Across East and South Asia, demographers and policymakers have long struggled with the imbalance between the numbers of boys and girls being born. The natural proportion should be approximately 105 boys for every 100 girls, but, in parts of these regions, ratios have risen as high as 130 or even 140 to 100.
Recently, the problem has also arisen in the South Caucasus and the Balkans.
The surplus of men, which is increasingly associated with the phenomenon of sex-selective abortion, has been associated with increases in violent crime, sex trafficking, prostitution, HIV infections, and social unrest.
RFE/RL correspondent Robert Coalson discussed these issues with Mara Hvistendahl, a China-based correspondent for “Science” magazine and author of “Unnatural Selection: Choosing Boys over Girls, and the Consequences of a World Full of Men.”
RFE/RL: What does the title of your book, “Unnatural Selection,” refer to?
Mara Hvistendahl: Unnatural selection is the phrase I used to refer to the over 100 million girls that are missing from the global population as a result of sex selection -- largely, sex-selective abortion. That is, when a woman is pregnant and going in to scan for the sex of the fetus and then aborting if the fetus turns out to be female.
Sex selection is connected to falling birthrates and that is what you have seen across the Caucasus countries and across East Asia and South Asia as well. Not that long ago women were having four or five children and then the chance they would get a son was really very high. And there was really no need to resort to technology to guarantee that one of your kids was a boy.
But today, unfortunately, the very strong desire for a son is still here, but many women in most of the world are now just having one or two children. So that's where the interest in using ultrasound and sex-selective abortion has developed.
RFE/RL: Rising sex selection seems to result from a combination of sexist traditions, falling birthrates in developing counties, and technology. How exactly has it unfolded around the world?
Hvistendahl: Beginning in the 1980s, in developing countries like China, India, South Korea, Taiwan, much of East Asia, ultrasound machines became available in big urban areas. And also at that time birthrates were falling in those countries. Those and some other factors combined to get a situation where a lot of people started selecting for [boys]. Initially what was happening -- and what has happened for several decades -- was sex-selective abortion fuelled by ultrasound scans.
Since around 2000, sex-selective abortion has taken off in the Caucasus countries -- in Georgia, Azerbaijan, and Armenia -- also in parts of the Balkans. For some countries it is hard to get reliable statistics, but Albania has documented sex-selective abortions now.
But, at this point, the technology is moving well beyond ultrasound to fetal blood tests that can be done when a mother is as early as seven weeks of pregnancy. Just with a small amount of the mother's blood it is possible to determine the sex of the fetus at a very, very early stage. And also there is something called preimplantation genetic diagnosis, which is done during in-vitro fertilization (IVF). So, even before it gets to a pregnancy, you can select the sex of your embryo.
RFE/RL: Is the sex-determination technology constantly developing, both in terms of how early you can use it and how cheap and available it is?
Hvistendahl: Definitely. Fetal blood tests are still kind of in the very early stages. They have been introduced in the United States and a few other places, but the trend is for the technology to become much more widely available and much, much cheaper, which is what we saw with ultrasound.
IVF is still very expensive. It is at the point where you have clinics in California that cater to wealthy parents from around the world. Parents fly in from Eastern Europe, from Asia, from Australia, from countries where sex selection is outlawed -- and they'll pay at this point tens of thousands of dollars to go through sex-selection during IVF. But we can expect the technology to become much, much cheaper in years to come.
RFE/RL: Are you saying that sex selection is not driven primarily by poor and uneducated people?
Hvistendahl: For years there was this perception that gender imbalance is something that hit poor countries, was a result of a kind of traditional mindset, that people were doing this in villages, and maybe combined with infanticide -- actually waiting until a girl was born and then drowning her in a bucket of water; really horrible practices. But if you look at the demographics, that is just not true.
What is actually happening is that sex selection is something that hits first in urban areas, in rapidly developing countries, not the poorest places in the world. That is why it hit China; that's why it hit India. And that is why it is now hitting parts of Eastern Europe. And when it hits those countries, it is the elite that takes up the practice first.
RFE/RL: The gender-gap crisis in China and India is well known. But you write that the countries currently in the grips of a crisis are in the South Caucasus.
