By Kavery Nambisan
25 July, 2004
Bihar, India 1997:
Ward Rounds in
a hospital in the small town of Mokama. I am examining a young woman
who delivered her second baby the previous night. I tell the mother
that her baby is healthy and beautiful. She turns away, sullen and silent.
"It's a girl," says the nurse. "That's why."
Kodagu, India 2003:
The couple sitting
opposite me in the clinic are young and wealthy. She is three months
into her third pregnancy and wants to know the sex of the unborn baby.
Their two bright-eyed daughters aged four and two are playing outside.
I explain. It is against the law; the number of girls in our country
is dwindling; all-girl families are often high achievers. The husband's
patience begins to wear thin. They leave my clinic with the frown of
those who will not come back to me. I find out later that the woman
"miscarried" in Bangalore. Yet again, a doctor careless of
the law, and one more added to the list of unborn girls, now numbering
* * *
The world's largest minority is an endangered species, thanks to one
of the most privileged and influential groups: the doctors. The medical
profession has been co-opted in a crime against girls and it is not
complaining. "I cannot refuse when a colleague sends a patient
with a request," says one doctor. He makes it clear that he is
taking a risk by defying the law and then extracts a large sum of money
for the favour.
Nature has tuned
the boy-girl ratio to be more or less equal. At birth, the girl is at
a slightly greater risk of serious congenital abnormalities and so the
normal ratio of girls being born is 95 for every 100 boys. This discrepancy
at birth is evened out later on, as the girl child has better instincts
of survival. In India, where female foeticide has increased steadily
in the last 25 years, we have a decreasing ratio. Punjab, Haryana, Delhi
and Gujarat have 79-87 girls per 100 boys. Amartya Sen in his article
"Missing Women revisited" in The British Medical Journal
of March 2004 has highlighted this aspect: the number of "missing
women" for the world as a whole is now 101 million. About 93 million
of this number is shared between India and China. The boy-girl ratio
in the age group 0-6 in India has fallen from a healthy 972 girls per
1000 boys in 1901 to an alarming 927 in 2001.
and affluence have failed to favour the girl child. Studies show that
the ratio is better among most tribal communities, and worse in the
cities. The profusion of ultrasound diagnostic centres and clinics performing
illegal abortions makes it as easy as going for a facial.
The simplicity of
the whole process makes it treacherously complex. Sex determination
and abortion are easy to perform. Most doctors say that misuse occurs
because of unregistered mobile scan machines used by quacks. The law
requires every ultrasound scanner to be registered but this only acts
as a legal cover and does not stop misuse: the doctor who does the scan
will signal the parents with a nod for a boy and a shake of the head
or a grimace for a girl. He will pocket his thousands while the parents
leave the clinic knowing if they must abort the foetus or keep it.
The Pre-Natal Diagnostic
Techniques Act (PNDT) came into being in 1994. It stipulates that ultrasound
and other techniques be used only to detect foetal abnormalities. In
the hands of the right people it has made childbirth safer. But the
Act has not achieved what it proposed to. Doctors simply put up a notice
that sex determination is banned and then continue to do it.
Doctors are a protected
species. Committed journalists teaming up with activists have exposed
erring doctors, only to find that the police are not permitted to take
action. A government-appointed medical team deals with the offence.
In most cases the scandal is covered up. Some doctors misuse science;
others protect those who do.
In the last few
years, there have been several decoy operations conducted by journalists
and activist groups to expose the crime. It is written about in the
papers and the doctors' names mentioned. In terms of fighting female
foeticide, this still remains the most significant step.
Consider the effect
of 10,000 ultrasound machines all over the country each doing one sex
determination per week. (This conservative estimate is based on the
assumption that a large number of ultrasonologists are incorruptible.)
If half the parents decide to do away with the baby because it is a
girl, you have 25,000 girls disappearing before birth every year.
There is also the
worrying fact that population control worsens the situation. Couples
determined to have only two children will see that they get their "share"
of boys. Doctors oblige. China is waking up to the reality of a society
dangerously short of women. The other danger is that as gene selection
and cloning become more refined, it will be possible to decide the sex
of a baby before it is conceived. A high-profile husband-and-wife team
were booked a few months ago in Bombay for claiming to help parents
"plan" the sex of their babies. The husband, until then, used
to write a regular column for a magazine on of all things
professionals, activists, and journalists are working hard to educate
the public in the dangers of a society with a diminishing number of
girls. It would help if the leaders in every religion spoke out against
customs that are loaded against the girl child. People respect their
words. Some soul-searching will reveal that while we decry the evil
influences of western consumerism, female foeticide is prevalent almost
exclusively in the Indian subcontinent and in China. Our regressive,
patriarchal mindset, which encourages the practice of dowry and male
inheritance, is largely to blame. Affluent families burdened with a
large inheritance are reluctant to let a girl child take it away to
another family. It is the "educated" rich who increasingly
resort to sex-determined abortions.
The crisis is as
urgent as it is enormous. As the number of girls declines, atrocities
against them will increase multi-fold. Girls will be afraid to leave
their homes even to go to school or college. Women will be shackled
at home. In the end, it is the doctors who have a lot to answer for.
Will we, as a select and privileged group speak out against the threat
to the world's largest minority? Or will we merely clear our throats
of indecision and go on as before, happy with our day-to-day hospital
work? Do we rewrite the medical curriculum, get guilty doctors booked,
rethink our strategy of population control, and ban the scan?
The privilege of
being trusted with the lives of others brings with it the larger responsibility
of fighting social evils. We could still redress the harm being done
by the misuse of technology. Medical Ethics and Humanities could be
made part of the medical curriculum so we don't produce doctors who
are technologically sound and morally corrupt. If we do not act now,
instead of being saviours, we will be the perpetrators of the world's
The writer is a surgeon and novelist. E-mail: firstname.lastname@example.org