Tiranë 2012 Tiranë Tiranë 2012 SEX IMBALANCES AT BIRTH IN ALBANIA Tiranë 2012 2 SEX IMBALANCES AT BIRTH IN ALBANIA Design & Shtypi: shtypshkronja “Pegi” Email: [email protected] / www.botimepegi.al Cel: 0694007501 Adresa: Lundër, Tiranë Sex imbalances at birth in Albania SEX IMBALANCES AT BIRTH IN ALBANIA 3 Acknowledgements .................................................................................................................... 4 0 Executive summary ............................................................................................................ 7 1 Sex Selection and the Albaniancontext ............................................................................ 10 1.1 Prenatal sex selection in the world: characteristics and trends ............................... 10 1.1.1 Skewed sex ratios at birth (SRB) observed from Asia to America ..................... 11 1.1.2 Variations in sex ratio at birth across social groups ........................................... 13 1.2 Why prenatal sex selection? ...................................................................................... 14 1.3 The socio-economic development in Albania ........................................................... 16 1.3.1 Socio-economic development under communism ............................................ 16 1.3.2 Socio-economic development during the transition ......................................... 18 1.4 The gender and family context in Albania ................................................................. 21 1.5 Demographic situation in Albania ............................................................................. 23 1.5.1 Population growth, fertility decline and abortion ............................................. 24 1.5.2 Mortality changes and the gender bias ............................................................. 29 1.5.3 International and internal migration ................................................................. 31 2 Main research questions and methodology .................................................................... 33 2.1 Research questions .................................................................................................... 34 2.2 Demographic sources ................................................................................................ 35 2.2.1 2001 census ........................................................................................................ 35 2.2.2 Birth registration data ........................................................................................ 36 2.2.3 Other survey sources .......................................................................................... 38 2.3 Methodology of the qualitative study ....................................................................... 39 2.3.1 Participants and survey instrument ................................................................... 40 2.3.2 Procedure and analysis ...................................................................................... 40 3 Demographic analysis of prenatal sex selection .............................................................. 42 3.1 Son preference and its correlates ............................................................................. 42 3.1.1 Opinions on the idealfamily composition .......................................................... 42 3.1.2 Son preference in fertility behavior ................................................................... 43 3.1.3 Social and regional variations in son preference ............................................... 45 3.2 The onset of prenatal sex selection in Albania .......................................................... 47 3.2.1 The rise in SRB levels during the 1990s .............................................................. 47 3.2.2 Parity and birth masculinity ............................................................................... 51 2 4 SEX IMBALANCES AT BIRTH IN ALBANIA 3.2.3 SRB differentials ................................................................................................. 54 3.2.4 A synthetic analysis of SRB determinants .......................................................... 56 3.3 Analyzing birth masculinity based on birth registration ........................................... 60 3.3.1 SRB trends in an historical perspective .............................................................. 60 3.3.2 SRB differentials based on birth registration data ............................................. 62 3.3.3 The effect of socio-economic variables.............................................................. 64 3.3.4 Deterministic patterns of birth masculinity based on registration data ........... 69 4 Qualitative analysis of son preference and sex selection ................................................ 73 4.1 Perceived value of sons ............................................................................................. 73 4.1.1 Cultural aspects of son preference .................................................................... 74 4.1.2 Socio-economic aspects of son preference ....................................................... 76 4.1.3 Community norms and family pressure ............................................................. 79 4.2 Knowledge and practices of prenatal sex selection .................................................. 80 4.2.1 Traditional practices and beliefs related to sex determination ......................... 80 4.2.2 Sex-selective abortions ...................................................................................... 83 4.2.3 Factors influencing attitudes towards sex selection and ideas about change .. 86 4.3 Factors contributing to prenatal sex selection .......................................................... 90 5 Demographic projections ................................................................................................. 92 5.1 Future trends in SRB and sex imbalances .................................................................. 92 5.2 Assumptions .............................................................................................................. 92 5.3 Results ........................................................................................................................ 94 5.4 Implications ............................................................................................................... 96 6 Conclusionand recommendations ................................................................................... 98 6.1.1 Conclusions ......................................................................................................... 98 6.1.2 Recommendations ........................................................................................... 100 References .............................................................................................................................. 103 3 Sex imbalances at birth in Albania SEX IMBALANCES AT BIRTH IN ALBANIA 5 Acknowledgements This research report on sex imbalances at birth in Albania is the product of close cooperation of several institutions and actors. This research was carried out based on the need to understand WHAT the situation is regarding sex imbalances at birth in Albania, HOW this sex selection is achieved under the conditions of Albania and WHY this sex imbalance at birth is taking place in Albania today. We would like to acknowledge and thank you UNFPA and World Vision for funding and supporting this research. We would also like to extend special thanks and acknowledgement to the Institute of Statistics of Albania (INSTAT) which provided the access and support on analysis of vital statistics data. The involvement of statistics experts from INSTAT, Pranvera Elezi and Blerina Subashi was a great support on analyzing the vital statistics related to the sex ratio at birth. We would like to extend special thanks and acknowledgement to the group of researchers and writers of this report: the team composed of international consultants, Christophe Guilmoto and Arjan Gjonca who designed and carried out the statistical assessment of the sex ratio at birth situation in Albania, and of national consultants, Izela Tahsini, Alba Jasini a Kristina Voko, who designed and carried out the qualitative study and provided an analysis of the potential deterministic pattern for son preference in the country and the mechanisms leading to skewed sex ratio at births levels. Finally, we would like to acknowledge and thank the families and health practitioners, who participated in this research, and who gave their time to answer questions and share their knowledge and expertise. 4 6 SEX IMBALANCES AT BIRTH IN ALBANIA Sex imbalances at birth in Albania SEX IMBALANCES AT BIRTH IN ALBANIA 7 0 Executive summary This report initiates from an initiative of the UNFPA a year ago in December 2011, when for the first time, in a conference in Albania, the issue of sex imbalances and sex selection at birth was discussed in the context of Albanian populations. Academics, national and international, policy makers, experts from the international community as well as civil society discussed the relevance and the issues related to the sex imbalance amongst Albanians at the start of the 21st century. One of the overwhelming conclusions of this conference was how little we know regarding this issue in Albania in particular and in the Balkans in general, at a time when the demography of the country and the region