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Factors Affecting Sex-Selective Abortion in India

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Factors Affecting Sex-Selective Abortion in India NATIONALFAMILYHEALTHSURVEY B w U w L w L w E w T w I w N International Institute for Population Sciences Factors Affecting Sex-Selective East-West Center Population and Health Studies Abortion In India Number 17 irth histories collected during India’s first and second National Family Health January 2003 Surveys (NFHS-1 and NFHS-2) show an unusually large proportion of male ISSN 1083-8678 Bbirths in some population groups, which suggests that female fetuses are being aborted. Normally, about 105 boys are born for every 100 girls in a population, resulting in a sex ratio at birth of about 1.05. In India as a whole, the sex ratio at birth This NFHS Bulletin summarizes findings was 1.06 during 1978–92, the 15-year period covered by NFHS-1. It rose to 1.08 during from India’s first and second National 1984–98, the 15-year period covered by NFHS-2, but this is still not much higher than Family Health Surveys, conducted in the biological norm. 1992–93 and 1998–99, respectively, There is, however, considerable variation in the sex ratio at birth among certain under the auspices of the Indian Ministry population groups. The sex ratio at birth is particularly high in certain western and of Health and Family Welfare. The northern states, in families that have daughters but no sons, and among women with surveys provide national and state-level a high level of education and media exposure. In a few states, the sex ratio at birth is estimates of fertility, infant and child unusually low in families that have sons but no daughters, indicating some selective mortality, family planning practice, abortion of boys. This issue of the NFHS Bulletin describes how geographic, socio- maternal and child health, and the economic, and demographic factors affect sex-selective abortion in India and goes on utilization of services available to to assess some likely trends. mothers and children. NFHS-1 interviewed 89,777 ever-married Sex-selective abortion: The current situation women age 13–49, and NFHS-2 In India as a whole, an estimated 5 to 6 million abortions occur annually. Abortion was interviewed 89,199 ever-married women legalized in 1971 with the Medical Termination of Pregnancy Act. As revised in 1975, age 15–49. Both surveys collected the act allows medical termination of pregnancy (i.e., abortion) for any of the following information on a range of demographic reasons: (1) the pregnant woman has a serious disease or medical condition that would and health topics. endanger her life if the pregnancy were to continue; (2) the fetus has substantial risk The International Institute for Population of physical or mental handicap; (3) the pregnancy resulted from rape; (4) the socioeco- Sciences (IIPS), Mumbai, conducted the nomic circumstances of the mother would endanger the health of the newborn child; or surveys in cooperation with consulting (5) the pregnancy occurred because of failure of a contraceptive method. organizations and population research This last reason, in effect, legalizes abortion on demand—but only for married centers throughout India and with the women. Among unmarried women, contraceptive failure is not grounds for abortion. East-West Center in Honolulu, Hawaii, Sex-selective abortion is a two-step process involving determination of the sex of and ORC Macro in Calverton, Maryland. the fetus followed by abortion if the fetus is not of the desired sex. Methods for The U.S. Agency for International determining the sex of a fetus became available in India in the 1970s. Three such Development (USAID) supported both methods are commonly used: amniocentesis, chorionic villus sampling, and ultrasound. surveys, and the United Nations Children’s Fund (UNICEF) provided Robert D. Retherford and T. K. Roy additional funding for NFHS-2. The Robert Retherford is a Senior Fellow and Coordinator of Population and Health United Nations Population Fund Studies at the East-West Center. T. K. Roy is a Senior Professor and Director of the (UNFPA) supported this analysis International Institute for Population Sciences. Professor Roy was a Visiting Fellow and the publication of this report. at the East-West Center when this report was prepared. 