The alarming gender gap
Editor While we were pondering over the widening gap between the numbers of girls and boys in our newborn unit, we came across the thought-provoking article of R. Hussain et al. (1).
The gender gap is gradually increasing in many developing countries, and India is no exception. In India, over the last fifty years, the number of females per thousand males has gone down from 1053 to 972 (2); in our newborn unit it is presently 918. The UN report launched on World Population Day, 11 July 2000, also draws attention to imbalance in the sex ratio in India.
Preference for a son and its influence on reproductive behaviour, as described by Hussain and colleagues, is common in many Asian countries including India and Nepal. The epics of Sanskrit literature depict the birth of a son as the sole purpose of marriage. There are a number of factors that contribute to the widening gap between boys and girls: neglect of the girl child, female feticide, etc. Even though antenatal sex determination has been made legally punishable in India, it may be one of the contributory factors, if not a major one.
In a vast country like India, with over 1000 million inhabitants, population control campaigns are incentive-led. In addition to a sizeable benefit to the couple, financial incentives are offered to health professionals who fulfil targets for terminal methods of contraception. The sex of the surviving child determines to a great extent the subsequent reproductive intention (3). Tubectomy, vasectomy, medical termination of pregnancy, intrauterine devices and other methods of contraception offset the natural balance of sex proportions in society.
A preference for sons influences the timing of a couples decision to use contraception, as they will be more likely to stop having children if they already have one or two sons. With only girls, they may decide to try again for a boy. The timing of the contraceptive decision is vital and has not received the attention it deserves. We believe that if incentives for a terminal method of sterilization are given to couples after they have given birth to girls, the balance between the sexes may improve over time. This is in addition to changing social attitudes towards the girl child. 
R. Satpathy, President
Saroj K. Mishra, former President
Indian Medical Association
Rourkela, Orissa
India
1. Hussain R, Fikree FF, Berendes HW. The role of son preference in reproductive behaviour in Pakistan. Bulletin of the World Health Organization, 2000, 78: 379388.
2. Mulay S. Population in the next millennium. In: Manorama year book, 35th ed., Kerala, 2000: 510515.
3. Ranade S. The gender gap. The Hindu, 9 June 2000: 10.