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Mainstream, VOL LIII, No 11, March 7, 2015

Beti Bachao: Patients’ Envy Doctors’ Pride

Monday 9 March 2015

by Harikrishnan B., Navneet Sharma and Pradeep Nair

The Prime Minister, Narendra Modi, has miles to go before he sleeps, especially when he is such a slow walker. As Chief Minister of Gujarat for more than a decade, he could not reach out to Vapi which is only 200 miles away from Gandhinagar. The recent Census of India (2011) shows Vapi with the lowest sex ratio with 734 women per 1000 men. The ‘ideal’ Gujarati pride finds a pitiable 12th position in the States’ ranking list according to sex ratio. The former ‘single’ Chief Minister in his new avatar as a ‘married’ Prime Minster launched the Beti Bachao Beti Padhao programme in Haryana which is already infamous with its staggering sex ratio. The only other place more appropriate for the launch of this scheme would have been either Dadra and Nagar Haveli or Daman and Diu with even lower sex ratios.

The Ordinance-based ‘good’ governance of the country would not find it more concerned with women’s birth/fertility/mortality/growth ratio, otherwise the rare insights of its Ministers would have been ‘seminal’ for another audience on the mooted idea—the idea which squarely puts the onus on women for their lower birth/survival rate. The Minister of Women and Child Development (WCD) of the Union of India, Ms Maneka Sanjay Gandhi, supported and advocated vehemently that all married couples should undergo a sex determination test of their foetus, in contrast to the existing Pre-conception and Pre-natal Diagnostic Techniques (PCPNDT) Act 2003 which prohibits it, so that there can be a legal binding on people to bring the girl child to the world and foster her.

Women across world, societies and religions are secondary citizens and beings. In this male-dominated world, believing that women do have a choice—and a choice to exercise it also—is not only illogical but inane. Women in this world are important so as to produce men. In the Indian milieu, the typical idea of India believed and propagated by the ‘cultural’ Hindu organisation, which holds the remote control of the present government, perceives women only as ‘birth givers’ of Shivaji or VeerSavarkar. Women, according to this organisation, ‘may’ learn self-defence only to defend the ‘prestige’ of the Hindu religion or commit sati rather than falling prey to the ‘mlechha’ Muslims. Hardly would this organisation ever realise that the low sex ratio of the country is only due to these kinds of mis-beliefs and mis-conceptions. Parenting a girl child in the era of Khap panchayats and Love Jihadists sounds a challenge if you abide by the above idea of Hindu pride and ‘ideal’ Hindu women. Finding a suitable match for your daughter with appropriate: with-in religion, caste, gotra, educational and economic state with affordable capacity for giving never the ‘just’ dowry is another uphill task. So why to complicate one’s own life, honour and name when one can ‘medically terminate pregnancy’ non-medically and illegally when you get to know the sex of the foetus?

A religious-minded society, where women do not have the claim or right to Moksha, and simultaneously can’t perform last rites for one’s passage to Moksha, makes one’s life more ‘sullied’ if the parent is not able to safeguard the daughter from the prospective rapists and other religionists who may succeed in enticing the girl into ‘Love Jihad’. This is what puts the female foetus at risk—the risk which a woman forebodes from womb to the grave. From coming into the world, surviving child molestation, stares, eve-teasing, rape, wife-bashing, dowry, destitution and widowhood to growing into a woman be-fitting and fulfilling to the apropos to the men’s world is a challenge both to the daughter and her parents. The easy option is not to ‘father’ a girl-child, thus forcing the woman not to bring in another woman into the world. The tragic irony is that this patriarchal approach survives and grows with women’s support which they even fail to fathom.

The exponents of the move to legalise sex determination of the foetus, which include the Women and Child Welfare Minister of Maharashtra, Pankaja Munde, and the strongest professional organisation of doctors in the country—Indian Medical Association [IMA]—argue that once it is legalised, clandestine clinics, which offer such services, will cease to exist, bringing down the female foeticide rate. Making it a carrot-stick approach, Pankaja Munde suggested that it will be made compulsory for all pregnant women to undergo the test and they will then be held legally responsible to deliver the child and foster her. This legal responsibility and punitive action work as the stick in this proposed arrangement while the incentives to giving birth to the female child constitute the carrot.

The IMA has fervently supported these suggestions and further suggested that the ‘draconian’ Preconception and Prenatal Diagnostic Techniques (PCPNDT) Act of 2003 is presently used only for victimising ‘innocent’ doctors. Observers list many external pressures to the proposed legalisation move which range from advocacy by the IMA to the clout of the notorious clandestine clinics which now offer these services. Apparently, Pankaja Munde’s own constituency, Parli, is infamous in Maharashtra for clandestine clinics offering foetal sex determination and abortions.