2 National Family Health Survey Bulletin, No. 17 Soon after these tests were introduced, NFHS-2 on the sex ratio at birth as an in- other characteristics included in the analy- they were aggressively advertised and direct indicator of sex-selective abortion. sis has a significant effect independent became widely available. In 1984, however, Several different factors may influence of other variables. a broad-based coalition of women’s levels of sex-selective abortion, con- groups, civil-liberties groups, and health founding the effect of any single variable. State and region. In many states, espe- organizations established the Forum For this reason, the effects of specific cially in the south of India, the sex ratio at Against Sex Determination and Sex Pre- variables are estimated using logistic re- birth is close to 1.05, indicating that sex- selection. This organization monitored the gression to control for the effects of other selective abortion is rarely practiced. But growing use of sex-determination tests for variables. Births are the units of analysis. in some states, mostly in the west and the purpose of sex-selective abortion and The following predictor variables are north, the ratios are very high, indicating agitated to outlaw the use of the tests for included in the analysis: a composite vari- a great deal of sex-selective abortion. this purpose. As a result of these and able indicating both child’s birth order and For 1984–98, NFHS-2 estimated sex ra- other efforts, the national government its mother’s number of living sons before tios at birth at 1.14 in Haryana and 1.20 in banned the practice in 1994 with the Pre- its birth; mother’s education; mother’s Punjab. Compared with national statistics natal Diagnostic Techniques Regulations media exposure; urban/rural residence; from other countries, Punjab has one of and Prevention of Misuse Act. religion; caste/tribe; household standard the highest sex ratios at birth in the world, This legislation specifies that: (1) only of living; mother’s age at childbirth; and indicating a very high level of sex-selec- government-registered clinics or labora- the five-year period in which the birth tive abortion. tories may employ prenatal diagnostic took place. Separate analyses were con- procedures that could be used to assess ducted for India as a whole and for 17 Birth order and number of living sons. the sex of a fetus; (2) no prenatal diagnos- states grouped into four geographic re- NFHS-2 results show clear evidence of tic procedures may be used unless there gions—west, north, east, and south. abortion of girls among second and third is a heightened possibility that the fetus The characteristics associated most births to women who already have daugh- suffers from a harmful condition or genetic strongly with a high sex ratio at birth, af- ters but no sons (Figure 1). National-level disease; and (3) “no person conducting ter controlling for the other variables, are results from NFHS-1 do not show this prenatal diagnostic procedures shall com- state and geographic region, child’s birth pattern, indicating a trend toward greater municate to the pregnant woman con- order and mother’s number of living sons, use of sex-selective abortion during the cerned or her relatives the sex of the fetus and two socioeconomic characteristics— six years between the surveys. by words, signs, or in any other manner.” mother’s education and mother’s media ex- In states where evidence of sex-selec- The law is easy to circumvent, how- posure. At the national level, none of the tive abortion is strong, NFHS-2 found ever. Private laboratories and clinics are not monitored as closely as government 1.14 1.13 facilities, and ultrasound is not monitored 1.12 as closely as the other tests. And despite 1.10 1.10 the restrictions, many doctors continue 1.08 to communicate the sex of the fetus to 1.06 1.06 parents who want to know. They do so 1.06 1.05 verbally rather than in writing, and they 1.04 Sex ratio atSex birth often raise the cost of the test to compen- 1.02 sate for the legal risk. 1.00 1 son 0 sons 2 sons 1 son 0 sons Who is practicing sex- Second-order births Third-order births selective abortion? Figure 1 Predicted values of sex ratios for second- and third-order births by Much of the evidence on the spread of mother's number of living sons before the birth: India, 1984–98 (NFHS-2) sex-selective abortion is anecdotal. There Note: Values of the sex ratio at birth are predicted by logistic regression. In the calculation, are no reliable statistics on the practice at predictor variables other than the composite variable, birth order × number of living sons, are either the state or national level. This held constant at their mean values. analysis uses data from NFHS-1 and Source: Retherford and Roy 2003. 3 National Family Health Survey Bulletin, No. 17 particularly high sex ratios for births to 1.12 women with daughters only. Among third- 1.10 1.10 order births to women with two daugh- 1.08 1.08 ters but no sons, the sex ratio at birth is 1.08 1.72 in Punjab, 1.57 in Haryana, 1.56 in 1.06 1.05 Delhi, and 1.28 in Maharashtra. 1.04 In three states, NFHS-2 also found evi- ratio atSex birth dence of sex-selective abortion of male 1.02 fetuses.
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