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Try out PMC Labs and tell us what you think. Learn More. The use of reproductive technology to service a preference for male offspring has created an artificial gender imbalance, notably in Asian countries. The social effects of this large surplus of young men are not yet clear, but concerted action might be necessary to address the problem.

In humans, this balance has been remarkably even, but the past few decades have seen a substantial shift towards men, notably in some Asian countries. The reason, however, is not biological; there has simply been a cultural preference for sons in the affected societies, which together with recent availability of prenatal sex-selection technologies has led to widespread female feticide. The result has been a huge excess of males in several countries. Whilst it is not yet fully clear how a surplus of millions of men will affect these societies—perhaps even leading to civil unrest—some countries have already taken steps to alleviate the problem by addressing the underlying cultural factors.

However, the problem is about to come to a crisis point, as a large surplus of men reach reproductive age. It will take many decades to reach a balanced representation of both sexes again. The sex ratio at birth SRB is defined as the of boys born to every girls. It is remarkably consistent in human populations, with around — male babies for every female ones. John Graunt first documented this slight excess of male births in for the population of London, and many studies have since confirmed his finding [ 1 ].

Higher mortality from disease, compounded by the male tendency towards risky behaviours and violence, means that the initial surplus of boys decreases to roughly equal of males and females during the all-important reproductive years in most populations. Researchers have studied a large of demographic and environmental factors that could affect the SRB, including family size, parental age and occupation, birth order, race, coital rate, hormonal treatments, environmental toxins, several diseases and, perhaps most intriguingly, war [ 2 , 3 , 4 ].

It is well documented that wars are associated with a small increase in the sex ratio. This phenomenon occurs both during the war and for a short period afterwards. However, these findings were not reproduced in the more recent Balkan Wars and the Iran—Iraq war [ 7 ]. There have been several biological explanations for these increases. It has been proposed, for example, that the stress of war adversely affects the viability of XY-bearing sperm.

Alternatively, a higher frequency of intercourse after prolonged separation during times of war is thought to lead to conception earlier in the menstrual cycle, which has been shown to result in more males [ 4 , 8 ]. There have been evolutionary explanations, such as the loss of large s of men in war leading to an adaptive correction of the sex ratio [ 4 , 9 ]. Nonetheless, the real causes of the altered SRB during war remain elusive: all of the discussed biological and social factors have been shown to cause only marginal deviations from the normal sex ratio.

Whilst war has only slightly shifted SRB towards more male babies and only for a limited time period, cultural factors, namely a strong preference for sons, has been causing large distortions of gender balance during the past decades. For centuries, sons have been regarded as more valuable, because males can earn higher wages especially in agrarian economies, they generally continue the family line, are recipients of inheritance and are responsible for their parents in illness and old age.

By contrast, daughters often become members of the husband's family after marriage, no longer having responsibility for their biological parents [ 10 ]. There are also location-specific reasons for son preference: in India, the expense of the dowry, and in South Korea and China, deep-rooted Confucian values and patriarchal family systems [ 11 ].

Until recently, son preference was manifest post-natally through female infanticide, abandonment of newborn girls, poorer nutrition and neglect of health care, all causing higher female mortality [ 12 ]. Studies have shown that unequal access to health care is the most important factor in differential gender mortality [ 13 , 14 ], especially in countries where health care costs are borne by the family [ 15 ]. As early as , the Indian economist Amaryta Sen estimated that differential female mortality had resulted in around million missing females across the developing world with the overwhelming majority of these in China, India, Pakistan and Bangladesh [ 16 ].

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To make matters worse, during the s, diagnostic ultrasound technology became available in many Asian countries, and the opportunity to use the new technology for prenatal sex selection was soon exploited. Indeed, the highest SRBs are seen in countries with a combination of son preference, easy access to sex-selection technologies and abortion, and a small family culture. The latter is important because where larger families are the norm, couples will continue to have children until they have a boy.

If the couple plan, or are legally restricted, as in China, to only one or two children, they will use sex selection to ensure the birth of a son [ 17 ]. This combination has resulted in serious and unprecedented sex ratio imbalances that are now affecting the reproductive age groups in several countries, most notably China, South Korea and parts of India.

South Korea was the first country to report a very high SRB, because the widespread uptake of sex-selection technology preceded other Asian countries. The sex ratios started to rise in the mids in cities; ultrasound was already widely available even in rural areas by [ 17 ]. By , the SRB was reported to be as high as in some cities. China soon followed. Here, the situation was further complicated by the one-child policy introduced in This has undoubtedly contributed to the steady increase in the reported SRB from in to in , in , in and as high as in some rural counties [ 18 ].

The latest figures for report an SRB of [ 19 ] National Bureau of Statistics of China , the first drop in three decades, suggesting an incipient downturn. However, the of excess males in the reproductive age group will continue to increase for at least another two decades.

Because of China's huge population, these ratios translate into massive s: in , an estimated 1. These overall figures conceal wide variations across the country Fig 1 : the SRB is higher than in a strip of heavily populated provinces from Henan in the north to Hainan in the south, but close to normal in the large sparsely populated provinces of Xinjiang, Inner Mongolia and Tibet.

Some are sceptical about these high SRB figures or have suggested that, under the constraints of the one-child policy, parents might fail to register a newborn girl, so that they might go on to have a boy [ 20 ]. However, recent evidence shows that such under-registration explains only a small proportion of missing females and that sex-selective abortion undoubtedly s for the overwhelming majority [ 18 ].

There are marked regional differences in SRB in India. Because incomplete birth registrations make the SRB difficult to calculate accurately, the closely related ratio of boys to girls under the age of six is used, showing distinct regional differences across the country with much higher levels in the north and west. According to the most recent census in , the SRB for the whole country was , a marginal increase on the census in , which showed an SRB of These national figures, however, hide wide differences from a low SRB of 98 in the state of Kerala to in Haryana State.

