Gender Violence in India Report 2014: Prenatal Sex Selection, Foeticide & Infanticide

Practices like female infanticide, female foeticide and prenatal sex selection have resulted in chronically low female-to-male sex ratios throughout India.

Sex selection is defined as “any procedure, technique, test or administration or prescription or provision of anything for the purpose of ensuring or increasing the probability that an embryo will be of a particular sex“.[1] Prenatal sex selection encompasses both the termination of a foetus because of its gender (female foeticide) and the prevention of the conception of a girl foetus, often through the use of medical technologies like ultrasounds, amniocentesis and sperm separation. While these technologies have been used worldwide to detect genetic and physical abnormalities in foetuses, they have been misused in India to facilitate a cultural preference for sons.

Female infanticide is defined as the deliberate and intentional act of killing a female child within one year of its birth, either directly or by conscious neglect on the part of the mother, parents or others to whose care the child is entrusted.[2]

The result of practices like prenatal sex selection and female infanticide is a declining sex ratio, which in turn facilitates other forms of gender violence, like dowry harassment and human trafficking.

Know the Law

While abortion in India is legal under specific circumstances, the abortion of a foetus on the basis of gender is illegal. In 1994 and again in 2003, the Indian legislature acted to curb such practices.

Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994

This Act criminalized disclosing the gender of a foetus to parents and limited the use of medical technologies to screening for genetic abnormalities. In addition, the Act set up a Central Supervisory Board (CSB) to advise authorities in state and union territories on implementation and enforcement.[3]

Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 2003

In 2003, the 1994 Act was amended to further regulate the use of medical technologies and to bring sex determination under the purview of the law. It also requires documentation of medical equipment that can discern the sex of the foetus and mandates that all offices using ultrasounds display a signboard stating that the detection and revelation of the sex of the foetus is illegal.

Medical practitioners that violate the above acts can be imprisoned for a period of up to three years and fined Rs. 10,000 for a first offense; subsequent convictions can result in up to five years’ imprisonment and fines up to Rs. 50,000 rupees. Any person that tries to find out the sex of a foetus from a medical institution or practitioner can be imprisoned for a period of three years and fined Rs. 50,000; additional convictions can result in up to three years’ imprisonment and fines of Rs. 1 lakh.

Keeping Count

The data on pre-natal sex selection and infanticide is best reflected by the sex ratios (the number of girls for every 1000 boys) generated by the Indian Census. Both Table 1 and Figure 1 show sex ratios from the past five decennial censuses:

Table 1: Sex Ratios in India According to Census Data

Year 1971 1981 1991 2001 2011
Overall Sex Ratio (females per 1000 males) 930 934 927 933[4] 943[5]
Child Sex Ratio (age 0-6) (girls per 1000 boys) 964 962 945 927[6] 919[7]

Figure I

Sex Selection Graphic

Child sex ratios significantly lower than the overall sex ratio are an indicator of the incidence of prenatal sex selection and female foeticide.

Aggregate data does not fully capture the considerable regional variation that exists; for instance, the states of Jammu and Kashmir, Haryana, Punjab and Gujarat historically report lower sex ratios (between 870 and 920 females per 1000 males), while states like Kerala, Tamil Nadu and Andhra Pradesh report higher ratios (above 990 females per 1000 males).[9] Within each state, sex ratios also vary significantly from district to district.

[1] The Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994, http://rajswasthya.nic.in, accessed 6th October, 2014.

[2] Tandon and Sharma, Female Foeticide and Infanticide in India: An Analysis of Crimes against Girl Children, 2006.

[3] See above note 2.

[4] Census of India 2001, Chapter 6: Sex Composition of the Population, p.3, www.censusindia.gov.in, accessed 6th October, 2014. Report includes overall sex ratios reported in decennial census data from 1901 to 2001; data from 1971 onward are included here.

[5] Census of India 2011, Primary Census Abstract: Figures at a Glance, p. xi, www.censusindia.gov.in, accessed 7th October 2014.

[6] Census 2001, p. 8 (see above note 4). Report includes child sex ratios from 1971 to 2001.

[7] See above note 5.

[8] Generated from the data displayed in Table 1.

[9] Census of India 2011, CensusInfo India 2011, http://www.dataforall.org/dashboard/censusinfoindia_pca/, accessed 7th October 2014.

