Objective: To investigate the social patterning in the proportion of sexes among infants in India before and after the implementation of the Pre-Natal Diagnostic Techniques (PNDT) Act in 1996.
Design: Multivariable regression analysis was performed on time series data from a nationally representative sample of households.
Participants: Households with infants under the age of 1.
Main outcome measure: Log odds of having a male infant. Results: The odds of having a male infant increased with income quartiles. Heads of household with postsecondary education had a higher odds ratio of having a male infant compared to those with no formal education. The odds of having a male infant did not differ between high and low caste groups, and was not associated with the educational attainment of the spouse. Punjab had a higher odds ratio of having male infant compared to Kerala. Kerala, meanwhile, was not particularly different from the remaining Indian states. The odds of having a male infant were similar in the pre- and post-PNDT periods. In the post-PNDT period, the income gradient in the odds of having a male infant was substantially weakened.
Conclusion: Social analysis of the distribution of sexes among infants in India suggest that neither improvements in socioeconomic circumstances, nor introducing policies that are not aligned with societal norms and preferences, are likely to normalize the sex imbalance in India.