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Macmillan Childrens Publishing Group

Equality for Women = Prosperity for All

The Disastrous Global Crisis of Gender Inequality

Augusto Lopez-Claros and Bahiyyih Nakhjavani; read by Soneela Nankani and the authors

Macmillan Audio




Numbers tell us, quietly, a terrible story of inequality and neglect.


When we see extremely skewed demographics, we have very good reason to suspect that something is wrong.



Let us try to keep a measured tone and talk politely about this subject, if we can. The naked truth is that after centuries of denial, we are finally acknowledging what might be called a predilection for sons in certain societies. That is to say, we are now ready to admit that many people, from various cultural backgrounds and across a wide spectrum of ages, have preferred to have baby boys rather than girls. This is one of the most disturbing and age-old manifestations of gender discrimination in the world and is accompanied by its dark double, the rejection of daughters.

Where have all the women gone, and what has happened to our girls?

There are bound to be missing factors in any assessment of what are the drivers of human prosperity. It is difficult to analyze exhaustively how these factors can weaken the fabric of society, or in what ways, for instance, discriminatory labor laws can jeopardize economic growth. But of all the absent elements in this analysis, none is as significant as leaving women out of it altogether.

There was a time when leaving women out of the records was the norm in both East and West. Most women in history, unless they happened to be queens or empresses, notorious prostitutes or apostates, were not considered a significant part of any equation. We learn of the missing through paintings and through literature, through private letters and personal objects, like thimbles, spindles, spoons, and lace. But history rarely gave us the identities of the users. The triumphs and tragedies of half the human race were all too easily obliterated.

But we have become better at keeping track of the missing in our own times. It is possible to maintain records of our losses in undreamed-of ways today. Instead of writing elegies read by few or private diary entries intended for none, we now mourn the missing publicly, litter the window fronts of post offices with photos of lost cats and dogs, and stick the faces of our children on the lampposts of city streets, to advertise their disappearances. And there may be darker reasons too for remembering. Massacres have left their bloody traces on the pages of history. Holocausts and genocides must not be forgotten if they are not to be repeated, even after years of political amnesia and denial. And we have discovered that forensic science can pursue war crimes into their graves and bring their perpetrators to court at last. We have learned to memorialize the missing in order to bear witness to their rights as well as to recall their names.

The erasure of half the human race surpasses designation, however; it is beyond calculation. It was not until this century that the missing women of the world began to be evaluated by society. Decades before the extremist group called Boko Haram kidnapped 276 girls in Chibouk, northern Nigeria, in April 2014, the Nobel Prize–winning economist and philosopher Amartya Sen brought the problem of missing girls to international attention. In his 1990 article in the New York Review of Books and a subsequent editorial he submitted to the British Medical Journal (1992), he noted that “son preference” may have resulted in as many as 100 million missing women worldwide. Sen arrived at this terrifying estimate by initially looking at the seemingly anodyne ratio of women to men in societies where both sexes received broadly equal health care and medical attention. He then assessed the number of extra women who ought to have been alive in a particular period in countries where women faced a number of disadvantages. Eleven years later, Sen (2003) reported that some reductions in female mortality worldwide had been “counterbalanced by a new female disadvantage … through sex specific abortions aimed against the female fetus” (p. 1297).1 In other words, in certain countries, females were undergoing a kind of prenatal gendercide.

These are harsh terms, but they are, unfortunately, supported by the facts. A cursory glance at male/female ratios over the last century alone shows some disturbing trends in demographics. The United Nations’ World Population Prospects 2015 indicates that in 2015, 50.4 percent of the world’s population was male, meaning there were some 101.8 males for every 100 females. In other words, there was a marked male advantage over the female population at this time, which means there are more men alive today than women. But the opposite should be true. It has been well established, in societies that provide broadly equal health care and nutrition to both sexes, that male mortality rates are usually higher than female ones,2 and there is a natural female mortality advantage in all age groups across the globe. In other words, given half a chance and the same opportunities, the norm would be for women to live longer, survive better, and overcome crises more easily than men. If our current male/female ratios indicate the opposite, therefore, if statistics show a reverse trend in the population at this time, we have to wonder why.

It should be noted that the current masculinity ratio reflects a global average; it spans different parts of the world and disguises substantial regional differences. For example, there is currently a very low ratio of 88.8 males for every 100 females in Eastern Europe, but a higher ratio of 97.9 to 98.4 in North America and up to 104.8 men for every 100 women in Asia. These differences, in turn, reflect the variations of the male/female ratio at birth and contrasting mortality rates in different countries. Such ratios can also fluctuate according to a wide range of factors, from cultural differences to forced migration. Ansley J. Coale (1991), one of America’s most distinguished demographers, pointed out, for instance, that in the late nineteenth and early part of the twentieth century, immigration to the United States was large and predominantly male. This had pushed the sex ratio up by 1910 to 1.06 males for every female. However, as the proportion of foreign-born citizens in the United States fell sharply in succeeding decades, the sex ratio also fell.

World wars as well as migration have created serious imbalances in populations too, and these also need to be taken into consideration. According to the 1897 census in Russia, for example, the male/female ratio was 1.001, but by 1946, under the burden of revolutions and world wars, there were only 77.3 men in the Soviet Union for every 100 women. Large declines in the male population were also observed in the aftermath of World War II in both Japan and Germany. But given these facts as well as the expected norms, what has led to the current predominance of men in the world? Why, despite recent anomalies caused by war and migration and the natural mortality advantage allowing for a higher ratio of women to men, are there more males than females on the planet today?

It is time to ask some serious questions about the missing women of the world. Where are they? What has happened to them? Are women in the early twenty-first century paying with their lives for the bloodletting on the battlefields of the twentieth century? Is the real Third World War being waged against women today? Even if “gendercide” is too strong a word to use, it may no longer be necessary to be quite so polite about “son preference.”


