Given the predominantly patriarchal setup in the country, the health and education of a girl child is highly neglected. Special programmes have indeed been initiated to stop early marriages and reduce school dropout rates. But a lot more needs to be done. Health & Education of Girl Child in India: An Increasing Concern – Dr Vibhuti Patel

1. NEWSLETTER | OCTOBER – DECEMBER 2015 | QUARTER 4 | ISSUE 7
girlscount
Dear Friends,
With this seventh edition of Girls Count
Newsletter, we welcome you all to the
last issue of 2015. Girls Count takes this
opportunity to wish you a happy, healthy
and harmonious New Year.
We are thankful to the authors for their
contribution and extend our gratitude to all
those who have been giving their valuable
feedback and comments on the issues we
have been raising though the Newsletter.
Through this edition, we have once again
tried to raise several debates around health
and education of girl child, safety of women
and girls, and concerns around surrogacy.
We hope that you will like the issues and
concerns we have raised through this
edition.
We look forward to your continuous
support in engaging and contributing
towards strengthening the ‘voice’for the
all-round development of girl child.
Contributors
You can share your views and opinion by
writing to us at info@girlscount.in
Dr Vibhuti Patel
Professor,
Department of Economics,
SNDT Women’s University,
Mumbai
Kalpana Vishwanath
Co-founder, Safetipin
New Delhi
Anju Dubey Pandey
Programme Specialist,
Ending Violence Against
Women, UN Women
New Delhi
Rakhi Ghosal
Secretary, Forum for
Medical Ethics Society
Mumbai
Given the predominantly patriarchal
setup in the country, the health and
education of a girl child is highly
neglected. Special programmes have
indeed been initiated to stop early
marriages and reduce school dropout
rates. But a lot more needs to be done.
Health & Education
of Girl Child in
India: An Increasing
Concern
– Dr Vibhuti Patel
During the South Asian Association for Regional Cooperation (SAARC)
Decade of the Girl Child (1990-2000), for the first time in the post-
independence period, issues related to “girl child” became a subject matter of
special inquiry in India. Several baseline surveys, micro-studies, and region-
specific case histories and narratives provided the database for a macro-
profile on health issues concerning the girl child. According to the Sample
Registration System (SRS), in 1997, more than 1/3rd (35.4 per cent) of the
total female population are in the age group of 0-14 years.
EDUCATION OF GIRL CHILD IN INDIA
Today, there are over 200 million illiterate women in India. It is estimated
that of the 10 girl children who enrol in Class I, only three reach Class X.
There is ample evidence to show that girls remain educationally backward as
compared to boys. Gender disparity in education still remains a serious issue
in India. The girl child is also a victim of the culture of women being restricted
to domestic work and burdened with family responsibilities at a very early age.
Dropout rates for girls are very high particularly in rural areas. Recent
studies have shown that in rural areas for every 100 girls enrolled in Class
1, there are only 40 in Class V, 18 in Class VIII and one in Class X. Low skill
and inadequate training, lack of information and low social status are the
1

2. consequences of such gender differentials. (UNDP Report,
2006).
The Government of India has started offering free education
at high school level to all girls of single child families and
those with two girls and no boys are entitled to receive
discounts of up to 50 per cent. It has been accepted that
investment in girls’ education is key to empowerment of
women as educated women are less likely to be oppressed
or exploited and more likely to participate in the political
process. In addition, they are likely to have smaller families,
and healthier and better-educated children. It is only
through education that the girl child can arm herself to
be independent and self-reliant. An immediate change is
thus necessary to reduce gender disparity and eliminate
illiteracy from India. Nonetheless, in both the centrally-
sponsored schemes under the Union Budget of India—Sarva
Shiksha Abhiyan and Secondary Education Campaign—it is
mandatory to use 30 per cent of the total allocation for girl
students.
HEALTH PROFILE OF GIRLS
IN INDIA
Health challenges concerning a girl child cover mortality,
morbidity, nutritional status and reproductive health, and
linked to these are environmental degradation, violence and
occupational hazards, all of which have implications in the
overall health of girls. It is intricately related to the socio-
economic status of the households to which she belongs
and her age and kinship status within the households. Given
the predominantly patriarchal set-up in the country, girls get
a lesser share in the household distribution of health, goods
and services compared to men and boys. Data shows that in
a situation of extreme food scarcity, the adverse effect on the
nutritional status of girls is greater than boys. Girls in the 13-
16 age groups consume less food than boys. Similarly, in the
intra-household distribution of labour, girls shoulder the major
burden of economic, procreative and family responsibilities.
Consequently, girls tend to neglect their health. Their lesser
access to food coupled with negligence invariably leads to
poor health of most of the girls. Changing determinants in
the struggle for survival of girls have created an alarming
situation during the five decades of post-independent India.
Declining Juvenile Sex Ratio (JSR) is the most distressing
factor reflecting the low premium accorded to girl child in our
country.
