How did more than 160 million women go missing from Asia? The simple answer is sex selection -- typically, an ultrasound scan followed by an abortion if the fetus turns out to be female -- but beyond that, the reasons for a gap half the size of the U.S. population are not widely understood. And when I started researching a book on the topic, I didn't understand them myself.
I thought I would focus on how gender discrimination has persisted as countries develop. The reasons couples gave for wanting boys varies: Sons stayed in the family and took care of their parents in old age, or they performed ancestor and funeral rites important in some cultures. Or it was that daughters were a burden, made expensive by skyrocketing dowries.
But that didn't account for why sex selection was spreading across cultural and religious lines. Once found only in East and South Asia, imbalanced sex ratios at birth have recently reached countries as varied as Vietnam, Albania, and Azerbaijan. The problem has fanned out across these countries, moreover, at a time when women are driving many developing economies. In India, where women have achieved political firsts still not reached in the United States, sex selection has become so intense that by 2020 an estimated 15 to 20 percent of men in northwest India will lack female counterparts. I could only explain that epidemic as the cruel sum of technological advances and lingering sexism. I did not think the story of sex selection's spread would lead, in part, to the United States.
Then I looked into it, and discovered that what I thought were right-wing conspiracy theories about the nexus of Western feminism and population control actually had some, if very distant and entirely historical, basis in truth. As it turns out, Western advisors and researchers, and Western money, were among the forces that contributed to a serious reduction in the number of women and girls in the developing world. And today feminist and reproductive-rights groups are still reeling from that legacy.
The story begins in the mid-20th century, when several factors converged to make Western demographers worried about global population growth. Thanks to advances in public health, people were living longer than ever before. Projections released by the U.N. Population Division in 1951 suggested what the sum of all those extra years of life could be: Rapid population growth was on the horizon, particularly in the developing world. As pundits forecast a global "population explosion," anxiety mounted in policy circles, and the population control movement that coalesced brought together everyone from environmentalists to McCarthyites. Viewed through a 1960s Beltway lens, mounting numbers of people meant higher rates of poverty, which in turn made countries more vulnerable to communism.
The U.S. Agency for International Development (USAID), the World Bank, and the Rockefeller Foundation were among the organizations that poured money into stanching the birth rate abroad, while the International Planned Parenthood Federation (IPrison Planet Forum) and the Population Council helped coordinate efforts on the ground. As these organizations backed research into barriers to couples accepting contraception, one of the obstacles quickly identified was that in most parts of the world, but particularly in fast-growing Asia, people continued to have children until they got a boy. As demographer S.N. Agarwala explained in a paper on India he presented at a 1963 IPrison Planet Forum conference in Singapore: "(S )ome religious rites, especially those connected with the death of the parents, can be performed only by the male child.... [T ]hose who have only daughters try their best to have at least one male child." Even in the United States, surveys suggested a preference for sons.
That raised the question: What if couples could be guaranteed a son from the start? Elsewhere, scientists were working to perfect fetal sex determination tests for women carrying sex-linked disorders like hemophilia, which only manifests itself in males. (The first sex-selective abortions, performed in 1955 by Danish doctors in Copenhagen, were actually done on women carrying male fetuses.)
But the technology was still incipient and required a late-term abortion. Proponents of population control began talking about nudging sex selection along. In 1967, for example, when Planned Parenthood Federation of America President Alan Guttmacher received a proposal from an Indian scientist interested in finding a way to "control SEX in human reproduction," he scrawled a note across the top in hasty red pencil, asking the organization's medical director to consider whether the research was in fact "worth encouraging."
Planned Parenthood didn't fund the research in the end, but on the technicality that the U.S. government had recently cut funding for fellowships to foreigners. Six months later Steven Polgar, the organization's head of research, went public with the notion that sex selection was an effective population control method. Taking the podium before an audience of scholars and policymakers at a conference sponsored by the National Institute of Child Health and Human Development (NICHD), Polgar "urged," according to the meeting's minutes, "that sociologists stimulate biologists to find a method of sex determination, since some parents have additional children in order to get one of specified sex."
