Indian Journal of Public Health

: 2010  |  Volume : 54  |  Issue : 4  |  Page : 209--212

A hospital-based study on knowledge, attitude and practice of pregnant women on gender preference, prenatal sex determination and female feticide

R Kansal1, Khan Amir Maroof2, R Bansal3, P Parashar4,  
1 Associate Professor, Department of Gynaecology and Obstetrics, Subharti Medical College, Meerut, India
2 Lecturer, Department of Community Medicine, University College of Medical Sciences & GTB Hospital, Delhi, India
3 Professor and Head, Department of Gynecology and Obstetrics, Subharti Medical College, Meerut, India
4 Professor and Head, Department of Community Medicine, Subharti Medical College, Meerut, India

Correspondence Address:
Khan Amir Maroof
Lecturer, Department of Community Medicine, University College of Medical Sciences & GTB Hospital, Delhi


India has witnessed a decline in sex ratio in the past few decades. A hospital-based cross-sectional study was carried out to find out the attitude toward gender preference and knowledge as well as practice toward prenatal sex determination and female feticide among pregnant women. A majority (66.0%) of the pregnant women did not show any gender preference, followed by male preference (22.2%) and female preference (11.8%). A high proportion, i.e. 84.7% and 89.7%, of the total subjects were aware that prenatal sex determination and female feticide is illegal, respectively.

How to cite this article:
Kansal R, Maroof KA, Bansal R, Parashar P. A hospital-based study on knowledge, attitude and practice of pregnant women on gender preference, prenatal sex determination and female feticide.Indian J Public Health 2010;54:209-212

How to cite this URL:
Kansal R, Maroof KA, Bansal R, Parashar P. A hospital-based study on knowledge, attitude and practice of pregnant women on gender preference, prenatal sex determination and female feticide. Indian J Public Health [serial online] 2010 [cited 2020 Nov 27 ];54:209-212
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Full Text

Sex ratio, an important social indicator measuring extent of prevailing equity between males and females in society, is defined as the number of females per one thousand males. Changes in sex ratio reflect underlying socioeconomic and cultural patterns of a society. There is a strong preference for sons in many societies. [1] As per 2001 census, the sex ratio in the population age group of 0-6 years in India is 927 females/1000 males. [2] About 70% of all abortions performed in Delhi are terminations due to the fetus being female. [3]

A shortage of girls would lead to a shortage of eligible brides thus making the girl a "scarce commodity." This trend which definitely manmade is very dangerous and needs to be reversed otherwise there will be serious negative social consequences.

Most of the factors that compel people to favor a male offspring are social and religious in origin. With the average family size decreasing rapidly and preference for male child remaining the same, the female population is showing a downward trend. The birth of female child is perceived as a curse with economic and social liability. [4] The proliferation and abuse of advanced technologies coupled with social factors such as dowry, concerns with family name and looking up to the son as a breadwinner, contributing to the low status of women, have made the evil practice of female feticide common in the middle and higher socioeconomic households, more so in the north Indian states. Advances in technology and diagnostic facilities have opened up avenue for the girl haters leading to serious disturbances in the sex ratio as a result of female feticide. Desire for male child manifests so blatantly that parents have no qualms about repeated, closely spaced pregnancies, premature deaths, and even terminating child before it is born. Female feticide resulting in a decline of the child sex ratio has led to enforcement of Preconception and Prenatal diagnostic Techniques (PNDT) act since February 2003.

In this light, studying the factors influencing sex selection in current scenario becomes relevant for placing a better intervention in this regard. The objective of the study was to find out the attitude toward gender preference and knowledge as well as practice toward prenatal sex determination and female feticide among the pregnant women attending the antenatal clinic of Gynecology and Obstetrics Department of C.S. Subharti Hospital, Meerut.

A cross-sectional, hospital-based, descriptive study was undertaken with 203 pregnant women who attended the antenatal clinic (ANC) of C.S. Subharti Hospital attached to Subharti Medical College, Meerut, Uttar Pradesh. Approval from the institutional ethics committee was taken before conducting the study. The study was carried out from January 2009 to September 2009. Data collection was done from February to August 2009. The sampling frame was the newly registered pregnant women attending the ANC OPD on the 3 days of the week during which the first author was one of the consultants in ANC OPD. A systematic random sampling method was employed to select the subjects wherein every alternate newly registered pregnant woman attending the ANC OPD was selected for the study. Only pregnant women were included in the study, pregnancy being defined as history of amenorrhea coupled with a positive urine hCG test and/or ultrasonologically confirmed pregnancy, or history of amenorrhea coupled with a clinically confirmed pregnancy. Emergency patients and patients already interviewed for this study once were not included in the study.

A pre-tested and pre-structured questionnaire was used to collect information on their knowledge and attitudes toward gender preference and female feticide. Verbal consent was taken before filling the questionnaire. The data were collected with the help of M.B.B.S. interns posted in the Gynecology and Obstetrics Department, after having trained them for the job. Cross checking of at least two completed forms daily was done randomly by the investigators on a regular basis to ensure good quality data collection. Strict confidentiality of the data and privacy of the patients was maintained. Data were entered in Microsoft Excel and analyzed using Analysis Tool Pak and Epi Info for Windows. The Chi-square test for proportions was used as the test of significance. Two-tailed P value of less than 0.05 was considered significant.

