By Dr. J. K. Bhutani
July of 2015: A village in Hisar, Haryana. Bateri is a 38 years illiterate female. Her husband is a labourer. She delivers 11th child (however, a female) in the hope of getting a second son. She already has 5 living daughters and a son. And had lost four girls after normal births…!
July of 2015: An affluent sector in Panchkula, Haryana. Renuka is a 32 years old female. Is a working I.T. professional. Her husband is a professor in a university. She opts for voluntary hysterectomy (surgery for removal of uterus) on medically flimsy grounds, having two sons and history of two abortions (medical termination of pregnancy,i.e.,MTP)….!
Common to both the scenarios is an underlying preference of the family to have a pair of sons. But the difference is in the access and use of modern technology of sex selection. The educated rich couple could access and afford the technology for their personal preference and goal while the illiterate ‘not-so-rich’ couple could not access the technology and used the natural multiple-birthing method to achieve the same goal. The latter naturally puts the health of the women in jeopardy and puts a population pressure on the nation as well. No doubt, India is witness to two issues: Skewed sex ratio and population explosion.
From this arises another issue of high maternal mortality rate. With a maternal mortality rate (MMR) of around 200 deaths/100,000 live births ,India is far from achieving the fifth Millennium Development Goals (MDGs) of reducing maternal mortality to 109 per 1,00,000 live births by next year. With population explosion, India is likely to surpass China to become the world’s most populous nation by 2022. How sex determination technology has evolved and how it has affected the population and skewed sex ratio is an interesting journey of misplaced notions and overpowering commerce.
It all started in 1974 with development of a technique called Amniocentesis (drawing amniotic fluid with a syringe from amniotic sac that surrounds the fetus). But it was soon replaced by Ultrasound machine as the latter was a safe, non-invasive method of detection of foetal wellbeing and sex detection. The 1980s and the 1990s saw the mushrooming of ultrasound centres across the country as they became an easy tool for doctors and quacks to make quick money by doing determination of sex on the foetuses growing in the wombs! The deeply rooted traditional gender bias notwithstanding, it is the rising wealth, elite attitude, and western influence and technology which affect and result in fewer children overall, and also many fewer girls. We must admit to this fact that the availability of ultrasound and ready access to abortions has sharply reduced the number of women in the world.
The technology of the eighties was so much lapped by the people of India who are quite obsessed with the male progeny. The trend soon became alarming with the annual declining females and a skewed gender ratio with female infanticide numbers becoming the matter of hot debates in government and social circles. And with the constant dip in the female numbers, with national figures of 940 (in 2011) and in some states like Haryana having 877 and Chandigarh having 773 per 1000 male children set the ball rolling for some tough decisions.
Government woke up too late:
The Pre-Conception and Prenatal Diagnostic Techniques (PNDT) Act was passed in 1994 and implemented two years later. By that time the sex selection, which had an approval of the West-influenced elite and educated class too had become a norm for the society. It may be noted that as late as the 90s, many intellectuals were not against sex selection as a means of birth control. Unfortunately, a traditional preference of a male child and readily available technology driven by pure commerce, a deadly recipe for the female feticide was staring at us. The launch of ‘Beti Bachao, Beti Padao’ (Save daughter and educate her) campaign by the Prime Minister last year in a sense shows the desperation of the situation! All women crimes, be it rape, violence or trafficking, are related to this skewed ratio in a way. The sins of eighties are visible now as there are insufficient number of brides for the boys born in the eighties and nineties. The current scenario, despite strict implementation of PNDT act, is as dismal as it was a decade back. The Haryana figures released in June of 2015 show a dismal SRB (Sex ratio at birth) of 869 per 1000, a decrease from the year 2014 ratio of 874/1000. Understandably, Haryana is one of the most active states currently working on the ‘Beti Bachao Campaign’.
Future Scene and Options:
With the proliferation of technology and decreasing costs, the bane of this technology will be more visible and we as a nation of predominant young people need to device the appropriate strategies. The implementation of the PNDT Act will be reduced to a technical and legal matter, unless we prime the conscience of the society! Thus, saving daughters should be transformed into a social movement.
The universal registration of the pregnancy linked with Aadhaar number is another good option worth considering by all the governments and should be popularised with provisions of ‘state-of-the-art’ antenatal and postnatal care plus monetary incentives. All ultrasound and other test records should be made electronic and linked with the monitoring centralised database.
The selection of sex may be allowed after two female children as it shall incentivise people not to go for multiple pregnancies (as our protagonist Ms. Bateri had to undergo).
In addition, conditioning of the society for equality of sex, anti-dowry ideals and respect for women should be undertaken via education, media, Bollywood, and the religious leaders.
The time to act is now! And till we achieve the ideal sex ratios, it is imperative to keep working on the solutions! Empower, respect and secure the women we have with us as they too were destined to be equal inheritors of this civilization.
Dr J.K. Bhutani MD is a protagonist of preventive and promotive health care based on austere biology and facilitating self healing powers of human organism.
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