unfpa publication 39664
TRANSCRIPT
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Evidence of Sex Selective Abortion fromTwo Cultural Settings of India:
A Study of Haryana and Tamil Nadu
By: Sayeed Unisa,C.P.Prakasam,R.K.Sinha andR.B.Bhagat
2003
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Acknowledgement
We would like to thank first and foremost, the respondents of selected villages of Jind` andSalem districts of Haryana and Tamil Nadu respectively, for their good will, support and sparing
time for this project work. We have been overwhelmed to observe the deep sense of affection,
and warmth of the respondents and the village community for our research team with a
remarkable sense of hospitality. Without this, the work could not have been completed. We
therefore acknowledge gratefully the contribution of the many such persons whose unflinching
support to the cause of women is indubitable.
The Chief Medical Officers and Medical Officers at the PHCs/CHCs of Jind and Salem
districts have been very helpful. We sincerely thank them. Dr Pramod Gauri, Director, State
Resource Centre, Rohtak, and his associates namely Mr Sunil, Mr Sohan Das, and Mr Hooda
took keen interest in this project and helped us in data collection in Jind district of Haryana. We
are extremely thankful to them.
The research team apart from the Principal Investigators consisted of Ms Sutapa
Aggrarwal, Mr Kailash Lakhara, Ms Usha, Mr Murugesan, and Ms Smita, who helped us in data
collection, tabulation and the statistical analysis. We highly appreciate their hard work and
sincerity. Ms Sucharita Pujari has been immensely helpful in getting the manuscript ready in the
present form. Thanks are due to her.
Ms Shushila, an M. MPhil student, M.D. University, Rohtak, and her family has been
very kind to us for extending all help at Jind. We thank Ms Shushila and her family for their kind
hospitality.
We would like to thank Professor N. Audinarayan and Dr N. Kabitha, Department of
Population Studies, Bhartiar University, Coimbatore, and Dr Rita Garg and Dr C. L. Garg, Maya
Devi Hospital, Jind for providing their valuable time in different stages of this project.
We would like to express our deep sense of appreciation for Professor T. K. Roy,
Director of the Institute and Professor G. Rama Rao for their keen interest in this project and
their time-to-time help and encouragement to us.
September 11, 2003 Principal Investigators
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CHAPTER - I
INTRODUCTION
1.1 Introduction
Several studies have reported high preferences for son in different states of India. Recent
improvement in medical technology and easy availability of sex determination test has
resulted in high incidence of female foeticide. Availability of abortion services in private
nursing homes has exacerbated the incidence of abortion as well as sex selective abortions
in India.
Demographically sex selective abortion can affect the sex ratio of the population. In
Indian context, particularly the decline of sex ratio in the last century was a matter of great
concern among social scientists. The Indian census has brought out that the sex ratio has
declined from 972 females per thousand males in 1901 to 927 in 1991. The declining trend
has reversed only twice during this period, once during 1941-51 and again in 1971-81.The
most recent census results of 2001 indicate that the sex ratio has improved by 6 points in
favour of females, from 927 females per thousand males in 1991 to 933 in 2001. However
the recent increase during 1991-2001 was completely offset by the fact that the sex ratio of
child population (0-6 years) declined substantially. The 2001 census shows that there are
927 girls (0-6 years) per thousand boys of the same age group, lower than the overall sex
ratio (933). The severe deficit of females among child population and overall lower sex ratio
has become a matter of great concern among demographers and social scientists. (Kundu
and Sahu, 1991 and Srinivasan 1994).
In large parts of the Indian sub continent there is an age-old tradition of preferring
sons to daughters. Since early 1970s amniocentesis has been used in the country for sex
determination at clinics that often offer abortion services. In 1986, in Mumbai, 85 per cent of
50 gynaecologists interviewed carried out amniocentesis for sex determination, considering
it a humanitarian gesture, although many of them performed it because it was highly
lucrative. In Punjab, a survey showed that 66 percent of families with 3 daughters and no
sons wanted more children compared to only 13 percent of those with 3 sons and no
daughters. (Krassmy and Besrgstrom, 1992 and Parasuraman, et al., 1998). Sons often
increase family income, while daughters dowry cause family indebtedness, which explains
why there are fewer girls than boys.
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Sex selective abortion has been documented in India as early as 1970s when
amniocentesis for genetic screening became available. (Ramanama and Bambawale 1980
and Patel 1989). It was only with the increasing availability of ultrasound technology during
late eighties that the practice of sex selective abortion became wide spread. In response to
growing practice of sex determination tests followed by selective female foeticide, the
Government of India enacted an act known as Prenatal Diagnostic and Prevention Act
(1994) to prevent the sex determination test. Many states have taken steps on this issue.,
Also the opponents of the legislation have pointed to the social and economic factors that
underlie the strong son preference in India. They argued that social prejudices cannot be
overcome simply by legislation, and that legislation will only drive the banned action
underground and lead to bribery and malpractices.
Recent studies have shown high prevalence of abortion in the states of Punjab,
Haryana, Tamil Nadu and Rajasthan. It has been reported that there are widespread sex
selective abortions taking place in these states despite the laws prohibiting them. In many
instances sex selective abortion takes place after 12 weeks of gestation, which is quite risky
for the health of the women. This can lead to obstetric morbidity and infertility among
women, an area hardly explored in the Indian context.
Abortion by itself is a life-threatening act. Under what circumstances do women
resort to abortion is a matter of enquiry. There are few studies available on this aspect and
very little is known about the reasons and circumstances under which women go for sex
selective abortions. Further, unsafe abortion is one of the most neglected problems of
health care in developing countries (Mishra, 2001).
Hence the objective of this study is to document the evidences of sex selective
abortions from two different cultural settings in India, namely, Haryana and Tamil Nadu
which are in the news for the practice of sex selective abortions. Knowing the causes and
circumstances under which women go for abortions would facilitate in the long run in
framing suitable policy and programs for interventions.
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1.2 Objectives
1. Mapping of abortion /sonography facilities in the selected district of Haryanaand Tamil Nadu.
2. To find out the prevalence and incidence of sex selective abortions
3. To study the causes and consequences of sex selective abortions andobstetric morbidity.
Keeping this in mind the following conceptual framework is developed.
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CONCEPTUAL FRAMEWORK OF CAUSES AND CONSEQUENCES OF SEX SEL
FAMILY LEVEL VARIABLES CONSEQ
DemographicFactors
EconomicFactors
ReligiousFactors
OM
SI
MH
S
FamilySizePreference
GenderPreference
Abortion/SexSelectiveAbortion
Availabilityof MedicalTechnology
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1.3 Methodology
In this study as a first step, in order to identify the clusters of high incident areas of induced
abortion, a secondary data analysis of child population (0-4 and 5-9) was done for 1981 and
1991 censuses by districts. The district that exhibited a very high sex ratio (Male /Female) in
1981 and 1991 was selected for the study. These districts were Jind in Haryana and Salem
in Tamil Nadu. The district maps were then prepared using child sex ratio (0-6 years) at the
village level. There were many villages with sex ratio of 125 and above. One of the
concentrations of such cluster was selected in both the districts. Subsequently mapping of
abortion and ultrasound facilities in the 20 km diameter of this cluster was carried out. For
this purpose, identification of facilities such as hospitals/ nursing homes/clinics (allopathic,
ayurvedic, and RMP) was done in all the nearby towns (towns with population below one
lakh) as well as in the villages. Data was also collected from health care providers offering
services of antenatal care, MTP and deliveries. In the first phase of the study prevalence
rate of sex selective abortions was calculated and in the second phase of the study
incidence rate was calculated, to satisfy the objectives of the study.
In case of Jind district, 42 healthcare facilities and in Selam 28 health care facilities
were found in the vicinity of those villages with high sex ratio. Out of these facilities 22
facilities in Jind and 10 in Salem were providing antenatal care, MTP, and delivery facilities
whereas nearly 10 hospitals in Jind and 5 in Salem also had the ultrasound facility. It may
be mentioned here that the idea was to do complete census of the villages but due to
budgetary constraint only 5 villages in Jind and Selam were chosen for the study. Besides
in one cluster 5 villages were sufficient to carry out the study. However at the time of data
collection the five villages in Selam district were divided into seven and that is how the
number of villages in the Salem district have been increased to seven.
From the cluster of villages with a sex ratio of 125 and above, five villages in Jind
and seven villages in Salem were selected randomly for the study. Complete household
enumeration was done in the selected villages. A total of 2,590 households in Jind and
1,791 households in Salem were covered. The total number of ever-married women in
reproductive ages who were interviewed in the selected villages was 2,646 in Jind and
1,706 in Selam district. Detailed information was collected on household characteristics,
pregnancy history, antenatal care, deliveries, abortion history, reasons for abortion, place of
abortion and obstetric morbidity for each pregnancy starting from marriage.