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This series of posts were researched, drafted and edited by Divya Bhat, Shakthi Manickavasagam, Titiksha Pandit and Mitha Nandagopalan.

December 2014

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Gender Violence:The Health Impact – Discriminatory & Prejudicial Medical Practices: An Instrument of GV

by Ragamalika Karthikeyan

In the aftermath of a rape, survivors are told to follow certain protocol to ensure that forensic evidence can be collected properly. The National Commission for Women advises women specifically to not take a bath or change their clothes, to tell someone about the incident, file an FIR and get a medical examination done, in that order[1].

However, getting that medical examination is in itself a traumatic experience for most sexual assault survivors in India, as a result of archaic medical practices such as the ‘two-finger test’. Indeed, there are several medical practices in India, not limited to examination of rape survivors, which are themselves instruments of gender violence. We explore some of the most serious discriminatory and prejudicial medical practices in this post.

Pre-natal Sex Determination

Female foeticide is a horrible social reality in India. While the Government of India banned pre-natal sex determination in 1994[2], the female sex ratio is still dangerously low. In fact, while the overall sex ratio increased from 933 females per thousand males in 2001, to 940 in 2011, the child sex ratio has declined from 927 females per thousand males in 2001 to 919 in the latest census[3].

Yet, as per the National Crime Records Bureau (NCRB), only 221 cases of foeticide were registered in the country in the year 2013.[4] According to the NCRB, the rate of crime under this head is ‘negligible’[5].

So, unless we believe natural selection has significantly skewed the numbers against women, we must conclude that there are medical practitioners in the country who still perform sex-selective abortions. Thus, twenty years after the banning of pre-natal sex determination, policy makers and civil society will need to think about how to tackle this menace; moreover, it is imperative that this discussion goes beyond the rhetoric about ‘problems of implementation’. At the same time, the regressive attitudes that lie behind sex-selective abortions must not be confused with the right of a woman to have a safe abortion.

Medical Termination of Pregnancy

Abortions in India are allowed under the Medical Termination of Pregnancy Act, 1971, but conditions apply; because the sex of a foetus can be determined after 12 weeks, the law mandates that terminating a pregnancy between 12 and 20 weeks requires the consent of two qualified medical professionals. For pregnancies under 12 weeks, a woman has to depend on the judgment of a doctor, who has to be convinced, in ‘good faith’, of one of the following scenarios[6]:

  • Risk to life, or physical/mental well-being of the woman
  • Risk to life, or physical/mental well-being of the unborn child
  • Contraceptive failure in case of a married woman
  • Rape, as professed by the woman

Abortion law in India, therefore, is more population control-centric and has very little to offer in terms of rights-based delivery of a medical service. This has left a large population of women vulnerable to unhygienic and unsafe ‘quick fixes’, and expensive and sometimes illegal private healthcare.

Thus, the stigma surrounding pre-marital sex has forced several women to opt for unsafe methods of terminating their pregnancies. According to a study conducted in Manipur on data collected over 5 years, 76 per cent of the women who came in for an abortion of a first-time pregnancy were unmarried[7]. The Report of the Dialogue on Gender, Sex-Selection and Safe Abortion published by CEHAT also talks about the judgmental attitudes of medical service providers on abortions, leading to ‘verbal (and sometimes physical) abuses during service delivery’[8].

Legally, doctors only need the consent of the woman undergoing the procedure for performing an abortion. However, case studies show that several medical practitioners demand the ‘permission’ of the husband for performing the procedures[9], further minimising the right of an adult woman to her own bodily autonomy.

Thousands of woman die every year because of unsafe abortions. Policy makers must recognise this reality, and work towards making the medical termination of pregnancy rights-based, while also creating more awareness about the use of contraceptives.

Sexual Assault and the ‘Two-Finger Test’

Following the gang rape of a young medical professional in Delhi in December 2012, sexual assault laws were modified as per the Criminal Laws (Amendment) Act, 2013. The Act was revolutionary in changing the definition of sexual assault beyond peno-vaginal penetration, as per the recommendations of the Justice Verma Committee. However, despite changes in the law, the medical practices around examination of rape survivors continue to be problematic.

