India has long been characterised by wide gender disparities and a strong preference for sons, historically manifested in postbirth disparities in feeding and health care patterns that raised the mortality of daughters as compared to sons, resulting in unbalanced sex ratios in favour of boys over girls. Since the 1980s, with the increasing availability of prenatal diagnostic technologies, postbirth discrimination has given way increasingly to prenatal gender-biased sex selection. As a result, sex ratios at birth have become skewed far beyond the normal ratio of 105 male births per 100 female (or 952 female births per 1000 male). In 2012, the sex ratio at birth stood at 908 female births per 1000 male. Furthermore, the child sex ratio in 2011 had plummeted to 918 females aged 0–6 per 1000 males from an already dismal 927 in 2001, and 945 in 1991. Persistently adverse sex ratios remain a challenge in India despite the 1994 Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act. Nevertheless, from 2001 to 2011 shifts to less adverse levels occurred in a few states, particularly in the north-western states of Haryana and Punjab, in which sex ratios had been particularly adverse.
Given the observed improvements in some districts, India is in a position to address the question: what works to counter adverse sex ratios in some parts of the country? However, knowledge about the reasons for these changes remains sparse. The objective of this report is to shed light on programmes and practices that may have resulted in improved sex ratios at birth in districts that recorded very adverse ratios a decade ago. Thus a comparison is made of two districts in Haryana which reported extremely adverse sex ratios in 2001, but in one case (Sonipat) showed no change in these ratios over the 2001–2011 period, while the other (Kurukshetra) displayed some improvement.
Comparisons are drawn from three perspectives, assessing their experiences and attitudes: first, women who had given birth in the recent past; secondly, health care providers engaged in delivering ultrasound or reproductive health services; and finally, those implementing programmes intended to enhance the survival and value of the girl child (for example, conditional cash transfer programmes) and those implementing programmes intended to reverse son preference. This report explores the extent to which the selected districts differ in their implementation of initiatives intended to enforce the PCPNDT Act, build gender equality, and promote advocacy, communication and community mobilisation.
The results are by no means conclusive, but provide insights into the potential for change in sex ratios at birth and what works to improve these ratios. The findings show that a full array of interventions is likely to be necessary: implementation of the PCPNDT Act; entitlements and conditional cash transfers for girls; communication, advocacy and community mobilisation efforts to change gender inegalitarian norms and discourage gender-biased sex selection. Even so, key informants from both districts expressed a belief that while entitlements and conditional cash transfer programmes for girls were effective in enhancing girls’ access to education and delaying their marriage, they were unlikely in the short run to influence parents’ willingness to have a (higher order) daughter or only-daughter family, although their longer-term impact should not be discounted.
Perhaps the most promising finding, observed consistently and distinguishing Kurukshetra from Sonipat, is the importance of communication, advocacy and community mobilisation efforts, which were more vigorously implemented and wide-ranging in Kurukshetra than in Sonipat. The evidence is strong: interpersonal communication by frontline workers, discourses by religious leaders, regular efforts by public health officers to connect with communities at the village level and in schools and colleges on a regular basis, all aiming to change norms and attitudes and raise awareness of the law, clearly distinguished the district in which improvement in the sex ratio at birth was observed from the one in which no such change was observed. The findings thus offer tentative support to the conclusion that while privileges for girls and implementation of the law are important, concerted efforts towards communication, advocacy and community mobilisation are essential to transform gender norms and discourage gender-biased sex selection.
Jejeebhoy, S.J.; Acharya, R.; Basu, S.; Francis Zavier, A.J. Addressing gender-biased sex selection in Haryana, India: promising approaches. Population Council, New Delhi, India (2015) xvi + 114 pp.