Female Foeticide in India
By Indu Grewal and J. Kishore

Introduction

Some of the worst gender ratios, indicating gross violation of women’s rights, are found in South and East Asian countries such as India and China. The determination of the sex of the foetus by ultrasound scanning, amniocentesis, and in vitro fertilization has aggravated this situation. No moral or ethical principle supports such a procedure for gender identification. The situation is further worsened by a lack of awareness of women’s rights and by the indifferent attitude of governments and medical professionals. In India, the available legislation for prevention of sex determination needs strict implementation, alongside the launching of programmes aimed at altering attitudes, including those prevalent in the medical profession.

Background

The killing of women exists in various forms in societies the world over. However, Indian society displays some unique and particularly brutal versions, such as dowry deaths and sati. Female foeticide is an extreme manifestation of violence against women. Female foetuses are selectively aborted after pre-natal sex determination, thus avoiding the birth of girls. As a result of selective abortion, between 35 and 40 million girls and women are missing from the Indian population. In some parts of the country, the sex ratio of girls to boys has dropped to less than 800:1,000. The United Nations has expressed serious concern about the situation.

The sex ratio has altered consistently in favour of boys since the beginning of the 20th century (see Table), and the effect has been most pronounced in the states of Punjab, Haryana and Delhi. It was in these states that private foetal sex determination clinics were first established and the practice of selective abortion became popular from the late 1970s. Worryingly, the trend is far stronger in urban rather than rural areas, and among literate rather than illiterate women, exploding the myth that growing affluence and spread of basic education alone will result in the erosion of gender bias.

Sex Ratio (females per 1000 males), India 1901–2001

Year Sex Ratio Sex Ratio

in Children (0–6yr)

1901 972 –

1911 964 –

1921 955 –

1931 950 –

1941 945 –

1951 946 –

1961 941 976

1971 930 964

1981 934 962

1991 929 945

2001 933 927

Source: Registrar General of India

Status of Indian Women

The adverse sex ratio has been linked with the low status of women in Indian communities, both Hindu and Muslim. The status of women in a society can be determined by their education, health, economic role, presence in the professions and management, and decision-making power within the family. It is deeply influenced by the beliefs and values of society. Islam permits polygamy and gives women fewer rights than men. Among Hindus, preference for the male child is likewise deeply enshrined in belief and practice. The Ramayana and the Manusmriti (the Laws of Manu) represent the ideal woman as obedient and submissive, and always needing the care of a male: first father, then husband, then son.

The birth of a son is regarded as essential in Hinduism and many prayers and lavish offerings are made in temples in the hope of having a male child. Modern medical technology is used in the service of this religion-driven devaluing of women and girls.

Religion operates alongside other cultural and economic factors in lowering the status of women. The practice of dowry has spread nationwide, to communities and castes in which it had never been the custom, fuelled by consumerism and emulation of upper caste practices. In the majority of cases, the legal system has no impact on the practice of dowry. It is estimated that a dowry death occurs in India every 93 minutes.

The need for a dowry for girl children, and the ability to demand a dowry for boys exerts considerable economic pressure on families to use any means to avoid having girls, who are seen as a liability. Sonalda Desai has reported that there are posters in Bombay advertising sex-determination tests that read, ‘It is better to pay 500 Rs now than 50,000 Rs (in dowry) later’.

Women and Developments in Reproductive Technology Abortion was legalized in India in 1971 (Medical Termination of Pregnancy Act) to strengthen humanitarian values (pregnancy can be aborted if it is a result of sexual assault, contraceptive failure, if the baby would be severely handicapped, or if the mother is incapable of bearing a healthy child). Amniocentesis was introduced in 1975 to detect foetal abnormalities but it soon began to be used for determining the sex of the baby. Ultrasound scanning, being a non-invasive technique, quickly gained popularity and is now available in some of the most remote rural areas. Both techniques are now being used for sex determination with the intention of abortion if the foetus turns out to be female. These methods do not involve manipulation of genetic material to select the sex of a baby. Recent preconception gender selection (PGS), however, includes flow cytometry, preimplantation gender determination of the embryo, and in vitro fertilization to ensure the birth of a baby of the desired sex without undergoing abortion. In PGS, X and Y sperms are separated and the enriched sperms are used to fertilize the ovum. The method was intended to reduce the risk of diseases related to the X chromosome, which are far more likely to occur in boys than in girls (who have two X chromosomes). Ironically, it is being used in India to avoid giving birth to girl children.

Most of those in the medical profession, being part of the same gender biased society, are steeped in the same attitudes concerning women. It is scarcely surprising that they are happy to fulfil the demands of prospective parents. Medical malpractice in this area is flourishing, and bans on gender selection, for example in Maharashtra, have had little effect.

