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Awareness and perception regarding PCPNDT Act and gender preference among mothers of under-five attending immunization clinic.

Introduction

The child sex ratio in India has fallen to 914 females against 1,000 male subjects, the lowermost since Independence in the 2011 Census Report, [1] indicating a continuing preference for boys. Falling sex ratio is signaling precipitation of demographic catastrophe in India. Girls have not vanished overnight. Decades of sex determination tests and female feticide has acquired genocide proportions. Female feticide, male child preference, and gender inequities are to be blamed. Social prejudice against women, already rooted in Indian society, has been impelled on by technological developments. Preconception and Prenatal Diagnostic Techniques (PCPNDT) (Prohibition of sex selection Act) 1994, as amended in 2003 came into effect from February 14, 2003. [2]

The need of the hour is to expand the awareness about female feticide so that people can recognize it as a social issue and can further try to control it.

Under this background, this study was carried out to study awareness and perception regarding PCPNDT Act among mothers of under-five children attending immunization clinic and gender preference among them.

Materials and Methods

This cross-sectional study was carried out among 200 mothers of under-five attending immunization clinic at Government Medical College, Nagpur, during April-June 2014.

Sample Size

Assuming the awareness of PCPNDT Act to be 32.49% (Srivastav et al., [3]) [alpha] = 5%, [beta] = 20%, sample size was calculated to be 200.

Approval from Institutional Ethics Committee was sought. Semistructured pro forma was prepared, and pilot study was conducted among five mothers to assess feasibility and to validate the pro forma. They were excluded from the final sample.

Mothers of the under-five children who attended the Immunization clinic since April-June 2014 were enrolled after taking written informed consent. Every fifth attendee of the clinic was enrolled avoiding those who had been previously included in the study. Data were collected by using interview technique.

Statistical Analysis

Data were entered in Excel sheet and analyzed using statistical software Epi Info 7. Percentage, mean, standard deviation, and range were used to summarize the descriptive characteristics. The [chi square]-test was used as test of significance, with P value less than 0.05 considered to be statistically significant.

Result

Mean age of the mothers was 26.35 [+ or -] 4.14 (range: 20-44) years. Mean age at marriage was 21.74 [+ or -] 2.63 (range: 18-29) years. Mean age at first pregnancy was 23.05 [+ or -] 2.58 (range: 19-29) years. Most of them were literate (99%).

Of 200 mothers, 150 (75%) were aware about the decrease in girl children in India [Table 1]. Television and newspaper were the source of information for most of them. More than half of them (129) were aware about the result of decrease in girl children. Most of them (70) replied that boys will not find the bride. Other consequences told by them were atrocities against women will rise (19), generation will not be propagated (11), it will lead to imbalance of nature (6), and progress of nation will be hampered (3) [Figure 1].

This study tried to find out the gender preference among mothers who desired to have more children [Figure 2]. Of 200 mothers, 83 (41.5%) said that they want more children. Among them, 33 (40%) preferred to have son as their next child, 36 (43%) had no preference, while only 14 (17%) said they wanted a daughter. When asked about reasons for son preference and nonpreference of daughter, the commonest reasons cited were "son carries name of the family" ( Vanshacha Diwa) and "takes care of parents in old age." Other reasons told by mothers were girls are burden on parents owing to dowry, male-dominated society; girls are trouble as they need to be protected; and male subjects are head of the family and they manage family affairs.

Availability of antenatal sex determination was known to 161 (80.5%); among them, 51 (25.5%) knew that ultrasound can be used for antenatal sex determination. Awareness about existence of PCPNDT Act was 65%, and 42.5% of them knew that antenatal sex determination is punishable under law. Among them, 29 mothers said that punishment for antenatal sex determination is imprisonment, 23 said it was monetary penalty, while 33 said that punishment is imprisonment and penalty both. But, none of the mothers were aware about the exact punishment under the Act [Table 1].

