Selective Abortion of Female Fetuses in India- Some Questions on the Lancet Article

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A recent article in the reputed journal Lancet concluded that "selective abortion" of female fetuses, usually after a firstborn girl, has increased in India over the past few decades, and has contributed to a widening imbalance in the child sex ratio.

The authors have compared the increasing male preponderance seen in the Census Data from India.  There were 7.1 million fewer girls than boys in 2011, compared to 6.0 million in 2001 and 4.2 million in 1991. The conclusion of the authors raises some serious questions.

male-female-sex-ratio-india

The Male - Female Ratio in the United States: 1900 - 2000. Source: U.S. Census Bureau, Census 2000 Summary File 1; 1990 Census of Population. Credit: nationalatlas.gov.  This chart shows the declining male-female ratio in the United States (This figure is included only for a comparison).

The article assessed the trends in sex ratio by birth order from 1990 to 2005 with three nationally representative surveys and assessed how any changes might have varied by education or wealth.

According to the Lancet article "Selective abortions of girls totalled about 4.2-12.1 million from 1980—2010, with a greater rate of increase in the 1990s than in the 2000s."

Interesting is an associated comment published alongside in Lancet which stated “The masculine nature of the Indian population has been a matter of concern since the first Indian census in 1871.”  Obviously there was no selective abortion in 1871! 

  Selective abortion is unconscionable.  But it's also about time to think of biological reasons for the imbalance in sex ratio, rather than trumpeting extrapolated conclusions. 

The above is an editorial introduction to the following blog post sent by Dr Bassa Babu: 

The study has major flaws:

1. Since all the data came from India, there are no scientifically acceptable controls. Such fluctuations may be normal in any given population in any country.

2. The methodology is vaguely described. It is not clear if the authors are part of any of these surveys or the data came entirely from the surveys conducted by the government census workers. Are there questions included in the questionnaire on the mothers if they actually have undergone abortions? The number of selective abortions was estimated from census data (as we understand) rather than obtaining it directly from the abortion clinics. Can the authors cross check if 4.2 - 12.1 million selective abortions have actually taken place during the time period in the areas mentioned?

3. Self fulfilling prophecy? If the number of selective abortions was determined entirely based on the census data where there has been no questions included on the abortions themselves, then the report constitutes a circular assumption often called a self-fulfilling prophecy. In other wards a postulation is made on the dynamics of a parameter and the same postulation is used in the determination of the parameter which in turn is used to prove the postulation.

4. What should have been an inductive method of science (explaining the data), this paper became a hypothetico- deductive work (obtaining data to support a hypothesis). Reporting errors, flawed data collection methods, and taboos associated with reporting on women are likely to explain the data better. Where are the data on the number of sex determinations in India?

5. Sex determinations have not been popular in India till recently. Vast swaths of land and whole range of small towns do not have sex determination clinics and selective abortions are unheard of in whole communities. It is still a fact that much less number of Indians has access to sex determination tests compared to the westerners.

6. According to the recent Indian census data (2011) this ratio changed more (towards less girls)  in the muslim communities who do not even practice birth control. Ask the Indian muslims, how many of them have undergone sex determinations.  Paradoxically, the female ratio of children improved  in Punjab and Haryana which supposed to have had more abortion clinics.

7. The matter of the fact is that educated people in India now see less difference between boys and girls as more and more girls started to work in the public and private sectors.

Was it appropriate to accept a paper that is wholly based on census data, and possibly a circular assumption because there might be some physiological and clinical causes that might explain the census observations that would remain unexplored?

-Babu V Bassa, Ph.D., San Diego.
 
Source Article: Trends in selective abortions of girls in India: analysis
of nationally representative birth histories from 1990 to 2005 and
census data from 1991 to 2011.  Prabhat Jha, Maya A Kesler, Rajesh Kumar, Faujdar Ram, Usha Ram, Lukasz Aleksandrowicz, Diego G Bassani, Shailaja Chandra, Jayant K Banthia.  Lancet. 24 May 24,2011.  doi:10.1016/S0140-6736(11)60649-1.

Lancet comment article: Can India achieve a balance of sexes at birth? SV Subramanian and Daniel J Corsi. Lancet May 24,2011. doi:10.1016/S0140-6736(11)60709-5.

 Dr Bassa Babu is a PhD in Biochemistry and a senior research scientist based in San Diego, California.  Dr Babu has published several original research articles in peer-reviewed journals.

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