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The second phase of the study, followed by a gap of 6 months, was repeated by
interviewing a subset of women with either one or some of the following characteristics:
1) had an abortion
2) had a still birth3) death of a female child occurred
4) undergone ultrasound test
Medical camps were organized in the selected villages with the help of a team
consisting of one gynaecologist and a physician. In-depth interviews as well as clinical
investigation reports by medical doctors (Gynaecologist) were collected with the consent of
the women.
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CHAPTER - II
HEALTH INFRASTRUCTURE
The survey on infrastructure of medical facilities was carried out in government and private
hospitals/nursing homes and clinics during October 2000 in the Jind district of Haryana with
population below ninety thousand (1991). The study included infrastructure survey of the
town and the selected five villages, for which complete census was done. In the selected
town and its periphery, all together 40-health facilities were found. Out of this, 18 were small
RMPs (Registered Medical Practitioners), homeopathic clinics and some allopathic clinics,
like orthopaedic and dental clinics. In the remaining 22 health facilities, data on
infrastructure was collected from medical doctors who were in-charge of the nursing homes.
There were four government health facilities and private practitioners ran the remaining
health care centres. Out of 18 private nursing homes, 12 were established very recently
during 1991-2000. Most of these clinics were run by the doctors from neighbouring states.
NFHS II survey has shown that in Haryana, only 60 percent of the pregnant women
go for antenatal care or for at least one ANC check-up. Percentage of births assisted by
health professional is only 42 percent for Haryana, 62 percent for Punjab and 90 percent for
Kerala. So, when these towns are not serving to a very large population and where the level
of antenatal and natal care is low, then the question arises as to why have so many nursing
homes and clinics come up in many small towns in Haryana?
2.1 Sex determination technologies
The prenatal diagnostic technique involves the use of technologies such as ultra
sonography, amniocentesis, choroin villi biopsy, foetoscopy, maternal serum analysis etc.
In the study area, only ultra sonography was being used and according to doctors, it is safe
and does not require any special training, extra staff and expenditure for operation. Out of
22 allopathic nursing homes/clinics, 10 provide ultrasonography and 3 of them have colour
sonography machines. Most of them use generators in their nursing homes. Apart from
regular nursing homes providing the ultra sonography, mobile ultrasound facilities are also
available in the villages. The charge for ultrasound is Rs.300/- to Rs.500/-, which is quite
affordable for the villagers.
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2.2 Antenatal care and sonography
As shown in table 2.1 in comparison to total antenatal cases, use of sonography was found
to be around 20 percent for all women visiting these clinics. The percentage for blood and
urine test is quite high (above 60 percent) but those are routine checkups whereas
sonography should be done only under special situation. In any case, 20 percent of women
visiting these clinics for antenatal care will not require this test (ultrasound) for the health of
the baby or mother, unless the motive is to know the sex of the foetus. The number of
antenatal cases, attended the clinic where sonography is available was also very large. This
could be both due to womens motive to undergo sonography or better facilities in these
nursing homes.
Table 2.1: Number of cases served during last six months for different medicalservices, JIND, October 2000
No. of clinics AntenatalCare*
Sonography* Urine Test* Blood Test*
WithSonographyfacilities (10) 10118
2192(21.7%)
6668(65.90%)
6458(63.8%)
WithoutSonography
facilities (12)
3236 - 148
(4.6%)
190
(5.9%)Total (22) 13354 2192
(16.4%)6816
(51.0%)6648
(49.8%)
*Information about number of antenatal, sonography and other tests are based on doctors self-reportingabout the care given by them daily/weekly/monthly.
2.3 Medical termination of pregnancies
Apart from ultrasound facilities, the nursing homes also provide abortion services to their
clients irrespective of the fact whether they are recognized as MTP centre or not (as shown
in table 2.2) and most of the abortions are done after 3 months of gestation period only
when the sex of the foetus becomes recognizable. Doctors revealed these facts during their
informal talks with the researcher; although they admitted that it could pose serious health
hazards for females. It was revealed that in comparison to 100 deliveries done at the
nursing homes with sonography facility, about 64 cases of MTP were done. In terms of
proportions nearly one-third cases were for MTP and two third for deliveries. In case of
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clinics/nursing homes without sonography facility, a higher proportion of women were going
for MTP services. In general, the procedure adopted for abortion is usually DNC in the
nursing homes where operation theatres are available. In case of clinics with no such
facilities, some of the doctors reported that they administer certain abortion inducing
injections, which has effect only after several hours, and ask the client to go to their homes.
In villages, the quacks/trained dais and ANMs are practicing induced abortions at premium
fees. The cost of abortion ranges from Rs. 1200/- to Rs 4000/- depending upon the clients
status, as well as the status of the nursing home and the risk period.
Table 2.2: Number of deliveries and MTP cases served during last six months, JIND,October 2000
No. of clinics *No. of delivery
cases
*No. of MTP
(Abortions)
Ratio of MTP to
No. of deliveriesWith Sonographyfacilities (10) 2475 1578 63.8WithoutSonographyfacilities 103 305 296.1
*Information about number of deliveries and MTP are based on doctors self-reporting aboutthe natal care given by them daily/weekly/monthly.
In a small town like Jind with population of 85 thousand in 1991 census, 10 nursing
homes were providing the ultra sound facility. These nursing homes are run by medical
doctors usually husband wife team with or without a gynaecologist. Some of the B.A.M.S.
degree holders and nurses are also providing the ultra sound facility (they have not
admitted this openly but the clients sitting in the waiting room reported this). Apart from this,
mobile ultra sound (Maruti van with ultra sound machine) facilities are available in the
villages of Haryana. The charge for an ultra sound in Haryana is Rs. 300 to 500.
In Selam, 28 health care facilities were found in the vicinity of those villages with
high sex ratio. Out of these health facilities, ten were providing antenatal care, MTP, and
delivery facilities and another five health facilities had the ultrasound facility as well.
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CHAPTER - III
SOCIO ECONOMIC AND DEMOGRAPHIC BACKGROUND OF THEHOUSEHOLD POPULATION
The present chapter presents a profile of the socio economic and demographic
characteristics of the household population.
3.1 Age and sex composition
Table 3.1 presents the percentage distribution of household population by age and sex for
Jind district in Haryana and Selam district in Tamil Nadu. The total household population for
Haryana is 15,171 and 7183 for Tamil Nadu. Thirty seven percent of the population in
Haryana is below 15 years of age of which 36 percent are females and 39 percent are
males and 8 percent are aged 60 or more. In Tamil Nadu 28 percent of the population are
below 15 years of age of which 26 percent are females and 31 percent are males where as
only 8.2 per cent of the total population are aged 60 and above.
The sex ratio (number of females per 1000 males) is an important measure that
indicates the balance of the sexes in the population. The sex ratio as shown in the table is
832 in Haryana and 867 for Tamil Nadu, the sex ratio being highly unfavourable towards
females in both the states.
3.2 Marital status
Table 3.2 shows the marital status of the household population according to age and sex for
the state of Haryana and Tamil Nadu. In Haryana among females 60 percent are currently
married and 34 percent are never married. In Tamil Nadu 64 percent of the females are
currently married and 24 percent are never married. The percentage never married is higher
among males (48.2 percent) than for females in Haryana. In Tamil Nadu the percentage
never married among males is highest in 15-19 age group (97.8 percent) and lowest in 30-
49 age group (3.1 percent).
Percentages of separated/ deserted/ widowed and divorced are small in both the
states for both the sexes. Twenty seven percent of females aged 50 plus, 5.3 percent
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women aged 30-49 are widow in Haryana. The corresponding percentages for males are 13
percent and 1 percent respectively. Similarly in Tamil Nadu 39 percent of the females, aged
50+ and 7.8 percent aged 30-49 years are widow. The corresponding percentages for
males are 2.3 percent and 1.1 percent only.
With regard to the proportions of persons marrying young, it is observed that in
Haryana in the age group 15-19, the proportion of married is 5.1 percent for males and 38.4
percent for females. In Tamil Nadu, the proportion of ever-married in 15-19 age group is 2
percent for males and 43.5 percent for females. By age 25-29, the proportion of females
marrying is virtually universal in both the states. The corresponding percentages for males
are 84.1 percent in Haryana and 71.1 percent in Tamil Nadu. Overall the table shows that a
large percentage of females marry at a relatively younger age in Tamil Nadu than in
Haryana. The number of females marrying at a young age is much lower when compared to
males in both the states.
3.3 Household composition
Table 3.3 shows the percent distribution of households by various characteristics of the
household head like sex, age, religion, caste, household type and the number of members
usually living in the household for the state of Haryana and Tamil Nadu. The table shows
that ninety three percent of households in Haryana are male-headed households and only
seven percent constituting female-headed households. In Tamil Nadu 53.6 percent of the
household heads are male. This shows that in Haryana the households are predominantly
dominated by males, which is not in case of Tamil Nadu. The median ages of the head of
the household in Haryana and Tamil Nadu are 42 and 43 years respectively having very
little variation. Household heads seems to be somewhat more concentrated in 30 44 age
group in both the states.