This study tried to find out the gender preference among mothers who desired to have more children [Figure 2]. Of 200 mothers, 83 (41.5%) said that they want more children. Among them, 33 (40%) preferred to have son as their next child, 36 (43%) had no preference, while only 14 (17%) said they wanted a daughter. When asked about reasons for son preference and nonpreference of daughter, the commonest reasons cited were "son carries name of the family" ( Vanshacha Diwa) and "takes care of parents in old age." Other reasons told by mothers were girls are burden on parents owing to dowry, male-dominated society; girls are trouble as they need to be protected; and male subjects are head of the family and they manage family affairs.

The proportion of those who were aware about PCPNDT Act was significantly higher among those who were educated up to high school or above, those mothers who were working, and those who belonged to upper and upper middle socioeconomic class [Table 2].

There was no statistically significant difference for son preference with respect to education, occupation, and socioeconomic status. But, the preference to have son as their next child was significantly associated with the previous birth of girl child [Table 3].

Questions regarding perception of mothers regarding PCPNDT Act were asked. The most frequent response was that it should be strict 33 (43.12%) so that female feticide can be curbed, while 27 (35.78%) felt it was appropriate. Few 9 (8.26%) mothers said doctors are solely responsible for improper implementation of PCPNDT Act [Table 4].

Discussion

In a recent landmark judgment the Mumbai High Court upheld an amendment to the PCPNDT Act banning sex selection treatment. The Court pronounced that prenatal sex determination would be as good as female feticide. Preconception sex determination violated a woman's right to live and was against the Constitution, it said.[45] Fall in sex ratio is a national shame.

In this study, two-thirds of the mothers were aware about the decreasing number of girl children in India. This is higher than the findings of Mitra et al. [6] (54.28%). In this study, 64.5% of the mothers knew the consequences of the declining sex ratio. It was higher than the findings of Srivastav et al. [3] (47%), Vedpathak et al. [7] (25.83%), and Puri et al. [8] (11.5%). Common consequences cited for decrease in girl children were that boys will not find the bride and atrocities against women will increase. Similar implications were noted by Srivastav et al. [3] In this study, most of the mothers (80.5%) were aware about the antenatal sex determination. This is similar to the findings of Dadwani and Thomas [9] (86%) and Srivastav et al. [3] (80.13%), Vedpathak et al. [7] (74%).

Awareness about PCPNDT Act was found to be 65% in this study. Varying proportion of awareness was reported by various studies conducted across India ranging from 32% to 85%.[3,10-13] This may be owing to the differences in the study setting such as urban-rural difference and hospital and community settings. These studies were conducted among pregnant females and women of reproductive age, whereas this study was conducted among mothers of under-five children.

In this study, proportion of female subjects who were aware about the legal punishment for sex determination was 42.5%. But, none of the mothers was aware about the exact punishment under the act. Puri et al. [8] found this proportion to be 16.4%, and in the study by Vedpathak et al., [7] it was 34.05%.

This study found the fertility preference among the mothers. Of 200 mothers, 83 (41.5%) said that they want more children. Among them, 33 (40%) said they want son as their next child, 36 (43%) had no preference, while 14 (17%) preferred to have daughter. Those who preferred to have daughter had at least one son. Two of the mothers who preferred to have son had already one son. They did not want daughter. This shows the strong son preference among the mothers. This finding is similar to the District Level Household Survey-3 where preference for boy was 33.2%, for girl 11%, 36.3% response was does not matter, and 19.5% said it is up to God. [14] Preference for male child was higher in the studies conducted in other parts of India as well [3,6-8,11,12] While in the study conducted by International Center for Research on Women [15] found that, in India, son preference is strong but not universal. Many mothers want a balance of sons and daughters, and so, at least some girls are wanted.