Before addressing the more chilling aspects of our collective response to these questions, it must be admitted, from the outset, that the numbers of missing women are particularly high in China and India. In a study published in the British Medical Journal in 2009, Wei Xing Zhu, Li Lu, and Therese Hesketh focused on China’s excess males, noting that, historically, preference for sons has been manifest postnatally through female infanticide and the neglect and abandonment of girls. Where this persists, it is mainly due to lack of access to necessary medical care. However, since the early 1980s, it has become possible to select males prenatally with ultrasonographic sex determination, and as a result, sex-selective abortion has become possible. This technology is now widely available in many countries, contributing to the emergence of high sex ratios from birth. The highest sex ratios are found where there is a combination of preference for sons, easy access to sex-selective technology, and a low fertility rate due to government restrictions. In these countries, the birth of girls must be prevented to allow for the desired number of sons within the allotted family size.

Zhu, Lu, and Hesketh report that for Chinese children born during the period 2000 to 2004, the overall sex ratios clearly indicated “son preference” across all age groups; they were high across virtually all regions with the exception of Tibet. They were highest in the one- to four-year age group, with a ratio of 1.24 more boys than girls, rising to 1.26 in rural areas. The latest UN data for China (2015) shows a sex ratio in the zero to one year age group of 1.15 more boys than girls, compared to 1.08 in 1990 and 1.04 in 1970.

In India, the data show a similar upward trend. In the northwest of the subcontinent, in 1991, there was only one district where the sex ratio showing son preference was in excess of 1.25, but by 2001, the number of districts showing similarly disturbing imbalances had risen to forty-six. The overall national average, moreover, had risen to a ratio of almost 1.08 more men than women, the highest it had been since 1961. But the latest census data for 2011 show an even further rise in the national average to 1.09, with the states of Haryana (1.20), Punjab (1.18), and Delhi (1.15) still showing particularly high ratios. We can see worrying signs in these statistics. According to an article in The Economist (2015), the consequences of the gender imbalance in India and China are likely to last for decades and will probably become worse before getting any better: “It will take the two countries with their combined population of 2.6 billion—a third of humanity—into uncharted territory.” Even a casual reader of such ominous warnings can recognize that something is very wrong. The drive to eradicate women and girls in certain countries will have devastating social consequences.

A 2010 study released by the Chinese Academy of Social Sciences noted that the shortage of young women threatens to become so critical that within a mere ten years, it is very probable that one in five young men in China will not be able to find a bride.

“If China had had a normal sex ratio at birth, there would have been 721 million girls and women living in 2010, according to a report in 2012 by the United Nations (UN) Population Fund. In fact, there were only 655 million women alive that year—a difference of 66 million, or 10 percent of the female population,” is how The Economist puts it. In other words, according to researchers Ebenstein and Sharygin (2009, p. 402), China is on the cusp of a major social crisis due to the “dramatic deterioration in men’s marital prospects.”

According to this same study, there will be some 30 to 40 million more young Chinese men than women aged nineteen and under by the year 2020, and for every 100 marriageable women during the four years between 2050 and 2054, there could be as many as 186 single men. This extreme imbalance, in a population roughly twice as large as the entire young male population of Germany, France, and the United Kingdom combined, carries serious implications.

In India, the corresponding estimates, which are also very worrying, suggest an excess of some 28 million males. There was a 9.2 million rise in the number of Indian men aged twenty-five to twenty-nine between 2000 and 2010. The numbers of Indian women who could marry them, in their early twenties, rose by only 7.6 million, however.3 According to The Economist (2015), “Even if India’s sex ratio at birth were to return to normal and stay there, by 2050 the country would still have 30 percent more single men hoping to marry than single women,” a dangerously high number. Christophe Guilmoto, senior fellow in demography at the French Institute for Development Research, claims that assuming no change in the sex ratio at birth, “the peak could be even higher” by 2060 to 2064, in fact almost double, with 191 men for every 100 women. Even if the sex ratio were to return to normal by 2020, Guilmoto believes “the marriage squeeze would still be severe, peaking at 160 in China in 2030, and at 164 in India 20 years later.”4

The consequences for women in these countries could be appalling and the social implications of this imbalance will certainly affect the rest of the world as well. But although it has proven traditionally difficult to address the problem, its cause is absurdly easy to identify. It is due to what Amartya Sen has called “son preference” in certain societies, which in other, less politically correct terminology is simply a war against women.

The time has come to account for the missing in this war.


There is no simple answer to the question of why societies prefer sons. Many reasons have been given for why some cultures retain a preference for sons; many explanations have been put forward to show how this preference has brought about the phenomenon of missing women. But the most obvious and endemic of the reasons is the prevalence of patriarchal family systems in many countries. This age-old tradition has served to marginalize women for millennia and is at the root of the phenomenon of missing women in the world today.

When patriarchal values are embedded in religious traditions and sanctioned as divinely ordained, they are very hard to eradicate. Ebenstein (2006, p. 6) points to the possible role of Confucian values in Chinese society, which clearly relegated women to a secondary role even during the Communist era. These values, which are being specifically evoked by the leadership of the country today, are betrayed by the maxim “The perfect woman must obey her parents when a child, her husband when a wife, and her son when a widow.” But China’s ancient belief systems are not the only ones that convey this same idea. Similar statements have been exploited in Jewish, Islamic, and even Christian religions to maintain the patriarchal systems in the West, both in the past and in the present, leaving lasting traces of “son preference” even in the most seemingly advanced societies.5

Traditional Hindu laws, too, exemplify to what a degree patriarchy has economic implications in India, where there is a critical need to pay dowries for daughters in order to offset the fact that a woman cannot, according to religious beliefs, inherit property.6 Sons in such cultures are valued as the source of wealth and long-term security, whereas daughters are naturally a liability, a potential for debt. Surveys in China and India also point to the perceived advantage of bringing sons into the world to do the backbreaking work on family farms and to provide old-age support to parents. This is particularly important in those countries with seriously inadequate levels of social protection for the elderly and the physical as well as financial dependence of older generations on the younger ones.