Overall 98 percent of the households head in Haryana are Hindus and 2 percent of
the heads of the households are Muslims. Similar is the picture in Tamil Nadu, where
almost 100 percent of the household heads are Hindus. Less than one percent of the head
of the household belong to Muslim, Christian and other communities.
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With regard to household type, 62 percent of the households in Haryana are of the
nuclear type corresponding to 75 percent in Tamil Nadu. The average household size is
slightly higher in the state of Haryana (5.8 persons per household) than in Tamil Nadu (4.1
persons per household).
3.4 Educational level
Tables 3.4a & 3.4b show the percent distribution of household population aged 6 and above
by literacy and level of education and median number of years of schooling according to
age and sex for Haryana and Tamil Nadu respectively.
The tables show that 34.6 percent of the population aged 6 and above are illiterate in
Haryana. 49 percent females and only 22.6 percent males are illiterate indicating a wide
gender disparity in literacy in Haryana. Correspondingly in Tamil Nadu 44 percent of the
population aged 6 and above are illiterate. Fifty five percent females and 35 percent males
are illiterate.
In 20-29 age group, nearly 26 percent males are higher secondary complete,
corresponding to only 7.6 percent in case of females in Haryana. The corresponding figures
for Tamil Nadu are 17 percent for males and 11 percent for females. A higher percentage of
males than females have completed each level of schooling in both the states. The
proportion illiterate is lowest at age 10-14 years and highest at age fifty and above for both
males and females in Haryana. In Tamil Nadu the proportion illiterate is lowest in 6-9 age
group and highest at age fifty and above. In both the sexes, the proportion illiterate is lowest
in 10-14 age group and highest among persons aged 50 and above.
The median number of years of schooling for males in Haryana is 6 years and 4
years in Tamil Nadu. For females the median number of years of schooling in Tamil Nadu is
zero as more than half of the females are illiterate. In Haryana, it is even less than 2 years
for females, as slightly less than half of the female population have never attended school.
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3.5 Housing characteristics
Table 3.5 provides information on household characteristics such as source of drinking
water, sanitation facility, type of house, and type of fuel used for cooking for the state of
Haryana and Tamil Nadu.
The table shows that 89 percent households in Haryana have electricity
corresponding to 78 percent households in Tamil Nadu. With regard to water sources and
sanitation facilities, in Haryana 30 percent of the household use tap located inside the
house, 42 percent use tap located out side the house, 24 percent use hand pump bore well
and well; and less than one percent use other sources of drinking water. In Tamil Nadu 68.5
percent of the households use tap located outside the residence and only 5 percent use tap
located inside the residence. Twenty six percent of the households use hand pump bore
well and well.
As far as sanitation facility is concerned 77 percent of the households in Haryana
have no toilet facility corresponding to 95 percent of households in Tamil Nadu. Thirteen
percent households in Haryana and four percent of the households in Tamil Nadu have own
toilets with flush facility. The percentage of household using public toilets with flush facility is
less than one percent in both the states.
Regarding type of house construction, 50 percent of the houses in Haryana are
pucca houses corresponding to 14 percent in Tamil Nadu. Forty three percent of the houses
are semi pucca and 7.5 percent are kachha houses in Haryana where as in Tamil Nadu 44
percent of the houses are semi pucca and 41 percent of the houses are kachha. The
proportion of houses, which are kachha, is much higher in Tamil Nadu than in Haryana.
Regarding type of fuel used, 83.8 percent of the households in Haryana use cowdung cakes for cooking, whereas in Tamil Nadu 87 percent of the households use wood for
cooking. Electricity as a method of cooking is used by 2 percent of the households in
Haryana and less than one percent in Tamil Nadu. LPG is used by 31.5 percent of the
households in Haryana corresponding to 13.5 percent in Tamil Nadu.
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3.6 Households owning agricultural land/house/livestock
Table 3.6 gives the percent distribution of household owning land, owning a house and
owning livestock. About 51 percent of the households in Tamil Nadu own no land,
corresponding to 37 percent in Haryana. Overall 61.5 percent of the households in Haryana
own agricultural land as compared to 25 percent in Tamil Nadu. Non-agricultural land is
owned by less than one percent of the households in Haryana compared to 18.2 percent in
Tamil Nadu. Ownership of house is nearly universal in Haryana. The proportion of
households owning a house in Tamil Nadu is 95.3 percent. The proportion of households
owning a livestock is 80 percent in Haryana and 42 percent in Tamil Nadu.
3.7 Households owning selected durable goods
It is said that the possession of consumer durable goods is an important indicator of a
households economic status. Table 3.7 shows the percentage distribution of households
owning selected durable goods. It is observed from the table that in the state of Haryana, as
a whole, majority of the households have cot/bed, electric fan, clock watch, mattress (98.2
percent, 88.0 percent, 86.9 percent and 60 percent respectively).
Other consumer durable goods often found in most of the households are black andwhite television (45 %), bicycle (42%), chair (45.5%), radio/ transistor (31.2%), pressure
cooker (28.3 %), water pump (20%), scooter/motorcycle/tractor (10%), telephone (9.5%)
and thresher (7%).
In Tamil Nadu majority of the households have mattress (96%), cot / bed (88%),
clock / watch (62%) and bicycle (55%). Other consumer durable goods often found in
the household are radio (36.7%), electric fan (35%), television (19%), motorcycle /
scooter (16%).
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Table 3.1: Percent distribution of household population by age and sex
HARYANA (Jind) TAMILNADU (Salem)Age Male Female Total Male Female Total
0-4
5-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980+
Total Percent
Number ofpersons
Sex Ratio
10.9
13.913.011.19.58.46.65.94.93.22.42.22.32.51.90.70.6
100.0
8,280
11.4
12.212.510.310.09.47.26.23.92.44.12.03.72.41.40.30.7
100.0
6,891
11.1
13.212.810.79.88.96.86.04.42.83.22.12.92.41.70.50.7
100.0
15,171
832
11.2
10.29.29.48.79.47.57.05.84.84.93.83.61.71.60.70.6
100.0
3,848
9.4
9.17.29.111.110.17.98.16.46.23.44.23.52.01.10.40.7
100.0
3,335
10.4
9.78.39.29.89.77.67.56.05.44.24.03.61.91.40.60.7
100.0
7,183
867
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Table 3.2: Marital status of the household population
Percent distribution of household population age 6 and above by marital status,according to age and sex
Marital status
Age Currentlymarried Separated/Deserted Widowed Divorced Nevermarried TotalpercentHARYANA
Male
13-14 0.3 0.0 0.0 0.0 99.7 100.015-19 5.1 0.1 0.0 0.0 94.8 100.020-24 44.3 0.5 0.5 0.0 54.7 100.025-29 84.1 0.3 0.1 0.0 15.5 100.030-49 96.2 0.1 1.7 0.0 1.9 100.050+ 85.0 1.2 12.8 0.1 0.9 100.0
Female13-14 3.1 0.0 0.0 0.0 96.9 100.0
15-19 38.4 0.3 0.4 0.1 60.8 100.020-24 92.9 0.3 0.3 0.3 6.2 100.025-29 98.9 0.2 0.5 0.0 0.5 100.030-49 94.0 0.5 5.3 0.1 0.1 100.050+ 71.5 0.9 26.7 0.4 0.5 100.0
TAMILNADUMale
13-14 0.0 0.0 0.0 0.0 100.0 100.015-19 2.0 0.3 0.0 0.0 97.8 100.020-24 26.7 0.3 0.3 0.9 71.8 100.025-29 71.1 0.3 0.3 0.0 28.3 100.0
30-49 95.5 0.7 1.1 0.0 3.1 100.050+ 88.9 0.4 2.3 0.1 41.7 100.0
Female13-14 0.0 0.0 0.0 0.0 100.0 100.015-19 43.1 0.7 0.7 0.0 55.5 100.020-24 86.4 0.5 0.3 0.0 12.7 100.025-29 92.9 2.4 2.1 0.3 2.4 100.030-49 87.7 3.2 7.8 0.5 0.8 100.050+ 57.9 1.8 39.2 1.0 0.2 100.0
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Table 3.3: Percent distribution of households by selected characteristics of thehousehold head, household type and household size
Background Characteristics Haryana (Jind) Tamil Nadu (Salem)
Sex of the head of the householdMale 93.0 53.6Female 7.0 46.4
Age of household head
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Table 3.4a: Percent distribution of household population age 6 and above by literacyand level of education, according to age and sex (Haryana)
Education levelAge Illiterate Literate,
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Table 3.4b: Percent distribution of household population age 6 and above by literacyand level of education, according to age and sex (Tamil Nadu)
Education levelAge Illiterate Literate,
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Table 3.5: Percent distribution of households by housing characteristics
Housing characteristics Haryana (Jind) Tamilnadu (Salem)ElectricityYes 89.3 77.8No 10.7 22.2
Source of drinking waterTap (Inside residence) 30.4 5.3Tap (Outside residence) 41.6 68.5Hand pump, bore well, well 24.3 26.2Pond 3.1 0.0Other 0.3 0.0
Sanitation facilityOwn toilet (flush) 13.2 4.1
Public toilet (flush) 0.2 0.2Own toilet (pit) 1.5 0.0Public toilet (pit) 7.6 0.4No facility 77.5 95.3
Type of housePucca 49.6 14.2Semi-pucca 43.0 44.4Kachha 7.5 41.4
Main type of fuel used for cookingElectricity 2.0 0.2LPG / Bio-gas 31.7 13.5Charcoal 18.7 19.2Wood 78.4 87.6Crop residue 9.8 37.2Cow dung cakes 83.8 15.1Others - 0.1
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Table 3.6: Percent distribution of households owning agricultural land/ house/livestock, Haryana & Tamil Nadu
Asset Haryana (Jind) Tamil Nadu (Selam)
No land 37.1 50.9
Agricultural land only
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Table 3.7: Percentage of households owning selected durable goods
Asset Haryana (Jind) Tamil Nadu (Salem)
Durable goods
Mattress 60.1 96.6
Pressure cooker 28.3 9.6
Chair 45.5 53.5
Cot/ bed 98.2 88.3
Electric fan 88.0 34.9
Clock/ watch 86.9 61.9
Telephone 9.5 4.7
Bicycle 41.7 55.5
Radio/ transistor 31.2 36.7
Television (B&W) 44.9 19.2
Television (Colour) 3.2 5.6
Moped/ scooter/motorcycle 10.1 16.2
Water pump 19.7 3.8
Thresher 6.9 0.2
Tractor 10.1 0.2
Other items 11.0 0.2
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CHAPTER - IV
SOCIOECONOMIC AND DEMOGRAPHIC BACKGROUND OF THERESPONDENTS
Womens health seeking and demographic behaviour is virtually linked with several other
characteristics including their age, marital status, religion, and caste. This chapter presents
a profile of the demographic and socioeconomic characteristics of ever-married women age
15-49 who were identified by the Household Questionnaire as eligible respondents for the
present study.
