1. SEX SELECTION:
IMPLICATIONS & CURRENT STATUS
Lt Col A S Kushwaha
Dept of Community Medicine
5/9/2012 Lt Col A S Kushwaha 1

2. NATURE
• Statistically speaking, there are 51 boys born
for every 49 girls.
• For every 100 females about 104-106 boys are
expected.
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3. HUMAN: MALE BABY OBSESSION
• 330 BC, Aristotle – Tying left testicle
• Chinese conception chart
• Wheelan method- timing of intercourse
• Shettles Method – position
• Urban Legends – diet, drugs, age
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4. Urban Legends
• Change your diet to include lots of red meat, salty
snacks, and cola soft drinks.
• Legend says if the man climaxes first, you'll conceive a baby
boy.
• Schedule your lovemaking sessions for odd numbered days
of the month.
• Have sex at night, preferably when there's a quarter moon in
the sky.
• Have as much sex as possible, since many people believe
more boys are conceived during the "honeymoon" phase of
a relationship.
• Have the man drink coffee before sex, since this causes the
sperm with Y chromosomes to become more active.
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5. Yatra naryestu pujjyante, ramante tatra devata’
- Ancient Indian scriptures
Having a daughter is like watering a flower in the neighbour's
garden. Tamil proverb (In Kannada : ‘maga manege; magalu
pararige’ )
‘Having a daughter is a punishment for the sins committed in
previous life’. - According to one dalit women,
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6. BAD GOOD UGLY
genetic
screening
cloning sex
selection
The
Technologies
gene
therapy artificial
placentas
post-
menopausal
motherhood
"The unholy alliance between tradition (son-complex) and
5/9/2012
technology is playing Col A S Kushwaha Indian Society”
Lt
havoc with

7. TECHNODOCS OPINION
providers of NRTs
• 64% - against sex selective abortions,
• 10 %- of them stated that too were against it but
they had to do it,
• 24% - approved of sex selective abortions.
A CEHAT study
5/9/2012 Lt Col A S Kushwaha

