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Paper - INDIAN STATISITCAL INSTITUTE

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Paper - INDIAN STATISITCAL INSTITUTE ...

    India’s Unborn Daughters - Victims of Demographic Terrorism

    Ashish Bose

Abstract

    I have every reason to believe, on the basis of census analysis and field work in various parts of India, that the 2011 census will record a further decline in the child

    sex-ratio (number of girls per 1000 boys in the age group 0-6 years). India‟s has

    launched several national programmes in the filed of health like eradication of small-pox, leprosy, polio, malaria and lately, HIV/AIDS. But we have not given enough attention to a greater malaise which goes beyond health and has much wider ramifications. In fact, the continuing decline in the sex-ratio at birth is indicative of our civilisational collapse.

    It is beyond the competence and comprehension of our bureaucrats in the Ministry of Health & Family Welfare and for that matter, the Ministry of Women and Child Development to curb female foeticide. It is tempting to think that our religious leaders will be able to sway the people to change their reproductive behaviour and abandon female foeticide but unfortunately the religious factor is at a discount and this approach has not worked. The less said about our politicians, the better. Their credibility in the eyes of people is an all time low. The talk of civil society is internationally popular but is not understood in India. One is driven to the conclusion that some other strategic interventions are called for, without writing off the bureaucrats, religious leaders and politicians.

    One strategic intervention on the part of the government is to introduce new social legislation and also seek help in a big way from concerned NGOs to make a massive effort to eradicate the social menace of female foeticide. Political will and the strong arm of law (as the Supreme Court has demonstrated) can work wonders. The starting point in all our efforts should be creation of a scientific database on

    female foeticide. I would urge the Indian Statistical Institute which is a pioneering institute in India with international reputation to take up this role. Not many people are aware of the priority tables in the Census of 2001. In my view, census tables on

    child sex ratio were an unintended by product of the government’s concern for generating literacy tables on a priority basis. The calculation of literacy in the 2001

    census excluded the age group 0-6 from the denominator; i.e. the rate was calculated for the age group 7+. Since all tables must give data separately by sex and also by rural-urban breakdown, in the very first Census paper of 2001, we have figures for child sex ratio (CSR) for the age group 0-6. Since the Census Commissioner, Mr. J. K. Banthia was conversant with Demography, he noticed the drop in CSR and presented detailed data in Census Paper 1 of 2001 - Supplement: To quote him:

     “….the decline in child sex ratio is assuming an alarming proportion in certain districts of Punjab, Haryana, Himachal Pradesh and the decline in majority of the districts in other states and union territories across the country (Uttar Pradesh, Madhya Pradesh, Chhatisgarh, Orissa, Karnataka, Assam, Delhi, etc) is rather intriguing. The social cultural bias against the girl child might have been possibly aggravated by recent medical support in terms of sex determination tests and requires further field investigation. Before arriving at any definite conclusion among other details we have to wait for single year age wise disaggregated population data for the 2001 Census”.

    Even single year age data will not enough for a proper analysis as CSR which is affected by mortality and migration. Along with Dr. Mira Shiva, an eminent medical scientist, I did field work on female foeticide in Punjab, Haryana and Himachal Pradesh. This study was sponsored by one of India‟s leading NGOs, (Voluntary Health Association of India). Our monograph was published with the title „Darkness

    At Noon‟ (2003) and was dedicated to “all the unborn girls of Punjab, Haryana and Himachal Pradesh”.

Following my earlier acronym BIMARU for the demographically sick states of Bihar,

    Madhya Pradesh, Rajasthan, Uttar Pradesh, I coined a new acronym DEMARU

    which stands for Daughter Eliminating Male Aspiring Rage for Ultrasound (in

    short, daughter killers).

    There are three pre-conditions for the spread of female foeticide, namely, road connectivity, availability of doctors with ultrasound machines and the client’s capacity to pay for the cost of test and abortion. Of course, the overriding factor is

    the deep-rooted „son complex‟ in Indian society (barring exceptions). The three preconditions explain why the middle class and upper middle class have taken to this perverse practice, and not the poor. The BIMARU states do not fulfill condition three, namely the ability to pay, which is the trigger for greedy doctors, and also precondition one (road connectivity).

    Strategic intervention is also called for to tackle the second precondition, namely, the doctors. We are aware of the PNDT Act of 1994 and the modified PCPNDT Act which have failed to punish the doctors. The law is going the same way as the Child Marriage Restraint Act of 1929, subsequently modified in 1978. Unfortunately, the sporadic incentives given for the girl child in different states basically centres around

    money power. For example, Himachal Pradesh has announced a scheme for giving Rs. 1,200 for each new born girl child. The amount may be an incentive for a poor family but not for a middle class family. In any case, the poor are not going for

    female foeticide.

    The Central and State governments have to think seriously about innovative laws which can be effective and not just think of cash incentives. The law should not only punish the doctors but also the parents of daughters who are nipped in the bud.

    Our field work shows that female foeticide is mixed up with the two child norm (which is getting widespread acceptance in India). It is quite usual to find that the most preferred family formation is one son and one daughter, if not two sons. The most unhappy situation is to have 2 or 3 daughters. This is the category which goes for the test and sex selective abortion. Even in the case families where the first child is a daughter, there is every possibility that in order to ensure that the second child is a son, they will go for the test and abortion.

