Death In The Womb
By Anna Dani
19 November, 2004
Times Of IndiaThe desire for a male child at all costs in India has now resulted in an alarming scenario. The child sex ratio for the country stands at 927 in 2001, down from 945 in 1991. But in India all statistics hide more than they reveal — if we disaggregate data we find great inequalities both between states and within states. The more prosperous states like Haryana, Punjab, Delhi and Gujarat show ratios which have declined to less than 900 girls for 1000 boys. Fur-ther disaggregation of data shows that 70 districts in 16 states and Union territories of the country have recorded a decline of more than 50 points in the sex ratio in the last decade.
Where does Maharashtra stand in this shocking development? The state recorded a child sex ratio of 946 in 1991; today it stands at 913. The prosperous sugar belt districts of Kolhapur, Sangli, Satara, Ahmednagar, along with Jalgaon, Beed and Solapur, all record child sex ratios below 900, with Sangli the lowest at 850. Panhala taluka in Kolhapur district has the dubious distinction of recording a sex ratio of 796, similar to many districts in Punjab.Ironically, the districts which have a high tribal population, areas chronically beset by all the ills of under- development as we conventio-nally understand it, record sex ratios which are more civilised and egalitarian — thus Gad-chiroli district stands at a ratio of 974, Nandurbar at 966 and Gondiya at 964.
The discovery of the ultrasound technique has proved to be the nemesis of the female foetus in India. The medical fraternity was quick to see entrepreneurial opportunities in catering to insatiable demands for a male child. The portable ultrasound machine allowed doctors to go from house to house in towns and villages. The Pre-conception and
Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act 1994 (PNDT Act) was a result of determined action by NGOs against grossly unethical medical terminations of healthy pregnancies. But while the Act seeks to regulate and prevent misuse of pre-natal diagnostic techniques, it rightly cannot deny them either.A decade later, we find plummeting sex ratios, especially in many urban areas of the country. Unfortunately, scientific inventions to detect genetic abnormalities, going far beyond the ultrasound technique, are playing a dubious role. One needs to spend just half an hour with infertility experts to be educated on the newest technologies. The menu is an impressive one — karyo-typing, which analyses chromosomal abnormalities and incidentally reveals the sex of the foetus, a procedure that takes about 11 days and costs around Rs 5,000; fluorescent in situ hybridisation, which has 95% accuracy, takes two days and costs Rs 10,000; comparative genomic hybridisation, a very recently introduced technology, requiring only two days; polymerase chain reaction, the results of which are available in a day with a cost of Rs 5000; and pre-implantation genetic diagnosis (PGD), where the results take about a week. PGD is made available in Thailand for sex selection of Indians who are aware of the law against such tests in the country, at a cost of about Rs 1.5 lakh.
All these techniques can be used to detect the sex of the foetus within four to six weeks of pregnancy, making abortions a less serious business than the usual methods that come into play only 14 weeks after preg- nancy. Thereafter, abortions not only become medically dangerous for the mother but acquire entirely different moral dimensions. The recent technologies do not automatically lend themselves to this heinous practice of sex selection. The PNDT Act allows pre-natal diagnosis only for chromosomal abnormalities, genetic metabolic disorders and congenital abnormalities. Similarly, PNDT techniques on pregnant women are allowed only in certain
conditions — if she is more than 35 years old, exposed to certain drugs, radiation, or has a history of mental retardation and so on.The law, however, permits ultrasound clinics, clinics for medical termination of pregnancies and assisted reproductive facilities as a routine matter and as a legitimate business. In a democracy it is difficult to restrict right to business and livelihood if the usual parameters are fulfilled. But genetic abnormalities do not affect more than 2 per cent of a population; infertility affects about 10-12 per cent of the population; and abortion ser-vice centres are far in excess of the small numbers which actually require such services for purely bona fide medical reasons.
However, the law also permits abortions for failure of contraception. In Maharashtra alone, there are more than 2,700 abortion centres (and counting) and 3,600 ultrasound clinics (also increasing daily). State statistics indicate that more than 1.25 lakh abortions are carried out "legally" every year. It is a huge challenge for the government to detect violations of the PNDT Act, since it is a crime of collusion and by consensus.
The Indian Council of Medical Research has now issued guidelines on regulation of genetic and assisted reproductive facilities. But since such facilities are not used across the board for sex selection, it remains to be seen if this has an appreciable impact on the sex ratio. The preferred methods will obviously remain the cheaper and more dangerous ones such as ultrasound and amniocentesis in the second trimester of pregnancy. Beyond that, the culture of deliberate neglect also contributes to ultimate deaths of older girl children.
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