8. July 23, 2007
In a shocking discovery, the Orissa police
recovered as many as 30 polythene bags
stuffed with female fetuses and the body parts
of new-born babies from a dry well near a
private clinic in Nayagarh, close to
Bhubaneswar. Police have arrested the
manager of the clinic.
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9. , ‘Had
these clinics were available 30 years ago, many of us
would never have seen this world!’
As narrated by a literate woman in Village M
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10. SEX SELECTION
• What is it?
• How it is done?
• Where?
• Why?
• How we can measure?
• Current status?
• What will it lead to?
• What we can do?
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11. What is sex selection?
Human sex selection is the attempt
to control the sex of the offspring to
achieve a desired sex.
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12. METHODS OF SEX SELECTION
PRE-IMPLANTATION
1. Sperm sorting - by flow cytometry.
2. Pre-implantation genetic diagnosis (PGD)
POST-IMPLANTATION
1. Prenatal diagnosis & sex-selective abortion
(Double illegality)
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13. POST-BIRTH
• Sex-selective infanticide
• Sex-selective child abandonment
• Sex-selective adoption
• Differential stopping behaviour
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14. SEX SELECTION
• What is it?
• How it is done?
• Where?
• Why?
• Current status?
• How we can measure?
• What will it lead to?
• What we can do?
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15. WHERE?
• Globally
• SEAR countries -China
• India
• Punjab, Haryana, Delhi
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16. WHERE?
• Poor - Rich
• Illiterate - Educated
• Rural - Urban
• Orthodox families - Modern
• BIMARU states – DEMARU states
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17. SEX SELECTION
• What is it?
• How it is done?
• Where?
• Why?
• How we can measure?
• Current status?
• What will it lead to?
• What we can do?
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18. WHY?
• SOCIAL
• DEMOGRAPHIC
• COMMERCIAL
• LOGISTIC
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19. SOCIAL
• Women empowerment
• Expression of reproductive rights
• Minimize violence against women
• Conserve property of family
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20. Son Preference and
Daughter Aversion
Economic progress has not necessarily changed the
traditions of gender discrimination
- dowry
- family name
- property
- last rites
- old-age support
•Patrilocal
•Patrilineage
•Patriarchal
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21. SOCIAL ATTITUDES
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22. SOCIAL PERCEPTIONS
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23. WHY?
• SOCIAL
• DEMOGRAPHIC
• COMMERCIAL
• LOGISTIC
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24. DEMOGRAPHIC
• Family balancing
• Prevented occurrences of unintended
pregnancy and abortion,
• Population stabilization- TFR & NRR
• Small family Norm
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25. WHY?
• SOCIAL
• DEMOGRAPHIC
• COMMERCIAL
• LOGISTIC
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26. SEX SELECTION & SEX SELECTIVE ABORTION
Rs. 1,000 crore industry
(US$ 244 million)
Easy & Quick money
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27. WHY?
• SOCIAL
• DEMOGRAPHIC
• COMMERCIAL
• LOGISTIC
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28. LOGISTIC /ADMINISTRATIVE
• Easy access to medical facilities
• Ability to pay the doctor and abortionist for
the test and abortion
• A good network of roads to cut down the cost
and time of travel
• Unholy alliance of traditional thoughts as
reflected in the ‘son complex’ and easily
available technological advances for sex-
determination in utero
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29. SEX SELECTION
• What is it?
• How it is done?
• Where?
• Why?
• How we can measure?
• Current status
• What will it lead to?
• What we can do?
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30. MEASUREMENTS
• M:F Sex Ratio
• Sex Ratio at Birth
• Child Sex Ratio (0-6 Yrs)
• Abortion rate & facilities
• Sex-selective abortion,
• Differential foetal mortality,
• Unreported female infanticide
• Excess female mortality
• Index of Son preference =100 (E/C)
(Where, E =the excess number of sons over daughters considered ideal)
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31. SEX RATIO
• Overall sex ratio
• Trend of sex ratio
• SRB (Sex Ratio at Birth)
• CSR (Child sex ratio)
• Females/1000 males (Female deficit) e.g. SR of
933/1000
• Males/100 females (Male surplus) = 107/100
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32. SEX SELECTION
• What is it?
• How it is done?
• Where?
• Why?
• How we can measure?
• Current status
• What will it lead to?
• What we can do?
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33. CURRENT STATUS
ECONOMIST -
“Where are the 100 million missing women?”
-Amartya Sen
Sen A. Development as Freedom. New York: Anchor Books; 1999
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34. MTP ACT 1971
• Law that turned against females for whom it
was designed.
• MTP Act + USG = Sex selective abortion
• PNDT Act 1994
• PCPNDT 2003
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35. 5/9/2012 Lt Col A S Kushwaha 35

36. Country
SEX RATIO
Sex Ratio
India 933
China 944
USA 1029
Indonesia 1004
Brazil 1025
Pakistan 938
Bangladesh 951
Japan 1041
Russian Fed.
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1140
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37. Sex Ratio: India
Year No. of Females
1901 972
1911 964
1921 955
1931 950
1941 945
1951 946
1961 941
1971 930
1981 934
1991 927
2001
5/9/2012 933
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38. 5/9/2012 Lt Col A S Kushwaha 38

39. 5/9/2012 Lt Col A S Kushwaha 39

40. Child Sex Ratio
Census Total Rural Urban
1981 962 963 931
1991 945 948 935
2001 927 934 903
SRB/
883 888 866
2003
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41. 5/9/2012 Lt Col A S Kushwaha 41