The PCPNDT Act, passed by the Indian Parliament, came into force in 1994 for regulation and prevention of misuse of the diagnostic techniques. The name of the Act that time was Pre-natal Diagnostic Technique (Regulation and Prevention of Misuse) Act. The Act became operational from January 1, 1996 in order to check sex-selective abortion. The Act prohibits determination and disclosure of the sex of the foetus. It also prohibits advertisements relating to pre-natal determination of sex and prescribes punishment for its contravention. The person who contravenes the provisions of this Act is punishable with imprisonment and fine.

Although implemented in 1996, the Act was routinely ignored and sex selection continued as a regular practice. In response to advocacy groups and a Public Interest Litigation (PIL) petition, the Supreme Court of India issued its opinion in 2001 and 2003 denouncing the practice of sex-selective abortion and calling for more vigorous implementation of the Act. Subse-quently, several amendments were made in the Act and the name of the Act was changed to Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act and a lot of limitations were imposed on the use of pre-natal diagnostic procedures to situations where they are medically necessary.

Similar to this, China also brought an Act into practice in 1994 itself to prohibit the use of medical technologies such as ultrasound and amniocentesis to identify the sex of the foetus, known as Maternal and Infant Health Care Law. The law states that sex identification of the foetus by technical means shall be strictly forbidden, except that it is positively necessitated on medical grounds. This law was later supplemented by the Regulation on Prohibiting Foetal Sex Identification and Selective Termination of Pregnancy for Non-medical Reasons in 1998 and the Population and Family Planning Law in 2002. The regulation was passed by the Chinese Government to ensure the normal gender structure of the population at birth as well as to promote the sustainable development of the population, economy and society. The regulation bans the determination of foetal sex and selective termination of pregnancy, except for medical reasons. Article 35 of the Population and Family Law of China also bans sex-selective pregnancy termination for non-medical purposes. The punishment for the violation of the above mentioned regulation and law includes administrative sanctions, fines, and possible loss of a provider’s medical licence. But in China, criminal liability only attaches if there is bribery involved.

In Europe, especially in the United Kingdom, sex selection is prohibited unless there are medical reasons, through a law passed in 1993. To make the law more effective, all sperm-sorting techniques, like MicroSort, were prohibited in the UK in 2007. Germany also prohibits sex selection for non-medical purposes by an Embryo Protection Act of 1990. In contrast, Italy allows first trimester abortions for women over the age of eighteen as long as the abortion falls within one of the many enumerated categories, including physical or mental danger to the mother and individual circumstances. Although Italy has strict laws restricting many aspects of assisted reproduction, including in vitro fertilisation and embryonic stem cell research. The Medically Assisted Reproduction Law (MARL) of Italy prohibits all kind of genetic analysis on embryos. The Assisted Human Reproduction Act of Canada also prohibits sex selection.

In the United States, the states like Arizona, Pennsylvania, Illinois and Oklahoma have passed legislations to prohibit abortion based on sex selection. Other states like Florida, Massachusetts, Missouri, New Jersey, New York, Ohio and Rhode Island have passed bills regarding the prohibition of sex-selective abortion. In this concern, a significant piece of legislation, the Prenatal Non-discrimination Act (PRENDA), a federal bill prohibiting sex-selective abortion was considered in the United States House of Representatives in 2011 suggesting a fine or imprison on anyone who performed an abortion based on the sex, gender, colour or race of the child. But unfortunately the bill failed to receive the two-thirds vote required to pass, with a final vote of 246-168 on May 31, 2012.

Though the PNDT Act has been enforced, it is often found ineffective to check the female foeticide in India. However, at times, when the government took a stern hand to enforce the Act, the subsequent periods witnessed improved gender ratios. Time and again both medical practitioners and patients used many techniques to bypass the restrictions. They range from handing over pink or blue candies—a colour coded hint about the sex (remember, blue for boys, pink for girls; Delhi Metro uses the same stereotypical pink colour appendage to mark the women coaches) of the foetus to avoid stating it directly in the records—to using the ‘services’ of the numerous illegal clinics operating for the cause.

Even in this situation, the Minster of WCD believes that if sex determination is legalised, it will bring down female foeticide since the mother will be legally bound to deliver the child. However, such a provision will in effect increase cases of ‘accidental’ abortions in a society which is notorious for its dependence on traditional methods of abortion, not to mention the abundant quacks who come knocking, eager to deliver these services in the cheap and best way.

