A Study to Assess the Knowledge about Decreasing Sex Ratio, and Attitude towards Female Foeticide of Pregnant Women Attending Antenatal OPD, in Selected Hospitals of Raichur

Proforma for Registration of Subjects for

Dissertation

K. Sandhya Rani

Navodaya College of Nursing Raichur, 2007 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidate: K. Sandhya Rani and address M.Sc. nursing (I year) Navodaya College of nursing Navodaya nagar Mantralayam road Raichur.

2. Name of the institution: Navodaya College of nursing

3. Course of study and subject: M.Sc. nursing (I year) Obstetrics and Gynaecology

4. Date of admission: 26-05-2007

5. Title of the topic:

“A Study to Assess the Knowledge about Decreasing Sex Ratio, and Attitude towards Female Foeticide of Pregnant Women Attending Antenatal OPD, in Selected Hospitals of Raichur”. 6. Brief Resume of the Intended Work 6.1 Need for the Study:

“A Woman is one of GOD’S greatest and complex creations”

“ELIMINATE INEQUALITY, NOT WOMEN DESTROY DOWRY, NOT DAUGHTERS DAUGHTERS ARE NOT FOR SLAUGHTER” 5

The constitution of India guarantees equality to women. It empowers the states to adopt measures for affirmative discrimination in favour of women and also impose a fundamental duty on its citizens to uphold the dignity of women but despite all this, India’s deep rooted “sons only” ethos continues and girls and women face inequity and inequality every where. They are devalued as human beings from the day they are born but what is worse is that they are even denied the right to be born if their families do not wish them to be born.1

India is a patriarchal society where men are seen as the role models and are the ones to look after the parents in the old age. Many as “watering the neighbours’ plants” see giving birth to a girl child and the birth of a male child is looked at as “feather in the cap” with great pride and joy.2

Women interests’, experiences and concerns are often rendered invisible or even inadequately voiced in decision making, effectively excluding them often from key decisions that affect the lives of their families and communities.2

New developments in medical technology have helped to improve health care for millions of people. One cheap and widely available test can determine the sex of the child, so blatant is our gender injustice that modern techniques for determining fetal abnormalities are being misused to detect the sex of the growing fetus in the mothers womb and are often followed by selective abortions when the results declare that the fetus is a female.2

The census report of 2001 presents a grim reality indicating an imbalance in the ratio of female& male. It is a common fact that the sex ratio in India is lower than the international standards i.e. sex ratio in India is 933 while world average is 986.1

The child sex ratio is calculated as the number of girls per 1000 boys on the 0- 6 years age group. The 2001 census reported a child sex ratio of 927 girls per 1000 boys. Therefore, there are 73 “missing girls” for every 1000 boys in India. The cultural preference for sons rather than daughters has skewed the sex ratios in India.2

According to the shocking statistics published in “times of India” June 1982, approximately 78,000 female fetuses were aborted in our country between 1978-1982 after sex determination test. According to another agency 40,000 female fetuses were aborted in Bombay city alone in 1984 adds a non-governmental agency, approximately 20 lakh female fetuses are aborted every year in India. Methods used to know the prenatal sex of a fetus are chorion villous biopsy, amniocentesis and ultrasonography.3

Data from 2001 census reveal that the sex ratio at birth may have increased by 6% points in India since 1985 and in some parts by 20% points data from the national family welfare health survey of 1998-1999 show that while the use of prenatal diagnostic techniques have become fairly common on only a minority misuses them for aborting female fetuses. 4

Prenatal diagnostic techniques act was enacted in 1994 as a result of pressure created by forum against sex-determination and sex- pre-selection, but it was not implemented after another decade of campaigning by women’s rights organizations and public interests litigation filed by CEHAT, MASUM and Dr. Sabu George. The PNDT (regulation and prevention of misuse) amendment act 2002 received the assent of the president of India on 17-0-2003 the act provides for the prohibition of sex selection, before and after conception and for the regulation of prenatal diagnostic techniques for the purposes of detecting genetic abnormalities or metabolic disorders and for the prevention of their misuse for sex determination leading to female foeticide and for the matters connected there with or incidental there to the PNDT (regulation and prevention of misuse) amendment rules 2003 have activated the implementation machinery to curb nefarious practices contributing for MISSING GIRLS. We have a great task in front of us i.e. to change the mindset of doctors and clients, to create a socio-cultural milieu that is conducive for girl child’s survival and monitor the activities of commercial minded techno-docs thriving on sexist prejudices then only we will be able to halt the process of declining sex ratio resulting into deficit of girls or women.5