The Indian figures contrast with the Chinese in two ways: nowhere in China is the sex ratio low, and in India the sex ratio is higher in rural than urban areas, whereas the reverse is true for China [ 22 ]. A consistent pattern in all three countries is a clear trend across birth order, that is first, second and subsequent children, and the sex of the preceding child. Where high fertility is the norm, couples will continue to reproduce until they have a boy. Where couples aim to restrict their family size, they might be content if the first child is a girl, but will often use sex selection to ensure a boy in the second pregnancy.

This was shown in a large Indian study: the SRB was for second births with a preceding girl, and for third births with two girls. By contrast, the sex ratios were normal when the first born was a boy [ 23 ]. The sex ratio by birth order is particularly interesting in China Table 1 because of the differences in implementing the one-child policy between urban and rural areas. In urban China, only one child is allowed, so some urban Chinese make the choice to select the sex of their first pregnancy. In most rural areas, two children are allowed, so if the first is a girl, couples are increasingly likely to select the sex of the second pregnancy.

In some provinces, the rural population are allowed a second child only after the birth of a girl. This variant of the one-child policy seems to lead to the highest sex ratios in second births. The SRB across the country for first births is , for second , and for rare third births In some provinces, the sex ratio for second births rises to , and for third to more than [ 18 ]. Adapted from Zhu et al [ 18 ]. South Koreans are inclined to use sex selection, even in their first pregnancy, as there is a traditional preference for the first-born to be a son.

This tendency towards sex selection rises for third and fourth births as parents try to ensure they produce a son. In the peak years of the early s, when the overall SRB was , the sex ratio for fourth births was [ 17 ]. Since prenatal sex determination only became accessible during the mids, and even later still in rural areas, the large cohorts of surplus young men have only now started to reach reproductive age. The consequences of this male surplus in the all-important reproductive age group are therefore still speculative and the existing literature about the consequences of distorted sex ratios is predominantly theoretical with few hypothesis-testing investigations [ 24 , 25 ].

In addition, most research focuses on countries in which sex ratios differ only marginally from biological norms [ 26 ]; few researchers have systematically examined the massive sex ratio distortion in China and India. These men will be unable to get married, in societies in which marriage is regarded as virtually universal, and where social status depends, in large part, on being married and having children. As a result, most of these unmarriageable men are poor, uneducated peasants.

One hypothesis assumes that not being able to meet the traditional expectations of marriage and childbearing will cause low self-esteem and increased susceptibility to psychological difficulties, including suicidal tendencies [ 28 ]. A recent study using in-depth interviews with older unmarried men in Guizhou province, in south west China, found that most of these men have low self-esteem, with many describing themselves as depressed, unhappy and hopeless [ 29 ]. The combination of psychological vulnerability and sexual frustration might lead to aggression and violence.

There is empirical support for this prediction: gender is a well-established individual-level correlate of crime, especially violent crime [ 30 , 31 ]. A consistent finding across cultures is that most crime is perpetrated by young, single males, of low socioeconomic status [ 32 ]. A particularly intriguing study carried out in India in the early s showed that the sex ratio at the state level correlated strongly with homicide rates, and the relationship persisted after controlling for confounders such as urbanization and poverty [ 33 ].

The authors had expected to find that the high sex ratio would lead to increased violence against women, but their conclusion was that high sex ratios are a cause of violence of all types in society. However, no other study has found similar . The study mentioned above from rural Guizhou, for example, could find no evidence that unmarried men were especially prone to violence and aggression.

Rather, the men were characterized as shy and withdrawn, rather than aggressive [ 29 ]. In addition, reports of crime and disorder are not higher in areas with a known excess of young, single men. This might be because there is not yet a large enough crucial mass of unmarriageable men to have an impact, or assumptions about male aggression do not apply in this context. A consistent finding across cultures is that most crime is perpetrated by young, single males, of low socioeconomic status. In China and parts of India, the sheer s of single men have raised other concerns.

Because these men might lack a stake in the existing social order, it is feared that they will bind together in an outcast culture, turning to antisocial behaviour and organized crime [ 34 ], thereby threatening societal stability and security [ 35 ]. Some theorize that it could lead to intergroup conflict and civil war could erupt [ 32 ]; other authors go further, predicting that such men will be attracted to military-type organizations, potentially triggering large-scale domestic and international conflicts [ 36 ].

However, there is no evidence yet to support these scenarios. Crime rates are relatively low in India and China compared with other countries [ 37 ]. Such outcomes are probably multifactorial in their causes, and therefore the role of sex imbalance is difficult to determine. An excess of men, however, should be beneficial for women, especially in those Asian societies in which women have traditionally low social status. In fact, much of the literature on sex ratios has focused on women's status and role in society, and on mating strategies; but again the literature has come from scenarios in which the sex ratio is only marginally distorted [ 38 , 39 ].

It is intuitive to see that women are a valuable commodity when sex ratios are high [ 40 , 41 ]. Because women generally prefer long-term monogamous relationships [ 42 ], it is predicted that monogamy will be more prevalent in high sex ratio societies, with less premarital and extramarital sex [ 43 ], lower divorce rates [ 38 , 24 ] and less illegitimacy [ 31 ]. In India and China, tradition militates against some of these eventualities; for example, divorce and illegitimacy are rare in both countries, owing to the traditional values of these societies. But other effects can be explored.

If women are more highly valued, it is predicted that they will have higher self-esteem, resulting in lower rates of depression and suicide [ 24 ]. However, this increase in the value of women could also have paradoxically adverse effects on women, especially in rural societies.

Benefits might accrue to men, such as fathers, husbands, traffickers and pimps, who control many female lives [ 35 ].

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