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The missing millions

Up to 100 million girls are 'missing' from the global population: victims of sex-selected abortion and neglect. The health of many who survive is severely compromised by poor nutrition, teenage pregnancy and harmful social practices. Professor Mahmoud Fathalla reports.

[ China ]
A girl from Quing Lai Province, China © Wang Gang Feng/ Panos Pictures
The killing of girl babies, a practice once prevalent in many societies, has not completely disappeared. In some cases it continues as a physical act by poor and desperate parents. In others, it has risen Phoenix-like in new forms. It has been brought earlier with the use of new technologies for the selective abortion of the female foetus, and it has been deferred and changed to a passive form of child death through neglect and discrimination.

Modern science has provided tools for prenatal diagnosis of congenital abnormalities. Ultrasound, amniocentesis and chorionic villus sampling have, however, been abused for prenatal sex diagnosis, and where pregnancy termination services are available, for selective abortion of the female foetus.

In a number of countries, the practice has taken a large dimension. The masculinity ratio has been rising steeply in China in recent years from the normal 105 to almost 120. In India, the practice became so prevalent that the government felt the obliged to punish it by law. Throughout the 1980s, selective abortion of female foetuses in South Korea has become more common. In 1991, 115 boys were born per 100 girls, up from 110 in 1985 and 107 in 1982. In 1991 the sex ratio for first-born children was 106:100, but for the second child it was 123, for the third 185, and for the fourth 212, according to the National Statistical Office.

This violation of the right of the girl child is particularly disturbing because it involves the medical profession and has been made possible by medical advances. In fact, a recent survey of 71 medical geneticists in four developing countries and 611 in 15 developed countries found widespread willingness to use prenatal diagnosis for sex selection purposes.

Awareness about gender discrimination in health is relatively recent. When attention was given to segregating infant and child mortality by gender, the evidence for discrimination became apparent.

In the World Fertility Survey conducted in the 1980s, the question of sex differentials in mortality was examined in 24 developing countries. The data are based on household surveys, thus eliminating a bias in death registration. For the infant, in all countries except two, the female mortality was lower. When the infant became a toddler, 12 out of 24 countries showed a higher mortality for the female. When it came to the 2 to 5 year-old child, 15 out of the 24 countries showed reversal of the mortality ratio in favour of the male child.

Perish the baby girls

It is difficult to explain these data on medical grounds only. Contrary to what some people may like to think, or are led to believe, the female of the species is the biologically stronger sex. Under equitable conditions of health care, infant and child mortality should be consistently lower for females. This biological advantage may be eroded by the social disadvantage of being female, particularly in resource-poor settings where children will compete for scarce resources.

A national sample household survey conducted in Egypt showed that, overall, infant mortality was lower for females. However, when the data were broken down between the neonatal (first month) and post-neonatal period, a different picture emerged. For the neonatal period, the mortality for the female was much lower than for the male. Deaths in the neonatal period result mostly from events during intra-uterine life, a phase protected from social prejudice. After the neonatal period, when the girl infant begins to face the consequences of social reality, the mortality differential was reversed.

The alarm bells about the massive "culling" of females that is opening a gender gap that could soon cause serious social upheaval, were rung by Newsweek, under the heading Perish the baby girls, in August 1995.

The magazine was able to draw on the work of demographers who analysed the sex ratios in different populations, compared to the expected ratios if societies offered equal health conditions to both males and females. They concluded that between 60 and 100 million females are missing in the world.

Son preference

[ Rural school ] Rural school consisting of 4 girls and 26 boys, Burkino Faso
© Mark Edwards/ Still Pictures
Gender differentials in mortality reflect a deep-seated preference for sons in many cultures, coupled with under-estimating the worth of the girl child. The World Fertility Survey estimated an index of son preference for 38 countries. The index ranged from 0.7 in Jamaica to 4.9 to Pakistan. Son preference is manifested by a differential access to health care, an unequal share of nutrition from the small family pot and possibly shorter durations of breastfeeding.

