Doke et al. BMC Public Health 2012, 12:543 http://www.biomedcentral.com/1471-2458/12/543 Page 4 of 6 Figure 1 Induced abortion rate and sex ratio at birth in the districts of Maharashtra, India. 30 [22]. From neighboring Bangladesh, a study recorded stillbirth rate of 30.74/1,000 births [23].In the slum areas of Karachi in Pakistan the stillbirth rate was 27/1,000 births [6]. The overwhelming majority (98%) of still- births occur in low/middle income countries [4,5,23]. Recent multi-centric studies have shown stillbirth rates of 12.5-23.0/1,000 births in developing countries [5,24]. In developed countries, the reported stillbirth rate is about 5-8/1,000 births [15,18]. Globally out of estimated 3.2-3.3 million stillbirths for year 2000, only a small frac- tion, about 2% are registered [25,26]. Stillbirths are grossly underreported in the developing countries [4,16,27]. The latest estimate (2009) of 2.64 million still- births across the world has shown decline [22]. The vast majority of stillbirths are preventable and there is im- mense need to enumerate them [28]. Enumeration is the first step in analysis and then prevention. From public health perspective, there is utmost need of meticulous information about period of stillbirths i.e. whether ante- partum or intra-partum, associated conditions, under- lying causes and availability and quality of health care. Considering the high risk of stillbirths in tribal areas due emphasis needs to be given on availability and qual- ity of ante-natal and obstetric care. Another reason for attention to stillbirth is its significant association with maternal mortality [29]. Sex ratio at birth gives latest indication of female male proportion. In a country wide study, the adjusted sex ratio for second birth when the preceding child was a girl was 759 per 1,000 males. The adjusted sex ratio for the third child was 719 if the previous two children were girls [30]. The documented sex ratio at birth in the present study was poorer than observed in a rural area of south India [19], and reported in SRS for the years 2006–2008 for the state [31]. The sex ratio at birth was lowest in Beed district. This is consistent with lowest child sex ratio reported in an earlier study mapping lat- est child sex ratio in the state [32]. We attempted to study the correlation of sex ratio at birth with induced abortion rate. Among top 50% i.e. 16 districts recording high induced abortion rate (more than 2%), all districts excluding two have poor sex ratio of 864 or less at birth. The two districts are Sindhudurg and Ratnagiri. These districts have high induced abortion rate but have better sex ratio at birth (>894). The districts are from the west- ern coastal division of Maharashtra, in which Mumbai is located. A sizable proportion of men in the productive age group from these districts are working in and around Mumbai. This is reflected even in the 2011cen- sus in two forms. Firstly, both Mumbai districts and these two districts are ranked lowest four in the state with regard to proportion of children in 0–6 year age group. Secondly best overall sex ratio is observed in these two districts whereas lowest sex ratio in two dis- tricts of Mumbai [33]. A study has vividly shown that among the migrants in Mumbai the highest number are from these two districts [34]. Pregnancy in a woman whose husband is away from home is culturally not ac- ceptable in the society and hence terminated. In fact, these two districts are constituted by bifurcation of one district. The correlation therefore was calculated exclud- ing these districts. We observed correlation although not strong but certainly significant. Earlier in a study carried out in the state, a clear association was revealed between the sex ratio and number of ultrasonography centers [35]. The present study reveals that there is a negative correlation between induced abortion rate and sex ratio at birth. This clearly points to the fact that sex selective