Gut tmacher Policy Review
Spring 2012 | Volume 15 | Number 2

GPR
A Problem-and-Solution Mismatch:
Son Preference and Sex-Selective Abortion Bans
By Sneha Barot

A

mong the widening panoply of strategies
being deployed to restrict U.S. abortion
rights—ostensibly in the interest of
protecting women—is the relatively
recent push to prohibit the performance of
abortions for the purpose of sex selection. Sexselective abortion is widespread in certain countries, especially those in East and South Asia,
where an inordinately high social value is placed
on having male over female children. There is
some evidence—although limited and inconclusive—to suggest that the practice may also occur
among Asian communities in the United States.
A broad spectrum of civil rights groups and reproductive rights and justice organizations stand
united in opposition to these proposed abortion bans as both unenforceable and unwise.
Advocates for the welfare of Asian American
women are particularly adamant in protesting that such laws have the potential to do
much harm and no good for their communities.
Moreover, they argue that proposals to ban sexselective abortion proffered by those who would
ban all abortions are little more than a cynical
political ploy and that the real problem that
needs to be addressed is son preference—itself
a deeply seated and complex manifestation of
entrenched gender discrimination and inequity.

Understanding the Root Problem…
Son preference is a global phenomenon that has
existed throughout history. Today, in some societies, son preference is so strong and sex-selective
practices so common that, at the population
level, the number of boys being born is much

18

greater than the number of girls. This is notably
the case in a number of South and East Asian
countries, primarily India, China, Singapore,
Taiwan, Hong Kong and South Korea, as well
as in such former Soviet Bloc countries in the
Caucuses and Balkans as Armenia, Azerbaijan,
Georgia and Serbia.
Particularly in India and China, a deep-seated
preference for having sons over daughters is
due to a variety of factors that continue to make
males more socially and economically valuable
than females. Inheritance and land rights pass
through male heirs, aging parents depend on
support from men in the absence of national
security schemes and greater male participation
in the workforce allows them to contribute more
to family income. Women, on the other hand,
require dowries and leave the natal family upon
marriage, which make them an unproductive investment. Moreover, only sons carry out certain
functions under religious and cultural traditions,
such as death rituals for parents.
At the individual and family level, the primary
consequence of son preference is the intense—
and intensely internalized—pressure placed on
women to produce male children. In the past,
when having a large number of children was desirable and the norm, one option was to simply
allow a family to grow until a son—or the requisite number of sons—was born; even so, female
infanticide—the most drastic possible expression
of son preference—was not uncommon. Today,
son preference is jutting up against widespread
desires for smaller families and, at least in China,

strict population policies that limit family size to
one or two children. And, of course, new technologies such as ultrasound imaging to determine
fetal sex, together with sex-selective abortion,
have facilitated the preference for and practice
of choosing boys without having to resort to
infanticide.
At the macro level, the results of entrenched son
preference are highly skewed national sex ratios,
which in turn can have decidedly negative social
consequences—again, largely for women and
girls. Societies with heavily lopsided sex ratios
may face a dearth of women for marriage, which
could increase the likelihood of coerced marriages or bride abduction, trafficking of women and
girls, and rape and other violence against women
and girls. A large cohort of young, single men
may lead to more crime-ridden, violent communities and general societal insecurity, especially
in cultures where social standing is closely connected with marital status and fatherhood.
Under normal circumstances, the sex ratio at birth
usually ranges from 102–106 live male births per
100 live female births.1 (Boys are biologically more
likely to suffer child mortality, so sex ratios at birth
are naturally higher.) The sex ratio at birth in China
has been growing at an alarming rate over the
last three decades. The ratio of boys per 100 girls
jumped between 1982 and 2005, from 107 to 120.2
At the regional level, the disparity is even sharper,
as the ratio in some provinces is higher than 130.3
The Chinese Academy of Social Sciences predicts
that by 2020, China will have 30–40 million more
boys and young men under age 20 than females
of the same age.4 India, too, is facing a national
crisis with its sex ratios. The Indian census does
not publish sex ratios at birth, but rather child sex
ratios, expressed as the number of females below
age seven for every 1,000 males. The last four
census surveys point to rapidly increasing disparities: The child sex ratio dropped from 962 (girls to
1,000 boys) in 1981 to 945 in 1991 to 927 in 2001,5
and according to the latest census, in 2011, the
ratio decreased further, to 914.6
As in China, India has considerable fluctuations
across different regions and localities. For example, the northern Indian states of Haryana and

