A study by a Nagpurbased research institute has found the sex ratio skewed in doctors’ families, too. The child sex ratio in these families was 907 girls per 1,000 boys, lower than the national average of 914.It was indicative of a deep-rooted social malady that could pose a critical challenge in correcting the sex ratio in India, the study stated.

The skewed ratio in the doctors’ families was strongly indicative of underlying sexselection practices even though the ratios offer only circumstantial evidence, rather than proof of such practices, the study stated. The study was published recently in the American Journal ‘Demography’ and titled ‘Skewed Sex Ratios in India: Physician Heal Thyself’.

The researchers investigated the sex ratio in 946 nuclear families with 1,624 children where either one or both parents were doctors who had studied at the Government Medical College and Hospital in Nagpur between 1980 and 1985. The medical college is a large tertiary care teaching hospital in Vidarbha region, admitting 200 students for the Bachelor of Medicine and Bachelor of Surgery (MBBS) course.

Other than being more skewed than the national average, the researchers observed that the conditional sex ratios consistently decreased with increasing number of previous female births. Third, the birth of a daughter in the family was associated with a 38 % reduced likelihood of a subsequent female birth.

“Our investigation has revealed startling concerns about the potential sex selection practices among doctors of Vidarbha region. We are aware of the limitations of this study as the sample size is not very big and hence may not faithfully represent the entire physician community in India. But it definitely warrants a closer look. It will also be interesting to consider whether these practices pervade other spheres of the medical profession, such as nurses and paramedical workers,” said principal investigator Archana Patel.

Patel also works as a professor and head of the department of paediatrics. She is a director of clinical epidemiology unit at Indira Gandhi Government Medical College, Nagpur. The other researchers who conducted the study with Patel are Neetu Badhoniya, Manju Mamtani and Hemant Kulkarni.

“The study was conducted for three reasons. The medical profession enjoys high esteem in India, and physicians are regarded as role models in society. Second, physicians have a crucial role in the implementation of the Pre Conception and Pre-Natal and Diagnostic Techniques (prevention of sex selection) Act to prevent the misuse of ultrasound and other techniques for prenatal sex determination, which has been implicated for selective abortion of girls. Third, little is known whether this preference for boys also exists among the families of Indian physicians. Hence, we investigated the pattern of sex ratios in the immediate families of physicians,” Patel said.

When contacted general surgeon Maya Tulpule, president of the city chapter of Indian Medical Association said, “I will discuss the matter with IMA managing committee members to see whether we can take up such a survey here in Pune.”

It was an important study which reflected the mindset of the society of which doctors are a part, said senior psychiatrist Devendra Shirole, former national vice president of IMA. “However, a multi-centric study with a larger sample size needs to be carried to assess the actual situation. We will discuss this study at IMA’s national working committee meeting soon,” he added.

Previous studies have also claimed that this son preference varies little with education or income and that selective abortion of girls is common in educated and affluent households, presumably because they can afford ultrasound and abortion services more readily than uneducated or poorer households.

• The researchers conducted the survey with students who were admitted to the college between 1980 and 1985. Traditionally, each student group celebrates its 25 years in the profession; the last of these groups recently completed its 25th anniversary
• An important part of this celebration is a souvenir ‘directory’ that contains selfreported information of the graduated and subsequently practicing physicians, including data on marital status, number of children, and children’s gender
• Using this source, the researchers collected demographic data on individuals who have been in this field for 15 years. To avoid duplication of information, the researchers ensured that if both partners were physicians who were admitted to the MBBS course during the aforementioned time, information was entered for one partner
• At the time of the release of the anniversary souvenir directory, the age of the physicians ranged from 38 to 43 years and 402 (42.5 %) respondents were women

• The study included data from 946 nuclear families with 1,624 children
• The sex ratio vis-a-vis girls born was even lower (900) for families with only one child
• The most surprising finding was that for physicians’ families with two children: If the first child was a male, the sex ratio of the next child was marginally in favour of the girl child
• Comparatively, if the first child was a girl, then the sex ratio plunged to 519, indicating a very strong sexselection bias
• A similar trend was observed in three-children families. The sex ratio for the third child was 1,000 in families with two previous sons, and it dropped to 600 if one of the previous children was a girl and to 455 if both the previous children were female
• The researchers, therefore, investigated the sex ratio contingent upon a previous female birth in the family. It found that if there was at least one previous daughter in the family, the sex ratio was only 593 as compared with 982 for no previous female birth in the family
• Using unconditional logistic regression analyses, the researcher estimated the ratio of a female birth if there was a previous female birth and found that with the exception of one batch, all the remaining demonstrated a consistently reduced likelihood of a female birth