4.1 Background characteristics of the respondents
Table 4.1 presents the percentage distribution of all women interviewed by age, marital
status, co-residence with husband, education, husbands education and employment for
Haryana and Tamil Nadu. The table shows that in Haryana, the proportion of respondents in
5-year age groups increases from 7.5 percent in 15-19 age group to 23.1 percent in 25-29
age group and then falls down to 5.3 percent in 45-49 age group. In Tamil Nadu the
proportion of respondents in the 5-year age group increases from 9.1 percent in 15-19 to
18.9 percent in 25-29 age group. It decreases to 14.8 percent in 30-34 age group and
increases to 15.4 percent in 35-39 age group after which it falls down to 11.4 percent in
45-49 age group.
A large number of the respondents fall in the high fertility age group of 20-29 in both
the states. More than half of the respondents in Haryana (51.6 percent) are in the early
reproductive age group of 15-29 years. In Tamil Nadu more than half of the respondents are
concentrated in the higher age group of 30-49 (53.8 %). Only 5.3 percent of women in
Haryana are in the 45-49 age group compared to 11.6 percent in Tamil Nadu.
As far as marital status is concerned, 97.1 percent women in Haryana reported to be
currently married and 2.9 percent women are widowed. In Tamil Nadu, around 93 percent
women reported to be currently married. The percentage of women who reported to be
divorced/separated is 4 percent each. Two to three percent women said that they were
widows. Nearly ninety nine percent of the respondents reported to be living with their
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husbands in Haryana compared to 95.3 percent in Tamil Nadu. A very small percentage of
women were not living with their husbands in both the states.
The literacy levels of the respondents and their husbands have an important bearing
on their health care and health seeking behaviour. More than 60 percent women in Haryana
(64.7%) and Tamil Nadu (62.7%) are illiterate. Among women who are literate, large
proportions are those who have completed primary but not middle school. Only 14.2 percent
women in Haryana and 16 percent women in Tamil Nadu reported to have completed
primary level of education.
Although 64.7 percent women in Haryana are illiterate, only 31.2 percent of their
husbands are illiterate. On the other hand, a higher percentage of husbands in Tamil Nadu
(53.4 percent) are illiterate. Again in Haryana, 21 percent women have husbands who are
high school complete, compared to 7.3 percent in Tamil Nadu.
Considering the fact that the employment/work status has an important influence on
a womens overall development as it nurtures her personality and helps her gain a sense of
economic independence, it would be interesting to see the work participation rate in any
kind of economic activity in any kind of economic activity either inside or outside house in
both Haryana and Tamil Nadu. The table shows that 49 percent of respondents in Haryana
have not been working in the past 12 months. The corresponding figure for Tamil Nadu is
41 percent. Nearly 35 percent women in Tamil Nadu are employed with someone else
compared to only 13.2 percent in Haryana. The figures have been just the opposite in case
of women, who reported to be working in their own family farm or running their own
business. The table shows that 35 percent women in Haryana compared to only 11 percent
in Tamil Nadu work in their respective family farm/business. The percentage of women who
are self employed is 2.7 percent in Haryana and about 12 percent in Tamil Nadu.
Thus more women in Tamil Nadu are seeking employment elsewhere compared to
women of Haryana who are more involved in family farm or business.
4.2 Exposure to mass media
In a country like India, where a large number of women are illiterate and have attained little
or no formal school education, informal channels such as mass media plays an important
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role in bringing about modernization and thereby influencing and motivating women about
their reproductive rights and choice.
Table 4.2 provides information on the percentage of ever-married women age 15-49
who read a newspaper or magazine, watch television or listen to radio at least once a week,
who visit a theatre once in a month by selected background characteristics for Haryana and
Tamil Nadu.
In Haryana regular exposure to media is higher among younger women below age
30, in comparison to Tamil Nadu where the exposure to mass media is more among women
in the higher age group of 30 and above (except in case of visits to cinema theatre). In
Haryana television has the greatest reach among women in all the age groups whereas in
Tamil Nadu listening to radio seems to be more popular among women in all the age
groups. However exposure to mass media is more in case of Tamil Nadu as compared to
Haryana.
Exposure to each of the media increases with education. The percentage of illiterate
women who are exposed to any kind of media is quite low in Haryana compared to illiterate
women of Tamil Nadu. On the whole, women of Tamil Nadu have wider exposure to mass
media than women of Haryana.
4.3 Perceived educational need for sons and daughters
Table 4.3 provides information on the womens educational aspirations for their children for
Haryana and Tamil Nadu. Investing in childrens education is not only an important factor in
bringing about a transition from uncontrolled fertility to controlled fertility, but is also an
indicative of the degree of son preference prevalent in the respective places.
In Haryana, 57 percent women believe that a son should be given as much
education as he desires compared to 48.5 percent of women who believe that a girl should
be given as much education as she desires. In Tamil Nadu only 33 percent women report
that a son should be given education till he desires and 24 percent women report the same
for girls. A very noticeable feature is that in Haryana, the percentage of women who believe
that an education above higher secondary school and above is appropriate for boys is 9.7
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and 7.9 percent for girls compared to 24.2 percent and 27.3 percent in Tamil Nadu. Thus
the percentage of women who are desirous of educating their girl child beyond higher
secondary school is more than what it is for boys in Tamil Nadu. This percentage in
Haryana is significantly low for both boys and girls.
On the whole the data show that women in Haryana and Tamil Nadu are more
desirous of educating their male child beyond graduation than they are interested for
educating their daughters for higher education.
4.4 Perceived age at marriage for sons and daughters
Table 4.4 shows the awareness and knowledge about the women in Haryana and Tamil
Nadu regarding the legal age at marriage for boys and girls. It is surprising to see that
around 40 percent of the respondents in Haryana believe that a boy should marry below 21
where as only 35 percent believe that a boy should marry above 21 years of age. In Tamil
Nadu women are however better informed about the legal age at marriage for boys and girls
as more than 80 percent gave the correct response regarding the legal age at marriage for
boys and girls.
4.5 Perceived duration of breastfeeding (in months) for sons and daughters
Table 4.5 shows the duration of breastfeeding in months for sons and daughters as
reported by respondents in Haryana and Tamil Nadu. In Haryana nearly 68 percent of
women say that boys and girls should be fed for 13 to 24 months in contrast to Tamil Nadu
where only 57 percent women are in favor of feeding boys and girls for 2 years. When mean
duration in months is calculated it is seen that in Haryana boys and girls are fed for little
more than two years where as in Tamil Nadu the mean duration in months is nineteen
months.
4.6 Mean Time spent by women on household chores and other activities
Table 4.6 provides information on the average time spent by women in Haryana and Tamil
Nadu for cooking, collecting drinking water, cleaning and mopping the house, washing
clothes, milking animals, collecting fuel/wood and collecting food for animals.
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The amount of time spent by women in various household activities determines their
status and autonomy in the household and their freedom of movement, which may likely
have an impact on her health seeking behaviour.