But patriarchy is manifest in political ideology as well as through religion and culture; it can have social as well as economic reasons, all of which play a role in the mystery of missing women in the world. Nor are the age-old traditions of infanticide the only ways in which “son preference” has been maintained. Programs such as China’s rigorous one-child policy, first introduced in 1979, imposed a compulsory reduction in fertility on the population and provided powerful incentives, both medical and financial, for parents to engage in sex selection in order to ensure the birth of a son. Scientific progress does not erase our prejudices; it simply makes it easier for us to implement them.

The following pages will show how patriarchal customs and patrilineal lines of kinship play an important role in “son preference.” They will also explore how ancestor worship has led certain cultures to believe that the fewer girls there are in a family, the better for its name, fame, wealth, and power, in both this world and the next. The reasons why there are far higher mortality rates for girls than boys during early childhood may underscore the causes for the missing women in the world.


A key factor in explaining the preference for sons in certain societies is the rigidity of patrilineal kinship systems. In countries where this problem is most pronounced, the main assets that provide the foundation of the family’s finances are passed through the male line only. This practice sharply limits the ability of women to sustain themselves outside the orbit of a man. In some instances, women do not have equal rights to inherit money; in others, they are unlikely to inherit land.7 Whatever the circumstances, they invariably symbolize an economic burden to the family. Strenuous efforts will be made, therefore, to maintain the male line, by adopting sons from the father’s male relatives, if necessary, or by the head of the household taking a second wife or concubine. Wherever patrilineal kinship is the norm, the negative consequence to a woman’s quality of life is considered less significant than the perceived costs to the family.

A girl’s primary responsibility, therefore, is to produce sons who would allow for the continuation of the family line and the stability of the patrilineal social order. In rural China, Korea, and parts of northwest India, the normal practice is for a girl to marry outside her village and to leave her own family in order to join that of her husband. This process, moreover, is nearly irreversible. In other words, it is very difficult—if the marriage fails—for a girl to return to her parental home. Her “place” in the family will have been taken and her notional land entitlement is likely to have been assigned to others, including incoming brides from other villages. Thus, a rigid, male-based social order has dire implications for the well-being of women and girls. Das Gupta et al. (2003, p. 11) note that “parents are under much social pressure to ensure that their daughters marry, as evidenced by the negligible proportions of women never married in their thirties in the censuses of these countries. Daughters must leave and make way for incoming daughters-in-law.” This is the case even if it means marrying undesirable or otherwise unsuitable partners.

“Son preference” in some countries can manifest itself in even more extreme ways. In Afghanistan, for instance, families without sons often opt for dressing young girls as boys. This will enable the “boy” to enjoy some of the social benefits of being a man, such as greater mobility and easier access to the educational system and to employment opportunities. By giving the sham “son” these benefits, moreover, the family as a whole will acquire an improved social status. The existence of a son, even a fake one, will not only bring economic advantages but prevents the public shame of not being able to carry forward the family line.8

What this means to the disguised daughter herself has been less well documented. If the example of Iran is anything to go by, it could account for the rise in sex-change operations in recent years, which attempt to endorse homosexual practices under religious law;9 it might also lead to an increasing dependence on artificial insemination in such cases, a further example of how scientific advance can be appropriated to support archaic patriarchal attitudes. Ultimately, it can only add to who is “missing,” at least in terms of political and legal visibility. The World Health Organization (WHO) includes Iran among the twenty-seven countries in the world most notorious for the impact of “son preference.”

To the extent that a young wife is able to deliver sons, moreover, she will see an enhanced status over her life cycle in a traditional patriarchal society. The relative power of Chinese grandmothers is proverbial, but it is a power base firmly anchored in the support of her sons. If she has none, she is more likely to lead a life of penury, humiliation, and marginalization, in which mistreatment and abuse are quite common and have been well documented.10 In parts of northwest India, a woman who has no sons might well be replaced by a second wife and relegated to the status of a servant performing household work. “Son preference,” therefore, has a direct impact on the social erasure of women.


There is a second reason for “son preference,” which is possibly even more significant in China and Korea than in other countries. Male ancestor worship means that if there is no son to ensure the maintenance of the patrilineal family line, the position of the father in the afterlife is gravely at risk. Furthermore, the wrath of ancestors is also incurred, and the family is doomed to difficulty and bad luck in this earthly life. The situation is no less dire in northwest India, where, according to this tradition, failure to ensure the continuity of the (male) family line risks spiritual oblivion. Ancestor worship entails additional complications in Korea, similar to those afflicting wealthy families in eighteenth- and nineteenth-century Europe, where sons do not have equal status within the family hierarchy. Preference is given to the eldest, who then bears the main responsibility for caring for his parents and ensuring the continuation of the family line. Younger sons have different rights and roles in society; their privileges and burdens are fewer in the family, although they still wield far more power than their mothers, sisters, daughters, or wives.

Unlike in some parts of China and India, a father without sons in Korea cannot co-opt the son of a brother to perform ancestor worship on his behalf. This may also help to explain why in Korea—a country with a much higher level of per capita income than China or India and at a more advanced stage of development—“son preference,” until relatively recently, has proved to be quite resilient to the advancement of education and overall modernization. In the survey work leading up to their 2003 study, Das Gupta et al. (p. 19) report that even among the highly educated classes in Korea, having girls only is perceived as “a terrible tragedy,” since no one in the family will be able to tend to the soul of the departed father. A life of spiritual desolation awaits the hapless father of girls. One grandmother insisted that it was not that daughters were unproductive or expensive to marry. On the contrary, women perform much of the hard labor in the fields, and their marriage costs virtually nothing. Rather, she said, “people don’t want daughters because they are not helpful to the family—they leave the family when they marry. Daughters are useless! It is sons who are able to inherit assets and keep the rituals of ancestor worship.”


The “missing women” phenomenon entails various kinds of discrimination, including the most violent, which can occur all through a woman’s life. There is an analysis in the next chapter regarding the more obvious forms this can take, such as rape, sexual abuse, and physical assault against women. But the present chapter will identify how female mortality, which is frequently caused by violence, can skew the sex ratios through lack of health care and proper nutrition, through reproductive illnesses and maternal mortality, and as a result of female genital mutilation and cutting.

