title: Social analysis of sex imbalance in India: before and after the implementation of the Pre-Natal Diagnostic Techniques (PNDT) Act.
abstract: BACKGROUND
  While the issue of sex imbalance in South Asia is well recognised, less is known about its social patterning. Social patterning in the proportion of sexes was investigated among infants in India before and after the implementation of the Pre-Natal Diagnostic Techniques (PNDT) Act in 1996. The act regulates the misuse of technologies for sex determination of fetuses and subsequent selective abortion.
  
  
  METHODS
  Multivariable regression analysis was performed on time series data from a nationally representative sample of households with infants. The outcome was log odds of having a male infant. Household income, parental education, social caste, a variable representing periods before and after the implementation of the PNDT Act and state of residence were the main predictors of interest.
  
  
  RESULTS
  The odds of having a male infant increased with income quartiles. Heads of household with post-secondary education had a higher odds ratio of having a male infant than those with no formal education. The odds of having a male infant did not differ between high and low caste groups, and was not associated with the educational attainment of the spouse. Punjab had a higher odds ratio of having a male infant compared with Kerala. Kerala, meanwhile, was not particularly different from the remaining Indian states. The odds of having a male infant were similar in the pre- and post-PNDT periods. In the post-PNDT period, the income gradient in the odds of having a male infant was substantially weakened.
  
  
  CONCLUSIONS
  Social analysis of the distribution of sexes among infants in India suggests that neither improvements in socioeconomic circumstances nor introducing policies that are not aligned with societal norms and preferences are likely to normalise the sex imbalance in India.
authors.affiliation: Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115-6096, USA. svsubram@hsph.harvard.edu
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.forename: S
authors.initials: S
authors.lastname: Selvaraj
mesh_terms: D004522:Educational Status; D005260:Female; D006801:Humans; D007194:India; D007231:Infant, Newborn; D007883:Legislation, Medical; D008297:Male; D011296:Prenatal Diagnosis; D012732:Sex Determination Analysis; D012743:Sex Preselection; D012744:Sex Ratio; D012923:Social Class; D012959:Socioeconomic Factors