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Insights into Editorial: Why India must urgently step up efforts to improve its sex ratio




Recently released Sample Registration System (SRS) Statistical report (2018) which measures the global population projection, highlighted that fertility rate has been declining in India for some time now.

In their joint opinion piece, C Rangarajan (former Chairman, Prime Minister’s Economic Advisory Council) and J K Satia (Professor Emeritus, Indian Institute of Public Health) argue that there is an urgent need to reach young people both for reproductive health education and services as well as to cultivate gender equity norms.

Skewed sex ratio could upset the gains from a falling fertility rate:

  1. Recently, there has been discussion in the media on India’s population future prompted by release of the Sample Registration System (SRS) Statistical Report (2018) and global population projections made by the Institute of Health Metrics and Evaluation (IHME), US.
  2. Fertility has been declining in India for some time now.
  3. SRS report estimated the Total Fertility Rate (TFR), the number of children a mother would have at the current pattern of fertility during her lifetime, as 2.2 in the year 2018.
  4. Fertility is likely to continue to decline and it is estimated that replacement TFR of 2.1 would soon be, if not already, reached for India as a whole. As fertility declines, so does the population growth rate.
  5. This report estimated the natural annual population growth rate to be 1.38 per cent in 2018. With India’s estimated population of 137 crore, this means that net 1.9 crore persons would have been added that year.
  6. A comparison of 2011 and 2018 SRS statistical reports shows that TFR declined from 2.4 to 2.2 during this period. Fertility declined in all major states.
  7. In 2011, 10 states had a fertility rate below the replacement rate. This increased to 14 states (including two new newly carved states Telangana and Uttarakhand).
  8. The annual natural population growth rate also declined from 1.47 to 1.38 per cent during this period.

Troubling Statistics in the SRS report:

  1. The most troubling statistics in the SRS report are for sex ratio at birth.
  2. Biologically normal sex ratio at birth is 1,050 males to 1,000 females or 950 females to 1,000 males.
  3. The SRS reports show that sex ratio at birth in India, measured as the number of females per 1,000 males, declined marginally from 906 in 2011 to 899 in 2018.
  4. There is considerable son preference in all states, except possibly in Kerala and Chhattisgarh.
  5. India must implement the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994 more stringently and dedicate more resources to fighting the preference for boys.
  1. In this context, the Drugs Technical Advisory Board decision to include ultrasound machines in the Drugs and Cosmetics Act, is a step in the right direction.
  2. The UNFPA State of World Population 2020 estimated the sex ratio at birth in India as 910, lower than all the countries in the world except China.
  3. This is a cause for concern because this adverse ratio results in a gross imbalance in the number of men and women and its inevitable impact on marriage systems as well as other harms to women.

Thus, much more attention is needed on this issue.

India’s Population reach its peak depends on replacement fertility levels:

  1. Many people believe that the population would stabilise or begin to reduce in a few years once replacement fertility is reached.
  2. This is not so because of the population momentum effect, a result of more people entering the reproductive age group of 15-49 years due to the past high-level of fertility.
  3. For instance, the replacement fertility level was reached in Kerala around 1990, but its annual population growth rate was 0.7 per cent in 2018, nearly 30 years later.
  4. The UN Population Division has estimated that India’s population would possibly peak at 161 crore around 2061 at the medium-fertility variant, and will be lower by about 10 per cent at the low fertility variant.
  5. Recently, IHME estimated that it will peak at 160 crore in 2048.
  6. Needless to add that estimates so far out in time have considerable uncertainty. Some of this momentum effect can be mitigated if young people delay childbearing and space their children.


Increasing female education and economic prosperity help to improve the ratio.

It is hoped that a balanced sex ratio at birth could be realised over time, although this does not seem to be happening during the period 2011-18.

In view of the complexity of son preference resulting in gender-biased sex selection, government actions need to be supplemented by improving women’s status in the society.

In conclusion, there is an urgent need to reach young people both for reproductive health education and services as well as to cultivate gender equity norms.

This could reduce the effect of population momentum and accelerate progress towards reaching a more normal sex-ratio at birth. India’s population future depends on it.