An important proviso should be borne in mind, however. This subject is notoriously difficult to evaluate, and there are still other causes of female mortality waiting to be researched, many of which may or may not be due to gender discrimination. In a recent contribution to the “missing women” literature, Siwan Anderson and Debraj Ray (2010), researchers at the University of British Columbia and New York University, respectively, undertook an interesting accounting exercise. They estimated how many women in India, China, and sub-Saharan Africa are “missing” across age groups and how they “disappear” due to different diseases. By comparing the relative death rates for males and females in these countries, the authors were able to calculate the number of excess female deaths by age and by disease in the year 2000. Some of their conclusions are startling: “(1) the vast majority of missing women in India and a significant proportion of those in China are of adult age; (2) as a proportion of the total female population, the number of missing women is largest in sub-Saharan Africa, and the absolute numbers are comparable to those for India and China.” Most interestingly, “a comparable proportion of women was missing at the start of the twentieth century in the United States, just as they are in India, China, and sub-Saharan Africa today” (p. 1262). Thus, the data suggest that the problem may reflect not only “son preference” and discrimination against girls and women but also excess female mortality related to other factors, not all of which have yet been identified. The question of why women are missing in such large numbers still remains to be fully answered.

One fact, however, is known: murder begins early. The problem starts with sex-selective abortion and continues with infanticide. As Sen (1999, p. 106) has pointed out, “There is indeed considerable direct evidence that female children are neglected in terms of health care, hospitalization and even feeding.”11 Ebenstein12 argues that among the millions born in China and India during the past four decades, the female deficit is largely explained by sex-selective abortion and neonatal infanticide, in that order.13 In China, somewhere between 37 and 45 percent of women are missing due to prenatal factors. In other words, the war against women often begins before birth. The World Bank (2012), analyzing these deeply entrenched cultural habits, reports that “Chinese and Indians living in the United States show very similar patterns of sex selection in first and second births” (p. 123).

If girl children survive the early years, their circumstances only deteriorate in many countries as a result of ill health and lack of nutrition. Their condition from early adolescence onward can be further aggravated by sexual violence, genital mutilation, and abuse, which often culminates in maternal mortality, suicide, and murder. But of all the factors responsible for women dying, Amartya Sen (1999) believes that it is the neglect of female health and nutrition that is the most important. Since the “missing women” dilemma relates directly to the public health dimensions of this problem, it may be helpful to begin by looking at the different ways that women and men have access to the fundamental safety and integrity of their persons and to the differences in their nutrition and health care.


Many factors contribute to the social inequalities experienced by women in the area of health care, particularly with regard to their reproductive well-being. As described earlier, the fundamental misogyny and misaligned power relationships implicit in patriarchal systems cause women to be frequently subjected to deprivation, chastisement, and abuse. Such treatment, in turn, leads to their urgent need of medical attention. But their plight becomes all the more desperate at such times because of lack of access to adequate health care services14 or unfair practices sometimes used by providers of such services, from the use of expired medication, for example, to financially crippling hospital bills. Such biases operate not only within the individual household, where women and girls are not equally valued—and are sometimes even deprived of adequate basic nutrition—but are reinforced by community norms and values regarding women’s sexuality, reproduction, and rights.15 Women are most neglected in their hour of greatest need.

Bias also operates at the level of health legislation, policy, and education, where the widely differing requirements and capacities of men and women regarding sexual functioning and reproduction are not adequately recognized and where funding is so often manipulated for political or sectarian ends. Gita Sen et al. (2002) underline this distinction when they write:

A gender and health equity analysis insists that, although differences in health needs between women and men do exist in relation to biological and historical differences, this does not “naturally” lead [to] or justify different or unequal social status or rights in just societies.16

Another aspect of bias is the way in which women are invariably exposed to greater health risks because of the nature of their traditional roles in certain societies. Where gender assigns to women the washing of clothes, the fetching of water, and the cooking of meals, they are exposed to much higher rates of infection and disease from contaminated water and indoor smoke,17 compromising them further in areas of reproductive health. For example, malaria in a first pregnancy is an important cause of chronic anemia; it also leads to spontaneous abortion, stillbirth, and maternal mortality.18 In addition to these factors, by far the most important cause for missing women in sub-Saharan Africa is HIV/AIDS. Biological differences combined with endemic poverty can therefore greatly affect the susceptibility of women to infection and disease, the severity of which can have serious consequences for society at large.


In their article on reproductive health, Cottingham and Myntti19 describe the intricate complexities of mapping reproductive health worldwide. Even with the epidemiological data available, it is very difficult to measure, with any accuracy, the global burden of disease according to the disability-adjusted life year.20 Much has been lost in translation and more always needs to be done to track the worsening condition of women in the world as a result of war, displacement, epidemics, and deteriorating environmental factors. The picture, grim as it is, could always become grimmer.

Based on the existing “map” of reproductive issues, such as sexually transmitted infections, maternal mortality and morbidity related to pregnancy and childbirth, perinatal conditions, congenital anomalies, HIV and AIDS, and the risks of unsafe sex, women account for fully 71 percent of the overall disease burden from unsafe sex. Furthermore, conditions related to unsafe sex account for 12 percent of women who die between fifteen and forty-four years of age, and of 15 percent of those who die of their disabilities, the highest numbers are in sub-Saharan Africa, India, Latin America, and the Caribbean.21 The research, disaggregated for sex, indicates that women constitute 22 percent of the global burden of reproductive ill health compared with 3 percent for men. But even these figures do not present a complete picture. Cottingham and Myntti do not take into account problems such as fistula and incontinence, conditions brought about by female genital mutilation or cutting, by stillbirth and infertility, or the consequences of sexual abuse and other forms of violence against women. Nor are the mental health dimensions measured of reproductive diseases.22 In other words, the truth is probably far worse than these figures might indicate.

