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JANUARY 1988
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Sex Differentials in Nutritional Status in a Rural Area of
Gujarat State : An Interim Report
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Leela Visaria
Women are regarded as both biologically
stronger and physiologically superior to men.
Biologically, the presence of a pair of X chromo
some protects women against chromosome linked
recessive disorders and makes them less suscep
tible to infectious diseases (1). Physiologically,
women are reported to be more efficient than men ;
for a given quantum of work, they require some
what less protein and energy than men(2). Other
things being equal, these innate differences would
result in lower female mortality compared to that
of men; this situation is observed in most parts
of the world today. In the developed countries,
the sex differences in mortality has been widening.
By 1983, a difference of 7 to 8 years in the life
expectancy at birth between males and females
was not at all uncommon and was reported by
USA, France, Finland and Australia (3). The once
common maternal deaths have been virtually
eliminated. At the same time, the biological disad
vantage of men is aggravated by a stressful life
style and accidents, which account for a significant
proportion of deaths. The observed high male
differences in mortality at ages 35-75 in countries
such as Finland, France, USA and USSR are attri
butable to the higher incidence of cardiovascular
and respiratory diseases (including lung cancer)
and accidents among men (4). In sharp contrast
to this general pattern is the situation reported by
the populations of the Indian subcontinent where
males enjoy lower mortality than females almost
from birth until about the end of the reproductive
period of the latter. This has been an important
factor contributing to the anomalous excess of
males in the population reported by the censuses
for nearly a century now. The age specific death
rates based on the recent large data sets such as
the Sample Registration System in India have
confirmed the excess female mortality suggested
by the earlier estimates of life expectancy at birth
and other ages, based on the census age data.
This paper is a preliminary examination of the
data on birth weight and on nutritional status or
weight gain among children under the five years
of age available from a research-cum-action project
in a rural area of Kachchh district of Gujarat state,
to see whether and how far these support the
widely held hypotheses about differentials in treat
ment between young boys and girls in terms of
food allocation and health care, being a major
cause of higher female mortality.
The Study Area
The study area was selected because of the
scope for collaboration withan NGO (non-govern
mental organisation) based in Ratadia village in
Mundra Taluka in Kachchh district. The NGO,
named Shri Sangh, is led by two health professio
nals, actively involved in multi-faceted develop
mental work while employed by the Panchayat
hospital with an attached maternity home. The
project area, spread over 25 villages, covers about
3400 households with a population of 17,000.
..
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Following a pretest in April 1985, a benchmark
survey of all the households was carried out during
June-July 1985. The region is very heterogenous
in caste composition and also has a long tradition
of outmigration to Bombay and other urban centres
and even abroad, to East Africa in earlier decades
and recently to the Gulf countries. This is reflected
in the sex ratio of population in rural areas of
Kachchh district, 975 males per 1000 females in
1981, was lowest in the State, compared to 1043
for Rural Gujarat.1
The action programme involves a careful re
cording of all the pregnancies, births and deaths
as well as monthly monitoring of the weight of
all the children below five years (or sixty months)
of age. (Measurement of height began in October,
1986). The growth monitoring activity began on
October 2, 1985 in five villages (total population,
2490; number of under-five children, 374). It
was expanded to four more villages in May 1986
(total population 3509, number of under-five
children, 414). The tenth village was added in
August 1986. In addition, we have data on births
that occurred in the maternity home since 1980.
boys and 28 percent of girls, born in our project
area during 1980-85, had a birth weight of less
than 2500 grams. The intercaste variations in this
percentage are very small except that more than
50 percent of the Harijan children (45 percent of
boys and 56 percent of girls) had birth weight of
less than 2500 grams. Such babies are considered
"high risk" according to the WHO standards.
However, the Indian pediatricians report that
"full-term" babies weighing between 2000 and
2500 grams can survive with minimum inputs.
As noted above, the data do not include any in
formation on the duration of gestation, but about
5 percent of all children (4 and 6 percent of boys
and girls, respectively), and 15 percent of the
Harijan children (8 percent of boys and 23 percent
of girls) had a birthweight of less than 2000 grams
and were "at risk" according to the Indian "stan
dards" as well.5
The observed sex difference in birthweights
in our project area was similar to that in the data
for the reference population of the National Center
for Health Statistics (NCHS). On an average,
girls weighed about 200 grams less than boys
at birth but the difference was not statistically
significant. The intercaste differences also do not
seem to be significant. The limited number of
observed births might be the likely explanatory
variable. Yet, surprisingly, among the Barot babies,
the average birthweight of girls exceeded that of
boys by 110 grams. Unlike other women in this
region, the Barot women tend to be tall and betterbuilt, but the observed difference is certainly not
statistically significant6.
Sex Differences in BirthWeights
Out of about 200-225 deliveries occuring in
the Ratadia maternity home each year, between
60 and 70 percent are to the mothers who come
from the project area.2
The hospital maintains
records of all the deliveries with details about
the caste, education, occupation of the parents
along with the sex, parity and the birthweight of
each baby.3 Over the six years 1980-85, recorded
birthweights are available for almost 800 babies
from the project area villages.
On the whole, boys do not begin life with any
marked advantage over girls in our project area.
We shall next examine whether and when in the
course of next five years, clearly identifiable dis
advantages emerge which adversely affect the girls.
Admittedly, the information on the gestational
age of the fetus is not accurate. Most of the
women come to the hospital for the first time
at the time of delivery or register their names just
a couple of weeks before the date of delivery.
Therefore, the information on the time elapsed
since last menstruation, given by the women or
their relatives, is accepted at its face value. The
hospital did not until recently ascertain the gesta
tional age of the fetus independently through
measurement of the fundus height.
Dynamics of the Child
Population
Under
Observation
In our programme of monthly weighing of
children, the base population changes every month.
Apart from the loss of some children because of
deaths, some children cross the stipulated age
limit; some migrate from the region permanently
with their families or are temporarily away; they
are not weighed. Some children may not be
brought for weighing because of illness or because
parents are busy or for any other reason. The
changes in the denominator as well as the numera
tor need to be monitored every month to assess
the proportion of children weighed and the reasons
Interestingly, the percentage distribution of
children of various caste groups according to their
birth weight Shows that both the mean and the
distribution are similar to those observed in many
other Indian Studies (cited in Visaria, 1985)4.
About 25 per cent cof the children (22
.
.percent of
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for the non-weighing of others. A summary of
our data on the subject in Table 1 below indicates
that close to 90 percent of the children eligible
for weighing have been weighed at least twice.
In a given month, however, this proportion may
be somewhat less, partly because of temporary
migration.
vention period. If ages of certain children could
not still be ascertained, reference was made to the
other children in the family and occasionally
even to the weight of the child. In the latter cases,
judgement of the health workers might have in
fluenced the recorded age, although we had to
resort to this approach only in very few cases.
Further, prima facie, the sex composition of the
under five children, who were weighed, shows a
preponderance of boys
(52.7 percent) over
girls (a sex ratio of 111 3) but its underlying factors
remain to be explored. An analysis of data by
village also will have to be done in order to under
stand the sex composition of the young children.
Children are weighed on a Salter spring balance
scale which is calibrated for 100 grams. The scale
has to be suspended from a beam. The health
workers have been trained in the procedures of
weighing the children, reading the weight accura
tely, managing the child who is fidgety or crying
and recording the weight in a register as well as
on the growth chart, which is kept with the mother
and which she brings during the weighing ses
sions. The mother is shown the plotted graph and
is told how her child is faring in relation to the
previous month's weight and in relation to the
reference curves.
Table
1
dynamics of the Under-five Child Population in
Nine Villages of Kachchh District
1. Total number of underfive children listed in the
Baseline survey plus new
births.
J
K
)
2. Number who completed
five years or permanently
migrated or died before
weighing began in 5 and
4 villages in
October
1985 and May 1986, res
pectively.
3. Number
weighing
eligible
4. Number
once
weighed
Boys
Girls
414
374
All
Subsequently, the weights of these children
are plotted on large graphs separately for boys
and girls so that both the weight distribution of
all children and the weight increment status of
each child over time are readily comprehensible at
a glance.
788
34
37
71
380
337
717
40
37
79
336
88.6
302
89.6
638
89.0
The nutritional status of the project area children
is assessed by using the data gathered by the
National Centre for Health Statistics of the United
States of America (NCHS) as the reference popu
lation. These data are based on a sample of Ameri
can children which contains between 300 and
1600 children in each yearly age group. In addition
to height and weight, other anthropometric mea
surements are also available such as arm and head
circumference, skinfold thickness etc. The Indian
standards prepared by the National Institute of
Nutrition are not based on anthropometric measure
ments for a sufficiently large sample. The NCHS
data are increasingly considered as most suitable
for use as an international reference. One of the •
advantages of NCHS reference is that the measure
ments are available separately for boys and girls.7
for
only
5. Number for whom pairs
of weight measurements
are available and whose
weight data are analysed
5 as % of 3
So far, we have been able to collect data on
weight only. (Measurement of heights of the
children has begun in October 1986. It is expected
that the height of the children will be measured
once in every three or four months, because the
increments in height are very small). The median
or the mean curve of the NCHS reference data is
taken as the standard. Cross-sectionally, very few
Indian children fall above the mean curve. The'
other three reference curves on the growth card
Distribution of the Children by their Nutri
tional Status and Age
A list of under-five children was prepared for
each village on the basis of the baseline survey
data. The list was again checked and updated and
ages were verified at the time of weighing of
children which began in five villages in October
1985. Updating was done for births, deaths, mig
ration and completion of 5 years during the inter-
3
show the two standard deviations below the mean,
three standard deviations below the mean and 60
percent of the mean, for each age. The area bet
ween the three standard deviations curve and 60
percent of the mean curve is shaded and warns
the health workers and the mothers that the child
falling in this region is a high risk child and should
be watched carefully. Those children who fall
below the 60 percent of the mean curve are clearly
in the very high risk category and would need
nutritional supplementation under careful super
vision. A single episode of illness in such children
can be hazardous.
Table 2 examines all available pairs of weight
measurements in terms of weight gain, constant
weight and weight loss. The salient findings are :
1. While 3 percent of all girls (majority of them
were in the age group 0-5 months) were above
the NCHS median, and 35 percent above the two
standard deviations from the mean curves, the
corresponding percentages for boys were less
than one and 34, respectively.
2. A higher proportion of girls (23.6 percent)
fell below the three standard deviations from the
mean curve than boys (20.8 percent). Thus, the
proportion of girls at the two extremes of nutri
tional status was higher than that of boys.
On the whole, after the age of six months, the
nutritional status of each child that prevailed during
a major part of the period shows a remarkable
stability in the weight increment status of children
in the sense that they rarely "Cross over" to the
adjoining reference curves.
3. As might be expected, during the initial
six months after birth, 90 percent of the children
fared well in terms of their nutritional status mea-
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Table 2
Distribution of Pairs of Observations of Weights of Children in Project Area According to
Their Nutritional Status, Direction of Change and Sex
Nutritional Status
£
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Number
of
children
Total
Pairs of
Observa
tions
Weight
gain
Above the Mean
2
5
100.0
bet. mean & 2 SD
114
481
71.3
10.2
18.5
100.0
bet. 2 SE & 3 SD
150
762
60.5
11.4
28.1
100.0
bet. 3 SD & 60% of mean
59
270
62.6
11.9
25.5
100.0
60% of mean
11
41
61.0
7.3
31.7
100.0
Total
336
1559
64.3
11.0
24.7
100.0
Girls
Above the mean
9
33
72.7
9.1
18.2
100.0
c
c
c
c
bet. mean & 2 SD
108
456
67.8
11.8
20.4
100.0
c
bet. 2 SD & 3 SD
115
575
67.7
10.6
21.7
100.0
Percent of Children Showing
Weight
unchanged
Total
Weight
loss
Boys
bet. 3 SD & 60% of mean
100.0
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5
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A
A
58
343
61.z
12.5
26.3
100.0
60% of mean
12
61
54.1
18.0
27.9
100.0
Total
302
1468
65.7
11.7
22.6
100.0
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sured by weight; but a higher proportion of girls
(12.3) than of boys (4.7 percent) fell in the "at
risk" category. The birth weight of a large majority
of children puts them between the mean and the
three standard deviations curves, and their growth
pattern broadly follows the standard curves.
4. After the age of six months, however, falter
ing of growth begins among both boys and girls.
The percentage of children below the three stan
dard deviations curve rises to 20-25 percent or
more from about six months upto four years of
age, with a relatively small sex difference. A proper
feeding of the children during the post-weaning
period as well as managing the weight loss or
lack of gain due to infectious diseases seem to
pose a problem.
5. After the age of 3 years, a markedly higher
percentage of girls, than of boys falls below the
three standard deviations from the mean curve.
However, given the small number of children, the
sampling error is large and the observed sex
differences are not statistically significant.
6. As indicated in Table 2, on an average, we
have 4.7 pairs of observations of weight per child.
About 65 per cent of the observed cases of both
boys and girls relate to weight gain. About 23-25
percent of weight observations indicated loss of
weight between two successive months. The extent
of seasonality in weight gain or loss, is yet to be
explored.
the projects area is smaller than observed in the
NCHS reference data.
The data also indicate that the weight gain of
the project area children was short of the NCHS
standard more during the first year of life than
during the next four years. Within the first year of
age, the growth shortfall was somewhat more
during the second half or the
post-weaning
period; the difference was particularly marked in
the case of girls.
Notes :
(refers to numbers in small print)
1. Besides rural Kachchh, an excess of females in
the population was reported by only one other
area-rural Valsad district (Sex ratio of 993
males per 1000 females) according to the 1981
census.
2. According to our baseline survey, nearly 30
percent of the births of the previous one year
in the project area took place either at Ratadia
hospital or at a similar institution elsewhere.
This figure is quite high for a rural area of
Gujarat. In rural area of Gujarat State as a whole,
the Sample Registration System has reported
less than 13 percent of the births to be occurring
in an institutional setting during 1982 and 1983
(SRS 1982, 1983).
3. The hospital nurse generally weighs the new
born on a spring baby weighing scale which
is calibrated for 50 gms.
Another way of looking at the serial weight
measurements (discussed by Jelliffe 1966) brings
some of the above observations in a sharper focus.
Ideally one needs a minimum of one year's weight
observations in order to calculate the average
monthly weight gain by age. However, to obtain a
larger number of observations in each group,
weight data for five villages (where the programme
was launched in October 1985) and those for four
villages (where it was launched in May 1986) are
pooled. The data for five villages based on 11
months' observations show a sex and age pattern
very similar to that evident from the pooled in
formation as for nine villages. The data indicate
that the total weight gain of the project children
upto five years of age was 68 percent and 77
percent of the mean standard of the NCHS for
boys and girls, respectively. Interestingly, girls
faired better than boys in relation to the standard
from the age of 6 months onwards. At every age,
the difference in the weight of boys and girls in
4. Prima facie, the implied sex ratio at birth of
1154 boys per 1000 girls appears implausible
and needs to be investigated.
5. An effort is under way to trace each of these
children to find out how they have fared later
in terms of their weight and survival.
6. Barots in Kachchh are largely engaged in animal
husbandry and maintain large herds of goats
and sheep. They also own some milch cattle
as well as land which is generally unirrigated.
The Barot women are quite active in tending
the cattle and also appear to enjoy decision
making power in household matters including
marriage.
7. For a discussion of the NCHS data, and their
advantages over other similar large data sets,
see : (Waterlow, 1977).
(Contd. in the next issue)
5
UJ H " 'o'
Sex Determination and Female Foeticide
In Baroda
incorrect. We found couples going for test at
first conception. We also found couplesa alrea
dy having one son (the only child) going for
✓
(A Report by Garbha Parikshan Virodhi Manch)
the test as they wanted son second time too.
£
Following the passage of the bill banning the
use of prenatal diagnostic techniques for sex deter
mination in the Maharashtra Assembly in March this
year. The Garbh Parikshan Virodhi Manch, a front for
med by the progressive organisations, doctors and
other concerned citizens in Baroda (Gujarat), decided
to conduct a survey to find out the misuse of such
• techniques in Baroda city and to roughly estimate
the extent of their misuse for female foeticide. The
Manch interviewed 1) 30 doctors 2) some patholo
gists 3) some women who have undergone the test
4) some women who are against such test and re
fusing to undergo despite having one or more dau
ghters and under social pressure 5) individuals from
/
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various economic, social and cultural stratas.
4
FINDINGS
4
A. Prevalence of Pre-natal Diagnostic Techinques.
In Baroda mainly two pre-natal diagnostic tec
hniques are used for sex-determination, viz.
Amniocentesis and Chorion-villi-biopsy (CVB).
Of these two, the Amniocentesis is much more
prevalent as it is comparatively cheap.
1
Except very few gynaecologists in Baroda, al
2
The extent oj Misuse :
jB.
According to one information, a well known
laboratory in Baroda has tested 20,000 samples
1
of amniotic fluid in last 10 years.
In 1987, in Baroda city alone estimated 2400
2
tests.
We came to know that a sizeable number of
'3
women go to Anand city to undergo the test;
the real number of women undergoing this test
must be much higher than estimated by us.
Some other findings :
C.
Following ate some qualitative findings based
on case studies aind observations.
Although doctors did admit the possible harm
ful effect of amniocentesis on mother and child,
and risk of abortion, sterility etc, none of them
maintain any record about the harmful effect
1
Observed by them.
2’
the female foeticide should' be encouraged as
most all,do amniocentesis.
3
Of those who are doing the test, except one,
all said that personally they do not favour the
a part of family planning programme.
3
Many doctors said that they will stop doing
this test if government bans it. But till then can
not say no as other doctors continue to do this
test and that will adversely affect their income.
4:
Some doctors said that they are new in the
business, they have just started their practice
-let us'earh a lot for while; After sometime, we
test
More than 70% of them admitted that the am
niocentesis could be harmful to the mother and
the foetus. Sometimes it leads to spontaneous
4
abortion and sterility.
The Manch also came to know that some doc
tors were doing amniocentesis with inadequate
precaution and facility' and thus endangering
the lives of the mother and 'the child.'
5
Women from all castes, religion and economic
classes go for this test. Many ,of them have tar
ken loan to pay for the test.-
6
A common view that parents with two or more
daughters go for such test was proved to be
7
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Some doctors said that sex-determination anti
will stop doing this test.'
5
5
O'Sly
O'Sly one doctor believed that this test should
be offered to all couples with two daughters.
According to that doctor, as long as daughters
are unwanted'in the world they have no right
to take birth.
6’ Only three doctors condemned the test and said
that it violates medical ethics and the medical
profession should take initiative to banish it.
"fl
e ii
7
Except these three doctors, the others, though
did not favour the test at personal level, bla
med the society for its spread. They believed
that doctor's give what the customers demand.
They completely absolved doctors from any
responsibility regarding the test and the female
coldgy are not permitted to offer facilities for MTP
in rural centres on the ground that their clinics are
illstaffed and do not have adequate blood bank
facilities. It is different matter that with the same
kind of set-up they can do, and indeed they do,
Caesarean section.
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foeticide.
8
People believe that banning prenatal sex deter
mination tests will not radically change the si
tuation. After such ban, the test will become
constlier.
(Translators' note for the MFC Bulletin : These
findings are taken from a mimeographed report of
the Manch in Gujarati. The presentation is changed
for stylistic reasons. On reading the Maneb's report
it was clear to me that the Manch has done' more
of an investigative report rather than a scientific
survey. However, this does not minimise the seriou
sness of the problem they have painfully highligh
ted. The findings are startling. The hypocracy of
the commercialised medical profession is fully expo
sed. We hope that some more systematic research
will be conducted on this subject so that an effort
can be made at national level to banish such inhu
man medical practice).
13 ®
DIALOGUE
Abortion
(V
Arun Cadre
lt was a great battle everybody fought to le
galise abortion in India. It was considered as a pro
gressive step in the liberation of women. By legali
sing abortion, it was thought that, i) unwanted
pregnancies would no longer be hindrance in the
progress of a woman's life, ii) MTP would offer a
permanent solution to the problem of unmarried
pregnancies; and iii) abortion could be taken out of
province of quacks into the safer hands of an expertNone of these objectives, I am afraid, have
been fully realised^ I identify four main problems:
Firstly quacks are still having a field day and
are openly practicing abortion in rural areas, slums
and even in cities. With Legal control over medica
practice being what it is, quacks continue to enjoy
scot-free status and are fully exploiting the situa
tion. It is a pity that- qualifieid specialists in Gynae-
Secondly, I strongly object to abortion being
considered an extended form of contraception.
With the sword of unwanted pregnancy no longer
hanging over their head, young weds have become
very casual in their overall aporoach to family pla- ■
nning. Thus the husband discards barrier contracep
tives and the wife conveniently forgets pills. Since
abortion is no longer a taboo in the modern society,
even if pregancy is discovered in the first year of
married life, 'wiser councel prevails' and abortion is
considered a practical solution to the 'unwanted
and unforeseen' problem.
Thirdly, abortion in the minds of naive cou
ples is Just another procedure/ They attach no more
importance to abortion than the procedure of say,
draining an abscess. But than it is not a simple pro
cedure and carries with it all the risks and complica
tions of surgery. Women are not aware that abortion
can lead to infection, bleeding and rupture of uterus
and can also leave behind the legacy of blocked
tubes. One can easily imagine the plight of a woman
getting her first pregnancy terminated, only to de
velop intractable sterility for the rest of her life.
Fourthly and lastly carnal pleasures and human
comforts have started taking precedence over the
traditional mother child relationship. Since a couple
wants to enjoy the marital bliss and a baby is con'
sidered as an unwanted intruder, it no longer hesi
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tates in getting an unborn off. May be our sensi
tivity to this issue has become blunted, may be an
abortion no longer kindles subtle emotions in such
couples, but the fact remains that an abortion has
become an in-thing in the first year of married life.
We must fight the misue of abortion. It will
i>
be a difficult battle. Abortion is destructive, dehu
manizing and disturbing. The earlier we take up this
issue, the better.
S ®
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U
Victim Blaming Is Not The Solution
Amar Jesani
One important negative off-shoot of the anti
sex-determination campaign is the stirring of anti—
abortionists. I remember that during the campaign
the members of the Forum Against Sex Determination
had to argue vociferously to distance their campaign
from the supporters of right-to-1ife, certain religious
organizations and the doctors who saw problem of
ethics in the MTP and the female foeticide (MTPJ
following amniocentesis as identical. The latter ar
guments might appeal to those who take a kind of
moralist standpoint against the misuse and overuse
>f any technology. This note is to examine the pro
blem of misuse and overuse of MTP from different
angle and to point out certain lacunae in these
arguments.
Let us start with the enactment of the MTP
Act. It is wrong to say that the MTP Act was for
mulated in response to the woman's movement's
demand. If it was, it should have been called, say,
Woman's Right to Abortion Act and there wouldn't
have been any need to keep so-called medical indi
cations for performing the MTP. It is know that the
feminists stand for the unconditional right to
abortion.
The
MTP
Act
does
not
give
any such unconditional right. And what was the
strength of feminist movement in the early 1970s ?
Thus, we have to look for elsewhere to find out
real reasons for government to pass this Act.
I submit that MTP Act is not an act for str
engthening women's right (although as a by-pro
duct women do get some facilities for less restric
tive abortion) but it is an act to regulate medical
profession. It was brought in to strengthen domi
nance of allopathic doctors in the Medical profe
ssion. It was passed to confer near monopoly to
perform MTP to the allopathic doctors. It is imma
terial that quacks were and are bad. What is impor
tant is the net effect. Can anybody argue that the
MTP Act did not help modern doctors to get the
most benefit from it ? Most of the doctors doing
MTP are more concerned about the government's
inability to stringently apply it so that the competi
tion from the quack is eliminated. But this is true in
all aspects of medicine practice, why to single out
abortion only ?
It is dangerous to link up lack of health edu
cation in the MTP seeker woman with the 'misuse'
7
of the MTP. There is nothing like misuse of the
MTP because I believe that woman should have
unconditional right to have it. One can punish a
pregnant woman (by forcing her to take baby full
term) because she is less educated, or husband is
less educated about contraception, or they are lazy
or, woman has no authority in the sexual relation
ship and in the family in general. Pregnancy is a
fact, a physical reality and to deny her right to abort
is to compound one oppression with another. And
medical profession is well known for victim blaming*
Nobody wili dispute concern for the plight of
the women who has no option but to undergo
MTP as she is a powerless person in the family, But
the solution is not in denying her even this escape.
Nobody will disagree with the plea for providing
sex education and education on contraception to
the woman and the man; and also plea to empower
women in the society. But this has to be done by
expanding the frontiers of women's right and
power and not by restricting whatever right she has
(for example that of abortion under the MTP Act).
Firstly, can woman say 'no' to husband when
she understands that she will conceive ? is there
any law empowering woman to do so ? Is marital
rape considered a criminal offence ? It is not suffi
cient to give sermon to the woman that she should
not allow a sexual relationship which makes her
conceive at a time when she does not want pregna
ncy. What is important is to make right to say no to
unsafe sex a fundamental right under law for wo
men and to create social support system all over the
country to implement such a law. The latter is more
important than the former because we do not want
an empty law like untouchability and many many
others. Are doctors who are so concerned about the
misuse of MTP ready to be part of such an effort ?
Let me assume that doctors would like to
contribute in such an effort. However, for such con
tribution they will have to first break their mental
barrier and prejudice against women's movement
however painful they might feel as a man in doing
so. For whatever effort that is being made in this
country to empower women is being done by the
women's organisations only. Such docotrs will have
to establish links with them rather than blaming
them for the ills within the medical profession.
This brings me to my last point, what does
doctor do when he or she notices a women under
going repeated MTPs ? Denying her the MTP would
n
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C
R.N. 27565/76
be, I believe, not only in human but also unethical.
The only way the doctor can help to 'cure* this pro
blem is by patiently finding out the problem and
then "to step out of medical confines" and "enter
the socio-political field." This has to be done beca
use there is no "medical solution" to such problemOne has to follow up such cases in the social fieldsby taking support of women's and health organi
zations, and by breaking the complacency of medi
cal or doctor's organisations. The acid test is how
many such doctors will be ready to demonstrate in
support of such wcmen? To make such a move
ment strong may take sometime, but that is the real
solution, or that has some possibility of taking us
nearer to the solution.
® g
One Daughter Family : Fact or Fancy ?
To promote the concept of 'One Daughter
Family' the Government of Maharashtra has intro
duced a novel award of Rs. 10,000 for couples un
dergoing permanent sterilization after one daughter
but without a son. (sic) The award christened as Pt
Jawaharlal Nehru Balkalyan Award was annouced
on 14 November 1988 to coincide with birth cen
tenary celebrations of Pt Nehru.
Strange as it may seem, this announcement
comes close on the heels of Raj Chengappa's article
in India Today (October 31) in which the author has
exposed the limitations and hollow claims of the
Government's family planning programmes in a thr
eadbare analysis. He denounced these programmesas ■
a big hoax and dismissed the popular slogan, 'Beti
ho ya Bete. Bacche do hi acchhe. as a worn-out cliche.
That the Government has paid no attention to this
article is obvious. For consider these reactions which
Chengappa has chosen as representative of people's
general out look at family planning. These explain
why people-atleast.from rural background-still long
for a male child. A farmer, for instance said 'I need
two sons. Otherwise who will light my pyre, who
will carry on the family name, who will help me on
the fields, who will look after me in my old age ?
Another farmer from Rajasthan spelled, out reasons
for aspiring for as many as five children : 'One to
look after my cows. Another to tend to my sheep.
One to help me on the field. One to help my
wife at home. Even a population expert agreed enti
rely: 'People are fanatical about having two living
sons. It is as sacred as religion to them.'
That our first Prime Minister was endeared by
children all over the world as Chacha Nehru, that
he loved children as much as the rose on his jacket,
that he had only one daughter and no son and that
this award should therefore be named after him to
ensure equal rights to women a la Nehru ervisagedall these things are admittedly true and might appeal
to the reason. But what surprises one most is the
Government's naive assumption that a carrot worth
Rs. 10000 will lure many a couple to stop after one
daughter. This approach takes no cognizance of tf
stark social realities. One can not help feeling pity
at this logic-or rather lack of it. How many couples
will accept this idea and stop after first daughter
voluntarily ? And will 'X' or 'Y' really make no diffe
rence to the hoi polloi 7
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These are indeed Ten Thousand Rupees Os !
fix
UN Jajoo & SP Kalantri
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Publishers
n.
S 0
lit
XV ANNUAL MEET OF MEDICO
FRIEND CIRCLE
27th, 28th and 29th January 1989
Technology in Health Care : Issues and Perspective
Venue: Alwaye (Kerala)
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meet instead of being on Cochin-Trivandrum
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for correcting this geographical
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Narendra Gupta, Convenor MFC, for . venue,
arrangements, charges, background papers etc.
at the following address :
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Devgarh. Via Partabgarh. Dist. Chittorgarh
Rajasthan - 31 2 621
>>
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Editorial Commitree :
Anil Patel
Abhay Bang
Dhruv Mankad
Kamala S. Jayarao
Padma Prakash
Vimal Balasubrahmanyan
Sathyamala, Editor
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UJ H - 3 •
C. J
Sex Differentials in Nutritional Status in a
Rural area of Gujarat State
PART II
Leela Visaria
Medical Intervention in the Event of Fatal
Illness
A review of studies and our own data on nutri
tional status provides little clear evidence of a
discriminatory behaviour towards girls.
The
question then arises; are there differentials in the
prevalence as well as the incidence of infant and
childhood illnesses ? Unfortunately, the relevant
information on morbidity patterns in our field area
is not yet analysed. However, what is available
is the information on infant and child mortality,
from our efforts at continuous recording of vital
events. We have tried to ascertain from the
parents of each deceased child, the symptoms
preceding the death of the child, the medical help
sought (if any) along with the names of the
practitioners and wherever possible the actual
treatment. One of the doctors attached to the
project in Ratadia has examined these records to
indicate further whether and to what extent the
cause of death can be diagnosed from the reported
symptoms.
The data relating to the infant and child deaths
during the 15 months since our benchmark survey
conducted during June-July 1985—upto Septem
ber 30, 1986 are summarized in Table 3. The
number of female infant deaths was two and a
half times that of male infants. But, yet, because
of the small number of events, it is difficult to
generalize about the sex-bias in the incidence of
fatal illnesses or in the utilization of medical help
prior to death. However, diarrhoea, infections
of respiratory tract and post-measles complications
account for close to 80 percent of all deaths.
The remainder were due to congenital problems,
prematurity or sheer "wasting away", presumed
to be due to chronic infection.
Interestingly, the sex bias, which is believed
to exist in the seeking of medical help, does not
seem to be extensive here. In the case of three
female child deaths, and one male child death the
family had relied on home remedies only; the
percentages of these deaths to total child deaths
were 17.6 and 14.3, respectively. Yet, overall,
4
young girls were also taken to the "doctors"
outside the village, when there was no "health
medical practitioner" within the village. (Out of
nine villages for which data on death are presented,
six had no "doctor" within the village, their resi
dents had to travel about 5 to 7 kms. to reach a
village with a medical practitioner. Each village
is connected with Ratadia by bus communica
tion, with at least one service per day.) In the
case of four girls, parents even went to the district
head quarters (Bhuj) and to another town (Anjar)
to consult qualified trained doctors. Perhaps,
our study region is a typical relative to other parts
of the country. The contacts with urban areas
as well as outside world have perhaps influenced
the perceptions of parents about seeking help in
the event of illness. Yet, given the wide sex
differentials in mortality, one cannot help wonder
whether parents
seek
medical help for their
daughters when it may be too late to do much
to save their life.
Discussion
On the whole, we cannot identify any clear
sex-bias in health care or food allocation in our
project area in Kachchh. Yet, the difference in
the number of boys and girls succumbing to death
appears quite so that one has a feeling that some
where something goes against girls in the process
of growing up. The one dark area to which we
referred earlier is the timely recourse to medical
help provided to girls. Is it sought too late ?
In the instance of two girls (both belonging to the
Rajput caste) we were told plainly that only home
remedies were tried because they were girls.
Strangely enough, one of the girls was a second
parity child; the earlier daughter born to the
mother also had died in infancy. The other girl
was a tenth parity child, with two surviving
(Another
sisters and six surviving brothers.
daughter had died earlier). In the case of a third
child (fifth parity, with two surviving brothers and
one surviving sister) belonging to a scheduled
caste, poverty was apparently the reason for not
seeking help from a private practitioner in the
nearby village. While help at Ratadia is free.
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was a labourer engaged in stone-quarrying (consi
dered so arduous that apparently the workers need
to rest for a day after every three or four days of
work).
TABLE 3
Statistics
Related to the Antecedents
Infant and Child Deaths
)
Males Females
1. Population of nine villages *
2617
(July L 1985)
of
2533
5150
5
12
17
3. Child deaths (July 85Sept. 86)
2
5
7
4. Total deaths under age 5
7
17
24
1
8
9
3
4
7
1
2
3
1
1
2. Infant deaths
Another issue, noted during our field visits
but not yet investigated in any depth, is the posi
tion of Rajput women in the community. The
available anecdotal information indicates that at
the time of marriage of a Rajput daughter, her
parents bid her farewell for good and give her,
among other things, even a shroud to cover her
dead body. The parents apparently do not hope
to see the married daughter again. Quite pro
bably, this practice is a relic of bygone era, when
the transport facilities were limited and maternal
mortality high, so that these women rarely had a
chance to visit their natal homes. The transport
facility is important because the Rajputs of Kachchh,
called 'Jadejas', had to marry non-Jadeja Rajputs,
of whom there are none in Kachchh.
(The
Jadejas of Kachchh claim themselves to be the
direct descendants of the ruling family of erstwhile
princely state of Kutch. Although today most
of them are small cultivators with their women
folk supplementing the limited family income by
spinning yarn at home, their behaviour and temper
resemble that of a feudal ruling caste. According
to our baseline survey, the Jadejas formed a little
over 20 percent of the total population of 10
villages). Therefore, spouses for marriageable
children had to be found in other parts of Gujarat
as well as Rajasthan. Even today, many daughtersin-law, brought from some districts of Rajasthan,
have come to Kachchh from more than 500 Kilo
meters away and have not visited their parental
homes even once in several years. Also, unlike
in other areas, the Rajput marriages were tradi
tionally performed in the village of the bridegroom,
with the bride brought there with only four escorts.
All
(July 85-
Sept. 86)
5. Symptoms preceding death :
(i) diarrohea
(ii) respiratory
fections
tract in-
(iii) Measles and post
measles complications
(iv) congenital problems
(v) premature birth
2
(vi) 'Wasting away'
2
2
2
3
6
2
2
6. Medical help Sought :
(i) at Ratadia
3
(ii) within the village
(iii) in another village
2
5
7
(iv) in the neighbouring
urban area
1
4
5
(v) used home remedy
only
1
3
Further, the married Rajput women observe
'purdah', stay indoors and do not take up work
outside their homes even when their family is
poor. They do not even fetch water from the
village well or collect fuelwood; these tasks are
done by the men; or those who can afford, employ
servants for the work. During their conversation
with us, the Rajput men often cite these facts
to argue that their women enjoy a high status in
the family and are spared the arduous chores that
women of other communities have to perform.
However, Jadeja
women,
especially young
daughters-in-law, narrate very different grim tales.
They recognize their low status and feel that they
are a burden on the family.
4
* It has not been possible to register vital events
in one of the villages due to internal conflicts;
our health workers have not been able to carry
out their tasks, except for monthly visits to
weigh the children.
money needed for busfare and the loss of a day's
wage can be a problem. The mother of this
unfortunate girl primarily collected fuelwood for
sale to the Rajput households, while her father
5
►z
Another point reported during our interaction
with some of the women was that girls are not
sent to school so that after marriage they may not
narrate their woes to parents through letters;
And yet, some informal channels presumbably
operate to facilitate exchange of Rajput news
about daughters between Kachchh and other
areas.
In recent years a small percentage of Jadeja
women have become literate or educated and
young girls have started going to school in large
numbers. The educated men are taking
up
salaried jobs in urban areas;
they take their
spouses with them. When they visit their native
village, their urban culture presumably has some
demonstration effect on others. In the short run,
each caste group functions virtually as an auto
nomous entity, hardly subject to influence by
other castes. Over time, however, pressures do
build up to alter the traditional behaviour.
(Contd. from p. 3)
r,
It is unlikely that this strategy would succeed
in delivering health care services to rural people,
particularly in the small villages of the large states
of Bihar, Madhya Pradesh, Rajasthan and Uttar
Pradesh. Alternative models based on increasing
mobility rather than multiplying sub-centres should
be seriously considered, along with other criteria
for logistic support and facilities for primary health
care.
L
Paradoxically enough, a large population has
helped and not hindered individual rural settlements
in having access to health services because our
health policy has an inbuilt bias in favour of
population size.
Our plea is for the fullest consi
deration of physical accessibility as an important
factor in planning for primary health care. This
is an obvious point. Nevertheless, our planners
have innocently ignored it.
Jadejas form a small minority in our project
villages as a group but in some villages they are
a dominant group. There are indications, how
ever, that the position of Jadeja women and
indeed of other women has begun to improve;
the question is one of accelerating the frustratingly
slow pace of change. The social scientists must
cling to the fond hope that their efforts at under
standing the prevalent situation will facilitate
the social engineering necessary to loosen the
foundations of
centuries-old
prejudices and
behaviour. To serve this purpose, the social
science research on such issues will
have to
assume a multi-disciplinary character to unravel
the complex web of intra-family relationships.
We shall attempt to pursue these issues over the
next two years.
(The paper was presented at the seminar on
"Health for all : concept and reality" in November,
1986 organised by "The Foundation for Research
in Community Health, Bombay)
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(See rule 8)
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Place of Publication
New Delhi 110029
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cation
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REFERENCES
1. Waldron I (1983). "The Role of Genetic and Biological
factors in sex differences in Mortality", in Lopez AD and LT
Ruzicka (eds) "Sex Differentials in Mortality; Trends, Determinants
and Consequences', Australian National University, Canberra,
PP141-164.
2. Rivers JPW (1982). "Women and Children Last : An
Essay on sex Discrimination in Disasters'", Vol. 6, No. 4, pp 256267.
3.
h
United Nations, Demographic Year Book, 1984.
4. Lopez AD (1983). "The sex Mortality Differential in
Developed Countries" in AD Lopez and LT Ruzicka(eds) 'Sex
Differentials in Mortality : Trends, Determinants and Conse
quences', Australian University, Canberra, pp 141-164.
6
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COMMUNITY HEALTH CELL
326, V Main, I Block
Kdramangala
Bangalcre-560034
India
HR
CjJ h - S ’
9^
IS WOMAN A “WEAKER SEX11
The diff ere.nti?,tion of women h^s been a long
and slow process, having its bearing on the changing living
z
condi ti ons, the biological differences, the coming into of
myths regarding instinctive sex into lust, the advent of
private property and consequently monogamy.
It is obvious, those early humans would hardly
be aware of being males and females. They oust be living with arc
emotional and sentimental attachments and solely guided by
their instincts.
The difference betvjeen enrly man and woman would
be no more than the difference between present day male and I
female chimpanzee.
Their behaviour was devoid of complexities of
love, romance. lust or any kind of differences and prejudices.
So it is clear. inspite of biological differences, they’ were
living on equal grounds. Every one was under no ones’ obligations
managing ones’ food,
food. seeking security and safety in trees or
I
|
I
caves, women bearing and rearing children like other inhabitants
?f the area.
The mode of living was changing under the impact
of changing living conditions. They had learnt the art of walk-
ing on hind legs and using hands more dexterously. These
milliuns of years living through "nature red in tooth and claw",
/?rJ
the lack of the knowledge of laws governing nature had engendered in them a fear of the. all power ful and ferocious nature in
the form of natural calamities and -wild beasts, ultimately
leading to the fear of death - an untimely death. This
contributed towards bringing the human beings around considering
— Gc *v.-t
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I
-2-
strength.as the criterion of the age, And thus accepted the
objects of nature as manifestations of strength, power and
superiority. The simple rites to appease these manifestations
of nature were becoming statutes governing those loose social
groups. Further develoment of the human race was accompanied
by the more complex statutes. And with the’origin of property1
some more taboos had to be introduced to achieve the desired
ends such as to confirm woman’s place in the home.
.In the coming years they had launched a planned
strategy, which had been selfish 9 illogical, wrecklessly nauseating to establish her. place in the home on the basis of her
physical structure.
'Women have narrow shoulders and broad hips.
Women ought to stay at home, the way they were created indicates
this. for they have broader hips and a fundament to sit upon,
keep home and bear and raise children'.
It appears in those days they had renounced
rational and scientific thinking and had taken refuse into
rationalization of pseudoscientific approach.
f Martin Luther : a protestant quoted in 0!Faolain and Martines 9
<
...
p 209?
209?:
The main differences between males and females
may be divided in two categories. Invisible and visible difference.
Under the first category we can count anatomical and physiolo
gical and biochemical difference. The biochemical differences
pertain to the presence of certain glands producing desirable
harmones1 for the farther functioning of certain organs of the
body. Under the second category outward appearance and physical
structure is considered.
Anatomically differenting the reproductive system
L
in males. the doctors confirm the presence of testicles to
produce sperms., In females there are ovaries to produce eggs,
falopian tubes where fertilization of the egg thkes place and
the uterus where the embryo develops. Stimulation of certain
glands in a female
produdes harmones to instruct her
body
i
W'
-3-
for milk production.
The period of puberty is full of hazards, stress
and strain for all but physiological changes are more prominent
and problematic in a female 9 the breasts start swelling. ovaries
start their function and monthly periods also start. Menstruation causes uneasiness, in some cases they feel nausea, for
others there is pain in the lower parts of the abdomen, for
others there is giddiness and lethargy. So many many troubles
are associated with it. Moreover, a continous bleeding for
four-five days causes a great deal of temporary sickness for
this period. But it is an important phenomenon in reproduction,
and for a layman. may be explained as a process through which
the unfertilized egg and the layer formed inside the uterus
for the growth of the embryo through physiological changes
are discarded or throwon out.
’Although through babyhood and through infancy
she has been sturdier and heavier and stronger than the boys,
at puberty the female- really becomes ’weaker sex’ for a time,
less resistant to illness than the male and actually more liable
to premature death’ .
We know, through medical science, puberty and
menstruation should hot cause such hazards as declaring woman
a ’’weaker sex”. But it actually is : malnutrition, prejudices
of society towards females worked through myths. customs.
and
established values cause such problems.
In the middle ages it was believed that in the
reproduction process womans’ function was passive where as tlie
man supplied with stronger and active element. And the foetus
was produced through menstrual blood.
’Aristotle fancied that the foetus arose from
the union of sperm and menstrual blood 9 woman furnished only
passive matter while the male principle contributed force 9
activity. movement, life.’
-4-
Aristotle might have predicted, it because woman
has not been physically so strong as
1.,
.man and in his time
Importance was attached to the display of physical strength*
•Man’s visible vigour was straight way associated with the
-
reproductive function and woman was given a passive role, where
as woman’s part in this painful function is more serious,
. difficult, consuming, painful and full of stress and strain
causing physical as well as mental hazards.
In the reproduction process male and female
both are equally Unportant. Male is to supply the sperms for
the fertilization of the egg produced in ovaries. The fertilized
egg develops in the uterus for about 280 days where the process
of its development and growth causes a great dedlt of physical
hazards, weakness, stress and strain to the mother. The word
ii
confined” has rightly been used for a pregnant lady* It
literally means imprisoned and there is no doubt a lady remains
in a state of imprisonment through out her. pregnancy.
So in the eyes of our society reproductive
function is considered as another cause for her second stature.
She, when pregnant or in her period, can’t work like man,
’while
not becoming a fellow workman with the labourer, she was also
excluded from the human Mi stein’ .
Man should not be allowed to go free so easily,
he must realize his responsibility towrads the woman and his
child to provide her with all the facilities to compensate for
the all time and energy consuming reproduction.
At the same time society can’t be allowed to go
scot free , responsibility ultimately falls on the prevailing
values and customs in our society.
In reproduction function both the parents play
important role, each one is to supply 24 chromosomes. The sex
cell of males have 23 pairs and two singles one ’X' and second
’Y’. The sex cells of females have 23 pairs and two ’X’ chromo-.
-5somes.
of the male combiness with the ’X1 of the .
female the off spring will be a girl. If the ’Y’
of the
male combines with the ’X’ of the female the off
spring will
be a boy.So it is easily seen how for
a woman is responsible
for giving birth to a girl. But the wrath of the
society falls
on the mother who bears girls and man goes free. He is no t
blamed for the birth of a girl.
It has been confirmed that menstruation is necessarily
a process for reproductive purposes, but such
an oozing o f
blood is no where seen in man,
So man unleashed this anamoly
as a weapon to ladawoman down.
Even so informed a man of the world as Pliny wrote
"If a woman strips herself naked while
she is menstruatir:-?
and walks round a field of wheat, the earthpills,wormsr
beetles, and other vermins will fall off the ear
11 - “"uans .uiting women were forbidden to enter the sugar refineries
in northern France because "there presence will turn sugar
black.
There are some of the myths engendered to humiliate
women. Myths on analysis give no facts but whims
So man did
not establishthese views on his experience but it was his
wishful thinking. And these myths help to maintain
order of the world. There are not’
the desired
rational but rationalizations’
And appear correct and appealing to unquestioning m±indo
In south India a woman in her period is not allowed
to enter
the kitchen. This is not because
people are very much considerate
and realise the hazards of the period hit belt.ave like this out
of the religious prejudices . They do not know that 'Menstruation
is only a manifestation of frustration
of the entire cycle when
l the egg can not be fertilised;.
There is no denying the fact that
male and female difference
lies in the physical strength, Man is usually well built
and have
power packed and distinct nuscles.
-6’Sex disparity in strength is understandable when we com
pare the sum total of muscles in man and woman. An average woman’s
muscle weigh 15 kilograms less tha± one third of her total 55.3 kg.
weight. A man’s
are 26.1 kg. considerably more than third ..of
his sixtyfive kilograms weight’ •
Girls throughout thetr life are not allowed to take part
in activities necessary to increase their physical strength. This
pr
ice has been prevailing from times immemorial, according to
sci.enctifice laws, the limbs rarely and unvigoi*rously used remain
underdeveloped. This happened with half of the world population. But
in this machine age. physical strength counts the least and every
job a man can do on a machine, can be done by a ‘wmman with the
same ease and alacrity.So the differentiation of male and female
on physical bas&s
is becoming immaterial. But where womsn work
with mennot on machines but perform physical labour women remain
less paid. At the same time men who. are weaker than other men are
not treated as sub humans. So physical strength is selfishly
used as a criterion for male superiority*
One more weapon in the armoury of society used against
woman is the myth of her being less intelligent than man, on the
basis of differen± sizes of brains in males and females.The question
of size of brain has often been raised to show inferiority of woman.
It is fact that woman has a brain smaller in size thaA that of man’s
brain but pseudoscientists have been strongly using this fact as
propaganda against woman. however, it is a common occurance that
bief .aloes do have big brains as compared to the brain of a women
but intellectually they are more inferior to her. Theolang has
attached thhs rryth : ’ A baby’s brain is immensely greater relative
to body size than an adult’s brain. A baby’s brain is some 15% of
baby’s body size as compared with the adult brain 2i % of body size.
By the sixth year of life an infants brain has reached
Ninty percent of weight it will have vin adults.isThe size of the
baby’s brain, however, is no indication of baby’s intellectual powers
-7-
It clearly infers that the exercise and not the
size of the organ (brain) counts much. At the stage of infancy
the brain remains iiunexercisedn hence low intelligence, but
with time one learns to exercise the brain properly and in
such a way as to show maximum understanding of the abound
world. The same view has been upheld by Chrisline di Pisan
quoted by Simone : ’The quaixel went through the fifteenth
century, until for the first time we see a woman take up her
pen in defence of her sex. When Christine di Pisan made a lively
attack on the cleries in her Epitre an Dieu d’ Amour, Later
she maintained that if little girls were a$well taught, they
would understand the subtleties of all the arts and sciences
as well as boys.’
Now there should remain no doubt regarding inferiority
of woman being established on the basis of smaller size of brain.
’One. of my researchers, after collecting findings
from phychologinal and sociological studies of comparative
male and female intelligence, has reached the conclusion that
in general women are more intelligent than men, or, at least
that more women than men achieve average I .0. ’
Womens’ inferiority in mental persuits has been
challenged.and proved incorrect and false, myths have rationali-
sed it and have fixed women as ’’second sex”, yet this notion
remains
unchanged in the minds of a majority of the population.
The values have been fossilised in our brains and women them-
selves are aware of these imprints and as a result have fallen
prey to inferiority complex. This is the only tragedy.. Men
who are the staunch supporters rather prime movers of such
thinking can only be changed if women assert and give voice
to their cause entheusiastically. But as per the prevailing
conditions it will take strenuous efforts on the part of women
to get rid of this complex. In the present set up the problem
-8stands as it is : men cannot free themselves from the shackles
of customs, traditions and values.
’’Belief in the innate, general inferiority of female
intelligence has long since been discarded, tut belief is quite
persistent, even among college students”.
Woman's’ weaknesses please men but her strong points
disappoint him and to show his superiority over her; concocts
stories as can degrade her. Womans’ proficiency and superiority
in verbal tests becomes a basis for his venomous vapourings
against her. Woman, it is strange, accepts and takes mans’
weaknesses as his qualities but society is not prepared even
to recognise her strong points.
A foot note in D/O.Hbbb’s”A Test Book of Psychology n
says that ”girls do better in verbal tests, boys with mechanical
spatial and qualitative ones, Males who are inclined to think
that verbal skill isz due simply to talking too much, may be
reminded that language is mans’ distinguished mark as a species.
The lower animals.also do better with non*-ver§al tests”.
The differences happening to occur in standard of
achievement in women is because of. the lack, of opportunities,
.-e/,
lack of education, lack of self confidence and the prejudiced
attitude of the society--.and part played by values and myths
in propagating and enhancing the gap*’
soc i.al pr as sur e
not genetic differences, is 'the efficient, cause of -girls7
inferior status’
Society has projected such values as to help present
woman as a ’’weaker sex”; femininity as a ’’prolonged infancy”.
These phrases are used to bring forth the emotional and
sentimental instability of woman. It is said with pride that
she is liable to hysterical out bursts, easy crying, tears
role down her cheeks so soon. But man does not endeavour to
know that such a timid behaviour in women is the doing of his
own forefathers and his also. ’
all her eagerness for
-9-
action whether physical or- spiritual , is instantly thwarted.
It is understandable that she can hardly regain her equilibrium#
Her unstable temperament, her tears, her nervous eries 9 are
less the consequence of physiological ..Reality than the evidence
of her profound maladjustment1.
The concept of ’’weaker sex" is actually more
appropriately applicable to man rather than to woman. V/oman
endures stress and strain better than mana Though woman has
less physical strength than man4he- undergoes the difficulty
and painful ordeal of child birth easily. She comes out
through sickness, mental strain, worldly worries and other
■?
difficulties more easily and less broken than a man can. Even
then she is called a "weaker sex", it points to the prejudiced
attitude of society towards her.
'The truth is 9 as doctors and psychologists confirm.9
S'
that the average woman can endure more mental and emotional
stress than a man can endure without mental or physical break
down'__
M'en are three times more liable than women
to be afflicted with stammering ______ we shcuU also note
that a woman is less likely than a man to become ' cr^ at
least in the more extreme meaning of the word,
Man's muscular power and his efficiency in feats
to display his power and metlle don't come to his help in
illiaess or in emotional disturbances. Endurance plays a vital
^ole in the expectancy of longer life. That is why women live
longer than men.
’The latest statistics show mans' life expectancy
is now 67; womans’ has leapt to 72.’ Inspite of this, the
society has used all the weapons to present woman as timid
and maudlin by associating "emotions” to her and "reasons" to
man. Had it been true , howmore men could go mad; come out
wreck through illness and have life expectancy lower than
woman. It shows the assiduous design of the society against
women.
-10-
Woman servitude has been enacted through political.
economical, social and cultural traumas. And through exaggerated.
biological differences-she has been intrigued. These over
t
wrought biological differences have been used most vehemently
and strategically for instituting prostitution. And through
this falony they have shattered the sanctity of human rights;
consequently proving his longing for promiscuous relation.
It is evident that woman has less muscular power,
has more endurance, is less susceptible to physical and mental
bneak downs, has more life expectancy, can part take in all
kind of mental work a man can do. But it is a shame that a
woman, not a man, is treated as a "second sex". This shows the
malign intention of the society to keep itself divided in two
halves : the superior and the inferior on the bases of sex.
1
her behaviour not only explains what
she is doing, tut indicates that she does it by the grace of
her superiors1#
*
30 CHILEREN DEE EVERY MI NOTE
I
$
I
# UNITED NATIONS 9 May 9 (UH) : Sweden has said that 30 childre:
4
'# die every minute because of lack of food or vaccine while in
$
1
zV
the same time span $1.3 million in spent for military use.
X-
■r-
&
-x-
*
I
The Swedish delegate, Mr. Britta Theorin, tild
l-K-
-X•X-X-X-
the U.N. disarmament commission yesterday that"the cost of
5X- one modern nuclear, submarine corresponds to the educational
I
x-x- budget of 23 developing countries with 100 million children
of school age”.
*
$
xX-
II
nEven in some of the world’s richest countries,
poverty and social misery are increasing in parallel with
x| military spending”.
*
*
*
*
*
*
I*
*
*
She said. : "The enormous resources spent on the
* military have not provided more security. On the contrary
y
f the world is buying less and less security at an ever mcrea^-g
J ing price".
("TEMES OF INIZA" - 10.5.1984)
|
f.,^*#****.^*****^********************************^*******^**^***
I'i
(11)
ARTICLE-25
The Shromini Akali Dal has put forth a
demand before the Centre Government that Explanation*
of the Article 25 of the Constitution of India may bi
deleted*
This demand has also raised some controvc .'y
about the right to property of Sikh women,
But on
close examination of this article it becomes clear that
it has nothing to do with the property rights,
The
article as such from legal point of view is discussed
here.
However, we would appreciate the comments of
the readers on the demands of change in the Article
and also about the validity of the alleged implications
of the Article 25 with its Explanation-II.
What Is Article 25 With Its
Discordent Explanation-II,
-m—at se-; uk.
.-k-;
-sx.-, _jk
ke -utu-jks-c»_
ratr 19
The Constitution of India has 395 Articles."
Part III of the Constitution containing Articles from
12 to 35 deals with the Fundamental Rights. Article 25
provides freedom of conscience and free profession,
practice and propaganda of religion. However, such
freedom is subject to State control on the grounds o:
Public order, Morality and Health.
Then clause(2)
of this Article empowers the State to Legislate Laws
(a)
Regulating or restricting any economic■
financial,politicial or other secular
activity which may be associated with■tee
reigious practice.
(b)
I.
II.
Providing for social welfare and reform.
Throwing open of Hindu, religious institutions
of a Public chracter to all classes and
sections of Hindus.
The expense of this article is further explained
through two Explanations which are;
Explanation I.
-y
Explanation II.
The wearing and carrying of Kirpans
shall be deemed to be included in
the profession of the Sikh religion.
In sub clause (b) of clause(2) the
reference to Hindus shall be construed
as including a reference to persons
professing the Sikh,Jain and Budhist
religion and the reference to Hindu
institutions shall be construed accordingly.
1
■«
-
■
(12)
OBJECTIVE OF THE NXPLAIIATIOL-II
Explanation-II is an extensive provision.,
doe^s not dbfine either Hindu or Sikh Or Jhin Or Bu" -Sfc.
a.Sai£PpjLicat?-oh. M.
explanation is limited only
■ a.l££d;1^i£ur'W3'l£ttP ep41113e fdmJ this extensive
n
-'-ied A.rapnyEpr any other purpose«
loos iou:#fectvfhfF^ expla^tion]-.!! the power's of the
Government in framing laws relating to Hindus( on tie
matters of social reform and welfare or throwing open
oi temples) are extended in their application of those
laws to the Sikhs,Jains and Budhists religion and their
religious institutions.
Question.
Whether the Sikhshave been considered
Hindus due to explanation II and thereby
independent entititr of Sikhs have been
denied. ?
Answert
Explanation I of this very Article negates
this assumption, wherein the carrying and
wearing of kirpans has been recognized as
the part of uikh religion only to the
exclusion of Hindu/Jain|Budhists.
V/hether the personal laws of any religion
spring from the Article 25 .?
Although the objections of the Akal^Cs is
not to- whole of the Article 15 but only to
its OXplanation II wiiich cannot be justified
by anny streethe' of•imagination to be the
source df any Personal Law. The only laws
Question.
Answer.
u.LnzH Gj . c
)OO£. bCH.JGJ •'.
wnich can be Legislated by virtue of this
Article, read with its explanation II hare
those which have been enumerated above
0
JSWAAN.
pF .INDIAN WOMAN;
ON 23rd MAY MOUNTVEREST , TRE
THE SKY LAND OF THE WORD
WAS UNDER THE FEET OF BACHHENDRI
l.D.E PAL AND INDIAN- WOMAN.
WOMAN NAS TRAMPLED DOW
DOWN
~ EXULT GREATLY THIS
AND
T4Ao rvr-> -r^-r-r
WITH THIS PERFORMANCE
^-CALN -LuTNEHED . THE LATENT
THE INVINCIBLE TOP.
WE CHSIEI-I
CHEISH
— — ————— ■ ——• ~ w—i—
_l
i
q
POl’ENTIALS OF WOMANHOOD.
WE. OR BiCHALF OF ALL THE WOIWDOM Fj^LICIT/TF THTS
COURAGEOUS-COURIER OF THE HILL-TOPC~
0
■f
’ .. . .
£
t
_BREAK THE CHAENS
_Fury Abroad ; An American Woman speaks
The main slogan for IWD
really struck a deep chord in me. A lot
has to do with women don’t
get angry; they are not supposed to get angrythey ar
aught that
don t get angny; they don’t express it. They
don’t g l angry they wom^n
get humiliated?
-hat s vhat you do. You make excuses
for the
"son. You blame
yourself, you internalize your anger.^Good” women
don’t g<-<. angry. Rage, I feel enraged with
the whole structure that
allows .-’ll this contempt to continue
against women. Women are subservient^
v/ornen are property
9 women are to be used and discarded
9 or stupid or
not important 9 they are caretakers of
property and children and of course
aie tnemselves property. womnn are
supposed to be part of a man. Your
purpose as a wewan is to be ”
coupledwith a man for the
purpose of raising
c Idren and
staying home... • You never
enlarge your brain in any way, you
never enlarge your brain am any way,
you# never think. You never have
tn think. YOu have
no chance to think. To
emantiidpate v/omen
J
isolation of the home is very important.
+
T *~
'—
The "Christian Case
Against V/Oment?
was absolutely wonderful. It •was so repulsive and
enlightening^
especially the philosophers, Aristotle
and Olatc . I don’t know what
I would have expected but it's ready
disgustin Jheir upfront
superiority, that
women are slaves and destined
for sub jo rajion*
T’\e fact that
- our children don’t belong to us,
that point. That’s
rearly heavy because
it’s true. Children are
programmed from birth on to
take theii image from television
. books in the library and schools.
The
Schools constantly indoctrinate ■
them to be submissive
to authority, to not
question authority 9 to ’’respect
a government not because it helps
you
tut because it is and
you can’t fight it.
Battered women — which I
am one of -
represent all women. All
women arebattered, some get brutalized
physically and mentally,
sexually,
emotionally. Tihey are just
constantly put down overwhelmed with
drudgery'and not hope 9 no outlook,
constantly told that they are really inferior
9
that they are scum And that they have
no right to want anything and
that if they do, they’ll
fi-ght and fight and fight for it
and they still
14-
won’t get it. They won’t get anything, not under this system. It’s not
possible. Women gotta really understand, this on a gut leveib
in
addition to an intellectual understanding, /hen, only then, will their
fury be unleashed.
They can’t get equal treatment, which is in' itself disgusting
and degrading. Who wants equal treatment?
But the point is that women
^T-|------------------------------■!
’■! I»«r
(■■■■■MMi
■*■«>■ « iWMarM
can’t even get th at under this system, I say who wants equal treatment
wants to be treated like the poor oppressed men of this
"kecause
society. I don’t want to be treated like that. I want to be treated like
-
. .
—
tJ.
.
II
I
I ■n—1 !■
■ I I
I I
I
■
omsr
■
Win
(,| ■ ■■■ ■mii.i.hii
11 —mi
i
i.wtnr i
'ii
■■
r«rj iir rwrri’
a human being, ^he men are enlsaved too, they just have more power than
the er slaved women. I won’t want a chunk out of this system. Being a
,
I
--
-
-- -
— I
III
II IB I II
part of this
iii«».
...... ......... ...
—i -IB.
' IB I—
......... .................................................... ■■■»
-w -«|1|,BH— |-B»^»ni» ■r irn^^Bi ,
I.
M»iB«irr»mi|i.n»,» IB. —,1 „ IIBHIBII'w ri-ffII I
... ..^ii—■ B-rw
system is just another form of battering.
I agree that the way this
system is set up, the man is placed .x
■the role of bourgeois in the home. The man is so oppressed and he’s
given the license to opress women. So the hierarchy continues
power. 'The man has his own
little kingdom with
of unfairr
his own little slaves .
And once he leave his little kingdom he is constantly reminded that
they is a bigger kingdom out there that vzill crush him so he returns to
his own little kingdom and is a tyrant. He batters the women 9 he batters
the kids because when he goes out lie’s on the front of a war
1 feel. there’s a war going on&, we are
*
The way
in a war. It is a war being
waged against the powerless by the powerful. Most of the powerless
dont’t even know there’s a war going on. They are being sacrificed
every day to keep this war machine going on. There is such disregard
for human life by the powerful.
Che whole domestic violence ’’Problem1’ is an important part o
many v
. n’s lives. The frustration of the meaningless lieves that
men li\ e are dumped onto the dwmen who dump their frustration on the
kids v
grow up and continue the cycle. It’s set up that way. It’s
an issue that government perpetuates. The government!s position is
its too much trouble. Who cares about women? It’s a woman’s issue 9 who
gives a shi£ ? It’s just a bunch of women being beaten up. Battering
in this system is the leading cause of injury for American womlen. The
laws protect the batterer ' more than the battered
If a woman kills a
r
-15-
4
5
man who repeatedly beats her sho goes to jail. She’ll be on trial, not
him. Just like Leslie Emmiek. o.' hen she killed her oppresser, her husband
her torturer--only be to be enslaved by the larger oppression of male-
dominated judicial system that dares call her a murderer. They certainly v.’Oi.
would not want people to think that ’it’s alright to kill your oppressor.
The system is absolutely behind all the violence in the household and the
mounting number of rapes, Tpe system is set up to keep women chained,
there is no real alternatives under this system.
omen who talk about wanting to make it better under this system
need to grasp that it’s not possible in this system
itfs an illusion
that there are alternatives. The only thing to do is eliminate this
system, it’s got to be torn down. Hopefully many women will read this
sue. there are many articles women can really relate to and really sort •>>
of understand a little more how deep it all is, how it permeates every
part of society to oppress women. And this issue didn’t even have to
touch on the powerfull impact of the media on telling women to make
themselves better. more desireable. etc, so that more profits can be reapfeu
reaped out of women’s despair and feelings of inferiority, and subordi-
nation. The media devalues both men and women. Women are objects to be
owned and men are portrayed as so stupid that the only thing they want is
the pfeece of meat. Give a man a beautiful woman an he’ll go to work
supporting the system for the rest of his life.
Another good point the Black sister made was that never again would
she rerreat back into that life of drudgery and be kept in the dark about
why this shit is going on, And how her 15elders" always told
her that
she ju.: t had to put up with it because it’ll never change. And this
keeps people
oppressed, keeps them from seeing what is really happening,
keeps them immobilised so that they are kept from seeing it for what it
is sd that it can be changed. I think there’s a lot of hidden power in
women to be unleashed. And this system does not want to unleash that
powex;, women have been so oppressed forever back in time. You let women
see and feel that they don’t have to be oppressed and you .ve got a
4aremendous amount of rage.
Raise their consciousness--Let them understand the depth of why
that is, that it goes a lot further than a batterer, that it goes all the
way up. And when women can understand their oppression from that perspec
tive, I think again that a tremendous power will erupt to topple rhe
system that con only enslave women.
A Battered V7oman
FTFFAT 0s
Yr
»■
4
*
r
A.,-
(16)
HOTLTgE ■ TO“irARRIOR WOMAN |
sr.-.. Jt--.V3’-fct .1.-stnrt>twu4CT-twar^,rH•fc.—.-m.Tr
MORTALITY OF BIBI AMAR KAUR ON
12th May,1984 IS AN ADDITION IN
THE GALAXY OF THE IMMORTALS. HER
TERRESTERIAL EXIT HAS PLUCKED FROM
OUR MIDST A PATRIOTIC PROFILE AND
-'
..
■
AN INTREPID PROLETARIAN FLAG-HOLDER.
WE MISS BY HER DEMISE A VOICE OF
CONSCIENCE DURING THIS ERA OF MORAL
POVERTY WHEN THE MYOPIC LEADERS AT
ALL LEVELS WEILD POWER FOR CORRUPT
ENDS.
MORE THAN ALL WE HAVE BEEN DEPRIVED
OF A SECULAR BEING WITH EVERY CELL
OF HER- A HUMANIST,EVERY DROP OF
HER BLOOD- A MILITANT,ANTI COMMUNALIST,
EVERY INCH OF HER PERSON-HOOD- AIN .
INSPIRING SYMBOL OF THE NOBEL IDEALS
WHICH INSPIRED OUR MARTAYORS IN THEIR
STRUGGLE FOR FREEDOM,
(Shackles & Women}
- -.i
1 •-
■ -'y
l'
f
Sex Differentials
in Mortality
in Rural Bangladesh
STAN D'SOUZA
LINCOLN C. CHEN
Although in all populations, the sex
ratio at birth slightly favors males, females typically have greater life expec
tancies than males at every age from birth on. Thus, with aging the expected
pattern is a gradual erosion and an eventual reversal of the initial numerical
superiority of males. Because of this pattern, observations in several devel
oping countries, particularly in Asia, of an imbalance in the sex ratio in adult
age groups favoring males have led researchers to hypothesize that environ
mental factors have counteracted the expected female superiority in life ex
pectancy.1 A high level of maternal mortality has been advanced as a partial
explanation of excess female mortality in the reproductive age groups. And
in several populations in which maternal mortality has fallen dramatically
over recent decades, the imbalance in the sex ratio in adult age groups has
been rectified.
But other environmental factors leading to differential mortality l>\ sex
may be at work as well. Anthropologists have demonstrated that in many
traditional societies in which patriarchal lainil\ structure and preferences for
sons over daughters are strong, females and males receive differential treat
ment throughout their lives, with the former being discriminated against in
food distribution, medical care, access to education, and other resources and
benefits scarce in a poor society.
It has been hypothesized that these and other forms of discrimination
257
TT
t,IVi«sjnras«»SMJSSS3C5T’■—
-'->-T-«•
258
SEX DIFFERENTIALS IN MORTALITY IN RURAL BANGLADESH
may shorten female life expectancy, in relation to male life expectancy, at all
ages. But because mortality data for developing countries are unavailable or
of poor quality, there has been little basis for testing this hypothesis. Vital
registration systems are either absent or imperfect, and retrospective methods depend heavily on the ability of mothers to recall accurately child births
and deaths.2 Problems of sex-selective omissions cause reporting biases, par
ticularly in societies where strong preferences for male children exist.3
Data from a district in Bangladesh permit an exploration of the issue of
differential mortality by sex. Because the data are based on a thorough sur
veillance system, they are unusually free of the types of reporting bias re
ferred to above. Since the system has been operating for over a decade, the
precise ages of young children and ages at death by sex are known.
Methods
and Procedures
1
1
jluBh
w
Wi
i
'••J-
The data for the analysis come from Matlab Thana, Com ilia District,
Bangladesh. Since 1963, the International Centre for Diarrhoeal Disease Re
search, Bangladesh (formerly the Cholera Research Laboratory) has oper
ated a demographic surveillance system among 228 villages of Matlab Thana,
containing a population in 1974 of 263,000. The surveillance system includes
regular cross-sectional censuses and the continuous registration of vital
events (births, deaths, migrations, and marriages).
The population of the study area is 88 percent Muslim and 12 percent
Hindu. The average household consists of six persons. Households of patrilineally related families are grouped in clusters called baris, having a com
mon courtyard. Landholding is skewed, with 18 percent of the households
owning 47 percent of the land. About 40 percent of the males and 16 percent
of the females over age 15 years have completed four years of schooling.
About 70 percent of the males and 6 percent of the females are classified as
"economically acti\ e.
Enumeration of regular residents of the study area has been under
taken periodically, most recently in 1974.4 Vital events registration has been
undertaken continuously since 1963. Recording of vital events at the village
level is the responsibility of 290 female village workers (called dais), man}- of
whom are illiterate. These village workers, responsible for an average of200
households each, visit each household weekly and enquire about vital
events. Events are entered in a village registry book, often maintained with
the help of literate relatives or friends.5
i his study presents demographic surveillance data for 1974-77. In ad
dition to demonstrating pronounced excess female mortality over male mor
tality, the data also reveal the abnormally high mortality among both sexes
.
-•I
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--------
259
Stan D'Souza I Lincoln C. Chen
during the flooding and food shortage years of 1974 and 1975. Because the
overall level of death rates was exceptional during these two years, the sex
differentials found are not necessarily reflective of normal periods.
Results
I
■J
Table 1 summarizes the demographic situation with regard to the Matlab
surveillance population in the four study years, 1974-77. For the period as a
whole, birth and death rates averaged 40.6 and 16.4 per thousand population
per year, respectively. The crude death rate for females (16.7) was higher
than the corresponding male rate (16.1). Marked fluctuations of these rates
occurred during and after the 1974-75 flooding and food shortage.6
Table 1
Mid-Year Population and Vital Events
in Matlab, Bangladesh, 1974-77
■?
Mid-year population
Births
Deaths
Crude rate per 1,000
Natural increase
Births
Deaths
Both sexes
Male
Female
1974
1975
1976
1977
Total,
1974-77
263,807
11,316
4,362
259,194
7,622
5,393
260,381
11,265
3,856
268,894
12,485
3,644
1,052,276“
42,688
17,255
26.4
8.6
29.4
28.5
43.3
32.8
42.9
46.4
24.2
40.6
16.5
15.5
17.6
20.8
21.0
20.6
14.8
14.7
14.9
13.6
13.3
13.8
16.4
16.1
16.7
“Person-years.
Table 2 presents infant mortality rates by sex. The rates for both sexes
are markedly higher for the years 1974 and 1975.7 Differentials by sex do not
appear important if one considers the overall infant mortality rates in the
four study years. However, a breakdown into neonatal and postneonatal
mortality rates (i.e., rates for infants up to one month and for infants ages
1-12 months) presents a very different picture. Neonatal rates for males are
significantly higher than those for females.8 Conversely, postneonatal female
rates are significantly higher than male rates.9 Sex differentials of infant mor
tality therefore display a reversal from the neonatal to the postneonatal pe
riod. It also appears that the 1974-75 disturbances affected the postneonatal
rates to a larger extent than neonatal rates.
-■I
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260
SEX DIFFERENTIALS IN MORTALITY IN RURAL BANGLADESH
Table 2
5
Infant Mortality Rat« (per4,000 Uy? birth.) by Year at
In Mattab, BM>gfad«h, 1974-77
I 'lb"
i
,
.97.
1OT
137.9
142.5
132.9
191.8
165.1
184.1
102.9
113.6
110.3
113.7
113.3
114.2
131.2
130.9
131.5
78.1
87.9
67.8
79.9
81.6
78.1
65.3
72.0
58.1
71.3
73.1
69.4
73.0
78.2
67.6
59.8
54.6
65.1
111.9
37.6
33.3
42.1
42.4
40.2
44.8
58J2
52.6
63.9
.................. _
<
(all infants)
Both sexes
Male
Female
Neonatal mortality rate
(infants less than one month)
Both sexes
Male
Female
Postneonatal mortality rate
(infants 1-11 months)
Both sexes
Male
Female
ft
98.4
126.3
KiTable 3 presents mortality data among children aged 1-4 years. Higher
mortality rates are registered for females than males at each age. The excess
female mortality rate for the age group 1-4 years is highly significant. 10
Table 3
Early Childhood Mortality Rates (per 1,000 population)
by Year and Sex in Matlab, Bangladesh, 1974-77
Age
(years)
1
2
1
1-4
n
I
1974
1975
1976
1977
1975-773
Both sexes
Male
Female
31.6
22.9
40.6
47.4
48.2
40.9
55.9
29.9
23.8
36.6
43.10
Both sexes
Male
Female
34.8
38.6
44.4
31.4
46.1
33.0
29.5
23.8
25.7
36.6
32.2
32.53
26.59
38.80
31.7
26.0
37.7
24.1
Male
Female
22.5
16.0
29.2
20.4
18.2
12.6
28.1
24.0
Both sexes
Male
Female
I 1.6
7.7
15.8
18.8
17.2
20.6
15.2
13.0
17.5
10.5
14.83
8.4
12.7
12.86
16.94
Both sexes
Male
Female
25.4
18.3
24.9
28.8
29.6
25.5
19.6
14.5
28.43
23.27
32.9
41.3
33.9
25.2
33.89
Both sexes
4
=|
Sex
38.4
56.8
a1974 not included.
■«-4asT<- - - ■
------------- --
-----
«- .-Her--.
16.1
35.23
51.28
24.36
19.37
29.65
261
Stan D'Souza I Lincoln C. Chen
Figure 1 depicts the direction and magnitude of sex differentials in
mortality for children under age 5 years for 1974-77. The ratios of female to
male mortality at specific ages are plotted. Male mortality exceeds female
mortality only during the neonatal period. Thereafter, female mortality ex
ceeds male mortality by increasing amounts up to age 3 years, when female
death rates are 46 to 53 percent higher than the corresponding male rate.
The ratio declines in the fourth year of life and falls further, to 1.35, for ages
5-14
Figure 1
Ratio of Female to Male Mortality Rates
for Children under Five Years
in Matlab, Bangladesh, 1974-77
-X \
1.50f
-
.
■
1.40
f
................................
’
1.30
?o 1.20 5
CD
5
b
,<D
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.2
re
01 1.00
/
0.90
•X
0 80 -
’
0
1
2
3
Age (Years)
4
5
A
262
SEX DIFFERENTIALS IN MORTALITY' IN RURAL BANGLADESH
Table 4 presents mortality rates by sex for ages 5-14, 15-44, 45-64,
and 65 and older. Higher levels of female mortality are maintained in the
5-14 year and 15-44 year age groups.11 The differentials are reversed for the
two age groups above 45 years. In the childbearing period (15-44 years), female mortality rates are higher than male in 1974, 1976, 1977, and for the
four years combined. Some inconsistencies in these differentials are to be
expected, given the disasters in 1974-75, when migration, which is predomi
nantly male, increased markedly and mid-year population estimates were
likely to be affected differentially by sex.
t-
Table 4
Mortality Rates for Children and Adults (per 1,000 population)
by Age and Sex in Matlab, Bangladesh, 1974-77
Age
(Years)
Sex
1974
1975
1976
1977
1974-77
Both sexes
Male
Female
3.34
3.18
2.78
3.92
3.78
3.13
4.23
2.51
2.16
2.87
3.19
2.70
3.70
Both sexes
Male
Female
3.40
2.84
3.95
4.75
5.24
4.26
2.90
2.86
2.95
2.69
2.36
3.00
3.70
3.61
3.79
45-64
Both sexes
Male
Female
17.46
18.42
16.36
31.02
37.12
24.10
17.84
18.99
16.57
16.53
17.80
15.11
20.24
22.13
18.00
65 and
older
Both sexes
Male
Female
88.75
77.84
103.12
112.58
113.41
111.48
74.64
74.04
76.15
76.15
76.15
88.46
85.72
92.07
5-14
15-44
2.78
3.60
75.43
Table 5 presents data on infant mortality among twin live births for the
four study years combined. Presumably, twins are at higher biologic risk at
birth, but during early infancy, any sex biases in parental decisions—both
explicit and implicit—with regard to the quality of care and level of resource
investment might be reflected in differential mortality of twins by sex. The
data in Table 5 confirm the very high mortality risks among twins, with
overall infant mortality rates ranging from 451.2 to 535.7 per thousand live
births, three times the level for single births. Surprisingly, sex differentials
are not marked during the postneonatal period, when parental care would be
expected to be most critical. In fact, the ratios of female to male postneonatal
mortality rates of 1.21 (calculated for twins of the same sex) and 1.06 (among
twins of mixed sex) are lower than the sex ratio for single births (1.23, see
Figure 1). Overall, these data fail to confirm the hypothesis that, under re
source stress, the male half of twin live births may receive preferential care
in comparison to the female half. It should be noted, however, that the
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Table 5
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Infant Mortality of Twin Births
in Matlab, Bangladesh, 1974-77
Twin Status
Twins of identical sex
Male
Female
Twins of different sex
Male
Female
.
J
Live
Births
Neonatal Deaths
Number
Rate
Postneonatal Deaths
Number
Rate
AH Infant Deaths
Number
Rate
—
212
196
71
77
334.9
392.8
25
28
117.9
142.8
82
82
21
21
256.1
256.1
16
17
195.1
207.3
56
105
452.8
535.7
451.2
463.4
->
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264
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SEX DIFFERENTIALS IN MORTALITY IN RURAL BANGLADESH
differential may be disguised by the very high levels of infant mortality—
essentially 50 percent of all twins die in the first year. Also noteworthy is the
fact that female-female twin births experienced the highest infant mortality
rate and male-male twin births experienced the lowest postneonatal mortahtyrate.
