UNFPA Publication 39664

7/31/2019 UNFPA Publication 39664

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Evidence of Sex Selective Abortion fromTwo Cultural Settings of India:

A Study of Haryana and Tamil Nadu

By: Sayeed Unisa,C.P.Prakasam,R.K.Sinha andR.B.Bhagat

2003


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Acknowledgement

We would like to thank first and foremost, the respondents of selected villages of Jind` andSalem districts of Haryana and Tamil Nadu respectively, for their good will, support and sparing

time for this project work. We have been overwhelmed to observe the deep sense of affection,

and warmth of the respondents and the village community for our research team with a

remarkable sense of hospitality. Without this, the work could not have been completed. We

therefore acknowledge gratefully the contribution of the many such persons whose unflinching

support to the cause of women is indubitable.

The Chief Medical Officers and Medical Officers at the PHCs/CHCs of Jind and Salem

districts have been very helpful. We sincerely thank them. Dr Pramod Gauri, Director, State

Resource Centre, Rohtak, and his associates namely Mr Sunil, Mr Sohan Das, and Mr Hooda

took keen interest in this project and helped us in data collection in Jind district of Haryana. We

are extremely thankful to them.

The research team apart from the Principal Investigators consisted of Ms Sutapa

Aggrarwal, Mr Kailash Lakhara, Ms Usha, Mr Murugesan, and Ms Smita, who helped us in data

collection, tabulation and the statistical analysis. We highly appreciate their hard work and

sincerity. Ms Sucharita Pujari has been immensely helpful in getting the manuscript ready in the

present form. Thanks are due to her.

Ms Shushila, an M. MPhil student, M.D. University, Rohtak, and her family has been

very kind to us for extending all help at Jind. We thank Ms Shushila and her family for their kind

hospitality.

We would like to thank Professor N. Audinarayan and Dr N. Kabitha, Department of

Population Studies, Bhartiar University, Coimbatore, and Dr Rita Garg and Dr C. L. Garg, Maya

Devi Hospital, Jind for providing their valuable time in different stages of this project.

We would like to express our deep sense of appreciation for Professor T. K. Roy,

Director of the Institute and Professor G. Rama Rao for their keen interest in this project and

their time-to-time help and encouragement to us.

September 11, 2003 Principal Investigators


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CHAPTER - I

INTRODUCTION

1.1 Introduction

Several studies have reported high preferences for son in different states of India. Recent

improvement in medical technology and easy availability of sex determination test has

resulted in high incidence of female foeticide. Availability of abortion services in private

nursing homes has exacerbated the incidence of abortion as well as sex selective abortions

in India.

Demographically sex selective abortion can affect the sex ratio of the population. In

Indian context, particularly the decline of sex ratio in the last century was a matter of great

concern among social scientists. The Indian census has brought out that the sex ratio has

declined from 972 females per thousand males in 1901 to 927 in 1991. The declining trend

has reversed only twice during this period, once during 1941-51 and again in 1971-81.The

most recent census results of 2001 indicate that the sex ratio has improved by 6 points in

favour of females, from 927 females per thousand males in 1991 to 933 in 2001. However

the recent increase during 1991-2001 was completely offset by the fact that the sex ratio of

child population (0-6 years) declined substantially. The 2001 census shows that there are

927 girls (0-6 years) per thousand boys of the same age group, lower than the overall sex

ratio (933). The severe deficit of females among child population and overall lower sex ratio

has become a matter of great concern among demographers and social scientists. (Kundu

and Sahu, 1991 and Srinivasan 1994).

In large parts of the Indian sub continent there is an age-old tradition of preferring

sons to daughters. Since early 1970s amniocentesis has been used in the country for sex

determination at clinics that often offer abortion services. In 1986, in Mumbai, 85 per cent of

50 gynaecologists interviewed carried out amniocentesis for sex determination, considering

it a humanitarian gesture, although many of them performed it because it was highly

lucrative. In Punjab, a survey showed that 66 percent of families with 3 daughters and no

sons wanted more children compared to only 13 percent of those with 3 sons and no

daughters. (Krassmy and Besrgstrom, 1992 and Parasuraman, et al., 1998). Sons often

increase family income, while daughters dowry cause family indebtedness, which explains

why there are fewer girls than boys.


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Sex selective abortion has been documented in India as early as 1970s when

amniocentesis for genetic screening became available. (Ramanama and Bambawale 1980

and Patel 1989). It was only with the increasing availability of ultrasound technology during

late eighties that the practice of sex selective abortion became wide spread. In response to

growing practice of sex determination tests followed by selective female foeticide, the

Government of India enacted an act known as Prenatal Diagnostic and Prevention Act

(1994) to prevent the sex determination test. Many states have taken steps on this issue.,

Also the opponents of the legislation have pointed to the social and economic factors that

underlie the strong son preference in India. They argued that social prejudices cannot be

overcome simply by legislation, and that legislation will only drive the banned action

underground and lead to bribery and malpractices.

Recent studies have shown high prevalence of abortion in the states of Punjab,

Haryana, Tamil Nadu and Rajasthan. It has been reported that there are widespread sex

selective abortions taking place in these states despite the laws prohibiting them. In many

instances sex selective abortion takes place after 12 weeks of gestation, which is quite risky

for the health of the women. This can lead to obstetric morbidity and infertility among

women, an area hardly explored in the Indian context.

Abortion by itself is a life-threatening act. Under what circumstances do women

resort to abortion is a matter of enquiry. There are few studies available on this aspect and

very little is known about the reasons and circumstances under which women go for sex

selective abortions. Further, unsafe abortion is one of the most neglected problems of

health care in developing countries (Mishra, 2001).

Hence the objective of this study is to document the evidences of sex selective

abortions from two different cultural settings in India, namely, Haryana and Tamil Nadu

which are in the news for the practice of sex selective abortions. Knowing the causes and

circumstances under which women go for abortions would facilitate in the long run in

framing suitable policy and programs for interventions.


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1.2 Objectives

1. Mapping of abortion /sonography facilities in the selected district of Haryanaand Tamil Nadu.

2. To find out the prevalence and incidence of sex selective abortions

3. To study the causes and consequences of sex selective abortions andobstetric morbidity.

Keeping this in mind the following conceptual framework is developed.


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CONCEPTUAL FRAMEWORK OF CAUSES AND CONSEQUENCES OF SEX SEL

FAMILY LEVEL VARIABLES CONSEQ

DemographicFactors

EconomicFactors

ReligiousFactors

OM

SI

MH

S

FamilySizePreference

GenderPreference

Abortion/SexSelectiveAbortion

Availabilityof MedicalTechnology


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1.3 Methodology

In this study as a first step, in order to identify the clusters of high incident areas of induced

abortion, a secondary data analysis of child population (0-4 and 5-9) was done for 1981 and

1991 censuses by districts. The district that exhibited a very high sex ratio (Male /Female) in

1981 and 1991 was selected for the study. These districts were Jind in Haryana and Salem

in Tamil Nadu. The district maps were then prepared using child sex ratio (0-6 years) at the

village level. There were many villages with sex ratio of 125 and above. One of the

concentrations of such cluster was selected in both the districts. Subsequently mapping of

abortion and ultrasound facilities in the 20 km diameter of this cluster was carried out. For

this purpose, identification of facilities such as hospitals/ nursing homes/clinics (allopathic,

ayurvedic, and RMP) was done in all the nearby towns (towns with population below one

lakh) as well as in the villages. Data was also collected from health care providers offering

services of antenatal care, MTP and deliveries. In the first phase of the study prevalence

rate of sex selective abortions was calculated and in the second phase of the study

incidence rate was calculated, to satisfy the objectives of the study.

In case of Jind district, 42 healthcare facilities and in Selam 28 health care facilities

were found in the vicinity of those villages with high sex ratio. Out of these facilities 22

facilities in Jind and 10 in Salem were providing antenatal care, MTP, and delivery facilities

whereas nearly 10 hospitals in Jind and 5 in Salem also had the ultrasound facility. It may

be mentioned here that the idea was to do complete census of the villages but due to

budgetary constraint only 5 villages in Jind and Selam were chosen for the study. Besides

in one cluster 5 villages were sufficient to carry out the study. However at the time of data

collection the five villages in Selam district were divided into seven and that is how the

number of villages in the Salem district have been increased to seven.

From the cluster of villages with a sex ratio of 125 and above, five villages in Jind

and seven villages in Salem were selected randomly for the study. Complete household

enumeration was done in the selected villages. A total of 2,590 households in Jind and

1,791 households in Salem were covered. The total number of ever-married women in

reproductive ages who were interviewed in the selected villages was 2,646 in Jind and

1,706 in Selam district. Detailed information was collected on household characteristics,

pregnancy history, antenatal care, deliveries, abortion history, reasons for abortion, place of

abortion and obstetric morbidity for each pregnancy starting from marriage.


