Gender-biased sex selection and unbalanced sex ratios at birth in South Asia: case studies of the situation and promising approaches to restore balance

Abstract

Sex ratios at birth in South Asia vary considerably. While the sex ratio at birth in Bangladesh and Pakistan has thus far been normal at the country level (103 and 102.5 males per 100 females, respectively), Nepal is showing signs of disturbed sex ratios at birth (106 males per 100 females), and the situation in India is particularly adverse (110 males per 100 females). In all of these countries, however, preconditions for a deterioration of the sex ratio at birth are evident. Preferences are expressed for small families, patriarchal social norms persist and societies tend to be gender-stratified with strong preferences for at least one son, and prenatal diagnostic techniques are widely available and used to monitor foetal development. Indeed, all four countries have long been characterised by wide gender disparities and a strong preference for sons, often manifested in terms of the greater investment in the health, nutrition and education of sons over daughters. There are, however, within-country differences in sex ratios at birth and among children, including in Bangladesh and Pakistan (where overall sex ratios at birth remain normal). These widely differing scenarios raise different research questions for each setting. With support from UKAid, the Population Council’s Bangladesh, India and Pakistan offices and CREHPA (the Centre for Research, Environment, Health and Population Activities, Nepal), undertook case studies that aimed to shed light on the issue of gender-biased sex selection in these countries and make evidence-based recommendations for actions that hold promise for responding to adverse sex ratios at birth in these settings. Given the wide contextual differences described above, a single research question across all four countries was not possible, and as such, the specific objectives of the studies differed across countries. The study also adopted a mixed method approach to deal with these differences. In Bangladesh, India and Nepal, it included surveys of married women with at least two children, one of whom was aged 0–5 years; this was accompanied by key informant interviews with health care providers and programme implementers from the public and NGO sectors. In Pakistan, where skewed sex ratios are not really observed and evidence is sparse, only the key informant interviews with health care providers were used. The survey explored, from the perspective of women, family size desires, the strength of son preference, and the extent of disclosure of the sex of the foetus and termination of pregnancies carrying a female foetus; it also explored women’s knowledge of the law, exposure to messages relating to raising the value of the girl child, in general, and addressing gender-biased sex selection, in particular. Where possible, primary research also explored the extent to which three types of programmatic interventions—law enforcement; communication, advocacy and community mobilisation efforts, and the provision of educational entitlements and conditional cash transfer programmes for girls—were implemented in each district, and the extent to which these interventions may have contributed to the different levels of sex ratios at birth in contrasting districts of each country. The study findings offer tentative support to the conclusion that while educational entitlements for girls and implementation of the law are important, concerted efforts towards communication, advocacy and community mobilisation are essential to transform gender norms and discourage gender-biased sex selection