New Study Shows Fewer Female Births in India’s Future

A new study predicts that there will be 6.8 million fewer female births compared to male births in India between 2017 to 2030, due to the country’s strong preference for sons and falling fertility rates.

Using a model to project sex ratios at birth (SRB) — the ratio of the number of boys to girls born in a given period — in 29 Indian states, researchers predict that, in 2030, the SRB in India will range from 1.035 to 1.16 across states and will be significantly higher than 1.05 in 16 of them. Under natural circumstances, 105 to 107 boys are born for every 100 girls, putting the expected SRB for any country at 1.05.

The preference for a son is the single largest driver of sex-selective abortions. When the study looked at son-preference intensity, 17 out of 21 states showed a positive correlation with SRB. Unsurprisingly, it was found to be the strongest in nine states, all in the northwest of India, where patriarchal norms are deeply rooted.

From his field trips across India, Dr. Sabu George, India’s leading activist against the practice of sex selection, has seen a swelling of clinics that offer sex determination tests.

Fetal gender determination test has been banned under Indian law since 1994, but enforcement is uncommon. A 2017 study observed doctors in North India offering their services to families in rural areas to determine the sex of the fetus, followed by an immediate abortion if the fetus was a girl. Even as ultrasound clinics are mandated to be licensed and to keep records of scans, they are rarely ever monitored, and violators — if caught — are let off with a small fine or granted bail. Conviction rates are also low: only 203 doctors have been convicted by courts from 2003 to 2014 out of 2,316 registered cases.

The problem, said Dr. George, is that sex selective abortion is not seen as violence. “Disregard for the law and the intrinsic levels of violence against women are ignored.”

The practice of sex-selective abortions in India took hold in the ’70s after abortion became legalized. The Medical Termination of Pregnancy Act of 1971 was brought into law so that women were not burdened with unwanted pregnancies caused by rape, failure of contraception, or pregnancies that posed a risk to the mother or unborn child. But this act inadvertently became a tool for discrimination against girls: The country started seeing a sharp decline in the SRB.

To combat this practice, the Pre-Conception and Pre-Natal Diagnostic Techniques Act (PCPNDT Act) was enacted in 1994 to ban fetal gender determination tests. But the PCPNDT Act remains largely on paper and is disregarded in most parts of the country.

“The real concern is of malpractice by medical professionals and corporates,” said Dr. George. “Before, North India was bad and South India was good. But now, the practice of sex selection is getting worse across India.”

With exception to the states of Maharashtra, Haryana and Rajasthan — where the PCPNDT act has been strictly implemented in recent years — Dr. George expects most other states to show a decline in sex ratio.

The study projects widely different trends in sex ratio in different states, however. The SRB in Chhattisgarh in central India and in Kerala in the south are projected to be lower than 1.05 — meaning that the number of boys and girls born will be almost equal. Six states — Haryana, Uttar Pradesh (UP), Uttarakhand, Gujarat, Punjab, Delhi, and Rajasthan — are projected to have the highest imbalance, with the SRB significantly higher than 1.10. UP, the most populous state, is projected to have 2 million missing female births, almost a third of the total.

“UP has always preferred sons,” said Dr. Alice Evans, a lecturer in the social science of development at King’s College in London and a faculty associate at the Harvard Center for International Development. “Across India, son preference has worsened due to falling fertility and rising wealth. If women only have one or two children, they want to be especially careful to have a son.”

In India, parents depend on sons to support them as they age and to continue the family line. In the past, it was common for couples to have as many as four to ten children. Couples would have many children and used sex-selective abortions until they had the desired number of sons. But in the last 30 to 40 years, the number of children per family has reduced to two to four.

“Earlier the third or fourth girl fetus was aborted,” said Dr. George. But as families became smaller, he added, even the first girl fetus would have been aborted.

The total fertility rate (TFR), or the number of children expected to be born to a woman during her reproductive years, also influences sex-selection practices. In India, the TFR fell from 4.2 in the ’70s to 2.2 in 2017. Research shows that a decrease in TFR increases the practice of sex selection, causing an imbalanced SRB.

