COMMENTARYa­ rbitrary, and corrupt rule of the babu­ is                                           s          Overall, give...
COMMENTARYNarain decided to ban SD tests for sex               of female foetuses, the dean of the hospi-       r         ...
COMMENTARYFASDSP meetings in Mumbai. Micro-­             s                                               ­ cientific techn...
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Vibhuti patel on a long battle for girl child epw 21 5-2001


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In several Asian countries, globalisation has facilitated easy import of new reproductive technologies leading to selective abortions of female foetuses. In India and China this phenomenon has reached an alarming proportion. 

Sex ratios in Europe, North America, Caribbean, Central Asia, the poorest region- sub Saharan Africa are favourable to women as these countries neither kill/ neglect girls nor do they use NRTs for production of sons. Only in the South Asia the sex ratios are adverse for women. The lowest sex ratio is found in India.

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Vibhuti patel on a long battle for girl child epw 21 5-2001

  1. 1. COMMENTARYa­ rbitrary, and corrupt rule of the babu­ is s Overall, given the various constraints, society at large would merely convert itthe cause of many maladies. Transparency the HLEG has done a good job. India has into a yet another radical report gatheringand accountability should not stop at the one of the most heavily privatised and dust. Various inconsistencies and weakdistrict level or at the directorate level but skewed healthcare systems in the world. points in this report need to be correctedmust be applicable to the secretariat level Yet some people conceive UHC within the but it is equally important to build aand above. framework of such a system in which the stronger opinion in favour of UHC broadly The progress report has clarified that the government is primarily a purchaser of on the lines formulated by the HLEG and inregulatory framework as proposed under private healthcare providing a huge market the background papers3 of the mfc’sthe systemic management reforms would for the corporate healthcare players. At n ­ ational meet on applicable to the entire private sector, to the other extreme are people who wishensure quality of care, rational interven- away the fact that a majority of the quali- Notestions and medication, as well as safeguard- fied doctors are practising privately and 1 “Towards Universal Access to Health Care ining of patients’ rights and ethical practices. the public sector does not have even one- I ­ ndia”, Concept Note for Medico Friend Circle, Annual Meet 2011, Abhay Shukla, Anant Phadke,Here one would add that the regulation fourth of the doctors needed for UHC. It is Rakhal Gaitonde, Medico Friend Circle Bulletin,should not be thrust from above by bu- heartening that the progress report steers 342 to 344, August 2010-January 2011, pp 1-13,reaucratic means but it has to be participa- clear of both these positions while keeping 2 “Financing the Universal Access Health Care Sys-tory, multistakeholder. Even then given the the focus on socialisation of healthcare. A tem”, Ravi Duggal, MFC Bulletin, op cit, pp 19-23.socio-political culture in healthcare, such more radical set of recommendations not 3 is going to be a Herculean task. backed by a commensurate churning in pers2011/am/bgpapers2011am.html.A Long Battle for the Girl Child since agricultural mechanisation and tractorisation had replaced them. My caste members, the Patidars of Kheda and Mehsana districts quickly started usingVibhuti Patel the CVB for identification of the sex of the human foetus and aborted the female foe- TThe Forum against Sex he 2011 Census of India data has re- tuses. Women members of my clan fromDetermination and Sex Pre- vealed that the child (0-6 age Anand and Vidyanagar would share group) sex ratios have been steadily s ­ tories about selective abortion of femaleselection began its campaign in declining from 971 in 1981 to 945 in 1991 foetuses in their families with me.Mumbai against discriminatory to 927 in 2001 to 914 in 2011. This deplor- In 1975, the All India Institute of Medicalabortions of female foetuses in able scenario is the result of the wide- Sciences (AIIMS) conducted a sample sur-April 1986. In the 25 years since spread use of sex determination (SD) and vey of amniocentesis to find out about foe- sex pre-selection (SP) tests throughout the tal genetic conditions and easily managedthen, laws have been enacted country. Advances in medical science to enrol 11,000 pregnant women as volun-against the practice but female r ­ esulted in SD and SP techniques such as teers for its research.1 The research teamfoeticide continues. It is a major sonography, fetoscopy, needling, chorionic found that the main interest of thesechallenge to fight the use of villi biopsy (CVB), amniocentesis and ultra­ v ­ olunteers was to know the sex of the sound. These tests were well known not f ­ oetus. Once they learnt the sex of thepre-selection techniques for son- only in urban India but also in the villages. foetus, the women ­ arrying female foe- cpreference without jeopardising The metros were the major centres for SD tuses demanded an abortion.2 The newlywomen’s right to safe abortion. and Sp tests with sophisticated laborato- formed Centre for Women’s Development ries. However, amniocentesis and ultra­ Studies (CWDS) led by Veena Mazumdar sound were used even in the clinics of met the health minister and demanded an small towns and cities of Gujarat, Mahar- immediate ban on the use of SD tests for ashtra, Karnataka, Uttar Pradesh, Bihar, abortion of female foetuses. But during Madhya Pradesh, Punjab, West Bengal, the Emergency (1975-77), the State was Tamil Nadu and Rajasthan in the late 1970s. i ­nterested in population control and saw the SD tests as effective tools to attain Science in Service of Femicide ­ opulation stabilisation.3 p In 1972, when Amul Dairy introduced CVB In the post-Emergency period, when to determine the sex of the foetus among women’s studies scholars connected sex-Vibhuti Patel ( has been cows and buffaloes, it was for sex selective selective abortions with the continuousa women’s rights activist for over three decades abortion of the male foetus. Bullocks were trend of declining sex ratio as revealed byand is with the SNDT University, Mumbai. generally not needed for agrarian chores the census, the Union Health Minister, Raj18 May 21, 2011  vol xlvi no 21  EPW   Economic & Political Weekly
  2. 2. COMMENTARYNarain decided to ban SD tests for sex of female foetuses, the dean of the hospi- r ­ elevant questions on the phone such as,s­ election in all government-run hospitals tal called a delegation from amongst the “Is the pregnancy 16 weeks old?”.5in 1978. However, this did not stop private picketers (that included me) for discus-health facilities that were rapidly expand- sion. He asked each of us, “How many Anecdotal Informationing in the early 1980s from offering amnio­ children do you have?” When one picketer Every time we approached the govern-centesis and other sex-selection tests that said, “Two sons”, he said, “So you are hap- ment, they told us that we were sharingbecame the “bread and butter” (as told to py with your sons! Why don’t you allow only anecdotal information; it would takeme by a gynaecologist in Amreli, Gujarat others also to be happy by use of sex selec- action only when our arguments were sup-in 1979) for many gynaecologists. A justifi- tion tests?” When he asked me the same ported by hard data. Many of us started do-cation for this was aptly put by a team of question, I replied, “One daughter”. He ing self-sponsored research on SDs and SPsdoctors of Mumbai’s Harkisandas Narot- sniggered, “Now I understand why you in the community. We were supported bytamdas Hospital (a pioneer in this trade) are picketing. You are jealous of those who trade unions, the Medico Friends Circle,in these words, “…in developing countries have sons or are making efforts to have a People’s Science movements and thelike India, as the parents are encouraged son.” The difference in per­ pectives that s A ­ ssociation of Nurses. As a result of suchto limit their family to two offspring, they we encountered then continues till today. research, many FASDSP members beganwill have a right to quality in these two as The medical fraternity by and large does presenting papers at the Indian Associa-far as can be assured. Amniocentesis pro- not see this as violence against women. tion of Women’s Studies (1981), Inter­vides help in this direction.”4 Here the During the 1980s, in other countries, national Socio­ogical Association (1984), lword “quality” raises a number of issues the SD tests were very expensive and under Inter­ ational Anthropological Associa- nthat we discussed with those doctors when strict government control, while in ­ ndia I tion, Feminist International Network ofthey shared their paper with us in 1982. the SD test could be done for between Resistance to Reproductive and Genetic Rs 70 and Rs 500 (about $6 and $40). Engineering (FINRRAGE), 1985 and NationalCampaign Hence, people across economic classes Conferences of Women’s Movements (1985,The Forum against Sex Determination could avail themselves of this facility. A 1988, 1990).and Sex Pre-selection (fasdsp) began its survey of several slums in Bombay (Mum- A sociological research project in Pun-campaign in Mumbai against discrimina- bai) showed us that many women had jab in 1982 selected in its sample 50% mentory abortions of female foetuses in April u ­ ndergone the test and after learning that and 50% women as respondents for their1986. Its first action was a demonstration the foetus was female, had got an abor- questionnaire on the opinions of men andin front of a reputed hospital that boasted tion done in the 18th or 19th week of preg- women regarding SD tests. Among theof performing 8,000 amniocentesis (sex se- nancy. Their argument was that it was male respondents were businessmen andlection) tests