Maharashtra- Women Activists ask govt not to mix sex selection and abortion

PUNE: Activists have demanded that the state government and social originations working in save girl child campaign should not insist on an amendment to the existing anti-sex selection laws and invoke murder charges against persons involved in sex selection.

The demand is gaining momentum in parts of the state and activists fear worse consequences of the same.

The Indian MTP Act allows abortion by a registered medical practitioner, where the duration of the pregnancy does not exceed 12 weeks or 20 weeks (the latter if not less than two registered medical practitioners are of the opinion that continuance of the pregnancy would risk the pregnant woman‘s life or may cause a grave injury to her physical or mental health; or there is a substantial risk to her health if the child were born).

“This will deprive women of their right to abortion, which is unacceptable. There should be continuous and strict monitoring of sonography centres, hospitals and nursing homes and strict action against all unlicensed centres. But this does not mean that safe abortion should not be allowed” said activists working in western Maharashtra region.

“According to the Pre-Conception Pre-Natal Diagnostic Techniques Act, sex selection itself is a crime and the doctors involved should be punished as per the provisions of the act. The pregnant woman on whom sex selection is performed or undertaken is not an offender according to the act. This should be upheld in Maharashtra,” said a protest letter signed by organizations such as stree mukti sanghatana, Forum against sex election, akshara, All India Democratic Women’s Association,  among others.

Activists say that by mooting murder charges against people found involved in sex selection , the state seems to be mixing issues relating to sex-selection (Pre-Conception Pre-Natal Diagnostic Techniques Act) and abortion ( Medical Termination of Pregnancy Act)


Punjab- Ultrasound machines sealed in Barnala #PCPNDT #MTP

Ultrasound machine sealed

Neel Kamal, TNN Jun 19, 2013

BARNALA: Detecting a case of sex selection , police have registered a case of medical termination of pregnancy (MTP) against a private hospital and has sealed the ultrasound machine of the hospital. The sex determination test was allegedly conducted with a machine having been already sealed some time back and the test was conducted after altering the seal.

A Barnala-resident pregnant woman had reached a private hospital where she was told that she is bearing a female child. The woman was offered termination of pregnancy if she did not want the female child. Accordingly an abortion was being conducted when the condition of the woman deteriorated and she was referred to another hospital where the illegal act came to light, Barnala SSP Sanehdeep Sharma said.

Barnala civil surgeon Dr Renu informed police, who registered a case. DSP Swaran Singh has been asked to conduct a thorough probe, Sharma said.


Mumbai- Do NOT link increase in the number of abortions to sex-determination tests

Mumbai recorded 44% more abortions last year
Pratibha Masand & Malathy Iyer TIMES NEWS NETWORK

Mumbai: Mumbai witnessed a 44% rise in the number of abortions last year, data from the city’s municipal body has shown.While 19,701 abortions were registered in 2011, Brihanmumbai Municipal Corporation (BMC) data from various public and private hospitals and nursing homes in 2012 showed 28,455 abortions.
Experts say the increase in the number of abortions shouldn’t be linked to sex-determination tests. “Most of these abortions have been carried out in the first trimester when it isn’t possible to detect the sex of the fetus,” said adoctor with a BMC hospital.
So what is the reason for the sudden increase? Public health officials say this is largely due to better reporting of data by hospitals aided on by computerization.
“The 2012 data is absolutely accurate in terms of reporting. Because of the stringent following of the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) law, most MTP centres started reporting abortions accurately,” said Arun Bamne, BMC’s executive health officer. He added that some areas are bound to have more number of abortions owing to better healthcare facilities.
In 2011-2012, the state started a widespread crackdown on doctors and clinics for not adhering to PCPNDT rules and took action against over 400 doctors. In the same period, it also started a check on abortion clinics.
Rekha Daver, who heads the gynaecology department of the state-run JJ Hospital, believes computerization is the main reason. “Most hospitals have to report their numbers online to the government or local municipal corporation website. The 44% increase is most likely due to computerized reporting,” said Daver.
Many experts feel there is another reason — fewer options for women with regard to the method of abortion. After the crackdown on doctors last year as well as on chemists stocking abortion pills, women have had no option but to opt for surgical abortion at hospitals. Nikhil Datar, a gynaecologist, said, “It could be the result of better reporting of both medical and surgical abortions.”
Incidentally, many feel that abortion data rarely shows the entire picture. Some non-governmental organizations feel abortions are under-reported. “In India, an estimated 6.6 million abortions take place each year. But the government records only 6.6 lakh of them,” said Nozer Sheriar, secretary general of the Federation of Obstetric and Gynaecological Societies of India.
But experts say it is not possible to detect a pattern in the number of abortions over the years. “With the increase in population, the number of abortions are bound to go up as abortions are always a percentage of the population; but the awareness about contraceptives has gone up too,” said Sheriar.