,
The consequences of extreme privation for sex differentials in mortality
can be examined during times of crisis. This is attempted in Figure 2, where
the percent of “excess” female death rates in comparison to male rates is
shown during the food shortage of 1974-75 and during the “normal” years
1975-77. For three critical age groups (1-12 months, 1-4 years, and 5-14
years) “excess” female mortality was consistently higher during the food
shortage years, suggesting that the increased mortality during disaster was
disproportionately experienced by young girls.
The excess female mortality pattern during crisis did not appear to
operate with regard to adult mortality. Higher male than female mortality
for the adult age group 15-44 years was noted in 1975 (Table 4). This repre
sents a reversal of the pattern for normal years. During the crisis year of
1975, net outmigration of adult males was considerably higher than in other
years.12 If the resident male population consisted of a less healthy group
than the out-migrants, this might partially explain the observed pattern.
Table 6 presents data on infant and child deaths for the last three study
years. Data for 1974 were excluded because definitions in 1974 did not con
form to those of subsequent years. These causes of death are subject to con
siderable uncertainty. They are based on reporting by non medical personnel
with no training in identifying cause of death. Furthermore, deaths are not
always due to single causes, and malnutrition can be an underlying cause in
many, even most, instances, although not directly identified as such. A few
important causes of death—tetanus, diarrheal diseases, respiratory diseases,
and measles—however, have been singled out in Table 6 because of their
relevance and the reasonable likelihood of accurate identification. For in
fants, tetanus appears to account for about a quarter of all deaths. Respira
tory and diarrheal diseases are next in importance. Sex differentials with
regard to cause of death do not appear significant during infancy. Since tet
anus is presumably due to unhygienic treatment of the umbilical cord during
delivery and manifests itself during the neonatal period, the lack of a strong
sex differential for this cause of death is not surprising.
For the age group 1—4 years, diarrheal diseases are the most important
identifiable cause of death. Over a quarter of all deaths in this age group are
attributed to diarrheal diseases. Other infectious diseases (respiratory dis
eases and measles, for example) also appear to be important causes of death.
Sex differentials are noted for all infectious causes of death, with female
deaths being consistently higher than male deaths.
Although data for developing countries analogous to those from Matlab
are scarce, model life tables can provide a useful framework for comparison.
!
j
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----------------
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1
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Stan I) Souza I Lincoln ('. ('.hen
265
Figure 2
Percent by Which Female Mortality Rates Exceeded
Male Mortality Rates in Infancy and Childhood
during Period of Food Shortage (1974-75)
and during Normalcy (1976-77), Matlab, Bangladesh
Sit
(
Itosr^r-.:.------ -
|1 Parted^Food Shortase ! 1874-75)'
L-~
[. ■ Normal Period (1976-77)’
■■
Issl
I X;L'S:•=• ' v'
__ _
KSjiSl
I -1 ■
:V..
ffl
w
wWHsBWWP
:
—
BUM
■
■
O’
10 -
I
few
Age 1-11 Months
Age 1-4 Years
Age 5-14 Years
To show how the sex differentials in mortality observed in Matlab diller from
average experience reflected in reliably recorded mortality information in
historical data, we have selected the “West model life tables.13 (Compari
son to sex differentials of mortality in other model life tables would lead to
broadly similar conclusions.) Panel A of Figure 3 shows that the excess male
I
266
SEX DIFFERENTIALS IN MORTALITY IN RURAL BANGLADESH
relative to female infant mortality shown by the “West” model is reproduced
much less intensely, if at all, in Matlab data for the years 1974, 1976, and
1977, while in the crisis year of 1975, female infant mortality is higher by a
gross margin than would be expected from the model relationship. For the
age groups 1-4 and 5-14 years, panels B and C indicate that in contrast tathe
“West” tables, which show a slight male excess mortality, the Matlab data
exhibit consistently higher female mortality rates.
Table 6
Infant (0-11 months) and Early Childhood (1-4 years) Mortality
by Sex and Major Causes of Death in Matlab, Bangladesh, 1975-77
Child Deaths
Infant Deaths
Tetanus
Both sexes
Male
Female
1174
599
575
37.42
37.26
37.59
59
30
29
0.60
0.59
0.61
Diarrheal
diseases
Both sexes
Male
Female
91
50
41
2.90
3.11
2.68
153
67
86
1.55
1.32
1.80
Respiratory
diseases
Both sexes
Male
Female
328
10.45
10.14
10.79
160
66
94
1.62
1.30
1.96
Both sexes
96
45
440
194
246
4.46
3.82
5.14
Cause of Death
Measles
Others
All causes
163
165
51
3.06
2.80
3.33
Both sexes
Male
Female
2352
1180
1172
74.96
73.39
76.62
1992
824
1 168
20.19
16.24
24.39
Both sexes
Male
Female
4041
2037
128.80
126.69
131.01
2804
1 181
1623
28.43
23.27
33.89
Male
Female
•:
Rate Per
1,000 Population
Number
I
■I
Number
Sex
Per
1,000 Live Births
2004
The relative disadvantage of Bangladesh females with respect to the
chances of dying is also pronounced in the age group 15—44 and to a lesser
degree in the age group 45-64 years. The comparisons are shown in panels
D and E. In both instances, 1975 is an exception. An explanation lor the
relatively higher mortality of males in that year could be that in a crisis, a
higher proportion of males in the adult age groups migrated to cities in
search of food and work; as a result, the population left behind may have
been sex-selectively biased in favor of less healthy males staying home and
thus at greater death risk.
a
i
-T
•V
I
i
I
♦
Figure 3
Mortality Rates in "West" Model Life Tables
and Observed in Matlab, Bangladesh, 1974-77
=«
5
'Imo'
<130120 -
I
110 -
I
100
-
.1977
•1976^
♦1975 '
100 -
___ :__
aor,
120
140
Males
1974
•
4.0
160
1974-77
180
1
J
80^
20 -
30
15 -
IQlZl I ill I ! Ill
10 15
20 25 30 35
Males
•1975
S
C. Death Rates at Ages 5-14
4.5 r
• 1975
4.0 -
•1974
1974-77
•.1976
83-5-
I -
3.0 -
2.5
I
25
E
i
1
g
• 1977.
20 -
1974-77
1976
1974 •* /
~V$TIS
10if .
15
I
20
.
I
■
I
25
30
Males
.
I
35
<
I
40
268
SEX DIFFERENTIALS IN MORTALITY IN RURAL BANGLADESH
Discussion
I
(
t
!
This study provides conclusive documentation of higher female than male
mortality shortly after birth through the childbearing^ages in a rural area in
Bangladesh. The higher male mortality rates during tire neonatal jmrfod^
consistent with overwhelming evidence that male biological risk of death is
higher than female, although male excess mortality is less pronounced in the
Matlab data.14 Although most available data suggest that this higher male
mortality risk continues through childhood and adolescence, the differential
is reversed during the postneonatal period in Bangladesh, with female mor
tality exceeding that of males by as much as 50 percent.
Son preference in parental care, and feeding patterns, intrafamily food
distribution, and treatment of illness favoring male children15 are possible
causes of such aberrant childhood mortality differences by sex. In the child
bearing years, pregnancy, childbirth, and induced abortion are obviously
factors in higher female mortality. Furthermore, from the observed excess
female mortality it may be inferred that similar sex differentials obtain also
with respect to illness, malnutrition, and morbidity.
Caution should be exercised in extrapolating these results to other re
gions of South Asia, or even to other regions of Bangladesh. However, the
authors believe that Matlab is not sociologically or demographically unique
in South Asia, and several other in-depth studies in diverse geocultural set
tings have reported findings that at least indirectly corroborate our data.16 In
the absence of contrary evidence, we consider the abnormally high relative
mortality’ of females observed in our study to be suggestive of the conditions
prevailing in many situations in rural South Asia.
Notes
|
1
4
S'
■J
1. Evidence in South Asia of an in
creasing sex ratio (number of males per 100
females) in successive decennial censuses sug
gests the possibility of excess female over
male deaths. See M. K. Jain, “Growing im
balance in the sex composition of India,” De
mography India 4, no. 2 (December 1975):
305-315.
2. United Nations, Manual /V, Meth
od'; of Estimating Basic Demographic Meas
ures for Incomplete Data (New York: United
Nations, 1967), ST/SOA, Series A.42.
3. Stan D’Souza, Sex Biases in Na
tional Data Systems (New York: UN Statistical
Office. December 1978). For example, in sit
uations in which vital registration data are de-
!
fective or inconsistent, the most important
source of information on childhood mortality
is census or survey reports on children ever
l>orn and children surviving. Thus, greater
under-reporting of female children bom who
are no longer alive would result in lower esti
mates for females than for males of the pro
portion of births dead by age 2 years and of
similar measures. When m<xlcl life tables are
used to extrapolate such early childhood mor
tality' estimates to the rest of the age span, an
illusorily lower mortality level for females
than males results. Such a bias methodology
problem may be inherent in national level es
timates. for example the Bangladesh Retro
spective Survey on Fertility and Mortality
(BRSFM), where sex differentials of mortality
■K
I
■f
I
s
*
r
269
Sian D'Souza I Lincoln C. Chen
differ from those reported in this study. See
Census Commission, Statistics Division, Re
port on the 1974 Bangladesh Retrospective
Survey of Fertility and Mortality (Dacca:
Ministry of Planning, 1977).
■
I
1
I
1
4. The field procedures for the collec
tion of the demographic data have been re
ported in several previous publications:
W. H. Mosley, A. K. M. A. Chowdhury, and
K. M. A. Aziz, “Demographic characteristics
of a population laboratory in rural East
Pakistan,” Population Research (September
1970), Centre for Population Research, Na
tional Institute of Child Health and Human
Development; and Lincoln C. Chen, S.
Ahmed, M. C. Gesche, and W. H. Mosley,
"A prospective study of birth interval dynam
ics in rural Bangladesh,” Population Studies
28 (1974): 277-297. These field procedures
were in operation during this study (1974-77).
The data collection system underwent minor
modifications in 1978.
crises in Bangladesh," Food Research In
stitute Studies 16, no. 2 (1977).
7. It should he noted that since the in
fant mortality rate relates infant births and
deaths within a calendar year, acute disrup
tions could artificially influence the rate by
temporary fluctuations of births and infant
deaths. Better estimates could be computed if
cohort rates were measured.
I
-I
8. The following statistics characterize
the reliability of this finding: p < .05, t=2.53,
df=3.
9. P
.0.5, t=2.53, cif=3.
10. p < .005, t=8.75, df=3.
11. In a previous publication, the mag
nitude of maternal mortality and the higher
level of female versus male adult mortality
rates for this population had already been
clearly documented. See Lincoln C. Chen,
M. C. Gesche, S. Ahmed, A. I. Chowdhury,
and W. H. Mosley, "Maternal mortality in
rural Bangladesh,” Studies in Family Planning
5, no. 11 (1974): 334-341.
5. The quality of vital registration data
is enhanced by the organizational arrange
12. Lado T. Ruzicka and A. K. M. A.
ments of the registration scheme. Female vil
Chowdhury, “Demographic Surveillance Syslage workers are supervised by 16 male field
tem-Matlab, Volume IV, Vital Events and Mi
assistants, who have high school-level educa
gration 1975,” Scientific Report No. 12
tion and practical field training. Each field as
(March, 1978). International Centre for Diar
sistant supervises about 16 female workers
rhoeal Disease Research. Bangladesh.
and covers a population of 16,(XX). Field assis
tants, accompanied by the female worker,
13. Ansley J. Coale and Paul Demeny,
visit each household monthlx to check on the
ReHiunal Modi I life 1 ablet and Slable Popucompleteness of registration and to record vi
lations (Princeton: Princeton Universits
tal events on standard reporting forms. The
Press. 1966).
work of the field assistants is checked by four
14. F. W A. Van Poppet
Regional
senior field assistants, who visit each house
differences in mortality in Western and
hold at least three times annually. These
• Northern Europe: A review of the situation in
workers are supervised in turn by a supervisor
the seventies” (Voorburg: Netherlands Inter
and three assistant superxisors, who, through
university Demographic institute. Working
random field visits, check on the quality and
Report no. 13. June 1978)
completeness of the registration system.
15. Among children under age 5, male
6. For more detailed analx ses of these
hospitalization exceeds female hospitalization,
fluctuations and their determinants, see
itself a possible reflection of sex bias in child
GeorgeT. Curlin, B. Hossain, and Lincoln C.
care. Among adults, female exceeds male hos
Chen. “Demographit crisis: The impact of the
pitalization. f his phenomenon has been ex
Bangladesh Independence War (1971) on
plained prcxiouslx by the increased health
births and deaths in a rural area of Ban
risk of mothers who maintain closer personal
gladesh,” Population Studies 30 (1976):
contact with children, who are the most sus
87-105; and A. K. M. A. Chowdhury and Lin
ceptible group to diarrheal diseases [Lincoln
coln C. Chen, “The interaction of nutrition,
C. Chen, "Control of diarrhoeal diseaseXmorinfection, and mortality during recent food
bidity and mortality: Some strategic issues,"
-
270
SEX DIFFERENTIALS IN MORTALITY IN RURAL BANGLADESH
American Journal of Clinical Nutrition 31
(1978): 2284-2291].
16. Susan C M. Scrimshaw, “Infant
mortality and behavior in the regulation of
family size,” Population and Development Review 4, no. 3 (September 1978): 383-403;
John B. Wyon and John E. Gordon, The
Khanna Study: Population Problems in Rural
Punjab (Cambridge: Harvard University
Press, 1971), pp. 193-195; Finis Welch, Sex of
Children: Prior Uncertainty and Subsequent
Fertility Behavior (Santa Monica: The Rand
Corporation, 1974).
J
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'1
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medico friend
124 circle
bulletin
JANUARY 1987
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Use and Abuse of Bio-Medical Technology
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(Amniocentesis-A Case Study)—Amar Jessani
Prenatal testing to determine sex of foetus has
recently created a big uproar in India. Two Bombay
based organisations-the Forum Against Sex Deter
mination and Sex Preselection and the Doctors Against
Sex Determination and Sex Preselection-with the
support of other like-minded women’s and health
organisations all over India are spearheading the
campaign against this nefarious medical service to the
extreme patriarchal practice of selecting the male
offsprings and eliminating the female ones. In a
short time span these organisations have fairly succee
ded in creating a sizeable informed public opinion by
organising a series of demonstrations, dharanas,
meetings, workshops etc. and by writing and giving
interviews in the English as well as the vernacular
press. Many of the members and sympathisers
of the Medico Friend Circle in Bombay are
actively participating in these efforts. The pressure
created by this campaign has started having its effect
even at government level. A private members’ bill,
sponsored by the opposition as well as the ruling party
MLAs has been introduced in the Maharashtra
Assembly.
The bill is for enacting a new law to
comprehensively ban sex determination at the prenatal
stage using any medical technique. It does not ask
for the ban on the prenatal medical techniques as such
but demands that the use of such techniques should be
restricted to the detection of medically recognised
foetal abnormalities, and even in such use, the sex of
the foetus should not be communicated to anybody
either directly or indirectly. The Union Govt, has
also issued statements saying that it does not approve
of female foeticide. And lastly, in response to all
such pressures, the Maharashtra Govt, has appointed
a committee under the chairpersonship of the State
Health Minister to make recommendations to the
Government in this matter. Significantly, several
members of the Forum and the Doctors a-e appointed
on this committee providing an opportunity to these
organisations for proposing comprehensive measures
to ban the use of medical technology for prenatal sex
determination.
Response of established medical profession:
The established professional bodies of doctors
initially pretended to be totally unconcerned about the
debate on the doctors’ collusion in female foeticide.
But the campaign soon made inroads into their do
main as it started gathering support of socially con
scious doctors. Further, the campaigners, instead of
going for sensationalism, came out with well research
ed information on the extensive use of these techni
ques not only in the big cities like Bombay, but also in
the smaller towns all over Maharashtra and other
states. Thus, the spokespersons of these professional
bodies were driven into open debate. The points they
raised in support of the practices of sex-preselection
and sex determination require serious examination as
the ideological basis of such arguments, has wider
ramifications.
First let us enumerate some of their points: (1)
Many doctors feel that it is none of their concern and
at best, it is a social issue (2) The techniques employed
for sex-determination are less dangerous or hazardous
than the danger involved in crossing roads in urban
centres. (3) They are catering to the psycho-social
needs of people by making known the sex of the child
and allowing the people to make their own choice
(4) Main culprits are people who go for abortion of the
female foetus. That is, society is at fault, not the
doctors. (5) Social activists should direct their fire
at the society, its traditions, customs and values, and
not on the medical profession which is making an
effort to cater to the needs of the people as cheaply and
as safely as possible. (6) Well, it may be a bad thing to
do, but people are justified in desiring a son after 3 or
4 daughters. (7) Some crude spokesperson justify it
in the name of helping population control progra
mmes of the government. (8) As such women are
maltreated, deprived of nourishment, suffer more
from diseases and burnt alive for dowry and so on.
Not allowing them to come in this world to suffer
such indignities is a human service to the women.
(9) Lastly, this is more vociferous, the govt, has al
ready legalised foetal killing by liberalising abortions.
If such foetal killing is ethical, why not female foeti
cide? Thus, if sex determination is to be banned,
then abortion should be banned, too.
medical angle. Yet, they do not seem to recognise it
precisely because as professionals they directly or
indirectly regard themselves quite apart from the
society in general. Thus they say that it is society
which is at fault and not they. If society allows one
practice (here abortion) another will follow (sex
determination). Such arguments can, at best, be
considered apology for their own mal-practices or at
worst, their criminal collusion in supporting the evil
practices in society. When taken together, however,
it indicates not only simple apology and collusion
on their part but a definite self-submission to the
ideology of patriarchy. This only adds to the fact
that the values of the medical profession, when exa
mined in the context of their practice and not merely in
their code of ethics, are the values of the society at
that point of time. And therefore, the medical pro
fession is neither apart from the society nor their
codes of practice is given once for all. This view, I
know will not be palatable to even many progressive
doctors, however. But this is only a generalisation to
underline the need to struggle for the better and human
code of ethics, a struggle which goes hand-in-hand with
the struggle for human liberation in the society at
large. In this sense, the success of the campaign
against prenatal sex determination will be a gain for
the larger struggle,.
What is interesting to note about these arguments
of the established section of medical profession is that
all of them, barring one about the hazards of the
technique, are socio-political-economic arguments and
not medical ones. By medical I mean the rational
justification for the use of a therapy or diagnostic
procedure based on the medical indications found in
the patient concerned. Thus, it is clear from the above
that we are not dealing with any controversy surround
ing what is called ‘medical treatment’ and all that goes
into determining rational medical treatment for the
concerned patient (that includes clinical examination,
laboratory investigations, etc.) But we are dealing
with another aspect of the medical practice, what is
considered the provision of ‘medical service’. That
is, medical profession providing service to a normal
human being in response to his/her need or demand
which may not be a medical need or demand.
Now elaborating our earlier points further, the
medical professions’, attitude of considering itself
separate and above society has many implications. In
doctor-patient relationship its reflection is simple—
the doctor knows better and the patient must ulti
mately accept the line of treatment prescribed. In
many countries this type of paternalism is being
challenged and patients have even dragged doctors to
court. But in India, the patients are almost absolu
tely vulnerable to doctors’ paternalism. There is no
Patients’ Bill of Rights in India.
Readers should recognise here that I am using
these terms ‘medical treatment’ and ‘medical service’
in a very narrow sense. In doing so I have no inten
tion of granting unlimited paternalistic privilege to
the physicians for taking arbitrary decisions in the
‘medical treatment’ aspects of their practice. Much is
written about ideology in the ‘medical treatment’
itself and about its commercialisation as well as the
question of human rights in it. Therefore, we will not
elaborate it here, on the other hand, the ‘medical
service’ which, as we have defined it in the narrow
sense, is purely ideological and socio-political.
At societal level, this paternalism of medical pro
fession takes oppressive and idelological shape. The
professional bodies take care that any critical opinion
on the practice of medicine coming from a‘ non
medical person is adequately discredited and suppress
ed. The professional organisation(s) of doctors are
indeed the most powerful organisations almost every
where in the world. Another aspect of their paterna-,
lism is to consider themselves fit to give their opinion
on all “non-medical” problems of society. Not only
to give opinions, but give a “solution” to the problem
being discussed. Therefore, for many of them the
pre-natal sex testing is a “medical solution” to the
social problem of women’s oppression. Thus .they
put Virchow’s famous statement “Politics is nothing
more than medicine on a grand scale” upside down.
Ideology of medical paternalism :
As I pointed out earlier, given the type of medical
practice involved in sex-determination and sex pre
selection, the established medical profession is hardly
able to produce a single argument strictly from the
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Meaning thereby that for our established medical
profession, the long lasting solutions of health prob
lems of people does not rest on the need for deeper
political change (as Virchow postulated), but the
professionals being part of the established oppressive
political nexus, they bring the oppressive communal,
casteist. sexist and capitalist politics at smaller scale
in their day-to-day medical practice.
In this context one must recall the role physicians
played during the Nazi holocaust. It has been firmly
established after the famous Nuremberg Trials of the
physicians, and the extensive documentation done on
the role of physicians, that the German medical profes
sion at that time could no longer escape from its responsibility by saying that it was coerced by the fascist state
apparatus to medicalise slaughter of certain races of
humanbeings. The fact is that a large section of German
physicians willingly accepted the Aryan Supremacy
doctrine of fascism and it devised medical means to
attain racial health by eliminating the non-Aryans.
It was indeed the self-submission of German
medicine to fascism that shocked the liberal opinion
of the medical world.
Without being unduly pessimistic, what I am trying
to point out is that there exists a dangerous trait in the
arguments of the established medical profession.
These arguments, along-with the actual practice of
eliminating female foetuses, seem to be just a beginn
ing of another self-submission of the medical profe
ssion, but of generalisation of the sexist, communal
and casteist oppression throughout the country. In
this generalisation, the lives of “undesired” commu
nity, caste or sex seem to have no human value. It
is only a matter of time that this dangerous trait, re
flected in the killing of minority community persons
in the hospital compound, refusal or reluctance to
treat minority community caste or community victims
of riots, doctors and police collusion in the bride
burning cases, doctors' collusion in torture of political
and criminal prisoners, doctors' participation in forced
sterilisation and so on, become a medical justification,
a medical solution to society’s problems. Fascism
made doctors to translate the fascist genocidal theory
into the terminology of hygienics (racial hygiene);
communalism, casteism, sexism and capitalism have
similar potential.
Thus, the fight against sex-determination and
female foeticide practices in the medical profession has
wider ramification. It should indeed be regarded as
the beginning of wider struggles that progressive doc
tors, women, dalits, minority communities, political
activists etc. will have to undertake to fight against
oppression at every level, including at the level of
i
J
Can the existing code of medical ethics of the Medi
cal Council of India help socially conscious doctors to
initiate such a struggle? Or is it too inadequate to help
us in bringing some sanity in the medical practice?
Or is the “medical service" aspect totally beyond the
framework of this> or any code of medical ethics?
Even if some progressive clauses are there in the code,
is it possible to use them for the benefit of the victims
°f medical profession when the regulatory body (the
Medical Council) itself is dominated by the established
medical and political interests? Should organisalions like the MFC make the existing medical pro
fessional bodies also a terrain for their struggles? On
this question of pre-natal sex-determination and
numerous such other practices how can debates, edu
cation campaigns, agitations etc be initiated?
When I thought of writing this article at the time
of mid-annual meet, I wanted to give partial answer
to these questions, for I believed and still do believe,
that the question of pre-natal sex-determination can
not be summed up in a for-or-against position, nor
it is as simple as to say that it is just a misuse. On
the face of it, it is indeed a misuse of medical techno
logy. But this ‘misuse’ is deeply rooted in the society
and the ideology-and that also concerns the medicos.
That is to say that medical ethics are rooted in the
social reality. And hence, when I started writing
this article, I realised that it is difficult to evaluate
medical ethics and the question of human rights in
health in one article. While discussing pre-natal sex
testing, this article only poses the issue. I hope to
continue this discussion and request others to also
contribute.
For back issues of the bulletin, mfc publications
and organizational matters contact:
Dhruv Mankad
MFC Convenor
1877, Joshi Gali,
Nipani-591237.
3
I 0
medical practice. To all working in the field of health,
these dangerous aspects of the ideology of medical
paternalism must be
made clear so that while making
-----------------health care available to people they are better equipped
to fight against it.
In the cleft of t|ie stick
With reference to the on-going nurses agitation in
the capital, vre reproduce below an article carried recent
ly by the Hindustan Tinies. We invite readers to give
their own comments on the in particular and the article
in general so that a debate on paramedicals, their sole
and service conditions can be initiated.
The role of nursingmtoday has undergone
a drastic
rhanap
"
nge From the old passive concept of looking
after patients m hospitals and dispensaries to the more
constructive one of preventing disease and promoting
general health in the community. Hospitals are
traditionally the domain of doctors who diagnose and
cure the stricken and the diseased. If nurses are
liberated from the confines of hospitals—the very
basis of the concept of primary health care—they will
be able to play a more active and meaningful role in
community life.
given the opportunity to do so because doctors did
not feel the need for overqualified nurses who could
threaten their dominance. But at stake, she asserts,
is welfare of the patient, and for this the involvement
of the nurses in policy-making is imperative. TNAI
feels that nurses should be provided avenues for
continuing education and advocates a system of
sponsoring candidates for long and short term courses
from every institution, with leave and financial asssilance for post-graduate studies.1
At present nurses find higher studies an uphill task.
Most nurses in Delhi hospitals said they needed the
written permission of the hospital to sit for an exami
nation of service, or else the would face termination
of service, or their confidential reports would
be ruined. One of them confided that she did a twoyear diploma course secretly in her own time (through
earned leave) because the hospital was unsupportive.
Unfortunately,while this potential of nursing for The diploma, however, could not be entered in herserthe good of the community has been acknowledged[ vice book. Such a situation is contrary to the reand the goal of ‘health for all by
- 2000 A.D.’adopted,
r , commendation of the Shetty Committee, 1954, that
nurses!have still not been given the statusin accordan- “nursing education should be brought into the maince with their new responsibilities,• They do not have stream of general education and nursing students pro
the power to make decisions or policies about either vided proper student status”.
themselves or the community at the national, state or
local levels, despite the fact that today most of them
The autonomy, said Miss Dhaulta, is needed to
are well educated and constitute a major force in the improve nursing care and the quality of nursing edu
health service.
cation. The primary health care system is a wel
come adyance in this direction because it is centred
around the nurse with doctors playing a supportive
role. It is also cheaper for the government who
anyway spends less on nurses than on doctors. But
even this system as it operates today is far from perfect,
The Shetty Committee of. 1954—the last formal study
of the conditions of service and emoluments of nursing
personnel—had recommended the creation of new
avenues of promotion by increasing posts in hospi
tals, districts, primary health centres and sub-centres
and giving proper remunerations according to the
posts and responsibilities held. It had also recom
mended that nurses in the community be better paid
than those in hospitals to attract them to rural areas.
It is not surprising to find, therefore, that there is
no statutory post for nurses in the Central Govern
ment. The highest post there, is only that of a Nurssing Advisor, as opposed to that of Director General
of Health Services for doctors. Nor:are all” categories
of nursing personnel placed under the direct control of
nurse administrators and nurse educators.
To end this anomaly of responsibility without
power, the Trained Nurses Association of India
(TNAI) has demanded a separate Directorate of Nurs
ing. The Government of Karnataka alone has
conceded the demand so far. However, till such
directorates come up in other states and at the national
level, TNAI has urged that more nurses be posted in
directorates of health services as Joint Directors
’
of
Nursing, and as Deputy Directors of Nursing Service,
Nursing Education and Research and Community
Nursing.
Like the proverbial Humpty Dumpty, the fourth
Pay Commission dashed more hopes to the ground
than can be put together again. TNAI laments that
the commission did not grant the parlies sought with
other general categories, but fixed salaries on the basis
of existing anomalies. With the result that nurses
with diplomas or degrees have been put in a lower
grade than personnel in general categories with less
training. For instance, public health nurses with
Miss Jaiwanti P. Dhaulta, assistant secretary,
TNAI, says that though nursing education today is
possible upto the doctorate level, not many nurses are
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diplomas and B.Sc degrees, should have been placed
at par with sister tutors on the educational side, but
were actually given a grade equivalent to ward sis
ters who are less qualified. Similarly, sister tutors
should have been given parity with deputy nursing
superintendents in hospitals, but were placed at par
with assistant nursing superintendents.
i
1
What is really resented is the fact that teachers of
nursing at the graduate and post-graduate levels have
not been given University Grants Commission scales
and professors of nursing have been accorded scales
lower than that of a principal in a college of nursing.
For instance, the principal of the Rajkumari Amrit
Kaur College of Nursing in the Capital has been placed
' in the scale of Rs. 3700-5000 and a professor in the
grade of Rs 3000-5000, though the principal is likely
to be academically less qualified.
with the mental stress and physical strain, since nurses
spend more time in these departments than doctors.
A risk allowance is also being claimed as nurses
are in direct contact with patients and are prone to
infections and disease. There have been cases of
nurses (and through them their families) contracting
tuberculosis from patients and not even receiving free
medical treatment from their hospitals.
TNAI points out that according to Recommenda
tion 157, Point 3, Clause 8 (1) of the International
Labour Organisation, nurses should work only 40
hours a week, whereas in India they put in 52 hours
weekly. Yet they do not get paid off-days as do other
government employees who work only 37.5 hours, five
days a week. Nurses, in contrast, do not get leave
even on national holidays. Another legitimate de
mand is for increasing the stipend of student nurses
from Rs 200 to Rs 600 per month. Rural nurses are
But there is a greater disparity. The principal of also pressing for housing and a transport allowance.
the Rajkumari Amrit Kaur College is getting the grade
equivalent to that of an associate professor of medi
cine and a professor of nursing that of an assistant
It is ironic that military nurses are getting a raw
professor of medicine (lecturer). This despite the fact deal in India when the founder of professional nursing
that the Pay Commission had recommended that the made her mark in the military hospitals at Scutari,
pay-scales of non-medical teaching staff of the medical Turkey, during the Crimean War. The highest rank
college under the Central Government should be the for a nurse in the Indian Army is that of major-gene
same as for the medical teaching staff.
ral, but the pay scale is that of one rank below. For
army doctors, on the other hand, the highest rank is
Lt Genera] and the pay scale is equivalent to the
Moreover, since the post of Nursing Advisor to the rank, with all other benefits such as a nonpractising
Government of India is the highest in the field it allowance.
should also have been the highest paid. But it was
placed at par with that of the principal of a nursing
One constant complaint is that there were not
college. On the medical side, however, the highest
enough promotional avenues open to nurses, most
post was awarded the highest salary.
promotions being according to seniority. The nurses
felt that there should be a selection grade for those
Nurses are also upset because the Commission with 10 years of service, as in the Central universities.
ignored their request for a timescale for all categories
of nursing personnel and abolished the selection grade
Indian nurses, thus, are in the cleft of the stick.
for C & D employees. It also rejected the plea for
Inside
hospitals, they are eclipsed by doctors and
family quarters as nurses these days are more often
outside,
they have not yet emerged as the custodians
than not married.
of the health of the community. The expected eleva
tion in their social status has, thus, not taken place.
The nurses are also demanding a non-practising Long hours, indeed years, of dedicated duty go un
allowance (paid to doctors and veterinary officers) as appreciated. The ‘lamp ’ continues to cast a shad
they too are licensed practitioners who are debarred ow .....................
from private practice. There is also a demand for a
special allowance of a minimum of Rs 100 per month
for nurses working in the intensive care unit, coronary
Sandhya Jain,
care unit, operation theatre and emergency wards be
Courtesy: Hindustan Times.
cause of the special nature of the work involved along
7
8^
Uk J W
Female Foeticide in Rural Haryana
Sabu M George
Ranbir S Dahiya
Female foeticide over the last 15 years has distorted sex ratios at birth in several Asian countries. Foetal
sex determination clinics have been established in India over the last 20 years in northern and western cities.
Presented here is the outcome of an intensive study of the abuse of prenatal diagnostic techniques for sex
selection in a rural population of 13,000 in Rohtak district. Parents tend to be calculative in choosing the
SCX of
I the next child and the decision is based on the birth order, sex sequence of previous children and
number of sons. Transfer 'of reproductive technology to India is resulting in reinforcement of patriarchal
values as professional medical organisations seem to be indifferent to ethical misconduct.
I
... Introduction
STRONG preference for sons over
daughters exists in the Indian subcontinent,
east Asia, north Africa and west Asia unlike
in the western countries (Muthurayappa
et al 1997, Lancet 1990, Okun 1996).
People realise smaller family sizes with
relatively greater number of sons by abuse
of medical technologies. Pregnancies are
planned by resorting to ‘differential
contraception’ - contraception is used
based on the number of surviving sons
irrespective of family size [Okun 1996].
Following conception, foetal sex is
determined by prenatal diagnostic
techniques after which female foetuses are
aborted [Park and Cho 1995, Arora 1996].
China adopted a ‘one child family’ norm
in 1979 and the phenomenon of millions
c
of ‘missing girls’ was recognised
by early
1990s [Coakc and Banister"1994]. Female
foeticide was a major cause of this
imbalance. As fertility declined rapidly in
east Asian counlries(South Korea,Taiwan,
Hong Kong), selective abortion of female
foetuses increased, leading to rising sex
ratios at birth (SRB) (male/female) over
the last 10 years (Park and Cho 1995].
In India the population sex ratio which
was 1.03 in 1901 census rose relatively
consistently to 1.08 in 1991 [National Com
mission for Women 1994]. Indian medical
researchers who pioneered amniocentesis
tluiU it would assist those
in 1975 said
J
Indian women who keep on reproducing
just to have a son; although this may notI
be
acceptable
to ‘persons in the west’
i_____
"
(Verma et al 1975]. Since then the
contribution of sex determination tests
(SDT) to the rising sex ratio has been
vigorously debated [Lancet 1983,
Chhachhi and Satyamala 1983, Kumar
1994]. While urban feminists demanded
legislation against SDT, several social
scientists fell that SDT had little impact
on sex ratio [Forum against Sex
Economic and Political Weekly
Determination and Sex Preselection 1993,
Rajan et al 1992].
According to the 1991 census, 15 of
the 20 districts with the highest child (0
Id 6 years) sex ratios were in the states
of Haryana and Punjab in northwest India.
A well known demographer suggested that
the distortions in child sex ratios in the
northwestern region for the last 100 years
could be due to biological peculiarity of
these women to have a highly distorted sex
ratio at birth, in favour of boys [Premi
1994]! However, UNICEF argued that
“female foeticide is reported to be a cause
for adverse sex ratios in some Indian
districts in the. 1991 census” [UNICEF
1994].Therefore, we selected villages from
oncsuch district in this region to investigate
if indeed SDT were being performed and
if so, to measure its impact on sex ratios.
We examined the role of doctors, and also
considered the contributions of contraccption and of the social practice of female
inlanlicidc in skewing sex ratios.
II
Subjects and Methods
Geographical Location and Background
This study was initiated in June 1996
in six villagesof Rohtak district in Haryana.
Haryana was part of the composite Punjab
state till 1966. This region witnessed
tremendous economic progress over the
last 30 years due to ‘green revolution’
[Singh 1997].Haryana spcrcapitaincomc
is among the highest and fastest growing
in
1997]. Consequently
i the country
, .[UNDP
...
,
income poverty reduced by more than 50
per cent. But the Anthropological Survey
of India reports that the status of women
in Haryana continues to be bad.
Haryana VigyanManch (HVM) has been
active in promoting literacy.■ -It worked
with the district administration (1991-95)
and succeeded in enrolling 1.15 lakh
illiterates in the literacy campaign. Ninety
per cent of the neo-litcrates and their
August 8. 1998
I
instructors were women. HVM provided
medical relief during floods and epidemics.
It organised successful public campaigns
in Rohtak to get clinics to remove
advertisements promoting foetal sex
determination [Chowdhry 1994]. After
literacy efforts, more villagers started
coming to the Medical College Hospital
where the second author works.
Selection of Study Villages
Following completion of the literacy
endeavour in 1995, HVM undertook a
survey in 36 villages where there was
good community participation. This was
motivated by the impression of the literacy
activists that in some villages about half
of the pregnancies were terminated after
SDT because the foetus was female. As
the enumeration was done by the village
activists only limited information on
children was elicited. Demographic data
such as birth order of children, timing of
pregnancy outcomes; and assessment of
the completeness of the survey were not
available from this attempt. This field
research is therefore a systematic effort to
follow upon indications of rampant female
foeticide.
Given the sensitive nature of induced
abortions and that it is a criminal offence
to do SDT we could not undertake a truly
random survey of women in the district.
We wanted to obtain reliable infonnation
on deliberate termination of female
foetuses and neglect of girls from the
women themselves. Our attempt was to
identify villages where there was gre^st
likelihood that communities would (rust
our intentions given our past social
commitments. An open dialogue on SDT
ispossibleonly when womencouldconfide
about such matters without fear of being
victimised. Therefore, we chose to select
villages where we had the most respected
women literacy activists. These women
have developed excellent rapport in their
villages. Some of these empowered women
2191
i
i
later got elected as members and even
chiefs of village panchayats. The study
villages were identified by asking the three
district literacy women co-ordinators who
independently ranked the women activists
present in the 36 villages. The six study
villages lie in blocks ol Rohtak out of the
total 12 blocks. On completion of the study,
this district (original Rohtak) was
subdivided into Rohtak and Jaghardistricts.
Today, our study villages lie in both the
new districts.
i
III
. Methodology
Discussions with medical practitioners
and others
I
J
(
i
I
!
f
I
J.
!
First we interviewed leading obste
tricians, medical practitioners of SDT in
Rohtak and women doctors of departments
of obstetrics and gynaecology (OG) and
radiology of the Post Graduate Institute
of Medical Sciences (locally called Medical
College Hospital and henceforth referred
to as MCH). We ascertained their per
ceptions and involvement in SDT. The
role of ultrasound scans in antenatal care
was ascertained. They were asked if SDT
could result in raising the status of women.
We met with about 150 village level literacy
activists in Jind district along with a senior
medical officer to be informed of SDT
practices. Jind is adjacent to Rohtak and
has the highest sex ratio in Haryana state.
Interviews with individual study women
suspected by the community as
accomplices of (he health department.
Prom our decades of contact with rural
women, we knew that any suspicion of
being associated with the coercive ‘family
planning’programme would make women
unwilling to reveal sensitive aspects of
thcirrcproductive history. We deliberately
avoided asking individual women whether
(hey went for SDT as we did not want to
make women feel guilty for not bearing
the desired number of sons. Rural men
blame women for not producing enough
sons. Some husbands married a second
time because the first wife did not bear
a son.
Of these interviews 98.9 per cent were
conducted by trained local women. Nearly
50 per cent of the interviews in each of
the six villages were conducted by the
same interviewer. No.study woman refused
to co-operate for individual interviews.
which result in a significant proportion of
women being married before 18 years, and
coercion of widows to undergo levirate
marriages
facilitated
by
state
administrative directives. However, for
brevity, only data on sex ratio distortions
and information related to abuse of
medical technology by doctors are
presented here.
In this paper we do not consider sophisti
cated reproductive technologies such as
X-Y sperm selection orpre-implanlalional
genetic diagnosis (PCD) which enable
families to choose the sex of the child
without having to resort to abortion
[Ramsay 1993. Parikh 1998J. In X-Y
separation, male sperms are separated and
are used to fertilise the egg. In PGD (he
pre-embryos are sexed for (he selective
Table I: Characterisiics or Study Families
(N = 1017)
Characteristic Variable
Validation of information
We obtained government sources of
information on vital events to validate the
reported information on deaths. We
independently contacted the anganwadi
worker (AWW), the female health worker
(FHW) and the chowkidar (functionary
reporting to police). As complete records
were available only for recent years we
had to limit validation to past five years.
AWW and the chowkidar were resident
in the village but FHW resided in Rohtak
town. We wcnt back to (he study women
in case of any discrepancy between the
information they reported and the official
records.
To reduce recall errors, we confined
interviews to women who experienced a
pregnancy outcome in the last five years
Dialogue with the communities
rather than to all village women. There
were 1,022 eligible women. The criterion
We shared the findings with village
of using pregnancy outcome in the last
women in 22 group meetings. On an
five years included almost all outcomes
average 20 women attended these sessions
in the study villages in the recent past, as
incach hamlet. We sought thcircxplanation
the average interval between successive
for any observed gender imbalances. We
births in Haryana is 28 months [NFHS
asked about discrimination against girls.
1993]. Our sampling excluded just four
In areas where there was no distortion of
women who had a previous pregnancy ’ SRB, we enquired if the practice of female
outcome and were currently pregnant. They
foeticide was prevalent.
were excluded as (hey experienced no
Outcomes
outcome in the last five years. The entire
history of pregnancies of study women is
In (he course of field work, qualitative
necessary for us to understand family
information and sociological data related
building strategies and to obtain accurate
to the practice of female foeticide were
birth orders of recently born children.
obtained. These strengthen some of (he
Women were interviewed at their homes
findings presented like caste differentials
in the presence of the local woman activist.
in foeticide. They also throw light on the
Pregnancy history was elicited from each
fact that foeticide is not an isolated
study woman, beginning with (he last
phenomenon but one of several ways
outcome. This demographic method is
patriarchy demeans women: others being
known to produce excellent results with
violence against women (Jcjccbhoy and
minimal.loss of information. We asked
Cook 1997], anti-women inheritance
very few questions in order not to be
practices, customary marriage conventions
Value
Demographic
Wife:
Mean age
Husband:
Mean age
Children:
Mean no
Sons:
Mean no
Abortions
(per cent)
25
25
2.60
1.28
10.3
wife
40.1
Educational
Illiterate
Primary and
neolitcrnte
7.0
5-10 years of
school
47.2
11-12 years
of school
5.6
College
1.7
Social (per cent)
Caste
Harijan
23.6
Artisan and
minor
10.6
Brahmin
4.3
Jat and yadav 61.5
Second
Husband
,3.4
Marriage
Wife
1.2
husband
9.3
3.4
68.9
12.3
6.1
Table 2: Percent Women Sterilised by Number
of Surviving Children vs Number
or Surviving Sons
No of Surviving Sons
0
1
2
Familics(N)
3
4
c
£
2
U
M
i*0
o
Z
0
I
2
3
4
5
6+
0
0
2
0
0
0
0
3
14
36
20
30
20
51
76
71
42
33
78
44
100
100
0
0
50
27
258
336
246
102
25
19
Note: Four women were excluded as they died
prematurely.
I
t
i
2192
Economic and Political Weekly
August 8, 1998
destruction of the female pre-embryo
(female embryocide). As the validity of
these methods appears to be uncertain
outside the research labs which developed
them. Also these very expensive methods
are available at present only in a handful
of clinics in a few cities.
I
i
I
of pregnancy were higher among women Disaggregation by caste indicates that there
who had relatively less number of surviving is no excess post-neonatal girl mortality
sons than daughters. Within each family in harijans but exists among the upper
size, the current rate of pregnancy were castes.
five to six times higher for mothers who
Another indicator of deliberate discrimi
had no sons as compared to mothers who nation against girls is the survival of livehad several sons.
boms in twin pairs. The women reported
A manifestation of intense son preference that 16 twin pairs were bom alive (23f+9m).
IV
in a population is that for a given family The mortality of the females was higher
'Results
size the sex ratio of the last bom child will than that of males (57 per cent vs 44 per
Virtually all (99.5 percent) study women, be greater than 1.06 (i e, skewed towards cent). One manifestationof discrimination
were interviewed and 94 per cent of the male). This is demonstrated by using the against girls is the observation that the
respondents were mothers themselves. The
‘gender preference indicators’, family size interbirth interval between successive
social, demographic and educational
sex ratio (FSSR) and the sex ratio of the livebornchildrcn isshorterif the preceding
characteristics of families of these women
last bom child (LCSR). Family size refers child is female. This observation has been
are described in Table I. The duration of to the total number of children liveborn. reported from Haryana state also [NFHS
cohabitation after marriage ranged from Table 3 indicates the sex ratio for each
I993J. We found greater discrimination in
one year to 30years (mean = 8.7). Thirteen
family size. The FSSR monotonously upper castes as compared to harijans
women had children who were already declines as the family size increases from (difference is 48 days vs 29 days).
married. Jats andyadavs are the cultivating one to ten. While the LCSR is generally
Demographers consider the SRB of
castes who own most of the land. Harijans more elevated than that of the FSSR. Both children born in last five years as the most
are the poorest section in this agrarian FSSR and LCSR are much higher for sensitive index of current gender imbalance
society; and are primarily labourers of the completed (sterilised) families (Table 4) at birth in the society. Table 7 suggests
landowning castes. There is gross disparity
with the exception of birth orders greater that SRB for all birth orders for recently
between the educational status of men and than five where due to small sample sizes born children are masculine including the
women.
the ratios are not stable.
first birth order. The SRB for harijans
The pregnancy outcomes reported by
A different strategy which some parents (lowest caste) was 1.02; whilst among
the women were 2,642 live borns, 48 still adopt to limit family size of surviving upper castes it was 1.27. The SRB of upper
births and 272 abortions (243 spontaneous children and to eventually have the desired caste children rose from 1.26 to 1.89 as
and 29 induced). Of liveborns 66.5 per number of sons is female infanticide birth order went up from 1 to 5 (above 5
cent were of orders I and 2; only 1.4 per [George ct al I992J. Direct infanticide numbers arc too small and therefore the
centofchildrenwereof orders greater than refers to killing of infant usually ratio not dependable). A similar rising
6. There were thrice as many families immediately afterbirth. Indirect infanticide trend was not seen in harijans. The SRB
having more than two surviving girls as
is death caused a little after birth, due to kept increasing over the last five years
those having more than two sons (110 vs deliberate neglect. This could be by
Table 3: FSSR and LCSR for All Families
37 respectively). The study women had a
inadequate child care, or by poor food
Family
Liveborn
maximum of five liveborn sons whilst the related practices or health related neglect.
FSSR LCSR
M
F
maximum number of liveborn daughters Of the 2,642 liveborns, 2,327 children Size
was nine. Just 14 per cent of families were still surviving at the time of the
1.41
134
1.40
I
95
1.39
1.33
359
259
account for 34 per cent of girls while interviews (Tables 5 and 6). We confine 2
1.49
347
1.01
352
having only 21 per cent of boys. Over 48 detailed examination of mortality to the 3
0.77
1.48
303
233
per cent of mothers who; reported deaths cohort born in last five years as the recall 4
0.73
2.39
120
165
5
in the cohort born in the past five years errors are minimal for recent events and 6
0.71
1.43
45
63
were not captured by the government also because records for validation from 7
1.50
0.66
36
55
workers. The official records revealed that official sources were only available for 8
0.55 -4)50
17'
31
0.0
0.20
15
3
only two mothers had not reported the this period. Further, this cohort represents 9
0.0
0.11
10
I
9
deaths (one female each) of their children virtually the total population of preschool
1.44
0.97
1300
1342
to us. Subsequently both mothers children in the villages. For this cohort, total
both sex ratio at birth (SRB) and sex ratio
confirmed that the deaths did occur.
The onus of contraception was almost of surviving children at the time of survey
Table 4: FSSR and LCSR for Sterilised
entirely on women. Tubal ligation are 1.20. Mortality data suggests that there
Families
(sterilisation) was virtually the only form is no excess girl mortality in the early
Liveborn
Family
of contraception used (270 women vs one neonatal or late neonatal phase (Table 6). Size
FSSR LCSR
M
F
But there appears to be excess girl mortality
man). The percentage of sterilised women
0
3
1
increased as they had more surviving sons in the post-nconatal phase and girls arc at
5.48
5.60
21
115
2
(Table 2). Such a strong rising trend was risk of significantly greater mortality after
2.25
1.58
193
122
3
not evident with increasing number of the first year of life. Ethnographic 4
2.93
1.00
116
116
girls. Just one mother got sterilised with information indicates thecxistence of direct 5
5.00
0.83
60
50
no surviving boys while 69 mothers who female infanticide in the study villages 6
1.00
0.78
27
2!
1.00
14
14
1.00
and 41 percent of the female early neonatal 7
had no surviving daughters got sterilised.
0.19
0.0
16
3
Furthermore, the family size and sex deaths are due to direct female infanticide. 8+
2.9
1
1.37
376
tofal
515
Excess
female
mortality
in
the
postcomposition of the surviving children of
women who were pregnant (N= 129) at the nconatal and later childhood suggest the Note: * Ratio could not be calculated as
denominator is 0.
time of interview indicated that the rates occurrence of indirect female infanticide.
Economic and Political Weekly
August 8, 1998
2193
were forced to rescind the policy after two
years when they started getting referrals
among upper castes. Il increased from
1.15 to 1.42 from the first 2.5 years to the
last 2.5 years. In fact, in the last year, the
SRB was as high as 1.80. Apart from birth
of botched abortions from their alumni.
This decision was reversed in the interests
order the sex composition of the preceding
born children seems to be an important
determinant of the sex of the next child
(Table 8) in the upper castes. Within each
birth order, sex ratio of the next child
increases as the number of preceding girls
increases. (Wc stopped at order 5 as there
are very Few children to fill the increasing
m/f combinations). For each birth order,
generally the ratio is often closer to the
of the lives of mothers.
Jind activists told us about the
widespread practice of female foeticide.
Despite Jind being one of the most
backward
districts
in
Haryana,
ultrasonography, a modern technology, is
extensively abused.
families with no boys the SRB ol the next
child increased from 1.47 to 2.50 as the
preceding number of girls went up from
one to four.
....
We presented the results of individual
women interviews at discussions held in
ehamlets.There was universal awareness
of SDT and most knew where to go for
the tests and abortions. In upper caste
hamlets there was open admission of the
widespread practice of female foeticide.
In a few places the women blamed doctors
Families continued to have children till
sons. Consequently small lamilics had
more sons while large families had more
daughters. That family size is inversely
related to the FSSR suggests differential
least two sons. When two surviving sons
arc ensured nearly 50 per cent of women
is abused for sexing foetuses. More doctors
are buying ultrasound machines and some
evidence that with two sons and one
daughter nearly 75 per cent of women use
sterilisation. Our Findings about comple
is used in the MCH for routine confirmation
of pregnancy as problems were
experienced in getting kits for the urme
test. Neither docs the MCH reveal the sex
of the foetus nor conduct sex selective
abortions. Following popularity of sex
selective abortions, the OG department
decided a few years ago not to train their
postgraduates to do mid trimester abortion
as it was fell that students would later be
a fraction of the observed gender imbalance
Table 8: Upper Cash- SRB by Biriii Order vs
Preceding Number or Children by Sex
Preceding Number
of Children by Sex
Females
Males
Birth
Order
1
2
0
I
0
3
2
1
0
3
2
I
0
4
4
5
0
0
1
0
1
2
0
1
2
3
0
I
2
3
4
3
n
I
0
sampleconsislsofall womeninlhc villages
who had a pregnancy outcome in the last
SUB
N
364 ~ 1.26
1.01
189
1.47
175
0.93
29
1.32
139
72
2
20
69
26
I
1.57
1 00
0.25
2.25
1.60
17
1.50
113
22
7
267
2.50
5
girl in this group and
therefore the ratio cannot be calculated.
Note: * There was no
five years and the study children comprise
Table 5: Sex Specific Survival of Liveborns by Birth Cohorts
Total
Dead
Survivors
M
Birth Cohorts
< 5 years
> = 5 years
Total
787
M
””654~
"66
"54
853
528
H82
89
106
447 •
634
160
1300
1342
F
155
Table 6: Sex Specific Death Rates by Age at Death
©Oto <7
F
(Pe* ceht)
© 28 to <365
© 365
OTO
Z58
2.97
0.47
1.55
43
15
0.71
II
51
Total Dead (N)
708
Death Rates
©7 to < 28
T99
2.40
M
F
F
F
358
1145
SexXAge at
Death (days)
Liverborn
•
M
pregnancies. The only dispute between
the radiologists and the obstetricians of
MCH was on the issue who was most
competent to do the scanning! Ultrasound
1992, George 1997]. We have an estimate
only from Tamil Nadu state, where direct
female infanticide accounted for 8 to 10
percent of all infant deaths in 1995[Alhreya
and Chunkalh 1997], Direct infanticide
affects just 0.99 per cent of our liveborn
females and therefore can account for only
a rcllection of intense son preference. Our
Almost everybody, including women
MCII doctors fell that selective abortion
of female foetuses would increase the status
of women. They were unanimous in the
positive role of ultrasound in normal
the contemporary times [Kakar 1980].
Though direct infanticide has been known
for centuries, systematic investigation of
study children (1342 f vs 1300 m) is itself
difference after the national law banning
of the testdoubled (now about 900 rupees).
in this region [Chowdhry 1994], There
have also also reports of its persistence in
not using any contraception (1.25 vs 0.97).
The marginal excess of girls in our total
are taking it in cars to villages. The only
•he test was passed in 1994 was that cost
female infanticide as it was prevalent earlier
use sterilisation (Table 2). There is some
children of sterilised couples are
significantly higher than that for couples
the following emerged: ultrasonography
to nine girls just to have one or two sons.
Il is imperative to examine the role of
appears that most women want to have at
following pregnancy is to put pressure on
them to determine the sex. II it is a boy
then only the need for ante-natal care is
denials about the practice.
From our dialogue with Rohlak doctors
instance, seven were willing to have six
stopping by contraception (Table 3). It
ted families (sterilised women) are
consistent with that reported for India
[Arnold 1996]. Sex ratio of surviving
in sex ratios were less (fable 7), there were
mothers who were desperate for sons; lor
the phenomenon is recent [George ct al
V
Discussion
who are doing this for money. Some women
complained that their families’ first concern
raised. In harijan areas where (he distortions
all their children; and this included some
Table 7: SRB by Birth Order and by Caste
CasteXBirth
Order
Upper Castes
Uarijan
All Castes
Total
Total
(N)
L2?
1.27
1169"
1.06
1.14
1.02
1.20
392
1561
Sex Ratios at Birth
I
2
L26
1.15
1.24
3
4
5
6+
1.34
L251.15
1.22
1.89
1.09
1.59
1.04
0.77
1.16
1.16
practising female foeticide. However, they
Economic and Political Weekly
2194
August 8, 1998
1994, Das Gupta and Visaria 1996). A part
in surviving preschool children. The averaging over five years (last year=!.8O
of the increase may reflect discrimination
vs
5
years=l.27).
Secondly,
sex
existence of indirect female infanticide in
against girls following foetal sex
our area is consistent with the finding of determination is done by poorly trained
determination in placeof birth. Male babies
excess girl mortality in Haryana state ultrasound imagers. Just as in other non
may be given the privilege of sal er hospital
western
countries
a
majority
of
Indian
[NFHS 1993). The deaths were
deliveries while for females delivery at
imagers
have
inadequate
training
[Mindcl
disproportionately high among higher birth
home in the village is considered adequate.
1997). In fact there is no formal certification
order children. This pattern has been
The
SRB of institutional deliveries in India,
reported from many parts of the of ultrasound imagers in India. One way
predominantly an urban sample, increased
women
respond
to
this
uncertainly
is
that
subcontinent (Das Gupta 1996). There is
from 1.06 to 1.12 over the period 1949no known biomedical reason to explain they go for scanning only at the end of
58 to 1981-91 [National Commission for
the
second
trimester
(instead
of
16
to
18
the observed higher risk of mortality for
Women 1994). Note that the latter estimate
weeks).
Despite
this,
we
are
not
certain
females bom in a twin pair. Village women
is based on 6 million live births.
rationalised the excess mortality of females that the sensitivity of sex determination
The existence of relatively greater gender
is
over
90
per
cent
for
boys.
Thus
in
the
by saying that mothers can take care of .
only one child. Such unspoken social' desperation for sons, some male foetuses equality in harijan castes has been reported
from south India [George et al 1994). This
sanction for severe neglect of females would have likely been aborted
is because the only economic asset harijans
inadvertently.
Our
doubts
are
based
on
within a twin pair has been witnessed in
have is their labour so women are seen as
errors
highlighted
in
the
media
[Lancet
south India by the first author and also
1983, Kakadkar 1997], literature [Booth productive members of the family.
reported by others [Miller 1985). The inter
— with imaging
-o- o Therefore harijans had no excess postet
al 1997) and from dialogue
birth interval after a girl is shorter because rxpertYTherefore/thereVlratesofinduced
neonatal girl mortality, or longer intergirls are breast-fed for a lesser period than
•
birth interval altera girl, or more favourable
boys (19 per cent less; from slate data abortions for sex selection are likely to be SRB as compared to upper castes. This
[NFHS 1993J). After consideration of higher than our estimate.
That female foeticide is occurring in does not imply that harijans do not express
mortality experiences we conclude that
sex preference. They do practice
past mortality of girls cannot explain the many cities of India is well known [Miller
differential contraception like the upper
1985, Booth et al 1997, Kishwar 1995).
masculinity in sex ratios of surviving
castes. But their intensity of preference for
The
following
observations
from
urban/
children (the higher post-neonatal girl
boys is lower. The overall LCSR is 1.05
clinic
studies
are
consistent
with
our
mortality is offset by higher early neonatal
findings: (I) SRB increases with birth for harijans as against 1.59 for upper castes,
boy mortality). However, mortality
..
j ° 'data ,,,
..iii.
r'- *•- - r__ -I-kir»k nrrlor ihn
corroborative evidence for order, (2) families with only daughters arc Further for almost every birth order the
provides c-----------more likely to practice female foeticide. LCSR is less distorted for harijans. Note
deliberate discrimination against girls.
The
latter is evident from our finding that that sex selective abortion can also raise
Demographically, SRB will not be affected
the
highest
distortion of SRB is among the LCSR like differential contraception.
by differential contraception but the sex
As couples who have girls continue to
ratio of the last born child will be higher families with no sons (Table 8). A
abort female foetuses until they have the
i
our
study
is
that
than normal (Coale and Banister 1994). significant outcome from
right number of boys at which point they
certain
rural
families
are
unable
to
tolerate
LCSR is masculine because women who
cease
childbearing. Our ethnographic
have not had enough sons continue to bear even the first child to be a female and
information
that female foeticide is much
will abort it. Our finding
children until they have the right number therefore
contradicts Das; Gupta and Visaria’s claim less among harijans is consistent with the
of boys when they undergo sterilisation.
that women arc unlikely to use SDT for 'demographic data presented.
The observed sex imbalance in children that women are unlikely to use SDT for
This comprehensive enquiry provides
the first pregnancy [Das Gupta and Visaria
born over past five years in ’upper castes’
incontrovertible evidence of the practice
1
996)
.
Their
reasoning
is
based
on
the
fact
can only be due to selective abortions of
of female foeticide in a rural population.
female foetuses as we have ruled out other that deliberate girl child neglect often Both in medical anthropology and
causes. Further, in groupdiscussionsupper spares the first girl. This extrapolation of anthropological demography meticulous
caste women confirmed that abortions of human behaviour from female infanticide micro level studies with people’s
female foetuses were taking place. The to female foeticide is fallacious. As a Lancet participation have beebme a standard
rising trend ofSRB overthe past five years editorial argued, new technology will research methodology. We have not
suggests an increasing incidence of female createnew problems for the society [Lancet
’ ‘ ’ attan individual
1974). The evidence from Delhi (Khanna captured female foeticide
foeticide in the villages. That increasing
level,
which
is
most
unlikely gi’vcn the
1997] as well as South Korea arc also
numbers of boys arc being born over recent
criminality
of
(he
act,
the collusion of
years is evident from sex dillerentials in supportive of our observation (Park and
medical professionals and cultural
Cho l995.Leele 1996). Our data indicates
chronological age of liveborn children.
sensitivity. However women collectively
Among uppercastes, boys are significantly that the proportion of families aborting
accepted the widespread extent of the
younger than girls by 66 days (N=l 169, female foetuses in the first pregnancy has practice in their villages. Our field research
p=0.03) while the difference in harijans been increasing over the past five years.
The increased popularity of female which has an ethnographic component
is only 39 days, which is not statistically
foeticide reported by doctors in Rohtak complements district level census data. In
significant (N=392).
matters like son preference which is
district
is consistent with the finding that
A sex ratio of 1.27 suggests that 16.8
over a period of two decades the SRB of intensifying, information from large
per cent of female foetuses have been
children bom in MCH. Rohtak has become surveys becomes outdated soon. Conse
aborted among upper castes in the last five
quently village studies need to be routinely
years (taking ’normal’ SRB as 1.06).
I "' , This pronouncedly masculine(SRB lorthe years carried out to understand the trends and
1993-95
is
1.25,
N=I2,I66
births).
is an underestimate of the current rate of
determinants of gender inequity in every
sex selective abortions. Firstly, we have Distorted SRB have been reported from district.
other
hospitals
in
this
region
(Booth
el
al
downplayed the dramatic rise in SRB by
Economic and Political Weekly
August 8. 1998
2195
Our research has a major limitation. We
have not explored the significant health
hazards of repeated late mid trimester
abortions for women. The villagers
reported that abortions are usually done
in unregistered village clinics (Chowdhry
1994]. Further, maternal depletion
following abortions in an environment of
extensive iron deficiency could have
additional adverse consequences for
women’s health.
The Rohtak district overall sex ratio is
1.18 while for Haryana it is 1.16 as per
the 1991 census. The sex ratio of surviving
children for both Haryana and Rohtak is
1.14. Our villages are better off than the
average Rohtak village as far as women’s
v w
status is concerned
based on the intimate
knowledge of the second author of the
district. Also our selection criterion
identifies the more liberal villages. The
emergence of women leaders in our villages
I
is significant in that it has occurred in one
of the most conservative regions of India
where women have led very secluded lives.
We therefore believe that the sex ratio of
surviving children in the district is likely
to be at least as masculine as in the study
villages. The sex ratio of surviving pre
school children in a December 1997 survey
of randomly selected households of rural
Haryana (total population= 10,000) was
found to be 1.18 (Kumar 1998].
Furthermore, sex ratios from Sample
i
!
Registration Surveysand indirect estimates
from 1981 & 1991 censuses; all arc
supportive ofsuchelevated child sex ratios
and sex ratios at birth for Haryana [Sudha
and Rajan 1998, Mari Bhat 1998]. Tims
these data along with our knowledge of
the extensive spread of SDT clinics all
over Haryana in the mid to late 1980s
suggests that the findings from our study
villages have relevance for the state.
We are not implying that the rates of
female foeticide elsewhere in rural India
are as high as in Haryana. There has been
a tradition of fierce patriarchy in this region
as in some other parts of north India [Dreze
and Sen 1996]. Women have long suffered
I
patriarchal practices as female infanticide,
child marriage, seclusion, dowry, levirate
and polygamy. Not surprisingly, Haryana
state has the highest overall sex ratio, the
highest sex ratio at birth, the highest excess
female child mortality and the lowest
divorce rate for women in the country
[NFHS 1993. GOI 1997]. SDT clinics
have been functioning in Haryana towns
for about 15 years. Mobile SDT clinics
have been visiting many Haryana villages
for over seven years (Chowdhry 1994].
The dramatic drop in fertility in Haryana
over the period 1971-91 has been
associated with increased use of SDT. The
total fertility rale in rural Haryana in 1971
was 7.15 children per woman; which was
the highest in India then, dropped to 4.17
by 1991 [Krishnaji and James 1998]. In
patriarchal cultures, son preference inten
sifies in the transition period when
fertility is declining [Das Gupta and
Visaria 1996].
We selected villages in this region as we
wanted to highlight the imbalance that
could take place in case the same intensity
of sex selective abortion were to take place
elsewhere in India. There is no reliable
data for the incidence of female foeticide
but the Central Committee on Sex
Determination described it as an epidemic •
across the length and breadth of the country
(National Commission for Women 1994].
A rough estimate of female foeticide and
direct infanticide together obtained by
indirect demographic techniques on census
data
is 1.2 million ’missing girls’ in India
‘
during 1981-91 (Das Gupta and Mari Bhat
1997]. If we attribute all the ‘missing girls’
to foeticide this would amount to less than
I per cent of female births. But the first
author acknowledged that most of the
selective abortions occurred during the
second half of the decade and predicted
that “we should expect to see more of it
in 1991-2001” [Weiss 1996]. Therefore
the I per cent figure should be cautiously
interpreted as there had beeni an explosioni
of SDT clinics in a few places from the
late 1980s and in most parts of the country■
by early to mid 1990s. The access for rural
populations enhanced substantially after
sophisticated ultrasound machines became
widelyavailable in India from early 1990s.
Historically, the east Asian experience
suggests that it takes less than a decade
of spread of clinics for a dramatic rise in
SRB to occur. Yet another comparative
study of the 1981 and 1991 Indian censuses
with a different methodology revealed that
there has been a marked shift towards
excess masculinity of SRB in 1991 in
India with the
northwest and in north 1----1
areas
of
Bihar and UP
exception of rural
(Sudha and Rajan 1998]. These authors
attribute this shift to female foeticide.
foeticide,
Further, our greatest concern is that female
rnPfieid
’eisbecominnnoDulareveninsoulh
foeticide
is becoming populareven in south
India where status of women has been
* *latej as 1987
historically much better. As
there were virtually no SDT clinics in the
Opposed to north and west India,
south as oj,
But over the last two to five years in
southern states ofTamil Nadu and Andhra
Pradesh, clinics have started mushrooming
in small towns and even in semi-urban
areas. We are aware from 13 years of field
work in Tamil Nadu that rural women are
increasingly resorting to SDT in recent
years. Though the present level of incidence
may not result in a serious distortion of
SRB at the stale level, the trends observed
in northwest India and elsewhere indicate
that it is just a matter of time before the
distortions become evident in population
data, unless these states immediately take
determined action to prevent emergence
of more SDT clinics and the abuse of these
tests.
Advances in medical technology for
sexing foetuses have made SDT more
convenient and less risky for Indian women
over the last twodecades. Initially chorionic
villus biopsy and amniocentesis were the
techniques used. Ultrasonography has
become the most widely used method of
sex determination from the early 1990s.
Besides being non-invasi ve, it also requires
no laboratory set up. Following adoption
of economic liberalisation policies by India
in 1991, several multinational companies
have entered the domestic ultrasound
market. Some have even begun to manu
facture the equipment in India. Increased
competition has led to the appearance of
lower priced portable models, flexible
credit and dependable service for the
customer. Doctors motivated in part by
multinational marketing muscle and con
siderable financial gains are increasingly
investing in ultrasound scanners. In
South Korea and China, domestic pro
duction of ultrasound machines facilitated
increased utilisation ot SDT [Cho and
Hong 1995].^
The
The general
genen lack of gender sensitivity
of Indian doctors and other professionals
contributed to the popularisation of SDT.
Just as in China, the first use of SDT in
India was in a Government, institution.
These researchers advocated the use of
amniocentesis for sexing foetuses*and
claimed that in the foreseeable future sex
selective abortions will not result in
increasing the number of males [Verma
et al 1975]! There are doctors who wanted
the government to promote STD to reduce
population growth [Lancet 1983]. Many
• J ; see female foeticide as a
gynaecologists
medical
solution to son. -preference and
i---------- -find nothing unethical in it [Lancet 1983].
Some economists argued that SDT would
result in better status of women based on
‘supply and demand’ logic. Ignoring that
cultural practices as son preference are not
predictable by economic principles (Arora
1996]. For over two decades, medical
abortions (MTP) were promoted by the
Indian government to reduce fertility. Also
traditional methods of abortion, though
unsafe are still used to space and limit
family size in rural India. Like traditional
!.
2196
Economic and Political Weekly
August 8. 1998
HJU—_ —
i
i
Chinese and Japanese societies, rural poor southern states. A reduction in this women literacy activists, some of whom spent
several months with us in the field. We thank the
Indians have beliefs and methods which mortality will likely reduce the gender ■
Rohlak district leaders of Health Workers' Union
disparity
in
post-neonatal
mortality
rates.
supposedly determine the sex of the foetus
and the Chowkidars’ Union for taking the trouble
‘ visit thestudy villages. The co-operation received
[Kakar 1980. Khanna 1997].-There is no Unfortunately, the entire focus of the health to
evidence to suggest that these are sensitive system is on fertility reduction. Till last |from the village anganwadi workers, chowkidars
; female health workers arc acknowledged. The
enough to distort sex ratios. But they arc year this was based on an elaborate system and
generosity
of over 20 people in Haryana Vigyan
of
targets
for
government
workers,
money
i
accepted on ‘faith’ and too often abortion
Manch who patiently assisted our work for 18
follows when the prediction is female. for acceptors and incentives for health 1
months is appreciated. We also thank A S Sharif.
Given all this, the widespread acceptance staff and even coercion of women [Bose S' Clark. T J John, M Bhat. V Patel. P and L
1
996,
Kumar
1
997].
This
led
to
widespread
’
of modern methods of sex determination
Visarias, L Caleb, S Almroth, C R Soman and R
]
(DEC) for their contributions. This field
and selective abortion of female foetuses falsification of data and corruption [Bose Palmer
was supported in part by the State Resource
1996] and alienated (he health system from study
«
in parts of India should not have been a
Haryana: Pondicherry Science Forum and
people. The contraceptive burden is almost Centre,
<
surprise.
Bharat Cyan Vigyan Sainiti, New Delhi.]
Some professionals hope that the national entirely on women. The government claims 1
law (1994) against SDT will prevent female that there is a change in approach from
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w
.. OCFR-^.g;
A '<
KIH 3-.Sa
Try
51-/
'■>-> St O Col&r> gA
2
51
The*Campaign Against Sex
Determination Tests
RAVINDRA R. P.
PROLOGUE
Chandigarh, March 9, /9»S’9
The banners for (he International Women's Day still Gutter in the
hall. The air is still thick with songs and slogans. Dreams in
clenched fists and raised voices still float in the eyes. However,
there is dead silence at Surinder Ldtowa’s house. This is the
happiest and luckiest day for him. Twenty-three years after
marriage, his dream is fulfilled : he has become the proud father
of a son.
His three daughters are not at all happy. As he returns
from the maternity home, he finds the door locked from
Inside. Nobody answers his calls. At last, he jumps over the
wall to enter the backyard. There is pindrop silence in the
house. Finally, he sees them : their bodies hanging from the
ceiling.
Anita, Sunita, Anamika, ages nineteen, seventeen and fifteen
years. Anamika was bright. She had recently won a prize as a
girl guide. Anita had been standing first in all examinations
throughout but for the December tests. When she was asked
whether there was any tension at home, she had replied confi
dently, None whatsoever, Just see, I shall regain my rank in the
next exam'. Anita wanted to be an IAS officer. She dreamt of a
thousand things. Sunita published an article in the Indian Ex
press, on the condition of Indian women, where she strongly
asserted that Today’s woman wants to gel ahead in e\'ery field,
to live independently and succeed. Our society will have to
cooperate with her'.
■■
/
52
The mother of the three girls, after Anamika’s birth, underwent
(he SI) test thrice. Twice it turned out to be a •gid’, and she had
an abortion each lime. The third time, it was a boy’, which on
her husband’s advice she decided to keep. Everytime, the
daughters, especially the elder two, fiercely debated with ’their
parents. The tension reached its height the third lime when the
parents decided not to abort the much wanted male child. The
feeling of ‘tinwantedness’ grew
j
in the minds of all the daughters
to such an extent that in Janniary Anita had attempted suicide by
swallowing sleeping pills.
Last fortnight, Union Cabinet Minister Shri Vasa nt Sa the
slated publicly that SI) tests should be encouraged
- - o-J as they help
only children who were wanted to be born. These tests would
also enhance women’s dignity and status in the society he
Said.
Excerpts from
friends :
a poem by Alka
Boilra, one of Sunita’s
What did you get
By dying like this?
The days haven’t changed
Nor nights.
Your sorrows have vanished
After embracing death.
But what about your thousands of sisters?
Should they too follow your path?
Your life was
The most precious thing in the world.
Why didn’t you keep fighting,
Lacing all challenges?
A noted psychiatrist expressed a view that the crumbling of
the institution of lhe joint family led to such situations. If there
were grandparents, uncles and aunts living in the same house,
the girls would peihaps have given vent to their feelings, and
the ciders might have counselled them and dissuaded them from
taking such an extreme step.
Gan we loo put the onus on t"
the crumbling of the institution
of the joint family anti relax? Aren
... ’tI wc all guilty?
\
\
/
A
v^D
7>o
ex 1 s->sA
( '•'•fV-c
SXs
53
An Encounter with a Pioneer
It was the summer vacation, and 1 happened to visit Dhulde, my
native place. Glancing through the window of my bus, I noticed
a board near a maternity home : Prenatal Sex Determination
Centre’. The maternity home and PSD Centre were run by a
husband and wife team. I walked in and told the nurse that I
had come to see the doctor. I was made to sit in a hall. The
benches were empty. On the left was a rolling blackboard
bearing a table : date of performing the test, pregnant woman’s
name and finally the result, three-fourth ‘male’ or female’.
People walked in to have a look al the ‘lottery result’ and
dispersed quietly. 'Phis must be a very efficient system I thought.
Il saved the doctor’s lime. Moreover, wiping the board would
remove all the evidence of having performed the lest. 'I’he lime
passed off very slowly. Suddenly a man entered the hall. It was
not difficult to make out that he must be a ‘not so proud father
of several daughters’. 'I’he nature slopped him there and then.
‘What do you want?’ she asked rather curtly.
‘That male-female test,’ he fumbled.
'How many months (of pregnancy) over?’
Three’.
'Bring her after completing four. Don’t come earlier and don’t
fail to bring the total amount of fees’.
His attire had not left any favourable impact on her.
'I'he lady doctor was not willing to talk at all. ‘You must see
him,’ she maintained.
I was finally called by ‘him’. He was in his forties and was
very guarded. However, the fact that I had come all the way from
Bombay, helped him to open up.
This business of sex determination seems to be going pretty
strongly in our Dhole town. I saw two advertisements (of SD
centres) in today’s local newspapers’. I said, making a cautious
beginning.
5-i
‘Forget the others. I am the pioneer here. I started way back.
Others have just been following me. 1 have performed over 150
cases in the last one and a half years. Would you believe?'
‘Why don't you write about it then? At least publish a research
pa per.’
You are right. But where’s the lime? You sec how busy 1 am.’
He was really very busy. As our talk progressed, one man
came running, almost panting. His face was tense.
What happened?’
Doctorsaab, last week you had performed that male/female
test on my wife. She is bleeding profusely.’
Where is she?’
‘Downstairs. We brought her from our place in a bullock carl.
It’s a 15-kilomelres journey.’
Hasn’t she thrown it out (aborted) completely? Go, keep her
there, Sister!’
1 started to leave. ‘You have to go, I understand.'
‘Forget it. This is the usual problem. You get one in ten cases.
These village people will never improve. They make their
womenfolk work in the ‘dust and in the garbage immediately
after the test. Never take any care. This is inevitable.’
I took time to recover from the shock. .Meanwhile, the doctor
continued, ‘Initially, only the moneyed people from the middle
castes came for the test. They have to pay tremendous amounts
as dowry. They keep on coming even now, but now our main
clientele has changed. Now it's the educated middle class.
Brahmins, traders, professors, government servants, lawyers,
officers. They come from everywhere. Very wise people. Not like
the rustic fools. They don’t wait till they have four to six
daughters, but approach me in the first or second chance. Really
systematic.’ He was all praise for his clients. After some lime, he
ga‘ v me his diary to browse through.
55
Diaiy. 1 he doctor’s diary. The data related to 450 ‘cases’ were
all jammed in that tiny book. No case papers, no files. The entire
documentation was in the form of a few notes made in the
handwriting ‘worthy of a doctor’. Full name, address dale of
performing the test, result and, in some cases, date of abortion
1 hat was all.
These data related to not less than <150 women, who came
horn far- oil places and went back to work amidst dust and dirt,
here was no mention of their ages, number of children they
had had, Instory of abortions, if any. The entire reproductive
histories of the women were conspicuous by their absence. And
ol course there was no quedstion of recording their consent
either. Did they have any say in the matter? Where was the
question of their giving consent?
■ All the talk of 'data recording’ and 'informed consent’ that I
had read of in medical journals lay meaningless here. What is
the use of all these scientific articles and their pious warnings?
I he test must be performed in a totally aseptic area, preferably
in an operation theatre. It must be carried out under ultrasonic
cover to enable the operator to guide the syringe into the
amniotic sac without damaging the foetus, placenta or internal
organs of the pregnant mother. In spite of all these precautions
certain side effects are inevitable. They include spontaneous or
delayed abortion, damage to foetal tissues and infection The
seventy and frequency of these damages depend upon doctor’s
skill and experience. The doctor should, before carrying out the
test, gtve a clear idea about the possible health hazards to the
concerned woman and obtain her consent in writing.
I he average age of marriage for girls in the rural areas of India
is fourteen or fifteen. .She experiences her first pregnancy around
l ie age of sixteen. Eighty per cent of rural Indian women are
anaemic. This pregnant girl lying on die table in the next room
must have been one of them, a mere number in statistics,
icgnant at sikxtcen, lest in the fourth month, abortion — either
natural or if the child happens to be ‘female’; next year next
pregnancy; again test and so on. the cycle would continue. If
56
anything goes wrong, one can always blame the dirty work on
dust and garbage.
In India the mortality rate for young women, especially during
pregnancy, is one of the highest over the world.
.S’e..v Detennination (S/)) Tests : Myths anti Reality
1. SI) tests are an effective tool for population control. Il helps
to reduce the number of women and thereby decrease the
productive rate.
(a) Is women a mere reproductive machine?
