Maneka Gandhi’s suggestion on mandatory sex tests aims to absolve doctors of blame for foeticide

Feb 4, 2016 on Scroll.in

The minister’s remarks are a response to a campaign by the medical community to change the sex selection law.

 

Kalpana Sharma  · Today · 10:30 am

Is Maneka Gandhi just shooting her mouth off or is a policy change imminent?

According to reports by journalists who heard her speak at a conference in Jaipur on Monday, the Union Minister for Women and Child Development seems convinced that the way to deal with sex-selective abortions, which has led to a precipitous decline in the sex ratio, is to make sex-determination tests on pregnant women mandatory.

Her logic is hard to fathom. The minister has suggested, in all seriousness, that doctors should reveal the sex of the foetus to pregnant women whether they want to know it or not. She believes that by doing this, women will then be afraid to abort female foetuses as its sex will be part of public record.

“It is really not feasible to go around trying to catch every ultrasound technician for revealing the foetal gender to parents in violation of the PCPNDT Act,” Gandhi was quoted as saying. “Rather, why not reverse the strategy? The moment a woman gets pregnant, we should find out the gender of the child, tell the mother about it, and immediately register it in public records. Then we can track which pregnancies are carried to full term.”

She continued: “Since the gender is already known, and given the law, families would be compelled to go through with the pregnancy especially when the foetus is female.”

If it ain’t broke…

In other words, Gandhi wants to turn the Pre-Conception and Pre-Natal Diagnostic Techniques Act on its head. The law prohibits the revelation of the sex of a foetus as it could lead to sex-selective abortions and it penalises doctors and ultrasound technicians who reveal the sex of the unborn child. The new proposal seems to suggest that the Union minister wants to shift this burden to the shoulders of pregnant women who will be considered criminals if they decide to abort a female foetus.

The proposal might never get through but it is worth considering the consequences if it did.

The Pre-Conception and Pre-Natal Diagnostic Techniques Act was the result of campaigns followed by consultations with groups that linked the use of sex-selection and sex-detection technologies to the decline in the sex ratio in India. They argued that the misuse of these technologies aided society’s preference for sons. The fact that the sex ratio had declined even in wealthy districts pointed to the widespread use of these technologies to limit the births of girls.

Paperwork pain

Doctors and ultrasound technicians were held responsible for revealing the sex of the foetus because this was a straightforward way to check rampant sex selection and the sex-selective abortions that followed.

Of course, this meant that all sonography machines had to be registered and doctors had to go through additional paperwork when dealing with pregnant women. However, this was considered a small price to pay given the enormity of the problem.

The law also kept in mind that women who were compelled to have multiple abortions before they produced a male child had no choice. They did this under circumstances where they were blamed if they produced only female children.

The medical lobby

Gandhi was quick to clarify that her remarks were just loud thinking and not the precursor to policy change. Yet, her proposal did not emerge out of thin air. It is in response to a concerted campaign by the medical community to change the Pre-Natal Conception and Diagnostic Technologies Act.

Doctors have complained not just about the paperwork but that they were being charged even for minor “clerical errors”. This argument has held sway in many cases and accounts for the low level of conviction in cases that fall under the law forbidding sex determination. Doctors have also complained about corruption by officials who demand bribes when they come to inspect papers.

In Maharashtra, doctors have been particularly vociferous in their demands for a change in the law. Not surprisingly, the first response to Gandhi’s statement came from the president of the Maharashtra branch of the Indian Medical Association, Dr Jayant Lele, who said, “The sex ratio has not dramatically improved after this law came into force. If expecting couples are tracked after sex determination shows it is a female foetus, they will be more fearful of breaking the law.”

In short, the medical community would like to be absolved of all responsibility and Gandhi’s proposal is precisely what it wants.

Fix basics first

Apart from being highly impractical, Gandhi’s proposal are unacceptably intrusive. In a country with over a billion people with millions being added every year, how will the government monitor every single birth to make sure that sex selective abortions are not taking place? Who will do it?