At first the language was gender-neutral. But before long the descriptions grew more blunt, and some proponents talked frankly about selecting for sons. In the years that followed, Population Council President Bernard Berelson endorsed sex selection in the pages of Science, while Paul Ehrlich advocated giving couples the sons they desired in his blockbuster The Population Bomb. "[I ]f a simple method could be found to guarantee that first-born children were males," he wrote, "then population control problems in many areas would be somewhat eased." In many countries, he wrote, "couples with only female children 'keep trying' in hope of a son." A wide range of population control strategies were on the table at the time, but by the end of the decade, when the NICHD held another workshop on reducing birth rates, sex selection had emerged as an approach that participants deemed "particularly desirable."
Other spokesmen -- for they were mostly men -- included Arno G. Motulsky, a geneticist at the University of Washington-Seattle, William D. McElroy, then head of the biology department at Johns Hopkins University, and British microbiologist John Postgate. Postgate was particularly resolute. He extolled sex selection in an article for the New Scientist, explaining that population growth was so great a threat that the drawbacks of a skewed sex ratio would have to be tolerated, grim as they were. "A form of purdah" might be necessary, he predicted, while "Women's right to work, even to travel alone freely, would probably be forgotten transiently." A handful of women got on board as well. In 1978, former ambassador and former U.S. Congresswoman Clare Boothe Luce wrote an article for the Washington Star in which she clamored for the development of a "manchild pill" -- a drug a woman could take before sex to ensure any children that resulted would be male.
Before long, sex selection emerged as a favored solution. In the context of '60s and '70s population politics, it had the appeal of being a voluntary strategy that played to individual behavior. In his paper for Science, Berelson ranked sex selection's ethical value as "high." Postgate pointed out, "Countless millions of people would leap at the opportunity to breed male." And other strategies being tried in Asia at the time entailed coercion, not choice.
In South Korea, Western money enabled the creation of a fleet of mobile clinics -- reconditioned U.S. Army ambulances donated by USAID and staffed by poorly trained workers and volunteers. Fieldworkers employed by the health ministry's Bureau of Public Health were paid based on how many people they brought in for sterilizations and intrauterine device insertions, and some allege Korea's mobile clinics later became the site of abortions as well. By the 1970s, recalls gynecologist Cho Young-youl, who was a medical student at the time, "there were agents going around the countryside to small towns and bringing women into the [mobile] clinics. That counted toward their pay. They brought the women regardless of whether they were pregnant." Non-pregnant women were sterilized. A pregnant woman met a worse fate, Cho says: "The agent would have her abort and then undergo tubal ligation." As Korea's abortion rate skyrocketed, Sung-bong Hong and Christopher Tietze detailed its rise in the Population Council journal Studies in Family Planning. By 1977, they determined, doctors in Seoul were performing 2.75 abortions for every birth -- the highest documented abortion rate in human history. Were it not for this history, Korean sociologist Heeran Chun recently told me, "I don't think sex-selective abortion would have become so popular."
In India, meanwhile, advisors from the World Bank and other organizations pressured the government into adopting a paradigm, as public-health activist Sabu George put it to me, "where the entire problem was population." The Rockefeller Foundation granted $1.5 million to the All India Institute of Medical Sciences (AIIMS), the country's top medical school, and the Ford Foundation chipped in $63,563 for "research into reproductive biology." And sometime in the mid-1960s, Population Council medical director Sheldon Segal showed the institute's doctors how to test human cells for the sex chromatins that indicated a person was female -- a method that was the precursor to fetal sex determination.
Soon after, the technology matured, and second-trimester fetal sex determination became possible using amniocentesis. In 1975, AIIMS doctors inaugurated sex-selective abortion trials at a government hospital, offering amniocentesis to poor women free of charge and then helping them, should they so choose, to abort on the basis of sex. An estimated 1,000 women carrying female fetuses underwent abortions. The doctors touted the study as a population control experiment, and sex-selective abortion spread throughout India.
In his autobiography, Segal professed to being shocked to learn that doctors at AIIMS were using a variation on his instructions to perform sex-selective abortions. But he neglected to mention that shortly after his stay in India he stood before an audience at the National Institute of Child Health and Human Development and described sex selection as a method of population control. (The minutes from the meeting describe "sex determination at conception" -- now finally available today through advances in assisted reproductive technology -- but in-utero sex determination was the form of sex selection furthest along at that point.)
Continued...
http://www.foreignpolicy.com/articles/2011/06/27/where_have_all_the_girls_gone
