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Abstract
ObjectiveThe accuracy of a population-based sex ratio at birth (SRB) in China has long been questioned. To depict a more accurate profile, the present study used data from a national surveillance system for health facility births to explore the characteristics of SRB in China.MethodsData from China’s National Maternal Near Miss Surveillance System between 2012 and 2015 were used. We restricted the analysis to live births of ≥28 completed gestational weeks or ≥1000 g birth weight. The strength of association between obstetric characteristics and SRB was examined using logistic regression, taking into account the sampling strategy and clustering of births within health facilities.ResultsThere were 2,785,513 boys and 2,549,269 girls born alive between 2012 and 2015 in 441 health facilities. The SRB was 111.04 in 2012, 110.16 in 2013, 108.79 in 2014, and 109.53 in 2015. The SRB was high in the eastern region, especially in rural areas. The SRBs increased with mother’s age and decreased with mother’s education. The SRB in women who were pregnant for the first time was 104.30. The SRB in primipara was normal (104.35), but it was extremely high in non-primipara, especially for women with three or more parities (141.76); only 5.26% of live births fell within this group. The SRBs increased significantly by the number of parities, especially in the rural areas of the central region. After adjustment for sociodemographic factors, women with three or more parities were 1.39 (95% CI 1.34, 1.43) times more likely to give birth to a boy compared with primiparae who were pregnant for the first time.ConclusionOur analysis suggests that the SRB was lower than what was reported officially but higher than normal. The government should keep strengthening supervision to prevent sex-selection, especially in the wake of the two-child policy implemented in 2015.
Highlights
Sex ratio at birth (SRB) is defined as the number of boys born per 100 girls[1]
Our analysis suggests that the SRB was lower than what was reported officially but higher than normal
The National Maternal Near Miss Surveillance System (NMNMSS) was established in Oct. 2010[26] in health facilities whose annual deliveries were more than 1000 and which were selected from 326 districts or counties in 30 provinces to surveillance national maternal deaths and maternal near misses
Summary
Sex ratio at birth (SRB) is defined as the number of boys born per 100 girls[1]. The national one-child policy, which intended to restrict the rapid growth of China’s population, pushed families to prefer the birth of boys. Girls were frequently concealed or omitted from declaration or it was reported that girls had died[12, 13] This was done to escape the punishment by the government or to obtain permission for another child. China is a populous country, and its increasing floating population (nearly 2.53 million in 2014)[14], adds to the difficulty of checking registering data, so the number of these unregistered girls who have not been investigated has remained a mystery[12, 15]
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