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| SHORT COMMUNICATION |
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| Year : 2011 | Volume
: 55
| Issue : 2 | Page : 128-131 |
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A study on sex ratio at birth in suburban slums of Mumbai
Ancilla Tragler
Community Health Coordinator, Senior Pediatric Consultant, Bandra Holy Family Hospital, Mumbai, India
| Date of Web Publication | 22-Sep-2011 |
Correspondence Address:
Ancilla Tragler
Community Health Coordinator, Senior Pediatric Consultant, Bandra Holy Family Hospital, Mumbai
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0019-557X.85250
 Abstract | | |
A cross sectional study was conducted in four selected suburban slums of Mumbai to determine the sex ratio at birth and to assess the various factors related to it. Information were collected on the sex of new born babies and other socio demographic characteristics of selected couples, including number of births, history of spontaneous and induced abortions and the preferred sex of siblings. Data were collected from a total of 302 families using a pre-tested interview schedule. There were 698 births of which 351(50.3%) were males and 347 females. The sex ratio at birth was 988 females for 1000 males. There were 84 abortions of which 60(71.4%) were induced and 24 (28.6%) were spontaneous. The reason stated for induced abortions was related to sex of the child in 31(51.7%) of the cases and in 26(83.9%) of these, the abortions were induced to prevent the birth of a female child. There was a preference for male children in the study families. Gender bias and its implications are discussed. Keywords: Abortions, Sex ratio, Slums
How to cite this article:
Tragler A. A study on sex ratio at birth in suburban slums of Mumbai. Indian J Public Health 2011;55:128-31 |
There has been a steady decrease in the sex ratio in India from 972 in the 1991 census to 933 females' per1000 males in the 2001 census. [1] Fertility decline has been accompanied by a rapid decrease in female births.
Both cultural preferences and social practices favor the birth and survival of one sex over the other. [2],[3],[4] Available data however reveal the use of prenatal sex determination techniques (PNDT), notably sonography, as the major cause of decreased female births. There is little information on the prevalent sex ratio at birth in slums of Mumbai and other cities. This study was undertaken to determine the sex ratio at birth and factors that might affect it in selected families of suburban slums in Mumbai.
A Community based study was conducted in 4 slum communities situated in Western and Eastern suburbs of Mumbai. The slum communities studied were accessible to the investigator through outreach community health program. Families were selected using the following criteria:1) Married couples living in the area for two or more years 2) Couples that were married at least 5 years and having children 3) Couples in the age group of 23-35 years. These criteria would help in defining current practices of reproductive couples with children in a stable population. There were 302 consenting families who met our selection criteria. The study was conducted in a period of 4 months, from January to April 2010.
A structured, pre-tested interview schedule was used covering the socio-economic data and other characteristics of the community. It included history of births, abortions, still births and questions on sex preferences of children. The preferred sex and the desired number of children irrespective of the actual children had, was noted as the sex preference. The reasons for induced abortions were obtained. Sex selective abortions (SSA) were abortions performed after the sex of the fetus was predicted by sonography. Knowledge of the PNDT Act and family planning acceptance were also studied. Those responsible in the decision making of the number of children and sex of children was recorded. Sex Ratio was defined as the number of females per thousand males. Sex ratio at birth was calculated for total births and also for each birth order.
The questionnaire was translated into Hindi as this language is accepted by a multi lingual slum community living in Mumbai. From each couple the wife was preferably interviewed. The respondent were approached and interviewed by home visits, after obtaining a signed informed consent. The data collection was done by health workers and social workers who were trained to conduct the study. The staff members were closely associated with the community for two or more years. The statistical analysis of frequency distribution was computed and a percentage was drawn and tabulated on it. Confidentiality was maintained of all records. Permission for conducting the study was obtained from the Ethics and the Research Committee of the Institution.
