Indian Journal of Social Psychiatry

: 2019  |  Volume : 35  |  Issue : 3  |  Page : 183--187

Knowledge and attitude regarding declining sex ratio and female feticide among married females (15–49 years) residing in a village in Shahpur, Kangra, Himachal Pradesh

Ankush Kaushal1, Neeta Rana2, Piyush Sharma1, Akshay Minhas3, Mitasha Singh4,  
1 Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
2 Department of Women and Child Development, Kangra, Himachal Pradesh, India
3 Department of Community Medicine, SLBSGMC, Mandi, Himachal Pradesh, India
4 Department of Community Medicine, ESIC Medical College and Hospital, Faridabad, Haryana, India

Correspondence Address:
Dr. Akshay Minhas
Department of Community Medicine, SLBSGMC, Mandi, Himachal Pradesh


Background: Female feticide and sex selective abortion are common in today's scenario of two-child norm. Objective: The objective of the study is to assess the knowledge and attitude of married females residing in rural area of district Kangra, Himachal Pradesh, toward declining sex ratio and female feticide prevalent in the society. Methodology: This descriptive study was conducted on married females aged 15–49 years residing after their marriage in a village of health block Shahpur, Kangra. Of 350 households from the village, 106 were covered in the given time period. Systematic random sampling was used to select households. The youngest married female from the household who has recently given birth to a child was selected. A predesigned semi-structured questionnaire containing sociodemographic details of the family and knowledge and attitude questions was used. Results: One-third heard about declining female-to-male ratio. Killing of fetuses was known to 84% of female respondents. Only 24.5% were aware about law related to abortion and prenatal sex determination. The reason for decreasing sex ratio was quoted as preference for a male heir (62.3%). Around 60% of females have been harassed by a male and 48.1% have at least once felt not to have a female child. The attitude toward consequences of declining sex ratio was neutral among the females. Conclusion: The consequences of low sex ratio are liable to damage our social and economic fabric beyond repair. Solution needs to be tailored in the social context of country.

How to cite this article:
Kaushal A, Rana N, Sharma P, Minhas A, Singh M. Knowledge and attitude regarding declining sex ratio and female feticide among married females (15–49 years) residing in a village in Shahpur, Kangra, Himachal Pradesh.Indian J Soc Psychiatry 2019;35:183-187

How to cite this URL:
Kaushal A, Rana N, Sharma P, Minhas A, Singh M. Knowledge and attitude regarding declining sex ratio and female feticide among married females (15–49 years) residing in a village in Shahpur, Kangra, Himachal Pradesh. Indian J Soc Psychiatry [serial online] 2019 [cited 2019 Nov 22 ];35:183-187
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Full Text


Sex ratio is defined as the number of females per thousand males. Child sex ratio being the sex ratio in children 0–6 years of age in India has gone down to 914 females per 1000 male, the lowest since independence.[1] The Pre-Conception and Pre-Natal Diagnostic Techniques (PC-PNDT) Act formulated in 1994 was amended, effectively implemented in 2003, and strictly amended in 2011. The Act prohibits sex determination of fetus during pregnancy. The PNDT Act has proven to be a double-edged sword, leading to increased early detection of female fetus and female feticide. This has also led to an increase in illegal and unsafe abortions where a nexus of medical professionals would conduct the entire procedure from diagnosis to the medical termination pregnancy.[2] The long nurtured patriarchal society, age-old social customs (such as dowry), and lack of women-centered economic growth add to the causes of decreasing sex ratio. Further, a belief that the return of investment in a male child is higher than a female leads to a vicious circle of gender discrimination at each stage of life.

The sex ratio at birth (male per 100 females) in district Kangra as per the DLHS-4 (2012–2013) was 105.[3] Since females play a significant role in determining sex ratio and bearing a child, their knowledge and attitude matter the most with respect to prevailing problem. This survey was carried out among married females of rural area of district Kangra, Himachal Pradesh (H.P.), to assess their knowledge and attitude toward declining sex ratio and female feticide prevalent in the society.


Study design, setting, and duration

A descriptive study was conducted in a village (having 350 households) which was nearest to the rural health and training center of a tertiary care center of district Kangra, H.P., located in health block Shahpur from November to December 2018.

Study population

This survey was conducted on married females aged 15–49 years residing in the study area after their marriage.

Sample size and sampling

Of 350 households, 110 were covered in the given time period. The village was divided into four geographical zones, namely north, south, east, and west from the center point of the village with the help of health worker of the village. Due to time constraints, a sample of 110 was decided to be covered from all four zones with 28–30 households from each zone. From every zone, the first house was selected randomly using random number tables applied to the serial numbers allotted to each house by the subcenter staff. Every third house from there on was selected till a sample of 28–30 was achieved from the same zone. If there were more than one married females in the household, only one was selected. The youngest married female who has recently given birth to a child was selected from within the household with more than one female. The households which did not consent to participate or did not have a married female of age 15–49 years were excluded. The selected household which was found to be closed or the study unit was not present during the time of interview was revisited. Even after three visits, if there was no response, the house was excluded and we moved to the next eligible house. After excluding all ineligible households, if the required sample size could not be completed in one sampling frame (zone), the sampling was restarted from the houses which were previously left out.

