congress]] has debated legislation that would outlaw the practice.<ref>{{cite news | url=http://www.cnn.com/2012/05/30/politics/house-abortion-gender/index.html | title=House debates abortion ban for sex of fetus | work=CNN Online | date=May 31, 2012 | access-date=May 31, 2010 | archive-date=July 1, 2019 | archive-url=https://web.archive.org/web/20190701040147/https://www.cnn.com/2012/05/30/politics/house-abortion-gender/index.html | url-status=live }}</ref> The legislation ultimately failed to pass in the [[United States House of Representatives|House of Representatives]].<ref>{{cite news | url=https://www.nytimes.com/2012/06/01/us/politics/house-rejects-bill-to-ban-sex-selective-abortions.html?_r=1 | title=House Rejects Bill to Ban Sex-Selective Abortions | work=New York Times | date=May 31, 2012 | access-date=May 31, 2010 | vauthors = Steinhauer J | archive-date=April 20, 2016 | archive-url=https://web.archive.org/web/20160420231639/http://www.nytimes.com/2012/06/01/us/politics/house-rejects-bill-to-ban-sex-selective-abortions.html?_r=1 | url-status=live }}</ref>

On the state level, laws against sex-selective abortions have been passed in a number of U.S. states;<ref name=christie20130529>{{cite web|url=https://www.huffingtonpost.com/2013/05/29/arizona-abortion-ban-race-sex_n_3355493.html|title=Arizona Race And Sex-Selective Abortion Ban Draws ACLU Lawsuit| vauthors = Christie B | website=[[HuffPost]] |date=May 29, 2013|archive-url=https://web.archive.org/web/20130530172555/http://www.huffingtonpost.com/2013/05/29/arizona-abortion-ban-race-sex_n_3355493.html|archive-date=May 30, 2013}}</ref> the law passed in [[Arizona]] in 2011 prohibits both sex-selective and race-selective abortion.<ref name=christie20130529 /><ref>{{cite web|url=http://www.azleg.gov/legtext/50leg/1r/bills/hb2443p.pdf|title=HB 2443: An Act amending Title 13, Chapter 36, Arizona Revised Statutes, by adding section 13-3603.02; ....|access-date=May 31, 2013|archive-date=August 12, 2019|archive-url=https://web.archive.org/web/20190812231651/https://www.azleg.gov/legtext/50leg/1r/bills/hb2443p.pdf|url-status=live}}</ref><ref>{{cite web|url=http://www.azleg.state.az.us/FormatDocument.asp?inDoc=/ars/13/03603-02.htm&Title=13&DocType=ARS|title=Arizona Revised Statutes, 13-3603.02. Abortion; sex and race selection; injunctive and civil relief; failure to report; definition|access-date=May 31, 2013|archive-date=March 4, 2016|archive-url=https://web.archive.org/web/20160304055629/http://www.azleg.state.az.us/FormatDocument.asp?inDoc=/ars/13/03603-02.htm&Title=13&DocType=ARS| work = Arizona State Legislature }}</ref>

