Health & Gender

Females face especially challenging health risks that profoundly affect the size and composition of the population of individual countries and the world as a whole. These health risks derive from the biological fact of being born female. The risk for females is especially acute at childbirth. Both the mother and the baby girls may be at risk.

Mothers at Risk

The maternal mortality rate is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy. The worldwide maternal mortality rate in 2015 was 216, amounting to more than 300,000 women. The rate exceeds 500 deaths per 100,000 live births in sub-Saharan Africa, compared to 8 in Europe (Figure 2-33). Nonetheless, the world has made progress: the world maternal mortality rate was 385 in 1990.

Maternal Mortality Rate, 2015

According to the United Nations, the most common cause of maternal death in poor countries is heavy bleeding (“obstetrical hemorrhage”), followed by high blood pressure (“hypertensive disorders of pregnancy”). Developed countries have medical facilities, advanced technologies, and trained personnel to limit the incidence of life-threatening conditions during childbirth. Physicians can monitor and treat conditions prior to delivery and manage complications during and after delivery.

The maternal mortality rate in the United States (14) is higher than in other developed countries. In addition, the United States is one of only a dozen countries, and the only developed country, where the rate has increased since 1990. The higher rate is attributable to difficulties faced by people with low incomes in the United States in gaining access to health care. Women who lack health insurance are four times more likely to die of a pregnancy-related complication than those with insurance.

The maternal mortality rate varies widely among U.S. states. Several southern states have rates that are more than twice as high as the national average.

Maternal Mortality Rate, U.S. States, 2016

Baby Girls at Risk

Around 700,000 female babies are “missing” every year in China and India as a result of gender-based sex selection. The United Nations Population Fund estimates that, overall, 117 million females have gone “missing” throughout Asia over the past several decades. The females are “missing” either because the fetus was aborted before birth, the female baby was killed in infancy, or the newborn female is being raised somewhere remote and not reported to census and health officials.

We know about the large number of “missing” females because of the sex ratio, which is the number of males per 100 females in the population. The standard biological level for humans at birth is around 105 male babies for every 100 female babies. Scientists are not sure why a few more males than females are born. The standard biological ratio is characteristic of the developed regions of North America and Europe as well as in the developing regions of Latin America and sub-Saharan Africa. However, the sex ratio at birth is 114:100 in China and 112:100 in India. The percentage of newborn females in the world’s two most populous countries is much too low to be random (Figure 2-36). The United Nations concludes that the “root cause” of the unequal sex ratio is gender inequality.

Sex Ratio At Birth

China: More Boys Than Girls

The extremely low percentage of female babies in China and India results from cultural preference on the part of parents to have sons rather than daughters. Sons are regarded as more likely than girls to help the family economically. Government policies in these two countries to promote smaller families have resulted in families with more male babies than female babies. Many Chinese and Indians have decided that if they are going to have a small number of children, they want them to be boys.

Efforts to ban gender-based sex selection have been ineffective because people instead seek out unregulated providers of these services. An ultrasound can reveal the gender of a fetus before birth, allowing parents to abort a baby girl before she is born. If a baby girl is born, her parents may hide her from authorities in a remote rural area, and she may receive less food and health care than a baby boy.

Aside from ethical questions about the devaluation of female lives, the widespread practice of sex selection in China and India is creating a practical problem. As the babies grow to adulthood, these countries are left with an enormous surplus of men who are unable to find women to marry.

Pause & Reflect 2.3.2

What other populous country in Asia, in addition to China and India, appears to have “missing” females?