Context: Skewed sex ratio in India and the flaws in data about Sex ratio at Birth.
Sample Registration System (SRS):
- Registration of births and deaths is an important source for demographic data for socio-economic development and population control in developing countries. The data on population growth, fertility and mortality serves as the starting point for population projections.
- Apart from these vital indicators, an adequate evaluation of a number of programs in the health sector, including family planning, maternal and reproductive health, immunization programs, is dependent upon the availability of accurate, up-to-date fertility and mortality data.
- With a view to generate reliable and continuous data on these indicators, the Office of the Registrar General, India, initiated the scheme of sample registration of births and deaths in India popularly known as Sample Registration System (SRS) in 1964-65 on a pilot basis and on full scale from 1969-70. The SRS since then has been providing data on regular basis.
- The main objective of SRS is to provide reliable estimates of birth rate, death rate and infant mortality rate at the natural division level for the rural areas and at the state level for the urban areas. Natural divisions are National Sample Survey (NSS) classified group of contiguous administrative districts with distinct geographical and other natural characteristics. It also provides data for other measures of fertility and mortality including total fertility, infant and child mortality rate at higher geographical levels.
Health Management Information Systems (HMIS): HMIS are one of the six building blocks essential for health system strengthening. HMIS is a data collection system specifically designed to support planning, management, and decision making in health facilities and organizations.
- Sex ratio is used to describe the number of females per 1000 of males.
- In the Population Census of 2011 it was revealed that the population ratio in India 2011 is 940 females per 1000 of males.
- At the same time Child Sex ratio (Age group 0-6 years) has reduced from 927 in census2001 to 914 in census 2011.
Recent Data findings by SRS:
- 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.
- 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.
- At present, about 5% of girls are ‘eliminated’ before they are born, despite the promises of the Beti Bachao Beti Padhao scheme.
- 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.
- 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.
- There are flaws in HMIS data. These are mostly incomplete and not representative of the country as a whole as births happening in private institutions are under-reported. This is one of the reasons that NITI Aayog used SRS data in its report ‘Performance of health outcomes’ in December 2016.
- It is criminal to use public funds to privilege boy births and facilitate discrimination against girl right from birth. However, for years, in the special neonatal care units (SNCU) set up by the government, there was an excess of about 8% male children in several States.
- There is problem with the implementation of PCPNDT Act. With the reach of technology to the core of Indian society, the sex ratio is in decline even in rural areas.
Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act (PCPNDT Act):
- The Census data indicate that the female ratio has been declining at an alarming rate and would lead to serious socio-cultural problem including violence and population imbalances. The Child Sex Ratio (CSR) for the age group of 0-6 years as per the 2011 Census has declined to 914 girls as against 927 per thousand boys (Census 2001).
- The issue of survival of the girl child is a critical one, especially in the conservative Indian Society. This therefore, needs a systematic effort in mobilizing the community. In order to check gender biased sex selection, the Pre-natal Diagnostic Techniques (Regulations and Prevention of Misuse) Act, 1994 was enacted and brought into execution from 1st January, 1996.
- Main objective: The main purpose of enacting the act is to ban the use of sex selection techniques before or after conception and prevent the misuse of a prenatal diagnostic technique for sex-selective abortion.
- Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994 (PNDT), was amended in 2003 to The Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act (PCPNDT Act) to improve the regulation of the technology used in sex selection. The Act was amended to bring the technique of pre conception sex selection and ultrasound technique within the ambit of the act. The amendment also empowered the central supervisory board and state level supervisory board was constituted.
Conclusion: Gender bias and deep-rooted prejudice and discrimination against the girl child and preference of the male child have led to the misuse of technology for gender biased sex selection leading to demographic imbalance in the last two decades. The declining child sex ratio in India is a major concern for all. The government has prioritized an 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 improving the known gender gaps at birth rather than be just showing off with dubious claims.