Prenatal sex determination

Bizarre solution

Print edition : May 12, 2017

The Sangli district police exhume female foetuses in Mhaisal village. Photo: By Special Arrangement

Bharti hospital at Mhaisal where illegal abortions were performed. Photo: Arunangsu Roy Chowdhury

Babasaheb Khidrapure, who runs the hospital, being taken to the court at Miraj in Sangli district. Photo: PTI

Dr Srihari Ghodke, Umesh Salunkhe and Kannchan Roje (far right), three other accused in the Swati Jamdade case, being taken to the court. Photo: Arunangsu Roy Chowdhury

In an inexplicable move, the Maharashtra Assembly’s Public Accounts Committee recommends making screening of sex selection mandatory to prevent gender-based abortions.

THE Budget session of the Maharashtra legislature touched two ends of the moral spectrum. At the progressive end was a new law that accorded the media some degree of protection. At the other end was a dubious proposition to make sex determination tests mandatory.

There was outrage when the Public Accounts Committee (PAC) of the Legislative Assembly suggested making prenatal sex determination and the tracking of pregnant women mandatory as a means of preventing sex selection and ending female foeticide. Aware of the existence of illegal sex determination and abortion clinics but seemingly unable to purge them from the system, the government had been considering various options. It was finally forced to act by the discovery of abandoned female foetuses at Mhaisal village near Sangli in March.

The foetuses were unearthed when the police acted on a complaint filed by the parents of Swati Jamdade, who died on February 28 when she was undergoing a medical abortion at a hospital run by a homoeopath, Babasaheb Khidrapure. Swati Jamdade, who was expecting her third child, decided to have her pregnancy screened to check the baby’s gender. When she was told that she was going to have a girl again, she and her husband opted for medical termination of pregnancy. Her parents complained to the police that their daughter was forced by her husband to undergo the procedure after the sonography scan had revealed a female foetus. A case was registered against the doctor and the hospital staff. Five days into the investigation, the police found 19 bags with what is medically termed as “products of conception”—foetuses, placental material and tissue matter from fertilised ova. The 19 female foetuses were found wrapped crudely and dumped near the hospital.

The disturbing part of the findings is that it took the death of a woman for the illegal activity of sex selection screening centres to come to light. It is not difficult to deduce that hundreds of women may have survived the abortion of unwanted female foetuses, thus encouraging the network of such centres and back-room abortionists to flourish. The government reacted to the Mhaisal foetus scandal by merely referring the issue to the PAC. The PAC’s solution was to legalise the operation.

The PAC’s 23-member panel, headed by Gopaldas Agrawal of the Congress, proposed that sex determination tests be done when parents come for a sonography and that the pregnant women be tracked regularly to check if they are coming for tests and especially so if the sonography reveals the foetus to be a female.

The panel report said: “When parents come for sonography, compulsory sex determination must be allowed and follow-ups must be done at the local level to ensure that the couples come for further check-ups. It is necessary to visit these couples at home if they stop check-ups.”

The report called for bringing parents under the purview of the Pre-Conception and Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, (PCPNDT), 1994. The committee recommended that local health officials should keep tabs on pregnant women to check female foeticide.

The panel’s suggestion seems to be based on the simple assumption that once it is established that a woman is carrying a girl child and she and her family know that she is on the state’s radar, there is less chance of any attempt to abort the foetus.

Apart from the fact that there is only one woman on the panel, there is much else that is wrong with the suggestion. It is intrusive and violates the privacy of the woman and her family. The woman becomes open to scrutiny by unscrupulous medical professionals and government health officials. The law takes away the responsibility from doctors who run sonography clinics. More than anything else, it infringes upon the PCPNDT Act. The Act was enacted to stop female foeticide, prevent declining sex ratios and, more importantly, ban prenatal sex determination tests.

More than a 100 activists and groups such as the Forum Against Sex Selection, the Akhil Bharatiya Janwadi Mahila Sanghatana, the Mahila Sarvgrameen Utkarsh Mandal, the Forum for Medical Ethics Society, the Forum Against Oppression of Women, the Jan Swasthya Abhiyan-Mumbai and the Maharashtra Mahila Arogya Hakka Parishad have opposed the PAC’s proposal.

Kamayani Bali Mahabal, the advocate-activist belonging to the Forum Against Sex Selection, said in a statement: “These recommendations are grossly violative of the PCPNDT Act and will impinge upon the MTP [Medical Termination of Pregnancy] Act as well. It is ironical that such a recommendation is being made in Maharashtra, which pioneered the law to curb sex selection after a long campaign by women and health activists that linked the use of sex-selection and sex-detection technologies to gender-based discrimination and thereafter to the declining child sex ratio in India.”

