International Centre for Diarrhoeal Disease Research, 1212, Mohakhali, Dhaka, Bangladesh.
BMC Public Health. 2024 Aug 13;24(1):2205. doi: 10.1186/s12889-024-19706-0.
National level Sex Ratio at Birth (SRB) is normal in Bangladesh despite its patriarchal social structures, strong son preference, and low fertility level, widely recognized as preconditions for Gender-Biased Sex Selection (GBSS). To better understand this anomaly, we examine the trend in SRB in a sub-district in Bangladesh and assess the impact of the introduction of fetal sex-detection technology and the history of induced abortion on child sex using longitudinal data.
We have used secondary data collected routinely by icddr, b's Matlab Health and Demographic Surveillance System (HDSS) between 1982 and 2018. All births occurring during this period (N = 206,390) were included in the analyses. We calculated the SRB and used multivariate logistic regression analyses to assess the likelihood of birth of a male child before and after the introduction of ultrasonogram in Matlab.
Overall, SRB was within the natural limit (106) during 1982-2018 in Matlab. SRB among women with a history of induced abortion was 109.3 before the introduction of ultrasonography in 2001 and 113.5 - after 2001. Women's history of induced abortion prior to introduction of ultrasonogram (1982-2000) increased the likelihood of birth of a male child 1.06 times (AOR 1.06; 95% CI- 1.01-1.11). In the period after, however, this likelihood was 1.08 (AOR 1.08; 95% CI- 1.02-1.15).
In a context with normal SRB, it was found to be skewed among women who had induced abortion. SRB was relatively more skewed among such women after the advent of ultrasonogram compared to a period without ultrasonogram. Moreover, induced abortion after introduction of fetal sex determination technology increased the likelihood of birth of a male child. These findings suggest the plausibility of GBSS in a sub-group. Further research is needed, particularly in regions with skewed SRB to examine whether GBSS is indeed a threat to Bangladesh.
尽管孟加拉国存在父权制社会结构、强烈的男孩偏好和低生育率等因素，这些因素被广泛认为是性别选择性别的先决条件，但全国出生性别比（SRB）仍处于正常水平。为了更好地理解这一异常现象，我们考察了孟加拉国一个分区的 SRB 趋势，并利用纵向数据评估了胎儿性别检测技术的引入和人工流产史对儿童性别的影响。
我们使用 icddr,b 的 Matlab 健康和人口监测系统（HDSS）在 1982 年至 2018 年期间收集的二级数据。在此期间发生的所有出生（N=206390）均纳入分析。我们计算了 SRB，并使用多变量逻辑回归分析评估了在 Matlab 引入超声检查前后男婴出生的可能性。
总体而言，1982 年至 2018 年期间，Matlab 的 SRB 处于自然范围内（106）。在 2001 年引入超声检查之前，有过人工流产史的女性的 SRB 为 109.3，而在 2001 年之后则为 113.5。在引入超声检查之前（1982-2000 年），女性的人工流产史使男婴出生的可能性增加了 1.06 倍（优势比 1.06；95%可信区间 1.01-1.11）。然而，在此期间之后，这种可能性为 1.08（优势比 1.08；95%可信区间 1.02-1.15）。
在 SRB 正常的情况下，发现有过人工流产史的女性的 SRB 存在偏差。与没有超声检查的时期相比，超声检查出现后，此类女性的 SRB 偏差更大。此外，在引入胎儿性别鉴定技术后进行人工流产增加了男婴出生的可能性。这些发现表明，在亚组中存在性别选择性别的可能性。需要进一步研究，特别是在 SRB 偏差的地区，以检查性别选择性别是否确实对孟加拉国构成威胁。