If even the basic job of ensuring that all pregnant women receive antenatal care so that they survive the pregnancy and deliver healthy babies is not being done how will health establishments across the country take on this additional task? And should they?
The proposal is even more perplexing when Gandhi suggests that the monitoring of every pregnant woman in the country will encourage institutional deliveries. The leap of logic she uses to arrive at this conclusion is unfathomable.

In a country where the word “inadequate” would be a gross understatement when it comes to the ratio of hospital beds to people, does the minister for Women and Child Development really think that we are ready to abolish home deliveries and compel all pregnant women to go to hospital for their deliveries?

Millions of babies are born at home, delivered by trained village dais, and survive. Yet, Gandhi believes “home deliveries pose a threat to the newborn as there might be an attempt on its life” and recommends that they be abolished.

If we have to put up with such ill-informed statements from a person tasked with ensuring the survival of women and children in India, perhaps the post of minister for Women and Child Development should be abolished.

Why Haryana CM's claim that state's sex ratio has improved is dangerous for women

On scroll.in  Tuesday January 19, 2016

Opinion

By claiming that the declining sex ratio can be turned around by a high-profile campaign, Khattar is trivialising an important issue.

Kalpana Sharma  · Today · 12:30 pm

Photo Credit: Roberto Schmidt/AFP

It is quite extraordinary that the chief minister of a state with the lowest sex ratio should claim that there has been a dramatic turnaround in less than a year. Haryana Chief Minister Manohar Lal Khattar was reported on January 16 as saying that the child sex ratio in his state had improved from 834 girls to every 1,000 boys in the 2011 census to 903 in December. He attributed this jump to the Beti Bachao Beti Padhao campaign launch by Prime Minister Narendra Modi last January.

The sex ratio, male-female and child sex ratio (0-6 years) cannot be measured every day – unlike, say, pollution levels. It is tracked over a period of time. Changes in the sex ratio become apparent in the census, conducted once every ten years. Thus, it was with the 2001 census data that alarm bells first rang out about the extent to which the sex ratio in India was skewed in favour of males, especially in the more prosperous districts. Specifically, it is the fall in the child sex ratio that caused concern as it fell from 927 in 2001 to 919 in 2011, clearly indicating that sex selection was widely prevalent.

However, civil society groups had warned of the dangers of the declining sex ratio three decades before the 2011 census when they noticed the growing misuse of medical technology to detect and abort female foetuses. In the 1980s, the first technologies to indicate the sex of the foetus came to India. Amniocentesis, an invasive process that removes amniotic fluid from the uterus of a pregnant woman to test the sex of the foetus, was costly and not widely available. Even so, it was evident that those who could afford the test went ahead and paid for it, followed by an abortion if the foetus was found to be female.

Misusing technology

The first group to begin campaigning and drawing attention to this came up in Mumbai. The Forum Against Sex Selection exposed the misuse of amniocentesis, meant to detect abnormalities in the foetus, and demanded that this and other such technologies be banned. In fact, in the early 1980s, Mumbai’s local trains carried advertisements selling the idea of sex selective abortions at centres that provided both services, amniocentesis and abortion, under one roof.

The FASS campaign eventually led to the Maharashtra government passing a law banning sex selection technologies in 1988. But by then, the technology had changed: it become non-invasive, cheaper and easier. Sonography machines could detect the sex of the foetus much earlier than amniocentesis, making abortion safer. There were no curbs on these machines. They were small and easily portable. Sex selection spread from cities to smaller towns and even villages.

The Maharashtra law led to the central government being persuaded to take note of the dangers of the spread of this technology and in 1994, the Pre-Conception and Pre-Natal Diagnostic Techniques Act 1994 was passed.

But all such laws have their limitations. It is not just a matter of checking the misuse of such technologies but stemming the demand for them. Sex selection is essentially the desire by thousands of Indian families to avoid giving birth to girls. If in the past, some communities resorted to infanticide, today technology provides a neater, easier way of getting rid of the problem – avoid giving birth to girls.

Many justify the use of sex selection by arguing that it will spare girls the tortures they will encounter later in life. It is a strange argument, for it accepts that woman in Indian society can never hope for fair treatment. Also, the fact that the better-off use sex selection clearly establishes that at root the issue is one of property and not any concern for the safety of girls or women.

