Misuse of diagnosis

Misuse of diagnosis

In view of the skewed sex ratio, the Ministry of Health and Family Welfare has undertaken several measures to provide for the prohibition of sex selection. The need is for generating more awareness to protect the girl child

By Dr Vinay Aggarwal

India, the child sex ratio is defined as the number of females per thousand males in the age group 0–6 years.  Obviously, an imbalance in this age group will extend to older age groups in future years. Currently, the ratio of males to females is generally significantly greater than 1, i.e. there are more boys than girls.Sex ratio is an important and useful indicator to assess relative excess of deficit of men or women in a given population at that point of time. Sex differentials can be due to difference in mortality rate, migration, sex ratio at birth and at times the undercounting of women at the time of population enumeration.

With Prime Minister Narendra Modi’s initiative to the `Beti Bachao Beti (Save Girl Child), Haryana’s child sex ratio (0-6 age group) has recently crossed the 900 mark, for the first time in 10 years, in December 2015. This is a major jump since 2011, when census figures revealed the state had the worst sex ratio in the country -834.

As per reports, Sirsa topped the table with 999 girls per 1,000 boys in the state infamous for female feticide. Officials said 12 districts have recorded gender ratio of above 900.Panchkula has registered a sex ratio of 961 followed by Karnal (959), Fatehabad (952), Gurgaon (946), Sonipat (942), Jind (940), Rewari (931), Mewat (923), Bhiwani, Mahendragarh (912) and Hisar (906). The state overall recorded a sex ratio of 903.

The government has set a target to achieve a sex ratio above 950 within the next six months for the entire state. The Jhajjar has been recorded the lowest sex ratio. To complete the mission Save Child Girl, the state government has announced an award of Rs 1 lakh for each informer giving leads about illegal sex determination tests and termination of pregnancies. The drive helped counter female feticide. The govt has awarded 17 people whose information has yielded results.

Several reasons are attributed to the decline in the number of girls – neglect of the girl child, high maternal mortality, female infanticide and foeticide. Sex-selective abortions have been greatly facilitated by the misuse of diagnostic procedures such as amniocentesis that can determine the sex of the foetus.

The prejudice against the girl child continues to be an issue of concern for UNICEF in India, which, together with its partners conceptualized the project ‘Initiative to Reduce Sex determination & Pre-Birth Elimination of Females’ to address the problem of female foeticide. As a result of the project activities in Mandya district in the state of Karnataka, the issue of sex selection and female foeticide was put on the public agenda and created mass awareness among the people in both rural and urban areas.

According to the decennial Indian census, the sex ratio in the 0-6 age group in India went from 104.0 males per 100 females in 1981, to 105.8 in 1991, to 107.8 in 2001, to 108.8 in 2011. The ratio is significantly higher in certain states such as Punjab and Haryana (118 and 120 respectively as per the 2011 census).

The impact of the current skewed sex ratio with more male children than females is already being felt in some parts of India, and is likely to continue to be so felt.

Having less women of marriageable age will mean that a significant proportion of men will in the first instance have to delay their marriage. This will initially affect younger generations of men in their 20s. These men will not only be in surplus within their cohort (age group), but they will also face competition from a backlog of older, unmarried men, who will still be in the marriage market.

This problem will not be overcome simply by delaying marriage, due to the cumulative impact of the skewed sex ratio over several generations. Thus a proportion of men will in due course have to forgo marriage altogether. The poorest males will be disproportionately affected by this marriage squeeze. This may cause destabilization, and may translate into class-based tensions.

It is commonly understood that males and females in the population balance each other in number. Little do they know sexes are imbalanced in different population across the worlds .According to United Nation estimates, the world had 986 females against 1000 males in 2000. Except Indonesia and Japan, all other Asian countries have low sex ratios. However, most of the developed European countries have high sex ratio. Interestingly the sheer weight of the population of the four Asian countries, particularly China (944) and India (933) with low sex ratio contributes to the preponderance of males over fameless in world.

The Census has shown an increase in the sex ratio of total population from 927 in 1991 to 933 in 2001 thought it still needs further improvement. Eighteen states/UTs recorded sex ratio above the national average of 933, while remaining seventeen fall below this. Chandigarh and Daman & Diu occupy the bottom positions with less than 800 females per 1000 males. In rural India, sex ration is higher at 946 while in the urban areas there are only 900 females per thousand male populations. Migration of males to urban areas could be one of the reasons for lower sex ration in urban areas. Only Kerala and Pondicherry have sex ratio in favour of females for all the areas, Manipur has preponderance of females in urban areas.

 

Child Sex ratio (0-6 years)

The decreasing sex ratio in this age group has a cascading effect on population over a period of time leading to diminishing sex ratio in the country. One thing is clear – the imbalance that has set in at this early age group is difficult to be removed and would remain to haunt the population for a long time to come.

 

Though the national average for child sex ratio in the case of rural population is higher at 934 if compared to 906 of urban population, the position is not encouraging as this is also below the natural sex ratio at birth. Moreover, this has registered a decline if compared to 1991 when it was 948. Only Dadra & Nagar Haveli (1003), Lakshdweep (999), Chhatishgarh (982), Meghalaya (973) and Jharkhand (973) have satisfactory child sex ratio.

The Ministry of Health and Family Welfare has undertaken several measures to implement the ‘Pre Conception & Pre Natal Diagnostics Technique Act (PC & PNDT Act). The Act provides for the prohibition of sex selection and for the prevention of misuse of diagnostic techniques for sex determination leading to female foeticide.

It also prohibits advertisements regarding facilities of pre-natal determination of sex of the foetus. All clinics in the country using pre-natal diagnostic techniques require to be registered. Violation of the Act is punishable with imprisonment. The State Medical Council of Punjab recently suspended the registrations of four doctors for violating the PC & PNDT Act.

 

(The author is Former President, Indian Medical Association and Founder Chairman, Max Superspeciality Hospital, Vaishali)

 

Several reasons are attributed to the decline in the number of girls – neglect of the girl child, high maternal mortality, female infanticide and foeticide. Sex-selective abortions have been greatly facilitated by the misuse of diagnostic procedures such as amniocentesis that can determine the sex of the foetus

 

The ‘Pre Conception & Pre Natal Diagnostics Technique Act (PC & PNDT Act) provides for the prohibition of sex selection and for the prevention of misuse of diagnostic techniques for sex determination leading to female foeticide