MALNUTRITION AMONG
GIRL CHILDREN
Studies conducted in three metropolitan cities—Bombay,
Calcutta and Madras—indicate that a significantly higher
proportion of girls compared to boys are in the grade II
and III malnutrition category. The cumulative effect of
poverty, undernourishment and neglect is reflected in their
growth, poor size of their body and narrow pelvis, as they
grow into adolescence, making child-bearing a great risk.
Girls between 13-18 years of age have lower percentage
of iron, protein, calories and Vitamin A. With the onset of
menarche, an average Indian girl becomes highly susceptible
to anaemia. A majority of poor adolescent girls are 12-15
cm shorter than their well to do peers. Conversely, eating
disorders found among the upper class girls trying to attain
the media image of ‘a beautiful woman’ who is extraordinarily
thin, makes even upper class girls anorexic. The National
Institute of Nutrition (NIN) studies have shown that 36 per
cent of upper class girls had low Body Mass Index (BMI) due
to their conscious attempts to maintain low weight.
EARLY MARRIAGES AND
PREGNANCY
Of the 4.5 million marriages that take place in India every
year, large number are of girls from poor households who
are pushed into early marriages. About three million girls
marry by 15-19 years and the marriage is consummated
almost immediately after menarche. Girls bearing their first
baby between the ages of 14-18 are at obstetric risk and the
subsequent result is low birth weight babies and pre-natal
complications. These girls are at a higher risk for pregnancy-
Studies show that in rural areas for
every 100 girls enrolled in Class 1,
there are only 40 in ClassV, 18 in
ClassVIII and one in Class X. Low
skill and inadequate training, lack
of information and low social status
are the consequences of such gender
differentials.
In a situation of extreme food scarcity,
the adverse effect on the nutritional
status of girls is greater than boys.
Girls in the 13-16 age groups consume
less food than boys. Similarly in the
intra-household distribution of labour,
girls shoulder the major burden of
economic, procreative and family
responsibilities.
COVERSTORY
2

3. induced hypertension and eclampsia that includes
seizure at delivery. The upsurge of female deaths in the
age group of 15-19 years bears testimony to the high
mortality rate of women.
The health of adolescent girls’ plays an important role
in determining the health of the future population,
because their health has an intergenerational effect.
The cumulative impact of the low health situation of
girls is reflected in the high maternal mortality rate,
the incidence of low birth weight babies, high prenatal
mortality and foetal wastage, and consequent high fertility
rates. Unwed pregnant girls (victims of rape, incest or
seduction) turn to abortion, whether or not it is legal.
Faced with unintended pregnancy, they take desperate
measures resulting in health risks from unsafe abortions,
such as sepsis caused by unsanitary instruments or
incomplete abortion, haemorrhage, injuries to genital
organs such as cervical laceration and uterine perforation
and toxic reactions to chemicals or drugs used to induce
abortion.
It has been observed that many Indian girls enter
motherhood because of not taking adequate precaution.
It results in high wastage of human resources and
increasing rate of maternal, infant and child mortality. The
most relevant cause behind these problems is ignorance
of the mother, inadequate preparation of adolescent girls
for safe motherhood and various undesirable practices
prevalent in Indian society.
Approximately 138 million of India’s population is in the
15-25 age groups. In UP, MP, Bihar and Rajasthan, about
50 per cent adolescent girls get married below the age of
20 which contributes to 40 per cent of India’s population.
It is rather unfortunate but true that majority of girl
children in India do not experience “adolescence” as they
shift from childhood to adulthood and soon become a
pregnant adult. In the rural and tribal areas also early child
bearing has been the reason for high dropout rate among
girls in the high schools.
— Dr Vibhuti Patel is the Director, CSSEIP & Professor
and Head, Department of Economics, SNDT Women’s
University, Mumbai
The health of adolescent girls’ plays
an important role in determining
the health of the future population,
because their health has an
intergenerational effect.
Ninety three million Indians live in the informal settlements
of the country, as per the latest census report. These
slum-dwellers do not have access to proper sanitation
system, clean water, uninterrupted electricity supply and
other basic services, including law and order. The worst
affected are women and girls who suffer due to lack of
infrastructure facilities which in turn affects their health,
education and security. Cities have better prospects and
women from marginalised socio-economic backgrounds
should be enabled to have access to places where there
are opportunities for growth. But to bring in gender equity,
it is also important to get rid of the infrastructural gaps in
these thickly-populated neglected urban camps where the
marginalised women population lives.
In low income neighbourhoods, inequality is not just
restricted to access to services and resources. It is based
on a patriarchal setup where women face barriers in
economic and social mobility as well. Lack of infrastructure
and services in the urban slums of India has its adverse
effects on the lives of girls and women vis-a-vis their
health, education, income and leisure pursuits.
Due to lack of toilets at homes, open defecation is often
the only option for women living in the slums. But they
feel embarrassed, are often harassed by the local youth
Infrastructure
in Urban Slums
& its Impact
on Women’s
Safety
The total population living
in the slums of India is
93 million. Read through
the article to examine the
infrastructural and service
gaps that exist in the
urban slums of India and
the negative affect it has on the health,
education and safety of women.