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The second phase of the study, followed by a gap of 6 months, was repeated by

interviewing a subset of women with either one or some of the following characteristics:

1) had an abortion

2) had a still birth3) death of a female child occurred

4) undergone ultrasound test

Medical camps were organized in the selected villages with the help of a team

consisting of one gynaecologist and a physician. In-depth interviews as well as clinical

investigation reports by medical doctors (Gynaecologist) were collected with the consent of

the women.


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CHAPTER - II

HEALTH INFRASTRUCTURE

The survey on infrastructure of medical facilities was carried out in government and private

hospitals/nursing homes and clinics during October 2000 in the Jind district of Haryana with

population below ninety thousand (1991). The study included infrastructure survey of the

town and the selected five villages, for which complete census was done. In the selected

town and its periphery, all together 40-health facilities were found. Out of this, 18 were small

RMPs (Registered Medical Practitioners), homeopathic clinics and some allopathic clinics,

like orthopaedic and dental clinics. In the remaining 22 health facilities, data on

infrastructure was collected from medical doctors who were in-charge of the nursing homes.

There were four government health facilities and private practitioners ran the remaining

health care centres. Out of 18 private nursing homes, 12 were established very recently

during 1991-2000. Most of these clinics were run by the doctors from neighbouring states.

NFHS II survey has shown that in Haryana, only 60 percent of the pregnant women

go for antenatal care or for at least one ANC check-up. Percentage of births assisted by

health professional is only 42 percent for Haryana, 62 percent for Punjab and 90 percent for

Kerala. So, when these towns are not serving to a very large population and where the level

of antenatal and natal care is low, then the question arises as to why have so many nursing

homes and clinics come up in many small towns in Haryana?

2.1 Sex determination technologies

The prenatal diagnostic technique involves the use of technologies such as ultra

sonography, amniocentesis, choroin villi biopsy, foetoscopy, maternal serum analysis etc.

In the study area, only ultra sonography was being used and according to doctors, it is safe

and does not require any special training, extra staff and expenditure for operation. Out of

22 allopathic nursing homes/clinics, 10 provide ultrasonography and 3 of them have colour

sonography machines. Most of them use generators in their nursing homes. Apart from

regular nursing homes providing the ultra sonography, mobile ultrasound facilities are also

available in the villages. The charge for ultrasound is Rs.300/- to Rs.500/-, which is quite

affordable for the villagers.


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2.2 Antenatal care and sonography

As shown in table 2.1 in comparison to total antenatal cases, use of sonography was found

to be around 20 percent for all women visiting these clinics. The percentage for blood and

urine test is quite high (above 60 percent) but those are routine checkups whereas

sonography should be done only under special situation. In any case, 20 percent of women

visiting these clinics for antenatal care will not require this test (ultrasound) for the health of

the baby or mother, unless the motive is to know the sex of the foetus. The number of

antenatal cases, attended the clinic where sonography is available was also very large. This

could be both due to womens motive to undergo sonography or better facilities in these

nursing homes.

Table 2.1: Number of cases served during last six months for different medicalservices, JIND, October 2000

No. of clinics AntenatalCare*

Sonography* Urine Test* Blood Test*

WithSonographyfacilities (10) 10118

2192(21.7%)

6668(65.90%)

6458(63.8%)

WithoutSonography

facilities (12)

3236 - 148

(4.6%)

190

(5.9%)Total (22) 13354 2192

(16.4%)6816

(51.0%)6648

(49.8%)

*Information about number of antenatal, sonography and other tests are based on doctors self-reportingabout the care given by them daily/weekly/monthly.

2.3 Medical termination of pregnancies

Apart from ultrasound facilities, the nursing homes also provide abortion services to their

clients irrespective of the fact whether they are recognized as MTP centre or not (as shown

in table 2.2) and most of the abortions are done after 3 months of gestation period only

when the sex of the foetus becomes recognizable. Doctors revealed these facts during their

informal talks with the researcher; although they admitted that it could pose serious health

hazards for females. It was revealed that in comparison to 100 deliveries done at the

nursing homes with sonography facility, about 64 cases of MTP were done. In terms of

proportions nearly one-third cases were for MTP and two third for deliveries. In case of


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clinics/nursing homes without sonography facility, a higher proportion of women were going

for MTP services. In general, the procedure adopted for abortion is usually DNC in the

nursing homes where operation theatres are available. In case of clinics with no such

facilities, some of the doctors reported that they administer certain abortion inducing

injections, which has effect only after several hours, and ask the client to go to their homes.

In villages, the quacks/trained dais and ANMs are practicing induced abortions at premium

fees. The cost of abortion ranges from Rs. 1200/- to Rs 4000/- depending upon the clients

status, as well as the status of the nursing home and the risk period.

Table 2.2: Number of deliveries and MTP cases served during last six months, JIND,October 2000

No. of clinics *No. of delivery

cases

*No. of MTP

(Abortions)

Ratio of MTP to

No. of deliveriesWith Sonographyfacilities (10) 2475 1578 63.8WithoutSonographyfacilities 103 305 296.1

*Information about number of deliveries and MTP are based on doctors self-reporting aboutthe natal care given by them daily/weekly/monthly.

In a small town like Jind with population of 85 thousand in 1991 census, 10 nursing

homes were providing the ultra sound facility. These nursing homes are run by medical

doctors usually husband wife team with or without a gynaecologist. Some of the B.A.M.S.

degree holders and nurses are also providing the ultra sound facility (they have not

admitted this openly but the clients sitting in the waiting room reported this). Apart from this,

mobile ultra sound (Maruti van with ultra sound machine) facilities are available in the

villages of Haryana. The charge for an ultra sound in Haryana is Rs. 300 to 500.

In Selam, 28 health care facilities were found in the vicinity of those villages with

high sex ratio. Out of these health facilities, ten were providing antenatal care, MTP, and

delivery facilities and another five health facilities had the ultrasound facility as well.


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CHAPTER - III

SOCIO ECONOMIC AND DEMOGRAPHIC BACKGROUND OF THEHOUSEHOLD POPULATION

The present chapter presents a profile of the socio economic and demographic

characteristics of the household population.

3.1 Age and sex composition

Table 3.1 presents the percentage distribution of household population by age and sex for

Jind district in Haryana and Selam district in Tamil Nadu. The total household population for

Haryana is 15,171 and 7183 for Tamil Nadu. Thirty seven percent of the population in

Haryana is below 15 years of age of which 36 percent are females and 39 percent are

males and 8 percent are aged 60 or more. In Tamil Nadu 28 percent of the population are

below 15 years of age of which 26 percent are females and 31 percent are males where as

only 8.2 per cent of the total population are aged 60 and above.

The sex ratio (number of females per 1000 males) is an important measure that

indicates the balance of the sexes in the population. The sex ratio as shown in the table is

832 in Haryana and 867 for Tamil Nadu, the sex ratio being highly unfavourable towards

females in both the states.

3.2 Marital status

Table 3.2 shows the marital status of the household population according to age and sex for

the state of Haryana and Tamil Nadu. In Haryana among females 60 percent are currently

married and 34 percent are never married. In Tamil Nadu 64 percent of the females are

currently married and 24 percent are never married. The percentage never married is higher

among males (48.2 percent) than for females in Haryana. In Tamil Nadu the percentage

never married among males is highest in 15-19 age group (97.8 percent) and lowest in 30-

49 age group (3.1 percent).

Percentages of separated/ deserted/ widowed and divorced are small in both the

states for both the sexes. Twenty seven percent of females aged 50 plus, 5.3 percent


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women aged 30-49 are widow in Haryana. The corresponding percentages for males are 13

percent and 1 percent respectively. Similarly in Tamil Nadu 39 percent of the females, aged

50+ and 7.8 percent aged 30-49 years are widow. The corresponding percentages for

males are 2.3 percent and 1.1 percent only.

With regard to the proportions of persons marrying young, it is observed that in

Haryana in the age group 15-19, the proportion of married is 5.1 percent for males and 38.4

percent for females. In Tamil Nadu, the proportion of ever-married in 15-19 age group is 2

percent for males and 43.5 percent for females. By age 25-29, the proportion of females

marrying is virtually universal in both the states. The corresponding percentages for males

are 84.1 percent in Haryana and 71.1 percent in Tamil Nadu. Overall the table shows that a

large percentage of females marry at a relatively younger age in Tamil Nadu than in

Haryana. The number of females marrying at a young age is much lower when compared to

males in both the states.

3.3 Household composition

Table 3.3 shows the percent distribution of households by various characteristics of the

household head like sex, age, religion, caste, household type and the number of members

usually living in the household for the state of Haryana and Tamil Nadu. The table shows

that ninety three percent of households in Haryana are male-headed households and only

seven percent constituting female-headed households. In Tamil Nadu 53.6 percent of the

household heads are male. This shows that in Haryana the households are predominantly

dominated by males, which is not in case of Tamil Nadu. The median ages of the head of

the household in Haryana and Tamil Nadu are 42 and 43 years respectively having very

little variation. Household heads seems to be somewhat more concentrated in 30 44 age

group in both the states.

