Child Sex Ratio in Kerala – A report

As per the census 2011, child sex ratio in India has decreased further to 914 as compared to 927 according to 2001 census raising deep concerns nationally.
In Kerala, Child Sex Ratio remained more or less the same during the decade – 960 as per 2001 census and 959 as per 2011 census (1). The child sex ratio in Kerala from its figures appears to be natural and within normal limits. The population sex ratio in Kerala has increased favoring females from 1058 in 2001 to 1084 in 2011 suggesting no significant gender discrimination resulting in mortality from the available statistics.
Sex selective abortions following prenatal diagnostic tests are widely been considered as the possible reasons for declining child sex ratio. Kerala is now with the highest Human Development Index among other states in India. From the available sources and statistics, it could not be suggested that sex selective abortions are prevailing in Kerala. PNDT Act is well implemented in Kerala and bringing about overall restrictions on abortions on this ground will not be the right solution for any anticipated decline in child sex ratio. Restrictions on abortion will adversely affect and discriminate women especially of the lower socio economic strata as it restricts a service that is required only by women (2). We have learnt from history that restrictions on abortions have increased the risk for mortality and morbidity of mothers from unsafe and illegal abortions. The more deep rooted causes for son-preference and other social determinants / reasons have to be addressed if we need to improve the child sex ratio or overall social position of a girl child or woman.
To make a valid comment on child sex ratio, knowing the sex ratio at birth is essential. Even further, changes in mortality rates for girls and boys from the age 0 to 6 years has to be studied over the years to know the trend to understand various factors that may contribute to changes in child sex ratio. Statistics from SAT Hospital (Mother & Child Hospital), Government Medical College, Trivandrum from January 2010 till date suggests a sex ratio at birth of around 958 female babies per 1000 male babies which is within normal / expected range.
It is a natural phenomenon that around 105 male babies are born for every 100 female babies without any human intervention. This would translate to a Child Sex Ratio of 952 female babies to 1000 male babies. A study conducted in 24 countries during the period 1962 and 1980 showed a natural child sex ratio of 934 to 952 female babies for every 1000 male babies as normal (3).
Studies show that more male babies are naturally lost through miscarriages and still births. As antenatal care improves and as more trained birth attendance and institutional delivery is available to women, there could be a mild increase in number of male babies born as compared to female babies (4).
In Kerala the Total Fertility rates (TFR) has dropped significantly to 1.71. It is a biological phenomenon that more male babies are born in the first delivery and as the order of pregnancy increases, the chance for a male baby decrease (5, 6). When TFR decreases, it means that families are limiting their size and hence children of higher order are less in number bringing down the number of female children. Further, as families tend to stop child bearing soon after getting a boy child, in this scenario, there is a chance of decline in the child sex ratio.
Literature shows there are even other factors affecting child sex ratio. It is reported as a biological phenomenon that when the birth intervals are short, there is a high probability of having a male baby (7). In societies like Kerala, where the usual practice is to complete the family very fast with one or two children and undergo permanent contraception, the chance for a low child sex ratio is possible. Timing of conception is also said to have some connection with sex of the baby. It has been reported that chances for a male baby is more when conceived during the initial and last days of menstrual cycle (8 - 10).
To summarize, there are several factors that play its role in deciding the child sex ratio. In-depth studies are needed to understand the various social determinants and behaviors that lead to son-preference and neglect of girl child in India. Such studies could guide policies and programs to improve the status of a girl child in the society. Sex selective abortions if at all present cannot be controlled effectively by just restricting abortions which will rather restrict access for women to safe termination of pregnancy. The key to improving the child sex ratio and respect for daughters is by addressing Gender Discrimination as a whole.
In Kerala, there is no such significant data that points to a decline in child sex ratio or to a prevalence of sex selective abortion following pre-natal diagnostic tests.
References
1. Census of India 2011: http://www.censusindia.gov.in/
2. Sundari Raveendran TK. India’s Declining Female Sex Ratio: Sex-selective abortion and other reasons: Document prepared for CommonHealth in partnership with Action Research and Training for Health (ARTH), Center for Health and Social Justice (CHSJ) and Sahaj (Society for Health Alternatives).
3. Chahnazarian A. Determinants of sex ratio at birth: review of literature. Social Biology 1988; 35: 214:35
4. Bhat PN Mari. Factors influencing the use of prenatal diagnostic techniques and the sex ratio at birth in India. Economic and Political Weekly, June 16, 2007:2292-2303
5. Erickson JD. The secondary sex ratio in United States 1966-71: associations with race parental ages, birth order, paternal education and legitimacy. Annals of Human Genetics 1976; 40: 205-12
6. James WH. The human sex ratio. Part 1: a review of the literature. Human Biology 1987; 59: 721-52.
7. James WH. Interpregnancy intervals, high maternal age and seasonal effects on the human sex ratio. Human Reproduction 1996; 11:7-8.
8. James WH. Sex Ratio, coital rate, hormones and time of fertilization within the cycle. Annals of Human Biology1997; 24(5), 403-9.
9. Sieff DF. Explaining biased sex ratios in human populations: a critique of recent studies. Current anthropology 1990; 31(1), 25-48.
10. James WH. The status of the hypothesis that the human sex ratio at birth is associated with the cycle day of conception. Human Reproduction 1999; 14: 2177-80.

Prepared by: Dr. Praveen G Pai, MPH Scholar, Achutha Menon Center for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala in consultation with various faculty of Achutha Menon Center for Health Sciences Studies.