In some states, as the fertility declined, the study found that the SRB was also projected to decline.

The northeastern state of Assam — considered a unique case considering its lack of strong correlation for son preference compared to the northwestern states — is one of four states in which the SRB was projected to decline with a decrease in TFR. The SRB here (which was almost normal — with equal number of boys and girls — until the late ’90s when fertility rates started falling) is projected to show a greater increase toward males than any other state in the next decade.

“The total fertility rate in Assam was already low,” said Sandhya Gautam, a program manager at the Center for Health and Social Justice in Delhi, who works in Assam with local partners.

“Since the [state] government introduced the two-child norm last year, we are seeing an increase in the practice of sex selection. When the first child is a girl, then the second child is terminated if the test shows that it is a girl again.”

Gautam believes the two-child norm is punitive: those who hold government jobs are either not promoted or not allowed the benefit of government schemes if they have more than two children. “Everyone wants a son,” she said. “With the introduction of the two-child norm, the female fetus is compromised.”

According to the most recent census, in 2011 there were 914 girls to every 1,000 boys nationally, but in some northwestern states, that number dropped below 850. In the state of Haryana, the SRB was of particular concern: The imbalance was so great that men could not find women to marry, and brides were bought and broughtfrom other states.

In 2015, the Center for Social Research, an advocacy group based in Delhi, introduced community watch groups in the five worst-affected districts of Haryana, under the Beti Bachao Beti Padhao(“Save the Daughter and Educate Her”) campaign, a Government of India campaign to protect and empower the girl child.

The watch groups followed the course of every pregnancy and monitored births in communities with low sex ratios. They also checked the activities of ultrasound centers and created awareness on biased sex-selection practices through street plays and campaigns with the help of locals and field personnel.

As a result of the ongoing program, there has been an observable reduction in the practice of sex selection, said Dr. Manasi Mishra, coordinator of the community watch program. The number of girls born was expected to improve from 830 in 2015 to 924 this year based on quarterly reports sent by the districts to the government.

But since April of this year, because of the lockdown and reduced mobility due to the global pandemic, the groups have been unable to monitor the communities, resulting in an increase of ultrasound clinics. “In Ambala district of Haryana, a man was recently caught doing the rounds in several villages conducting sex-selection from a mobile van,” said Dr. Mishra. Reports from the district indicate that the number of girls born has subsequently dropped from 924 to 890.

Dr. George has observed the same issue with monitoring in Delhi. “Last year, the government conducted 400 inspections of ultrasound clinics between April to June. This year, only 11 were conducted in the same period.”

The implementation of certain rules of the PCPNDT Act was also suspended in April until June 30 — a notification from the Ministry of Health and Family Welfare stated it was “in view of the emergency situation arisen due to the pandemic Covid-19” and the countrywide lockdown.

Three rules of the Act were suspended: one requiring labs and clinics to re-register when their licenses were due to expire; another, to send a complete report of all pregnancy-related procedures conducted every month; and a third that mandates appropriate authorities to send quarterly reports to the government and maintain information on all practitioners.

Dr. Sital Kalantry, clinical professor of law and director at Cornell Law School, said that the government was trying to create a balance between the law and the pandemic as reporting is cumbersome.

“The reporting requirement does not mean anything,” she said. “Revealing the gender of the fetus is still illegal. But mobile vans and illegal operators violating the law do not report anyway.” She added that the impact of the suspension of rules would be very minor, as implementation of the Act itself has not been effective.

Dr. George disagrees and views the suspension as a deliberate obstruction of the law. “The next census will give us an idea of its impact, but we are going to see big declines in sex ratio across India,” he said.

The study is a red flag that highlights the need for interventions in the practice of sex selection. Dr. Chao said she hopes the study will make policymakers and the general public aware of the possible female birth deficits that will occur in the coming decade. “They should make use of our projections and help with their policymaking and planning.”

Going forward, Gautam said that local administrations will have to be more vigilant about sex selection, surveil clinics strictly, and take action when needed. “More importantly, social value systems that lead to discriminatory practices against girls and preference for sons need to be addressed,” she said, through awareness campaigns and creating economic opportunities for women.