Overall 98 percent of the households head in Haryana are Hindus and 2 percent of

the heads of the households are Muslims. Similar is the picture in Tamil Nadu, where

almost 100 percent of the household heads are Hindus. Less than one percent of the head

of the household belong to Muslim, Christian and other communities.


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With regard to household type, 62 percent of the households in Haryana are of the

nuclear type corresponding to 75 percent in Tamil Nadu. The average household size is

slightly higher in the state of Haryana (5.8 persons per household) than in Tamil Nadu (4.1

persons per household).

3.4 Educational level

Tables 3.4a & 3.4b show the percent distribution of household population aged 6 and above

by literacy and level of education and median number of years of schooling according to

age and sex for Haryana and Tamil Nadu respectively.

The tables show that 34.6 percent of the population aged 6 and above are illiterate in

Haryana. 49 percent females and only 22.6 percent males are illiterate indicating a wide

gender disparity in literacy in Haryana. Correspondingly in Tamil Nadu 44 percent of the

population aged 6 and above are illiterate. Fifty five percent females and 35 percent males

are illiterate.

In 20-29 age group, nearly 26 percent males are higher secondary complete,

corresponding to only 7.6 percent in case of females in Haryana. The corresponding figures

for Tamil Nadu are 17 percent for males and 11 percent for females. A higher percentage of

males than females have completed each level of schooling in both the states. The

proportion illiterate is lowest at age 10-14 years and highest at age fifty and above for both

males and females in Haryana. In Tamil Nadu the proportion illiterate is lowest in 6-9 age

group and highest at age fifty and above. In both the sexes, the proportion illiterate is lowest

in 10-14 age group and highest among persons aged 50 and above.

The median number of years of schooling for males in Haryana is 6 years and 4

years in Tamil Nadu. For females the median number of years of schooling in Tamil Nadu is

zero as more than half of the females are illiterate. In Haryana, it is even less than 2 years

for females, as slightly less than half of the female population have never attended school.


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3.5 Housing characteristics

Table 3.5 provides information on household characteristics such as source of drinking

water, sanitation facility, type of house, and type of fuel used for cooking for the state of

Haryana and Tamil Nadu.

The table shows that 89 percent households in Haryana have electricity

corresponding to 78 percent households in Tamil Nadu. With regard to water sources and

sanitation facilities, in Haryana 30 percent of the household use tap located inside the

house, 42 percent use tap located out side the house, 24 percent use hand pump bore well

and well; and less than one percent use other sources of drinking water. In Tamil Nadu 68.5

percent of the households use tap located outside the residence and only 5 percent use tap

located inside the residence. Twenty six percent of the households use hand pump bore

well and well.

As far as sanitation facility is concerned 77 percent of the households in Haryana

have no toilet facility corresponding to 95 percent of households in Tamil Nadu. Thirteen

percent households in Haryana and four percent of the households in Tamil Nadu have own

toilets with flush facility. The percentage of household using public toilets with flush facility is

less than one percent in both the states.

Regarding type of house construction, 50 percent of the houses in Haryana are

pucca houses corresponding to 14 percent in Tamil Nadu. Forty three percent of the houses

are semi pucca and 7.5 percent are kachha houses in Haryana where as in Tamil Nadu 44

percent of the houses are semi pucca and 41 percent of the houses are kachha. The

proportion of houses, which are kachha, is much higher in Tamil Nadu than in Haryana.

Regarding type of fuel used, 83.8 percent of the households in Haryana use cowdung cakes for cooking, whereas in Tamil Nadu 87 percent of the households use wood for

cooking. Electricity as a method of cooking is used by 2 percent of the households in

Haryana and less than one percent in Tamil Nadu. LPG is used by 31.5 percent of the

households in Haryana corresponding to 13.5 percent in Tamil Nadu.


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3.6 Households owning agricultural land/house/livestock

Table 3.6 gives the percent distribution of household owning land, owning a house and

owning livestock. About 51 percent of the households in Tamil Nadu own no land,

corresponding to 37 percent in Haryana. Overall 61.5 percent of the households in Haryana

own agricultural land as compared to 25 percent in Tamil Nadu. Non-agricultural land is

owned by less than one percent of the households in Haryana compared to 18.2 percent in

Tamil Nadu. Ownership of house is nearly universal in Haryana. The proportion of

households owning a house in Tamil Nadu is 95.3 percent. The proportion of households

owning a livestock is 80 percent in Haryana and 42 percent in Tamil Nadu.

3.7 Households owning selected durable goods

It is said that the possession of consumer durable goods is an important indicator of a

households economic status. Table 3.7 shows the percentage distribution of households

owning selected durable goods. It is observed from the table that in the state of Haryana, as

a whole, majority of the households have cot/bed, electric fan, clock watch, mattress (98.2

percent, 88.0 percent, 86.9 percent and 60 percent respectively).

Other consumer durable goods often found in most of the households are black andwhite television (45 %), bicycle (42%), chair (45.5%), radio/ transistor (31.2%), pressure

cooker (28.3 %), water pump (20%), scooter/motorcycle/tractor (10%), telephone (9.5%)

and thresher (7%).

In Tamil Nadu majority of the households have mattress (96%), cot / bed (88%),

clock / watch (62%) and bicycle (55%). Other consumer durable goods often found in

the household are radio (36.7%), electric fan (35%), television (19%), motorcycle /

scooter (16%).


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Table 3.1: Percent distribution of household population by age and sex

HARYANA (Jind) TAMILNADU (Salem)Age Male Female Total Male Female Total

0-4

5-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980+

Total Percent

Number ofpersons

Sex Ratio

10.9

13.913.011.19.58.46.65.94.93.22.42.22.32.51.90.70.6

100.0

8,280

11.4

12.212.510.310.09.47.26.23.92.44.12.03.72.41.40.30.7

100.0

6,891

11.1

13.212.810.79.88.96.86.04.42.83.22.12.92.41.70.50.7

100.0

15,171

832

11.2

10.29.29.48.79.47.57.05.84.84.93.83.61.71.60.70.6

100.0

3,848

9.4

9.17.29.111.110.17.98.16.46.23.44.23.52.01.10.40.7

100.0

3,335

10.4

9.78.39.29.89.77.67.56.05.44.24.03.61.91.40.60.7

100.0

7,183

867


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Table 3.2: Marital status of the household population

Percent distribution of household population age 6 and above by marital status,according to age and sex

Marital status

Age Currentlymarried Separated/Deserted Widowed Divorced Nevermarried TotalpercentHARYANA

Male

13-14 0.3 0.0 0.0 0.0 99.7 100.015-19 5.1 0.1 0.0 0.0 94.8 100.020-24 44.3 0.5 0.5 0.0 54.7 100.025-29 84.1 0.3 0.1 0.0 15.5 100.030-49 96.2 0.1 1.7 0.0 1.9 100.050+ 85.0 1.2 12.8 0.1 0.9 100.0

Female13-14 3.1 0.0 0.0 0.0 96.9 100.0

15-19 38.4 0.3 0.4 0.1 60.8 100.020-24 92.9 0.3 0.3 0.3 6.2 100.025-29 98.9 0.2 0.5 0.0 0.5 100.030-49 94.0 0.5 5.3 0.1 0.1 100.050+ 71.5 0.9 26.7 0.4 0.5 100.0

TAMILNADUMale

13-14 0.0 0.0 0.0 0.0 100.0 100.015-19 2.0 0.3 0.0 0.0 97.8 100.020-24 26.7 0.3 0.3 0.9 71.8 100.025-29 71.1 0.3 0.3 0.0 28.3 100.0

30-49 95.5 0.7 1.1 0.0 3.1 100.050+ 88.9 0.4 2.3 0.1 41.7 100.0

Female13-14 0.0 0.0 0.0 0.0 100.0 100.015-19 43.1 0.7 0.7 0.0 55.5 100.020-24 86.4 0.5 0.3 0.0 12.7 100.025-29 92.9 2.4 2.1 0.3 2.4 100.030-49 87.7 3.2 7.8 0.5 0.8 100.050+ 57.9 1.8 39.2 1.0 0.2 100.0


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Table 3.3: Percent distribution of households by selected characteristics of thehousehold head, household type and household size

Background Characteristics Haryana (Jind) Tamil Nadu (Salem)

Sex of the head of the householdMale 93.0 53.6Female 7.0 46.4

Age of household head


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Table 3.4a: Percent distribution of household population age 6 and above by literacyand level of education, according to age and sex (Haryana)

Education levelAge Illiterate Literate,


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Table 3.4b: Percent distribution of household population age 6 and above by literacyand level of education, according to age and sex (Tamil Nadu)

Education levelAge Illiterate Literate,


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Table 3.5: Percent distribution of households by housing characteristics

Housing characteristics Haryana (Jind) Tamilnadu (Salem)ElectricityYes 89.3 77.8No 10.7 22.2

Source of drinking waterTap (Inside residence) 30.4 5.3Tap (Outside residence) 41.6 68.5Hand pump, bore well, well 24.3 26.2Pond 3.1 0.0Other 0.3 0.0