In Haryana, the mean time spent in collecting food for animals is 106.53 minutes,
which has been the highest, followed by time spent in herding cattle (101.63) The meantime
invested for cooking is 76.73 minutes, for cleaning and mopping the house 77.47 minutes
and the average time spent for washing clothes is 79.03 minutes. The mean time spent for
collecting drinking water is 56.97 minutes and for milking animals is comparatively much
less as against other activities (97.04 mins.) Thus, women in Haryana seem to spend a
longer duration of time working outside home.
In Tamil Nadu, the mean time spent has been the least for collecting drinking water.
(45.12 minutes), collecting food for animals (122.38 minutes) and for making cow dung
(124.49 minutes) is more or less equally distributed. The mean time spent for cooking is
89.61 minutes, for cleaning and mopping the house is (56.55 minutes), and washing clothes
is (92.69 minutes) in Tamil Nadu.
The average time spent by women for other activities is 262.77 minutes. The
average time spent outside home is high in comparison to time spent in activities insidehome.
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Table 4.1: Percent distribution of the respondents by their background characteristics
Background Characteristics Haryana (Jind) Tamil Nadu (Salem)
Age Groups15-19
20-2425-2930-3435-3940-4445-49
Marital StatusCurrently MarriedWidowedSeparatedDivorced
Co-residence with HusbandLiving with husbandNot living with husband
EducationIlliterateLiterate
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Table 4.2: Exposure to Mass Media
Haryana (Jind) Tami
Background Characteristics
Reads newspaper or
magazine once aweek
Watches TV atleast once a
week
Listens tothe radio atleast once a
week
Visit acinema
theatre atleast once a
month
Reads newspaper or
magazine oncea week
Watchesleast on
wee
Age15-1920-2425-2930-3435-3940-4445-49
EducationLiterate
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Table 4.3: Perceived educational need for sons and daughters, Haryana and Tamil Nadu
Haryana (Jind) Tamil Nadu (Salem)Education forChildren Boys Girls Boys Girls
No Education
Less than Primary
Primary School
Middle School
High School
Higher Secondaryschool and above
Graduate and above
As much as he/shedesires
Depends on theeconomic condition
0.0
0.2
0.5
0.6
18.6
9.7
12.4
57.1
0.8
0.2
0.5
3.5
6.9
25.2
7.9
6.6
48.5
0.8
0.0
0.0
0.0
3.0
18.2
24.2
21.2
33.0
0.0
0.0
0.0
6.1
12.1
24.2
27.3
6.1
24.2
0.0
* All figures are in terms of percentage
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Table 4.4: Percent distribution of women regarding age at marriage for boys and girls
Age Haryana Tamil Nadu
Boys
Below 21At 21Above 21
Girls
Below 18At 18Above 18
39.725.335.0
13.365.421.3
5.97.7
86.4
12.913.174.0
Table 4.5: Percent distribution of women regarding duration of breast milk (in months) tobe given to boys and girls for Haryana and Tamil Nadu
Haryana Tamil NaduDuration in months
Boys Girls Boys Girls
1-5
6-12
13-24
25+
1.6
3.6
67.4
27.4
1.5
3.7
68.1
26.7
0.5
35.6
57.4
6.5
0.8
35.8
57.2
6.2
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Table 4.6: Mean time spent by women on different household chores and other activities (Time in mi
Time spent in
Name of the districtCollectingdrinkingwater
Cooking Cleaningandmopping
the house
Washingclothes
Milkinganimals
Collectingfuel/wood
Collectingfood foranimals
JindMeanNStd. deviation
56.97243232.39
76.73251538.05
77.47249540.75
79.03236843.20
49.95199640.74
91.19183964.12
106.53188858.18
SelamMeanNStd. deviation
45.12168034.36
89.61167944.39
56.55167231.96
92.69161943.01
52.8136556.84
125.8699663.81
122.3840361.53
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CHAPTER - V
PREGNANCY AND ANTENATAL CARE
5.1 Pregnancy history
One of the ways to determine the prevalence of sex selective abortions is to see what
percentage of live birth and abortions (induced) have occurred to women (ever married)
starting from their first pregnancy till their fifth pregnancy and above. The analysis below
shows the number and percentage of women according to outcome of pregnancy by order
of pregnancy for ever married and currently married women of Tamil Nadu and Haryana.
Tables 5.1 and 5.2 show that in Selam (Tamil Nadu), 91 percent of women have had
a live birth in their first order of pregnancy. This percentage has shown a decline with higher
orders of pregnancy. As is observed from the table, with a higher order of pregnancy there
is a subsequent decline in the percentage of women giving live birth with a corresponding
increase in the percentage of women going for induced abortions, thereby resulting in a
large number of foetus wastage. The percentage of women having stillbirth or spontaneous
abortions are lesser than the percentage of women having induced abortions in all the
orders of pregnancy. The percentage of women having induced abortion has increased
from less than 2 percent in the second order of pregnancy to more than 20 percent in the
fifth order and above. The analysis shows that there are less and less number of live births
and more incidence of induced abortions at higher orders of pregnancy which could be
perhaps to limit the family size or could be due to high son preference.
Tables 5.3 and 5.4 show that in Haryana 91.4 percent of women have had a live
birth in their first order of pregnancy. Unlike Selam, this percentage has shown an increasetill the third order of pregnancy and then there has been a decline. Percentage of women
having had a live birth has been the highest in the third order of pregnancy. Percentage of
induced abortions has been less than one percent in the first, second, and third order of
pregnancy. In Haryana because of the preference for bigger family size, the percentage of
induced abortions is perhaps low till the first three order of pregnancy.
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5.2 Influence of previous pregnancy outcome on the present pregnancy outcome
It is said that the outcome of a pregnancy to a large extent is determined by the outcome of
the previous pregnancy. A woman who has had a live birth is more likely to deliver a live
baby in her next pregnancy than a woman who has had a stillbirth or an abortion in her
previous pregnancy. On examining the influence of the outcome of the previous pregnancy
on that of the present birth, table 5.5 shows that in Selam, 90 percent of the second
pregnancy was a live birth when the previous pregnancy was also a live birth. The
proportion of live births in the subsequent deliveries slowly declined, even though the
outcome of the previous pregnancy was a live birth. The percentage of abortions
(spontaneous and induced) has increased from 5.7 percent in the second pregnancy to 22.2
percent in the seventh and above confinements for women whose previous pregnancy was
a live birth. In Haryana, as shown in table 5.6 more than 90 percent of the cases resulted in
a live birth when the previous pregnancy outcome was also a live birth in all the subsequent
deliveries. When we look at the percentage of abortions that occurred, it is seen that the
percentage of abortion in Haryana has increased from 3.4 percent in the second pregnancy
to 7 percent in the seventh pregnancy for all those women whose previous outcome was
also a live birth.
The analysis shows that in Selam district in Tamil Nadu the incidence of abortion is
more at higher orders of pregnancies in comparison to Jind district in Haryana. As has been
reiterated earlier, the preference for a smaller family size could perhaps be one of the
reasons leading to high-induced abortions in Selam in Tamil Nadu.
5.3 Antenatal Care (ANC)
Antenatal care refers to pregnancy related health care provided by a doctor or a health
worker in a medical facility or at home. Ideally, antenatal care should monitor a pregnancy
for signs of complications, detect and treat pre-existing and concurrent problems of
pregnancy and provide advice and counselling on preventive care, diet during pregnancy,
delivery care, post natal care and related issues. The Reproductive and Child Health
programme recommends that the pregnant women should have at least three antenatal
checkups that include blood pressure checks and other procedures to detect pregnancy
complications.
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Tables 5.7 and 5.8 provide coverage of ANC for women by birth orders for Tamil
Nadu and Haryana. Three components such as antenatal checkups, blood test and urine
test were studied to ascertain to what extent women give importance to antenatal care
during pregnancy.
Table 5.7 shows that in Selam, out of 1563 pregnant women, 49 percent of women
went for antenatal checkups during their first pregnancy. This percentage has declined to 40
percent for women in their second pregnancy, 32.3 percent women in the third pregnancy
and 24.4 percent women in the fourth pregnancy. Thus, we see, that with the increase in
the order of pregnancy, there is a subsequent decline in the percentage of women going for
ANC checkups. This shows that in case of live births of earlier pregnancies, there is more
anxiety among women regarding their health and their babys health, which gradually
diminishes for births at higher order pregnancies. In Haryana as table 5.8 shows out of 2398
women in the first birth, 21 percent reported having gone for ANC checkups. There was a
constant decline in percentage in the second (18.5 %), third (15.8%) fourth (12.4%) and fifth
birth and above (12.6%).
In Selam, 40 percent women reported to have done a urine test during their first birth
and this percentage declined to 11.8 percent for women in the fifth birth and above.
Similarly, 18.2 percent of women out of 2398 women in their first pregnancy in Haryanareported to have done urine test and this percentage further declined for women in higher
births. With regard to blood test, the percentage of women who reported to have done a
blood test is higher in the first birth order and there is a corresponding decline in the
percentages in both the states with the increase in parity.
In Selam though 49 percent of women in their first birth reported to have done ANC
checkups only 39 percent reported to have gone for a blood and a urine test. This shows
that the women of higher parities are in general ignorant and less conscious about their
health as compared to women of first and second births in Haryana as well as in Tamil
Nadu.
