Life-Long Inequality

Abstract

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.

Appendices

Appendices

1.1 Appendix 5.1: Maternal Mortality

The maternal mortality rate, which measures the percentage of female deaths attributable to pregnancy or childbirth, for every 100,000 live births is, in theory, a significant indicator of the health conditions of the female population. It is only reliable, however, when it is calculated on the basis of accurate reporting of maternal deaths, which was not the case in China until the late 1980s (Tan 2006). The official data for that period show surprisingly low maternal mortality rates, as well as an equally implausible sharp rise between 1980 and 1990, when maternal mortality apparently increased by 140 % in cities and by 130 % in rural areas. Most of that increase should therefore be ascribed to more accurate identification and recording of this cause of death.

The data available from 1989, when China’s Ministry of Health organized a national survey of maternal mortality, provide more plausible trends. In that year, maternal mortality was apparently 95 per 100,000 across the country, breaking down as 50 per 100,000 in urban areas, and 115 per 100,000 in rural areas. The data also show a sharp decline in maternal mortality nationwide to 62 per 100,000 in 1995, then to 53 per 100,000 in 2000. That rapid decline puts China in an enviable position in relation to the three other Asian giants (Bangladesh: 684 per 100,000; India: 440; Indonesia: 390), but a long way behind its closest neighbour, Republic of Korea, which reports 30 maternal deaths per 100,000 live births.⁸ In 2010, the maternal mortality rate fell to 30 per 100,000.

The available data reflect a fairly steady decline in maternal mortality since the early 1990s, which can be attributed partly to progress in maternal and child healthcare since the late 1970s. It should also be remembered that the simultaneous steep decline in fertility and spacing of births mechanically reduced the risks associated with maternity and therefore the number of women dying from pregnancy or childbirth. It would also appear that the Chinese government’s efforts to combat maternal mortality in the 1990s are starting to pay off in rural as well as urban areas.

Strong disparities persist between provinces, however. The provinces in central China, and even more so those in the west, are disadvantaged in terms of reproductive healthcare. Access to contraception is much more limited, and childbirth in hospital, which is the norm in the developed eastern provinces, is much less common: one birth in four takes place in hospital in Guizhou, and one in five in Tibet.

Whereas in 2000 the infant mortality rate in Beijing and Shanghai was similar to that in developed countries (around 5 per 1,000 live births), in Xinjiang, more than 1 child in 20 died before its first birthday. Maternal deaths, which were very low in Beijing and Shanghai (fewer than 10 per 100,000 live births), were 10–40 times more frequent in the western provinces, at more than 140 per 100,000 in Guizhou, Qinghai and Xinjiang, and 466 in Tibet. Overlapping with economic disparities and differential access to healthcare, the different provinces are characterized by profound inequalities in terms of access to information and services.

Table 6 Reproductive health indicators in selected eastern and western provinces, 2000

The low prevalence of hospital births until the 2000s remained one of the main factors in maternal mortality: in 1985, fewer than half of Chinese women (43.7 %) gave birth in hospital, of whom 73.6 % in cities and 36.4 % in the countryside. In 2000, the percentage rose to 72.9 % nationwide, although with sharp disparities between urban and rural areas: 84.9 and 65.2 % respectively (WMC 2004). Strong inequalities between provinces were observed, with the percentage of births in hospital above 99 % in Beijing, Tianjin and Shanghai, but only 30 % in Tibet, 39 % in Guizhou, and 60–70 % in Yunnan, Gansu, Qinghai and Xinjiang, for example (Tan 2006).

1.2 Appendix 5.2: Women and Suicide

Poverty, persecution by their mothers-in-law or an inability to produce a male child are driving more and more rural women to suicide. An ordinary scene in the Chinese countryside: it is dinner time in the Zhang household, a family of farmers who live in a village of around 100 houses in central China. In the main room, lit by a single neon, the men sit around a low table, eating, talking, smoking and drinking rice wine. Around them, the women who made the meal stand silently in the shadows, watching on. When the sons, brothers and husbands leave the table, the women will eat the leftovers from their bowls. That will mainly consist of zhou, or rice water, to which they will add a few vegetables. It has been this way for thousands of years. The Zhang are neither poor nor rich. They are middling peasants that trade with the small towns in the region. Two of the sons even went to work in Shanghai for 3 years. But women in remote rural areas still have a second-class status. A woman’s role is to have children, preferably male heirs, be hardworking and faithful to her husband. Half a century of Communism has done nothing to change these traditions.⁹

The most common method of suicide is swallowing pesticides:

A 24-year-old woman attempted to commit suicide. Her husband had left for the city to look for work and her mother-in-law was making life difficult for her. Her first child was a girl and she had just given birth to a second daughter. Forced to pay a high fine for breaking the one-child rule, the family criticized her for not being able to conceive a boy, the only insurance policy for the parents’ old age.¹⁰

Suicide is not disapproved of in Chinese culture: after a humiliation, a disappointment, a family feud, suicide offers a respectable way out. “Women around here used to hang themselves or throw themselves into the well, but there weren’t nearly as many suicides as there are now,” says Grandma Zhang, 78.

