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Doing away with daughters

A recent newspaper advertisement for an `American kit' that helps in pre-natal gender determination has focussed attention once again on the issue of a preference for sons. What happened to the Pre-Natal Diagnostic Techniques Act, 1994, asks AMMU JOSEPH.

Exploiting the preference for sons ... Advertisements on the availability of the ultrasound scan are common in many cities.

A RECENT newspaper advertisement for Gen-Select, an allegedly American medical kit that ostensibly permits couples to select the sex of their children to be, has kicked up a storm that has focussed attention once again on the persistent problem of "son preference" in India. Widespread criticism of the publication of the offending ad by at least one leading English newspaper prompted the daily to publish an editorial acknowledging the ethical questions involved but ultimately defending its decision to carry the ad.

A protest demonstration spearheaded by Vimochana, a women's organisation, was staged on November 26 in front of the Bangalore office of the newspaper. Letters to the editor deploring the publication of the ad were sent to both the concerned daily and others. In addition, the legality of the ad and its publication has apparently been challenged through writ petitions filed before courts in some parts of the country.

Meanwhile, encouraged by the positive response to the ad from couples wishing to try their luck with the kit, the manufacturers are reportedly planning to set up operations in India as soon as possible. They are no doubt pleased to have struck gold with the little ad that launched a big debate.

Not long ago, pre-natal sex determination and selection caused concern mainly among women's groups and progressive health professionals, as well as a few gender-conscious demographers and economists. However, the depletion of the country's female population has now been officially acknowledged as an impending national crisis, thanks largely to the alarming statistics thrown up by the Census of India 2001, which revealed a sharp decline in the sex ratio of children in the 0-6 age group in the 10 years since the last census (from 945 to 927 females per 1000 males).

Occurring as it did during a decade that witnessed a marginal improvement in the skewed ratio of females to males in the adult Indian population (from 927 to 933:1000), the sudden fall in the number of girls in the youngest age group is believed to be proof of the increased incidence of sex-selective abortion (or female foeticide) following sex determination through the abuse of medical technologies such as ultrasound scanning and amniocentesis.

The most dramatic drop in the child sex ratio seems to have taken place in Punjab, Haryana, Himachal Pradesh, Gujarat and Maharashtra, where clinics specialising in sex determination and sex-selective abortion are known to have been in existence for at least a couple of decades. However, it is now common knowledge that such clinics have since spread to most other parts of the country. In places where female infanticide was a customary practice, female foeticide has come in as a deadly substitute that is more convenient, less traumatic and equally effective. If amniocentesis was the first medical technology to be widely abused for the purpose, in recent years ultrasound scanning has emerged as a simpler and more popular alternative.

On a recent visit to Hospet, a small town in Karnataka whose main claim to fame is its proximity to the famous ruins of Hampi, a casual inquiry at the local government health office yielded a list of more than a dozen private nursing homes with ultrasound scan facilities.

In the absence of the officer in charge, who happened to be out of town, the administrative staff provided the information quite readily. They clearly had no idea that this could be sensitive information because of concern about the routine misuse of such facilities for sex determination, and because the government is legally responsible for ensuring that they are not used for this purpose and that, as a first step towards preventing misuse, all such machines are registered with the appropriate authority (the Directorate of Health and Family Welfare Services at the State level).

Similarly, local gynaecologists whose nursing homes offer ultrasound scan facilities seemed unaware of the renewed call for registration through advertisements issued by the State Government in June 2001. However, they were obviously more conscious of the illegality of sex determination and sex-selective abortion. Those interviewed said they recommended at least one scan in the course of a pregnancy in order to rule out foetal anomalies but never revealed the sex of the foetus. Some suggested that there was not much demand for such information in this part of the country; others said they did not accede to such requests. Almost all of them claimed that their machines could detect the sex only in the fourth or fifth month of pregnancy, when abortion is not as simple a procedure as it is in the first trimester.

Circumstantial evidence suggested otherwise. If scans were meant merely for routine screening, why was the service so prominently advertised outside many clinics? At least one had a huge sign painted on the side-wall of the building proclaiming: Ultrasound scan facilities available here. Few nursing homes announce the availability of HIV/AIDS testing so publicly, although most of the gynaecologists interviewed said they routinely screened pregnant women as well as all inpatients for HIV, mainly to protect themselves and their staff.

Interestingly, the local 100-bed government hospital does not have scan facilities. Patients who want, need or are told to undergo ultrasound scanning have no option but to turn to the private sector. In fact, one gynaecologist attached to a public health facility also practices at a family-run nursing home that offers scanning.

