The document discusses the imbalance in the sex ratio in rural Tamil Nadu, specifically in Salem district, attributed to factors like son preference, sex-selective abortions, and female infanticides. Data from various studies indicate high prevalence rates of induced abortions among married women, often linked to the desire for male children and influenced by socio-economic conditions. The study aims to analyze the prevalence and reasons for abortion in this region and its effect on the sex ratio, highlighting the significant role of prenatal sex determination technologies.

1. 1
Imbalance in Sex ratio in rural Tamil Nadu:
A case study of Salem District
By
Prof.C.P.Prakasam
International Institute for Population Sciences,
Deonar, Mumbai-400088
prakasam@vsnl.com
Introduction:
Sex ratio at birth is a biological constraint with a value that lies in between 943 to 954 of
females per 1000 males in India. As the male infant mortality is higher than female in
normal populations, the child sex ratio would tend to increase and improve over male in
the age group 0-6 years in Developed countries. In India and in some developing
countries, sex ratio at birth and sex ratio 0-6 years favors male. A recent phenomenon in
the developing countries viz: China, Korea, India (Haryana, Tamil Nadu) shows a strong
son preference contributed to the decline in sex ratio brought out by sex selective
abortion, feticide and neglect of female babies. Studies carried out in India by Das Gupta
and Bhat (1997), Sudha and Raja (1999), Booth, Verma and Beri (1994), Sachar RK et, al
(1990), have discussed that prenatal sex determination through induced abortion
perpetuated the discrimination against female fetus and female infanticides leading to
imbalance in sex ratio. By using NFHS-2 data Arnold, Kishor, Roy (2002) examined the
evidence for the sex selective abortions in Indian states and revealed that the use of
modern technologies to avert the birth of daughters and impact on sex ratio at birth.
Similarly Retherford, Roy (2003) by analyzing the NFHS-1, NFHS-2 data of major states
by examining the factors affecting sex selective abortion revealed that imbalances in sex
ratio at birth may be attributed to sex selective abortion. Above studies revealed indirect
evidences of sex selective abortion on sex ratio. But there are very limited studies exists
(Chunkath, SR & Athreya VB (1997), George SM, Dahiya RS (1998),Unissa, Prakasam,
Sinha (2003)) which focuses on practice of female feticides through induced abortion and
infanticide practices in Haryana and Tamil Nadu influencing sex ratio.
Abortion, procedure of extracting fetus with in three months of pregnancy under
medical supervision considered being safe and appropriate for the health of mother. Safe
abortion practice has been considered one of the methods of delaying the pregnancy and
used as family planning method. However in India and mostly in rural areas where son
preferences and sex preferences are predominant, practice of abortion for different
reasons has been observed.
In the early 1970s, India was one of the first countries in the world to pass the
Medical Termination of Pregnancy Act. The passage of the Act imply that a woman who
decided to terminate her pregnancy would no longer be hindered by the law in making
this choice, nor would she be forced to risk her life doing so. Although the provision of
MTP services has increased, restrictions have been provided by the Act and are said to be
counterproductive to the availability of abortion services. It was noted that the stigma
associated with induced abortion, limited access to authorized abortion providers, the
financial costs associated with legal abortion, and low levels or awareness regarding the