Early and unwanted childbearing, HIV and other sexually transmitted infections, and pregnancy-related illnesses account for the greatest proportion of health problems experienced by women—especially those in low-income countries. It is estimated that about 225 million women do not have access to elementary family planning techniques enabling them to choose the number and the spacing of their children. This results in some 85 million unintended pregnancies per year in developing countries, with all their attendant consequences and complications.23


The inferior status of women obviously adds to the numbers of female deaths and the most dramatic indicator of this inequity comes from the maternal mortality ratio. This ratio is defined as the number of maternal deaths in a given period per 100,000 live births during the same period. The WHO reports that 303,000 women die every year—over 800 daily—from problems related to pregnancy and childbirth alone. According to WHO statistics (compiled in the World Bank’s World Development Indicators), the highest lifetime risk of dying in childbirth in 2015 was in Sierra Leone, where the probability that a fifteen-year-old female would die eventually from a maternal cause was 1 in 17. In India, it is 1 in 220; in China, it is 1 in 2,400; in the United States, 1 in 3,800; in Italy, 1 in 17,100. Numberless impoverished women in the world suffer obstructed childbirth24 and are unable to access competent obstetrical care in time. They either die during labor or suffer permanent injuries, such as fistula, and are simply banished from their communities and left alone to perish.25

Unsafe abortion is another killer and accounts for 13 percent of global maternal mortality. This means that about eight deaths from abortion take place every hour. Of the 46 million abortions performed annually worldwide, some 20 million are performed by nonmedical and untrained individuals, resulting in complications that lead to 68,000 to 70,000 deaths each year. In those cases where women survive, they are usually left with lifelong health problems.26 Iqbal Shah and Elisabeth Ahman (2009, p. 1149) from the WHO report that maternal deaths due to such problems are higher in regions with restrictive abortion laws. Moreover, their study also confirms what has long been known, namely, that legal restrictions on safe abortion do not reduce its actual incidence: “[W]hile the numbers of legal and safe abortions have declined in recent years, unsafe abortions show no decline in numbers, despite being entirely preventable.” They concluded that the Millennium Development Goal was unlikely to be achieved “without addressing unsafe abortion and associated mortality and morbidity.”27


Female genital mutilation or cutting continues to be performed for nonmedical reasons on an estimated 2 to 4 million girls each year. Many of these girls are teenagers and not a few are below the age of eight. Dating back centuries and defended by its proponents, both Muslim and Christian, as ensuring the virginity and marriageability of girls, this practice has been reported in all parts of the world and is recognized internationally as an extreme form of discrimination against women. Usually performed by nonmedically trained women, it not only leads to severe trauma and excruciating pain but routinely results in such long-term complications as shock, ulceration, chronic infection, and bleeding as well as obstructed childbirth. Although most prevalent in Africa and the Middle East, the practice of some form of female genital mutilation or cutting occurs in immigrant communities in parts of Asia and the Pacific, North and South America, and Europe, according to reports by Amnesty International. This subject, linked directly to the question of culture, will be discussed in Chapter 4, but it needs to be mentioned here because of its critical impact on female mortality and the sex ratio.

In fact, violence against women—to be discussed in the next chapter—is also critical to the sex ratio. In countries where the population balance is skewed and even where the sex ratio is falling, the incidents of violence against women invariably increase. The long-term effects of this anomaly, moreover, are likely to be felt for decades. This is particularly the case in China, where the problem of rising violence and a declining female population has acquired worrying proportions. The fact that a higher ratio of single men than women in society leads to antisocial behavior is a stark reality that is no longer possible to ignore.28

Columbia University’s Lena Edlund and several of her colleagues at the University of Hong Kong (2008) argued that an increase in the sex ratio in China had a dramatic impact on crime. It accounted for a high percentage of urban violence and property destruction, offenses that almost doubled between 1988 and 2004.29 Valerie Hudson and Andrea den Boer (2005), professors at Brigham Young University and the University of Kent, took this research one step further and made a strong case that large numbers of “unattached young adult males” posed serious security threats to society as a whole. They warned that according to the evidence, an imbalance in favor of males in the population definitely increases crime rates in cities, and in proportion to the rise in violent crime, there is a parallel upsurge in drug use, drug smuggling, and prostitution. The worst effect is the expansion of a thriving market in the kidnapping and the trafficking of women. These undesirable consequences, in turn, led governments to “favor more authoritarian approaches to internal governance and less benign international presences.”

A recent example of this tendency can be found in the jailing of five young Chinese feminists who tried to display their indignation at the rise of sexual harassment by demonstrating on the streets of Beijing on the eve of International Women’s Day in 2015.30 Following their summary arrest and detention, these women were subjected to incessant interrogation;31 instead of listening to their warning message and taking heed of its seriousness, the Chinese government attempted to blame them for “picking quarrels and provoking troubles.” Even though international attention led to their release on bail, their story illustrates how the devaluation of women places them under pressure as a result of sex ratios being skewed.

Ebenstein and Sharygin (2009, p. 400) argued that a rapidly rising population of single men in China “will affect the prevalence of commercial sex activity and the transmission of sexually transmitted infections, including HIV.” They also provided some historical support for the thesis that imbalanced sex ratios could have a security dimension. In the eighteenth century, “the Qing dynasty government responded to the rising sex ratios brought about by high levels of female infanticide by encouraging single men to colonize Taiwan.” A century later, when poor economic conditions in Shandong Province led to rampant female infanticide once again, a similar problem was created, and rebellion was the result. As the large numbers of males in the population matured, they “organized an uprising against the Qing dynasty.”

Although we have developed new strategies as well as casualties in the deadly wars we wage these days, we seem to repeat the same mistakes again and again in the age-old war against women. No matter how sophisticated we think we are, we are still mired in the mud of that ancient battlefield.


One interesting dimension of the phenomenon of “missing” women and girls is its pervasiveness across various social strata and geographical regions. It does not matter how rich, how poor, how sophisticated, or how “primitive” we may be, this problem is endemic. It has appeared in countries at different stages of development and with different degrees of industrialization, with diverse levels of openness to the world, and with contrasting social and economic factors. In other words, the idea that the poor might show a greater proclivity than the rich when it comes to sacrificing their daughters is not borne out by the data.