– Kalpana Vishwanath
INFOCUS
3

4. and are a victim of ridicule by men. Consequently they
wait till dusk to attend nature’s call. This results in serious
health issues like stomach aches, urinary tract infections,
skin diseases and bladder problems in them. Even in slums
where there are community toilets, women face sexual
harassment and often have to wait for hours in long queues
for their turn. The health risks are thus both physical and
psychological.
Another important factor that restricts the development
of women and girls and reduces their standard of living is
the lack of leisure time and space. The space for leisure
activities in slum communities is severely restricted. The
unplanned and congested residences are not built keeping
public spaces in mind. There are hardly any open spaces
or parks and those that exist are not accessible to girls and
women. Various studies show that girls ‘disappear’ from
playgrounds once they hit puberty. Social customs force
young girls to behave in a certain way and ‘not act like boys’
by participating in sports. Adult women too are forced to
stay indoors for fear of ridicule and sexual harassment in the
streets.
Various studies have also revealed that in these slums,
the responsibility of collecting water for drinking, cooking,
bathing and other household chores, is on women and girls.
As a result, they either miss classes or drop out of school
altogether. The collection of firewood, cooking, cleaning
and disposal of waste (mostly in open drains outside the
homes) is also done by women due to the gendered division
of work at home. If the time and effort wasted by women on
these petty tasks could be saved through improvement in
infrastructure, it would most certainly lead to upward social
mobility and greater participation of women in other spheres.
It would give them ample time and energy to complete their
education and fulfil their other social aspirations.
Our social enterprise Safetipin, which provides a number of
technology solutions to make cities safer for women, has
introduced several mechanisms to identify and bridge this
gap. One such attempt is through the setting up of Safety
Chaupals, a platform where women and girls discuss with
the local authorities about the safety issues faced by them in
their daily lives.
In 2014, with an understanding on how infrastructure plays
an important role in women’s safety, Safetipin collaborated
with Jagori, a leading women’s rights NGO in India, to set up
a Safety Chaupal in Badarpur. The women self help group
(SHG) collected safety data using the Safetipin app, which
showed that only 43 per cent of the Badarpur area had
lighting and that too on the main roads; 53 per cent had no
walkways for people to walk safely; and 80 per cent of the
community had no visible policing.
A report with the analysis of the data collected was
presented by the women in a stakeholders meeting that
was attended by the police, people’s representatives and the
larger community of the area. The advocacy report with its
unique set of data that pinpoints the lacunae, like lighting,
security, lack of clean and safe roads in the area, led to
swift changes in the community. Today, we can see CCTV
cameras in the area, increased police patrolling, proper
street lights and construction work of two new community
halls in progress. This endeavour of ours was a successful
pilot project using technology to effectively bring visible
changes in the infrastructure of a slum community.
Safetipin, a mobile app that collects safety data from various
cities across the world, is yet another initiative. It is a tool
to address the fear of violence that women face while
commuting. At the core of the app is women’s safety audit
(WSA). The app currently being used in nine cities of India
and four cities overseas, collects data on nine parameters
namely, lighting, openness, visibility, walk path, security,
crowd, public transport, gender usage of the area, and
the feeling of safety. The data collected is then used for
advocacy with various organs of the government to initiate
strong data backed change projects.
Safetipin is undoubtedly a strong advocacy tool for making
communities safer for women. The process of capturing
data on infrastructure and services of cities pinpoints the
lacunae on nine parameters that have strong connections to
feeling of safety.
Cities need to be built keeping in mind the diverse needs
of its citizens and especially women, so that they can have
access to the varied opportunities of growth that exist there.
The infrastructure gaps in the urban areas of India once
identified would be easy to fix. Hence our efforts should
be towards creating a gender-friendly urban infrastructure
which would ensure a safe and healthy life to India’s
neglected women.
—Kalpana Viswanath is a researcher who has been working
on issues of gender and safer cities for women for over
20 years. She is the co-founder of Safetipin, a mobile app
developed to support community and women’s safety.
In low income neighbourhoods,
inequality is not just restricted to
access to services and resources. It is
also based on a patriarchal setup where
women face barriers in economic and
social mobility.
INFOCUS
4

5. Women’s right of reproductive choices must be safeguarded. In the communication and
positioning related to ARTs and surrogacy, due care should be taken to avoid positioning
infertility as a ‘flaw’, and ARTs and surrogacy arrangements as the ‘solutions’.
– Anju Dubey Pandey
Surrogacy: Major
Issues and
Concerns
The last few months once again witnessed many debates
and discussions on the issue of surrogacy in the context of
the draft Assisted Reproductive Technology (Regulation)
Bill 2014 that was put on the website of the Department of
Health Research, Ministry of Health and Family Welfare, for
comments by concerned stakeholders and public at large.
A surrogate is defined as a ‘substitute’ or a replacement,
a deputy for another person in a specific role. A surrogate
mother is a ‘substitute mother’, a woman who bears a child
on behalf of a couple unable to have a child, either by artificial
insemination from the man or implantation of an embryo from
the woman. This can either be done for altruistic purposes or
for monetary gain, widely known as commercial surrogacy.