A total of 302 families participated in the study. There were 282 (93%) female respondents, 13 (4%) male respondents while 7 were jointly answered by husband and wife. Of the total, 169 (56%) were Hindus, 64 (21%) Muslims, 34 (11%) Christians, 33 (11%) were Buddhist and 2 (1%) were of other religions. The data on education level of the husbands revealed that 267 (88%) of them were literate, 53 (18%) had completed primary education, 184 (60%) secondary education, 29 (10%) were college educated. Of the wives 207 (85%) were literate, 168 (56%) had secondary education. Of all respondents 149 (49%) were from Maharashtra, origin of others were from Northern states 84(28%), 56 (19%) were from Southern states and 13 (4%) were from other regions of India. Most of the families were of low socio-economic status.
Of the respondents 205 (68%) lived in chawls and 93 (32%) lived in hutments. Decision about the number and sex of children was in the majority, 218 (72%), a combined decision of husband and wife, but in 70 (24%) the in-laws were part of decision making. Husbands alone, and wives alone were also decision makers regarding the above in 14 cases.
The majority of the respondents (58.3%) were in favor of one male and female child. A preference for at least 2 males was seen in 76(25%). The preference for two females was 26 (9%), while 16 (5%) wished for 2 males and 2 female children and 8 (3%) had no sex preference. In 91(30%) of the families there were no daughters while in 63(21%) families there were no sons. Family Planning was practiced by 216 (72%) respondents. There were 84 (28%) abortions of which 24 (21%) were spontaneous, and 60 (79%) were induced. Of the induced abortions, 15(25%) were for medical reasons, 31 (52%) were sex selective abortions (SSA) and 14 (23%) were induced to reduce the number of siblings.
Education levels of husbands and wives of (SSA) group were compared to the rest of the study families [Table 1]. In husbands SSA clearly decreased with higher level of education The SSA was (13.8%) and (11.5%) in the illiterate and Primary level respectively as compared to the (10.3%) and (3.3%) at secondary school and college level In wives the same relationship was seen except SSA was slightly increased (16.7%) as compared to the illiterate group (10.4%) In both the study group and the SSA group 47% of the families had knowledge of the PNDT Act. | Table 1: Distribution of Study Subjects according to education level of husband and wife
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In those having induced abortions for medical reasons only four cases had sound medical reason and did not have any living child. In the rest medical reasons were minor illness or just 'weakness'. In those having sex related abortions, 26 (84%) of the 31 stated they had the abortions to avoid the birth of a female child, and all of them had two or more female children. In three cases (10%) there was one previous male child; still the induced abortion was carried out to avoid the birth of a female child. The others had no male child. There were 2 stillbirths and 4 under five deaths in the last 5 years.
Of the 698 births, 351 were males and 347 were females giving a sex ratio at birth of 988 females to a 1000 males [Table 2]. In the first birth order there were more males to females (163 males to 132 females). But in succeeding births, females were more than males. Regarding spontaneous abortions 18 of the 24 were in the first and second order while 56 of the 60 induced abortions were in the third fourth and fifth order. | Table 2: Distribution of Sex Ratio at Birth and Abortions by Birth Order
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The study was carried out in a population that was of low socio- economics status, a multi religious group and of various native places, characteristics prevailing in many slum areas. In this study the sex ratio at birth was 988. The all India sex ratio of the 2001 census is 933. The sex ratio in the first birth was 810. This is higher than that found in the urban community of Delhi. [2] The findings revealed that SSA decreased with increase in the level of education. This is clearly demonstrated incase of husbands. In wives the same relationship is revealed except SSA is slightly more (16.70 among wives with primary education as compared to the illiterate wives (10.4%) Lower levels of literacy and higher illiteracy was found in sex selective abortion cases as compared to the rest of the study population. This differed from the study reported by Akoijam and coworkers [3] where there was an association of sex selective abortions with higher literacy. Even illiterate couples were having sex selective abortions in this study. Families of low socio economic status living in slums also had sex selective abortion in this study. Studies have shown that gender bias is not motivated by economic hardship but rather by cultural factors. [4] With increasing birth order the number of female children increased. It could be stipulated that the families with daughters had more children with the hope of having sons. This leads to an increased number of female births, a paradoxical gain for the female population. Family planning was acceptable to the majority. Induced abortion was unfortunately a method of family planning in 23% of the induced abortions.
