title: Low female[corrected]-to-male [corrected] sex ratio of children born in India: national survey of 1.1 million households.
abstract: BACKGROUND
  Fewer girls than boys are born in India. Various hypotheses have been proposed to explain this low sex ratio. Our aim was to ascertain the contribution of prenatal sex determination and selective abortion as measured by previous birth sex.
  
  
  METHODS
  We analysed data obtained for the Special Fertility and Mortality Survey undertaken in 1998. Ever-married women living in 1.1 million households in 6671 nationally-representative units were asked questions about their fertility history and children born in 1997.
  
  
  RESULTS
  For the 133 738 births studied for 1997, the adjusted sex ratio for the second birth when the preceding child was a girl was 759 per 1000 males (99% CI 731-787). The adjusted sex ratio for the third child was 719 (675-762) if the previous two children were girls. By contrast, adjusted sex ratios for second or third births if the previous children were boys were about equal (1102 and 1176, respectively). Mothers with grade 10 or higher education had a significantly lower adjusted sex ratio (683, 610-756) than did illiterate mothers (869, 820-917). Stillbirths and neonatal deaths were more commonly male, and the numbers of stillbirths were fewer than the numbers of missing births, suggesting that female infanticide does not account for the difference.
  
  
  CONCLUSIONS
  Prenatal sex determination followed by selective abortion of female fetuses is the most plausible explanation for the low sex ratio at birth in India. Women most clearly at risk are those who already have one or two female children. Based on conservative assumptions, the practice accounts for about 0.5 million missing female births yearly, translating over the past 2 decades into the abortion of some 10 million female fetuses.
authors.affiliation: Centre for Global Health Research, St Michael's Hospital, and Department of Public Health Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada. prabhat.jha@utoronto.ca
authors.forename: Prabhat
authors.initials: P
authors.lastname: Jha
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
authors.forename: Priya
authors.initials: P
authors.lastname: Vasa
authors.forename: Neeraj
authors.initials: N
authors.lastname: Dhingra
authors.forename: Deva
authors.initials: D
authors.lastname: Thiruchelvam
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data*; D001722:Birth Order; D003625:Data Collection; D005260:Female; D005298:Fertility; D006801:Humans; D007194:India; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D011247:Pregnancy; D012743:Sex Preselection; D012744:Sex Ratio