The panel appears to be of the view that turning its recommendations into law would make parents more accountable.

The report reads: “Since the law only provides for action against doctors (for carrying out sex selection tests), there is no fear of the law among parents. But this fear of law among parents is necessary to increase the sex ratio. Doctors, parents, district health officers [DHOs] and NGOs must be involved in the tracking system.” That is just a euphemistic way of shifting the onus onto the woman and absolving doctors. The woman and her family will be hounded by the authorities. In fact, underscoring the fact that many pregnant women did not have autonomy over their pregnancies, amendments to the PCPNDT Act in 2003 kept the pregnant woman out of the scope of the Act. Kamayani Bali Mahabal said: “This new proposal will only result in a 24-hour surveillance of pregnant women both within the family and by the state authorities.”

Informed decision

The right of women to make an informed decision about their pregnancies will also come under fire if the panel’s suggestion is accepted. Kamayani Bali Mahabal pointed out: “[The authorities] will unnecessarily target every woman bearing a female foetus, and will link any abortion that such a woman has (for any reason) to sex selection. This will adversely impact women’s already poor access to safe abortion. It will fuel a proliferation of illegal facilities for getting rid of unwanted female foetuses.”

Interrogation of Khidrapure, who was arrested on March 7, revealed that he was part of a larger network covering Maharashtra and Karnataka. He had been associated with this group of medical professionals and corrupt government officials since 2009. In fact, even before the news broke about Khidrapure’s abortion clinic located in the border district of Sangli, there was a raid on an illegal clinic in the border district of Kolhapur in February.

If the Maharashtra government accepts the suggestion, it will be that much easier for the criminal activity to flourish. Couples from Karnataka—where there is no move to make sex selection mandatory—desperate for a male child, could easily cross the border to determine the child’s gender in the neighbouring State. This is likely to open a new line of revenue generation for prenatal diagnostic clinics.

In order to bolster the case for implementation of its suggestion, the panel said that 550 cases registered under the PCPNDT Act were pending in courts in the State. Its thinking seems to be that the existing Act has no power, but the fact is that the majority (330) of the cases were filed between 2011 and 2012 after the expose of an extensive illegal sex selection and abortion racket in Beed district in a clinic run by Drs Sudam and Saraswati Munde. This proves that the PCPNDT Act does have teeth and only requires proper implementation. This fact has found support from the Shiv Sena, which has taken an open stand against the panel’s suggestion.

The panel noted that “the sex ratio in Maharashtra in 2010 was 854 girls per 1,000 boys. It went up to 861 in 2011 and 919 in 2014.” The figures prove that the existing Act has been effective and only needs stringent implementation and not any modification or addition.

It is interesting to see gender selection in a global perspective. Population First, the advocacy and communications group which states that one of its key objectives is to help eliminate the falling sex ratio in India’s population, explains in a 2014 report:

“Worldwide, the natural ‘sex ratio at birth’ is 105. This means that at birth, there are 105 males born for every 100 females. The sex ratio at birth is usually expressed as the number of boys born alive per 100 girls born alive. Nature provides that the number of boys born is slightly more than the number of girls, owing to greater biological vulnerability of the male child. Sex Ratio at Birth: China 118, India 109, Pakistan 106, Bangladesh 104.9, Singapore 107, South Korea 106, Vietnam 111, Azerbaijan 116.5, Armenia 114.9, Georgia 113.6, Albania 111.7, Montenegro 109.8. These figures point at the proportion of deficit in female births, indicating that prenatal sex selection has become increasingly a global phenomenon. (Source: “Sex-ratio imbalance in Asia: Trends, Consequences and Policy Responses”, Christophe Z Guilmoto, UNFPA). Across the globe, UNFPA [United Nations Population Fund] estimates a total gender gap of 117 million women missing in 2010, most of them from China and India. In India, the 2011 Census found about 7.1 million fewer girls than boys under the age of six as against a deficit of 6 million girls in 2001. The UNFPA estimates that 30 per cent of the women in India resort to sex selection for their last birth in absence of a previous male child. As per Census 2011, the all India child sex ratio (0-6 age group) is 914:1000, an all time low in last 50 years.”

Implementing the PAC panel’s suggestion will amount to victimisation of women. Stringent implementation of the PCPNDT Act is the answer to preventing gender-selective abortions.

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