Awareness and perceptions of anganwadi workers about female feticide and girl child discrimination in district Ludhiana, Punjab.

BACKGROUND: It is a matter of grave concern that a girl child continues to be insecure and vulnerable in the state of Punjab. To ingrain gender equality in social system, it is very important to make community an important stakeholder to deal with the situation. This study focuses on the awareness and perceptions of anganwadi workers regarding girl child discrimination and female feticide.
MATERIALS AND METHODS: A total of 2206 anganwadi workers between the age group of 20-70 years of different blocks of Ludhiana district, Punjab, were enrolled. They had come for Anganwadi Worker (AWW) Training Workshop, organized at Urban Health Centre, Ludhiana, Punjab. Data were analyzed in terms of proportions.
RESULTS: Study subjects showed high level of awareness about female feticide (98.8%). A majority of the subjects (93.3%) agreed to the fact that practice of discrimination is being followed between boys and girls. They were also of the opinion that this practice is harmful and it should be stopped (98.9%). Various contributing factors enumerated by them included sons are intelligent, carry on family lineage, and they take care of their parents in old age. Regarding perception of anganwadi workers for curbing this social evil, 70.7% of subjects were of the view that by giving equal opportunities, equal status to girls, and empowering girls, this practice can be stopped, while 42.4% of the subjects were of the view that increasing awareness among the rural women, parents, and family is the solution to stop this practice.
CONCLUSION: The anganwadi workers had optimum level of awareness about female feticide and almost all of them strongly felt that this harmful practice should be stopped altogether.

Introduction

Sex ratio is an important social indicator to measure the extent of the prevailing equity between males and females in a society at a given point of time. Changes in sex ratio largely reflect the underlying socioeconomic and cultural patterns of a society in different ways.[1] Internationally observed sex ratio at birth is 952 or more females per 1000 males. In India, the sex ratio as reported by National Family Health Survey-4 survey is 919 females per 1000 males; however, the same figures for the state of Punjab are 792 and 909 females per 1000 males in urban and rural Punjab, respectively.[2] These figures reflect the need of much-needed provision of safe social environment for unborn girl child, despite the fact that the law Pre-Conception and Pre-Natal Diagnostic Techniques Act (PC-PNDT) specifically prohibits prenatal sex determination in India. Therefore, it is very important now to look at other measures to bring desired social change in addition to legislative measures.

To ingrain gender equality in social system, it is very important to make community an important stakeholder to deal with the situation. But before that, a necessary step is to increase awareness among the masses and to identify female feticide as a social evil. Community awareness against female feticide can be achieved by involving basic workers working at ground level. Such workers can spread the message effectively as their acceptance at the community level is very good.

Anganwadi workers are very important in this context of providing knowledge through Integrated Child Development Services (ICDS) program. They can be seen as vital change mediators in elimination of social problems of female feticide and girl child discrimination prevalent in the society. Therefore, this study was conducted to know the knowledge and perceptions of anganwadi workers about these social issues.

Materials and Methods

This study is a cross-sectional study carried out at urban health and training center in Ludhiana, Punjab. A total of 2206 anganwadi workers were the study subjects. These workers were interviewed while they were attending a training workshop meant for all the anganwadi workers of Ludhiana districts. Therefore, this opportunity was used to collect the information by administering a pretested questionnaire to the anganwadi workers. The questionnaire had multiple-choice questions and one open-ended question. The questions were asked in Punjabi and Hindi languages.

At the end of the training workshop, the workers were asked to fill the questionnaire in the presence of investigators after taking their consent. They were not permitted to communicate with each other while filling the Performa. Data were entered and analyzed by means of simple comparisons and proportions. Investigators analyzed the answers to open-ended question in each questionnaire and themes were generated. Ethical clearance for the study from institutional ethics committee was taken before commencement of the study.

Results

A total of 2206 anganwadi workers between the age group of 20–70 years of different blocks of Ludhiana district, Punjab, were enrolled. More than half of the subjects (58.7%) were in the age group of 36–50 years, followed by 22.7% in 20–35 years and 18.6% in 51–70 years [Table 1]. The study subjects showed high level of awareness about female feticide; 98.8% of the subjects knew correctly about female feticide. A majority of the subjects (93.3%) agreed to the fact that practice of discrimination is being followed between boys and girls. They were also of the opinion that this practice is harmful and it should be stopped (98.9%). It was interesting to observe that in response to the question “whether equal opportunities are given to girls as compared to boys,” 78.2% of the subjects gave response in affirmation [Table 2]. Perception of subjects regarding reasons for male child preference and no preference for girl child were generated through multiple-choice questions. Most of the subjects responded (52.6%) that sons were preferred because they carry the name of the family, while 8.6% responded that sons take care of their parents in old age, and 38.5% responses for the choices that included all the reasons (carry name of family, boys are intelligent, take care of their parents). When subjects were asked at which level the discrimination between boys and girls was seen, the majority of them (77.1%) had felt it at society level followed by in the family (15.6%). While few subjects (6.9%) reported nil discrimination at any level. When asked why girl child is not preferred, maximum responses (62.9%) were received for all the choices combined, namely, burden on family, dowry, and girls cannot take care of their parents in old age; this was followed by 17.4% of responses for dowry as the main reason for not preferring girls in the family [Table 3].