2. 2
legality of the procedure has kept women away from availing safe abortion services
(Nanda AR, 2000). NFHS-1 data analysis (Das NP; Desai G; Patel R., 2000) covering 24
states in India revealed that about 4 percent of the ever-married women interviewed had
opted for induced abortion in their lifetime. The rate of induced abortion found among
ever-married women was about 1.3 percent. State-level analysis of the incidence of
induced abortions showed the highest incidence being reported at Delhi (4.6%), followed
by Tamil Nadu (4.3%). A Community-based study was undertaken in rural South India
(Varkey P; et. al, 2000) to determine the prevalence of induced abortion, revealed that
there was a high prevalence of induced abortion (28%) among the study population,
mainly among women who were not using contraception. Most abortions were carried
out in the first trimester of pregnancy and unqualified practitioners performed 65 percent
of terminations.
Research studies also showed that higher proportion women undergone abortion
belongs to age group 20-34 years (Rao and Kanbargi, 1980; Khan et al., 1996, Chhabra
and Nuna 1993). The average number of children living at the time of acceptance of
Maternal Termination of Pregnancy (induced abortion) varies between 2 to 4 (Rao and
Kanbargi,1980, Jamshedji and Kokate 1990).These research reviews confirms that
women seek abortion for various reasons such as socio-economic, medical, failure of
contraception, physical conditions. But the study carried out by Chunkath, SR and
Athreya, VB (1997) by analyzing a field survey data revealed that women seek abortion
for sex selectivity and the practice of female infanticides practice exists in few blocks of
Madurai and Salem district influencing sex ratio. Keeping in view of above points, the
present study aims to find out the prevalence of abortion in the districts of Tamil Nadu
and to explore the possible reasons for abortion in rural set up and its influence on sex
ratio.
Why Salem?
Sex ratio represents number of females for 1000 males, was 974 in Tamil Nadu in1991
increased to 986 in 2001 census period. During 2001 census period, of the 30 districts in
the state, 15 districts have exhibited sex ratio less than 1000. Among these 30 districts
and lowest sex ratio was reported in Salem district (929) in 2001, also observed to be
lowest in 1991 it was 925 censuses period and found to be lowest since 1971.
Dharmapuri district has the second lowest sex ratio of 938 in 2001 census. Fig 1 shows
lowest sex ratio districts (Salem, Dharmapuri) in comparison with the state for the period
1961-2001. Sex ratio of Dharmapuri and Salem (fig 1) was found to be equal during
1961.Later period sex ratio declined in Salem. From the census data it was evident in
Tamil Nadu, lowest sex ratio was in Salem and this trend has been observed form the past
three-four decades. Further, examining the sex ratio and sex ratio of 0-6 population of
talukas of Salem district, it has been observed that (Table 1) over all sex ratio found to be
lowest in Edappadi talukas (868), followed by Omalur (878) and Sankari (889) talukas.
Further examining the sex ratio of 0-6 population, it has been observed that Edappadi
(714) and Sankari (774) talukas exhibits lowest among 9 talukas of Salem district. Sex
ratio and sex ratio of 0-6 population of 2001 census data for the villages in Salem district
has been analyzed (Table 2) and shown that there were 10 villages less than 800 sex ratio

3. 3
Fig: 1 Lowest Sex Ratio Districts in Tamil Nadu 1961-2001
880
900
920
940
960
980
1000
1961 1971 1981 1991 2001
1.Salem
2.Dhamapuri
Tamil Nadu
Table: 1: Over all Sex ratio and Sex Ration of 0-6 Population
In Talukas of Salem District -2001 Census
Talukas Over all
Sex Ratio*
Sex Ratio of
0-6 population
1. Mettur
2. Omalur
3. Edappadi
4. Sankari
5. Salem
6. Yercaud
7. Vazhapadi
8. Attur
9. Gangavalli
885
878
868
889
954
970
968
976
979
776
795
714
774
905
942
912
911
895
Salem District 929 851
*Females per 1000 males
But there were 248 villages less than 800 sex ratio of 0-6 population. There are 12
villages in Sankari/Edappadi talukas where sex ratio of 0-6 population found to be less
than 500 (Table 2). Hence investigations have been made to find out the imbalances in
sex ratio by selecting two talukas viz: Sankari and Edappadi of Salem District of Tamil
Nadu
Materials and Methods
This study is based on the data collected from a survey carried out by the authors
in rural areas of Salem district, Tamil Nadu, during the last quarter of 20031
. As
discussed early Salem District was selected because the sex ratio and sex ratio of 0-6
population found to be low and the number of abortions found to be high. From this
district at random two tehsils are selected. At the second stage eight villages from these
two tehsils have been identified as sample villages (Table3).
1
This survey was conducted during last quarter of 2002 with a follow up at the end of the year. This survey
was funded by the International Institute for Population Studies under research projects for the year 2002-
2003.