In the northern states of India—as well as in Korea, where census data have picked up high juvenile sex ratios in the last several decades—evidence actually points to higher levels of discrimination among those who are better off. In fact, the worst sex ratios in India have been registered in Punjab and Haryana, which are among the richest states in the country. In China, the provinces with higher literacy rates tend to have higher sex ratios. However, the data also show that, beyond cross-group comparisons—for example, the rich versus the poor—it is also possible to detect a rise in discrimination against girls when the family is subject to some external stress that worsens its relative economic situation with respect to the recent past. Families that have become poorer as a result of crop failure or the closing down of traditional markets for their products will revert to increased “son preference.” In China and Korea, war and famine in the mid-twentieth century resulted in more active discrimination against girls.

Nor is the problem concentrated only in China, India, and Korea. According to the UN, abnormally high sex ratios are also prevalent in several of the former Soviet republics, such as Armenia, Azerbaijan, and Georgia. The problem is also evident in some of the former Yugoslav republics, namely, Serbia and Bosnia. It exists in Egypt, in Bangladesh, and in Pakistan too and, perhaps not surprisingly, in other countries with a large mixed population, such as Singapore, which has sizable Chinese and Hindu minorities (see Figure 1.1). Declining fertility rates and the increasing availability of ultrasound technologies could well result in a broader dissemination of the war against girls, a war that, according to Amartya Sen (1999, p. 104), is one of the most “crude and sharply visible aspects of gender inequality.” It is literally taking place on a global scale.

Figure 1.1: Sex ratios: An international perspective, 2015–2017 (sex ratios at birth per 100 female newborns)

Source: United Nations, World Population Prospects: The 2017 Revision, Population Division

Although China is now taking steps to adjust its population policy, the impact on the current imbalance is still uncertain.32 In India, the latest UN data show the sex ratio at close to a historically high level, but the ratio may be on its way to stabilizing or, in any event, may be peaking; this allows for the possibility that the growth rates of masculinization are decelerating in the population. This has already happened in Korea, where the sex ratio has actually fallen from its peak in 1995.33 In an editorial titled “Too Many Single Men,” The Economist notes that “the war on baby girls is winding down, but its effects will be felt for decades.” The authors emphasize this point, adding, “But whatever policymakers do now, the sex imbalance will cause trouble for decades. The old preference for boys will hurt men and women alike.”34

If we draw back from the close scrutiny of statistics for a moment and look at the larger picture of social development at the levels of education, of employment opportunities, and of careers available to women, we discover that these too have a significant impact on demographics. The aging populations of North America, Europe, and East Asia clearly indicate that fertility rates in these countries have dropped below the normal replacement levels. In other words, they show that when there has been a choice between career and reproduction, career has come first. Couples in these countries have put off having children during economic downturns. Although children may represent social security and care for the elderly in poor populations, they may be an economic liability for the middle classes or the upwardly mobile. A study in the United States found 49 percent of high-achieving women to be childless, as compared with only 19 percent of their male colleagues.35 Many women who choose not to have children are not distressed about this choice, despite pressure from friends and family.36 However, the career structure in these countries seldom allows for time out to have children; it does not encourage women to achieve a balance between work and family responsibilities and often forces them to choose one or the other. When they opt for raising a family, they frequently are penalized for it. Many women who stop working to have children find themselves in great difficulty when they attempt to return to their previous careers.

Consequently more and more women in certain countries prefer to have no children. The proportion of American women between ages forty and forty-four who have never given birth rose to 15 percent in 2014, which is up from 10 percent in 1976. Among the educated members of this population who have advanced degrees (M.D.s or Ph.D.s), the proportion of childless women is 20 percent, but this has been even higher in the past and is a decline from 35 percent in 1994.37 The United States has maintained some population growth through immigration and higher birth rates among the poor, but in European countries (e.g., Italy), we see sharply declining birth rates among the educated and native-born middle classes. However, this is not due to the increase in working women, because Italy, which has the lowest fertility in Europe, also has the fewest women in the workforce. Only those countries with policies that help women both to work and to have children can maintain replacement levels and keep the population stable.38

One hidden dimension of gender bias is the different reactions to demographic imbalances. Although an excess of males is seen as socially destabilizing, as discussed earlier in this chapter, little concern has been expressed for the implications of an excess of women. What happens to women who are unable to find husbands, who are unable to have babies and raise families, especially in societies where women’s opportunities and independence are constrained? Whether in relation to the plight of girls in Afghanistan who have to pretend to be boys in order to protect their family’s honor, or the members of either sex in Iran who are forced to endure the complications of sex-change treatment in order to meet the strictures of sharia law, there are ways, as mentioned before, of sweeping women under the proverbial carpet that redefine the “missing” as those who have simply been made, in Ralph Ellison’s famous term, “invisible.”


Despite the overwhelming evidence that gender bias has led to cases of “missing women” in the world, there are nevertheless some curious examples that fly in the face of perceived patriarchal orthodoxy and challenge us to question our assumptions.

Although it is true that, in certain cultures, the majority of the old do, indeed, live with their married sons, this pattern is not universal. Evidence shows that in the Philippines, older parents are just as likely to live with the families of married daughters as with those of married sons, making daughters just as valuable as sons in performing this essential role of social protection. It is not surprising, then, that there is no evidence of pronounced “son preference” in the Philippines, where sex ratios are broadly normal—in fact, 1.05, close to the world average.

The extent to which the payment of dowries is a strong disincentive to have girls is not wholly convincing either. The data actually show that parents spend three to five times more on the wedding of a son than on that of a daughter, often providing the new couple with housing and many household items. However, the parents may see such expenses and the additional costs of providing a son with an early financial push in his new life as a worthy investment. They ensure his place within the patrilineal family line—akin to buying domestically produced goods—unlike the money spent on a daughter’s wedding, the benefits of which will accrue to her husband’s family and must therefore be perceived as a net loss of resources to the girl’s own. In this case, the funds might be better saved for the wedding of a son. What is portrayed as the economic argument for “son preference”—the high cost of dowries—may, in fact, merely reflect the built-in cultural factors that justify “son preference” and are upheld by the rigidity of the social order and the primacy of males within it. The fear of dowry debts may not necessarily lead to female infanticide.