Hvistendahl: That's right. The last numbers I've seen are for 2005. In Azerbaijan, Armenia, and Georgia, the sex ratio at birth -- that is, the number of boys per 100 girls -- had reached into the 110s. In Armenia, I believe, it was 120 boys for every 100 girls. That is alarming because it is just as bad as in China, which has a very, very serious problem.
Those figures really took demographers by surprise. No one had expected sex selection to spread to that area, but as in much of East Asia, the abortion rate is quite high. The new prenatal diagnostic technologies have come in as these countries develop. And the birthrates have also fallen very rapidly in these areas. These are the same trends that we saw decades earlier in East Asia and now they are hitting the Caucasus region.
RFE/RL: How do authorities in countries where sex selection is uncovered usually respond to this information?
Hvistendahl: In pretty much every country where sex selection hit, their first reaction was denial -- this isn't happening here. It is a shameful thing for a modernizing country to admit. But since 2010 it has gotten increasingly difficult to deny the trend in the Caucasus region. The Council of Europe has adopted a statement condemning sex selection in that region and also has sent a delegation to look into what is going on.
At this point, it is difficult to hide it. I haven't seen evidence that governments in the region are doing that much at this point. But it usually takes some time before they admit the problem and act. I did get to another region, to Albania, when I was reporting my book and definitely among health officials there, there was a degree of denial about what was happening.
If you speak to doctors, it is another story. They'll tell you that they see sex selection in their hospitals. They are often the first people to sound alarms. But it takes quite a while before it is recognized as enough of a national problem for it to be addressed.
RFE/RL: And why should it be addressed? What are the social problems associated with gender imbalance?
Hvistendahl: At its roots, it suggests an immense problem with sexism and with the status of women. But beyond that, if you go on generations where people have been selecting for boys, you are going to have a lot of men who can't get married, who can't find a female partner in their community.
What we have seen in countries like China and India, where people have been doing this for decades, is that men are buying women from poorer parts of the country. They are travelling to Southeast Asia on marriage tours to pick out women and bring them home as brides. Trafficking has taken off. Also, [a proliferation of] sex workers is another thing that picks up when there are too many men. And in the long run, it is also not good for the stability of a country.
It is sad, but ultimately, that is what's made governments in East Asia take action and finally notice the sex-ratio imbalance -- the fact that they are worried about all these extra men who won't have wives and could potentially be a force for instability in the future.
RFE/RL: The South Caucasus is already a volatile, unstable region. Is gender imbalance going to exacerbate this?
Hvistendahl: I think, first and foremost, it is a local issue and that's partly why you see China now beginning to address its gender imbalance. But in the long run you could certainly see conflicts over the trafficking of women.
In Asia, increasingly, men are starting to go outside their own borders to find wives. Vietnam has become a huge destination for men from around Asia and the Vietnamese government is not happy about it at all. So, you could see conflicts developing over that sort of thing.
There is the fact that men are proportionately responsible for a lot more crime and a lot more violent crime than women. Having a large number of young men at the age when they are more likely to commit crimes and more likely to be violent is not a good idea.
RFE/RL: Beyond the Caucasus, is there any idea where the gender-gap crisis is going to appear next? Are we likely to see such problems in Central Asia, countries like Kazakhstan?
Hvistendahl: It is hard to predict where it will hit next. When I talk to demographers, their focus is on trying to find which countries will be next. But often by the time that census or survey results come out and show a big imbalance in births, show many more boys being born, it is too late. At that point sex selection has been happening for quite a while.
I have heard anecdotally that sex-selective abortion is happening in Turkey. Beyond that, Macedonia is a country that demographers have looked at, but it is very hard to tell until those numbers come out. Unless you go to each country and do a careful fact-finding mission, it is something that is easy to hide at the national level for the first years.
RFE/RL: Short of rooting out sexism altogether, is there anything that can be done to confront the unnatural-selection problem?
Hvistendahl: Getting at the roots of sexism would be great, but I'm not that optimistic that it will happen seeing that we are now in 2013 and this desire for sons has persisted. It is a difficult thing to get rid of. I think we need to address the technology at some point because these technologies, many of them, are developed in the West and when they are developed, the fact that they could lead to sex selection can be seen in advance. But bioethics is kind of considered retroactively and I don't think that should be the case.
The other thing is that this is an issue that needs more international action. The fact that the Council of Europe has taken it up is really encouraging, but I would like to see the United Nations Population Fund do a lot more. I'd like to see more effort from population organizations in general. It is not something that governments in these individual countries should have to deal with on their own.
