Where it all began
The origins of this research probably go back much further than I ever realised.
From childhood, I often heard the same story about the day I was born. As my family remembers it, in Georgia in the 1990s, men were not routinely allowed into maternity wards. On the day I was born, however, my father broke that restriction because he was so happy, he entered the maternity ward to see his newborn daughter. Later, he celebrated my birth with his friends. As a child, I was incredibly proud of this story. I knew that my birth had brought my father genuine joy.
There was another important part of the context. At that time, finding out the sex of the baby during pregnancy was not as common or accessible as it is today. In many cases, parents learned whether they were having a boy or a girl only at birth. So, for me, this family story was always connected with that moment of happiness when my father discovered that he had a daughter.
At the time, I did not realise that behind what seemed like an ordinary family memory lay a much broader social context.
Then, during my school years, I began hearing very different stories.
Classmates and friends told me about their families, one girl said that her father had hidden the fact that she had been born because he was disappointed that the baby was a girl. Others said that their families had been hoping for a boy and that they had been born because “the boy never came”. At the time, I heard these stories as a child and simply found them strange.
Looking back now, I realise that they were some of my earliest everyday encounters with gender preference.
Later, as an adult, I continued to hear similar comments, this time in a different setting. Around pregnant women, after learning that the baby was a girl, people would sometimes say: “A girl? It’s okay, the next one will be a boy.”
The more often I heard these comments, the less harmless they seemed to me. Why should the birth of a girl be treated as something that needed to be “corrected” by a future pregnancy?
For years, I simply carried these observations with me.
Then I became a researcher.
At some point, I realised that the questions that had surrounded me for years did not have to remain personal observations. They could become research questions.
That was the beginning of my academic journey into this topic.
From personal observation to a research question
I began thinking about what the sex ratio at birth[1], the number of boys born for every 100 girls, could tell us about Georgia.
The measure itself is simple. But the social processes behind it can be much more complex.
I wanted to know not only whether the sex ratio at birth had been elevated in Georgia, but how it had changed over time. I was also interested in whether the pattern was the same across different birth orders and regions, and what changes in the national pattern might mean in the context of reproductive behaviour.
These questions eventually led to our study of the sex ratio at birth in Georgia between 2005 and 2022.
At that point, a personal history became data.
How we studied the change
Our study was based on administrative data on live births in Georgia from 2005 to 2022. In total, the analysis included 920,803 live births (Otarashvili et al., 2026).
We examined the sex ratio at birth over time and looked not only at the national pattern, but also at differences by birth order and region.
This was important because a national average can conceal substantial differences between population groups and geographical areas.
For me, one of the most interesting parts of the research process was seeing how a more detailed look at the data could tell a very different story from the national average alone.
What did the 18-year trend show?
The first major finding was a decline in the overall sex ratio at birth in Georgia.
In 2005, there were 113.0 boys for every 100 girls born in the country. By 2022, this had declined to 107.2 (Otarashvili et al., 2026).
That change is important, but one of the most striking findings emerged when we examined the data by birth order.
Among third and higher-order births, the sex ratio at birth was 145.7 boys per 100 girls in 2005. By 2022, it had fallen to 114.3 (Otarashvili et al., 2026). (Figure 1)
Figure 1: Male-to-female birth ratio by birth order, 2005-2022
The contrast becomes particularly striking when we place these figures side by side. The national sex ratio changed substantially, but the change among third and subsequent births was much more pronounced.
That raised another question for me:
Does the national average really tell the whole story?
Probably not.
One Georgia, or several different demographic realities?
Another important part of the study was examining regional differences.
Georgia is not a demographically uniform space. Regions differ in population structure, socioeconomic conditions, family and reproductive patterns, and cultural context.
Our findings showed that the decline in the sex ratio at birth was not uniform across the country. In 2022, for example, the sex ratio was 106.0 in Tbilisi, 115.8 in Guria, and 119.7 in Samtskhe-Javakheti.
These differences are important not because any single region can be assigned one simple explanation, but because they demonstrate that demographic change does not necessarily happen at the same pace or in the same way everywhere.
A declining national average does not mean that every region, or every family, is experiencing the same change.
So, what do these numbers tell us?
This is where the most important, and most cautious, part of the interpretation begins.
Our data show a trend. They show that the sex ratio at birth in Georgia declined between 2005 and 2022, and that the change was particularly pronounced among third and subsequent births.