(b) The sex ratio in certain South Asian countries including
India is adverse to females. In certain regions, the differ
ential in male- female population is steadily widening.
The decline in number of females has not proved to have
contributed to checking the population growth in these
regions.
(c) Several studies have proved that an important parameter
governing the success of family planning programmes is
the ‘woman’s status in family and society'. Women do
not need to be taught about the benefits of a small family.
They already know them. But they lack the freedom to
lake decisions and act on them. Societies and regions
where women have better access to education, a role in
economic activities, better status and dignity at home and
in society and access to material conditions conducive to
survival of existing children are invariably the ones
where family planning is a success. Regions with low
status for women also show less acceptance of small
family norm. Kerala and Rajasthan are two conslrasting
examples.
(d) Declarations at international population conference have
underlined the fad that the right to small family is
inseparable from other fundamental human rights such
as right lo equality, gainful employment, and old age
security. Hence, one cannoi be obtained al lhe cost of
others.
57
(e) Il means justify ends for population control, why not
encourage other equally effective sex-selection means,
for instance, dowry murders and female infanticide?
2. SO tests are resorted to only by couples having two or more
daughters. Hence, they would not adversely alfect the sex
ratio while they help in population control.
(a) A sizeable number of couples opting for SI) tests already
have a son. They do not want a daughter, but more sons.
(b) The number of couples going in for SI) tests during the
first or second pregnancy is quite high, specially among
the education middle class.
(c) The ideal family size as believed by a majority people in
India is two sons and one daughter. The preference lor
sons is often accompanied by contempt for daughters.
There is no reason to believe that people would stop
procreating after one son.
(d) While thousands of cases of selective abortion of female
foetuses are reported, one hardly hears of aborting a male
foetus.
3. The law has not helped in solving any of the women’s issues
in India (e.g., dowry, rape, sati) SD tests cannot be an
exception, because the law cannot change values, attitudes
and societal structure, and all these issues are linked to the
attitudes, values and structure of this society. Nevertheless
progressive legislation has an important role to play in this
context.
(a) Such legislation delegitimizes the social sanction to such
practice. Il also creates space for more effective social
action.
(b) One needs to diferentiaic between issues like dowry an
d SI) tests because:
(i)
Evils like dowry and rape arc deeply embedded in our
society, each with a long history. The issue of SI) tests is
a recent phenomenon and hence relatively easy to con
front.
(ii) AltlkHigh (he techniques for the withdrawal of amniotic
fluid is relatively easy, (he key element of this technology
'74
•
...
It
’l
58
is chromosomal analysis, which is highly sophisticated,
expensive and is hence centralized. Accuracy level above
95% can be arrived at only through experience. Control
ling these genetic laboratories where analysis is carried
out would virtually controll the entire SI) business.
Presently the genetic laboratories in India are limited in
number and arc mostly located in large cities. The
majority of them are in Government institutions.
(iii) An additional element here is the medical community,
which is by and large-abiding. Adverse publicity <1 any
kind being detrimental to their professional interests, the
number of doctors who would care to break the law only
to earn money would be quite limited, if they are
convinced that the government is sincere in its imple
mentation.
’4. The SI) tests are the perfect solution to the dowry problem
People saying no to daughters do not necessarily say no to
dowry. They are opposed to paying dowry, not accepting it. The
system ofdowiy will continue for as long as people continueto
look upon daughters as burdens’, as long marriages will be
based on false concepts of prestige (related to caste and class)
and not on imutual understanding and respect. Dowry cannot be
separated from patriarchal control. SI) reinforce, rather than
counters all these factors.’
5. Opponents of SD tests oppose 'female foeticide' but
not
abortion per se. Is this not a contradiction?
(a)
We oppose abortion not only of female foetuses. We
oppose all sex-selective abortions (except when they are
lherapulically justified, for example in serious sex-linked
disorders). 1 hat means we would oppose selective abor
1
tion ol male foetuses too, although such a question does
not arise in the present social system. Our basis of
opposition is not pro-life’, but ’discrimination’. Choos
ing the sex ol one’s offspring is the most sexist sin.’
(b) We uphold women's right to abortion although we do
not support or encourage use ol abortion as a routine
family planning method, because such a* practice is
i
v ■
■
‘f
59
injurious to women’s health. However, a woman should
have a right to abortion since in the present social
structure, she has no right over her body, sexuality and
over the process of reproduction. Quite often, pregnancy
is thrust upon her. She alone is held responsible for
nurturing the child first in the womb and then outside
and for rearing it. Hence, as the last defence, she should
have a right to say ‘no’ to continuation of pregnancy.
6. It is more humane to abort a female foetus rather than
subjecting her to a life where al every moment she is made
to feel that she is unwanted. Female foeticide is preferable to
dowry murders and sali.
Il is basically wrong to pose reality in form of such a
a.
cynical option. It is like a poultry-owner giving his
chickens a choice between whether they would like io
be roasted or fried. This is no choice; we do not accept
such a cruel and self-defeating choice. We assert lhal
women do have an option to a dignified life, an option
which they have established through sweat, blood and
tears.
b.
While we do not wish to deny harsh realities of today’s
society, we believe that it is totally wrong to project a
part of reality as total reality and also to accept it as an
eternal, never- changing truth. Today the world is under
the constant shadow of nuclear holocaust, ecological
disaster and social conflicts. We are on lop of a sleeping
volcano. But nobody stops procreating for the fear that
their sons would most probably edie in a nuclear war or
a riol or more painfully due to an ecological catastrophe.
In fact, the very inspiration behind procreation is human
kind’s nerve-dying optimism. We all hope that the future
of the next generation would be a brighter one, that our
offsprings will learn from our mistakes and make inis
world a more beautiful and humane place to live in. Why
not direct our energies to make lhal happen?
7. A mother has a fundamental right to choose the sex of the
child. Banning SO t'-sis amounts to depriving a woman of this
60
crucial right of 'freedom of choice’. Let the mother decide
whether or not she would like to give birth to a duaghter.
a.
A woman, like any of the oppressed sections of society,
should have a right to choose. However, the concerned
choice and the decision should be totally her own. The
question is Do women have such a free choice today? A
woman who decides to undergo SI) tests and abort the
female foetus does not do so on her own free will. Most
often this decision is prompted by pressures, subtle or
explicit; from the memebers of her husband’s family.
There is a fear underlying the decision : of rejection/deseilion by husband, of husband marrying another girl to
beget a son, of being subjected to unending harrassment.
At times, there is cynicism coupled with frustration.
Women after living a wretched life feel that a woman's
life itself is worthless and hence lake such a decision. It
cannot be termed as free choice.
b.
The Indian woman has no say or choice in matters most
crucial to her life such as education, marriage, sexuality,
economic independence. In such a milieu the right to
choose the sex of the child is adding insult to her injury.
It would be interesting to find who has been asking for
such a right. None of the women’s organization have ever
asked for such a right. Its advocates include doctors who
wish to further their vested interests in the name of
women, and those men who want a male heir for
property and for the continuation of male lineage. These
are the very forces who oppose women’s groups when
the latter seek the freedom of choice in other fields of
life, for instance contraception (opposing long term
hoi monal contraception), childbirth (opposing indis
criminate use of caesarean section).
cl.
Even when any individual woman would ask for such a
freedom of choice, the ultimate decision would have to
be taken after ascertaining that individual rights do not
restiict, contravene or oppose wide interests or rights of
women as a whole. I his is true not only of SD tests but
61
of the whole range of new rv prod 11cl i ve (ec11 no Iogi es
(NRTs).
In a markel economy, demand for a particular producl/service/technology can be created. Couched in the liberal jargon of
■freedom of choice’, it can then be marketed. Hence, concepts
like ‘surrogate motherhood’ and •genetic engineering’ which are
detrimental to women’s health and their wider social good arc
being introduced and propagated using psuedo-feminist jargon
of freedom of choice*. The key question is then of the interpre
tation of the term ‘freedom of choice’. Shall we equate it with an
uncontrolled right of any individual or judge il in the framework
of the wider social reality?
Dowry, rape, sati, sex-selective abortions are different mani
festations of atrocities against women. They all stem from a
system based on inequality, injustice and oppression of women.
Hence, their ultimate solution lies in the fundamental restructur
ing of society on the foundations of equality, justice and mutual
respect. For all of us, struggle against SD tests is a pan of the
wider struggle for equality and women’s liberation. We arc thus
involved in raising awareness and changing attitudes and values
of people. I his article is a travelogue of our march, our voyage,
our journey. It encompasses the reflection and evaluation of the
past as well as the loud thinking and appeal for the future.
1 he yeai 1982 was when the issue of Sex Determination (SD)
lests captured the nation’s attention for the first time. It instantly
became a media issue and was hostly discussed for months. What
exactly triggered it off?
1 he flashpoint came in the form of an error in the determina
tion of foetal sex carried out at the New Bhandari Hospital at
Amritsar. Such errors are not uncommon. They had occurred
earlier in cases of lesser mortals. This time, however, it was not
an ordinary foetus. A powerful government officer, craving for
a son, had asked his wife to undergo the test. Diagnosis as female
was, as usual, followed by abortion of the foetus. It was then
discovered that the aborted foetus happened to be male. The
embittered lather made the news public in order to discredit the
hospital. The rest is now history.
62
'fhe technique of amniocentesis which was used lor sex
determination in this case was originally discovered lor the
detection ol genetic abnormalities. Il is still used in most pails
of the world for the same purpose. However, in a country like
India being female is considered as an ‘abnormality’ or a ‘crime’.
No wonder the technique came to be used chiefly lor seeking
the ‘pre-climinalion’ of unwanted female children through SD
followed by (he abortion of the ‘wrong sex’. 'Hie gross misuse
of medical technology for SI) at the New Bhandari Hospital had
continued unabated for several years, 'fhe Bhandaris who pio
neered the SI) ’business’ had done their best to attract clients.
'The technique was pi
projected
ojcclccl as an ultimate solution to the dowi)
problem. The advertisements appeared everywhere in the lorm
of wall writings, pamphlets and huge banners. Doctors wcic
offered handsome commissions. Wives of inllucnlial political
leaders, bureaucrats, among others, queued up lor undetgoing
the test. Had it not been the abortion of the much wanted male
child of an influential person, the issue would not have become
national news.
It would be interesting to find out what exactly happened
when the issue came into focus. Editorials were written. Leiteis
to Editor were sent and published, women’s groups organized
meetings and morchas and passed resolutions. The opposition
raised the issue in Parliament. MPs belonging to different politi
cal parlies made fiery speeches. All these people condemned the
practice of female foeticide as immoral and detrimental to
women’s status and dignity. 'I hey all demanded urgent sliingent
punishment to the concerned doctors and a han on the missue
of sex determination tests. The concerned minister replied that
he shared the feelings ol all the members and declared that the
government would lake all possible steps lo check the menace
of SI) tests He, however, said that the solution to the problem
lay in raising people’s consciousness and changing their altitudes
and not in enacting a law.
The debate continued in the popular press and journals lor
months. Although all views were published, by and large, the
press supported women and condemned the practice ol SI) tests
and its advocates — doctors performing the lesis. family mem-
#
63
hers (mostly in-laws) forcing women to undergo it and the values
justifying and nurturing such a practice. As compared to any
other women’s issue raised in the women’s decade, the issue of
sex selective abortion seemed to have drawn maximum sympa
thy and support not only Irom media, but also from political
parties. Hut. in the final analysis, what was the outcome ol all
the* hue and cry that was raised in 1982? I low much did it
contribute to the solution of the problem? The debate and the
heat generated by it subsided within six months. Then everything
became quiet all over again. The New Bhandari Hospital toned
down its aggressive advertisements. But contrary to the promises
given in the Parliament, no action was taken against it by the
central government. The state government seemed to be equally
uninterested. (As it happened in most such cases, the govern
ment was at a loss to find out under which legal provision it
could take action.) The Bhanclaris must have been thankful to
the media as their name instantly became known all over
northern India. Dr. I.oomba, the geneticist working al that
hospital was so much impressed by the increase in the business
following the controversy that he opened his own genetic
laboratory in the very heart of Delhi. All the leading newspapers
in Delhi carried the advertisement of'Normal Boy or Girl?’ of Dr.
Loomba’s Hospital almost daily. They continue to do so even
now. Even newspapers writing stringent condemning SD seem
to be carrying this advertisement. There seems to be a peaceful
co-existence of (he edit page and the ad page in all newspapers.
Meanwhile, the Bhandari Hospital too seems to be doing fine.
Many enterprising doctors have helped the ‘technology trans
fer’ to remote cornersol India. Bombay had been the Gateway
of New 'I’cchnology' for India, and sex determination tests were
carried out in Bombay even before Amritsar and Delhi. The 1982
controversy indeed provided (he impetus lor the rapid (.ommeicializalion of the SD technique. Earlier, the Government of India,
through a circular, had banned the misuse of medical technology
for SD in all government institutions. This important but inade
quate decision had marked the beginning of privatisation and
commercialization ol the technology. I he l‘>82 debate lurlher
accelerated this process all over India, specially in north and
west India. The SI) epidemic' spread rapidly in Maharashtra,
64
(iujarat, Uttar Pradesh, Haryana, Delhi. Bihar and even to Goa
and West Bengal. Gujarat topped the list with SD clinics spread
ing even in small towns After the initial phase of cautious lull,
the clinics started advertising aggressiv ely. Within six years, the
SI) business came to Slav
Activists working in different movements, sociologists and
many othet conscientious and sensitive people were alarmed by
the tapid proliferation of th * SI) test epidemic'. Il was obvious
that such a technology would create* havoc in a country where*
a daughter is considered to be an eternal liability’, ora ’passport
to hell’. There is no celebration at her birth nor any sorrow al
her death. No wonder, technology ensuring quiet death without
any apparent violence would indeed be welcome in such a
society. People were also concerned about the probable reper
cussions of rapid proliferation of this technology on the health
of ptegnant women and over (he already deteriorating sex ratio.
Ihis concern and restlessness paved the way for the next phase
of the* campaign.
This section is an attempt to look back and to gauge the future.While it does reflect the collective thinking of the Forum that
was set up to campaign against SI) tests, it must be said that not
everyone shared the same views on every matter.
FORUM AGAINST SEX DETERMINATION AND SEX PRFSF! PO
TION (FASDSP)
In October 1984 the Forum Against Sex Determination and Sex
Preselection was founded in Bombay. Members had varied
interests and backgrounds, women’s liberation, health, human
rights, people’s science movement (PSM). For instance, Gayalri
w.is a tenowned lawyer; Sonal had de«.adcs of experience of
working on women’s issues and on the cultural front; Lata and
Vibhuti were working with Women’s Centre as a part of the
women’s movement; Harpal and Preela while working al a
tcse.uch institute were active in other movements as well.
Kamaxi and Sanjeev, fresh graduates of medicine w'ere looking
for a field of action, preparing at the same time for further
studies. Mohan Deshpande, an artist at bean and a physician by
ptofession, was active on both the fronts of art and medicine.
65
Chayanika, a researcher in physics, was actively involved with
the women’s movement, theatre and l-SM. Manisha and Amar,
researchers imcommunity health, were a part of the emerging
health movement. Sanskriti, Kunda, Swali andOdil brought with
them the legacy of the women's movement. Premkumar, Dn'ies'i
and Rajaneesh had 'graduated' from the PSM School while
Vrijendra was one of the few human rights activists for whom
SD too was an issue of priority. Thus ours was a helerogeneoe.s
group. Many of us were greenhorn activists. Most ol us wete
already Involved in more than one of the issues apart from our
jobs. Not all of us knew each other. Very lew bad the experience
of working together on broad issues. I he mor/ns o/w/onr/t ol
Issue-based campaign requiring patience, follow-up and a higher
degree of organization and coordination was unknown to us.
e
came together and worked as equal comrades. We trted to
s- analyse the experience of 1982, learn from it, and evolve and
\ sustain a new campaign.
Innumerable people have contributed to the campaign. More
Innumerable people ha
often than not, their contribution has remained unknown, unac
knowledged, although eacli one of them has helped the cam
paign in an unique wayl. Perhaps, without that specific
contribution, our struggle would have remained Incomplete and
weak . Dr. Sathyamala and Amrit Chad! of Delhi were mvolvcd
from 1982. They highlighted die health hazards of SD tests (as
they are performed in' India) and carried out the first survey of
SD clinics in Delhi. Their counterparts in Bombay were Ammu
Abraham and Sonal Shukla who surveyed SD climes In Bombay
in 198'’ They were instrumental In exposing the double stand
ards of the 'vegetarian, egg-forbidding', charitable I lari Kisondas
Hospital whose commitment to ethics did not deter them ftom
emerging as one of the biggest SD centres in Bombay. Ma im
Karkal introduced us to the science of demography and high
lighted the link between the politics ol population control and
women s issues. Had it not been for her we would have though
that NHRI must have been in the name of a fertilizer! NURI stands
for 'Net Reproductive Rate-1; i.e., each mother should be re
placed by only one daughter).
<;•
66
M.K. Shankar who became involved had earlier no connection
with activism. A him writer, he was disturbed that many of his
highly (jualilied friends went in lor SI) and he pursued the issue
on his own. Not satisfied with research, he invested all his
savings in the making ol a Hindi documentary Samadhan. Later
when he met the FASDSP group, he volunteered to show his film
wherever and whenever we wanted. It helped in creating the
right atmosphere and in focussing the issues before any discus
sion. Shankar is yet to get his invested money back. But his film
has won for us several friends and supporters. Mrinal Gore was
instrumental in raising this issue al the slate legislature along
with two other MLAs through the introduction of private mem
bers. Later she followed it up at various levels.
Relatively less known is Dhule’s Vijaya Chauk. She look up a
women’s morcha to the district collecorate when the bill came
.up for discussion in the Maharashtra Assembly. She also took
this issue to grassroot level through shibis (workshops). There
are several people like her who have been silently inducing
people to think and act on this issue. The activities of a small
group like ours situated in Bombay could lead to a larger
campaign through the actions of such people.
An effort which needs to be repeated clscw here was initialed
by the Pune group of the Democratic Women’s Federation of
India (DWF1). There is not a single SD clinic in Tamil Nadu. But
the maximum number of signatures on the ‘Letter to PM’ sent by
our forum are from this state. Aruna Gnanadasan of Madras
played an important role in networking on this issue with various
groups in the state. She used the platforms of churches and
related organizations, without diluting the feminist fervour while
raising this issue. What is more important is her success in
keeping the campaign away from the shadow of prof-life groups.
Slree Mukli Sanghatana took this issue all over rural Ma
harashtra through its Slree Mukli Yalta. In Gujarat, the Gujarat
Voluntary Health Association (GVHA) and Forum Against Sex
Determination (FASD), Ahmedabad, are fighting a lough battle
with the vested interests, Bailancho Saad’. Goa even succeeded
in pressurizing the state government to introtluce a near-perfect
bill in the Assembly.
«
67
The list of our supporters is extremely long. How can we
record and even know the contributions of everyone? Il could
be Smita Patil in the ninth month of her pregnancy feeling sorry
lor not being able to join our march. Il could be an unknown
lace in the crowd which disappeared after a gesture of support.
It was the strength, courage and confidence given by them that
helped us in our journey from there to now.
PREPARING FOR THE CAMPAIGN
Before initiating any action, we had intense discussions within
and outside the forum. We tried to meet scientists, lawyers and
doctors to understand their viewpoints. We thought it is essential
to understand the dynamics, achievements and more important,
the failures of the 1982 campaign. We could draw certain
conclusions for the future campaign based on our analysis.
(i)
We should not focus this question only as a women’s
issue because in our country, women’s issues are meant
to be discussed ad nauseam, never to be resolved.
Moreover, by doing so, 52 percent of India’s population,
the men, would lend to get isolated from the campaign.
Because although ‘he’ is supposed to include ‘she’ , ‘she’
is never considered to include ‘he’. Men tend to ignore
or ridicule women’s issues. Hence, we would raise SD as
an issue for men and women. For us the real issue is not
of women, but of the men-women relationship in society.
We would raise this issue simultaneously at various
planes: equality of sexes, of health and of human rights.
In a wide sense, we would raise it as an issue of
democratic decision making on vital issues like technol
ogy usage. We would assert that a few scientists or
technocrats should not have the right to decide on
matters which affect society as a whole. We should try
to initiate a process whereby a technology would be
allowed to operate within a society only after ascertain
ing its benefits and risks to all concerned.
(ii) We should not restrict our discussion to the technique of
‘amniocentesis’, as in 1982. Today simple and presum
ably safer techniques like Chlorionic Villi Biopsy (CVB)
are available for the same purpose. In future, still simpler
\
■ y-
V
68
3'
and relatively non- invasive techniques would come into
existence. Hence, we should discuss all techniques, both
present and future, which can be used for SI).
(iii) We cannot view SI) in isolation. Il is a part of the entire
spectrum of New Reproductive Technologies (NRT). Next
to SI) would be sex selection. Surrogate motherhood is
being developed in different parts of the world. These
NRTs along with genetic engineering (GE) would sooner
of later knock at our doors. 'Their impact on society as a
whole and on women in particular needs to be discussed.
We need to develop a comprehensive understanding of
all these issues. However, our first focus should be on
the issue of SD: people can relate to it, understand it, and
would be ready to act on it. Moreover, SD provides the
lowest common denominator for people to come to
gether. The area of consensus is much wider. Il also has
several dimensions. So we should raise a demand and
plan action in the context of SD tests. Our experience in
this campaign would enrich our understanding of other
technologies. Whatever success that we might gel would
create some space and environment in which we can take
up the further issues. Hence, our analysis should be
comprehensive, but action should be on specific issues.
(iv) We should not ask for a blanker ban on prenatal diag
nostic techniques which can be misused for SD. We
should ask for banning the misuse and at the same time
for regulating the proper use of these techniques for
detection of genetic abnormalities. Our demands would
be based on the right of equality enshrined in the Indian
Constitution and on the social need for regulating the sex
ratio balance.
(v) The issues of SD have several dimensions: technical,
social, demographic, legal, ethical and ol public policy
(related to family welfare). We need to develop a clear
understanding of each of them and of their interelalionships. Lack of clarity of understanding and absence ol
follow-up were chiefly responsible for the failure of the
1982 campaign.
»*
4
f
I
i?
;
-I,lit" fS
.
•.
.i‘»
’
1
69
‘
(vi) We need to get massive support from the media. How
ever, we must guard against certain tendencies which are
often evident in media debates. Quite often tehse debates
end up trivializing or sidelining the main issues. In 1982,
for example, newspapers lay too much emphasis on
matters like 'errors in diagnosis leading to abortion of
male foetusses'. Even the marathon debate in Economic
and Political Weekly lost its sharp edge when a scholar
like Dharma Kumar said, ‘Is it really belter to be born
and left to die than be killed as a foetus?’ Although such
fatalistic arguments were countered important issues like
medical ethics, question of choice, and so on remained
untouched. Il was obvious that allowing the birth of
daughters would not automatically raise their status. But
the solution lies not in ‘more humane ways of eliminating
women’ but in fighting all forms of their exploitation and
subjugation. To avoid such problems, we must retain the
initiative in all such debates. Instead of wasting our
energy sn responding to our opponents, we should force
them to debate on our terms, to respond to the issues we
would raise. We should also be alert to see that people’s
interest in the campaign is not allowed to fade away.
(vii) Our campaign must reach out to people, beyond the
usual circle of activists and intellectuals. We need to
discover new, imaginative ways for reaching out.
THE CAMPAIGN BEGINS
On 8 April 1986, we organized a workshop at YWCA, Bombay.
There were four sessions in which we discussed the technical,
social, legal and campaign aspects. The newspaper coverage was
very encouraging. The battle had begun. Events followed very
rapidly. The response was overwhelming. Our weekly meetings
had a packed agenda. New faces showed up during each
programme/meeting. There were new challenges at every step,
Dr. Datta Pai look cudgels on behalf of the pro-SD lobby. His
theatrical performances, challenges and threats electrified the
atmosphere. That was precisely the lime when advertisements
for SD reached a crescendo in Bombay. There were l.uge boards
everywhere, pamphlets. We planned to counter them. We
70
wanted to show people the other side of the issue. The problem
was how to reach millions of people effectively with the help of
limited resources. Then emerged the concept of'train campaign
through the counter advertisement’. After discussion with the
group, Dr. Mohan Deshpande came up with a brilliant poster. It
was of the same size as the most popular SD advertisement in
the local train, using the same color and similar symbols. Hence,
people could immediately relate it as a counter advertisement.
It communicated effectively with the help of one picture and
one-line message of 'Ban SD tests’. (Today, however, some of
us feel that the poster and some other visuals used in the
campaign might be misinterpreted as being anti- abortionist.)
The counter advertisement conveyed our message to millions of
people and kept on repeating it for several months. Normally
posters stuck up in local trains have a life of only a few days.
However, our posters lasted for several months, a few for ever)'
more than two years.
’Hie train campaign was followed by a dbama outside a SD
clinic. We then started collecting signatures for a letter to the
Prime Minister. We started addressing people at seminars, work
shops and public debates. We did not know all the answers when
we began. We learnt a lot through experience. Our repliv.'- to the
arguments pro-SD tests were the product of group efforts during
the campaign.
Once Manisha was addressing a seminar. The earlier speaker
had repealed the favourite myth that women’s status would
improve with decline in their number. While countering him,
Manisha started describing a scenario where women would be
the miserable minority. She said, 'Even now, when we travel in
a bus or train specially at night there are very few women around.
There is an unspoken terror, tension and constant fear. It is
mailer of a few minutes. Il is our daily routine journey. Still we
feel so insecure. Imagine how insecure a woman would feel if
she were to lead all her life in a similar environment.’ The women
audience could immediately grasp the point. This was when I
realized that I had never spoken in this way. I used to provide
information from books because I had never experienced the
insecurity and tension that a woman experiences in such situ-
71
ations. This experience taught me the difference between sym
pathy and empathy.
Slowly each one of ns developed a style which had certain
features in common. We put forth feminist analysis, but made a
point to relate to both women and men. We emphasized that
everybody was in fact involved with the issue and no one was
outside it. Perhaps due to the positive impact of women’s groups,
we never felt ashamed of talking of experiences, of feelings. For
us, the warmth of emotion was as important as the sharpness of
logic.
FASDSP has no office bearers, no leaders. We have no bank
account. We could generate funds sufficient for our activities and
could maintain accounts properly. But we never bothered to
collect kinds for it, which also had its drawbacks. Except a book
sfor Nari Jeevan Sangharsh Yatra, we could not publish a single
booklet, even a folder. Moreover as the initial phase of intense
action got over, it was difficult to generate new action. For the
same reason we have been weak in long-term planning.
SEARCH FOR NEW MEDIA
We all felt the need for new media to attract attention of people.
Moreover, we thought that such media should match our content.
The search for new media lead us to the Parents- Daughter Yatra
organized on the Children’s Day 1986. ‘Half the Children Are
Female or Ought To Be’ was the slogan for this day. Several
young girls and their proud parents participated in the march.
The participants included personalities like Vijay and Priya
Tendulkar as well as activists from different organizations and
many more people. A convent school in Santacruz sent their
students in uniform along with teachers. There were songs and
dances; it was a festive occasion.
On the next Children’s Day, we planned a programme spe
cially for children. Hundreds of children gathered at Hutatma
Smarak. I hey included students from convent schools as well as
tribal children from Thane district brought by Kashlakari Sanghatana. Four kalakars in colourful attire were dancing and
singing with children. Novel games exploding sex stereotypes
weie being played. Children and adults wore colourful caps \
72
bearing slogans like litclki hci ladkci sc kaui (Girls are not inferioi
lo boys). Manasvi(ni and Jiinnka, two young children coined a
new slogan ambi midi srula phuli, iiahi phunkcwaiiihi chith (XX e
girls arc ever blooming Howers, wc don I care about lighting
stoves). While the children played in large circles, ciders pul up
an exhibition along the loadside on the issue ol SI).
It was a treat to watch the children play. One ol the games
involved mimicking various activities. Girls were asked to per
form male jobs like repairing a schooler and playing cricket while
boys were asked to wash utensils and clean the room. We
observed that while the girls were at ease in doing all sons of
jobs, the boys found ii was very hard lo perform the feminine
chores. Later an activist from YUVA translated the drama and
songs in Marathi and staged the same programme with the help
J-
of children residing in a workers’ colony.
\
We also experienced that people were receptive lo novel ideas
and helped in carrying them forward. Many artists were Inspired
by this campaign. For two consecutive years the Asok Jain
Memorial Competition for Social Awareness Advertisement was
flooded with entries on the issue of Sd, many of which won
wards. Their creators ranged from schoolchildren to renowened
commercial artists. It was gratifying to find that most ol the artists
had really understood the message of the campaign and that they
succeeded in blending the message with the medium.
An eye-catching advertisement made use of Indira Gandhi s
charisma. It said that if such a lest were available earlier and had
)
Kamala Nehru used it, Indira Gandhi would not have been born.
Il also indicated how women like P.T. Usha and Mother leresa
have raised the dignity of women. After looking at that adver
tisement, Mohan made an excellent poster. He stuck his daugh
ters phologra-ph on a paper and wrote below, My daughter may
not become a P.T. Usha, a Mother Teresa or an Indira Gandhi.
But she is my daughter. I am proud of her. Oppose SD tests.’
Mohan was our most prolific and imaginative artist, lie prepared
many posters and a cartoon series. To top it all, he prepared a
special slicker for children’s day 1988. Il was a post card with
Nehru’s picture in form of a stamp. I he card had a caption, lie
loved female children loo.
;fr.
73
Dee pa Ba Isa war* was the final year student studying comniercial arts Instead of choosing the campaign of a marketed
product, she chose an advertisement campaign against Si) tests
for her project work. The result was a series of excellent posters
and models. PTl-TV prepared a documentary on this theme. Mr.
Singh from IIT, Bombay, prepared another documentary in Hindi
named Ajata. It presents all the arguments in support of Sd,
as well as very effective countering of these arguments by
the opponents of SD. Forum prepared a slide show in
Marathi. It songs provided many catchy slogans foi the
ca mpaign.
The issue caught attention of people in Maharashtra. 1 he
regional press loo debated the issue for months. A renowed
dramatist wrote a play based on this theme. The play Paul
Khuna (foot prints) revolves round a middle-class family
\caught in a turmoil when the husband takes a decision that
his wife should undergo a SD lest. The most remarkable part
of the play is the portrayal of his sensitive young daughter
who is the most affected by this decision. She is also the most
articulate person who raises questions too embarrassing for
her father and for entire society. The play won first prize al
the state level and was later launched on commercial stage.
We thus witnessed a chain reaction around us. We had only
initiated it. It had its own momentum. It was growing day by
day. We only look care to see that the flame was not extin
guished.
Our efforts of sconsiousness raising culminated in a month
long Na:i Jeevan Sanf>barash Yal>a. It was organized in and
around Bombay during March-April 1988 with the help of several
local groups. Our aim was to present the issue of sex-selective
abortions in its entire perspective. We tried to link it with other
struggles for women’s survival and dignity. The yatra interacted
with people from schools, chaivls, middle-class housing colonies
and slums.. The issues to be highlighted at each place were
chosen by the local groups. We used video films, slide shows,
posters and plays to raise a few questions which were later
discussed in detail. The issues discussed included family laws,
domdestic violence, women and health, test tube babies etc. I le
I .
I.
74
yalrci also provided an opportunity to several women slum
dwellers to come together and collectively write, direct and
present a play on topics related to their everyday lives. The forum
also published a set of posters used in the yatm in the form of
a book.
THE GOVERNMENT MOVES
I he campaign gained momentum, we were still unaware of what
needs to be done to pressurize the government to enact a suitable
law. We decided to do the most obvious thing: to file a Public
Interest Litigation (PIL) because everybody around seemed to be
doing it. Overnight the draft of the legislation was prepared with
Gayatri’s help. We were not sure whether the judiciary could
direct the legislation to enact a particular law. Still we decided
to try out the option. (Later Mahila Dakshata Samili filled a
litigation in the High Court following the death of mother and
foetus due to the SD test. It did not come up for hearing for
years.)
One evening a man in his late fifties came to see us. He was
a senior officer from the Mantralaya (Secretariat) on the verge of
retirement. He told us of his varied interests in social issues. He
was fond’ of drafting bills on important social issues. He used
to pass them to interested MLAs or MLCs who in turn would
introduce them as private members’ bills. He wanted material
related to SD. Although we could not figure out exactly what he
was saying, we handed over the relevant material to him. After
a few days he sent us a message: ‘’Hie draft of the bill is ready.
It will soon be introduced in the Legislative Assembly by three
MLAs
Mrinal Ghose from Janata Party, Shyam Wankhede and
Shaiayu Ihakar of Congress (1). The introduction of a private
members bill added an entirely different dimension of the
campaign. It forced the slate government to give serious consid
eration to the issue and act accordingly. It laid the foundation of
the entire legislative exercise al the state and central government
levels. 7he issue could attain some degree of success. Hence
some activists associated with the campaign could be in the
limelight. The names of MLAs who lent their names to private
members bill have also been registered in the history of this
campaign. Bui die person who was the spirit behind the legisla-
1
75
live process has remained unknown to all. We are greatly
indebted to him.
In the meantime we were called for discussion by 1).I. Joseph,
Secretary, Department of Public Health, Government of Ma
harashtra. We discussed the issue in details countering the
opposing views which were put forth aggressively. Al the end
of the discussion, we said with a smile, You may not be knowing
it. But you have convinced the right person. Now it is my
responsibility to bring about some concrete action on this issue.’
We look his remarks with a pinch of salt
But our subsequent experience showed that Joseph was
indeed seized by the issue. In our country, bureaucrats are virtual
rulers. They have tremendous powers. A sensitive and conscien
tious administrator can effectively use these powers to a con
structive end. Joseph's contribution to the solution of this issue
is a case in point. To begin with, he asked the Foundation for
Research in Community Health to conduct a survey of SD clinics
in Bombay. Dr. Sanjeev Kulkarni carried out a sample survey of
gynaecologists. The findings of the survey were immediately
published. The survey, one of the most authentic statistics
available on this subject, vindicated our viewpoint.
Until then, all the statistics that we had were unofficial. It is
next to impossible to collect authentic data related to this
problem, because doctors carrying out SD tests hardly keep any
records. We did not have access to most of such records. Even
when we could collect sufficient information through whatever
means we had, it could not provide sufficient idea of the larger
reality. In the initial phases, we were often questioned, especially
by foreign correspondents about official or authentic nature of
our information. This question came mainly through their igno
rance about the nature of SD clinics in India. In India it is not
necessary to register a SD clinic or centre. Any doctor can start
one. (In Maharashtra the situation has changed to some extent
after the law.) In a country like (he USA the doctor has to obtain
‘informed consent’ from the patient even before performing a
minor medical intervention such as withdrawal of blood. Amnio
centesis can only be performed by a qualified person with
sufficient experience provided (hat the necessary infrastructure
76
such as an operation theatre and ultrasonic cover is available.
However, in India all that is required is a syringe of suitable
aperture and a doctor prepared to insert it into the amniotic sac
of a pregnant woman. In such an environment, how could we
collect authentic data? However, Dr. Kulkarni’s study proved
beyond doubt that our observations were indeed vaiid. The
very fact that about 85 percent of the gynecologists covered
by the survey agreed to have been using techniques like
amniocentesis chiefly for the purpose of SI), silenced our
detractors once for all. That the doctors admitted it to a person
officially conducting the survey on behalf of the slate govern
ment at a lime when the issue was al the centre of worldwide
media attention further' highlights the significance of the
findings. The ever-increasing force of the campaign, coupled
with the findings of this survey and the introduction of private
>-m’embers’ bill in the legislative assembly forced the state
^government to act.
Another important development during that period was the
formation of the group, Doctors Against Sex Determination
(DASD). FASDSP was constantly being accused of being
‘against doctors’ by our opponents. Actually our campaign was
never against the medical profession of gynecologists. We
were raising our voice against the gross violation of medical
ethics by a section of gynecologists and other medical experts
indulging in the SD business, the pro-SD lobby had tried to
raise the bogey of ‘doctors prestige in danger’. Hence, certain
doctors who were active in or sympathetic to our campaign
felt the need of raising an independent forum of conscientious
doctors to support the campaign. Ils convenor was Dr. B.M.
Inamdar, a young gynecologist from Goregaon. He showed
courage and conviction. He dared to come out in the open on
this issue at a lime when many reputed senior and progressive
doctors refused to take any public stand on this issue. Certain
doctors were active in both FASDSP. as well as DASD. DASD
publicly asked Indian Medical Association (IMA), Indian Medi
cal Council (IMC) and Federation of Organization of Gyne
cologists Societies of India (F’OGSl), to take a stand on this
mailer. Barring FOGSI, the other organizations are not even
ready to discuss this issue. They did not even bother to
77
acknowledge die DASD letters. These very organizations are
entrusted with the task of die preservance and upholding of
ethical values of t|iis very noble profession : much for their
concern for medical ethics.
EXPERIENCES AT THE GOVERNMENT COMMITITE
The private members’ bill was scheduled for discussion in the
1986 winter session of the Maharashtra legislature. Hence, the
government felt the need to act before it came up for discussion.
Keeping up its tradition of appointing expert committees on all
embarrassing topics, it announced the formation of an Expert
Committee on SO and Female Foeticide (Infanticide said the first
official letter). From the campaigners’ side, Manisha and 1 were
invited to become members, obviously at the instance of Mr.
Joseph. However, one of the members of this committee was Dr.
Pai, the person who had proclaimed at an international confer
ence, ’Selective abortion of female foetuses is the only solution
to India’s population problem.’ Hence, the government’s inten
tions seemed to be quite dubious. The past experience of
government committees, their structure, functioning and fate,
had not been at all encouraging. So we were not keen on joining
this committee. However, after much deliberation, we decided
to accept the offer. In the past, we had all protested against the
exclusion of people who were appropriate from government
committees. We thought'that we should use this opportunity to
gain the experience about the dynamics of a government com
mittee and to learn from it. We also fell that by being a part, we
could prevent the committee from sidetracking the main issue.
It was agreed that the campaign would maintain its pressure from
outside. Moreover, we always had the option of quitting after
making sufficient noise in case the committee went astray or
became defunct. The committee appointed three sub-committees
to go into the details of the technical legal and awareness aspects
of the issue. Dr. Inamdar of DASD and Dr. Ilema Purandare of
the Genetic Research Centre were included in the technical sub
committee. Excellent co-ordination among the activist members,
the pressure of the campaign from outside and the clear stand
against SD taken by Bhai Savant and Rajani Satav (cabinet
minister and minister of state) contributed to the success of the
<.
78
committee. Dr. S. Pai and Dr. Pmandare. in spile of their personal
views to the contrary, lent their consent to the report which was
thus accepted unanimously. The report of the committee submitled in May 1987 whichi was never published, contained the
following conclusions:
<i)
The misuse of prenatal diagnostic techniques for SI)
should be totally banned.
(ii) These techniques should be allowed to be used for the
detection of congenital anomalies
(in) I his use should only be restricted to government and
public institutions (e.g. municipal hospitals). The serv
ices available in the private laboratories, should be, if
required, channelized through government institutions
licensed for this purpose.
(iv) The stale government should enact a special law for this
purpose.
(v) The state government should pressurize the central gov
ernment to enact a similar legislation at the national level.
(vi) I he Medical Termination of Pregnancy Act, if required,
may be amended so as to include in it a clause explicily
stating sex- selective abortion (except where it is theraputically justified) as a legal offnee.
(vii) The law can succeed only if it is supported by a wellplanned, long-term movement for health education and
consciousness raising. The government should take suit
able measures to that effect.
The committee had thus upheld our stand on the issue. But
there was no room for complacency. We soon realized that
governments have their own ways. They have too many tricks
up their sleeves. First is their phenomenal slow pace. (It is
calculated. They can be extra fast when they choose to ) The
report although completely in our favour, was never released
and discussed. The state government was just buying time till
the tempo of the campaign would subside.
H was the end of December 1987. Twenty months after the
campaign, we had not succeeded in extracting anything concrete
79
from the government. The announcement macle by the ministers
within and outside the legislative houses, and reports of expert
committees amounted to nothing. The crux of the matter lay in
the decision of the cabinet. The cabinet was not yet ready to give
a green signal to the proposed law. It had its own priorities,
views and idiosyncracivs. Then, almost unexpectedly on the
night of 31 December, the chief minister Mr. S B. Chavan.
announced that the cabinet had accepted all the recommenda
tions of the committee. The official bill was to be introduced in
the legislative houses soon. It was his new year gift to the people
of Maharashtra.
.
TIhis 1988 began with a bang. The state government received
kudos from all concerned for introducing the first major legisla
tion on the regulation of medical technology in India. However,
the media, and the activists were guarded in their reaction. We
^expressed happiness. ‘But the real test lies in implementation ’
\he said.
’
On 10 January, the Times of India carried an article ‘Should
There Be a Choice?’ by J.B. D’Souza in its Sunday supplement.
It strongly argued against the government’s decision. The argu
ments in the article were pretty worn out and had been countered
several times ever since the debate began in 1982. However, we
had learnt through experience that what is significant in such
debates is who is saying it. Often the debate does not move
ahead. People raise the same old arguments over and again. I bis
is when you feel trapped. You have limited lime, energy and
resources. You just do not feel like going through the same bout
o aiguments aga.n. But if you do not reply, the same myths are
petpelualed through infinite repetitions.
What was alarming was that the pro-SD lobby had finally got
a respectable spokesperson. |.B. D’Sonza was a name to reckon
With. He belonged to the first I.A.S. batch and had retired as the
Secretary to the Government of India. He had also served as a
consultant to the World Bank. Besides being an able administra
tor, he was also known for his bold views. (The dereservation
of plots in Bombay which snowballed into a major political issue
tn Maharashtra is a recent example). The Times of India took
one full month to publish our rejoinder. We slowly realized that
80
even the English press which had been almost totally supportive
had slowly begun to lake ‘a balanced stand’ on the issue. This
was reflected in the reduced coverage of letters and news in
support of the campaign. The regional press, baring publications
° a./eW gO°d artlc,es llad not helped the campaign to any
significant extent. Time was running out.
Mie summer session ol Maharashtra legislation began in April
1988 in Bombay. The official bill on SO was put before the
leg.slative council. It was suddenly decided that it would be
'•'Ken up for discussion on (he very next day. With great
difficulty, we could procure a copy. And we were shocked' Many
provisions in the bill were in total contravention of the commitments made by the government. Certain objectionable clauses
naci also been incorporated.
y (i)
\
The bill provided for granting licences to private centres/laboratories while the expert committee report and
even the chief minister’s announcement said categori
cally that licences would be given only to government
centres/laboratories.
(ii) An important clause in the bill provided for punishment
to the woman undergoing SD tests. Although the clause
said that such a woman would normally be assumed to
be innocent, it provided for the punishment if it was
proved that she went for the test on her onw. In the
present social context, very few women would plead
before the court that they were indeed pressurized by
the family members to undergo the test. Thus, in effect
while the in-laws would go scot-free, the poor woman
would be punished. (The exact magnitude of punishment
was debatable. It was interpreted as a fine of Rs. 50 by
some and an imprisonment for three months by other
legal experts.) This clause amounced to further victimi
zation of the woman who is already a victim of social
structure.
(iii) Clause 21 of the bill denied the right to move the court
by any individual or organization who wanted to bring
to the notice of court any contravention of the act. It
restricted such a right onlyh to the official organs of the
81
implementing machinery, namely the State Appripriate
Authority (SAA) and State and Local Vigilance Commit
tees (SVC; LVCs). Others were required to furnish the
information first to SAA or SVC. If no action was taken
by them within a period of 60 days, then only could such
an individual or organization mo\ e the court.
(iv) Even in such a situation, the bill had granted powers to
SAA and SVCs to refuse to make available any document
to such individuals or organizations it was essential for
guarding public interest.
(v) Another clause gave blanket powers to the state govern
ment to exempt an institution under its control from any
or all requirements for the use of techniques as laid down
by the bill.
(vi) The bill did not provide for any time limit for the
\
constitution of SAAs and SVCs — the very foundation for
the implementation of the act.
(vii) Clause 4 of the Bill listed the conditions under which the
use of prenatal diagnostic techniques would be allowed.
One of them was exposure to potentially teratogenic
drugs, radiations, infections of hazardous chemicals. We
had suggested this clause to ensure that women who
become victims of such exposure (e.g., as in ecological
catastrophes like the Bhopal workers in the Union Car
bide plant leak disaster, in chemical and pharmaceutical
industries where working conditions are unsatisfactory)
gel an access to such tests. However, in the bill the wrods
‘potentially teratogenic’ were dropped from the clause.
Il meant that any woman could get the test done even
the pretext of a minor infection such as influenza or after
consumption of an aspirin tablet.
The ‘Statement of objects and reasons’ which forms the
prologue to the Bill was good. But the bill itself contained so
many loopholes that it would not have s icceeded in catching
any culprit anytime. The meaning of this stark contradiction was
clear: some experienced hand must have given final touches to
the draft. All that we had won in the battle would soon be lost
in the treaty.
...................... '
.T-—
*
82
fhe pro-SD lobby was not ready to take chances. On 3 March
laharashtra Times published an article by Dr Sarita Deshmukh
t strongly pleaded that the proposed law wo
1 to
he women’s burden of problems. It advocated SD
aid
population control’ and ’to help fulfil the natural parental urge
no ffel tl°nS' “ aSked al‘ MLAS and MLCS Whelhe' they ‘o° “id
not feel the same urge and appealed them to defeat the bill The
mses. It caused a lot of turmoil as many members were
“
’n*'
d ~»«le
"X
' St
,
.
° °
,e WaS ”
Certain how “'e bill»would
be received
h
n X™' 7
lhV'
°r"" ““ “ «
X's?? "”,in
‘referring the bill
J mean j----d.an„s or X~ d,‘" Maharashtra would have affected oo.
law enacted at the all-India level.
The only option left
pet thp r .i ? US WaS tO preSS for nlaxin^'m amendment and £get the
’
Btll cleared by the House. Luckily Loksatta
another
leading
b7“‘-'t,Ci,U"lg Marathi.
Maratlli>newspaper published a detailed point’
»n n"X“ °o Xi." lThI' a”° dls“b,,“' ■n"
“
many amendments would be enterWnedWr WerC
that
Because,
acceptance
of amendments- would have meant loss of
prestige for the
v”Z "LT’r Tndnients suggest«'
Sa^-nd
Th
' dls mguished member of the opposition were accented
fhey rebated to clauses 4 and 25 of the bill. In (1 e cl use re am !
chJXw ‘ahaZardOUS
mf^ctions o
over he cl ose
I f r1"1'11"7 ,eratO8enic’ were added. Moremenr
‘° fi,Ving l,lanket Powers to the governO th A Xenipt ,nsti'“ti°"s nnderthe control from the provisions
t': .:a o'Ota,fyMlr,OPPed' ll Was r°"
‘nZ
offiS bill
0 M---Ilarashlm that the amendments to an
cial bill suggested by an opposition member were accepted.
83
The bill was unanimously passed by the legislative council on
13 April and by legislative assembly on 16 April. Alter obtaining
the Governor’s assent, it was published as Maharashtra State Act
No. XV of 1988 in the government gazette on 28 April. The title
of the Act was Maharashtra Regulation of Prenatal Diagnostic
Techniques Act 1988. A battle was won, but the success left us
little to cheer about.
However, the enactment of law in Maharashtra had a spinoff
effect in other parts of India. The Forum Against Sex Determina
tion was formed in Gujrat. Il included feminist groups, lawyers,
sociologists, health activists and most, importantly, doctors. Dr.
Zubeda Shah, a leading gynecologist, emerged as the main
spokesperson of the Forum. After a long drawn out struggle, the
group succeeded in introduction of a private member’s bill in
Maharashtra Act. In Goa, the campaign against SD spearheaded
l?y Bailancho Saad (Voice of Women) even succeeded in intro
duction of an official bill in the Assembly. The bill includes most
demands of activist groups like ours. The bill could not be
discussed and hence lapsed as the assembly was dissolved. In
Karnataka, a scandal related to SD clinic run clandestinely at a
university department by a private practitioner was exposed and
brought into focus by journalists. The clinic had to close down
and all concerned had to resign following the appointment of
an enquiry committee. (
Another positive effect of the passing of bill in Maharashtra
was the optimism generated by it. Everywhere around us we find
injustice and atrocities. Everything around us seems to be
gloomy. When we do not have much faith that anything would
ever improve, news like the passing of a law against SD is
encouraging. We feel there is still room for hope. It is still
possible for a few sincere and conscientious people to pressurize
the government for a good cause and to succeed. Even if our
success is incomplete, nevertheless it is a success.
The number of SD clinics in Maharashtra went down signifi
cantly after the passing of the Act. Aggressive advertisements had
stopped soon after the campaign. However, we were aware that
certain doctors in the city of Bombay continued to perform the
test at exorbitant rales. Al some public places, advertising
84
displays were still to be seen. For the success of the law it was
necessary that a few cases be lodged against violators ot the law
within a first few months. It was equally important to highlight
legal action through media. This was the only way to let everyone
know that the law would not be confined to the books. But how
could one file a case? According to the act. only SAA and SVC
had the right to move the courts. Groups like ours could do so
only after giving 60 days notice to the government committees.
But the committees were yet to be formed. 1 he health minislet
Bhai Sawant had to resign following the Lemin Commission
controversy, and the new health minister Jawahar Darda did not
take any interest in the matter.
Then came 1989. The stale government at last appointed SAA
and SVC. Surprisingly the government which made a point to get
maximum publicity through any of its action on the issue of SD
kept quiet all this time. With great difficulty we could get to know
'the names of the newly appointed committee members.
None of the FASDSP members were included. The names of
many reputed persons in related fields who had contributed to
the campaign and had taken a clear stand had been suggested
to the government. However, none of them were included. The
non- government nominees were no doubt persons of repute in
the field of health. Some of them had served in several govern
ment committees. The relevant questions, however, were What
was their contribution to this issue? Did they use their reputation
to raise this issue at least in their professional field? Our fears
were genuine. One of the committee members had in the past
publicly stated that SD tests should be encouraged to curb the
population growth.
The government outdid all its mischiefs by appointing a
renowned geneticist on the committee. She had at several limes
stated publicly that ‘SD tests against metical ethics’. She had told
the Press and filmmakers that she was one of the very, few
persons who were engaged in using techniques like amniocen
tesis for the right purpose. She had taken up a similar stand as
a member of the technical sub-committee of the expert commit
tee appointed by the state government. What she preached and
what she actually practised, however, were totally different. She
85
routinely used techniques like CVB specially for sex determina-.
tion. However on records all such tests were shown to be
genuine case of prenatal diagnosis of congenital malformations.
Even when most doctors in Bombay had stopped misusing the
tests for SD she continued with her practice. Meena Menon, a
correspondent then working with Mid Day had thoroughly
exposed her by posing as a prospective client and publishing
the entire report. Tjhe government was very much aware ol this
scoop. Moreover, the geneticist herself had accepted this fact in
her paper presented at several international conferences. T here
she stated : Out of 1500 chorionic biopsies performed, 9871 were
for ‘nongenetic reasons’ (anxious couples). The government was
aware of this paper too. The most damaging fact was that in 1988
she was convicted by the Civil Judge of Ghaziabad of severe
lapses in practice. The geneticist, her colleague and a gynecolo
gist were fined Rs. 3 lakhs each for their error in diagnosis of
Down’s Syndrome in an unborn child. Thus, the government had
shown its true colours by appointing a ©person who had
repeatedly made false statements to the public, media and
government; whose professional skills were doubted by the
activists and whose vested interests lay directly in propagating
SD. That her task was to check the misuse of techniques for SD
was a contradiction in itself. Finally, she had to resign not
because of the government’s insistence, but because of the
pressure by FASDSP and the press. Time passed. Mr. Joseph was
transferred. The new secretary evidently did not show any
interest in this issue.
DELHI
The campaign initialed in Maharashtra soon reached other states.
Campaign groups were organized in different parts. I hey raised
the demand for a nation-wide law. On 19 December 1986, the
Minister of Health and Family Welfare, Government of India,
convened a national conference on Sd. 1 was one of the invitees.
The participants were mostly government officers, doctors, rep
resentatives of family planning organizations. Feminist groups or
activist groups working on this issue were hardly present. I did
not know whether they were invited or not. Two of my feminist
friends from Bombay, though invited, did not attend. Maybe
86
many others also thought that such conference do not serve any
useful purpose. Ms. Mira Sheth, secretary of the department was
in the chair. She set the lone of the meeting by thorough y
condemning SD. She said there was no question of allowing this
unethical, anti-woman practice. She appealed to all the partici
pants to give precise recommendations for the consideration ol
the government. Against such a background, nobody could have
openly defended SD. But what many people spoke was intoler
able.
An old man simply dived into the unfathomable ocean ol ‘our
great Indian culture and our glorious history’. Aller speaking al
great length he concluded, ‘Today, Indian women lace several
problems. Organizations like ours are engaged in solving them.
The government must be generous in providing financial help
to us.’ Another fellow suggested that all problems could vanish
■''if all people started fearing God.
The experts from the law department could not, till the end,
understand the need for a new, separate act for curbing SD. I hey
kept on referring to the MTP Act. The failure of all governmen
ts to file a single case of sex selective abortion under the MTP
ACt made no impact on them.
1 kept on cursing my Bombay friends whose absence I could
feel strongly. However,,1 experienced that even in such a millieu,
one could make one’s presence felt. In fact, one’s commitment
knowledge and intensity of feelings become much more evident
in such an atmosphere and one can reach out and share one’s
thoughts and feelings. Mr. Joseph too supported my stand and
pleaded strongly for a bold initiative on the part of the govern
ment. The conference ended on a somewhat optimistic note.
In April 1987, the Government of India, Ministry of Health and
Family Welfare, Department of Family Welfare announced the
formation of an expert committee on this issue. Under the
Chairmanship of Mr. Joseph, the four non-government members
of the committee included a gynecologist Dr. Jain, geneticist r.
Varma, legal expert Kapila K. Hingorani and me. In general, all
those who were vocal and somewhat articokite in the conference
were made members of the committee. If only Bombay friends
87
were here, I felt. I had io again prepare myself for a lonely battle
in a totally unknown front.
Delhi is an insulated island. Very narcissist; unconcerned
unaffected by the storms hovering over other parts. All the
meetings of the committee were held in Delhi as the government
officials there were loo busy to travel outside. The invitation for
the meetings used to reach me on the very day of meeting,
sometimes even later. II 1 was fortunate enough to receive it in
time and reach Delhi in the morning, the meeting did not
commence for hours as local members were not available. The
meeting used to get over within one and a half hours. The
discussions were superficial and repetitive.- Nothing really
moved.
The biggest nuisance was the legal expert on the committee.
Half the lime she was busy describing how close she was to the
political bigwigs. Every time we put forth a detailed draft for
discussion, she used to come up with her alternate page draft.
Her draft revolved round the constitutional clause under which
the law could be framed. The degree of her awareness and
general knowledge could be gauged by the fact that she wanted
the facility of ‘genetic counselling and prenatal diagnosis’ at
every Primary Health Centre (PMC) of the country. She conven
iently neglected the facts that such PHCs do not even have
essential drugs for the most common diseases like fever and
diarrhoea. She was informed that in villages a doctor is often not
available in the radius of fifty to a hundred miles. But her stand
remained unaffected. The most damaging aspect was her insis
tence to punish the woman who took a SD test. For months, we
debated this issue. Her logic was strange. She though that women
would refuse to undergo SD tests once they realized that (hey
might be punished. She even boasted that this provision in the
law would embolden Indian women to fight against the tyranny
of husbands and in- laws. I pointed out that the experience of
women’s groups in Bombay was that even women on (he
deathbed who had received 90 percent burns were unwilling to
confess that they had been burnt by husbands or in-laws. Given
that this was the reality, was it likely that they would give a
statement that they were forced by in-laws or husbands to
“
■.
-■
‘
•; . ...............■: •
• • '■
x-ii*
88
undergo SD test? Then she came up with her final weapon: *1 am
a woman. I am involved with women’s issues. Naturally 1 have
more right to talk and decide about women’s problems. There
were the limes when 1 cursed my female feminist friends of
Bombay who had chosen to be absent’.
As lime flew, I became more restless. No campaign can be
sustained for years. This campaign had a few chances of regen
eration as people were getting frustrated. When 1 tried lo protest
about the slow pace of working of the committee, 1 was made
lo understand certain things in a very sophisticated way. After
all Delhi did not think we were worth giving much consideration.
Who are you? What is your nuisance value? How many people
are behind you? Maybe a handful of people in Maharashtra and
South India. How about the great Hindi hinterland? How about
Delhi itself'' How can we take you seriously unless anything
happens here? Unless some highup there are affected? Although
nobody said this in so many words, the message was quite clear
for me.
We still cannot figure out the lack of enthusiasm on this issue
in Delhi. In fact there are many individuals in Delhi who are
sensitive and willing to act on this issue. DWEI has consistently
raised the demand of ban on SD tests. Swami Agnivesh had lead
a large niorcba of rural women on this subject. The issue is very
much alive in and around'Delhi. The newspaper advertisement
of Dr. Loomba’s genetic laboratory is an everyday reminder. As
early as 1982 common people seemed to be knowing about SD
tests. That was the year when my pregnant wife and I visited
Delhi; many people advised us lo gel the test done. However,
barring a short- lived attempt triggered by Vibhuti and Chayanika
— two of our members — no effective group action has yet been ■
taken on this issue.
After prolonged delil>eniiion and tremendous efforts by the
active members, the Central Government Expert Committee
finalized the draft legislation which was then circulated to all
state governments for getting their feedback. After several
months 1 could lay my hands on one such copy and was again
shocked. Once again, the experienced hand had given furnishing
touches to the draft. All the objectionable clauses in Maharashtra
.............................................................................................................................................
■.
■
:
-
-
1
89
Act were included in it. Alter a prolonged debate, the objection
able clauses were removed. The committee submitted its report
along with the finalized draft of the bill in June 1989. The
committee members are yet to receive an official copy from the
ministry.
I he report of the committee is an important document. It deals
at length with the various aspects of the problem. It explicitly
stales the thinking behind the act. It gives suitable explanation
lor each clause included in the bill. The basic framework of the
report is quite close to the views expressed on this subject by
activist groups like I’ASDSP. The committee has also made
certain useful recommendations about the constitution of medi
cal councils and for creating awareness among people. These
recommendations, if implemented sincerely, would be of great
help not only to this campaign, but also to similar activities in
the Held ol health, consumersand women. Although I agree with
the overall thinking in the report, 1 was pained to note that some
issues which are vital to the implementation of the act have been
left unresolved by (he committee. Hence, I have appended a
note of dissent’ to (he report. It deals with the following points:
(i)
Punishment ol a woman undergoing SI) test.
(ii) Licencing private sector for the use of prenatal diagnostic
techniques.
It is now left to the campaigners to raise these issues and
create a public opinion in their favour. It is essential that the
report of the committee be published. It can provide (he frame
work for (he debate on central legislation.
It is important for all of us to understand the strength and
limitations of the state apparatus in supporting or opposing us.
An indifferent or antagonistic bureacrat can create innumerable
hurdles in order to drain one’s momentum and stamina. A
senisilive and sympathetic bureaucrat can go a long way in
removing these hurdles and creating a favourable atmosphere.
I lowcver, one has to rely exclusively on (he sirenglh of campaign
on vi(al issues like appoimments on implemenhng bodies and
on major politi- al questions related to the law, for example one’s
attitude towards whether a woman should be punished for
90
undergoing the SD lest. Allowing the private sector to obtain
licences for the use of pienatal diagnostic techniques is directly
ielated to lobbying by, interestt ggroups. We have to fight issue
battles on our own strength. Clarity/ on this important issue can
prevent a lot of unnecessary tensions, misunderstanding and
a pprehension.
All organizations have tto decide their approach towards
government. It has remained an unresolved issue and would
continue to remain so for a long
o time. Activists are often in
dilemma over this issue. On one hand there is
- • ' a veiy valid fear
of being co-opted, of being accepted
i
-I ‘ind then conveniently
sidetracked. On the other hand some intereaction with the state
is inevitable. One has to rely on or seek support from the state
machinery in some way or the other. That’s why activist groups
. keep on asking for new laws or amendments in law. They make
cemands directed at the government issues related either to
women, environment or development specially need to be
lobbied and rraised. Because their solution is not linked to the
nature of the state apparatus alone. That is why 1 discussed in
detail my experience in government committees. Many of us
have been strong in campaigning, but weak in lobbying. We
have become visible and-audible, but have not altered macro
equations significantly.
WHERE DO WE STAND'NOW?
After four years of struggle, where are we? It is time to take stock
of the situation. Time for rejection and planning. In Maharashtra,
there has not been any major action in the last one year. The
law has remained on paper. Local Vigilance Committees aree vet
to be set up. SAA and SVC are yet to stabilize. What they have
done so far has remained a mystery. Even the list of Centres and
Laboratories which have received licences for using the tech
niques is not made public. The government under the act is
bound to publish findings of the labs and centres once in three
months. No such reports have yet been published. A few boards
advertising SD clinics are still visible. FASDSP had sent letters to
concerned authorities to take action against doctors performing
anu/or advertising SD, or at least to inform us what we can do
in that context. Our letters are not even acknowledged.
j
91
'rhere are a few clinics performing SI) tests clandestinely at
exorbitant prices. At present their number is small. I lowever, this
can multiply soon it the law remains on paper. The gynecologists
performing SI) tests have developed many ingenious ways to
violate the law and mint money. For example, there is a gyne
cologist practising in a north suburb of Bombay. He asks for an
advance of Rs 5,()()(). The ahcarges for the test are Rs. .-$,()()(). If
the foetus turns out to be female, the patient should get the MTP
done (here. The charges for MTP are Rs. 3,(X)(). So in that case,
the patient must pay Rs. 1,()()() more. If the foetus is found to be
male, then Rs. 2,000 are refunded. Very surprisingly, all reports
turn out to be daughters. This is because the amniotic fluid is
not sent to the laboratory for analysis? The patient is orally
informed and immediately MTP is performed. There is no record.
No outsiders are involved. Il’s a safe bargain: ‘Parents unwilling
to pay dowry for their daughters are willing to pay it to a doctor
to get rid of their daughter’ quipped Lata, a FASDSP member.
Outside Maharashtra, the picture is somewhat different. While
the SD business is proliferating in some states, awareness on this
issue is also growing. However, organized action is weak in Uttar
Pradesh, Madhya Pradesh, Punjab, Haryana and Delhi. In the
South and East, SD has not succeeded in making its presence
felt. The awareness in these states is indeed quite high. Mean
while, the report of the expert committee and the draft bill
prepared by it is deeply buried in the pile of files in the Ministry.
Recently, the health minister, Mr. Routrary, while replying to a
question on this issue, said in the Lok Sabha, The government
is planning to amend the MTP Act. We are also thinking of
introducing a new bill. However, the nexus between sex deter
mination and abortion is not yet proved. Hence, we have not yet
taken decision’, (.an there be more contradictions and inaccura
cies in any single answer?
His reply shows:
(i)
The concerned minister does not know anything about
the issue.
(ii) After fifteen years history of sex-selective abortions, two
nationwide campaigns, reports of two expert committees,
a dozen assurances by concerned ministers, recommen-
f-- '■
92
dations of several national and international bodies
assurances given in manifestos of different political par
ties (including supporters of the present government)
i ie minister does not know whether the problem really
exists. Can anybody suggest a method for establishing a
nexxis between SD and sex-selective abortion in a way
which the minister can understand?
(hi) If (he nexus between Sd and abortion is not established
(hen why talk of amending the MTP Act and/or introduce
a new law?
Civ) An amendment in the MTP Act would nt most be of a
symbolic value. The minister does not know that the
issue IS not MTP. It is sex- selective abortion. And that
too during the SAARC International Year for the Girl
Child, 1990?
'■ NEW CHALLENGES
Ne7tSD ‘ecllniclues are bein8 developed. CVB is in vogue It
rou iiel
“Vf6 thlrti m°nth °f Pre8nancy- Sonography is being
o ttnely used for monitoring pregnancy. It can also be ujsed for
SD. However, determination of feota! sex is possible at a much
and‘^r
°f Pre«nancy <makin8 Portion very hazardous
and illegal). Moreover, the accuracy of techniques is low But
there are enough doctors trying to sell sonography as a 'simple
accurate and safe bD tool to be used in the first trimester’ Tlfere
are enough people around, too willing to believe these doctors
and spend thousands of rupees [o get rid of unwanted daughters
cientific journals have reported new methods such as analysis
ol maternal blood and chromosomal analysis of IVF-ET (In Vitro
Feuiiliz.-uion-bmbryo Transfer) embryo.
In 1988 1 saw an
an advertisement
advertisement in
in the Diwali special number
ol a renowned Marathi’ magazine:
Amniocentesis is a developed science
To misuse it for abortion is a great sin.
Better go in for sex-selection.
93
Read this book. Consult your family doctor for a sure way of
begetting sons.
This was an advertisement of a booklet Y-\'irilene written by
Dr. Pa ran jape from Bombay.
I read a lairly large hook on this subject recently published in
Marathi, written by a foreign returned’ sexologist Dr. Prakash
Varekar. It is entitled Mul^a Pabye? Mulgath //of//(Want a son?
Gel a son!) The back cover eulogizes the author as the follower
of the great tradition of medicine which strives to educate
people. .Th.c.bnok disuissLj numbci of icmtuics langmg irom
diet (exclude milk and eggs, consume more tea, salt, cheese and
sausages) to the ancient ritual of Pansarana used by Ayurvedic
experts.
For years, a Gujarat-based company. Vasu Pharmaceuticals,
has been marketing a product for sex preselection. ’Select-T and
‘Select-2’ capsules are meant for consumption by a pregnant
woman 45 days from LMP (Last Menstrual Period) for a period
of two weeks. The manufacturers claim that it can change the
sex of foetus from female to male after conception. It is recom
mended by severalrenowned doctors, especially in Gujrat
(though modern science warns against the use of any medicine
in the first trimester, as it can lead to deformities in the foetus.)
The urgency of a prompt and comprehensive action has been
underlined by the recent findings of Barbara Miller (author of
The Endangered Sex). She had earlier published her findings
about sex ratios of rural districts of India based on the 1971
census, h was shown that the sex ratio (calculated as the number
of females per thousand males) was dangerously low in one-third
of the rural districts in north and west India. She had attributed
this to the neglect of female children in these areas.
The 1981 census figures show that the region where sex ratio
balance is being rapidly destroyed is expanding in size. It has
crossed the Hindi Heartland’ and reached northern Maharashtra
and also touched Tamil Nadu. This rapid imbalance in sex ratio
was caused by the neglect of born daughters and selective
elimination of daughters before birth operak simultaneously is
anybody’s guess Looking al the proliferation of SD clinics, a
&
94
serious imbalance in sex-ratios across a very large territory of
India cannot be ruled out. No one knows exactly what might
happen then. One thing is certain, it would make women’s lives
more insecure, rest riel ivu and less dignified. It would make
human life more miserable and violent. There is no immediate
way to restore the sex ratio balance after its disruption. Maybe
» al that l:r ,
\e;, Si.;\i\al wouL'
.......... . ....... .
immediate concern and action. The question is. should we allow
the situation to deteriorate or shall we work systematically to
confront this challenge now?
I
I
|
I
Sex selection (through sex determination followed by abortion
of the wrong sex’ or through sex pre-selection) is just the
proverbial tip of the iceberg of new reproduction technologies.
Techniques like Inevitro Fertilization-Embryo Transfer (IVF-ET)
and Gamete In Fallopian Transfer (GIFT), popularly known as
‘test lube baby techniques’ have already arrived in India.
S'n notate Motherhood
’Industry' is looking out to poor women from the Third World
as potential hirers of wombs at cheap rates. Research in gene
manipulations and cloning (technique for reproducting several
identical celis/lissues/organisms) have horrific potentialili. s. All
these technologies have raised several disturbing complex social,
cultural, ethical, political issues for entire humankind. The first
world has already started regulating these technologies and
debating their probably impact. In India, we are still fumbling at
the very first step. The situation is distressing, but surely not
frustrating. Our balance sheet does show many achievements.
On the credit side:
(i)
We have proved that the content and degree of imple
mentation of a particular law depends directly on the
pressure expcrled by the campaign over the government.
The unanimous passing of an act seeking to regulate the
use of modern medical technology in itself is an achieve
ment. Il only means that belatedly, we have joined the
mainstream of countries where the use of technology is
subject to checks and balances outside the profession.
The acceptance by the (iovernment of Maharashtra of the
95
amendments suggested by an opposition member as well
as the resignation of Dr. Purandare from the SVC also
indicate that public opinion can bring about desirable
changes. Out stand on the law has been vindicated l>y
the experience in Maharashtra. We have maintained that
matters like restricting the use of prenatal diagnostic
techniques to government institutions and not punishing
the woman undergoing SD test is inevitable for the
success of the act and not a way of bargain or negotiation.
(ii) The reduction in number of SD clinics and the rise in the
rales have at least checked the influx of SD tests. Il has
also shown that doctors, by and large, follow a law, if
they are made to understand that breaking a law would
not be in their interest.
s
\
• (iii) The achievements of groups in Goa and Gujarat towards
a legislation better than in Maharashtra which need to be
commended.
(iv) We should retain our initiative in the campaign; we are
effective as long as we do so. After losing the initiative
to people like J.B. D’Souza, Dharma Kumar and Vasant
Sathe, we had to spend most of our energy in replying
to them or had to remain silent.
(v) Even now, people and media have not lost interest and
hopes. South and'East India is more or less free from this
’epidemic’. In northern India, SD clinics are still restricted
to large place. There is still room for us to intervene.
(vi) BJP and CPI(M) have included the demand for a ban on
SD tests in their manifestos. Even Janata Dal and Cong(l)
are not opposed to it. At least today this issue will not
affect vote banks and economic interest of parlies; it is
possible now even for a not- so-progressive government
to enact this law al least following the SAARC Year of the
Girl Child, 1990.
(vii) Success in the campaign against SD is the firs' step
towards regulation of the new reproduction technolo
gies. If we succeed in gelling a law against SD on the
grounds of the constitutional right to equality and soci
ety’s right to intervene for restoration of the sex-ration
•
••
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96
balance, we can challenge sex preselection on the same
grounds.
grounds. Il
It can
can also
also pave
pave a way for belter understanding
of issues related to these reproduction technologies as a
whole.
The task before us is gigantic. But turning our back to reality
is no solution. We need to study more1, plan more carefully,
interact and coordinate our energies and resources. I’or this, all
of us will have to come together — women and men, researcheis
and activists working lor gender justice, health, consumers,
democratic rights. Because reality cannot be understood in
compartments. The issues concern us all. The answers can only
be found collectively. For this, we shall have to evolve new
methods of campaigning, of creating awareness; learn to lobby
for a cause. Research and activism cannot be separated. They
must go hand in hand. One should evolve through the other and
again lead to it. The journey of the campaign from 1982 to 1990
was quite tough. The challenge of 1990’s would surely be
tougher. Let us prepare to face it.
Postscript, January 1992
We have come a long way since the inception of the campaign
in April 1986. Our route has been circuitous, unplanned, unpre
dicated. We now have reached a stage where many questions
and doubts reign supreme. We are not sure whether we have
really made any headway in the right dhection. While dilemmas
and confusions are plentiful, determined efforts to resolve themare lacking. We have lost our initiative. Our actions have been
reduced to reactions (often half-hearted) to outside stimuli. The
activists are exhausted, their mental and intellectual energies
have drained out. All said and done, the campaign is down but
not out. It remains to be seen whether it would emerge once
again in a metamorphized form. For, in the past, one more than
one occasion, we have acted in an unbelievably swill manner.
The apparently stagnant movement snowballed and gathered
momentum in no time.
One such occasion had been the bid by the Chandra Shekhar
government to introduce in Parliament a bill on sex determina
tion (SD) tests. The government formed by V.P. Singh had (alien
97
at a time when the SI) bill had at last reached the cabinet agenda
We had rakvii a deci/W m>t tb raise this issue before Chandra
Shekhar’s puppet government which lacked both credibility ad
stability. However, newspaper reports informed us of the gov
ernmental decision to introduce the bill in Parliament. The undue
hush in pushing the bill and the version of the bill as reported
by the press were sufficient to alarm us. Within a week’s period,
we succeeded in organizing protests among different groups.
I he All-India People’s Science Network started a signature
campaigns. The activists from all over India who assembled at
Calicut to attend the Women’s Liberation Conference threatened
to march to Delhi. They also passed an unanimous resolution to
condemn the government’s design. We could convey to the
concerned minister in no uncertain terms that we would defeat
die bill if it were introduced in the parliament without necessary
amendments and debate. The issue was followed up by women’s
groups in Delhi. The minister then shelved the proposal for a
few weeks, and the government fell soon thereafter.
I hen came a period of lull. The general elections came. But
we did not use it as an opportunity of raising this issue with the
political parties. No doubt a number of political parlies included
a ban on amino< ■ ntesis15 in their manifestoes. But then we have
come a long way from 1982. Our active intervention would have
at least sensitized the parties more on this issue. Probably then
(hey would have gone beyond banning amniocentesis, they
might have al least accepted the demand lor not punishing the
woman undergoing the SD test and for restricting the licenses
lor carrying out prenatal diagnostic tests to medical colleges and
government hospitals.
In November 1991 came the central bill. In the absence of a
visible campaign and of lobbying in Delhi, it was not surprising
to find that the bill was a diluted and distorted version of what
we had asked for. In some respects, it was worse than that passed
by the Slate of Maharashtra. Il left no room for intervention by
voluntary groups/individuals in matters like vigilance, policy
making 01 access to judiciary. I he onus on the woman is heavier.
In fact, it seems to have intelligently borrowed all objectionable
clauses from the various bills (e g.. Gujarat bill). ()ur reflexes
I
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I .
I
I
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98
were slow; there were no signs of debate on this issue within
and outside the parliament.
I
I
I
I
Then came the good news without our cl loris. A joint parlia
mentary committee was constituted to study the bill in toto. Il had
representation from almost all political parlies. Il mainly com
prised of women and doctors. The committee wrote to several
groups and professional organizations, asking lor their comments.
Earlier, it seemed that the bur 'aucratic procedures would neutral
ize all the good intentions of the commitice. 'Io some, il looked
like a ploy lo delay the bill. However, out dialogue with the
committee has evoked good response. The committee has agreed
to invite feedback from a much wider group, in a more partici
patory manner. Very soon, public hearings on the bill would be
I
I
I
I
I
organized in different status by the committee. I he committee
■’-would submit its report by the 1992 monsoon session of Parlia
ment. Hie report along with the bill, would then be placed before
Parliament. Thus, 1992 could be the year when the fate of central
legislation on the SD test would be decided.
As we look back in order to look forward, a mixed picture
emerges. It shows our utter ignorance of an ambivalence towards
legislative means. Many events which helped the campaign, for
I
example, the introduction of private members’ bill in Ma
I
harashtra or the appointment of the joint parliament committee
occurred without our efforts or intentions. The lacunae i the
Maharashtra Act and the State Government’s lack of political will
lo implement it have been known lo us for years. But we failed
to expose the government on both the counts. We approached
I
the bureaucracy, which seemed lo be totally unresponsive. But,
we did not use the Slate Legislature even one after the passing
of the bill. Most important ins the fact that in the last three years
we have not organized any programme lo inform and to involve
people on this issue.
Another stark failure is on the front of lobbying. In spite of
the high visibility and acceptance of the issue, we failed to
translate it in terms of policy changes. One finds active lobbying
groups on issues like drug policy and Narmada. I hey have
worked more consistently against heavier odds, in a way, they
are more used lo the long distance running’ which any issue-
t
99
based group should lake for granted. Periodic reverses do nol
seem to affect them to a large extent. The issue of sex selection
has a much greater interface with society and more visibility. We
need to learn more from such groups.
At the same lime, we must acknowledge the efforts of those
who have carried forward the struggle in their own wavs Ci roups
in (.jujaiai have continued in spite of an exiremely hostile
atmosphere. Their efforts at lobbying, using media for raising
consciousness, research and documentation need to be high
lighted. The official bill introduced in the (ioa assembly remains
(ill today the most progressive bill on this issue. The credit for
the same should go lo the activist group ‘Bailancho Saad’.
Various people uninvolved in the campaign have been trying lo
spread awareness on this issue. Mrinalini Sarabhai (Sim’s daugh
ters) and Rajeev Dixit (campaign against multinational corpora
tions and foreign technology) are two such examples.
In the meanwhile we continue to verify our positions. We
I
cannot help but feel guilty towards the physically and mentally
handicapped when we support use of prenatal diagnosis for
detection of (and eventually abortion of) congenital malforma
tions. We are still in (he dark about the policy changes which
need to be ushered in to improve the status of women. We have
no concrete measures to counter the demographic imbalance. We
still debate whether government’s intervention would be helpful
to the women’s cause. We do not know how to build bridges
across ideologies, beyond activist groups, with professionals.
Nevertheless, we march on. The events in the next couple of
months would shape the law on the anvil. T hey would also seal
the future of the campaign. The demographic (rend underlined
by the 1991 census and the advances in the field of sex prediction
and sex preselection have, however, indicated that ‘sex selection’
would be a decisive issue of the next few decades. The recent
formation of l orum in Support of Sex-Selective Abortions floated
by doctors and the organization of three-day training camps on
sex-prediction techniques indicate that the other side is getting
ready for a prolonged battle. It remains to be seen how activists
and others, women and men striving for gender equality and
gender jusiice.s face (his challenge.
J.
3-gl r.
To
?
51
The Campaign Against Sex
Determination Tests
RAVINDRA R. P.