Consequences of Female Foeticide

Given the lower value placed on women in Indian society, prenatal sex determination with the intention of preventing female births must be viewed as a manifestation of violence against women, a violation of their human rights. The pregnant woman, though often equally anxious to have a boy, is frequently pressurized to undergo such procedures. Many women suffer from psychological trauma as a result of forcibly undergoing repeated abortions. More generally, demographers warn that in the next twenty years there will be a shortage of brides in the marriage market mainly because of the adverse juvenile sex ratio, combined with an overall decline in fertility. While fertility is declining more rapidly in urban and educated families, nevertheless the preference for male children remains strong. For these families, modern medical technologies are within easy reach. Thus selective abortion and sex selection are becoming more common.

In rural areas, as the number of marriageable women declines, men would tend to marry younger women, leading to a rise in fertility rates and thus a high rate of population growth. The abduction of girls is an associated phenomenon. The Hindustan Times recently reported that young girls from Assam and West Bengal are kidnapped and sold into marriage in neighbouring Haryana.

The impact on society should not be underestimated. According to Chinese estimates, by 2020 there are likely to be 40 million unmarried young men, called guang guan or ‘bare branches’, in China, because of the adverse sex ratio. A society with a preponderance of unmarried young men is prone to particular dangers. More women are likely to be exploited as sex workers. Increases in molestations and rape are an obvious result. The sharp rise in sex crimes in Delhi have been attributed to the unequal sex ratio.

Prevention of Sex Determination

In 1994, the Government of India passed the Pre- conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act with the aim of preventing female foeticide. The implementation of this Act was slow. It was later amended and replaced in 2002 by the Prenatal Diagnostic Techniques (Regulation and Prevention of Misuse) Act without ever having been properly implemented.

The Act has a central and state level Supervisory Board, an Appropriate Authority, and supporting Advisory Committee. The function of the Supervisory Board is to oversee, monitor, and make amendments to the provisions of the Act. Appropriate Authority provides registration, and conducts the administrative work involved in inspection, investigation, and the penalizing of defaulters. The Advisory Committee provides expert and technical support to the Appropriate Authority. Contravening the provisions of the Act can lead to a fine of Rs 10,000 and up to three years imprisonment for a first offence, with greater fines and longer terms of imprisonment for repeat offenders. The Appropriate Authority informs the central or state medical council to take action against medical professionals, leading to suspension or the striking off of practitioners found guilty of contravening the provisions of the Act.

Before conducting any prenatal diagnostic procedure, the medical practitioner must obtain a written consent from the pregnant woman in a local language that she understands. Prenatal tests may be performed in various specified circumstances, including risk of chromosomal abnormalities in the case of women over 35, and genetic diseases evident in the family history of the couple. Implementation of the 1994 Act

We conducted a study to assess the implementation of the 1994 Act in South Delhi and make recommendations for its improvement. This involved examining the organizational structure, observing 26 clinics, and distributing a questionnaire to patients. The results showed up serious failures in management and implementation, lack of commitment and motivation, widespread corruption, and little knowledge in clinics of the provisions of the Act. The presence of individuals outside the medical profession, in particular those involved with human rights, would have helped to prevent fraternity bias – an unwillingness to bring medical colleagues to account.

The survey of patient attitudes showed that only 40% of male patients and 30% of female patients were aware of the prohibition of sex determination. While 90% purported to agree with the principle of the Act, they nevertheless maintained that a male child was important for the strengthening of the family.

Preventing Female Foeticide

The removal of this practice in Indian society is a serious challenge. It must involve

Ï A move away from religious teachings and the advocacy of a scientific, rational, and humanist approach.

Ï The empowerment of women and a strengthening of women’s rights through campaigning against practices such as dowry, and ensuring strict implementation of existing legislation.

Ï Ensuring the development of and access to good health care services.

Ï Inculcating a strong ethical code of conduct among medical professionals, beginning with their training as undergraduates.

Ï Simple methods of complaint registration, accessible to the poorest and most vulnerable women.

Ï Wide publicization in the media of the scale and seriousness of the practice. NGOs should take a key role in educating the public on this matter.

Ï Regular assessment of indicators of status of women in society, such as sex ratio, and female mortality, literacy, and economic participation.

It is only by a combination of monitoring, education campaigns, and effective legal implementation that the deep-seated attitudes and practices against women and girls can be eroded.

Dr. Indu Grewal is Senior Medical Officer, Directorate of Health Services, Government of Delhi. Dr. J. Kishore is Associate Professor of Community Medicine, Maulana Azad Medical College, New Delhi.