Female Foeticide

Female Foeticide has become a significant social phenomenon in several parts of India. It transcends all castes, class and communities. The girl children become targets even before they are born. The latest advances in modern medical sciences –like Amniocentesis and Ultra-sonographys, which were originally designed for detection of abnormalities of the foetus, are being misused for determining the sex of the foetus with the intention of aborting it, if it happens to be that of a female. The worst situation is when these abortions are carried out well beyond the safe period of 12 weeks, endangering the women’s life. Since most deliveries in rural areas take place at home, there is no record of the exact number of births/deaths that take place.

Indian society, like most of the societies world over, is patrilineal and patriarchal. According to religious beliefs, a man has to be reborn as a man to attain moksha
(redemption). A man cannot attain moksha unless he has a son to light his funeral pyre.
Also, it says a woman who gives birth to only daughters may be left in the eleventh year of marriage. Obviously, it shows the gender bias in our male-dominated society.

The age old preference for sons is motivated by economic, religious, social and emotional desires and norms that favour males and make females less desirable. Parents expect sons—but not daughters—to provide financial and emotional care, especially in their old  age; sons add to family wealth and property while daughters drain it through dowries; sons continue the family lineage while daughters are married away to another household; sons perform important religious roles; and sons defend or exercise the family’s power while daughters have to be defended and protected, creating a perceived burden on the household. This stereo-type notion of women as “burden” is one of the main reasons behind female foeticide and infanticide.

Causes

• as the cost of marriage and dowry has increased, daughters are now a financial liability
• one’s status in society is higher, in a house with sons
• Globalisation: a son would go abroad to work, thereby increasing the status of the family, which is perceived to have higher income
• Socio-cultural fabric of society: a son is raised to carry on the family name, support parents in old age and perform funeral rites when they die; a daughter cannot do this as she lives and becomes a part of her husband’s family
• Poverty
• Illiteracy
• Preference for the male child
• Difficult to protect the chastity of a girl before marriage
• Women – want to please their husbands and in-laws (a woman’s worth is measured by her ability to produce sons and she loses value & respect of her family, on bearing a daughter)
• Girls are consumers, rather than producers
• Inflation
• Post marital problems faced by the girl
• Denial of property to the girl child
• To keep the girl child population in check
• A bad investment; parents raise the child and pay for her up-bringing while the in-laws bear the fruit

Legal Provisions

Until 1970, the provisions contained in the Indian Penal Code (IPC) governed the law on abortion. The Indian Penal Code 1860 permitted ‘legal abortions’ done without criminal intent and in good faith for the express purpose of saving the life of the mother. Liberalisation of abortion laws was also advocated as one of the measures of population control. With these considerations, the Medical Termination of Pregnancy Act was passed in July 1971, which came into force in April 1972. This law was conceived as a tool to let the pregnant women decide on the number and frequency of children. It further gave them the right to decide on having or not having the child. However, this good intentioned step was being used to force women to abort the female child. In order to do away with lacunae inherent in previous legislation, the Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act had to be passed in 1994, which came into force in January 1996. The Act prohibited determination of sex of the foetus and stated punishment for the violation of the provisions. It also provided for mandatory registration of genetic counselling centres, clinics, hospitals, nursing homes, etc. Thus both these laws were meant to protect the childbearing function of the woman and legitimise the purpose for which pre-natal tests and abortions could be carried out. However, in practice we find that these provisions have been misused and are proving against the interest of the females.

The Indian government has conceded that abortion may be carried out if there is

• Danger to the life of the mother if the pregnancy continues till the child birth,
• Danger to the child by or at risk of being born handicapped, or
• If the woman has conceived the child as a result of rape.

Women are also allowed the right to abortion if they wish to do so in the interest of keeping the family small . However, abortion has to be done within a specific period when it is difficult to identify the sex of the foetus. If the abortion is to be carried out after 16 - 18 weeks of pregnancy, because of any medical reasons, the opinion of two doctors is a must. Unlike abortion, female foeticide is usually done beyond the legal period i.e. when the foetus is much older and developed, and is done only because the foetus is a girl.

Female foeticide is a punishable offence in our country. The offenders (both doctor and parents) may be imprisoned or fined or both. Month 3, 4 and 5 is when most female foeticides take place (anecdotal evidence) Month 5 Female foeticide is a gross violation of many rights. The first is the right to life of the unborn child. The second right violated is that of the woman’s right over her body. Often the decision not to have the child is taken by the man (husband) or the family and the opinion of the mother who painfully bears the child is rarely considered. At the macro level, this has an impact on the sex ratio of the country.

The main law for prosecuting persons who are engaging in sex selective abortion is the Pre-Natal Diagnostic Techniques (Regulation And Prevention Of Misuse) Act, 1994. The PNDT Act now stands renamed as the Pre Conception and Pre Natal Diagnostic

Techniques (Prohibition of Sex selection) Act from 2003.