Recently, the problem has also arisen in the South Caucasus and the Balkans.
The surplus of men, which is increasingly associated with the phenomenon of sex-selective abortion, has been associated with increases in violent crime, sex trafficking, prostitution, HIV infections, and social unrest.
RFE/RL correspondent Robert Coalson discussed these issues with Mara Hvistendahl, a China-based correspondent for “Science” magazine and author of “Unnatural Selection: Choosing Boys over Girls, and the Consequences of a World Full of Men.”
RFE/RL: What does the title of your book, “Unnatural Selection,” refer to?
Mara Hvistendahl: Unnatural selection is the phrase I used to refer to the over 100 million girls that are missing from the global population as a result of sex selection -- largely, sex-selective abortion. That is, when a woman is pregnant and going in to scan for the sex of the fetus and then aborting if the fetus turns out to be female.
Sex selection is connected to falling birthrates and that is what you have seen across the Caucasus countries and across East Asia and South Asia as well. Not that long ago women were having four or five children and then the chance they would get a son was really very high. And there was really no need to resort to technology to guarantee that one of your kids was a boy.
But today, unfortunately, the very strong desire for a son is still here, but many women in most of the world are now just having one or two children. So that's where the interest in using ultrasound and sex-selective abortion has developed.
RFE/RL: Rising sex selection seems to result from a combination of sexist traditions, falling birthrates in developing counties, and technology. How exactly has it unfolded around the world?
Hvistendahl: Beginning in the 1980s, in developing countries like China, India, South Korea, Taiwan, much of East Asia, ultrasound machines became available in big urban areas. And also at that time birthrates were falling in those countries. Those and some other factors combined to get a situation where a lot of people started selecting for [boys]. Initially what was happening -- and what has happened for several decades -- was sex-selective abortion fuelled by ultrasound scans.
Since around 2000, sex-selective abortion has taken off in the Caucasus countries -- in Georgia, Azerbaijan, and Armenia -- also in parts of the Balkans. For some countries it is hard to get reliable statistics, but Albania has documented sex-selective abortions now.
But, at this point, the technology is moving well beyond ultrasound to fetal blood tests that can be done when a mother is as early as seven weeks of pregnancy. Just with a small amount of the mother's blood it is possible to determine the sex of the fetus at a very, very early stage. And also there is something called preimplantation genetic diagnosis, which is done during in-vitro fertilization (IVF). So, even before it gets to a pregnancy, you can select the sex of your embryo.
RFE/RL: Is the sex-determination technology constantly developing, both in terms of how early you can use it and how cheap and available it is?
Hvistendahl: Definitely. Fetal blood tests are still kind of in the very early stages. They have been introduced in the United States and a few other places, but the trend is for the technology to become much more widely available and much, much cheaper, which is what we saw with ultrasound.
IVF is still very expensive. It is at the point where you have clinics in California that cater to wealthy parents from around the world. Parents fly in from Eastern Europe, from Asia, from Australia, from countries where sex selection is outlawed -- and they'll pay at this point tens of thousands of dollars to go through sex-selection during IVF. But we can expect the technology to become much, much cheaper in years to come.
RFE/RL: Are you saying that sex selection is not driven primarily by poor and uneducated people?
Hvistendahl: For years there was this perception that gender imbalance is something that hit poor countries, was a result of a kind of traditional mindset, that people were doing this in villages, and maybe combined with infanticide -- actually waiting until a girl was born and then drowning her in a bucket of water; really horrible practices. But if you look at the demographics, that is just not true.
Mara Hvistendahl
What is actually happening is that sex selection is something that hits first in urban areas, in rapidly developing countries, not the poorest places in the world. That is why it hit China; that's why it hit India. And that is why it is now hitting parts of Eastern Europe. And when it hits those countries, it is the elite that takes up the practice first.
RFE/RL: The gender-gap crisis in China and India is well known. But you write that the countries currently in the grips of a crisis are in the South Caucasus.
Hvistendahl: That's right. The last numbers I've seen are for 2005. In Azerbaijan, Armenia, and Georgia, the sex ratio at birth -- that is, the number of boys per 100 girls -- had reached into the 110s. In Armenia, I believe, it was 120 boys for every 100 girls. That is alarming because it is just as bad as in China, which has a very, very serious problem.