Equally suspect is the argument that sons are needed for the hard work of the family farm. An overwhelming body of data shows that women contribute a significant share to farm labor. However, the data on labor force participation tend not to pick up on the work performed by women. This is because it is perceived largely as an extension of women’s domestic duties at home, which, of course, find no place in the statistics on the gross national product.39 As noted by Das Gupta et al. (2003, p. 170), “[O]fficial statistics show that the State of Haryana in northwest India has an especially low rate of female labor force participation, but in fact women do almost all the manual labor on the fields through the whole crop cycle, while men spend short periods of time ploughing with tractors and operating tube wells.” When surveys are done to measure labor force participation, men’s contribution to the farm is duly noted, given male ownership and overall managerial control.40 But the vital input of women is invisible.

It is also interesting to note that in the countries of Southeast Asia that have a less rigid social order and where girls are perceived by their parents as having a higher intrinsic value—as opposed to simply being an export to be sold out of the family and more or less struck from its genealogy—the sex ratio is also much closer to normal levels. In such cultures, daughters are able to sustain meaningful, stable relationships with their parents even after marriage, because they are the ones on whom the elderly increasingly depend.

In fact, there is overwhelming evidence worldwide to disprove the idea that sons are essential for the protection of the elderly. It has been estimated that over 60 million families in the United States are caring for an aging or disabled person at home, and according to one source, at least 66 percent, or two-thirds, of the caregivers are women.41 Nor does this high percentage indicate an easy option, emotionally or financially. “As parents live longer, more women are feeling the crunch.”42 Over the next five years, it has also been estimated that one out of five workers, principally women, will have to quit their jobs in order to care for an elderly parent. The impact on their personal lives as well as on the economy will require further study.

Who will care for the elderly if there are fewer women in the world? Who will take on this role if the rising male ratio increases violence against women, and democratic values and social services are eroded as more and more of them experience rampant female abuse? How long will old people survive in societies suffering from such gender imbalances? Is it any wonder that euthanasia is increasingly an option, or that nine out of ten support its legalization in certain European countries today?43 Are the armies of female carers of the elderly a sign of coming change, or do their numbers simply reveal a new set of casualties in the war on women?

It is certainly time to talk about peace. A number of options suggest themselves in thinking about the public policies that might be put in place to help mitigate discrimination against girls and bring an end to the numbers of “missing women.” These include protection for the aged, gender budgeting, and changes through civil society and grassroots initiatives. These efforts may not end the war on women yet, but they could signal a much-needed and long-overdue truce.


One of the options before us concerns the urgent need to protect the old and provide for their well-being in countries without adequate systems of social protection or where there are austere and extremely low levels of pension coverage. Public policies aimed at strengthening the systems of social protection in China and India would clearly allow a growing number of parents to feel less vulnerable and less inclined to see their sons as insurance policies against the liabilities of old age. Without the need to depend on sons financially, the “son preference” would gradually give way to a more balanced attitude toward daughters. This is a particularly important consideration in China, where rural peasants account for some 44 percent of the country’s 1.4 billion people, the vast majority of whom have no access to social security or state-provided medical care and who therefore are traditionally reliant on the support of sons in old age.44

Studies comparing the savings behavior of households with sons and those with daughters have shown, moreover, that the former amass more than the latter in all parts of China. Shang-Jin Wei and Xiaobo Zhang (2009) estimate that half of the increase in savings in China during the period from 1990 to 2007 can be attributed to the increase in the sex ratio. Given the dearth of brides that is expected in the next decade in China, this is a curious development. Strange as it may seem, families with sons tend to respond to the scarcity of brides by increasing their savings; interestingly, this behavior then spills into the real estate market, so that regions with a higher sex ratio have shown rising housing prices.

To the extent that they might encourage people to spend more and hoard less, better social safety nets and pensions for the elderly would certainly be useful in a country like China. This could perhaps boost national consumption too and would certainly help reduce China’s trade surplus, which at times has been a source of friction with trade partners. This is particularly the case with the United States and the European Union, but also other Asian countries as well. Such reforms might not have a direct impact on ancestor worship but would surely reduce the pressure on men to have sons. One can only hope that these reforms might also raise the value of daughters to some extent, at least above the rampant housing markets.


A government’s budget is also a powerful mechanism for implementing new priorities in society. Over the past twenty years—particularly in economic programs supported by international financial institutions—increased attention has been paid to ways in which a government may try to assess whether particular fiscal measures could adversely impact women and undermine the goal of gender equality. This is particularly important in the majority of countries where women are not represented during budget deliberations; it is urgent where distributional implications of particular budget formulations involve social dislocations and place an unfair portion of the burden of the economic adjustment on vulnerable groups. Gender budgeting could play a vital role in pursuing a variety of economic and social goals, such as a better-functioning tax system and increased spending on education and maternity care; this, in turn, would ensure an improved profile in public finances while also having an impact on the safety and health of women.

Needless to say, the overwhelming majority of finance ministers, chairs of parliamentary budget committees, and other senior officials working on draft budgets are men at this time. Experience shows that equity issues are seldom given the prominence they deserve in their deliberations. The reasons vary. In some cases, governments do not have the administrative capacity to do the sort of budget targeting that is at the center of effective social policy. This is particularly true in the developing world, as illustrated by the regressive energy subsidies that governments often provide, the overwhelming share of whose benefits go to the wealthy rather than the needy in their populations. In other cases, a government’s budget often becomes the arena for negotiating compromises with the political opposition, in which case the education of women or girls or indeed any other cause with a strong gender dimension seldom is given high priority.

In fact, the historical deficit bias in fiscal policy making and the levels of public debt in countries everywhere usually drown out such concerns amid a rising tide of red ink. Sadly, what happens all too often is that governments either just do not care or else are held to ransom by privileged elites who distribute the spoils of the state as they will. In this respect, the more transparent the budget process and the more open it is to public scrutiny, the easier it will be to monitor and analyze the gender effects of various policies. The more likely, too, will it be possible to hold policy makers to account for the effects of their decisions on the well-being, health, and lives of women.

