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Background
Amartya Sen noticed that in China, rapid economic development went together with worsening female mortality and higher sex ratios. Although China has been traditionally discriminatory against women, a significant decline in China's female population happened after 1979, the year following implementation of economic and social reforms under Deng Xiaoping. Sen concluded that there were multiple reasons why the environment for Chinese women had deteriorated, particularly since 1979.

The one-child policy was implemented in 1979 in effort to control the size of families, which meant having a "one-child family" for most Chinese families, with some exceptions. Because of a strong son preference, these compulsory measures resulted in a neglect of girls and in some cases led to female infanticide. Female infant mortality dramatically increased in the early years after the reforms in 1979, and some statistics imply that female infant mortality doubled from 1978 to 1984.

A general crisis in health services arose after economic reform because previously funding for China's extensive rural health care programs had largely come from agricultural production brigades and collectives. When the economic reforms abolished these traditional structures, they were replaced by the household-responsibility system, which meant that agriculture remained concentrated within the family and availability of communal facilities in China's extensive rural health care system were restricted. In general, the effect of a restriction in medical services was neutral, but in a Chinese rural society that looked up to men and down on women, the reduction in health care services significantly affect women and female children. The household-responsibility system involved a reduction of women's involvement in paid agricultural labor. At the same time, employment opportunities outside agriculture were generally scarce for women. According to Sen's cooperative conflicts approach ("who is doing productive work and who is contributing how much to the family's prosperity can be very influential"), the effect of this systematic change on women within the household was negative, because women had fewer bargaining powers in their families. This reality motivated families to prefer boys over girls, which contributed to reduced care for female children.

Non-registration of female babies at birth
Some of the missing women in China result from under-reporting and non-registration of baby girls. The family planning policy is disproportionately implemented across China, especially in rural areas. In order to leave opportunities to have sons and to avoid paying penalties on over-quota children, some parents in rural areas of China will not register their female babies, leading to a shortfall of girls registered as residents. Although it is the responsibility of the village leaders to enforce the policy, they will under report the number of births so they will not face penalties from higher authorities.