42. INDIA
CHILD SEX RATIO IN
AGE GROUP 0-6
N.A.
INDIA
N.A.
INDIA
CHILD SEX RATIO IN CHILD SEX RATIO IN
AGE GROUP 0-6 AGE GROUP 0-6
1991 2001
A
A
A
FEMALES PER 1000 MALES A
IN AGE GROUP 0-6
800 AND BELOW
801 - 850
851 - 900
901 - 950
951 - 1000
1001 AND ABOVE N.A. DATA NOT AVAILABLE
Data Not Available
1991 2001
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43. PUNJAB
CHILD SEX RATIO IN AGE GROUP 0 - 6
(DISTRICT)
2001
1991
PUNJAB
PUNJAB CHILD SEX RATIO
CHILD SEX RATIO IN AGE GROUP 0-6
IN AGE GROUP 0-6 2001 (PROVISIONAL)
1991 Gurdaspur (DISTRICT)
Gurdaspur (DISTRICT) 775
878
Hoshiarpur
Hoshiarpur 810
Amritsar 884 Amritsar
861 783 Kapurthala
Kapurthala 775
879 K
K Jalandhar
Nawanshahr
Jalandhar Nawanshahr 797 810
886 900
Rupnagar
Ludhiana Rupnagar Moga Ludhiana
791
Moga
877 884 Faridkot 819 814
Faridkot 867 Fatehgarh 805 Fatehgarh
865 Sahib Sahib
874 754
Firozpur
Sangrur Muktsar Sangrur Patiala
Firozpur Muktsar
Patiala 819 807 Bathinda
873 871 784 770
887 Bathinda 779
858
860
Mansa Mansa
873 P FEMALES PER 1000 MALES IN AGE GROUP 0-6 779 P
800 AND BELOW
801 - 850
851 - 900
901 - 950
951 - 1000
1001 AND ABOVE
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44. HARYANA
CHILD SEX RATIO IN AGE GROUP 0 - 6
(DISTRICT)
1991 2001 Panc hkula
Panc hkula
890 837
Ambala 784 Yam unanagar
888 Yam unanagar Ambala 807
888
770
Kurukshetra Kurukshetra
868
Kaithal Kaithal
Karnal
854 Sirsa 789
Karnal 808
Fatehabad 818 Fatehabad
Sirsa 871
830
873
883
JIN D 807
Jind Panipat His ar 818 Panipat
858 889
His ar 830
864 Sonipat
Sonipat
878 Rohtak
Rohtak 783
796
868 Bhiw ani
Bhiw ani 838
Jhajjar Jhajjar
885 886 805
Gurgaon
895
Mahendragarh Rew ari Faridabad Mahendragarh Gurgaon
Rew ari
892 894 884 814 863
814
Faridabad
856
CHILD SEX RATIO
800 AND BELOW
801 - 850
851 - 900
901 - 950
951 AND ABOVE
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45. DELHI
CHILD SEX RATIO IN AGE GROUP 0 - 6
(DISTRICT) 2001
1991
North West
North West 854
913
North East North East
North 867
North 917 West 870
West 920 858
913 Central
Central 902 East
937 East
918 New Delhi 868
New Delhi 882
919
South West
South West 845
904
South
South 886
912
CHILD SEX RATIO
800 AND BELOW
801 - 850
851 - 900
901 - 950
951 AND ABOVE
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46. Excess Female Mortality
OR
OR
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47. CURRENT STATUS
• Since 1991, 80% of districts in India have
recorded a declining sex ratio
• New Delhi , Punjab, Haryana and Uttar
Pradesh. have recorded a more than 50 point
decline in the child sex ratio in 10 years.
• CSR in Punjab stood at a mere 775 females
per 1000 males.
• India - deficit of 3.5 crore women when it
entered the new millennium.
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48. STATUS REPORT
• 2002-2003- every ninth household in the state
acknowledged sex selective abortion. (According to the
Chandigarh-based Institute for Development and Communication)
• More than 100,000 sex-selective abortions in India
every year (Arnold et al. 2002).
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49. Money –Sex selective abortion link
CSR
5/9/2012
WEALTH
Lt Col A S Kushwaha

50. PROVING THE NEXUS
• Sex selective abortion & USG
• The evidence of substantial sex-selective
abortion in states such as
Punjab, Haryana, Delhi, and Maharashtra is
consistent with the high rates of use of
ultrasound and amniocentesis (Retherford and
Roy 2003).
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51. Pregnancies with an Ultrasound
Percent of pregnancies in the past 5 years WHO GOES FOR USG
65 62
44
24
16
9
4
Total Rural Urban None 12+ Lowest Highest
Residence Education Wealth Index
5/9/2012 Lt Col A S Kushwaha