The total sample studied was 203 of the total eligible population of 221, as 18 (8%) refused to participate in the study. The mean age of the studied sample was 23.98 years (range from 19 to 35 years) and standard deviation of 3.02. Of the sample studied, 146 (71.9%) belonged to the rural area and 57 (28.1%) belonged to the urban area. A majority (43.8%) were educated up to high school, followed by intermediate (34.0%), and 22.2% were illiterate.

[Table 1] shows that about two thirds (66.0%) of the pregnant women did not show any gender preference, followed by male preference (22.2%) and female preference (11.8%). This finding is in contrast to that reported by Vadera et al.[5] and Puri et al.[6] who reported male preference as 58.5% and 56%, respectively. In our study, male preference is more as compared to female preference, but not as high as have been reported in the above-mentioned studies. Moreover, in the study done by Vadera et al,[5] it was not mentioned whether only two options (i.e. male and female child preference) were given for responding to the question of gender preference or "no preference" was also given as an option, which we have provided in our study, and a large proportion of the respondents opted for it. The study by Puri et al.[6] was conducted among the married women of slums of Chandigarh, not a hospital-based study like ours. This difference can also be due to the fact that these studies were done about 5 years back (i.e. in 2004) and there have been changes in the awareness regarding the prenatal sex determination and female feticide due to female empowerment, education, and job opportunities. In our study we have found a high awareness about these topics, so it implicates that this may be the reason for not having or disclosing so strong bias toward son preference as has been reported in these above-mentioned studies.{Table 1}

When the 45 women who preferred male child were asked about the reason for their preference, 51.1% cited the reason that they were already having female children before and now to balance the family they desire a male child. Surprisingly, about one-third (31.1%) gave no reason for their male preference. Among the other reasons given were that boys carried out the social responsibility (8.9%), propagate the family name (6.7%), and they can depend on son in old age (2.2%). When the 24 women who preferred a female child were asked the reason for their preference, 33.3% told that they already have male children and so now they desire female child and again an equal number of women did not give any reason for their preference. Among the other reasons cited were girls bring good luck (16.7%), propagate life (8.3%), and are more responsible (8.3%). It seems that a balanced family, i.e. having both sons and daughters in the family was more preferred among the respondents rather than having a strong unidirectional preference for male child. Those who were having female children preferred male child and those having male children preferred female child. Puri et al.[6] had reported a similar finding.

The present study found that 4 (2%) women already knew about the sex of the unborn child. Out of these, 2 were from urban and 2 from rural background. They had approached a Radio-diagnostic center and got an ultrasound done for detection of sex of fetus. They were not ready to reveal any further details. As for the remaining 199 women, when it was asked why they did not want to go for sex determination, 61.8% told that it was God's will and they had nothing to do with it, whereas 16.1% wanted a good surprise, 15.6% told that it's illegal and only 6.5% told that it is a sin to detect the gender of the child before birth.

A majority (74.9%) of the women were aware of female feticide. When asked whether they would go for female feticide if they could know that the fetus is a female, 92.6% responded in the negative, whereas 7.4% told that in such case they would like to go for female feticide. On trying to explore the reasons for not going for a female feticide if female fetus, the majority i.e. 51.06% responded their moral values as the reason, 29.79% said that since it is illegal, they would not go for it, and 19.15% gave no reason. It seems that morality has an upper hand in preventing female feticide rather than legal reasons.

Awareness about the social consequences of female feticide was also explored. Out of the 189 who responded, 36.28% said that it will result in social imbalance, 34.61% said that men would not find brides for marriage, 20.87% told that families cannot be run, and 8.24% told that there would be an increase in violence in families.

It was found that 84.5% of the total respondents, with 89.5% of urban respondents and 82.9% of rural respondents, were aware that prenatal diagnostic test is illegal and this urban-rural difference was statistically not significant. When the association between the awareness that prenatal diagnostic tests are illegal and education status was seen, it was found that 100% of the intermediate pass women, 78.7% of high school pass women, and 73.3% of illiterate women were aware about the illegality of prenatal diagnostic tests. This association was statistically significant [Table 2].{Table 2}

89.7% of the respondents were aware that female feticide is illegal. 100% of the urban respondents knew that female feticide is illegal and 85.6% of the rural respondents; the difference being statistically significant. As the education status improved, the awareness that female feticide is illegal also improved [Table 2].

This increased awareness about the illegality and immorality of gender selection may be a reason for not having or not disclosing so strong bias toward son preference as has been mentioned in the other studies.

Television (53.9%) followed by friends/relatives (36.1%) were the main source of information regarding female feticide for the study subjects followed by radio (15.7%), print media (13.6%), and doctors/paramedical staff (12.6%).

Government of India has taken several steps to improve the status of women in society. The steps primarily intend to provide them with greater opportunities for education and employment as well as empowering them with inheritance rights. This momentum in terms of improvement of the status of women in the society and to ensure effective implementation of the PNDT Act has to be maintained with further strengthening.


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