Sanitation facilityOwn toilet (flush) 13.2 4.1

Public toilet (flush) 0.2 0.2Own toilet (pit) 1.5 0.0Public toilet (pit) 7.6 0.4No facility 77.5 95.3

Type of housePucca 49.6 14.2Semi-pucca 43.0 44.4Kachha 7.5 41.4

Main type of fuel used for cookingElectricity 2.0 0.2LPG / Bio-gas 31.7 13.5Charcoal 18.7 19.2Wood 78.4 87.6Crop residue 9.8 37.2Cow dung cakes 83.8 15.1Others - 0.1


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Table 3.6: Percent distribution of households owning agricultural land/ house/livestock, Haryana & Tamil Nadu

Asset Haryana (Jind) Tamil Nadu (Selam)

No land 37.1 50.9

Agricultural land only


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Table 3.7: Percentage of households owning selected durable goods

Asset Haryana (Jind) Tamil Nadu (Salem)

Durable goods

Mattress 60.1 96.6

Pressure cooker 28.3 9.6

Chair 45.5 53.5

Cot/ bed 98.2 88.3

Electric fan 88.0 34.9

Clock/ watch 86.9 61.9

Telephone 9.5 4.7

Bicycle 41.7 55.5

Radio/ transistor 31.2 36.7

Television (B&W) 44.9 19.2

Television (Colour) 3.2 5.6

Moped/ scooter/motorcycle 10.1 16.2

Water pump 19.7 3.8

Thresher 6.9 0.2

Tractor 10.1 0.2

Other items 11.0 0.2


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CHAPTER - IV

SOCIOECONOMIC AND DEMOGRAPHIC BACKGROUND OF THERESPONDENTS

Womens health seeking and demographic behaviour is virtually linked with several other

characteristics including their age, marital status, religion, and caste. This chapter presents

a profile of the demographic and socioeconomic characteristics of ever-married women age

15-49 who were identified by the Household Questionnaire as eligible respondents for the

present study.

4.1 Background characteristics of the respondents

Table 4.1 presents the percentage distribution of all women interviewed by age, marital

status, co-residence with husband, education, husbands education and employment for

Haryana and Tamil Nadu. The table shows that in Haryana, the proportion of respondents in

5-year age groups increases from 7.5 percent in 15-19 age group to 23.1 percent in 25-29

age group and then falls down to 5.3 percent in 45-49 age group. In Tamil Nadu the

proportion of respondents in the 5-year age group increases from 9.1 percent in 15-19 to

18.9 percent in 25-29 age group. It decreases to 14.8 percent in 30-34 age group and

increases to 15.4 percent in 35-39 age group after which it falls down to 11.4 percent in

45-49 age group.

A large number of the respondents fall in the high fertility age group of 20-29 in both

the states. More than half of the respondents in Haryana (51.6 percent) are in the early

reproductive age group of 15-29 years. In Tamil Nadu more than half of the respondents are

concentrated in the higher age group of 30-49 (53.8 %). Only 5.3 percent of women in

Haryana are in the 45-49 age group compared to 11.6 percent in Tamil Nadu.

As far as marital status is concerned, 97.1 percent women in Haryana reported to be

currently married and 2.9 percent women are widowed. In Tamil Nadu, around 93 percent

women reported to be currently married. The percentage of women who reported to be

divorced/separated is 4 percent each. Two to three percent women said that they were

widows. Nearly ninety nine percent of the respondents reported to be living with their


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26

husbands in Haryana compared to 95.3 percent in Tamil Nadu. A very small percentage of

women were not living with their husbands in both the states.

The literacy levels of the respondents and their husbands have an important bearing

on their health care and health seeking behaviour. More than 60 percent women in Haryana

(64.7%) and Tamil Nadu (62.7%) are illiterate. Among women who are literate, large

proportions are those who have completed primary but not middle school. Only 14.2 percent

women in Haryana and 16 percent women in Tamil Nadu reported to have completed

primary level of education.

Although 64.7 percent women in Haryana are illiterate, only 31.2 percent of their

husbands are illiterate. On the other hand, a higher percentage of husbands in Tamil Nadu

(53.4 percent) are illiterate. Again in Haryana, 21 percent women have husbands who are

high school complete, compared to 7.3 percent in Tamil Nadu.

Considering the fact that the employment/work status has an important influence on

a womens overall development as it nurtures her personality and helps her gain a sense of

economic independence, it would be interesting to see the work participation rate in any

kind of economic activity in any kind of economic activity either inside or outside house in

both Haryana and Tamil Nadu. The table shows that 49 percent of respondents in Haryana

have not been working in the past 12 months. The corresponding figure for Tamil Nadu is

41 percent. Nearly 35 percent women in Tamil Nadu are employed with someone else

compared to only 13.2 percent in Haryana. The figures have been just the opposite in case

of women, who reported to be working in their own family farm or running their own

business. The table shows that 35 percent women in Haryana compared to only 11 percent

in Tamil Nadu work in their respective family farm/business. The percentage of women who

are self employed is 2.7 percent in Haryana and about 12 percent in Tamil Nadu.

Thus more women in Tamil Nadu are seeking employment elsewhere compared to

women of Haryana who are more involved in family farm or business.

4.2 Exposure to mass media

In a country like India, where a large number of women are illiterate and have attained little

or no formal school education, informal channels such as mass media plays an important


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role in bringing about modernization and thereby influencing and motivating women about

their reproductive rights and choice.

Table 4.2 provides information on the percentage of ever-married women age 15-49

who read a newspaper or magazine, watch television or listen to radio at least once a week,

who visit a theatre once in a month by selected background characteristics for Haryana and

Tamil Nadu.

In Haryana regular exposure to media is higher among younger women below age

30, in comparison to Tamil Nadu where the exposure to mass media is more among women

in the higher age group of 30 and above (except in case of visits to cinema theatre). In

Haryana television has the greatest reach among women in all the age groups whereas in

Tamil Nadu listening to radio seems to be more popular among women in all the age

groups. However exposure to mass media is more in case of Tamil Nadu as compared to

Haryana.

Exposure to each of the media increases with education. The percentage of illiterate

women who are exposed to any kind of media is quite low in Haryana compared to illiterate

women of Tamil Nadu. On the whole, women of Tamil Nadu have wider exposure to mass

media than women of Haryana.

4.3 Perceived educational need for sons and daughters

Table 4.3 provides information on the womens educational aspirations for their children for

Haryana and Tamil Nadu. Investing in childrens education is not only an important factor in

bringing about a transition from uncontrolled fertility to controlled fertility, but is also an

indicative of the degree of son preference prevalent in the respective places.

In Haryana, 57 percent women believe that a son should be given as much

education as he desires compared to 48.5 percent of women who believe that a girl should

be given as much education as she desires. In Tamil Nadu only 33 percent women report

that a son should be given education till he desires and 24 percent women report the same

for girls. A very noticeable feature is that in Haryana, the percentage of women who believe

that an education above higher secondary school and above is appropriate for boys is 9.7


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and 7.9 percent for girls compared to 24.2 percent and 27.3 percent in Tamil Nadu. Thus

the percentage of women who are desirous of educating their girl child beyond higher

secondary school is more than what it is for boys in Tamil Nadu. This percentage in

Haryana is significantly low for both boys and girls.

On the whole the data show that women in Haryana and Tamil Nadu are more

desirous of educating their male child beyond graduation than they are interested for

educating their daughters for higher education.

4.4 Perceived age at marriage for sons and daughters

Table 4.4 shows the awareness and knowledge about the women in Haryana and Tamil

Nadu regarding the legal age at marriage for boys and girls. It is surprising to see that

around 40 percent of the respondents in Haryana believe that a boy should marry below 21

where as only 35 percent believe that a boy should marry above 21 years of age. In Tamil

Nadu women are however better informed about the legal age at marriage for boys and girls

as more than 80 percent gave the correct response regarding the legal age at marriage for

boys and girls.

4.5 Perceived duration of breastfeeding (in months) for sons and daughters

Table 4.5 shows the duration of breastfeeding in months for sons and daughters as

reported by respondents in Haryana and Tamil Nadu. In Haryana nearly 68 percent of

women say that boys and girls should be fed for 13 to 24 months in contrast to Tamil Nadu

where only 57 percent women are in favor of feeding boys and girls for 2 years. When mean

duration in months is calculated it is seen that in Haryana boys and girls are fed for little

more than two years where as in Tamil Nadu the mean duration in months is nineteen

months.

4.6 Mean Time spent by women on household chores and other activities

Table 4.6 provides information on the average time spent by women in Haryana and Tamil

Nadu for cooking, collecting drinking water, cleaning and mopping the house, washing

clothes, milking animals, collecting fuel/wood and collecting food for animals.


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The amount of time spent by women in various household activities determines their

status and autonomy in the household and their freedom of movement, which may likely

have an impact on her health seeking behaviour.