The comments of a gynaecologist and a health official reinforce the suspicion that a small town like Hospet would not boast so many clinics with ultrasound scan facilities if all they were being used for was routine screening for possible foetal abnormalities.

A young woman, pregnant soon after a caesarean section delivery, who had come to the gynaecologist's clinic with a request for medication to induce abortion, was counselled instead to undergo tubectomy after the second baby was born. After the disappointed would-be patient had left, the doctor explained that she had taken a decision not to perform abortions, mainly because of her experience as a member of a team working on a World Health Organisation sponsored research project on abortion methods, which had put her off the procedure.

According to her, many of her colleagues do not bother to advise patients about contraception, even when pregnancy is medically inadvisable, at least partly because they stand to profit from every unwanted pregnancy. ``Abortions are the bread and butter of most O&Gs,'' she pointed out.

Her remarks were echoed by a senior health officer who did not realise that he was speaking to a journalist. He implied that the proliferation of ultrasound scan machines in a small town like Hospet clearly pointed to the fact that they were being used for sex determination. He, too, spoke of the profitability of sex-selective abortion. Asked why he had not taken action against the illegal practice, he suggested that any such effort was futile because it was promptly and invariably stymied through political pressure. He claimed to be speaking from experience. He also confessed that it was awkward for him to take punitive action against fellow doctors, some of them former classmates or colleagues. According to him, he tried to advise them instead.

The gynaecologist also confirmed that the demand for sex determination was by no means confined to certain notorious areas in the country but was evident even in a place like Hospet.

The facts revealed by the census speak for themselves. While the adult sex ratio in Karnataka rose from 960 in 1991 to 964 in 2001, the child sex ratio fell from 960 in 1991 to 949 in 2001. In some districts the ratio of female to male children is far lower than the State average. The five worst districts for girls are Belgaum (924), Gulbarga (937), Koppal (938), Bagalkot (939) and Bangalore Urban (940). But Bangalore Rural (941), Dharwad (944) and Uttara Kannada (946) also fall below the state average, while Bellary and Davangere are up to par at 949. Interestingly, with the exception of Bagalkot, the six districts with the most severe girl child deficit have registered a slight increase in the ratio of women to men.

Hospet is located in Bellary district. Clearly the situation there and in other districts — and other parts of the country — with similar or lower child sex ratios needs to be investigated, monitored and corrected.

The identities of the doctors, health officials and nursing homes mentioned here are being withheld because it would be easy enough to make scapegoats of a few people without taking steps to change the situation in any real sense.

Arbitrary, sporadic and half-hearted action against stray individuals and institutions is unlikely to solve the problem, which is clearly endemic and requires sustained, systemic action on many fronts by the Government, the medical profession and civil society.

There is little doubt that the Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994, which came into being thanks mainly to pressure from gender and health activists, and is supposed to have come into force from January 1996, has not been very effective thus far. In fact, the evident non-implementation of the law had led last year to the filing of a writ petition by health policy expert and activist Sabu M. George, together with the Maharashtra-based organisations, Centre for Enquiry into Health and Allied Themes (CEHAT) and Mahila Sarvangeen Utkarsh Mandal (MASUM).

The Supreme Court's interim order on the petition, issued in May 2001, castigated the Central and State Governments — first for their inaction with regard to the law, and then for their tardiness in responding to the court's own notices following the admission of the petition.

The order, given by Justices M.B. Shah and S.N. Variava, includes specific directions to the Central Government, the Central Supervisory Board (provided for by the act) (CSB), State Governments and the administrations of union territories, as well as the appropriate authorities empowered to take action against violations of the act.

Among these is the instruction to the CSB to examine the need to amend the law "keeping in mind emerging technologies and difficulties encountered in implementation of the Act". A draft amendment suggested by the technical committee appointed by the government to consider required changes in the law, as directed by the Supreme Court, is currently before the union cabinet, awaiting approval prior to being tabled in Parliament. According to George, the draft covers all possible current and future technologies that aid and abet sex determination and/or selection — pre-natal, pre-conception et al.

The Supreme Court has also called upon the Central and State Governments, as well as associations and bodies comprising medical professionals to initiate campaigns to create public opinion against the practice of sex determination, selective abortion and pre-selection. For once the onus has not been placed solely on women's groups and non-governmental organisations. If all that the apex court has directed comes to pass, perhaps the manufacturers of Gen-Select and others hoping to follow suit, will not find fertile ground in this country for their claims and products, dubious or otherwise.

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