Editorial Notes

[Editorial Notes] Finding the data on missing girls

The figure quoted by the government fails to completely take into consideration of child deliveries in private hospitals.
By IASToppers
August 03, 2019


  • Introduction
  • A view on declining ratio of girls
  • Region wise SRB figures
  • Flaws in Health Management Information System (HMIS)
  • Suggestions
  • Conclusion
  • IT’s Input

Finding the data on missing girls

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  • Female foeticide continues to increase at an alarming rate, as per the Sample Registration System (SRS) data released in July for the period 2015-2017.
  • The sex ratio at birth (SRB) has been dropping continuously since Census 2011.
  • Sex ratio at birth is defined as the number of girls born for every 1000 boys born.

Overall view on declining ratio of girls:

  • As per the yearly SRS Statistical Reports, the sex ratio has been declining from 909 girls per thousand boys in 2011-2013 to 896 girls in 2015-2017.
  • In the 2014-2016 period, of the 21 large States, only two, Kerala and Chhattisgarh, had an SRB of above 950 girls per 1000 boys.
  • Thus at present, about 5% of girls are being killed before they are born, despite the promises of the ‘Beti Bachao Beti Padhao’ scheme.

ezgif.com-gif-maker (2)

Region wise SRB figures:

SRB figures IASToppers

  • SRB is decreasing in the institutional deliveries in government hospitals.
  • Institutional deliveries refer to the facilities like hospitals, trained health care professionals etc. for women for giving birth to child.
  • The worst regional SRB for government sector was for Northern India (885 girls per thousand boys).
  • In Central India (926) and Southern India (940) has better SRG while the performance of Eastern India (965) and Western India (959) was even better.
  • In the Northeast, where the government is the dominant health-care provider, the government sector SRB equaled that of the private sector (both have 900 SRG).

Flaws in Health Management Information System (HMIS)

National Family Health Survey-4 1 IASToppers

Excludes Private healthcare institutions:

  • Health Management Information System (HMIS) is a fundamentally flawed source that largely considers home deliveries and births in government institutions.
  • Data from the HMIS are incomplete and not representative of the country as a whole as births happening in private institutions are under-reported.
  • As per the National Family Health Survey-4 (NFHS-4), the SRB at home, government hospitals and private hospitals were 969, 930 and 851 respectively.

National Family Health Survey-4 IASToppers

  • Thus, private hospitals had a disproportionate excess of male children births, which the HMIS sample
  • The HMIS report itself acknowledges that based on the estimated number of births, the number of reported births is much less in both the years considered– 2015-16 and 2018-19.
  • Also, the NITI Aayog confirmed that they did consider HMIS data but found after statistical examination that it was unreliable and therefore used Sample Registration System (SRS).

Prioritization for Male births:

  • The private health care institutions, too often, have more male children birth even when the total number of births were small in number.
  • These data of child birth in private healthcare institutions have not been adequately dealt with by the NFHS reports or the Health Ministry, giving them higher SRG number than actual.
  • For years, in the special neonatal care units (SNCU) set up by the government, there was an excess of about 8% male children in several States. It is criminal to use public funds to privilege boy births and facilitate discrimination against girls right from birth.
  • The government has prioritized an expansion of SNCUs rather than deal with the issue of less girl births.
  • Protecting the integrity of birth statistics will help the people, governments and health professionals to focus on ameliorating the known gender gaps at birth rather than be complacent with dubious claims.

sncu__sick_newborn_care_unit_indianbureaucracy IAStoppers

Bias over first-born child in NFHS data:

  • An analysis of the NFHS-4 data revealed its bias when it comes to the first-born child.
  • The SRB among first-born children was 927, meaning that 5% of first-born girls are eliminated before birth.
  • This is due to the absence of a stringent implementation of the Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act (PCPNDT Act). Anyone who wants to determine the sex of the foetus is able to get it done illegally.
  • Therefore, the increased elimination of girls at birth in States like Maharashtra, Haryana and Rajasthan in recent years has been undermined by the less strict implementation of law by other biggest States.


  • The Central Supervisory Board established under the PCPNDT Act has not met for over one-and-a-half years. It should have met at least thrice during this period.
  • The Indian Medical Association (IMA) has to ensure that private hospitals don’t profit from discrimination against girls before birth.

Indian Medical Association (IMA) IASToppers


  • The combination of sex discrimination and advanced technologies for prenatal sex determination and abortion is decreasing the SRG.
  • The Supreme Court has been continuously reminding medical associations since 2002 of their obligation to follow the law.
  • Its latest reminder being the formidable judgment against the Federation of Obstetrics and Gynecological Societies of India (FOGSI) in 2019.

Federation of Obstetrics and Gynecological Societies of India (FOGSI) in 2019 IASToppers

IT’s Input:

There are four major sources of vital statistics in India, namely;

(a) The Sample Registration System (SRS)

(b) The Civil Registration System (CRS)

(c) Indirect estimates from the decennial census

(d) Indirect estimates from the National Family Health Surveys (NFHS)

About SRS:

  • The SRS is the most regular source of demographic statistics in India. It is based on a system of dual recording of births and deaths in fairly representative sample units spread all over the country.
  • The SRS provides annual estimates of (a) population composition, (b) fertility, (c) mortality, and (d) medical attention at the time of birth or death which give some idea about access to medical care.
  • The population composition from SRS coupled with the decennial census counts, enables fairly reliable estimate of population in the intercensal periods.
  • Average time to publication of SRS annual reports is about two years.

About HMIS system:

  • The Health Management Information System (HMIS) is an online portal that provides information on health indicators in India.
  • HMIS compiles data from state- and district-level health authorities, the National Family Health Survey (NFHS), the District Level Household Survey (DLHS), and the Office of the Registrar General & Census Commissioner, among other sources.



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