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1 Despite a rich literature documenting sex-selection practice linked to son preference, largely in Asia, the evaluation of policy responses to sex selection remains an under-researched topic. This well-documented book by Laura Rahm is thus an original and welcome contribution. In it, Rahm analyses anti–sex-selection policy in the contrasting contexts of South Korea, India, and Vietnam. Her ambitious study takes a comparative perspective, offering insightful reflections on policy processes and the limits of policy transfer.

2 The book is divided into three parts. Before explaining her conceptual framework and analytical strategy, Rahm begins by recalling the extent and broad motives of sex selection, sustained by patriarchal kinship systems and associated economic and political factors. Sex selection is manifested by the masculinization of the sex ratio at birth (SRB) and at young ages. The phenomenon led to an overall estimated 126 million missing women in 2010, documented in Asia (mainly), the Caucasus, and Eastern Europe. She introduces the methods of gender-biased sex selection (GBSS), from infanticide, neglect, and abandonment of girls to the development of foetal sex-determination techniques beginning in the late 1970s, allowing female-selective abortion and, more recently, preconception sex-selection techniques. Policies addressing the motives, methods, and magnitude of GBSS are the three pillars of her conceptual framework for analysing policy intentions, responses, and impact. She also comments on the conflicting objectives of population policies and the role of international organizations, especially the United Nations Population Fund (UNFPA), in shaping recommendations aimed at reducing sex selection.

3 In the second part, she devotes three chapters to more in-depth analyses of policy responses to sex selection in South Korea, India, and Vietnam successively. Each chapter begins by analysing well-documented national and regional demographic trends evidencing sex selection. They then detail national policy responses and present an illuminating in-depth analysis of a local case study, drawing on primary data collection (observations, semi-structured interviews). South Korea was the first of the three countries to experience a rapid masculinization of the SRB (from the 1980s), followed by India and then Vietnam from the early 2000s, driven by the diffusion of prenatal sex-selection practices. South Korea has since experienced a complete reversion to normal sex ratios, while the degradation of the SRB in the vast and heterogeneous country of India was more progressive and is still a major concern. In Vietnam, the masculinization of the SRB started later but increased rapidly after the turn of the century. Did policy influence sex ratios in these countries? Rahm shows that despite a common perception of South Korea’s policy ‘success’ as a model, the SRB had already started to decrease in the late 1990s, before any interventions to raise awareness or enforce the sex-selection ban had taken place. The local case study in Daegu, affected by some of the most unbalanced sex ratios in the 1990s, offers a striking example of the disconnection between decreasing sex ratios and policy intervention. Instead, Rahm points out, according both to some scholars and to interview participants, the conditions for weakening son preference were provided by a set of intertwined factors: shifts in family norms and structures, urbanization, socio-economic development, and women’s increasing education and labour force participation. Possibly, she argues, the priority given to rapid fertility reduction to boost economic growth may have acted as a disincentive to the enforcement of a ban on sex selection until the late 1990s, while the shift from anti–gender-selection campaigns to anti-abortion discourse may have been driven by the contemporary issue of very low fertility and population ageing.

4 Inspired by the Korean experience of combining a prenatal sex-selection ban, communications campaigns, and other reforms to promote gender equality within families, the other countries featured in Rahm’s study adopted similar policy packages. Overall, however, the ban on sex determination and selection has not been strongly enforced in India and Vietnam. Rahm explains in some detail the role of the powerful private medical sector in Vietnam, and how the lucrative business of sex selection is subject to widespread corruption in India. But the district analysed in her case study in India, the northern state of Punjab, notorious for its strongly unbalanced child sex ratios, has experienced a significant reduction in sex-ratio bias. This reduction is largely attributable to pregnancy tracking and vigorous enforcement of the ban to prevent female-selective abortion by local authorities, under the widely praised initiative and exceptional commitment of a zealous district commissioner in the 2000s. Although the case lends credence to the role that enforcing anti–sex-selection laws can play in tackling sex-ratio imbalances, the author convincingly shows how ephemeral the effect of such interventions can be, because they are based on strong leadership (a factor difficult to replicate), and how they can produce ethically undesirable side effects. Rahm argues that this policy of fear, combining aggressive campaigning, monitoring, and community control, is at odds with women’s reproductive rights and well-being. Sex selection remains an acute policy issue in India overall, with persistent sex-ratio imbalances at young ages in large parts of the country, despite awareness campaigns and incentives to promote the protection and valuing of girls in the last 2 decades.

5 In her case study on the city of Hai Duong in Vietnam, the author examines a policy intervention largely designed and supported by UNFPA and including rare baseline and endline surveys for policy evaluation. Her analysis of the policy reports highlights a number of inconsistencies in the quantitative results, methodological biases, and other limitations that impede a rigorous evaluation of the policy’s effects. Although the local reported SRB imbalance decreased in the study area, the role of policy remains unclear and doubtful. The discourse of stakeholders and policymakers strongly focuses on the need to change the mindsets of both families and doctors as a long-term strategy. It is too early to say whether the UNFPA policy can explain the plateauing of the SRB in Vietnam, Rahm notes, although communications campaigns have had a positive impact by raising awareness and bringing stakeholders together on the issue. This may pay off through changes in mindsets in the long run, but Rahm wonders whether a commitment to enforcing a sex-selection ban could help curb sex selection in the short term, and argues for more reporting, monitoring, and evaluation to support the policy.

6 The third part of the book compares the analyses of the three countries and the associated case studies, and discusses the benefits of and limitations on international policy transfer to address sex selection. Overall, Rahm argues, the evidence on the role of policy in changing sex-ratio trends is mostly inconclusive or doubtful. The exception—the clear policy success at curbing sex selection seen in the Indian case study—is difficult to reproduce and has undesirable side effects. Continued policy evaluation in India and Vietnam would be needed to complete this extensive and important assessment. Comparing policies, Rahm points to the similar toolkit promoted by international organizations and applied in the three countries. National and international stakeholders have promoted the Korean cocktail of sex-selection measures combining ban enforcement, awareness campaigns, and broader gender equality laws as a model of success. This is despite little evidence of the effectiveness of this policy package and the uncertain results of the policy responses that it inspired in India and Vietnam. Importantly, despite a convergence of policy measures, Rahm’s analysis shows that the emphasis, framing, and objectives of national policies remain quite distinct across countries. South Korean policy is aimed at saving girls and female foetuses, Indian policy at protecting women from coercion, and Vietnamese policy at addressing the negative social consequences of the gender imbalance. Specific political and societal contexts shape such variations in policy objectives and implementation. In the early 2000s, Vietnam became a testing ground for policy transfer for international organizations, in a top-down approach orchestrated by the central government, Rahm explains, calling for more efforts to engage local communities. Questioning the benefits of lessons supposedly learned and of policy transfer, she recommends more country-specific innovation in designing anti–sex-selection policy responses.

7 Based on three well-documented and contrasting national contexts and local case studies, this well-written book provides a rich policy analysis of interventions aimed at curbing sex selection against female children. It is a precious resource for critical reflection on the process and limitations of international knowledge transfer.

Sylvie Dubuc
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