Tables 5.9 and 5.10 provide the percentage distribution of women, who went for a
sonography test, who motivated them to go for the test, and whether the sex of the baby
was revealed to them after doing the sonography.
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In Selam, out of 49 percent women in their first pregnancy who went for ANC
checkups, only 5 percent reported to have done the sonography test. Out of these 5 percent
women, nearly one third of them have reported that the sex of the baby was revealed to
them during sonography. In the second birth, out of 1290 women, 39.8 percent went for
ANC check-up and only 2.7 percent women reported to have gone for sonography test, out
of which nearly one-fifth have reported that the sex of the baby was revealed to them during
the test. In the third pregnancy slightly more than 3 percent of women reported of going for
a sonography test, higher than what it was in the second pregnancy. This shows that the
inquisitiveness to know the sex of the baby is more after the birth of the first two children
among women in Selam.
In Haryana, out of 21.1 percent women who went for ANC checkups in their first
birth, 4.6 percent women went for a sonography test out of which nearly one sixth of women
reported that the sex of the baby was revealed to them during the test. The percentage of
women who said that they were told about the babys sex during sonography increased
from the third birth and onwards. Whereas the percentage was 14.2 in the first birth it rose
to 35.9 percent in the fourth birth. Correspondingly there has also been an increase in the
percentage of women who reported of having done the sonography test from the third birth
onwards in Haryana.
With regard to persons who suggested these women to go for a sonography, the
data shows that in Selam out of the five percent women who reported to have gone for
sonography during their first birth confinement, the proportion of women who said they went
by doctors suggestion was 44 percent. This percentage decreased in the third birth to 36
percentage. The proportion of women who went out of their own interest or the husbands/
family interest was less than 20 percent in all the births.
5.4 Health problems during pregnancy
Tables 5.11 and 5.12 provide information about the proportion of women who suffered from
any disease during pregnancy, and specific health problems during pregnancy by order of
confinement for Tamil Nadu and Haryana. In Selam 78.6 percent of women reported that
they are suffering from one or the other health problems during the first pregnancy. The
percentage of women suffering from any disease has declined in the higher order
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pregnancies. Only 51 percent of women in the 5th pregnancy and above reported to have
some health problems. Similarly in Haryana, the percentage of women who had any health
problem has been the highest in the first pregnancy (64.2 percent). This percentage has
declined to 58.6 percent for women in the fifth pregnancy and above.
This shows that women in their first birth are more likely to suffer from various health
problems, which decrease considerably in case of deliveries at higher parities.
Nausea and vomiting as a health problem was reported by maximum percentage of
women during the pregnancies at all parities both in Jind and in Selam. Seventy-three
percent women in Selam and 54 percent women in Haryana reported to have suffered from
nausea and vomiting during their first pregnancy. This percentage showed a decline with
the increase in the order of pregnancies. The percentage decline between the first and the5th and the above pregnancy is more than 20 percent in Selam and around 10 percent in
Haryana. Apart from Nausea and vomiting, weakness and dizziness seems to be a common
problem among women in both the states.
More than 30 percent women reported the above two problems in the state of
Haryana during all the pregnancies. In Selam, the percentage of women who reported
suffering from dizziness and paleness was more than 30 percent in the first birth but
declined slowly with the increase in the order of the pregnancy. Less than 10 percent
women in Selam reported having problems of paleness, bleeding, visual disturbance,
hypertension, swelling etc. during all the pregnancies.
In Haryana, the proportion of women who reported bleeding to be a problem has
increased from 6 percent in the first birth to 18 percent in the second birth. After seeing a
decline in the third there is a sudden rise from the fourth and onwards. The overall picture
shows that women in Selam in Tamil Nadu are in better health conditions than women of
Jind in Haryana.
5.5 Type of doctor visited
Tables 5.13 and 5.14 show the proportion of women who consulted a doctor for their health
problems and the type of doctor visited according to order of pregnancy for Tamil Nadu and
Haryana.
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Out of the 78.6 percent women in Selam who reported to have suffered from any
health problems in their first birth order, only 25 percent women reported visiting a doctor for
their health problems. Twenty one percent women in their first and second births went for
doctors consultation. This percentage further declined to 18 percent for women during the
fourth and above pregnancies.
In Haryana, out of 64 percent women who had health problem of any kind, 31
percent reported having visited a doctor in their first birth order. This percentage further
declined to 26 percent during the higher pregnancies. The percentage of women who
reported having consulted a doctor for their health problem is highest among women of the
first order of pregnancy.
The analysis shows that at the time of first pregnancy women are more conscious
about their health status than they are in the higher orders of pregnancies.
In Selam, out of the 25 percent women who visited doctor during their first
pregnancy, 40 percent of the women referred a Government doctor, whereas 64 percent of
women went to a private doctor. Only 17 percent women went to other health care providers
such as (ANM, Nurse Homeopathic/ Ayurvedic/Unani doctors etc). In the second and third
pregnancies, this percentage has shown an increase in case of visit to Government doctors,but the percentage of women who went to private doctors has shown a decline from 64
percent in the first birth to 62 and 60 percent during the second and third order of
pregnancies respectively.
In Haryana, the percentage of women visiting private health care providers is highest
in the second order of pregnancy (65.1%) than the percentage in the first. A very striking
feature observed in Haryana is that the percentage of women visiting private doctors is
lowest during the third pregnancy (19.1%) as compared to 41 percent of women who visited
the Govt. doctors during the same order of pregnancy.
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Table 5.1: Percentage and number of women according to outcome and order of pregnancy(Ever married women, Selam District, Tamil Nadu)
Live Birth Still Birth SpontaneousAbortion
InducedAbortion
Order ofpregnancy
No. % No. % No. % No. % Total
12
3
4
5
6&above
14021132
697
359
142
89
91.288.9
82.8
80.1
71.0
61.8
4035
31
11
5
2
2.62.7
3.6
2.4
2.5
1.3
9382
48
31
12
6
6.06.4
5.7
6.9
6.0
4.1
123
65
47
41
47
0.061.8
7.7
10.4
20.5
32.6
15361272
841
448
200
144
Table 5.2: Percentage and number of women according to outcome and order of pregnancy
(Currently married women, Selam District, Tamil Nadu)
Live Birth Still Birth SpontaneousAbortion
InducedAbortion
Order ofpregnancy
No. % No. % No. % No. % Total
1
2
3
4
5
6&above
1313
1063
655
334
136
83
91.6
89.2
82.9
79.3
70.8
60.5
37
32
30
10
5
2
2.58
2.69
3.80
2.38
2.60
1.46
82
75
43
31
12
6
5.72
6.30
5.4
7.3
6.2
4.3
1
21
62
46
39
46
0.07
1.7
7.8
10.9
20.3
33.5
1433
1191
790
421
192
137
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Table 5.3: Percentage and number of women according to outcome and order of pregnancy(Ever married women, Jind District, Haryana)
Live Birth Still Birth SpontaneousAbortion
InducedAbortion
Order ofpregnancy
No. % No. % No. % No. % Total
12
3
4
5
6&above
21591932
1437
805
416
365
91.492.9
93.2
90.4
87.9
89.0
6733
23
16
11
8
2.81.5
1.4
1.8
2.3
1.9
135106
77
60
38
33
5.75.1
5.0
6.7
8.0
8.0
17
4
9
8
4
0.040.34
0.26
1.01
1.6
0.98
23622078
1541
890
473
410
Table 5.4:Percentage and number of women according to outcome and order of pregnancy
(Currently married women Jind District, Haryana)
Live Birth Still Birth SpontaneousAbortion
InducedAbortion
Order ofpregnancy
No. % No. % No. % No. % Total
1
2
3
4
5
6&above
2088
1864
1388
772
395
348
91.3
92.8
93.2
90.6
88.1
89.0
64
32
22
15
11
6
2.8
1.5
1.4
1.7
2.4
1.5
133
104
75
56
36
33
5.8
5.1
5.0
6.5
8.0
8.4
1
7
3
9
6
4
0.04
0.3
0.2
1.0
1.3
1.0
2286
2007
1488
852
448
391
