|Year : 2007 | Volume
| Issue : 3 | Page : 212-214
The disappearing girl child: Possible role of sterilizations as a method of family planning
Sanjiv Kumar Bhasin, NK Saini, VK Trikha, ID Joshi
Department of Community Medicine, UCMS and G T B Hospital, Dilshad Garden, Delhi, India
|Date of Submission||03-Jul-2006|
|Date of Acceptance||01-Jun-2007|
Sanjiv Kumar Bhasin
Department of Community Medicine, UCMS and G T B Hospital, Dilshad Garden, Delhi - 110 095
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bhasin SK, Saini N K, Trikha V K, Joshi I D. The disappearing girl child: Possible role of sterilizations as a method of family planning. Indian J Community Med 2007;32:212-4
|How to cite this URL:|
Bhasin SK, Saini N K, Trikha V K, Joshi I D. The disappearing girl child: Possible role of sterilizations as a method of family planning. Indian J Community Med [serial online] 2007 [cited 2019 Dec 9];32:212-4. Available from: http://www.ijcm.org.in/text.asp?2007/32/3/212/36833
| Introduction|| |
The sex ratio in India has constantly been unfavorable to women. Although the 2001 census  figures show it to be marginally better than the previous census figures, yet there was a marked decline in child sex ratio (0-6 years) from 945 females per 1000 males in 1991 to 927 in 2001. The anti-female bias is not limited to poor-performing states but also to better-performing states. There are a number of important demographic factors (e.g., sex composition of the previous children, birth order of children and sex differentials in mortality, etc.) which are responsible for this declining sex ratio. A little lesser talked about factor is the possible role of sterilizations performed under the National Family Welfare Programme. The present study was aimed at finding out possible relationship of sterilizations as a method of family welfare with the declining sex ratio.
| Materials and Methods|| |
The present study is based on records obtained from an old-pattern PHC of the state of U.P. covering a population of about 5 lakhs. The PHC is in process of being upgraded to a CHC. Since this PHC is in close proximity to Delhi, there has been a rapid influx of migrants from other parts of U.P. and Bihar, which has resulted in a big increase in the population covered by it. The details of sterilization operations performed in the last 7 years, i.e., 1999-2006, were analyzed and are being presented. These operations were performed at this PHC once a week by a district-level team of experts.
| Results|| |
[Table - 1] depicts the number of sterilizations as per birth order and percentage of female children. Out of a total of 2,371 sterilizations, maximum sterilizations were done at birth order 3 (46.5%), followed by birth order 4 (31.5%) and 5 (11%). Only in some cases, sterilizations were done at birth order 2 (7.1%). Tubectomy accounted for almost all of these sterilizations (98%).
An analysis of the sex composition of children at different birth order sterilizations revealed that the percentage of sons was maximum at birth order 2 (72.8%), and then it gradually decreased up to birth order 5 (54%), after which the percentage of daughters increased. The detailed sex composition of families has also been depicted in detail in [Figure - 1]. [Figure - 2] depicts the scatter plot with best line of fit using simple linear regression analysis taking percentage of daughters as independent variable and birth order as dependent variable. The regression coefficient was found to be highly significant ( P <0.01).
| Discussion|| |
The deficit of women in the Indian population has been known at least since the first synchronous census conducted in the British-occupied parts of India in 1881. Analysis of results of successive censuses has witnessed a male-favoring sex ratio. The situation took a new turn when results of 2001 census were published. While the overall female sex ratio slightly improved, the child sex ratio fell dramatically. The decline in sex ratio has been more in prosperous and highly literate states of the country. In the state of U.P., from where the data has been taken, the sex ratio as per 2001 census was 898 females per 1000 males, and the child sex ratio was 916 girls per 1000 boys in the 0-6 years age group.
Various reasons which have been propagated for the adverse sex ratio are imbalanced sex ratio at birth, female feticide and higher rate of mortality among girls due to social discrimination.  Preference of sons and practice of dowry are important reasons for sex-selective abortions, which have been well documented and also confirmed by NFHS-2. 
One of the lesser-probed reasons for adverse child sex ratio is the role of sterilizations done under the National Family Welfare Programme. The NFHS-II data shows that out of 42.8% couples who were using modern methods of contraception in India, 36% were using terminal methods.  Among terminal methods also, female sterilization constitutes an overwhelming majority and the same was also observed in this study. The priority of terminal methods over other family planning methods under the National Family Welfare Programme has been continuing for long for achieving targets of the program. Is it true that people wait for a male child to be born before accepting a terminal method and thereby effectively preventing birth of a girl child? The intention behind preventing further pregnancies is derived from the desire for acquiring sequential or compositional family goals and has a direct influence on the sex ratio at birth, which declines in women using permanent methods of family planning. It indicates that sterilizations are used after getting a child with the preferred sex (which obviously is a male). 
Our data indicates that 96.2% of sterilizations were carried out with more male children in their family, thus effectively avoiding the birth of a girl child. The law of probability would have ensured almost equal male and female offspring, but selective sterilization and the compulsion to limit the family size is disturbing the natural course of events. In other words, by performing sterilizations with more male children in the family, the National Family Welfare Programme is also contributing to the decrease in sex ratio.
The data also shows that 7.2% of couples accepted sterilization after limiting family size to 2 children as per the policy promoted by the government, and this proportion is going to increase further. Thus if more couples adopt permanent method after two children, then as per the proportion of male children in the presented data, the sex ratio will be more disturbed.
Our analysis also revealed that the population of sons remained high from birth order 2 (72.8%) till birth order 5 (5.4%). The maximum number of sterilizations in our study was seen at birth order 3, i.e., 1,103 out of 2,371 (46.5%). At birth order 3, the percentage of daughters was only 34.7%. Thus couples who underwent permanent method of sterilization had much lesser number of female than male children, thereby altering the sex ratio in favor of male children. Moreover, it also indicated that the couples waited for the sons to be born before deciding for tubectomy. The possible reasons for higher proportion of males at birth order 1-5 could be natural or deliberate in the form of sex-selective abortions, as has been noted by many studies throughout the country. 
Promotion of spacing methods over terminal methods could be one way to deal with the situation. Another solution could be to provide terminal methods only to those couples who have at least one female child in the family. But these measures may hamper the population-control measures, and further discussions are needed on this subject.
| Limitations of the study|| |
Since it was a record-based study, other demographic variables affecting child sex ratio could not be studied.
| References|| |
|1.||Census of India, 2001. Available from: http://www.censusindia.net. |
|2.||Bandyopadhyay M. Missing girls and son preference in rural India: Looking beyond popular myth. Health Care Women Int 2003;24:910-26. |
|3.||National Family Health Survey (NFHS-2) 1998-99. International Institute for Population Sciences. IIPS: Mumbai; 1999. |
|4.||Shekhar C, Malaviya A. understanding Sex Ratio at Birth in India. Mumbai: IIPS: 2005. Available from: http://www.iipindia.org/rtk/ar/apdx3.pdf. [Last assessed on 2007 may 10]. |
|5.||Oommanb N, Gantara BR. Sex selection: The systematic elimination of girls. Reprod Health Matters 2002;10:184-8. |
[Figure - 1], [Figure - 2]
[Table - 1]