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These authors also noted an increase in the sex ratio in the 1974–1978 birth cohorts, probably reflecting an increase in female infanticide in the first few hours or days after birth, and higher excess female mortality in early childhood resulting from differential access to healthcare just a few years after the introduction of the third family planning campaign in 19712 (Coale and Banister 1994). 2). 9 in the 2010 census (PCO 2012). In China and the other Asian countries with abnormal excess masculinity at birth, a direct link has been established between the increase in the sex ratio at birth and the decline in fertility (Bhat and Zavier 2007; Croll 2000; Gu and Roy 1995; Kim 2005).

Although the sex ratio at birth was still lower in urban areas than in rural areas in 2010, when this indicator is broken down by birth order, urban/rural differences are much less distinct. 2). Moreover, the imbalance was bigger in urban areas (cities and towns) than in rural areas for births of order 2 and higher, which exhibit sex ratios 40–60% above the normally expected levels. Thus, the main difference between urban and rural areas is the distribution of births by birth order, since births of order 2 and higher have the most imbalanced sex ratios.

Healthcare practitioners are adopting increasingly mercenary strategies. With the dismantling of collective structures, the majority of families are now deprived of any healthcare coverage. By 1983, only 40–45 % of villages were still covered by the collective medical system. Now, almost everywhere, only small expenses are covered, whereas exceptional costs are mostly supported by families. d Since the mid-1990s, efforts have been made to implement new insurance systems in cities, where medical costs are split between employees (geren zhanghu) and employers (gongji zhanghu).

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