|Year : 2013 | Volume
| Issue : 8 | Page : 469-472
Perspectives of medical interns regarding female feticide and declining sex ratio in India
Shubhada Avachat, Pritish Raut, Mrinal Zambare, Dilipkumar Gund, Rutuja Pundkar
Padmashri Dr. Vitthalrao Vikhe Patil Foundation Medical College, Ahmednagar, Maharashtra, India
|Date of Web Publication||30-Aug-2013|
5, Samartha colony Bhutkarwadi, Savedi Road, Ahmednagar - 414 003, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Female feticide, skewed sex ratio, and its attendant social evils have grave ethical undertones for medical professionals and our commitment to save lives. A concerted effort by all is essential against female feticide. Aim: This study was to assess the knowledge of female feticide, declining sex ratio, and corrective measures among medical interns. Materials and Methods: A cross-sectional study was conducted among 79 medical interns. Data werecollected with the help of predesigned structured questionnaire. Chi-square tests, Kruskal-Wallis tests, and Z tests were used to test the significance level. Results: Knowledge of current sex ratio was significantly better among female interns than male interns. Majority of interns opined that creating awareness is an effective measure to combat declining sex ratio and only 33 interns had correct knowledge regarding all measures. Only 37.9% of interns knew all the legal indications for use of prenatal diagnostic techniques. However, 81% of interns were aware of punishments mentioned for violation of the Act. Mean score of knowledge was 22.06 among males and 24.4 among females. Conclusion: The findings in our study underline the need to sensitize doctors regardingevery aspect of Pre-Conception and Prenatal Diagnostic Techniques Act and selective sex determination.
Keywords: Female feticide, Interns, Sex ratio
|How to cite this article:|
Avachat S, Raut P, Zambare M, Gund D, Pundkar R. Perspectives of medical interns regarding female feticide and declining sex ratio in India. North Am J Med Sci 2013;5:469-72
|How to cite this URL:|
Avachat S, Raut P, Zambare M, Gund D, Pundkar R. Perspectives of medical interns regarding female feticide and declining sex ratio in India. North Am J Med Sci [serial online] 2013 [cited 2020 Jan 18];5:469-72. Available from: http://www.najms.org/text.asp?2013/5/8/469/117302
| Introduction|| |
Sex ratio is always an issue of discussion in public health forumsand journals. Sex ratio, an important social indicator measuring extent of prevailing equity betweenmales and females in a society, is defined as number of females per 1000 males. Changes in sex ratio reflect underlying socioeconomic and cultural patterns of a society.
The overall sex ratio in India has increased to 940 as per 2011 census against 933 as given by 2001 census. However, the area of grave concern is that the child sex ratio plummeted to 914 from 927 in 2001.  Female feticide besides skewed sex ratio and its attendant social evils has grave ethical undertones, especially for medical professionals and their commitment to save lives as per the Hippocratic oath.
The unaffected ratio in the census of 1981 was 978 but after sex selective feticide came into practice, the ratio dropped steadily to 934 in the census of 2001 and then further to 905 in 2003. Though there is certain improvement of up to 940 in census 2011. This change is very slow and not uniform in the entire country.  The female feticide in 1997 is estimated by different experts and the figures vary from a low of 106 thousand to half a million. ,
The worsening of the country's hugely skewed sex ratio is largely due to misuse of prenataldiagnostic techniques despite stringent laws banning their use for sex selection and consequent increase in cases of female feticide.  The sex selection in a globalized economy has dragged the fetus to the market place. In spite of a massive influx of legal regulations barring the female fetuses, technology facilitates a series of selective abortions after prenatal sex determination. 
The meansto showbetter off in respect to sex ratio is only through improving the child sex ratio in the next few years, so it will again reflect in future censuses in terms of better overall sex ratio. In spite of this, if the child sex ratio still remains low in next census, we have to bear its effects until the middle of 21 st century as it is definitely going to reflect in long term. The only means to get satisfaction in the next census in terms of sex ratio is the intensive measures directed to improve the child (0-6) sex ratio. 
A concerted effort by the medical fraternity, the lawenforcers and political leaders, NGOs, media, teachers, and the community itself are essential against this social evil. If the doctors are willing to fight against this emerging concern, the problem could easily be curbed. To sensitize tomorrow's doctors about the ethics related to the inappropriate and indiscriminate use of technology is the need of the hour, so that these future doctors can join their hands to improve the status of women in India. Hence, the present study was conducted in a medical college to assess the knowledge and attitude of interns regarding declining sex ratio and female feticide.
| Materials and Methods|| |
Study design and setting
Across-sectional study was conducted in a medical college in an urban area of Western Maharashtra from February 2013 to April 2013. All medical interns of the medical college were included as study participants. A total of 79 interns participated in the study. The purpose of the study was explained to the participants and informed verbal consent was taken from all the participants. Data werecollected with the help of questionnaire. Questions were developed by reviewing relevant literature ,, and also based on the vital statistics data of India and current prevalent practices regarding methods of sex selection and related legislationsin India. The questions were both open-ended and closed-ended and related to three domains viz., sex ratio, Pre-Conception and Prenatal Diagnostic Techniques (PCPNDT) Act, female feticide and measures to combat it. Every intern participated in the study and there were no nonresponders. The responses of the participants were evaluated by giving the score. Each correct response was given the score of 1 (one) and each incorrect response was given 0 (zero). Total score of the individual participant was calculated by adding all correct responses. Maximum score was 29.
Data were analyzed using SPSS software version 20.0. Percentages and proportions were estimated and chi-square tests, standard error of difference between two means (Z tests) and Kruskal-Wallis tests were used to test the significance.
| Results|| |
In a cross-sectional study conducted among 79 medical interns, 47(59.5%) were male and 32(40.5%) were female. Parents of 27(34.2%) interns were in medical profession. Majority of interns 52(65.8%) were from an urban area.
