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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 4  |  Issue : 1  |  Page : 21-25

Awareness of prenatal sex determination and preconception and prenatal diagnostic techniques act: A comparative study among rural and urban females of reproductive age group (15–45 years) attending a tertiary care teaching hospital in North India


1 Community Medicine, GMC, Kangra, Himachal Pradesh, India
2 Community Medicine, Dr. RPGMC, Kangra, Himachal Pradesh, India
3 Community Medicine, ASCOMS and Hospital, Jammu, Jammu and Kashmir, India

Date of Submission04-Aug-2017
Date of Acceptance30-Nov-2017
Date of Web Publication25-May-2018

Correspondence Address:
Sunil Kumar Raina
Dr. RPGMC, Tanda, Kangra, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrsm.jcrsm_43_17

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  Abstract 


Background: Preference for a male child by the family leading to a sex-selective abortion has been a leading factor for the skewed sex ratio in India. This has long-term social and demographic consequences. The present study was conducted with the aim to assess the awareness and attitudes regarding prenatal sex determination and preconception and prenatal diagnostic technique act (PC-PNDT) among females of reproductive age group (15–45 years) attending a tertiary care teaching hospital in Jammu district of J and K state in North India.
Materials and Methods: A hospital-based cross-sectional study was carried out among 210 females of reproductive age group. The study participants were administered a predesigned and pretested questionnaire. Data thus obtained were analyzed using SPSS Version 20.0 and expressed in percentages. Chi-square test was used as test of statistical significance with P < 0.05 taken as statistically significant.
Results: Awareness about sex determination among respondents was 94%. Higher proportion of urban respondents knew about ultrasound as the technique for sex determination than their rural counterparts (P < 0.05). Awareness regarding the PC-PNDT act and determination of sex of a child being a crime was higher among urban respondents (P < 0.05). Among the attitude, more rural females would prefer to know the sex of the child (P < 0.05) than their urban counterparts.
Conclusion: Respondents had high awareness about sex determination as well as technique used for it. Awareness about PC-PNDT act was on the lower side. Education programs for the women about gender equality and wider publicity of the act in the mass media need to be scaled up.

Keywords: Attitude, awareness, preconception and prenatal diagnostic technique act, reproductive age women


How to cite this article:
Gupta RK, Langer B, Singh P, Raina SK, Kumari R, Hussain S, Gupta R. Awareness of prenatal sex determination and preconception and prenatal diagnostic techniques act: A comparative study among rural and urban females of reproductive age group (15–45 years) attending a tertiary care teaching hospital in North India. J Curr Res Sci Med 2018;4:21-5

How to cite this URL:
Gupta RK, Langer B, Singh P, Raina SK, Kumari R, Hussain S, Gupta R. Awareness of prenatal sex determination and preconception and prenatal diagnostic techniques act: A comparative study among rural and urban females of reproductive age group (15–45 years) attending a tertiary care teaching hospital in North India. J Curr Res Sci Med [serial online] 2018 [cited 2018 Aug 17];4:21-5. Available from: http://www.jcrsmed.org/text.asp?2018/4/1/21/233193




  Introduction Top


Among the various social indicators to assess the prevailing equity between males and females in the society, sex ratio remains the key indicator. Globally, the sex ratio is calculated as the number of males per one hundred females in a population, while in India, it is defined as number of females per 1000 males.[1],[2] India is among those countries in the world which have not shown any improvement in the sex ratio over the years, and sex ratio has been on decline since 1901.[3] As per Youth in India report brought out by the Ministry of Statistics and Program Implementation, the sex ratio in India is projected to fall from 939 women for 1000 men in 2011 to 898 women for 1000 men by 2031.[4] It should set off alarm bells in the government and civil society groups.

The decline in sex ratio is man-made and has been ascribed to various factors including increased sex-selective female abortions as well as female feticide. The desire for a male child is so intense that couples go for repeated pregnancies and even opt for sex-selective abortions. The main reason for female feticide is based on a common perception that the female child is an economic burden on the family due to dowry and their vulnerability to sexual harassment whereas males carry out family business and support parents at a later age.[5] Reports from various quarters have indicated that the fear of violence may be the cause for female feticide. In addition, women who give birth to daughters face much more domestic violence which makes them complicit in getting rid of girl child. The ugly social practice of polygamy, forcible marriages of widows, and purchasing of brides have made a comeback in certain areas.

