Monday, June 11, 2018

Book Review: Unnatural Selection: Choosing Boys Over Girls, and the Consequences of a World Full of Men by Mara Hvistendahl

The high number of sex-selective abortions taking place across Asia has tipped the gender balance to such an extreme that over 160 million females are “missing” from the population. Therese Hesketh finds that a wealth of fascinating historical detail makes Unnatural Selection a strong read, but a number of important contemporary issues seem to have been omitted. 
Unnatural Selection. Mara Hvistendahl. Public Affairs. June 2011. 336 pages.
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Mara Hvistendahl is the Beijing-based correspondent for Science and has written on a very wide range of topics. In this, her first book, she explores the emerging problem of the huge gender imbalance in many Asian countries which has resulted from easy access to prenatal sex selective technology. The book is an illuminating and very readable expose of an issue of great importance in the areas of gender, demography, human rights and women’s health.
Most of this book is devoted to documenting the problem, exploring the historical context and describing the reasons for the gender imbalance.  The problem is massive. In human populations around 105 boys are born for every 100 girls. If the sex ratio at birth exceeds 107 it must therefore be the result of manipulation, that is prenatal sex selection. This is the case in many Asian countries, most notably the two biggest, China with a sex ratio at birth of 118 and India with ratio of 108. In both countries wide variations mean that in some localities the sex ratio at birth rises to as high as 150.
Highly skewed sex ratios at birth were first reported in the late-1980s in South Korea. China soon followed and here they were initially attributed to female infanticide and non-registration of girls. But it soon became obvious that easy access to ultrasound was allowing for fetal sex identification and in countries where abortion was readily available this was resulting in female fetocide on a massive scale. While the rich urban elite were the first to access sex selection, it soon became widely available even to the poor. And while the first countries to be affected were South Korea, China, Taiwan and India, the problem has spread now to Azerbaijan, Georgia and Armenia.
The last third of the book concentrates on the consequences of a large excess of males. The focus here is on trafficking for marriage, the rise in prostitution, the men who are unable to marry and the societal consequences in terms of crime and security. While this is the most interesting section of the book, it is weakest on evidence. For example, nearly all of the chapter on the problems of excess unmarriageable men examines historical examples, where the gender imbalance was caused by female infanticide and neglect of girls resulting in only marginal distortions compared to those of some countries today. There is almost no actual evidence presented about the impact of these distortions. Much is made of the fact that men who don’t have a sexual partner have high levels of testosterone which will lead to aggression and crime, that prisons are full of unpartnered men. But no evidence is given to show that countries or areas with high sex ratios actually have higher rates of crime. Indeed, China has a strikingly low rate of violent crime.
The style of the book is investigative journalism, making it an entertaining and absorbing read. However, since much of the text is devoted to interviews with highly selected individuals, while other experts barely get a mention, the overall picture is rather unbalanced. And in places the political agenda of the author is rather too transparent. For example, it is highly contentious that in the 1990s, American scientists supported sex-selection as part of a population control agenda. But it is very good to see the scandal of the UN’s failure to acknowledge the issue of female fetocide clearly highlighted.
There is a lot of historical detail in this book, much of which is fascinating, but a number of important contemporary issues seem to have been omitted. Firstly, the hypothesis that  women in high sex ratio societies will be more valued is dismissed. In fact, there is considerable evidence from China that poor rural women are definitely exploiting their value by migrating to cities, marrying-up and leaving rural areas permanently, exacerbating the already high sex ratio in these areas. The men left behind are the poorest, least educated and least marriageable, and contrary to the assumptions made in the book, very few can afford to buy brides.
Secondly, there is little mention of the fact that socio-economic change in both China and India has led to a fall in the overall sex ratio, and studies of sex preference show consistent trends towards gender indifference and daughter preference, even in rural areas. So while the very high birth cohorts for sex ratio have yet to reach reproductive age, it is likely that the worst will be over soon, though normal sex ratios in these countries are probably a few decades away.
Finally, the long section on sex selective technologies fails to mention the most recent: a blood test for the pregnant woman, available on the internet for just £179, which claims to be able to determine fetal sex from seven weeks gestation. The fact that ultrasound cannot identify the sex of a fetus until at least 16 weeks is a deterrent to abortion for many. An earlier diagnostic test could make sex-selective abortion much more acceptable. The hope is that this remains unavailable in Asia.
Therese Hesketh is Professor in Global Health at UCL Centre for International Health and Development. Trained in paediatrics in Bristol and London, Therese has worked with NGOs and UN organisations in China, Indonesia, Cambodia and Laos as a clinical teacher and manager of health programmes. These included the development of the first Neonatal and Paediatric Intensive Care Unit in China and the first neonatal outreach programme for the training of doctors and nurses. Since joining CIHD she has developed a number of research projects in China in adolescent and reproductive health. She has explored the epidemiology of hepatitis B and C, STIs and HIV, the vertical transmission of infection and the impact of population policy on the health of women and children in China. Read more reviews by Therese.

Editor's note: This review was originally published in The London School of Economics Review of Books, and has been reposted with permission. It is available under Creative Commons and the original page can be found here. Like what you read? Subscribe to the SFRB's free daily email notice so you can be up-to-date on our latest articles. Scroll up this page to the sign-up field on your right.

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