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HEALTH-INDIA: Laws Fail to Remedy Skewed Sex Ratio

Sandhya Srinivasan

MUMBAI, Jan 16 2006 (IPS) - Damning evidence in the British medical journal ‘The Lancet’, that illegal sex selective abortions in India were responsible for 10 million ”missing” girls over the last two decades, has goaded health authorities and campaigners into renewed action.

On Jan 12, the Maharashtra state health department held a meeting to discuss the fall-out of The Lancet study. Some suggestions: conduct sting operations in clinics, ensure registration of all sonography clinics and monitor their work; also, track second trimester abortions.

Prenatal sex detection was outlawed in India in 1994 but the practice remains rampant. India’s 2001 census findings confirmed a skewed sex ratio of girls to boys, under the age of six, for the first time.

“After all the public awareness we generated, what does it take for the mindset to change? On the other hand, if we hadn’t campaigned for the law, who knows how much worse the situation would be today,” says women’s activist Chayanika, member of the Mumbai-based Forum Against Oppression of Women, which was a member of the campaign against sex selection which led to the outlawing of selective abortions.

The Lancet study, published Jan. 9, by two doctors-Prabhat Jha from the University of Toronto, Canada, and Rajesh Kumar from the Post Graduate Institute of Medical Education and Research, Chandigarh, India – and their colleagues, has firmly established the link between India’s low sex ratio and sex selective abortion.

They examined data from the Special Fertility and Mortality Survey (SFMS), a nation-wide government survey of 1.1 million households, conducted in 1998. The SFMS is part of the Sample Registration System, an on-going and regularly monitored government data collection exercise.

“Ever-married” women were interviewed in detail for information including the number of children they’d given birth to in the previous year, their sex and their birth order.

Researchers found that the sex ratio of second- or third-born children was affected by the sex of the previous child or children.

The sex ratio for first order births was found to be 871 girls for every 1,000 boys, compared to the expected sex ratio of 950-980: 1,000. If the first child had been a girl, the sex ratio of second children was as low as 759 girls for every 1,000 boys. This got further skewed to 719: 1,000 for the third child, if both first and second children had been girls.

This was only possible if, as the authors write, “households are ensuring that at least one boy is born,” through sex selective abortion.

Some other alarming findings:

– There were twice as many “missing girls” among the children of educated women than in those of illiterate women;

– The sex ratio of second children when the first child was a girl was as low as 614: 1,000 in Punjab, 527: 1,000 in urban Rajasthan and 572: 1,000 in urban Bihar.

– Though the sex ratio was closer to the normal in progressive states such as southern Kerala and Tamil Nadu, even in those states were “clear differences between the sex ratio after a previous female birth versus a previous male birth,” write the authors.

-Religion had no influence on this practice.

-Affluent and educated parents were more likely to resort to sex selection than others.

The researchers concluded that 500,000 girls were “missing” in 1997. They would have been born, but they were not, because of foetal sex determination and sex selective abortion. The technology became available in India in the early 1980s.

Women’s and health groups under the banner of the Forum Against Sex Pre-selection and Sex-selective Abortion, first got outlawed, sex detection in the states of Goa and Maharashtra in 1989.

They pointed to the once widespread promotion of this practice by doctors openly advertising with posters in suburban trains a “solution” to parental burdens: “Pay Rs 500 now and avoid spending Rs five lakh later!” -referring to the dowry for a girl’s marriage.

The state laws were followed by national legislation in 1994, the Prenatal Diagnostic Techniques (Regulation and Prevention of Misuse) Act 1994. But six years after the law was passed, the 2001 census found that the child sex ratio had dropped from 962: 1,000 in 1981 to 945: 1,000 in 1991, to 927: 1,000 in 2001.

The sharpest declines were in Himachal Pradesh, Punjab, Haryana, Gujarat, Uttaranchal, Maharashtra and Chandigarh, where sex selection technology was widely available.

The 2001 census findings galvanised health activists to renewing their campaign.

In 2002, a writ petition was filed by Dr Sabu George and two organisations, Centre for Enquiry into Health and Allied Themes (CEHAT), Mumbai and Mahila Sarvangeen Utkarsh Mandal (MASUM), Pune -seeking to implement the existing law against prenatal sex selection, and amend the law to include newer sex selection techniques such as pre-implantational genetic diagnosis or “sex selection through in vitro fertilisation”.

The result was the Preconception and Prenatal Diagnostic Techniques Act (PNDT), 2003, which included pre-conceptual techniques and also called for specific action by the government to implement the law, including registering prenatal diagnostic machines and tracking their use.

But as of end 2005, only 300 cases had been registered under the PNDT Act, about 250 of which were about paperwork, and only 24 about sex selection. And not a single person had been successfully prosecuted under the law.

”Sometimes we feel cynical,” said Chayanika, who believes that it takes much more than mere laws to change society’s preference for male children.

“The campaign has created a lot of awareness and there is a consensus that medical professionals are one of the key guilty parties in this practice,” says health activist Amar Jesani, also part of the campaign since its inception. “Today, at least, even medical associations are saying the practice is unethical. It is another thing that they have not taken any action against their colleagues who are breaking the law.”

The practice has only become more refined. Sonography is widely used, and doctors give cues to indicate the sex of the foetus, with keywords to indicate a girl or boy.

Also, activists are strongly opposed to attempts to shift the focus of the campaign to abortion and away from sex determination. The Maharashtra government’s proposal, last week, to monitor second trimester abortions have been opposed.

“In fact, in the early days (of the campaign), we consciously focused on the diagnostic technology rather than the abortion law, to avoid any restriction on abortion,” said Chayanika.

There is also concern that efforts to control fertility like the two-child policies being promoted by various state governments could promote sex selection. Indeed, the population control programme in China is believed to have led to exactly the same phenomenon now being seen in India.

Demographers Udaya Mishra of the Centre for Development Studies and Mala Ramanathan of the Achutha Menon Centre for Health Sciences Studies, both in Thiruvananthapuram, Kerala, have warned that, like in China where there is a son preference, efforts to control fertility will further distort the sex ratio in India.

“It can be expected that pre-natal sex determination and sex selective abortions will be more intense in restrictive fertility regimes characterised by lower age at sterilisation, shorter birth intervals, and lesser proportions of women progressing beyond second parity,” said a 2004 paper written for CEHAT.

“There is now more than anecdotal evidence that the two-child norm has contributed to the skewing of the child sex ratio,” notes Dr Mohan Rao of the Centre for Social Medicine and Community Health, Jawaharlal Nehru University in New Delhi.

“Two studies covering a total of six states have indicated that coercive population policies are compelling women to go in for sex selective abortions,” Rao said.

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