6.2 Review of Literature:

One of the major functions of review is to ascertain what is already known in relation to a problem of interest. Review of literature is a written summary of the state of existing knowledge on a research problem. It involves systematic identification, location, scrutinization and summary of written material that contain information on a research problem.6

A descriptive study was conducted to assess the knowledge of women about decreasing sex ratio and attitude towards female foeticide of pregnant women in selected hospitals of Ludhiana. Fifty pregnant women were chosen for the study by purposive random sampling technique. Data was collected by using structured questionnaire. The study results showed that 80 percent of the pregnant women had below average knowledge about decreasing sex ratio and its affects.7

A descriptive study was conducted to assess the preferences of male child among women in selected areas of Chandigarh. The sample of 373 females was chosen for the study by purposive sampling technique. Data was collected by structured questionnaire and interview schedule. The study showed that 209 i.e. 56 percent married women prefered male child.8

A prospective study was conducted to assess the attitude of graduates regarding use of prenatal diagnostic techniques for sex selection in U.S two hundred and forty two U.S. graduates were selected for the study by purposive sampling technique. Data was collected by using a questionnaire. The study results showed that one third i.e. 31 percent of them supported the use of some kind of sex selection technology in conceiving children although the study did not breakdown preferences regarding methods.9

A descriptive study has been conducted to assess the awareness of rural couples about sex ratio. Fifty couples under he age of 45 years were randomly selected to make a total sample size of 100 couples. Data was collected by a structured questionnaire. The results showed that 74% females and 64% males had no knowledge about the sex ratio and 41% males and 36% females cited female foeticide as the main reason for the imbalanced sex ratio. The study concluded that Eighty one percent males and sixty five percent females felt that the major problem due to imbalanced sex ratio would be due to non- availability of brides.10

A retrospective study was conducted to compare the expected and observed sex ratio of babies born to women with one previous live birth and women with two all singleton pregnant women at Hong Kong; Chinese. Two thousand six hundred and four women of parity 1 and seven hundred and fifty two women of parity 2 were chosen for the study. The results of the study showed that the sexes of the children of parity 1 women and the sex distribution of their newborns were consistent with the predicted values. The parity 2 women were more likely to have 3 children, off their previous children were of the same sex (P- value < 0.001). The study concludes that the parity 2 women attending one antenatal clinic had 3 pregnancies because of socio-economical or environmental reasons. Thus the biological or parental factors were unlikely to be important in influencing the sex of the newborn. 11

6.3 Statement of the problem:

“A Study to Assess the Knowledge about Decreasing Sex Ratio, and Attitude towards Female Foeticide of Pregnant Women Attending Antenatal OPD, in Selected Hospitals of Raichur” 6.4 Objectives of the study:

1. To assess the knowledge of pregnant women about decreasing sex ratio.

2. To assess the attitude of pregnant women towards female foeticide.

3. To find out the relationship of attitude of pregnant women towards female foeticide with variable. i.e. age, education, religion, occupation, married for years, family income, parity and source of information and area to which mother belongs. .

6.5 Operational definitions:

1. Pregnant women attending antenatal OPD: Refers to all antenatal mothers attending the antenatal OPD for a routine checkup.

2. Knowledge: It refers to the level of understanding of pregnant women regarding female foeticide and decreasing sex ratio.

3. Decreasing sex ratio: It is the ratio of the male child and the female child wherein the number of female death rate is higher than that of male due to unwanted or devalued female births i.e. imbalanced sex ratio of male: female, which would lead to non availability of bride.

4. Attitude: it refers to the specific behaviour or opinion or view of female foeticide and decreasing sex ratio. 5. Female foeticide: death of the female growing fetus in the womb of the mother.

