Siwan Anderson and Debraj Ray analyzed figures from the year 2000 from sub-Saharan Africa, China, and India, to better understand at what age the missing women are dying, and what they’re dying from. As they explain in their paper, Missing Women: Age and Disease, “The possibility of gender bias at birth and the mistreatment of young girls are widely regarded as key explanations. . . . While we do not dispute the existence of severe gender bias at young ages, our computations yield some striking new findings.”

Their news? Anderson and Ray found that the majority of missing women died as adults (older than 15), not from sex selection in utero or childhood gender bias, as previously thought. The authors’ suggested percentages of “excess female deaths” occurring later in life are striking: 66 percent in India, 55 percent in China, and 83 percent in sub-Saharan Africa.

In China and India, many of these deaths are attributed to “injuries”-a term unsettling in its vagueness. In the Star article, Anderson says that the majority of China’s 141,000 excess female deaths from “injuries” were the result of suicide, usually by ingesting crop pesticides.

“Injuries” in India accounted for the deaths of 86,000 women ages 15 to 29. Here the researchers suspect dowry-related deaths, which can include “bride burnings”- a particularly brutal form of violence in which a woman is doused with kerosene and lit on fire.

The largest number of missing women is in sub-Saharan Africa, where more than one-third died of HIV/AIDS. Other factors here may also include lack of access to care and other psychosocial factors.

Two decades ago, Sen wrote that “[i]f this situation is to be corrected by political action and public policy, the reasons why there are so many ‘missing women’ must first be understood.” Anderson and Ray’s work now brings us closer to that understanding-and makes all too clear the ultimate toll gender discrimination can take on a woman’s life.

For more reading:

Economist Emily Oster’s challenge of Sen’s theory in 2005: “Hepatitis B and the Case of the Missing Women” (arguing that biology, and not gender discrimination, skewed the ratios in Asia)

Monica Das Gupta’s response to Oster’s controversial claim: “Explaining Asia’s Missing Women: A New Look at the Data” (families whose first-born was a daughter  later had sons, suggesting measures to ensure boys)

A 2008 report that the effect of HBV on sex ratio imbalance was insignificant: “Can Hepatitis B Mothers Account for the Number of Missing Women: Evidence from Three Million Newborns in Taiwan”

Oster re-examines the data and issues a 2008 retraction: “Hepatitis B Does Not Explain Male-Biased Sex Ratios in China”

Authors suggest that legalization of abortion accounted for an increase in sex ratio at birth in the 1980s-and a decrease in excess female mortality: “More Missing Women, Fewer Girls Dying: The Impact of Abortion on Sex Ratios at Birth and Excess Female Mortality”

Paper concludes that increasing female income-and holding male income constant-increases girls’ survival rates: “Missing Women and the Price of Tea in China: The Effect of Sex-Specific Income on Sex Imbalances”

Last month, the New York Times published a piece on the surprising birth bias for boys found in some Asian American communities:  “U.S. Births Hint at Bias for Boys in Some Asians“

Despite China’s recently implemented HIV prevention and treatment efforts, the country has a long history of discrimination against HIV-positive individuals. The same Reuters article reported that many people “have been turned away from hospitals and schools that fear contagion from AIDS patients.” Although the government has attempted to incorporate mass HIV/AIDS education campaigns into local communities, AVERT notes that a lack of qualified teachers for HIV/AIDS prevention education (especially in rural areas) and lack of HIV/AIDS education material in minority languages may be hindering efforts.

More links below the fold. China Pediatric AIDS report

CIA World Factbook: China

Needle Exchange Programs in China

Drug Use and HIV in China

AVERT: HIV/AIDS in China

A paper recently published in the journal Mental Health, Religion, and Culture describes an innovative healing approach for monks who have suffered under China’s occupation of Tibet – innovative not in the sense that it tries anything new, but that it actually integrates Tibetan and Western medicine. The paper also demonstrates the challenges and need for expansion of cross-cultural treatment of refugees.

Dr. Michael Grodin of the Boston Center for Refugee Health and Human Rights tailored a treatment for eight Tibetan monks in Boston that includes both Western and Tibetan diagnoses, combining mainstream healthcare with alternative therapies. One patient, Yeshi Togden, was repeatedly imprisoned and tortured in the late 1980s for his participation in peaceful protests against China’s presence in Tibet. Dr. Grodin diagnosed Togden with post-traumatic stress disorder (PTSD), as well as srog-rlung, an imbalance of the life-wind; his treatment included Taoist breathing and musical bowl-playing concurrent with psychotherapy and antidepressants.

With a rising global number of refugees and evidence of the long-term effects of trauma on the mental health of relocated refugees, it is important for the medical community to develop effective ways of providing care to this vulnerable group. For example, a 2007 study from Australia found that trauma and PTSD continue to affect the mental health of Vietnamese refugees even a decade after resettlement. The right to health should include the right to culturally-sensitive medical care, and we applaud the efforts of Dr. Grodin and others who provide it; all refugees deserve the same respect given to these Tibetan monks.

To read the full article from the Boston Globe, click here

See also:

2008 Human Rights Report: China – U.S. Dept of State, Feb 2009

New video of torture exposes Chinese brutality in Tibet – Telegraph, Mar 2009

China says Tibet torture video is ‘a fake’ as it blocks youtube – Telegraph, Mar 2009

Chinese officials decry prison torture, vow checks – Reuters, Mar 2009

The policy allows regions like Hong Kong to operate on different economic and political systems from mainland China, with a large degree of autonomy. One of its unintended consequences, however, is the perpetuation of migrant sex workers’ disadvantaged status through the systematic denial of their right to social and economic progression and the failure to provide adequate health services or protection from exploitation and abuse. While prostitution is technically legal in Hong Kong, related activities such as soliciting, as well as traditional brothels, are not. Operating alone and without protection, prostitutes are vulnerable to abuse and lately, to a disturbing string of murders. Migrant sex workers are far more vulnerable given their illegal status, and feel they cannot report crimes committed against them or seek health services for fear of legal repercussions.

The authors are spot on in recognizing that female migrant sex workers are in a far more complex situation than the terms “trafficking victims” or “illegal immigrants” convey. They find that medical anthropologist Paul Farmer’s concept of marginalized groups as victims of structural violence is more appropriate: China’s sociopolitical situation forces many women into migration in search of employment, particularly to Hong Kong. While Hong Kong has eased travel restrictions, it is a crime for migrants to seek employment. By focusing on the legal status of migrant sex workers, the Hong Kong government can avoid taking responsibility for creating conditions that create the need to migrate.

The article suggests that dealing with structural violence requires structural interventions: China and Hong Kong should become signatories to the Trafficking and Smuggling Protocols of the UNCOTC, which would provide another legal avenue for sex workers to report abuses. Other suggested interventions include allowing migrants to legally engage in sex work using visas, and expanding the role of NGOs dedicated to providing health education, legal counsel, and other avenues of empowerment. Gaining protection under the law is an essential first step for ensuring rights for female migrant sex workers.