Nashik – Relatives stomp on Pregnant woman leading to abortion

Press Trust of India | Updated: April 16, 2013 15:18 IST

Nashik, MaharashtraIn-laws of 20-year-old pregnant woman here have been charged with murdering an unborn girl child after they allegedly stomped on her stomach and beat her, killing the two-month-old foetus, police said today.
The incident took place in the Mhasrul locality where victim Suvarna Gaikwad was being harassed mentally and physically for dowry since her marriage to Khanderao Gaikwad in June last year, they said.The young woman was being tortured to bring a dowry of Rs. 1.5 lakh for building a house. Later, when her in-laws came to know that she was pregnant, they took her to a ‘godman’ Shyambaba Shinde at Niphad, who told them that she was carrying a girl, police said.Suvarna was told to abort the girl child but when she refused to do so, she was allegedly roughed up by her husband, and family, including the mother-in-law killing the foetus on April 4.The matter was brought to light by Mahendra Datrange, President of Nashik unit of Blindfaith Eradicating organisation following which the husband, his brother Vijay Gaikwad, maternal father-in-law Dilip Suryavanshi and one of his kins Jalinder Suryavanshi was arrested yesterday, police said.

Offences have been registered against them under different sections of IPC at panchavati police station yesterday, police said.

Suvarna’s family, which alleged murder of the girl, is demanding the arrest of her mother-in-law Bibabai, Shinde and others involved in the killing

Sex discrimination in India begins in the womb: Study

PTI | Mar 28, 2013, 12.49 PM IST

A study suggests sex discrimination begins in the womb in male-dominated societies such as India.
WASHINGTON: Women in India are more likely to get prenatal care when pregnant withmale babies, according to a groundbreaking study that has implications for girls’ health and survival in patriarchal societies.

The study by Leah Lakdawala of Michigan State University and Prashant Bharadwaj of the University of California, San Diego, suggests sex discrimination begins in the womb in male-dominated societies such as India.

“It paints a pretty dire picture of what’s happening,” said Lakdawala, MSU assistant professor of economics.

In India, while it’s illegal for a doctor to reveal the sex of an unborn baby or for a woman to have an abortion based on the baby’s sex, both practises are common, Lakdawala said.

However, knowing the sex of the baby through an ultrasound also can lead to discrimination for those pregnancies that go full-term, she said in a statement.

In studying the national health-survey data of more than 30,000 Indians, the researchers found that women pregnant with boys were more likely to go to prenatal medical appointments, take iron supplements, deliver the baby in a health-care facility – as opposed to in the home – and receive tetanus shots.

Tetanus is the leading cause of neonatal deaths in India. According to the study, children whose mothers had not received a tetanus vaccination were more likely to be born underweight or die shortly after birth.

The researchers – the first to study sex discrimination in prenatal care – also looked at smaller data sets from other countries.

In other patriarchal nations of China, Bangladesh and Pakistan, evidence of sex-discrimination in the womb existed. But in Sri Lanka, Thailand and Ghana – which are not considered male-dominated – no such evidence existed.

“This type of discrimination we’re seeing, while not as severe as sex-selective abortion, is very important for children’s health and well-being,” Lakdawala said.

Given that previous research has linked early childhood health to later outcomes, sex discrimination in prenatal care might also have long-term effects.

“We know that children born at higher birth weights go to school for longer periods and have higher wages as adults, so the future implications here are pretty serious,” Lakdawala said.

The study appears in the Journal of Human Resources.


