The publisher's final edited version of this article is available at J Christ Nurs Abstract Female gender discrimination related to cultural preference for males is a common global problem, especially in Asian countries. Numerous laws intended to prevent discrimination on the basis of gender have been passed in India, yet the distorted female-to-male sex ratio seems to show worsening tendencies.
Using detailed, two-year longitudinal chart abstraction data about delivery records of a private mission hospital in rural India, we explored if hospital birth ratio data differed in comparison to regional data, and what demographic and contextual variables may have influenced these outcomes. Using quantitative chart abstraction and qualitative contextual data, study results showed the female-to-male ratio was lower than the reported state ratio at birth.
Nurses may be key to turning the tide. India is no exception. Gender discrimination manifesting as increased female mortality, female infanticide, and sex-selective abortion has received considerable attention in recent years.
Sex ratio, defined as the ratio of one sex to another Last, is the statistic most often reported to describe this phenomenon. Most epidemiologic literature uses the term sex ratio to denote the number of males per 1, females in a given population.
Although all nurses provide compassionate care, Christian nurses have a special role when they work in environments where cultural patterns of disparities and injustice are prevalent; to provide care, as well as educate and be sensitive to the pressure affected individuals may feel. Christian nursing practice is guided not only by these values, but also knowledge of current issues. The research presented here provides cultural context to guide nurses and other healthcare professionals planning interventions.
However, when the sex ratio at birth is skewed in favor of male babies, it indicates human meddling by means of sex identification and sex-selective abortion Singh, India is one of several countries where such concerns are persistent and significant Guilmoto, Numerous laws intended to prevent discrimination on the basis of gender have been passed over the years in India Basu, , yet the distorted female-to-male sex ratio seems to show worsening tendencies Jha et al.
Therefore, when the mortality rate of infants and children is higher for females, nurses should be aware this is a warning sign that neglect of the female child may be occurring Singh. A normal adult sex ratio of at least 1. In India, the estimated sex ratio for adults aged 25 to 54 in India was 0. Croll points out that the sex ratio of females-to-males is even more disturbingly low among the 0-to age group, particularly among those 0 to 4 years of age.
According to the Census of India, the child sex ratio 0—6 years of age was 0. This declining pattern continues, as the provisional results of the Census of India indicate the child sex ratio 0—6 years is 0. The National Family Health Survey-2 data indicate that among Indian women, who had ultrasound or amniocentesis during antenatal care, an estimated 6.
This is done to increase the number of male babies born within the family, thus obtaining the desired family composition of having more sons than daughters Agrawal, However, in Asia, son preference has actually increased with economic development, decreased fertility rates, and small family size. The difference in how son preference continues to evolve in Asia is due to deep cultural roots regarding gender identity Croll, ; Das Gupta et al.
Indeed, in India, son preference is present across differing groups of socioeconomic status, education levels, castes, tribes, religions, and state of residence Paul et al. The dowry system casts daughters as a liability, a net loss or economic ruin of her family. Though it is difficult to find alternate explanations for distorted sex ratio at birth, interpretation must be carefully considered.
Chamarbagwala and Ranger noted regional variations across India, as well as other patterns. This may be because if sons are born first, the couple may choose not to have any more children, whereas other couples continue having children until the desired number of sons is attained. Poor data quality and availability complicate the interpretation of sex differences Sawyer, Additionally, technology has made preconception sex determination possible by two methods: X and Y sperm separation and preimplantation genetic diagnosis.
These methods were touted as more ethical means of ensuring the birth of a boy. In light of its Christian mission to serve all human beings equally, the hospital set out to carefully follow and implement Indian law, which actively seeks to deter sex identification.
Our desire was to better understand the female-to-male sex ratio through research, in order to guide future interventions by the nurses and other healthcare professionals in a culturally relevant way. Data included demographic variables, such as maternal age, religion, town or village of residence, and whether or not women had preregistered for delivery at the hospital.
We then analyzed these data using t-tests, and calculated sex ratios. We also conducted post hoc analysis using t-tests, comparing women on the general ward to women in private rooms, as private rooms are a comparatively expensive choice.
To further explore our findings with trend analyses, we used the aggregate delivery data for — that the hospital reports to local governmental agencies. These data consist of total number of births by gender for each month.
These totals were then summed for annual totals. To explore these quantitative patterns further, we conducted 17 qualitative key informant interviews.
As encouraged in qualitative research, triangulation was sought for the purpose of gaining a broad perspective and convergent validation Berg, All potential participants we approached consented to participate.
The informed consent form was written in English and in Hindi, and read to participants who were illiterate, who signed with their thumbprint. Interviews were conducted with hospital staff physicians and nurses , women who had delivered at the hospital, accompanying family members, and village council members.
A semistructured interview guided open-ended questions regarding prenatal care, preferred delivery methods and setting, fertility expectations, and customary practices. All interviews were audio-recorded, translated, and transcribed verbatim.
Transcripts were coded and organized into categories with sub-codes by two independent coders. In , there were deliveries, including 16 sets of twins for a total of births. The difference in percentage of low birth weight babies for each year was not statistically significant, The lowest birth weight recorded was grams, and the maximum was 4, grams normal weight is 2,—4, grams.