In Haryana, the mean time spent in collecting food for animals is 106.53 minutes,

which has been the highest, followed by time spent in herding cattle (101.63) The meantime

invested for cooking is 76.73 minutes, for cleaning and mopping the house 77.47 minutes

and the average time spent for washing clothes is 79.03 minutes. The mean time spent for

collecting drinking water is 56.97 minutes and for milking animals is comparatively much

less as against other activities (97.04 mins.) Thus, women in Haryana seem to spend a

longer duration of time working outside home.

In Tamil Nadu, the mean time spent has been the least for collecting drinking water.

(45.12 minutes), collecting food for animals (122.38 minutes) and for making cow dung

(124.49 minutes) is more or less equally distributed. The mean time spent for cooking is

89.61 minutes, for cleaning and mopping the house is (56.55 minutes), and washing clothes

is (92.69 minutes) in Tamil Nadu.

The average time spent by women for other activities is 262.77 minutes. The

average time spent outside home is high in comparison to time spent in activities insidehome.


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Table 4.1: Percent distribution of the respondents by their background characteristics

Background Characteristics Haryana (Jind) Tamil Nadu (Salem)

Age Groups15-19

20-2425-2930-3435-3940-4445-49

Marital StatusCurrently MarriedWidowedSeparatedDivorced

Co-residence with HusbandLiving with husbandNot living with husband

EducationIlliterateLiterate


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Table 4.2: Exposure to Mass Media

Haryana (Jind) Tami

Background Characteristics

Reads newspaper or

magazine once aweek

Watches TV atleast once a

week

Listens tothe radio atleast once a

week

Visit acinema

theatre atleast once a

month

Reads newspaper or

magazine oncea week

Watchesleast on

wee

Age15-1920-2425-2930-3435-3940-4445-49

EducationLiterate


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Table 4.3: Perceived educational need for sons and daughters, Haryana and Tamil Nadu

Haryana (Jind) Tamil Nadu (Salem)Education forChildren Boys Girls Boys Girls

No Education

Less than Primary

Primary School

Middle School

High School

Higher Secondaryschool and above

Graduate and above

As much as he/shedesires

Depends on theeconomic condition

0.0

0.2

0.5

0.6

18.6

9.7

12.4

57.1

0.8

0.2

0.5

3.5

6.9

25.2

7.9

6.6

48.5

0.8

0.0

0.0

0.0

3.0

18.2

24.2

21.2

33.0

0.0

0.0

0.0

6.1

12.1

24.2

27.3

6.1

24.2

0.0

* All figures are in terms of percentage


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Table 4.4: Percent distribution of women regarding age at marriage for boys and girls

Age Haryana Tamil Nadu

Boys

Below 21At 21Above 21

Girls

Below 18At 18Above 18

39.725.335.0

13.365.421.3

5.97.7

86.4

12.913.174.0

Table 4.5: Percent distribution of women regarding duration of breast milk (in months) tobe given to boys and girls for Haryana and Tamil Nadu

Haryana Tamil NaduDuration in months

Boys Girls Boys Girls

1-5

6-12

13-24

25+

1.6

3.6

67.4

27.4

1.5

3.7

68.1

26.7

0.5

35.6

57.4

6.5

0.8

35.8

57.2

6.2


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Table 4.6: Mean time spent by women on different household chores and other activities (Time in mi

Time spent in

Name of the districtCollectingdrinkingwater

Cooking Cleaningandmopping

the house

Washingclothes

Milkinganimals

Collectingfuel/wood

Collectingfood foranimals

JindMeanNStd. deviation

56.97243232.39

76.73251538.05

77.47249540.75

79.03236843.20

49.95199640.74

91.19183964.12

106.53188858.18

SelamMeanNStd. deviation

45.12168034.36

89.61167944.39

56.55167231.96

92.69161943.01

52.8136556.84

125.8699663.81

122.3840361.53


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CHAPTER - V

PREGNANCY AND ANTENATAL CARE

5.1 Pregnancy history

One of the ways to determine the prevalence of sex selective abortions is to see what

percentage of live birth and abortions (induced) have occurred to women (ever married)

starting from their first pregnancy till their fifth pregnancy and above. The analysis below

shows the number and percentage of women according to outcome of pregnancy by order

of pregnancy for ever married and currently married women of Tamil Nadu and Haryana.

Tables 5.1 and 5.2 show that in Selam (Tamil Nadu), 91 percent of women have had

a live birth in their first order of pregnancy. This percentage has shown a decline with higher

orders of pregnancy. As is observed from the table, with a higher order of pregnancy there

is a subsequent decline in the percentage of women giving live birth with a corresponding

increase in the percentage of women going for induced abortions, thereby resulting in a

large number of foetus wastage. The percentage of women having stillbirth or spontaneous

abortions are lesser than the percentage of women having induced abortions in all the

orders of pregnancy. The percentage of women having induced abortion has increased

from less than 2 percent in the second order of pregnancy to more than 20 percent in the

fifth order and above. The analysis shows that there are less and less number of live births

and more incidence of induced abortions at higher orders of pregnancy which could be

perhaps to limit the family size or could be due to high son preference.

Tables 5.3 and 5.4 show that in Haryana 91.4 percent of women have had a live

birth in their first order of pregnancy. Unlike Selam, this percentage has shown an increasetill the third order of pregnancy and then there has been a decline. Percentage of women

having had a live birth has been the highest in the third order of pregnancy. Percentage of

induced abortions has been less than one percent in the first, second, and third order of

pregnancy. In Haryana because of the preference for bigger family size, the percentage of

induced abortions is perhaps low till the first three order of pregnancy.


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5.2 Influence of previous pregnancy outcome on the present pregnancy outcome

It is said that the outcome of a pregnancy to a large extent is determined by the outcome of

the previous pregnancy. A woman who has had a live birth is more likely to deliver a live

baby in her next pregnancy than a woman who has had a stillbirth or an abortion in her

previous pregnancy. On examining the influence of the outcome of the previous pregnancy

on that of the present birth, table 5.5 shows that in Selam, 90 percent of the second

pregnancy was a live birth when the previous pregnancy was also a live birth. The

proportion of live births in the subsequent deliveries slowly declined, even though the

outcome of the previous pregnancy was a live birth. The percentage of abortions

(spontaneous and induced) has increased from 5.7 percent in the second pregnancy to 22.2

percent in the seventh and above confinements for women whose previous pregnancy was

a live birth. In Haryana, as shown in table 5.6 more than 90 percent of the cases resulted in

a live birth when the previous pregnancy outcome was also a live birth in all the subsequent

deliveries. When we look at the percentage of abortions that occurred, it is seen that the

percentage of abortion in Haryana has increased from 3.4 percent in the second pregnancy

to 7 percent in the seventh pregnancy for all those women whose previous outcome was

also a live birth.

The analysis shows that in Selam district in Tamil Nadu the incidence of abortion is

more at higher orders of pregnancies in comparison to Jind district in Haryana. As has been

reiterated earlier, the preference for a smaller family size could perhaps be one of the

reasons leading to high-induced abortions in Selam in Tamil Nadu.

5.3 Antenatal Care (ANC)

Antenatal care refers to pregnancy related health care provided by a doctor or a health

worker in a medical facility or at home. Ideally, antenatal care should monitor a pregnancy

for signs of complications, detect and treat pre-existing and concurrent problems of

pregnancy and provide advice and counselling on preventive care, diet during pregnancy,

delivery care, post natal care and related issues. The Reproductive and Child Health

programme recommends that the pregnant women should have at least three antenatal

checkups that include blood pressure checks and other procedures to detect pregnancy

complications.


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Tables 5.7 and 5.8 provide coverage of ANC for women by birth orders for Tamil

Nadu and Haryana. Three components such as antenatal checkups, blood test and urine

test were studied to ascertain to what extent women give importance to antenatal care

during pregnancy.

Table 5.7 shows that in Selam, out of 1563 pregnant women, 49 percent of women

went for antenatal checkups during their first pregnancy. This percentage has declined to 40

percent for women in their second pregnancy, 32.3 percent women in the third pregnancy

and 24.4 percent women in the fourth pregnancy. Thus, we see, that with the increase in

the order of pregnancy, there is a subsequent decline in the percentage of women going for

ANC checkups. This shows that in case of live births of earlier pregnancies, there is more

anxiety among women regarding their health and their babys health, which gradually

diminishes for births at higher order pregnancies. In Haryana as table 5.8 shows out of 2398

women in the first birth, 21 percent reported having gone for ANC checkups. There was a

constant decline in percentage in the second (18.5 %), third (15.8%) fourth (12.4%) and fifth

birth and above (12.6%).

In Selam, 40 percent women reported to have done a urine test during their first birth

and this percentage declined to 11.8 percent for women in the fifth birth and above.

Similarly, 18.2 percent of women out of 2398 women in their first pregnancy in Haryanareported to have done urine test and this percentage further declined for women in higher

births. With regard to blood test, the percentage of women who reported to have done a

blood test is higher in the first birth order and there is a corresponding decline in the

percentages in both the states with the increase in parity.