• It prohibits misuse and advertisement of – pre-natal diagnostic techniques for determination of sex of foetus, leading to female foeticide.
• It permits and regulates the use of pre-natal diagnostic techniques for detection of specific genetic abnormalities or disorders and use of such techniques only under certain conditions and only by the registered institutions.
• It provides for punishment for violation of the provisions given in the act.
• The complaint made by any person should be first given to the appropriate authority with the notice of not less than thirty days for proper action and with the intention to make a complaint to the court.

Apart from this law, the following sections from the Indian Penal Code, 1860 are also important.

• When death is caused by a person (Section 299 and Section 300).
• Voluntarily cause a pregnant woman to miscarry the unborn baby (Section 312).
• Act done with intent to prevent child being born alive or to cause it to die after birth (Section 315).
• Causing quick death of unborn child (Section 316).
• Exposing and abandoning of child below 12 years (Section 317).
• Concealing the birth of child by secretly disposing her /his body (section 318).

The punishment for these offences extends from two years up to life imprisonment, or fine or both.

Ground reality:

The ban on the government hospitals and clinics at the centre and in the states, making use of pre-natal sex determination for the purpose of abortion — a penal offence — led to the commercialization of the technology; private clinics providing sex determination tests through amniocentesis multiplied rapidly and widely. These tests are made available in areas that do not even have potable water, with marginal farmers willing to take loans at 25 per cent interest to have the test. People are encouraged to abort their female foetuses through advertisements in order to save the future cost of dowry. The portable ultrasound machine has facilitated doctors to go from house to house in towns and villages.

Geographics:

In the northern region, the child sex ratio is dismal for the states of Punjab, Haryana, Delhi, Gujrat, Uttranchal and Maharashtra. The states of Bihar and Jharkhand seem to be much better off than the more prosperous states in this comparison. The North East Region shows healthy sex ratios.

One of the districts with the highest prevalence of female foeticide in India is Salem in Tamil Nadu with the child sex ratio being staggeringly low at 763 females to 1000 males.

Income and wealth, usually taken as symbols of prosperity and development, have not led to a change in the social mindset of the people. The highly prosperous areas of the country are not immune to the trend of female foeticide. Areas of Punjab and Haryana are the most prosperous states in the country, and Gujarat and Maharashtra the most industrialized. Yet the practice pervades in these prosperous states as well. The child sex ratio stands at a mere 754 in Fatehgarh Sahib district in Punjab, the lowest in the country. i.e. there are only 754 girls to 1000 boys in the district. The Kurukshetra district of Haryana has the ratio as low as 770, Ahmedabad has a ratio of 814 and South West Delhi has 845. These regions again are among the most prosperous i n the country. The ratio in Mumbai is also seen to be falling at 898.’

Unlike the belief that foeticide occurs where people are poor, illiterate and unaware, the highest ratios of foeticide have been observed in economically developed areas. Punjab and Haryana today are India’s most prosperous states. These are the states where introduction of technologies like those for the Green Revolution have revolutionized the prosperity of the people. The states, at the same time, are also providing the maximum number of sex determination clinics.

According to a recent report by the United Nations Children's Fund up to 50 million girls and women are missing from India's population as a result of systematic gender discrimination in India. The disastrous impact of the consumerist culture spawned by globalisation that has been widely held to account by social scientists for the spread of infanticide in India.

States where female foeticide is most prevalent:

• Punjab
• Delhi
• Madhya Pradesh
• Rajasthan
• Gujarat
• Haryana
• Chandigarh

Female Foeticide and NRIs:

Indians in other countries are also going for sex selective abortions. This is evident by the fact that the sex ratio at birth among the Indian community in New Jersey is as bad as in Punjab and Haryana. A report in the British Newspaper, 'observer', hand come up with evidence that British Asian women go to India to abort their baby girls. The British Law does not allow parents to choose the sex of their babies except to avoid certain gender linked diseases. This forces many to go abroad. Abortion on the ground of sex is not allowed under the Abortion Act of 1967 in the UK. But sex can be disclosed by patients if they ask during the ultrasound.

Many women suffer from psychological trauma as a result of forcibly undergoing repeated abortions. More generally, demographers warn that in the next twenty years there will be a shortage of brides in the marriage market mainly because of the adverse juvenile sex ratio, combined with an overall decline in fertility. While fertility is declining more rapidly in urban and educated families, nevertheless the preference for male children remains strong. For these families, modern medical technologies are within easy reach. Thus selective abortion and sex selection are becoming more common.

In rural areas, as the number of marriageable women declines, men would tend to marry younger women, leading to a rise in fertility rates and thus a high rate of population growth. The abduction of girls is an associated phenomenon. The Hindustan Times recently reported that young girls from Assam and West Bengal are kidnapped and sold into marriage in neighbouring Haryana.

The impact on society should not be underestimated. According to Chinese estimates, by 2020 there are likely to be 40 million unmarried young men, called guang guan or ‘bare branches’, in China, because of the adverse sex ratio. A society with a preponderance of unmarried young men is prone to particular dangers. More women are likely to be exploited as sex workers. Increases in molestations and rape are an obvious result. The sharp rise in sex crimes in Delhi have been attributed to the unequal sex ratio.