'/
PROLOGUE
Chandigarh, March 9, 1989
The banners for the International Women’s Day still nutter in the
hall. The air is still thick with songs and slogans. Drcams in
clenched fists and raised voices still float in the eyes. However,
there is dead silence at Surinder Ldtowa’s house. This is the
happiest and luckiest day for him. Twenty-three years after
marriage, his dream is fulfilled : he has become the proud father
of a son.
His three daughters are not at all happy. As he returns
from the maternity home, he finds the door locked from
inside. Nobody answers his calls. At last, he jumps over the
wall to enter the backyard. There is pindrop silence in the
house. Finally, he sees them : their bodies hanging from the
ceiling.
Anita, Sunita, Anamika, ages nineteen, seventeen and fifteen
years. Anamika was bright. She had recently won a prize as a
girl guide. Anita had been standing first in all examinations
throughout but for the December tests. When she was asked
whether there was any tension at home, she had replied confi
dently, ‘None whatsoever, Just see, I shall regain my rank in the
next exam’. Anita wanted to be an IAS officer. She dreamt of a
thousand things. Sunita published an article in the Indian Ex
press, on the condition of Indian women, where she strongly
asserted that 'Today’s woman wants to get ahead in every field,
to live independently and succeed. Our society will have to
cooperate with her’.
f
52
The mother of the three girls, after Anamika’s birth, underwent
the SI) test thrice. Twice it turned out to be a ‘girl’, and she had
an abortion each lime. The third lime, it was a ‘boy’, which on
her husband’s advice she decided to keep. Everytime, the
daughters, especially the elder two, fiercely debated with their
parents. The tension reached its height the third time when the
parents decided not to abort the much wanted male child. The
feeling of‘unwantedness’ grew in the minds of all the daughters
to such an extent that in January Anita had attempted suicide by
swallowing sleeping pills.
Last fortnight, Union Cabinet Minister Shri Vasant Sathe
stated publicly that SD tests should be encouraged as they help
only children who were wanted to be born. These tests would
also enhance women’s dignity and status in the society, he
vSaid.
Excerpts from a poem by Alka Boitra, one of Sunila’s
friends :
What did you get
By dying like this?
The days haven’t changed
Nor nights.
Your sorrows have vanished
After embracing death.
But what about your thousands of sisters?
Should they loo follow your path?
Your life was
The most precious thing in the world.
Why didn’t you keep lighting,
Facing all challenges?
A noted psychiatrist expressed a view that the crumbling of
the institution of the joint family led to such situations. If there
were grandparents, uncles and aunts living in the same house,
the girls would perhaps have given vent to their feelings, and
the elders might have counselled them and dissuaded them from
taking such an extreme step.
Can we loo put the onus on the crumbling of the institution
of the joint family and relax? Aren't we all guilty?
\
4
I
C_4.>
'T-e^A-^
^l cX »'vi.^
(
"n-c
1'Vy
9 Vs
P^Jb-^
^LcaAou^-f^.
53
An Encounter with a Pioneer
Il was the summer vacation, and I happened lo visit Dlmlde, my
native place. Glancing through the window of my bus, I noticed
a board near a maternity home : ‘Prenatal Sex Determination
Centre’. The maternity home and PSD Centre were run by a’
husband and wife team. I walked in and told the nurse that I
had come to see the doctor. 1 was made to sit in a hall. The
benches were empty. On the left was a rolling blackboard
bearing a table : date of performing the lest, pregnant woman’s
name and finally the result, three-fourth ‘male’ or ‘female’.
People walked in to have a look al the ‘lottery result’ and
dispersed quietly. 'Phis must be a very efficient system I thought.
It saved the doctor’s lime. Moreover, wiping the board would
remove all the evidence of having performed the test. The lime
passed off very slowly. Suddenly a man entered the hall. Il was
not difficult lo make out that he must be a ‘not so proud father
of several daughters’. The nature stopped him there and then.
‘What do you want?’ she asked rather curtly.
‘That male-female test,’ he fumbled.
‘How many months (of pregnancy) over?’
‘Three’.
'Bring her after completing four. Don’t come earlier and don’t
fail to bring the total amount of fees’.
His attire had not left any favourable impact on her.
The lady doctor was not willing lo talk al all. ‘You must see
him,’ she maintained.
I was finally called by ‘him’. He was in his forties and was
very guarded. However, the fact that I had come all the way from
Bombay, helped him to open up.
‘ 1 his business of sex determination seems to be going pretty
strongly in our Dhule town. I saw two advertisements (of SD
centres) in today’s local newspapers’. I said, making a cautious
beginning.
54
‘Forget the others. 1 am the pioneer here. I started way back.
Others have just been following me. I have performed over 450
cases in the last one and a half years. Would you believe?’
‘Why don’t you write about it then? At least publish a research
pa per.’
‘You are right. But where’s the time? You see how busy I am.’
He was really very busy. As our talk progressed, one man
came running, almost panting. His face was lense.
What happened?’
‘Doctorsaab, last week you had performed that male/female
test on my wife. She is bleeding profusely.’
‘Where is she?’
’Downstairs. We brought her from our place in a bullock cart.
Il’s a 15-kilometres journey.’
‘Hasn’t she thrown it out (aborted) completely? Go, keep her
there, Sister!’
I started to leave. ‘You have to go, 1 understand.’
‘Forget it. This is the usual problem. You get one in ten cases.
These village people will never improve. They make their
womenfolk work in the 'dust and in the garbage immediately
after the test. Never take any care. This is inevitable.’
1 look lime lo recover from the shock. Meanwhile, the doctor
continued, ‘Initially, only the moneyed people from the middle
castes came for the lest. They have lo pay tremendous amounts
as dowry. They keep on coming even now, but now our main
clientele has changed. Now it’s the educated middle class.
Brahmins, traders, professors, government servants, lawyers,
officers. They come from everywhere. Very wise people. Not likethe rustic fools. They don’t wail (ill they have four to six
daughters, but approach me in the first or second chance. Really
systematic.’ lie was all praise lor his clients. After some lime, he
ga- e me his diary lo browse through.
55
Diary. I he doctor’s diary. The data related to 450 ’cases’ were
a jammed in that tiny book. No case papers, no files. The entire
documentation was in the form of a few notes made in the
handwriting ’worthy of a doctor’. Full name, address, date of
performing the test, result and, in some cases, dale of abortion
I hat was all.
These
related to not less than 450 women, who came
bom far- oil places and went back to work amidst dust and dirt,
here was no mention of their ages, number of children they
had h id, history of abortions, if any. The entire reproductive
histories of the women were conspicuous by their absence And
ol course there was no quedstion of recording their consent
cither. Did they have any say in the mailer? Where was the
question of their giving consent?
■ All the talk of 'data recording’ and ‘informed consent’ that I
had read of in medical journals lay meaningless here. What is
I ie use of all these scientific articles and (heir pious warnings?
The test must be performed in a totally aseptic area, preferably
in an operation theatre. It must be carried out under ultrasonic
cover to enable the operator to guide the syringe into the
amniotic sac without damaging the foetus, placenta or internal
oigans o the pregnant mother. In spite of all these precautions
certain side effecLs are inevitable. They include spontaneous or
delayed abortion, damage to foetal tissues and infection. The
severity and frequency of these damages depend upon doctor’s
sktll and experience. The doctor should, before carrying out the
test, give a clear idea al,out the possible health hazards to the
concerned woman and obtain her consent in writing.
The average age of marriage for girls in the rural areas of India
is fourteen or fifteen. She experiences her first pregnancy around
the age of sixteen, eighty per cent of rural Indian women are
anaemic. Ibis pregnant girl lying on the table in the next room
must have been one of them, a mere number in statistics,
icgnant at sikxteen, lest in the fourth month, abortion
cither
natural or if the child happens to be ’female'; next year next
pregnancy; again lest and so on, the cycle would continue. If
56
anything goes wrong, one can always blame the dirty work on
dust and garbage.
hi India the mortality rate for young women, especially during
pregnancy, is one of the highest over the world.
Sex Deienninalion (SD) 7ests : Myths and Reality
1. SI) tests are an effective tool for population control. It helps
to reduce the number of women and thereby decrease the
productive rale.
(a) Is women a mere reproductive machine?
(b)
I he sex ratio in certain South Asian countries including
India is adverse to females. In certain regions, the differ
ential in male- female population is steadily widening.
The decline in number of females has not proved to have
contributed to checking the population growth in these
regions.
(c) Several studies have proved that an important parameter
governing the success of family planning programmes is
the ‘woman’s status in family and society’. Women do
not need to be taught about the benefits of a small family.
They already know them. But they lack the freedom to
take decisions and act on them. Societies and regions
where women have better access to education, a role in
economic activities, better status and dignity al home and
in society and access to material conditions conducive to
survival of existing children are invariably the ones
where family planning is a success. Regions with low
status for women also show less acceptance ol small
family norm. Kerala and Rajasthan are two conslrasting
examples.
(d) Declarations at international population conference have
underlined the fact that the right to small family is
inseparable from other fundamental human rights such
as right to equality, gainful employment, and old age
security. Hence, one cannot be obtained at the cost ol
others.
57
(e) Il means justify ends for population control, why not
encourage other equally effective sex-selection means,
for instance, dowry murders and female infanticide?
2. SI) tests are resorted to only by couples having two or more
daughters. Hence, they would not adversely affect (he sex
ratio while they help in population control.
(a) A sizeable number of couples opting for SI) tests already
have a son. They do not want a daughter, but more sons.
(I)) The number of couples going in for SI) tests during the
first or second pregnancy is quite high, specially among
the education middle class.
(c) The ideal family size as believed by a majority people in
India is two sons and one daughter. The preference for
sons is often accompanied by contempt for daughters.
There is no reason to believe that people would stop
procreating after one son.
(d) While thousands of cases of selective abortion of female
foetuses are reported, one hardly hears of aborting a male
foetus.
3. The law has not helped in solving any of the women’s issues
in India (e.g., dowry, rape, sati) SD tests cannot be an
exception, because the law cannot change values, attitudes
and societal structure, and all these issues are linked to the
attitudes, values and structure of this society. Nevertheless
progressive legislation has an important role to play in this
context.
(a) Such legislation dclegititnizes the social sanction to such
practice. It also creates space for more effective social
action.
(b) One needs to diferenliale between issues like dowry an
d SI) tests because:
(i)
Evils like dowry and rape are deeply embedded in our
society, each with a long history. The issue of SI) tests is
a recent phenomenon and hence relatively easy to con
front .
(ii) Although the lechnitjues for the withdrawal of amniotic
fluid is relatively easy, the key element of (his technology
•r
A
58
Is chromosomal analysis, which is highly sophisticated,
expensive and is hence centralized. Accuracy level above
95% can be arrived at only through experience. Control
ling these genetic laboratories where analysis is carried
out would virtually controll the entire SD business.
Presently the genetic laboratories in India are limited in
number and arc mostly located in large cities. The
majority of them are in Government institutions.
(iii) An additional element here is the medical community,
which is by and large-abiding. Adverse publicity cl any
kind being detrimental to (heir professional interests, the
number of doctors who would care to break the law only
to earn money would be quite limited, if they are
convinced that the government is sincere in its imple
mentation.
4.
I he SD tests are the perfect solution to the dowry problem
People saying no to daughters do not necessarily say no to
dowry. They are opposed to paying dowry, not accepting it. The
system ofdowry will continue for as long as people continueto
look upon daughters> as burdens’, as long marriages will be
based on ffalse concepts of prestige (related to caste and class)
and not oni imutual understanding and respect. Dowry cannot be
separated from patriarchal control. SD reinforce, rather than
counters all these factors.’
5. Opponents of SD tests oppose ’female foeticide’ but
abortion per se. Is (his not a contradiction?
not
(a) We oppose abortion not only of female foetuses. We
oppose all
.in sex-selective
ot-A-dini abortions
di>oiuons (except
(.except when
when they
they are
therapulically justified, for example in serious sex-linked
disorders). I hat means we would oppose selective abor
tion of male foetuses too, although such a question does
not arise in the present social system. Our basis of
opposition is not pro-life’, but ‘discrimination’. Choos
ing the sex of one’s offspring is the most sexist sin.’
(b) We uphold women’s right to abortion although we do
not support or encourage use of abortion as a routine
family planning ineihod, because such a* practice is
■ i
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59
.I
■
’'i ■•';■■
I
i
.•
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■
injurious io women’s health. However, a woman should
have a right to abortion since in the present social
structure, she has no right over her body, sexuality and
over the process of reproduction. Quite often, pregnancy
is thrust upon her. She alone is held responsible for
nurturing the child first in the womb and then outside
and for rearing it. Hence, as the last defence, she should
have a right to say ‘no’ to continuation of pregnancy.
6. It is more humane to abort a female foetus rather than
subjecting her to a life where al every moment she is made
to feel that she is unwanted, female foeticide is preferable to
dowry murders and sati.
It is basically wrong to pose reality in form of such a
cynical option. Il is like a poultiy-owner giving his
chickens a choice between whether they would like to
be roasted or fried. This is no choice; we do not accept
such a cruel and self-delealing choice. We assert that
women do have an option to a dignified life, an option
which they have established through sweat, blood and
a.
tears.
While we do not wish to deny harsh realities of today’s
b.
‘
society, we believe that it is totally wrong to project a
part of reality as total reality and also to accept it as an
eternal, never- changing truth. Today the world is under
the constant shadow of nuclear holocaust, ecological
disaster and social conflicts. We are on top of a sleeping
volcano. But nobody slops procreating for the fear that
their sons would most probably cdie in a nuclear war or
a riot or more painfully due to an ecological catastrophe.
In fact, the very inspiration behind procreation is human
kind’s nerve-dying optimism. We all hope that the future
of the next generation would be a brighter one, that our
offsprings will learn from our mistakes and make this
world a more beautiful and humane place to live in. Why
not direct our energies to make that happen?
7. A mother has a fundamental right to choose the sex of the
child. Banning SD t'. sts amounts to depriving a woman of this
i'
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•
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•
»u I
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60
crucial right of •freedom of choice’. Let the mother decide
whether or not she would like to give birth to a duaghtei.
A woman, like any of the oppressed sections of society,
should have a right to choose. However, (he concerned
choice and the decision should be totally her own. I he
question is Do women have such a free choice today/ A
woman who decides to undergo SD tests and abort the
female foetus does not do so on her own free will. Most
often this decision is prompted by pressures, subtle or
explicit; from the memebers of her husband’s family.
There is a fear underlying the decision : of rejection/desertion by husband, of husband marrying another girl to
beget a son, of being subjected to unending harrassment.
Al times, there is cynicism coupled with frustration.
Women after living a wretched life feel that a woman’s
life itself is worthless and hence take such a decision. It
a.
b.
c.
d.
cannot be termed as free choice.
The Indian woman has no say or choice in matters most
crucial to her life such as education, marriage, sexuality,
economic independence. In such a milieu the right to
choose the sex of the child is adding insult to her injury.
It would be interesting to find who has been asking fot
such a right. None of the women’s organization have ever
asked for such a right. Ils advocates include doctors who
wish to further their vested interests in the name of
women, and those men who want a male heir for
property and for the continuation of male lineage. I best
are the very forces who oppose women’s groups when
the latter seek the freedom of choice in other fields of
life, for instance contraception (opposing long term
hormonal contraception), childbirth (opposing indis
criminate use of caesarean section).
Even when any individual woman would ask lor such a
freedom of choice, the ultimate decision would have to
be taken after ascertaining that individual rights do not
restrict, contravene or oppose wide interests or rights of
women as a whole. This is true not only of SD tests but
61
of the whole range of’ new re produclive technologies
(NRTs).
In a market economy, demand for a particular product/service/lechnology can be cieated. Couched in the liberal jargon of
‘freedom of choice’, it can then b.- marketed. Hence, concepts
like sunogate motherhood' and genetic engineering’ which arc
detrimental to women’s health and their wider social good are
being introduced and propagated using psuedo-feminist jargon
of freedom of choice’. The key (piestion is then of the interpre
tation of the term ‘freedom of choice’. Shall we equate it with an
uncontrolled right of any individual or judge it in the framework
of the wider social reality?
Dowry, rape, sad, sex-selective abortions are different mani
festations of atrocities against women. They all stem from a
system based on inequality, injustice and oppression of women,
lienee, their ultimate solution lies in the fundamental restructur
ing of society on the foundations of equality, justice and mutual
respect. For all of us, struggle against SI) tests is a pan of the
wider struggle for equality and women's liberation. We are thus
involved in raising awareness and changing attitudes and values
of people. I his article is a travelogue of our march, our voyage,
our journey. It encompasses the reflection and evaluation of the
past as well as the loud thinking and appeal for the future.
The year 1982 was when the issue of Sex Determination (SD)
Fests captured the nation’s attention for the first time, it instantly
antiI was hostly discussed for months. What
*became *a - media issue
------ -----exactly triggered it oil?
I he flashpoint came in the form of an error in the determina
tion of foetal sex carried out al the New Bhandari Hospital at
Amritsar. Such errors arc not uncommon. 'Ihcy had occurred
earlier in cases of lesser mortals. This lime, however, it was not
an ordinary foetus. A powerful government officer, craving for
a son, had asked his wife to undergo the test. Diagnosis as female
was, as usual, followed by abortion of the foetus. It was then
discovered that the aborted foetus happened to be male. The
embittered father made the news public in order to discredit the
hospital. The rest is now history.
62
The technique of amniocentesis which was used lor sex
determination in this case was originally discovered for the
detection of genetic abnormalities. It is still used in most parts
of the world lor the same purpose. However, in a country like
India being female i.s considered as an 'abnormality' or a ‘crime’.
No wonder the technique came to be used chiefly for seeking
the ‘pre-eliminalion’ of unwanted female children through SI)
followed by the abortion of the ‘wrong sex’. Thu gross misuse
of medical technology for SI) al the New Bhandari Hospital had
continued unabated lor several years. The Bhandaris who pio
neered (he SI) ‘business' had done their bust to attract clients.
The technique was projected as ah ultimate solution to the dowry
problem. The advertisements appeared everywhere in the form
of wall writings, pamphlets and huge banners. Doctors were
offered handsome commissions. Wives of influential political
leaders, bureaucrats, among others, queued up lor undergoing
the test. Had it not been the abortion of the much wanted male
child of an influential person, the issue would not have become
national news.
Il would be interesting to fine! out what exactly happened
when the issue came into focus. Editorials were written. Letters
to Editor were sent and published, women’s groups organized
meetings and morchas and passed resolutions. The opposition’
raised the issue in Parliament. MPs belonging to different politi
cal parties made fiery speeches. All these people condemned the
practice of female foeticide as immoral and detrimental to
women’s status and dignity. They all demanded urgent stringent
punishment to the concerned doctors and a ban on the missue
of sex determination tests. The concerned minister replied that
he shared the feelings .of all the members and declared that (he
government would lake all possible step.*; to check the menace
of SI) tests. He, however, said that the solution to the problem
lay in raising people’s consciousness and changing their attitudes
and not in enacting a law.
'The debate continued in the popular press and journals for
months. Although all views were published, by and large, the
press supported women and condemned the practice of SI) tests
and its advocates — doctors pct forming the tests, family mem-
63
bets (mostly in-laws) forcing women to undergo it and the values
justifying and nurturing such a practice. As compared to any
other women’s issue raised in the women's decade, the issue ol
sex selective abortion seemed to have drawn maximum sympa
thy and support not only from media, but also from political
parties. But. in the final analysis, what was the outcome of all
the hue and cry that was raised in 1982? I low much did it
contribute to the solution of the problem? The debate and the
heat generated by it subsided within six months. Then everything
became (juict all over again. The New Bhandari I lospital toned
down its aggressive advertisements. But contrary to the promises
given in the Parliament, no action was taken against it by the
central government. The stale government seemed to be equally
uninterested. (As it happened in most such cases, the govern
ment was at a loss to find out under which legal provision it
could lake action.) The Bhandaris must have been thankful to
the media as their name instantly became known .dl over
northern India. Dr. Loomba, the geneticist working al that
hospital was so much impressed by the increase in the business
following the controversy that he opened his own genetic
laboratory in the very heart of Delhi. All the leading newspapers
in Delhi carried the advertisement of ‘Normal Boy or Girl?’ of Dr.
Loomba’s Hospital almost daily. They continue to do so even
now. Even newspapers writing stringent condemning SD seem
to be carrying this advertisement. There seems to be a peaceful
co-existence of the edit page and the ad page in all newspapers.
Meanwhile, the Bhandari Hospital loo seems to be doing fine.
Many enterprising doctors have helped the 'technology trans
fer’ to remote corners of India Bombay had been the Gateway
of New Technology' for India, and sex determination tests were
carried out in Bombay even before Amritsar and Delhi. The 1982
controversy indeed provided the impetus lor the rapid commer
cialization of the SD technique. Earlier, the Government of India,
through a circular, had banned the misuse of medical technology
for SD in all government institutions. This important but inade
quate decision had marked the beginning of privatisation and
commercialization of the technology. The l'>82 debate further
accelerated this process all over India, specially in north and
west India. The SD 'epidemic’ spread rapidly in Maharashtra,
64
Gujarat, Uttar Pradesh, Haryana, Delhi. Bihar and even to Goa
and West Bengal. Gujarat topped the list with SD clinics spread
ing even in small towns. After the initial phase of cautious lull,
the clinics started adverti<ing aggressively. Within six years, the
SI) business came to stav
Activists working in different movements, sociologists and
many other conscientious and sensitive people were alarmed by
the rapid proliferation of th • SI) test epidemic’. It was obvious
that such a technology would create havoc in a country where
a daughter is considered to lx* ‘an eternal liability', ora 'passport
to hell’. 1 here is no celebration al her birth nor any sorrow al
her death. No wonder, technology ensuring quiet death without
any apparent violence would indeed be welcome in such a
society. People were also concerned about the probable reper
cussions of rapid proliferation of this technology on the health
of pregnant women and over the .already deteriorating sex ratio.
'Phis concern and restlessness paved the way for the next phase
of the campaign.
1 his section is an attempt to look back and to gauge the future.
While it does reflect the collective thinking of the Forum that
was set up to campaign against SD tests, it must be said that not
everyone shared the same view's on every matter.
FORUM AGAINST SEX DETERMINATION AND SEX PRESELEC
TION (FASDSP)
In October 1984 the Forum Against Sex Determination and Sex
Preselection was founded in Bombay. Members had varied
interests and backgrounds: w'omen’s liberation, health, human
rights, people’s science movement (PSM). For instance, Gayatri
wras a renowned lawyer: Sonal had decades of experience of
working on w'omen’s issues and on the cultural front; Lata and
Vibhuti were working with Women’s Centre as a part of the
w'omen’s movement; llarpa! and Preeta while w'orking at a
research institute were active in other movements as well.
Kamaxi and Sanjeev, fresh graduates of medicine w'ere looking
for a field of action, preparing at the same lime for further
studies. Mohan Deshpande, an artist at heart and a physician by
profession, was active on both the fronts of art and medicine.
65
Chnyanika, a researcher in physics, was actively involved with
the women's movement, theatre and PSM. Mamsha and Amat,
researchers hvcommunity health, were a part of the emergmg
health movement. Sanskriti, Ronda, Swat! and Odil brought with
them the legacy of the women's movement. Premkumar, Ganesh
and Rajaneesh had 'graduated' horn the PSM School w/hik
Vrijendra was one of the few human rights activists for whom
SD too was an issue of priority. Thus ours was a heterogeneous
group. Many of us were greenhorn activists. Most ol us were
already involved in more than one of the issues apart from oui
jobs. Not all of us knew each other. Very lew had the experience
of working together on broad issues. The modus operand, o
Issue-based campaign requiring patience, lollow-up and a higher
decree of organization and coordination was unknown to us. \X t
came together and worked as equal comrades. We tried to
- analyse the experience of 1982, learn from it, and evolve and
sustain a new campaign.
Innumerable people have contributed to the campaign. More
often than not, their contribution has remained unknown, unac
knowledged, although each one of them has helped the cam
paign in an unique wayl. Perhaps, without that specific
contribution, our struggle would have remained incomplete and
weak Dr. Sathyamala and Amrit Chad! of Delhi were involved
from 1982. They highlighted the health hazards of SD tests (as
they are performed in India) and carried out the first su.yey o
SD clinics in Delhi. Their counterparts in Bombay were Ammu
Abraham and Sonal Shukla who surveyed SD clinics in Bombay
in 198? They were instrumental in exposing the double stand
ards of the 'vegetarian, egg-forbidding', charitable Han K.sondas
Hospital whose commitment to ethics did not deter them fiom
emerging as one of the biggest SD centres in Bombay. Malm.
Karkal introduced us to the science of demography and high
lighted the link between the politics of population control and
women-.s issues. Had it not been for her we would have thought
that NRR1 must have been in the name ol a fertilizer! NHRI stands
for 'Net Reproductive Hate-1; i.e., each mother should be replaced by only one daughter).
66
M.K. Shankar who became involved had earlier no connection
with activism. A film writer, he was disturbed that many of his
highly (Qualified friends went in for SI) and he pursued the issue
on his own. Not satisfied with research, he invested all his
savings in the making of a Hindi documentary Samadhan. Later
when he met the FASDSP group, he volunteered to show his film
wherever and whenever we wanted. Il helped in creating the
right atmosphere and in focussing the issues before any discus
sion. Shankar is yet to gel his invested money back. But his film
has won for us several friends and supporters. Mrinal Gore was
instrumental in raising this issue al the slate legislature along
with two other MLAs through the introduction of private mem
bers. Later she followed it up at various levels.
Relatively less known is Dhule’s Vijaya (Jtauk. She look up a
women’s morcha to the district collecorate when the bill came
up for discussion in the Maharashtra Assembly. She also look
this issue to grassroot level through shibis (workshops). There
are several people like her who have been silently inducing
people to think and act on this issue. The activities of a small
group like ours situated in Bombay could lead to a larger
campaign through the actions of such people.
An effort which needs to be repeated elsewhere was initiated
by the Pune group of the Democratic Women’s I’ederaiion of
India (DWId). There is not a single SD clinic in Tamil Nadu. But
the maximum number of signatures on the ‘Letter to PM’ sent by
our forum are from this slate. Aruna Gnanadasan of Madras
played an important role in networking on this issue with various
groups in the slate. She used the platforms of churches and
related organizations, without diluting the feminist fervour while
raising this issue. What is more important is her success in
keeping the campaign away from the shadow of prof-life groups.
Stree Mukli Sanghatana took this issue all over rural Ma
harashtra through its Stree Mukti Yalta. In Gujarat, the Gujarat
Voluntary Health Association (GVHA) and Porum Against Sex
Determination (FASD), Ahmedabad, are fighting a lough battle
with the vested interests. Bailancho Saad’. Goa even succeeded
in pressurizing the stale government to introduce a near-perfect
bill in the Assembly.
67
The list of our supporters is extremely long. How can we
record and even know the contributions of everyone? Il could
be Smita Patil in the ninth month of her pregnancy feeling sorry
lor not being able to join our march. It could be an unknown
face in the crowd which disappeared after a gesture of support.
Il was the strength, courage and confidence given by them that
helped us in our journey from there to now.
PREPARING FOR THE CAMPAIGN
Before initiating any action, we had intense discussions within
and outside the forum. We tried to meet scientists, lawyers and
doctors to understand their viewpoints. We thought it is essential
to understand the dynamics, achievements and more important,
the failures of the 1982 campaign. We could draw certain
' conclusions for the future campaign based on our analysis.
(i)
We should not focus this question only as a women’s
issue because in our country, w'omen’s issues are meant
to be discussed ad nauseam, never to be resolved.
Moreover, by doing so, 52 percent of India’s population,
the men, would lend to get isolated from the campaign.
Because although ‘he’ is supposed to include ‘she’ , ‘she’
is never considered to include ‘he’. Men tend to ignore
or ridicule women’s issues. Hence, we would raise SD as
an issue for men and women. For us the real issue is not
of women, but of the men-women relationship in society.
We would raise this issue simultaneously at various
planes: equality of sexes, of health and of human rights.
In a wide sense, we would raise it as an issue of
democratic decision making on vital issues like technol
ogy usage. We would assert that a few scientists or
technocrats should not have the right to decide on
matters which affect society as a whole. We should try
to initiate a process whereby a technology would be
allowed to operate within a society only after ascertain
ing its benefits and risks to all concerned.
(ii) We should not restrict our discussion to the technique of
‘amniocentesis’, as in 1982. Today simple and presum
ably safer techniques like Chlorionic Villi Biopsy (CVB)
are available for the same purpose. In future, still simpler
I
68
;?■
and relatively non- invasive techniques would come into
existence. Hence, we should discuss all techniques, both
present and future, which can be used for SI).
(iii) We cannot view SI) in isolation. Il is a part of the entire
spectrum of New Reproductive Technologies (NR I). Next
to SO would be sex selection. Surrogate motherhood is
being developed in different parts of the world. These
NRTs along with genetic engineering (GE) would sooner
of later knock at our doors. Their impact on society as a
whole and on women in particular needs to be discussed.
We need to develop a comprehensive understanding of
all these issues. However, our first locus should be on
the issue of SD: people can relate to it, understand it, and
would be ready to act on it. Moreover, SD provides the
lowest common denominator for people to come to
gether. The area of consensus is much wider. It also has
several dimensions. So we should raise a demand and
plan action in the context of SD tests. Our experience in
this campaign would enrich our understanding of other
technologies. Whatever success that we might gel would
create some space and environment in which we can take
up the further issues. Hence, our analysis should be
comprehensive, but action should be on specific issues.
(iv) We should not ask for a blanker ban on prenatal diag
nostic techniques which can be misused for SD. We
should ask for banning the misuse and at the same lime
for regulating the proper use of these techniques for
detection of genetic abnormalities. Our demands would
be based on the right of equality enshrined in the Indian
Constitution and on the social need for regulating the sex
ratio balance.
(v) The issues of SD have several dimensions: technical,
social, demographic, legal, elhical and ol public policy
(related to family welfare). We need to develop a clear
understanding of each of them and of their interelationships. Lack of clarity of understanding and absence ol
follow-up were chiefly responsibile for the failure of the
1982 campaign.
69
(vi) We need to get massive support from the media. How
ever, we must guard against certain tendencies which are
often evident in media debates. Quite often lehse debates
end up trivializing or sidelining the main issues. In 1982,
for example, newspapers lay loo much emphasis on
matters like ‘errors in diagnosis leading to abortion of
male foetusses’. Even the marathon debate in Economic
and Political Weekly lost its sharp edge when a scholar
like Dharma Kumar said, 'Is it really better to be born
and left to die than be killed as a foetus?’ Although such
fatalistic arguments were countered important issues like
medical ethics, question of choice, and so on remained
untouched. It was obvious that allowing the birth of
daughters would not automatically raise their status. But
the solution lies not in ‘more humane ways of eliminating
women* but in fighting all forms of their exploitation and
subjugation. To avoid such problems, we must retain the
initiative in all such debates. Instead of wasting outenergy in responding to our opponents, we should force
them to debate on our terms, to respond to the issues we
would raise. We should also be alert to see that people’s
interest in the campaign is not allowed to fade away.
(vii) Our campaign must reach out to people, beyond the
usual circle of activists and intellectuals. We need to
discover new, imaginative ways for reaching out.
THE CAMPAIGN BEGINS
On 8 April 1986, we organized a workshop at YWCA, Bombay.
There were four sessions in which we discussed the technical,
social, legal and campaign aspects. The newspaper coverage was
very encouraging. The battle had begun. Events followed very
rapidly. The response was overwhelming. Our weekly meetings
had a packed agenda. New faces showed up during each
programme/meeting. There were new challenges at every step,
Dr. Datta Pai look cudgels on behalf of the pro-SD lobby. His
theatrical performances, challenges and threats electrified the
atmosphere. Thai was precisely the time when advertisements
for SD reached a crescendo in Bombay. There were b.uge boards
everywhere, pamphlets. We planned to counter them. We
S- ■
■
70
wanted to show people the other side of the issue. The problem
was how to reach millions of people effectively with the help of
limited resources. Then emerged the concept of‘train campaign
through the counter advertisement’. After discussion with the
group, Dr. Mohan Deshpande came up with a brilliant poster. It
was of the same size as the most popular SD advertisement in
the local train, using the same coIorand similar symbols. Hence,
people could immediately relate it as a counter advertisement.
It communicated effectively with the help of one picture and
one-line message of ‘Ban SD tests’. (Today, however, some ol
us feel that the poster and some other visuals used in the
campaign might be misinterpreted as being anti- abortionist.)
The counter advertisement conveyed our message to millions of
people and kept on repeating it for several months. Normally
posters stuck up in local trains have a life of only a few days.
However, our posters lasted for several months, a few for every
more than two years.
The train campaign was followed by a dhama outside a SD
clinic. We then started collecting signatures for a letter to the
Prime Minister. We started addressing people at seminars, work
shops and public debates. We did not know all the answers when
we began. We learnt a lol through experience. Our replic* io the
arguments pro-SD tests were the product of group efforts during
the campaign.
Once Manisha was addressing a seminar. The earlier speaker
had repealed the favourite myth (hat women's status would
improve with decline in their number. While countering him,
Manisha started describing a scenario where women would be
the miserable minority. She said, 'Even now, when we travel in
a bus or train specially at night there are very lew women around.
There is an unspoken terror, tension and constant fear. It is
mailer of a few minutes. Il is our daily routine journey. Still we
feel so insecure. Imagine how insecure a woman would feel if
she were to lead all her life in a similar environment.’ The women
audience could immediately grasp the point. This was when I
realized that I had never spoken in this way. I used to provide
information from books because I had never experienced the
insecurity and tension that a woman experiences in such situ-
71
ations. This experience taught me the difference between sym
pathy and empathy.
Slowly each one of us developed a style which had certain
features in common. We put forth feminist analysis, but made a
point to relate to both women and men. We emphasized that
everybody was in fact invoked with the issue and no one was
outside it. Perhaps due to the positive impact of women’s groups,
we never fell ashamed of talking of experiences, of feelings. For
us, the warmth of emotion was as important as the sharpness of
logic.
FASDSP has no office bearers, no leaders. We have no bank
account. We could generate funds sufficient for our activities and
could maintain accounts properly. But we never bothered to
collect funds for it, which also had its drawbacks. Except a book
'\for Nari Jeevan Sangharsh Yatra, we could not publish a single
booklet, even a folder. Moreover as the initial phase of intense
action got over, it was difficult to generate new action. For the
same reason we have been weak in long-term planning.
SEARCH FOR NEW MEDIA
We all felt the need for new media to attract attention of people.
Moreover, we thought that such media should match our content.
The search for new media lead us to the Parents- Daughter Yatra
organized on the Children’s Day 1986. ’Half the Children Are
Female or Ought To Be’ was the slogan for this day. Several
young girls and their proud parents participated in the march.
The participants included personalities like Vijay and Priya
Tendulkar as well as activists from different organizations and
many more people. A convent school in Santacruz sent their
students in uniform along with teachers. There were songs and
dances; it was a festive occasion.
On the next Children s Day, we planned a programme spe
cially for children. Hundreds of children gathered at Hulatma
Smarak. I hey included students from convent schools as well as
tribal children from Thane district brought by Kashtakari Sanghatana. Four kalakars in colourful attire
e were dancing and
singing with children. Novel games exploding
g sex stereotypes
were being
I
played. Children and adults wore colourful caps
\
. ....
—
72
bearing slogans like kidki tut Icidka se kcuti (Girls are not inferior
to boys). Manasvijni and Junuka, two young children coined a
new slogan amhi nudisadapbidi, tuihiithtinkai'tnuhi chidi (We
girls are ever blooming Howers, we don't care about lighting
stoves). While the children played in large circles, elders put up
an exhibition along the roadside on the issue of SI).
It was a treat to watch the children play. One of the games
involved mimicking various activities. Girls were asked to per
form male jobs like repairing a schooler and playing cricket while
boys were asked to wash utensils and clean (he room. We
observed that while the girls were at ease in doing all sorts ol
jobs, the boys found it was very hard to perform the feminine
chores. Later an activist from YIJVA translated the drama and
songs in Marathi and staged the same programme with the help
of children residing in a workers’ colony.
\
We also experienced that people were receptive to novel ideas
and helped in carrying them forward. Many artists were inspired
by this campaign. For two consecutive years the Asok Jain
Memorial Competition for Social Awareness Advertisement was
flooded with entries on the issue of Sd, many of which won
wards. Their creators ranged from schoolchildren to renowened
commercial artists, it was gratifying to find that most of the artists
had really understood the message of the campaign and that they
succeeded in blending the message with the medium.
An eye-catching advertisement made use of Indira Gandhi s
charisma. It said that if such a lest were available earlier and had
Kamala Nehru used it, Indira Gandhi would not have been born.
It also indicated how women like P.T. Usha and Mother Teresa
have raised the dignity of women. Alter looking al that adver
tisement, Mohan made an excellent poster, lie stuck his daugh
ters photograph on a paper and wrote below, ‘My daughter may
not become a P.T. Usha, a Mother Teresa or an Indira Gandhi.
But she is my daughter. I am proud of her. Oppose SI) tests.
Mohan was our most prolific and imaginative artist, lie pivpaied
many posters and a cartoon series. 'To (op it all, he prepared a
special slicker for children’s day 1988. Il was a post card with
Nehru’s picture in form of a stamp. I he card had a caption, lie
loved female children too.
J
■
73
Deepa Balsawar was the final year student studying commer
cial arts. Instead of choosing the campaign of a marketed
product, she chose an advertisement campaign against SO tests
for her project work. The result was a series of excellent posters
and models. PTl-TV prepared a documentary on this theme. Mr.
Singh from IIT, Bombay, prepared another documentary in Hindi
named Ajata. It presents all the arguments in support of Sd,
as well as very effective countering of these arguments by
the opponents of SD. forum prepared a slide show in
Marathi. It songs provided many catchy slogans lor the
ca mpaign.
The issue caught attention of people in Maharashtra. I he
regional press too debated the issue for months. A renowed
dramatist wrote a play based on this theme. The play Paul
Khuna (foot prints) revolves round a middle-class family
caught in a turmoil when the husband takes a decision that
his wife should undergo a SD test. The most remarkable part
of the play is the portrayal of his sensitive young daughter
who is the most affected by this decision. She is also the most
articulate person who raises questions too embarrassing lor
her father and for entire society. The play won first prize al
the state level and was later launched on commercial stage.
We thus witnessed a chain reaction around us. We had only
initialed it. It had its own momentum. Il was growing day by
day. We only look care to see that the flame was not extin
guished.
Our efforts of sconsiousness raising culminated in a month
long Nari Jeeuan Sangharctsh Yatra. It was organized in and
around Bombay during March-April 1988 with the help of several
local groups. Our aim was to present the issue of sex-selective
abortions in its entire perspective. We tried to link it with other
struggles for women’s survival and dignity. The yatra interacted
with people from schools, chcuvls^ middle-class housing colonies
and slums,. The issues to be highlighted at each place were
chosen by the local groups. We used video films, slide shows,
posters and plays to raise a few questions which were later
discussed in detail. The issues discussed included family laws,
domdeslic violence, women and health, test tube babies etc. I he
I
i'
1
74
ycitici also provided an opportunity to several women slum
dwellers to come together and collectively write, direct and
present a play on topics related to their everyday lives. The forum
also publishedI a set of posters used in the yalin in the form of
a book.
THE GOVERNMENT MOVES
I he campaign gained momentum, we were still unaware of what
needs to be done to pressurize the government to enact a suitable
law. We decided to do the most obvious thing: to file a Public
Inteiest Litigation (P1L) because everybody around seemed to be
doing it. Overnight the draft of the legislation was prepared with
Gayatri’s help. We were not sure whether the judiciary could
direct the legislation to enact a particular law. Still we decided
to try out the option. (Later Mahila Dakshata Samiti filled a
htigation in the High Court following the death of mother and
foetus due to the SO test. It
nott come Up for hearing for
-- did
— ..v
years.)
One evening a man in his late fifties came to see us. He was
a senior officer from the Mantralaya (Secretarial) on the verge of
retirement. He told us of his varied interests in social issues. He
was ‘fond’ of drafting bills on important social issues. He used
to pass them to interested MLAs or MLCs who in turn would
introduce them as private members’ bills. He wanted material
related to SD. Although we could not figure out exactly what he
was saying, we handed over the relevant material to him. After
a few days he sent us a message: ‘The draft of the bill is ready.
It will soon be introduced in the Legislative Assembly by three
MLAs — Mrinal Ghose from Janata Party, Shyam Wankhede and
Sharayu Ihakar of Congress (1). The introduction of a private
members’ bill added an entirely different dimension of the
campaign. It forced the state government to give serious consid
eration to the issue and act a-ccordingly. It laid the foundation of
the entire legislative exercise at the state and central government
levels. The issue could attain some degree of success, lienee
some activists associated with the ccampaign could be in the
limelight. I he names of MLAs who lent their names
names to
to private
private
members bill have also been registered in the history of (his
wns (|le
Spjri( he|nn(j the Jegislacampaign. r»...
But the■ jperson
who
■?
75
live process has remained unknown to all. We are greatly
indebted to him.
In the meantime we were called for discussion by 1).I. Joseph,
Secretary, Department of Public Health, Government of Ma
harashtra. We discussed the issue in details countering the
opposing views which were put forth aggressively. Al the end
of the discussion, we said with a smile, ‘You may not be knowing
it. But you have convinced the right person. Now it is my
responsibility to bring about some concrete action on this issue.'
We look his remarks with a pinch of salt
But our subsequent experience showed that Joseph was
indeed seized by the issue. In our country, bureaucrats are virtual
rulers. They have tremendous powers. A sensitive and conscien
tious administrator can effectively use these powers to a con
structive end. Joseph’s contribution to the solution of this issue
is a case in point. To begin with, he asked the Foundation for
Research in Community Health to conduct a survey of SD clinics
in Bombay. Dr. Sanjeev Kulkarni carried out a sample survey of
gynaecologists. The findings of the survey were immediately
published. The survey, one of the most authentic statistics
available on this subject, vindicated our viewpoint.
Until then, all the statistics that we had were unofficial. Il is
next to impossible to collect authentic data related to this
problem, because doctors carrying out SD tests hardly keep any
records. We did not have access to most of such records. Even
when we could collect sufficient information through whatever
means we had, it could not provide sufficient idea of the larger
reality. In the initial phases, we were often questioned, especially
by foreign correspondents about official or authentic nature of
our information. This question came mainly through their igno
rance about the nature of SD clinics in India. In India it is not
necessary to register a SD clinic or centre. Any doctor can start
one. (In Maharashtra the situation has changed to some extent
after the law.) In a country like the USA (he doctor has to obtain
‘informed consent' from the patient even before performing a
minor medical intervention such as withdrawal of blood. Amnio
centesis can only be performed by a qualified person with
sufficient experience provided that the necessary infrastructure
/•n
s?
76
such as an operation theatre and ultrasonic cover is available.
However, in India all that is required is a syringe of suitable
aperture and a doctor prepared to insert it into the amniotic sac
of a pregnant woman. In such an environment, how could we
collect authentic data? However, Dr. Kulkarni’s study proved
beyond doubt that our observations were indeed valid. The
very fact that about 85 percent of the gynecologists covered
by the survey agreed to have been using techniques like
amniocentesis chiefly for the purpose of SD, silenced our
detractors once for all. That the doctors admitted it to a person
officially conducting the survey on behalf of the state govern
ment at a lime when the issue was al (he centre of worldwide
media attention further' highlights the significance of the
findings. The ever-increasing force of the campaign, coupled
with the findings of this survey and the introduction of private
■>-members’ bill in the legislative assembly forced the state
•government to act.
Another important development during that period was the
formation of the group, Doctors Against Sex Determination
(DASD). FASDSP was constantly being accused of being
‘against doctors’ by our opponents. Actually our campaign was
never against the medical profession of gynecologists. We
were raising our voice against the gross violation of medical
ethics by a section of gynecologists and other medical experts
indulging in the SD business, the pro-SD lobby had tried to
raise the bogey of‘doctors prestige in danger’. Hence, certain
doctors who were active in or sympathetic to our campaign
felt the need of raising an independent forum of conscientious
doctors to support the campaign. Ils convenor was Dr. B.M.
Inamdar, a young gynecologist from Goregaon. He showed
courage and conviction. He dared to come out in the open on
this issue at a time when many reputed senior and progressive
doctors refused to take any public stand on this issue. Certain
doctors were active in both FASDSP. as well as DASD. DASD
publicly asked Indian Medical Association (IMA), Indian Medi
cal Council (IMC) and Federation of Organization of Gyne
cologists Societies of India (FOGSl), to take a stand on this
matter. Bailing FOGSl. the other organizations are not even
ready to discuss (his issue. They did not even bother to
77
acknowledge die DASD letters. These very organizations are
entrusted with the task of the preservance and upholding of
ethical values of this very noble profession : much for their
concern for medical ethics.
EXPERIENCES AT THE GOVERNMENT COMMflTElThe private members’ bill was scheduled lor discussion in the
1986 winter session of the Maharashtra legislature. Hence, the
government felt the need to act before it came up for discussion.
Keeping up its tradition of appointing expert committees on all
embarrassing topics, it announced the formation of an Expert
Committee on SD and Female Foeticide (Infanticide said the first
official letter). From the campaigners’ side, Manisha and I were
invited to become members, obviously at the instance of Mr.
Joseph. However, one of the members of this committee was Dr.
Pai, the person who had proclaimed at an international confer
ence, 'Selective abortion of female foetuses is the only solution
to India’s population problem.’ Hence, the government’s inten
tions seemed to be quite dubious. The past experience of
government committees, their structure, functioning and fate,
had not been at all encouraging. So we were not keen on joining
this committee. However, after much deliberation, we decided
to accept the offer. In the past, we had all protested against the
exclusion of people who were appropriate from government
committees. We thought'that we should use this opportunity to
gain the experience about the dynamics of a government com
mittee and to learn from it. We also felt that by being a part, we
could prevent the committee from sidetracking the main issue.
It was agreed that the campaign would maintain its pressure from
outside. Moreover, we always had the option of quilling after
making sufficient noise in case the committee went astray or
became defunct. The commiltee appointed three sub-committees
to go into the details of the technical legal and awareness aspects
of the issue. Dr. Inamdar of DASD and Dr. Hema Purandare of
the Genetic Research Centre were included in the technical sub
committee. Excellent co-ordination among the activist members,
the pressure of the campaign from outside and the clear stand
against SD taken by Bhai Savant and Rajani Salav (cabinet
minister and minister of stale) contributed to the success of the
78
committee. Dr. S. Pai and Dr. Purandare. in spile of their personal
views to the contrary, lent their consent to the report which was
thus accepted unanimously. The report of the committee submit
ted in May 1987 which was never published, contained the
following conclusions:
(i)
I he misuse of prenatal diagnostic techniques for SD
should be totally banned.
(ii) These techniques should be allowed to be used for the
detection of congenital anomalies.
(iii) 1 his use should only be restricted to government and
public institutions (e g. municipal hospitals). The serv
ices available in the private laboratories, should be, if
lequiied, channelized through government institutions
licensed for this purpose.
\
(iv) The slate government should enact a special law for this
purpose.
(v) 'fhe state government should pressurize the central gov
ernment to enact a similar legislation at the national level.
(vi) I he Medical Termination of Pregnancy Act, if required,
may be amended so as to include in it a clause explicily
slating sex- selective abortion (except where it is theraputically justified) as a legal offnce.
(vii) The law can succeed only if it is supported by a wellplanned, long-term movement for health education and
consciousness raising. The government should lake suit
able measures to that effect.
The committee had thus upheld our stand on the issue. But
there was no room for complacency. We soon realized that
governments have their own ways. They have loo many tricks
up their sleeves. First is their phenomenal slow pace. (It is
calculated. They can be extra fast when they choose to.) The
report although completely in our favour, was never released
and discussed. The stale government was just buying time till
the tempo of the campaign would subside.
h was the end of December 1987. Twenty months after the
campaign, we had not succeeded in extracting anything concrete
79
fiom the government. The announcement made by the ministers
within and outside the legislative houses, and reports of expert
committees amounted to nothing. The crux of the matter lay in
the decision of the cabinet. The cabinet « as not yet ready toeive
a green signal to the proposed law. It had its own priorities
views and idiosyncracies. Then, almost unexpectedly on the
night of 31 December,
the
c*. " minister Mr. S.B. Cha van.
? chief
announced that the cabinet had :
.
—
accepted all the recommendalions of the committee. The official bill
was to be introduced in
the legislative housessoon. It was his new
year gift io (he people
of Maharashtra.
..
'
Thus 1988 began with a bang. The state government received
kudos from all concerned for introducing the first major legisla
tion on the regulation of medical technology in India. However
the media, and the activists were guarded in their reaction \vj
> expressed happiness. 'But the real test lies in implementation '
\ne said.
’
On 10 January,' the Times of India carried an article Should
There Be a Choice?' byJ.B. D'Souza in its Sunday supplement.
rongly aigued against the government’s decision. The arguments in the article were pretty worn out and had been countered
several times ever since the debate began in 1982. However we
had learnt through experience that what is significant in such
debates is who is saying it. Often the debate does not move
a ieac . eople raise the same old arguments over and again. This
is when you feel trapped. You have limited time, energy and
resources. You just do not feel like going through the same bout
of arguments again. But if you do not reply, the same myths are
perpetuated through infinite repetitions.
What was alarming was that the pro-SD lobby had finally got
a respectable spokesperson. J.B. D’Souza was a name to reckon
w,th. He belonged to the first I.A.S. batch and had retired as the
Secretary to the Government of India. He had also served as a
consultant to the World Bank. Besides being an able administraor, he was also known lor his bold views. (The dereservation
° plots in Bombay which snowballed into a major political issue
in Malianishtra is a recent example). The Times of India took
one full month to publish our rejoinder. We slowly realized that
t.
*
80
even the English press which had been almost totally supportive
had slowly begun to Lake 'a balanced stand’ on the issue. This
was reflected in the reduced coverage of letters and news in
support of the campaign. The regional press, baring publications
ol a few good arhcles had not helped the campaign to any
significant extent. Time was running out.
session Of Maharashtra legislation began in ,\p, il
1988 tn Bombay. The official bill on SD was put before the
legislative council. It was suddenly decided that it would be
'ere" ,UP
cliscilssion on
very next day. With great
difficulty, we could procure a copy. And we were shocked! Many
provisions in the bill were in total contravention of the commit
ments made by the government. Certain objectionable clauses
nact also been incorporated.
y’ (0
Tlie bill provided for granting licences to private centres/laboratories while the expert committee report and
even the chief minister’s announcement said categori
cally that licences would be given only to government
centres/laboratories.
Gi) An important clause in the bill provided for punishment
to the woman undergoing SD tests. Although the clause
said that such a woman would normally be assumed to
be innocent, it provided for the punishment if it was
proved that she went for the test on her onw. In the
present social context, very few women would plead
before the court that they were indeed pressurized by
the family members to undergo the test. Thus, in effect
while the in-laws would go scot-free, the poor woman
would be punished. (The exact magnitude of punishment
was debatable. It was interpreted as a fine of Rs. 50 by
some and an imprisonment for three months by other
legal experts.) This clause amounced to further victimi
A
zation of the woman who is already a victim of social
structure.
(lll) K.lau!e 21 .°f.l!le l)il1 denied t,le '^gl't to move the court
by any individual1 or organization who wanted to bring
lo the notice of court
any contravention of the act. It
restricied such a light onlyh lo (he official organs of the
81
implementing machinery, namely the State Appripriate
Authority (SAA) and State and Local Vigilance Commit
tees (SVC; LVCs). Others were required to furnish the
information first to SAA or SVC. If no action was taken
by them within a period of 60 days, then only could such
an individual or organization move the court.
(iv) Even in such a situation, the bill had granted powers to
SAA and SVCs to refuse to make available any document
to such individuals or organizations it was essential for
guarding public interest.
(v) Another clause gave blanket powers to the slate govern
ment to exempt an institution under its control from any
or all requirements for the use of techniques as laid down
by the bill.
(vi) The bill did not provide for any lime limit for the
\
constitution of SAAs and SVCs — the very foundation for
the implementation of the act.
(vii) Clause 4 of the Bill listed lhe conditions under which the
use of prenatal diagnostic techniques would be allowed.
One of them was exposure to potentially teratogenic
drugs, radiations, infections of hazardous chemicals. We
had suggested this clause to ensure that women who
become victims of such exposure (e.g., as in ecological
catastrophes like' lhe Bhopal workers in the Union Car
bide plant leak disaster, in chemical and pharmaceutical
industries where working conditions are unsatisfactory)
get an access to such tests. However, in lhe bill the wrods
‘potentially teratogenic’ were dropped from lhe clause.
It meant that any woman could get the test done even
(he pretext of a minor infection such as influenza or after
consumption of an aspirin tablet.
The ‘Statement of objects and reasons’ which forms the
prologue to the Bill was good. But the bill itself contained so
many loopholes that it would not have s icceeded in catching
any culprit anytime.The meaning of this sun k contradiction was
clear: some experienced hand must have given final touches to
the draft. All that we had won in the battle would soon be lost
in lhe treaty.
82
Mnh- nslL ?
y :!S ?Ot1reaCly tO take cl,ances- 0" 3 March.
It ionc v nl 771
S’
an ar'iC,e hy Dr' S:,riI:' ^’nn.kh.
It strongly pleaded that the proposed law would rather add to
he women’s burden of problems. ,t advocated SO 'to md
Population control’ and ’to help fulfil the natural parental urge
not f-I tl0"5 ' " aSked al1 MLAS anJ MLCS whell'e’r they too dkl
no fed the same urge and appealed (hem to defeat the bill. The
rt cle was photocopied and distributed to members of both
houses, h caused a lot of turmoil as many membe.s we e
«—4^^
"r
in th.' 1
° r WaS Certain l,OW "le 1,111 wonld be received
n the House on the next day. Passing of the bill as it was would
e mean, only a symbolic victmy for us. Because we were sure
Uiat I( was impossible to implement it. It would only legitimize
S the od^
rraS|PUSl7 l'nder ‘he Carpel afler the campaign On
other hand, withdrawal of the bill would have sealed the fate
WOUH 777 °n“ rfOr a"' ThC Savin«
odd have been referring the bill to a select committee’
to getVthe hw WOl,'d7ean P°StpOnin8 it mdefinitely. Our failure
chances f
Maharashtra ^otdd have affected our
chances of getting such a law enacted at the all-lndia level.
ment'and'LT^J6!. ? US 7S ‘O PreSS f°r nlaximum ame^another leading M B‘ cleared by [he House. Luckily Loksatta,
bv noim
g
newspaper published a detailed pointby-pomt rejointer to Dr. Deshmukh’s article. We distributed it to
he members of the legislature. We also distributed an apnea o
all members to pass the bill. However, we were toW 7at not
many amendments would be entertained. Because acceptance
Of amendments, would have meant loss of prestige for the
Varde™dis'lint' 'T' 7° anlendnients suggested by Sadanand
The^ehtecdo d
'"emb,er°f ll,e °PP™‘ion, were accepted,
to l7exno 7 .aUfeS 7 ” °f
bi"’ ,n tbe da^ Elated
chemic
nve he
ment
.
d'^S °f nldia‘io"S ^^tions or
7 'Potentially teratogenic’ were added. More'
’ ‘O S'VinS blankct l,owcrs to the govern-
ew
!
o the AcrZ 777s Under
COnt'■O,
precisions
lem n.w ,
° ‘ *' drOPPed- "
for the firs. tilne in [|le
gtslanve history o Maharashtm that the amendments to an
official bill
•■’nfigested by an opposition member were accepted
83
The bill was unanimously passed by (he legislative council on
13 April and by legislative assembly on 16 April. After obtaining
the Governor’s assent, it was published as Maharashtra State Act
No. XV of 1988 in the government gazette on 28 April. The title
of the Act was Maharashtra Regulation of Prenatal Diagnostic
Techniques Act 1988. A battle was won, but the success left us
little to cheer about.
However, the enactment of law in Maharashtra had a spinoff
effect in other parts of India. The Forum Against Sex Determina
tion was formed in Gujrat. It included feminist groups, lawyers,
sociologists, health activists and most, importantly, doctors. Dr.
Zubeda Shah, a leading gynecologist, emerged as the main
spokesperson of the Forum. After a long drawn out struggle, the
group succeeded in introduction of a private member’s bill in
Maharashtra Act. In Goa, the campaign against SD spearheaded
by Bailancho Saad (Voice of Women) even succeeded in intro
duction of an official bill in the Assembly. The bill includes most
demands of activist groups like ours. The bill could not be
discussed and hence lapsed as the assembly was dissolved. In
Karnataka, a scandal related to SD clinic run clandestinely al a
university department by a private practitioner was exposed and
brought into focus by journalists. The clinic had to close down
and all concerned had to resign following the appointment of
an enquiry committee.
Another positive effect of the passing of bill in Maharashtra
was the optimism generated by it. Everywhere around us w'e find
injustice and atrocities. Everything around us seems to be
gloomy. When we do not have much faith that anything w'ould
ever improve, news like the passing of a law against SD is
encouraging. We feel there is still room for hope. It is still
possible for a few sincere and conscientious people to pressurize
the government for a good cause and to succeed. Even if our
success is incomplete, nevertheless it is a success.
The number of SD clinics in Maharashtra went down signifi
cantly after the passing of the Act. Aggressive advertisements had
slopped soon after lhe campaign. However, we w’ere aware that
certain doctors in lhe city of Bombay continued to perform lhe
lest al cxorbiianl rales. At some public places, advertising
84
displays were still to be seen. For the success of the law it was
necessary that a few cases be lodged against violators ol the law
within a first few months. It was equally important to highlight
legal action through media. This was the only way to let eveiyone
know that the law would not be confined to the books. But how
could one file a case? According to the act. only SAA and SVC
had the right to move the courts. Groups like ours could do so
only after giving 60 days notice to the government committees.
But the committees were yet to be formed. 1 he health minister
Bhai Sawant had to resign following the Lemin Commission
controversy, and the new health minister Jawahar Darda did not
lake any interest in the matter.
Then came 1989. The stale government al last appointed SAA
and SVC. Surprisingly the government which made a point lo gel
• maximum publicity through any of its aciion on the issue of SI)
S kept quiet all this time. With great difficulty we could gel lo know
the names of the newly appointed committee members.
None of the FASDSP. members were included. The names of
many reputed persons in related fields who had contributed to
the campaign and had taken a clear stand had been suggested
to the government. However, none of them were included. The
non- government nominees were no doubt persons of repute in
the field of health. Some of them had served in several govern
ment committees. The relevant questions, however, were What
was their contribution to this issue? Did they use their reputation
to raise this issue at least in their professional field? Our fears
were genuine. One ol the committee members had in the past
publicly stated that SD tests should be encouraged to curb the
population growth.
The government outdid all its mischiefs by appointing a
renowned geneticist on the committee. She had al several times
staled publicly that ‘SD tests against metical ethics’. She had told
the Press and filmmakers that she was one of the very, few
persons who were engaged in using techniques like amniocen
tesis for the right purpose. She had taken up a similar stand as
a member of the technical sub-commillee of the expert commit
tee appointed by the state government. What she pleached and
what she actually practised, however, were totally different. She
85
routinely used techniques like CVB specially for sex determina
tion. However on records all such tests were shown to be
genuine case of prenatal diagnosis of congenital malformations.
Even when most doctors in Bombay had stopped misusing the
tests for SD she continued with her practice. Meena Menon, a
correspondent then working with Mid Day had thoroughly
exposed her by posing as a prospective client and publishing
the entire report. Tjhe government was very much aware of this
scoop. Moreover, the geneticist herself had accepted this fact in
her paper presented at several international conferences. There
she stated : Out of 1500 chorionic biopsies performed, 9871 were
for ‘nongenetic reasons’ (anxious couples). The government was
aware of this paper loo. The most damaging fact was that in 1988
she was convicted by the Civil Judge ot Ghaziabad of severe
lapses in practice. The geneticist, her colleague and a gynecolo
gist were fined Rs. 3 lakhs each for their error in diagnosis of
Down’s Syndrome in an unborn child. Thus, the government had
shown its true colours by appointing a ©person who had
repeatedly made false statements to the public, media and
government; whose professional skills were doubted by the
activists and whose vested interests lay directly in propagating
SD. That her task was to check the misuse of techniques for SD
was a contradiction in itself. Finally, she had to resign not
because of the government’s insistence, but because of the
pressure by FASDSP and the press. Time passed. Mr. Joseph was
transferred. The new secretary evidently did not show any
interest in this issue.
DELHI
The campaign initiated in Maharashtra soon reached other states.
Campaign groups were organized in different parts. I hey raised
the demand for a nation-wide law. On 19 December 1986, the
Minister of Health and Family Welfare, Government of India,
convened a national conference on Sd. I was one of the invitees.
The participants were mostly government officers, doctors, rep
resentatives of family planning organizations. Feminist groups or
activist groups working on this issue were hardly present. I did
not know whether they were invited or not. Two of my feminist
friends from Bombay, though invited, did not attend. Maybe
86
many others also thought that such conference do not serve any
usefid purpose. Ms. Mira Sheth, secretary- of the department w s
in the chair. She set die tone of the meeung by tho.otig y
condemning SD. She said there was no question of allov- mg
•
unethical, anti-woman practice. She appealed to all the puhcipants to give precise recommendations for the consider on of
the government. Against such a background, nobody could have
openly defended SD. But what many people spoke was intolerable.
An old man simply dived into the unfathomable ocean of'our
great Indian culture and our glorious history’. After speaking a
great length he concluded, 'Today, Indian women face several
problems. Organizations like ours are engaged m solving them
-vu..
.^,.-,,.ni most
must be
be generous
eenerous in providing financial help
The government
to us.’ Another fellow suggested that all problems could vanish
' if all people started fearing God.
The experts from the law department could not, till the end
understand the need for a new, separate act for curbing SD. 1 my
kept on referring to the MTP Act. The failure of all governmcn
is to file a single case of sex selective abortion under the MT
ACt made no impact on them.
I kept on cursing my Bombay friends whose absence 1 could
feel strongly. However,.I experienced that even in such a milheu
one could make one’s presence felt. In fact, one s comma nen
knowledge and intensity of feelings become much more ev.den
in such an atmosphere and one can reach out am s rare
.
thoughts and feelings. Mr. Joseph too supported my stand and
pleaded strongly for a bold initiative on the part of the govern
ment. The conference ended on a somewhat optimistic no c.
In April 1987, the Government of India, Ministry of Health and
Family Welfare, Department of Family Welfare announced the
formation of an expert committee on this issue. J
Chairmanship of Mr. Joseph, the four non-government membos
of the commiuee included a gynecologist Dr. Jam, genetics Dr
Varma legal expert Kapila K. Hingorani and me. n general, all
those who were vocal and somewhat artieulate in the conleic net
were made members of the committee. II only Bombay Inc
87
were here, 1 felt. I had to again prepare myself for a lonely battle
in a totally unknown front.
Delhi is an insulated island. Very narcissist; unconcerned
unaffected by the storms hovering over other parts. All the
meetings of the committee were held in Delhi as the government
officials there were loo busy to travel outside. The invitation for
the meetings used to reach me on the very day of meeting,
sometimes even later. If 1 was fortunate enough to receive it in
time and reach Delhi in the morning, the meeting did not
commence lor hours as local members were not available. The
meeting used to get over within one and a half hours. The
discussions were superficial and repetitive. Nothing really
moved.
The biggest nuisance was the legal expert on the committee.
Half the time she was busy describing how close she was to the
political bigwigs. Every lime we pm forth a detailed draft for
discussion, she used to come up with her alternate page draft.
Her draft revolved round the constitutional clause under, which
the law could be framed. The degree of her awareness and
general knowledge could be gauged by the fact that she wanted
the facility of ‘genetic counselling and prenatal diagnosis’ at
every Primary Health Centre (PMC) of the country. She conven
iently neglected the facts that such PHCs do not even have
essential drugs for the most common diseases like fever and
diarrhoea. She was informed that in villages a doctor is often not
available in the radius of fifty to a hundred miles. But her stand
remained unaffected. The most damaging aspect was her insis
tence to punish the woman who took a SD test. For months, we
debated this issue. Her logic was strange. She though that women
would refuse to undergo S[) tests once they realized that they
might be punished. She even boasted that this provision in the
law would embolden Indian women to fight against the tyranny
of husbands and in- laws. 1 pointed out that the experience of
women’s groups in Bombay was that even women on the
deathbed who had received 90 percent burns were unwilling to
confess that they had been burnt by husbands or in-laws. Given
that this was the reality, was it likely that they would give a
statement that they were forced by in-laws or husbands to
■
-
'
■
■■
\
.
W
lli
88
undergo SD test? Then she came up with her final weapon: ‘I am
a woman. 1 am involved with women’s issues. Naturally 1 have
more right to talk and decide about women’s problems. There
were the times when 1 Cursed my female feminist friends of
Bombay who had chosen to be absent’.
As time Hew, 1 became more restless. No campaign can be
sustained for years. This campaign had a few chances of regen
eration as people were getting frustrated. When 1 tried to protest
about the slow pace of working of the committee, 1 was made
to understand certain things in a very sophisticated way. After
all Delhi did not think we were worth giving much consideration.
Who are you? What is your nuisance value? How many people
are behind you? Maybe a handful of people in Maharashtra and
South India. How about the great Hindi hinterland? How about
Delhi itself? How can we take you seriously unless anything
happens here? Unless some highup there are affected? Although
nobody said this in so many words, the message was quite clear
for me.
We still cannot figure out the lack of enthusiasm on this issue
in Delhi. In fact there are many individuals in Delhi who are
sensitive and willing to act on this issue. DWFI has consistently
raised the demand of ban on SD tests. Swami Agnivesh had lead
a large morcba of rural women on this subject. The issue is very
much alive in and around'Delhi. The newspaper advertisement
of Dr. Loomba’s genetic laboratory is an everyday reminder. As
early as 1982 common people seemed to be knowing about SD
tests. That was the year when my pregnant wife and I visited
Delhi; many people advised us to get the test done. However,
barring a short- lived attempt triggered by Vibhuti and Chayanika
— two of our members — no effective group action has yet been
taken on this issue.
After prolonged deliberation and tremendous efforts by the
active members, the Central Government Expert Committee
finalized the draft legislation which was then circulated to all
state governments for getting their feedback. After several
months I could lay my hands on one such copy and was again
shocked. Once again, the experienced hand had given furnishing
touches to the draft. All the objectionable clauses in Maharashtra
4
89
Act were included in it. Aller a prolonged debate, die objection
able clauses were removed. The commiiive submitted its report
along with the finalized draft of the bill in June 1989: The
committee members are yet to receive an official copy from the
ministry.
I he report of the committee is an important document. It deals
at length with the various aspects of the problem. It explicitly
slates the thinking behind the act. It gives suitable explanation
loi each clause included in the bill. The basic framework of the
report is quite close to the views expressed on this subject by
activist groups like I'ASDSP. The committee has also made
certain useful recommendations about the constitution of medi
cal councils and for creating awareness among people. These
iecommendations, if implemented sincerely, would be of great
help not only to this campaign, but also to similar activities in
the field of health, consumersand women. Although I agree with
the overall thinking in the report, I was pained to note that some
issues which are vital to the implementation of the act have been
■ left unresolved by the commiaee. Hence, i iiaw appended a
note of dissent’ to the report. It deals with the following points:
(i)
Punishment of a woman undergoing SI) test.
(ii) Licencing private sector for the use of prenatal diagnostic
techniques.
It is now left to the campaigners to raise these issues and
create a public opinion in their favour. It is essential that the
report of the committee be published. It can provide the frame
work for the debate on central legislation.
It is important for all of us to understand the strength and
limitations of the slate apparatus in supporting or opposing us.
An indifferent or antagonistic bureacral can create innumerable
hurdles in order to drain one’s momentum and stamina. A
senisitive and sympathetic bureaucrat can go a long way in
removing these hurdles and creating a favourable atmosphere
I lowever, one has to rely exclusively on the strength of campaign
on vital issues like appointments on implementing bodies and
on major polili- .il questions related to the law. for example one’s
attitude towards whether a woman should be punished for
3
■■•...
90
undergoing the SD test. Allowing the private sector to obtain
licences for the use of prenatal diagnostic techniques is directly
related to lobbying by interest groups. We have to fight issue
battles on our own strength. Clarity on this important issue can
prevent a lot of unnecessary tensions, misunderstanding and
apprehension.
All organizations have to decide their approach towards
government. It has remained an unresolved issue and would
continue to remain so for a long lime. Activists are often in
dilemma over this issue. On one hand there is a veiy valid fear
of being co-opted, of being accepted and then conveniently
sidetracked. On the other hand some intereaction with the state
is inevitable. One has to rely on or seek support from the slate
machinery in some way or the other. That’s why activist groups
keep on asking for new laws or amendments in law. They make
demands directed at the government issues related either to
women, environment or development specially need to be
lobbied and rraised. Because their solution is not linked to the
nature of the state apparatus alone. That is why I discussed in
detail my experience in government committees. Many of us
have been strong in campaigning, but weak in lobbying. We
have become visible and-.audible, but have not altered macro
equations significantly.
WHERE DO WE STAND'NOW?
After four years of struggle, where are we? It is time to take slock
of the situation. Time for reflection and planning. In Maharashtra,
there has not been any major action in the last one year. The
law' has remained on paper. Local Vigilance Committees aree yet
to be set up. SAA and SVC are yet to stabilize. What they have
done so far has remained a mystery. Even the list of Centres and
Laboratories which have received licences for using the tech
niques is not made public. The government under the act is
bound to publish findings of the labs and centres once in three
months. No such reports have yet been published. A few boards
advertising SD clinics are still visible. FASDSP had sent letters to
concerned authorities io lake action against doctors performing
and/or advertising SD, or at least to inform us w'hat we can do
in that context. Our letters are not even acknowledged.
I.
91
There are a lew clinics performing SI) tests clandestinely at
exorbitant prices. At present their number is small. However, this
can multiply soon it the law remains on paper. The gynecologists
performing SI) tests have developed many ingenious ways to
violate the law and mint money. For example, there is a gyne
cologist practising in a north suburb of Bombay. He asks for an
advance of Rs. 5,()()(). The ahcarges for the lest are Rs. 3,000. If
the foetus turns out to be female, the patient should get the MTP
done there. The charges for MTP are Rs. 3,000. So in that case,
the patient must pay Rs. 1,000 more. If the foetus is found to be
male, then Rs. 2,000 are refunded. Very surprisingly, all reports
turn out to be daughters. This is because the amniotic fluid is
not sent to the laboratory for analysis' The patient is orally
informed and immediately MTP is performed. There is no record.
No outsiders are involved. It’s a safe bargain: ‘Parents unwilling
to pay dowry for their daughters are willing to pay it to a doctor
to get rid of their daughter’ quipped Lata, a FASDSP member
Outside Maharashtra, the picture is somewhat different. While
the SD business is proliferating in some states, awareness on this
issue is also growing. However, organized action is weak in Uttar
Pradesh, Madhya Pradesh, Punjab, Haryana and Delhi. In the
South and East, SD has not succeeded in making its presence
felt. The awareness in these slates is indeed quite high. Mean
while, the report of the expert committee and the draft bill
prepared by it is deeply buried in the pile of files in the Ministry.
Recently, the health minister, Mr. Routrary, while replying to a
question on this issue, said in the Lok Sabha, ‘The government
is planning to amend the MTP Act. We are also thinking of
introducing a new bill. However, the nexus between sex deter
mination and abortion is not yet proved. Hence, we have not yet
taken decision’. Can there be more contradic tions aiul inaccura
cies in any single answer?
His reply shows:
(i)
The concerned minister does not know anything about
the issue.
(ii) After fifteen years history of sex-selective abortions, two
nationwide campaigns, reports of two expert committees,
a dozen assurances by concerned ministers, recommen-
1I
92
dat.ons of several national and international bodies
. ssu.ances g,ven tn manifestos of different political pari
cs (tncludtng supporters of the present government),
U>c mtmster does not know whether the problem really
exists. Can anybody .suggest a method for establishing a
nexus between SO and sex-selec.ive abortion in a way
winch the minister can understand?
(iii) If the nexus between Sd and abortion
is not established,
then why talk of amending the MTP Act and/or introduce
a new law?
(iv) An amendment in the
MTP Act would at most be of a
symbolic value. The iminister does not know that the
issue is not MTP. it is
: sex- selective abortion. And that
too, during the SAARC International
---------- 1 Year for the Girl
Child, 1990?
\ NEW CI IALLENGI-S
Ne7|SDc^Chn,qUeS arC beins deve,oped. CVB is in voeue It
routi^l
'"t'f 6 third m°nth Qf Pre8nancy- Sonography is being
tneh used for monitoring pregnancy. It can also be ujsed for
advancufosT
of
1 - - P°-ibIe at 1 much
and hleXl) M
(makinS Gordon very hazardous
and illegal). Moreover, the accuracy of techniques is low But
there are enough doctors trying to sell sonography as a 'simple
ccurate and safe SD tool to be used in the first trimester'. There
. re enough people around, too willing to believe these doctors
Scienfifi
OUS|an.C‘S °‘‘ ruPees !° 8et rid of unwanted daughters.
Sclentific journals have reported new methods such as analysis
ma c i n.i > ood and chromosomaUnalysis of IVF-ET (In Vitro
Fertthzauon-Embryo Transfer) embryo.
In 1988 I saw an advertisement in
the Diwali special number
of a renowned Marathi magazine:
Amniocentesis is a developed science
To misuse it for abortion is a great sin.
Better go in for sex-selection.
tj turasasa&i'’! ^.jjj.ksp*-^ ?:^< *■ ■s.^f^ai^u^^ti. .,
■sw. '■’.it'af
.
9S
Read this book. Consult your family doctor for a sure way of
begetting sons
Ibis was an advcrtisenunt of a booklet Y-1 'irilene written by
Dr. Paranjape from Bombay.
1 read a lairly large book on this subject recently published in
Marathi, written by a foreign returned’ sexologist Dr. Prakash
Varekar. Il is entitled Mul^a Pahije? Mid[>ach lloil! (Want a son?
Gel a son!) The back cover eulogizes the author as the follower
of the great tradition of medicine which strives to educate
people. I he book discusses a number of remedies ranging from
diet (exclude milk and eggs, consume more lea, salt, cheese and
sausages) to the ancient ritual of PiiHsavctiia used by Ayurvedic
experts.
l or years, a Gujarat-based company. Vasu Pharmaceuticals,
has been marketing a product for sex preselection. ‘Select-1’ and
‘Select-2’ capsules arc meant for consumption by a pregnant
woman 45 days from LMP (Last Menstrual Period) for a period
of two weeks. The manufacturers claim that it can change the
sex of foetus from female to male after conception. It is recom
mended by severalrenowned doctors, especially in Gujrat
(though modern science warns against the use of any medicine
in the first trimester, as it can lead to deformities in the foetus.)
The urgency of a prompt and comprehensive action has been
underlined by the recent findings of Barbara Miller (author of
The Endangered Sex). She had earlier published her findings
about sex ratios of rural districts of India based on the 1971
census. It was shown (hat the sex ratio (calculated as the number
of females per thousand males) was dangerously low in one-tliird
of the rural districts in north and west India. She had attributed
this to the neglect of female children in these areas.
The 1981 census figures show (hat the region where sex ratio
balance is being rapidly destroyed is expanding in size. It has
crossed the Hindi Heartland’ and reached northern Maharashtra
and also touched Tamil Nadu. I his rapid imbalance in sex ratio
was caused by the neglect of born daughters and selective
elimination of daughters before birth operau simultaneously is
anybody’s guess Looking al the proliferation of SD clinics, a
A-Jit
W\F^..*CH38W'«rear|i® * ■•*
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-J.3JL
*t4 fii-i' -. ■■
94
serious imbalance in sex-ratios across a very large territoiy of
India cannot be ruled out. No one knows exactly what might
happen then. One thing is certain, it would make women’s lives
more insecure, restrictive and less dignified. Il would make
human lite more miserable and violent. There is no immediate
way to restore the sex ratio balance after its disruption. Maybe
al that time, women’s very survival would become an issue of
immediate concern and action. The question is. should we allow
the situation to deteriorate or shall we work systematically to
confront this challenge now?
Sex selection (through sex determination followed by abortion
of the wrong sex’ or through sex pre-selection) is just the
proverbial lip of the iceberg of new reproduction technologies.
Techniques like Inevitro Fertilization-Embryo Transfer (IVF-ET)
and Gamete In Fallopian Transfer (G1FD, popularly known as
‘test tube baby techniques’ have already arrived in India.
Surrogate Motherhood
Industry’ is looking out to poor women from the Third World
as potential hirers of wombs at cheap rates. Research in gene
manipulations and cloning (technique for reproduciing several
identical cells/tissues/organisms) have horrific potentialiti- s. All
these technologies have raised several disturbing complex social,
cultural, ethical, political issues for entire humankind. The first
world has already started regulating these technologies and
debating their probably impact. In India, we are still fumbling at
the very first step. The situation is distressing, but surely not
frustrating. Our balance sheet does show many achievements.
On the credit side:
(i)
We have proved that the content and degree of imple
mentation of a particular law depends directly on the
pressure expertecl by the campaign over the government.
The unanimous passing of an act seeking to regulate the
use of modern medical technology in itself is an achieve
ment. It only means that belatedly, we have joined (he
mainstream of countries where the use of technology is
subject to checks and balances outside the profession.
The acceptance by the Government of Maharashtra of the
jsvnwsawesxu.
