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The significance of the Lancet study on skewed sex ratios

By Sandhya Srinivasan

While Census 2001 showed sex ratio distortions that could be correlated with the availability of sex selection technology, the Lancet study reporting 1 crore "missing" girls in India over the last generation actually analyses the reasons behind this phenomenon and quantifies the impact

More than 1 crore girls in India are "missing" as a result of sex-selective abortion in the past generation. This shocking finding of a study published in the British journal The Lancet puts a number to the practicethat has thrived despite the fact that foetal sex selection technologies have been banned in the country since 1994.

Canada-based researcher Prabhat Jha, India-based Rajesh Kumar and their colleagues arrived at the 1 crore figure after looking at data from the Special Fertility and Mortality Survey, a nation-wide government survey with information on fertility and mortality.

Indian demographers Udaya Mishra and Mala Ramanathan support the analysis in the Lancet report. They also suggest that further analysis would also have specified the impact of the government's female-sterilisation-driven family planning drive on sex-selective abortion.

Dr Jha and his colleagues had access to data gathered in 1998, in which women who were or had been married were interviewed in detail about the number of children they'd given birth to in the previous year, their sex and their birth order. Their analysis of 133,738 births confirmed other estimates that the male-female sex ratio at birth is distorted.

The authors also examined information on the sex ratio of children by parity or birth order - meaning whether they were born first, second or third. They found that the sex ratio of second- or third-born children was affected by the sex of the previous child or children.

The sex ratio for first order births was 871 girls for every 1,000 boys, compared to the expected sex ratio of 950-980: 1,000. If the first child had been a girl, the sex ratio of second children was as low as 759 girls for every 1,000 boys. This got further skewed to 719: 1,000 for the third child, if both first and second children had been girls.

In other words, the birth of a first girl-child increased the chances that families would do something to reduce the chances that the next child would also be a girl. And that something was sex-selective abortion. "Our interpretation of our findings is that households are ensuring that at least one boy is born," write the authors.

Interestingly, the sex ratio was more skewed in the children of educated mothers than those of illiterate mothers. Apparently, education increased the chances of using sex selection technologies. "Even state such as Kerala or Tamil Nadu, in which women are generally better educated and child mortality rates are lower, show clear differences between the sex ratio after a previous female birth versus a pervious male birth," write the authors. Income or wealth did not seem to be an influence, nor did religion.

Was the sex ratio skewed by female infanticide? Were families killing baby girls? The researchers didn't think this practice was responsible for the skewed sex ratio. Not only were the reported stillbirths and neonatal deaths more commonly male, the number of stillbirths reported was fewer than the total number of missing births.

Based on the number of children born in that year, and the expected natural sex ratio, the researchers concluded that 500,000 girls were "missing" in 1997. They would have been born, but they were not, because of foetal sex determination and sex-selective abortion. Since the technology became available in India in the early-1980s, after which it has continued to be widely available despite a ban, the researchers calculated that 1 crore girls were missing because of sex-selective abortion in the last 20 years.

"The study has used simple numerical analysis and multivariate logistic regression to establish clearly and unequivocally that pre-natal sex determination and sex-selective abortion contribute significantly to the distortion in sex ratios of children born in 1997 in India," say demographers Udaya Mishra of the Centre for Development Studies and Mala Ramanathan of the Achutha Menon Centre for Health Sciences Studies, both in Thiruvananthapuram.

The SFMS is part of the Sample Registration System, an ongoing data collection programme with a large sample size and regular monitoring of data quality, providing reliable annual estimates of fertility and mortality at the national level and for major states.

The Census 2001 had already documented the sharp drop in the child sex ratio (under six years) in the previous decade, from 962: 1,000 in 1981 to 945: 1,000 in 1991, to 927: 1,000 in 2001. The sharpest declines were in Himachal Pradesh, Punjab, Haryana, Gujarat, Uttaranchal, Maharashtra and Chandigarh, where sex selection technology was widely available.

"While the Census showed sex ratio distortions and one could correlate this with the availability of sex selection technology, this study actually analyses the reasons behind this phenomenon and quantifies the impact," notes Dr Mishra. "This sample is large, and the data collection very accurate, with regular cross-checking and monitoring," adds Dr Ramanathan.

The study findings should also silence the proponents of couples' right to sex selection for "family balancing" - having children of both sexes. Clearly, "family balancing" has a serious impact at a societal level.

The study could have also looked at the impact of the government's programme which pushes female sterilisation as an exclusive contraceptive method, note Drs Mishra and Ramanathan. Given the clear link between birth order and sex ratio, it is reasonable to presume that efforts to control fertility - or reduce the number of births per family along with son preference - will further distort sex ratio. "It can be expected that pre-natal sex determination and sex-selective abortions will be more intense in restrictive fertility regimes characterised by lower age at sterilisation, shorter birth intervals, and lesser proportions of women progressing beyond second parity," wrote Dr Mishra and his colleague Dilip T R in a 2004 paper for the health organisation Cehat. Women who face the prospect of being sterilised after two children are likely to try to use sex-selection technology to reduce the chances of giving birth to a girl.

InfoChange News & Features, January 2006