The first issue in this regard is that until recently, there was no standardised protocol for collecting forensic evidence in India. Essentially, the tests done on a survivor depended solely on her doctor. After years of public demand for standardisation of the procedure, the Ministry of Health and Family Welfare came up with guidelines for medical examination of rape survivors in March 2014. For the first time, the guidelines explicitly ban the conduct of a two-finger test in rape examinations; yet, this archaic medical procedure is still practiced in several hospitals across the country.

Over 115 years ago, French jurist L. Thoinot is believed to have been the first person to prescribe the two-finger test to determine the virginity of a woman or a child, in his book, ‘Medico-legal Aspects of Moral Offences’. In the India of 2014, this test is still performed on sexual assault survivors, to determine whether they were sexually active before the purported rape. Essentially, the test involves inserting two fingers into the vagina of the woman to ascertain its ‘elasticity’.

The problem with this medical practice is manifold. Firstly, the very suggestion that the sexual history of a rape survivor is of any value to an investigation of the crime is regressive. Secondly, the two-finger test, or the hymen tear test, is not medically conclusive on whether or not the survivor was raped, or on what the sexual history of a woman is.[10]

Thirdly, and most importantly, medical practitioners do not seek the explicit consent of the survivor for the two-finger test. Consent is sought for a bundle of procedures without informing the survivor of the exact nature of each test. By the very definition of sexual assault, this procedure without the consent of the survivor amounts to rape.

The ‘Not Injured, Not Assaulted’ Myth

Another major issue is that medical examinations of sexual assault survivors perpetuate stereotypes of who can and cannot be a victim. The stress on visible physical injury on the body of the survivor as evidence of whether or not she consented to sex goes against internationally accepted norms. This emphasis on injury fails to recognise that force need not always be physical. Medical examination of survivors does not take into account whether she was blackmailed, or forced to submit by other means.

Sensitisation of Medical Practitioners

Gender Violence is perpetuated by society, and medical practitioners are a part of the society that we live in. Thus, while laws around medical care may not always be discriminatory or prejudicial, in practice, women and girls are at the receiving end of archaic notions about gender and sexuality – even when it comes to something as critical as healthcare, something that not just policy makers, but the medical community and society as a whole needs to work on correcting.

[1] http://ncw.nic.in/MeeraDidiSePoochoEnglish/Chapter02.pdf

[2] Pre-Conception and Pre-Natal Diagnostics Techniques (PCPNDT) Act, 1994

[3] Census 2001, Census 2011

[4] Crime in India-2013, National Crime Records Bureau

[5] Pg 96, Crime in India-2013, National Crime Records Bureau

[6] Medical Termination of Pregnancy Act, 1971

[7] Characteristics of Primigravid Women Seeking Abortion Services at a Referral Center, Manipur. (Ibetombi T Devi, BS Akoijam, N Nabakishore, N Jitendra, Th Nonibala, 2007)

[8] Report of the Dialogue on Gender, Sex-Selection and Safe Abortion, CEHAT 2013

[9] Abortion Needs of Women in India: A Case Study of Rural Maharashtra (Manisha Gupte, Sunita Bandewar, Hemlata Pisal), CEHAT

[10] Dignity on Trial: India’s need for sound standards for conducting and interpreting forensic examinations for rape survivors. Human Rights Watch, 2010

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Ragamalika Karthikeyan is a Prajnya volunteer, and currently a fellow with PRS Legislative Research’s Legislative Assistants to Members of Parliament programme. A television journalist before she made the switch to policy research, Ragamalika is interested in issues surrounding gender, social hierarchies, and sanitation.

Why do we not want girls?

Kalpana Sharma writes in The Hindu (24 July 2011) about India’s declining sex ratio, in the context of preliminary census data. As she says, this is one issue we have to keep returning to, again and again, to try and find answers to this question: why are girls not wanted in India?

The Other Half – Insurmountable hurdle

As the declining sex ratio from Census 2011 shows, merely having laws against sex selective abortion is not enough. Fighting entrenched social attitudes is a much tougher call…

Three cheers for Japanese women. Their soccer team beat the powerful U.S. team and won the FIFA Women’s World Cup. Indeed, in a week with much gloom, this was the one cheerful piece of news. Even more to celebrate was the fact that women’s sports is finally making headlines, and is not relegated to a single column at the bottom of the page.

