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1 The Percentage of Men in the Adult Population

The masculinization of China’s population is largely a “bottom-up” process in the sense that first it affects births (through increasing use of prenatal sex selection) and then children (as a consequence of excess female infant and child mortality) and then continues into adulthood as cohorts grow older (Chu 2001; Mo 2005). However, the sex distribution in adulthood can be also influenced by other factors. When there is no sex-differentiated migration, the sex ratio can be rebalanced by improvements in women’s survival, particularly at reproductive ages; by gains in female life expectancy at birth; or by worsening living conditions for men, in particular at working ages, owing to high-risk occupational and social behaviours which expose them to excess mortality. Conversely, the masculinization process can accelerate in adulthood due to insufficient gains or worsening living standards for women, leading to relative excess mortality.

The percentage of adult men in China’s population increased in various age groups between 1953 and 2000 (Fig. 5.1). The only exceptions were the youngest group (aged 15–19 in 2000) and the 30–39 age group. In those two age groups, which exhibited high sex ratios in 1953, there has been some sex rebalancing, whereas all other age groups now show an even higher over-representation of men than in 1953.Footnote 1 Masculinization is particularly pronounced in the oldest age groups (over 50), which contrasts with the trends usually observed in the context of an ageing population.

Fig. 5.1
figure 00051

Sex ratios at adult ages in different age groups, China, 1953 and 2000 (Sources: relevant surveys and censuses (NBS 1988; PCO 2002))

2 A Mortality Regime Skewed Against Women

The growing prevalence of prenatal sex selection is an undeniable factor in the masculinization of China’s population. This new manifestation of the traditional preference for sons, made possible by increasingly widespread access to methods for determining the sex of an unborn child, reinforces age-old practices of neglect towards girls that contribute to their excess mortality and therefore to a deficit of females relative to males (Das Gupta and Li 1999; Li and Zhu 2001).

Excess female infant and child mortality undeniably contribute to the masculinization of the child population and to the persistence of relatively small gender gaps in life expectancy at birth. The female deficit could also be accentuated by excess female mortality that persists at older ages. Excess female mortality after age 5 is harder to measure accurately than mortality at young ages, however. Whereas male and female infant and child mortality rates are mainly influenced by biological factors (Hill and Upchurch 1995), at older ages they are determined by genetic factors and, to a large extent, by sex-specific behavioural factors (Clarke 2000; Vallin 2002). Most populations therefore exhibit excess male mortality in adulthood owing to biological factors, but above all to men’s greater propensity to engage in risk behaviours.

The data shown below, drawn from empirical observations, indicate that although no population can be considered completely free of sex-specific behaviour that could affect mortality rates, the trends observed in different countries are fairly similar. At an equivalent male life expectancy at birth, the female-to-male ratios of the age-specific probabilities of dying fall within a fairly narrow range and the dispersion is small (Figs. 5.2a, b, c, d). This appears to confirm the observation that there are no pronounced differences between countries in the sex ratio of deaths at each age (Clarke 2000).

Fig. 5.2
figure 00052

Correlation between the female-to-male ratio of the age-specific probabilities of dying and male life expectancy at birth, in 43 countries at various dates (Sources: see Appendix 5.3, pp. 73–74)

Figures 5.2a, b, c, d are based on empirical data for 20 countries in Europe, America, Asia and the Pacific at various dates in the twentieth century. Forty-four life tables for Switzerland, Belgium, France, Norway, Sweden, Finland, Denmark, Austria, the Netherlands, Germany, England and Wales, Ireland, Greece, Australia, New Zealand, Canada, Japan, Taiwan and Republic of Korea were selected because they are considered to be of fairly good quality, are available for various years in the century and offer a broad range of mortality levels (see Appendix 5.3 at the end of this chapter for the detailed data).Footnote 2

These graphs show the strong correlation between male life expectancy at birth and the female-to-male ratio of the age-specific probability of dying in the various age groups, and that in China the bulk of female excess mortality is observed after age 5, in the 5–9, 10–19, 20–29 and 30–39 age groups (Fig. 5.2a, b, c, d). Despite some dispersion, the relationship is clear: as male life expectancy increases, the female-to-male ratio of the age-specific probability of dying in the various age groups diminishes, which means that the gender gap widens in favour of women (with coefficients of determination R2 = 0.565, 0.821, 0.688 and 0.454 and corresponding correlation coefficients r = 0.751, r = 0.906, r = 0.829 and r = 0.674 respectively in those four age groups).

That finding supports the hypothesis that the difference between the female and male probabilities of dying at each age after five is not completely random but results from sex-specific genetic factors and socio-cultural behaviours that, to a certain extent, are common to all populations, at a given male life expectancy at birth.

