India's sex ratio at birth (SRB) has declined from 54% male births in 1991 to 51.6% in 2020, indicating a shift toward a more natural gender ratio. However, the recent study reveals uneven progress in the gender ratio across regions and socio-economic groups in the country.

The study, based on data over five decades from 1968 to 2021, of birth histories from India's National Family Health Surveys indicate that the SRB trends differ by region, socio-economic status in the country, and policy interventions have failed to get the desired results.

The report identifies a steady decline in SRB in last decade; however, this downward trend is not uniform. The northern and western states, especially Punjab, Haryana and Gujarat have had high boy birthrates during the 1990s before witnessing reductions in the 2000s, while southern states like Kerala and Tamil Nadu began showing improvements much earlier and continue to maintain or improve the status quo. Historically, the northwestern states also fare better in SRB rate.

According to the study, Punjab now shows an improvement in SRB, but still, the state has a high male birth ratio of around 54%. This indicates that gender disparities continue in the state despite policy interventions and awareness campaigns.

Haryana, another state with historically high SRB, also presently has above 53% male births. While Kerala, which is among the least skewed states as a near natural SRB of 51%, Tamil Nadu is also moving towards a natural SRB ratio with a 51.5% male birth rate.

The findings also underscore the influence of economic, cultural, and regional factors in the negative SRB ratio biased against girl child. The economically better households consistently recorded higher SRBs, while poorer households and regions displayed more balanced ratios. The family planning initiatives and the low fertility rate in recent decades among urban and affluent families also has contributed to the lower sex ratio in communities that prefer male children.

"The wealthiest groups in the North continue to have the most distorted sex ratios, underscoring the need for targeted policy actions," the report states.

The analysis also shows that the SRB rates were significantly impacted after country introduced legislation allowing abortions in 1971, with abortions targeting girls increasing in numerous states. The easy access to affordable ultrasound technologies in the early 1980s enabled sex-selective practices, further skewing SRB.

"Sex-selective abortion became a significant manifestation of son preference, driven by cultural, social, and economic factors," the study finds.

Though India has enacted laws to prevent prenatal sex determination tests, such as the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994.

Different policies by the government has played a pivotal role in reducing SRB imbalance in India. However, ineffective implementation and cultural resistance among many communities in the country have limited their impact. Research show that the sex ratio is directly corelated to the cultural practices and traditions that are followed by communities in India. Initiatives like Beti Bachao and Beti Padhao have also been criticised for their uneven rollout, inefficient allocation and release of funds, and overemphasis on awareness campaigns rather than systemic change by the economists and policy experts.

The study's findings call for a systematic approach to address the gender disparities in the country. While national policies and laws provide a framework, region-specific strategies are necessary in tackling persistent imbalances in a country that has diverse cultural and religious practices. Addressing the structural and cultural factors for Indian society's preference for male children, as well as the steps to enhance women's progress, is essential to improving the SRB ratio.

The report concludes, "A combination of policy enforcement, socio-economic shifts, and grassroots interventions is key to normalising India's SRB and fostering gender equity." The study was led by Mohan Diwakar, associate research professor at the Johns Hopkins Bloomberg School of Public Health.