Those figures really took demographers by surprise. No one had expected sex selection to spread to that area, but as in much of East Asia, the abortion rate is quite high. The new prenatal diagnostic technologies have come in as these countries develop. And the birthrates have also fallen very rapidly in these areas. These are the same trends that we saw decades earlier in East Asia and now they are hitting the Caucasus region.
RFE/RL: How do authorities in countries where sex selection is uncovered usually respond to this information?
Hvistendahl: In pretty much every country where sex selection hit, their first reaction was denial -- this isn't happening here. It is a shameful thing for a modernizing country to admit. But since 2010 it has gotten increasingly difficult to deny the trend in the Caucasus region. The Council of Europe has adopted a statement condemning sex selection in that region and also has sent a delegation to look into what is going on.
At this point, it is difficult to hide it. I haven't seen evidence that governments in the region are doing that much at this point. But it usually takes some time before they admit the problem and act. I did get to another region, to Albania, when I was reporting my book and definitely among health officials there, there was a degree of denial about what was happening.
If you speak to doctors, it is another story. They'll tell you that they see sex selection in their hospitals. They are often the first people to sound alarms. But it takes quite a while before it is recognized as enough of a national problem for it to be addressed.
RFE/RL: And why should it be addressed? What are the social problems associated with gender imbalance?
Hvistendahl: At its roots, it suggests an immense problem with sexism and with the status of women. But beyond that, if you go on generations where people have been selecting for boys, you are going to have a lot of men who can't get married, who can't find a female partner in their community.
What we have seen in countries like China and India, where people have been doing this for decades, is that men are buying women from poorer parts of the country. They are travelling to Southeast Asia on marriage tours to pick out women and bring them home as brides. Trafficking has taken off. Also, [a proliferation of] sex workers is another thing that picks up when there are too many men. And in the long run, it is also not good for the stability of a country.
It is sad, but ultimately, that is what's made governments in East Asia take action and finally notice the sex-ratio imbalance -- the fact that they are worried about all these extra men who won't have wives and could potentially be a force for instability in the future.
RFE/RL: The South Caucasus is already a volatile, unstable region. Is gender imbalance going to exacerbate this?
Hvistendahl: I think, first and foremost, it is a local issue and that's partly why you see China now beginning to address its gender imbalance. But in the long run you could certainly see conflicts over the trafficking of women.
In Asia, increasingly, men are starting to go outside their own borders to find wives. Vietnam has become a huge destination for men from around Asia and the Vietnamese government is not happy about it at all. So, you could see conflicts developing over that sort of thing.
There is the fact that men are proportionately responsible for a lot more crime and a lot more violent crime than women. Having a large number of young men at the age when they are more likely to commit crimes and more likely to be violent is not a good idea.
RFE/RL: Beyond the Caucasus, is there any idea where the gender-gap crisis is going to appear next? Are we likely to see such problems in Central Asia, countries like Kazakhstan?
Hvistendahl: It is hard to predict where it will hit next. When I talk to demographers, their focus is on trying to find which countries will be next. But often by the time that census or survey results come out and show a big imbalance in births, show many more boys being born, it is too late. At that point sex selection has been happening for quite a while.
I have heard anecdotally that sex-selective abortion is happening in Turkey. Beyond that, Macedonia is a country that demographers have looked at, but it is very hard to tell until those numbers come out. Unless you go to each country and do a careful fact-finding mission, it is something that is easy to hide at the national level for the first years.
RFE/RL: Short of rooting out sexism altogether, is there anything that can be done to confront the unnatural-selection problem?
Hvistendahl: Getting at the roots of sexism would be great, but I'm not that optimistic that it will happen seeing that we are now in 2013 and this desire for sons has persisted. It is a difficult thing to get rid of. I think we need to address the technology at some point because these technologies, many of them, are developed in the West and when they are developed, the fact that they could lead to sex selection can be seen in advance. But bioethics is kind of considered retroactively and I don't think that should be the case.
The other thing is that this is an issue that needs more international action. The fact that the Council of Europe has taken it up is really encouraging, but I would like to see the United Nations Population Fund do a lot more. I'd like to see more effort from population organizations in general. It is not something that governments in these individual countries should have to deal with on their own.