Even now mothers, who give birth to the female child, suffer terrible apathy and even physical abuse from the family. Female infanticide is also rampant in many parts of the country. These instances are not the effect of absence of legislation, but the collective psyche of the society which is trained to see the girl child as unlucky and a burden to the family. The same reason makes the chances of physical abuse of pregnant women and instances of female infanticide more likely in a scenario where pre-natal sex determination is legalised.

As per the advocates of the legalising foetal sex determination, the PCPNDT Act, which is not effective in improving gender ratios or to prevent female foeticide, is used mainly to harass ‘innocent’ medical practitioners for minor clerical errors. Apparently, these minor clerical errors range from not registering the ultrasound equipment to not filling up forms correctly during a test, to keep things hazy. So the proposition will keep the patient and her family more responsible, thus ending the victimisation of doctors.

This perspective puts forward the idea that the actual culprit is the patient who decides to go for sex selective abortions. Both the government and medical practitioners exist away and beyond this reality of the individual/the mother/mother-in-law/husband who has the sole agency to decide and kill a female foetus. This construction of the culprit other is a handy task of stuffing a multifaceted socio-cultural issue into a convenient mould of binary opposites. Since the individual is the culprit, it is sensible to keep him/her responsible/legally bound. A much easier game since we all are now on either of the sides—either innocent onlookers or the agents of murder. But in fact, we are all on one side. We are the agents of murder.

Studies have noted that the family of the pregnant woman looks at sex determination as an issue of affordability only. If you can afford the test, then it is your right to decide if you want a son or a daughter. Similarly, many practitioners—both certified and clandestine—believe that by delivering these services, they are helping the public to get rid of an unwanted child. This illustrates that the root of the cause does not lie on individuals. Time and again it is said that the enigma of the poor sex-ratio at birth is closely linked to the highly patriarchal mindset of the Indian society. Though this pops up in any discussion on falling gender ratios in India, it is more significant in the present context.

The male child preference of the majority Indian society is often termed as a result of the age-old beliefs and practices, or as many foreign [read Western, ‘mysterious India’ loving] observers put forth—the result of the indelible imprint of the culture which stays unchanged for hundreds of years. However, culture is something constructed through an ongoing complex social process. Though it is ingrained in the unwritten rules of the patriarchy, they are time and again reiterated and enforced in the collective conscious of the society, often mixed well with many populist ideas and ideologies to make sure that they survive the test of time. Recent example rests with the very government which is mulling over saving the daughters of the nation.

It was most ironical that the official project to save the daughters of the nation from the omniscient Right-wing power at the helm started almost parallel to the calls from its elected members to the Hindu community to turn their women into child-producing factories with at least ten children, to challenge the ‘demographic threat’ posed by minority communities. Interestingly, none of these rants called for giving birth to ten female children. They wanted ten males—since the male child only can devoted to fight for the country or to be donated to the sadhus to take part in the building of the Hindu nation. The very name BBBP itself sounds similar to another campaign supported by similar agencies—bahu bachao-beti bachao bythe Bajrang Dal—to save the Hindu women from the Love Jihadists. The very sexist idea of female as something to be saved or to be guarded resonates here also. Such are the very many ways how the deep-seated patriarchal notions are sanctified time and again in the collective consciousness of the society. Trying to single out individuals and then blaming only them will not solve the root cause. Stopping female foeticide is a collective responsibility, not always an individual one. The government and medical practitioners in the country cannot run away from this collective responsibility pointing to the agency of decision-making with individual patients.

In Pune, the women’s wing of the ‘cultural’ Hindu organisation—Rashtriya Swayamsevika Samiti—is ‘disciplining’ the Hindu woman to be the ideal Hindu wife and Hindu mother. The programme to make ‘women’ invisible is political. The objective of the Hindu fundamentalists is that women, when they look into the mirror, should see either Hindu or non-Hindu women. The ‘empowerment’ of Hindu women reflects a manipulated, falsely constructed consent and intentionality. The ploy is to subjugate women and the equality, dignity and rights of women by portraying the woman as one who is a decision-maker in the sex-selective abortions whereas she is the victim or patient aka ‘abala bharatiya nari’.

Harikrishnan B. is an Assistant Professor in the Department of Journalism and Creative Writing, Central University of Himachal Pradesh; Navneet Sharma, Ph.D, is an Assistant Professor in the Department of Teacher Education, School of Education, Central University of Himachal Pradesh; Pradeep Nair, Ph.D, is an Associate Professor and Head in the Department of Mass Communication and Electronic Media, Central University of Himachal Pradesh.

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