While countries like France, Germany, Italy, Spain and Finland
do not permit surrogacy, commercial surrogacy is widely
practiced in India today. Certain countries partially allow
surrogacy. For example countries like the United Kingdom,
Belgium, Netherlands and New Zealand allow altruistic
surrogacy but commercial surrogacy is illegal. Australia also
recently recognised altruistic surrogacy. Some countries
allow limited surrogacy, e.g. in the United States, laws on
paid surrogacy vary widely from state to state. States which
are generally considered to be surrogacy friendly include
California, Illinois, Arkansas, Maryland and New Hampshire
among others. South Africa does not allow surrogacy for
parents from another country, even though they permit it
for residents. The Israeli Government legalised gestational
surrogacy under the “Embryo Carrying Agreements Law”,
making Israel the first country in the world to implement a
form of state-controlled surrogacy in which each and every
contract must be approved directly by the state. In some
countries, commercial surrogacy is not only legal; it is also
encouraged as a growing industry that attracts foreign
visitors. Georgia, Russia, Ukraine are major destinations for
fertility tourism.
Since the first surrogate delivery in India twenty-one years
ago, the country has steadily emerged as an international
destination for “commissioning parents”. The first gestational
surrogacy took place in 1994 in Chennai. Thereafter,
according to statistics, the number of surrogacy births
doubled between 2003 and 2006. It is estimated that in the
last decade there have been as many as 3,000 recorded
births through surrogacy. Many factors have contributed
to this growth, including relatively inexpensive medical
services, know-how in reproductive technology, availability
of women largely from poor socio-economic backgrounds
willing to take up the ‘task’ and the lack of laws to regulate
the practices. Indian surrogates receive $3000-$6000
(compared with an annual income per head of around
$500), thus making surrogacy a potentially financially
attractive option for poor Indian women (Palattiyil et al 2000).
In fact, reproductive tourism or travel in India is ‘valued at
more than $450 million a year’ and was forecast by the
Indian Council of Medical Research (ICMR) to be a six billion
dollar a year market in 2008. The boost is not only because
of domestic but also of international demand.
Issues and concerns regarding surrogacy in India are several,
layered and complex. These have obvious implications not
just for the users and providers of these procedures, but also
for policy-makers, practitioners and implementers. A seminal
study by the women’s rights organisation, Sama, conducted
in 2012, raised critical concerns. It drew attention to the fact
that surrogacy has pushed pregnancy from the private to the
public domain, from care to work, and in doing so, has raised
many pertinent issues, including how women’s reproductive
role is defined and understood by society. The research
indicated that the feminist critiques of surrogacy have
brought attention to the fact that the assisted reproductive
SincethefirstsurrogatedeliveryinIndia
twenty-oneyearsago,thecountryhas
steadilyemergedasaninternational
destinationfor“commissioningparents”
OPINION
5

6. technology (ART) industry lies at the intersection of
patriarchy and market, wherein these technologies meet
rather than question the pressure on women to be mothers.
Further, the study pointed out that the political economy
context of women’s labour under globalisation presents a
picture of informalised and sexualised work that is inattentive
to women’s rights and health, while also destroying
indigenous livelihoods.
There are divergent positions on issues relating to surrogacy
in India. Anecdotally, altruistic surrogacy is seen as more
humane and more easily accepted because it is positioned
as a noble and generous act that helps a hitherto childless
couple experience parenthood. The Sama study pointed out
that in one way this imparts informality to the arrangement
but in another it affects and weakens the bargaining
power of surrogates in commercial arrangements. ‘The
vocabulary of altruism also becomes a significant device
when surrogates encounter stigma attached to this
work’ (Sama; 2012). When this act of bearing children
moves into the space of market, despite a price that is
put on it, it is still deprived of the dignity and equal worth
of being an economically and socially productive activity.
Commercial surrogacy raises ethical concerns regarding the
commercialisation of women’s womb. The positions present
very interesting and curious contestations, including on
definitions of ‘work’.
In addition to the ethical issues, there are very obvious
socio-economic concerns. The choices for women to
become surrogate mothers are driven and determined
by factors like poverty, unemployment, lack of awareness,
illiteracy, etc. Anecdotal reasons shared by women for their
choosing to be surrogates vary from getting treatment
for ailing family members, marrying off their daughters,
child’s education, paying out debts, buying or building
accommodation, etc. There is evidenced research on multiple
hardships/exploitation faced by surrogate mothers during
the process of surrogacy. These include among others,
ambiguous contracts, health consequences due to multiple
invasive procedures, exploitation by middle men or hospital
authorities, lack of enforceability of contract by mothers due
to their socio-economic vulnerability, etc. As surrogacy is
currently unregulated, medical/life insurance to surrogate
mothers, medical facility for health concerns other than
reproductive issues, etc. are not provided. Moreover, women
choosing to be surrogate mothers experience social stigma.
They have to stay away from their families for long duration
of time, leaving their children in custody of relatives. In some
cases, women have also reported desertion by husbands
and/or abandonment by family members.
