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Newborns in China. Sex selection, a result of easy access to new technologies, means that parents are choosing to have vastly more boys than girls. (PATTY CHEN/REUTERS)
Newborns in China. Sex selection, a result of easy access to new technologies, means that parents are choosing to have vastly more boys than girls. (PATTY CHEN/REUTERS)

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Where are all the missing girls? Add to ...

As every woman who has had an amniocentesis test knows, the procedure is a haunting and morally uncomfortable one. A long needle penetrates the taut skin of the pregnant belly and a hard-edge white line shows up on the ultrasound screen as the needle invades the uterine sac where the fetus floats, utterly vulnerable and unaware that it is being tested for health problems. The fact that the pregnant woman has been informed that the procedure has a slight risk of miscarriage makes the moment even more emotionally freighted. If the results of my own two amnio tests had told me something was wrong, I did not know then and still don't know what I would have done (cross that bridge etc.).

Change the scene to a woman getting an amniocentesis test (or, in recent years, an ultrasound) to determine if the fetus is a boy or a girl and making the decision to abort if it's a female, and you have the core scenario of Mara Hvistendahl's brave, well researched and imminently controversial new book. Cut now to governments and non-governmental organizations promoting sex selection (overtly or wink-wink, nod-nod) as a means of controlling overpopulation because anthropologists and sociologists have determined that many people in Asia keep having babies until they get a boy, and you've arrived at the heart of Unnatural Selection: Choosing Boys Over Girls, and the Consequences of a World Full of Men.

Hvistendahl is a Beijing-based, Chinese-speaking correspondent for Science. Her first book takes the reader into the vital intersection of population control, human rights and the deep human need to have children and pass on what is in our hearts, our families, our cultures and our legacy.

Unnatural Selection begins with Christophe Guilmoto, a French demographer, who noticed that not only were fertility rates dropping in India, but the proportion of boys to girls was rising rapidly, from a normal ratio of 105 boys to 100 girls up to 126 to 100 in at least one particularly wealthy region. In the Jiangsu province of China, Hvistendahl found a ratio of 150 to 100. She calculates that 163 million females, more than the entire population of females in the United States, are missing over the past few decades.

Hvistendahl structures her story and her case around the personal narratives of demographers like Guilmoto, Chinese husbands making use of new wealth, Indian medical students, politicians such as Franklin Roosevelt and Henry Kissinger, Paul Ehrlich, author of The Population Bomb, and kidnapped young women imprisoned as prostitutes or sold as brides to men in regions where there are not enough women. She writes in a colourfully anecdotal style, showing her reader that the subject of demography, far from dry and dusty, is like a juggernaut gathering up history, science, geopolitics, biology, anthropology, sociology and economics into itself as it hurtles toward the future.

There are three weaknesses in the case Hvistendahl wants to build.

The most important is that she fails to convincingly make the argument that the populations of China and India could have been kept anywhere near their current numbers (by 2030, 16 per cent less than without intervention) without sex selection. Had the 163 million missing females been born, their number would have doubled, probably tripled, when they grew up and had children. Hvistendahl does not adequately address the problems that would have arisen from having half a billion more mouths to feed.

Hvistendahl makes the argument that economic development, access to contraception and educating women lower the birth rate as effectively as authoritarian population control, sex selection and abortion, but she does not establish how long that approach would take, nor does she address the fact that the new economic wealth in India and China is directly tied to lower fertility. Without lower fertility, where would economic development come from?

Second, Hvistendahl refers repeatedly to the enormous and alarming damage sex selection is doing to the world, but she doesn't explain what that damage is until the last third of the book. By then, the build-up has been too big for the damage she does point to, much of it still only potential: There are now a lot of single young men ("surplus men," she calls them) who are potentially volatile (single, childless men have higher testosterone levels than married fathers) and can't find mates.

