Sex-Selective Abortion Continues to Widen India's Gender Divide

By Ronnie Cohen

April 19, 2021

(Reuters Health) - A cultural preference for sons has led to an increasing number of sex-selected abortions throughout India - resulting in as many as 22 million fewer female births over 35 years, new research shows.

Since ultrasound began being used to reveal the gender of fetuses, from 1981 until 2016, between 13.5 million and 22.1 million fewer girls were born in India than researchers would have predicted based on a natural gender birth ratio, The Lancet study found.

"Female feticide is quite common and increasingly widespread in India, and it's moving to the second and third child and to many more states," senior author Dr. Prabhat Jha told Reuters Health in a phone interview.

The gender imbalance is worsening and appears in almost all states in India, said Jha, professor of global health at the University of Toronto. He urged the government to include questions about birth gender on an upcoming census and in local population registries.

In an accompanying editorial, Rohini Pande, a Maryland social demographer and gender expert who has worked in public health in India, called for increased opportunities for girls and women and an end to a patriarchal system that fuels daughter aversion.

"It's clear that circumstances, attitudes and opportunities need to change so that girls and women have real choices with what to do with their lives in ways they can be an asset to themselves and their families, rather than being considered a burden to everyone," she said in a phone interview.

After examining 2.1 million births, or 1.5% of all births in India, in nationally representative household surveys over 35 years, Jha and his team estimated 13.5 million female births were missing based on a conservative estimated natural sex ratio of 950 girls for every 1,000 boys.

The number of missing female births climbed from 3.5 million between 1987 and 1996 to 4.5 million between 1997 and 2006 and jumped again to 5.5 million between 2007 and 2016.

The researchers calculated an annual average of more than half a million missing female births a year in India in the most recent time frame, from 2007 to 2016.

When the researchers applied a natural sex ratio of 975 girls per 1,000 boys to their calculations, they estimated that 22.1 million female births were missing in India over the 35 years.

The study showed deficits of girls at all birth orders, but more than half of missing female births were second-born or third-born births following an earlier daughter or daughters.

"The social consequences of the imbalance are going to be quite profound," Jha said. He cited a scarcity of eligible brides and increasing violence against women.

In 1994, the Indian government prohibited revealing the sex of an unborn child in the Pre-Conception and Pre-Natal Diagnostic Techniques Act (https://bit.ly/3dnbZVm). But doctors have developed ways to signal the gender of their fetuses to expectant parents, Jha said.

"Aborting girls in India is big business," he said.

He would like the research to trigger discussion and debate about the practice of sex-selective abortion. He also suggested identifying the mothers of daughters and placing them under surveillance to prevent them from selectively aborting female fetuses.

"Sounds very Handmaid's Tale," said Pande, who was not involved with the study. "What are you going to do, prevent her from getting an ultrasound? Then you're taking away her right to choose a health service. I think that is a nonstarter."

Wealthy women would hire lawyers to put a stop to surveillance, while poor women would be subject to it, she predicted.

Banning the technology that enables sex-selective abortion might narrow the gender gap at birth, Pande said. But she added: "It's not a guarantee that the girls will be treated equally as well as their brothers because of the underlying patriarchal system that still has a hold."

While working in Western India, Pande met a woman who left her baby daughter to die. When Pande asked the mother why, she explained she already had 12 daughters, and her mother-in-law insisted she continue to get pregnant until she bore a son. What kind of life would her 13th daughter have, the woman asked.

"It's not just a question of banning the ultrasound machines," Pande said. "It's a question of pulling up our sleeves and tackling the underlying issue of women and girls in our society."

SOURCE: https://bit.ly/3at486X and https://bit.ly/3dhTMbN The Lancet, April 8, 2021.

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