Methods:

Female foeticide is a two-step practice. The first step involves the detection of the sex of the unborn baby in the womb of the mother. This could be done at the behest of the mother or father or both, or under family pressure. The second step involves a decision taken by the mother or father or both, under pressure from the family, to have or not have the child.

The three chief pre-natal diagnostic tests that are being used to determine the sex of a foetus (sexing) are amniocentesis, chronic villi biopsy (CVB) and ultrasonography. Amniocentesis is meant to be used in high-risk pregnancies, in women over 35 years. This embryonic pre-natal test requires the removal of 15-20 ml of amniotic fluid. The cells have to be cultured for three weeks, or else there is an inaccuracy rate of 10-20%. CVB is meant to diagnose inherited diseases like thalassaemia, cystic fibrosis and muscular dystrophy.

Ultrasonography is the most commonly used technique. It is non-invasive and can identify upto 50% of abnormalities related to the central nervous system of the foetus. But sexing has become its preferred application. Depending on the ultrasonologist’s expertise, chances of a correct prediction are 95-96%, with greater accuracy as the pregnancy advances. If the foetus is female, a second trimester, even a third trimester abortion is carried out either by a doctor or a quack.
Already, the abortion pill (part of the state-initiated family welfare programme) makes surgical termination of pregnancy redundant. New non-invasive drugs like antiprogestogen-mifepristone derivatives, which, studies have shown, are 85-97% effective, are available over the counter.

Medically speaking, what a Medical Termination of Pregnancy (abortion) involves is opening and dilating of the cervix to evacuate the uterus by suction. This process requires connection of the vagina to the uterus. As the uterus is connected to the vagina during the process, there are fair chances of the bacteria travelling to the uterus and the fallopian tubes, causing undetected damage such as blockage of the tubes.

There is also a possibility of scraping too little or too much. If the uterus is scraped too little for fear of damage to the uterus wall, particles of the embryo may remain in there and the patient may require a second or third D&C (Dilation and Curettage). If this were to happen, there is a chance of excessive bleeding and discomfort. On the other hand, if the scraping is too much, it might damage the uterus walls. They may not heal and instead stick together-causing infertility. The condition is called Asherman's Syndrome and while it can be treated in a minor case, it may be so severe that it cannot be treated at all. Nowadays, a good antibiotic is pushed into the uterus before the Medical Termination of Pregnancy or abortion is undertaken.

The other complication associated with an MTP (Medical Termination of Pregnancy) or abortion is perforation. The surgeon may perforate the uterus and pull the intestines or other vital organs, presuming they are part of the embryo. If detected in time, the patient has a chance or else, in a bad case this could be fatal as well. And there is also the possibility that the uterus is damaged so badly that it has to be removed all together. Of course, small perforations are fairly common during an MPT (Medical Termination of Pregnancy) or abortion but these heal by themselves. In all, a Medical Termination of Pregnancy is a five to ten minute procedure and can even be undertaken under local anaesthesia but for the last, the patient has to be sufficiently motivated and co-operative. Local anaesthesia may be advisable for somebody who has been through a pregnancy and knows the operational ropes. The cervix is also easily dilated the second time around so a local anaesthesia works as well.

EQUIPMENT, DRUGS & ANCILLIARY INSTRUMENTS

The equipment & supplies required for performing first trimester abortion include:

• Suction machine with connecting tubing Electric or, Manual (Hand or foot operated) or, Electric-cum-Manual.
• Menstrual Regulation syringe,
• Suction cannulae,
• D&C set
• Other instruments,
• Essential drugs.

SURGICAL PROCEDURES

Surgical procedures for first trimester pregnancy termination include:

• Suction evacuation
• Menstrual regulation
• Dilatation & evacuation

SUCTION EVACUATION

Rapid dilatation of cervix is done with graduated dilators followed by evacuation of uterine contents with a suction cannula and curettage using a blunt curette. The method is simple, rapid, less traumatic and has become the standard procedure for first trimester abortion throughout the world.

MENSTRUAL REGULATION

It is a procedure for removal of uterine contents, within two weeks after a missed period, without confirming whether the woman is pregnant or not. It is, in fact, a miniature suction curettage performed with a small flexible plastic cannula and hand held gynaecologic syringe. It aspirates the superficial endometrium along with the products of early conception, if present. The procedure can be performed quickly in the outpatient, without dilatation and without anaesthesia. The blood loss associated with the procedure is negligible and complication rate is low.

DILATATION AND EVACUATION (D&E)

In this method, the evacuation of uterine contents is done by ovum forceps or a blunt curettage alone, after rapid instrumental dilatation of cervix. The procedure is still commonly performed in rural areas, because of non-availability of electricity and suction apparatus. But it is no longer recommended, as a procedure of choice as it is a time consuming process and associated with more blood loss.