4. 4
Table: 2: Number of villages by over all sex ratio and Sex ratio of
0-6 population in rural areas of Salem District in Tamil Nadu-2001
Sex Ratio Over all sex ratio Sex ratio (0-6)
Number of villages Number of Villages
Less than 500
501-550
551-600
601-650
651-700
701-750
751-800
less than 800
801-850
851-900
901-950
951-1000
1001 and above
10
71
134
112
156
74
12
3
19
25
59
62
67
248
55
68
52
54
80
Total Villages 557 557
A complete enumeration of the selected eight villages was done. The present study was
confined to 1565 currently married women in the age group 15-49 and experienced at
least one pregnancy. The list of sample villages and the Hamlets studies is given in Table3.
Table: 3: Number of Villages/Hamlets selected as study villages in rural Salem District,
Tamil Nadu
Villages/Hamlets Villages/Hamlets Villages/Hamlets Villages/Hamlets
1.Samudram
1.Narimedu
2.Erangadu
3.Karatukadu
4.Koolidasan vulvae
5.Kallampatti Vulvae
6.Mayilandi Vulvae
2. Koranampatty
1.Erikadu
2.Ottatheru
3.Kuthagaikadu
3. Kalinganoor
4. Poochireddiyur
5.Kattoor
1.Kattuvulve
6.Vembadithalam
8.N-Mettukadu
9.N.Kattoor
10.Andipalyam
1.Muniappan kovil
2.Theerthangadu
3.Pandarangadu
4.Kombaikadu
5.Kattukadu
6.Samiar Thottam
7.Thottakadu
Table 4 shows the currently married women by background characteristics. It has been
observed that majority of women (50.1%) were less than 29 years of age and 72.1 percent
married less than 18 years. Around 62 percent of currently married women were illiterate.
Among the rural women 20 percent experienced at least one abortion during their
reproductive life. The prevalence of abortion (spontaneous and induced) has been studies
by duration of marriage, previous delivery outcome, birth order, surviving children,
experience of abortion and use of family planning method, with the abortion experience.
Results:
The data collected from the currently married women in rural Tamil Nadu (Salem
District) reveals that nearly 11 percent (Table 5) of women with marital duration less than
5 years and 20 percent with 5-10 had experienced abortion. Higher percent Women (24.9
%) with more than 20 years of marital duration had experienced abortion. Prevalence of
abortion by out come of pregnancy (Table 6) shows that around 5 to 7 percent of women

5. 5
experienced spontaneous abortion during their reproductive life. It has been observed that
percent of induced abortion increases with the order of pregnancy. Nearly 8 percent of
Women with third order pregnancy seek Induced abortion and increases to 31 percent at
6th
and above order (Table 6).The high percentage of women seeking for induced abortion
Table 4: Background Characteristics of Currently Married Women
in Salem District, Rural Tamil Nadu.
Background Characteristics Currently
Married women
Percentage
Age at Marriage
Less than 18 years
19-25 years
26 and above
1128
399
38
72.1
25.5
2.4
1565 100.0
Education Level
Illiterate
Primary
Middle
Secondary
Graduate
960
217
210
58
20
61.3
13.9
19.8
3.7
1.3
1565 100.0
Number of Abortions
No abortion
Only One abortion
Two Abortions
More than Two
1252
212
69
32
80.0
13.5
4.4
2.0
1565 100.0
Table: 5 Prevalence of abortion by Duration of Marriage in the
Study area, Rural Tamil Nadu
Duration of Marriage Experienced Abortion Number of
women
Yes No
Less than 5 years
5-10 years
11-19 years
20 and above
10.5
20.3
21.6
24.9
89.5
79.7
78.4
75.1
325(100.0)
370(100.0)
388(100.0)
482(100.0)
Total 20.0 80.0 1565 (100.0)
may depend upon previous out come of pregnancy, hence the present out come with the
previous out come by order of pregnancy has been analyzed. The results revealed that
(Table 7) the previous birth was life birth the percent women seeking present pregnancy
terminating as induced abortion increases with the birth order. It increases from 2 to 16.1
between first births to fourth birth. Further women experiencing abortion (spontaneous
and induced) by surviving children has been examined and given in Table 8. With the
increase in surviving children percent women experiencing abortion increases. It has been
observed that 14.4 percent of women experienced abortion with one surviving child,
increases to 22.1 for women with two or more surviving children (Table 8).There is no
significance between experience of abortion and number of surviving children (χ-square

