The Impact of Social Health Insurance on Sex Selection

Xiaoqian Wang, Zixuan Fu and Julie Shi

China & World Economy, 2025, vol. 33, issue 4, 211-246

Abstract: Male‐biased sex imbalance is a common social concern in many developing countries. Using 2015 One Percent National Population Sample Census data and macro‐level indicators from various sources in China, this study examines the impact of social health insurance on sex selection at birth. The results show that social health insurance significantly affected the sex ratio at birth for the second child in families with a first‐born girl, and there was salient urban–rural heterogeneity. Urban health insurance programs decreased the male–female ratio at the birth of the second child, suggesting that these programs mitigated the sex imbalance. In contrast, the expansion of rural health insurance caused an increase in the imbalanced sex ratio, indicating an exacerbation of the trend. The urban–rural difference in these impacts could be explained by a greater crowding‐out effect in urban families and larger income and expenditure effects in rural families.

Date: 2025
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