Surrogacy in India is largely practiced as a commercial
arrangement in the absence of any statutory binding
law. Currently, there exists a draft Assisted Reproductive
Technology (Regulation) Bill, 2014. The Indian Council for
Medical Research (ICMR) had also issued guidelines in
2005 for regulation of surrogacy, though it is not binding.
The Ministry of Home Affairs has issued instructions vide
letter No.25022/74/2011-FI (Vol III) on March 11, 2015,
regarding foreign nationals intending to visit India for
commissioning surrogacy and the most recent instructions
not to support commercial surrogacy have been issued
by the Department of Health Research, Ministry of Health
and family Welfare vide letter No. V.25011/119/2015-HR
issued on November 4, 2015.
While the debate continues and the draft bill is being
finalised, it is important to flag that the rights of surrogate
mothers/women must be taken care of in the regulatory
framework. Women’s right of reproductive choices must
be safeguarded. In this context it is important to reiterate
the recommendation made by UNFPA (United Nations
Population Fund) in recent debates on the issue that in
the communication and positioning related to ARTs and
surrogacy, due care should be taken to avoid positioning
infertility as a ‘flaw’, and ARTs and surrogacy arrangements
as the ‘solutions’. Such positioning only serves to further
reinforce the stereotyping associated with ‘motherhood’ and
‘childlessness’ which has negative implications for women.
Additionally, as advocated by UNFPA, infertility management
should be integrated in primary healthcare provisioning.
A major proportion of the infertility in India is secondary
infertility. Therefore, it is important that the health sector is
equipped to manage the underlying causes of infertility at the
primary healthcare level to ensure that infertility management
is accessible and affordable for all. Certain standards of care
need to be laid out for antenatal and postpartum care of
surrogate mothers especially not to be treated as patients
restricted in hospital settings during pregnancy. Adoption
should be universally and actively promoted.
Further, issues related to citizenship of the child, sex
selection in case of a girl child, ‘twiblings’, i.e. the practice of
multiple embryo transfers or multiple pregnancies among
surrogate mothers i.e. two surrogate mothers at the same
time to increase the success rate of surrogacy necessitate
further dialogue and discussions in this context. More
importantly, the idea of ‘surrogacy’ based on patriarchal
premise that ‘having a biological child is most important for
a woman’, needs to be challenged and revisited. Infertility
as a social stigma should not be promoted. Child bearing
and rearing may be promoted as an informed choice of
individuals rather than a social compulsion.
—Anju Dubey Pandey works with UN Women Office for India,
Bhutan, Maldives & Sri Lanka as a Programme Specialist on
Ending Violence Against Women (Disclaimer: This opinion
piece does not reflect the official position of UN Women)
OPINION
6

7. The state has been trying to regularise the arbitrarily growing fertility industry of the
country, but vested interests and skewed priorities coupled with faulty understanding
of gender issues keep sabotaging its intentions
– Rakhi Ghosal
Regularising the
Fertility Market in
India
In 2013, Bollywood actor Shahrukh Khan and his wife
had a son through surrogacy. The news precipitated much
furore. Varsha Deshpande, activist-lawyer and founder of
Lek Ladki Abhiyaan, filed a case against the star couple
and Dr Firuza Parikh of Jaslok Hospital. The Bombay High
Court dismissed her petition, but at the same time the issue
re-opened a trail of debates.
With the aid of technology we have moved from
identification to elimination of foetuses considered
underdeveloped and/or lacking. But amniocentesis, the
procedure used to find chromosomal anomalies, and
obstetric ultrasound which helped identification of foetal
developmental anomalies, also facilitated the identification
of the sex of the child much before it was born. As a result,
in countries like India, known for its high son-preference, it
is the female children who were eliminated in increasingly
growing numbers.
Since 1961, the child sex-ratio has consistently gone from
bad to worse. The fad is for designer babies—babies with
the right bodies and the right sex. In order to curb this
growing trend and criminalise foetal sex selection and sex
selective eliminations, the Pre-Natal Diagnostic Techniques
Act was enacted by the Parliament in 1994. Further
advancement in medical research unleased the potential
of In-Vitro Fertilization (IVF): it was now possible to implant
sex selected embryos in the womb, i.e., sex selection could
be done prior to conception. Subsequently, the 1994 Act
was amended in 2003 to become the Pre-Conception and
Pre-Natal Diagnostic Techniques (PCPNDT) Act, which
prohibits selection of the foetal sex prior to conception.
IVF, a technology under the larger gamut of assisted
reproductive technologies (ARTs), is one of the
most commonly used techniques to facilitate/assist
reproduction—in one’s own womb or in a hired one, with
one’s own gamete or donated ones. India has emerged
as a leading player in the global fertility industry especially
because of its cheaper costs, easy availability of surrogates,
world class medical facilities, and lack of governmental
regulation. In 2008, the surrogacy market in India was
estimated to be worth $445 million. But owing to the
lack of specific laws, India has also become a minefield
of lapses, exploitation and contradictions. The state has
been trying to regularise the market, but vested interests
and skewed priorities, coupled with faulty understanding
of gender issues keep sabotaging the intentions of these
guidelines.
