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Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
摘要：
背景：尽管孟加拉国具有父权制的社会结构，但国家出生性别比（SRB）是正常的，强烈的儿子偏好，和低生育水平，被广泛认为是性别偏见性别选择(GBSS)的先决条件。为了更好地理解这种异常，我们研究了孟加拉国一个分区的SRB趋势,并使用纵向数据评估了引入胎儿性别检测技术和人工流产史对儿童性行为的影响.
方法：我们使用了icddr常规收集的次要数据，1982年至2018年的Matlab健康和人口监测系统(HDSS)。在此期间发生的所有出生(N=206,390)都包括在分析中。我们计算了SRB，并使用多变量逻辑回归分析来评估在Matlab中引入超声图像之前和之后男孩出生的可能性。
结果：总体而言，SRB在1982-2018年期间在Matlab中处于自然极限(106)之内。在2001年引入超声检查之前，有人工流产史的妇女的SRB为109.3，在2001年之后为113.5。在超声检查之前，女性的人工流产史（1982-2000年）使男性孩子出生的可能性增加了1.06倍（AOR1.06；95％CI-1.01-1.11）。在之后的时期,然而,此可能性为1.08（AOR1.08；95%CI-1.02-1.15）。
结论：在正常SRB的情况下，它被发现在人工流产的妇女中存在偏差。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相对更加偏斜。此外，引入胎儿性别确定技术后的人工流产增加了男孩出生的可能性。这些发现表明GBSS在一个亚组中的合理性。需要进一步的研究,特别是在SRB倾斜的地区，以检查GBSS是否确实对孟加拉国构成威胁。
方法：我们使用了icddr常规收集的次要数据，1982年至2018年的Matlab健康和人口监测系统(HDSS)。在此期间发生的所有出生(N=206,390)都包括在分析中。我们计算了SRB，并使用多变量逻辑回归分析来评估在Matlab中引入超声图像之前和之后男孩出生的可能性。
结果：总体而言，SRB在1982-2018年期间在Matlab中处于自然极限(106)之内。在2001年引入超声检查之前，有人工流产史的妇女的SRB为109.3，在2001年之后为113.5。在超声检查之前，女性的人工流产史（1982-2000年）使男性孩子出生的可能性增加了1.06倍（AOR1.06；95％CI-1.01-1.11）。在之后的时期,然而,此可能性为1.08（AOR1.08；95%CI-1.02-1.15）。
结论：在正常SRB的情况下，它被发现在人工流产的妇女中存在偏差。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相对更加偏斜。此外，引入胎儿性别确定技术后的人工流产增加了男孩出生的可能性。这些发现表明GBSS在一个亚组中的合理性。需要进一步的研究,特别是在SRB倾斜的地区，以检查GBSS是否确实对孟加拉国构成威胁。