Table 1

Sociodemographic profile of study subjects

Variable	Frequency	Percentage
Age (years)
20-35	500	22.7
36-50	1295	58.7
51-70	411	18.6
Total	2206	100.0
Education
Matric and below	1013	45.9
Above matric	1193	54.1
Total	2206	100.0

Table 2

Awareness about female feticide

Variables	Yes	No
Q1. Aware of the definition of female feticide (n=2206)	2179 (98.8)	27 (1.2)
Q2. Do you feel discrimination practice being followed b/w boys and girls (n=2185)*	2038 (93.3)	147 (6.7)
Q6. Whether equal opportunities given to girls or not (n=2197)*	1718 (78.2)	479 (21.8)
Q7. Whether educated about female feticide in any training? (n=2199)*	2116 (96.2)	83 (3.8)
Q8. Have you shared information that practice of female feticide should be stopped with the society/mothers? (n=2199)*	2174 (98.9)	25 (1.1)

*n varies as per the responses given by the study subjects

Table 3

Perception of anganwadi workers about male preference

Q3. At what level do you find discrimination b/w boys and girls (n=2194)*
Family	342	15.6
Society	1691	77.1
Anganwadi centre	10	0.5
No discrimination is there	151	6.9
Q.4. Why male child is preferred? (n=2187)*
Carries the name of family	1151	52.6
Boys are more intelligent	7	0.3
Takes care of parents	188	8.6
All above	841	38.6
Q5. Why girl child not preferred? (n=2183)*
Burden on family	363	16.6
Cannot take care of parents	66	3.0
Dowry	380	17.5
All above	1374	62.9

*n varies as per the responses given by the study subjects

After going through the responses for the open-ended question, “How this practice can be stopped?” a variety of responses were obtained from the subjects, and the various themes were generated [Table 4].

Table 4

Themes generated from Respondent's opinion

Themes	Study subjects’ responses
By giving equal opportunities/equal status/empowering girls (70.7%)	“Girls are equal to boys in all terms. They should be encouraged to prove themselves by allowing them to utilise all opportunities and rise.” “Women should not be denied equal rights and freedom. They should be liberalised as our men.” “Promoting gender equality and creating gender awareness at school level. Inculcation of gender sensitivity in etiquettes of students.”
By increasing awareness of rural women/parents/family (42.4%)	“An awareness generating lecture should be delivered at religion places, at sikh shrines on special occasions condemning gender discrimination and promoting equality.” “People should be made aware that both male and female have equal contribution in birth of a girl child.” “From a women, a society is born. Without women, there would be no one at all. She creates new life; nutures families. Therefore she should not be subjected to gender bias.”
By bringing educated mothers to the forefront to curb this evil (26.8%)	“Parents can become role models to their kids. They should extend equal and maximum support to their daughters both before and after marriage.” “Educated female is well receptive to family planning and her health education.”
By enforcing ban on prenatal sex detection (9.5%)	“Female feticide is not only a sin but a crime. Government should ensure free education, free medical facilities since birth and legal protection against all types of exploitation to girls.”
By improving the nutritional status of girls (8.9%)	“Special counselling and health education esp regarding anaemia should be imparted to adolescent girls aged 11-18 years through special meetings.”
By changing the attitude of society (7.3%)	“As per our holy book, women have given births to saints, kings and she cannot be a sinner or inferior. Without women there would be no-one at all. Women today are wiser, educated, organised and courageous to accept any challenge. They are pillars of support to parents. They are not subordinate to men.” “We should look upon girls like Kalpana Chawla, who went into space and should learn to give freedom to our daughters rather than confining them in boundaries. Mary Kom, Indira Gandhi, Kiran Bedi are exemplary for women.” “Daughters should be surrounded by love and encouragement so they have confidence to reach summits and bring best out of them.” “Every child is a gift of God. Respecting this creation; girls should not be discriminated on basis of gender.” “Efforts should be made to counsel senior citizens of the society.”
By giving responsibility to mothers (3.1%)	“Mothers should be motivated to stand against sex detection and abortion.” “Making women capable to walk hand in hand with their life partners and also empowering her daughters to be independent.” “Parents are role models to their children. Gender disparity is to be minimized at family level first.”
By eliminating illiteracy/poverty in the society (2.7%)	“Impart right education to girls in our family and make them capable so that they set an example for coming generations and girls are no longer considered a burden in our society. Girls are capable of leading a family and even a county.” “Right to education; freedom and work will help women to elevate them socially, financially and morally. They should be prioritized for jobs.”
By giving responsibility to males/new generation to stop female feticide (1%)	“Every son should be raised respecting females at home. He should be taught and motivated to decline dowry; respect other females and not abort his own girl child. He can start a chain of spreading this word to his own friends and situations in our country can improve this way.” “Boys and men should break stereotypes and condemn the practise of social evils against women.”

