Where Have All the Girls Gone?

It's true: Western money and advice really did help fuel the explosion of sex selection in Asia.

BY MARA HVISTENDAHL, |Foreign Policy, JUNE 27, 2011

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 (IPPF) 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 IPPF 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 ofpurdah" 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.)

Sex selection hit China the same year the AIIMS experiments began. The country accepted Western aid belatedly, in 1979. But after years of being kept out of the Middle Kingdom, the U.N. Population Fund (UNFPA) and IPPF jumped at the opportunity to play a role in the world's most populous country, with UNFPA chipping in $50 million for computers, training, and publicity on the eve of the one-child policy's unveiling. Publicly, officers at both UNFPA and IPPF claimed China's new policy relied on the Chinese people's exceptional knack for communalism. But, according to Columbia University historian Matthew Connelly's account of the population control movement, Fatal Misconception, in January 1980 IPPF information officer Penny Kane privately fretted about local officials' evident interest in meeting the new birth quotas through forced abortions. Accounts of those eventually leaked out, as did reports of sex-selective abortions. In 1982, Associated Press correspondent Victoria Graham warned that those augured a spreading trend. "These are not isolated cases," she wrote, adding: "Demographers are warning that if the balance between the sexes is altered by abortion and infanticide, it could have dire consequences."

Today, some of those dire consequences have become alarmingly apparent. Part of that is the extent to which organizations like UNFPA have found themselves unable to perform legitimate services in the developing world because of their historic connection to population control. For it was news of sex-selective and forced abortions that helped fuel a budding anti-abortion movement in the United States. Protesters showed up at the 1984 World Population Conference in Mexico City, wielding evidence of abuses in China. The next year, President Ronald Reagan unveiled what would become known as the "global gag rule," cutting off $46 million in funds to UNFPA -- money that might have gone toward maternal and child health as well as population control. The struggle to fund reproductive health continued over the next two decades, with subsequent U.S. presidents withdrawing or reinstating the gag rule along partisan lines.

Nowadays, of course, UNFPA and Planned Parenthood are led by a new wave of feminist bureaucrats who are keen on ensuring reproductive rights, and they no longer finance global population control. Thanks to a thriving anti-abortion movement, Planned Parenthood can barely make contraceptives and safe abortion available to the American women who actually want them. But contentious American politics has these and other groups on the left stuck in what Joseph Chamie, former head of the U.N. Population Division,calls "the abortion bind." The United Nations issued an interagency statement condemning sex selection and outlining recommendations for action last week, and UNFPA was among the agencies that helped draft it. The organization has also funded research on sex selection and sex ratio imbalance at the local level. But its legacy in the developing world continues to haunt its leaders, to the detriment of women worldwide. Lingering anxiety over taking on issues involving abortion, activists and demographers have told me, now has UNFPA reluctant to address sex selection head-on at the international level -- a reluctance that has left the organization's enemies to twist the issue to fit their own agenda. (Anti-abortion groups and pundits have provenall too eager to to take on the issue, though they seem far more interested in driving home restrictions on abortion than they do in increasing the number of women in the world and protecting the rights of women at risk.)

Meanwhile, as American politicians argue over whether to cut Planned Parenthood's U.S. funding and the Christian right drives through bans on sex-selective abortion at the state level, the effects of three decades of sex selection elsewhere in the world are becoming alarmingly apparent. In China, India, Korea, and Taiwan, the first generation shaped by sex selection has grown up, and men are scrambling to find women, yielding the ugly sideblows of increased sex trafficking and bride buying. In a Chinese boomtown, I watched soap operas with a slight, defeated woman from the poor mountains of the west who had been brought east by a trafficker and sold into marriage. (Her favorite show: Women Don't Cry.) In the Mekong Delta, I visited an island commune where local women are hawked by their parents for a few thousand dollars to "surplus" Taiwanese men. While the purdah forecasted by John Postgate has not yet come to pass, feminists in Asia worry that as women become scarce, they will be pressured into taking on domestic roles and becoming housewives and mothers rather than scientists and entrepreneurs.

But what happens to women is only part of the story. Demographically speaking, women matter less and less. By 2013, an estimated one in 10 men in China will lack a female counterpart. By the late 2020s, that figure could jump to one in five. There are many possible scenarios for how these men will cope without women -- and not all, of course, want women -- but several of them involve rising rates of unrest. Already Columbia University economist Lena Edlund and colleagues at Chinese University of Hong Kong have found a link between a large share of males in the young adult population and an increase in crime in China. Doomsday analysts need look no further than America's history: Murder rates soared in the male-dominated Wild West.

Four decades ago, Western advocacy of sex selection yielded tragic results. But if we continue to ignore that legacy and remain paralyzed by heated U.S. abortion politics, we're compounding that mistake. Indian public health activist George, indeed, says waiting to act is no longer an option: If the world does "not see ten years ahead to where we're headed, we're lost."