The International Conference on Population and Development, convened in Cairo in September 1994, urged that "Leaders at all levels of the society must speak out and act forcefully against patterns of discrimination within the family, based on preference for sons. One of the aims should be to eliminate excess mortality of girls, whenever such a pattern exists."

Assault on the clitoris

Female genital mutilation is another striking example of the failure to protect the girl child's right to health. Estimates of the worldwide prevalence of female genital mutilation range from 85 to 114 million, with an annual rate of increase of about 2 million per year. About 6,000 girls are "circumcised" each day.

A lot has been said and written about the physical, mental and social health risks associated with this harmful traditional practice. One fact is sometimes lost: The practice is a flagrant violation of human rights, as a harmful procedure performed on a child who cannot give informed consent.

The General Assembly of the International Federation of Gynaecology and Obstetrics (FIGO) unanimously adopted in 1994 a resolution calling for an end to this harmful practice.

Mothers too soon

When a teenager is made a mother, she is not only at an increased risk of complications related to the current pregnancy and childbirth, but she has to face long-term consequences, physical, mental and social, which impact on her health.

Only few of the teenage pregnancies are really wanted by the young mother. The girls have either been coerced by social pressure into early marriage and early pregnancy, or as unmarried adolescents have been denied free access to contraception. In some areas too, young girls exchange sexual favours to meet their material needs. Adolescents account for at least 10 per cent of all induced abortions

Judgement day

The Holy Muslim book, the Koran, includes a vivid description of an awe-inspiring scene from God's judgement day, in which the horrendous crime of female infanticide is brought to justice. The little infants are brought forward and are asked to testify about the circumstances of their death.

Those of us who believe in God and in God's judgement day should make no mistake about it. When millions of girl children are denied their God-given right of life and health are brought forward to testify on God's judgement day, many will be called to account for their actions, and many more will be called to account for their lack of action.

Dr Mahmoud F. Fathalla is Professor of Obstetrics and Gynaecology at Assuit University in Egypt.

The Chinese puzzle

The story of Chinaís missing girls is not new. Chinese records suggest that the traditional preference for boys goes back as long as Chinese written history, writes Sue Mulley.

At the national level the shortage of girls is quite phenomenal and growing worse, according to Professor Judith Banister of the Division of Social Science at Hong Kongís University of Science and Technology. In 1990, there were 110 boys per 100 girls in the zero to four-year-old age group, but five years later, the sample census showed that there were 118 boys per 100 girls in this category.

"There is an interesting argument that this is a self-correcting problem: that when you have a severe shortage of marriageable women, all of a sudden females become more valuable because they are rarer, and that raises the status of females. I think this is incorrect.

"For the last several thousand years there has been discrimination against girls, so severe that it has caused a shortage of females at every age and it hasnít done a thing for the status of females," says Professor Banister.

"Until this century, and really until the Peopleís Republic of China started implementing an ideology of male/female equality in 1949, you had atrocious discrimination against females at all levels of society. It didnít matter that in 1953, the whole population had a ratio of 100 females to 108 males."

The shortage of females has been linked to the abduction of women for forced marriage. Some 70,000 women and children were freed from 1992 to 1996 and some 130,000 kidnappers arrested, according to reports from China Womenís News and Associated Press.

The number of missing girls varies greatly by rural and urban areas, and from province to province, with the most missing in Guangdong, Guangxi and Zhejiang, says Professor Banister. The most serious missing girl problem is in traditional Han regions of China, and the problem is not nearly as serious or is non-existent in the border and minority provinces.

Although the census does not explain what is causing the missing girls, an educated guess can be made by comparing the ratio of boys to girls at each age group.

By 1990, in some provinces sex-selective abortion was introduced, and this is reflected in the rapid shift in the missing girls by single year of age among the children. In some provinces, sex-selective abortion had begun to be used in urban but not rural areas, and vice versa in other provinces.

"It partly had to do with attitudes towards girls, and also the availability of the technology," Professor Banister explains. However, there appeared to be continuing use of infanticide and selective neglect against girls.

The next complete population census is due to be held in the year 2000.

Sue Mulley is People & the Planet correspondent in Hong Kong.


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© Copyright: People & the Planet Vol 7/3, 1998