#India-Allow abortions up to 24 weeks, national women’s panel says

TNN | Feb 3, 2013, 04.33 AM IST

Allow abortions up to 24 weeks, national women's panel says
NCW says no couple will wait till 20 weeks of pregnancy to abort a foetus on the basis of gender as such offenders wait for barely 12 weeks or so to seek abortion on the grounds that contraception had failed.
MUMBAIThe National Commission forWomen (NCW) has advised the Union health ministry to push the time limit for abortions from 20 weeks of pregnancy to 24.”The ministry had asked us to review the Medical Termination of Pregnancy (MTP) Act, 1971, and send our recommendation if any. We sent them the proposal last month,” NCW member Nirmala Samant Prabhavalkar said.

The recommendation on the NCW website says, “Keeping in view of the present scientific development in medical diagnostic technologies as well as social scenario, laws/statutes need to be revamped”.

While some experts feel extending the abortion time limit will be abused to commit female foeticide, NCW members are sure it will not. “No couple will wait till 20 weeks of pregnancy to abort a foetus on the basis of gender. Such offenders wait for barely 12 weeks or so to seek abortion on the grounds that contraception had failed,” Samant-Prabhavalkar said.

The NCW draft note goes on to say that a new situation demands new laws. “A woman may be raped or a minor may have become pregnant or a woman from a depressed class violated, a woman/girl deserted by partner who had promised to marry her — the present law does not address these special circumstances, hence the NCW feels it necessary to review Section 3- 5 of the MTP Act,1971,” the note adds.

Tweak law

Accordingly, the NCW wants that Section 3(2)(b) of the MTP Act to be tweaked to read, “where the length of the pregnancy exceeds 12 weeks but does not exceed 24 weeks”.

Incidentally, this was the lone recommendation the NCW made to the government.

Experts say the extended time limit will help couples with malformed foetuses to take a call. “Most cardiac anomalies can only be detected after 22 weeks of pregnancy. Thereafter, the parents need time to talk it out with family and friends. So a 24-week limit seems fair,” said Dr Nikhil Datar, who had supported his patient Niketa Mehta to move the court in 2008 for abortion after a cardiac defect was detected in the foetus in the 24th week of gestation. The plea was turned down by the court, but she miscarried thereafter. The foetus reportedly had severe heart problems.

In brief:

* On August 4, 2008, the Bombay high court dismissed Niketa Mehta’s plea for abortion as the foetus had a congenital heart problem. The defect was detected in the 24th week

* The bench said the court could just interpret the law and not make the law

* The Centre is reviewing the MTP Act

* The NCW studied MTP laws in the US and the UK and consulted doctors before recommending that 3(2)(b) of the MTP Act should be changed to allow abortions up to 24 weeks


#India-The Desire for Sons and Excess Fertility

Volume 38, Number 4, December 2012

The Desire for Sons and Excess Fertility: A Household-Level Analysis of Parity Progression in India

By Sanjukta Chaudhuri

CONTEXT: The desire for sons often influences fertility behavior in India. Women with a small number or low proportion of sons may be more likely than other women to continue childbearing.

METHODS: Data from India’s 2005–2006 National Family Health Survey were used to examine several hypotheses regarding the association between sex composition of children and parity progression among parous women aged 35–49. Descriptive analyses and multivariate logistic regression analysis that controlled for possible confounders were performed separately by parity.

RESULTS: Women with more sons than daughters were generally less likely than those with more daughters than sons to continue childbearing; parity progression driven by the desire for sons accounted for 7% of births. At any given parity, the last-born child of women who had stopped childbearing was more likely to be a son than a daughter (sex ratios, 133–157). In multivariate analyses, women without any sons were more likely than women without any daughters to continue childbearing at parities 1–4 (odds ratios, 1.4–4.5). At most or all parities, continued childbearing was positively associated with having had a child who died, and negatively associated with levels of women’s education and media exposure and with household wealth.

CONCLUSIONS: The desire for sons appears to be a significant motivation for parity progression. Although population policies that reduce family size are essential, also imperative are policies that reduce desire for sons by challenging the perception that sons are more valuable than daughters.

