Where Have All the Young Girls Gone?

Female feticide and its impact on human trafficking

by Laura J. Ledererposter3sm

In 1992 Amartya Sen wrote an article in the British Medical Journal in which he introduced the concept of "missing women." The phrase referred to early female mortality in poor countries due to bias in healthcare, food, income, education, employment, and more. Sen reached the conclusion that the number of missing women worldwide was greater than 100 million. Other scholars followed up with sophisticated demographic studies and got similarly large numbers. In disaggregated data, Sen suggested that China was missing 44 million women, India 37 million, and other countries in South Asia and sub-Saharan Africa similarly high numbers.

In 2003 Sen revisited this issue and found that over the previous decade female mortality had been reduced substantially as a result of programs to address differences between women and men in their access to sufficient nutrition, healthcare, and fundamental human rights. But he also found that, even as adult female mortality declined, the deficit of females persisted. Why? Because, as Sen noted, all the improvements had been "counterbalanced by a growing trend in sex-specific abortions of the female fetus."


For over 40 years the Chinese government has enforced a strict one-child policy in an attempt to address overpopulation and poverty. In a country with a strong traditional preference for boys, Chinese couples abort female fetuses in the hope that their next pregnancy will produce a boy. This situation has created a growing gender imbalance in China, one that has the potential to threaten China's future stability.

In 2005, China's sex ratio at birth (SRB) for newborn babies was 118 boys to 100 girls, a significant jump from 110 boys to 100 girls just five years earlier. In some regions, such as the southern provinces of Guangdong and Hainan, the ratio has ballooned to 130 boys to 100 girls. (The average SRB for industrialized countries is about 104-107 boys for every 100 girls).

The British medical journal Lancet estimated that the male-female gap in China is currently approximately 50 million. A study by the government-backed Chinese Academy of Social Sciences named the gender imbalance among newborns as "the most serious demographic problem for the country's population of 1.3 billion," and Chinese demographers fear that by 2020 more than 24 million Chinese men of marrying age could find themselves without spouses.

Traditional preferences for boys directly impact human trafficking, particularly sex trafficking. China's first generations of boys from the one-child policy are now in their 20s and 30s. According to some NGOs, this lack of females is already creating a black market industry for purchase of brides, servile marriage, labor and agricultural trafficking, domestic servitude, and sex trafficking. Girl children and young women are being trafficked into China from Laos, Cambodia, Thailand, Burma, and Vietnam.


As part of a program at the State Department titled "The Impact of Sex Selection on Human Trafficking," I traveled to India early last year to investigate a disturbing trend that has emerged there from the convergence of new technologies (such as ultrasound and early-term abortion) with traditional practices and preferences (such as the preference for male children).

Research suggests that Indian women are carrying to term and birthing many more males than females. Demographers estimate that Indian women have almost 7 million abortions per year. Aborted girls outnumber boys by half a million per year, for a total of 10 million more girls aborted than boys over the past decade. In one study in Bombay, all but one of 8,000 aborted fetuses were female. Some doctors in India believe as many as 2 million girl fetuses are killed annually simply because they are female.

The 2001 Indian census showed the national SRB average to be 927 girls for every 1,000 boys, but in Punjab the number of girls for every 1,000 boys is now at 793. Aborting female fetuses used to be more common in urban areas where sonograms were more readily available, but in the last 15 years ultrasound companies have perfected portable, life-saving ultrasound devices designed for hard-to-reach or medically underserved places. These are now in every remote area in India, where they are used for the purpose not of saving lives but of determining whether a life merits elimination. This has led to some of the rural states in India having the worst problems of all in terms of sex ratio at birth. US embassy officials in India anticipate that the 2010 census will show the SRB has fallen as low as 300 to 1,000 in some rural states, a point at which it will be impossible to reverse the trend. Currently India has the highest sex-ratio imbalance of any country in the world.

A number of factors combine to create the Indian preference for male children. One cause is the Hindu belief that parents need a son to perform last rites in order for salvation to be achieved. In addition to the fact that daughters can't perform funeral rites, they also have to be married off with a substantial dowry. Sons are considered breadwinners who will look after their parents and continue the family name, whereas daughters are a liability, a costly burden to bear. Dowry deaths/bride burnings (women murdered by their husbands or in-laws in order to take a new wife—with a new dowry), abandonment, female infanticide, and trafficking of young women are all a result of the demands placed on families with daughters.

While it is true that the preference for boys in India is thousands of years old, the boy-to-girl ratio in India didn't widen precipitously until the advent of the ultrasound in the 1970s, which allowed parents to know the gender of their fetus by the fourth month of pregnancy. A traditional practice has been exacerbated by the misuse of modern technology to become a 21st-century problem.


The Indian government has been aware of the problem of female feticide for some time now and has enacted new laws, created new policies and programs, and tested new projects, several of which I will discuss here.

In 1994, India passed the Prenatal Diagnostic Techniques Act (PNDT). The law bans sex-determination tests for pregnant women, imposes fines for couples who obtain them, and calls for prison terms for doctors who reveal the sex of the fetus to the parents. However, as one of our embassy officials remarked, "Everyone knows they're not supposed to do it; there are signs posted in every hospital, on every delivery floor, and yet everyone does somehow have the test done and some- how finds out the results." In a resolute (though some say futile, given how difficult the law is to enforce and how deter- mined couples are to have a boy) attempt to bolster the law, a magistrate in Mumbai convicted, in November 2009, two female doctors for breaking the PNDT law — the first and only conviction since the law was passed over 15 years ago. The doctors, sentenced to three years in prison, were brazenly advertising in a weekly magazine, where they offered "special treatment" for couples eager to have a boy.

