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The Baby Doom

By Kavery Nambisan

25 July, 2004
The Hindu

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 millions.

* * *
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.

Education, modernity 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 — medical ethics.

Committed health 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 worst holocaust.

The writer is a surgeon and novelist. E-mail: