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The natural human sex ratio at birth was estimated, in a 2002 study, to be close to 106 boys to 100 girls.[14] 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).[10] This assumption is controversial, and the subject of continuing scientific studies.

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In a widely cited article,[17] 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.[11]

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.[8][19] 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.[20][21] 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.[22] 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.[23]

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.[34] 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.[21]

In 2017, according to CIA estimates,[35] 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 Macedonia (108). Also in 2017 the lowest ratio (i.e. more girls born) was in Nauru at 83.[35] 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.[35]

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.[14] 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.[8] 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.[22] 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.[23]

In addition, in many developing countries there are problems with birth registration and data collection, which can complicate the issue.[36] 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 women could not vote until 1984.[37][38] At the same time, there have been accusations that the situation in some countries, such as Georgia, has been exaggerated.[39] In 2017, Georgia' sex ratio at birth was 107, according to CIA statistics.[40]

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[41] 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.[42] Other variations are more significant; for example, CIA projects[41] the birth sex ratio for Pakistan to be 105, United Nations FPA office claims[43] the birth sex ratio for Pakistan to be 110, while the government of Pakistan claims its average birth sex ratio is 111.[44][45]

The two most studied nations with high sex ratio and sex-selective abortion are China and India. The CIA estimates[41] 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;[46] while United Nations FPA estimates China's 2011 birth sex ratio to be 118.[47]

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.[50][51]

The exact prevalence of sex-selective abortion is uncertain, with the practice taking place in some societies as an open secret without formal data on its frequency. Some authors argue that it is quite difficult to explain why this practice takes place in some cultures and not others, and that sex-selective abortion cannot be explained merely by patriarchal social norms, because most societies are male dominated, but only a minority practice sex-selective abortion.[57] Although this practice is more common in certain cultures over other, some main reasons for choosing sex-selective abortion are inheritance rules, selected dowry systems, and the idea that mothers of sons are of higher importance than mothers of daughters.[58]

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.[62] The Chinese Academy of Social Sciences estimated that more than 24 million Chinese men of marrying age could find themselves without spouses by 2020.[62] 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 abortions and forced sterilizations, but gradually loosened until it was formally abolished in 2015.[63]

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[13] and to 118 by 2010 per its official census.[64][65] 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.[66]

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.[69] Three years later, the Ministry of Health outlawed the use of sex determination techniques, except for in diagnosing hereditary diseases.[70] 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.[13] 350c69d7ab


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