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Table 5.5: Influence of previous pregnancy outcome on present pregnancy outcome, SelamDistrict, Tamil Nadu
Outcome of the subsequent pregnancyOrder of pregnancy Live Birth
Percentage/NumberStill Birth
Percentage/NumberAbortion
Percentage/Number
First*LB-1066*SB-34*A-68
SecondLB-676SB-25A-68
ThirdLB-339
SB-16A-51
FourthLB-148SB-4A-32
FifthLB-57SB-3A-19
SixthLB-18SB-1A-7
91.5(976)91.1(31)51.4(35)
83.1(562)80.0(20)70.5(48)
83.0(282)50.0(8)58.8(30)
80.4(119)50.0(2)37.5(12)
78.9(45)33.3(1)31.5(6)
77.7(14)-
28.5(2)
2.6(28)8.8(3)
-
3.5(24)16.0(4)2.9(2)
0.8(3)12.5(2)1.9(1)
2.0(3)25.0(1)3.1(1)
-33.3(1)
-
-1-
5.7(61)2.9(1)
47.0(32)
12.1(82)4.0(1)
22.0(15)
1.1(4)37.5(6)39.2(20)
17.5(26)25.0(1)59.3(19)
21.0(12)33.3(1)57.8(11)
22.2(4)-
57.1(4)Abbreviations: LB: live birth SB: Still birth A: Abortion* Absolute numbers are given in parentheses
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Table 5.6: Influence of previous pregnancy outcome on present pregnancy outcome, JindDistrict, Haryana
Outcome of the Subsequent PregnancyOrder of pregnancy Live Birth
Percentage/NumberStill Birth
Percentage/NumberAbortion
Percentage/Number
FirstLB-1764SB-53A-103
SecondLB-1305SB-25A-75
ThirdLB-731
SB-16A-44
FourthLB-355SB-9A-32
FifthLB-164SB-8A-20
SixthLB-70SB-9A-
SeventhLB-38SB-A-4
EighthLB-14
SB-A-2
95.0(1683)81.0(43)63.0(65)
95.3(1244)80.0(20)74.6(56)
92.6(681)68.7(11)68.1(30)
91.8(326)77.0(7)65.6(21)
93.2(153)87.5(7)83.3(15)
92.8(65)44.4(4)
-
94.7(36)-
25.0(1)
100(14)
50.0(1)
0.96(10)15.0(8)2.0(2)
1.1(15)12.0(3)2.6(2)
0.2(2)12.5(2)2.2(1)
2.5(9)11.0(1)
-
0.6(1)13.0(1)
-
---
---
-
--
3.4(60)4.0(2)
34.0(35)
3.4(46)8.0(2)
22.6(17)
4.8(36)18.7(3)
29.5(13)
5.5(20)11.0(1)
34.3(11)
6.0(10)-
20.0(4)
7.0(5)55.5(5)
-
5.2(2)-
75.0(3)
-
--
Note: Same as of table 5.5
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Table 5.7: ANC information for women by order of pregnancy, Salem District, Tamil Nadu
Percentage of Women who reported of doing ANC check up, UrinePregnancy test and have undergone blood test by order of
pregnancyDetailsFirst Second Third Fourth Fifth and
aboveWhether gone for ANCcheck-up
Undergone UrinePregnancy test
Undergone blood test
48.9
39.9
39.4
39.8
31.0
30.7
32.3
23.5
22.5
24.4
16.1
15.7
16.7
11.8
11.8
Table 5.8: ANC information for women by order of pregnancy, Jind District, Haryana
Percentage of Women who reported of doing ANC check up, UrinePregnancy test and have undergone blood test by order of
pregnancyDetailsFirst Second Third Fourth Fifth and
aboveWhether gone for ANCcheck-up
Undergone UrinePregnancy test
Undergone blood test
21.1
18.2
16.3
18.5
15.7
14.3
15.8
13.5
11.9
12.4
10.9
10.1
12.6
12.4
11.1
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Table 5.9: Percentage of women who went for sonography, who motivated them to go andwhether the sex of the baby was revealed to them by order of pregnancy, Selam District(Tamil Nadu)
Order of Pregnancy 1st 2nd 3rd 4th 5+
% of women who wentfor Sonography
5.0(79) 2.7(35) 3.5(30) 0.9(4) 2.4(8.0)
Persons who suggestedthem to goSelfHusbandFamily & relativesNursesDoctorsOthers
6.317.710.13.8
44.374.6
8.517.18.5-
45.7-
10.016.616.66.636.6
-
--
25.0-
75-
-2525-
50-
Sex of the baby revealed 39.2 28.5 20 25 25
Table 5.10: Percentage of women who went for sonography, who motivated them to go andwhether the sex of the baby was revealed to them by order of pregnancy, Jind District(Haryana)
Order of Pregnancy 1st 2nd 3rd 4th 5+
% of women who wentfor Sonography
4.6(112) 3.7(78) 3.8(59) 4.3(39) 5.4(42)
Persons who suggestedthem to goSelfHusbandFamily & relativesNursesDoctorsOthers
28.523.27.1
11.647.3
-
29.419.25.1
10.237.1
-
32.227.1
5.013.532.2
-
23.025.67.6
12.830.7
-
30.928.516.67.1
19.0-
Sex of the baby revealed 14.2 15.3 28.8 35.9 42.8
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Table 5.11: Proportion of women suffering from any health problems and specific healthproblems during pregnancy by order of pregnancy, Selam District (Tamil Nadu)
Order of pregnancy First Second Third Fourth Fifth & above
Percentage of womensuffering from anydisease
78.6 70.3 65.5 61.1 51.3
Proportion of womensuffering from specifichealth problemsNausea/vomitingWeaknessDizzinessPalenessBleeding
Pain in abdomenVisual disturbanceHypertensionSwellingWeak foetusAbnormal presentationOthers
73.047.035.06.22.0
10.33.08.41.30.30.10.2
64.938.424.63.61.0
6.92.26.20.70.2--
60.035.723.13.71.5
1.72.25.60.80.20.2-
52.532.920.26.41.1
4.83.16.41.10.4--
45.023.218.94.02.1
2.82.47.40.60.3--
Table 5.12: Proportion of women suffering from any health problems and specific healthproblems during pregnancy by order of pregnancy, Jind District, (Haryana)
Order of pregnancy First Second Third Fourth Fifth &above
Percentage of womensuffering from anydisease
64.2 61.3 59.9 56.9 58.6
Proportion of womensuffering from specifichealth problemsNausea/vomitingWeaknessDizziness
PalenessBleedingPain in abdomenVisual disturbanceHypertensionSwellingWeak foetusAbnormal presentationOthers
54.038.233.5
23.56.0
17.88.26.0
10.64.91.52.6
50.837.933.2
23.117.916.88.76.49.64.61.12.1
48.637.733.4
21.67.7
16.28.66.39.94.70.92.3
45.835.032.2
20.98.1
15.08.36.79.34.01.01.6
43.935.532.3
21.39.1
17.59.88.89.42.30.91.6
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Table 5.13: Proportion of women who consulted a doctor for their health problem, type ofdoctor consulted by order of pregnancy, Selam District, (Tamil Nadu)
Order ofpregnancy
No. ofwomen withany disease
Percentage ofwomen whoconsulted
doctor
Percentageof women
visiting
govt. doctor
Percentageof women
who visited
pvt. doctor
Percentage ofwomen whovisited other
healthcareproviders
First
Second
Third
Fourth
Fifth&above
1226
905
545
272
154
25.6(314)
21.8(198)
21.4(117)
18.3(50)
18.8(29)
39.8(125)
44.4(88)
52.9(62)
52.0(26)
41.3(12)
64.3(202)
62.1(123)
59.8(70)
66.0(33)
68.9(20)
17.5(55)
16.6(33)
11.9(14)
12.0(6)
6.9(2)
Table 5.14: Proportion of women who consulted a doctor for their health problem, type ofdoctor consulted by order of pregnancy, Jind District, (Haryana)
Order ofpregnancy
No. ofwomen withany disease
% of womenwho consulted
doctor
% of womenvisiting
govt. doctor
% of womenwho visitedpvt. doctor
% of womenwho visited
other healthcareproviders
First
Second
Third
Fourth
Fifth &above
1524
1279
925
507
437
31.0(471)
28.6(367)
26.8(248)
26.8(136)
25.8(113)
47.5(224)
41.1(151)
43.1(107)
37.5(51)
41.5(47)
55.4(261)
65.1(239)
19.7(49)
63.9(87)
60.1(68)
7.2(34)
5.7(21)
9.2(23)
7.3(10)
11.5(13)
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Chapter - VI
ABORTION AND SON PREFERENCE
Abortion can be linked to son preference in two ways. First, the prevalence of abortions may
differ according to the sex of the living children in the family, even if the sex of the foetus is
not known. Secondly, sex selective abortions may be used to avoid birth of children of an
undesired sex after the sex of the foetus has been determined. The following analysis
shows whether abortion in Haryana and Tamil Nadu is related to son preference or not.
During data collection, it was observed that there is a clandestine practice of aborting
female foetuses in Jind city. Nursing Homes have put up signboards disseminating theavailability of colour ultrasound with them. Female foetuses are aborted after three and half
months when the sex of the foetus becomes recognizable as reported by doctors. During the
last few years cases of abortion has raised significantly and people of rural areas are flocking
in large numbers for induced abortions. The cost of abortion ranges from Rs.1200/- to
Rs.4000/- depending upon the clients status as well as the status of the nursing home. It has
been reported by the doctors that a couple with one or two daughters mostly go for abortion,
as they dont want additional daughters. Abortion is rarely resorted to in respect with the first
child and the birth of the daughter is tolerated also. There is a pressure for abortion by the
neighbours and friends who advise the couple for resorting to abortion. This has become an
accepted practice among the people as well as the doctors. There are three types of medical
Institutions in Jind City apart from Civil Hospitals. They are:
Private Nursing Homes
Charitable Hospitals and
Private Clinics
Private Nursing Homes usually admit pregnant women for deliveries as well as
abortion. They have bed facility and conduct tests like ultrasound. Blood, Urine, and Stool
tests are also conducted. Generally a team of nurses or midwives run this type of nursing
homes. Some of them have just B.A.M.S. Degree. Very few have M.B.B.S. degree with
specialization in Gynaecology. The conditions of these Nursing Homes are deplorable as
several women are seen crowded in a large size room or lobby. Abortions are frequently
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conducted in these nursing homes as was revealed to the researcher after deep probing.
