Invited commentary: Natural versus unnatural sex ratios--a quandary of modern times.

The typical dilemma with sex-ratio findings is that when they are real, they aren't interesting, and when they are interesting, they aren't real. In this issue of the Journal, Fernández et al. (Am J Epidemiol. 2011;174(12):1327-1331) describe a deviation of the sex ratio that is apparently both large and real. There was a temporary but distinct spike in the proportion of boys born in Cuba around the time of the collapse of the national economy during the 1990s. Although an excess of boys does not fit the prevailing biologic theory regarding maternal stress and the sex ratio, the data are consistent with results from the Dutch famine (where population-level deprivation was even more extreme). A new quandary arises in the modern era with interpretation of the sex ratio: If the decision to abort a pregnancy is influenced by the sex of the fetus, a change in the behavior of even a small proportion of women could influence the sex ratio at birth. The possible role of sex selection in the Cuban context is discussed.