Study tool

The study tool was a predesigned, self-administered, semi-structured questionnaire containing sociodemographic details of the family and knowledge, attitude, and practice questions from the selected female in family. Modified Uday Pareek socioeconomic status scale for rural area was used to assess the socioeconomic status of the family.[4] The tool was developed in English as a part of curriculum by the Bachelor of Social Work students and their supervisor after five in-depth interviews. It was further evaluated by two public health experts, a medical social worker, and a language expert. After arriving at a consensus, the relevant items were finalized in the questionnaire. The questions related to knowledge and practice had binary outcome. Attitude items were measured on Likert scale. Attitude was divided into three groups: perception toward declining sex ratio (two items), role of technology and women in female feticide (four items), and improve feticide situation (five items). All the items had positive statements except two. Of these two, negative questions were reversed. The Likert score range from strongly disagree (1) to strongly agree (5). Higher the score on Likert scale depicts strong agreement with a statement. The total score of perception toward declining sex ratio ranges from 2 to 10; in contribution of women and technology toward female feticide domain, it ranges from 4 to 20, and in ways to improve the current situation domain, it ranges from 5 to 25. The scores in each domain were added up and converted into a categorical variable. The score higher than the median was labeled as positive or sympathetic attitude.

Ethical consideration

Investigators were aware of the Ethics in Biomedical Research Policy of ICMR (2006) and the Declaration of Helsinki Revised in 2002. The ethical clearance was sought from the institute (Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, H.P.) ethical committee for biomedical research. Keeping in view, written informed consent of all participants was obtained before gathering any information. The information collected is kept strictly confidential and individual identity will not be disclosed under any circumstances. The study involves no risk to the subject and involves no financial burden.

Data collection and analysis

Data were collected by the students of Bachelor of Social Work using the study tool through interviews. As a part of their curriculum, the students were trained for conducting data collection and interview techniques in the local language of community. They visited the field practice area twice weekly for 1 month. The interviews were conducted by after explaining the purpose of the study and obtaining written consent from the head of household and the eligible female (study population). After filling the questionnaire, the students imparted correct knowledge to the members of household regarding declining sex ratio and female feticide and ways to prevent it. The filled questionnaires were checked by the supervisor and the incomplete ones were excluded. Hence, finally, 106 completely filled questionnaires were entered in the Microsoft excel and analyzed using Epi Info version 7 (CDC, Atlanta, Georgia, US). The categorical data are presented as proportions and continuous/scores as mean.


The mean age of the 106 married female respondents and their spouses was 33.34 years (±2 standard deviation, 6.21) and 38.74 years (±6.39), respectively. Majority of respondents were educated till 12th standard (34%) and none were illiterate. Almost half of the husbands also completed their education till 12th standard (50.9%). Around 60% had their mother-in-law and father-in-law alive and living with them in the family. Majority of the respondents (71.7%) were homemakers. Around 47% had two children and 17% had none. More than two-third (67%) belonged to middle class socioeconomic status according to the Uday Pareek scale.

Only one-third (33%) have heard about declining ratio of females over males. Killing of fetuses was known to 84% of female respondents; however, large-scale abortion as a means to eliminate female fetus was known to 37.7%. Majority had awareness regarding health effects of abortion (98.1%). Only 24.5% were aware about law related to abortion and prenatal sex determination [Table 1].{Table 1}

After sensitizing the study population about sex ratio and its decreasing trend, the reason for this quoted by majority (62.3%) was preference for a male heir. When talked about killing of female fetuses after assessing their knowledge, 40.6% gave social and cultural conviction as one of its causes and 24.5% thought that girl child is considered as a burden and hence the killing of female fetuses [Table 1].

Overall, 47.2% preferred male child over female, of which 38% quoted societal prestige of having a son as one of the causes. Son providing support in old age to parents (28%) and will preserve tradition of the family (16%) were some other causes. Around 60% of females have been harassed (physically or mentally) by a male and 48.1% have at least once felt not to have a female child. Among those who felt of not having a female child, 47.1% did not want another female to face problems they have faced. Further, around 43% regarded fear, insecurity, and increasing crimes against women as the cause of not having a female child. Male child was the preference as first child among 40.6% of females. Majority (98.1%) denied using sonography for sex determination during their pregnancy [Table 2].{Table 2}

The study participants' attitude toward consequences of declining sex ratio was sympathetic and thoughtful among 36.8% of participants. The attitude of 92.5% of participants held technology (in terms of diagnostics and advertising), doctors, and females themselves responsible for female feticide. 77.4% of the study population had a positive attitude toward role of education, economic empowerment, reservation, and political empowerment of women in improving the current situation.


The current study tried to explore the attitude and knowledge of females in reproductive age group in their own households of rural area. Previous literature from other parts of country has tried to study the pregnant female, female patients attending hospitals, and health care staff. Few studies have conducted community-based survey among adolescents (both males and females) and women in the reproductive age group too.

