New research published Online First and in an upcoming Lancet shows that, in Indian families in which the first child has been a girl, more and more parents are aborting their second child if prenatal testing shows it to be a girl, presumably to ensure at least one child in their family will be a boy. These declines in girl to boy ratios are larger in better-educated and in richer households than in illiterate and poorer households, and now imply that most people in India live in states where selective abortion of girls is common. The Article is led by Professor Prabhat Jha, Centre for Global Health Research, Dalla Lana School of Public Health, University of Toronto, Canada, and colleagues from India, including the former Registrar-General of India, Dr Jayant K Banthia.

The 2011 Indian census revealed about 7•1 million fewer girls than boys aged 0-6 years, a notable increase in the gap of 6•0 million fewer girls recorded in the 2001 census and 4•2 million fewer girls recorded in the 1991 census. In this study, the authors analysed census data to determine absolute numbers of selective abortions and examined over 250,000 births from national surveys to estimate differences in the girl-boy ratio for second births in families in which the first-born child had been a girl.

They found that this girl-boy ratio fell from 906 girls per 1000 boys in 1990 to 836 in 2005; an annual decline of 0•52%. Declines were much greater in mothers with 10 or more years of education than in mothers with no education, and in wealthier households compared with poorer households. But if the first child had been a boy, there was no fall in the girl-boy ratio for the second child over the study period, strongly suggesting that families, particularly those that are more wealthy and educated, are selectively aborting girls if their firstborn child is also a girl.

After adjusting for excess mortality rates in girls, the authors' range estimates of number of selective abortions of girls rose from 0-2•0 million in the 1980s, to 1•2-4•1 million in the 1990s, and to 3•1-6•0 million in the 2000s. Each 1% decline in child sex ratio at ages 0-6 years implied between 1•2 and 3•6 million more selective abortions of girls. Selective abortions of girls are estimated at between 4 and 12 million over the 3 decades from 1980 to 2010.

The authors point out that the between the 2001 and 2011 censuses, more than twice the number of Indian districts (local administrative areas) showed declines in the child sex ratio compared to districts with no change or increases. They also point out that, the Indian Government implemented a Pre-Natal Diagnostic Techniques Act in 1996 to prevent the misuse of techniques for the purpose of prenatal sex determination leading to selective abortion of girls. Yet they add it is unlikely that this Act has been effective nationally.

The authors conclude: "The selective abortion of female fetuses, usually after a firstborn girl, has increased in India over the past few decades, and has contributed to a widening imbalance in the child sex ratio. Reliable monitoring and reporting of sex ratios by birth order in each of India's districts could be a reasonable part of any efforts to curb the remarkable growth of selective abortions of girls."

In a linked Comment, Dr S V Subramanian, Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA, and Dr Daniel J Corsi, Population Health Research Institute, McMaster University, Hamilton, ON, Canada, say: "The demand for sons among wealthy parents is being satisfied by the medical community through the provision of illegal services of fetal sex-determination and sex-selective abortion. The financial incentive for physicians to undertake this illegal activity seems to be far greater than the penalties associated with breaking the law."

They add that although efforts to reduce such sex bias have been successful in settings such as South Korea, it is troubling that the sex bias found among second-borns recorded in India has also been found among Indians living in the USA, where the same social pressures do not exist. They conclude: "This finding raises a difficult and provocative question for public policy: if no male biases are noticeable for the first born as is the case in India, should medical technology and services be allowed to play a part in letting a family plan their desired composition, especially when there is an active public policy effort to voluntarily limit family size to replacement level?"

Link to Article and Comment

Press conference

    Tuesday, May 24, 2011 from 11.30-13.30 hrs New Delhi Time.
    Taj Mahal Hotel,
    Room: Diwan-i-Khas, 1 Mansingh Road, New Delhi, India
    Mrs. Shailaja Chandra, Former Executive Director, National Population Stabilisation Fund; Former Secretary, Government of India; and Former Chief Secretary
    Government of Delhi, India

    Prof. Prabhat Jha, Director, Centre for Global Health
    Research, University of Toronto

    Prof. Rajesh Kumar, Head, School of Public Health
    Postgraduate Institute of Medical Education and Research, Chandigarh, India
The Lancet