ART BILL
The Indian Council of Medical Research (ICMR) drafted
the first guidelines to regularise the ARTs and fertility
industry in 2005; revisions were demanded by civil society
organisation in the wake of several lapses in the guidelines,
and they were subsequently revised in 2008 and 2010.
However, as on date, an Act is to still see the light of day–
implying that unbound by law, vested interests and corrupt
practices continue to influence the ART market.
It is demanded that the state mandates
a reasonable and respectable payment
for the surrogates, so that women who
are often compelled by circumstances
to act as commercial surrogates are at
least compensated in terms of money.
However, the debate on if at all such
a service can be compensated, will
continue.
FEATURE

8. In discussing the demerits of the ART Bill, civil society
organisations have overwhelmingly focussed on the issue
of surrogacy, the rights of the surrogate and the lapses in
the Bill vis-à-vis the surrogates negotiating powers and
position in the contract. Even though surrogacy (especially
in India) involves a woman who is at the receiving end in
the power relation between her and the commissioning
parent(s)-ART clinic, the Bill displays little concern for
her rights, reserving much of it for those who pay for
the surrogacy. However, in the absence of more definite
laws, fertility clinics have developed their own contingent
rules—of course in sync with their own interests and those
of the ‘paying clients’. Surrogates are kept away from
their families during the larger part of the gestation, not
allowed to breastfeed, at times not even permitted to see
the newborn. Some clinics even hold back the surrogates’
documents such as the voter’s or Aadhar card so that they
cannot break the contract before the child is born.
These practices have been widely criticised by activists
and civil society organisations, but not much has changed
in terms of everyday reality. The profit-oriented fertility
industry justifies its actions by claiming that at the end of
the day surrogates are economically benefited and thus
should have little to complain. The amount of money to
be paid to the surrogate is negotiated on a case-to-case
basis by the clinics, leaving much room for exploitation. It
is demanded that the state mandates a reasonable and
respectable payment for the surrogates, so that women
who are often compelled by circumstances to act as
commercial surrogates are at least compensated in terms
of money. However, the debate on if at all such a service
can be compensated will continue.
THE ARTs AND PCPNDT
In the PCPNDT Act, the government mandated all centres
offering ultrasound tests, all USG machines, and all
practitioners conducting any pre-natal or natal diagnostic
tests, to be registered. Also, all records of tests conducted
should be preserved for up to two years by the clinics.
Despite all this, there is a spurt in unregistered fertility
clinics and surreptitious sex selection continues unabated,
where sperm sorting or chromosome segregation is used
to ensure an XY embryo.
Media reports claim that the IVF and surrogacy industry
has produced a disproportionately high number of
male children—implying that surreptitious sex selection
continues. Recently, the Disease Management Association
of India (DMAI) urged the Central Government to set up
a committee to enquire into the functioning of Artificial
Insemination (AI) and the IVF treatment industry. Such an
enquiry is urgently required especially because there is
to date no systematic evidence based study in the public
domain which could say with certainty if the IVF and AI
technologies are indeed being misused to feed India’s son-
preference ideology.
THE ROAD AHEAD
However, as is evident, notwithstanding the plethora of
guidelines to regulate the fertility industry, we have a long
way to go before the problem is smoothened out. It needs
to be kept in mind that medical research and technology
per se are not problematic; it is the intention behind using
them that needs to be reworked.
In current debates on fertility, ‘technology’ has largely come
to connote ultrasound and IVF, while the twin issues that
generate much discussion are sex selection and surrogacy.
There are, however, other challenges to be dealt with as
well like the camouflaged ‘success rates’ flagged by the
fertility clinics which try to disguise implantation rates as
live birth rates; multiple embryo transfers in order to boost
the success rates of the clinics at the cost of the woman’s
health; exploitation faced by egg donors (the deaths of
Sushma Pandey in 2010 and of Yuma Sherpa in 2014 for
instance); the blatant violation of ethics by several fertility
clinics, etc.
While the projected aim of the ARTs is to assist couples to
have a child, in practice, the contemporary fertility industry
in India is a capitalist market, lacking ethics and feeding
into ideas of patriarchy and gender stereotypes.
—Rakhi Ghoshal is a bioethics researcher. She is Secretary
of the Forum for Medical Ethics Society, and is associated
with the Indian Journal of Medical Ethics.
The Disease Management Association
of India has urged the government to
set up a committee to enquire into the
functioning of artificial insemination
and the IVF treatment industry. An
enquiry is required as there has been
no systematic study which could
say with certainty if the IVF and AI
technologies are indeed being misused
to feed India’s son-preference ideology.
FEATURE
8

9. The report card is based on assessment of the court cases filed, inspections done and
action taken by state medical councils in 12 sex ratio critical states of the country
Civil Society Report Card on
PCPNDT Act...
...Calls for Consistent
Engagement & Action
With an intention to help the state governments review
the implementation of the Pre-Conception and Pre-Natal
Diagnostics Technique (PCPNDT) Act and introspect
about the work done since its enactment till now, Girls
Count in December 2015 released its Civil Society
Report Card on PCPNDT Act. The report card is based
on assessment of the court cases filed, inspections done
and action taken by state medical councils in 12 sex ratio
critical states of the country.