The sex preference for the next child becomes more pronounced particularly among women with two or more surviving children. Only 13.6% of those having two living children wanted a girl against 53.3% wanting a boy as an additional child. These gaps become wider over the number of surviving children. [10] In a study by Frost et al. [16] in Nepal, they found that the sex ratio of a firstborn does not differ significantly from the expected level of 950-975 females per 1,000 male subjects. However, for secondborn children, especially where the firstborn was female, there has been a sharp (and significant) fall in the number of girls when compared with boys. [16] In the present study, commonest reasons cited for son preference were "son carries name of the family (Vanshacha Diwa)" and "takes care of parents in old age." Similar finding was noted by Ashturkar et al. [10] and Metri SS et al [17]

No association was found between literacy status and socioeconomic class of the study subjects and preference to male child in our study as opposed to the study by Srivastav et al. [3] and Khatri M et al [18] where unawareness regarding PCPNDT Act and preference for male child was significantly associated with the literacy status of females. In a study done by International Center for Research on Women, [11] they found that mothers' education is the single most significant factor in reducing son preference. Access to media also significantly reduces son preference. Wealth and economic development do not reduce son preference.

Bringing about changes in the demand for sex determination is a long process and has to be tackled through women's education and empowerment. States in the North East and in Kerala where women have these rights show a comparatively better sex ratio.

In this study, around one-third of mothers had never heard of PCPNDT Act. This is in spite of extensive mass media campaign for raising the awareness. Preference for male child was significantly associated with birth of previous female child. Son preference did not differ significantly with respect to education, occupation, and socioeconomic status of the mothers.

Conclusion

Awareness regarding PCPNDT Act is high among those with higher education, upper socioeconomic class, and working mothers. Preference for male child is significantly associated with the birth of previous female child.

References

[1.] Office of the Registrar General and Census Commissioner, India. Provisional Population Totals Paper 1 of 2011 India Series-1. New Delhi: Government of India, 2011.

[2.] National Rural Health Mission. The Preconception and Prenatal Diagnostic Techniques (Prohibition of Sex-Selection Act, 1994) and Rules with Amendments. New Delhi: Government of India, DGHS, 2010-2011.

[3.] 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(2):273-6.

[4.] UNICEF Press Release. Female Foeticide in India. Available at: http://unicef.in/PressReleases/227/Female-foeticide-in-India (last accessed on January 3, 2016).

[5.] Judgements Stressing the Importance of the Implementation of the Act and Directions Issued by Supreme Court and High Courts. Available at: http://www.delhi.gov.in/wps/wcm/connect/ 942bac804456c088a16eff1f5798cc31/Impjud.pdf?MOD=AJPERES&lmod = 1902902117&CACHEID=942bac804456 c088a16eff1f5798cc31 (last accessed on January 14, 2016).

[6.] Mitra PS, Dasgupta M, Banerjee P, Soreng PS, Shirazee HH, Adhikari S. A study on preferences and awareness regarding prenatal sex determination among antenatal women attending Obstetrics and Gynecology outdoor of Medical College, Kolkata during the time period of January to June, 2012. IOSR J Dent Med Sci 2013;6(6):100-4.

[7.] Vedpathak V, Kakrani V, Nagaonkar A, Deo D, Dahire P, Kawalkar U. Gender preference and awareness regarding sex determination among pregnant women--a hospital based study. Int J Med Sci Public Health 2013;2(4):1054-7.

[8.] 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;32(1):60-2.

[9.] Dadwani RS, Thomas T. Knowledge regarding sex-ratio and PCPNDT Act--a cross sectional study. Int J Sci Res 2014; 3(8):274-6.

[10.] Ashturkar M, Fernandez K, Pandve HT. A cross-sectional study of factors influencing sex preference of a child among married women in reproductive age group in a rural area of Pune, Maharashtra. Indian J Community Med 2010;35(3):442-3.

[11.] 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(4):209-12.

[12.] Sarkar I, Dasgupta A. Gender preference and perception of PNDT: a community based study among ever married women in a rural area of West Bengal. Int Arch Integrated Med 2015; 2(6):183-91.

[13.] Madhukumar S, Gaikwad V, D Sudeepa D. A study about awareness regarding pre-natal sex determination and gender preference among antenatal women in rural Bangalore. Indian J Publ Health Res Dev 2013;4(4):222-6.

[14.] International Institute for Population Sciences (IIPS). District Level Household and Facility Survey (DLHS-3), 2007-08. Mumbai, India: IIPS, 2010.