My neighbour was 35. Her three children were already grown up, but they didn’t have enough land. Just one mu¹¹ for the whole family. She said she didn’t see any point in going on living.¹²

The countryside is suffering the adverse effects of the economic reforms and is severely strained by the contradictions of the system. Social pressure; tyrannical mothers-in-law; insufficient land; rising poverty; men who migrate to the cities, leaving the villages populated by women, old people and children; an excessively strict birth control policy, etc. Rural women are starting to realize that a different kind of life is possible in the cities, with all the dreams fuelled by consumer society. But when those dreams remain mirages, the only solution left to them is suicide, which is widespread in rural areas, where people have fewer opportunities to express their grievances or seek redress in the courts.

1.3 Appendix 5.3: Female-to-Male Ratio of the Probabilities of Dying in Different Age Groups at a Given Level of Male Life Expectancy at Birth in Various Countries

Country	Years	Male life expectancy at birth e0	Age group
			5–9 years	10–19 years	20–29 years	30–39 years
Australia	1946–1948	66.1	0.716	0.558	0.749	0.907
	1970–1972	67.9	0.724	0.447	0.394	0.625
	1975–1977	69.5	0.710	0.395	0.350	0.563
Austria	1949–1951	61.9	0.716	0.658	0.677	0.735
	1980–1982	69.2	0.712	0.382	0.308	0.494
Belgium	1928–1932	56.0	0.898	0.970	0.944	0.883
	1959–1963	67.7	0.738	0.494	0.430	0.604
	1968–1972	67.8	0.697	0.477	0.447	0.579
Canada	1951	66.3	0.725	0.600	0.583	0.765
	1966	68.7	0.749	0.443	0.358	0.575
	1971	69.3	0.767	0.439	0.367	0.582
Denmark	1921–1925	60.3	0.949	1.021	0.997	1.171
	1956–1960	70.3	0.622	0.510	0.516	0.824
England and Wales	1960–1962	68.1	0.674	0.460	0.505	0.725
Finland	1946–1950	58.4	0.700	0.772	0.609	0.612
	1986–1990	70.7	0.591	0.423	0.306	0.334
France	1910	49.5	1.070	1.067	0.899	0.838
	1954	65.0	0.738	0.603	0.593	0.652
	1966	67.8	0.719	0.479	0.437	0.507
Germany	1996–1998	74.0	0.721	0.472	0.363	0.476
Federal Republic of Germany	1949–1951	64.5	0.752	0.646	0.632	0.730
	1986–1988	72.2	0.628	0.478	0.386	0.527
Greece	1955–1959	66.3	0.796	0.692	0.716	0.768
	1960–1962	67.4	0.822	0.701	0.677	0.760
	1980	72.1	0.791	0.481	0.419	0.458
Ireland	1990–1992	72.2	0.771	0.463	0.326	0.531
Japan	1957–1958	63.8	0.806	0.757	0.744	0.831
	1985	74.8	0.585	0.409	0.451	0.556
	1968–1969	69.2	0.636	0.551	0.537	0.612
Netherlands	1951–1955	70.7	0.651	0.612	0.588	0.849
New Zealand	1934–1938	65.4	0.820	0.698	0.883	0.918
Norway	1911–1915	56.3	0.926	0.938	0.767	0.909
	1946–1950	69.0	0.618	0.654	0.665	0.710
	1995	74.8	0.867	0.384	0.328	0.493
Republic of Korea	1970	59.8	0.829	0.810	0.790	0.867
Sweden	1946–1950	69.0	0.584	0.687	0.691	0.842
	1982–1986	73.7	0.626	0.499	0.398	0.530
Switzerland	1910–1911	50.6	0.957	1.144	1.028	0.869
	1920–1921	54.5	0.991	0.998	1.067	0.917
	1948–1953	66.3	0.685	0.567	0.553	0.699
	1950–1960	67.7	0.636	0.489	0.441	0.656
	1958–1963	68.7	0.675	0.451	0.399	0.596
Taiwan	1956–1958	60.2	0.885	0.844	0.841	0.823
United Kingdom	1981–1983	71.0	0.715	0.463	0.443	0.654

1. Sources: Column 1: (except Japan) data from the Human Life-Table Database, developed jointly by Max Planck Institute for Demographic Research, Rostock, Germany, Department of Demography at the University of California, http://www.lifetable.de/cgi-bin/datamap.plx
2. The data for Japan are from the Abridged Life Tables, Institute of Population Problems, Ministry of Health and Welfare, Research Series, for the corresponding years; Columns 2–5: calculations based on the same sources