Affidavits submitted by the state governments in the
Supreme Count of India by September 2014 were
reviewed and quantitative data on PCPNDT since the
inception of the Act were compiled for the purpose. The
Report Card is an attempt to showcase what the data
implies in terms of what the states are doing, what they
are not doing and what more they should do. It considers
absence of actions such as inspections, court cases and
convictions as the indicators of non-implementation of the
Act and not merely the absence of violations.
The Report Card highlights on the major gaps in the
enforcement of the Act in states like Bihar, Delhi, Gujarat,
Madhya Pradesh, Haryana, Punjab, Odisha and Rajasthan,
mainly in the area of inspections, suspension/cancellation
of registrations, filing of court cases, acquittals, convictions,
sealing and de-sealing of ultrasound machines/centres,
reporting of cases to state medical councils, etc.
The Report Card indicates that the cases filed under the
Act are pending since years in many courts of the country
and presumes that the ignorance of the officials on duty
during inspections about the offences and poor drafting
of the cases could be the reason for more number of
acquittals.
The Report Card was released on December 9, 2015, by
Justice Hemant Laxman Gokhale, former Judge, Supreme
Court of India, in Delhi. Among the other dignitaries present
during the release were: Bindu Sharma, Director, PCPNDT,
Government of India and Dr Satish Agnihotri (IAS), former
Secretary Coordination, Cabinet Secretariat, Government
of India. Representatives of many civil society organisations
from Delhi and neighbouring states were also present.
Justice Hemant Laxman Gokhale stated that the PCPNDT
Act is based on Article 15 of the Indian Constitution and
questioned: “Why do we see a decline in the sex ratio at
birth (SRB) in spite of the existence of law?” He said that it
is very unfortunate that in India girls are not born free and
in many cases it is made sure that they are not born at all.
RESEARCHSTUDY
The Report Card highlights on the
major gaps in the enforcement of
the Act in states like Bihar, Delhi,
Gujarat, Madhya Pradesh, Haryana,
Punjab, Odisha and Rajasthan
Amitabh Behar, member Girls Count; Justice Hemant Gokhale, former Judge,
Supreme Court and Bindu Sharma, Director, PCPNDT, Govt. of India
9

10. Govt-CSO
Partnership
Critical for
Success of
BBBP Scheme
The series of consultations organised
by the coalition partners of Girls Count
provided a platform for consolidating
the efforts of various organisations and
networks in different regions to create
substantial ways to support the BBBP
initiative. It helped discuss and identify
local issues prevalent in the states, which
lead to the decline in child sex ratio.
A series of Regional Consultations on the theme “Beti
Bachao Beti Padhao (BBBP): Building a Collective
Response-Strengthening Civil Society Engagement and
Community Action” organised by coalition partners of Girls
Count, brought together more than 400 representatives
of civil society organisations from 28 states and union
RESEARCHSTUDY
WAY FORWARD
The Report Card highlighted on the following
measures that needs to be taken for the proper
implementation of the PCPNDT Act and check
further decline in sex ratio at birth.
• Proper documentation of the records, data and
follow-up action by the concerned department
under the PCPNDT Act is an area which needs
to be addressed on a priority basis.
• The process of the implementation of the
PCPNDT Act should not be connected to
abandoned foetus. It is important to implement
the Act itself by conducting inspections and
checking records on a regular basis rather than
taking random action against the centres after
an abandoned foetus is found.
• Tracking of pregnant women through a device
like ‘Active Tracker’ or any other means to
prevent gender-biased sex selection is not
advisable.
• Ensuring that women register for ante-natal
care on time and undertake all check-ups
during pregnancy is a constructive measure,
but the monitoring should not be based on
the assumption that they are ‘conduits’ to sex
selection.
• The implementers must recognise the
consequences of the declining child sex ratio,
the context in which discrimination takes place
and realise that they need to play an effective
role in tackling gender discrimination through
law.
– Girls Count Secretariat
Bindu Sharma, Director, PCPNDT, Ministry of Health
and Family Welfare, Government of India, said that sex
selection is carried out with the consent of two mutual
parties i.e. the service providers and the family members
of the pregnant women. Therefore, the onus is more on
the service providers not to reveal the sex of the foetus.
But as the act encroaches upon their profession, she
stressed that the service providers should be included
in the discussion on the misuse of technology. Sharma
further added that the Ministry is looking into the flaws
and problems in the implementation of the PCPNDT
Act and is working hard on bringing in the best possible
solutions.
10

11. territories across the country. The objective of the
consultations held across the country from October-
December 2015, was to build a collective response to
BBBP initiative and ensure civil society engagement with
this initiative in a more cohesive and consistent way.
The consultations were organised on behalf of Girls Count
by Dalit Mahila Vikas Mandal (DMVM), Maharashtra; Ekta,
Tamil Nadu; Foundation for Social Transformation (FST),
Assam; Mayaram Surjan Foundation (MSF) Chhattisgarh;
Reach India, West Bengal; Vatsalya, Uttar Pradesh
and Voluntary Health Association of Punjab (VHAP),
Chandigarh, in collaboration with the BBBP initiative of
Government of India, National Foundation for India (NFI),
Ipas India, UN Women and United Nations Population
Fund (UNFPA) at Bhopal, Chandigarh, Chennai, Guwahati,
Kolkata, Lucknow and Mumbai.