Misguided measures

Not surprisingly, a law passed to give women equal rights to inherit ancestral property, the Hindu Succession (Amendment) Act 2005 went against them in places like Haryana where the status of women is low in all respects. As this article by Chander Suta Dogra points out, since the law came into effect, the desire to avoid giving birth to girls has accelerated in Haryana rather than decreased.
Ironically, many government schemes aimed at checking the decline in the sex ratio are aimed at poor people through cash transfer schemes, such as Dhan Lakshmi and Ladli, Kanyadan, even though the groups that are most likely to practice female foeticide is well above the poverty line.

Even as we accept that sex selection is a symptom of the larger problem, the implementation of the PCPNDT Act has been patchy at best and mostly indifferent. Even in Haryana, where the declining sex ratio has been the focus of many campaigns for well over a decade, only 58 FIRs had been registered under this law in the last six months. These are registered cases, not convictions. In many instances, those operating sonography machines without registering them are caught but there is no way to prove that they have been used for sex selection. Even if this law was enforced more strictly, it only deals with the technology of sex-selection when the problem is embedded in societal attitudes.

Regressive environment

In Haryana, these attitudes have a long way to go before they change. Political parties, including the BJP that has launched the Beti Bachao Beti Padhao campaign with such fanfare, refuse to take a stand against regressive institutions like the khap panchayats that have a direct impact on the status and rights of women in that state.

Whatever the credibility of the figures recently released by the Haryana government about the improvement in the child sex ratio, the larger problem of women’s rights remains unaddressed. By claiming that something as serious as the declining sex ratio can be turned around by a campaign high on optics is to trivialise an important issue. Such boasts are not just false, they are dangerous. What they do is deny the process required to change mindsets. Even if a state has a reasonably good sex ratio, if its women are harassed, denied choice in marriage, restricted in their movement, dictated what they should wear and what they can do, can we conclude that women’s status has improved and that all girls in the future will be safe? This is the question Khattar and his colleagues need to answer.

Read the original here.

Aamir, listen in

The Hindu, Sunday Magazine, May 13, 2012

Photo: N. Sridharan

Everyone is talking about Aamir Khan's Satyamev Jayate programme. The criticism is muted and much of it predictable. Most viewers have been impressed by it. The first episode was suitably engaging and shocking. It focussed on sex-selective abortion (a more precise and correct term rather than the more commonly-used ‘female foeticide') and the consequences of the declining sex ratio. Even the cynics must agree that every attempt to make a dent in the entrenched mindset in this country, where educated people think nothing of making women go through multiple abortions simply because they believe they must have a son, is welcome.

The actor has probably got all his episodes in place. But here is a subject that he should consider, one that requires the same kind of puncturing of middle-class attitudes that he did quite effectively in his maiden episode. Predictably, people interviewed said only the poor, illiterate and rural people resort to practices like sex-selection. Khan established with effective and simple graphics that the exact opposite was the case. I also liked the simple and clear way he stated that it is the male that determines the sex of the foetus. It's frightening how many people refuse to accept this as a fact.

Helping hands

The subject I suggest is a programme on domestic help. All of us have people “working” for us. Yet, we do not grant them the rights of workers. They are invisible, part of the furniture, taken for granted. With increasing urbanisation, and women stepping out of the home for jobs, the middle class is ever more dependent on such help. Yet greater demand has not led to better conditions for these workers.

Despite articles in the media, some campaigns, and notable documentary films like “Laxmi and Me” by Nishtha Jain, we do not see a shift in attitudes towards domestics. Instead, we read stories of violence and abuse. So, Aamir Khan, how about something on the way we treat our domestic help?

The good news is that finally, after years of campaigning for some regulation governing domestic workers, the union cabinet has prepared a note based on a draft national policy on domestic work that was prepared by the Ministry of Labour in 2009. If the policy is accepted, domestic help will come under existing laws that govern all workers such as the Minimum Wages Act, the Trade Union Act, the Payment of Wages Act, Workmen's Compensation Act, Maternity Benefit Act, Contract Labour (Regulation and Abolition) Act and the Equal Remuneration Act.