;United Kingdom
The law on sex-selective abortion is unresolved in the United Kingdom. In order for an abortion to be legal, doctors need to show that continuing the pregnancy could threaten the physical or mental health of the mother. In a recent case, two doctors were caught on camera offering a sex-selective abortion but the Director of Public Prosecution deemed it not in the public interest to proceed with the prosecution.<ref>{{cite news | url=https://www.telegraph.co.uk/health/healthnews/11208011/MPs-vote-to-make-sex-selection-abortion-illegal.html | archive-url=https://web.archive.org/web/20141104230502/http://www.telegraph.co.uk/health/healthnews/11208011/MPs-vote-to-make-sex-selection-abortion-illegal.html | archive-date=November 4, 2014 | title=MPs vote to make sex selection abortion illegal| date=November 4, 2014| vauthors = Graham G }}</ref> Following this incidence, MPs voted 181 to 1 for a Bill put forward by [[Tessa Munt]] and 11 other MPs aiming to end confusion about the legality of this practice.<ref>{{cite web|title=Burnham's MP Tessa Munt backs sex-selection abortion bill|url=http://www.thisisthewestcountry.co.uk/news/11644656.Burnham_s_MP_Tessa_Munt_backs_sex_selection_abortion_bill/|publisher=thewestcountry.co.uk|access-date=January 5, 2015|date=December 5, 2014|archive-date=September 10, 2017|archive-url=https://web.archive.org/web/20170910221221/http://www.thisisthewestcountry.co.uk/news/11644656.Burnham_s_MP_Tessa_Munt_backs_sex_selection_abortion_bill/|url-status=live}}</ref><ref>{{cite journal|title=UK: Sex-Selective Abortions Voted Illegal By Parliament Members|journal=Gender Selection|issn=2204-3888|url=http://gender-selection.com.au/index.php/component/content/article/19-portfolio/dec-2014-1-1/39-jia-ge?Itemid=0|publisher=gender-selection.com.au|access-date=January 5, 2015|date=December 1, 2014|archive-url=https://web.archive.org/web/20150105103146/http://gender-selection.com.au/index.php/component/content/article/19-portfolio/dec-2014-1-1/39-jia-ge?Itemid=0|archive-date=January 5, 2015}}{{unreliable source?|date=March 2020}}</ref> Organisations such as [[BPAS]] and [[abortion Rights (Organisation)|Abortion Rights]] have been lobbying for the decriminalisation of sex-selective abortions.<ref>{{cite web|title=Statement on sex-selective abortion|url=http://www.abortionrights.org.uk/statement-on-sex-selective-abortion|publisher=Abortion Rights|access-date=December 9, 2014|date=September 18, 2014|archive-date=September 11, 2017|archive-url=https://web.archive.org/web/20170911071423/http://www.abortionrights.org.uk/statement-on-sex-selective-abortion/|url-status=live}}</ref><ref>{{cite web|title=Statement on sex-selective abortion|url=http://spikedonlinepodcasts.podbean.com/e/on-air-off-message-ann-furedi-on-sex-selective-abortion/|publisher=Spiked.com|access-date=December 12, 2014|date=May 23, 2014|archive-date=September 10, 2017|archive-url=https://web.archive.org/web/20170910220633/http://spikedonlinepodcasts.podbean.com/e/on-air-off-message-ann-furedi-on-sex-selective-abortion/}}</ref>

;China
China's government has increasingly recognized its role in a reduction of the national sex ratio. As a result, since 2005, it has sponsored a "boys and girls are equal campaign."<ref name=JianSong>{{cite conference | vauthors = Song J |year=2009 |title=Rising sex ratio at birth in China: responses and effects of social policies |conference=International Population Conference |url=http://iussp2009.princeton.edu/papers/91145 |access-date=March 14, 2014 |archive-date=March 4, 2016 |archive-url=https://web.archive.org/web/20160304090705/http://iussp2009.princeton.edu/papers/91145 }}</ref> For example, in 2000, the Chinese government began the "Care for Girls" Initiative.<ref>{{cite web | title = Care For Girls' Gaining Momentum | url = https://www.chinadaily.com.cn/english/doc/2004-07/08/content_346700.htm | work = China Daily | date = August 7, 2004 }}</ref>{{Better source needed|reason=The current source is insufficiently reliable ([[WP:NOTRS]]).|date=March 2023}} Furthermore, several levels of government have been modified to protect the "political, economic, cultural, and social" rights of women.<ref name= JianSong /> Finally, the Chinese government has enacted policies and interventions to help reduce the sex ratio at birth. In 2005, sex-selective abortion was made illegal in China. This came in response to the ever-increasing sex ratio and a desire to try to detract from it and reach a more normal ratio.<ref>{{cite journal | year = 2005 | title = China Makes Sex-Selective Abortions a Crime | jstor=3776292| journal = Reproductive Health Matters | volume = 13 | issue = 25| page = 203 }}</ref> The sex ratio among firstborn children in urban areas from 2000 to 2005 did not rise at all, so there is hope that this movement is taking hold across the nation.<ref name="Junhong_2001" />

UNICEF and UNFPA have partnered with the Chinese government and grassroots-level women's groups such as All China Women's Federation to promote gender equality in policy and practice, as well engage various social campaigns to help lower birth sex ratio and to reduce excess female child mortality rates.<ref>{{cite web | url = http://www.unicef.cn/en/index.php?c=index&a=lists&catid=135 | title = Gender Equality | archive-url = 
https://web.archive.org/web/20140601045804/http://www.unicef.cn/en/index.php?c=index&a=lists&catid=135 | archive-date=June 1, 2014 | work = UNICEF | date = 2012 }}</ref><ref>{{cite web | url = https://www.unfpa.org/gender/docs/sexselectn_china.pdf | title = UNFPA First Agency to Campaign against Sex Selection in China | archive-url = https://web.archive.org/web/20120604164913/https://www.unfpa.org/gender/docs/sexselectn_china.pdf | archive-date=June 4, 2012 | work = United Nations Population Fund | date = 2012 }}</ref>