Guttmacher Policy Review | Volume 15, Number 2 | Spring 2012

Punjab are notorious for their exceedingly disparate ratios, at 830 and 846, respectively, with
some districts dipping into the 770s.6 In contrast,
south India has normal sex ratios. In this regard,
it is worth noting that the status of women in
parts of south India is higher than in the rest of
the subcontinent; gender discrimination—and
thereby son preference—apparently is not motivating women and their families to use the same
accessible technology for sex-selection purposes
in these regions.
Finally, a discernible pattern among most countries with skewed sex ratios is that disparities
increase with birth order. In other words, even in
China, the sex ratio is near normal for first-order
births;3 however, it increases dramatically for second-order births and sky-rockets for third-order
or later births.1 This evidence shows that families
will accept a daughter if she is a first-born child,
but then will take inordinate steps to guarantee
that the second one is a son. For example, in
certain provinces in China, the sex ratio for thirdorder births exceeds a whopping 200 (boys per
100 girls).3

…And Effectively Addressing It
Women’s rights advocates, researchers, multilateral agencies and affected governments have
been working on the problem of son preference
and the outcome of imbalanced sex ratios for
many years; however, with the limited exception
of South Korea (see box, page 21), relatively little
headway has been made. That said, recent international agreements provide insights into how—
and how not—to move forward.
The consensus documents brokered by more
than 180 United Nations (UN) member states at
the 1994 International Conference on Population
and Development (ICPD) in Cairo and the 1995
Fourth World Conference on Women in Beijing
represent seminal agreements on women’s
health and rights. Both the ICPD Programme
of Action and the Beijing Declaration squarely
identify sex selection as a manifestation of son
preference and frame the problem of son preference as a form of gender discrimination and a
violation of women’s human rights.8,9 And the
ICPD Programme of Action urges governments to

19

“eliminate all forms of discrimination against the
girl child and the root causes of son preference,
which results in harmful and unethical practices
regarding female infanticide and prenatal sex
selection”8—a recommendation also echoed in
the Beijing Declaration.9
The most authoritative and instructive roadmap
on how to understand and counter the problems of sex selection is a statement released
last year by five UN agencies—the Office of
the High Commissioner for Human Rights, the
United Nations Population Fund (UNFPA), the
United Nations Children’s Fund (UNICEF), UN
Women and the World Health Organization. This
joint interagency statement outlines the lessons
experienced by different governments in addressing sex selection and lists five categories of
recommendations for action, including the need
for more data on the magnitude of the problem
and its consequences; guidelines on the use of
technology in obstetric care that do not reinforce
inequities in access; supportive measures for
girls and women, such as education and health
services; laws and policies to strengthen gender
equality and equity in areas such as inheritance
and economic security; and advocacy and communication activities to stimulate behavior
change regarding the value of girls. Notably, the
statement includes this caution: “Experience also
indicates that broad, integrated and systematic
approaches need to be taken if efforts to eliminate son preference are to succeed…[and] to
ensure that the social norms and structural issues
underlying gender discrimination are addressed.
Within this framework, legal action is an important and necessary element but is not sufficient
on its own.”1
On that note, three dozen countries have enacted
laws or policies on sex selection.10 Both India
and China outlaw prenatal testing—particularly
ultrasound—to detect the sex of the fetus (except
for medical reasons), and China additionally bans
sex-selective abortions. Neither country’s laws,
however, have been effective in stopping sexselective abortions,11 likely because enforcement
is extremely difficult, affordable ultrasound services are widely available and fetal sex information can be relayed to potential parents without

20

even saying a word. Moreover, an ultrasound
may be performed in one location and an abortion obtained in another, where a woman can
provide alternative reasons for the procedure.
An even more compelling argument against sexselective abortion bans is that restrictions on
access to prenatal technologies and to abortions
can create barriers to health care for women
with legitimate medical needs; scare health care
providers from providing safe, otherwise legal
abortion services; and force women who want
to terminate their pregnancies into sidestepping
the regulated health care system and undergoing unsafe procedures. Accordingly, the joint UN
statement stresses that “States have an obligation to ensure that these injustices are addressed
without exposing women to the risk of death or
serious injury by denying them access to needed
services such as safe abortion to the full extent of
the law. Such an outcome would represent a further violation of their rights to life and health.”1

Enter U.S. Abortion Politics
While governments in Asia grapple with the serious consequences of entrenched son preference
and lopsided sex ratios, antiabortion lawmakers
in the United States are working overtime to capitalize on the issue for their own ends. In February,
the House Judiciary Committee approved legislation to ban sex-selective abortions. Among other
actions, the bill would allow criminal prosecution
of health care providers who perform such abortions, and of medical and mental health professionals who do not report suspected violations of
the law. It would make no exceptions to save the
life or health of the mother, or to allow for medical, sex-linked reasons for an abortion. (The bill
also bans so-called race-selective abortions, citing disproportionately high abortion rates among
communities of color as evidence that abortion
providers are “targeting” them, while ignoring
the underlying racial disparities in unintended
pregnancy rates; see “Abortion and Women of
Color: The Bigger Picture,” Summer 2008.)
Rep. Trent Franks (R-AZ) originally introduced
the Susan B. Anthony and Frederick Douglass
Prenatal Nondiscrimination Act (PRENDA) in
2008, and reintroduced it in 2011, as chairman of