Societies with a high ratio of males are bad for women and come with increased prostitution, kidnapping, bride buying and reduction of women in the work force, as those of child-bearing age are pressed into having children and raising families - and bad for the societies in that the increased levels of high-testosterone frustration can lead to violence, war and political instability.

The third weakness is that Hvistendahl has a tendency to imply equivalences in the area of human suffering that don't stand up. She wonders, for example, if there is much difference between the fate of being kidnapped and forced to work as a prostitute "servicing dozens of men a day," or being bought as a bride, having children and adapting to life in a strange place away from friends and family.

In the chapter titled The Feminist, Hvistendahl quotes Sharada Srinivasan, a feminist sociologist at York University in Toronto: "It's very important to establish up front that whether it is sex-selective abortion, female genital mutilation, or domestic violence, it is a form of patriarchal oppression. There is something common that runs through all of this."

Hvistendahl leaves the question of where to place the act of late-term abortion for sex selection on the spectrum of human "wrongs" largely open. The book would be stronger if she had included a chapter mapping out the ethical fine points more clearly. In my mind, there is no comparison between female genital mutilation - a very painful practice forced on terrified young girls compromising forever their ability to take pleasure in sexual intercourse - and a mature woman deciding, if she can have only a limited number of children, whether she is willing to abort a female fetus to make sure she has at least one son.

Hvistendahl introduces a comparison between the attention and resources globally given to the AIDS epidemic and the relative silence about the "quieter epidemic" of sex selection. The death of millions of sexually active women, women who are mothers, daughters and wives, and the death of children born with HIV and the lives of men, gay and straight, cut down by a preventable disease, do not have the same weight on the level of human suffering, and therefore of human rights, as the choice many women or couples are making to ensure they have a son. Of course, every person will place these harms at different points on their own ethical compass.

That Hvistendahl feels tremendous pain at the loss of all those potential female souls, and outrage that that loss is being treated as if it were nothing, is moving and just.

She makes an utterly convincing case that abortion for sex selection must stop, particularly when it involves late-term abortion, a frequent occurrence given that gender can be determined only at 18 to 20 weeks with amniocentesis and 16 to 20 weeks using ultrasound. She is a brave woman to raise the issue of these sex-selection abortions when feminists are so worried (with good reason) that the right to choice might be threatened. "After decades of fighting for a woman's right to choose the outcome of her own pregnancy," she writes, "it is difficult to turn around and point out that women are abusing that right - that in union with population pressures and technology, choice has been perverted."

In a wonderful chapter on the colonial roots of the practice of sex selection in Asia, Hvistendahl executes a masterful takedown of smug, under-informed Western assumptions, quoting, among others, U.S. Secretary of State Hillary Clinton, who recently called the abortion of female fetuses the result of "deeply set attitudes," when the truth in India at least is that colonial practices, along with pressure by the West to reduce the number of children being born, accompanied by the vigorous export of new technologies, ultrasound and amniocentesis, are largely responsible for the plummeting rate of live female births.

From the distant vista of the West, where we don't really consider what it would mean to have an only son who can never find a mate, the unbalanced sex ratio in Asia may seem like relatively small news. This remarkable book goes a long way to bringing the pain and the urgency of the issue home.

Mara Hvistendahl is not just entering an important conversation, she's starting one.

Facing the facts

Here's a very small sampling of the kind of nuggets Hvistendahl turns up:

* In the United States in the sixties and seventies, "the list of abortion's early champions reads like a directory of the Republican Party" (as long as abortion was either in communist countries or countries at risk of becoming communist).

* "Between January, 1981, shortly after the (one-child) policy was introduced, and December, 1986, Chinese women underwent 67 million abortions."

* "Japan finally granted women the right to take birth-control pills in 1999."

* In Taiwan, men now often bring wives from Vietnam, with the result that the insular homogeneity of that society is changing.

Claudia Casper's just completed third novel, The Last Murder, envisions a post-climate change world in which all citizens live under a one-child law. Her Twitter address: @claudiacasper.

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