Addressing Gender Disparities

Contemporary Indian society holds a strong belief in everyone’s right to life and dignity. Yet, rights relating to the weaker and more vulnerable sections, especially women and girls, are often violated. Every year, millions of women get married dreaming of starting a family filled with the sounds of happy children. But in India, pregnancy is too often followed by the anxious question: is the unborn child a girl or a boy? There are different ways to measure gender equity in a population, and one common tool is the sex ratio. Globally, the sex ratio shows different patterns across countries. The worldwide sex ratio is 984 females for every 1000 males. However, in India, the child sex ratio has dropped to 914 females per 1000 males, indicating a preference for boys. Despite various laws to prevent foeticide and schemes to encourage families to have daughters, the decline in the sex ratio was described as a "grave concern" by India’s Census Commissioner, C. Chandramoli.

There’s an urgent need for a massive nationwide campaign to educate people about the importance of the girl child, reinforcing the idea that she is an asset, not a burden. Community health workers, who provide easy access to health services especially in rural areas, play a crucial role in educating the community. Nurses, in particular, have a direct impact on society, especially on the health of mothers. Nurses and ASHA workers can spread information about preventing female foeticide. But first, they need to be knowledgeable about female foeticide themselves to effectively educate others.

Review of literature:

Over the past 50 years, India has made considerable social and economic progress. But despite optimism on the economic front, the future for India’s unborn female children looks increasingly bleak. Dr. Manmohan Singh, the former Prime Minister, once said in a national conference on "The Role of Women in Nation Building," that the "unacceptable crime of female foeticide, encouraged by the misuse of modern technology, must be stopped."

Historically, female infanticide has happened on a global scale. Various studies report its practice among Arabian tribes, the Yanomami in Brazil, and ancient Rome. The worldwide sex ratio is 984 females per 1000 males (2011 Census). Kerala, Tamil Nadu, and Andhra Pradesh have the highest sex ratios, while Haryana and Sikkim have the lowest.

The main factors contributing to female foeticide and infanticide include dowry, social security, patriarchal society, technology development, cultural factors, illiteracy, poverty, and the small family norm. The high dowry is a significant reason for female foeticide. In Varanasi district, Uttar Pradesh, a study found that 80% of diagnostic centers conducted sex determination tests due to client pressure and monetary incentives. The PNDT Act, 1994, remained largely ineffective. Most patients interviewed had college degrees, came from middle-class families, and were members of high-caste Hindu society. They wanted to avoid dowry problems, find suitable matches for daughters, and believed having a male child was essential for 'moksha.'

The Indian government has taken steps to raise awareness through workshops, seminars, the 'save the girl child campaign,' and seeking cooperation from NGOs and religious leaders. But until societal mindset changes, this inhuman practice cannot be stopped. At a symposium on female foeticide, J.K. Banthia, the Registrar General and Census Commissioner of India, emphasized population stabilization and sex ratio parity. According to an official from the family department, education and employment are crucial strategies to solve the problem of female foeticide.

A study assessed attitudes towards abortion, sex selection, and selective pregnancy termination among healthcare professionals, ethicists, and clergy. Most respondents were in the medical profession. Acceptance of abortion varied by religion and gestational age but not by other factors. Sex selection was largely considered unethical. Selective termination was deemed appropriate in certain situations, like multifetal gestations with anomalies.

Another study looked at the perspectives of future doctors. Among 62 interns and 39 MBBS students at Maulana Azad Medical College, New Delhi, fewer than a third supported stricter punishment for doctors involved in female foeticide. More female participants supported women empowerment strategies. The study highlighted the need to educate future doctors about the ethics of technology use.

In Chandigarh slums, a study found that 88.4% of married women were unaware of sex determination techniques, and 65.5% recognized it as a crime. Most preferred male children, reflecting a strong desire for sons among urban slum women. This underscores the need to educate underprivileged women about gender equality and PNDT act recommendations to improve the declining sex ratio.

Section 1: Socio-demographic, Family-Related, and Clinical Variables of Nursing Personnel and ASHA Workers

a. Socio-demographic Variables:

In this study, 59.4% of the intervention group and 56% of the control group were above 30 years old. Almost all respondents were female. Regarding education, 47.5% of the intervention group and 42.2% of the control group had passed SSLC. A study in Ludhiana showed similar findings, with 28.33% of respondents aged 20-25 and 30% aged 30-35.

b. Family-Related Variables:

More than half the participants in both groups were from joint families. Most families had more than four members. The study supports findings from Ludhiana, where most families were joint, and many had only one or two daughters.

c. Clinical Variables:

Section 2: Knowledge Levels of Nursing Personnel and ASHAs

Before the intervention, 65.6% of the intervention group had average knowledge, and 19.4% had good knowledge. In the control group, 53% had average knowledge, and 25.9% had good knowledge. A study in Bikaner found similar results, with the majority having medium awareness about female foeticide.

After the intervention, 70.6% of the intervention group had excellent knowledge, and 23.8% had good knowledge. In the control group, 54.2% had average knowledge, and 28.3% had good knowledge. By the second post-assessment, 99.4% of the intervention group had excellent knowledge. The study supports findings from Jaipur, where educational programs significantly increased awareness among adolescents.

Section 3: Effectiveness of the Structured Training Program

The training program significantly improved knowledge and attitudes about female foeticide. The mean pre-assessment knowledge score in the intervention group was 16.77, and post-assessment I mean score was 28.075, a mean difference of 11.31. The control group showed no significant change. The study demonstrates that the training program significantly raised awareness about female foeticide.