ArticleProceedings of the National Academy of Sciences of the United States of America2019
Systematic assessment of the sex ratio at birth for all countries and estimation of national imbalances and regional reference levels.
Article in Proceedings of the National Academy of Sciences of the United States of America, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 69 papers, 1 of them a synthesis that pooled it.
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Who cites it
69 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Clinical Risk Factors Associated With Late-Onset Invasive Group B Streptococcal Disease: Systematic Review and Meta-Analyses.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022Pooled it
- Historical Trends and Implications of the Sex Ratio at Birth in Georgia, 1926-2024.Research square · 2026Article
- Patriarchal norms and reproductive vulnerability: association between son preference and high-risk fertility behaviour in India.Tropical medicine and health · 2026Article
- Spatial non-stationarity in son preference: a district-level geographically weighted regression analysis of NFHS-5 in India.International journal of health geographics · 2026Article
- Masculinization of populations reverses sex differences in fertility.Proceedings of the National Academy of Sciences of the United States of America · 2026Article
- Dietary inequality marker reveals 10,000 years of gender and cultural disparity in Europe.PNAS nexus · 2026Article
- Estimates of Under-Five Mortality From a Mobile Phone Survey During the COVID-19 Outbreak: An Observational Study Comparing Three Instruments in Malawi.Demography · 2026Observational
- Sex Ratios at Birth Following Non-Invasive Prenatal Testing in Victoria, Australia.Prenatal diagnosis · 2026Article
- Sex differences in the global burden of autism spectrum disorders: An analysis based on GBD 2021 data.Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences · 2026Article
- Temperature and sex ratios at birth.Proceedings of the National Academy of Sciences of the United States of America · 2026Article
- Article
- Secondary Sex Ratio in the Face of Global Challenges: Beyond the Headlines.International journal of environmental research and public health · 2025Review
- Ambient air pollution and the sex ratio at birth: a systematic review and narrative synthesis.medRxiv : the preprint server for health sciences · 2025Article
- Retrospective study on the 'sex ratio at birth' in Western Sydney Local Health District between 2011 and 2020.BMJ open · 2025Article
- Unveiling the Effects of Natural Disasters and Nuclear Energy on the Secondary Sex Ratio: A Comprehensive Review.Life (Basel, Switzerland) · 2025Review
- Sex Ratio at Birth in Northern Ireland During the COVID-19 Pandemic: A Comparison With Published Data From the Republic of Ireland, England and Wales.American journal of human biology : the official journal of the Human Biology Council · 2025Article
- Effects of sport disciplines on offspring sex ratio in elite athletes: an observational study.Scientific reports · 2025Observational
- Is 'gender equality in health' the right goal? Exploring issues of definition and measurement.BMJ global health · 2025Review
- Trend Analysis of the Sex Ratio at Birth in Greece.Cureus · 2025Article
- Sex-selective abortions over the past four decades in China.Population health metrics · 2025Article
9 more citing papers are in PubMed but not listed here.
Corrections and comments
- Erratum issued
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The sex ratio at birth (SRB; ratio of male to female live births) imbalance in parts of the world over the past few decades is a direct consequence of sex-selective abortion, driven by the coexistence of son preference, readily available technology of prenatal sex determination, and fertility decline. Estimation of the degree of SRB imbalance is complicated because of unknown SRB reference levels and because of the uncertainty associated with SRB observations. There are needs for reproducible methods to construct SRB estimates with uncertainty, and to assess SRB inflation due to sex-selective abortion. We compile an extensive database from vital registration systems, censuses and surveys with 10,835 observations, and 16,602 country-years of information from 202 countries. We develop Bayesian methods for SRB estimation for all countries from 1950 to 2017. We model the SRB regional and national reference levels, the fluctuation around national reference levels, and the inflation. The estimated regional reference levels range from 1.031 (95% uncertainty interval [1.027; 1.036]) in sub-Saharan Africa to 1.063 [1.055; 1.072] in southeastern Asia, 1.063 [1.054; 1.072] in eastern Asia, and 1.067 [1.058; 1.077] in Oceania. We identify 12 countries with strong statistical evidence of SRB imbalance during 1970-2017, resulting in 23.1 [19.0; 28.3] million missing female births globally. The majority of those missing female births are in China, with 11.9 [8.5; 15.8] million, and in India, with 10.6 [8.0; 13.6] million.
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