Representatives from community based organisations
(CBOs), non-government organisations (NGOs), state
officials and experts on women and gender issues
deliberated on different aspects of sex ratio at birth (SRB),
child sex ratio (CSR) and various forms of discrimination
against women and girls. The progress made in BBBP
districts, the challenges faced, and the role of networks
and individuals were also discussed. The dialogue
provided a platform for consolidating the efforts of various
organisations and networks in different regions to create
substantial ways to support the BBBP initiative. The
consultations helped discuss and identify local issues
prevalent in the states, which is often a reason for the
decline in child sex ratio.
CONCERNS RAISED
AROUND BBBP
Participants at the consultations expressed concern over
several issues and stated that civil society organisations
should work in tandem with the government departments
in the implementation of this flagship programme of
the government. They said that inter-departmental
convergence at the state and district level under BBBP
is not visible and hence NGOs should be included in the
state, district and block level task force, and their selection
process needs to be clearly laid out. The mapping of civil
society organisations (CSOs) should be the first step
towards effective implementation of the BBBP scheme,
they felt.
In order to strengthen the BBBP programme, the
representatives suggested that the campaign against
gender-biased sex selection should be expanded to all the
districts of the country and not just the 100 gender-critical
Participants at the consultation
expressed concern over several
issues and stated that civil society
organisations should work in tandem
with the government departments
in the implementation of the Beti
Bachao Beti Padhao programme of
the government
COALITIONINITIATIVE
Representatives of civil society organisations, state government departments, academicians and activists at the Regional Consultation held in Guwahati
11

12. 3/42, 2nd Floor, Jangpura-B, New Delhi-110014
T +91-11-24379452
E info@girlscount.in
W www.girlscount.in
/girlscount
Girls Count is an independent national level coalition of more than 200 civil society organizations and individuals across India, working to address
factors that lead to declining child sex ratio. Members are united in their commitment towards creating a more gender equal and gender just soci-
ety by challenging patriarchy and stopping gender-biased sex selection. At present, the coalition secretariat is supported technically and financially
by UNFPA and NFI, while it continues to raise resources for its various campaigns and activities.
districts. Further, a fact sheet to monitor the indicators
under the BBBP scheme should be released by the
District Collectors every quarter to inform and educate
people about the developments. This will also help maintain
transparency in the utilisation of funds under the BBBP
scheme at the district level.
ISSUES IDENTIFIED AND
SUGGESTIONS MADE
Several roadblocks which lead to the non-implementation
of the PCPNDT Act were identified during the
consultations. The participants stated that in many states,
the statutory bodies are not functional and hence they
recommended that to begin with, services providers should
be discouraged to communicate the sex of the foetus and
the mapping of ultrasound centres and their registration
needs to be ensured. They said that engagement of men
in addressing domestic violence and promoting value of
women and girls is necessary, and promotion of the ‘One-
Stop Crisis Centre’ is necessary as many women are still
unaware of its existence and the ways to access those.
The civil society representatives further
made the following suggestions to ensure
the effective implementation of the BBBP
programme:
• Review the school curriculum of states running BBBP
scheme to know if it is gender sensitive.
• Develop a comprehensive gender, sexuality and life
skills module, similar to the one developed for HIV/
AIDS and implemented by schools affiliated to Central
Board of Secondary Education (CBSE) and the state
board.
• Target youth, teachers and the community members
to spread awareness about various schemes and Acts
related to women and gender issues.
• NSS units in colleges and government initiatives
such as Kudumbashree, Janashree Bima Yojana and
Jagritha Samithi must have a gender perspective built
in, with special focus on gender-biased sex selection.
• Start free legal service centres for women at
panchayat level.
• Regularise capacity building of Self Help Groups
(SHGs) and youth groups on gender-biased sex
selection and its consequences.
• Work on safe motherhood and safe birth and provide
mothers with healthy and nutritious food including
medicines. This would be important for the survival of
the girl child.
• Girls in many BBBP districts are more vulnerable
to trafficking. So 3Ps – prevention, protection and
prosecution should be made effective in combating
child trafficking.
• Address the increasing trend of ‘honour killings’
in many BBBP states. Moral policing and hyper
vigilantism restricts the mobility of girls and women.
• Evolve effective long-term strategies to address the
economic reasons for son preference.
• Make sure greater involvement of the community in
monitoring and tracking gender-based discrimination
and crimes against women.
• Ensure critical review and monitoring of the BBBP
scheme and participatory community assessment.
• Highlight positive stories of change and interface with
CSOs and media.
– Girls Count Secretariat
A fact sheet to monitor the indicators
under the BBBP scheme should be
released by the District Collectors
every quarter to inform and educate
people about the developments. This
will also help maintain transparency
in the utilisation of funds under the
BBBP scheme at the district level.
COALITIONINITIATIVE