Last year, Indian delegates at the International Labour Organisation (ILO) voted for employment standards for domestic workers. The government has extended the Rashtriya Swasthya Bima Yojana (RSBY), the central health insurance scheme, to cover domestic workers and three members of their families.

In the policy, a domestic help is described as “a person who is employed for remuneration whether in cash or kind, in any household through any agency or directly, either on a temporary or permanent, part-time or full-time basis… but does not include any member of the family of an employer.”

What this means is that you cannot get away with paying your domestic help the pittance that most people do. As the National Floor Level for Minimum Wage is currently Rs.115 per day, a full-time domestic should be paid at least Rs.3,450 a month. She would be entitled to maternity leave, annual leave, sick leave and paid for overtime. The sexual harassment law has finally included domestic workers in its ambit. So she would be protected against sexual abuse and violence.

Syndrome of sorts

A policy like this comes not a day too soon. We shed tears about women who are forced to abort female foetuses or other victims of violence. But are we aware of the daily exploitation under our very noses? We refuse to accept that paying a woman less than the minimum wage, for work that is back-breaking and certainly something we don't want to do, is exploitative. Yet in this day and age, there is simply no justification for the “servant” syndrome to continue.

Of course, in India, rules and laws alone rarely bring about real change. It is the attitude of the people, those who employ domestics, that needs to undergo a revolutionary change. Just as in the case of sex selection, simply having a law, even with strong implementation, is not enough to make people think differently. One hopes that media interventions, like Aamir Khan's show, will begin to make a difference. At least, the issue will be discussed. It will be in the open. And those who continue with the old view will be exposed.

Similarly, domestic work needs to be talked about, the reality constantly exposed, the law implemented. The rules governing domestic work are particularly difficult to implement because contracts are individually negotiated, the exploitation takes place behind closed doors, inside people's homes. How can any government agency monitor this or insist on compliance? A change is only possible if the “employers”, people like you and me, accept that these invisible hands that make our lives so comfortable need respect, acknowledgement and above all a fair wage. 

(To read the original click here)

Where have all the girls gone?

The Hindu, Sunday Magazine, April 17, 2011

THE OTHER HALF

KALPANA SHARMA

Does economic development only reinforce regressive values? How else can one explain the phenomenon of disappearing girls in modern India?

Photo: V. Sudershan 

Will laws alone help?

India's Cricket World Cup victory followed by Anna Hazare's indefinite fast on the Lokpal Bill virtually knocked out of the news arena some really bad news. Just days before all these media-grabbing events, the Census office released preliminary figures for 2011. The most shocking of them is that in the 0-6 year age group, the number of girls to every 1,000 boys is just 914, even lower than the 927 of the 2001 census.

How has this happened even as the adult sex ratio has gradually crept up from 933 women to 1000 men in 2001 to 940 women to 1000 men today? Why has this happened even as women's literacy rate has gone up and the gap between male and female literacy rates has shrunk? Why has this happened even when there are laws in place to ensure that sex-selection does not lead to the elimination of girls?

Perhaps a coincidence, but just a few days after the disturbing census results were made public, a group of activists met in Mumbai to mark 25 years since they launched a campaign against the use of medical technology for sex detection and selection. Their campaign had culminated in the first law against sex-selective abortions being passed by the Maharashtra government on January 1, 1987.

Misuse of technology

In those days, the popular method of sex detection was amniocentesis. It was an invasive procedure involving amniotic fluid being extracted from the womb for testing. The technology had been devised to detect foetal abnormality. Instead, in India it began to be used to detect the sex of the foetus. Women risked an abortion if the test confirmed a female foetus even if they got to know at a later stage of pregnancy.

In the absence of a law or any restraining regulation, those conducting these tests were openly advertising them. Advertisements like “Better 500 now than 50,000 later” were common, suggesting that Rs. 500 on a test to confirm the foetus today was better than spending many times more for a dowry later.

There are several aspects of how this first legislation came about that are pertinent in the context of the recently-concluded agitation by Anna Hazare and his supporters for a Jan Lokpal Bill to check corruption. The Maharashtra law banning sex selection came about through a push from below by the activists and a response from above. The activists tried to gather together as much evidence and data that they could about something that was just below the surface. It was virtually impossible to prove as neither the mother, nor the doctor, would admit that the test had been used for such a purpose. Ironically, they had stumbled upon this issue when a multinational company, concerned about the mounting medical claims from its women employees who had sought abortion, asked women activists to speak to them.

