Context

The sex ratio at birth (SRB) has been dropping continuously since Census 2011, coming down from 909 girls per thousand boys in 2011-2013 to 896 girls in 2015-2017 as per the SRS Statistical Reports. 

Facts

• Female foeticide continues to increase at an alarming rate, as per the Sample Registration System (SRS) data released for the period 2015-2017

• In the 2014-2016 period, of the 21 large States, only two — Kerala and Chhattisgarh — had an SRB of above 950 girls per 1000 boys. Thus at present, about 5% of girls are ‘eliminated’ before they are born

Data problem

• Niti Aayog acknowledged the seriousness of the problem in its latest report.

• Despite all the officially acknowledged facts, WCD Minister claimed in the Lok Sabha that SRB has improved from 923 to 931 girls. She was quoting data from the Health Management Information System (HMIS), a fundamentally flawed source that largely considers home deliveries and births in government institutions.

• Data from the HMIS are incomplete and not representative of the country as a whole as births happening in private institutions are under-reported. 

• The report itself acknowledges that based on the estimated number of births, the number of reported births is much less in both the years considered — 2015-16 and 2018-19.

Different data sources

• The differences among the three points of delivery become evident when SRB is calculated using data from National Family Health Survey-4 (NFHS-4). Of the 2.5 lakh reported births in the 2010-2014 period, the distribution of births at home, government hospitals and private hospitals was 21%, 52% and 27% respectively and the corresponding SRB figures were 969, 930 and 851

• Thus, private hospitals had a disproportionate excess of male children births, which the HMIS sample excludes

• Sources in the Niti Aayog confirmed that they did consider HMIS data but found after statistical examination that it was unreliable and therefore used SRS.

• Even when we only consider institutional deliveries in government hospitals, the SRB is falling. 

• The worst regional SRB for government sector was for Northern India (885 girls per thousand boys). 

• The picture was somewhat better for Central India (926) Southern India (940) while the performance of Eastern India (965) and Western India (959) was even better.

• In the Northeast, where the government is the dominant health-care provider, the government sector SRB rivaled that of the private sector (both are 900).

• That data for the private sector are more skewed has not been articulated in the NFHS reports or adequately dealt with by the Health Ministry. For two decades, in private hospitals, too often, there were more male children even when the total number of births was small in number.

• In the special neonatal care units (SNCU) set up by the government, there was an excess of about 8% of male children in several States. The government has prioritized the expansion of SNCUs rather than deal with the issue of the ‘missing girls’. 

• Protecting the integrity of birth statistics will help the people, governments and health professionals to focus on ameliorating the gender gaps at birth

Bias over first-born child

• An analysis of the NFHS-4 data also revealed a bias when it comes to the first-born child — the SRB is among first-born children was 927, meaning that 2.5% of first-born girls are eliminated before birth

• Field visits in Uttar Pradesh and Bihar revealed a massive expansion of ultrasound clinics even in remote corners. And in the absence of stringent implementation of the PCPNDT Act, practically anyone who wants to determine the sex of the foetus is able to get it done illegally. 

Insights

• Increased deterrence in States like Maharastra, Haryana and Rajasthan in recent years has been undermined by the laxity of the biggest States.

• Central Supervisory Board established under the PCPNDT Act has not met for over one-and-a-half years. It should have ideally met at least thrice during this period.

Supreme Court has been continuously reminding medical associations since 2002 of their obligation to follow the law, its latest reminder being the 92-page judgment against the Federation of Obstetrics and Gynecological Societies of India (FOGSI) earlier this year. The Indian Medical Association (IMA) has to ensure that private hospitals don’t profit from discrimination against girls before birth.