;India
In India, according to a 2007 study by MacPherson, Prenatal Diagnostic Techniques Act (PCPNDT Act) was highly publicized by NGOs and the government. Many of the ads used depicted abortion as violent, creating fear of abortion itself within the population. The ads focused on the religious and moral shame associated with abortion. MacPherson claims this media campaign was not effective because some perceived this as an attack on their character, leading to many becoming closed off, rather than opening a dialogue about the issue.<ref name=macpherson>{{cite journal | vauthors = MacPherson Y |title=Images and icons: harnessing the power of the media to reduce sex-selective abortion in India |journal=Gender & Development |date=November 2, 2007 |volume=15 |issue=3 |pages=413–423 |doi=10.1080/13552070701630574 |doi-access=free }}</ref> This emphasis on morality, claims MacPherson, increased fear and shame associated with all abortions, leading to an increase in unsafe abortions in India.<ref name=macpherson />

The government of India, in a 2011 report, has begun better educating all stakeholders about its MTP and PCPNDT laws. In its communication campaigns, it is clearing up public misconceptions by emphasizing that sex determination is illegal, but abortion is legal for certain medical conditions in India. The government is also supporting implementation of programs and initiatives that seek to reduce gender discrimination, including media campaign to address the underlying social causes of sex selection.<ref name="wbhindia">{{cite web | url = http://www.wbhealth.gov.in/download/IMPLEMENTATION%20OF%20THE%20PCPNDT%20ACT%20IN%20INDIA.pdf | title = Implementation of the PCPNDT Act in India – Perspectives and Challenges | work = Public Health Foundation of India | quote = Supported by United Nations FPA | date = 2010 | archive-url = https://web.archive.org/web/20151023143908/http://www.wbhealth.gov.in/download/IMPLEMENTATION%20OF%20THE%20PCPNDT%20ACT%20IN%20INDIA.pdf | archive-date = October 23, 2015 }}</ref><ref>{{cite web | url = http://jskvrc.gov.in/ipas/2.pdf | title = MTP and PCPNDT Initiatives Report | archive-url = https://web.archive.org/web/20140601012501/http://jskvrc.gov.in/ipas/2.pdf | archive-date=June 1, 2014 | work = Government of India | date = 2011 }}</ref>

Other recent policy initiatives adopted by numerous states of India, claims Guilmoto,<ref name=czg /> attempt to address the assumed economic disadvantage of girls by offering support to girls and their parents. These policies provide [[conditional cash transfer]] and scholarships only available to girls, where payments to a girl and her parents are linked to each stage of her life, such as when she is born, completion of her childhood immunization, her joining school at grade 1, her completing school grades 6, 9 and 12, her marriage past age 21. Some states are offering higher pension benefits to parents who raise one or two girls. Different states of India have been experimenting with various innovations in their girl-driven welfare policies. For example, the state of Delhi adopted a pro-girl policy initiative (locally called ''Laadli scheme''), which initial data suggests may be lowering the birth sex ratio in the state.<ref name=czg>{{cite web | vauthors = Guilmoto CZ | url = https://www.unfpa.org/webdav/site/global/shared/documents/Guilmoto_Revised_presentation_Hanoi_Oct2011.pdf | title = Sex imbalances at birth Trends, consequences and policy implications | archive-url = https://wayback.archive-it.org/all/20120604063319/https://www.unfpa.org/webdav/site/global/shared/documents/Guilmoto_Revised_presentation_Hanoi_Oct2011.pdf | archive-date=June 4, 2012 | work = United Nations Population Fund | location = Hanoi | date = October 2011 }}</ref><ref>{{cite web | url = http://delhi.gov.in/wps/wcm/connect/doit_wcd/wcd/Home/Delhi+Ladli+Scheme/ | title = Delhi Laadli Scheme | date = 2008 | archive-url = https://web.archive.org/web/20140708060319/http://delhi.gov.in/wps/wcm/connect/doit_wcd/wcd/Home/Delhi+Ladli+Scheme/ | archive-date = July 8, 2014 | work = Government of Delhi, India }}</ref>

== See also ==
{|width=100%
|-valign=top
|width=50%|
* [[Abortion debate]]
* [[Child abandonment]]
* [[Fetal rights]]
* [[Feticide]]
* [[Gendercide]]
* [[Gender role]]
* [[Female foeticide in India]]
|width=100%|
* [[Genetics and abortion]]
* [[Infanticide]]
* [[Missing women of Asia]]
* [[Missing women of China]]
* [[Psychohistorical views on infanticide]]
* [[Selective reduction]]
* [[Sex selection]]

|}

== References ==
{{Reflist}}{{Abortion}}
{{Population}}{{Discrimination}}
[[Category:Female infanticide|*]]
[[Category:Abortion debate]]
[[Category:Abortion]]
[[Category:Sexism]]
[[Category:Gendercide]]
[[Category:Sex selection|Abortion]]