In Selam though 49 percent of women in their first birth reported to have done ANC

checkups only 39 percent reported to have gone for a blood and a urine test. This shows

that the women of higher parities are in general ignorant and less conscious about their

health as compared to women of first and second births in Haryana as well as in Tamil

Nadu.

Tables 5.9 and 5.10 provide the percentage distribution of women, who went for a

sonography test, who motivated them to go for the test, and whether the sex of the baby

was revealed to them after doing the sonography.


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In Selam, out of 49 percent women in their first pregnancy who went for ANC

checkups, only 5 percent reported to have done the sonography test. Out of these 5 percent

women, nearly one third of them have reported that the sex of the baby was revealed to

them during sonography. In the second birth, out of 1290 women, 39.8 percent went for

ANC check-up and only 2.7 percent women reported to have gone for sonography test, out

of which nearly one-fifth have reported that the sex of the baby was revealed to them during

the test. In the third pregnancy slightly more than 3 percent of women reported of going for

a sonography test, higher than what it was in the second pregnancy. This shows that the

inquisitiveness to know the sex of the baby is more after the birth of the first two children

among women in Selam.

In Haryana, out of 21.1 percent women who went for ANC checkups in their first

birth, 4.6 percent women went for a sonography test out of which nearly one sixth of women

reported that the sex of the baby was revealed to them during the test. The percentage of

women who said that they were told about the babys sex during sonography increased

from the third birth and onwards. Whereas the percentage was 14.2 in the first birth it rose

to 35.9 percent in the fourth birth. Correspondingly there has also been an increase in the

percentage of women who reported of having done the sonography test from the third birth

onwards in Haryana.

With regard to persons who suggested these women to go for a sonography, the

data shows that in Selam out of the five percent women who reported to have gone for

sonography during their first birth confinement, the proportion of women who said they went

by doctors suggestion was 44 percent. This percentage decreased in the third birth to 36

percentage. The proportion of women who went out of their own interest or the husbands/

family interest was less than 20 percent in all the births.

5.4 Health problems during pregnancy

Tables 5.11 and 5.12 provide information about the proportion of women who suffered from

any disease during pregnancy, and specific health problems during pregnancy by order of

confinement for Tamil Nadu and Haryana. In Selam 78.6 percent of women reported that

they are suffering from one or the other health problems during the first pregnancy. The

percentage of women suffering from any disease has declined in the higher order


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pregnancies. Only 51 percent of women in the 5th pregnancy and above reported to have

some health problems. Similarly in Haryana, the percentage of women who had any health

problem has been the highest in the first pregnancy (64.2 percent). This percentage has

declined to 58.6 percent for women in the fifth pregnancy and above.

This shows that women in their first birth are more likely to suffer from various health

problems, which decrease considerably in case of deliveries at higher parities.

Nausea and vomiting as a health problem was reported by maximum percentage of

women during the pregnancies at all parities both in Jind and in Selam. Seventy-three

percent women in Selam and 54 percent women in Haryana reported to have suffered from

nausea and vomiting during their first pregnancy. This percentage showed a decline with

the increase in the order of pregnancies. The percentage decline between the first and the5th and the above pregnancy is more than 20 percent in Selam and around 10 percent in

Haryana. Apart from Nausea and vomiting, weakness and dizziness seems to be a common

problem among women in both the states.

More than 30 percent women reported the above two problems in the state of

Haryana during all the pregnancies. In Selam, the percentage of women who reported

suffering from dizziness and paleness was more than 30 percent in the first birth but

declined slowly with the increase in the order of the pregnancy. Less than 10 percent

women in Selam reported having problems of paleness, bleeding, visual disturbance,

hypertension, swelling etc. during all the pregnancies.

In Haryana, the proportion of women who reported bleeding to be a problem has

increased from 6 percent in the first birth to 18 percent in the second birth. After seeing a

decline in the third there is a sudden rise from the fourth and onwards. The overall picture

shows that women in Selam in Tamil Nadu are in better health conditions than women of

Jind in Haryana.

5.5 Type of doctor visited

Tables 5.13 and 5.14 show the proportion of women who consulted a doctor for their health

problems and the type of doctor visited according to order of pregnancy for Tamil Nadu and

Haryana.


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Out of the 78.6 percent women in Selam who reported to have suffered from any

health problems in their first birth order, only 25 percent women reported visiting a doctor for

their health problems. Twenty one percent women in their first and second births went for

doctors consultation. This percentage further declined to 18 percent for women during the

fourth and above pregnancies.

In Haryana, out of 64 percent women who had health problem of any kind, 31

percent reported having visited a doctor in their first birth order. This percentage further

declined to 26 percent during the higher pregnancies. The percentage of women who

reported having consulted a doctor for their health problem is highest among women of the

first order of pregnancy.

The analysis shows that at the time of first pregnancy women are more conscious

about their health status than they are in the higher orders of pregnancies.

In Selam, out of the 25 percent women who visited doctor during their first

pregnancy, 40 percent of the women referred a Government doctor, whereas 64 percent of

women went to a private doctor. Only 17 percent women went to other health care providers

such as (ANM, Nurse Homeopathic/ Ayurvedic/Unani doctors etc). In the second and third

pregnancies, this percentage has shown an increase in case of visit to Government doctors,but the percentage of women who went to private doctors has shown a decline from 64

percent in the first birth to 62 and 60 percent during the second and third order of

pregnancies respectively.

In Haryana, the percentage of women visiting private health care providers is highest

in the second order of pregnancy (65.1%) than the percentage in the first. A very striking

feature observed in Haryana is that the percentage of women visiting private doctors is

lowest during the third pregnancy (19.1%) as compared to 41 percent of women who visited

the Govt. doctors during the same order of pregnancy.


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Table 5.1: Percentage and number of women according to outcome and order of pregnancy(Ever married women, Selam District, Tamil Nadu)

Live Birth Still Birth SpontaneousAbortion

InducedAbortion

Order ofpregnancy

No. % No. % No. % No. % Total

12

3

4

5

6&above

14021132

697

359

142

89

91.288.9

82.8

80.1

71.0

61.8

4035

31

11

5

2

2.62.7

3.6

2.4

2.5

1.3

9382

48

31

12

6

6.06.4

5.7

6.9

6.0

4.1

123

65

47

41

47

0.061.8

7.7

10.4

20.5

32.6

15361272

841

448

200

144

Table 5.2: Percentage and number of women according to outcome and order of pregnancy

(Currently married women, Selam District, Tamil Nadu)


InducedAbortion

Order ofpregnancy


1

2

3

4

5

6&above

1313

1063

655

334

136

83

91.6

89.2

82.9

79.3

70.8

60.5

37

32

30

10

5

2

2.58

2.69

3.80

2.38

2.60

1.46

82

75

43

31

12

6

5.72

6.30

5.4

7.3

6.2

4.3

1

21

62

46

39

46

0.07

1.7

7.8

10.9

20.3

33.5

1433

1191

790

421

192

137


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Table 5.3: Percentage and number of women according to outcome and order of pregnancy(Ever married women, Jind District, Haryana)


InducedAbortion

Order ofpregnancy


12

3

4

5

6&above

21591932

1437

805

416

365

91.492.9

93.2

90.4

87.9

89.0

6733

23

16

11

8

2.81.5

1.4

1.8

2.3

1.9

135106

77

60

38

33

5.75.1

5.0

6.7

8.0

8.0

17

4

9

8

4

0.040.34

0.26

1.01

1.6

0.98

23622078

1541

890

473

410

Table 5.4:Percentage and number of women according to outcome and order of pregnancy

(Currently married women Jind District, Haryana)


InducedAbortion

Order ofpregnancy


1

2

3

4

5

6&above

2088

1864

1388

772

395

348

91.3

92.8

93.2

90.6

88.1

89.0

64

32

22

15

11

6

2.8

1.5

1.4

1.7

2.4

1.5

133

104

75

56

36

33

5.8

5.1

5.0

6.5

8.0

8.4

1

7

3

9

6

4

0.04

0.3

0.2

1.0

1.3

1.0

2286

2007

1488

852

448

391


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Table 5.5: Influence of previous pregnancy outcome on present pregnancy outcome, SelamDistrict, Tamil Nadu

Outcome of the subsequent pregnancyOrder of pregnancy Live Birth

Percentage/NumberStill Birth

Percentage/NumberAbortion

Percentage/Number

First*LB-1066*SB-34*A-68

SecondLB-676SB-25A-68

ThirdLB-339

SB-16A-51

FourthLB-148SB-4A-32

FifthLB-57SB-3A-19

SixthLB-18SB-1A-7

91.5(976)91.1(31)51.4(35)

83.1(562)80.0(20)70.5(48)

83.0(282)50.0(8)58.8(30)

80.4(119)50.0(2)37.5(12)

78.9(45)33.3(1)31.5(6)

77.7(14)-

28.5(2)

2.6(28)8.8(3)

-

3.5(24)16.0(4)2.9(2)

0.8(3)12.5(2)1.9(1)