International Perspectives on Sexual and Reproductive Health, 2012, 38(4):178–186, doi: 10.1363/3817812

Sons are considered more valuable than daughters in India. Son preference is deeply rooted in various patriarchal practices, including a patrilineal inheritance system, a patrilocal marriage system, the social custom of dowry and the dependence of aging parents on sons.[1–9] A major demographic outcome of son preference is that the proportion of living sons in a family influences the probability that the parents will procreate further. Known variously as differential stopping behavior,[10,11] son-targeting fertility behavior[1] and asymmetric procreation behavior,[12] childbearing driven by a desire for sons occurs when parents continue to progress to higher parities, within a maximum limit, until they have the desired number of sons.

Parity progression driven by a desire for sons has several demographic and health ramifications. First, if prenatal sex detection and abortion are unavailable, parental desire for a certain number of sons will increase the average family size. Biologically, only 26% of couples who want two sons will have fulfilled this desire after two births.[12,13] Even after having six children, about 10% of couples will have been unable to achieve their goal of having two sons. Thus, to the extent that it is the prevalent means of fulfilling the desire for sons, parity progression delays India’s demographic transition by keeping fertility rates higher than they would be otherwise, because parents who have not achieved their “son target” continue to procreate.[12,14,15] Indeed, the desire for sons is positively associated with the desire for more children[16,17] and the total fertility rate,[18] and negatively associated with contraceptive use.[16,17]In Nepal, for example, the fertility rate is about 6% higher than it would be in the absence of son preference.[15]

Second, parity progression driven by a desire for sons may result in imbalances in the sex ratio by family size. Although the desire for sons has considerable bearing on fertility, it does not distort the overall population sex ratio;[19] if parity progression is the only method of fulfilling the desire for sons, then the population will be large but balanced. However, the desire for sons can skew the sex ratio by family size: Smaller families will have a disproportionate number of sons, because parents whose first children are male may decide to stop childbearing, while larger families will have a disproportionate number of daughters, because parents whose first children are daughters will likely continue having children.[1,10] Consequently, boys will tend to grow up in smaller families with fewer siblings and girls in larger families with more siblings, and girls will be more likely than boys to be born at earlier parities.[1]

The third probable consequence of son preference is the occurrence of gender disparities in health, education and other outcomes. In larger families, fewer household resources are available for each child. In an environment of son preference, daughters are less likely than sons to receive resources,[20–23] which can result in undernutrition, wasting, stunting and even excess infant mortality. In addition, because daughters are more likely than sons to have younger siblings, they may be required to perform household chores and provide child care to younger family members, even if such chores come at the cost of their educational attainment.[24]

The gender disparities in infant health outcomes may be due, in part, to duration of breast-feeding. Because breast-feeding inhibits conception, parents who desire sons may wean daughters more quickly than they do sons, thus expediting the conception of the next (preferably male) child. Consistent with this scenario, studies conducted in South Asia[15,25] and Africa[26] have found that birth intervals are shorter after the birth of a daughter than after the birth of a son. In India, the median duration of breast-feeding is shorter for daughters than for sons, and this difference not only may lead to gender disparities in child health but may explain 9% of the excess female infant mortality in India.[21]

Although India has one of the world’s oldest population programs and is a signatory to various international instruments and agreements aimed at eliminating gender bias, the country’s population policy has not directly addressed son preference as a source of excess fertility and gender disparities.[17,27,28] Given that India is expected to become the world’s most populous country by 2025,[29] examining the relationship between the desire for sons and excess fertility in India is important for understanding patterns and determinants of fertility and in exploring appropriate population policies.

Current Study

Most studies on son desire and fertility in India have focused on the relationship between the sex ratio of the living children in a family and measures of intended (rather than actual) fertility.[16–18] These include studies on the association between the number of sons and such variables as contraceptive use, desire for more children and whether the last birth was wanted. Not much attention has been paid to systematic statistical analysis of the relationship between the sex composition of a family’s living children and realized fertility, as measured by probability of parity progression. Although Arnold and colleagues have studied this relationship in India,[20] using data on eight states from the first (1992–1993) National Family Health Survey, their analysis was narrow and did not focus on how the desire for sons affects the relationship between family size and sex ratio of children. Although they controlled for other correlates of parity progression, such as mother’s education, they did not discuss the implications of these correlates for parity progression driven by desire for sons.