95
amendments suggested by an opposition member as well
as the resignation of Dr. Purandare from the SVC also
indicate that public opinion can bring about desirable
changes. Out stand on the law has been vindicated by
the experience in Maharashtra. We have maintained that
matters like restricting the use of prenatal diagnostic
techniques to government institutions and not punishing
the woman undergoing SD test is inevitable for the
success of the act and not a way of bargain or negotiation.
(ii) ’fhe reduction in number of SD clinics and the rise in the
rates have at least checked the influx of SD tests. It has
also shown that doctors, by and large, follow a law, if
they are made to understand that breaking a law would
not be in their interest.
G’O
achievements of groups in Goa and Gujarat towards
a legislation belter than in Maharashtra which need to be
\
commended.
(iv) We should retain our initiative in the campaign; we are
effective as long as we do so. After losing the initiative
to people like J.B. D’Soiiza, Dharma Kumar and Vasant
Sathe, we had to spend most of our energy in replying
to them or had to remain silent.
(v)
Even now, people and media have not lost interest and
hopes. South and'East India is more or less free from this
‘epidemic’. In northern India, SD clinics are still restricted
to large place. There is still room for us to intervene.
(vi) BJP and CP!(M) have included the demand for a ban on
SD tests in their manifestos. Even Janata Dal and Cong(l)
are not opposed to it. At least today this issue will not
affect vote banks and economic interest of parties; it is
possible now even for a not- so-progressive government
to enact this law at least following the SAARC Year of the
Girl Child, 1990.
(vii) Success in the campaign against SD is the first step
towards regulation of the new reproduction technolo
gies. If we succeed in getting a law against SD on (he
grounds of the constitutional right to equality and soci
ety’s right to intervene for restoration of the sex-ration
96
balance, we can challenge sex preselection on the same
grounds. Il can also pave a way for belter understanding
of issues related to these reproduction technologies as a
whole.
'I he task before ns is gigantic. But turning our back to reality
is no solution. We need to study more, plan more carefully,
interact and coordinate our energies and resources, l or this, all
of us will have to come together — women and men, researchers
and activists working for gender justice, health, consumers,
democratic rights. Because reality cannot be understood in
compartments. The issues concern us all. The answers can only
be found collectively. For this, we shall have to evolve new
methods of campaigning, of creating awareness; learn to lobby
for a cause. Research and activism cannot be separated. They
must go hand in hand. One should evolve through the other and
again lead to it. The journey of the campaign from 1982 to 1990
was quite tough. The challenge of 1990’s would surely be
tougher. Let us prepare to face it.
Postscript, January 1992
We have come a long way since the inception of the campaign
in April 1986. Our route has been circuitous, unplanned, unpre
dicated. We now have reached a stage where many questions
and doubts reign supreme. We are not sure whether we have
really made any headway in the right dhection. While dilemmas
and confusions are plentiful, determined efforts to resolve them
are lacking. We have lost our initiative. Our actions have been
reduced to reactions (often half-hearted) to outside stimuli. Ihe
activists are exhausted, (heir mental and intellectual energies
have drained out. All said and done, the campaign is down but
not out. It remains to be seen whether it would emerge once
again in a metamorphized form. For, in the past, one more than
one occasion, we have acted in an unbelievably swift manner.
The apparently stagnant movement snowballed and gathered
momentum in no lime.
One such occasion had been the bid by the Chandra Shekhar
government to introduce in Parliament a bill on sex determina
tion (SD) tests. The government formed by V.P. Singh had fallen
1
97
at a time when the SI) bill had :ii last reached the cabinet agenda,
We had taken a decision not to raise this issue before Chandra
Shekhars puppet government which lacked both credibility ad
stability. However, newspaper reports informed us of the go\ernmental decision to introduce the bill in Parliament. The undue
hush in pushing the bill and the version of the bill as reported
by the press were sufficient to alarm us. Within a week’s period,
we succeeded in organizing protests among different groups
I he /Ml-lndia People’s Science Network started a signature
campaigns. The activists from all over India who assembled al
Calicut to attend (he Women’s Liberation Conference threatened
to march to Delhi. They also passed an unanimous resolution to
condemn the government’s design. We could convey to the
concerned minister in no uncertain terms that we would defeat
the bill if it were introduced in the parliament without necessary
amendments and debate. The issue was followed up by women’s
groups m Delhi. The minister then shelved the proposal for a
few weeks, and the government fell soon thereafter.
lhen came a period of lull. The general elections came. But
we did not use it as an opportunity of raising this issue with the
political parties. No doubt a number of political parlies included
a ban on amino< ntesis1 in their manifestoes. But then we have
come a long way horn 1982. Our active intervention would have
at least sensitized the parties more on this issue. Probably then
they would have gone beyond banning amniocentesis, they
might have al least accepted the demand for not punishing the
woman undergoing the SD test and for restricting the licenses
lor carrying out prenatal diagnostic tests to medical colleges and
government hospitals.
In November 1991 came the central bill. In the absence of a
visible campaign and of lobbying in Delhi, it was not surprising
to find that the bill was a diluted and distorted version of what
we had asked lor. In some respects, it was worse (han that passed
by the Suite ol Maharashtra. It left no room for intervention by
voluntary groups/individuals in matters like vigilance, policy
•
Iliak|ng or access tn
i(li<-iary; The onu.. -..n th.
Heavier.
In fact, it seems to have intelligently borrowed all objectionable
clauses h<>m the various bills (e g., Gujarat bill). Our reflexes
’
"
;
'*
’
'■ • •-
• * A.
98
were slow; there were no signs of debate on this issue within
and outside the parliament.
Then came the good news without our ellorls. A joint parlia
mentary
mentary committee
committee was constituted to study the bill in toto. It had
representation from almost all political parties. Il mainly com
prised of women and doctors. The committee wrote to several
groups and professional organizations, asking lor their comments.
Earlier, it seemed that the bur'aucratic procedures would neutral
ize all the good intentions of (he committee. Io some, it looked
like a ploy to delay the bill. However, out dialogue with the
committee has evoked good response. ’I he committee has agreed
to invite feedback from a much wider group, in a more partici
patory manner. Very soon, public hearings on the bill would be
organized in different status by the committee. The committee
\would submit its report by the 1992 monsoon session of Parlia
ment. Tlie report along with the bill, would then be placed before
Parliament. Thus, 1992 could be the year when the fate of central
legislation on the SD test would be decided.
As we look back in order to look forward, a mixed picture
emerges. It shows our utter ignorance of an ambivalence towards
legislative means. Many events which helped the campaign, fot
example, the introduction of private members’ bill in Ma
harashtra or the appointment of the joint parliament committee
occurred without our efforts or intentions. The lacunae i the
Maharashtra Act and the State Government’s lack of political will
to implement it have been known to us for years. But we failed
to expose the government on both the counts. We approached
the bureaucracy, which seemed to be totally unresponsive. Bui,
we did not use the Slate Legislature even one alter the passing
of the bill. Most important ins the fact that in (he last three yeais
we have not organized any programme to inform and to involve
people on (his issue.
Another stark failure is on (he front of lobbying. In spite of
the high visibility and acceptance of the issue, we failed to
translate it in terms of policy changes. One finds active lobbying
groups on issues like drug policy and Narmada. I hey have
worked more consistently against heavier odds. In a way, (hey
are more used to (he ‘long distance running’ which any issue-
I
'VX^
i
99
based group should take for granted. Periodic reverses do not
seem to affect them to a large extent. The issue of sex selection
has a much greater interface with society and more visibility. \X'c
need to learn more from such groups.
At the same time, we must acknowledge the efforts of those
who ha\ e carried forward the struggle in their own ways. Groups
in Gujarat have continued in spite of an exiremely hostile
atmospheie. I heir efforts at lobbying, using media for raising
consciousness, research and documentation need to be high
lighted. 1 he oflici.il bill introduced in the Goa assembly remains
(ill today (he most progressive bill on (his issue. The credit for
the same should go to the activist group 'Bailancho Saad’.
Various people uninvolved in the campaign have been trying to
spread awareness on this issue. Mrinalini Sarabhai (Sila’s daugh
ters) and Rajeev Dixil (campaign against multinational corpora
tions and foreign technology) are two such examples.
In the meanwhile we continue to verify our positions. We
cannot help but feel guilty towards the physically and mentally
handicapped when we support use of prenatal diagnosis for
detection of (and eventually abortion of) congenital malforma
I
tions. We are still in the dark about the policy changes which
need to be ushered in to improve the status of women. We have
no concrete measures to counter the demographic imbalance. We
still debate whether government’s intervention would be helpful
to the women’s cause. We do not know how to build bridges
across ideologies, beyond activist groups, with professionals.
Nevertheless, we march on. The events in the next couple of
months would shape the law on the anvil. They would also seal
the future of the campaign. The demographic trend underlined
by the 1991 census and the advances in the field of sex prediction
and sex preselection have, however, indicated that ‘sex selection’
would be a decisive issue of the next few decades. The recent
formation of Forum in Support of Sex-Selective Abortions floated
by doctors and the organization of three-day training camps on
sex-prediction techniques indicate that the other side is gening
ready for a prolonged battle. Il remains to be seen how activists
and others, women and men striving for gender e(|ualiiy and
gender justices face this challenge.
a a. >^«<»i^ssaraR?rs®wj^»-' *>"«
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■
REFINED TECHNIQUES’OF FETICIDE
Foetal.Sex-Determination & Sex Pre-Selection/Technical Aspects
- RAVINDRA R.P. -
The contributory of Science and technology in shaping various
aspects of human life needs no elaboration. At present, amongst
*
activists there are two basic streams of thoughts regarding such
role of Science & Technology.
a
neutral & Value-free.
-According to one, T Science is
Technology (its application) can be used
for or against people depending upon the motives & interests of
groups controlling it. They feel, by
-large, technology has
immensely helped humankind by reducing drudgery and ever widening
frontiers of knowledge. Only its anti-people use by ruling
classes’ (used in abroader sense) needs to be countered . However,
some people believe that science is value-loaded. Not only the
application, but its contents, the very paradigm of Science, in
’the historical process of its development has imbibed the values
and prejudices of the ruling elites;'
Whatever may be our
perspective on science & technology vis-a-vis people the issue
of sex determination and s^x pre-selection presents us an
opportunity to fight unitedly against its anti-people effects.
May be, v/e all can judge the relevance (or otherwise) of our
concepts as we attempt to tackle this issue,
However, it wouldn’t
be out of place to warn that whatever might be the benefits of
ideological battles amongst all activists on this issue, they
should not be allowed to hinder united action. We are belatedly
fighting a losing battle and the only hope of stalling the
victory of anti-people forces in the war lies in our unity.
It is undisputable that technological progress should be in
conformity with human development. That such a development should
lead to freedom, equality, justice and should put an end to
the existing relationships based on exploitation. Any process which
. . .2
♦
K
. ; • --x - -'
I
'-i.
v.»’-
♦
L
L
1
4
. *
*-
• 2.
may provide more choices, power & control to'afew
individuals/groups at the cost of loss of such power/
control by larger group? cannot be termed as ’development’.
Anniocenteses, the most popular technique used for
sex determination was basically developed for detecting
chromosomal abnormalities in foetuses.
Subsequently, it
became necessary -to determine sex of such abnormal
foetuses, as in most such cases, females were mere
carriers' of such deformity, whereas males had 50%
chances of getting it. In such cases, male foetuses
were aborted if the parents so desired.
However, in India,
its use for sex determination soon gained prominence.
Today, it is almost exclusively being used for sex
determination and subsequently for female foeticide.
Most people (and even some doctors) do not know its .
principal use for detection of hereditory abnormalities.
Its ready acceptance by people at large has set
the ball in motion. Hence, 'we have mere refined
methods of foetal sex determination and various techniques of
sex-preselection on the threshold.
Not far behind
are the to In Vitro Fertilization (TVF) technologies,
DNA probes and all the latest developments in New
Reproductive Teohnologieis (NRTs).
It is necessary
to understand the basic principles of such techniques
before judging their likely repurcussions.
THE S3IENTIFIC BASIS OF SEX-DETERMINATION & SEX-PRESELECTION
Each human cell (except a few) contains 23 pairs
of ’chromosomes in its nucleus. Chromosomes are the
'AL --.- •
carriers of hereditory characters.
Of these, both
.3
)
a 3
.
►
the chroiBosomes in each pair are exactly identical in
22 pairs* It is not so in the 23rd pair which determines
the sex of the embryo or foetus. Cells of’females have
two identical cnromosomes (X-X) whereas males have two
different chromosomes (X-Y).
The gametes (sex cells) -
i.e, those leading *to formation of sperms and ovum
contain exactly half the number of chromosomes, i.e. one
from each pairs. The cell division leading to formation
of such ’haploid’ cells is called as meiosis. Moiasis
leads to the formation of cells bearing X-chromosomes
in females and X or Y - chromosomes in males.
During
conception, female cell (egg) bearing X-chromosome fuses
with male cell (sperm) bearing X- or Y chromosome.
Formation of cell bearing XY - chromosomes would result in
a male offspring, and that bearing XX-chromosomes to
a
female offspring.
Fathefs Cell
("xX x)
X
(X)
X; (X)
Mother’s Cell
M eiosis
gametes
I
Fertilization
y,
0'^
Daughter
Son
The sex..,of tjie. Off spring is determined at. the moment of
SPP.cejo,tiQn__and is unalterable thereafter.
Sex of child is determined by the chromosome in the male
gamete (X-or Y-). So it’s mainly the father who is responsible
for the sex of child. (Although conditions orevailing in
the mother’s reproductive tract may favour one of the two
types of gametes., and hence influence the sex of the offspring).
..4
.4.
The external genitalia of foetus are-not clearly
distinguishable even upto the fifth month. Hence,
most sex determination methods depend upon the removal
of foetal cells and their chromosomal analysis (either
directly or preferably after culturing and Karyotypingthe latter method is seldom used in India). Presence of
a mass of fluorescent fF-bodiesf in UV light/laser beam
under a fluorescent microscope indicates presence of
male cells. A stainable nuclear material indicates female
cells.
The accuracy of results claimed by most Indian
clinics is 97-99%.
I
All attempts of sex pre-selection are based on seperation
of X- and Y- bearing gametes within or outside the body
and fertilizing the egg with the desired male gamete.
It would mean altering the composition of female reproduc
tive tract to facilitate passage of Y- bearing sperms
(in Vivo) or seperation of gametes, followed by fertiliza
tion all processes occuring outside the body (in Vitvo
Fertilization IVF).
Methods of. pre-natal
1.
sex determination
ATPi99entesis (Amnion : membrane, Kentesis ^pricking)
At present, this is the most widely method used for sex
determination in India. In the mother’s womh, the foetus
floats
^.4.;;,:'.
in amniotic fluid filled in the- amniotic
sac (bag of waters). A few cells of foetus are found
in the fluid. The number of such cells increase as the
foetus grows. However the amniotic sac gets increasingly
filled up due to the growing size of foetus. .Amniocentesis
. .5
V
.5.
consists of inserting a long, aseptic needle into
the amniotic sac through the mother’s abdomen- and
withdrawing from it 15-20 cc of amniotic fluid for
chrcnmosonal analysis. It is usually performed
between
16th to 18th ’Weeks of pregnancy during which it is
relatively easier to withdraw fluid containing sufficient
number of cells without damaging the placenta or foetus.
It should preferably be carried out under the ultrasonic
cover by means of which the movement of the foetus and
location of placenta can directly be viewed on a screen
using in audible sound waves. This helps in the insertion
‘ of needle without causi
any damage to mother, foetus
or placenta.
Po$.sib 1 e .haz ar d s • Insertion of needle into amniotic sac .
can damage the placenta or foetus resulting in puncture
marks over body, organ damage or even spontaneous abortion.
The result of sex determination is known after the end
'
■
1
of fourth month of pregnancy. MTP carried out after
that period (i.e. in the second trimester of pregnancy)
is more difficult and r.isky and can adversely affect the
mother’s health, specially making her more anemic.
A repeated cycle of pregnancy - Sex- detn.-abortion
pregnancy - can be very hazardous for her health.
Due to the abovementioned hazards associated with
amniocentesis, efforts are being made to evolve a simpler,
safer method of sex determination which can be used in
the earlier phases of pregnancy. Of these, at present
S.11Q ri Q n ic_ Vi 11 i B i o p s y (CVB ) seems to be the most effective
. .6
.6.
and is replacing amniocentesis. It consists of removing
the column like cells (Villi) from the chorionic
part-of uterus through cervix under ultrasonic scanning.
The cells can then be studied by chromosomal analysis .
or with specific dN-A probes.
•It carries 3-5% risk of
bleeding, pain & spontaneous abortion in the next two
weeks.
However, it is considered to be less painful and
safer than amniocentesis.
It is carried out in 6th-13th
week of pregnancy making abortion in first trimester
possible.
Ultrasonics is
a-
useful non-invasive technique used
for directly viewing the foetus. Fortunately, on its own
it cannot be misused for sex-deteimination as the external
genitalia of foetus are not well defined even in 5th
r
month of pregnancy. However, extensive research is going
on for a simpler, quicker method of sex determination.
Some such attempts include measuring hormonal level in
the mother’s saliva/biovd, testing cells from IVF embryo,
testing foetal cells in me-ther’s blo'vd etc. None of these
is yet perfected. However, it may not be surprising if within
a decade sex determination may become as simple as •
withdrawing blood' from mother’s arm, separating foetal
cells from it and then determinihg foetal sex by chromosomal
analysis/other methods. With the deyelopment of .safer-quicker
and non' invasive methods of sexdetermination, the room for
opposing them on grounds of foetal/matc-rnal health is being
increasingly depleted.
Opposition of the same should now come
from a__m.Qre basic ideolpq-ioal angle.
.. .7
.7.
SEX- PRE-SELECTION
In the modern technology’s bid for a greater control over
woman’s body, sex preselection technology is the more advanced
stage of sex determination technologies, for the former pre-empts
the need for the J. at ter.
Once the birth of a particular sex
of child can be medically manoeured, all sex determination
technologies and one’s opposition to them would automatically
become a priority research field for the same reasons as sex-detn.
Needless to say, in India Sex^pre-selection is used exclusively
for begetting sons.
Notwithstanding the claims of success of
hundreds of such techniques the Internation al Planned Parenthood
Federation (IPPF.) stated in 1985 that no such method has been
scientifically proved to be effective.
Apart from the centuries
old prescriptions ranging from drinking lion s blood to a
ceitus
in full moonlight, the present claims for sex-preseiection
methods can be grouped into three categoriesAyuryedic,_Pr4ctices.• According to Ayurveda, the sex of child,
is not fixed till 3 months of pregnancy.
It can be altered by
suitable medication and rituals termed ^s ’Punsavana Vidhi*.
According to ancient texts, the sex of child depends, apart
from other factors, upon the union of souls and dominance of
Sanskaras (dominance of aggressiveness, firmness and carrage
for son and that of submissiveness, meekness & cowardice for
d aughter).
How medication can affect such factors is beyond
comprehension.
At present, a research project on ’sex pre-selection’
is going on in the government run Poddar Ayurvedic Hospital using
nasal drop therapy to beget sons.
There’s even a product
’select’ in the Gujarat market which claims 80% to 85% success by
administration of capsules to mother in second month of pregnancy.
. 8 .
Dr.Shared Gogte & Ravi foundation
(both from Bombay)
claim to use Ayurvedic therapy to increase the sperm count.
However, no scientific evidence is yet provided to substan
tiate the claim.
The second set of methods focus-on altering the
environment in the female reproductive tract making it more
conclusive for sperms bearing Y-chromosomes.
V arious
methods like diet control, use of acidic/alkaline
voginal
douches before conception, scheduling time of conception
are being advocated.
Although a large number of people are
willing to pay fat sums of money to try these methods
(the consultation charges for 2 month diet course proposed
by Ravi Foundation is Rs.1200/-), none of them have yet
been proved to be effective in India & outside.
The third set of methods is in accordance with the
principles of modern biological sciences..It uses the
difference in physical properties (eg. density, motility,
electric .charge etc.) between X-and Y- bearing sperms
for seperation of both types of sperms. The fraction rich in Ychromosomes is then used for IVF with egg. Although the
approach is scientifically correct, nature ■••i •
always had an upper hand in such experiments and
persistent efforts of total seperation of X-and Y-bearing
sperms have failed. There are too many .variables. The variation in properties of the sperms of the same persons or
different persons vary so widely as to obscure the difference
in properties of X-and Y-bearing sperms. Moreover, the
technique of IVP is sophisticated and requires considerable
skill. The moral issues surrounding IVF,
also contribute
. .9
1
.9.
to the relatively slow acceptance of this technique in
India at present.
No one can predict whether or not they
would be accepted here in the future. '
•
Various questions emerge from this scenerio. The first
one is about the modern science’s outlook on women’s health.
If we look at the development of this Science, specially in the
last two decades, we observe a persistent pattern of efforts
made to control women’s bodies, .Hormonal contraceptives,
injectable contraceptives, ’implants, sexdetn. sex pre-selection,
all have an implicit assumption that women’s bodies are objects
to be tampered with, experimented upon without bothering .
about the effects of such efforts on them. The aim is to
control the reproductive processes - the number of children
she should have, the timings of their conception, their
sex- almost everything seems to be controlled by some agency
other than women themselves. This raises the basic question
of who should have such a control. Women themselves, scientists
& technologists, religious establishments or State ?
This also raises the oft-repeated question of Twho
should decide about the relevance (or othewise)
of any
scientific research. Should the sci^tists and technologist
have limitless powers so that they can go to any extent without
bothering about their effects on society?
What should be
the criteria for taking such a decision - pursuit of. knowledge,
welfare of society as a whole/of persons concerned, sweet will
be scientists and/or rulers?
Shouldn't the people affected
by reseaich have a voice in this decision?
• .10
1
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It is worth noting that technologies reducing
drudgery or improving'quality of life of women are either
not explored; and if explored, hardly react them. In about
four decades after independence, clean water, basic, sanitation
facilities havenTt reach most villages. More than half Indian
women are anaemic.The sex ratio is most unfavourable fo’r women
in India. Infant mortality rate, specially for females is one
of the highest. Technology has failed women in improving
their lot. But, technology which can be used for anti-women
purposes is readily accepted in all strata of society. Unfor-
tunately in India there is a very larqe number of women
scientists and doctors who are working for propogation of
such technologies in India.
It is no good blaming the illiterate masses with
regressive ideas for propagation of such technologies. The
other end of the link - the highly educated, 1 enlightened’
scientists, technologists, doctors (and of course the state)
which helps propagate such a situation need to be questioned.
The basic question is ^lould we allow science and
technology be harnessed for such blatant anti-women purposes.
If we wait for social transformation to take case of it, we
may be paving way for more hazardous technologies which would
have far more devastating effects on society in general and
women in particular.
FORUM AGAINST
SEX DETERMINATION
AND SEX PRE SELECTION
TECHNIQUE
SOCIAL IMPLICATIONS OF SEX-DETERiMlNATIQN TESTS
Advances in medical field supporting backward_socia.l YaliJes>
The use of amniocentes and other tests for sexdetermination
leading to termination of pregnancies in case of female foetuses
is one more example of how advances in medical technology are
used to discrimiraate against women more effectively. This
phenomenon is universal as well as ancient Medical science has
been used to degrade humiliate and exploit women as well as
other underprivileged members of the society. Cliteroidectomy,
that horrid practice of mutilating the clitoris of a woman so
as to decrease her sexual response has been going on for
centuries in Africa and West Asian countries. The emasculation
of poor males who used to be employed to guard the fvirtue f
of women in bar1ms of kings is also a testimony to this, The
female sexuality or rather female sex organs are treated as
objects of male enjoyment and property.
Women must produce
children, preferably male children. It is men who must have
children but also have sexual enjoyment. And the latest to
come in the line is Hymenoplaesty, the practice of surgically
repairing hymen of a woman so as to make her a ’virgin’
again. And all these just in the field of surgery!
New
surgical methods are being discovered, in these cases, to
suit most unfair demands made on a woman. And then the
discovery and its uses pass as something that actually help
women fullfil such demands i.e. that she not only remains a
virgin but
appears to be one when her man first ’has’ her,
that she produces male children and this avoid humiliation
for herself.
Advances in technology have of course, led to discrimi
nation against women in other fields also. When sophisticated
. .2
. 2 .
machines are installed
in work places it is followed
by retrenchment .of women workers.
The argument used
■
when this happened on a large scale in the thirties was
that a woman with an employed husband could stay home and
be a good wife and a mother.
The social role is a woman
as a wife and a mother is enhanced so that her rights as
, mother may be denied to her. Even in the field of
a
consumer goods, every product is advanced technology
which is then used to further
seems to become a dowry item
subjugation of woman,
Items like radio, TV, cassette-
players, video, bicycles, scooters, pressure cookers, ovens
etc. are compulsory gifts at most middle and uppei class
weddings. Some of these are also expected by bridegrooms
from several working class communities which are in
transition from brideprice to dowry practices.
Male preference in India.:
Though universal, descriminarion against women in a male
dominated society has different manifestations in different
parts of the world. In West Asia, it is oppression of women
with renewed vigour under resurgence of Islamic fundamentalism.
In Africa, it is continuation of clitorodectomy and other
anti-women practices under the guise of ’African Identity'.
In Latin America, woman have to face traditions of Macho Man.
Treating women as sex objects is one of the many exploitative
practices in North America and Western Europe. In our South
Asian region, it is the obsessive male preference which
results in misery and death of female intants and also of
adult woman whether by neglect or by actual intention.
History & Tradition I
' Two of the major interventions that the British had made
in Indian Social life were abolition of sati and female
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inf anticide.
Of all the social reforms, prevention of
female infanticide was the one attempted solely on the
British initiative,
Female Jnfanticide was a common
practice detected among Rajputs as'well as some other
communities in the present areas of Gujarat,Rajasthan
and U.P.
Arguments for doing away with daughters ranged
from inability of poor parents to pay dowry to the practice
being an integral part of Rajput culture and tradition.
As a matter of fact,
at one point the Prime Minister
of Kutch had argued on behalf of his king that the British
were unreasonable to insist that the Jadeja clan discontinue
a tradition that had gone on uninterrupted from the time of
Lord Krishna himself 1
(The Jadejas consider themselves
descendents of Yadavs.
According to them they were
following practices established during Krishna's reign).
It is reasonable to assume that female infanticide was more
widely' prevalent and not merely continued among Rajputs or
Patidars of Gujarat.
The practice among these community
was detected and recorded, others right have gone unnoticed.
In any case, putting a ban of practices of sati, female
infanticide or dowry do not put an end to the general
oppression and exploitation of women which give rise to
these practices. These oppression and exploitation manifest
themselves is less crude and blatant forms even in these
communities where they do not have direct social sanction.
Neglect of female children in matters of health and
nutrition is a well established fact as also the adverse
female ratio in Indian population,
Impact of availability
of sexdetermination can easily be seen in view of this
utter disregard for a woman’s life.
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Added to the traditional disregard for a woman’s
health and life is the strong religious support to male
preference among Hindus. A son is absolutely essential
for the ultimate salvation as he alone can perform final
rites after one1s death. Adoption, in the traditional
Hindu way, was only adoption of a son. Be mother cf a
hundred sons!
recently.
was said routinely in a blessing until
Hindu mythology is full of stories of various
pious kings having performed. Yagnas to be get a son.
A son was so valuable that even a Kshetraj Putra ( a son
born to one’s wife through somebody
or literally one
that has grown in one’s field because of the traditional
seed and soil theory of male and female roles in
conception) had a legitimate status at least in what was
considered a crisis. Hence, Shantanu’s wife Satyavati
invited Ved Vyas to help her widowed daughters-in-law
beget sons when her sons by Shantanu burnt themselves
alive after becoming impotent. Ved Vyas was her son
through a pre-marital liaison with Muni Parashar
according to the story but he could help perpetuate
the kuru dynasty in which she later married. A son is
absolutely needed to secure a place in the heaven and
male heirs alone can perform regular rites for the
benefit of ancestors.
All this is not so wayout and archaic as it may
appear. The actual practices may be discontinued, the
stories may be treated as rediculous myths but the
tendency they reflect continue in subtle or crude forms
and provide a social basis for female foeticide in
modern times by keeping the foetus alive only if it is
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a male one. These historical aspects and their social
cultural manifestations help us understand how strong
and deep rooted is the male preference resulting in
anti-woman bias in our society and how it appropriates
adv anc es
in science and technology to strengthen this
bias even further.
In modern era, the role of media in projecting
indirectly contributed to
sexual stereotypes have also
further biases against women. Women being shown as
objects or as long suffering spineless,characters
do not generate much enthusiasm for having daughters.
Some products like wristwaches, suiting textile,
and silk saris have opent been advertised as dowry
policies by
items. Even saving schemes and insurance
:
nationalised banks and LIC were:• advertised as useful
weddings
of sons1 future education and daughters
until a protest was made by women’s groups.
A society in which women were considered a burden
resorted to female infanticide, Same kind of belief
today loads to the phenomenon of
t
Z
exdetermination tests
. Female
and selective abortions of female foetus
oppression in
foeticide is a backward extention of
the time scale.of a woman’s life. Isn’t it wiser
and more economical
it s'eems to Me say, to nip off
an evil in the bud?
Is it a woman's choice?
we see around us
Nearing the end of 20th Century
some signs of the improvement of the status of woman.
However, much of it remains on paper, there are even
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newer and more perverse developments affecting women
adversely as we go along. Vast sections of people live
within the frame work of ageold social norms and attitudes
almost untouched by new changes and factors like ignorance,
pverty and religious obscurantism continue to play their roles
fully. Even today the life of a childless woman, with very
few urban upperclass exceptions, is one of untolf miseries
and the life of a woman who has only daucihtc *?s is hardly
diff erent. This is not the fate of-Hindu upper caste woman
alone (while male preference has religious sanction for
Hindus, it is actually prevalent among Indians of all
communities).
It is only nutural if a woman placed in
such a plight regards anything that assures her a son
and the facility of an abortion to avoid the birth of a
daughter a blessing. Doctors too are usually quite eager
to help such a woman from her immediate plight. It is not
just that they make money out of it, though that is certainly
the factor behind the mashroom growth of sexdetermination
clinics, many doctors also this as helpir
a woman and
a legitimate way of family planning. That their attitudes
are affected by insidious anti-woman, biases of the society
is something they would hardly admit. Doctors generally
coming from urban upper classes also reflect the mindless
population control ideas of those strata. Population
control in practice means creventing births in the
unwanted categories, the poor, the minorities, the women
by whatever means available. In case of preventing female
births,, the commonest and strongest argument put forth by
our righteous and ’socially aware’ medical fraternity is*
How
can we deny help and services when a woman has come
on her o wn
asking for it?
True, in many cases the
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the pregnant women themselves volunteer for amniocentesis
or any sexdetermination tests. But are these decisions
made in a social vacuum?
For brought up as they are right
from birth onwards in our male supremist ideas and placed
as they are in the plight of being sonless wives what
are• the alternatives for these pregrant women to submit
themselves to the tests?
They might as well do it willingly’
Again in many instances it is the mother-in-law who
decides that the daughter-in-law should get an amniocentesis
done and an abortion if necessary. This is often cited as an
example of ’Woman - Oppresses Woman’ theory.
The husband, the
father-in-law and sometimes other adult members of the
family too play their roles in this decision making if
not by actually advocating such a step but at least by their
silent approval of it. And get is the mother-in-law who
takes the decision. Mother-in-law, who is also equ-ally
dehumanised as the pregnant woman by the ’male-all and
male-only1
valuing out society thus’becomes an agent of
the society in perpetrating and furthering the oppression
of woman1 .
A Socially convenient matter*
It is the very timing of the amniocentesis which
makes it so dangerous a phenomenon. If a female child
young daughter or an adult woman in the family is
maltreated or neglected resulting in their misery,
undernutrition, illhealth or death it is at least seen
by and known to the neighbourhood that is the outside
world and to that extent is open for criticism. But of
amniocentesis and selective female feliride ? When the
woman is just four months pregnant she is taken to a
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/
j
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.8.
doctor for a quick amniocentesis and followed by a.
quiet abortion if needed aodi it is all over. As far as
the outside world is concerned she was not pregnant
at all and hence the question of criticising or taking
action against a crime does not even arise. It is this
aspect of amniocentesis and a selective abortion viz. that
it can be done clandestinely as a 'hush job’ that makes it
all she more
acceotable by our society. And in the bargain
womb-to-tomb’ oppression of the woman becomes,tragio ally
literally true.
enough
There is one more facet to this 'hush job* nature of
amniocentesis. In our society, the very basis of which
a
is injustice and where hypocrisy is an accepted norm,
crime is a crime only to the extent it is seen and known
to the outside world and so also is the guilt feeling
arising thereof. So when a-, woman gets rid of a f emale
fetus on th the quiet, if hardly ever hurts the
conscience of the family members and is quickly
forqotten. Only to be followed by another series of
pregnancy - amniscentesis - female feticide until a
son decides to come on the scene and make one and all
happy.
I
Of course the various arguments that are made in
|
justification of a practice like amniocentesis
are common to the whole range of anti-woman practices.
Like
son will be the breadwinner for the family,
son
| will be the prop.in old age, son will ensure, salvation,
son will continue the family line whereas a daughter
after all gets married and goes to someother household,
she is only a burden to be brought up and married off etc.
These are too well known to be detailed out again here.
..9
. 9 .
*
Family Planning Argument:
There is also another argument that selective
female feticide may infact act are cheek on the population
explosion,of our country. That this argument holds no
water is
new evident from the statistics. India is one
/
of the only four countries in the world which have
an adverse female - male ratio in the populations and
this has actually worsened over the last six decades.
And yet this has not had any significant imfact on the
rate of population increase of our country.
As pointed out earlier population control is
quite different from family planning. Selectively
controlling the population of a category of powerless
people by those wielding social and political power is
a clearly anti-democratic practice to say the least.
The genderbased sections of society are not so ciearly
divided as those based on class, caste or religion.
Therefore, opposition to gender injestive is much more
difficult to organise or even t" perceive women, the
victims of gender inequality and oppression can even
be co-opted in perpetuation, some of it.
therefore mean that
It does not
they should be encouraged to
control the size of their families through selective
abortions.
Selective abortions necessarily means
aborting when the foetus is female. Against over a
thousand female foetus discovered in a Bombay hospital
and later aborted elsewhere•only one male foetus was
removed selectively as found out by two woman activists
in Bombay. This was the case of a Par si woman who
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already had a son and wanted a daughter. The management
of the hospital concerned is deeply religious and does
not allow abortions to be performed in the hospital but
provides this ’very humane and beneficial’ facility of
sexdetermination clinic according to one of its leaflets!
The hospital required, the. worn an concerned to inform it
after the abortion if the foetus was male or female for
the hospital records of the reliability of the test.
Full amniocentesis buttery was never given, was not even
available as a facility to those women who were likely to
give birth to a genetically defective child.
Needless to say that opposition to selective abortion
is not to be confused with women’s right to free,
safe and
legal abortion. Women must have rights on their own bodies.
They must be able to avoid unwanted pregnancies by abortion.
We cannot force unwanted motherhood on them. But if a
woman wanted fewer children, she would terminate a
pregnancy irrespective of the sex of the child as unmarried
pregnant women usually do.
As things go, in many families
especially from communities where large cowries and bride
burning are rampant, any female foetus is got rid of
even if the couple has no daughter. Some of the so called
respectable clinics and hospitals piously claim that
they perform the sexdetermination test only if the
worn an has already has at least one daughter. They are only
regreeting a couple’s right to have a ’balanced’ families
with both sons and daughters according to them. They quite
deliberately ignore the reality that almost no one comes
to them to balance family in this manner when the couple
only has a son.
There is no question of their having to
make it compulsory that the couple at least has one son
. .11
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.11.
before the woman goes through sexdetermination test.
Also, they cannot vouch safe for countless other
doctors who will perform these tests anyway without
restrictions.
Struggle against this iniustice\
It is not withinrthe scope of this paper to consider
measures of removing this particular discrimination
against women and misuse of medical technology. Some
points are being noted down so that they may be consider
for planning a wider campaign later on.
Doubtlessly, we need adequate legal support to prevent
misuse of amniocentesis and other useful medical
advances against women or any other weaker section of
Society.
Mere reforms in legal or medical fields will not themselves do away with this even growing phenomenon of
female foeticide. Spread of social literacy will
have to be undertaken widely with specific content to
remove unscientific ideas about women,
Even among
somewhat educated people the knowledge of physiology
of reproduction is practically nil. Simple yet basic
f acts like a)
both the male and woman contribute equally in the
process of reproduction
b)
a woman gives only X chromosomes whereas a man
may give an X or a Y chromosome which results in
the birth of a girl or a boy. That it is the man’s
contribution which determines the
sex of the
child should be taught effectively in school in
social education programmes and through all other
suitable platforms.
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In fact, media can play quite an effective role in
removing ageold bias and misconceptions. Press has played
a positive role in struggles against dowry and rape.
Gurrently, Muslim women’s issue is also kept alive by the
press by constantly reporting on efforts made by Muslim
progressives and publishing articles and editorials in
supports of Muslim women’s rights. It could do much to
highlight the issue female foeticide also. Apart from
press audio-visual media, both regular and parallel
will have to be used if the campaign against selective
abortions is to be effective. With rare insight, a family
planning advertisement in recent months shows a couple with
two daughters along with a message that whetherits sons
or daughters two should do.
Inspite of all other possible methodsj
If past experience is any indication, there will have to
be much public protest before any official steps will be
taken to counter the prejudice against the birth of a
daughter.
-SONAL SHUKLA
SANJEEV KULKARNI.
•*«
FORUM AGAINST
SEX DETERMINATION
AKP SEX PRE-SELECTiQ^
TECHNIQUE
IV1NI0CENTESIS ~
THE LEGAL PROVISIONS PERTAINING TO IT:
Since the abortion laws play an important role in
allowing selective abortions, let us examine these laws
in the light of the amniocentesis controversy.
C HIM IN AL L AW:
Until the enactment of the Medical Termination of
Pregnancy Act, 1971, there was no comprehensive law
relating to abortion. Abortions were governed by the
provisions of the Indian Penal Code, 1860. These provisions
were extremely archaic and''made abortion a crime. Both the
woman who underwent the abortion as well as the abortionist
were liable to be punished except where it had to be
induced in order to save the life of the woman.
Abortion may be classified into three categories*
first, natural abortions; secondly, legal abortions and
thirdly ^violent” of* "forced0 abortions. The Indian'
Penal Code penalises abortions of the third category
but exonerates those falling in the second category,
because they are done without, criminal intent and in
good faith. The abortion which is performed, without good
f aith, upon a woman by herself or by some other person
with or without her consent is an offence under the I.P.-C.
Even if the woman concerned consents to the abortion, it
is an offence under the criminal law, if the abortion
is not done to save her life. Such abortions are con
sidered "forced0.
Sections 312 to 316 of the I.P.C. deal with
abortions.
SECTION 312 provides punishment of three
. ..2
.2.
years and/or fine for causing miscarriage to a woman,
unless the miscarriage is done in "good faith" for
the purpose of saving tne life of the women. If the
foetus is developed, the sentence may go up to seven
years and fine. The woman who causes herself to miscarry
is also covered by this section.
SBJTIuN 313 provides
for punishment which may extend to 10 years imprison
ment and/or fine if a person causes a woman to miscarry
without her consent. Under SECiICM 314,if death is caused
to a woman at the time of miscarriage,
the person who
causes the death is liable fox punishment with imprison
ment which may extend to 10 years and fine. The offence
is aggravated if the act is done without the consent
of the woman. The punishment is enhanced to life
imprisonment.
Sections 315 and 316, though deal with acts similar
to miscarriage, penalise causing death to born or
unborn child at the time of birth, Section 315 punishes
an act done with intention of "preventing the child
from being born alive” or "causing it to die after its
birth1’, except when it is done in good f aith for
the purpose of savino the life of the mother. The
pct resulting in death of the child after its birth,
Is not, Strictly speaking, an act of causing mis-
carriage. The offence commitced under this section
is foeticide of the fully developed foetus, in case
the child is killed before its birth, or infanticide
when death is caused immediately after birth. The
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. 3 .
former is committed while the child is still in
the womb while the latter is committed after delivery
and may amount to murder.
If the act of causing death to a developed
unborn child would have caused death to the mother,
the said act amounting to culpable homicide is punish-
able under section 316 for a term which may extend to
10 years imprisonment and f ine.
MEPIC AL TERMINATION AST, 1971•
The MTP Act was enacted with a view to enable
women to undergo abortions under certain permissible
circumstances. However, the Act was enacted more as a
measure to tackle the family planning •’problem" than
as a concern over the woman’s right to choose whether
she wants to have the child or not. Nevertheless,the
Act has liberalised the Indian Penal Law on abortion.
This does not mean that the provisions relating to
abortion in the I.P.C. have become redundant. They are
still in force in so far as they seek to protect an
expectant woman from the hazards of quack abortionists
or the negligence of doctors.
The M.T.P. Act lays down certain conditions under
which an abortion can be conducted legally. Section 3
authorises a registered medical practitioner to termi-
nate a pregnancy of a woman not exceeding 12 weeks
with her consent or if she is below 18 years of age
or a "lunatic" with the written consent of her guardian.
In case of a pregnancy exceeding 12 weeks but not
..4
• 4.
exceeding 20 weeks the concurring opinion of at least
two registered medical practitioners is required. The
opinion favouring termination of pregnancy must be
based on the following considerations 2i)
that its continuance ’’would involve a risk to the
life of the pregnant woman or of grave injury to
her physical or mental health”.
or
the child, if born may suffer from physical or
mental abnormalities.
When a pregnancy is caused by rape the only presumption
that the doctor shall have is that the pregnancy
constitutes a ’’grave injury to the mental health of
the pregnant woman”.
Whereas if a married wornan
pleads for the termination of her pregnancy on the
ground that it has occured ”as a result of failure of
any device or method used by her ..r her husband for
the purpose of limiting the number of children”, the
doctor has a discretion to terminate the pregnancy
on the ground that the ’’unwanted pregnancy may be
presumed to constitute a grave injury to the mental
health of the pregnant woman”.
To determine what
would constitute” a grave injury to the mental
health of the pregnant woman” her ’’actual or reasonably
forseeable environment” may be considered. It may
be noted that the plea of ’’failure of contraceptives”
can only be taken by married women.
Section 4 provides that under the Act pregnancies
can be terminated only at the government run hospitals
or at places for the time being approved by the Government.
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I
The rules framed under ■the Act lay down the safe
and hygienic conditions under which abortions are to be
performed. Under Rule 4 of the M.T.P. Rules, 1975 the
Chief Medical Officer is authorised to inspect any approved
place or seize articles from such places.
Regulations have alsb been framed by the Central
Government for the maintenance of proper records and
secrecy about the cases The regulations provide for the
maintenance of an admission register at each place of
termination of pregnancies. The name and other particulars
of the pregnant woman seeking abortion are entered only
in this register and a serial number is allotted to the
case, vathin three hours of the termination of the
pregnancy, the registered medical practitioner has to fill
in a prescribed form under the Regulations giving details
of the pregnancy. The register is a secret document and
can be inspected only under proper authorisation. The
•5 of five years
register shall be destroyed at the eno
since the date of last entry made
therein, unless otherwise
ordered by the Central Government, or a magistrate of
the first class or a district judge*
If any complication
arises, information has to be sent in a
sealed co Ver marked
’’Se-ret” to the Chief Medical Officer within a month of
the operation. A weekly statement of cases a* e to be sent
to th^ Chief Medical Officer of the state by every head
of the hospital ar owner of the approved f place•
Sr
Having gone through a* rather detailed and -extensive
overview o: the provisions relating to abortion, lot us
examine the legal position relating to sex determination
tests and the abortion of female foetuses.
♦ .
r
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I
. 6 .
AWIpCENTESIS AND THE LAW:
#
r"' .... .
At present the legal position is that this test
is allowed only to check the genetic abnormalities in the
foetus. In the 1970’s- when the test was first introduced
in India, it was being used for detecting both genetic
defects and the sex of the foetus. In 1975, the Govern-
went requested the government hospitals to restrain from
using these tests for sex determination. Ihus, though the
exclusive use of these tests for sex determination is
banned, they are openly being used by private clinics.
The reasons for this are not far to see. There is no
legal provision regarding the banning of selective
abortion of female foetusis. There is, th.?
. re, the
need to introduce certain changes in the M.T.P. Act,
which would legally lay down the conditions under which
the Amniocentesis test can be carried out.
SUGGESTIONS:
Article 14 of the Constitution of India provides for
equal protection of laws and Article 15 of the Constitu
tion of India states that there shall be no discrimina1*
tion against women. The fact that women are undergging ■
sex-determination tests and aborting female foetuses,
implies that certain social and economic conditions
compell them to do so.
The aborting of female foetuses
implies an element of compulsion, however, ’’free and
independent”, the woman’s choice might be. It implies
that there is a preference for boys aS against that
of girls. There is no justifiable or rationale reason
why female foetuses should be discriminated against.
The aborting of female foetuses or selective abortion
is thus violative of Articles 14 and 15 of the
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.7.
Constitution. It presumes that there is something
inherently defective in female foetuses on the ground
of sex alone.
Though, under the MTP Act, there is no provision
for selective abortion, yet these provisions are being
misused for selective ^bortion. Since the tests are
conducted in the private clinics and the abortions are
conducted in the government run hospitals, there is
no link established between the two. The private clinic
which p-erforms the test may inform the woman that she
is expecting a female child. The woman might then go
to a government run hospital and get the child aborted
on any of the grounds mentioned in the M.T.P.Act,
without referring to the amniocentesis test.
Thu s, to prevent such misuse, the following
recommendations are being put forth for discussions'
1.
The amniocentesis test should be performed only
for the detection of deformed foetuses. Section 3
of the MTP Act to be amended accordingly. Sex of
the child should not be disclosed to the parents.
2*
Only the government run hospitals should be
authorised to conduct the tests.
SECTION 4
of the MTP Act should be amended to
include* "No termination of pregnancy AND/OR
THE USE OF AMNIOCENTESIS for the purp*s« of detecting
deformed -.foetuses shall be made in accordance
with this Act at any place other than . .8
«
. 8 .
a)
a hospital established or maintained by
government;
or
b)
a place for the time being approved for the
purpose of this act by government.
411 the safety and hygienic rules and regulations
applicable
to hospitals performing abortions should
be extended to those performing amniocentesis tests.
The amniocentesis test for detecting foetal abnorma
lities should be done under safe and hygienic condi
tions. The harmful effects of amniocentesis should
be known to the patients.
4.
The clinics/hospitals performing the tests should
maintain, proper records*
a)
The '.weekly report sent by the head or owner
of the Hospital to the Chief Medical Officer
shall contain details of whether the foetus
aborted was male or female;
b)
The admission register shall contain details
of the foetus aborted;
c)
detailed medical history of the woman under
going the amniocentesis test shall be maintained;
d)
weekly reports shall be made accessible to
any womens, health and/or social welfare
organisation.
5.
If
c^-nics/hospitals are found to be performing
the test for sex-determination, their licences
will be Hable to be revoked;
. -9
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.9.
6.
The conducting of sex-determination tests and
aborting female of foetuses shall be made a criminal
offence and a penalty imposed. The I.P.O.should
be amended accordingly.
7.
Section 3 of the MTP Act should be amended to include
the conditions under which an amniocentesis test will
be conducted; for example, the test should be made
available to all pregnant woman between the age group
35 years and above, or to those who have a medical
history of genetic deformities, or to those who have
been exposed to chemical,occupational?^environmental or
other hazardous substance likely to affect the child.
8.
X
Banning research on sex determination and sex pre
selection.
Legal reforms by themselves are not a solution to this
problem, ihe demand for banning sex-determination tests
has to be coupled with a campaign for social awareness.
For the stricter the laws become, the chances of the tests
f or sex-determination being used illegally increases.
-- Gayatri Singh.
C
Al GN
- A3AINST .SEX DETERMINATION AND PRE-SELECTION TECHNIQUES -
The use of sex determination and pre-selection techniques
i
and so also the efforts at finding newer and newer, less painful
and less hazardous techniques for sex pre-selection is increasing
at an alarming rate. The techniques like amniocentesis which
were discovered for the original objective of detecting genetic
deformities of foetus have become synonymous with sex determina
tion and female foeticide. Any campaign planned to counter these
techniques at a social level will have to take into account
all the complex dimensions of the problem .
It must be agreed that primarily,
it is a social
problem arising out of the craze for the male child, which has
its deep roots among others, in the real status of women in the
present society. This society has reduced their status
only
as ’male child producing machines’. For the present society.,
where dominance of male and its importance in every aspect of
family and social life and the total denial of identity and
existence to the women, the sex determination and pre-selection
techniques have come as a boon - because it could easily kill
the girl child in the womb itself, without any guilt of murder.
The campaign againt these sex determination and pre-selection
techniques will definitely form part of a wider struggle against
women’s oppression and their discrimination by this male
dominated society.
People have immense faith in science and technology, which
projects its so called neutrality. But misuse of many inventions
and discoveries of science against the people is an integral part
of present social structure of society. The male domination and
..2
.2.
and pre-selection and the related research whose every
aspect is ranged against the women is part of the wider
struggle to fight the misuse of science and technology
against the people in general and the women in particular.
Finally the wide spread use of these techniques for
female foeticide, is also the question of concern for
human life. This society has never treated women as human
beings and has the least concern for the lives of women,
girls or female infants. The killing of lactating
baby girls,
low mortality of girls, dowry deaths, or women being forced
to commit suicides, happens in the same male dominated
society which sanctions and carries out the use of sex
determination and pre-selection techniques for female
foeticide. To raise one’s voice against these sex determina
tion and pre-selection techniques is also showing a concern
for the right of women and girls to live - a concern of
human rights.
It clearly emerges from the foregoing points that the
campaign must consider the issue at multiple levels - an
issue of women’s direct oppression, an issue of misuse of
science and technology, ar. issue of human rights.... Due to
this multi-dimensional character of the issue, various social
action groups can be involved in the campaign against sex
determination and pre-selection techniques. The campaign
could include the various women or other groups working
against women’s oppression, various people science groups
including the health action groups, various human rights
groups including civil liberty and democratic rights action
groups and various social groups (including legal action
groups) and individuals who feel concerned about the issue in
general.
. .3
. 3 .
What could be the content and the focus of this campaign
Whenever a wider debate on the campaign
to be effective?
against sex-determination and pre-selection is initiated, two
points often are raised. First that one must organize a
4
general awarness drive against this issue,
particularly
concentrating on women. Other point being, that no purpose
will be served by the campaign since women themselves go to
clinics for sex-determination and the subsequent selective
abortion of female foetus. Let us probe these points a little
deeper. While it is true that large number of women are
going to clinics for sex determination and pre-selection
and the selective abortion but on the other hand, this
behaviour of women is not borne out by an exercise of inde
pendent option.
Women who are treated merely as a ’child
producing machines’ and subjected to enormous family
pressures and training, in this male dominated and controlled
society. Denied an independent existence and identity, women
both submit to and internalise the ’’ary male dominated values,
which act against them. Well known example is mother-in-law
oppressing the daughter-in-law. The vast majority of women
agreeing tor sex pre-selection and female foeticide is the
result of this internalisation and the submission to the
social demand for male child. If a change has to come about
in this mental state of women. as well as in the society at
large, a wide spread awareness amongst women about their
independent identity and a relentless struggle against tb
male dominated values is the only alternative. This will be a
long drawn process.
But the rate at which sex-determination and pre-selection
techniques are becoming widespread and the rate at which
...4
f
. 4 .
scientific research is bringing newer and newer techniques
to the fore, requires an immediate action to put a full
stop to these anti-social practices. From this perspective
it emerges that an immediate concentrated action to build
a awakened public opinion against the practices will be the
primary goal of the campaign. The awakened public opinion
aroused by this campaign will be able to bring the pressure
on the Government of India for the ban on all sex determina-
tion and pre-selection techniques and for halting the related
research activities. While amniocentesis could be the focus
|of the campaign but the campaign must struggle against all
sex-determination and pre-selection techniques and
related research activities.
The campaign against sex-determination and pre-selection
techniques could include the following activities to make it
effective to achieve its aims J
a)
The campaign should attempt to bring together all
organisations and individuals who have raised their
voice against this issue in the past and all those who
a
are now concerned with this issue. 3 years ago,
number of women groups to a larger extent and people’s
science groups to some extent made serious attempts
to force the government to ban the sex -d c-t ermin at ion
tests. Anong other reasons for their unsuccessful
campaign was, that the various groups raised their
voice in isolation. A concerted joint struggle by
various interested social groups this time could
achieve better results.
Effects, must be made to
approach as many organisations as possible for this
campaigns and co -ordinate the campaign at the country
wide level. As a first step toward
this larger goal,
. .5
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. 5 •
co-ordination of various social action groups interested
in the issue, must be done at the city level. Also a nation
wide signature campaign against the issue could be
undertaken immediately.
i
b.
<
Exchange of information is very trit al for the various
actions to be initiated for this campaign, in particular
for the legal action and for public awareness through
press. The co-ordination for the exchange of the informa
tion of different organizations and institutions is
urgently needed at country wide level.
c.
One of the primary aims of this workshop is to discuss
various myths £nd biases and evolve correct perspective
regarding this issue along with the activists of various
social action groups. This is the beginning of building
if
people1s pressure groups against this issue. More seminars,
debates, and workshops from time to time at various
places across the country will help hasten the build up
of the awakened public opinion. In newspapers and
magazines detailed articles and special supplements on
the issue covering various aspects, should be printed.
For this we could prepare a full package of articles
with photographs covering this issue.
d.
In order to make the'camoaign effective, area wise groups
against sex det ermin atior. and pre-selection techniques
should be formed. Such groups could collect all the
<
data and information regarding various irregularities
in the clinics, private and public hospitals in their
zone.
The groups could launch campaigns exposing the
clinics, hospitals and doctors performing these tests
..6
*
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.6.
and/or the subsequent selective abortion of female
foetus. Street plays and slide shows could' be made
and shown to build such groups. Dharnas (sit-in) at
the various centres from time to time along with
poster exhibitions could be arranged to highlight the
problem and bring public pressure against the centres.
e.
A
9
wider campaign against the advertisement of these
techniques or the clinics performing them, in the news-
papers or other media must be launched. Defacing
of the advertisements, pasting the posters demanding
the
u
ban on these techniques by/side of these advertisements,
and : • * widespread wall writing should form
part of such a campaign.
f.
The campaign should involve newer forms to highlight
this social issue and its various aspects. Some of
the effective forms for campaign will be the parents -
daughter yatra, march of school going girls with
floweis, dharna by prominent parents having only
daughters.
g.
The filing of legal petition against the widespread use ■
of these techniques will be used to highligh the issue
?;•
and building public Ruessure.
The demand for a legislation banning these techniques
for sex-determination and pre-selection,
closure of all
centres performing these tests, and changes in the MTP
act, is uhe Rain demand <£ the campaign. Based on the
information collected on nation wide scale,
a case for
banning the techniques and related research activities
. .7 ..
9
.7.
should be sent to public health department, women and
social justice deparmtne, I.C.M.R., all political parties
all members of parliament and the Prime Minister, President
and Chief Justice of India.
As a long term prospective on the issue, the demand
for inclusion of a special chapter on amniocentesis
and other techniques, their social discriminatory use
against women should be made in the compulsory sexeducation for all students in school and colleges.
( This paper has been jointly prepared by Lata and Harpal).
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VIKAS ADHYAYAN KENDRA
June '95 VOL II # 3
. INFORMATION BULLETIN
I
C 0~ M M E h1 T
MYTHS ABOUT
SEX DETERMINATION TESTS
Contributed by R..P. Ravindf*
A Myriad Questions
'Choosing the sex of one's child
is the most sexist sin.'
We live in an era of paradoxes and contradictions — the
•
their bodies and bodily processes are being projected as
“hi-tech solutions” to women’s problems. There is an ur
gent need to fight on each of these issues separately and
also within a unified frame of reference.
realty was never so multifaceted, the issues never so com
plex. Everything around us seems to be melting andunfortunately the new forms acquna.1 by the congealing of the mol
ten mass leaves us little to rejoice a*. Forces which had op
posed amendments in the Hindu Code Bill are today clamoring for a Uniform Civil Code; a new policy for women in
Maharashtra has been followed by the sordid events of the
Jalgaon sex scandal and the mirage of women's empower
ment raised at the Cairo Conference is evaporates in the
heat of a Delhi tandoor!
Sex Determination (SD) represents a focal point for thinking
and action at various levels It is the violation of women’s
foremost, basic human right - the right to survive. SD is the
most subtle and hence the most potent weapon of women’s
elimination which takes discrimination against them to the
womb. It negates the fundamental right to equality. It also
GUILTY . of being a girl.
Sentenced to death.
Her parents wanted a boy.
From local to global levels, we find the feminist expressions
being hijacked by the Establishment while the teal women's
issues continue to be relegated to the backstage. The period
of two decades spanning Nairobi to Beijing has witnessed
Having a girl would be a lifetime
burden.
They used amniocentesis, (
an innocent pre-natal test !
meant to detect
>
g.. j genetic abnormalities |
greater visibility, sharpening and focussing of women’s is
sues but little progress in terms of concrete action. Drafting
of new legislations (sex determination tests) and amendments
in existing laws (dowry, rape, prostitution etc.) leave much to
be desired while implementation of these laws, even in their
!
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present forms is almost nil. While the New Economic Policy
has started taking its toll in terms of growing unemployment,
neglect of health and education, devastation of natural re
sources and environment and marginalisation of the ‘chil
dren of a lesser God’, the worst affected are women. The
declaration at the International Conference on Population
and Development (ICPD), Cairo notwithstanding, several
new Long Acting Contraceptive (LACs) are being added to
the armour of hazardous contraceptives targeted at women.
New Reproductive Technologies (NRTs) which would fur
ther reduce whatever little control women have retained over
;
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When the tests showed the i
k foetus to be a gid, they
unhesitatingly ended
her little life.
Her parents turned
into executioners.
Your daughter is your child too.
Let her be born.
J
June '95
!
!
determination.
FACTS against MYTHS
--
in the foetus, as an
instrument for sex-
FOR PRIVATE CIRCULATION ONLY
|
Page I
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raises important issues on the interfacing of technology,
health and society, of misuse of medical technology, of us
ing technocentric solutions for social problems, of viola
tion of the principles of medical ethics, of social and demo
graphic implications of such technologies, of the decision
making processes involving technology, which can have
far-reaching social effects, of regulating the medical profes
sion (specially reproductive technology) both internally
and externally, of limits to research and the techno-docs’
power ‘to play God', of the role and limits of social legisla
tion in tackling social problems; of‘informed consent’, and
patients' rights and doctors accountability, of the possible
fall-out of lite advent of New Reproductive Technologies
(NRTs) from Sex Pre-Selection Techniques (SPSTs) to noncoital reproduction through 1VF- ET or GIFT, surrogate moth
erhood to genetic engineering; of decision-making process
in family and society and women's role (or lack of it) in them.
All these issues affect us all directly or indirectly. They
detennine how we define and interpret our past and shape
our present and future. Like ecological issues, they ques
tion rhe wisdom of interfering with nature's method of selec
tion and of disrupting its subtle balances.
It is difficult to find another issue which could
raise so many complex interrelated issues and yet
touch human beings directly and intimately,
Perhaps, in the Indian context, it is the most appropri- f
ate example of the 'Personal Is PoliticalHowever, it is I
difficult to refocus the nation's attention on this issue. I
fhe earlier two nationwide campaigns and the [—----- I
resultant enactment (but non-implementation) of 1
H
a nation-wide law have strengthened the ethos I
off cynicism and frustration prevalent today. The
B
law has also given an alibi to the government to ■
escape international humiliation and condemna- j
lion on this issue. While China and S.Korea, fac
ing similar situations, have advanced to some
extent on the paths chosen by their respective
governments, the Indian government and soci
ety are simply not ready to confront this issue.
However we would be able to tackle the more
complicated questions raised by the advent of
NRTs only by using the space and insights gained
by effectively confronting SD tests.
As it grows, the vested interests would become very pow
erful and they would counter all efforts to control it.
Accordingly to the 1991 census, four States and five Union
Territories report sex ratios less than 900, the situation is
worse in certain rural districts and castes with a tradition of
female infanticide. New simpler techniques for pre-natal sex
prediction are being searched throughout the world. Such a
technique, say, of predicting an offspring’s sex through
analysis of a pregnant mother's blood would make prolif
eration of SD much beyond monitoring and control. Evolu
tion of a simple, effective and cheap SPST would also make
our campaign redundant and futile. In the meantime, people’s
acceptance of sex-selective abortion as ‘a part of socialcultural practice and the frustration of non-implementation
of laws on this issue might further stall our efforts.
However, it is still possible to fight and win. The earlier
campaigns have already raised consciousness on this is
sue. Lakhs of people have directly supported the campaign
through their action. Artists, moved by this issue have ex
pressed themselves through films, cartoons, posters,
slideshows, theatre and street-plays, songs, poems, social
advertisements and classical dance. Experience in
_
Maharashtra underlines the fact that the pressure of
■ campaign can close down most SD clinics (and lhat,.in
absence of such pressure and with the govemmerti’s
I lack of political will, such clinics resurface). Although
i the Centre is yet to implement the nationwide law passed
( by the Parliament in 1994, lately the National Human
7^1 Rights Commission and the National Commission for
i \Women have taken some initiatives on this issue. The
Department of Women and Child Welfare has taken
lieps for the study of selected districts with very low
sex ratios.
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It is time for all of us to rise to the occasion. Activists,
academicians and common people, women and men,
people working on health, gender, development, ethics, human rights, demography, public policy and con
sumer rights- all should join hands to analyse, debate
and solve this issue. Each small success gained in this
SIruSg*e would have a great spin-off effect in several
ielated issues e.g. exposing the role of medical coun
cils in safeguarding the interests of the pro-SD lobby
would strengthen the ongoing feeble campaign to
uphold medical ethics, effective monitoring of vigi
lance committees may lead to their replication in other
fields, and curbing research on SPSTs would raise the
We are running out of lime. We do not have more
w
than a decade to effectively curb (ifnot eliminate)
this problem, which, even now has acquired the
P o •!
status of ‘a social phenomenon’. Thousands of
issue of limits to research in all NRTs.
clinics are already in operation, spanning the en
tire north, central and west India, many of them in
smaller towns and villages. The region most af
_____________ _ coincides with
VV1U1 the
UJC
I I
fected by this _phenomenon
demographically sensitive region- where for economic, j ;
R.P. Ravindra is the founder-member of Forum Against
social and culture factors, female mortality is much more
Sex-Determination and Sex Pre-Selection (FASDSP); Mem
ber. Expert Committees on SD Tests appointed by Govern
pronounced. The SD phenomenon and with it, the dan
ment of Maharashtra and the Union Government; Lecturer
ger of a demographic catastrophe is rapidly spreading to
in Pharmaceutics at SNDT Women’s University; and ac
newer geographical territories. The economic slakes
tively involved on issues related to health and gender.
in this growing business involve few hundred crores
of fupees today.
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FACTS against MTTHS
June *95
Pace 2
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' '
.....
Sex-selective -abortion is an effective tool for
population control/family planning.
FACT
Many people believe that due to the son-preference deeply
engraved in the Indian psyche, a large number of people
keep on increasing the family size with the hope of beget
ting a son. SD tests according to them, is the best measure
of Family Planning. Several others, including certain policy
planners consider women as ‘procreation machines’. Hence,
‘decreasing the number of machines would automatically
lower their total output’ is their logic. It has resulted in fixa
tion of NRR1 (Net Reproductive Rate = 1) i.e. each surviv
ing female should be replaced by only one daughter-as an
important target earmarked for India’s population
programme.
!• Son-preference (and conversely, criminal neglect of
I daughters) in Indian society is an established fact. How
ever, that is not an important determinant of India’s rising
population. Several studies have shown that poverty is
an important cause rather than an effect of population
growth; that poor people produce more children because
their chances of survival are less and because most of
them, residing in third world countries are not supported
by any system of social security, specially in old age;
• Global consensus, as outlined in the Declaration of ICPD
held at Cairo considers Women's empowerment to be the
best contraceptive. Women mostly want a small family.
However, their secondary status and inability of partici
pation in decision-making processes prevent them from
enforcing the small-family norm. Women's education,
awareness and participation in economic activities, lead
ing to their development and empowerment can effec
tively curb population growth. Kerala is the best example,
• Sex-selective abortions strike at the very root of women’s
dignity and the principle of equality. How can women be
empowered in a milieu which denies them even the right
to life? SD tests, would thus oppose the process of fam
ily-planning through women’s empowerment;
• SD tests (and subsequent sex-selective abortions) can
only eliminate the ‘undesirable’ sex; they do not guaran
tee the birth of offspring of a ‘desirable’ sex;
• Family planning and family welfare go much beyond the
narrow concept of numbers. ‘ Quality of life' is insepa
rable from them. What would be the quality of life of the
Indian woman (mostly anaemic and a young mother) who
is made to pass through a vicious cycle of conception,
SD tests, abortion and subsequent conception?
• Women, like men, are full and equal human beings, cap
able of participating and contributing in each walk of life.
Reducing their worth to 'reproductive machines' has deep
sexist connotations. Attempting to solve the population
problem through reduction in women's numbers would
justify dowry murders and ‘femicide’!
FACTS against Wls s US
I
Sex determination tests are safe and
accurate
FACT
SD techniques consist of two components—methods for
removal of foetal cells and chromosomal analysis of these
cells to identify foetal sex. Presently, amniocentesis and
Chorionic Villi Biopsy (CVB) are being used for the former,
while the latter part is carried out by geneticists in genetic
laboratories. (Sonography being a different technique would
be discussed separately).
• Of the various techniques used for SD, amniocentesis
and CVB carry the risks of spontaneous abortion and
infections leading to further complications. Amniocente
sis carries the added risk of injury to placenta, or to vital
organs of the foetus even when performed under ultra
sonic cover by trained experts. In India, both these tech
niques are being performed by untrained persons in con
ditions which are far from ideal, thus increasing the
chances of immediate/delayed complications.
• Following SD tests, abortion is normally performed in the
second trimester of pregnancy. Abortion at such an ad
vanced stage is hazardous to the mother. In India, 70%
women are anaemic; average maternal age at first preg
nancy in rural areas is around 17-18 years and the mater
nal mortality rate in India is one of the highest in the
world. The risks of repeated abortions and the vicious
circle of pregnancy—test—abortion-pretinancv must be
viewed in the context of this morbidity - mortality data.
• Sonography, although used commonly to monitor preg
nancy is not totally free from side-effects and hence
should not be used routinely.
• Chromosomal analysis of material derived from
amniocentesis or CVB has an accuracy of up to 97% with
highly skilled operators, the accuracy is much less for
poorly trained persons as are working in India.
• Sonography cannot be relied upon as a technique for
predicting foetal sex. Identification of the offspring’s sex,
using this technique, becomes possible only after four
months of gestation, after which abortion would become
complicated (and illegal after 20 weeks). The probability
of false positive and false negative results is too large to
make this method dependable for sex prediction.
MYTH;
Sex determination tests would not alter the
sex ratio of the population
FACT:
The general impression is that SD is resorted to only by
those in need of sons to balance their families and that they
stop soon after gening a son.
• Studies in different parts of India show that though SD
tests are first adopted by a section of the population where
preference for a son is extremely pronounced, they are
soon accepted by other sections of society. People hav
ing no living daughters or those with one or more sons
June '95
Pace 3
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are also known to adopt SD technique^ to pre-eliminate
women from their families.
• The average desirable family composition in India is 2
sons and a daughter. While there have been no incidence
of people aborting sons till a daughte^is bom, lakhs of
dauuhters have been aborted with theliope of begetting
a son. This process of abortion of daughters may con
tinue even after the birth of a son in thd“family till at least
two sons are bom.
• Sex-selective abortions are more acceptable in castes/
regions where son-preference is more pronounced. In
these regions/castes, the sex ratio is already precarious
owing to the discrimination against daughters. Abortion
of unborn daughters is bound to accelerate the down
ward slide of females along the demographic ladder.
Secondary Sex Ratio (SSR) i.e. the number of males bom per
j 100 females can be taken as a sure indicatpr of sex-selective
I abortions in a given population. Universally normal values
of SSR vary between 104 and 106 to account for a slight
excess of biologically weaker male sex afbirth. Thus, a SSR
consistently greater than 107 can be taken as a sure indica
tor of occurrence of sex-selective abortion of females. SSR
values for Ludhiana from 1981 to 1988 are as follows:
Year
1981
‘82
‘83
‘84
‘85
*86
‘87
‘88
| SSR.
105
105
113
113
113
112
114
122
Similarly, corresponding values for a cluster of vil lages around
i Ludhiana are as follows:
| Year
1984
1984 1985 .1986
j SSR.
116
116
101
117
1987
1988
114
119
1982-83 was the year when SD started | roliferating in that
region. According to a study by the Mr rrison Institute for
Population and Research Studies at Stanford University,
California, the SSR for India is 108.7 ma es per 100 females.
More accurate micro studies from diffen nt regions of India
substantiate the fear of demographic damage due to SD tests.
MYTH
Reduction in the number of women would
enhance their worth.
FACT
A perverse logicvdoing the rounds is that reduction in
. number makes them more ‘wanted’.-lA-foclr-SD^
proponents claim that in future bridegrooms may have to
pay dowry, due to shortage offemales of marriageable age.
• Applying the economic theory of ‘dt-mand and supply’
to complex social issues reflects two facts: patriarchal
prejudice and the ignorance about fundamental concept
of social organisation and social dynamics. It is an ob
noxious view to equate women with grains and cereals
whose value depends upon their being in short supply!
• In several regions, especially in most South Asian socie
ties, low sex ratios (deficit of females in population) re
flect their lower status and secondary role in society.
b Historically, a drastic reduction in the number of females
resulting in the disruption of sex rauo balance has oc! curred ouiy in a few small societies Sociologists fear that
FACTS against fAlsHS ’
such a phenomenon would result in greater incidence of
rape, forced marriages, polyandry, in general in making
women’s lives more insecure and sex stereotyping more
pronounced. Women would be compelled to stay within
the four walls of their homes and avoid contact with the
insecure and hostile ‘outside world’ for ‘their own ben
efit’. Thus all the advances made by women through their
struggle for emancipation would come to a zero and women
would have to fight for their most basic right of survival.
• In a society like ours, powerful men would maintain a
'zanunkhana to demonstrate their power and influence
while several men. finding no companions might resort to
any means to force a woman for a sexual/marital relation
ship. In either case, a woman would have no control over
her yfe. Recently, several instances have came to light in
which young men have killed women in cold blood for
refusing to marry them or having sex with them. A large
number of young people find this is ‘normal , macho
behavior. 4n future, it might become a respectable norm!
MYTH
Laws cannot curb sex determination tests.
FACT
True, progressive legislation alone cannot solve any social
problems like SD tests. However, they can create space
within which solutions could be explored and implemented.
Legal action, if coupled with measures for creating aware
ness and suitable policy interventions can at least check
large scale sex-selective abortions. The ultimate solution of
this problem lies in the fundamental restructuring of our
society on the foundations of gender equality and justice.
Ultimately, a socio-cultural revolution would be needed to
solve this problem. Nevertheless short term measures in
cluding a stringent and workable law can surely curb it
• Unlike other problems related to women’s status in soci
ety (e.g. dowry, sail, child marriage), this issue has an
additional player in the game viz. the doctor. Doctors,
although no more ethical than other members of society,
are definitely law-fearing (provided they are convinced
that the law would be implemented) it is in their profes
sional interest to follow laws. The negative publicity
resulting after ‘getting caught’ acts as a major deterrent
for most doctors. In Maharashtra, most of the SD clinics
slopped business immediately after the enactment of the
Slate level law against SD tests. (They, however, gradu
ally reappeared when the Government, through inaction
and lethargy demonstrated a lack of political will to imple
ment the law.)
• Sex of the unborn is mostly predicted by chromosomal
analysis of foetal cells, which is carried out only by a
small number of well-equipped genetic laboratories situ
ated in large cities. Hence, monitoring SD business, in
effect, means monitoring these few laboratories in cities.
• If licences for prenatal diagnosis are granted only to gov
ernment institutions, the task of vigilance would be fur
ther simplified. The ban on misuse of techniques for SD
imposed upon government institutions has not been vio
latedfor the past 15 years.
June '95
Page 4
f ‘
MYTH
Banning SD would infringe upon-women's
right to choose the sex of the offspring.
FACT
The pro-SD lobby argues that the right to choose the sex of
the offspring is a logical culmination of tlie ‘pro-choice’
theory as rhe woman should decide how many children she
should base, when to have then, so also their sex. It would
be worthwhile to ask a few questions. Did the common
women ot the poor South Asian countries (where SD tests
are ma a common) or the women's movement in this region
ever ask lor such a right? Who asked for it and who gave it?
Do these women enjoy basic human rights such as the right
to equality ? Can they decide whether and when to get mar
ried?. can they demand the right to education, health, nour
ishment.& equal treatment? Can they say ‘no' to a sexual
relationship forced upon them? In the absence of all these
rights, does the right to decide the offspring’s sex serve any
purpose?. The answers to these questions would reveal
the following facts:
.• Women from poor countries have never asked for a right
to decide the offspring’s sex. It is a bogey raised.by the
pro-SD lobby, specially doctors whose interests are
served by proliferation of SD tests.
lion. The number of choices doesn’t reflect the degree of
autonomy of an individual or a group e.g. asking Indian
women to choose from Norplant, Depo Provera or con-,
traceptive vaccine (without improving women’s status,
obtaining their informed consent or upgrading the health
care setup) would decrease rather than improve their con
trol over their bodies. In the words of the noted thinker
Dada Dharmadhikari, “providing a chicken a choice be
tween getting roasted or fried is no choice"
SEX RATIO: INDIA*_____________
Year
1901 ’11
SR
972
’21
’31
’41
‘51
’61
71
’81
’91
964 955 950 945 946 941 930 934 927
’ No. of lemales/1000 males in population
States/U.T.s with low sex ratio: 1991 census
Chandigarh
Andaman & Nicobar
\ Delhi
Arunachal Pradesh
793
820
830
861
1 Haryana
874
U.P
Punjab
Sikkim
882
888
888
890
Nagaland
What Can You Do?
• In a social milieu where a woman cannot take even the
most basic decisions related to her life, viz. education,
health, marriage, economic freedom, it is downright in
sulting to talk of the choice to decide whether to have a
son or a dauglrter!
• Write to the Minister for Health and Family Welfare,
Minister for State for Women and Child-welfare. Min
ister for Law and Justice, demanding-
• In reality, a women does not have such a choice: The
decision about children-when and how many to have,
etc. is taken largely by her in-law’s fami ly. She cannot say
‘No’ to undergo a SD test for the fear of being deserted,
divorced or alienated in the family. Moreover, after the
SD test, the choice of undergoing abortion is not her
own; she cannot opt to continue the pregnancy if the
foetus is detected to be a female nor can she decide to
abort a male foetus. Hence, the choice doesn’t exist.
^ensuring proper representation of voluntary grou >s
• At times, we find women supporting/asking for SD test.
But. is their ‘choice' totally free and fully informed? It is
often based on subtle or not-so-subtle pressures operat
ing in the family and society. The fear of being driven out
of family or having to lose one’s status in family weighs
heavily on the women's mind when they ask for SD
• On the basis of their experiences, women have been de
manding ‘choice’ in various walks of life. However, our
society does not seem to be keen to furnish them. Even in
the held of health, several of women's demands have
remained unfulfilled: women want safe deliveries with the
least medical interventions (but most hospital-based de
liveries involve as Caesarean section); safe, simple, con
traceptives in their control (what they get are hazardous
long acting contraceptives); their gynecological prob
lems to be attended to with sympathy and concern (but
they arc labelled as psychosomatic)...
• It mint be remembered that in a consumerist culture, the
demand for a choice could he created and nurtured and a
choice be marketed .:s fulfilling an important social func-
FACTS against MYTHS
^implementation of the Regulation of Prenatal Diag
nostic Techniques Act, 1994,
active on this issue at all levels of the implementii g
machinery viz. Appropriate Authority, Superviso y
Board and Vigilance Committees;
^amending the Act in the next session of Parliament o
as to restrict licences for prenatal diagnosis to go ernmcnt/municipal institutions;
''removal of the clause of punishment to women u
dergoing SD test;
^automatic suspension/cancellation from the Regist- y
of Medical Practitioners of the name of doctors four J
guilty by the court without referring the matter to tl e
Medical Coui.T?..
• Pressurise the concerned State governments to speedily
implement die Act.
• Maintain vigilance over aulhorised/unauthorised cer ires laboratories using prenatal diagnostic techniques for
SD.
• Highlight the biological fact that the mother is not r< sponsible for the sex of the offspring.
• Create awareness and help explode myths about SD an i
NRTs.
• Publicise social'cultural alternatives which strike at t:
root of son-preference (nomenclature system doing aw a
w ith clan caste indicating surnames, adding mother's nam ?
to one's own name, daughters perfonning last riles o i
parents, daughters supporting parents in old age etc.)
June *95
Pace 5
A
I
MYTH
How can you oppose selective abortion if you
are not opposed to abortion?
FACT
1 his twisted argument has been used by different people to
juit their purposes. On one hand, the pro-life lobby tried to
appropriate the campaign against SDtests under their logic
yvhile the pro-SD lobby tried to use the argument to divide
and confuse the supporters of ant i-SD campaign. Some femi
nists in the West chose not to support this campaign lest
their stand be misinterpreted or misunderstood as pro-life.
There is an additional danger that our support to abortion
as a women's right could be misused in its indiscriminate
use as a family planning tool.
