The womb is not the only place where the girl child is at a disadvantage. Data from sick newborn care units (SNCU) across the country for the last three years, shows families are reluctant to seek treatment when a premature or very sick baby is a girl, experts say.
The Ministry of Health and Family Welfare — where the SNCU data is available — has flagged the issue and even written to states, but without tangible results so far. The data shows a 60-40 per cent breakup of boys and girls, even after accounting for 919 girls per 1,000 boys national sex ratio at birth (SRB).
An integral part of India’s plan to control infant mortality, SNCUs are fully equipped paediatric ICUs meant for newborns up to the age of 28 days (neonates). At present, there are 700 SNCUs in the country — more than one in each district. In 2015-16, 58.6 per cent of babies admitted in these units were boys and in 2016-17 and 2017-18, boys accounted for 58.8 per cent.
Dr Vinod Paul, NITI Aayog member and former professor of paediatrics at the All India Institute of Medical Sciences (AIIMS), says, “The ratio should be nearly equal, because we expect serious illnesses at birth to be nearly equal for boys and girls. This clearly shows poor care-seeking behaviour on the part of families when it is a girl child.”
“It is not a health issue. It is a social and a community issue. Sex ratio at birth can only partially account for this but the disparity is too big really. Just the SRB cannot account for that,” he says. According to Dr Paul, families’ reluctance to seek medical advice for the girl child is something he encountered in his own medical practice too. He says, “Look at heart surgeries and you will see that an overwhelming number of boys undergo them.”
The SNCU numbers are also in line with findings in this year’s Economic Survey that 21 million girls in India are unwanted — girls whose parents wanted a boy but had a girl instead. The number was determined by looking at the sex ratio of the last child (SRLC), which is heavily male-skewed, indicating that parents keep having children until they get the desired number of sons.
The idea is based on papers published in 2017 by development economist Seema Jayachandran of Northwestern University in the US. While the ‘son meta preference’ does not lead to sex-selective abortion, as Jayachandran’s paper points out, it is “detrimental to female children because it may lead to fewer resources devoted to them”.
Manoj Jhalani, additional secretary and mission director of the National Health Mission and Ayushman Bharat, says, “We have drawn the attention of states to this gender skew and requested them to make sure that girl newborns make it to the SNCUs when required. They should not be neglected; in fact special attention should be given to the girl child.”
“The ideal ratio is supposed to be 50-50 but under no circumstances should it go below 53-47. There is a possibility that probably parents are not paying adequate attention to the premature girl child or when the girl child is suffering from common neonatal afflictions such as infections,” he says.
At 640,000 newborn child deaths in 2016, India has the largest number of babies dying in the world, according to a recent UNICEF report. The neonatal mortality rate in India currently stands at 39 per 1,000 live births. Neonatal mortality is defined as death within the first four weeks of life.