The current study presents a robust analysis of the impact of the desire for sons on parity progression in India by assessing the relationship between sex composition of children and continued childbearing. The analysis examines several hypotheses regarding the desire for sons as a motivation for parity progression. The first hypothesis is that at earlier parities, the proportion of daughters will be positively associated with the probability of parity progression. Second, at any given parity, the last-born child of a woman who has stopped childbearing is likely to be a son. Consequently, the third hypothesis is that the sex ratio (number of males for every 100 females) will be unevenly distributed across family size: Smaller families will have a disproportionately high number of sons, while larger families will have a disproportionately high number of daughters. Finally, the proportion of daughters in a family will remain positively associated with parity progression after adjustment for socioeconomic factors.

This study also compares, at each parity, the sex ratio at birth of the last-born child of women who stopped childbearing with the corresponding ratio for women who continued to the next parity.


Sample and Variables

India’s 2005–2006 National Family Health Survey (NFHS-3), the third in a series of nationwide household surveys using random samples, provided the data for this study. The NFHS-3 obtained demographic and socioeconomic information on 124,385 ever-married women aged 15–49 years who had had a total of 280,870 live births. Women provided information on the number of sons and daughters who were living in the household, had left the household or had died; the birth order of each child; and age at death for any deceased children.

The current analysis is restricted to women who had given birth to at least one child and had completed childbearing. It follows Park and Cho[19] in assuming that women aged 35–49 had completed childbearing.*

A total of 37,441 respondents satisfied the age and fertility conditions. Of these, 875 respondents were excluded because they had had one or more multiple births (twins, triplets, etc.) at any parity. After exclusion of respondents for whom complete information on socioeconomic characteristics was unavailable, the final sample consisted of 33,245 women who had had 112,805 births.

The sample was divided by parity and sex composition, resulting in 14 predictor variables: parity 1 (0 or 1 son), parity 2 (0, 1 or 2 sons), parity 3 (0, 1, 2 or 3 sons), and parity 4 (0, 1, 2, 3 or 4 sons). “Sex composition” in this study refers to all possible combinations of sons and daughters at a given parity, without regard for birth order. The dependent variables were four binary variables on women’s parity progression: whether they progressed from parity 1 to 2, from parity 2 to 3, from parity 3 to 4, and from parity 4 to 5. Although only birth orders up to five were analyzed, at each parity the sample included women who may have continued to parity 6 or beyond. Four multivariate binary logistic regressions were estimated, one each for parities 1–4, to determine a woman’s odds of progressing to the next parity according to current sex composition.

Because other factors are likely to influence parity progression, the multivariate analyses included a variety of control variables. First, child mortality may be a major motivation for having more children. A binary variable was included that indicated whether a woman had lost one or more children from prior parities at least 12 months before the birth of the last-born child. For women who stopped childbearing at a given parity, this variable indicated whether a child from any parity had died. Socioeconomic measures used in the analyses include the mother’s age, her education (none, primary, secondary or more than secondary), her religion (Hindu, Muslim or other) and whether she had an occupation.

A media exposure index quantified the mother’s use of TV, radio and print media (newspapers and magazines); for each category, respondents rated their exposure on a scale from 0 (never uses) to 3 (uses almost every day), yielding a total score ranging from 0 (no media exposure at all) to 9 (uses three media almost daily). Other measures included in the multivariate analyses were husband’s education, whether the husband had an occupation, the household standard of living, residence (urban or rural) and region (categorized as north, central, west, east, northeast and south, as per the NFHS).



The average age of women in the sample was 41 years (Table 1). Forty-five percent had no education, while 46% had a primary or secondary education and 8% had more than a secondary education. Some 45% of women reported that they had an occupation. The majority of women (58%) lived in a household with a high standard of living, the remainder in a household with a medium (18%) or low (24%) standard of living. Hinduism was the dominant religion (74%), followed by Islam (12%); smaller proportions of women were Christian (8%), Sikh (3%) or members of other religions (3%). Slightly more than half (53%) of women lived in rural locations. On average, women had had 3.8 births (not shown).