It may be worth exploring an additional dimension in this debate by asking if governments do enough to deploy the state budget as an instrument to promote gender equality. We live in a world of scarce resources, and how effective a government is in its use of available funds has a considerable bearing on its ability to promote or detract from sustainable economic development. Unfortunately, there are far too many examples of massive waste when it comes to state budgets. Rather than utilizing resources to promote opportunity and shared prosperity, many governments, particularly in the developing world, use them to distort and deteriorate income distribution. An eloquent example of this is provided by a 2015 International Monetary Fund study that factors in the cost of negative externalities from energy consumption according to which subsidies for petroleum products, electricity, natural gas, and coal amount to some $5.3 trillion per year. This astronomical sum is the equivalent of about 6.3 percent of global gross domestic product, or 8 percent of total government revenues, the world over. However, the benefits of gasoline subsidies, as the study shows, are the most regressively distributed in the world, with over 60 percent of the total accruing to the richest 20 percent of households. For diesel and liquefied petroleum gas, 42 percent and 54 percent, respectively, of the benefits go to these higher-income groups. The removal of such subsidies, the authors of the International Monetary Fund study claim, could lead to “a 21 percent decline in CO2 [carbon dioxide] emissions.” It could also generate “positive spillover effects” by reducing global energy demand and thus have a tangible impact on mitigating the effects of climate change. Indeed, it would be difficult to come up with a public policy that is more socially and environmentally destructive than subsidizing energy consumption. And this is a policy that has been put into place and maintained for the most part by men.45

When we learn, therefore, that the latest data (2015) in India shows that there are 287 million people (two-thirds of them women) who cannot read and write—that is to say, who do not have access to the most important tool to escape from poverty in the twenty-first century—we have to be careful not to imply that the reason for this is because “India is a poor country.” The reality is quite different. India spends dozens of billions of dollars on energy subsidies every year.46 Like other governments that account for the $5.3 trillion in subsidies mentioned earlier, policy choices made, for the most part by men, are feeding the driving habits of the middle classes over the more urgent needs of hundreds of millions who do not have access to information and to knowledge today. While a minority in India and in dozens of other countries as well are driving around in their air-conditioned cars, the majority find the most important portals for poverty alleviation slammed shut in their faces.


There is obviously a role for civil society, too, when it comes to changing public policy. Promoting healthier attitudes on issues of gender equality is already a broadly established discourse in much of the developing world. The relative influence of nongovernmental organizations and other civil society organizations in promoting equity has been considerably enhanced, moreover, by the arrival of the internet and other modern communication technologies. Governments intent on providing better incentives for families to see girls as equally valuable could work with nongovernmental organizations and the media to promote more egalitarian values from a gender perspective.

In this respect, the Chinese government’s Care for Girls campaign—providing girls with free public education in some of the regions with the highest male sex ratios—is an encouraging sign of the increasing seriousness with which problems of gender inequity are being viewed. Further collaboration with the nongovernmental organization community could prove to be particularly fruitful, in light of the limited gains made as a result of other government-sponsored policies. In China, for instance, the family planning law of 2002 banned the use of ultrasound or other technologies to establish the sex of the fetus, but the policies—implemented at the local level—have run up against the tougher population targets imposed by China’s one-child policy, which, since 2015, is finally being relaxed, for the first time in many years.

But even in the obdurate case of female genital mutilation and cutting, it has been found that although Western efforts to eradicate the practice have long been perceived as “interference,” local, grassroots programs employing group efforts of mothers and daughters in neighboring villages are proving effective when they focus on the medical risks.47

One hopeful sign that a combination of sound public policies and the forces of globalization can help reverse the problem of “son preference” is provided by Korea, whose sex ratio over the past decade, as already mentioned, has gradually begun to return to more normal levels. Although still on the high side—1.05 in 2016, compared to nearly 1.15 in 1995—these reductions show that even deeply entrenched prejudices and cultural norms are not immune to education and modernization; they clearly indicate that the empowerment of women resulting from integration into the labor market is a force of change.


Gender equality is frustratingly slow to achieve. As sex ratios and underlying demographic imbalances indicate, it poses a challenge to one of the most profound of human prejudices. Despite all the intense efforts of agencies and organizations and the outspoken courage of individual leaders to reverse these trends, the picture is still grim. Too many women are still missing from the picture. However heartening it is to learn that Botswana lifted restrictions on the industries in which women may not work, that Finland, the Kyrgyz Republic, and Moldova now allow fathers to take extended parental leave, or that Morocco revised its contract law to give married women the right to start businesses and get jobs without their husband’s permission, the war against women remains rampant. Rural women everywhere still represent more than two-thirds of the world’s illiterate adults, and women only hold about 23 percent of elected parliamentary seats globally. Even where basic gender equality appears to have improved, we are still far from living in societies where men and women are in true partnership.

Clearly, it will take far more than demographics to achieve this. In addition to changes in the law and directions of policy in this regard, there needs to be a profound transformation in our values, our attitudes, and our understanding of equality as well as gender if we are to alter entrenched habits in the home, engrained customs in the community, and the moral environment at decision-making levels of society. The sad truth is that many of the barriers facing women still stand. The battlefront may have shifted but the war against them still rages.

And it takes place, increasingly, at the unprotected frontiers of their own bodies. Violence against women is on the rise. Rape is still not considered a crime in many countries and goes unpunished. Sexual enslavement and forced prostitution still devastate the lives of the poor and, like physical violation, continue to be routinely used as weapons. Female infants are still being buried alive, and prenatal testing is now being used as a subterfuge for aborting female fetuses.48 As award-winning journalists Nicholas Kristof and Sheryl WuDunn have pointed out, forced marriage and bride burning are still common in South Asia, and a pregnant woman in Africa is 180 times more likely to die of complications than in Western Europe. Even in the United States, 90 percent of AIDS cases in people under twenty years of age are girls, and women everywhere are still at the mercy of the brutality and abuse, the wife beating and harassment that have oppressed them for millennia.

When will it end?

Copyright © 2018 by Augusto López-Claros and Bahiyyih Nakhjavani.