on pregnant women. It better to spend Rs 200 or even Rs 800 white-collar employees in the income groupclaimed that only one pregnant woman than to give birth to a female baby and of Rs 1,000 to Rs 3,500 per month, whilewith three sons wanted a daughter and spend thousands of ­ upees on her mar- r the female respondents were mainly house-7,999 pregnant women wanted only sons. riage later. wives. All of them knew about the test andAs the hospital was against abortion, it We were approached by the social found it useful.6 Punjab was the first statea­ dvised those women whose tests had w ­ elfare officer of Larsen and Toubro, a to start the ­ ommercial use of this test as cshown female foetuses to go for abortion m ­ ultinational engineering industry in early as in 1979. The advertisements inelsewhere but the women were told to bring 1984 as the popularity of this test attracted newspapers regarding the New Bhandariback the aborted foetuses to the ­ ospital h its young employees aspiring for upward Ante-Natal SD Clinics in Amritsar first per-for further research. Our placards had slo- economic mobility and wanting only sons. suaded the press and women’s groups togans in English, Hindi, Marathi, Gujarati As a result, medical bills showing the denounce the practice. A section of thethat said: “Eliminate Inequality, Not amount spent on the test were submitted m ­ edia too helped by covering our cam-Women”, “Destroy Dowry and Dehumani- by the employees for reimbursement by paign against the sex determination tests.sation, Not Daughters”, “Say ‘No’ to Sex- the company. The welfare department was Roger Jeffery, a medical anthro­ ologist pdetermination, Say ‘Yes’ to Empowerment astonished to see that these employees from Edinburgh University, UK attendedof Women, Say ‘No’ to Sex Discrimination, were treating sex determination tests soSay ‘Yes’ to Gender Justice”, “Daughters casually. They organised a two-day semi- Style Sheet for AuthorsAre Not for Slaughter”, “Stop Femicide, nar in which doctors, social workers, repre- While preparing their articles for submission,Promote Equity”, “Girls Are the Equals of sentatives of women’s organisations as contributors are requested to follow epw’sBoys, All They Need Is Opportu­ ity”, “Sex n well as the Family Planning Association of style sheet.Selection is a Crime against Humanity”, India (FPAI) were invited. One doctor who The style sheet is posted on epw’s web site at“Respect Bodily Integrity of Women”, carried on a flourishing business in SD stated“Women Are Not Son-Producing Machines”, in the seminar that from Cape-Comorin to It will help immensely for faster processing andand so on. After we spent four hours ­ logan s Kashmir people phoned him at all hours of error-free editing if writers follow the guidelines in style sheet, especially with regard to citationshouting, distributing leaflets and collect- the day to find out about the test. Even his and preparation of signatures against selective abortion six-year-old son had learnt how to askEconomic & Political Weekly  EPW   May 21, 2011  vol xlvi no 21 19
  3. 3. COMMENTARYFASDSP meetings in Mumbai. Micro-­ s ­ cientific techniques of prenatal diagnosis patients. Self-help kits for sex selectionresearch in Bijnor district of Uttar Pradesh solely for the purpose of detecting genetic that can be ordered for pregnant womenby his team revealed that clinical services or metabolic disorders or chromosomal on the internet from abroad were impos-offering amniocentesis had existed in the abnormalities or certain congenital anom- sible to monitor. In 2003, the PCPNDT Actregion from 1974.7 According to the 1981 alies or sex-linked conditions and for the was amended but the challenges of imple-Census, the child sex ratio of ­ ttar U prevention of the misuse of prenatal sex mentation continue.Pradesh and Bijnor district respectively, determination leading to female foeticide In this context, it is imperative to changewere 886 and 863 girls per 1,000 boys. and for matters connected therewith or the mindset of people and introduce affirm-They also discovered that female infanti- incidental thereto (LC Bill No VIII of 1988). ative action to increase the value of girls.cide practised in Bijnor district until 1900 In June 1988, it became an Act. Its pur- Organisations like Men against Violencehad been limited to Rajputs and Jats who view was limited only to SD tests; it did not and Abuse (MAVA) have taken the initiativeconsidered the birth of a daughter as a loss say anything about the SP techniques. It to provide a platform for all like-minedof prestige. By contrast, the abuse of amni- admitted that medical technology could people who want to save the girl child.ocentesis for the purpose of female foeti- be misused by doctors and banning of SD Civil society initiatives on this issue usecide was prevalent in all communities in tests had taken away the respectability of symbols, imagery, and slogans that at timesBijnor district in 1983. these tests. In the eyes of law both the cli- convey anti-abortion messages. Com­ on m Doctors