[15.] Pande R, Malhotra A. Son Preference and Daughter Neglect in India. What Happens to Living Girls? Washington, DC: International Centre for Research on Women, 2006.

[16.] Frost MD, Puri M, Hinde PR. Falling sex ratios and emerging evidence of sex-selective abortion in Nepal: evidence from nationally representative survey data. BMJ Open 2013;3(5):e002612.

[17.] Metri SS, Venktesh GM, Thejeshwari HL. Awareness regarding gender preference and female foeticide among teachers in the Hassan District, South India. J Clin Diagn Res 2011;5(7):1430-3.

[18.] Khatri M, Acharya R, Sharma G. Knowledge, attitude and practices (KAP) related to Pre-Conception & Pre-Natal Diagnostic Techniques (PC & PNDT) Act among the antenatal women in Bikaner. Open Access Scientific Reports 2012;1(1):1-7.

Source of Support: Nil, Conflict of Interest: None declared.

Sonal R Deshpande (1), Pragati G Rathod (1), Sharad B Mankar (2), Uday W Narlawar (1)

(1) Department of Community Medicine, Government Medical College, Nagpur, Maharashtra, India.

(2) Department of Physiology, Government Medical College, Nagpur, Maharashtra, India.

Correspondence to: Sonal R Deshpande, E-mail: sonal.deshpande@gmail.com

Received January 19, 2016. Accepted February 9, 2016

DOI: 10.5455/ijmsph.2016.17012016368
Table 1: Awareness about decrease in girl children, sex
determination, and PCPNDT Act

Variables                                                Aware
                                                       (n = 200)

                                                       No.    %

Decrease in girl children in India                     150   75.0
Antenatal sex determination                            161   80.5
Sonography as a means of prenatal sex determination     51   25.5
PCPNDT Act                                             130   65.0
Punishment for prenatal sex determination               85   42.5

Table 2: Factors associated with awareness of PCPNDT Act (n = 200)

Factors                           Total   Awareness about   P *
                                            PCPNDT Act

                                            Number (%)

Education
  High school and above            123       95 (77.23)     <0.001
  Others                            77       35 (45.45)
Occupation
  Working                           24       21 (87.50)      0.013
  Housewives                       176      109 (61.93)
Socioeconomic status
  Upper and upper middle            66       56 (84.84)     <0.001
  Lower middle and upper lower     134       74 (52.22)

* [chi square]-test, df = 1.

Table 3: Factors associated with son preference (n = 83)

Factors                           Total   Son preference    P *

                                            Number (%)

Education
  Others                           25       10 (40.00)      0.97
  High school and above            58       23 (39.65)
Occupation
  Housewives                       74       30 (40.54)      0.67
  Working                           9        3 (33.33)
Socioeconomic status
  Lower middle and upper lower     52       24 (46.15)      0.12
  Upper and upper middle           31        9 (29.03)
Previous birth of female child
  Yes                              47       28 (59.57)     <0.001
  No                               36        5 (13.88)

* [chi square]-test, df = 1.

Table 4: Perception about PCPNDT Act (n = 109)

Perception about PCPNDT Act     Mothers

                              No.     %

It should be strict           33    43.12
It is appropriate             27    35.78
Not properly implemented      14    12.84
Doctors are responsible        9     8.26
Not completely effective       3     2.75

Figure 1: Result of decrease in number of girl children.

Boys will not     70
find the bride

Atrocity          19
against girls
and women
will rise

Generation        11
won't be
propagated

Imbalance of       6
nature

Progress of        3
the nation
will be
hampered

Note: Table made from bar graph.

Figure 2: Gender preference among those desirous of more children
(n = 83).

Son              33, 40%

Daughter         14, 17%

No preference    36, 43%

Note: Table from pie chart.
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Article Details
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Title Annotation:Research Article; Preconception and Prenatal Diagnostic Techniques
Author:Deshpande, Sonal R.; Rathod, Pragati G.; Mankar, Sharad B.; Narlawar, Uday W.
Publication:International Journal of Medical Science and Public Health
Geographic Code:9INDI
Date:Sep 1, 2016
Words:2882
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