To curb sex-selective abortions, the Government of India introduced the Pre-Natal Diagnostic Techniques Act (PNDT) that was later amended as the Pre-Conception and Pre-Natal Diagnostic Techniques Act Act (PCPNDT).[6] The act prohibited the determination of sex of fetus and stated punishment for the violation of the provisions. To create awareness in the public, mass media was used extensively. Even help from spiritual and religious leaders was sought in this regard. However, apparently, these measures failed to achieve the desired results with no improvement in the sex ratio.[7]

Jammu district of state of Jammu and Kashmir (J and K) has a sex ratio of 889 females per 1000 males as per 2011 census while it was 892 female per 1000 males in 2001. The current study was conducted in Gynecology – Obstetrics Outpatient Department (OPD) of a tertiary care teaching hospital in Jammu, the winter capital of J and K state. The females in the reproductive age group (15–45 years) attending the OPD for any reason were interviewed to assess their awareness as well attitude regarding prenatal sex determination and PCPNDT Act.


  Materials and Methods Top


The present cross-sectional study was conducted in a tertiary care teaching hospital in Jammu district of J and K state in NorthWest India. Permission was sought from the Institutional Ethical Committee before the commencement of the study.

A study period of 3 months (January–March 2017) was considered. The study population included females in the reproductive age group (15–45 years) attending the OPD of the gynecology department. A total of 210 females who consented for the study were selected using consecutive sampling. The sample was chosen in such a manner that both urban and rural respondents were in equal proportion. Those not willing to give written consent were excluded from the study. The purpose of this study was explained to the participants and information given by the participants, and their identity was kept confidential. The questionnaire was prepared by the public health experts of the community medicine department of the tertiary care teaching hospital. A pilot study was conducted to test the validity, applicability, and practicability of the questionnaire and to assess the time required for the respondent to answer the questions. The questionnaire consisted of three sections. Section A deals with general information of the participants, Section B about awareness of prenatal sex determination and penalization purposed in PCPNDT Act, while Section C deals with the attitude of the respondents toward prenatal sex determination act.

The data thus collected were entered into Excel sheets and results expressed in percentages. SPSS version 20.0 (IBM, Armonk, New York, United States) was used for statistical analysis. Chi-square was used as test of significance with values < 0.05 considered statistically significant.


  Results Top


During the study, 210 respondents were interviewed, 105 each belonging to rural and urban background, respectively. Half of them were in the age group of 20–30 years and a majority (71%) of them belonged to the Hindu religion. A higher proportion of urban females was literate, which was statistically significant (P < 0.05). On the basis of occupation, more urban females were employed in comparison to rural females, and this difference was significant statistically (P < 0.05) [Table 1].
Table 1: Sociodemographic characteristics of the respondents (n=210)

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A total of 87.62% of the urban respondents knew about the declining sex ratio in India in comparison to 71.43% of their rural counterparts, and this difference was found to be statistically significant (P < 0.05). Both the rural as well as urban respondents had good awareness about sex determination. A higher proportion of urban respondents knew about ultrasound as the technique for sex determination (P < 0.05). The difference in awareness about the place of sex determination among the rural and urban respondents was also found to be statistically significant (P < 0.05) [Table 2].
Table 2: Awareness about sex determination among the participants (n=210)

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Awareness regarding the PCPNDT Act, determination of sex of a child being a crime and legal punishment for determination of sex of a child was higher among the urban respondents, and this difference was found to be statistically significant (P < 0.05) [Table 3].
Table 3: Awareness regarding preconception and prenatal diagnostic technique act among the participants (n=210)

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Among the attitudes, a higher proportion of rural females preferred to know the sex of an unborn child which was found to be statistically significant (P < 0.05). Regarding spread of awareness about PCPNDT Act, more urban than rural respondents had a positive attitude. A higher proportion of urban respondents said they would provide equal opportunity to a son or a daughter and this difference was also statistically significant (P < 0.05). Further, 97% and 93% of urban and rural respondents, respectively, would not go for termination of pregnancy if the sex of the fetus was determined to be female, and more than two-third of both urban and rural respondents did not want routine sex determination to be allowed. Nearly 84% of rural and 90% of urban respondents would like to have a right to take a decision regarding the fate of the fetus. These attitude parameters were found to be statistically not significant (P > 0.05) [Table 4].
Table 4: Attitude of respondents toward preconception and prenatal diagnostic technique act (n=210)