In 2001, the Indian Supreme Court issued a policy statement calling on federal and state governments to draw up national action campaigns to enforce the 1994 law. These included registering the hundreds of prenatal diagnostic centers in each state; calling for the revocation of medical licenses of MDs who perform sex-selection abortions; setting up central supervisory boards to make quarterly reports on the implementation of the PNDT; and formation of local committees to create local educational campaigns.

The ban on government medical centers' use of prenatal sex selection has led to doctors giving results of a sonogram to parents verbally—eliminating any paper trail evidence that a subsequent abortion was obtained due to fetal gender. One NGO representative said results are delivered in code, for example: "you will have a fine footballer" means you have a boy, or, in the reverse, "I'm sorry it's a cloudy day for you today" means "It's a girl.

As government hospitals have begun to enforce the ban on prenatal sex selection, thousands of new private ultrasound and abortion clinics have sprung up in every city, town, and village. The private clinics are not subject to the poorly written law and have multiplied even in areas so poor that they don't have potable water. It is common practice for even poor people to take out loans at 25 percent interest to have the sonogram test.

In 2004 the state of Tamil Nadu launched an experimental program that gave monetary rewards to couples who agreed to be sterilized after the birth of their first or second child — a program which, not surprisingly, was met with little enthusiasm. The state also created Cradle Babies, a program in which empty cradles were placed in government centers across the state. Couples were then offered the opportunity to abandon unwanted female children instead of killing them, but some complain that this only promotes the idea that girl children are a burden.

In India, practices such as polyandry, where several men share the same wife, are already emerging in areas where there are fewer women, as are the trafficking of girls brought in from surrounding regions and the giving of mentally handicapped girls in marriage. To put a face on this problem, look at the painfully poignant photographs by Ruhani Kaur, which expose the plight of poor Indian women and girls.


While many organizations are documenting the problem, few have tackled the more serious issue of how to address it. My discussions with NGOs and FBOs are in the initial stages; however, the list of possible programmatic responses ranges from public education to law and law enforcement to incentives.

Government-sponsored campaigns. In 2005 the Indian NGO Population First initiated a campaign called "Laadli—A Girl Child Campaign" with the slogan "Celebrate Her Life."

It is a comprehensive communications campaign working with youth, media, communities, and medical professionals to change the mindset that undermines the girl child. Their "1 Million Signatures" campaign registers Indian protest of sex selection and female feticide.The program is supported by the United Nations and by India's Ministry of Health and Family Welfare and is probably the best long-term approach.

Web campaigns. A new website has been established by Datamation Foundation Charitable Trust dedicated to the issue of female feticide. The campaign aims to sensitize the general public and women about the importance of girl children. More such web-based campaigns are necessary.

The gospel of Jesus Christ. India's minority Christian community has a more balanced sex ratio at birth than other communities. Christian communities, missionaries, and faith-based relief and development organizations can share Jesus' liberating love for women but need to take care to avoid exacerbating underlying religious divisions.

Training. The laws addressing female feticide in India are good, but they are not enforced. Training aimed at local police, prosecutors, judges, hospital authorities, health professionals, religious leaders, community leaders, and others in positions of authority is important. New efforts are currently underway to inspect clinics and—where illegal sex selection is occurring—to close down the clinic, but much more needs to be done. Training should include background on the laws and policies themselves, investigation techniques, and how to arrest, charge, prosecute, and convict in these cases.

Complaint lodging process. Developing a formal process by which citizens can lodge complaints against doctors, nurses, hospitals, maternity homes, ultrasound clinics, and radiology clinics is essential. Complaints need to be fully documented, and an investigatory body is needed to follow up on complaints lodged.

Money for girls. In 2008, authorities in Punjab began offering cash to families who bring a girl child to term, with additional sums earned for vaccinating and educating her, as well as delaying her marriage beyond a certain age. This model (based on a similar one in France that rewards French families for every child beyond the second one) is an excellent program.

Address the dowry. In earlier times, a dowry was a token gift meant to start a couple out on their marriage with some financial security (much like our bridal showers). Today, the dowry has become a way for the groom's family to accumulate wealth. It has morphed from a token gift to a required condition of marriage, a demand for a specific amount, a kind of bridal blackmail. I broached the subject of dowry education with staff at the US Embassy and was told it is too deeply ingrained in the culture to challenge it. Yet dowry as it is now practiced must be addressed if we are to be successful in our programmatic endeavors. As feminist Alice Clark noted: "In a patrilineal kinship system where marriages are arranged on principles of dowry and hypergamy, and where women and girl children are objects of exchange along with other forms of wealth, excess female mortality is…an inevitable outcome. Clearly, for a poor family to try to cope with paying dowries for several daughters is a frightening burden and leads to attempts to limit the birth of daughters."

The former senior advisor on trafficking in persons to the US under- secretary for global affairs in the Department of State, Laura Lederer now teaches at Georgetown Law Center and is vice president of Global Centurion, an NGO working to curb the demand side of sex trafficking, particularly child sex trafficking. In 2009 she received both the University of Michigan's Alumni Award and the Protection Project's Human Rights Award for her contribution to the global movement to combat human trafficking.


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