Societies must address gender bias in children’s nutrition, health care, education and other opportunities that leads to higher mortality rates.
By Riaz Hassan*
Gender bias in mortality has resulted in fewer women in India and other parts of the developing world. This problem did not attract much attention until Nobel Laureate Amartya Sen used sex ratios to assess the cumulative effects of gender bias in mortality, estimating the additional number of females of all ages who would have been alive if there had been equal treatment of the sexes – close to 100 million in South Korea, India, China and other nations. Sen referred to those women as “missing” because they had died as result of discrimination in the allocation of survival related goods.
This is not a minor social and cultural issue, but one of the major catastrophes of modern times. For example, the number of “missing women” in early 1990s is larger than the combined deaths from all famines in the 20th century, also exceeding the combined death toll of the two world wars. Potential consequences of such imbalances, research suggests, include large numbers of frustrated men who cannot find partners, possible violence as well as a growing sex industry and sexual trafficking.
Boys outnumber girls at birth everywhere in the world. For every 100 females born, there are 106 males. After birth, nature tends to favor women. Women, in general, tend to live longer than men if they receive the same health care and nutritional allocations. This biological advantage for higher frequency of male births over females is linked to human evolution. But social and economic inequities and cultural patterns have a deleterious effect on gender equality. Expressions of these inequalities are not uniform in general – for example, in India, Pakistan and China such expressions tend to disadvantage women in obtaining equal access as men to survival-related goods such as nutrition, economic opportunities, health care and medical attention. This relative neglect of women has led to higher rates of morbidity and mortality resulting in a lower proportion of women in many parts of the world than would not have been the case if they had received equal care.
India accounts for 40 million of the missing women. Only China with 41 million has larger number of missing women. The good news is that public health and welfare policies in India have reduced the female disadvantage in mortality in recent years, reflected in improved sex ratios between 1991 and 2011. During this period, the sex ratio, or the number of females per 1000 males, increased from 927 to 940. Counterbalancing this improvement is a significant decline in the sex ratio of children under the age of 6 years, from 945 to 914 during the same period. In other words, the marginal 1.4 percent improvement in sex ratio during this period was offset by 3.3 percent decline in child sex ratio.
The net result of these two trends is that improvement in the sex ratio has not produced gender balance in India. The reason for this is the radical medical advances in the past two decades that created a new female disadvantage through sex-specific abortions aimed at the female fetus, which has counterbalanced reduction in female mortality. Modern techniques to determine a fetus’ sex have made sex-selective abortions possible and easy, and these are widely used in countries with cultural norms of male preference. As a consequence, sex ratios have become more imbalanced, increasing the magnitude of missing women.
A recent study on the subject in the British medical journal Lancet by team of Indian medical scientists led by Prabhat Jha offers significant evidence on the practice of selective female abortions in India. The researchers reviewed data gathered from three rounds of nationally representative National Family Health Surveys carried out between 1990 and 2005 and examined sex ratios by birth order in 0.25 million births to estimate the scale of selective abortions of girls. The study compared sex ratios of second-order births after firstborn girls with the second-order sex ratios after firstborn boys – and the influence of a mother’s wealth and education. The findings revealed a statistically significant fall in sex ratio for second-order births when the first-born was a girl from 906 per 1000 boys in 1990 to 836 in 2005.
The practice of female-fetus abortions is much more prevalent among mothers with 10 or more years of schooling than mothers with no education as well as in wealthier households compared with poorer households. After adjusting for excess mortality rates in girls, the number of selective abortions of girls rose from zero to 2 million in 1980 to 1.2 million to 4.1 million in 1990s, and 3.1 million to 6 million in this century. A 1 percent decline in child sex ratio from birth to 6 years of age implied 1.2 million to 3.6 million more selective abortions of girls. The study estimated that selective abortions of girls totaled about 4.2 million to12.1 million from 1980 to 2010, with a greater rate of increase in the 1990s than in the 2000s.
India’s sex ratio statistics mask the large variations among individual Indian states. Some states have significantly lower sex ratios compared with the national norm. Using the sex ratio for India as a benchmark splits the country into remarkably almost contiguous halves. The states in the north and the west have sex ratios significantly below the national benchmark figure led by Madhya Pradesh, Rajasthan, Maharashtra, Gujrat, Bihar, Uttar Pradesh, Haryana and Punjab. Evidence shows that between 2001 and 2011 the child sex ratios in the predominantly Hindu and with relatively higher economic-growth rate northwestern districts of India declined significantly due to increasing selective-female abortions. The states in the other half with sex ratios above the benchmark are concentrated in the south and the east with Kerala, Tamil Nadu, Andhra Pradesh, Odisha and West Bengal leading the pack.
Some of the differences may be due to cultural factors that coincide with the rise in support for Hindu religion parties in the northern and western states. In 1999 and 2014 elections, the Bharatiya Janata Party won more than 75 percent of its parliamentary seats from these states. Both developments – the rise of Hindu religion parties and the practice of selective abortions of female fetuses – are relatively new phenomena, and deeper understanding requires further research.
A growing body of empirical evidence shows that sex-selective abortion has risen sharply in the last two decades among more affluent and educated families, making this a national crisis. The scale of the problem of selective-female abortions requires urgent public policies and interventions to stop the practice of premeditated selective gender-related abortions. The practice exists because of entrenched discrimination against women in private and public domains of Indian society. The use of medical technologies to decide whether to abort a female foetus is illegal in India, but poor monitoring and implementation of relevant laws have not improved the situation. India, in particular, must improve status for women, ensuring equal social and economic rights. Societies must raise public awareness, educating parents and societies on the consequences. Stringent monitoring and enforcement, targeting clinics and health providers, are required to stop the practice.
*Riaz Hassan is Emeritus Professor of Sociology Flinders University, Adelaide Australia, and visiting research professor at the Institute of South Asian Studies National University of Singapore. He is also a senior fellow at the Asian Institute, University of Melbourne.