Four percent of women who stopped childbearing at parity 1 reported that the child had died (Table 2). In contrast, 7% of those who continued childbearing reported that their first child had died. Therefore, there was a three percentage-point gap in the child death rate between women who stopped childbearing at parity 1 and those who continued to parity 2. Among women with at least two births, the gap in the death rate for the first two children between women who stopped at parity 2 and those who continued to parity 3 was 12 percentage points (6% vs. 18%). Similarly, the gaps between women who stopped childbearing and those who continued was 17 percentage points for parity 3, and 13 percentage points for parity 4.

Parity Progression

Of the 33,245 women who had a first birth, 93% of those who had a son and 95% of those who had a daughter had at least one subsequent birth (Table 3). At parity 2, 85% of women with no sons moved to parity 3; this proportion dropped to 73% for women with one son, and to 70% for women with two sons. At parity 3, 84% of women with no sons progressed to the next parity, compared with 68% of women with one son, 58% of women with two sons and 64% of those with three sons. At parity 4, women with no sons had an 81% chance of moving to parity 5; the proportion dropped to 67% for women with one son, 56% for women with two sons, 57% for women with three sons, and 66% for women with four sons.

Excess number of annual births. The above results suggest that the desire for sons drives parity progression. To estimate the excess fertility driven by desire for sons, the number of births that would have occurred at each parity if parents had had no gender preference was calculated. An underlying assumption in these calculations was that the minimum parity progression percentages in Table 3 would prevail at each parity, regardless of sex composition; thus, 93% of women would move from parity 1 to 2, 70% from parity 2 to 3, and so on.[19] In this scenario, the number of live births that would have occurred by parity 5 is 104,667, or 8,138 fewer than the observed total of 112,805. This suggests that 7% of births by parity 5 in the sample can be attributed to differential probabilities of parity progression driven by a desire for sons.

Sex Ratio at Birth of Last-Born Child

An alternative analytic approach is to compare, for each parity, the sex ratio of the last-born child among women who had stopped childbearing with the ratio among those who had a subsequent birth. If the desire for sons motivates progression to the subsequent parity, then women may be more likely to stop childbearing if their last-born child was a son rather than a daughter. If this is the case, then the sex ratio at the birth of the last-born child of women who have stopped childbearing would be greater than the biologically expected ratio of 105 males for every 100 females.[28,30] Conversely, women would be expected to be more likely to continue childbearing if their last-born child was a daughter; as a result, the sex ratio at birth among children of women who continue childbearing would be less than 105. The NSFH-3 data support this hypothesis. Among Indian women who stopped childbearing at parity 1, the sex ratio at birth was 143 males for every 100 females (Table 4, page 182). In contrast, the sex ratio at birth was 106 among women who continued childbearing. At parity 2, the sex ratio at birth was 153 among women who had no more children, but only 98 among women who continued to have children. Similarly, sex ratios at birth were substantially higher among women who stopped childbearing than among those who had additional children at parity 3 (157 vs. 94), parity 4 (139 vs. 93) and parity 5 (133 vs. 96).

Family Size

A third approach is to examine mean sex ratio by completed family size (i.e., total number of children ever born). Here, the hypothesis is that if parity progression is contingent on number of sons already born, then the sex ratio will be uneven across family sizes. Women who have more sons than daughters at earlier parities will stop childbearing and thus have smaller families. In contrast, women who have more daughters than sons at earlier parities will continue childbearing and have larger families. Consistent with this hypothesis, the mean sex ratio of all children ever born declines as completed family size increases, from 143 for a completed family size of one and 146 for a completed family size of two to 126 and 108 for completed family sizes three and four, respectively (Table 5). Mean sex ratios of all children ever born are smaller still for completed family sizes five (99) and completed family sizes six or larger (93).

Multivariate Analyses

Sex composition. The associations between sex composition of a woman’s children and the probability that she will have additional children were similar in unadjusted models (not shown) and adjusted models (Table 6) across parities, suggesting that the relationships are largely independent of socioeconomic factors. The results indicate a positive association between the proportion of daughters in a family and the odds of parity progression. At parity 1, the odds of parity progression among women with a daughter are 1.4 times those of women with a son. At parity 2, the odds of having another child are greater among women with two daughters (odds ratio, 3.5) or with one daughter and one son (1.3) than among women with two sons. At parity 3, the odds of parity progression are greater among women with three daughters (4.5) or two daughters and one son (1.5) than among women with three sons, but women with two sons and one daughter are less likely than women with three sons to continue childbearing (0.8). Finally, at parity 4, women with no sons (3.4) or one son (1.3) are more likely than women with four sons to have a subsequent birth; the odds of reaching parity five are reduced, however, among women with two daughters and two sons (0.7) or one daughter and three sons (0.6).