But a statistical trend does not, by itself, allow us to attribute that change to a single cause.
Sex ratios at birth may be shaped by social norms, family and reproductive preferences, demographic conditions, technological change, and different aspects of health policy and the healthcare system. For that reason, it would be overly simplistic to explain the observed trend through one factor alone (Bongaarts, 2013; Dyson, 2012; Duthé et al., 2012; Meslé et al., 2007; UNFPA, 2012).
For me, one of the most valuable outcomes of this research is precisely that it raised more questions than it answered.
What cannot be seen in a table?
Numbers are very good at showing us what changed.
They are much less capable of telling us why it changed.
This is perhaps the most important lesson I took from the study. When you work with hundreds of thousands of birth records, the data become an extraordinarily powerful tool. But behind every record is a human decision_a family, an expectation, a social norm, and a particular social environment.
That is why, for me, the natural next step is to look beyond the numbers and explore the human, social, and regional factors that may help explain these patterns.
From one childhood memory to a dataset
When I look back at this research now, I find it striking that its first “research question” did not actually begin as a question.
It began with a family story about my birth.
Then came the stories of other girls.
Then the seemingly ordinary comments I continued to hear over the years.
And eventually, when I became a researcher, I was able to ask:
Can the things we notice in everyday life also be seen in demographic data?
Our study showed that the sex ratio at birth in Georgia changed over time, and that the national trend concealed a much more complex picture, particularly across birth order and regions.
But for me, the end of this study is really the beginning of another one.
Because once the data show us that something has changed, the next question becomes unavoidable:
What changed in people’s decisions, perceptions, and circumstances that may have contributed to these numbers?
That is the question that continues to drive my research.
[1] The sex ratio at birth (SRB), or secondary sex ratio, is a demographic indicator defined as the ratio of male to female children born alive, it is usually expressed as the number of live births of boys per 100 girls. Under natural conditions, SRB is relatively stable, generally ranging from 102-106 boys per 100 girls (United Nations Secretariat 1998; Visaria 1971), with an average value of approximately 105, representing the expected biological range (Bongaarts 2013; Dyson 2012; United Nations 2011; James and Grech 2017; Mathews and Hamilton 2005). A sex ratio at birth that rises significantly above 106 or falls well below 102 often indicates non-natural influences or external interventions, such as sex-selective abortion or other socio-cultural influences (World Health Organization 2021; UNFPA 2012).
References:
- Otarashvili K, Mirzazadeh A, Paatashvili E. The trend in male-to-female ratio at birth from 2005 to 2022 in Georgia. Afr J Reprod Health. 2026 Aug 3;30(14):(Afr J Reprod Health 2026; 30 [14] 19-25). doi: 10.29063/ajrh2026/v30i14.3. PMID: 42544491.
- Bongaarts, J. (2013), The Implementation of Preferences for Male Offspring. Population and Development Review, 39: 185-208. https://doi.org/10.1111/j.1728-4457.2013.00588.x
- Dyson, Tim. 2012. “Causes and consequences of skewed sex ratios.” Annual Review of Sociology 38: 443-461. https://doi.org/10.1146/annurev-soc-071811-145429
- James, William H., and Victor E. Grech. 2017. “A Review of the Established and Suspected Causes of Variations in Human Sex Ratio at Birth.” Early Human Development 109: 50-56. https://doi.org/10.1016/j.earlhumdev.2017.03.002
- Mathews TJ, Hamilton BE. Trend analysis of the sex ratio at birth in the United States. Natl Vital Stat Rep. 2005 Jun 14;53(20):1-17. PMID: 15974501.
- United Nations. 2011. Preventing Gender-Biased Sex Selection: An Interagency Statement. Geneva: World Health Organization.
- United Nations Population Fund (UNFPA). 2012. Sex Imbalances at Birth: Current Trends, Consequences and Policy Implications. Bangkok: UNFPA Asia and the Pacific Regional Office.
- United Nations Secretariat. 1998. “Levels and trends of sex differentials in infant, child and under-five mortality.” In Too Young to Die: Genes or Gender? New York: United Nations Population Division, Department of Economic and Social Affairs, United Nations, 84-108.
- Visaria, Pravin. 1971. The Sex Ratio of the Population of India. Monograph No. 10, Census of India, 1961. New Delhi: Office of the Registrar General of India.
- World Health Organization. 2021. Gender and Health. Geneva: World Health Organization.