India Marks Progress in Sex Ratio at Birth with 12 States Surpassing National Average

India has made encouraging strides in addressing the long-standing issue of sex-based discrimination marked by skewed sex ratios at birth, according to recent government reports and expert analyses. Data from the 2021-23 Sample Registration Survey (SRS) reveal an improvement in the sex ratio at birth (SRB) from 899 females per 1,000 males in 2016-18 to 917 in 2021-23, signaling a positive development in gender equality efforts. Twelve Indian states now report SRBs higher than the national average of 917, highlighting regional progress in combatting gender bias at birth. These findings were presented by Union Health Minister J.P. Nadda during the 31st meeting of the Central Supervisory Board (CSB), convened to review the implementation of the Pre-Conception and Pre-Natal Diagnostic Techniques (PC and PNDT) Act, a key legal framework designed to prevent sex selection and prenatal elimination of female fetuses.

Key Findings and Developments
The improved national SRB figure is a result of sustained legal enforcement and awareness programs rooted in the PC and PNDT Act, which prohibits sex determination and selectively abortions based on fetal sex. Twelve states reporting SRBs above 917 demonstrate advances in social, legal, and health interventions that protect the survival and rights of female children. The improvement from 899 to 917 females per 1,000 males suggests a steady but fragile shift toward normalizing biological sex ratios closer to the natural norm of approximately 950–975 females per 1,000 males at birth—a standard recognized by global health authorities such as the World Health Organization.

Union Health Minister Nadda emphasized the importance of continuing intensive court cases, medical facility inspections, and mandatory registrations, which have collectively enhanced the enforcement of anti-sex determination laws. He also highlighted the emergence of new challenges related to portable diagnostic technologies, genetic testing, and online platforms advertising sex determination services, urging state-level awareness workshops to address these evolving risks.

Expert Perspectives
Dr. Meera Singh, a pediatrician and gender health researcher not involved with the government review, commented, “India’s rising sex ratio at birth is a hopeful indicator of changing societal attitudes reinforced by robust legal action. However, the gap between current figures and natural sex ratios indicates that underlying cultural preferences and socioeconomic factors still need attention.” She cautioned that improved SRB figures do not guarantee permanent change without comprehensive education and empowerment initiatives targeting entrenched gender biases.

From a public health perspective, sex ratio imbalances have long-term societal impacts including skewed population demographics, increased violence against women, and social instability. Dr. Rajiv Kumar, a demographer from a reputed Indian public health institute, notes, “While the government’s focus on legal measures is commendable, addressing root causes such as son preference, female education disparity, and economic dependence is vital for sustainable gender balance.”

Context and Background Information
India’s sex ratio has historically leaned toward a disproportionate number of males due to son preference manifesting in sex-selective abortions. This was exacerbated by access to diagnostic technologies misused for prenatal sex determination, despite being banned under the PC and PNDT Act of 1994. The act’s enforcement has varied regionally but has gradually shown impact as evidenced by improving SRB data.

According to the National Family Health Survey (NFHS-5, 2020-21), the overall sex ratio in India was 1020 females per 1,000 males, with rural areas showing higher ratios than urban regions. Yet, the child sex ratio—the proportion of girls to boys aged 0-6—still reflects disparities with some states showing worrying lows. Regions such as Kerala, Tamil Nadu, and Manipur consistently report higher-than-average sex ratios, attributed to better literacy and gender equity efforts.

The practical implication for public health is that improved sex ratios will translate into better gender equality, improved female child survival, and healthier demographic structures. However, variations between states indicate the need for targeted interventions where cultural norms strongly influence gender bias.

Potential Limitations and Counterarguments
Despite optimistic improvements, India’s sex ratio at birth remains below the natural biological norm, and the risk of underreporting or misreporting in some data sets cannot be entirely excluded. Furthermore, the rise in sex ratio can be uneven and influenced by socioeconomic status, access to healthcare, and urban-rural divides. Social scientists emphasize that legal enforcement alone is insufficient without addressing deep-rooted societal norms and gender discrimination.

Moreover, technological advancements in prenatal testing, while beneficial for genetic health screening, pose challenges by increasing the covert availability of sex determination if not strictly regulated.

Implications for Daily Health Decisions
For families and communities, recognizing the importance of gender equality begins with supporting female child survival and education. Encouraging broader awareness about the harms of sex-based discrimination and adherence to laws protecting female fetuses can influence healthier family planning decisions.

Healthcare providers play a pivotal role by adhering to the legal framework, counseling expectant parents against gender bias, and promoting balanced narratives on the value of girls and boys alike.

Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.

References:

• Economic Times. “India sees improvement in sex ratio at birth, 12 states above national average: J P Nadda.” October 27, 2025.