For decades, China's sex ratio at birth (SRB) has risen significantly. This trend was found in different provinces and between different parities. Three direct causes have led to the imbalanced SRB: underreporting of female births, which refers to girls who are alive but are hidden from the census count; high rates of female infanticide, which refers to the killing of female infants shortly after birth; and sex‐selective abortion, which refers to the selective abortion of female fetuses. In addition to these immediate causes, China's One‐Child Policy and the cultural preference for sons constitute underlying causes for the imbalanced SRB. Distortions in the SRB can have serious social and economic consequences, including the loss of potential population growth, a “marriage squeeze,” precipitated social instability, and an aging workforce. However, China can improve the status quo by taking appropriate measures such as relaxing fertility regulations and preventing sex‐selective abortions. Establishing a comprehensive pension system can help address the high SRB in the long run. However, a policy reversing the high SRB may have a negative effect on other demographic factors. China needs to find a way to reverse the SRB without harming other demographic indicators and has to do so soon.
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