Amidst all these conflicting realities, we beiieve• We oppose sex-selective abortion not because it violates
life, but because it violates tne dignity and negates even
(he existence of women. The issue is discrimination, not
right to life. If a woman chooses to abort her offspring,
irrespective of its sex. we have no objection. But aborting
a child only due to sex is discrimination and hence should
be opposed.
• Abortion, if used routinely as a F.P tool is detrimental to
women's health. Moreover; it shifts the responsibility of
contraception completely to woman, if she doesn't want
to undergo abortion. Contraception and child-rearing
should be the common, shared concerns for both men
and v.umen.
• 1 lowc\er. women should have the right to abortion as an
extension of (heir right over their bodies and specially
because in the Indian context, abortion represents women’s
last defence against an unwanted pregnancy. Quite of
ten she cannot oppose a relationship forced upon her.
nor can she use or make her partner use contraceptives.
UltimateK.she may have to face social stigma (if the birth
for lite child is socially unacceptable) or opposition from
family (if the child is unwelcome) so she must have the
last option, of abortion, available to her.
• We are also opposed to SPSTs in which there is no appar
ent bloodshed and stigma attached to ‘kil ling’. Never
theless, SPST is simply an extension of SD. based on the
same principle - of selection based on discrimination.
MYTH
Sex-selective abortions are more humane
than dowry murders and sati.
FACT
o Can poverty be eradicated by bombing slums or minori- ■
lies problems be solved by eliminating minorities ? Women
aren't the problem.The problem is society’s attitude to
wards them. The remedy lies in making daughters ‘wanted’
and ‘welcome’ and not in refusing them their existence.
• If this fatalistic argument is extended to all walks of life
and we stan eliminating ‘unwanted people', the earth
would soon turn into a gigantic graveyard.
• Why this deceptive choice between getting killed at birth
or later? Women do have a choice to lead a full, healthy,
dignified life.
• Nobody stops producing sons for the fear of a nuclear
war. riot or a road accident. In fact, a basic motivation
behind procreation is humankind’s undying optimism. We
always hope for a better tomorrow, for a more beautiful
humane world for our children. Why presuppose that a
daughter bom would be subject to atrocities? It is better
to work towards making daughters ‘wanted’ and happy.
SJucicd Reading
I ’ I he Scarcer Half. Rav indru.R I’/Centrc for Education &
Documentation Bombay. 1986.
2. Report of the Central Committee on SDTests/Govt. of
India.Minis, oi l iealth & Family Welfare. New Delhi. 1989.
?. ‘Struggle Against Violencc’/Ed.Chhaya Dalar/Stree Publica
tions. Calcutta. 1993.
4 Seminar'/Special number
5. (Hindi) Nari Jeevan Sangharsh/Ling Janch aur Chunav Virodh.
Mauch’ Bombay. 19X8
6 In Search ol’Our Bodies’/Shakti. Bombav/1987.
.ACKNOWLEDGMENT: We are extremely grateful to Mr. R.P
Ravindra lor preparing this issue ol' I'acis Aycunst Myths.
L
!
Printed Matter
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and fallacies, etc. including infor
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I
I
-Xr -4 r-*- -
'c
CAMPAIGN AGAINST SEX SELECTIVE ABORTION
Contact Address: 11, Kamala 2nd Street, Chinna Chokkikulam,
Madurai - 625 002. Phone & Fax : 530486
16"‘ October 1999.
Dear
Greetings.
We extend our sincere thanks to all the member organisations for their
participation in the one-day consultation and the campaign committee meet held
at Chennai on 28th and 29th September 1999.
Please find enclosed the
consultation statement, minutes of the campaign committee meet and an Appeal
of IMA to its medical fraternity on female feticide.
Warm regards
Yours sincerely
/o TH.
P PHAVALAM
(Convener)
Encl: as above
Minutes of the Campaign Committee meet at ICSA, Chennai on 29th September 1999.
The following members were present:
Dr V.Benjamin - Community Health Cell, Dr D.Gabriele - CSA, Dr Sabu George, Dr
M.V.Radhakrishnan - MCCSS, Ms Usha Saju - TNVHA, Ms G.Shantha - DAWN, Mr
S.Perumal - VELS, Ms Gandimathi, Ms A.Indirani - SNEHA, Ms T.Nanthini - VRDP,
Mr Jeeva, Ms C.Mounam, Ms C.Jeyamani, Ms P.Phavalam - SIRD.
Mr Jeeva facilitated the meeting. The minute of the previous meet on 5th May was
ratified.
The agenda of the meeting was decided as follows:
> Review of the campaign work since the last meet:
> Discussion on the reflection of the consultation held on 28th September
> Formulation of concrete action plan for the next one year
> Formulation of action plan for the next three months.
1. Review of the campaign work:
a Data collection
Data collection is an ongoing programme of the members of CASSA.
The present status of the child sex ratio documented by the member organization is
presented in the following table.
0-5 population:
Area
No. of villages
Sex-ratio
SIRD
Usi lam patti
88
879/1000
Women’s Collective
Chellampatti
40
918/1000
SEARCH
Dharmapuri
55
820/1000
Name of the Organisation
(under 14 yrs)
SNEHA
Nagapattinam
47
SRED
Aundipatti
in process
VRDP
Salem
in process
Penn Urimai lyakkam
Chennai
in process
Janki Ammal Trust
Coimbatore
in process
924/1000
Scan Centres:
SIRD has identified 53 centres in Madurai District. SNEHA has identified 19 centres in
Nagai, Karaikal Districts. SEARCH has identified 22 centres in Dharmapuri District.
SRED has identified 6 centres in Theni District. VRDP has identified 31 centres in
Salem District. Women’s Collective has come out with a list of centres in their working
areas. TNVHA volunteered to collect the addresses in 11 districts and the list of centres
in Chennai will be jointly collected by TNVHA, MCCSS and Women’s Collective.
The proceedings of the National Workshop on “Gender Bias Focussing on Female
Feticide and Infanticide” organised by IMA and UNICEF on 7th and 8th of August was
shared by Dr Sabu George. Dr Benjamin Ms Phavalam and Ms Gandimathi shared the
process of the Conference organised by National Law School and IMA at Bangalore on
24th of September.
2. Discussion on the reflection of the consultation held on 28th September:
The draft Consultation Statement was presented before the members and the resolutions
passed in the one day Consultation was taken up for discussion. Based on the outcome of
the deliberation, it was decided to execute the following action plan for the next one year
and for the next three months.
Action Plan for the next year:
1. Data collection on pre-natal diagnostic centres, child sex ratio, birth rate, death rate.
Infant Mortality Rate, data pertaining to MTP to be collected by the member
organisations.
2. Organising a media workshop including district level media representatives on the
issue of technologies and techniques that contribute to the declining sex ratio.
3. Review of available studies on declining sex ratio
4. Follow up with the Appropriate Authority for the effective implementation of the
PNDT Act with special reference to registration and to take action on the defaulters.
5. Pressurising the Appropriate Authority and the State for the democratisation of the
structure and functioning of the Appropriate Authority and Advisory Committees.
6. Regional consultations for the women presidents of village panchayats to sensitise
them in preventing the declining sex ratio.
On a priority basis, this consultation
should be convened for the women presidents of the districts where the incidence of
female infanticide and feticide is reported high.
7. Facilitating regional consultation focussing on the theme of elimination of sex
selective abortion.
8. Training to the adolescent girls in preventing the declining sex ratio in co-ordination
with the task force of adolescents constituted by UNICEF.
9. State-level consultation for the women sangam leaders in preventing the declining sex
ratio.
10. Advocacy and lobby with IMA of Tamil Nadu and other fraternal groups of IMA
through the following:
x* Sending an appeal to the General Secretary of IMA to request the medical
fraternity to comply with the provisions of the PNDT Act and thus preventing
the selective discrimination and elimination of female fetuses.
> Constitution of Steering Committee to foster an ethical practices and monitors
the compliance of the medical practitioners with the Act.
11. Networking and building alliances with the Tamil Nadu People s Science Forum,
Agricultural Movement, National Human Rights Commission, National Women’s
Commission to enable the campaign to became a broad base movement.
12. Filing of Public Interest Litigation for the effective implementation of the PNDT Act.
13. Interact and provide an orientation to Street Theatre Groups to enable the message to
be widely disseminated.
14. Bringing out education materials such as brochures and booklets about the campaign
and PNDT Act
15. Organising awareness programme to the students of Higher Secondary Schools in
halting the decline in sex ratio.
3
Action Plan for the next three months:
1. Data collection on pre-natal diagnostic centres, child sex ratio, birth rate, death rate.
Infant Mortality Rate, data pertaining to MTP
2. Regional conference in Chennai will be organised by members of Chennai region
such as MCCSS, Women’s Collective and TNVHA
3. Sending an appeal to the General Secretary of IMA to request the medical fraterhity
to comply with the provisions of the PNDT Act and to foster medical ethics in their
practice.
4. Follow up with the Appropriate Authority for the effective implementation of the
PNDT Act with special reference to registration and restructuring the state and district
Advisory Committees
5. Filing litigations against the defaulters.
The following views were emerged from the discussion:
Broad basing the campaign:
The member felt the need to broad base the Campaign as the present membership is
restricted to NGOs. Female Feticide is not only the concern of NGOs. It is also the
concern of Women’s Organisation, Women’s Movement, Human Rights Movements and
any other like minded groups like Tamil Nadu People’s science Forum, Agricultural
Movements, Food Security Movement, Tamil Thesiya lyakkam. Academic Institutions,
Trade Unions and other social forums. Hence CAS SA could take efforts to make
alliances and linkages with such units.
Psychological perspective on female infanticide andfeticide:
Dr Gabriele stressed the need to understand the psychological factors, which forces the
mother to kill the girl child. She stressed that in the absence of conductive environment
for the girl child to survive, grow and develop, her psychological domain is filled with
negative images and negative emotions. They are conditioned to suppress the negative
emotions. This psychological domain needs to be understood in the context of cultural
practice. Only on healing the underlying psychological bruises, by erasing the negative
images and emotions and by providing positive environment, the anti-woman bias could
be removed. She reiterated that research studies should be carried out to understand the
mental status of women and role of psychological factors to the elimination of girl
children. It was suggested that universities and research institutions such as MIDS might
be contacted to carry out such studies.
Research Intervention:
Dr Gabriele also shared that the elimination of girl children is more in agricultural states
such as Tamil Nadu, Andhra, Bihar, Punjab, Haryana and Rajasthan. She reasoned out
that the agricultural communities find it difficult to support the girl children and
considered them as liability because agricultural practices are increasingly becoming
unsustainable and non-renewable. They are more anti-life. It is in this regard, it was felt
to trace the existing studies on female infanticide and feticide and to document the
findings of the studies.
Alliances with IMA:
IMA, in its conference held at Delhi, took a stand that the medical fraternity would not be
a party to the heinous crime of selective discrimination and elimination of fetuses and
they would comply with the PNDT Act. But the representative of IMA - Tamil Nadu
who participated in the consultation pointed their fingers on the common public and
stated that the medical fraternity should be protected from legal pressures.
In such
situation, the National Hon. Secretary asked for the support of CAS SA to work with them
in organising a national conference on female infanticide and feticide.
CASSA’s
response to the invitation of National Hon. Secretary was discussed. As IMA is one of
the stakeholders, it was decided to work with IMA. All the members in IMA may not be
sensitive to this issue. However, CASSA should find way and make use of the chances to
sensitise the members of IMA and use the platform of IMA to eliminate this heinous
practice.
It was decided to convene the next meeting on 15th December 1999.
5r: 5|: jjc ’f1 #
CAMPAIGN AGAINST SEX SELECTIVE ABORTION
Contact Address: 11, Kamala 2nd Street, Chinna Chokkikulam,
Madurai - 625 002. Phone <& Fax : 530486
State-level Consultation to Formulate Strategies and an Action Plan for
Preventing the Declining Sex Ratio
28th September 1999
Consultation Statement
The child sex ratio has been dramatically declining in Tamil Nadu over the last 30 years.
This relative decline over the last 30 years is among the worst in the country Genetic
Counselling Centres, Genetic (ultrasound) Clinics, Genetic Laboratories only next to
Bihar. The child sex ratio for Tamil Nadu was 995 in 1961 and declined to 948 in 1991.
The All India figure for 1961 was 976 and in 1991 it declined to 945. However, the 1991
census figures was at a time when sex selective abortions involving Pre-natal Diagnostic
Techniques had not yet arrived in a major way in Tamil Nadu. The census figures for
2001 regarding the sex ratio could be more revealing.
The Government of Tamil Nadu has refused to accept this reality.
Reproductive
technologies, which facilitate the selective creation of male fetuses, are booming with
hardly any regulation.
This is the contribution of Private Medical Health Care.
Privatisation and lust for profits have resulted in technologies and techniques that
consciously prevent the birth of girl children. Infanticide, feticide and now also pre
selection tests even before conception are all contributing to this heinous crime of
eliminating the girl child. The medical community must take responsibility for these
inhuman actions. For those medical professionals involved in Genetic Counselling,
(Ultrasound) Genetic Clinics and Genetic Laboratories, medical ethics must remain
paramount. The Government of Tamil Nadu with the commitments that is expected of
the State has not enforced the Pre-natal Diagnostic Techniques Act (Regulation and
Prevention of Misuse) Act 1994. Till today registration has not been accorded by the
Government of Tamil Nadu, even for one clinic despite 250 applications for registration.
It is in this context that the Campaign Against Sex Selective Abortion organised a State
level consultation on ZS* September 1999 at Chennai to formulate strategies and an
Action Plan to prevent and halt the declining child sex ratio. The following resolutions
and programme regarding education. Advocacy and mobilisation is the outcome of the
deliberations of the Consultation.
Resolutions:
> Information provided by Government of Tamil Nadu, Department of Health says that
544 applications for registration under the Pre-natal Diagnostic Techniques Act have
been issued and 250 applications for registration have been received as of September
1999. Ironically the districts that account for large number of scan centres and have a
history of infanticide account (ie. Madurai, Theni, Dindigul and Dharmapuri) for only
(Madurai - 18, Theni & Dindigul - 5,
25 of the applications for registration.
Dharmapuri - 2). Vellore district accounts for 11 applications. The Government of
Tamil Nadu should ensure that all Genetic Counselling Centres, Genetic (ultrasound)
Clinics, Genetic Laboratories are registered. The State should make data regarding
registration publicly available on a quarterly basis. With the expiry of the deadline
for Registration, Government of Tamil Nadu should file cases against those who have
not applied reading Article 18 together with 25 & 27 of the Act.
> All doctors should be prohibited from receiving commissions from any scan centre.
Medical Council of India and Indian Medical Association should pass directives in
this regard to enable citizens to file complaints before them with regard to this
practice and take appropriate action.
>
Indian Medical Association has recognised that doctors are committing feticide and
have condemned this practice at the National Workshop held in August 1998 in New
Delhi. The letter from the Hon. General Secretary to all branches directing doctors to
comply with the law must be widely circulated to all doctors. IMA should take urgent
steps to get all members involved with Genetic Counselling Centres, Genetic
(ultrasound) Clinics, Genetic Laboratories to register under the Act.
2
> All reproductive technologies and procedures including pre-selection technology and
techniques, which facilitate the selective creation of male fetuses, should be banned
under the PNDT Act 1994.
The Delhi Artificial Insemination Act 1996 already
forbids X-Y sperm separation.
> Government should rigorously implement the Pre-natal Diagnostic Techniques
(Regulation and Prevention of Misuse) Act 1994 by monitoring the registration of the
clinics and take action against those who violate the provision of the Act. The powers
and structure of the Appropriate Authority and Advisory Committee needs to be
democratised by restructuring and decentralising the committees at the district-level
to include several women activists, trade unions, NGOs and consumer organisations
in the State and district level Advisory Committees. Adequate powers are required to
enable them to function effectively.
> The Act requires that for registration of a Genetic Counselling Centre, Genetic
(ultrasound) Clinic, Genetic Laboratory, it is sufficient that the institution has in its
employment a registered medical practitioner. This must be revised and several and
several criteria laid down for an institution to get registration.
> In the meantime, complaints will be filed against genetic counselling centres,
ultrasound clinics and laboratories and medical professionals violating the law
including for non-registration, advertisement and declaring the sex of the child to
parents, relatives and friends.
> The Campaign will co-ordinate with Presidents of Village Panchayats, especially
women Presidents for monitoring births and deaths, abortions, infanticide and feticide
practices.
> The Campaign will work closely with medical professionals to foster ethical medical
practices. Medical professionals should enforce ethical conduct among themselves.
> The Medical Council of India and its State branches who are responsible for setting
and monitoring ethical standards for doctors will be lobbied to take stringent action
against doctors committing feticide. Complaints against doctors will be referred to
3
the Council for their action demanding that doctors found violating this law should
have their registration cancelled and barred from practicing.
>
The Campaign will form steering / monitoring committees in the districts comprising
of doctors, representatives of media, police, women’s organisations, lawyers and
judges, consumer organisations and NGO representatives to check and monitor the
decline in sex ratio specifically the functioning of Genetic Counselling Centres,
ultrasound clinics and laboratories and any technology used that contributes to the
decline in sex ratio.
> A state-wide investigation on a continuing basis will be undertaken to examine PHCs,
Government and Private Hospital registers on births and deaths of children and
abortions to monitor the trends in child sex ratio.
The state should issue orders
permitting citizens forums / registered organisations to examine these registers.
Similar investigation should be done of the registers required under the Medical
Termination of Pregnancy Act. This investigation will be immediately started in
selected pockets.
>
An investigation will be conducted into the sex of the fetus used by / referred to
research institutions. In every teaching institution, public and private hospitals, the
sex of every fetus used for research should be recorded and the register made
available for public scrutiny.
The Kerala Chapter of the Indian Medical Association issued a directive that no
referral doctors should be given commission by scan centres. Further, the Kerala High
Court held that this is a bonafide decision by the IMA.
The IMA, Tamil Nadu
chapter will be lobbied to pass such a similar directive and a committee instituted to
receive complaints of violation of the directive.
> Government should ensure that free, quality education is guaranteed and provided for
all girls and boys up to the secondary level by strengthening the basic educational
infrastructure and providing free government bus transport in the local interior areas.
The state should also guarantee continuation for higher education.
> Government should strengthen the public distribution system and other basic needs
programme so that all children have access to a balanced diet, safe drinking water and
adequate health care to drastically reduce infant and child and maternal mortality.
z* Advocacy and lobbying with government, administrators, MLAs and MPs will be a
priority. Specifically a constituency based strategy will be framed for preventing /
halting the declining sex ratio.
> The Campaign will co-ordinate with the National Commission on Women and
National Human Rights Commission and its state chapters urging them to also
monitor pre-natal diagnostic technologies and techniques that contribute to the
declining sex ratio.
> Resolved to involve various political parties and mass organisations to enable the
campaign to become a broad based movement to halt the declining sex ratio and stop
unethical medical practices.
Education, Communication & Mobilisation:
> Organising camps / training programmes for adolescent girls on issues related to
preventing the declining sex ratio.
> Organising a State level / district conventions of delegates of Women’s Sangams on
preventing / halting the declining sex ratio.
Organising a State-level / district conventions of Women Panchayat Presidents on
strategies to prevent / halt the declining sex ratio.
> Organising awareness programmes and competitions in higher secondary schools on
the issue of halting the decline in sex ratio.
> Jointly with IMA and associations of obstetricians, gynecologists, sonologists,
pediatricians, to organise gender sensitisation programmes and legal awareness
programme to sensitise doctors and medical students.
>
Jointly with IMA, to pressurise the existing training institutions on pre-natal
diagnostic techniques to include ethical practice in their curriculum.
>
Organising a Media Workshop including district level media representatives on the
issues of technologies and techniques that contribute to the declining sex ratio.
>
Organising gender awareness programmes for enforcement machineries of the PNDT
Act, which includes police, BDO, RDO and other bureaucrats who are part of the
enforcement machineries.
> Interact and provide an orientation to street theatre groups to enable the message to be
widely disseminated.
>
Co-ordinate with the Inter Media Publicity Co-ordination Committee to spread the
message widely through all government media.
>
Doordarshan and Private TV channels to be contacted for providing gender equality
messages free of cost.
> The network of NSS students should be involved in publicising the message of the
campaign specifically the campaign will work to orient women college students to
carry on a state-wide campaign on the issue of declining sex ratio.
>
Need to co-ordinate with the Task Force on Adolescent Girls for monitoring the sex
ratio and education of adolescent girls on their rights.
>
Communication strategies need to be strengthened and widespread including using
drama, TV, radio, print media, specifically popularising messages (1 minute spot on
television, 1 minute songs on AIR)
>|< 5|< 5jC * 5|C
AN APEAL
FEMALE FOETICIDE: A THREA T TO OUR NOBLE PROFESSION
A CT BEFORE THE SOCIETY ACCUSES !!
Since 1901. there has been a tremendous fall in the female population in India. In 1901, there were
about 972 females per thousand males, but during 1991 census this ratio further declined to 927
females per thousand males. In Northern Hindi speaking States, this sex ratio is much worse. This
was mainly due to the various sex determmation tests and abortion of female foetus in the society.
Since last two decades, there has been an emergence of a new trend of sex determination tests
thereby increasing termination of female foetus in the womb, also known as female foeticide. In the
last 5 years, it has become a social epidemic.
According to a non-governmental agency, about 20 lakh female foeticide are being reported every
^year. IMA activists feel the figure is around 50 lacs. The statistics available are very few and
incoherent and reflect just the tip of the iceberg. All of us must have heard about all these happenings
in our society rampantly and we doctors are party to this crime. It is very strange that in smaller
cities and towns where even the basic facilities of day-to-day life are not available, facilities of
prenatal sex determination are freely available, thanks to perverted and enterprising spirit of some of
our medical personnel. All of us, being responsible citizens of this country, should take this issue of
female foeticide seriously. What we did yesterday is immaterial. Let us mend our wrong doings
today and show our seriousness and commitment by taking the following oath.
“We all pledge that as responsible citizens of this country and members of
the medical profession, we will not indulge ourselves or be a party to this
heinous crime of sex determination and selective female foeticide”
What about Pre-natal Diagnostic Techniques Act 1994. which came into force from 1st January
1996, to curb the practice of sex determination and female foeticide ?
This Act is as follows
1.
Prohibition of the misuse of pre-natal diagnostic techniques for determination of sex of the
foetus leading to female foeticide.
2.
Prohibition of advertisement of pre-natal diagnostic techniques for detection or determination
of sex of the foetus.
3.
Permission and regulation of the use <of~ pre-natal diagnostic techniques for the purpose of
specific genetic abnormalities of disorders.
4.
Permitting the use of such techniques only under certain conditions by the registered
institutions
5.
Punishment for violation of the provisions of the Act.
We all know that ultrasound has become synonymous with sex determination, but S.6 of the above
Act mentions that under no circumstances, these techniques will be allowed to determine the sex of
the foetus.
The Act even provides that no person conducting pre-natal diagnostic procedure (under S.4) shall
communicate to the pregnant women concerned or her relatives, the sex of the foetus by words, signs
or in any other manner. If he does so, then he may be punished for that offense.
Doctors conducting this can be fined upto Rs. 10,000 or 3 years in jail for the first charge. The fine
increases to Rs.50,000 and 5 years in jail for second conviction. They are also liable to disciplinary
action like derecognition by Medical Council of India if a complaint is lodged against the doctor.
According to Dr. Ketan Desai (President, MCI), Medical Council of India will not be soft to the
errant doctors.
There are nearly 20,000 ultrasound units in this country of which less than 1 percent are registered.
IMA FEELS THAT ETHICAL MEDICAL PRACTICE IS THE NEED OF THE HOUR
Female foeticide is illegal under Indian Penal Code
(A)
The IMA requests every HOSPITAL, NURSING HOME OR CLINIC to ensure that:
1.
Prenatal sex determination by Ultrasound/Chorion biopsy/Aminocentesis and sex selection
by X-Y chromosome separation or P.G.D. are not practised in their premises.
2.
No second Trimester Pregnancy Termination should be done for indications other than
(a)
(b)
(c)
Proven congenital malformation or genetic defect of the fetus
Pregnancy following Rape (M.L. Case)
Grave risk to the life of mother
All other prenatal sex determination tests done in Hospitals/Nursing Homes/Clinic premises will be
considered a case of FEMALE FOETICIDE, UNLESS PROVED OTHERWISE.
2
Advertisements or any other means of public display (including internet), offering facilities
for prenatal sex determination and pre-pregnancy sex selection (by X-Y chromosome
separation) are BANNED (Delhi Artificial insemination Bill 1995)
THINK, PONDER AND ACT. JOIN US IN THE CRUSADE AGAINST FEMALE FOETICIDE
OUR DREAM - AN INDIA, FREE FROM FEMALE FOETICIDE
COME WITH US AND MAKE IT HAPPEN
DR. V.C. PATEL
NATIONAL PRESIDENT
IMA
DR.PREM AGGARWAL
HONY.GENERAL SECRETARY,
IMA
SEPTEMBER 29, 1999
THE NEW INDIAN EXPRESS
‘State indifferent to steps against female infanticide’
Express News Service
men.t the Act to be able to pro
ve what needs to be changed.
A serious threat prevails as
there is deliberate neglect on
part of the State as it silently
permits this genocide by some
medical practitioners using
pre-natal diagnostic techniq-
ation and decentralisation of
the appropriate authority and
advisory committee.
They also demand dissemina
tion of information about the
Act in such manner to reach
all sections of the public, to extend 50 per cent representation
The Joint Director of Medi
cal Termination of Pregnancy,
Dr.N.Bakthi Devi says hint
only 515 applications wort1 i; ui
ed out of Which only 250 were
registered.
The lowest turn-out was
from Dharmapuri district
which had only 2 registrations,
pre-natal sex determ
Letters have been issued by the Indian wherein
ination tests are widely preva
Medical Association to all the doctors regar- lent.
Despite the enactment of the ding the crime of foeticide and telling doctThey were, N.Ram, editor, [
Pre-natal Diagnostic Techniq- ors to comply
--------- f...........
n -x the Act
with
Banning of Frontline, Dr.(Capt.) Ramasub- I
ues (Regulation and Prevent artificial insemination, whereby X V sperm
bu, director of Medical and Ru
ion) Act, 1994, the state has
ral Health Services, Isabella
separation
is
done,
needs
to
•
be
incorporabeen indifferent to the implem
Austin, regional representat
ted in the Act.'
entation of this Act.
ive, UNICEF, Dr.V.Vasanthi
A draft on the strategies for
Devi, former vice-chancellor,
preventing tlie declining sex ra ues such as ultrasonogiam for to women in all decision Manonmaniyam Sundaraiuutio has been made. Letters profit motives.
making bodies of the State, ens- university, Mina Swaminath- i
have been issued by the Indian
This gets endorsed by a soci uring free and quality educat an, director, Project Access,
Medical Association to all the ety which prefers sons over ion for all girls upto secondary Dr.M.S.Swaminathan Resea
doctors regarding the crime of daughters,
level.
rch
Foundation,
foeticide and telling doctors to
To bring about proper impleAlso ensuring economic emp- Dr. V.B.Athreya, H.O.D.Dept.
comply with the Act.
mentation of the Act, CASSA . owennent by the State such of Economics, Bharatidasan
Banning
of artificial
has
formulated
demandsinsemito the _________________________
that women have rights and University, Dr.N.Bakthi Devi
nation, whereby X ¥ sperm sep- Government in order to addr- control over productive resou joint director, (MTP), Srilaksaration is done, needs to be in ess the root issues leading to rces are some of the other dem luni Prasad IPS., superintend
corporated in the Act.
tliis extreme form of violence ands put forward by the forum. ent of police, Dr.Selvam, Ind
Steps should be taken to imp of female infanticide and foet ic
A call for registration of the ian Medical Association, and
rove upon the provisions of the ide.
genetic clinical centres was Andal Damodharan, hon.grnAct. It is important to impleThey demand for democratis- made m July 1999.
.secretary. ICCW, Chennai.
Chennai, Sept 28: The invas
ion of medical technologies at
the rural level has led to adve
rse sex ratio against females.
The Campaign Against Sex Sel
ective Abortion (CASSA) at
the state level consultation programme today discussed meas
ures for preventing the declin
ing sex ratio which is as low as
800/1000 in several rural areas.
TUESDAY
28 SEPTEMBER 1999
TODAI
Concern over decline
in sex ratio in TN
Our Staff Reporter
Chennai, Sept 28:
Erosion of medical ethics, ignorance on
the part of State-level administrators and
social attitude that give preference to the
male child had contributed to the decline in
the sex ratio in Tamilnadu.
This was emphasised by various speak
ers at the day-long deliberations organised
by Madurai-based NGO - Campaign
Against Sex Selective Abortion (CASSA) in the city to hold the State-level consulta
tion on ‘Formulating strategies and action
plan for preventing declining sex ratio’.
Addressing the panel comprising doctors,
journalists, social workers and government
representatives, V Vasanthi Devi, former ViceChancellor, Manonmaniam Sundaranar Uni
versity, said scanning centres were being il
legally run in the State and this was despite
the law that requires registration of scanning
centres mandatory. Lamenting the role of
government agencies in preparing the list
of scanning centres, she said the govern
ment figures were inadequate in this mat
ter and asked the government to ‘go be-
yond official channels and accept the list'
which the NGOs were willing to provide.
Pointing out the lack of credibility that a gov
ernment missionary evokes, Vasanthi Devi
called upon the government authorities to cre
ate greater credibility and also to advertise their
activities widely in order to create awareness.
She also suggested that criminal proceed
ings be initiated against erring institutions
and sought speedy judicial action on those
apprehended on this charge. She also sug
gested that maximum punishment be given
to doctors who practise this.
But while connivance between the crimi
nals and the police and the law enforcing
authorities was a reality, it is the public
whose active role can prevent and check
the nexus, she said.
Regretting that the medical profession
has today become profit-oriented, she
said she was sceptical of the possibility
of calling upon the medical profession to
be ethical as even an entrance into medi
cal college itself entailed a donation
which ran into several lakhs of rupees.
N Ram, editor, Frontline, who chaired the
session, said Tamilnadu was currently notori
ous for kidney sale, which was illegal and
blamed the doctors for this unethical practice.
The monitoring body for the medical eth
ics too has thrown up its hands in this re
gard, he said.
Mina Swaminathan, director, Project Ac
cess, Dr M S Swaminathan Research Foun
dation, in her address, said that a long-term
solution would be to change the social atti
tude of people and envisaged a greater ro|o
by the various traditional and modern h jedla
V B Athreya, head of department (end
nomics), Bharathidasan University, ap
pealed to the NGOs to work with the elated
local bodies to effectively implement social
welfare schemes. Isabella Austin, regional
representative, UNICEF, promised help and
also sought participation at the field-level
in the implementation of strategies to pre
vent female infanticide.
Jeeva, director, Society for Integrated Rural
Development, said CASSA was involved in
preparing a list of scanning centres in the State
and would submit it to the State goverment in
order to take action upon it in this regard.
I
I
kJ YA % -
NATIONAL DIALOGUE ON CHALLENGES OF SEX SELECTIVE ABORTION
Jan Swasthya Abhiyan
The 2001 Census highlighted the drastic decline in child sex ratios in several states in
North and West India and continued declines in major Southern states. The above dialogue was
held in Rohtak, Harayana on 14,15 April 2001 Jan Swasthya Abhiyan organised the event. This
Abhiyan is an outcome of the People’s Health Assembly (PHA) held in Calcutta in November
2000. PHA was a collective effort of 18 major networks of organisations in the country.
Over 40 delegates from 8 states came for this dialogue. Women’s organisations,
researchers, medical professionals, trade unionists, media representatives and NGOs participated
in the deliberations. Participants included Dr. Mira Shiva (Voluntary Health Association of
India), Dr. Ranbir Singh Dahiya, (Professor Rohtak Medical College), Dr. Amit Sen Gupta (All
India People Science Network), Mr. M. Jeeva (TamilNadu Campaign against Sex Selective
Abortion), Dr. K. Biswas (West Bengal Vigyan Manch) Dr. Sabu George (Community Health
Cell, Bangalore), Ms Sudha Sundaraman (All India Democratic Women’s Association), Ms. K.
Kalpana (Tamil Nadu Science Forum), Ms. Archana Kaul (SCOPE, Jammu & Kashmir) Ms. R
Kaur (National Federation of Indian Women), Ms. Savita (All India Women’s Conference) and
Dr. Dinesh Khosla (Kids’ Careclinic, Rohtak & Indian Academy of Pediatrics).
Specific recommendations for legislative, administrative and professional action were
finalised. The policy statement and the demands to the Government are enclosed. The
participating organisations committed to launch public campaigns against this heinous crime. The
campaign will sensitise the medical professionals and make efforts to involve the ethical
practitioners. Further, we will reach out to the Government health workers, Anganwadi workers,
Panchayat representatives, teachers and trade unions The campaigns will first be initiated in the
states of Haryana, Delhi, UP and Himachal. The ongoing campaign against sex selective abortion
in TamilNadu will be strengthened and extended over the next 6 months to the adjacent statesKarnataka and Andhra.
We deeply regret to note that none of the invited Government officials of the Health
Departments from the states of Haryana, Punjab, Delhi participated. Despite the strenous efforts
of the organisers, the senior functionaries of the Union Health & Family Welfare Ministry did not
attend We were disappointed that not even the National Appropriate Authority of the PNDT Act
chose to send a representative to this meeting.
Contact Person-Professor R. S. Dahiya
National Convener of the Dialogue & Haryana Cyan Vigyan Samithi
19/8 FM, Medical College Enclave, Rohtak, 124001
Phone-01262-51231 (Residence), 01262-44916 (Office); email-dahiyars@rediffmail.com
April 15, 2001
POLICY STATEMENT ON SEX SELECTIVE ABORTION (Female feticide)
The 2001 Census reveals that there has been a dramatic drop in child sex ratios (0 to 6
year olds) in the states of Punjab, Haryana, Himachal, Delhi, Gujarat, Chandigarh and
Maharastra as compared to the 1991 Census. Punjab has an alarming ratio of 793 girls per
thousand boys. These were the states where the private fetal sex determination clinics were
first established and the practice of selective abortion of female fetuses became popular in the
late seventies and early eighties. Even the Southern states such as Karnataka, TamilNadu and
Andhra have shown decline in child sex ratios. The drops in this Census are less than the
Northern states as the sex determination clinics emerged in the South only a decade after they
became popular in the North. The emergence and spread of the prenatal sex determination
clinics are the early warning signals for the distortion of sex ratios at birth in the coming
decade following selective elimination of girl fetuses.
People’s Health Assembly (PHA) held in Calcutta in November 2000 was a collective
effort of 18 major networks of organisations in the country. Jan Swasthya Abhiyan which has
been launched following the PHA organised a dialogue on the challenges of sex selective
abortion (female feticide) at Rohtak, Haryana on April 14-15, 2001. Delegates of 8 states
right from Jammu & Kashmir to TamilNadu were involved. Women’s organisations,
researchers, medical professionals, trade unionists, media representatives and NGOs
participated in the deliberations. Specific recommendations for legislative, administrative and
professional action were finalised. This event is significant in that it involved participants who
have been warning the government and the public for nearly a decade about this impending
disaster They have been highlighting the lack of ethics in the medical profession and the
almost complete lack of enforcement of the 1994 national law against prenatal sex
determination by the Union and State Governments.
Various functionaries of the Government of India and the State governments should be
seized of the enormity of this form of gender violence. The drop in child sex ratios is a
reflection of the worsening status of women in our country. Regrettably, the 1994 Prenatal
diagnostic technologies act (prevention and regulation of misuse) has not been implemented in
these states. For instance, the National Advisory Committee has not been meeting every six
months as mandated by the Act and the Appropriate Authonties in almost all the Districts have
not constituted by the states as of June 2000. The National Appropriate Authority had not
taken effective steps for even registration of all ultrasound machines.
We consider prenatal sex determination tests as a basic human rights violation and a
violation of the rights enshrined in the Constitution, the United Nation Convention on the
rights of the child (CRC) and the Convention on the elimination of all forms of discrimination
against women (CEDAW). Female feticide must be seen as one manifestation of gender
violence against women. Further, efforts to aggressively implement various acts such as
Medical Termination of Pregnancy Act, Dowry Act etc., which protect women’s rights must
also be taken up. Our campaign against prenatal sex determination is not part of the campaign
against abortion. The right to abortion is an essential right of women.
While population policy documents in the country may not be explicitly promoting sex
determination, but in actual reality a significant part of the decline in growth rates is caused by
selective elimination of girl fetuses in parts of the country where female feticide has received
widespread legitimacy. Even United Nations Fund for Population Activities (UNFPA) has
acknowledged this finally. We advocate that the Government’s family welfare policies and
programmes should endeavour to attain a demographic transition to lower fertility rates with
gender equity Otherwise, the current emphasis solely on population stabilisation would lead
to serious decline in child sex ratios in other parts of the country also, which will cause
irreparable psychological and physical trauma to generations of surviving women.
DEMANDS TO THE GOVERNMENTS
Given the enormity of sex selective abortion, the participants demand that1.
The Government of India should effectively implement the 1994 PNDT Act. The
Appropriate Authority of the Act should urgently take steps to notify the State
Governments to register all Ultrasound machines as today ultrasound has become the
most common technology being abused for sex determination. The State Governments
of TamilNadu, Kerala and Karnataka have recently initiated registration of these
machines.
2
The Government should file criminal cases immediately against medical professionals,
scan operators and clinic owners who violate the PNDT Act. Particularly, those who
advertise prenatal sex determination should be identified and prosecuted Regulatory
authorities such as Medical Council of India (MCI) should take action against the
erring Doctors.
3.
The Government should urge professional medical associations such as the Indian
Medical Association (IMA) and other specialist medical organisations to get their
members to register their ultrasound machines and monitor their use Regrettably,
even prominent IMA members such as national office bearers and even the Delhi
Health Minister have not taken the lead in getting ultrasound machines registered
4.
The Government should vigorously publicise the PNDT Act, highlight the value of the
girl child and sensitise the society about the inevitable increase in violence against
surviving girls,/women in the decades to come.The National Population Commission
should immediately convene a special session to discuss the decline in child sex ratio.
The National population policy should explicitly state that population stabilisation
should be attained without distortions in sex ratio at birth.
5.
All Government programmes for the welfare of the girl child and women should be
implemented vigorously to reduce and eliminate gender biases. The longstanding
demands of women’s organisations of equal wages for women, property rights and
social security measures should be immediately enforced
6.
The National Commission for Women should be directly involved in the
implementation of the PNDT Act Therefore, the existing Act be amended so that the
NCW appointees becomes the Co-Appropriate Authorities at the Union and State
levels. Note the original Maharastra Act of 1988 had a multi-member group as the
Appropriate Authority.
Vo H '?>■
NATIONAL DIALOGUE ON CHALLENGES OF SEX SELECTIVE ABORTION
Jan Swasthya Abhiyan
The 2001 Census highlighted the drastic decline in child sex ratios in several states in
North and West India and continued declines in major Southern states. The above dialogue was
held in Rohtak, Harayana on 14,15 April 2001 Jan Swasthya Abhiyan organised the event. This
Abhiyan is an outcome of the People’s Health Assembly (PHA) held in Calcutta in November
2000. PHA was a collective effort of 18 major networks of organisations in the country.
Over 40 delegates from 8 states came for this dialogue. Women’s organisations,
researchers, medical professionals, trade unionists, media representatives and NGOs participated
in the deliberations. Participants included Dr. Mira Shiva (Voluntary Health Association of
India), Dr. Ranbir Singh Dahiya, (Professor Rohtak Medical College), Dr. Amit Sen Gupta (All
India People Science Network), Mr. M. Jeeva (TamilNadu Campaign against Sex Selective
Abortion), Dr. K. Biswas (West Bengal Vigyan Manch) Dr. Sabu George (Community Health
Cell, Bangalore), Ms. Sudha Sundaraman (All India Democratic Women’s Association), Ms. K.
Kalpana (Tamil Nadu Science Forum), Ms Archana Kaul (SCOPE, Jammu & Kashmir) Ms. R
Kaur (National Federation of Indian Women), Ms. Savita (All India Women’s Conference) and
Dr Dinesh Khosla (Kids’ Careclinic, Rohtak & Indian Academy of Pediatrics).
Specific recommendations for legislative, administrative and professional action were
finalised. The policy statement and the demands to the Government are enclosed. The
participating organisations committed to launch public campaigns against this heinous crime. The
campaign will sensitise the medical professionals and make efforts to involve the ethical
practitioners. Further, we will reach out to the Government health workers, Anganwadi workers,
Panchayat representatives, teachers and trade unions. The campaigns will first be initiated in the
states of Haryana, Delhi, UP and Himachal. The ongoing campaign against sex selective abortion
in TamilNadu will be strengthened and extended over the next 6 months to the adjacent statesKarnataka and Andhra.
We deeply regret to note that none of the invited Government officials of the Health
Departments from the states of Haryana, Punjab, Delhi participated. Despite the strenous efforts
of the organisers, the senior functionaries of the Union Health & Family Welfare Ministry did not
attend We were disappointed that not even the National Appropriate Authority of the PNDT Act
chose to send a representative to this meeting.
Contact Person-Professor R. S. Dahiya
National Convener of the Dialogue & Haryana Cyan Vigyan Samithi
19/8 FM, Medical College Enclave, Rohtak, 124001.
Phone-01262-51231 (Residence). 01262-44916 (Office); email-dahiyars@rediffmail.com
April 15, 2001
POLICY STATEMENT ON SEX SELECTIVE ABORTION (Female feticide)
The 2001 Census reveals that there has been a dramatic drop in child sex ratios (0 to 6
year olds) in the states of Punjab, Haryana, Himachal, Delhi, Gujarat, Chandigarh and
Maharastra as compared to the 1991 Census. Punjab has an alarming ratio of 793 girls per
thousand boys. These were the states where the private fetal sex determination clinics were
first established and the practice of selective abortion of female fetuses became popular in the
late seventies and early eighties. Even the Southern states such as Karnataka, TamilNadu and
Andhra have shown decline in child sex ratios. The drops in this Census are less than the
Northern states as the sex determination clinics emerged in the South only a decade after they
became popular in the North. The emergence and spread of the prenatal sex determination
clinics are the early warning signals for the distortion of sex ratios at birth in the coming
decade following selective elimination of girl fetuses.
People’s Health Assembly (PHA) held in Calcutta in November 2000 was a collective
effort of 18 major networks of organisations in the country. Jan Swasthya Abhiyan which has
been launched following the PHA organised a dialogue on the challenges of sex selective
abortion (female feticide) at Rohtak, Haryana on April 14-15, 2001. Delegates of 8 states
right from Jammu & Kashmir to TamilNadu were involved. Women’s organisations,
researchers, medical professionals, trade unionists, media representatives and NGOs
participated in the deliberations. Specific recommendations for legislative, administrative and
professional action were finalised. This event is significant in that it involved participants who
have been warning the government and the public for nearly a decade about this impending
disaster. They have been highlighting the lack of ethics in the medical profession and the
almost complete lack of enforcement of the 1994 national law against prenatal sex
determination by the Union and State Governments.
Various functionaries of the Government of India and the State governments should be
seized of the enormity of this form of gender violence. The drop in child sex ratios is a
reflection of the worsening status of women in our country. Regrettably, the 1994 Prenatal
diagnostic technologies act (prevention and regulation of misuse) has not been implemented in
these states. For instance, the National Advisory Committee has not been meeting every six
months as mandated by the Act and the Appropriate Authorities in almost all the Districts have
not constituted by the states as of June 2000. The National Appropriate Authority had not
taken effective steps for even registration of all ultrasound machines.
We consider prenatal sex determination tests as a basic human rights violation and a
violation of the rights enshrined in the Constitution, the United Nation Convention on the
rights of the child (CRC) and the Convention on the elimination of all forms of discrimination
against women (CEDAW). Female feticide must be seen as one manifestation of gender
violence against women. Further, efforts to aggressively implement various acts such as
Medical Termination of Pregnancy Act, Dowry Act etc., which protect women’s rights must
also be taken up. Our campaign against prenatal sex determination is not part of the campaign
against abortion. The right to abortion is an essential right of women.
While population policy documents in the country may not be explicitly promoting sex
determination, but in actual reality a significant part of the decline in growth rates is caused by
selective elimination of girl fetuses in parts of the country where female feticide has received
widespread legitimacy. Even United Nations Fund for Population Activities (UNFPA) has
acknowledged this finally. We advocate that the Government’s family welfare policies and
programmes should endeavour to attain a demographic transition to lower fertility rates with
gender equity Otherwise, the current emphasis solely on population stabilisation would lead
to serious decline in child sex ratios in other parts of the country also, which will cause
irreparable psychological and physical trauma to generations of surviving women.
DEMANDS TO THE GOVERNMENTS
Given the enormity of sex selective abortion, the participants demand that:1.
The Government of India should effectively implement the 1994 PNDT Act. The
Appropriate Authority of the Act should urgently take steps to notify the State
Governments to register all Ultrasound machines as today ultrasound has become the
most common technology being abused for sex determination. The State Governments
of TamilNadu, Kerala and Karnataka have recently initiated registration of these
machines
2.
The Government should file criminal cases immediately against medical professionals,
scan operators and clinic owners who violate the PNDT Act. Particularly, those who
advertise prenatal jsex determination should be identified and prosecuted. Regulatory
authorities such as> Medical Council of India (MCI) should take action against the
erring Doctors.
3.
The Government should urge professional medical associations such as the Indian
Medical Association (IMA) and other specialist medical organisations to get their
members to register their ultrasound machines and monitor their use Regrettably,
even prominent IMA members such as national office bearers and even the Delhi
Health Minister have not taken the lead in getting ultrasound machines registered.
4.
The Government should vigorously publicise the PNDT Act, highlight the value of the
girl child and sensitise the society about the inevitable increase in violence against
surviving girls,/women in the decades to come.The National Population Commission
should immediately convene a special session to discuss the decline in child sex ratio.
The National population policy should explicitly state that population stabilisation
should be attained without distortions in sex ratio at birth.
5.
All Government programmes for the welfare of the girl child and women should be
implemented vigorously to reduce and eliminate gender biases. The longstanding
demands of women s organisations of equal wages for women, property rights and
social security measures should be immediately enforced
6.
The National Commission for Women should be directly involved in the
implementation of the PNDT Act. Therefore, the existing Act be amended so that the
NCW appointees becomes the Co-Appropriate Authorities at the Union and State
levels. Note the original Maharastra Act of 1988 had a multi-member group as the
Appropriate Authority.
1^)Y\ - K
NATIONAL DIALOGUE ON CHALLENGES OF SEX SELECTIVE ABORTION
Jan Swasthya Abhiyan
The 2001 Census highlighted the drastic decline in child sex ratios in several states in
North and West India and continued declines in major Southern states. The above dialogue was
held in Rohtak, Harayana on 14,15 April 2001. Jan Swasthya Abhiyan organised the event. This
Abhiyan is an outcome of the People’s Health Assembly (PHA) held in Calcutta in November
2000. PHA was a collective effort of 18 major networks of organisations in the country.
Over 40 delegates from 8 states came for this dialogue. Women’s organisations,
researchers, medical professionals, trade unionists, media representatives and NGOs participated
in the deliberations. Participants included Dr. Mira Shiva (Voluntary Health Association of
India), Dr Ranbir Singh Dahiya, (Professor Rohtak Medical College), Dr. Amit Sen Gupta (All
India People Science Network), Mr. M. Jeeva (TamilNadu Campaign against Sex Selective
Abortion), Dr. K. Biswas (West Bengal Vigyan Manch) Dr. Sabu George (Community Health
Cell, Bangalore), Ms. Sudha Sundaraman (All India Democratic Women’s Association), Ms. K
Kalpana (Tamil Nadu Science Forum), Ms Archana Kaul (SCOPE, Jammu & Kashmir) Ms. R
Kaur (National Federation of.Indian Women), Ms. Savita (All India Women’s Conference) and
Dr. Dinesh Khosla (Kids’ Careclinic, Rohtak & Indian Academy of Pediatrics).
Specific recommendations for legislative, administrative and professional action were
finalised. The policy statement and the demands to the Government are enclosed. The
participating organisations committed to launch public campaigns against this heinous crime. The
campaign will sensitise the medical professionals and make efforts to involve the ethical
practitioners. Further, we will reach out to the Government health workers, Anganwadi workers,
Panchayat representatives, teachers and trade unions. The campaigns will first be initiated in the
states of Haryana, Delhi, UP and Himachal. The ongoing campaign against sex selective abortion
in TamilNadu will be strengthened and extended over the next 6 months to the adjacent statesKarnataka and Andhra.
We deeply regret to note that none of the invited Government officials of the Health
Departments from the states ofHaryana, Punjab, Delhi participated. Despite the strenous efforts
of the organisers, the senior functionaries of the Union Health & Family Welfare Ministry did not
attend We were disappointed that not even the National Appropriate Authority of the PNDT Act
chose to send a representative to this meeting.
Contact Person-Professor R. S. Dahiya
National Convener of the Dialogue & Haryana Cyan Vigyan Samithi
19/8 FM, Medical College Enclave, Rohtak, 124001.
Phone-01262-51231 (Residence); 01262-44916 (Office); email-dahiyars@rediffinail com
April 15, 2001
POLICY STATEMENT ON SEX SELECTIVE ABORTION (Female feticide)
The 2001 Census reveals that there has been a dramatic drop in child sex ratios (0 to 6
year olds) in the states of Punjab, Haryana, Himachal, Delhi, Gujarat, Chandigarh and
Maharastra as compared to the 1991 Census. Punjab has an alarming ratio of 793 girls per
thousand boys. These were the states where the private fetal sex determination clinics were
first established and the practice of selective abortion of female fetuses became popular in the
late seventies and early eighties. Even the Southern states such as Karnataka, TamilNadu and
Andhra have shown decline in child sex ratios. The drops in this Census are less than the
Northern states as the sex determination clinics emerged in the South only a decade after they
became popular in the North. The emergence and spread of the prenatal sex determination
clinics are the early warning signals for the distortion of sex ratios at birth in the coming
decade following selective elimination of girl fetuses.
People’s Health Assembly (PHA) held in Calcutta in November 2000 was a collective
effort of 18 major networks of organisations in the country. Jan Swasthya Abhiyan which has
been launched following the PHA organised a dialogue on the challenges of sex selective
abortion (female feticide) at Rohtak, Haryana on April 14-15, 2001. Delegates of 8 states
right from Jammu & Kashmir to TamilNadu were involved. Women’s organisations,
researchers, medical professionals, trade unionists, media representatives and NGOs
participated in the deliberations. Specific recommendations for legislative, administrative and
professional action were finalised. This event is significant in that it involved participants who
have been warning the government and the public for nearly a decade about this impending
disaster. They have been highlighting the lack of ethics in the medical profession and the
almost complete lack of enforcement of the 1994 national law against prenatal sex
determination by the Union and State Governments.
Various functionaries of the Government of India and the State governments should be
seized of the enormity of this form of gender violence. The drop in child sex ratios is a
reflection of the worsening status of women in our country. Regrettably, the 1994 Prenatal
diagnostic technologies act (prevention and regulation of misuse) has not been implemented in
these states. For instance, the National Advisory Committee has not been meeting every six
months as mandated by the Act and the Appropriate Authorities in almost all the Districts have
not constituted by the states as of June 2000. The National Appropriate Authority had not
taken effective steps for even registration of all ultrasound machines.
We consider prenatal sex determination tests as a basic human rights violation and a
violation of the rights enshrined in the Constitution, the United Nation Convention on the
rights of the child (CRC) and the Convention on the elimination of all forms of discrimination
against women (CEDAW). Female feticide must be seen as one manifestation of gender
violence against women. Further, efforts to aggressively implement various acts such as
Medical Termination of Pregnancy Act, Dowry Act etc., which protect women’s rights must
also be taken up. Our campaign against prenatal sex determination is not part of the campaign
against abortion. The right to abortion is an essential right of women.
While population policy documents in the country may not be explicitly promoting sex
determination, but in actual reality a significant part of the decline in growth rates is caused by
selective elimination of girl fetuses in parts of the country where female feticide has received
widespread legitimacy. Even United Nations Fund for Population Activities (UNFPA) has
acknowledged this finally. We advocate that the Government’s family welfare policies and
programmes should endeavour to attain a demographic transition to lower fertility rates with
gender equity. Otherwise, the current emphasis solely on population stabilisation would lead
to serious decline in child sex ratios in other parts of the country also, which will cause
irreparable psychological and physical trauma to generations of surviving women.
DEMANDS TO THE GOVERNMENTS
Given the enormity of sex selective abortion, the participants demand that:1.
The Government of India should effectively implement the 1994 PNDT Act. The
Appropriate Authority of the Act should urgently take steps to notify the State
Governments to register all Ultrasound machines as today ultrasound has become the
most common technology being abused for sex determination. The State Governments
of TamilNadu, Kerala and Karnataka have recently initiated registration of these
machines.
2.
The Government should file criminal cases immediately against medical professionals,
scan operators and clinic owners who violate the PNDT Act. Particularly, those who
advertise prenatal sex determination should be identified and prosecuted. Regulatory
authorities such as Medical Council of India (MCI) should take action against the
erring Doctors
3.
The Government should urge professional medical associations such as the Indian
Medical Association (IMA) and other specialist medical organisations to get their
members to register their ultrasound machines and monitor their use Regrettably,
even prominent IMA members such as national office bearers and even the Delhi
Health Minister have not taken the lead in getting ultrasound machines registered
4.
The Government should vigorously publicise the PNDT Act, highlight the value of the
girl child and sensitise the society about the inevitable increase in violence against
surviving girls,/women in the decades to come The National Population Commission
should immediately convene a special session to discuss the decline in child sex ratio.
The National population policy should explicitly state that population stabilisation
should be attained without distortions in sex ratio at birth.
5.
All Government programmes for the welfare of the girl child and women should be
implemented vigorously to reduce and eliminate gender biases. The longstanding
demands of women’s organisations of equal wages for women, property rights and
social security measures should be immediately enforced.
6.
The National Commission for Women should be directly involved in the
implementation of the PNDT Act Therefore, the existing Act be amended so that the
NCW appointees becomes the Co-Appropriate Authorities at the Union and State
levels. Note the original Maharastra Act of 1988 had a multi-member group as the
Appropriate Authority.
8'
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WHO - CAN YOU TRUST ?
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its SO good. After this promotion we get the dis
claimer - ^However, this method is not entirely free
of risks.......... ” The style is reminiscent of cigarette
ads with the health hazard warning in small print at
the bottom.
(Reprinted from ‘Right to choose’, issue No. 26,
Autumn 1983; article contributed by members of
the Anti-Depo Provera campaign, NSW)
Who are W.H.O.?
Looking into the makeup of the “expert” panels
that have contributed to these reports we find the
names of employees of the drug’s manufacturers,
plus the same experts who have written pro-Depo
articles for the many journals and magazines publish
ed by the International Planned Parenthood Federa
tion or the United Nations Fund for Population
Activities. They are part of an international net
work of doctors and scientists whose uniting interest
is population control and its direct and indirect
profits.
Further into the article the authors do admit
evidence which indicates the dangers of this drug.
However, they gloss over it, twisting a lack of properly
designed research into a lack of negative evidence.
When they say no research has show problem X, it's
often because there has been No research on problem
X at all. By the rime you reach the conclusion the
most they are prepared to say is “further research is
needed” - meanwhile women should be encouraged
to use the drug.
Some examples
Tn some countries, in some circles, “population
Teratogenicity (the effect of the drug on infants
control” is given positive value-seen as a good thingand the experts will be quite blatant there about their exposed to it while in the womb): Firstly, the authors
motivation. Tn western countries which do not have admit that “NO studies have systematically followed
a population “problem” and where feminism has the healtfy and development of infants exposed in utero
had some impact, the tone changes to one of “allow to DiMPA (depo)" (1). They go on to mention
ing women a greater range of options from which to three reported cases of clitoral enlargement among
make an informed choice”. But do not be mislead- the daughters of women who had received Depo
it’s still population control. Throughout the litera early in their pregnancies. From here they leap to
ture relating to the use of Depo in western countries the conclusion that “IF any increase in risk of con
certain phrases recur frequently such as “target genital anomalies exists - and there is no clear evi
populations”, “institutionalised women”, “women dence that it does - it must be quite small." Again
who are not responsible contraceptors”. Looking Jn the conclusion we get the rider “Research should
at use patterns in these countries we see what these continue in these areas."
phrases mean - the typical users are women in institu
tions, and the racial minorities - Asians in the U.K., Exposure through breast milk:
blacks in the U.S., Maoris and Polynesians in N.Z.,
Here again we see the glossing over of possible
Aborigines in Australia.
risks accompanied by an admission of the lack of
Added to this racism is an underlying misogyny appropriate long term studies and followed by the
which says that women should be sexually available reassurance that exposure to the drug through breast
to men at all times at whatever health cost to the milk is “UNLIKELY to give rise to adverse effects on
woman while men are protected from the annoying the child's development." (2)
possibilities of unwanted paternity.
In the body of the text there is reference to one
animal study which has ^suggested a possible effect
Illogical Leaps of Faith
on reproductive developmenty Searching out this
The introduction to the first article, (“Injectable study (3) we find that rats exposed to Depo through
hormonal contraceptives, technical and safety as breast milk exhibited a ^significant delay in the onset
pects”) - (1) - sets the scene. We are immediately of vaginal opening and of the first oestrous cycle" com
told how effective and widely used Depo is and why pared to controls. Human children have only
5
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■______________
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been studied up to the age of thirteen. NO studies . INTRODUCTION OF NET-EN CHALLENGED
have followed children through puberty. This ab
For the first time in India, the attempts of the
sence of appropriate research is twisted by an Austra Health Ministry and the 1CMR to push through a
lian author into the statement “There is NO EVI hazardous contraceptive for women has been chaDENCE of long term effects on the breast fed infants llenged by a writ petition filed in the Supreme Court
of DMPA treated mothers." (4)
on the 7th of April this year. On 1st May, the Court
The world wide promotion of Depo use amongst
breastfeeding women has led to the anomalous situa
tion in Jamaica where nearly 9°o of breastfeeding
women use it compared to only 5% of non-breast
feeding women. (5)
Cancer:
In the literature on the possible carcenogenicity
(potential to cause cancer) of Depo we find the most
amazing perversions of logic. The finding of cancer
in beagles treated with Depo has been a large stumbl
ing block for Depo advocates as it was a major cause
of the FDA’s refusal to approve the drug. Conse
quently, over the past few years medical journals
have been littered with articles attempting to prove
that the beagle is not a suitable test animal - aspersions
have been cast on monkeys too (1) & (2) and others.
One would expect that this would lead to a search
for a more suitable test animal. However, the ur
gency is too great and the conclusion has been that
the only really suitable test animals are women. So far
“most of the human studies have been poorly designed
and do not provide much useful information." (6) As
many cancers take 20 to 30 years to develop, millions
of women will be exposed to this drug before any
definitive statement on the cancer question can be
made.
In a desperate attempt to refute the cancer risk
theory researchers in Thailand conducted a study on
previous Depo use among women admitted to hospi
tal for endometrial carcinoma (cancer of the lining
of the womb). Although 16 of the 27 women came
from areas where Depo is widely used, none of
the drug. This study is quoted in both the W.H.O.
reports. The logic of it is astounding - women who
had cancer didn't use Depo, therefore Depo is safe!!
Despite the “experts” dismissal of the beagle as a
suitable test model, the manufacturers, Upjohn have
repeated the beagle studies and the results will be
presented to the FDA who still require beagle tests
at the coming hearing (7).
The lack of a conclusive statement on the car
cenogenicity of Depo just opens the way for more
widespread use of the drug in the interests of re
search. To this purpose one would expect that wo
men given Depo would be told of the investigational
issued notice to the respondents as to why the peti
tion should not be admitted and stay order granted on
further trials of the contraceptive. In addition to
the Health Ministry, the ICMR. and the State of
Andhra Pradesh, the Drug Controller of India was
also impleaded as a respondent. The notice was
returnable on July 15 1986. The respondents are
yet to file in their reply.
The contraceptive in question is Norethisterone
enanthate (NET-EN). a progestin derived from
testosterone, prepared in an oily solution and ad
ministered as an injection. The petitioneis (three
women’s groups and six individuals) contend that the
drug is a definite hazard to women's health and a
potential hazards to their progeny. Further, they
state that under Indian conditions, given the present
state of health services, the potential hazards of this
drug do not justify its introduction into the mass
Family Planning Programme. The petitioners also
allege that the clinical trials conducted by ICMR
have violated the ethics of human experimentation
by recruiting women without their informed consent.
The petitioners demand that all further experiments
on Indian women with this drug be stopped immedia
tely and the drug be banned for use in India.
—Saheli Collective, N. Delhi.
nature oi the drug and the need for repeated cancer
tests for at least 20 years following their first injection.
However,' the WHO studies in fact say: “IDEALLY
annual pelvic and breast examinations should be undertaken" (2) and: “WHEN LOCAL CIRCUMSTANC
ES PERMIT breast and pelvic examinations should
be included. The pap smear is on OPTIONAL exa
mination to be performed when indicated and when
resources permit.'" (1)
So what are they really saying? It appears that
in order to maintain their scientific reputations
some controlled cancer studies will be done in future
on selected samples of women, but that in the mean
time women worldwide should use Depo and only
be checked for cancer “if resources permit .
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The articles give advice on how Depo should be
presented to women and how to train non-medical
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personnel to do this. The WHO is part of the wes adds that oral and injectable methods “have an
tern medical monoculture and, therefore, pays lip incredible profit margin". They are “amongst the
service to a woman's right to make an informed most profitable of all pharmaceuticals" (7). These
choice. However, their attempts at feminism are WHO reports are really advertising blurbs presented
transparent revealing paternalism and the same old in the manner that doctors expect. The racism,
“doctor knows best” attitudes. For example: “If paternalism and greed of the international commu
her choice is an injectable hormone then the nature nity of experts is not well hidden and the lust for this
and type of common side effects should be explained drug is obvious. While protecting themselves by
with an EMPHASIS ON THEIR TRANSIENT admitting the risks of the drug to each other (not to
women, of course), they salve their consciences with
NATURE."
the universal panacea of “more research is needed”.
They also give an example of the wording that Meanwhile......... Mrs. Smith, did you say you were
could be used in the package insert which “should be having trouble remembering your pill.......... Well ..
worded as simply as possible. The essential informa
References:
tion should be presented objectively and SHOULD
(1) “Injectable hormonal contraceptives, technical and safety
NOT AROUSE APPREHENSION OR ANXIETY
aspects," WHO Offset Publication No. 65 (1982).
on the part of the consumer."
I
(2) “Facts about injectable contraceptives'", Bulletin of the
World Health Organisation 60 (2): 199-210 (1982).
The information they regard as essential includes
details of possible disturbances to the menstrual
cycle, headaches, dizziness and weight gain. NO
mention is made of any of the cancer or breastfeeding
debates. Thus, the advice that women are to be given
(from which to make an INFORMED choice) in
cludes none of the basic areas of concern which in the
WHO articles are described as follows: “Doubts
which have been expressed regarding the safety and
appropriateness of an injectable hormonal contracep
tive for widespread use are related to their possible
carcenogenicity. impairment of future reproductive
function, adverse metabolic effects, potential teratogeni
city and other possible adverse effects on the progeny
(as a result of exposure to the steroid hormone either
in utero or via breast milk')."
(3) “The effect of medroxyprogesterone acetate, administered
to the lactating rat, on the subsequent growth, maturation
and reproductive function of the litter,” N. Satayasthit,
M. Tankeyoon & R.R. Chaudhury, Journal of Re
productive Fertility, (1976) 46, 411-412.
(4) “Post-partum sexuality and contraception” by Edith
Weisberg in Healthright. Vol. 1, No. 3, May, 1982.
(5) “Women in the developing world who breastfeed their
infants rarely use hormonal contraceptives”, International
Family Planning Perspectives, Vol 8, No. 2, June 1982.
(6) “Injectable Contraception”, by Peter Hall & Susan Hoick,
World Health, May 1982.
(7) “Depo-Provera debate revs up at FDA”, by Marjorie
Sun, Science, Vol 217, July 1982.
Form IV
(See rule 8)
New Delhi 110029
I. Place of Publication
Potential for Abuse
2. Periodicity of its publi
cation
For most of a decade women's and consumer
groups have repeatedly pointed out that the main
danger with injectable contraceptives is their poten
tial for abuse. Women can be given the drug with
out their consent or knowledge or it can be presented
so attractively that it is hard to resist. It can be used
to curb unwanted sections of the population such as
ethnic minorities, refugees, handicapped women, etc.
Only one of the articles even mentions the ques
tion of abuse. Referring to a meeting of the experts
they say that the topic of abuse “iras- not discussed in
detail(2)
Hard Sell
The value of Depo sales has already reached S 25
million and would rise dramatically with FDA appro
val, according to market analyst Arnold Snider. He
Monthly
3. Printer’s Name
(Whether citizen of India?)
Address
Sathyamala
Yes
B-7/88/1, Safdarjung Enclave
New Delhi-110029
4. Publisher's Name
(Whether citizen of India?)
Address
Sathyamala
Yes
B-7/88/1, Safdarjung En- x
clave New Delhi 110029.
Editor’s Name
(Whether citizen of India?)
Address
Sathyamala
Yes
B-7/88/1, Safdarjung En
clave, New Delhi 110029.
6. Name and address of indi
viduals who own the news
paper and partners or
share holders holding
more than one percent of
the total capital.
Medico Friend Circle Bulletin
Trust 50 LIC Quarters
University Road, Pune
411016
5.
:1
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7
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FOCUS ON COMMUNICATION
I
-y Beyond Sexism : Media and Women’s Question
VIMAL BALASUBRAHMANYAN
be seen and placed in a context: The legitimation in
recent years of women’s issues in the media, along
with a simultaneous subversion of the movement
itself.
Women’s issues are today as much a part of the
‘media-mix’ as, say, bonded labour, environment
XT one of these are headings from a feminist journal and exploitation of tribals. Papers like The Tele
or a women’s magazine. Nor are they from the graph, the Deccan Chronicle, the Hyderabad and
women’s pages of daily newspapers.
Vijayawada editions of the Indian Express and The
The first is a frontpage report in The Statesman, Statesman's ‘Sunday Miscellany’ all have a weekly
Delhi, on the landmark Shah Bano case judgement. ‘Women’s page’. Some, like the Amrit Bazar Patrika
The second is a review of six feminist books on the (‘Gender theme’) and the Deccan Herald (‘On women,
literary pages of The Hindustan Times. The third for women’), have a regular column on women.
is an edit page article in the Free Press Journal. The
Some women’s columns are handled by a regular
fourth is a frontpage “News analysis’’ feature in columnist while others have a number of contribu
The Times of India, Delhi. And the fifth is a top tors. The (Delhi) Statesman s column, ‘Women’s
article on the edit page of The Hindu coinciding with World’is written by one staffer. EPW periodically
the UN conference marking the end of the Women’s brings out a special ‘Review of women’s studies’
Decade at Nairobi in 1985.
section in addition to fairly frequent articles on a
Women's issues are not invisible anymore in the variety of women’s issues. And the left-wing journal
general media. Nobody would describe The Hindu Mainstream has a “Women’s World’ sectidn which
paper,
but its Sunday magazine section used to be regular but now appears only occasionally
as a feminist
f.
. T
on July 12, '1987 actually had five separate
,
items
‘
J mainly because, I rather suspect, of a shortage of
Nobody
on topics pertaining to women. "
\ would appropriate contributions.
A number of new glossies have made an appeardescribe The Telegraphy feminist either, but this
is the paper which published on its edit page Madhu ance in the ‘women’s magazine’ category, while the
Kishwar’s perceptive analysis of the Shah Bano mass-circulation current affairs magazines all publish
issue, reproducing in two or three parts her original serious reportage on women’s issues.
The women’s question gained legitimation in the
article in the feminist journal Manushi.
That serious discussion with a feminist perspective general media rather tentatively during the eadyon a range of issues (and not just the so-called years of the ‘Women’s Decade, but very substantially
women’s issues) appear regularly in a left-wing by its close in 1985. A major reason has been the
journal like the Economic and Political Weekly (EPW) high audibility of women’s issues, particularly
is not surprising. Or that a leftist paper like the during the latter half of the Decade, with the validity
Patriot should have periodic edits and edit page of the question getting acknowledged in national
articles on women’s issues as well as occasional and international forums.
' full-page lead at tides on the women’s question in * Governments and UN agencies announce schemes
its Sunday magazine section! Progressive move for women, and policies in areas like health, education
ments, their struggles for social change, and the ques and employment. Social science reports are published
______
____
J raise on
_
r£____
.
.
\
... ’js
tions
they
oppression
and exploitation
analysing
women*’s conditions. Activist women
inevitably get consistent coverage in the progressive groups stage protestsand launch campaigns. All
left-oriented media. What is noteworthy about the these make news, and are reported in the news
women’s question is the prominence it is receiving columns, commented upon in edits and analysed in
in the establishment media. Here it exists side by side feature articles.
In the past,, the print media has been criticised
with the old sexist images— the stereotypes and the
for: (1). Neglect of women’s, issues in coverage and
backpage pin-ups.
The high visibility of the women’s question in the comment; (2) Perpetuation of sex-role stereotypes;'
mass circulation glossies and dailies however has
’
to and .(3) Sexual exploitation of women’s bodies.
The second and third charges remain as valid
This article is based on the author s research
today as they were before the start of the Women’s
for a longer report to be published by the
Decade. On the face of it, the first charge doesn’t
Centre for Educational Documentation, Bombay.
seem to hold water anymore. Indeed, there is a
“Equality before law“
“Power and visibility of Women'9
“Pak feminists fight for equal rights99
“Laws don't deter crimes on Women"
“Diverse nature of Feminism"
MAINSTREAM March 26, 1988
31
■
School of thought among some sections of both opts for a ‘mix’ that sells. Where women are con
readers and also media people that what they are cerned, this mix once contained exclusively sexist
getting today is an overdose of the women’s question. fare. Now there is an added component — serious
Certainly there is enhanced coverage today, but is reportage on women — because the women s ques
this coverage totally wholesome? Does.it give no tion is ‘in’.
This lack of editorial perspective and the absence
cause for anxiety? Does it present the real and the
complete picture? And is it in one with the aspira of a clearly defined‘code’ or policy results in odd
phenomena like: Militant feminist features in
tions of the women’s movement?
The next two sections (‘Subversion’ and Media Sunday magazine section of the Indian Expn
and the Movement’) will try to examine some of while the Monday-morning musings of its editorial
the questions flowing from the legitimation of the staff in the city notebook columns of the different
women’s question as seen in media’s spotlight women editions include snide items deriding ‘the libbers’.
Sympathetic analyses of women’s issues in the
questions which go beyond the undoubted sexism
inherent in media’s stereotyping and sexploitation features columns of The Times of India and The
of women. So much has been written about sexism Hindustan Times, while the ‘ third edit in the
in the media that I shall not try to define or describe papers is often a sarcastic take-off on some aspect
it here. To keep this article to a manageable length, of the women’s movement. Informative articles on
a content-analysis of the women’s magazines and women-and-law on the edit page of Newstime while
sexist cartoons are regular fare in the Sunday
women's pages will also not be attempted.
Even while giving generous space and coverage magazine section.
A telling example of what might be described ;
to women’s issues, the general media subverts the
the
‘pantomime-horse’ syndrome (where the front
women’s question in a variety of ways. It does this
doesn't
know — or care — what the back is doii
subtly as well as blatantly through: (1) Contradic
comes
from Sunday. The June 8, 1986 issue of
tory images; (2) Selective coverage; (3) Reinforce
ment of traditional values; (4) The operation of Sundv had a detailed report on ‘the unwanted girl
‘news values’; (5) Hostility to feminism; and (6) child’, very sympathetic to the feminist perspective
on the campaign in Bombay against misuse
The use of‘humour’.
Consider the following examples. Sunday (April of amniocentesis and the questions raised by
26,1987): Khushwant Singh’s Gossip, Sweet and women’s groups regarding the newer sex-choice
earlier, the
Sour’ (Women, Haslinis and Poets) has a typical technologies. Barely three months c
snce
March
16,
issue
of
the
same
journal
in
its
Singh comment on women’s anatomy. But the same
and
technology
’
section
had
a
typical
issue also has a six-page special report on atrocities
against Indian worn n, which includes interviews objective’ medical viewpoini piece on the
technologies, written with the air of announci
with activist groups and lawyers.
Gentleman (May 1987): The Notebook’ column exciting new advances and without the smalics
has light-hearted items on: Ershad’s second wife; attempt to place these scientific advancements in a
Miss India’s participation in the Miss Universe social context. The headline: an exuberant ‘It’s a
contest; ‘Love is Bigamous’ — on actress Jayaprada s Boy!’ And as far as I know, the magazine did not
marriage to an al ready-married man; and the love publish the letter by the Forum against sex-deter
life <k ‘seductive’ dancer Leena Das. In the same mination tests, Bombay, protesting against the tone
issue, ‘The Sexes’ column has a serious piece by of the science and technology piece.
As can be seen from the above examples, con
Femina editor Vimla Patil, while the ‘People page
tradictory
images cast much doubt on the credibility
has a profile of an award-winning feminist journalist.
of
media
’
s
apparent espousal of the women's cause.
India Today (July 1, 1979): The Globe-Trotting
column has an item on Ursula Andress and Jane
O
Fonda — one fighting a court case against her
C
ome
issues
get
written
about
but many others don't.
builder for faulty construction and the other tor a
Some
issues,
like
population
policy, are covered
seat in the California Arts Council. The headline
reads ‘Women’s Lip (Sic): Sex symbols to the without incorporating the women's perspective.
fore’. The illustration shows a topless Andress. Some issues, whose larger implications are relevant
Neither the headline nor the p:cture have anything to women all over the country, are often reported
to do with the news. This is an all too familiar and only in the local press and are considered to be of
frequent ploy to rate a comment here, but for the ‘local’ significance only by the media. For example,
fact that the same issue has a special. report on the the controversy over the DDA’s announcement of
do’-iry system — well-researched, interview-based, compulsory joint ownership of flats never got beyond
giving details of some cases and the comments of Delhi papers.
“Dowry deaths and rap? are staples for the media.
leadinc activists in the capital.
Reporters
told an activist, whose organisation takes
The point is this: Except for the left-oriented
progressive journals and papers, where women s up issues like minimum wages, that such issues are
issues are written about as part of an editorial policy not ‘interesting’ to write about. (Why don't you
to tfocus on all socially relevant issues, the general take up cases like dowry and obscene posters?) Even
media, despite its coverage on womens issues, the dowry/rape staple tends to be sensationalised in
doesn't really have an overall editorial perspective or a manner which either serves to titillate the readers
a committed and ethical stand on the women s or de-sensitise them.”
Or take the women-and-law topic which attracts
question. Like a consumer product, the mass media
32
I
•
instant media attention. Judgements on marriage,
divorce and dowry are obvious ‘news’ and are
quickly followed by a ponderous edit. But judge
ments related to, say, employment, don’t attract the
same interest and may get written about only in
papers where there is a regular ‘legal column’. Even
this is not quite the same as the paper itself taking an
editorial stand on such issues. Edits on the Shah
Bano, conjugal rights, and Stridhan verdicts were very
predictable. But how many edits were there on such
- landmark cases as C.B. Muthamma's petition against
discriminatory IPS rules? Or the Kerala High Court’s
strictures against the Karunakaran government for
its bias against recruitment of women?
At the time of writing, the Bombay High Court’s
judgement on ‘night work’ for women working in
bars has aroused no editorial comment so far. Ban
on night work has been a complex issue for women
all over the world and there is much debate on
whether it is a discriminatory law or a necessary
piece of protective legislation. The pros and cons of
this subject figure in feminist research and in the ILO
journals, but for the general media, commenting on
a topic like this not only means having a distinct
perspective but also delving into the social science
background. Simpler and safer, then, to stick to
rape and dowry and perhaps marriage and divorce.
It is only when there are individual writers, both
staffers and freelancers, who have an ideological
commitment, that some of these neglected issues and
aspects get written about. Some current issues on
which the media by and large has not taken an
editorial stand are: adverse effects on women of free
trade zones which apparently increase women’s emp
loyment prospects; anti-woman nature of government
policy on the new reproductive technologies; guar
anteed equal-pay employment for all women; hotels
for working women; creches at work sites for work
ing mothers; missing women’s dimension in the new
child-survival strategies...It is a long list, and the
best way of identifying topics ignored and overlook
ed by the general media is to take a look at the
parallel feminist media, some of the UN journals,
‘and the left-wing periodicals, where a range of topics
of concern to women are written about with percep-'
tion
and1 Jdepth.
*
Consider the following headlines:
“Motherhood at home front is exciting”
“Being away from family isn’t good”
“Women prefer happiness to career success’’
“Women in workplace unhappy”
“They prefer to be housewive”.
All these are headlines from The Hindu. Many of
the items have been reproduced by arrangement with
foreign newspapers. If The Christian Science Monitor
publishes an article on women preferring mother
hood or the dilemmas of working women, you can
be sure that The Hindu will reproduce it.
However, social change is never smooth or
problem-free. In India and in the world, where
women are questioning old roles and values, they are
bound to face conflict. They know this and they
don’t need The Hindu or any other paper to go on
and on about it. To focus exclusively on “the
problems of liberation”, as it were, and imply that
MAINSTREAM March 26, 1988
the old values serve women’s interests better is
reactionary but not untypical of the establishment
media. Successful feminist struggles too get features
in the foreign press but would The Hindu dream of
reproducing these items? This newspaper with its
regular backpage homilies from religious discourses
on the sacred duties of the ideal wife, and along
with its ‘thing’ for motherhood, selectively reinforces
and endorses traditional values while apparently
focussing on the women’s question. Its somewhat
tepid coverage on, say, women construction workers,
or an occasional didactic piece on dowry are
examples of a conservative newspaper’s cautious
efforts to step with the times while remaining care
fully within its self-defined patriarchal limits.