As revealed in [Table 1], knowledge of current sex ratio was significantly better among female interns compared to male interns. However, there was no significant difference in knowledge regarding causes of declining sex ratio and its implications in male and female interns.
A total of 61interns opined that creating awareness is the effective measure to combat declining sex ratio, while 49 interns thought that legislative measures are the useful means and only 33 interns had correct knowledge regarding all measures [Table 2].
Only 37.9% of interns (15 male and 15 female) knew all the indications for use of prenatal diagnostic techniques mentioned under PCPNDT Act. However, 81% of interns were aware about punishments mentioned for violation of the Act. Almost all interns (92.4%) in our study were aware of indications for Termination of Pregnancy under MTP Act, 1971. However, there was no significant difference in knowledge about measures to combat declining sex ratio among male and female interns.
Knowledge of measures to reduce female feticide and responsibilities of doctors and other members was significantly better among female interns than among male interns [Table 3].
Mean score of knowledge was better among female interns and significant difference was observed after applying Z test for standard error of difference between two means [Table 4].
Kruskal-Wallis test was applied to test the significance.
| Discussion|| |
A cross-sectional study was conducted among 79 interns to assess their knowledge about sex ratio and female feticide. In our study, almost all interns were aware of thefactors responsible for the declining sex ratio. A total of 26.6% of interns knew that increase in crime and violence would be one of the implications of declining sex ratio. A total of 41.9% of male interns and 25.7% of female interns were aware of all implications of female feticide and declining sex ratio like increase in crime, sexually transmitted diseases, effect on women's health and so forth. Similarly, Sidhu et al.,  in their study conducted among medical students reported that 43% of respondents knew about the dangers of female feticide. While in a study conducted by Nath et al.,  57% of male interns and 43% of female interns participated in the study and 63.2% of male and 61.2% of female interns knew about implications of declining sex ratio as increase in crime and 52% reported that there will be effect on women's health. The majority of interns 61(77.2%) stated that creating awareness about declining sex ratio is an effective measure while 49(62.2%) opined strict implementation of law is necessary to deal with this issue.
In order to improve child sex ratio, the female feticide practice should be curbed, creating awareness among people against this social evil. Legislative measures and raising the status of women are the strategies to reduce female feticide. In our study, female interns had significantly better knowledge in this domain compared to male interns. Similar to our study, Nath et al., mentioned that 88.3% of female and 70.2% of male interns stated raising status of women and 46% of males and 65.5% of females opined that strict and deterrent punishment of persons involved are important measures to reduce female feticide.
The shocking fact revealed by our study was that the majority of interns knew only one or two indications and only 37.9% interns knew all indications for correct use of prenatal diagnostic techniques. However, 81% were aware of punishments mentioned for violation of the PCPNDT Act. Similar to our study Singh et al.,  mentioned that 33.69% were awareof the provisions of PCPNDT Act, while 31.02% were partly aware and 24.93% were not aware at all. Similarly, a report from National Institute of Public Cooperation and Child Development mentions that a serious knowledge gap was observed regarding MTP Act and PNDT act among health functionaries. 
| Conclusion|| |
Our study revealed that medical interns had better knowledge of current sex ratio and causes of its decline as compared to other aspects of this issue. However, their knowledge regarding measures to reduce female feticide, PCPNDT Act was not up to the mark. The findings in our study underline the need to sensitize tomorrow's doctors regarding the ethical and medicolegal aspects of PCPNDT Act and avoid unethical and indiscriminate use of the technology in selective fetal sex selection and female feticide. This can be done by conducting regular workshops/continuing medical educationsessions and awareness campaigns among nonmedical and medical fraternities.
| References|| |
|1.||Janaki G, Chandrasekarrayya T, Murthy P. Declining sex ratio in India: Trends, issues and concerns. Asia Pac J Soc Sci 2011;3:183-98. |
|2.||Office of Registrar General. Sample registration system statistical report 2003, Report No. 2 of 2005. Delhi, Controller of Publication, 2005. |
|3.||Arnold F, Kishor S, Roy T. Sex selective abortion in India. Popul Dev Rev 2002;28:759. |
|4.||Jha P, Kumar R, Vasa P, Dhingra N, Thiruchelavam D, Moineddin R. Low male-to-female sex ratio of children born in India: National Survey of 1.1 million households. Lancet 2006;367:211-8. |
|5.||Bhat MP, Zavier FA. Factors influencing the use of prenatal-diagnostic technique and the sex ratio at birth in India. Econ Polit Wkly 2007;42:2292-303. |
|6.||Ratha KC, Mahapatra Sk. India's missing daughters: An ominous sign of democracy, working paper series 122/2012 Amrita School of Business Koimbatore April 2012. |
|7.||Desai B, Solanki P. What we predict for the sex ratio in India for the next census 2021? J Indian Assoc Prev Soc Med 2009;34:164-5. |
|8.||Nath A, Sharma N, Ingle G. Knowledge and attitudes of medical students and interns with regard to female feticide. Indian J Community Med 2009;34:164-5. |
|9.||Singh AK, Singh K, Verma A. Study of medico-legal case management in tertiary care hospital. J Indian Acad Forensic Med 2011;33:337-42. |
|10.||Gopal AK. A socio cultural study of declining sex ratio in Delhi and Harayana. Report of National Institute of Public cooperation an child Development, 2008. p. 20. |
|11.||Sidhu TK, Kumar S, Kaur PA. Study of knowledge and attitude of medical undergraduate students regarding prenatal sex determination and female feticide. Indian J Matern Child Health 2011;13:2-6. |
[Table 1], [Table 2], [Table 3], [Table 4]