Photo: Reuters.
The recently released fifth National Family Health Survey (NFHS-5) sheds light on alarming trends on sex ratio at birth (SRB). According to the WHO, the biological SRB is 1,000 females for every 1,050 males born. But in 18 of the 22 states for which the data has been released, the SRB that is strongly biased against the girl child. Second, in seven of these 18 states, the skewed SRB has further worsened since NFHS-4.
For example, the SRB for Goa has declined by a stark 13% from 966 in 2015-2016 to 838 in 2019-2020. This indicates an increase in the prevalence of sex-selective abortions and the practice of female foeticide and infanticide. From a social perspective, it also betrays a rise in the natality inequality – a preference for having a boy child over a girl child.
What happens to girls that are born and don’t suffer the fate of being aborted? Are they treated equally by family members or do surviving girls have unequal access to resources? An important indicator to measure this survival inequality is the life expectancy at birth (LEB). LEB indicates the probable number of years that a male or female is expected to live for at the time of birth. Without any sex-based discrimination, and biologically speaking, the life expectancy of females is higher than males throughout their lifetime. And in India, this holds true for all states barring one: Bihar.
In Bihar, according to the latest Sample Registration System estimates, LEB for females is lower than that for males: 68.6 years and 69.2 years, respectively.
The deviation from biological trends for both SRB and LEB shows that females in Bihar suffer from a double burden of inequality. Sex discrimination has led to the birth of fewer females – whereas surviving females have a survival disadvantage compared to their male counterparts.
But why does Bihar in particular fare so poorly?
The answer requires a scrutiny of the state’s fertility transition. Traditionally, Bihar has had a high total fertility rate (TFR) – which is a reflection of the universality of marriage, culture of early marriage and childbearing and the prevalence of a strong male-child preference. There have been sociological studies to show that an Indian bride is often not fully ‘accepted’ in her husband’s home until she begets a male child.
Data from NFHS-4 asserts that preferences for male children are the strongest in Bihar, where 37% women and 30% men of men said they wanted more sons than daughters. Consequently, parents continue to have children until they have a male child. According to the 2018 Economic Survey, the sex-ratio of the last-born child in Bihar was found to be heavily skewed towards the male, affirming this anti-female bias. All these factors together have led to a historically high TFR in the state.
Given Bihar is the second-largest Indian state in terms of population with the highest TFR, the state government has made some efforts to encourage family-planning, through access to contraception and awareness. The NFHS data shows how the use of contraception has more than doubled – from 24% in 2015-2016 to 56% in 2019-2020. As a result, the TFR has declined from 4 in 2005-2006 to 3.41 in 2015-2016, and to 3 at present. While there is much to boast about the success of these interventions, they have had some adverse consequences as well.
On the one hand, the success of family planning interventions has encouraged people in Bihar to understand its benefits and to limit the number of children in their families. But on the other, the desire to have a certain number of male children continues to persist. In this trade-off, the only losers are the women, who suffer from both the natality and survival inequalities. An effort to limit the number of children while ensuring the desired number of sons has potentially led to a spike in sex-selective abortions. Meanwhile, girls that are born in these gender-discriminatory settings suffer from unequal access to food and resources. This in turn leads to higher mortality risk and lower LEB compared to their male counterparts.
The SRB and life expectancy statistics only reflect the deeper problem of gender discrimination. Bihar is among the most gender unequal states in India across most empowerment indicators. For instance, as many as 64% of non-pregnant women are anaemic, and 40% have experienced, domestic violence, according to NFHS-5. Then it stands to reason that the gains from a reduction in fertility rates have been tempered by a commensurate increase in the prevalence of gender discrimination.
From a policy standpoint, lawmakers, policymakers and experts must explicitly recognise this tenuous relationship as a cornerstone of any effort towards stabilising the population.
Phalasha Nagpal is a researcher at Oxford Policy Management. She previously worked as a social policy analyst with the Economic Advisory Council to the Prime Minister, under the mentorship of Bibek Debroy. The views expressed here are the author’s own.