6. 6
0.1973, N.S). It is an important observation that 17.6 percent women experience with no
living children.
Experience of spontaneous and induced abortion among women who are current
user of family planning method has been analyzed. Out of 1565 reproductive women 35.7
percent women are current user of family planning. Table 9 shows women experienced
spontaneous or induced abortion among user and non user of family planning method.
Among the users of family planning method (Table 9), it has been observed that induced
abortion practice found to be high (16.3) than spontaneous abortion (8.6). Among the
never users of family planning method, percent of women experiencing spontaneous
abortion found to be more (12.6%) than induced abortion (5.4%).
Table: 6 Spontaneous and Induced Abortions by
Order of Pregnancy in Rural Tamil Nadu
Pregnancy Spontaneous
Abortion
Induced
Abortion
Total number
of women
pregnant
First
Second
Third
Forth
Firth
Sixth and above
5.7
6.4
5.8
7.0
5.5
4.2
0.1
1.8
7.8
10.6
20.6
31.0
1433
1272
833
445
199
141
Comparison between users and non users of family planning with spontaneous abortion
(yes/no) shows that there is no significance between these experiences (χ-square 0.0159,
N.S.), similarly comparison between users and non users of family planning methods with
induced abortion found to be not significant (χ-square 0.0215, N.S.). Hence prevalence of
abortion among the rural women in the study area was not influenced by use and non use
of family planning methods, but not statistically significant. From the table 9 it has been
observed that there were 150 (9.6 percent) women who had under gone induced abortion.
Information further elicited regarding the reasons for induced abortion and results are
given in table 10. Reasons for induced abortion by order of pregnancy revealed (Table
10) that nearly 31 percent of women undergone induced abortion after revealing the sex
of the fetus (female).Among the women who had induced abortion , been observed that
51 percent (Table 10) women under gone induced abortion at first pregnancy, who had
ultra sound test. One women with 7th
pregnancy revealed that she had undergone sex
selective abortion. Hence analysis reveals that in the study area sex selective abortion are
prevailing and ultra sound test (sonography) for sex determination. To examine the
imbalance on sex ratio, sex ratio has been calculated by considering women who had
undergone “test” and or not. The results show that (Table 11) sex ratio by order of birth
found to be more or less half in women who had undergone ultrasound test than women
who had not. Further sex ratio declines with the increase in birth order found to be more
in women who had induced abortion after the “test”.

7. 7
Table 7: Prevalence of Abortion by Present and Previous Pregnancy outcome
Previous Out come Present Pregnancy out come Total Number of
women delivered
Prevalence of
Spontaneous Abortion
Prevalence of
Induced Abortion
First
Live Birth
Still Birth
Abortion: Spontaneous.
Induced
3.8
2.7
45.1
--
2.0
--
--
--
1272
1152
37
82
1
Second
Live Birth
Still Birth
Abortion: Spontaneous.
Induced
3.8
7.1
29.0
--
8.4
--
1.6
20.0
833
728
28
62
15
Third
Live Birth
Still Birth
Abortion: Spontaneous.
Induced
4.6
29.4
28.1
--
9.2
5.9
--
48.0
445
371
17
32
25
Forth
Live Birth
Still Birth
Abortion: Spontaneous.
Induced
2.5
--
43.8
--
16.1
25.0
--
77.8
199
161
4
16
18
Table 8: Prevalence of abortion by Surviving children in rural Tamil Nadu
Surviving Children Abortion Total
No Yes
No 150(82.4) 32(17.6) 182(100.0)
One 255(85.6) 43(14.4) 298(100.0)
Two 442(78.2) 123(21.8) 565(100.0)
More than Two 405(77.9) 115(22.1) 520(100.0)
Total 1252(80.0) 313(20.0) 1565(100.0)
χ- Square=.1973 N.S
Table 9: Experience of Abortion by current user and non user of
Family Planning method in rural Tamil Nadu
Experienced Abortion Current user of Family
Planning method
Non user of Family
Planning method
Total
Spontaneous Abortion
Yes
No
48 (8.6)
510 (91.4)
127 (12.6)
880 (87.4)
175 (11.2)
1390 (88.8)
Total 558 (100.0) 1007 (100.0) 1565 (100.0)
χ- square=.0159 N.S
Induced Abortion
Yes
No
91 (16.3)
467 (83.7)
59 (5.9)
948 (94.1)
150 (9.6)
1415 (90.4)
Total 558 (100.0) 1007(100.0) 1565 (100.0)
χ- square=.0215 N.S