6.6 Selected variables:

1. Age: Refers to the chronological age of the women. For the present study it is categorized as a) 21-25yrs b) 26-30yrs c) 31-35yrs d) 36-40yrs e) Above 40yrs

2. Education: It refers to the training that helps to cultivate the mental abilities of the clients. For the present study education is divided into the following categories a) 5th -10th standard b) Intermediate c) Graduation d) Post Graduation and above

3. Religion: Refers to their spiritual belief. For the present study religion is categorized as a) Hindu b) Muslim c) Christians d) Others 4. Occupation: It refers to a job or a profession of a women. For the present study occupation is categorized as a) Housewife. b) Working women

5. Type of family: It refers to the family type. For the present study it is categorized as a) Joint c) Nuclear

6. Duration of married life: It refers to the number of years of their marriage. For the present study it is categorized as a) 1-5 years b) 6-10 years

7. Family income: It refers to the monthly earnings of the family. The following ranges of income are taken for the present study a) Rupees 1001 to 3000/month b) Rupees 3001 to 5000/month c) Rupees 5001 to 7000/month d) Rupees 7001 to 9000/month e) Rupees 9001 and above

8. Parity: refers to the number of times a mother had delivered live baby after the completion of 38 weeks of gestation. For the present study parity is categorized as a) Primi Para b) Para 2 c) Para 3 d) Para 4 e) Para 5 and above

9. Source of information: It refers to the media through which the information was gathered. For the present study it is categorized as a) Mass media b) Literature c) Health Team Member d) Family Members

10. Area which the mother belongs to: it refers to the place which the mother belongs to and for the present study it is categorized as a) Rural b) Urban

6.7. Hypotheses

H1 - There will be significant association between the age and the knowledge of the pregnant women about decreasing sex ratio and their attitude towards female foeticide.

H2 - There will be significant relationship between the educational status and the knowledge of the pregnant women about decreasing sex ratio and their attitude towards female foeticide. H3 - Significant relationship will be there between the religion with regard to the knowledge of the pregnant women about decreasing sex ratio and their attitude towards female foeticide.

H4 - Significant relationship will be there between the occupation with regard to the knowledge of the pregnant women about decreasing sex ratio and their attitude towards female foeticide.

H5 - There will be significant relationship between the type of family and the knowledge of the pregnant women about decreasing sex ratio and their attitude towards female foeticide.

H6 - Significant relationship will be there between the duration of married life with regard to the knowledge of the pregnant women about decreasing sex ratio and their attitude towards female foeticide.

H7 - Significant association will be there between the family income with regard to the knowledge of the pregnant women about decreasing sex ratio and their attitude towards female foeticide.

H8 - There will be significant relationship between the parity and the knowledge of the pregnant women about decreasing sex ratio and their attitude towards female foeticide.

H9 - There will be significant relationship between the source of information and the knowledge of the pregnant women about decreasing sex ratio and their attitude towards female foeticide. H10 - Significant association will be there between the area hich the mother belongs to with regard to the knowledge of the pregnant women about decreasing sex ratio and their attitude towards female foeticide.

6.8 Limitations

This study is limited to pregnant women  Who are willing to participate in the study.  Who are attending the antenatal OPD.  Who are able to read and write Kanada, Telugu or English.

6.9 Projected outcome:

The present study gives us insight into the knowledge level of pregnant women about the decreasing sex ratio and female foeticide and their attitude towards it so that the researcher can take steps to educate women and make them aware about the same.

7. Materials and methods

7.1. Sources of data:

Design: A descriptive survey design will be adopted for conducting the present study.

Setting of the study: The study will be conducted in the antenatal OPD of selected hospitals in Raichur Population: The population of the study comprises of pregnant women attending the antenatal OPD irrespective of the number of pregnancies and the weeks of pregnancy.

Sample: Based on the selection criteria 100 pregnant mothers who are attending antenatal OPD are selected for conducting the study.

Sampling technique: A purposive sampling technique was used to select the hospital and convenience sampling will be used to choose the subjects.

Inclusion criteria: The study includes pregnant mothers who are 1. Attending antenatal OPD at selected hospitals in Raichur 2. Willing to participate in the study 3. Available at the time of data collection 4. Able to read and write Telugu, Kannada or English.

Exclusion criteria:

The study excludes pregnant mothers who are

1. Not attending antenatal OPD at selected hospitals in Raichur 1. Not Willing to participate in the study 2. Not Available at the time of data collection 3. Not Able to read and write Telugu, Kannada or English 7.2 Data collection instrument.