Similarly, other themes were generated as follows:

By eliminating practice of seeking dowry (10.2%)

By training of anganwadi workers/ASHA workers (2.3%)

By putting an end to violence against women (2.0%).

Discussion

In this study, the subjects showed high level of awareness about female feticide; 98.8% of the subjects knew correctly about female feticide. A study done by Siddharam et al., among the teachers in Hassan district, South India, reported that all the participants (100%) were aware of female feticide.[3] In another study, which was done by Walia, among adult populations in three districts of Punjab which had a low sex ratio, that is, in Ludhiana, Bhatinda, and Ferozpur, although the awareness regarding female feticide was found to be very high, the majority of the respondents approved of this heinous act.[4] In this study, high level of awareness of subjects about female feticide can be attributed to education given to them at different workshops and trainings as 96.2% of the subjects had received education about female feticide in different workshops attended by them. In this study, 52.6% of subjects cited carrying the name of the family as the main reason for son preference, whereas another 38.5% were of the view that in addition to carrying the name of the family, they are more intelligent and also take care of their parents. This was in consonance with the findings of a study done by NIPCCD in 2008 in Delhi and Haryana among different stakeholders where responses of supervisor and anganwadi workers were dominated by the reason that “son continues the family name (86.9%)” and “he is support and provider in old age (82.6%).”[5] A study conducted in Delhi (2002) on 530 adult respondents revealed reasons for son preference as they perpetuate the family name, inherit property, they are the providers in old age, and they perform the last rites.[6] Another study conducted by Shashi et al., among anganwadi workers from Jammu district, observed that the reason for son preference was that they were seen as a support provider in old age (67%) and for performing the last rites (56%).[7] The reasons other studies had for wanting a son are to attain moksha, power, and prestige, to perform the last rites, and to continue the family lineage.[8] In this study, a majority of the subjects (62.9%) were of the opinion that a girl child was not preferred because of the burden on family, dowry, and girls cannot take care of their parents in old age, while another 17.4% subjects were in favor of dowry as the only reason for not preferring girls in the family. Another study carried out by Yadav et al (2018) on adolescents responded that not carrying family name (39%) and being burden to the family (34%) were the most common reasons for not preferring a girl child.[9] Voluntary Health Association of India (2003) has published its research reports that “the immediate cause for the practice of female feticide is that daughters are perceived as economic and social burden to the family due to several factors such as dowry, the danger to her chastity and worry about getting her married.”[10] As per a study done by NIPCCD in 2008, dowry was perceived as the main reason for not preferring a girl child; other reason voiced by the ICDS and health functionaries was “investing in girls is seen as a waste, with no returns.”[5] Srivastava et al., in a study conducted on 200 married men and women to elicit their attitude toward the girl child and the declining sex ratio in Bhopal, found that rearing a daughter is perceived to be more difficult than bringing up a son. The problems perceived in bringing up a girl were arranging for her dowry, safeguarding her chastity, and socializing the daughter for the future role as daughter-in-law.[11] In this study, after going through the responses for the open-ended question “How this practice can be stopped?” few respondents also touched upon the insecurity regarding raising girl child in the current scenario. They hinted upon the insecurity of sending the girls to school/workplace in wake of incidences of rape reported frequently in the society. Therefore, the respondents also suggested of providing safe environment to girls in schools, society, and workplace. In this study, while answering the question “whether equal opportunities are given to girls as compared to boys,” 78.2% of the subjects gave response in affirmation. Whereas in another study conducted by Langde et al. among secondary school children in urban slum area of Mumbai when asked “how female feticide should be stopped,” only 29.3% of subjects gave affirmation of giving equal status to girls.[12] Another study conducted by Nath et al. among interns of Maulana Azad Medical College, New Delhi, stated that raising the status of women (88.3% female interns and 70.2% male interns) is one of the important measure to reduce the female feticide.[13]

Conclusion

Satisfactory awareness was observed in study subjects regarding female feticide. Anganwadi workers are important stakeholders to spread awareness among mothers and young girls. The spectrum of services at anganwadi center offers a unique opportunity to address the problem of female feticide and gender discrimination. Opportunity of celebrating Mamta Diwas can be used for spreading awareness. Almost 96% of anganwadi workers had received training regarding prenatal sex determination act. The same training can be further used in spreading the awareness among masses by making it mandatory to be discussed during celebration of Mamta Diwas. Involvement of ASHA workers in further spreading of message can be done.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.