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.

1. COMMENTARY
a
­ rbitrary, and corrupt rule of the babu­ is
s Overall, given the various constraints, society at large would merely convert it
the cause of many maladies. Transparency the HLEG has done a good job. India has into a yet another radical report gathering
and accountability should not stop at the one of the most heavily privatised and dust. Various inconsistencies and weak
district level or at the directorate level but skewed healthcare systems in the world. points in this report need to be corrected
must be applicable to the secretariat level Yet some people conceive UHC within the but it is equally important to build a
and 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 in
regulatory framework as proposed under private healthcare providing a huge market the background papers3 of the mfc’s
the systemic management reforms would for the corporate healthcare players. At n
­ ational meet on UHC.
be applicable to the entire private sector, to the other extreme are people who wish
ensure quality of care, rational interven- away the fact that a majority of the quali- Notes
tions and medication, as well as safeguard- fied doctors are practising privately and 1 “Towards Universal Access to Health Care in
ing 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 http://www.mfcindia.org/curissue.pdf
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 http://www.mfcindia.org/main/bgpapers/bgpa-
regulation 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 using
Vibhuti Patel the CVB for identification of the sex of the
human foetus and aborted the female foe-
T
The Forum against Sex he 2011 Census of India data has re- tuses. Women members of my clan from
Determination 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 female
selection 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 Medical
abortions 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 managed
then, 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 team
foeticide continues. It is a major sonography, fetoscopy, needling, chorionic found that the main interest of these
challenge 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 the
pre-selection techniques for son-
only in urban India but also in the villages. foetus, the women ­ arrying female foe-
c
preference without jeopardising The metros were the major centres for SD tuses demanded an abortion.2 The newly
women’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 (vibhuti.np@gmail.com) has been cows and buffaloes, it was for sex selective selective abortions with the continuous
a women’s rights activist for over three decades abortion of the male foetus. Bullocks were trend of declining sex ratio as revealed by
and is with the SNDT University, Mumbai.
generally not needed for agrarian chores the census, the Union Health Minister, Raj
18 May 21, 2011 vol xlvi no 21 EPW Economic & Political Weekly

2. COMMENTARY
Narain 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?”.5
in 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 Information
ing 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 sharing
became the “bread and butter” (as told to py with your sons! Why don’t you allow only anecdotal information; it would take
me 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 SPs
doctors of Mumbai’s Harkisandas Narot- sniggered, “Now I understand why you in the community. We were supported by
tamdas 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 the
like India, as the parents are encouraged son.” The difference in per­ pectives that
s A
­ ssociation of Nurses. As a result of such
to limit their family to two offspring, they we encountered then continues till today. research, many FASDSP members began
will 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), Inter­
vides help in this direction.”4 Here the During the 1980s, in other countries, national Socio­ogical Association (1984),
l
word “quality” raises a number of issues the SD tests were very expensive and under Inter­ ational Anthropological Associa-
n
that we discussed with those doctors when strict government control, while in ­ ndia
I tion, Feminist International Network of
they 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 National
Campaign 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% men
tory abortions of female foetuses in April u
­ ndergone the test and after learning that and 50% women as respondents for their
1986. Its first action was a demonstration the foetus was female, had got an abor- questionnaire on the opinions of men and
in front of a reputed hospital that boasted tion done in the 18th or 19th week of preg- women regarding SD tests. Among the
of performing 8,000 amniocentesis (sex se- nancy. Their argument was that it was male respondents were businessmen and
lection) tests on pregnant women. It better to spend Rs 200 or even Rs 800 white-collar employees in the income group
claimed that only one pregnant woman than to give birth to a female baby and of Rs 1,000 to Rs 3,500 per month, while
with 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 and
As the hospital was against abortion, it We were approached by the social found it useful.6 Punjab was the first state
a
­ dvised those women whose tests had w
­ elfare officer of Larsen and Toubro, a to start the ­ ommercial use of this test as
c
shown female foetuses to go for abortion m
­ ultinational engineering industry in early as in 1979. The advertisements in
elsewhere but the women were told to bring 1984 as the popularity of this test attracted newspapers regarding the New Bhandari
back 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 to
gans in English, Hindi, Marathi, Gujarati As a result, medical bills showing the denounce the practice. A section of the
that 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
p
determination, Say ‘Yes’ to Empowerment astonished to see that these employees from Edinburgh University, UK attended
of Women, Say ‘No’ to Sex Discrimination, were treating sex determination tests so
Say ‘Yes’ to Gender Justice”, “Daughters casually. They organised a two-day semi- Style Sheet for Authors
Are 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’s
Boys, 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 http://epw.in/epw/user/styletocontributors.jsp
“Women Are Not Son-Producing Machines”, in the seminar that from Cape-Comorin to It will help immensely for faster processing and
and 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 citation
shouting, distributing leaflets and collect- the day to find out about the test. Even his
and preparation of references.
ing signatures against selective abortion six-year-old son had learnt how to ask
Economic & Political Weekly EPW May 21, 2011 vol xlvi no 21 19

3. COMMENTARY
FASDSP meetings in Mumbai. Micro-­ s
­ cientific techniques of prenatal diagnosis patients. Self-help kits for sex selection
research in Bijnor district of Uttar Pradesh solely for the purpose of detecting genetic that can be ordered for pregnant women
by 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 Act
region 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 change
were 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 Violence
had been limited to Rajputs and Jats who view was limited only to SD tests; it did not and Abuse (MAVA) have taken the initiative
considered the birth of a daughter as a loss say anything about the SP techniques. It to provide a platform for all like-mined
of 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 use
cide was prevalent in all communities in tests had taken away the respectability of symbols, imagery, and slogans that at times
Bijnor 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 have
was formed at the initiative of FASDSP ing of these tests. a dramatic effect but threaten women’s
member Sanjeev Kulkarni, a member of By 1990, private members’ bills to regu- right to safe abortion as a backup service
Medico 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-preference
not curb abortions that are permitted ernment formed a committee in 1991 to within the matrix of gender justice and
through the Medical Termination of Preg- formulate a central law on this issue. The without jeopardising women’s right to
nancy 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 was
mensions 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 Development
sex 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 in
Community 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 and
tigate the prevalence of this test in Mum- Utkarsh Mandal (MASUM), Pune filed a K P Patil (1979), “Prenatal Sex-prediction by
bai. Forty-two gynaecologists were inter- public interest litigation (PIL) that was Amniocentesis – Our Experience of 600 Cases”,
paper presented at the First Asian Congress of
viewed 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 News­
performing 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), “Opinion
ernment appointed an expert committee prompt implementation of The Pre-con- of Men and Women Regarding Amniocentesis”,
College of Home Science, Punjab Agricultural
to propose comprehensive legal provisions ception and Pre-natal Diagnostic Tech- University, Ludhiana, India.
to 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-
i
­dentifying 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 Maharashtra
a 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!” A
do so. In fact, the forum approached sev- who were in the State Appropriate Author-
Response to Nilima Dutta’s Comment on the Law
eral 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