Most of these Private nursing homes conduct 2-4 abortions daily. The cost of sonography is
Rs.500/- and is done in selected laboratories in Jind City apart from some nursing homes.
Some lady doctors with M.B.B.S degree have been conducting sonography at their
residence. Most of the nursing homes are a part of the residential buildings of the
practitioners, and a few of them do not have separate rooms for the doctors. The toilet
facilities were bad in condition. One could see several women being administered drips
lying on the cots in a hall. The male doctor, usually the husband is the in charge of the
Nursing Home and the lady doctor usually the wife supports him in his work. The women do
not hesitate to get themselves examined by male doctors nor do their husbands demand
them to be examined by lady doctors whenever they accompany them.
The charitable hospitals mostly maintained by Jain and Bania communities reported
that they do not practice abortion usually. However, in complex cases such as bleeding or
risk to the life of the expected mother they resort to abortion as it is considered to be good
from their religion point of view.
Private clinics where there is no bed facility also practice sex selective abortion.
Some of the doctors reported that they administer certain drugs and medicines for abortionincluding injections, which has effect only after several hours, and ask the client to go to
their homes. In some cases villagers themselves administer drip to the women to induce
abortion. In villages trained dais and ANMs are also practicing induced abortions.
Some of the villagers openly admitted that they are aborting female foetuses
because it is very difficult to get their daughters married to a suitable boy. They consider
them a liability. Some villagers who were desirous of male children are also duped by few
footloose doctors by giving some tablets or injections to the women on the pretext that a
male child will be born to them.
The Prenatal Diagnostic and Prevention Act, 1994, is mostly flouted. This has
accentuated recently because of the factors such, as proximity of towns to villages in the
wake of increased accessibility by roads.
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The demographic characteristics of the sample of 2646 women in Haryana and 1706
women in Tamil Nadu are broadly similar. Interestingly, mean age of respondents in both
the sample was more or less same (29.3 and 31.6 years) but mean age of husbands was
lower by 4 years in Haryana compared to Tamil Nadu (33.9 and 38.1 years). Most of the
women in Haryana were currently married (97percent) and in case of Tamil Nadu, the
proportions of currently married women were found slightly lower (92.8 percent). Literacy
rate of respondents were 36.5 and 37.8 percent in the state of Haryana and Tamil Nadu
respectively. Literacy rate of males in Haryana were significantly higher than in Tamil Nadu.
6.1 Abortion by socioeconomic and background characteristics
Tables 6.1a&b presents abortion by socio economic and background characteristics for thestate of Haryana and Tamil Nadu.The table shows very minimal differences with regard to
the type of women who go for abortions. In Tamil Nadu majority of the women who have
had abortion were from medium SLI, were literate, but had not completed primary school
education, and in majority of the cases husband 's occupation was cultivation. In Haryana
however no such significant differences are observed.
6.2 Abortion incidence
Table 6.2 shows all abortions, reported by women (spontaneous as well as induced). In the
state of Haryana, 486 women and in Tamil Nadu 496 women reported that they had
abortions. Abortion reported by women, revealed that the rate of abortions per 100 live
births increased markedly from 1971 to 2001 in both the states. Overall reporting of abortion
in Tamil Nadu is almost double to that of Haryana. In the recent period, difference in
abortion rate has narrowed down in both the states. In case of Tamil Nadu, rate of abortion
since 1984 is more or less constant.
6.3 Frequency of abortion
Abortion rates calculated for the women show that one- third of Tamil Nadu women and
one-fifth of Haryana women had abortions. From the frequency of abortion presented in
table 6.3 it is noticed that around 15 per cent women in Tamil Nadu and 8 per cent in
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Haryana had at least one abortion. A noticeable percentage of women in both the states
had undergone two abortions. A small proportion of women have also undergone three and
more abortions. From the frequency of abortion, it can be concluded that a significant
number of women are undergoing repeated abortions, which points to the practice of
abortion in both the states.
Nearly eight per cent of all reported abortions in Haryana and 45 per cent in Tamil
Nadu were induced. Data of first phase was collected during the month of January - March
2001 when the hearing of Public Interest Litigation about the enforcement of Pre-natal
Diagnostic Techniques (prevention and regulation misuse) Act 1996 (PNDT Act) was in
Supreme Court. In Haryana 72 percent of the respondents husband were literate and quite
a few were graduates and postgraduates. Low reporting of induced abortion in north Indiacould be due to existing socio-cultural factors as well as many people seemed to be aware
about the Pre-natal Diagnostic Techniques (prevention and regulation misuse) Act 1996
(PNDT Act) as many of them have said that sex selective abortions are illegal. Under such
prevailing condition at the time of data collection, direct evidence of sex selective abortions
was almost non-existent in both the states. Respondents in Tamil Nadu at least reported
induced abortions whereas respondent in Haryana although reported abortion during
pregnancies, but avoided to report it, as induced. Using pregnancy history, antenatal care,
and abortion histories, following six conjectures can be drawn.
6.4 Distinction of spontaneous and induced Abortion
In up to 60 per cent of spontaneous abortions, the foetus is absent or grossly malformed,
and in 25 to 60 per cent, it has chromosomal abnormalities incompatible with life; thus
spontaneous abortion in more than 90 per cent of cases may be a natural rejection of a
maldeveloping foetus (The Merck Manual of Diagnosis and Therapy, Chapter 252). In manycases women are not able to differentiate spontaneous abortions from regular delayed
menses with heavy bleeding. It will be difficult for her to remember this event and report in
her pregnancy history. Chhabra and Nuna (1993) in their study on abortion suggested that
three-fifth of the total abortions are induced. Using this conjecture, it can be said that most
of the reported abortions are induced in both the states.
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6.5 Distribution of abortions by pregnancies
Table 6.4 shows the distribution of abortions by pregnancy. In the state of Haryana highest
number of the reported abortions had occurred during the first pregnancy of the women
followed by second and third pregnancies. Tamil Nadu depicts a different story by having
highest number of abortions in the third pregnancy followed by second. Abortion during the
first and second pregnancy may be spontaneous or sex selective whereas higher order
abortion may be induced to control family size. Mean number of children ever born in
Haryana was 2.93 and in Tamil Nadu was 2.35, and the abortion before achieving this
number may be considered as sex-selective or untimely pregnancies. Based on this
analysis it can be concluded that 60-80 per cent of total abortions are induced and around
40 per cent seem to be sex selective abortions.
6.6 Closed Interval between Pregnancies
In the pregnancy history section of the questionnaire, duration between two conceptions
was asked starting from marriage to last birth. Table 6.5 presents closed interval between
pregnancies with outcome of pregnancies. This analysis is done on the assumption that
shorter intervals will lead to induced abortions for birth spacing. T-test is also applied toexamine the significance of difference of intervals in two different outcomes of pregnancy. In
case of first interval from marriage to first conception, differences are insignificant in two
outcomes namely live birth and abortions. The first pregnancies, which had resulted in an
abortion, may be spontaneous or to some extent sex selective, among those who had
strong desire to have first child as male. It is surprising to note that all other intervals are
significantly different in case of live birth and abortion.
A further analysis of duration of intervals in terms of median as well as distribution
reveals that nearly 3 percent intervals were very short (less than 12 months) preceding the
abortion. Other intervals were same as that of live birth intervals. Based on this evidence it
may be estimated that 80 percent of these pregnancies were wanted but were terminated
on account of sex selection.
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6.7 Gestation period
In table 6.6 mean period of gestation (in weeks) by type of abortion and number of abortions
are presented. Data for mean duration of pregnancy indicate that average gestation period
in case of spontaneous abortion in both the states is above 12 weeks (first trimester).
According to Merck manual, about 85 percent of spontaneous abortions occur in the first
trimester and tend to have foetal causes. Making adjustment with medical evidence and
gestation period, it is estimated that nearly 77 per cent of the spontaneous abortions were
sex selective abortions.
In Tamil Nadu, reported induced abortions have lower mean duration of gestation
compared to spontaneous abortion in all the pregnancies. The reported induced abortions
are around 12 weeks of gestation and this may be for spacing and limiting family size. In all
cases of abortions, gestation period is well above 12 weeks in Haryana. If abortion is to limit
the family size or spacing, women would not wait till 14 to 15 weeks for abortion. The
possible reason for second trimester abortion could be linked to sex determination tests.
Before twelve weeks of gestation, sex cannot be determined by the ul