Through a variety of techniques, including sending in decoys to doctors suspected of conducting such tests, the activists assembled some proof. They were lucky to find at least one sympathetic senior bureaucrat, the Maharashtra Health Secretary. Without any dharnas or fasts and little media coverage – there were no private TV channels those days – the government and activists spoke to each other, argued over the provisions in the Bill and ensured that it was finally passed. That law was the precursor to the central law banning sex-determination tests passed in 1994 and amended in 2003 – the Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex-selection) Act 2003.

Loopholes

Even after the 1994 Central Act was passed, the activists were not happy. They pointed out that not a single doctor had been convicted under the Act. Also the law made women who undertook the test culpable for the crime. Furthermore, sex pre-selection techniques did not come under the ambit of the Act. After advocacy and dialogue had failed to get the law amended, the activists turned to the courts and presented their case. It was at the intervention of the Supreme Court that the government was compelled to amend the law to make it more watertight.

But given the latest Census figures, it is evident that the law even today is not strong enough. So the question that must be asked is whether making it any stronger will make a difference if the mindset of families remains firmly set against girls. Can laws really deal with what is essentially a social problem in India?

The other question that needs to be raised and discussed is whether high economic growth and women's status in society are necessarily linked. As India becomes economically stronger, will the value and worth of its women also become higher? In 2001, this was disproved as the lowest sex ratios existed in districts that were the most prosperous.

Today, there is an additional and more worrying phenomenon. Like a virus, the declining child sex ratio is spreading to districts that till now had not been affected. More research will reveal why this has happened but could this be one of the negative fallouts of economic growth?

For, has increased prosperity actually resulted in easier access to technology that assists sex selection? Sonography, the technology currently most popular in sex selection, does not come free although it is far cheaper today than when first introduced. Portable sonography machines can be loaded in the back of a car and taken to even smaller towns or larger villages. But even this would not have made a difference had there been no demand for the technology. That a growing demand exists is evident from the census figures.

Getting more conservative?

Also, is the availability of more money actually having the opposite effect? Is it reinforcing regressive attitudes? Instead of bringing in more enlightened and liberal attitudes, is it making people more conservative, getting them to hold on to beliefs that should find no place in a modern India? How else can one explain the story of India's disappearing girls?

Apart from the law, a great deal of work has been done to create awareness about the value of the girl child. There have been campaigns; state governments offer incentives for girls' education, and even the media and the advertising fraternity has been sensitised to the issue.

But all this seems to be of no avail. So while India shines on the cricket field and in other arenas, the darker, uglier side of our society continues to stare us in the face.

Dealing with this is at least as challenging as rooting out corruption. But will people come out and demonstrate for what someone called this ‘invisible constituency'?

(To read the original, click on the link above)

Where have all the young girls gone?

I will be writing more on this subject -- of the disappearing Indian girls -- but here's a short comment I did for The Guardian.  It is written for a non-Indian audience and I was also constrained by the word length, only 600 words.  But I have tried to convey the conundrum.  Here's the link:

http://www.guardian.co.uk/commentisfree/2011/apr/10/missing-girls-dark-side-india-abortion

Missing: 42.7 million women

The Hindu, Sunday Magazine, April 4, 2010

THE OTHER HALF

Lack of access to healthcare, malnutrition and selective abortion — all these have contributed to over 40 million women dying in India. And these are the issues the government needs to address now…

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In India, women constitute 48.2 per cent of the population, worse than Pakistan...

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Photo: V. Ganesan

A struggle all the way...

Last month, on March 8, we celebrated the centenary of International Women's Day. A day later some celebrated the passage of the Women's Reservation Bill in the Rajya Sabha while others ranted and raved against it. Still others asked whether 63 years after Independence, any of this made a material difference to the lives of the majority of Indian women.