On the basis of these empirical observations and taking inspiration from the methodology used by Hill and Upchurch (1995) to determine the “expected” gender gap in the age-specific probabilities of dying in infancy or childhood, we have attempted to determine the “likely” expected gender gap in the age-specific probabilities of dying after age 5. The methodology is also based on the idea that, as Clarke (2000) indicates, sex differences in mortality are relatively homogeneous across continents and cultures at every age at a given mortality level but that China does not fit this general observation.

A comparison of the situation in different countries, excluding China (Fig. 5.3a, b, c), reveals that, at an equivalent male life expectancy at birth, the female-to-male ratio of the age-specific probabilities of dying at given ages is fairly constant, even if there are undeniable differences in levels. Overall, it is before age 5 and at reproductive ages that the female-to-male ratios are the highest and the gender gap in mortality is the smallest.

Fig. 5.3
figure 00053

Female-to-male ratio of the age-specific probabilities of dying in China and other countries (Source: for China: CPIRC (1995) and Banister (2007); for the other countries: see Appendix 5.3, pp. 73–74.)

By contrast, it is in early adulthood (15–25) and roughly between ages 55 and 65 that women have the strongest mortality advantage. This relatively homogeneous pattern shows that the gender gap in the countries in the sample falls within a relatively narrow range of values, at a given male life expectancy at birth. China does not follow the same pattern, however. Compared with the cases presented here, China exhibits excess female mortality in early childhood (0–4 years), in early adulthood – probably partly due to still relatively high maternal mortality at those ages (see Appendix 5.1)Footnote 3 – and, more recently, at ages 50–65. Although these results should be interpreted with caution, – until the 1990s, adult Chinese men behaved in ways more conducive to their survival at ages at which men in other countries were more likely to engage in risk behaviour (Banister 2007) –, the relative excess mortality of Chinese women cannot be ignored. In practice, as noted by Phillips et al. (2002), violent death by suicide and self-inflicted injuries is the leading cause of death among Chinese women aged 15–34, in particular rural women, for whom this cause accounts for 31 % of deaths in this age group, compared with 15.8 % for urban women (compared with 13.1 % for rural men and 7.4 % for urban men in the same age group) (Table 5.1). China is indeed one of the few countries in the world where women commit suicide more frequently than men (approximately 600 women committed suicide per day at the end of the 1990s, according to the World Health Organization), with mortality rates ranging from 40 to 140 per 100,000 among women aged 55 and over, a level four to five times higher than men in the same age group (Phillips et al. 2002). Chinese women commit more than half (56 %) of all female suicides in the world. These suicides are impulsive acts but the women who commit them show no sign of mental illness or depression and are not under the influence of alcoholFootnote 4 (Attané 2005) (see Appendix 5.2). Suicide is now the leading cause of death among Chinese women aged 15–34. Among rural women, there are seven times more deaths due to suicide than to medical complications of pregnancyFootnote 5 (Phillips et al. 2002).

Table 5.1 Leading causes of death from external causes by sex and place of residence, China, 1995–1999

By applying the algebraic formula describing the correlation between male life expectancy at birth and the female-to-male ratio of the age-specific probabilities of dying in each of the age groups considered, we estimated a standardized value for the female-to-male ratio of the age-specific probabilities of dying at a given male life expectancy at birth (Table 5.2).

Table 5.2 Standardized female-to-male ratios of the age-specific probabilities of dying in various age groupsa

Thus, for a male life expectancy at birth of 70, for example, the corresponding value for the female-to-male ratio of the age-specific probabilities of dying is 0.704 at ages 5–9, 0.513 at ages 10–19, 0.468 at ages 20–29, and 0.611 at ages 30–39. In China, the female-to-male ratio of the age-specific probabilities of dying in the 10–19 age group was 0.802 in 1990, when male life expectancy was 68.4 according to the CPIRC (1995), whereas it should have been around 0.569 according to the standardized values. That indicates excess female mortality of around 40 % in that age group. In 2000, when male life expectancy in China was 69.3 years, the female-to-male ratio of the age-specific probabilities of dying in the 10–19 age group was 0.671 whereas it should have been around 0.541, which means that excess female mortality in this age group still exceeds 24 %.

In order to estimate relative excess female mortality in China, the female-to-male ratios of the probabilities of dyingFootnote 6 in various age groups were calculated and then compared with standardized values at a given male life expectancy at birth. For that purpose, the standardized ratios were considered to reflect a situation where mortality conditions in the countries concerned were largely unaffected by discrimination against women and where the genetic and behavioural characteristics of each sex were common to all countries, and which reflected the low level of ­heterogeneity between the countries considered here, with the exception of China.