But the bad news from Census 2011 about women is relentless. Once again, as provisional data is released on the 2011 Census, and we know now, for instance, that India is becoming increasingly urban, we are also getting confirmation that India is increasingly male. We were warned in 2001 that the situation was alarming; in 2011 that adjective appears an understatement.

Persistent problem

India’s declining sex ratio is a subject one has to revisit repeatedly. No matter how often you think about it, or write about, it is difficult to come up with a straightforward or simple solution to the situation we face in India: Where girls are simply not wanted. They can excel in sport, in studies, in jobs, as politicians, as bureaucrats, as writers, as engineers. But none of that changes the attitude of the couple on the verge of parenthood — who long for a boy and grieve if a girl is born.

Now, in addition to the usual breast-beating about this appalling situation, we have people suggesting that access to abortion should be restricted. In Maharashtra, where the 0-6 years sex ratio has seen a precipitous decline, suggestions are flying around of restricting access in different ways. For instance, the Nagpur Municipal Corporation has made it compulsory for all radiologists and gynaecologists to post details of their work online. That might prove a salutary step. But in addition, they must get clearance from the municipality before they perform an abortion. How adding a layer of bureaucracy to the process will check the misuse of abortion facilities for sex-selective abortions beats comprehension.

India’s abortion laws are considered to be progressive because they recognise the right of women to have access to safe abortion. The importance of safe abortion cannot be emphasised enough. India has the highest number of unsafe abortions in the world and an estimated 56 per cent or more than half the recorded abortions that take place, are under unsafe conditions. As a result, 15 to 20 per cent of maternal deaths are due to unsafe abortions. India’s maternal mortality rate is one of the highest in the world. So women who need to undergo an abortion for a variety of reasons including rape, or contraceptive failure when they are not ready for another child, should have legal, safe and clean facilities for the procedure.

Unfortunately, even what exists by way of public facilities is grossly inadequate. According to studies on abortion in India, only 25 per cent of abortion facilities are in the government sector. Studies have also revealed that as little as six per cent of all primary health centres have abortion facilities. This means women living in rural areas have no option but to turn to private practitioners, of whom many resort to unsafe procedures.

In cities, health facilities are better. But the people who misuse legalised abortion for sex selection rarely use government facilities. They can afford the private practitioners who ask no questions and charge a hefty fee.

Not a solution

So restricting abortion facilities will affect poor women, already burdened with inadequate health facilities; while those with money, who also seem to have decided they do not want girls, will continue as before.

The dilemma is a real one. Since 2001, when the first shock of the extent of the decline in the sex ratio hit home, there have been many discussions about the problem. The Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 2003 has been tightened. Despite that, there have only been a small number of convictions; out of 800 cases in 17 states, only 55 convictions. Clearly the law is not being implemented the way it should be.

But even if it were strictly enforced, would there be a difference? Indians are notoriously proficient in bypassing even the best-made laws. If they want to do something, they find a way of doing it.

To give you a simple example of how difficult it is to get people to obey a law. In most states, it is compulsory to wear helmets if you drive a motorbike or scooter. The law has been made for the safety of those who ride these machines, people who should know that the law is in their best interests. Yet, in city after city, you will see people risking their lives and finding ways to evade being caught rather than wearing helmets, or quickly putting them on just before they see a policeman. In fact, there is an advertisement on television these days showing a young man finding an ingenious way to side-step the rule when he sees a cop on the horizon; he puts on a hollowed-out watermelon on his head in place of his non-existent helmet. And the ad is supposed to be light-hearted and funny.

Perhaps this example is not a direct parallel to the ways in which the PC&PNDT Act has failed to make a difference. But it illustrates an approach towards law that makes implementation of any law an even greater challenge in India. When that law meets entrenched social attitudes, the hurdle appears almost insurmountable.

So the dilemma before us is how we get people to actually not resort to sex selection and sex selective abortions. One way is to keep the issue alive in the media, to provoke debates on this in colleges, and to constantly remind people that a country progresses if all its people are secure, if all feel they have rights, and not if one half of the population is made to feel so unwelcome that you ensure that they are never born.

Email the writer: sharma.kalpana@yahoo.com