against Sex Determination and ents and the practitioners of the SD tests use of terms such as “foeticide”, “murder”,Sex Pre-selection (DASDSP) in Mumbai were culprits and it forbade the advertis- “genocide”, “slaughter” of daughters havewas formed at the initiative of FASDSP ing of these tests. a dramatic effect but threaten women’smember Sanjeev Kulkarni, a member of By 1990, private members’ bills to regu- right to safe abortion as a backup serviceMedico Friends circle Amar Jesani and late antenatal sex selection tests were in- on demand by women. It is a major chal-I­ ndian Medical Association member Bal troduced in Karnataka, Goa, Gujarat, Tamil lenge to fight against discriminatory abor-Inamdar.8 However, they were clear that Nadu and Rajasthan. By 1991, FASDSP had tions of female foetuses and use of pre-­the ban on sex selective abortion should been active nationally. The central gov- selection techniques for son-preferencenot curb abortions that are permitted ernment formed a committee in 1991 to within the matrix of gender justice andthrough the Medical Termination of Preg- formulate a central law on this issue. The without jeopardising women’s right tonancy Act, 1971.9 The DASDSP focused on Prenatal Diagnostic Techniques (Regula- safe abortion.medical malpractices and the ethical di- tion and Prevention of Misuse) Act wasmensions of SD and SP. enacted in 1994 by the central govern- Notes A committee to examine the issues of ment. But there was gross violation of 1 Veena Mazumdar (1994), “Amniocentesis and Sex Selection”, Centre for Women’s Developmentsex determination tests and female foeti- this legislation. Studies, Delhi, Occasional Paper Series No 21.cide, formed at the initiative of the Mahar- 2 Amrita Chhachhi and C Stayamala (1983), “Sex-ashtra government in 1986, appointed Initiatives by the State and NGOs determination Tests: A Techno­ogy, Which Will l Eliminate Women”, Medico Friend Circle Bulletin,Sanjeev Kulkarni to conduct a study. To be In 1997, Sabu George, the Centre for India, November, No 95, 3-5.done under the Foundation of Research in E ­ nquiry into Health and Allied Themes 3 Tulsi Patel (2006), Sex Selective Abortions inCommunity Health (FRCH) it was to inves- (CEHAT), Mumbai and Mahila Sarvangeen India (Delhi: Sage Publications), p 361. 4 M H Patanki, D D Banker, K V Kulkarni andtigate the prevalence of this test in Mum- Utkarsh Mandal (MASUM), Pune filed a K P Patil (1979), “Prenatal Sex-prediction bybai. Forty-two gynaecologists were inter- public interest litigation (PIL) that was Amniocentesis – Our Experience of 600 Cases”, paper presented at the First Asian Congress ofviewed by Kulkarni, himself a gynaecolo- fought on their behalf by the Lawyers I ­ nduced Abortion and Voluntary Sterilisation,gist. His findings disclosed that about 84% ­ ollective (Delhi).10 After consistent cam- C March, Bombay.of the gynaecologists interviewed were paigning around the PIL, the Supreme 5 Ammu Abraham (1985), “Larsen and Toubro Sem- inar on Amniocentesis”, Women’s Centre News­performing amniocentesis for SD tests. Court directed all state governments on letter, Bombay, October, 1 (4), 5-8. In March 1987, the Maharashtra gov- 4 May 2001 to make an effective and 6 Gurmeet Singh and Sunita Jain (1983), “Opinionernment appointed an expert committee prompt implementation of The Pre-con- of Men and Women Regarding Amniocentesis”, College of Home Science, Punjab Agriculturalto propose comprehensive legal provisions ception and Pre-natal Diagnostic Tech- University, Ludhiana, restrict sex determination tests for niques (Prohibition of Sex Selection) 7 Roger Jeffery and Patricia Jeffery and ­ ndrew A Lyon (1984), “Female Infanticide and Amniocen-i­dentifying genetic conditions. The com- (pcpndt) Act. Most of the state govern- tesis”, Social Science and Medicine (UK) 19(11),mittee was appointed in response to a ments lacked ­ olitical will to implement p 1207-12.p­ rivate bill introduced in the assembly by the PCPNDT Act. Budgetary allocation for 8 Amar Jesani (1988), “Banning Pre-natal Sex De- termination II: Scope and Limits of Maharashtraa member of the legislative assembly the implementation of the Act was grossly Legislation”, Radical Journal of Health, Vol II,(MLA) who was persuaded by the forum to inadequate. Members of women’s groups No 2. 9 Amar Jesani (1988), “Hands Off the MTP Act!” Ado so. In fact, the forum approached sev- who were in the State Appropriate Author- Response to Nilima Dutta’s Comment on the Laweral MLAs and MPs to put forward such a ity and State Vigilance Committee were Relating to Prenatal Diagnosis in The Lawyers,bill. In April 1988, the Maharashtra gov- dejected due to the lack of response from O ­ ctober, pp 22-3, (Response). 10 Asmita Basu (2003), “Sex Selective Abortions”,ernment introduced a bill to provide for the authorities even after the culprits had Lawyers Collective, Vol 18, No 11, November,the regulation of the use of medical or been caught red-handed by using decoy pp 20-23.20 May 21, 2011  vol xlvi no 21  EPW   Economic & Political Weekly