It emerges that, at an equivalent male life expectancy at birth, the female-to-male ratios of the probabilities of dying in the age groups considered is generally higher in China than the standardized ratios. That finding suggests either that women’s living conditions are generally less favourable to their survival, or that men’s living standards are generally more favourable to their survival than in other countries. Either way, the gender gaps in mortality, which are smaller in China than the standardized gaps, highlight excess female mortality relative to males, which indicates that, overall, women’s life expectancy gains have been smaller than what might have been expected in a context of egalitarian living conditions between the sexes.

3 Excess Female Mortality in Early Adulthood, a Cause of the Female Deficit?

The excess mortality of Chinese women relative to Chinese men before their fortieth birthday, as highlighted by the comparison with various other countries, is not in doubt. Its exact impact on the numbers of female deaths still needs to be estimated, however.

Using the same method for estimating excess infant and child mortality on the basis of the standardized ratios established by Hill and Upchurch (1995), we estimated excess female deaths between the ages of 5 and 40 in the 1990 and 2000 censuses with reference to the standardized ratios shown in Table 5.2. The simulations presented in Tables 5.3 and 5.4 give an indication of excess female deaths before age 40, manifestly due to unequal living conditions between men and women. It thus appears that, with the notable exception of the 30–39 age group in 2000,Footnote 7 characterized by a female-to-male ratio of the age-specific probability of dying that is smaller than the standardized ratios, Chinese women exhibit what can be analysed as recurring excess mortality relative to Chinese men. The number of excess female deaths between the ages of 5 and 40 is estimated to have been roughly 88,600 in 1989 and more than 27,000 in 2000. Again, through simple interpolation, the excess female deaths in this age group can be estimated at around 697,000 between 1989 and 2000, representing an annual average of 58,069 over those 12 years. Consequently, the female deficit assumed to be due to excess female mortality can be estimated at around 190,200 per year (i.e. 58,069 annual excess deaths between the ages of 5 and 40, plus an annual average of 19,600 excess female child deaths, plus an annual average of 112,560 excess female infant deaths).

Table 5.3 Observed and standardized deaths and probabilities of dying, and estimated excess female deaths, China, 1990
Table 5.4 Observed and standardized deaths and probabilities of dying, and estimated excess female deaths, China, 2000

In the 1990s, the average number of girls eliminated each year by sex-selective abortion has been estimated at around 500,000–600,000 (see p. 25). These figures are consistent with the estimates made by Jiang et al. (2005), who estimated that a total of 6.3 million females were missing from the cohorts born between 1990 and 2000. That estimate is also consistent with those of Cai and Lavely (2003), who established a total female deficit of around 12 million in the cohorts born between 1980 and 2000.

In both cases, we obtain an annual average deficit of female births due to sex-­selective abortion of around 500,000–600,000. The impact of excess female mortality before age 40 on the total female deficit therefore seems much smaller than that of sex-selective abortion. According to our estimates, excess female mortality could nevertheless be responsible for more than 190,000 excess female deaths every year. It could therefore be considered as one of the factors explaining the surplus of males in China’s population.

Logically, excess female mortality before age 40 in China is slowing gains in female life expectancy. A simulation of the life table for Chinese women excluding excess female mortality before age 5 (i.e. using the corrected female age-specific probabilities of dying in infancy and childhood based on the expected ratios established by Hill and Upchurch 1995) raises female life expectancy at birth to 72.8 years in 1990 and 73.2 years in 2000, respectively 10.8 months (or 0.9 years) and 12 months (1 year) longer than the adjusted observed data (Banister 2007) (Table 5.5). Another simulation of the female life table, this time corrected for excess female mortality between birth and the fortieth birthday, raises female life expectancy at birth to 73.2 years in 1990 and 73.9 years in 2000, i.e. 1.3 and 1.7 years, respectively, above the initial values. These corrections thus bring the gender gaps in life expectancy at birth in China closer to those usually observed at an equivalent male life expectancy, raising them by 37 % (from 3.5 to 4.8 years) in 1990, and by 58 % (from 2.9 to 4.6 years) in 2000.

Table 5.5 Female life expectancy at birth corrected for their excess mortality between 0 and 40 years, 1990 and 2000

While prenatal sex selection and sex-selective abortions seem to be the main cause of the gender imbalance at young ages and of the recent masculinization of China’s population, the role played by excess female mortality, particularly before age 5 but also in early adulthood, should not be underestimated. In our efforts to explain the female deficit, this finding encourages us to look beyond the relationship between a preference for sons and sex-selective abortions, and to investigate the living conditions of women in China more broadly.