The latter were, of course, right. Symbolic gestures have little meaning when every year over 40 million Indian women die for no other reason than not being able to access healthcare, if and when they do being discriminated against, being so malnourished that even if they get treatment they cannot survive, and all this only if they are not eliminated before birth or after being born.

Yes, also on March 8, the United Nations Development Programme (UNDP) released its 2010 Asia-Pacific Human Development Report titled, “Voice and Rights: A turning point for gender equality in Asia and the Pacific”. The picture that emerged of India was not a happy one. In most countries, women generally outnumber and outlive men. As a result, they are a little over half the population. But in India, they constitute 48.2 per cent of the population, worse than Pakistan where the situation is bad enough with women being 48.5 per cent of the population. Even Bangladesh is better at 48.8 per cent. The reason this has happened is a combination of the factors that have led to 42.7 million “missing” women (2007 data).

Chilling reminder

As if we needed another reminder, The Economist magazine carried a hard-hitting feature under the headline: “Gendercide – The worldwide war on babies” (March 4, 2010). “Technology, declining fertility and ancient prejudice are combining to unbalance societies”, stated the article as it reported on several Asian countries, particularly India and China and the skewed sex ratio. The article should have been titled “Femicide” as only one gender is being eliminated — the female. Still, it was a chilling reminder of the reality in the world's two most populous nations, where, as an old Chinese lady who witnessed female infanticide was quoted by The Economistas saying, “It's not a child. It's a baby girl, and we can't keep it…Girl babies don't count.”

But someone is counting baby girls and boys, men and women. In fact, thousands of people are right now fanning out across India for the mammoth exercise, one of the largest in the world, of the 2011 Census.

The 2001 census brought home the point starkly that millions of girls in India never saw the light of day. Either they were never allowed to be born, due to sex-selective abortions, or were killed shortly after birth. As a result, in the 0-6 year age group of children, there was a marked increase in boys as compared to girls in some of the richest districts in the country. Clearly medical technology, that the better off could afford, had been perversely put to this kind of use — of ensuring that girls were eliminated before birth.

The 2011 census will be significant in more ways than one. In 2001, the problem that had been lurking for years was exposed through stark, irrefutable data. As a result, the government had to act. It tightened the Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act 2003 (also known as the PCPNDT Act). Campaigns were run for the “girl child”, incentives given for her education, and threats held out of punishment and fines against those misusing technology for sex-selective abortions. How effective were all these efforts? Results from the 2011 census will tell us.

It is small comfort to know that this problem is not unique to India. The article in The Economist, for instance, gives startling data on the situation in China where decades of son preference and a one-child policy as well as sex selection have resulted in a marked difference between the number of young men and women. The article quotes research by the Chinese Academy of Social Sciences that predicts that by 2020, China will have 30-40 million more men less than 19 years of age as compared to women. (The current sex ratio in China is 123 boys to 100 girls).

Serious consequences

Such a situation fraught with serious sociological consequences, not the least of which is the shortage of brides. In India, in states like Haryana this has already come about with brides from other states being bought by young men who just cannot find a woman from their own region. Every other day we read stories about women from as far away as Kerala or Assam who have made Haryana their home. Nothing wrong with such cross-fertilisation in a country that is so divided by caste, religious and regional identities as long as the women know their rights and have a way out if things don't work out. What is disturbing is the reason this is happening — not free choice but no choice.

Tragically, none of this kind of data seems to create any ripples amongst those in a position to make a difference. Take Maharashtra, for instance, one of the richest states in India. This year's Economic Survey revealed that by 2011, the state's sex ratio would be 915 women to 1000 men, down from 922 in 2001 when it was significantly lower than the national average of 933. Maharashtra also has the dubious distinction of ranking 15 out of 28 states in India in terms of its sex ratio.

Yet, what is preoccupying the men who govern the state? Chief Minister Ashok Chavan has been tying himself up in knots trying to explain how the actor Amitabh Bachchan, who has chosen to identify with Gujarat Chief Minister Narendra Modi as the state's brand ambassador, came to share a dais with him at an official function. How does any of this matter? States like Maharashtra need governance, not showbiz.

The Economist referred to India as “that super giant”. But such compliments count for nothing if our government does nothing about “femicide” and those “missing” women.

(To read the original, click on the link above)