Other correlates. At most parities, replacement of deceased children is a significant motivator of parity progression. After adjustment for other correlates, women at parity 2 who had lost a child were substantially more likely to continue childbearing than were women whose two children were alive (odds ratio, 2.7). Similarly, having a lost a child was associated with increased odds of moving from parity 3 to parity 4 (2.6) and from parity 4 to parity 5 (1.8).

In general, women’s education level was negatively associated with parity progression. For example, women with one child were less likely to continue childbearing if they had a secondary education (odds ratio, 0.5) or more than a secondary education (0.2) than if they had no education. At parities 2–4, women had reduced odds of parity progression if they had a primary (0.7–0.8), secondary (0.3–0.6) or more than secondary (0.1–0.2) education than if they had no education.

Women’s scores on the index of media exposure were negatively associated with parity progression in all models. For each one-point increase in women’s exposure scores, the odds of reaching higher parities were reduced by 7–10% (odds ratios, 0.9 each).

At parity 1, the only level of husband’s education associated with parity progression was primary; women whose husband had attained that level of schooling had 24% higher odds of progressing to parity 2 than did women whose husband had no education (odds ratio, 1.2). At parities 2–4, women were less likely to have another child if their husband had a secondary (0.8 for each) or greater (0.6–0.7) education, rather than no education; at parity 4, the odds of parity progression were also reduced among women whose husband had a primary education (0.9).

There is some evidence that a higher standard of living was associated with a lower likelihood of parity progression. Although women’s likelihood of parity progression did not differ by standard of living at parity 1, at the next parity a high standard of living was associated with 24% lower odds of progression than a low standard (odds ratio, 0.8). At parities 3 and 4, the odds of parity progression were reduced among women with a medium (0.8–0.9) or high (0.6–0.7) standard of living. Last, religion was consistently associated with parity progression. At all four parities, the odds of continued childbearing were greater among Muslim women than among Hindu women (1.9–3.4); they also were elevated among women of other religions (1.2–1.6).


Prior research has established that the desire for sons has a significant influence on fertility behavior in Korea,[19] Taiwan,[31,32] Bangladesh,[16] Pakistan[33,34] and India.[10,35,36] This study, which used NSFH-3 data on women aged 35–49 who had at least one child, also found such a relationship. One unique feature of this study is that by examining several hypotheses on the relationship between children’s sex composition and women’s fertility, it presents a comprehensive analysis of the relationship between desire for sons and fertility behavior. In general, women with more sons than daughters were less likely to progress to higher parities than were women with more daughters than sons. Although the findings supply considerable evidence of desire for sons, parents were by no means completely averse to having daughters. The proportion of women in our sample who progressed to the next parity was lowest among women with at least two sons and at least one daughter, a result consistent with previous research that found that although parents in India desire sons more than daughters, they do want one or more daughters. One study explained this fertility preference by alluding to the Hindu custom of kanyadaan (giving away a daughter in marriage), which proponents believe earns spiritual merit for parents.[17] The current analysis suggests that roughly 7% of births in India through parity 5 can be attributed to parity progression driven by a desire for sons. This finding is similar to a previous estimate that the desire for sons is responsible for about 8.4% of fertility in Calcutta, India.[37]

The findings also support the sibling effect hypothesis by showing a positive correlation between family size and the proportion of daughters. In this sample, families of up to four children had a disproportionate number of sons, while families with five or more children had a disproportionate number of daughters. These results are similar to those of Park and Cho, who found that in Korea, among women who had completed childbearing, the mean sex ratio was masculine for completed families with one or two children but was feminine for completed families with three or more.[19]

Another unique feature of this article is that it examined parity progression driven by desire for sons through formal, parity-specific multivariate regression models. This analysis showed that even after adjustment for socioeconomic factors, having a higher proportion of daughters was associated with significantly elevated odds of parity progression. Among other correlates, women with deceased children had elevated odds of parity progression, while women who had higher levels of education, media exposure, or wealth, or who had an educated husband, had reduced odds of parity progression.