Spring 2012 | Volume 15, Number 2 | Guttmacher Policy Review

Multiprong Measures
South Korea stands as a useful example of a country that has made real
progress in improving a highly imbalanced sex ratio. The country’s already
elevated sex ratio at birth climbed even
higher during the 1980s, when sex
detection—and therefore sex-selective
abortions—became commonplace.
The ratio peaked at almost 116 in the
mid-1990s, but declined to 107 by 2007.1
(Nonetheless, the ratio remains outside

the normal biological range, and even
greater imbalances persist among
later order births.) Korea’s approach
to its sex ratio problem is instructive
because the government espoused a
multitude of economic, social and legal
avenues. Although the government
pursued concerted attempts to enforce
its laws against prenatal sex detection,
researchers give much of the credit
for the turnaround to the country’s in-

the Judiciary Committee’s Subcommittee on the
Constitution. In the interim, bills to outlaw sexselective abortion were introduced in 13 states
and enacted in two: Oklahoma and Arizona.
The “findings” included by Rep. Franks in the
preamble of his bill rely on international evidence
of sex selection because U.S. data on the subject
are both limited and inconclusive. What is conclusively known is that the U.S. sex ratio at birth
in 2005 stood at 105 boys to 100 girls, squarely
within biologically normal parameters.12 Beyond
that salient fact, two studies using 2000 U.S. census data to examine sex ratios among Chinese-,
Indian- and Korean-American families found that
although the ratio for first-born children in such
families was normal, there was evidence of son
preference in second- and third-order births, if the
older children were daughters.13,14 Notably, the
authors do not pinpoint the cause of the disparate
ratios—whether prepregnancy techniques involving fertility treatments or sex-selective abortions.
In addition, they comment that these three ethnic
communities constitute a very small proportion—
less than 2%—of the U.S. population.13 A third
analysis that supporters of PRENDA rely on is a
small-scale qualitative study involving interviews
with 65 immigrant Indian women who practiced
sex selection, either before pregnancy or during
pregnancy through an abortion.15 Many of these
women spoke of the social and cultural basis for
son preference and the intense pressure faced by
women in their communities to produce sons.

Guttmacher Policy Review | Volume 15, Number 2 | Spring 2012

dustrialization, urbanization and rapid
economic development, which together
played a major role in fundamentally altering underlying social norms.1,7 Other
trends that increased the status of
women included more female employment in the labor market, new laws and
policies to improve gender equality and
awareness-raising campaigns through
the media.

Advocacy organizations, such as the National
Asian Pacific American Women’s Forum
(NAPAWF), that work in these communities readily acknowledge that son preference is an important global concern that needs attention wherever
it continues to exist. But they also emphasize that
“son preference is a symptom of deeply rooted
social biases and stereotypes about gender” and
that “gender inequity cannot be solved by banning abortion. The real solution is to change the
values that create the preference for sons.”16
Reproductive justice and Asian women’s rights
groups, in fact, cite myriad problems that sexselective abortion bans could create. At the most
practical level, such restrictions are neither enforceable nor effective, as already demonstrated
internationally. And various attempts to enforce
them, they stress, would only perpetuate further
discrimination in their communities through
stereotyping and racial profiling of Asian women
whose motivations for an abortion would be
under suspicion. In a recent op-ed explaining their
opposition to PRENDA, the executive directors
of NAPAWF and the National Latina Institute for
Reproductive Health wrote: “Immigrant women
already face numerous barriers to accessing
health care of any kind, including reproductive
health care and abortion, and this ban would
make an already difficult situation far worse.”17
At the end of the day, these advocates are fiercely
denouncing PRENDA and its copycats because of

21

their deep-seated conviction that the true motivations of the measures’ proponents have everything to do with undermining abortion rights and
nothing to do with fighting gender discrimination—and that, in fact, the measures themselves
threaten only to exacerbate that very problem. In
written testimony opposing PRENDA, 24 organizations from the reproductive justice community
had this to say: “This anti-choice measure dressed
as an anti-discrimination bill…further exacerbates
inequities and diminishes the health, well-being,
and dignity of women and girls by restricting their
access to reproductive health care. We represent
the women and people of color this bill purports
to protect, and we are announcing our unequivocal condemnation of it.”18 www.guttmacher.org

South Korea? The role of development and public policy, and the
implications for China and India, World Bank Policy Research Working
Paper, Washington, DC: World Bank, 2007, No. 4373, <http://papers.
ssrn.com/sol3/papers.cfm?abstract_id=1020841>, accessed May 1,
2012.

