Is there a shift in the attitude of Kerala society towards the value of daughters? Is son preference spreading in a State once known to be above extreme gender bias? A recent study on child sex ratio generates more questions than it answers. By R. KRISHNAKUMAR in Thiruvananthapuram

ABORTION of female foetuses after parents learn of their gender using medical diagnostic techniques is believed to be one of the central reasons for the fall in the number of female children vis-a-vis male children in many States.

A decline in the “sex ratio at birth”, or the ratio of female live births per 1,000 male births, is therefore considered a sign of the growing scale of sex-selective abortions and of a society’s dislike to having daughters, though many other factors could also contribute to it.

Another facet of the worrisome phenomenon of gender bias is the prejudice that girls face vis-a-vis boys in getting an equal share of household resources or identical access to health care and nutrition. Such discrimination is so intense in many parts of India that it often affects the very survival of female children.

The girl child may be disadvantaged thus at birth and in childhood too, and social scientists gauge the intensity of such discrimination by estimating also the “child sex ratio”, the ratio of females per 1,000 males in the 0-6 age group. This ratio reflects both the scale of mortality of girl children in the 0-6 age group and of sex-selective abortions of the female foetus that may be happening in a region, among other things.

So whenever a decline in the child sex ratio is noticed, the question raised is whether the shortfall in the number of female children is mainly (a) because of the preference of parents for boys over girls, which leads to increasing sex-selective abortions, or (b) because the female children face discrimination after birth in terms of nutrition and health care, which leads to the nasty trend of unusually high mortality of girls in the under-six age group.

Changing scene

Kerala, a State with very high levels of women’s literacy, a long tradition of education for women and their perceived liberated position in society, traditional property rights favouring women in sections of society, early exposure to the outside world and an egalitarian political culture, had for long been considered to be above the national trend of bias against daughters.

But by the late 1990s such assumptions were being challenged by some scholars who pointed out citing the 1991 Census figures that the ratio of female children per 1,000 males in the under-six population was indeed falling in Kerala too.

They chose to link their observations to what they termed as “obvious signs of diminishing status of women in the State”, such as the rise of the dowry system, increasing instances of crime and violence against women, and their growing marginalisation from paid employment. They also called attention to the unbridled growth of private hospital facilities and diagnostic services specifically targeting women in Kerala, the “unjustified” (as per World Health Organisation norms) rise in the number of caesareans and hysterectomies conducted in many hospitals, and the fact that in a State where nearly all births took place in hospitals, the number of abortions too had gone up manifold.

The fertility rate was falling and the sterilisation rate was rising. The number of institutions approved by the government to conduct medical termination of pregnancy also had increased and, they said, couples in Kerala increasingly chose “abortion as an option, instead of adopting family planning measures”.

The suggestion that all this meant a growing preference for sons and the possibility of sex-selective abortions being on the rise in Kerala were, however, met with much scepticism. And nobody even dared argue then that discrimination of daughters could also be a reason for the noticed fall in the child sex ratio in the State.

The Kerala unit of the Indian Medical Association (IMA) denied that sex-selective abortions were being resorted to in the State. Some argued that the demographers who suggested it as a possibility made a mistake by concentrating on the decline in the child sex ratio in 1991 alone, whereas a similar decline could be noticed in the 1981 Census too, representing a period when the technology for sex-selective abortions was not available in the State.

Many cautioned against the State jumping to quick conclusions. “There is fairly strong medical evidence all over the world to suggest that males outnumber females at birth. Given the decline in the total fertility rate and the intensity with which female sterilisation is adopted in Kerala, a ‘masculining’ of the population can happen on its own,” a researcher had told Frontline then.

Others, however, said policymakers should stop being complacent. “The environment is conducive. Facilities for sex determination and abortion are widely available. Just because doctors continue to deny it, can we say it is not happening in Kerala?” they said. The flutter died down on its own after some time, and some researchers pointed out that the fall in the child sex ratio in 1981 and 1991 in fact reversed in 2001, with the 2001 Census figures indicating an improvement.

New study

A recent study commissioned by the Social Welfare Department of the Kerala government has reopened the debate. The study, “Child sex ratio in Kerala”, by M. Kabir, former Head of the Department of Economics of the Government College for Women, Thiruvananthapuram, and K. Pushpangadan, formerly a Professor at the Centre for Development Studies (CDS), argues that inter-district and time-trend analysis of data do not provide a promising picture of the widely held view of comparatively better gender equality in Kerala.