8. 8
Table 10: Reasons for induced abortion by order of pregnancy of study women in
Rural Tamil Nadu
Reasons First Second Third Fourth Fifth Sixth Seventh Total
Sex of Child
Wrong
Position
Child Health
Abnormal
Mothers
Health
21
40
12
2
2
11
15
3
1
-
10
9
7
4
-
-
-
4
-
-
2
-
2
1
1
1
1
-
-
-
1
-
-
-
-
46 (30.7)
65 (43.3)
28 (18.7)
8 (5.3)
3 (2.0)
Total--
Percent--
77
(51.3)
30
(20.0)
30
(20.0)
4
(2.7)
6
(4.0)
2
(1.3)
1
(0.7)
150
(100)
Total: 150
Table 11: Inbalance in sex ratio due to TEST by birth order in the Study area
of Rural Tamil Nadu
Birth order Sex Ratio Sex Ratio
With Ultra Sound
test
No Ultra
Sound test
First
Second
Third
Fourth
Fifth
Six and above
880
769
731
634
695
589
698
455
400
*
*
*
898
786
742
646
693
767
All 779 593 795
Observations are small to calculate proper rates.
Conclusions
This study is based on a large survey conducted in the rural areas of Salem district
of Tamil Nadu. The reproductive history of 1565 currently married women revealed that
20 percent of rural women and around 30 percent women with less than 10 years of
marital duration had experienced abortion. Further prevalence of abortion increases with
order of pregnancy. Induced abortion found to be more among women who had previous
out come was live birth. It has been observed that induced abortion found to be more
among current user of family planning method. From this study it was evident that
practice of induced abortion found to be high and mostly for desired sex selection. The
increase in induced abortion by order of pregnancy, previous birth was live birth and in
current user of family planning, gives indirect evidence that it was for want of male
offspring. During this survey time it has been observed that apart from sex selective
abortion, female infanticides found to be prevailing in these areas. In some
communities even male infanticides has been observed in this district. To prevent the
practice of sex selective abortion it is necessary to implement policy decisions which will
up lift the rural communities. Government Tamil Nadu recently introduced “Cradle Baby
Scheme” to prevent infanticides and feticides. How ever efforts are far reaching the
village house hold level to stop the practices. Planners should focus on programs related
to improving Women status, formal education of women, counseling of social stigmas

9. 9
related to Dowry system, property inheritance. Community education program related to
gender equality should be organized. Income generating schemes which will enhances
women status should be implemented in these rural areas of Tamil Nadu to bridge the
Gender gap.
References:
Arnold F; Kishor S; Roy TK (2002): “Sex-selective abortions in India.
Population and Development Review, 2002 Dec; 28(4):759-785.
Booth, B.E, M.Verma, R.S.Bari (1994): “Foetal sex determination in infants in Punjab,
India: Correlations and implications”, British Medical Journal,
309:1259-61
Chunkath SR; Athereya VB, (1997): “Female infanticide in Tamil Nadu: some evidence”,
Economic and Political Weekly, April 32(17)
Chhabra, R and Nuna SC (1993): “Abortion in India: An overview”, Veerendra Printers,
Delhi.
Das NP; Desai G; Patel R (2000):” Incidence of induced abortion in India: a study of
socio-cultural aspects from NFHS data” Demography India. 2000
Jul-Dec; 29(2):149-64
Das Gupta, M and P.N. Mari Bhat (1997): “Fertility decline and increased manifestation
of sex bias in India” Population Studies, 51: 307-316
George, S.M. and Dahiya, R.S.(1998): “Female Foeticide in Rural Haryana”, Economic
and Political weekly, August 8, pp 2191-2198.
Jamshedji, A and Kokate, N (1990): “Medical termination of Pregnancy and concurrent
contraceptive acceptance” Journal of Family Welfare, XXXVI (3),
Sept.
Khan, M.E., Basu, S and Thilip (1996): “Abortion in India-An overview” in Social
Change, XXVI (3&4), September.
Nanda AR (2000): “Abortion services and health care”, ISSRF Newsletter. 2000
Jan ;( 3):1, 3-4.
Rao, NB and Kanbargi, R (1980): “Medical Termination of Pregnancy: An analysis of
trends and differentials in legal abortions in Karnataka”, Himalaya
Publishing House, Bombay.
Retherford RD; Roy TK, (2003): “Factors affecting sex-selective abortion in India and 17
major states”, NFHS subject reports No.21, IIPS, Jan 78pp.
..Sachar, R.K., J.Verma, V. Prakash, A.Chopra, R.Aklaka, and R.Sofat (1990): “Sex
selective fertility control: An outrage”, Journal of Family Welfare, 36
(2):30-35
Sayeed Unisa, C.P.Prakasam, R.K.Sinha and R.B.Bhagat (2003): “Evidence of sex
selective abortion from two cultural settings of India: A study of
Haryana and Tamil Nadu”, International Institute for Population
Sciences, Mumbai.
Sudha S; Rajan SI (1999): “Female demographic disadvantage in India 1981-1991: sex
selective abortions and female infanticide”.
DEVELOPMENT AND CHANGE, Jul; 30(3):585-618
Varkey P; Balakrishna PP; Prasad JH; Abraham S; Joseph A (2000): “ The reality of
unsafe abortion in a rural community in south India”.
REPRODUCTIVE HEALTH MATTERS, Nov; 8(16):83-91