References

13. Almond D and Edlund L, Son-biased sex ratios in the 2000 United
States Census, Proceedings of the National Academy of Sciences of
the United States of America, 2008, 105(15):5681–5682, <http://www.
pnas.org/content/105/15/5681.full>, accessed May 1, 2012.

1. World Health Organization, Preventing Gender-Biased Sex
Selection:An Interagency Statement OHCHR, UNFPA, UNICEF, UN
Women and WHO, 2011, <http://whqlibdoc.who.int/publications/
2011/9789241501460_eng.pdf>, accessed May 1, 2012.
2. Li S, Imbalanced sex ratio at birth and comprehensive intervention
in China, paper presented at the fourth Asia and Pacific Conference
on Sexual and Reproductive Health and Rights, Hyderabad, India, Oct.
29–31, 2007, <http://www.unfpa.org/gender/docs/studies/china.pdf>,
accessed May 1, 2012.
3. Zhu WX, Lu L and Hesketh T, China’s excess males, sex selective
abortion, and one child policy: analysis of data from 2005 national intercensus survey, BMJ, 2009, 338(7700):920–936, <http://www.bmj.
com/content/338/bmj.b1211.abstract>, accessed May 1, 2012.
4. The worldwide war on baby girls, The Economist, Mar. 4, 2010,
<http://www.economist.com/node/15636231>, accessed May 1,
2012.
5. Government of India, Ministry of Home Affairs, Office of the Registrar General and Census Commissioner, Census and you – gender
composition, 2011, <http://censusindia.gov.in/Census_And_You/
gender_composition.aspx>, accessed May 1, 2012.
6. Office of the Registrar General and Census Commissioner, Census
of India 2011, 2012, <http://censusindia.gov.in/2011census/
censusinfodashboard/index.html>, accessed May 1, 2012.
7. Chung W and Das Gupta M, Why is son preference declining in

22

8. UN, Population and Development: Programme of Action Adopted at
the International Conference on Population and Development, Cairo,
Sept. 5–13, 1994, New York: Department for Economic and Social
Information and Policy Analysis, UN, 1995.
9. United Nations (UN), Declaration of the Fourth World Conference on
Women, Beijing, September 4–15, 1995, New York: UN, 1995.
10. Darnovsky M, Countries with laws or policies on sex selection,
Berkeley, CA: Center for Genetics and Society, 2009, <http://
geneticsandsociety.org/downloads/200904_sex_selection_memo.
pdf>, accessed May 1, 2012.
11. Ganatra B, Maintaining access to safe abortion and reducing
sex ratio imbalances in Asia, Reproductive Health Matters, 2008,
16(31 Suppl.):90–98, <http://www.ipas.org/~/media/Files/
Ipas%20Publications/GanatraRHM2008.ashx>, accessed
May 1, 2012.
12. Mathews TJ and Hamilton BE, Trend analysis of the sex ratio at
birth in the United States, National Vital Statistics Reports, 2005, Vol.
53, No. 20, <http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_20.
pdf>, accessed May 1, 2012.

14. Abrevaya J, Are there missing girls in the United States? Evidence
from birth data, working paper, Austin, TX: University of Texas at
Austin, 2008, <http://dx.doi.org/10.2139/ssrn.824266>, accessed May
1, 2012.
15. Puri S et al., “There is such a thing as too many daughters, but
not too many sons”: A qualitative study of son preference and fetal
sex selection among Indian immigrants in the United States, Social
Science & Medicine, 2011, 72(7):1169–1176, <http://www.ncbi.nlm.
nih.gov/pubmed/21377778>, accessed May 1, 2012.
16. National Asian Pacific American Women’s Forum, Testimony of the
Miriam Yeung, MPA, National Asian Pacific American Women’s Forum
(NAPAWF), Dec. 6, 2011, Washington, DC: NAPAWF, <http://judiciary.
house.gov/hearings/pdf/Yeung12062011.pdf>, accessed May 1, 2012.
17. González-Rojas J and Yeung M, Race and sex-based abortion ban
hijacks civil rights, commentary, New America Media, Feb. 24, 2012,
<http://newamericamedia.org/2012/02/race-and-sex-based-abortionban-hijacks-civil-rights.php>, accessed May 1, 2012.
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Spring 2012 | Volume 15, Number 2 | Guttmacher Policy Review