A structured questionnaire will be developed about pregnant women regarding their knowledge and attitude towards decreasing sex ratio and female foeticide

It consists of three parts

Part I: Deals with demographic data or personal information about age, education, religion, occupation, duration of marriage, family income, type of family, number of children, source of information and area which she belongs to.

Part II: deals with the knowledge related items i.e. decreasing sex ratio, causes of declining sex ratio and its affects, and problems related to female foeticide.

Part III: Deals with assessing the attitude, which is concerned with the belief, interests, ideas of person and also his behavior.

7.3 Data collection method

After obtaining prior permission for data collection from the selected hospital authorities and with consent from the subjects, the investigator will assess the knowledge and attitude of pregnant women attending antenatal OPD regarding decreasing sex ration and female foeticide. 7.4 Plan for data analysis

Data analysis will be done with the help of descriptive and inferential statistics.  Descriptive statistics will be used to describe the background characteristics of pregnant women.  Testing the level of significance will be done with inferential statistics like chi- square test.  Co-efficient co-relation will be used to identify relationships between knowledge with selected variables.  Five point LIKERT SCALE will be used to asses the attitude of the pregnant women towards the female foeticide.

7.5. Does the study require any investigations or interventions to be conducted on patients of other humans of animals? If so, please describe briefly?

Since it is a descriptive study, the study does not require any investigation or intervention to be conducted.

7.6 Has ethical clearance been obtained from your institution in case of 7.5?

Ethical clearance has been obtained from the institution research committee. 8. List of References:

1. Kaura, Girjashankar (2001), “Female foeticide on rise”. THE TRIBUNE. June 23rd.

2. Meenu anand, “female foeticide- a quest for survival”, SOCIAL WELFARE. September 2004 Pg. 5.

3. Dr. Neelam Singh MBBS MD (OBG),”Lynching women- female Foeticide” HEALTH ACTION. June 1998. Pg. 25.

4. P.N. Mari bhat, A.J.Francis zavier; “factors influencing the use of PNDT and sex ratio at birth in India. ECONOMIC AND POLITICAL WEEKLY. June 16TH 2007. Pg.2292.

5. Missing………mapping the adverse child sex ratio in India, office of the registrar general and census commissioner, Indian ministry of health and family welfare and U.N population fund. 2003. Pg. 3

6. Denise F. Polit, Benedeth P Hungler. Nursing Research Principles and methods. 6th Edition. Philadelphia. Lippincott Company; 1999.

7. Sarna, kamla, “decreasing sex ratio and pregnant women’s attitude towards female foeticide” NURSING JOURNAL OF INDIA. April 2005. Pg.13-20: 52(1). 8. “Gender preferences and awareness regarding sex determination among married women in slums of Chandigarh”. INDIAN JOURNAL OF COMMUNITY MEDICINE. Vol 32 No.1 (2007-01 to 2007-03).

9. Gilroy F.D, Steinbacher.R, “Sex selection technology utilization, further implications for sex ratio imbalance”.SOCIAL BIOLOGY.1991 fall-winter 38(3- 4)285-8.ISSN:0037-766X

10. Esther A gosh, Rita Goel and Shanti Balda.”awareness of rural couples about sex ratio” JOURNAL HUMAN ECOLOGY. 18(2) Pg. 167-168 (2005).

11. Wong, S.F, Ho lc ”sex selection in practice among Hong Kong, Chinese” SOCIAL SCIENCE AND MEDICINE. August 2001. Vol 53 No.3 Pg. 393-397 ISSN:0277- 9536 9. Signature of the Candidate :

10. Remarks of the Guide :

11. Name and Designation of 11.1. Guide : Mrs. Sreelekha. C Assistant Professor Department of Obstetrics and Gynecology Navodaya College of Nursing 11.2. Signature :

11.3. Co- Guide (if any) :

11.4. Signature :

11.5. Head of the Department : Mrs. Sreelekha. C Assistant Professor Department of Obstetrics and Gynecology Navodaya College of Nursing 11.6. Signature :

12.1. Remarks of the Chairman : and Principal

12.2. Signature :