52. USG & PREGNANCY
• Undergone USG :20.1%
• Who asked :Doctor (53.2%)
• Where :Govt. facility (52 %)
:Private (20%)
• Why
• Abnormality :2.6 %
• Fetal position :15.6 %
• Age 35+ : 6.5 %
• Sex Determination : 26 %
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53. ARE ULTRASOUNDS BEING CONDUCTED FOR
SEX-SELECTION?
• There is evidence of sex selection, when the
sex ratio at birth deviates from the normal of
about 960-970 girls per 1,000 boys
• Thus, the question can be answered by
examining the sex ratio at birth for births that
result after a pregnancy with an ultrasound
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54. USG- SEX RATIO LINK
NO USG
100
USG
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55. Are ultrasounds being conducted for
sex-selection?
Girls per 1,000 boys born in the past 5 years (for pregnancies with an ultrasound)
988
876 908
849
751
665
570
Total 0 sons 1 son 0 sons 2 sons 0 sons 2-3 sons
1 child 2 children 3 children
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56. IMPLICATIONS
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57. Implications
• By 2020 there could be more than 35 million
young "surplus males" in China and 25
million in India.
• Resurgence of practices such as
polyandry, infanticide?
• Trafficking ?
• Violence against women and girls
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58. The ‘shortage’ of women does not lead to their
increased value, but to greater restrictions and
control placed over them.
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59. • Ethical Concerns –designer babies
• Demographic concerns – gender imbalance
• Legal concerns -Of the 36 countries with laws
or policies on sex selection:
0 explicitly permit it
5 prohibit sex selection for any reason
1. China
2. India
3. Israel
4. New Zealand
5. UK
31 prohibit it for social or “non-medical” reasons
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60. SATA PRATHA
JAISALMER/JAIPUR:
Padam Mali (30) is unable to find
a suitable bride for himself
neither from his own caste nor
from others. The reason: his sister
is a minor and therefore, not yet
ready for marriage. It may sound
far-fetched, but the skewed sex
ratio in the desert district of
Jaisalmer has led to parents
marrying off their daughters in
families from where they can get
a bride for their son.
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61. A Silent National Emergency
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62. • Rooted in patriarchal value of son preference
Sex selection is a key social issue
• Indicative of a gender divide in society which is not in tune
with the development aspirations of the country
• Also responsible for the demographic divide in the country
as it encourages large families in anticipation of an elusive
son
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63. • Falling sex ratio should be declared a national
emergency and adequate resources should be
allocated for the same.
It is time to bring in a social movement
• It is also important to build a national consensus on
the issue and mobilize all the stakeholders to stop
the practice of sex selection
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64. • In 1995, the Fourth
World Women’s
Congress passed the
Declaration of
Beijing, and Action
Plan, which have
become major
principles for
promoting gender
equality
internationally
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65. It is time ----
to change the perceptions and
values to create a positive image
of the girl child
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66. GOVT INITIATIVES
• National Support & Monitoring Cell
• Inspection Committee – visits
• Computerization of the records
• Community awareness – IEC campaign
• Training modules
• Medical curriculum
• Sex ratio indicators – RCH/NRHM
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67. ELEVENTH PLAN
• Develop targets & indicators- SRB, CSR
• Target: CSR 0-6 Yrs to 935 by 2011-12 and 950
by 2016-17
• Gender budgeting in health
• Resource transfers
• Data for tracking
• PHC level enumeration – routine
• Independent auth at district level
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68. Sex Selection
Never…
• Commit
• Condone or
• Remain silent
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69. Campaign Against Sex Selective Abortions
• DOWN WITH DISCRIMINATION
• SAY “NO” to FEMALE EXTERMINATION
• Eliminate Inequality, not Women”.
• “Destroy Dowry, not Daughters”.
• Daughters are not for slaughter.
• Say “NO” to Sex Determination
• Say “YES” to Gender Justice
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70. "A son is a son till he takes a wife
A daughter's a daughter the rest of her life."
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71. Women Achievers
????? MANY MORE
ELIMINATED BEFORE
THEY COULD ……….
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