2.0(3)25.0(1)3.1(1)

-33.3(1)

-

-1-

5.7(61)2.9(1)

47.0(32)

12.1(82)4.0(1)

22.0(15)

1.1(4)37.5(6)39.2(20)

17.5(26)25.0(1)59.3(19)

21.0(12)33.3(1)57.8(11)

22.2(4)-

57.1(4)Abbreviations: LB: live birth SB: Still birth A: Abortion* Absolute numbers are given in parentheses


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Table 5.6: Influence of previous pregnancy outcome on present pregnancy outcome, JindDistrict, Haryana

Outcome of the Subsequent PregnancyOrder of pregnancy Live Birth

Percentage/NumberStill Birth

Percentage/NumberAbortion

Percentage/Number

FirstLB-1764SB-53A-103

SecondLB-1305SB-25A-75

ThirdLB-731

SB-16A-44

FourthLB-355SB-9A-32

FifthLB-164SB-8A-20

SixthLB-70SB-9A-

SeventhLB-38SB-A-4

EighthLB-14

SB-A-2

95.0(1683)81.0(43)63.0(65)

95.3(1244)80.0(20)74.6(56)

92.6(681)68.7(11)68.1(30)

91.8(326)77.0(7)65.6(21)

93.2(153)87.5(7)83.3(15)

92.8(65)44.4(4)

-

94.7(36)-

25.0(1)

100(14)

50.0(1)

0.96(10)15.0(8)2.0(2)

1.1(15)12.0(3)2.6(2)

0.2(2)12.5(2)2.2(1)

2.5(9)11.0(1)

-

0.6(1)13.0(1)

-

---

---

-

--

3.4(60)4.0(2)

34.0(35)

3.4(46)8.0(2)

22.6(17)

4.8(36)18.7(3)

29.5(13)

5.5(20)11.0(1)

34.3(11)

6.0(10)-

20.0(4)

7.0(5)55.5(5)

-

5.2(2)-

75.0(3)

-

--

Note: Same as of table 5.5


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Table 5.7: ANC information for women by order of pregnancy, Salem District, Tamil Nadu

Percentage of Women who reported of doing ANC check up, UrinePregnancy test and have undergone blood test by order of

pregnancyDetailsFirst Second Third Fourth Fifth and

aboveWhether gone for ANCcheck-up

Undergone UrinePregnancy test

Undergone blood test

48.9

39.9

39.4

39.8

31.0

30.7

32.3

23.5

22.5

24.4

16.1

15.7

16.7

11.8

11.8

Table 5.8: ANC information for women by order of pregnancy, Jind District, Haryana

Percentage of Women who reported of doing ANC check up, UrinePregnancy test and have undergone blood test by order of

pregnancyDetailsFirst Second Third Fourth Fifth and

aboveWhether gone for ANCcheck-up

Undergone UrinePregnancy test

Undergone blood test

21.1

18.2

16.3

18.5

15.7

14.3

15.8

13.5

11.9

12.4

10.9

10.1

12.6

12.4

11.1


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Table 5.9: Percentage of women who went for sonography, who motivated them to go andwhether the sex of the baby was revealed to them by order of pregnancy, Selam District(Tamil Nadu)

Order of Pregnancy 1st 2nd 3rd 4th 5+

% of women who wentfor Sonography

5.0(79) 2.7(35) 3.5(30) 0.9(4) 2.4(8.0)

Persons who suggestedthem to goSelfHusbandFamily & relativesNursesDoctorsOthers

6.317.710.13.8

44.374.6

8.517.18.5-

45.7-

10.016.616.66.636.6

-

--

25.0-

75-

-2525-

50-

Sex of the baby revealed 39.2 28.5 20 25 25

Table 5.10: Percentage of women who went for sonography, who motivated them to go andwhether the sex of the baby was revealed to them by order of pregnancy, Jind District(Haryana)

Order of Pregnancy 1st 2nd 3rd 4th 5+

% of women who wentfor Sonography

4.6(112) 3.7(78) 3.8(59) 4.3(39) 5.4(42)

Persons who suggestedthem to goSelfHusbandFamily & relativesNursesDoctorsOthers

28.523.27.1

11.647.3

-

29.419.25.1

10.237.1

-

32.227.1

5.013.532.2

-

23.025.67.6

12.830.7

-

30.928.516.67.1

19.0-

Sex of the baby revealed 14.2 15.3 28.8 35.9 42.8


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Table 5.11: Proportion of women suffering from any health problems and specific healthproblems during pregnancy by order of pregnancy, Selam District (Tamil Nadu)

Order of pregnancy First Second Third Fourth Fifth & above

Percentage of womensuffering from anydisease

78.6 70.3 65.5 61.1 51.3

Proportion of womensuffering from specifichealth problemsNausea/vomitingWeaknessDizzinessPalenessBleeding

Pain in abdomenVisual disturbanceHypertensionSwellingWeak foetusAbnormal presentationOthers

73.047.035.06.22.0

10.33.08.41.30.30.10.2

64.938.424.63.61.0

6.92.26.20.70.2--

60.035.723.13.71.5

1.72.25.60.80.20.2-

52.532.920.26.41.1

4.83.16.41.10.4--

45.023.218.94.02.1

2.82.47.40.60.3--

Table 5.12: Proportion of women suffering from any health problems and specific healthproblems during pregnancy by order of pregnancy, Jind District, (Haryana)

Order of pregnancy First Second Third Fourth Fifth &above

Percentage of womensuffering from anydisease

64.2 61.3 59.9 56.9 58.6

Proportion of womensuffering from specifichealth problemsNausea/vomitingWeaknessDizziness

PalenessBleedingPain in abdomenVisual disturbanceHypertensionSwellingWeak foetusAbnormal presentationOthers

54.038.233.5

23.56.0

17.88.26.0

10.64.91.52.6

50.837.933.2

23.117.916.88.76.49.64.61.12.1

48.637.733.4

21.67.7

16.28.66.39.94.70.92.3

45.835.032.2

20.98.1

15.08.36.79.34.01.01.6

43.935.532.3

21.39.1

17.59.88.89.42.30.91.6


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Table 5.13: Proportion of women who consulted a doctor for their health problem, type ofdoctor consulted by order of pregnancy, Selam District, (Tamil Nadu)

Order ofpregnancy

No. ofwomen withany disease

Percentage ofwomen whoconsulted

doctor

Percentageof women

visiting

govt. doctor

Percentageof women

who visited

pvt. doctor

Percentage ofwomen whovisited other

healthcareproviders

First

Second

Third

Fourth

Fifth&above

1226

905

545

272

154

25.6(314)

21.8(198)

21.4(117)

18.3(50)

18.8(29)

39.8(125)

44.4(88)

52.9(62)

52.0(26)

41.3(12)

64.3(202)

62.1(123)

59.8(70)

66.0(33)

68.9(20)

17.5(55)

16.6(33)

11.9(14)

12.0(6)

6.9(2)

Table 5.14: Proportion of women who consulted a doctor for their health problem, type ofdoctor consulted by order of pregnancy, Jind District, (Haryana)

Order ofpregnancy

No. ofwomen withany disease

% of womenwho consulted

doctor

% of womenvisiting

govt. doctor

% of womenwho visitedpvt. doctor

% of womenwho visited

other healthcareproviders

First

Second

Third

Fourth

Fifth &above

1524

1279

925

507

437

31.0(471)

28.6(367)

26.8(248)

26.8(136)

25.8(113)

47.5(224)

41.1(151)

43.1(107)

37.5(51)

41.5(47)

55.4(261)

65.1(239)

19.7(49)

63.9(87)

60.1(68)

7.2(34)

5.7(21)

9.2(23)

7.3(10)

11.5(13)


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Chapter - VI

ABORTION AND SON PREFERENCE

Abortion can be linked to son preference in two ways. First, the prevalence of abortions may

differ according to the sex of the living children in the family, even if the sex of the foetus is

not known. Secondly, sex selective abortions may be used to avoid birth of children of an

undesired sex after the sex of the foetus has been determined. The following analysis

shows whether abortion in Haryana and Tamil Nadu is related to son preference or not.

During data collection, it was observed that there is a clandestine practice of aborting

female foetuses in Jind city. Nursing Homes have put up signboards disseminating theavailability of colour ultrasound with them. Female foetuses are aborted after three and half

months when the sex of the foetus becomes recognizable as reported by doctors. During the

last few years cases of abortion has raised significantly and people of rural areas are flocking

in large numbers for induced abortions. The cost of abortion ranges from Rs.1200/- to

Rs.4000/- depending upon the clients status as well as the status of the nursing home. It has

been reported by the doctors that a couple with one or two daughters mostly go for abortion,

as they dont want additional daughters. Abortion is rarely resorted to in respect with the first

child and the birth of the daughter is tolerated also. There is a pressure for abortion by the

neighbours and friends who advise the couple for resorting to abortion. This has become an

accepted practice among the people as well as the doctors. There are three types of medical

Institutions in Jind City apart from Civil Hospitals. They are:

Private Nursing Homes

Charitable Hospitals and

Private Clinics

Private Nursing Homes usually admit pregnant women for deliveries as well as

abortion. They have bed facility and conduct tests like ultrasound. Blood, Urine, and Stool

tests are also conducted. Generally a team of nurses or midwives run this type of nursing

homes. Some of them have just B.A.M.S. Degree. Very few have M.B.B.S. degree with

specialization in Gynaecology. The conditions of these Nursing Homes are deplorable as

several women are seen crowded in a large size room or lobby. Abortions are frequently


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conducted in these nursing homes as was revealed to the researcher after deep probing.