“The State government decided to commission the study because the latest Census figures showed that there was a reduction in the child sex ratio in Kerala. It is a worrisome trend in a State like this and unless you monitor it closely, it could explode on your face. So we wanted to look into it in detail,” Rajeev Sadanandan, Principal Secretary, Health and Family Welfare Department, said. The conclusions of the study were presented at a seminar at the CDS in early March soon after it was submitted to the State government. Among its major findings were:

(a) In the two decades from 1991, child sex ratio showed a declining trend in Kerala. It fell from 976 to 958 in the two decades from 1971 to 1991; it registered a marginal increase to 960 in 2001; and fell again to 959 in 2011;

(b) “The female deficit” in the 0-6 age group increased in six of the total 14 districts during the same period. The six districts were Kasaragod, Kannur, Wayanad, Palakkad, Thrissur and Idukki. The northern district of Palakkad, bordering Tamil Nadu, showed a steady decline in all the censuses from 1991;

(c) A trend of lower female-male child sex ratios seemed to be spreading in clusters of contiguous taluks in the State. Altogether, 26 of the total 63 taluks in Kerala had lower female-male child sex ratios in 2001 than in 1991; and 39 taluks had lower female-male ratios (FMRs) in 2011 than in 2001. However, no taluk had a sex ratio below 900, the threshold level to be called alarming, in any of the censuses from 1991;

(d) A trend of “increasing masculinisation at birth” was also visible. However, despite the fall in the sex ratio at birth, “in all the districts those ratios were within the demographically accepted ‘normal’ range of 104 to 107 males for every 100 females”; and

(e) Several sources of data indicated that there was excess female mortality in the 0-6 age group in an increasing number of districts from 1981.

Kabir told the seminar that he considered three of these as the most important findings of the study: “One, the contiguous nature of the declining child sex ratio trend in taluk clusters; two, though the sex ratio at birth is within the normal range, a decline is observed in all the districts; three, and perhaps the most important, is the finding of higher female mortality among children.”

According to Pushpangadan, the multi-variant analysis, which took into account the child sex ratio, sex ratio at birth and data relating to mortality of children, showed that “the mortality story is a very valid proposition”.

‘Disturbing percept’

The report therefore concludes with a stunning statement: “Statistical analysis indicates that both sex ratios at birth and mortality differentials are significant in explaining child sex ratios in Kerala. But, the sex ratio at birth, despite the fall in some of the districts, is within the internationally accepted ‘normal’ range.

On the contrary, the excess mortality of female children raises serious questions which relate to the discrimination of the female child. The data point towards the question, ‘Is Kerala not different from the north Indian States?’”

Kabir said: “Though an increase in masculinity at birth has taken place, the ratio is within the normal range. We cannot be sure whether such an increase is due to random biological variations—it is well known that, left to nature, more males are born than females—or due to some ‘extraneous intervention’. But since it is within the normal range it is not a matter of very serious concern; but, of course, the decline matters and why it has taken place needs to be studied.”

The report seeks to set aside the possibility that the fall in the child sex ratio observed in Kerala could be a result of a rise in sex-selective abortions, as it was suggested earlier. Instead, it embraces the second possibility, so far considered unlikely in Kerala, that it could instead be that female children are facing such discrimination in the State that it results in relatively more of them dying by the age of six.

So does it mean that there is surely a shift in the attitude of Kerala society towards the value of daughters? And is son preference spreading in the southern State to such an extent that girls in the 0-6 age group are dying because of it? (Interview with Prof. T.K. Sundari Ravindran on page 114.)

A heated discussion has ensued with some participants terming it as a “disturbing percept” and claiming that “if it is discrimination against the girl child, then there are enough facilities in Kerala which allows people who do not want a baby girl, not to have one”.

Valid doubts are in the air: If it is discrimination of the female child after it is born, as the report suggests, then what is the explanation for the trend spreading in contiguous taluks? Is it possible that both sex-selective abortion and gender discrimination factors may be at work? How many girls in the 0-6 age group are actually dying in Kerala, and what are the causes of death?

Questions are also raised about the reliability of some of the data used in the study.

The continuing lack of hard evidence or dependable studies to prove or disprove any of the theories on an issue that has been disturbing researchers and planners in Kerala for over two decades is painfully becoming evident.

“We may have to go for fresh inquiries. The questions regarding declining child sex ratio in the State have not been satisfactorily answered by the commissioned study,” Rajeev Sadanandan said.

Interestingly, according to the 2011 Census, Kerala had 1,084 females for every 1,000 males in the entire population, up from 1,058 females per 1,000 males a decade earlier.