This study has several limitations. First, although the use of cross-sectional data allows the examination of associations between variables, it does not allow conclusions on causality to be drawn. Second, the conclusions on desire for sons are based on measures of realized fertility, and not on variables that explicitly measure son preference, such as women’s ideal sex ratio of children. Third, because the survey was based on retrospective self-reports, misreporting may have occurred, and inaccurate responses concerning the number and sex of children could have skewed the results on sex ratios at birth. One potential source of bias is inaccurate recall, especially concerning children who had left home. Moreover, women may have tended to exclude children who had died, especially if the death occurred soon after birth. In addition, parents in India tend to underreport the number of daughters they have. Although some researchers have contended that these types of underreporting are unlikely to be a problem in the NFHS because the interviewers are trained to probe respondents,[38,39] misreporting is nonetheless likely to have led to a small bias in the results; Clark estimated that the underenumeration of female births in the NFHS may be as high as 6%.[10] A final limitation of the study is that the regression results could have been biased by the omission of other correlates of parity progression.

From a population policy perspective, the study’s key finding is that 7% of births in India would be avoided if parity progression driven by the desire for sons were eliminated. Because higher levels of female education are associated with lower odds of continued childbearing, policies that encourage women’s education are a possible solution for reducing parity progression and eliminating excess fertility. However, reduction in parity progression alone does not address the deep-rooted cultural issues concerning son preference. This is because parity progression is not the only method of fulfilling the desire for sons. Since the mid-1980s, sex determination technology and abortion have become increasingly accessible in India,[40,41] and used together they allow parents to have smaller families, while still having the desired number of sons, by selectively aborting unwanted female fetuses. Considerable evidence points to the possibility that the sex ratio at birth has increased in India in recent decades (even while the total fertility rate has declined) as the result of sex-selective abortion.[42] Although the disproportionately high sex ratio seen in the current study among last-born children could simply be due to parents’ having stopped childbearing as soon as they had a male child, the likelihood exists that parents who wanted fewer births used sex determination and abortion technology to guarantee that they had a son.

The fact that higher levels of female education are associated with lower odds of parity progression does not necessarily mean that more educated women have less of a desire for sons. Although some authors have contended that women’s education reduces both son preference and fertility,[9,27] others have pointed to the possibility that although more educated women may prefer fewer children, they may also be more “efficient” in fulfilling their desire for sons by using their greater access to sex determination and abortion technology. In that case, the negative relationship between education and parity progression may be the result of fewer females being born.[43,44] One study in India reported that in 2005, the sex ratio for second births was excessively high if the firstborn child was a daughter; this was especially the case in wealthier households and among women with 10 or more years of education.[43]

Similar caution needs to be exercised in interpreting the negative association between wealth and parity progression. Wealth has been known to increase access to sex determination and abortion technology, especially in northern India, where gender bias is greater. Increased accessibility and affordability of sex determination and abortion services due to greater wealth could result in fewer births, but a more masculine sex ratio at birth.[44,45]

Population policies that focus exclusively on reducing parity progression will not solve the underlying issues of gender bias. As long as the desire for sons continues to be of central importance in determining fertility behavior, efforts to reduce fertility may be counterproductive, as parents will use sex-selective abortion to have their desired number of sons within smaller families. Either way, son desire will be achieved at the expense of the welfare of daughters.

Although policies encouraging women’s education are essential to reducing parity progression, such approaches are likely to be countered by dominant patriarchal values. Therefore, there is an urgent need to challenge established patriarchal values that create the perception that sons are more valuable than daughters. Such interventions have been successful in Korea, where the sex ratio at birth, which had been the most masculine in Asia in the 1990s, returned to normal levels in 2007. Sociologists have attributed this astonishing change to rapid economic and social advancement, along with unprecedented modernization and urbanization that led to massive shifts in underlying patriarchal social structure and reduced son preference.[46] Similar suitable interventions should be considered for India. Thus, comprehensive policy packages are needed that challenge underlying patriarchal values, improve women’s status and thus reduce desire for sons by making daughters and sons equally valuable to parents.


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