Sex ratio, alarm and tunnel vision

The Vital Statistics of India report, based on the Civil Registration System 2016 published by the Office of the Register General of India is out and with it, the alarm about a dropping sex ratio (3.16 Sex Ratio at Birth) and assumptions of deliberate killing of unborn female children.

The overall sex ratio in India has dropped from 881 in 2015 to 877 in 2016. We are talking of a staggering 13,76,782 less female births (97,77,121) reported than male ones (1,11,53,903).

Where my mind looks at data like this and wonders why it would be so, at least three groups I was on (2 WhatsApp + 1 email) appeared to have no hesitation blaming sex selection for this situation. And indeed, it seems to be the one and only factor ever talked about when it comes to the sex ratio.

I think the numbers are significant enough to apply more of our mind than the intellectual laziness of blaming a marked target – misogyny. Hate for the female child.

While it is no secret that it is common in India to desire a female child, getting rid of 6% of unborn female infants would involve illegally testing about a tenth of them. Sex determination would be an open secret and facilities would abound. It would be common to see women get un-pregnant for mysterious reasons if that happened to one in every twenty pregnant women – in addition to natural miscarriages.

So let us look at this realistically.

The Sex Ratio

The sex ratio is the number of children born compared by sex. Worldwide, the ratio appears to be measured as number of boys per hundred girls. In India, we count it as number of girls born per 1000 boys.

Worldwide, there are between 102 to 108 boys born per 100 girls, with an accepted average of 107 – even among societies where sex selection is not common (and predating sex selection procedures). Translated to the Indian sex ratio, this would be 934 girls born per 1000 boys. 10 Indian states have a ratio higher than this.

However, it is undeniable that our overall ratio is much lower, and alarmingly so. The limited point above was that the “normal” to compare to is not 1000 but 934.

Note: I have deleted the data points for Bihar and Assam in 2010, which says the sex ratios were 323 and 1244 respectively – my belief is that no surreal rise and fall in the sex ratio happened or it would certainly make news, and it is one of the government’s bizarre data glitches. Mentioning it here, so you know, in case you find it significant.

Note 2: If the tangle of lines made by our huge democracy feels bewildering to make sense of, hovering over the name of the state in the legend will highlight the line for that state, so you can see how the sex ratio changed clearly.

Of course, this is overly simplified and there are more factors, like births reported without gender mentioned (6%!) or the data for Telangana being a part of Andhra before its creation, but this is good enough to get a gist.

Sex selection methods, reliability and viability as cause for such a large difference

Assuming that everyone in India who wants sex selective offspring wants boys, we can see how it could be done.

Sex selection pre-implantation

Pre-implantation methods mostly involve IVF (reliable), Artificial insemination (less reliable but improves chances of desired sex) and voodoo science (unreliable methods involving timing of intercourse, etc). The first two are either unnecessary or out of accessibility for the vast majority of the Indian population and the third is unlikely to be reliable. Which brings us to…

Sex selection post-implantation

This is after the woman is already pregnant, which means it involves determining the sex of the fetus and an abortion in the event of the fetus being of the undesired sex.

Free Cell DNA testing is reliable 98% of the time, but expensive. Facilities are rare. The chances of a facility in India offering it for sex determination are practically neglibible as there is no need to take illegal risks. Even if a few did, the majority would find these inaccessible and unaffordable.

Chorionic villus sampling (CVS) and amniocentesis don’t make sense, because they are not just expensive, they come with the risk of miscarriage. What’s the point of knowing it is a boy, only to miscarry because of the test?

Which brings us to Ultrasound. A normal legal ultrasound costs about one thousand rupees, give or take. Sex identification before the fifth month of pregnancy is unreliable, which means by the time you illegally come to know the sex, it is already too late to have a legal abortion as well. The later in the term the abortion is, the greater the risk to the mother’s life (hence the ban).

So, we are talking of not just about 10% of all pregnancies being illegally tested, we are assuming 6% of those opt for illegal and risky mid term abortions. We are assuming that those offering these procedures find the risk of a patient dying as a result acceptable. And this is assuming that everyone who does illegal testing actually goes on to kill the unborn girl, even at the cost of the mother’s life. One would like to imagine that number isn’t 100% or at least the women don’t want to die. Which means that more than one in ten pregnancies get tested for sex nationwide.

Not to mention, we’d see a lot more visibly pregnant woman get unpregnant without explanation. Even if there weren’t an abortion done, and some household method to cause a miscarriage was used – miscarriages are more common in the first trimester, when the pregnancy is barely showing. We simply don’t see visibly pregnant women lose their babies that often. Not to mention, there would be at least some deaths and given that most women born in homes orthodox enough to want a male child also tend to have children less than 7 years after getting married, those deaths would come with mandatory post mortems and investigations. How could all this not be noticed?

There is no doubt sex selective abortions happen illegally, but none the news of clinics busted, nor availability of facilities, nor prevalence of mid term “missing” pregnancies, significant numbers of dead mid-late term pregnant women that would be expected with this kind of number is there. Not to mention in a country starved of healthcare facilities, there is no reason for ultrasound facilities to go rogue wholesale unless they made huge profits – which would make them unaffordable on this scale.

Sorry to say, but our current theories of who to blame for the sex ratio are inadequate.

Some other factors to consider

There are many factors implicated in altered sex ratios beyond invisible evil parents. Many of these factors are related to environmental exposure and there are over a thousand studies done testing various corelations with results ranging from conclusively no to inconclusive to conclusively yes.

There has been speculation of the possibility of altered sex ratios being early warning signs for environmental concerns.

Factors studied include nuclear contamination, pesticide exposure and Hepatitis B! Conversely, there may a possibility of greater mortality among male fetuses in extremes of cold weather.

Perhaps it is time we set aside our intellectual laziness and invested serious resources into investigating why our ratios are falling. More importantly, why there are dramatic drops in some cases.

If it wants to, a country the size of India can draw on tremendous data, Pesticide sales by region, proximity to nuclear plants, reported cases of Hepatitis B and so on. These things should have easily accessible data to find starting points for in-depth research.

But it is a can of worms that could require the government to stop the politics of profit and come down hard on risk factors.

And if we are certain that sex selective abortions are still the biggest cause, ultrasound machines are difficult to procure enough for there to be ways to trace and monitor every single one of them.

Sure beats using Aadhaar to track individual citizens to deprive them their rights. And should be way easier too.

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