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  Discussion Top


Half of the respondents in the present study were in the 20–30 years age group with >60% in the upper middle class as per modified BG Prasad classification.[8] Shidhaye et al. similarly observed 73.4% respondents in 20–30 years age group but only 32% belonged to the upper middle class.[9]

Skewed sex ratio remains an issue of major concern which has long-term social and demographic consequences for the country. Nearly 80% of the respondents in the present study knew about the declining sex ratio in India, and 94% of them had awareness about sex determination. Ultrasonography (USG) as the technique of sex determination was reported by 65% of them. The results are in agreement with those reported by Srivastav et al.[10] and Shidhaye et al.[9] In line with the results of the present study, Chavada and Bhagyalakshmi [11] reported that 91% of urban and 96% of rural women were aware of sex determination; and USG for sex determination done at a private hospital was known to 90% of respondents. Kumar et al.[12] also reported that 90% of the respondents knew USG as technique for sex determination while marginally lower rates were reported by Metri et al.[13] However, in stark contrast, a study conducted by Puri et al.[14] observed that only 11.6% of the married women residing in slums had awareness regarding sex determination techniques. The reasonably good levels of awareness among the respondents in the current study could be best explained on the basis of high literacy rate among majority of them.

Although only one-third of the respondents knew about the PC-PNDT Act, yet 80% knew about legal punishment for sex determination. Mass media was the main source of information. These results concur with those reported by Kumar et al.,[12] Shidhaye et al.,[9] and Srivastav et al.[10] In contrast, Sharmila et al.[15] reported a higher rate (68%) of respondents being aware of the Act and 84.3% reporting that prenatal sex determination was a punishable offence.

An interesting observation in the current study was that about half of the respondents were nulliparous and 90% of the respondents knew that determining the sex of the child is a crime with legal punishment. It is expected that this information among the respondents might act as a deterrent for the selective sex-selective abortions among them, and they may well serve as message-bearers for the rest of the society.

About 18% of the respondents (more so in rural) in the present study were willing to know the sex of the unborn child, but only 4.76% would go for termination in case it is a female child. Contrary to our results, Kumar et al.[12] reported that half of the respondents would prefer to know the gender of their unborn child but only one respondent (0.8%) would opt for pregnancy termination if the sex of the fetus turned out to be female. Among other studies, Srivastv S et al.,[10] Kansal et al.,[16] and Vadera et al.[17] reported 7.4%–20.5% of the respondents showed a preference for abortion if the sex of the fetus is revealed to be female. The majority (89%) of the respondents were willing to educate family members/friends about PC-PNDT Act which is in agreement with the results reported by Kumar et al.,[12] Sharmila et al.,[14] and Shidhaye et al.[9]

There have been some positives in the current study, but the declining sex ratio calls for much greater political will and the help of powerful organizations such as the clergy and of course civil society groups.


  Conclusion Top


There was good awareness among respondents about sex determination and techniques used for sex determination. The awareness about PC-PNDT Act was not up to the mark, and authors call for more vigorous measures by government agencies and media to create better awareness of this Act among the public at large. Health staff need to be actively involved in dissemination of information.

Recommendation

The authors recommend that enhancing the literacy levels among women along with wider publicity of the PC-PNDT Act by the mass media and other agencies is the need of the hour.

Limitation of the study

The study was carried out a tertiary care teaching hospital and thus lacks generalization. The small sample size is another limitation of the present study. The inclusion of age group <18 and >40 may have diluted the results as this age group may not have been reproductively active.