A history of abortion was reported in 28% of the families. Of these 79% were induced abortions. Both these are higher than found in the Manipur study. [3] Spontaneous abortions were seen in earlier birth orders while induced were more after the birth of two children. In the majority (84%) of the sex selective abortions it was reported that the abortion was carried out to prevent the birth of a female child. Female feticide is evidence of the "missing girls" theory in this study population. [5] The scenario has shifted from female infanticide to female feticide. It is more convenient and not easily detected. Sex selective abortions are being carried out despite the governments' efforts to increase its measures to enforce the PNDT Act. [6] The latest census records a drop of the female population in the Maharashtra state in the last decade.
The overall implication of a decreased sex ratio and female feticide is the low value of the girl child, the resulting exploitation of women and violence against women. The health implications of gender bias result in higher girl child mortality and morbidity. [7] A concern has also been raised of social unrest that may result from unequal population of sexes. [7]
In this study population, a preference for the male children was documented by the fact that the preference for two male siblings was higher than for two female siblings and there were more families with no daughters as compared to those with no sons . The prevailing gender bias for male children is one of the major problems in the Indian societyth also documented by other studies. [8] India on the whole is a patriarchal society. Women too value their sons more, as they perceive the son to be a major source of support in the future. Women are inculcated often by women themselves to believe their value is attached to men.
No amount of legal steps can make a difference as much as social reforms and awareness in the society. Awareness programs should include both husband and wife together with extended family as they take part in decision making of the family constellation. Society needs to accept women as vital member of the family. Most importantly, women need to believe in themselves.
This study in selected families of suburban slums of Mumbai depicted a strong preference for male children, that sex selections abortions were being carried out in this population and the majority of the sex selective abortions were to prevent the birth of a female child. The study hopes to be an eye opener for Mumbai and other urban centers regarding sex selective abortions and the resulting sex discrimination. Social reforms, better enactment of government legislation, commitment of the medical profession, awareness programs and media interventions for upliftment of women, will go a long way to put a brake on sex discrimination and sex selective abortions.
| Acknowledgment | |  |
The author wishes to acknowledge with gratitude the Management, the Research Department, The Ethics Department of the Bandra Holy Family Hospital also the director and staff of the Navjeet Community Health Center and specially to health workers ,Naseema Khan, Arifa Shaikh, Luiza Dowling and for technical support to Jacinta Saunur and Chiara Paoli.
| References | | |
| 1. | Census of India 2001. Available from: http://www.censusindia.net [Last accessed on 2010 Nov 4]. 
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| 2. | Khanna R, Kumar A, Vaghela JF, Srinivasan V, Puliyet JM. Community based Retrospective study of sex in infant mortality in India. BMJ 2003;327:126-30.
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| 3. | Brogen AS, Shantibala K, Rajkumari B, Laishram J. Determination of Sex Ratio by birth order in an urban community in Manipur. Indian J Public Health 2009;53:13-7.
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| 4. | Arnold F, Kishore S, Roy TT. Sex selective abortions. Popul Dev Rev 2002;28:759-85.
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| 5. | Coale AJ. Excess Female Mortality and the balance of sexes in the population: An estimate of the number of "Missing Females ". Popul Dev Rev 1991;17:517-23.
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| 6. | The Preconception and Prenatal Diagnostics Techniques (Prohibition of sex selection Act, 1994 9 Act No. 57 of 1994) [as amended by the Prenatal Diagnostics Techniques (Reg. and Prevention of misuse) and Act 2002] (Act 14 of 2003).(PNDT Act) The Gazette of India, 2011.
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| 7. | Chan CL, Yip PS, Ng EH, Ho PC, Chan CH, Au JS. Gender Selection in China: its meaning and implications. J Assist Reprod Genet 2002;19:426-30.
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| 8. | Sudha S, Indaya RS. Female demographic disadvantage in India 1981-1991. Sex selective abortions and female infanticide. Dev Change 1999;30:585-618.
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[Table 1], [Table 2]
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