Majority of our respondents and their spouses were educated up to higher secondary. None of the females were illiterate; however, two of husbands were illiterate. Around half of the families had two children. Similar scenario was reported by Abraham et al., in their study from Mangalore on women in reproductive age group.[5] Majority of families which were visited belonged to middle class socioeconomic status. Studies from mixed population of urban and rural area antenatal clinics of Jamnagar, Ahmadabad (Gujarat), and Meerut (Uttar Pradesh) had around 20%, 8%, and 22.2% of illiterate study population.[6],[7]

Majority believed that declining sex ratio is result of son preferences among the community. This belief was also quoted by Choudhary among females attending hospital of Ludhiana and Vadera et al. and Puri et al. among pregnant females from Jamnagar and Chandigarh, respectively.[6],[7],[8],[9] Sociocultural conviction, girl child being a burden, and pressure of relatives were some of the common reasons opted by the study population for female feticide. Similar social reasons and female child being observed as a burden were quoted by females attending hospital in Ludhiana.[6] Adolescents from Mangalore observed poverty and illiteracy along with male preference as cause of increasing female feticide.[5]

Only one-fourth of the study population was aware of laws related to abortion and prenatal sex determination. It was lower among the adolescent population of Mangalore (11%) as compared to our population.[5] Contrasting observation from adolescents was reported by Kishore Yadav et al. from Telangana, with 35% being aware of prenatal gender detection as severely punishable act.[10] Around 90% of the pregnant females from Suburban Gujarat were aware of prenatal sex determination.[11]

Preference to male child was further elaborated in our study by reasons such as societal prestige, old age support to parents, and preservation of family tradition by the sons. The desire for male child has been expressed by 47% of females in our study. However, this leads to a bias in favor of male child by the parents throughout life. This has been observed in the form of better dietary intake, educational status, and social status among boys as compared to girls. A comparable proportion of 59%, 56%, 22%, and 32% pregnant women from Jamnagar, Chandigarh slums, Meerut, and Ahmedabad, respectively, have expressed male child preference.[6],[7],[9],[11] A higher preference has been reported from rural parts of our country as compared to urban.[12]

Women in the current study did not want a female child as they do not want them to face problems they have undergone. Fear of insecurity, increasing number of crimes against women, expenses on marriage, and dowry were some other reasons quoted by them. Similar findings were reported by Kishore Yadav et al. from Telangana.[10] Choudhary et al. in their study from Ludhiana reported that 17% of females believed that female feticide is beneficial to society by decreasing their number; crime and population will itself decrease.[8] The attitude of our study population toward female feticide tended more toward blaming technology, doctors, and females themselves. To improve the current situation, education, economic empowerment, reservation, and political empowerment of women have been agreed by the study population. There has been a persistent bias against female child evident across all regions, economic classes, and castes across the country. The reason for such prejudice is an amalgam of several social, cultural, and economic factors.[13] Literacy has been always debated to change the mindset of a population. However, literacy rates do not ensure absence of primitive mindsets and actions; even the literate females are not empowered enough to have a final say in matters pertaining to reproductive, finance, and family structure. Even in the current study, all females were literate. It is actually the unfortunate acceptance by the female that “woman-can't-survive-without-a-man's-support” complicates the matter more. Furthermore, the fear of raising a girl child in an insecure and violent environment is not totally baseless.[14] Laws against various aspects have been in effect for decades but have failed to produce the desired impact of influencing the mindset and behavior of society.

The current study population was neutral toward the consequences of declining sex ratio. Kansal et al. in their study from Meerut also reported that only about one-third of the women believed that there will be social imbalance and lesser brides available.[7] Social problems such as dowry deaths, forced polyandry, rape, child marriage, bride selling, and kidnapping of women for marriage will keep on rising as few of the haunting consequences.[14] A link between sex ratio and violence as a whole has been reported. In addition, it is not just the violence against women that will be perpetuated due to shortage of females.[15]

Behavior change is the core of intervention to prevent this social menace. However, behavior changes in the society a major challenge and is indispensible. The schemes by the Government of India like “Beti Bachao Beti Padhao” have the potential to make the desired break through.[16]Sukanya Samridhi Account Scheme, where the girl child is provided financial help through opening bank accounts and active involvement of the government officials in targeting areas with low sex ratio, could go a long way in bringing a change.[17]


The solution to prevent skewness in sex ratio lies in devising an approach targeted at addressing the challenges faced by her at different stages of life as a daughter, daughter-in-law, wife, mother, and mother-in-law. The study participants of the current study were married females who were all literate. Their knowledge about low sex ratio in country and in their region was low. Although after sensitizing the population with the low sex ratio and female feticide, majority opened up that they are aware of sex selective abortion being prevalent. Social and cultural conviction was quoted as major reasons for female feticide and desire for male child. The study population was aware of the causes and consequences of the decreasing sex ratio; however, their attitude toward consequences was neutral. The findings are limited by the use of a nonvalidated questionnaire.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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