Relevance of the study

The study would be relevant for programme planners to lay more emphasis among rural females on issues regarding the PC-PNDT Act and implementation of the Act in a more stringent manner.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Definition of the Indicators of Population Ageing. World Population Ageing 1950-2050. UNFPA. Available from: http://www.un.org/esa/population/publications/worldageing19502050/pdf/95annexi.pdf. [Last accessed on 2017 Nov 23].  Back to cited text no. 1
    
2.
Census of India. Gender Composition; 2011. Available from: http://www.censusindia.gov.in/Census_And_You/gender_composition.aspx. [Last accessed on 2017 Nov 23].  Back to cited text no. 2
    
3.
Census of India. Sex Composition of India. Available from: http://www.censusindia.gov.in/Data_Products/Library/Provisional_Population_Total_link/PDF_Links/chapter 6.pdf. [Last accessed on 2017 Nov 23].  Back to cited text no. 3
    
4.
Youth in India – Ministry of Statistics and Programme Implementation. Available from: http://www.mospi.gov.in/sites/default/files/publication_reports/Youth_in_India-2017.pdf. [Last accessed on 2017 Nov 23].  Back to cited text no. 4
    
5.
Imam Z. India bans female feticide. BMJ 1994;309:428.  Back to cited text no. 5
    
6.
Handbook of PCPNDT Act and Rules with Amendments. Ministry of Health and Family Welfare Government of India; 2006. Available from: http://www.iria.in/uploadNotices/Handbook_on_PNDT_Act.pdf. [Last accessed on 2017 Nov 23].  Back to cited text no. 6
    
7.
Declining Sex Ratio – A Matter of Concern India: UNICEF. Available from: http://www.unicef.org/india/child_protection_1360.htm. [Last accessed on 2017 Nov 23].  Back to cited text no. 7
    
8.
Singh T, Sharma S, Nagesh S. Socio-economic status scales updated for 2017. Int J Res Med Sci 2017;5:3264-7.  Back to cited text no. 8
    
9.
Shidhaye PR, Giri PA, Nagaonkar SN, Shidhaye RR. Study of knowledge and attitude regarding prenatal diagnostic techniques act among the pregnant women at a tertiary care teaching hospital in Mumbai. J Educ Health Promot 2012;1:36.  Back to cited text no. 9
    
10.
Srivastav S, Kariwal P, Kapilasrami MC. A community based study on awareness and perception on gender discrimination and sex preference among married women (in reproductive age group) in a rural population of district Bareilly Uttar Pradesh. Natl J Community Med 2011;2:273-6.  Back to cited text no. 10
    
11.
Chavada M, Bhagyalakshmi A. Knowledge, attitude and practice regarding sex determination among married women a comparative study between urban and rural area. Indian J Matern Child Health 2011;13:1-8.  Back to cited text no. 11
    
12.
Kumar N, Darshan BB, Unnikrishnan B, Kanchan T, Thapar R, Mithra P, et al. Awareness and attitudes regarding prenatal sex determination, pre-conception and pre-natal diagnostic techniques act (PCPNDTA) among pregnant women in Southern India. J Clin Diagn Res 2014;8:JC09-11.  Back to cited text no. 12
    
13.
Metri SS, Venktesh GM, Thejeshwari HL. Awareness regarding gender preference and female feticide among teachers in the Hassan District, South India. J Clin Diagn Res 2011;5:1430-32.  Back to cited text no. 13
    
14.
Puri S, Bhatia V, Swami HM. Gender preference and awareness regarding sex determination among married women in slums of Chandigarh. Indian J Community Med 2007;1:60-2.  Back to cited text no. 14
    
15.
Sharmila V, Babu TA, Singh D. Knowledge, awareness and attitude about prenatal sex determination, pre- conception and pre-natal diagnostic techniques act among pregnant women in the South Indian union territory of Puducherry. Int J Reprod Contracept Obstet Gynecol 2016;5:3470-4.  Back to cited text no. 15
    
16.
Kansal R, Maroof KA, Bansal R, Parashar P. A hospital-based study on knowledge, attitude and practice of pregnant women on gender preference, prenatal sex determination and female feticide. Indian J Public Health 2010;54:209-12.  Back to cited text no. 16
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17.
Vadera BN, Joshi UK, Unadakat SV, Yadav BS, Yadav S. Study on knowledge, attitude and practices regarding gender preference and female feticide among pregnant women. Indian J Community Med 2007;32:300-1.  Back to cited text no. 17
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