Most of these Private nursing homes conduct 2-4 abortions daily. The cost of sonography is

Rs.500/- and is done in selected laboratories in Jind City apart from some nursing homes.

Some lady doctors with M.B.B.S degree have been conducting sonography at their

residence. Most of the nursing homes are a part of the residential buildings of the

practitioners, and a few of them do not have separate rooms for the doctors. The toilet

facilities were bad in condition. One could see several women being administered drips

lying on the cots in a hall. The male doctor, usually the husband is the in charge of the

Nursing Home and the lady doctor usually the wife supports him in his work. The women do

not hesitate to get themselves examined by male doctors nor do their husbands demand

them to be examined by lady doctors whenever they accompany them.

The charitable hospitals mostly maintained by Jain and Bania communities reported

that they do not practice abortion usually. However, in complex cases such as bleeding or

risk to the life of the expected mother they resort to abortion as it is considered to be good

from their religion point of view.

Private clinics where there is no bed facility also practice sex selective abortion.

Some of the doctors reported that they administer certain drugs and medicines for abortionincluding injections, which has effect only after several hours, and ask the client to go to

their homes. In some cases villagers themselves administer drip to the women to induce

abortion. In villages trained dais and ANMs are also practicing induced abortions.

Some of the villagers openly admitted that they are aborting female foetuses

because it is very difficult to get their daughters married to a suitable boy. They consider

them a liability. Some villagers who were desirous of male children are also duped by few

footloose doctors by giving some tablets or injections to the women on the pretext that a

male child will be born to them.

The Prenatal Diagnostic and Prevention Act, 1994, is mostly flouted. This has

accentuated recently because of the factors such, as proximity of towns to villages in the

wake of increased accessibility by roads.


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The demographic characteristics of the sample of 2646 women in Haryana and 1706

women in Tamil Nadu are broadly similar. Interestingly, mean age of respondents in both

the sample was more or less same (29.3 and 31.6 years) but mean age of husbands was

lower by 4 years in Haryana compared to Tamil Nadu (33.9 and 38.1 years). Most of the

women in Haryana were currently married (97percent) and in case of Tamil Nadu, the

proportions of currently married women were found slightly lower (92.8 percent). Literacy

rate of respondents were 36.5 and 37.8 percent in the state of Haryana and Tamil Nadu

respectively. Literacy rate of males in Haryana were significantly higher than in Tamil Nadu.

6.1 Abortion by socioeconomic and background characteristics

Tables 6.1a&b presents abortion by socio economic and background characteristics for thestate of Haryana and Tamil Nadu.The table shows very minimal differences with regard to

the type of women who go for abortions. In Tamil Nadu majority of the women who have

had abortion were from medium SLI, were literate, but had not completed primary school

education, and in majority of the cases husband 's occupation was cultivation. In Haryana

however no such significant differences are observed.

6.2 Abortion incidence

Table 6.2 shows all abortions, reported by women (spontaneous as well as induced). In the

state of Haryana, 486 women and in Tamil Nadu 496 women reported that they had

abortions. Abortion reported by women, revealed that the rate of abortions per 100 live

births increased markedly from 1971 to 2001 in both the states. Overall reporting of abortion

in Tamil Nadu is almost double to that of Haryana. In the recent period, difference in

abortion rate has narrowed down in both the states. In case of Tamil Nadu, rate of abortion

since 1984 is more or less constant.

6.3 Frequency of abortion

Abortion rates calculated for the women show that one- third of Tamil Nadu women and

one-fifth of Haryana women had abortions. From the frequency of abortion presented in

table 6.3 it is noticed that around 15 per cent women in Tamil Nadu and 8 per cent in


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Haryana had at least one abortion. A noticeable percentage of women in both the states

had undergone two abortions. A small proportion of women have also undergone three and

more abortions. From the frequency of abortion, it can be concluded that a significant

number of women are undergoing repeated abortions, which points to the practice of

abortion in both the states.

Nearly eight per cent of all reported abortions in Haryana and 45 per cent in Tamil

Nadu were induced. Data of first phase was collected during the month of January - March

2001 when the hearing of Public Interest Litigation about the enforcement of Pre-natal

Diagnostic Techniques (prevention and regulation misuse) Act 1996 (PNDT Act) was in

Supreme Court. In Haryana 72 percent of the respondents husband were literate and quite

a few were graduates and postgraduates. Low reporting of induced abortion in north Indiacould be due to existing socio-cultural factors as well as many people seemed to be aware

about the Pre-natal Diagnostic Techniques (prevention and regulation misuse) Act 1996

(PNDT Act) as many of them have said that sex selective abortions are illegal. Under such

prevailing condition at the time of data collection, direct evidence of sex selective abortions

was almost non-existent in both the states. Respondents in Tamil Nadu at least reported

induced abortions whereas respondent in Haryana although reported abortion during

pregnancies, but avoided to report it, as induced. Using pregnancy history, antenatal care,

and abortion histories, following six conjectures can be drawn.

6.4 Distinction of spontaneous and induced Abortion

In up to 60 per cent of spontaneous abortions, the foetus is absent or grossly malformed,

and in 25 to 60 per cent, it has chromosomal abnormalities incompatible with life; thus

spontaneous abortion in more than 90 per cent of cases may be a natural rejection of a

maldeveloping foetus (The Merck Manual of Diagnosis and Therapy, Chapter 252). In manycases women are not able to differentiate spontaneous abortions from regular delayed

menses with heavy bleeding. It will be difficult for her to remember this event and report in

her pregnancy history. Chhabra and Nuna (1993) in their study on abortion suggested that

three-fifth of the total abortions are induced. Using this conjecture, it can be said that most

of the reported abortions are induced in both the states.


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6.5 Distribution of abortions by pregnancies

Table 6.4 shows the distribution of abortions by pregnancy. In the state of Haryana highest

number of the reported abortions had occurred during the first pregnancy of the women

followed by second and third pregnancies. Tamil Nadu depicts a different story by having

highest number of abortions in the third pregnancy followed by second. Abortion during the

first and second pregnancy may be spontaneous or sex selective whereas higher order

abortion may be induced to control family size. Mean number of children ever born in

Haryana was 2.93 and in Tamil Nadu was 2.35, and the abortion before achieving this

number may be considered as sex-selective or untimely pregnancies. Based on this

analysis it can be concluded that 60-80 per cent of total abortions are induced and around

40 per cent seem to be sex selective abortions.

6.6 Closed Interval between Pregnancies

In the pregnancy history section of the questionnaire, duration between two conceptions

was asked starting from marriage to last birth. Table 6.5 presents closed interval between

pregnancies with outcome of pregnancies. This analysis is done on the assumption that

shorter intervals will lead to induced abortions for birth spacing. T-test is also applied toexamine the significance of difference of intervals in two different outcomes of pregnancy. In

case of first interval from marriage to first conception, differences are insignificant in two

outcomes namely live birth and abortions. The first pregnancies, which had resulted in an

abortion, may be spontaneous or to some extent sex selective, among those who had

strong desire to have first child as male. It is surprising to note that all other intervals are

significantly different in case of live birth and abortion.

A further analysis of duration of intervals in terms of median as well as distribution

reveals that nearly 3 percent intervals were very short (less than 12 months) preceding the

abortion. Other intervals were same as that of live birth intervals. Based on this evidence it

may be estimated that 80 percent of these pregnancies were wanted but were terminated

on account of sex selection.


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6.7 Gestation period

In table 6.6 mean period of gestation (in weeks) by type of abortion and number of abortions

are presented. Data for mean duration of pregnancy indicate that average gestation period

in case of spontaneous abortion in both the states is above 12 weeks (first trimester).

According to Merck manual, about 85 percent of spontaneous abortions occur in the first

trimester and tend to have foetal causes. Making adjustment with medical evidence and

gestation period, it is estimated that nearly 77 per cent of the spontaneous abortions were

sex selective abortions.

In Tamil Nadu, reported induced abortions have lower mean duration of gestation

compared to spontaneous abortion in all the pregnancies. The reported induced abortions

are around 12 weeks of gestation and this may be for spacing and limiting family size. In all

cases of abortions, gestation period is well above 12 weeks in Haryana. If abortion is to limit

the family size or spacing, women would not wait till 14 to 15 weeks for abortion. The

possible reason for second trimester abortion could be linked to sex determination tests.

Before twelve weeks of gestation, sex cannot be determined by the ul

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