Like the ongoing series on “Women bosses” in
Newstime's Sunday section, a fair amount of the
enhanced coverage on women is devoted to the
women-can-make-it to-the-top formula. The ingre
dients are usually: a scientist, a judge, an IAS officer,
and perhaps a glamorous ad agency chief executive
thrown in for good measure. There are two pitfalls
in this phenomenon: One, a shifting of attention
from the social system while propagating the womentoo-can-succeed message. And two, when such
interviews become the staple of the women’s maga
zines and the women’s pages of the dailies, they
result in ghettoising and downgrading women’s
achievements. Most of the time such interviews
are superficial and lack the perspective which could
make them meaningful.
News values tend to subvert the movement parti
cularly in the way feminist “heroines” are played up.
While feminist struggles and analyses of issues are
low priority for writing about, feminist celebrities
are not.
Germaine Greer is good copy, as is her sex life,
especially for the Khushwant Singhs of the media.
(See Sunday, Gossip column, February 22, 1986).
Writing about her, or reproducing large chunks of
her famous books, Sex and Destiny, (as Sunday and
The Illustrated Weekly did-in 1984), also gives a
chance to have a dig at the movement as a whole —
by taking some of her statements out of context and
using these as evidence of a massive ‘retraction’ by
the most feminist of them all. Gloria Steinem writing
about Marilyn Monroe is ‘news’. And much mileage
can be got from the feminist-writes-on-sex-bomb
formula (The Sunday Observer, December 28, 1986).
News values tend to operate in a way that is
counterproductive to the aims and efforts of the
women’s movement — by distoring the reality of
women’s lives and giving a false picture of what the
movement is all about.
Media’s treatment of the women’s question can
be summed up in the dictum: “Selective coverage
of women’s oppression, yes, but feminism, no’’.
Sympathetic reportage on- injustices does not imply
endorsement of feminist struggles against these. It
is quite predictable for an article on innocent girls
in West Bengal jails to have an intro: “In India
women are the weaker sex, often destined to bear
the cross of neglect and exploitation...” This is from
The Illustrated Weekly (July 5, 1987), whose anti
feminist stand has been both explicit and implicit —
33
study which revealed that many successful women in
the USA are sinsle because of a shortage of suitable
partners. Or the heading “Danish women die of
liberatian” from the same paper (August 18, I98o).
This is an item on suicide rates among women in
Denmark where, despite ‘libleration’, women face
many problems at home and work. In both cases
hjEDiA's hostility to feminism has to be seen in the headings give an unwarranted start to an objec
a
whole.
the context of media sociology as
tive news report.
Umpteeb studies by media researchers in the West
Unattractive images of feminism are, of course, a
have shown that whether the issue is racism of classism, media acts to preserve the status quo and to1 result of media's distorted understanding of the
reinforce the dominant values of society. Feminism, women’s question. Feminism misunderstood is one
by going to fundamentals, and questioning deeply reason for feminism misrepresented by the media.
entrenched and accepted ‘givens’, is a threat to the Such hostile stereotyping will persist unless the
comfortable patriarchal order of which the media media people make a conscious effort to put aside
people both men and women are themselves a part. their pre-conceived notions about bra-burning
Though, like all ‘decent’ folks, they abhor dowry libbers, and get acquainted, through social science
research and analysis, with feminist theory and
deaths, rape and atrocities on helpless women.
“So, while reporting on the more blatant and practice.
visible’forms of exploitation, and acknowledging
Cartoons which trivialise the issues taken up by
that injustice must be fought, the media’s attitude is women (as opposed to cartoons which use satire as
that feminism is not the way to go about it. But a- tooL
tool ro
forr social comiiicuy
comment) a«c
are legion in the media.^
then it is feminist groups who are exposing and Especially pernicious is the Indiannotes column of
Today
waging struggles against oppression and so report- ^ndia
- - • which, through
----- u text and cartoons, has
age^on them and their campaigns, through distor persistently reduced the most serious news items
tions in headlines and texts, creates new stereotypes on women’s struggles to cruel jokes, in appallingly
and conveys the message that feminists are extre bad taste even by India Today's own not very exact
mists who reflect the opinion of a small minority; ing standards.
most women themselves don’t want radical change,
‘“Third edits’ in papers like The Times of India,
women are their own enemies; feminists are anti The Hindustan Times, and occasionally the Indian
male, anti-motherhood and pro-free-sex, etc, etc.
Express have used a very laboured brand of humour
Media sociology has shown that rebels against to comment on out of the way news items, using
the established order get depicted by the media as these as a handle to mock the movement. Topics
anti-social and as ‘deviants . Feminism as deviant
like wages for housework or high bride price in
behaviour is portrayed through snide references Gulf countries are meat and drink to these edit
to a bra-burning-brigade and labels like libbers , writers. (Interestingly, the same papers also have
always used in a derogatory sense. Or through edits expressing disapproval of dowry deaths and
descriptions and headings which contradict the female foeticide, and hailing landmark jungements.)
substance of a piece of news.
Time was when it used to be The Statesman which
Fbr example, take this mocking reference in 'The indulged in edit-page humour on women, but today
Illustrated Weekly's ‘Idiot Box’ column (February one finds that this paper frequently has edits with
15 1987) to activist Indira Jaisingh as “the nre-spitt- a distinct women’s perspective, and often comments
ing, crusading lady lawyer.” The item is about Ms. editorially on issues ingnored by the edit writers in
Jaisin”h’s petition in the Supreme Court against other papers. (I remember in the early 80s, whenever
Dodrdarshan for cutting out crucial portions of I came across a ‘freak’ news item on women, the
her comments on the Muslim Women s Bill. The kind that is always ‘boxed’ and put in bold type, I
point here is that the Weekly itself has devoted would tell myself, ‘here’s material for a Statesman
much space to analysis and comment on the Shah third edit’, and sure enough it would appear, three
Band issue. The Weekly also likes to project itself days later, snide heading, sly dig, puns and
as a crusader against government authoritarianism all.)’’
and censorship. Logically it sought to be making a
Analysis with a feminist perspective particularly
complimentary rather than a tongue-in-cheek refer of complex issues, generally exists in feminist
ence to someone taking a courageous action on journals and in the left-wing media, and to a far
both these issuer (Can you, for example, imagine
lesser extent in the mainstream media. When the
the Weekly making this kind of a snide reference to, feminist perspective does find its way into the
sav columnist Romesh Thapar, who too had filed a general media, it is usually because of the presence,
petition protesting against the way government is within the staff, or as freelancers, of writers, who
usinCT the official media?) Not only does the language are committed to the feminist cause and are con
used" in the item trivialise and water down the sciously trying to bring important issues to the atten
importance of the petition, it tends to nulli.y the
tion of a larger readership.
Weekly's credibility as a champion of causes.
While many papers had edits on the new code
’ " women in the media,
articled widfa tbminist analysis of its loopholes and
of India, June 8, 1987). The item quotes a research t-------- .
despite the fact that it has focussed on important
women's issues as diverse as Muslim Personal Law
and amniocentesis.
34
i
shortcomings have come from feminist writers, either
active in the movement or in close touch with it.
(Incidentally, The Times of India heading (May 11,
1987) for the news announcing the Code was: “No
more baring of women on TV’’ — expressing an
almost wistful regret on the part of the sub-editor
concerned that semi-nudes are henceforth out.)
Or take the massive response by Maharashtra’s
women farmworkers to Sharad Joshi’s call at
Chandwad. All the papers reported it, but only a
few commentators-in the Express, Sunday Magazine,
(November 23, 1986), The Statesman s ‘Women’s
World’ column (November 29, 1986) and in the EPW
(November 22, 1986) came up with an understand
ing of the wider implications of this rally and the
limitations of Sharad Joshi's radicalism. The
Finacial Express news report (November 11, 1986)
had a typical*‘Women-up-in arms’ heading.
©
T mentioned earlier the sociological fact of mass
x media inevitably serving as an instrument to main
tain the status quo. Because of this characteristic of
the mass media al! over the world, a host of small
journals and newsletters have emerged brought out
with difficulty by struggling progressive groups, low
on funds and facilities, and taking up issues ranging
from health, environment and women, to the
nuclear question, the peace movement and questions
concerning minorities and the oppressed everywhere.
The birth ard growth of the parallel media — and
this includes the feminist media — is a comment on
the inadequacies of the mainstream media in serving
the cause of progressive movements everywhere.
However, progressive groups all over the world
are also alive to the importance of using the mass
media to raise and widen consciousness and for
the specific purpose of influencing official policy and
stimulating official action. The women's movement
too needs to keep in mind this role of mass media. A
critique of the media is the refore, not an end in itself,
but the basis for understanding the how and why
of media’s responses, and working out strategies for
change. And change has to be initiated from both
within and without. Some questions may be raised
in this context for which the answers are neither
straight-forward nor simple.
Today there are writers, both male and female,
within the media, who support or are sympathetic to
the feminist cause. Are there ways by which they
could influence decision-makers to adopt a more
committed editorial perspective and policy in cove
rage of women’s issues? Are there already examples
of such initiatives — which could be shared with
others and used as a model? Can these progressive
elements within the media get journalists’ unions
to draw up a code, as for example has been done in
Britain and Australia? Do such codes help at all?
Does the Press Council have a role?
Outside the media, feminist writers and women’s
groups have had mixed experiences in using the
media. While this has partly been due to media's
MAINSTREAM March 26, 1988
hostility to feminism, there are other aspects which
activist groups could perhaps seriously look at, as
part of a strategy to use the media more effectively.
To name only a v^ry few: writing terse and timely
press releases and short snappy reports explaining
the rationale and salient points of the issues which
they take up; acquiring media skills themselves and
writing about issues which media tends to neglect
or ignore; sustained feeding of information to sympa
thetic elements in the media so as to set right the
present skewed coverage.
“A word about feminist writing may be in order
here. Some of it is so loaded with polemics and
ideological jargon that a reader is surely tempted
to simply turn the page. Much of it is in a social
science-research report style which makes for tough
reading even in an academic journal and is painfully
unreadable in the general media. Feminist writers
are quite rightly trying to use the mass media for
consciousness raising. But they can’t do this unless
they are persuasive and they can't persuade unless
they communicate in the first place.”
Conscious efforts by a handful of change agents
inside and outside the media appear to be the only
hope for making any dent on media's distortion of
the women's question. Left to itself the media
will continue to pay lip service to women’s issues: ’
sensational reports on women as victims, nestling
cheek by jowl with the soft porn and stereotypes:
‘Good’ women who swear by motherhood and the
somewhat ‘bad’ ones who will continue to be
described in headings as ‘eves’ who are either ‘up
in arms’ or ‘on the warpath’. When they are not
indulging in ‘sexual politics’ that is, or wallowing
in the ‘feminine mystique’.
Even the Patriot with its very positive perspective
on women has on occasion indulged in mindless
‘instant headings’, and has published the Punjab
government’s extremely objectionable ads pushing
laparoscopy in the most unethical manner. Sexism
occasionally rears its head in The Gambols comic
strip as it sometimes used to in a few of Mickey
Patel’s front-page pocket cartoons.
For example, on ‘Night Work’, there was one
informative article by a freelancer in The Times of
India ‘Features’ section (July 17, 1987) and one
comment in The Lawyers (May, 1987). The
Statesman had an edit (March 27, 1987) as well as
‘Women’s World’ piece (March 30, 1987) criticising
Zail Singh's vicious attack on women who ‘refuse’
to breast feed. The issue did not arouse editorial
comment in the rest of the media.
One may mention here the need also for conscientising those at the receiving end of media’s
distortions that is, the readers’. Len Masterton
(Teaching the Media, Comedia Publishing Group,
1985) writes that ‘media education’ is one of the few
instruments for empowering the public to challenge
‘the inequalities in knowledge and power’ between
those who manipulate and manufacture informa
tion and those who guilelessly consume it as news
or entertainment.
(Courtesy: Countermedia)
35
TT^A^^^LA^T- .A cT ’
"
■
KA RN.Al' A KA
No.JJF^ 44 PTD 95
■ /
s-f
riKi
4>-5:.y
J
•
Karnataka Government Secretariat,
M.S. Bull ding
J
Banga 1. □ re, Bated.:j26-2-199<1.
notification-
In supersession of the earlier orders issued in this regard
/
-.V'and
/
r
in exercise of the powers conf^ipred by Clause(b) of
sub-section (4) of Section 9 of the Transplantation of Hur.ian
Organs, Act 1994,. (Central Act 42 of 1994) the Government of
’’‘'•..Karnataka hereby re-const it utes with immediate effect and
until further orders an Authorisation Committee for the l-'Tio ]. e
■State, consisting of the following members
namely
1. Secretary to Government,
Law Department,
V idhana Soudha,
bangalore.
Cha irman
i
i
2. The Director,.
Health
Family Welfare Services^
BANGALORE.
f
Me nib er
■
I
1'T
3. 'The’Professor with
Sp;ecilisation in Nephrology or
‘•Urtd.ogy*.
■ h. 1 ( ’ •
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Member
By order and in the name of the’
Governcj<r of KaVnataka,
h'
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7.^--
1
An
( J. SRlNf/ASAN)
''
b..|
)
Under Secretary to Government,
y. Health .w Jjhinily Welfare Department.
To:
T
Compiler, Karnataka Gazette, Bangalore for publication
h the Gazette Extra-Ordinary, and to supply 25 copies to
the Health
Riniily Welfare Department.
WeP ire ctor , Health
Family Welfare Services, Bangalore.
^^The Director, Medical Education, Bangalore.
pC) The Secretary to GoverXm -t, Law Depart:lent, Bangalore.
T ho N ep hro 1. og iot , 7icv
il Hospital, Bangalore.
x5) All the Teaching Hospit ■ l.s in the State G through the
Director 'of Med i
’’
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I
. \
V
\
2
7) All the Autonomous Bodies/Institutions.
-
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■
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■
’8) All the Private Hospitals in the State (through
• iJDPrect ion of Health C: Family ’Welfare Services, Bangalore)
hSr/rvl p
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.9) The Private Secretary to Secretary to Chief Minister,
'V idhana ’ Soudha , Bangalore.
•
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?•' ■ ■'
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•
•
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7'"
10) Private...Secretary to Minister for Medical Education',
V idhaha^'Soudha, Bangalore. ■ '
’
11) 'Private Secretary to Minister for Health
Family i"elfare,
widhana Soudha, Bangalore.
1 2) ' B .A. to ' Secretary,/ Deputy Secretary( JIealth)/Depaty Secretary
(jM.E.),
(M.E.), Health A Family ’-Yelfare
"elfare Department.
1 13) S. G. File/Spare Copies.
14) Press Table.
.r
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[pha-ncc] Fw: Please consider signing on to letter against sex selection in the US
Subject- [pha-ncc] Fw: Please consider signing on to letter against sex selection m die US
Date: 11111, 8 Nov 2001 09:47:28 +0530
From: "masum" <masum@vsnl.com>
Organization: MASUM
To: <pha-ncc@yahoogroups.com>
— Original Message —
From: Rajani Bhatia
To: masum@pn2.vsnl.net;in
Sent: Wednesday, November 07, 2001 7:52 PM
Subject- Please consider signing on to letter against sex selection in the Ub
November 7, 2001
Dear friends:
variety" in their families.
around the world.
ssSxSBSSSSsrr:
iSSSSTrn
tt is for identification purposes only Organizational endorsements imH appear in bold.
----- -
We intend to send this letter to the ASRM, and wil make it available to the media If you have any VJ®5*'0"5 or
concerns, please contact Tania Simoncei at taniaegenetics-and-society.org or Shamita Das Dasgupta at
shamitadas@hotmail.com.
For background information, see Gina Kolata, "Fertiity Ethics Authority Approves Sex Selection," New York Times,
Sept 28, 2001.
Thanks for your support.
Sincerely,
Rajani Bhatia, Committee on Women Population and the Environment
Nahar
Alam, Andolan
NaharAtam,
Marcy Darnovsky, Center for Genetics and Society
\
Shamita Das Dasgupta, Manavi, Inc.
Judy Norsigian, Boston Women's Health Book Colective
Tanfa
Tania Simoncei, Center for Genetics and Society
J:
&
io v—
ri'‘ '"7^'
r-
November x, 2001
1/
I
OS-'
J. Benjamin Younger, M.D.
Executive Director
r i. j
American Society for Reproductive Medicine
1209 Montgomery Highway
&
dr),
G C- M
11/9/01 10:5—
X
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4i-Select How it works
Subject: Gen-Select How it works
Date: Mon, 3 Dec 2001 16:42:59 -1-0530
From: "SROBONA ROY CHOUDHURY" <SROBONA@THEHTNDU.CO.IN>
Organization: THE HINDU BANGALORE
To: sochara(^vsnl.com
GEN-SELECT
How It Works:
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as it is intricate. ±t is tne utilization ana application or tnis
scientific knowledge that makes Gen-Select so special. Similar servic
available in highly specialized gender selection laboratories around t
world that require the couple to come to them and at a cost of up to
$10,000.00 U.S. dollars per conception! Gen-Select and The Fully Inte
Program is the only product of its kind in the world that comes direct
you at a fraction of the cost and is to be used in the privacy of your
home 1
n-Select utilizes only those scientific principles that have been sh
dependent laboratory and clinical studies to influence pre-conceptio
gender selection, The Fully Integrated Program is the culmination of
efforts to create a product that effectively utilizes these principles
is at the same time simplistic to perform at home, Outlined below is
simplified overview of some of these principles utilized by The Fully
Integrated Program.
Nutriceuticals:
A unique component of The Fully Integrated Program is the gender speci
nutriceuticals. Clinical trials published in the International Journa
Gynecology and Obstetrics have shown that the differential consumption
specific univalent and divalent cationic elements can greatly influenc
gender of subsequent conceptions. These elements are found in variable
concentrations in both the seminal fluids from the male and in the flu
the female reproductive tract. They are known to influence the allost
properties of enzymatic systems and also influence the chemotactic
ncoperties of the unfertilized egg. The scientists at Gen-Select have
ilized this knowledge to carefully formulate separate gender specifi
nutriceutical supplements that include these specific univalent and di
cationic elements. Furthermore, these elements are then combined with
appropriate vitamins and herbal substracts that increase their
bioavailability. Our proprietary formulas help to ensure that the
appropriate allosteric and chemotactic influences are generated within
around the unfertilized egg, thus creating the strongest bias possible
successfully accomplishing a conception of the requested gender. All a
of The Fully Integrated Program are enhanced by their use. These
nutriceuticals are produced in U.S. FDA approved facilities utilizing
guidelines to ensure both the safety and efficacy of this product; a
fundamental priority followed during the development of this product!
Ovulation:
Conception can occur only after the female has released an egg from he
ovary; a process known as ovulation. Once this has occurred, the egg
then only capable of being fertilized over the next few hours. Strong
<3
-i-Select How it works
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12/4/01 10:09 AW
evidence exists whicn snows fnat tne ratio ot viable ”i" carrying (mal
sperm and ”X” carrying (female) sperm differ in concentration in the f
reproductive tract depending upon when they were deposited. Subsequen
knowing when ovulation will occur and when it has occurred is very
important. Coordinating this event with the timing of intercourse is
not only important for conception, but is also very important in the
pre-conception gender selection process.
Gen-Select takes advantage of natural signals that indicate the variou
stages of the ovulation process. A U.S. FDA approved ovulation predic
utilized to predict when ovulation will occur. These predictors are o
98% accurate and are calibrated to be 35% more sensitive than that req
by the 2nd International Standard.
Additional assistance in determining when ovulation will occur and whe
has occurred is obtained by detecting the biphasic basal body temperat
shift. There is a surae in the level of estradiol oroduced by the fem
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fall. Once ovulation occurs, there is a surge in the production of
progesterone, which leads to a rapid rise in the basal body temperatur
This ’’biphasic" temperature pattern signals that ovulation has occurre
Once again, Gen-Select uses this information to coordinate the timing
intercourse with the remainder of The Fully Integrated Program.
Accurate monitoring and charting of the basal body temperature is made
possible with the digital thermometer provided within the kit. Easy t
^llow instructions are provided that outline when and how to use the
armometer along with simple charting instructions. Charting of the
body temperature is performed on a daily basis throughout the entire p
and often provides the first indications that a conception has occurre
Vaginal Environment:
The first obstacle that the sperm encounter on their journey to fertil
the egg is the secretions within the vagina. Scientists have shown th
carrying (female) sperm have a survival advantage in acidic secretions
”¥” carrying (male) sperm have a motility advantage in more alkaline
secretions. Furthermore, the viscoelastic properties of the mucopepti
secreted within the cervical mucus are highly dependent upon both the
the fluid and on the electrolyte content. By altering these parameter
selection bias for either the
sperm or ”Yn sperm can be created,
scientists at Gen-Select developed gender specific vaginal douches tha
advantage of these properties to further augment the effectiveness of
Fully Integrated Program.
u.et:
It is well known by scientists that the composition of an individual’s
can strongly influence the outcome of natural bodily processes. Gen-Se
takes advantage of this knowledge by providing specific dietary guidel
that work in conjunction with the gender specific nutriceuticals to he
alter the concentration of critical elements in the males’ and females
reproductive fluids. When utilized with the remainder of The Fully
Integrated Program, our dietary guidelines greatly augment the
pre-conception gender selection process.
The Fully Integrated Program is the culmination of our efforts.
f3
Each
12/4/01 10:09 AM«
-n-Select How it works
of the program has been shown to have a significant effect on pre-conc
gender selection. By combining these aspects together and appropriate
coordinating their utilization, the maximal effect on pre-conception g
selection is achieved. Gen-Select now brings all aspects of The Fully
Integrated Program to you, the consumer, in an easy to use kit. Simpl
follow the instructions provided and you will be well on your way towa
achieving the chosen gender of your next child.
Helps to deter foeticide
Our legal team has researched the legal issue to the fullest. We are f
LIFE! We are aware of India laws and let us assure you that we are not
violation of any.
In reference to the India law: Act #57 of 1994, reference ’’The Pre-Nat
Diagnostic Techniques (Regulation & Prevention of Misuse), Gen-Select
not violate this enacted law .
is act is to provide for the regulation of the use of pre-natal diag
techniques for the purpose of detecting genetic or metabolic disorders
chromosomal abnormalities or certain congenital malformations or sex 1
disorders and for the prevention of the misuse of such techniques for
purpose of pre-natal sex determination leading to female foeticide, an
matters connected there with or incidental thereto.
***Our product does not utilize diagnostic techniques nor does it have
purpose any claim to diagnose or treat any disease process or disorder
any kind. It is not intended for the prevention of sex-linked disorder
either. By definition, our product does not involve any pre-natal port
the pregnancy. There is no termination or destroying of life what so e
Our product is a pre-conception product and is subsequently not govern
provisions addressing pre-natal concerns. (The pre-natal term of a pre
begins following conception!)
This product has received tremendous support from ethicist as it lends
itself to the prevention of foeticide. Our product is a pro-life produ
such, the Catholic Church has endorsed this approach to gender select!
...e most resounding point that exempts our product from the above prov
is again that it IS NOT A PRE-NATAL PRODUCT, and subsequently does not
violate the wording or intended spirit of the Act.
To further reassure you about any safety or liability concerns, Gen-Se
has already secured substantial product liability coverage which invol
very in-depth scrutinization of all aspects of our product.
if 3
12/4/01 10:12 AM-
S3H- S'
HEALTH POLICY AND PLANNING; 11(2); 117-131
© Oxford University Press 1996
Review article
Complications of unsafe abortion in sub-Saharan
Africa: a review
MNIE BENSON/ LOW ANN NJCHOLSON,' LYNNE GAFFrKIN^ AND STEPHEN N KINOTP
a study in I994 t0 document
X"^Snent °f that StUdy' and “
most common complications of unsafe abortion seen at PpaIthS
are6
9Ynaec°lo9Y admissions. The
porttng a woman's decision to abort or use contraception were similariv lacVnn Ar.in!
Background
In November 1993, the 21st Conference of Health
Ministers for East, Central and Southern Africa
(ECSA) was held in Maseru, Lesotho. At this con
con-
ference, (he Health Ministers adopted a resolution in
which they identified unsafe abortion1 as a major
cause of maternal morbidity and mortality in the
region (Kinoti et al. 1993). In addition, the Ministers
recommended specific actions to address the problem
of unsafe abortion in member countries.
.’ n SUP‘
As a next step, the Commonwealth Regional Health
Community Secretariat (CRHCS), in collaboration
with JHPIEGO and IPAS, undertook a study in 1994
to document the magnitude of abortion complica
tions in Commonwealth member countries2 and
sub-Saharan Africa (SSA) as a whole. The study
involved two components: 1) a literature review on
abortion in SSA covering the years 1980-1994, and
2) primary data collection in three Commonwealth
countries (Malawi, Uganda, Zambia)3 to yield more
118
Janie Benson et al.
recent findings. The results of both components of
that study form the basis of a reference document
entitled Monograph on Complications of Unsafe
Abortion in Africa* (henceforth referred to as the
Monograph).
This paper presents the results of the literature review
component of the CRHCS study, discussing the find
ings of the research that has been conducted to date
and identifying gaps in the research that require fur
ther study. Programme and policy implications of the
findings obtained through this study will be presented
in another article to be published at a later date.
Literature review methodology
The literature review involved two complementary
activities: 1) a computerized search for published
literature using numerous bibliographic databases and
2) a manual search for any ‘unpublished’ documents
(referred to as gray literature in the Monograph and
throughout this paper) available in the Common
wealth member countries on abortion. Ultimately 99
published and 169 gray articles were identified and
annotated; many other articles were identified, but
they were either irretrievable or were submirted too
late to be annotated. The published literature con
sisted primarily of articles presented in peer review
journals and books (or chapters of books) catalogued
by the Library of Congress. The gray literature in
cluded articles from other journals (i.e. those not
peer-reviewed/indexed), meeting proceedings,
reports, official country papers, legal briefs, news
paper articles, student theses, etc.
The main criteria for selecting documents were that
they be published between 1980 and 1994 (or written
during (his time for the gray literature), and that they
reflect research conducted in, or information gathered
on, one or more SSA countries. Under these criteria,
the following documents were deemed most relevant:
hospital- and community-based epidemiological
studies; studies focusing on provider attitudes toward
and experiences with abortion and/or post-abortion
patients; studies focusing on women’s perspectives
on the quality of and access to emergency abortion
treatment services; studies examining men's perspec
tives on the problem of unsafe abortion; studies
documenting the social and financial costs of abor
tion; studih demonstrating programme linkages be
tween treatment of abortion complication services and
other reproductive health services; clinical studies
documenting the safety and effectiveness of different
abortion treatment modalities; and articles covering
the general legal situation.
Computerized searches were carried out using select
key words (see the Monograph, Annex 8, for a list
of the keywords used) on the following databases:
SCIMATE, a bibliographic cataloguing software used
by IPAS; POPCAT, a cataloguing software used by
the University of North Carolina Population Center;
MEDLINE, a clinical and medical database main
tained by the United States (US) National Library of
Medicine and accessed through the MEDLA
system; Dissertation Abstracts International, whu .
catalogues masters’ theses and doctoral dissertations
of US students, accessed through the computerized
DIALOG system; SOCIAL SCISEARCH, which
catalogues social science research articles and is also
accessed through DIALOG; and POPLINE, which
features population and family planning articles and
is maintained by the Johns Hopkins University/CCP/
PCS/PIP. Overview articles and commentaries were
generally not annotated; however, the reference pages
of these documents were reviewed to identify addi
tional literature for inclusion in the monograph (see
the Monograph, Annex 7, for a list of the overview
articles which were reviewed to identify relevant
literature).
The Africa-based search for gray literature engaged
the services of Institutional Scientific Officers (ISOs)
in 10 (of the now 13) CRHCS member countries. The
ISOs searched the following data sources for relevant
gray literature: dissertation files of medical schools
and university social science departments; Ministry
of Health (MOH) documentation files; health/population research institute libraries; national family plan
ning programme document lists; and other nation
archives where documents on the problem of unsafe
abortion might be maintained in each country.
Each of the 99 published and 169 gray literature ar
ticles was annotated and entered into ProCite version
2.1.1, a computerized bibliographic software pro
gram, using a standard bibliographic format (see the
Monograph, Annex 9, for details on the bibliographic
format used). Following the annotation process, all
Monograph documents were classified into 6 topic
areas: 1) magnitude of unsafe abortion (including
socio-dcmographic characteristics of women ex
periencing the problem); 2) clinical issues; 3) cost
issues, 4) contraception and abortion (including post
abortion family planning services); 5) male perspec
tives; and 6) abortion laws.
Complications of unsafe abortion
In this article, only the major findings and general
trends identified for each subject area arc presented.
Published articles are noted and discussed individually
only when their methodology(ies) arc so unique or
innovative, and/or their findings are so dissimilar
to those found in the other studies for that subject
area, that the article warrants special attention.
Additional or contrasting information provided by
the gray literature is incorporated as appropriate.
These findings are presented below, along with an
assessment of the quality of the published literature
an''
identification of gaps in the available research
res
Results
Magnitude of unsafe abortion
Forty-two published articles documented the
magnitude of unsafe abortion in SSA. Almost onethird of these articles were from Nigeria, the rest
coming from countries scattered throughout the
region. Most of the research was conducted in
hospitals (e.g. record reviews, interviews with
women admitted for treatment of complications of un
safe abortion), and the gray literature, on the whole,
supports the findings reported from the published
literature. In several published studies, researchers
focused on patients with complications of induced
abortion, and therefore, they attempted to distinguish
between these cases and those with spontaneous abor
tion. The criteria and methods used for differentiating
between-categories, however, were often unclear in
these articles. In other studies, incomplete abortion
cases or deaths resulting from complications were in
vestigated, without distinguishing between induced
or S’- 'aneous abortions.
Since this topical area is so broad, we further sub
categorized these articles as follows: mortality and
morbidity statistics, patient characteristics, and pro
vider characteristics.
Mortality and morbidity statistics
Reliable statistics on the incidence of abortion and
associated morbidity/mortality were difficult to ob
tain as variations existed in the way abortion statistics
were defined or calculated. Two measures that were
calculated most frequently and consistently in the
literature reviewed were maternal mortality rate
(MMR)5 and the proportion of maternal deaths
attributable to abortion complications (i.e. propor
tionate mortality rate). The overall MMR cited in the
ng
published articles ranged from 1.18 to 9.6 maternal
deaths per 1000 live births (Mhango ct al. 1986;
Yoseph and Kiflc 19886), with the majority falling
between 2 and 6 per 1000 live births. The pro
portion of maternal deaths attributable to abortion
ranged from 2% in Nigeria7 to 54% in Guinea8
(Chukudebelu and Ozumba 1988; Toure et al. 1992).
t
Two studies, a household survey conducted in
Ethiopia (Kwast et al. 1986) and a combined review
of hospital and community deaths in Guinea (Toure
et al. 1992) are notable because of their community
orientation. The Ethiopian study9 found that com
plications of abortion were the leading cause of mater
nal mortality in the population surveyed, accounting
for 54% of the direct obstetric deaths and 29% of all
maternal deaths. The Guinean study reported that
15% (see endnote 7) of the hospitals’ maternal deaths,
and an additional 54% (see endnote 7) of the mater
nal deaths in the community, were due to abortion
complications. These statistics are higher than those
obtained from the majority of hospital-based studies,
most of which reported a range of 18-28% for
abortion-related maternal deaths. These figures high
light the possibility that the MMRs reported in the
majority of the literature represent only the ‘tip of
the iceberg’ and that population-based abortionrelated mortality is likely to be higher than hospital
based figures indicate.
Contributing causes of abortion-related mortality
cited in the literature included: delay in seeking
care; lack of drugs and other supplies; provider
technical/clinical error in treating complications of
unsafe abortion; problems in patient management
(e.g. high patient/staff ratio); and administrative re
quirements to obtaining legal abortion procedures
(Kampikaho and Irwig 1991; MacPherson 1981;
Mhango et al. 1986; Megafii and Ozumba 1990).
Sepsis and haemorrhage were often cited as impor
tant major complications of unsafe abortion and were
the two main clinical causes of abortion-related deaths
indicated in every study reporting this statistic.
Patient characteristics
In the literature reviewed, adolescents were overrepresented among those presenting with complica
tions of unsafe abortion. In one Kenyan study, for
example, 5% of septic patients were under age 20
(Aggarwal and Mali 1980). Two Nigerian studies,
also of septic abortion patients, found that 61% and
75% of the patients were adolescent girls (Adetoro
1986; Adetoro et al. 1991, respectively). A third
120
Janie Benson et al.
Nigerian study found that 61 % of the patients treated
for complications of induced abortion were adoles
cents (Omu et al. 1981). Given the predominance of
young women among incomplete abortion cases, it
is not surprising that numerous studies also found that
many abortion patients were unmarried (Chatterjee
1985; Archibong 1991; Okonofua et al. 1992; Ag
garwal and Mati 1980; Baker and Khasiani 1992) and
were of low parity (Chatterjee 1985; Okonofua et al.
1992; Nichols et al. 1984).
Overall, the educational status of women having ex
perienced an abortion was difficult to compare due
to differences in the classification of school levels and
the populations studied (e.g. adolescent versus all
abortion patients). However, several studies discussed
the consequences of unwanted pregnancy and unsafe
abortion on a woman’s education (Lampley et al.
1985; Adetoro et al. 1991). For example, research
on Nigerian adolescents with septic abortion found
that over 50% of the young women had been expelled
from school because of their pregnancy (Adetoro
et al. 1991).
Only two published studies attempted to quantify the
socioeconomic status (SES) of women who had
undergone abortion. One study, from Zambia, found
that 53 % of women seeking an abortion were of low
or middle SES (Chatterjee 1985). The other study,
also from Zambia, found that over half the women
who died from an induced abortion were of high or
average SES (Mhango et a). 1986). Many other
published studies, however, mentioned that abortion
patients were of low SES. A gray literature document
suggested that women of low SES are more likely
than women of middle and high SES to self-induce
abortion or to seek care from unskilled providers
because of the high cost of and lack of access to
higher quality abortion services (International
Planned Parenthood Federation 1994).
Abortion patients represented a large percentage of
total gynaecological admissions in several of the
hospital-based studies: 28.4% in one Nigerian study
and 60% in e^ch of two studies from Kenya and
Nigeria (Omu et al. 1981; Aggarwal and Mali 1982;
Adetoro et al. 1991, respectively). Many women in
these studies reported having had a previous abor
tion. .Many of the studies also found that for most
abortion pntients, knowledge, cvcr-usc, and current
use of contraception were low (Chatterjee 1985;
Adetoro 1986; Archibong 1991; Okonofua et al.
1992). Almost all of the studies found little use of
contraception prior to the index pregnancy, with the
exception of one article from Zimbabwe (Crowther
and Verkuyl 1985). In this study, contraceptive
failure had occurred in 18% of the patients treated
for abortion complications. Of these, 44% had been
using oral contraceptives.
Only one study examined the effect of being human
immunodeficiency virus (HIV) positive on the incid
ence of pregnancy wastage and low birth weight
(Grass et al. 1992). This Tanzanian study compared
groups of women presenting with spontaneous abor
tion and those presenting for delivery. The investig?
tion found that infected women had increased rat
of both these indicators compared to non-infectea
women, which contradicts the results of similar
studies conducted in the US and Europe where no
negative pregnancy outcomes were found.
Women’s reasons for seeking abortion were discussed
in several studies (Archibong 1991; Bleek 1981;
Huntington et al. 1993). These included inappropriate
timing of the pregnancy, fear of expulsion from
school, financial difficulties, and uncertainties about
the partner.
Provider characteristics
Several studies indicated that women seeking care for
complications of unsafe abortion had sought their
abortion outside of the hospital from traditional
healers and chemists. However, two Nigerian studies
found that among those women presenting at hospital
for treatment of induced abortion complications. 32%
and 18% of them had had their abortion performed
by a medical practitioner (Okonofua et al. 1992;
Archibong 1991, respectively). In yet another
Nigerian study, almost one-third of the illegal ter
minations were performed by physicians, wit’
two-thirds of the deaths in the last year of the stud
occurring in women who had obtained an abortion
from a physician (Adewole 1992). Interviews with
Kenyan nurses showed that they had limited and in
correct knowledge about safe methods for inducing
abortion, the safest gestation period, and possible
associated complications; however, 11 % admitted to
having performed an abortion (Kidula et al. 1992).
Assessment of literature
The published studies provide a wealth of descrip
tive, primarily hospital-based information about (he
magnitude of the problem of unsafe abortion in the
region (e.g. epidemiological rates and/or ratios) as
well as characteristics of abortion patients and
i
I
i
Complications of unsafe abortion
information about providers. In general, the findings
indicate that women seeking care for abortion com
plications represent all women of reproductive age
(i.e. married and single, young and old. low and high
parity). Although the published literature reported
that young, often unmarried women comprise a large
percentage of abortion patients treated in hospitals,
this finding reflects, in part, that many facility-based
studies are conducted in urban teaching hospitals
where single women, some still in school, are likeiy
to seek treatment.
In
iral, the studies, mostly cross-sectional in
natu._, appeared to be well designed although there
were differences in the definition of unsafe abortion,
as well as in the methods for measuring outcomes,
which made it difficult to compare and contrast find
ings. Measurements of maternal mortality based on
hospital-based data should be interpreted with caution
because of built-in selection bias associated with such
study groups. In some studies, the total number of
abortion patients (N) and/or deaths studied was very
small.
Few longitudinal, case-control and intervention
studies were described to yield estimates of risk.
Similarly, the proportion of maternal deaths attrib
utable to abortion complications varied by the popula
tion studied and other factors. However, the findings
all point to a similar trend; that is. abortion-related
complications are a major contributor to maternal
mortality and morbidity in the region.
Clinical issues
Twenty published articles described clinicallyoriented investigations conducted in a number of SSA
coun*“"*s. The majority of these studies were from
Nig
;7) and Zimbabwe (4), and there was one
multi-centre study from the region. A variety of study
designs were used including retrospective record
reviews, case-control studies and clinical trials. Both
the gray and the published literature addressed tradi
tional methods for inducing abortion.
Approximately half of the articles specifically ad
dressed complications and treatment. Several reported
on serious injuries resulting from poorly perfonned
abortions. For instance, a Nigerian study found
that the mortality rate among 11 septic abortion pat
ients with bowel perforation was high, at 64%
(Megafu 1980). Another retrospective review of 647
septic abortion patients in South Africa found that
6.5% had undergone laparotomy. 5.4% had had a
121
hysterectomy, and 1.8% had died (Richards et al.
1985). Haemorrhage, shock, sepsis, cervical and
vaginal lacerations, uterine and visceral perforations,
tetanus, thromboembolic complications, pelvic in
flammatory disease (PID), and infertility were all
complications noted in the published and gray
literature. Another two articles reported on the use
of antibiotics to treat abortion complications (Abudu
et al. 1986; Seeras 1989).
The sequelae of unsafe abortion were the focus of
a multi-centre study supported by the World Health
Organization (WHO). This study (n = approximately
5800) attempted to determine the extent to which sex
ually transmitted diseases (STDs), PID, and postpartum/postabortion infections are associated with
bilateral tubal occlusion (BTO) in infertile couples
(WHO 1987). In Africa, the authors found a stronger
association between the occurrence of BTO and the
number of previous live binhs than between BTO and
the number of previous abortions. For all regions
studied, the researchers found that STDs and preg
nancy complications affect the magnitude of the
occurrence of BTO and other infection-related infer
tility; however, they found that the most widespread
problems occur in Africa.
Nine studies focused on various clinical techniques
for inducing abortion. Of these, two studies described
the use of PGF2o for legal mid-trimester induced
abortion (Guidozzi et al. 1992; Rogo and Nyamu
1989), one reported the findings of research on
misoprostol (Cytotec) for inducing abortion (Bugalho
et al. 1993), and 6 evaluated the use of manual
vacuum aspiration (MVA)10 for the treatment of
incomplete abortion. Numerous other studies reported
on the use of alternative, including traditional,
methods for terminating pregnancy.
Both of the studies that reported on the use of PGF,a
involved extra-amniotic instillation of the prosta
glandin; however, their results differed markedly.
The South African study (n=319) (Guidozzi et al.
1992) reported complication rates five times higher
than those reported in other studies involving suc
tion termination, yet the Kenyan study (n=58) (Rogo
and Nyamu 1989) reported no major complications
and low rates of minor complications. The Mozam
bique study on the use of intravaginal misoprostol
(n= 169) found the drug to be at least as effective as
other prostaglandins for pregnancy termination bet
ween 12-22 weeks gestation, independent of patient
characteristics (Bugalho et al. 1993).
122
Janie Benson et al.
Six studies evaluated the use of MVA" versus sharp
63.6% had inserted an object into the vagina, and
curettage in the management of abortion complica
48.2% had used traditional herbs (Kidula et al. 1992).
tions. A prospective study in Zambia (n = approxi
Traditional Yoruba healers (n=106) were found to
mately 13 000) concluded that MVA improves
have used even more questionably effective methods
services, as measured by better quality of care,
of inducing an abortion, including medical soap or
more efficient patient flow and lower levels of pain
cream, sacrifice, consultation of the oracle, and
control, resulting in the ability to provide post
scarification (Oyebola 1981).
abortion family planning services immediately
following the procedure (Bradley et al. 1991). One
Assessment of literature
descriptive study in Nigeria (n=375) (Ekwempu
The clinical research highlights the negative health
1990) and a randomized study conducted at a Kenyan
consequences of unsafe abortion when not performed
hospital (n=585) (Kizza and Rogo 1990) both found
by skilled providers in hygienic conditions - seps
short hospital stays (significantly shorter in the
haemorrhage, and sometimes death. The researc..
Kenyan study) to be a benefit of the MVA techni
on MVA as a technique for uterine evacuation was,
que. A longitudinal study in Zimbabwe (n=1423)
in general, of high quality. In most of the investi
revealed MVA to be more effective than sharp curet
gations, both safety and effectiveness of the two
tage. as measured by statistically significant lower
techniques were assessed, the number of cases was
rates of uterine re-evacuation; the same study found
large enough to make valid generalizations, and
MVA to be more acceptable to patients, as measured
two of the studies - intervention in nature - involved
by less reported pain and lower rates of infection and
random assignment to MVA or sharp curettage
other post-procedure complications (Mahomed et al.
groups.
1994). Another Zimbabwean study (n = 357) found
lower mean intra-operative blood loss and higher
The quality of the other clinical studies varied,
mean haemoglobin levels at follow-up among the
however. For instance, the two studies on
MVA versus the sharp curettage group (both find
PGFjGuidozzi et al. 1992; Rogo and Nyamu
ings were statistically significant) (Verkuyl and
1989) were descriptive and did not compare the use
Crowther 1993). Finally, the use of MVA for per
of this drug with dilation and evacuation for mid
forming menstrual regulation (MR)12 procedures
trimester procedures. The studies involved different
was assessed by a Kenyan study (n=223) (Oyieke
sample sizes and different populations which could
1986). The author found this evacuation technique
explain, in part, why the authors’ conclusions dif
to be quick and to result in low blood loss and
fered so much. The study on the use of the prostaglan
high rates of complete evacuation (96%), with very
din Cytotec (Bugalho et al. 1993) had no control
few immediate complications. All of these studies
group and the results, therefore, should be viewed
recommended that MVA be more widely used for
as exploratory until further research can be con
treatment of incomplete abortion and legally available
ducted.
Other studies examined women's and providers’
use of alternative abortion methods. A Burkina Faso
study (n=61), for example, found that schoolgirls
had used a wide variety of alternative methods for
inducing abortion, including: modern chemical com
pounds (such as indigo, potassium permanganate, a
-U-tablet dose pf chloroquine, and large quantities of
instant coffee powder); traditional chemical com
pounds (such as leaves, roots and large quantities
of honey wjith no other food for several days); in
addition to r lodcrn methods (such as medical abor
tion) (Gdrgdn cl al. 1993). The most dangerous
method mentioned was swallowing beer-bottle glass
gtotmd into mortar. Among nurses who admitted to
having performed an abortion for another person in
the past (n=[2l8). 82.1% had used medications.
Cost issues
Cost-related issues were mentioned in many of the
published articles reviewed for this monograph
(Johnson et al. 1993; Konje et al. 1992; Fig&Talamanca et al. 1986; Omu et al. 1981; Archibong
1991; Okonofua et al. 1992; Aggarwal and Mali
1982; Binkin et al. 1984; Aggarwal and Mati 1980;
Bradley et al. 1991). Brief descriptions of the cost
of obtaining an induced abortion, the average length
of stay for women treated for abortion complications,
and the time needed to perform an evacuation pro
cedure were among the points cited. Only three
published aitides, however, focused primarily on
health care facility costs associated with abortion
complications (Johnson et al. 1993; Konje et al. 1992;
Figa-Talamanca et al. 1986).
Complications of unsafe abortion
The first study, conducted in Kenya, found that the
average length of stay was markedly shorter for those
patients treated with MVA versus sharp curettage
(76% shorter in one hospital and 49% shorter in a
second); the reduced patient stay resulted in lower
hospital costs, and most likely, reduced loss of poten
tial patient earnings. This same study found that the
cost of treating incomplete abortion patients with
MVA was much less than that associated with sharp
curettage. The average cost per sharp curettage
patient in one district hospital in Kenya was US
$JC
when MVA was used the cost decreased by
6
to US $5.24). These cost reductions reflected
decreases in the amount of resources used such as
staff time, bed space and pain medication to treat in
complete abortion patients.
The second study, carried out in Nigeria in the 1980s,
found that abortion patients presenting with sepsis
remained in the hospital an average of 26.4 days, and
that average treatment costs for a septic abortion
patient (at the time of the study) were US S223.11
(Konje et al. 1992).
Another Nigerian study, conducted in the 1970s,
reported an average stay of 10.5 days for patients
treated for complications of induced abortion and 7.5
days for treatment associated with complications
of spontaneous abortion (Fig^-Talamanca et al.
1986).
Only one gray literature article addressed the cost
issue. A Tanzanian study estimated the mean cost
of obtaining an induced abortion at US $22.00; this
compared to an average patient monthly wage of
US SI2.50. In addition, the study found that it cost
the hospital an average of US S7.5O per patient to
tre
ortion complications compared to an annual
MU., per capita budget of US $1.00 (Mpangile
et al. 1992).
Assessment of literature
Very little information exists on the cost of treating
complications of unsafe abortion, although many
authors speculated that this service consumes a
disproportionate amount of scarce hospital resources.
Most of the published literature that did discuss cost
issues focused on the average length of stay.
The Kenyan study was the only one to describe
methods used for calculating costs (Johnson et al.
1993). This gap should be addressed in future
research so that the soundness of methodologies used
can be assessed.
123
Contraception and abortion
Of the 15 published articles reviewed which focused
on the relationship between contraception and abor
tion (including post-abortion family planning ser
vices), more than 60% were from Nigeria. The
remainder had either a regional or country focus,
including Kenya, Tanzania, Uganda and Zaire.
In more than half of the articles, adolescents were
the primary study population. In most of these
studies, data were collected through school-based
interviews using either self- or intervieweradministered questionnaires. The remaining articles
focused on all women of reproductive age. Three of
these involved the use of hospital-based patient in
terviews, two involved community-based interviews,
and another involved interviews with traditional
healers. The remaining two articles were a review
of findings from the World Fertility Survey (WFS)
and Contraceptive Prevalence Survey (CPS) for
various SSA countries, and a commentary on un
wanted pregnancy.
Although a variety of methodologies were used, the
majority of the adolescent studies aimed to examine
adolescents’ knowledge, attitudes and practices
associated with contraceptive use and abortion.
Several studies found a high number of adolescents
to be sexually active (Agyei et al. 1992; Nichols et
al. 1986; Lerna 1990) - up to 76% of non-student
male adolescents in one Nigerian study (Nichols et
al. 1986). Correspondingly, a fair number of
adolescents also reported having been pregnant;
25.6% in one Ugandan study and almost 50% of the
female student population in the Nigerian study
(Agyei 1992; Nichols et al. 1986, respectively). And,
a significant number of those who had become preg
nant had sought an induced abortion; 17% in the
Ugandan study, and almost all in the Nigerian study.
Contraceptive use varied widely in the literature
reviewed; a notable finding in the Nigerian study was
that sexually active females who had had an induced
abortion were less likely to be currently using con
traception than those who had never been pregnant
(Nichols et al. 1986).
Reasons given for non-use of contraception by
adolescents were similar across studies: fears about
the safety of contraceptives, lack of knowledge about
family planning and lack of access to services. In
terestingly, focus group results from Nigeria and
Kenya suggested that the adolescent respondents had
124
Janie Benson et al.
more accurate knowledge about and more positive
attitudes towards abortion than towards family plan
ning (Barker and Rich 1992). Another study found
a gender-related difference in attitudes toward family
planning or abortion. A Nigerian study of secondary
school students found that more female than male
students were favourable towards abortion while
more male than female students advocated use of con
traceptives to prevent abortion (Oshodin 1985).
Only one article focused on postabortion family plan
ning, examining the use of contraceptive methods by
unmarried adolescents in Nigeria following contra
ceptive counselling (Ezimokhai et al. 1981). This
study found oral contraceptive discontinuation rates
at the end of the 2 'h. year study period to be higher
(72%) among those women treated for abortion com
plications than among a similar socio-demographic
group of general family planning clients (50% discon
tinuation rate).
Many published studies examined attitudes toward
and use of contraceptive methods among all women
of reproductive age. One notable facility-based study
in Nigeria reported on pregnancies due to method
failure among family planning clients, and found that
less than 1 % of those interviewed had experienced
contraceptive failure (Ogedengbe et al. 1991).
Two community-based studies also provided insight
into contraceptive use (Olukoya 1987; Shapiro and
Tambashe 1994). In both studies, contraceptive use
was low and in the Nigerian study (Olukoya 1987),
70% of the women were using either abstinence,
no method, or relatively ineffective contraceptive
methods following their abortion. Interestingly, in
this study those women who had a history of abor
tion had a higher rate of previous family planning
use than the group as a whole.
The author of a retrospective review of WFSs and
CPSs concluded that abortion was being used to con
trol entry into childbearing or to change the starting
pattern of fertility, and therefore, did not indicate a
desire to limit fertility (Frank 1987).
The gray literature identified repeat abortion as a
problem. According to some researchers, most abor
tion patients had never used a modern method of con
traception. iclportcdly clue Io a lack of knowledge or
access tAlihonou 1993; Family Planning Association
ol Madagascar 1994). The authors recommended
intensifying liamily planning services for men and
women; expanding family planning services to
include a strong educational component, especially
for adolescents; liberalizing abortion laws; and
making safe abortion services more widely available.
Assessment of literature
Although the quality of the research varied, the studies
ind icated thatcontraceptive use is 1 imited. that induced
abortion is not uncommon, and that serious obstacles
remain to increasing the use of family planning
methods (e.g. misconceptions about the risks of con
traceptive use). One of the most striking findings i.c
the virtual absence of research on post-abortio.
family planning. Based upon the existing literature,
serious gaps remain in our understanding of the
relationship between contraception and abortion.
Male perspectives
Only one published article, an opinion survey of male
Nigerian undergraduates studying in the US. focused
specifically on males’ perspectives toward abortion
(Adebayo and Nassif 1985). Almost two-thirds (64%)
of the males surveyed for this article stated that they
were opposed to abortion, and an additional 17%
were uncertain. Those with fewer children and those
with no male children were significantly more likely
to be against abortion, while those who were unmar
ried were more likely to favour abortion. The authors
concluded that values and opinions acquired in one’s
own culture are often preserved, despite exposure to
Western culture.
The gray literature, although limited, was able to pro
vide some additional insights into the role of men in
the decision to terminate a pregnancy. According to
one study from Tanzania, 30% of the women seek
ing treatment in public hospitals for complications or
unsafe abortion became pregnant by casual partners.
12% of the married women became pregnant by men
who were not their husband, and 31% of the
teenagers (17 years and below) became pregnant by
men age 45 or older (Mpangile et al. 1992). Findings
such as these support the contention that spousal
authorization for post-abortion services could be a
significant barrier to access and timely care (Arm
strong 1987). Post-abortal psychological support from
the male partner often was found to be lacking,
although a number of studies indicated that male part
ners usually pay for the woman’s care.
Assessment of Iit e rut n re
The paucity of literature on male perspectives on
abortion underscores the need for additional research
r
<
H
■
*
Complications of unsafe abortion
on this topic. The one published article that was
available was methodologically weak due to the lack
of baseline or other comparative data and problems
in how questions were worded. The gray literature
(and references to male involvement in articles
covered in other topic areas) does seem to indicate
that male partners are not actively involved in deci
sions related to how and where the abortion procedure
is performed, except perhaps to provide financial
support.
Ar
on laws
The relationship between abortion and the law was
examined as the primary focus in 18 published
studies, although numerous studies reviewed in
the other topic areas recommended legal reform to
help address the negative health consequences of
restrictive laws. Seven articles were on abortion laws
in South Africa, three were on Nigerian laws, four
had a regional perspective (e.g. Commonwealth or
Francophone Africa), and the remaining focused on
laws in individual countries (including Botswana.
Mauritius. Swaziland, Tanzania, Zambia, and
Zimbabwe).
Abortion laws in many SSA countries trace their
origins to English or French legal codes (Cook and
Dickens 1981; Knoppers et al. 1990). They are
therefore generally restrictive, allowing legal abor
tion only tor a narrow range of indications such as
saving the life of the woman. In addition, some laws
include procedural requirements, for example, con
sultation with more than one medical professional,
committee approval, etc. Of note, the author of over
views of the Nigerian abortion law pointed out that,
des
v"-“r~ 'he existence of such laws, authorities in that
cou
were reluctant to prosecute medical practitioners for performing abortions
------ or women
------ ,for
w.obtaining them (Okagbue 1988; Okagbue 1990).
Law reform was recommended in many of these
articles so that the legal code for abortion reflects
* a public health rather than a criminal orientation. Sug4 gestions for reform included: clarification of current
« law; broadening the indications for legal abortion;
w removing the liability for women who seek, and
providers who perform, abortions; and clarification
of the requirements for health facilities offering
pregnancy termination. One author noted, however,
that methods used for fertility regulation before
pregnancy can be confirmed (i.e. before ‘quicken
ing - usually 12 to 14 weeks after the LMP) can
125
already be legally introduced into Commonwealth
countries based upon a strict interpretation of the law
(Cook 1983).
Three published articles, two from South Africa and
one from Zambia, commented on the administrative
requirements and other conditions which create bar
riers for women seeking abortion. One study argued
that the restrictive bureaucratic regulations of the
1975 South African Abortion and Sterilization Act
have resulted in lower access to legal abortion ser
vices for black South Africans who live in the poor,
more rural, areas where the appropriate medical pro
fessionals are not available (Sarkin-Hughes and
Sarkin-Hughes 1990). In support of this statement the
authors note that 78% of legal abortions performed
in 1984-5 were for white women. This argument is
further borne out by the second South African article
which reported on the experience of a hospital
psychiatry department in providing referrals for abor
tion on psychiatric grounds (Nash and Navias 1983);
over a six-year time period, only 10 black women
were referred for psychiatric reasons compared to 919
white women and 328 coloured women.
The Zambian article explained that even though
abortion is legal in that country, burdensome ad
ministrative requirements and the provision of legal
abortion services in only one teaching hospital in the
whole country, limit women’s access to safe services
(Castle et al. 1990). The result is that many women
resort to unsafe abortions to terminate their
pregnancies.
In addition to articles on the legal situation in SSA
countries, two published articles reported on the
opinions of South Africa's gynaecologic and psy
chiatric professional societies on the country’s
abortion law (Dommisse 1980; Nash et al. 1992).
Although the studies were conducted about 10 years
apart, the majority of both groups (over 80% of the
gynaecologists and 89% of the psychiatrists)
supported changes in the law. Large percentages of
both groups supported pregnancy terminations in
populations such as the very young (e.g. under 14
or 16) or older women (e.g. over 40), those experi
encing failed contraception, or those of high parity
(e.g. 6 or more). Just over half of the psychiatrists
and 32% of the gynaecologists supported abortion on
request.
In addition, three published opinion pieces presented
various arguments for maintaining or liberalizing
126
Janie Benson et al.
restrictive abortion Jaws. Several authors indicated
Table 1. Lessons learned from a review of studies on (he com
that, although few abortion cases are actually proplications of unsafe abortion in sub-Saharan Africa
SefUuted’ th°Se that are tried in court have a major
inhibiting effect on other women in terms of seeking
safe abortion services.
• Abortion procedures performed in an unsafe environment or
Legal advocacy efforts within SSA countries were
also well documented, with four published articles
offenng accounts of efforts to reform abortion laws
in individual countries. A South African activist
described the (unsuccessful) efforts of an advocacy
group to pressure the government to approve firsttrimester legal abortion on request (Cope 1993).
Legal reform efforts in Mauritius (unsuccessful) and
Botswana (ultimately successful in the early 1990s)
were also presented in separate articles (Muvman
Liberasyon Fam 1988; Mogwe 1992, respectively),
nie success of the effort in Botswana is notable, given
that the imbetus for change came from medical pro
fessionals rather than from women’s or human rights'
organizations. In another document, a Nigerian
gynaecologist argued that restrictive laws encourage
clandestine abortions which are performed by poorly
trained practitioners working in unsanitary conditions
(Ladipo 1986).
Assessment of literature
Numerous articles addressed the fact that legal abor
tion is restricted to a very limited set of circumstances
m the region. In most instances, the published
literature on legal issues was well-referenced and
helped to place abortion laws in the region in
histoneal and legal context. Although using different
methodologies (e.g. reviews of legal and ad
ministrative codes, opinion surveys, descriptions of
advocacy efforts) and writing from a variety of
^rspectives, virtually all of the authors concluded
at res nctive laws negatively affect women's health
primarily because clandestine, unsafe abortions occur
m greater numbers in such environments
Conclusion
Much is already known about the negative conse
quences of unsafe abortion, and providers and pro
gramme managers should be continually striving to
apply that knowledge in order to improve the quality
o their servjcbs (see Table I). At the same time, there
is still much no learn about the complications of un
safe abortion and many of these issues arc now
presented hek w as recommended lor future research
m (his field.
by an unskilled provider are a major public health problem:
arc responsible for a large proponion of maternal morbidity
and mortahty: and affect women of all ages, ethnic
backgrounds, educauonal levels, and marital arrangements.
* C°?P’iC,ati°nS of unsafe abonion affcct women in the prime
of their lives; result from unsafely-performed induced abor
tion procedures, including self-induced abortion: can be severe
enough to cause infertility, chronic illness, or death; and can
be managed trough the use of a technology which is safer
than and as effective as sharp curettage for uterine evacuati
- manual vacuum aspiration.
• Treatment of complications of unsafe abortion consumes vast
amounts of scarce monetary and human resources. These
resources can be more efficiently utilized through improvements
in treatment services and provision of preventive health care.
* ^TfCly indUCed aborTions are th« inevitable consequence of:
high numbers of sexually active adolescents; extremely low
levels of knowledge about family planning among all women,
especially concerning safe, modem contraceptive methods: lack
ot access to modem contraceptives: and low continuation rates
either caused or exacerbated by fears about family planning
method safety as well as the absence of routine post-abortion
family planning services.
Opinions of males, as partners, practitioner;, and policy makers,
are critical m determining women s access to contraceptives
and safe treatment services, in addition to women s continued
ettective family planning use; yet men's perspectives have
remained virtually unstudied.
National laws that are overly restrictive or that require stringent,
compbeated administrative approvals prior to receiving care
needlessly restnet women s access to safe abonion procedures,
thus fostering the proliferation of unsafe, clandestine abonions.
Context of abortion research
Over the last 15 years, abortion research in suboaharan Africa, as well as in other regions, has been
influenced by a complex set of factors. United States
government policies which restricted funding for
abortion-related activities, the sensitivity of the topic
in many regions of the world, and the methodological
difficulties inherent in conducting high-quality
research about clandestine abortion have all con
tributed to notable gaps in our understanding of the
issue. 1 he fact that a sizeable body of published and
unpublished literature exists from sub-Saharan Africa
is testament to the magnitude of the problem and the
Mgmlicancc of ihc issue to health and other profes
sionals involved in the region.
Complications of unsafe abortion
Recent changes in the policies of the United States
government, along with those of many other govern
ments, coupled with a new focus on integrated
women’s reproductive health by the international
community, have resulted in a resurgence of research
about unsafe abortion. Methodological challenges
and suggestions for addressing them have been
described by various researchers (Barreto et al. 1992;
Coeytaux et al. 1989). New and modified
approaches for studying specific issues about abor
tion have been implemented in a variety of settings
(Huntington et al. 1993; Anderson et al. 1994;
A
'athy et al. 1993). While these and other
n.
xiologies will refine our understanding of the
factors associated with unsafe abortion, the sugges
tion that complications from unsafe abortion are a
major health problem in the region is well supported
from available evidence.
Research for the future
The most glaring gap in the epidemiological research
is the lack of knowledge about the magnitude of abor
tion complications at the population level; specifi
cally, the number of women who do not seek care
in public facilities because: 1) they only have minor
complications; 2) they cannot or choose not to seek
care in such facilities; 3) their complications have
been attended to through other channels (e.g. private
practitioners); or 4) they die before receiving medical
treatment. Community-based studies should be con
ducted to complement the wealth of hospital-based
data in order to gain a clearer picture of the true
magnitude of unsafe abortion complications in the
region.
Other facets of the problem of unsafe abortion must
als
studied. For instance, research on long-term
sequ^.ue of unsafe abortion (e.g. chronic disabilities)
and on special populations (e.g. adolescents, HIV
positive women) is needed. In addition, no studies
report on pain control and perceptions of pain from
the woman’s point of view. Clinical studies which
evaluate the effectiveness of different combinations
of pain control medications and abortion treatment
modalities are needed. Specifically, additional clinical
studies on antibiotic therapies for incomplete abor
tion patients is one area of recommended focus, given
the use, in many instances, of unsafe techniques to
induce abortion, and the high prevalence of sexuallytransmitted diseases among some populations of
women. This research should be complemented by
strengthening and disseminating international
127
guidelines on antibiotic use to assist clinicians in
the treatment of incomplete abortion and other
complications.
Aroothcr information gap relates to clinical practice
at the lower levels of the health care system. Carefully
controlled studies which examine uterine evacuation,
stabilization of patients, and referral by non-physician
providers at first-referral and primary-level facilities
would determine the feasibility of and methods for
bringing safe post-abortion care close to the majority
of women who need it. Finally, the infrastructural,
personnel and follow-up requirements for providing
induced abortion services (whether using MVA.
sharp curettage, or mifepristone), where legally in
dicated. should be evaluated so that safe, high-quality
abortion services can be expanded.
The paucity of literature on the cost of treating abor
tion complications makes this one of the most wideopen, potentially fruitful, areas for future research.
Investigations should examine system-wide resources
expended, including an analysis of opportunity costs
(e.g. long-term productivity losses due to morbidity
and mortality from unsafe abortion). The definition
of cost should be expanded to include measurements
of the psycho-social and economic costs to families
and communities as a result of abortion-related mater
nal deaths and disabilities. In addition, cost-benefit
analyses of interventions are needed; for example,
cost savings from the introduction of post-abortion
family planning or liberalization of the laws (which
would hypothetically decrease the number of late and
complicated abortions) could be examined.
Although the linkage of treatment of abortion com
plications and post-abortion family planning seems
a natural one - in order to prevent future unwanted
pregnancy - it is one that most researchers and
providers currently do not make. Studies on the effect
of post-abortion family planning programmes on
contraceptive acceptance, future contraceptive use,
unintended pregnancy rates and repeat abortion are
essential. Future hospital-based operations research
is crucial in order to identify the most effective ways
to link emergency treatment of abortion complica
tions and family planning programmes. In addition,
(he relationship between abortion and contraception
over time has not been well examined (e.g. what are
the contraceptive antecedents to an unintended or
unwanted pregnancy and subsequent abortion?).
Qualitative data collection methods would be appro
priate to examine women s fears about contraceptives
128
Janie Benson et al.
and the effect of an abortion experience on future con
traceptive use.
Studies on males as partners, providers, and decision
makers are also grossly lacking. Understanding males
as partners - specifically in terms of the decision to
seek an abortion, the level of emotional and economic
support offered to women seeking an abortion, the
decision to initiate and continue the use of contracep
tion, and how each of these may vary between mar
ried and unmarried couples - is crucial to improving
the reproductive health of women. In addition, males
in SSA are in the majority among practitioners who
provide (legal) induced abortions or treatment
services, and among policymakers who make deci
sions about the national priority given to women’s
reproductive health issues. Thus, a thorough under
standing of male perspectives on these issues, and
factors which affect male decision-making in these
areas, is critical.
While articles on the current legal environment
abound, studies on the impact of legal restrictions
and/or reform are needed. Analyses of the feasibility
of legal reform in a variety of political, cultural, and
Table 2. Action needed on the research agenda
religious settings, and studies on the impact of other
reproductive health laws and policies on women
who seek abortions should be conducted. For ex
ample, regulations that prohibit contraceptives for
adolescents or require spousal consent are particularly
onerous for those treated for abortion complications,
since they will continue to be at risk for a subsequent
unwanted pregnancy.
The need to conduct this research should not be used
as an excuse to delay decisions or actions, but rather,
the findings from the research should be constantly
used by managers and providers as a tool for assess
ing their programme options and management of then
services. Unsafe abortion has been clearly identified
and documented as a major public health problem
in the region. What is needed now are concrete
programmatic plans to address the problem, and
directed action on the research agenda (see Table 2)
to provide programme managers and providers with
relevant information to aid them in improving their
services in the future.
Endnotes
1 Unsafe abortion is defined as a procedure for terminating un
•
Document the magnitude of abortion complications at the
population level and determine the long-term sequelae of un
safe abonion.
•
Set up clinical studies to evaluate different combinations of pain
control medications and procedures; options for antibiotic
therapy and other treatment regimens; and provision of post
abortion care by non-physician providers.
•
Document work-years and income lost to abortion-related mor
bidity and mortality; health system-wide resources expended
on post-abortion care; and projections of the amount of
resources saved with increased accessibility to and use of
organized post-abortion services.
•
Conduct operations research on the integration of emergency
treatment with family planning services; decentralization of
p<>st-abortion care; organization of treatment services: and other
similar topics to address quality and accessibility of care.
•
t
Maternal Health and Safe Motherhood Programme, Divison of
Family Health, World Health Organization, p. 3).
Botswana, Kenya. Lesotho, Malawi, Mauritius. Namibia.
Seychelles. South Africa (added November 1994). Swaziland.
Tanzania. Uganda. Zambia and Zimbabwe. In May 1995. the
CRHCS changed its name io the East. Central and Southern Africa
Health Community (ECSAHC).
3 These three countries were selected for the primary data col
lection activities because they met a set of criteria outlined during
the planning phases of the study. These included membership as
one of the Eastern. Centra) and Southern Africa (ECSA) Com
monwealth countries, little abonion research conducted to date,
limited major research currently underway, and a situation of poten
tial
interest to the field. Specifically, Uganda and Malawi
Examine the social, cultural, and economic context within
represented countries where a limited amount of previous or cur
which induced abortion occurs, (he role of males as partners,
rent research was conducted: Malawi was also the site of the up
coming 1994 meeting of the Commonwealth Health Ministers
us service providers, and as policymakers; and the relation
ship between contraceptive use and abortion.
•
wanted pregnancy either by persons lacking the necessary skills
or in an environment lacking (he minimal medical standards or
both (World Health Organization. 1993. The Prevention and
Management of Unsafe Abonion: Repon of a Technical Working
Group. Geneva. 12-15 April 1992 (WHO/MSM/92.5). Geneva:
Prepare ca-e studies that describe experiences
experiences with
w ith the
the provi
provi-
sion of snfcl k'g;i| alvifiinn services in ci'initries wliere die abor
tion law has been libeialize.J tin <nder n> idenlilX constraints
and kssoiis learned).
where a draft of the monograph was to be presented; and Zambia
has a liberal abortion law which is unique in the rccion.
Kinoti SN el al. Monogruph on Complications of Unsu/'e
Abonion in Africa. Arusha. Tanzania: CRHCS. 1995
I he MRR is technic.illy a ratio hut historically has been lelerred to as a rate (Mnusncr J. Rahn A. 1974 ffndemiologv; An In
troductory Test
Philadelphia: WB Saunders Co., p. 195).
Complications of unsafe abortion
6 Over a two-year period. 60 maternal deaths were identified
(Mhango ct al. 1986): over a six-year period. 216 maternal deaths
were identified (Yoseph and Kifle 1988).
Of 239 maternal deaths over a five-year period, five were
attributed to abonion. The authors suggest that the low number
of abonion-relaied deaths is a result of under-reponing.
During the 12-month study period, 123 deaths registered in
health institutions and 11 community deaths occurred. Of these,
19 maternity unit deaths (15%) and 6 community deaths (54%)
were due to abonion complications.
Of pregnancies reported for 9315 women, 45 maternal
deaths occurred during the two-year study period. Twenty-four
of these were direct obstetric deaths. 13 attributable to abortion
complications.
10 MVA is a technique for uterine evacuation. The MVA instrutr
nsists of a portable, hand-held, single- or double-valve
syrinx
j an assortment of flexible plastic cannulae. The
instrument can be used for treatment of incomplete abortion and
induced abortion at 12 weeks gestation or less. In addition, MVA
can be utilized for obtaining samples for endometrial biopsy
(Greenslade -FC et al. 1993. Manual Vacuum Aspiration: A
summary of clinical and programmatic experience worldwide.
Carrboro. North Carolina: IPAS. p. ix).
11 It is important to note that in some of the studies. MVA was
used on women presenting at more than 12 weeks since their last
menstrual period (LMP). The package insert of the MVA kit clearly
states, however, that the Karman cannula and syringe should be
used only for uterine evacuations at 12 weeks LMP or less. IPAS
produces and distributes the MVA kits.
*• Menstrual regulation (MR). ‘This term refers to use of the
manual vacuum aspiration technique with a hand-held syringe
for termination in very early pregnancy and sometimes refers
to uterine evacuation when pregnancy has not been confirmed.’
[World Health Organization. Complications ofAbonion: Technical
md Managerial Guidelinesfor Prevention and Treatment. Geneva:
WHO. 1995)
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Acknowledgements
The Commonwealth Regional Health Community Secretarial
would like to thank Dr Winnie Mpanju-Shumbusho, Geoffrey J
KalF
Lawrence Gikaru. John Makalla. Mackey Manga, and
Jes<
lando. JHPIEGO would like to (hank Dr Noel McIntosh.
Dr r__. Blumenthal. Penelope Riseborough. Dana Lewison.
Elizabeth Oliveras. Jennifer Butler, John McGrath and Christine
Bicknell. A very special note of thanks goes to Natalie Maier,
Senior Evaluation Coordinator at JHPIEGO. for her invaluable
participation in and coordination of all aspects of this project.
IPAS would like to thank John Dorward. Veronica Williams. Jenny
McCartney. Rob Cringle. Shana Davis. Shirley Greer. Dr Forrest
Greenslade and Colleen Bridger. A special note of thanks goes
to Hannah KS Searing for her close work with IPAS on the
bibliographic annotation process. In addition, the authors would
like to thank Jane Cottingham, Dr Suman Mehta. Dr Mark Belsey,
Phyllis Gestrin. Bob Haladay. Lennie Kangas. Anne Wilson.
Suzanne Prysor-Jones. Peter Spain. Judy Brace, and Rhonda Smith.
Finally, thank you (o the Institutional Scientific Officers and (he
Ministries of Health of the Commonwealth member states for mak
ing (his project possible and for taking action on (he findings,
respectively.
131
Biographies
Janie Benson earned her Bachelor of Arts degree in Sociology and
Education from Trinity University of Texas in 1973. She earned
her Master of Public Health degree from the Johas Hopkins Univer
sity School of Hygiene and Public Health in 1984. Since earning
her masters' degree. Ms Benson has worked as a health educator
and patient advocate for Planned Parenthood of Delaware
(1984-1985): as a Population Fellow with The Population Coun
cil's Regional Office for Latin America and the Caribbean in
Mexico City, under the auspices of the University of Michigan
Population Service Fellowship Program (1986-1987); as a Pro
gram Manager for Latin America for The Pathfinder Fund
(1988-1990); and as Director of Health Systems Research for IPAS
(1990-present).
Lori Ann Nicholson earned her Bachelor of Arts degree in Music
and Business from the Honors College at Michigan State Univer
sity in 1990. She earned her Master of Public Administration/Public
Policy Analysis degree, with an emphasis in international health
and population, from the University of North Carolina-Chapel Hil
in 1993. Since earning her master's degree, Ms Nicholson has
worked as Research Technical Associate for IPAS (1993-1995).
Dr Lynne Gaffikin earned her Bachelor of Ans degree in An
thropology from the University of California. Berkeley in 1976;
her Master of Public Health degree in epidemiology from the
University of California. Los Angeles in 1980; and her Doctor
of Public Health degree in epidemiology and community health
from the University of Illinois. Chicago in 1988. Since earning
her doctorate. Dr Gaffikin has worked as a health information
system advisor for the Ministry of Health in Kenya and as Assistant
Research Professor for Tulane University School of Public Health
and Tropical Medicine. Department of Biostatistics/Epidemiology
(1988-1990); as a consultant to family planning programs for
Management Sciences for Health, John Snow, Inc., and Tulane
University (1990-1991); and as Associate Director and then Direc
tor of Research and Evaluation for JHPIEGO (1991-present). She
is also currently an Adjunct Assistant Professor at the Johns
Hopkins University School of Hygiene and Public Health. Inter
national Health Department, and the evaluation focal person for
the USAID Health and Human Resources and Analysis for Africa
(HHRAA) Project.
Dr Stephen N Kinoti is a medical doctor with specializations in
paediatrics and child health and international nutrition, and post
doctoral qualifications in epidemiology, reproductive health and
programme management in health. He earned his Bachelor of
Medicine and Bachelor of Surgery degrees from Makerere Univer
sity in 1973; his Master of Medicine specialist degree in Paediatrics
and Child Health from the University of Nairobi in 1978: and his
Master of Professional Studies in International Development Nutrition from Cornell University. New York in 1980. He has
subsequently held various positions, rising to the posts of Professor
of Paediatrics and Child Health in the University of Nairobi Medical
School, and the Director of the Medical Research Centre KEMRI
in Kenya. He is currently the Coordinator of Health Research for
the Commonwealth Regional Health Community Secretariat for
East. Central and Southern Africa.
Cnrrcspondeiice: Ms Janie Benson. Director of Health Systems
Research. IPAS. 303 East Main Street. PO Box 999. Carrboro.
NC 27510. USA.
- 'g
CAMPAIGN AGAINST SEX SELECTIVE ABORTION
^nLad c hldren: 111 DCaniala. 2nd Sbffly ^tunna. ^Itokkikiiliifu, Madurai - 625 002.
^Pliont & Cfr-aje. : 5304S6& 524762 f.-nuLiL:drdnuiu(°)h&iniad.eoni
Chennai: Qlu. lO-^kumar Qlngar, dZitllr Jltaunl^ Saidapri-, Qtirnnai 600 015.
(T>konr: 044 2353503 (^ax: 2355905
14lh February 2002.
Dear Friends
Greetings. Please find enclosed the minutes of our CASSA meet held in Chennai on 22nd
January 2002. Hope you are aware that CASSA had a workshop on PNDT Act on 22nd
January, to review the proposed draft amendment in PNDT Act.
Based on the
suggestions proposed by the participants, CASSA incorporated the relevant amendments
in the proposed draft amendment of PNDT Act. Please also find enclosed the summary
of the recommended amendments of CASSA.
Warm regards
Yours sincerely
izo /o-Q'yt-
(P PHAVALAM)
Convenor
Encl: as above
Ip -
A SUMMARY OF THE RECOMMENDED AMENDMENTS
TO BE INCORPORATED IN THE
PROPOSED DRAFT AMENDMENT
IN THE PNDT ACT BY MINISTRY OF HEALTH AND FAMILY WELFARE
■
The title of the Act should be re-articulated to explain the purpose of the Act in
an explicit manner.
*
There should be a direct penalty clause for disclosure of sex by the medical
practitioner and his/her agents.
■
There should be a direct penalty clause for non-maintenance of records
■
The referral medical geneticists who are referring the pregnant woman for
undergoing ultrasound scan/pre-natal diagnostic test/pre-natal diagnostic
procedure should maintain records comprising the details of the pregnant
women, reasons for such test/procedures and details of imaging specialists.
■
The complainant has a right over document related to violation of the
provisions of the PNDT Act from Appropriate Authority
■
Women should be considered innocent under all conditions
■
The certifying authority under sec 2(o) to be specified to avoid possible
misuse / foul play.
■
Appropriate Authority should always have the same power as vested in the
Civil Court under Civil Procedure Code, including while trying a suit.
•
The Chairperson of State Women Commission and the Director of
Prosecution of State should be included as members in the State Supervisory
Board
-
Immunity to the members of various bodies in the Act should be removed and
there should be penalty clause for non-compliance of/misusing/evading their
duties and responsibilities
■
Government should create public awareness about the Act and organise
gender sensitisation programmes with the implementing authorities and
various interest groups.
■
The pregnant woman should give in writing the conditions for which she
wishes to undergo the pre-natal diagnostic techniques on her.
■
Quorum for official and non-official members in Central Supervisory Board
meet should be made as fifty per cent
•
The State Supervisory Board should have the power to give permit to the
manufacturers of the pre-natal diagnostic technique including ultrasound
machine and pre-selection technique for the sale and distribution of the same
to the Genetic Clinics and Genetic Laboratories and the list of addresses of
Genetic Laboratories and Genetic Clinics should be provided to the State
Appropriate Authority and Central Supervisory Board periodically.
■
The registration fee and the amount collected through penalty should be
generated as Corpus Fund and should be maintained by the Appropriate
Authority for the effective implementation of the Act.
■
The Ministry of Health and Family Welfare can issue a GO to temporarily
suspend the registration
of clinic until the need for more such Genetic
Centres, Genetic Laboratories and pre-natal diagnostic techniques on the
basis of the population and prevalence of possible fetal abnormalities and sex
linked disorders, established on a scientific basis by the Medical Council or
any other independent competent body appointed by the Government.
Minutes of the Campaign Committee Meet
held at Gurukul, Chennai on 22nd January 2002.
The following members were present:
Mr. Thomas Jayaraj - CCRD, Ms N.Radha - LEAD, Ms Donna Fernandes &
Ms D.G.Sumathi - Vimochana, Ms Jesu Rethinam & Ms T.Annalakshmi Neythal, Ms M.Valli Gopal - SIGA, Ms A.lndirani - SNEHA, Mr. Ossie Fernandes
-HRF, Ms J.P.Saulina Arnold - TNVHA, Ms M.Essaki - PREPARE,
Mr. R.Nallathambi - VRDP, Ms R.Gayathri & Mr. A.V.Ugine - AREDS,
Mr. M.S.Jayachandrababu - Village Consumers Protection Council, Ms Bhavani
- WIDA, Mr. Jeeva - BIRD, Ms G.Shantha - DAWN, Ms P.Phavalam &
Ms A.Gandimathi - CASSA and Dr Sabu M.George
The agenda of the meeting:
-
Review of five months activities
■
Discussion on filing of case against ‘Genselect’
«
Implementation of UNICEF’s programme
*
Health Register - Data collection to be initiated
■
Booklet on CASSA’s three years activities
«
Possibilities of filing test cases by member organisations
■
Any other issue
The new members LEAD-Trichy, WIDA-Thiruvannamalai, Village Consumers’
Protection Council-Thiruvallur were introduced.
Review of five months activities:
The following activities of CASSA since last meeting was shared.
*
The convenor met the Chief Minister on 17th August 2001 and submitted a
memorandum requesting her to issue direction for the effective
implementation of the PNDT Act and expedite the process of registering the
clinics.
•
EKTA convened a two days regional level workshop on 6th and 7th September
2001, to prepare a State Level Policy on Women, in Salem, on behalf of
Department of Women and Child Development. In this meet, CASSA was
asked to speak and present a paper on “Issues Challenging Girl Children and
Role of Civil Society with special reference to Infanticide, Feticide and
responses of CASSA. Mr. Jeeva, a core-member of CASSA spoke on the
theme and circulated a paper.
■
Media Advocacy on the issue of female fetiicide was undertaken by the
convenor on September 19, through the programme Theriyuma Ungalukku
organised by Doordarshan.
«
CASSA extended material and ideological support to the one-day convention
of Sanagam Women organised by district-level networks of NGOs in
Pudukkottai on 21st September 2001.
*
The Ministry of Health and Family Welfare, Government of India circulated a
draft note on the possible amendments, to enlist the public opinion. A small
team of CASSA (Mr John Aruldass, TNVHA, Mr. Ossie Fernandes - HRF, Ms
K.Kalpana - TNSF, Ms Mina Swaminathan - ACCESS, Dr Sabu George, Mr.
M.Jeeva, Ms A.Gandimathi and Ms P.Phavalam) met on 6th October 2001, in
Chennai and reviewed the Proposed Amendment in PNDT Act drafted by the
Ministry. Our suggestion with the necessary amendment was sent to the
Ministry of Health and Family Welfare and Department of Legal Affairs for
consideration. Some of our suggestion were included in the final draft of the
proposed Amendment in PNDT Act.
*
Mr. Shanmugavelayutham of TN Forces and Ms Mina Swaminathan have
been selected as task force members of the Tamil Nadu Government
Planning Commission. As requested by Mr. Shanmugavelayutham, CASSA
sent a background note on perspectives, magnitude of the issue in Tamil
Nadu, strategies and the recommendations to be forwarded to the
government. We insisted the planning committee to include the issue of
female feticide in the terms of reference for action by the State.
■
The convenor and Ms Gandimathi met the Appropriate Authority on 13th
December 2001, in his office and discussed about the enforcement of PNDT
Act and registration of scan centres. Also discussed about the advertisement
came out in Times of India and in the Website and requested to take action
against it as it was a violation of Sec 22 of PNDT Act.
■
Zonal-level Consultation on 'Strategies for the Protection of Child Rights’ was
organised by LEAD, HRF and CCRD in Trichy, on 17th December. Phavalam
and Gandimathi on behalf of CASSA participated and spoke on the topic
“Promoting Children’s Rights to Health; Halting Female Feticide and
Infanticide’.
■
The convenor and Ms Gandimathi, a core-member of CASSA met the Health
Secretary in Theni on 21st December and requested him to expedite the
process of enforcement of PNDT Act. Shared the information about the
advertisement came out in Times of India and in the Website and requested
to take action against it as it was a violation of Sec 22 of PNDT Act.
■
CASSA received a letter from Joint Secretary of Social Welfare and Nutritious
Meal Programme Department on 8th January. We were asked to send base
papers on “Female Feticide Advocacy Role for Social Welfare Department”
for formulating the 10th Five Year Plan and the same was sent.
■
Pre-natal Diagnostic Techniques Act 1994 prohibits and misuse of tests which
are meant to detect fetal abormalities, for sex determination. However, the
medical lobby argues that it does not address pre-conception sex
determination techniques ranging from pills and potion to an assortment of
new reproductive technologies. Amongst them PGD is currently on offer. It
can identify male and female embryos during invitro fertilisation. The embryo
of the preferred sex is implanted into the womb. This has parked a wave of
protest from women right groups and health activists.
CASSA sent a letter to Dr Younger M.D., who is the Executive Director for
Reproductive Medicine. We mobilised signatures from the eminent citizens
and sent the same, pressurising them to take a policy stand to discourage the
use of pre and post conception sex selection.
■
CASSA brought out three posters on PNDT Act in Tamil
Discussion on filing of case against ‘Genselect’:
The convenor briefed the new sex selection technology, ‘Gen-Select’, which is a
pill-and-douche kit - the product of an Orangeberg, South Carolina Firm, USA.
Advertisement came out in ‘Times of India’ about ‘Gen-Selecct’, the Fully
Integrated Programme for the parents who have the desire to choose the sex of
their children.
The product was also advertised in the website
‘genderselectkit.com’, to lure people for sex selection. The material downloaded
from the website and the advertisement came out in ‘Times of India’ were
circulated for reference. Our country which is dominated by son-preference
attitude has a fertile market for the sex selection technology. To catch the fertile
market, the website carried a toll-free number for ‘only India’. It was flashed that
there is a tremendous response to this product from India, both from the public
and distributors. The advertisement violates Sec 22 of the PNDT Act. It was
shared that complaint was sent to the AA on 4th January, on behalf of CASSA, to
take necessary action to ban the sale in India, within 30 days, failing which
CASSA will resort to judicial intervention.
Deliberation was initiated regarding filing of case against ‘Times of India’.
Donna of Vimochana was asked to share the Karnataka experience.
Ms
Ms Donna shared that Times of India repeatedly carried the advertisement about
‘Gen-Select’ in four different editions of the newspaper. Throwing the media’s
ethics or social responsibility and social concern to the wind, it callously
published the advertisement. As soon as the advertisement came out on the first
day, Vimochana and other women’s groups expressed their sentiments to the
publishers. Yet, the paper carried the advertisement for four days. They also
sought the support of other print media to question the ethics of ‘Times of India’.
This effort became futile and media is not willing to critique their own media
friends. Many organisations raised their objections and sent letters to the editor
condemning the unethical publication of the advertisement of sex selection kit,
which encourages couples to choose the gender of their child. They condemned
in the strongest term the social irresponsibility of the owners and call upon them
to desist from adding to the exploitation of the existing sentiments of gender bias
and prejudice. But none of the letter was published in the ‘letter to editor column’.
3
Vimochana generated public opinion and to condemn the social irresponsibility of
the owners/publishers of the Times of India and to express their strongest protest
against such unethical behaviour of Times of India, they organised rally and
demonstration before the office of Times of India, Bangalore. The publishers
assured them that they would express their sentiments to the publishers/editor in
Delhi. Many print and electronic media hesitated to give coverage to this
demonstration.
She shared that many NGOs were reluctant to join the
demonstration as they did not want to openly resist the media.
Letter Campaign was launched by Vimochana. 200 organisations sent letters to
State Appropriate Authority to take action for violating the provisions of PNDT by
They
openly publishing advertisement about the sex selection technology. “
a
shared that the mounted pressure made the Appropriate Authority to file case
in the High Court of Karnataka.
Vimochana and Bangalore based Network of Women Journalists jointly
organised a meeting on ‘The ethics of sex selection’, on 29th December 2001.
The meeting was felt urgent in the context of ‘Gen-Select’. Government officials,
lawyers, people from media, social activists were invited.
Pressure was also exerted to State Women Commission to include the issue pre
sex selection and sex determination in their priority agenda. Taking serious view
of the situation, the president of State Women Commission made fact finding
visits to five clinics.
She also stated that they have decided to contact the manufacturers/dealers of
imaging technology to get the addresses to which they have supplied the
technology. Other plans included bringing out poster on PNDT Act and to
organise meeting with government doctors to generate awareness about PNDT
Act and their roles and responsibilities in following the provisions of the Act.
After much deliberation, it was decided to send an appeal letter by member
organisations of CASSA to Appropriate Authority expressing our concern
and sentiments and demanding the AA to wake up to the seriousness of
the issue and ban the sale of 'gen-select’ kit and to take legal action
against ‘Times of India’.
Implementation of UNICEF’s programme:
The convenor shared that CASSA submitted proposal to UNICEF to carry out the
following programme:
■ State-level Consultation with enforcement authorities, on strategies to
halt the declining child sex ratio, to be jointly organised with UNICEF.
■
Workshop on PNDT Act
■
Sensitisation programme for Panchayat Presidents on Girl Child Right
and PNDT Act.
■
Sensitisation programmes for adolescent girl children
'r
•
Training programme for Village Health Nurses.
■
■
Consultation on the role of doctors in halting the declining child sex
ratio
Sensitisation programme to Medical College Students of Chennai.
-
Workshop on Role of teachers in halting the declining child sex ratio.
■
Sensitisation programme to school students on girl child rights through
competitions and cultural programme
A copy of the project and budget proposal was left open for the members. It was
also shared that UNICEF released an advance of Rs. 167,000/- to carry out the
following programmes.
■
Workshop on PNDT Act
•
Sensitisation programme for Panchayat Presidents on Girl Child Right
and PNDT Act.
-
Sensitisation programmes for adolescent girl children
-
Sensitisation programme to Medical College Students of Chennai.
Mr. Ossie Fernandes of HRF-Chennai expressed his willingness to co
ordinate with CASSA to carry out the sensitisation programme for Medical
College Students of Chennai and Ms Radha of LEAD -Trichy expressed her
willingness to carry out sensitisation programme to the members of
Panchayat Raj Institutions in Urban Areas and sensitisation programmes
for adolescent girl children, covering the districts of Trichy, Erode and
Karur.
Ms J.P.Saulina Arnold expressed her willingness to co-ordinate with
CASSA, to organise consultation on the role of doctors in halting the
declining child sex ratio.
It was decided that the details will be planned with the respective member
organisations.
Mr. N.Ram, Editor of Frontline pointed out the need to organise an
advocacy programme with the students of journalism and ethical doctors
to enlist the support in addressing the issue of declining child sex ratio.
He was also willing to extend his support in convening this programme
both at the ideological and material levels.
Health Register- Data collection to be initiated:
The convenor shared that the pilot study was carried out by VRDP and AREDS
and the data was consolidated by the respective organisations.
The
consolidated report was shared with the members. The representing members
A'
off VRDP and AREDS were requested to share their experience in the process of
data collection and consolidation.
The staff representing AREDS shared that the villagers of the study area have no
access to scan centres. But there are elders, experienced in finding out the sex
of the fetus by sensing the pulse of the pregnant women. On finding the fetus is
female, traditional and crude methods are used to abort the female fetuses. It
took 10 days time to collect the data by employing 20 stafff. It would be an
additional burden for them if the data need to be updated once in three months.
VRDP too had similar experience. It took 15 days for them to complete the data
collection. There was opposition from the menfolk and they feared that the data
would be used against them. Both the groups shared that the women are
resorting to traditional and crude methods and not to Medical Termination.
Dr Sabu George responded that the data would be valid if the study area covers
atleast a block and the data would be updated once in 3 months to avoid
overlooking a single case of pregnancy and its outcome.
Ms Radha of LEAD expressed her willingness to carry out the task of
maintaining Village Health Register in two blocks, one from Erode and
another from Trichy District. Ms Saulina Arnold told that TNVHA would
maintain the registers in the districts of Dharmapuri, Namakkal, Theni and
Viluppuram Districts.
Booklet on CASSA’s three years activities:
The convenor shared that the two years activities since the inception of the
campaign was consolidated and the three year report in the booklet format would
be brought out before the next meet.
Possibilities of filing test cases by member organisations:
Ms Gandimathi shared the discussion with the Health Secretary of Tamil Nadu.
The Health Secretary opined that the very purpose of the Act does not end with
registration of scan centres and he is keen in filing cases against the violators of
the provisions of the Act. He sought CASSA’s help in identifying scan centres
which discloses the sex of the fetus and the pregnant women who underwent
scan tests to whom the sex of the fetus was disclosed and tenacious in giving
evidence before the court.
The members’ support was asked to file test cases.
Any other issue:
■ The strategy to pressurise the Minsitry of Health and Family Welfare to
incorportate the necessary amendment suggested by CASSA in the PNDT
act and the follow up to be done to place the proposed amendment bill in the
coming session of the Parliament was discussed.
6
■
It was decided that the core-team of CASSA will prepare the proposed
amendment in consonance with the suggestion emerged from the
review of PNDT Act in the workshop.
■
A memorandum demanding the incorporation of the suggestions made
by CASSA, in the proposed draft to be submitted to the
Ministers/Parliamentary Affairs Minister etc will be drafted by the
convenor and the same would be circulated to the member
organisations, for lobbying by the individual organisaiton.
■
A team will be meeting and submitting the above memorandum to the
State Minister of Health and Family Welfare, who is based in Trichy, to
expedite the process of placing the proposed amendment in the budget
session itself (March 2002). Ms Radha took the responsibility of getting
appointment with the Minister,
■
Advocacy should be carried with different political party leaders and members
of Parliament before the budget session and a signature campaign is to be
launched by the member organisations.
*****
(jC H ' 8
«*■
Surgery to Remove the Uterus - Hysterectomy
This book let/to educate 4rhe ordinary citizens ibout their
health probl^w^so as to provjjier'a scientific and etjiic^r founds t ipfr^
medical spepJtaT/ists
is compiled by th
to the sMKfical profession
?le's
Science^^
Arogya
Samiti
(P
of Lokvidnyan Sanghat
Organisation - Heal
Committee).
Thisj is an attempt to facilitate dialogue between the doctor and the
patient!
Surgery to remove the uterus
Mhy is hysterectomy done'?
To remove the uterus by surgery is called hysterectomy. It is done to
eliminate specific problems of the uterus. However,two types of
tendencies prevail in our society. On the one hand there is a
tendency to avoid hysterectomy which results in aggravation of
existing problems. On the other hand hysterectomies are done even
With
when not actually required. Both these tendencies are damaging,
a view to avoid this^it is important to know basics about this
surgery such as : its specific indications, possible risks and
method.
Diagram No- 1
Female reproductive system (frontal section)
Female reproductive organs are in the lower abdomen considerably
below the navel. A vertical cut of the lower abdomen from the front
and side gives an approximate idea of the placement and size of the
female reproductive organs.
This kind of view is reproduced in the
accompanying diagram Ho. 1 and 2. The inner lining of the uterus is
shown in the diagram No.l. The fetus is implanted there and the
placenta is formed from it.
The female reproductive system consists of four organs: 1. Uterus,
within which the fetus grows, 2. Two ovaries, which produce ova every
month after attaining puberty and secrete female hormones, 3.
Fallopian tubes which carry ova and 4. Vagina.
Diagram No• 2 ; Female reproductive system (Side section)
Hysterectomy becomes necessary to alleviate the following conditions
affecting the female reproductive organs: (Doctors will be able to
identify which of the following diagnosis exists in a particular
patient.)
1. Fibroids (lumps> in the uterus: Around 15% of women have these
lumps when they are in reproductive period. Fibroids grow due to
influence of female hormones called estrogen secreted by ovaries.
When estrogen production stops due to menopause, fibroids shrink or
vanish. Generally fibroids do not turn cancerous. But in some cases
they cause heavy bleeding during menstruation, excessive pain,
difficulty in urination and clearing the bowel. Some times fibroids
grow very fast. At such a point they need to be removed. It is
advisable to remove the uterus instead of removing only the fibroids
if there are multiple fibroids, and if the woman does not want
further children. It is difficult to remove multiple fibroids. It can
cause excessive bleeding while operating and the fibroids can grow
even after removal. Therefore to remove the uterus along with the
fibroids is easier and advisable.
2. Prolapse of the uterus: The uterus is held in its place by the
ligaments and muscles of the lower abdomen. The uterus prolapses
towards vagina due weakening of the ligaments and muscles. These
become weak due to many reasons like : deliveries with wrong
procedure, repetitive deliveries, not taking proper exercises after
the delivery, malnutrition and aging. If neglected, the uterus
descends into the vagina and protrudes out. This causes extreme
difficulty in urinating and defecating and also results in excessive
white discharge and discharge mixed with blood. In such situation the
ligaments and muscles need to be tightened with surgery. If the woman
is above 40 years of age, if she does not want to bear children, if
she does not mind early menopause the uterus is removed. But when
the woman is young and minor prolapse is caused due to delivery it
can be rectified with proper exercises.
3. Infect ion of. reproduct ive ortfans: Sometimes even after treatment
by antibiotic and anti-inflammatory drugs, infections of the uterus,
ovaries or fallopian tubes cannot be controlled. In such cases women
suffer from pain in the abdomen, difficulty in defecation, discomfort
during sexual intercourse, complaints during menstrual periods. If
the swelling becomes chronic then the uterus needs to be removed by
surgery.
4. Growth of uterine 1 ining
unusual sites (Endometriosis)» In some
cases some cells of the inner lining of the uterus grow either in the
muscles of the uterus or outside the uterus like the growth of hair
on the hand. During the menstrual period this unwanted, extra growth
also bleeds. This secretion of blood cannot be released from the body
and it causes severe pain in the abdomen. It also causes adhesions of
other organs to the uterus due to periodic bleeding. In some cases
the drug Danazol helps to keep the discomfort and complications under
control. In some other cases these tissues can be removed by a minor
surgery. When this does not help, the uterus along with the abnormal
growth of endometrial tissue needs to be removed by surgery. In such
cases even the ovaries need to be removed. This is because there is a
risk of small parts of tissue remaining left behind even after a
careful surgery since they are sometimes invisible. Since ovaries
secrete estrogen the tissues so left over start bleeding every month.
There is a better chance of complete relief only when the ovaries are
also removed.
5. Cancer: If any part of the uterus is affected by cancer, the
uterus, ovaries and fallopian tubes need to be removed by operation
as there is a danger of cancer growing rapidly from one organ to
another. In most of the cases even though the cancer is detected in
one organ, others are also affected. The decision to operate can be
made only after judging the stage of cancerous growth. If the cancer
is in its last stage surgery does not help.
In India cervical cancer is the most common type among women. If this
cancer is detected in its early stage and the uterus is removed the
patient can be cured. Surgery and radiotherapy are advised only after
assessing the stage of the cancer and the patient's convenience.
6. Excessive bleeding during menstruation (menorrhagia): Some women
suffer from excessive bleeding due to hormonal imbalance. This
results in excessive bleeding, passing clots, longer duration of
bleeding and shorter gap between two periods etc. With proper
medication this discomfort can be kept under control, But if
medication fails then the uterus needs to be removed, In sone cases,
patdents with these complaints have pre-cancerous conditions, (Pre
cancerous conditions increase the likelihood of cancer developing
later on). Such changes can be detected by scraping the inner lining
of the uterus by D & C and doing a biopsy. If pre-cancerous changes
*tre detected the uterus needs to be removed immediately.
The inner lining of the uterus can be removed by a new technique
called TCER. But considering the udifficulties and risks involved in
_-j this technique routinely. In
the technique it is advisable not to use
difficult
case removal of the uterus is d------- due to obesity this technique
is used.
7 Post-deliverv complications: In some cases the uterus does not
contract after delivery and bleeding continues. This bleeding can be
controlled with effective strong drugs. When medication fails the
situation can become life threatening. In such cases the arteries
providing blood to the uterus are closed surgically. When
®7;SO
fails to stop the bleeding, an emergency operation is done and the
uterus is removed.
In some cases the uterus is torn unevenly during delivery and it
becomes impossible to stitch it. Sometimes such a uterus becomes
severely infected. In either situation the uterus has to be removed
surgically.
Why are the ovaries and fallopian tubes also renoved along with the
uterus?
As mentioned earlier, the ovaries and fallopian tubes are also
removed along with the uterus when cancer is detected. But the vagina
is not removed.
The decision to remove the ovaries should be taken only after
carefully weighing the pros and cons in each case. It can be risky to
retain the ovaries as the possibility of cancer increases with the
advance age. This kind of cancer remains undetected for a long time.
Many doctors are prone to remove the ovaries while operating uterus
as it is very easy to do so and also it takes care of future risk o
cancer. But removal of ovaries disrupts hormone secretion processes
and may cause the following problems:
As removal1 of the ovaries results in hormonal imbalance, certain
bodily changes associated with aging occur prematurely. The blood
vessels stiffen and this can lead to heart disease. The
* — bones become
brittle due to calcium depletion. Due to sudden cessation of hormonal
secretion which had been there since the last 10 years or more, there
may be hot flushes, palpitations, profuse sweating, sudden cooling of
body, skin losing its lustre, dryness of the vagina, reduction of
immunity, irritability and
loss of libido. Therefore, all the
standard medical textbooks recommend removal of ovaries only for the
following specific reasons:
1. If there is disease of the ovaries e.g. infection of the ovaries
along with the total reproductive tract.. VWhen during surgery the
have- some disorder esp. if cancer is suspected.
ovaries are found
1---- to
-- —
2. If the endometrium grows in unusual places, as explained earlier
the uterus along with ovaries need to be removed.
3. If the patient has a personal or family history of cancer of the
intestine, ovaries, uterus or breast, the chances of such a person
getting ovarian cancer are high. Therefore the ovaries are removed
along with the uterus.
After the ovaries have been removed, hormonal replacement therapy is
done by prescribing estrogen. All the negative side effects due to
lack of estrogen can be controlled with such therapy.
What are the risks involved in this surgery?
There has been considerable advancement in medical technique in the
last 20 years reducing the risks due to this surgery. Yet it is
ultimately a major surgical procedure. Even when all precautions are
taken, there is a fatality of about 1 in 1000 patients, while some
patients may be affected by minor problems after the surgery. There
are risks which are common to all major surgeries like risks of
anesthesia, excessive bleeding, and infection in the surgical wound.
Some of the specific risks of this surgery are injury to neighboring
organs like the bladder, ureters and intestine. This possibility
increases if there are pre-existing adhesions due to disease.
Secondly, if the healing of wound of the vagina is delayed, it may
lead to white discharge mixed with blood stains. The after effects of
ovaries being removed are detailed earlier. All these risks are not
common but do exist.
Still this surgery is advisable when any of the
indications mentioned above exists.
Does removal of the uterus cause a cavity in the abdomen? Is it the
end of femininity?
No. It does not leave a cavity as the reproductive organs are small
in comparison with other organs in the abdominal cavity. The small
cavity cased by the surgery is easily filled up by other organs in
the abdomen.
Since the vagina is retained even after surgery, one can continue
sexual life as usual. However menopausal changes develop prematurely
if the ovaries have also been removed.
What is seant by surgery from above or below?
Surgery from above means a cut is made on the abdomen to remove the
uterus from within, If the uterus is adhering to other organs or
there is cancer, or in certain other specific situations, such
abdominal surgery is performed. This surgery leaves a scar on the
abdomen. On the other hand if the uterus is prolapsed or small, then
a cut is made in the vagina and uterus is removed per vagina. This
avoids the scar on the abdomen but it requires more skill.
What are the precautions to be taken before and after this surgery?
General information in this regard is given in the article
'Precautions to be taken before and after surgery'. Besides this, as
this is a major surgery, patients are admitted on the previous day.
An enema is given and blood is kept ready in case it is needed.
The decision to give general or spinal anesthesia is taken depending
on the general condition of the patient and the nature of illness.
Following this surgery it is advisable to avoid sexual intercourse
for six weeks. After this the patient can resume normal sexual life.
The pre and post operative care:
(This chapter is devised with twin purpose in mind. One is to inform
the patients about the specific details regarding this surgery and
second is to equip the patients about the general precautions to be
considered regarding any major surgery.)
The lay persons are panic with the thought of anesthesia and surgery
itself. But the advancement in medical science has reduced the risk
factor to a large extent. To understand the risk factor one can
compare the situation with the risk of two wheeler as a mode of
transport. The risk of anesthesia is a little less to this risk, It
is important to do thorough check up of the patient-^sT lealth
including all the pathological tests. It is better to get a clear
idea of what is involved when one prepares oneself for the surgery.
Let us proceed in the format of commonly asked questions and answer.
Whi' is thorough check up done before anesthesia and surgery?
introducing anesthesia. The
A thorough check up is necessary before
anesthetic ana surgeon
—
^^^helps
X^’to^0°
anesthetic and surgeon ask very crucial
get
sufficient
and necessary
patient*s
’physical
capacity to bear the strain
strain of
of operation.
operation. The
line:
enquiries are made along this line-
- Whether any surgery was done in the past.
- Whether addicted to smoking, drinking.
history of fits,
^ethlr
a^ m^nilne^ike
jaundice in the previous
major illness _
6 months.
climbing stairs.
- Whether there is breathlessness after walking,
- Whether there is breathlessness during nights,
- Whether there is condition of continuous coughing.
- If female, whether there is pregnancy.
- What medicines are Ibeing taken by the patient.
is allergic to certain drugs, what are they.
- Whether the patient
- Whether the patient is using denture.
All these enquiries are made and the of
physical examinations are undertaken.
heart,
lungs and other
Lok Vidnyan Sanghatana has published a list of such questions to be
y. This is being used in
answered by the patient before any surgery
with the doctors
many hospitals in Pune. The patients can cooperate
c
by filling this questionnaire.
pathological tests like urine. blood are done before the surgery?
There are two types of pathological tests done
_r
One type of tests are to confirm the diagnosis by ^lood tests, x ray
etc. Second type of tests are to arrive at proper judgment about the
general health of the patient and to find out patient s capaci y
withstand the strains of operation The first type
^sts are
dependent on the type of ailment. If the surgery of ^a^t, kidney or
(lever) is to be undertaken specific tests are done to judge
conditions of these particular organs. Barring these
some tests are common to most of the surgeries. Let us find out about
them.
the following
The kind of general tests necessary is dependent upon
criteria:
’ .e. maj or or minor. What kind of anesthesia is
Type of surgery i.
1.
of the patient.
to Ibe given and what is the age
What kind of ailments the patient has suffered in the past and
2.
the present one.
1. TVpe of surgery and anesthetic, and patient.^
Though any surgery, whether minor or major cannot be taken casually,
there is I difference between the heart surgery and surgery done
remove corn.
A Let us understand what types of tests are done for surgeries where
knot Ionins of r.splr.tlon,
i» not .ttnio.^ For
th,
surgery of hernia, tonsils, cataract, any small lump, Pile* or
fissure and D & C for female patient. Suppose the patient does not
have any other condition other than, the ailment mentioned ®bov®^ To
determine whether such a patient-o&n bear the strain of anesthesia
and surgery and to judge whether any complications may crop up due t
such background as diabetic, some minimum tests axe to be undertaken.
As there are not other conditions it is difficult to direct the
the standard text books which is reproduced here.
--- y tests for different
This chart gives information about the necessary
•
i
ratified
by
the
of,
surgeries.
-- that
-Association
> test
surgeries. The chart has been
the chart
urine and ^lood
Hospitals, Pune. It
is
clear
from
the
chart
L.
1
■ below fifty. The tests
is adequate for men below forty and for women
*
like ECG, x-ray, blood etc. are needed for those who
arer above forty
examined
and
such
conditions
and fifty. When such patients are
---- -.
.
. . likex.
high
blood
pressure
is
found
or
sometimes
blood
and
urine
tests
giv
high
pressure
is found or sometimes
nign blood
maw
t
But it is important to
indications further tests are required,
routine minimum tests are very
understand that for such
i--- - surgeries
—
few.
Chart:
Tests required prior to minor surgeries
Sr.No.
Age
1. Upto 12 years
2.
12 to 40 years
Tests for men
Tests for women
Just like men
Routine complete
urine test, blood
tests for hemoglobine and white bl
ood corpuscles.
All the above tes- Just like men
sts. Also urine
test on consuming
75 grams glucose on
empty stomach.
3. 40 to 50 years
All the above tes
ts plus ECG for
heart.
No need of ECG
4. 50 to 60 years
All the above tes
ts. Also on empty
stomach aft#£
consuming glucose
blood, serum and
criatanin tests
Just like men
5. Above 60 years
All the above plus
x-ray of lungs.
Just like men
*
r a lot o£ strain ie put on all
B. In such surgeries like •hysterectomy
well
as the anesthesia given
bodily functions due to surgery as v-Therefore
some
specific
types of tests are
during these surgeries. -1--- T
required to be done,
or iat in in in
i. Ta £ind out whether kidney is functioning normally
blood needs to be tested.
ii For any major surgery blood group needs to be determined. This is
done to keep the matching blood supply ready in case the emergency
arises. When the possibility of blood loss is high the blood is kept
ready by doing 'grouping-cross-matching test.
2 The past and present details of. ailments: If the patient had
suffered jaundice in the past six months blood tests to determine
lever function is necessary. The same principle applies to ailment
regarding urinary system. If the patient has conditions like blood
pressure, asthma, cough it is important to determine the severity of
such ailments. For this some more tests become necessary. Similarly
there are some specific problems like obesity, addictions like
smoking and alcohol or some genetic ailments. Depending on the
specificity of the patient's case history some tests are required.
Are all these tests really needed?
Currently, scores of tests are available. The chart Mentions the
minimum required tests. These tests give proper knowledge to the
surgeon and anesthetics to judge the bearing capacity of the patient.
These tests can ensure proper care for the patient.
All the available tests are studied to arrive at minimum tests which
lend maximum protection in terms of cost and medical need and a list
is prepared. The list is prepared after doing statistical cost
effectiveness study. Most of the tests give normal results. But how
can one decide before doing the tests? The tests are needed to avert
the risks if any. The tests give a fair idea of possibility and
extent of risks. Therefore proper care can be taken to minimize the
risks though the risk factor cannot be overcome fully.
There is a chart :
Spinal anesthesia : A cross section of spine
Hhich surgery is risky and difficult?
The risk is dependent on such factors like organ involved, the
problem affecting the concerned organ, overall health of the patient.
The risk factor is high in some emergency major surgeries like when
twisting of intestine or rupture of intestine takes place. If the
level of health of the patient become poor risk increases. Modern
science has helped to reduce the risk factor considerably. In cases
where brain and heart are involved the risk factor is minimized with
proper preparation. The basic principle is to weigh the risk involved
with and without surgery. Only when the patient is risking less by
undergoing the surgery it is undertaken. It is important to remember
that in all the surgery emergency complications and risks are
probable.
Sojnetixif s anesthesia is given by injection in the spine and sonetiues
total anesthesia is given. Hon is this decided?
It must be noted that the injection is given between the two vertebra
around the area of spinal cord. There are certain advantages of this
method : 1. Sometimes general anesthetic causes throat pain and cough
which can be avoided, 2. After the recovery resumption of normal
functioning of body systems is faster. The side effects of anesthetic
medicine can be avoided. If the baby is to be delivered by caesarean
the side effects of anesthetic medicine on the baby can be avoided.
The anesthetics are prone to use this method in such cases. 3. It
avoids strain on respiratory system. The patients prone for these
problems are given this type of anesthesia.
It is presumed that spinal anesthesia is given only when surgery is
undertaken on organs below naval and which last for one and one and
half hour. There is sub-category of spinal anesthesia called epidural
anesthesia. In this method a drip is introduced to numb the upper
portion of the spinal cord which can last for any length of time.
This method enables to numb the portion above naval. This method is
becoming more popular compared to general anesthesia. This technique
cannot be applied when heart, lungs or any parts above neck are
involved. In such cases general anesthesia is used. General
anesthesia is introduced for surgeries which last for 5 to 10 minutes
like setting of bones or D & C etc.
because the patient can come out
of the spell as small quantity of medicine can be introduced. The
spinal anesthesia technique does not have this advantage.
The children panic and cannot co-operate. Therefore in case of child
patient, general anesthesia is given. Barring such cases, there is a
growing trend to depend upon spinal anesthesia. This has reduced the
after effect severity and risks.
Doctors SLdvise to fast before and after the anesthesia. ifhy?
The medicines given for operation and anesthesia lead to nausea. The
patient vomits when still under anesthesia and this sometimes enters
into the respiratory track causing risk. The advise to fast is to
avoid such eventuality.
Does anesthesia cause any probien?
The anesthesia is injected through a vein. That area can pain. When
there is spinal anesthesia some patients experience pain in that area
afterwards. But there is a misconception that spinal injection
results into back ache. This anesthesia causes head ache in some
cases. If the patient takes rest for 5-6 days it is controlled and
stops afterwards.
A tube is inserted into the respiratory track through throat while
giving general anesthesia. This results into pain as the tube causes
friction. Sometimes anesthesia causes nausea, vomiting sensation,
body ache, psychological disturbances. The patient should not panic
because all settles down to normalcy after a while.
The hair on and around the area of the part to be operated is
removed. Khy?
The area of the part where surgery is to be done needs to be cleaned
and made germ free. Hair growth creates obstruction. The germs and
dust in the hair cannot be cleaned thoroughly. Therefore it is best
to remove the hair for cleaning.
Ifhat care needs to be taken immediately after the surgery?
The patient is not shifted out of the operation theatre immediately
after the surgery. Before the patient is shifted it is ensured that
the heart and respiration is functioning normally. The pulse and
blood pressure is monitored depending of the type of the surgery. The
doctors need to be cooperated. To do this following things can be
done:
* If there is a possibility of vomiting, care can be taken that it
does not enter the respiratory track. The patient is made to sleep on
the side. If that position is not possible it is best to turn the
head to one side. A tube is kept in the mouth before the patient
recovers from the anesthetic phase. When the patient starts
recovering the tube is pushed out by the tongue or the patient
removes it by hand, It is better to keep it in the mouth till this is
done.
* When the patient is still under anesthetic effect, the patient
hauls or wails and talks irrelevant things. It is not advisable to
panic as this is the effect of being in semi-conscious stage.
* The saline drip is continued by a needle prick in the vein of hand
or feet. Sometimes this needle is ejected out with the movement of
the patient. It is necessary to guard against this eventuality.
* Sometimes after the major surgery it is advised to consciously make
the movement of legs. It is important to keep the advise as it helps
in avoiding formation of blood clots in the veins due to less
movement.
* Sometimes it is advised to take deep breath when the anesthesia is
introduced for a longer time. This is done to avoid catching of any
infections of lungs due to poor oxygen supply. Sometimes the exercise
of deep breathing cases pain in the wound. Still it is good to
continue the exercise.
tihy is saline given? and how such?
Saline is given to take care of the need of normal water intake.
Approximately
Approximately three
three liters
liters or six bottles of saline is given to an
adult patient per day. The quantity varies according to the weather (
of anesthesia, --condition
of the patient^
hot season), vomiting, type *-'*■
---type of surgery etc. Saline is nothing but germless salt water,
of resuming water intake in normal
such time the patient is capable
t--the
saline
drip
is
continued.
manner
Nhat care needs to be taken to avoid tension on the stitches after
the surgery?
There are several misunderstandings regarding the stitches. It is
important to remember the following things: The number of stitches is
not a relevant consideration.
The specific body part and the problem
for which it is operated is a relevant consideration. Similarly, the
stitches .do not open up due to normal movements. On the contrary if
the normal movements are resumed after the operation, it helps to
heal the wound faster. It also reduces the chances of hardening of
the wound thus reducing the pain. It is not required to stay in the
hospital till the stitches are removed. The patient can go home if
all the body functions are normal and no complications like bleeding
take place after the surgery. Discharging the patient from the
hospital is dependent on the type of surgery, general health of the
patient, maintenance of cleanliness at• •home., facilities at home etc.
.
Once home, it is good to follow doctor s advise
.
Ifhen can one bathe after the surgery?
Once the normal movements arej resumed the patient can bathe. It is
necessary to ensure 1that
--- the
-- bandage on the stitches does not get
wet. If it wets it is better to change, It is convenient to avoid
But there is no hard and fast
bathing till the stitches are removed,
important
precaution
is to keep the wound dry and
rule about it. The l
clean.
Ifhat are the dietary restrictions to be observed after the surgery?
The fatigue after surgeryr is not reduced or controlled by any tonics.
loss is considerable then it is necessary to take iron
If the blood
---------tonic with the doctor's advise.
It is important to *
increase the intake of pulses which helps to speed
"
If
the
of green vegetables and fruits is
up recovery.
_ -- quantity
.
clean
the
bowel without strain.
increased it helps to
The conception that certain types of food loads to pus; formation in
the stitches is not rational, It is not necessary to observe such
type of dietary restrictions.
In how nany days the wound is healed after the surgery?
If there is no complication, major portion of the WCTUad is healed
within the first 7-8 days. It takes three weeks to three months for
the muscles to acquire their previous toning. There is no risk in
resuming the normal movements which do not cause any muscular
tensions after 8 days from the surgery. But it is essential not to
take up any strenuous activity at least for four weeks after the
surgery. Such normal activities like driving, lifting bucket of water
can be resumed after four weeks.
■■ ■ *S’ .
.
-'
■-
:
t.
•
'A =.
■
.
■
1
■
CAMPAIGN AGAINST SEX SELECTIVE ABORTION
11, DCeufiala 2nd
Qhhuia ^Jt^kkdudan^ JMadurui- 625 002.
^Pketie & (fax : 530486A 524762 mailtiirdtndu^ho httaiL. coni
Chennai: Q4c. lO-^honuu Qlagnr,
JHj&uhL, Saidupfl^ Phennai 600 015.
OmLojA
^Pkone: 044 2353503Cfax: 2355905
Fax Message
Kind Attention:
Fax No.:080 5525372
Dr Thelma Narayan
Community Health Cell
367, Srinivasa Nilaya, First Main
Jakasandra, Koramangla
Bangalore 560 034.
Date: 28.5.2002
Dear Dr Thelma Narayan
As you are aware, CAS SA is a state-level campaign body working for the protection of
the rights of girl children for the past three years. CASSA is rigorously campaigning for
the enforcement of PNDT Act and opposing sex selective abortion.
It recently held a
state-level workshop to review the PNDT Act and has come out with various
amendments.
Bharatscans, a known institution in Chennai has recently installed an imported
technology called 4D Real Time Scanner. The very advertisement has attracted parents to
have choice, to decide the sex of the child. We are planning to oppose this technology.
Before that, we would like to understand the functioning of this machine. We have asked
for a live demo. It is in this context, we are inviting you to be part of the delegation
team, to review the live demo, to be done by Bharatscans. We are enclosing the copy of
the advertisement and our response to the same by mail.
We look forward to hear from you at the earliest, to finalise the date and the delegation
team.
Warm regards
Yours sincerely
(P PHAVALAM)
Convenor
C H/- -
PJL,
CAMPAIGN AGAINST SEX SELECTIVE ABORTION
Qonlad c'lddftJi: 11f JCantala 2nd Street., @hinna (^lijokldiudani, Jttadiirai - 625 002,
('frh&ne & (Jar, : 530486A 524762e niailiilrilmdu^kolnuLilrom
QhennahQin. 10-Qltfimai Qtageir, kittle Jltonnf, Saidinpel, Chennai 600 015,
Skenes 044 2353503 Cfax: 2355905
10th May 2002.
To
Dr R.Emmanuel
Managing Director
Bharat Scans
197, Peters Road
Opp. New College
Royapettah
Chennai 600 014.
Dear Sir
We are writing this with reference to the advertisement carried out in ‘The Hindu’ and
‘Business Line’ issued by your institution, Bharat Scans, Chennai, on 7th April 2002. We
are shocked at the publication of the above dated advertisement, which amounts to
promoting sex determination and selection using ‘Realtime 4D Ultrasound Scanner’, a
technology imported from Austria and advertising scans in the name of A Window to the
Womb - the Real Bondage Starts here from the Womb, Basically this technology is
designed to determine the sex of the fetus which has a broader market in a society with
son preference. This reductionist technology is not only anti-girl child but also aims at
eliminating the birth of the children with disabilities. The very advertisement highlights
the informed choice of the parents in sex and anomalies. It infringes directly on the
rights of the girl child and the disabled to be bom. We also bring to your notice that this
advertisement issued by you is in violation of Sec. 22(1) of Pre-Natal Diagnostic
Techniques Act and the Supreme Court Interim Orders. This advertisement also attracts
Sec 6(a) of PNDT Act.
By issuing this advertisement, we feel that Bharat Scans not only encourages the anti
women bias but negates the reproductive rights of the women. We are living in a society
where being bom as a female is perceived as a birth defect and birth defects can be dealt
with (eliminated) by technological means.
Given the fact that all the recently evolved
pre-natal diagnostic techniques have most often been used to eliminate the female
foetuses. This is very well understood from the existing child sex ratio in Tamil Nadu
which has declined to 939 in the year 2001 from 995 in 1961 and in four districts it has
declined to less than 900.
Given the context of increasing violence against women, allowing an advertisement that
talks of informed choice is a mockery to womenkind and to humanity itself. Worldwide,
Women’s Movements and Human Rights Organisations all over the World have opposed
the ‘Doctrine of Informed Choice’ as it amounts to gender cleansing and against the
rights of persons with disabilities. This advertisement is violently sexist, anti-persons
with disabilities and strengthening legitimacy to parental preference of the male child.
This is in clear violation of the law and Supreme Court rulings.
At a time, when the Supreme Court has issued directions to the Union Government and
all State Governments calling for the launch of a vigorous media campaign against
female feticide and the practice of sex determination aiming at the elimination of girl
child, it is discouraging that Bharat Scans chose to throw all social concern for the girl
child to the winds and allow economic consideration by issuing this advertisement.
Moreover, the Supreme Court has directed all the States to take stringent action against
the violators of the PNDT Act and is in the process of re-framing the PNDT Act to
include all technologies and techniques including pre-conception sex selection.
We condemn in the strongest terms, the social irresponsibility of a leading
Institutions like Bharat Scans and for violating the provisions of the PNDT Act. In
this regard, we request you to take the following actions with immediate effect.
1. Immediately suspend the use of
Realtime 4D Ultrasound Scanner as it is
violative of under Sec 6(a) of PNDT Act.
2. Kindly extend an open apology in leading dailies, both in English and Tamil for
your earlier act of issuing an anti-women advertisement.
3. Publish a status report on the consumers who used this reductionist technology
from 7th April onwards.
We regret to tell you that in the failure of action from your side. Campaign Against
Sex Selective Abortion (CASSA) will opt for judicial proceedings against Bharat
Scans.
Looking forward to hear from you
Yours sincerely
(P PHAVALAM)
Convenor
7
=—--
An ISO 9002 Organisation
On the Occasion of World Health Day 2002
Inaugurating today - 7th April 2002
at their Jtoyapcnah Centre
/
REALTIME
• A■ ^ktz
j
Ultrasound
(from Kraz Technology - Austria)
HCWCEO/IOia
move for health
Realtime 4^ Ultrasound is
1 1
Ii
i r
Realtime
enables Parents to see their Baby
Scratching its nose,
Sucking thumb and even hccuping
on a Realtime Plasma Screen.
■ REAL & ACTUAL
Cannot debate science evidance
■ BONDING^;#
t; '.
p J a.
*
Hears the heartbeat tnl view* ;KiMfy
and development of tie baby >
f'
■ POSITIVE It Y
>
Realtime imaging of
Congenital Anomalies
cleft lip / palate, Polydactyly,
Spina bifida, low-set ears,
cardiac malformation,
facial dysmorphia,
clubfeet and
many more extraordinary
features of the Whole Body.
7X' 1
Dispiays the beauty cfHe
■ EDUCATIONAL
I
Ultrasound Scanner
; .C
< .
l'r. '•
Reduces teen and enta pregnancies
1 '.
■
■ INFORMATIVE
Aftows an informed chxa ■* • •
'i.
■ SUPPORTIVE ‘
r/'
7
Fathers, families and bend* an
educated to provide exxxjragernent
ole
o.
The Real Bondage Slants here from the Womb
C ■•’
..
is w»^»
I
32ixl Ww4> b«<c*w b<Th -
birth
Twin 11 Wwkt
r
Twin 1! W«#kx
ar?
•J®
22 Wwkt
32 W»«ka
illll
I f’li 1
ml
PRODIGY ORACLE-The Bone Densitometer <
State-of-the-art Scanner that unmasks the silent disease
“Osteoporosis ”
t
Osteoporosis Is a skeletal disorder that compromises
bone strength and predisposes one to increased fracture risk
1
;
Oslevpcxoso is a disease of epidemJc p—portions, affecting all populations and aces.
Post-menooau&al women are the most susceptible. However mon too are afloctcd
by thus d-sease. The risk of hip fracture due to Osteoporosis in women is larger tr-*i
<
I
2
■
the sum of tne nsks of developing breast, uterine and ovarian cancerl
•
•
•
•
•
I
I-
1 *»
Common risk factors
Bl'F
Females above th* age group (/40
Post menopause
Low calcium diet
Family history of csteoporusis
Lack of Exercise
$
DEXAscan can :
• Thin frame / 'smaLbonerT
• Smoking and AJccool abuse
• Excess use of cerain medications such as
Steroids, anti-corwtsants, Thyroid hormone
fell
IS 1y *»tnu*
Aum
•
•
•
DetBd osteoporosis before a fracture occurs.
Predict your chances of fracturing in the future.
Determine your rate of bone loss and or monitor the
effects of treatment
Can also assess the amount of fat In our Body
(useful in monitoring weight loss)
*s if Is ln ohesity / slimming treatment
s.
MBH
■>s
W R130 Muttisllca Helical CT Mammography
3D Color Doppter Ultra sou nd & Echo Cardiography
1ft* P»'rtV-w>1 ry.n hftrwf'.'ivv rrv.<n,v . (UV) pi |
ai
g^r'
WhoUbody 3D Colour 3p4ni CT
__ Scanning Centrw x_________
"S7, Tbifv. Vi. Kx Influnnol Ev,**,
r...
r»M-M<ni finbri;
.11...
■:THE>SUNDA¥vPIONEER ^DEGEMBER'16,' 2001 V" ■■ •
'^^EwE'
5
-
'
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■
i' • l''** r.
1't y ■
i ;
'r
'SWtSitewAeMA
;Si; W-
|
i yen before basic medical services made inroads
'
?W • '
i:
''
..■';■!-■;
g
They were a source qf.easy money ps.new technolo- .
‘
aU- i.•
"
y-i.a-:
.
h'lU
merely looked the other way. .
Things changed.in Faridabad only this year with
F* ?SJ?’?.iya h®lri» “PPoihied appropriate.authority • ■■
In AphK. Haryua-has ’a sex ratio' of 820 in (he bee
group of zero to six yeareSooh after he topkover as’
chief civil surgeon, he.did.what no other civil surgeon
in the countprhas done so^ far — crick the whip on
doctors involved m illegal female foeticide, pr Dalii ya
and his team came down heavily on private clinics in
andaroundFaridabadinvolvedinillegalsex.determination of foetuses and female abortions.
;
As a result of his efforts, sex determination and the
|
abortion of female foetuses by private clinics are at
least nut all that conspicuous, if they have not stopped
all together. Registration of ultrasound machines In
the district has also been strictly enforced, as per the
i
directives of the Supreme Court.
The way pr Dahiya went about enforcing the law, .
|
in letter and spirit, commands determination and in|
genuity. When it got tough to obtain evidence against
j
private medical practitioners, Dr Dahiya even sent in
decoy customers with spy cameras attached to their
bodies. Over half a dozen doctors were nabbed this
way while the rest of their brethren lay low, fearing
’
the law. It was the first time in six years, after the Act
had come into existence, that there was any fear of
j the law. The team took Its operations to as far as
Chandigarh, another, district notorious for Its declin
ing sex ratio.
Ihe team had no prior experience With Imple
menting the Pre-Natal Diagnostic Techniques
• ■ (Pr*v®n,l°n of Misuse) Act They were armed only
i with the will to bring the culprits to book. Of the less .
than a dozen cases, booked in the, country under the .
PNDT Act, most have been filed by the Faridabad chief
civil surgeon. In doing so. the team has taken on the
entire medical fraternity, which still has a "sofi cor
ner” for doctors involved In (he malpractice.
Ask his opinion of the medicos and Dr Dahiya does
) not hesitate to wy, ‘They are the devil's own agents,
j They carry out crimes against humanity even after tak
ing an oath to save human lives." He Is quick to point
out that unscrupulous doctors advise pregnant women
| to undertake the foetus sex determination test and abort
I the female ones.
Dr Dahiya started with the usual goverriment ap
proach. by way of educating and cajoling doctors to
stay away from illegal foetus sexi determination. The
soft approach did not stir the medical association In‘
to taking action against erring doctors. For private Clin-
•
'
...
•
I
•.
■
'
■
'• *<
••
•••’A;
'
/^/
%/
/
I K . The main conctm for Dr Dahiya and his team was •
get around the problem of Insufficient evidence
I against doctors and uittasonologists Involved in illegal sex determination.The family and private clinics,
.
'
■
WhOD It 00t tOUflll tO Obtalll
When It got tough to obtain
i Fandabad team thenp?rtnOT
ln
™
c
famous
•"Hence
against
private medical •
came up with their novel solu’
J lion - spy cuneras a la Tehelka. About half a dozen
^<1
..
•% • •• !|« !•«•*«ivl*
• **. .*
•t
•tn|f I 'int’-rt.
■“ ft*.
i
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■■
doctors were booked within a span of six months and
for the first time after the law was enacted in 1994,
did the case proceed to Court. Other cases in Delhi
were still floundering for want of evidence and were
referred back by the Court.
But the going wu tough for Dahiya and his team.
I They had taken on the close-knit medical fratemity •
1
Ctvn0!!°W-n*Se ,eMCr Of
In.his ,b*
PraCtltlOnCrS. Dr D8hlV8 eVfill
j
I the case files removed after pre?sure from “higher■ ups". In another incident, the team was intimidated
I by a rowdy crowd and Dr Dahlya himself was man-
i
was later withdrawn after the Union Ministry of Health
-■
“
sent In decoy
customers
with spy
cameras attached to their bodies
“““•
■
The Supreme Court has put |u might behind the
Implementation of the law. In one of its recent hilings,
it castigated state governments for not initialing ac
tion against private clinics which have nol even reg
istered their usage of ultrasound machines. It also
Dulled up the Central and state governments for tardy
implementation of the law. The court Is literally do
ing t^e job of. the bureaucrats, by regularly taking slock
of its various judgments and directives on the Issue.
The Apex Court has directed Stale Appropriate
■Authorities to furnish quarterly reports on the im
mentation and working of the Act to the Central
• -““J ”«•«' m-ervenea.
try where a girl child's wi’rth is^ixld at» discount. Even
- the girl child faces b losing battle, the 600-odd
A...L—!.jeg u.ros| counljy Jj.g yet l0
pul their acts toge’her.
/
r
•
Yoga Ranggtia
o
1
I
1
WEDNESDAY. SEPTEMBER 26, 2001
® . gi ? BS
8
I
Ycur Meishbourhood FJewspapep. From The Times of India
Volume I, No. 24 (4 pages)
I sFROMAJECOYTOHIDDENCAMERASXDRDAHlYA^HfiSUSED
Rajiv Rathee
determined and dedi
cated, but low profile
civil surgeon of Faridabad district. Dr. B.S. Dahiya,
has literally become a terror
to those, who have been ille
gally carrying out ultrasonog
raphy test on pregnant wom
en to determine the sex of the
child in the womb. And thus
aborting the female foetus,
thereby, flagrantly violating
the Medical Termination of
Pregnancy (MTP) law for
years in the district and for
that matter elsewhere in the
country.
Though the union health
ministry has, by designating
the civil surgeon as ‘appro
priate authority’ under the
Prenatal Diagnostic Tech
niques (PNDT) (Regulation
and Prevention of Misuse)
Act, 1996, made it obligatory
for every nursing home to get
itself registered with the civil
surgeon and notify if it is
equipped with ultrasound
machine, not many cared to
comply with this stipulation.
Further the PNDT enjoins
upon the ultrasound-owning
medicos to maintain detailed
records of the patients un
dergoing ultrasound tests as
also of those, who undergo
MTP on "health grounds”.
Many private practitioners,
as it is now learnt, do not
maintain these records and
carry out female foeticide, to
extort heavy fee-from igno
rant women, who do not.,
want, for various reasons, to
give birth to a girl child. On
his taking over as civil sur
geon of Faridabad, a few
months ago, Dr. Dahiya dis-,
cussed this "criminal act” on
mediJMwiih the^Srict ad-
i X-j i1, HI
ii t
clothes, cracked down on a
‘popular’ private nursing
home of Palwal, where three
“decoy” pregnant women,
Shahjahan,
Preeti
and
Barkha underwent ultrasonography on payment of
Rs 1,200 each. Dr. Kewal,
also a part of the civil sur
geon’s team, was deployed to
keep a vigil on the goings
and inform the task force,
which also managed to take
along, ex-president, Faridabad district branch of the
IMA, Dr. R.L. Monga, as ob
server.
The nursing home's lady
g ■ doctors told two of the three
‘decoy’ pregnant women
that the sex of the baby in
their womb was that of a fe
male and to abort the foetus,
they would be charged Rs
3,000 each.
The nursing home staff
was not aware that their ac
tivities were being secretly
taped in a video. The civil
surgeon took into posses
sion the relevant records of
the nursing home and
recorded the “confessions”
of the lady doctors, who did
the ultasonography and
prepared the two “decoy”
women for abortion of the
female child. The conpermission of his superiors cerned
authorities
at
to use all fair techniques, in- Chandigarh and New Delhi
eluding decoy clients and use were accordingly informed
of camera .crew of a leading and proceedings launched
TV channel, to expose the in the court. Meanwhile, according to Dr. R.L. Babbar,
.
,. —_____
the lady, doctor..whom-the.
’ task force had caught, has
Sukhram Hospital, Palwal, where
the PNDT team had gone for
inspection
II
Dr B.S. Dahiya, a civil surgeon, in a rare show of sternness, has cracked the whip
on those unscrupulous private practitioners who have been illegally carrying out
ultrasonography test on pregnant women to determine the sex of the child
1
of tbe district magistrate, S.C.
s
Jain, and duly approved by
c
t
the district attorney, the al2^3 leged accused was referred to
F
the chief judicial magistrate.
But...the
”
................
law itself has certain
h
ig.JacjmRe and.may. ultimately.
?S come to the rescue of this
. I medico in the court.
ima s vJ
Within the next few days,
primary mem bersntp.
Dr. Dahiya’s task force, I
Dr. Dahiya and his task
J similarly uabbed another
force claim to have
ui
th
| doctor. The evidence of the
vowed to take it as a miswl
piegnant woman was record- . black sheep and createfool- sion to put an end to the
oil
•.:a to prove that she under- proof evidence against the “murder of the girl child”,
B-S- Dahiya
rhe hu‘de vlew of the hoapka1, where foeddde ww being conducted
Dr. B-S. Datuya
went
ultrasonography
and
guilty.
The
doctors
also
give
credit
thl
ministration.
dunng the Inspection.
had come to undergo MTP, if
In the first week of this to the NGOs, powerful reliSo
A district-level advisory Panchayati Raj leaders and tute a broad-based task force the civil surgeon managed to the child in womb was a girl, month. Dr. Dahiya’s task gious organisations like the
nu
panel was constituted :nclud- legislators of the district. The of doctors and social activists get the backing of senior su- To the shock of Dr. Dahiya’s force, comprising Dr. Chha- Arya Samaj and local legis
wi
ing representatives of district panel
strictly enforce
enforce the
the two
two perintendent
perintendent of
of police
police (SSP)
(SSP) task
task force,
force, they
they were physi- trapal. Dr. Rekha Mishra, Dr. lators, panchayati leaders,
t's
panel was
was constituted
constituted to
to prepre- toto strictly
pa
branch
laws.
” ’ ’ Sharma and....
^ranch of the Indian Medical pare
parean
an "action
action plan
plan” to
to first
first laws.
Ranbir
his force, c.illy prevented from enforc- Tanin Kumar
Dr. IMA, and the administraKumar and
wii
.Association
Lest the
the —
move
to crackdown
".
..... p”. (IMA), social ac- educate the public about the
—
..
Within a few days an influ- ir.g the law and humiliated.
Snchlnta. equipped with hid- tion and the police for makup
ttxists, NGOs. national and two central laws and their on the defiant persons creat- ential
Dr. Dahivn was not discour- den camera, etc., and accom- ing their endeavour a sucential doctor
doctor was
was caught
caught redredurt
state women’s commissions, irnplications and then conjjtt- ed hnv and order urobl.-ms. handed, with the perniissian aged. H- managed to get the panied by r'»ps in plain cess.
' isn
ssi
Faridahad Plus
been susPended from
Exclusives
’
Ji
i Pi IS
® r?c^; _
g»e^.^
nr
■"jg/’T is another war - not for
Ea territory, religion or power
Pq . but for a place In the
9 mother's womb. Seven
wBeLb years have elapsfv’ rlnce
the
Pre-Natal
biiiguosdic
Techniques .(Reculatiun and
PirrventioQ of Misuse) Act came
Into force in 1994 banning sex- campaigns’, not much Is said about
selective abortions, but only 'Q actual action taken including the
cases have been filed so -far number of clinics raided or the
1 throughout the country and not a ultrasound machines registered.
single conviction has been’made The Centre, however, has
for violatingthe Act. Ironically not informed the Supreme Court that
I
a single case has been filed in it would set up a • National Q
‘ ‘ Punjab,’whJcErecdfded (he high” ■’Inspection’ "and’—MonllorW-”^
est drop in the female sex ratio in Committee, which would visit .
1 the age group of M>.
each state and report on the status
Anguished at the indiscrimi of implementation of the Act The
nate misuse of advanced tcchnolo- next hearing will be on December
tv effecting female foeticide the alarming decline in the
Though the Health Ministry
temalc-to-malc ratio in the age has. by designating the civil sur
group of 0-6 that this has led to - geon as ‘appropriate authority'
?.2
the Supreme Court has directed under the PNDT Act made it
the Centre and the state govern obligatory for every nursing home
ments to stringently' enforce the to get itself registered with the
taw banning sex determination civil surgeon and notify' if it is
stud sehxlion procedures In ils equipped
with
ultrasound
verdict on a PILfiled by Outre for machines, not many cared to com
<--r:
Enquiry into Health and Allied ply with this stipulation. Many
..... Themes (UEHAT) activi§{~Sabh private practilitloncrs alx/do not
George
and
tiie
Mahila —
renni*.*!.;maintain
the detailed records 6T
Sarvangeen Utkarsh Mandal. the the patients undergoing ultra
Apex Court asked the stale guv- sound testa and medical termina
pique allows sperm to be
ernments to file regular quarterly tion of pregnancy on . health
processed tn a laboratory so that
affidavits on action taken for the grounds, as provided in the Act.
tlic XX a»xl YY chromosomes are
implementation c»f this Act.
Moreover, since the PNDT Act
separated, ensuring the birth of a
Dut sources In the Department dre-o not cover pre-natal genetic
boy
h
of Family Welfare in the Ministry diagnosis, clinics in Punjab,
To plug some of the loopholes
of Health revealed while the states Haryana and other slates are offer
ir. the ?M!?T .Act. tharc very uiuth iui iiicuwiiug in p»u- ing such faciiiihs. Tills tnro ieviiis considerinK to put forward producing evidence on ‘•’wareness
hl-: : •
.•
tcring each and every ultrasound i<rr. who lw*v
ing out ultrasoTi<)|~;- :-.
machine should be done away
pregnani women tu ci- '■■ i' !
with in the proposed amendments.
"Ultrasound machines have sex of the child. »’ !tk r...
■■••.
l»eomc very important diagnostic, patients and r-.khA-n :
to-ii.. and can be used fur detection tape iceortk-rs - fuixi- ;«■; •« 'stciune
num
their
v'vnp..
.ki:n>
uf viher problems like stone or
tumour apart from genetic coun raided clinics -jn: c-i-Ct.4 •- ’
seling. There is no need to register red-headed while pc-rt.:» i.uthe machines, which are used for selcclive tests.
Klatoi-J'inf. the ce.mns r• = .
other diagnostic purposes,"' Dr
in ra: Ung the ' tinres Jb
Malik said.
But ultrasound machines used assistant Dr Veklu. M»for sex detection are those used for we t:-k-: th-- help
. normal diagnostic purjioscs xnd womee- foriK-sini; •
.—.are iintsnrdaLxnachhies. Anultra-. ing to jnclcrU'.k ■
tests. Wc c-trnr f
sonologist needs to locus on t!<
re;u»rdii:.1: '•’.t ■1 _■
foetus to know the sex of t he c’
So how can it be ensured
..a try h- win over u>:- . W-.:.
machine supposed to be used for lire uvclors. whose
< ,ur •‘■■enorma] diagnostic purposes is not sup|a:.-'J
monitfs every rr.'.nvnH
•..used for sex dcUxiinn?
"This cm not b<? ensunxl even if ik'clors and kseps a t:.v» -.r
visitors
or
•agent
■
the machines arc registorixl.’ Dr
p;i'.;eii!StarSCX df:t*r“!:"'-. •
Malik said.
Tire 2001 Census revealed that .-.iwixxi for a enmn.-v * .••.••. ’
Eui'-hit-sisin^ til*
the sex ratio in the 0-G age group
lias declined sharply front 1'45 aooj>ang a
females per 1000 males in ISSJl to ing with the inis>-r--- ;
□,'t
’
n
iya
said
hi
<<''.•!
1
927 fcinales in 2001 .Tire decline is
sharp tn '- nu of (be pnisjrernus have identined Kh-’ud'i-. • •
_________ ^-•nuv.- F.-.-,r .statiJuc l<umak..HaD.,;uiis^-U.ll£2.5£iuh1
•—nrannfcrcturers—of- -ullrftBound—■
a and Gujarat.Hunjab, have beeu filed, six id--li. : ;
I_ wachlncrThould" report ’ where - v.-itv. toe highest
per capita income took up in April arxl the :• -i.t. ■
have sold their machines.
SSw[ they
the lowest sex ratio of TXi nls'> nssisteo
Indian Medical Association. ba.-,
1
i l..uid;r.ari: :•»
f
th«! Act. Ilxi amended Act will also' however, feels that the exist ing law : hirudes per !<xx) males.
Pu: th'*:— are gnrener pastures
include pre-natal genetic diagno . is stringent enough to tackle the
:
.
•
;■
.ftuation.
which
pro
sis and mobile ultrasound centres.
problem and the law, even if
worth «.-miilatinv
It will be mandatory for all nurs anu-urieu. shook. :>c a prw:! ica'.
>. . -rid;iTc-.<!thfedi?<licaic<lte;mi<«t
ing Ikcii-is and clinics to maintain one'. El:dk>r.-it::!g ItYA’s stand on
S. -iib.> .**•. * '•Je-rit •
t!.<Civil
Siirgtren
Dr I’ K Dahiy.i
detailed r«-porls of all patients1 tnis is>ut!. its s-vretary 9r Smyiv ]
Hi-- whip on tlvw
uiidcrc->ing ultrasound tests and1 Mali?. ;:.;«t::i"<«ii»ulationr>r regis- si-nr i ro. ■
MT!’. Even the wholesalers and
The girl child’s hope for survival
iwWi
1W
posals for amendments in Hie com
ing seu'on of the Pa: hament com
mencing from N> ventber 19.
Secretary of the f, .-arlinenl of
Family Welfare A P Nauiia said,
die proposals wil’ • i-.i'- institutirm nt miiltl-nw ■ - cnurooriate
authority for taipa-mentation of
| Having recorded
| the highest drop
| in the female
I sex ratio in the
I' age group’of “ "
g 0-6, Punjab is
| guilty of
| encouraging
| indiscriminate
| use of advanced
§ technology7 for
| effecting female
I foeticide
I
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I
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KJ H- -
& RLPl?00
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Conceptualised by:
Dr. Kamini A. Rao
<
•
J.*;-'S'
■
:
■*'
■
" ’ •:
SK^&gv'-
r '
■
Convenor, WSRR Project
unre0'
mains »■)<>"<
and ^e
jvce ve'
a„a6ona''8SOU’
,s. o<
,dd oi ne^
,en as
and
,s. a^0'- , served
vaW »’ *)W
^tionatiV P00^
lnln<Sa.«'a
continoeotode ,odaot as
.ome""'8"3' .eval o'a’"a' .ness
.
aS
\ngW
\ncrea
most^
Despite^5’
/x oene’f
also»acon'
.atities.cation ■
daV’a
!a\tb and edP
econoo"0»
•note eX/eW.ntVAe^or\d'
^poon'
ln«'aa'eaS'otPe! ^'^and treats.ent- Ever/
’
■aitP aC'
|d or df09s oV
pte9nanCV orc'
S\/mp^ot
’
.
statistics
bride ^or
tronon*5
a reso't
a teenag®
ot so VAuge
^oman dres a ado\escent’'
m
tbe
'ace
^astrca^'
irnate an an'
3he\p'esS \stdat,^e
be it an on'-
pere0TZaa'
-■
oider
ibtnetn'nd,
ied'.
tend to notn’ aprotoiem- *''’*^0^'"
andpe^asWe xhs need o1
deatns
. msthat
rtanV'<eed
^'rtab\eW
dab
.p,
abieirtaW”
.•
‘
“
’
'Sei*
abX.A-^se"
hea\tti and
J
TTvC/ VlOlO~LA^ CycZc/
OW.. women’s health is most often
compromised not by a lack of medical knowledge but by the infringement of
human rights. When childhood deprivation ends in nutritionally deprived and
underweight mothers, it results in her producing low birth weight babies.
According to the UNICEF, there is a growing nutritional gap between boys and
girls in India. The girl child tends to be taken to health centres less frequently
than boys, receives less food than boys and is given less education than boys.
She is also breast- fed for a shorter duration. Discrimination against women
begins even before birth - By abortion of female fetuses diagnosed by prenatal
sex determination. Female feticide continues unabated in our country, while the
mother’s ability to choose when to have children, whether to have prenatal
diagnosis or not, or to make uncoerced choices to end a pregnancy, remains a
distant dream in many societies. This is because the concept of reproductive
rights itself is poorly understood. Governmental authorities merit issues of civic
concern over that of the reproductive rights of woman.
Here/ifY where/fCX^SI corner Cn/. We/atterapttfr'
wtake/ a/ d^ffe^ertce/ and/ pat guv end/ to tbit:..
FUTURE MANDATE
AS AN ADVOCACY GROUP
wssSswaaawsw
Serious efforts are required to correct centuries of subordination through well-
planned strategies to enhance women’s status within the household and in
society. In this context there is an urgent need for working towards a human
rights framework and framing reproductive rights as a part of a package of other
rights that improve women’s options for self determination and ensure their
■i
access to good quality, affordable and comprehensive health care services. A
rights based approach is essential in the delivery of reproductive health care, its
components extending far beyond maternal health, family planning and sexually
transmitted diseases to include topics such as
infertility, unsafe abortion, reproduction related
diseases such as genital cancers and the
discouragement of harmful practices such as
genital mutilation and gender
based violence. An attempt has to be made to
counter menaces such as gender and domestic violence
f
against women. An improvement in the quality
I
of reproductive health care will necessitate expanded and
upgraded formal and informal training in sexual and repro
ductive health including skills in interpersonal
communications and counselling as a user and on gender
a>fG'
perspectives.
* We would like all our member societies to pass a
resolution urging all obstetricians & gynecologists to respect the
rights of women in their daily practice and ensure standards for service
quality.
Kcbb
FOGSI intends to collaboratively develop several intervention strategies
involving women’s groups, health organizations, NGOs, as well as the
MOHFW, GOI, thus enhancing public- private collaboration.
* Promote community education by institutionalising quality-training
programs.
* Lobby for the simplification of Govt, procedures for certification etc
I
* Promote monitoring and research.
SHIFT FROM A SERVICE DELIVERY ORGANISATION TO A
A RIGHTS GROUP
WOMEN’S SEXUAL & REPRODUCTIVE
RIGHTS PROJECT
* Plan to identify priority areas in the country where human rights failings
impact on women’s health and where FOGSI alone or with others can
make a change.
*
Plan to educate and increase awareness of
Ob/Gyn professionals about women’s rights
relating to sexual and reproductive health.
*
Plan to commission a draft on professional
standards and guidelines on the respect and
promotion of Human Rights related to sexual and repro
ductive health.
* This draft will be carried among Ob/Gyn professionals
and others concerned, prior to finalization and adoption
as part of a National Code of Ethics.
* Attempt to incorporate this National Code of Ethics into
the curriculum of undergraduate and postgraduate
^o-rkyhop Orv
education.
OUR AREAS OF CONCERN...
ADOLESCENT REPRODLICTIVE AND SEXUAL HEALTH
Adolescents constitute a distinct population group with particular needs and
capacities. More than 1 billion young people are between the ages of 15 to
24 years and most of them are in developing countries. One of the most
sensitive issues associated with adolescence is sexuality. Adolescents
receive inadequate education, guidance and services to help them make the
transition to adulthood. They are vulnerable to sexually transmitted diseases
and infections including HIV/AIDS, substance abuse, sexual exploitation and
violence. We also need to recognize that
5 SWi go
boys also have reproductive
health needs and responding to those needs is also important. It is our aim to
j
enable adolescents to enjoy their reproductive and sexual rights, including their
rights to information, education and services, to ensure that young girls and
boys gain self-esteem and confidence.
The Adolescent Health Committee of FOGSI has been working with various
schools all over India and this has resulted in the education of over one lakh
adolescents on issues such as menstrual hygiene and sexuality. These
efforts are now being intensified.
* FOGSI would like to work with NGO’s and the Govt, of India in formulating
programs with a strong emphasis on sexuality, education, gender and HIV
prevention.
* We would like to identify and develop strategies for reorienting and
improving the quality of curricular and teaching materials, ensuring that they
are gender sensitive.
* Ensure that HIV prevention education is included at all appropriate levels.
PREVENTING HIV/AIDS
Sexual behaviour is the most important determinant of the spread of
HIV and AIDS. In India, the mainstream measures such as using
condoms, sexual abstinence and access to appropriate
treatment for STDs are not effective by themselves alone. These |
measures should be implemented in combination of empowerment |
of women, so that women are able to control their lives,
particularly decision making in sexual & reproductive matters.
* Empowering women and girls to exercise their right to refuse
unsafe sex or abstain from unprotected sexual relations.
* Changing men’s attitudes and behaviour towards women.
* Tackling the lack of information and education, since they contribute to
the spread of HIV/AIDS.
* Strengthening the integration of HIV prevention interventions into
antenatal and safe delivery services.
ANAEMIA PREVENTION
Anaemia is perhaps one of the most common health problems affectin^^m
women. A disease mainly of the lower socio-economic strata of society,
its root cause is poverty. Women eat ‘last’ or ‘not at all’ in India, often
getting only the leftovers. The problem is compounded by menstruation and
pregnancy. It is estimated that 20% of all maternal deaths are due to anaemia.
FOGSI has decided that the theme for the year 2002 will be “Anaemia
Prevention” and this will be a major thrust issue for every member and
every society.
FEMALE FETICIDE
The girl child in India is born almost against all odds, if born at all. Though
official figures do not support the claim, the IMA feels that not less than 50 lakh
female feticides/ infanticides are taking place annually. In 1991, for every 1000
boys there were only 927 girls, and in 2001 this figure had dropped even lower.
The figure for industrialised nations is 1050 females for every 1000 males.
‘Missing girls’ are a matter of shame and effective steps need to be taken to
ensure the survival of the girl child.
|
* Intervention to sensitise doctors, NGOs and the Government
machinery starting from the Panchayat level on the need to protect the unborn
girl child.
* Education and sensitisation of male members of the family and
community, regarding gender bias, female feticide and female infanticide.
* Improve awareness regarding the PNDT Act.
* Initiate measures for effective implementation of the PNDT Act.
To this effect, FOGSI members have taken an oath at the annual conference at
Bhubaneswar that we will not practice sex determination and anyone doing so
would be removed from the primary membership of FOGSI. We would like to
assure the MOHFW that we stand shoulder to shoulder in helping them to wipe
out this heinous crime.
SAFE ABORTION SAVES LIVES
Unsafe abortions are a major health problem in India leading to high
morbidity and mortality. It is believed that nearly 15 million abortions are
taking place in our country every year, out of which 10 million women risk
their lives and health by submitting to quacks to terminate unwanted
|
pregnancies. As a consequence 15,000-20,000 women die from
complications arising out of illegal abortions each year.
The FOGSI’s Safe Abortion programme seeks to catalyse FOGSI’s
national membership of obstetricians and gynecologists and other
doctors to become key advocates and implementers for increasing
access to safe abortion in India. We designated the theme for the year 2001
as “Safe Abortion, Saves Lives.” The Ministry of Health and Family Welfare,
GOI, backed our cause by declaring the year 2001 as the year of “Safe
Abortion”. We made maximum impact in the area of safe abortion services at
all levels of prevention ie. education, contraception, safe services and quality
care. In this connection public forums including a bicycle rally and safe
abortion walks were organized to bring about public awareness regarding this
issue. We have been playing a pivotal role in creating awareness, in
lit■■ :
promoting innovative policies and practices and in bringing together different
< Il
stakeholders like the Govt., NGOs, medical associations, health
practitioners, trainers and community care providers. As part of an integrated
approach, FOGSI with the help of I PAS, Pharmacia and WHO, implemented
a nation wide programme of orientation workshops which were of three types
* A Training of Trainers Workshop where a speaker bank of 75 Travelling
Scholars was identified.
* YUVA - FOGSI Workshops in the four zones of India.
* 52 Society level workshops, which has resulted in the training of over
12,000 doctors, from the government as well as the private sector.
All workshops were designed to create a general awareness on the following:
* The need for expanded access to safe abortion.
■
iili
if
* The availability and proper use of safe abortion techniques.
* Introduction of simpler techniques like the MVA.
* Increasing the access and availability of contraceptive methods including
emergency contraception.
* The importance of pre and post procedure contraceptive counselling in
preventing repeated unwanted pregnancies.
As a result of such sensitization programmes, training workshops and
numerous meetings with the government, a pilot project on MVA has been
initiated in seven states ie. West Bengal, Tamil Nadu, Uttaranchal, Uttar
Pradesh, Orissa and Andhra Pradesh by the MOHFW which is a significant
step forward.
AND, IN THE FINAL ANALYSIS...
It is important that overall societal and male attitudes change! The girl child’s
perception of herself and the tacit acceptance of her lot must be given up.
Improved female literacy will lead to an improved self-image of the woman.
There must be a relentless effort of the entire Society to undo the
injustice of centuries. Only then can women gain their rightful
status in Society. The issue of the reproductive health needs
of all women, maternal mortality and abortion is not
about statistics; it is about women who have names^
women who have faces!! Let us take a stand to
fight for the rights of Women. No longer need
Women’s rights be ignored! Sexual abuse be
Q
tolerated! Medical care be denied! The freedom^
of choice is ... ours!!
si
ALL ABOUT FOGSI
Female
Foeticide
*
The Federation of Obstetric and Gynecologi
cal Societies of India (FOGSI), is the vanguard of
Obstetrics and Gynecology in India.
*
i h/vM/Os
It is probably, one of the largest
*
medical federations in the world, and its
greatest strength lies in its in-built
national network of 150 societies and
L
over 16,000 members.
* As the main custodian of
professional self-regulation in the
Contra06’’"0" Anaemia
Safe
^^orf/on
country, FOGSI has a major role in
defining standards and ensuring
that these standards are met.
ALL ABOUT TIGO
*
Founded in 1954, the International
Federation of Gynecology and
Obstetrics (FIGO), is a federation of 100
national member societies.
k
a
<e
* The mission of the federation is to
A
promote the health and well being of women and
/
improve the practice of gynecology and obstet
rics.
* Its various committees, advisory panels and
interventional projects contribute significantly to
improving the health of women, considering the heavy
global health burden of reproduction related disorders in
women.
Editorial Assistance Kaavya Kasturirangan
Design and Layout - Madhyam
Contact: Bangalore Assisted (Jonception Centre Pvt. Ltd., # 6/7, Kumara Krupa Road, High Grounds, Bangalore - 560 001
Tel.: 2260880, 2269245, 2380080/81, Fax : 91-80-2250465 e-mail.: kambacc@vsnl.com
)
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