    Our fieldwork also reveals that people are justifying female foeticide in the name of

    small family. It is unfortunate that even government schemes like Janani Suraksha Yojana (JSY) give additional cash incentives, if any woman undergoes sterilisation after the delivery of a child in an institution (hospital, CHC, etc). Unless there is conceptual clarity and consistency in various programmes lunched by the government, there will be confusion all around.

    As an effective deterrent to female foeticide, I would suggest bold legislation which

    will debar sons of parents who have taken recourse to female foeticide to get any job in the government/public sector, defence services etc. All over India, there is a

    great craze for government jobs at any level. This is the justification for my argument

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    in favour of such legislation. Of course, it is extremely difficult to identify people indulging in female foeticide. This calls for a very innovating monitoring system

    and keeping a record of every pregnancy and the out come pregnancy at the village/town/city level. Action is called for at the local level. At the same time, one

    has to be careful that the system is culturally sensitive and does not violate human rights and individual privacy. There are quite a few success stories in India about innovative intervention at the local level by district magistrates, NGOs etc. Case studies must be made of such interventions.

    We must not only stall the continuing trend of sex selective abortion but take bold step to eradicate it. Female foeticide is a disgrace and a tragedy, unacceptable to any civilised society.

    Honorary Professor, Institute of Economic Growth, Delhi. Member, National Commission on Population

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     I am deeply grateful to Indian Statistical Institute, and in particular, to the Economic Research Unit and Dr. Manoranjan Pal for giving me the opportunity for participating in the Platinum Jubilee celebrations this year. My humble felicitations on this occasion. The late Professor Mahalanobis ignited so many minds and put ISI on the world map. We are indeed proud of our brilliant statisticians working all over the world.

     Let me now turn to the subject I have chosen for the keynote address, namely, the growing menace of sex selective abortion, or simply put, female foeticide, which

    I consider to be a greater menace than HIV/AIDS in India.

     Let me briefly (though bluntly) conceptualise the issues at the outset. Planned (both at the family and community level) female foeticide is a form of demographic

    terrorism which in turn is motivated by demographic fundamentalism which

    reflects the deep-rooted son-complex in Indian society (as in many other societies around the world). The son complex cannot be changed by academic arguments or newspaper advertisements. One may legitimately ask : the son complex has always been there but why should this be responsible for female foeticide now?

     This phenomenon calls for some explanation. In this ontext, the concept of livelihood security is important and must be understood by policy makers and

    planners. In the name of rational attitude, one may condemn the son complex as superstition, which unfortunately it is not. It is a strategy of survival in an agricultural country. Simply put, a son is an asset, a daughter a liability. But there is nothing new in this argument and this alone cannot explain the upsurge of female foeticide in India.

     I believe that there are at least four factors which have triggered off the inherent son complex to produce the phenomenon we are describing. These factors are : (i) the advent of medical technology which enables one to know the sex of the unborn child in advance ( by pre -birth sex-determination tests), (ii) availability of doctors who can perform the tests as well as the availability of the necessary equipments with them, (iii) capacity of the client to pay the doctor for the test as well as for the abortion, if the foetus is female, and (iv) human settlement pattern, the road network and the connectivity of villages with big towns and cities.

     Let me reflect on the future for a while. Medical technology is getting increasingly sophisticated. This will further facilitate female foeticide. The number of doctors who can conduct these tests is increasing. The CCPNDT Act has put some brakes on doctors but my field work shows that doctors are cleverer than bureaucrats and legal experts. Nothing much is happening or likely to happen by way of prosecuting doctors for violation of the Act. The third factor concerns the capacity of the client to pay for the services which obviously is higher in urban areas than in rural areas. Therefore, one can argue that with increasing urbanization and high growth rates of GDP, things will only worsen, as far as female foeticide is concerned. The fourth factor is about connectivity. Here again, we may note that there will be a vast increase in the years to come in road transportation. Add to this, the mobile phone revolution in India which has made a quantum jump in connectivity. The future scenario, therefore, seems to me to be bleak.

     If my line of thought is accepted, it follows that there is every possibility that female foeticide will spread all over India. Whatever statistical evidence we have give indication that female foeticide is indeed spreading all over India and is not confined to Punjab or Haryana. Measures like the CCPNDT Act are welcome but cannot fight this menace. This calls for strategic thinking. I hope this national seminar will generate new ideas which are sound both at the conceptual and operational level. One

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    may recall what happened to the Child Marriage Restraint Act of 1929 with modification later. Has it really succeeded in curbing child marriages even after seven decades ? Let the PCPNDT Act not meet the same fate.

     Let me now turn briefly to the consequences of continuing female foeticide. My thesis is simple : Demographic terrorism reflected in female foeticide will end up in fullscale terrorism. Millions of young men without jobs and without wives may choose the path of violence and take to crime of all sorts, and in particular, crime against women. In short, female foeticide will fuel widespread terrorism. In this

    context, it is important to note that in the next few decades, India‟s age structure is such that the work force will increase rapidly adding more young persons looking for employment every year. It is unlikely that the entire addition to the youthful population in the working age group will get employment, in spite of higher growth rates of GDP.

     Let us think of possible intervention strategies to curb this perverse phenomenon. A word of caution is called for. In a country of India‟s enormous population size end incredible diversity, it would be hazardous to look for blanket solutions. We should start with collecting reliable data on the trend of sex ratio at birth at the village/town/city level. This will help the planners and administrator in devising appropriate strategies which are region specific and culture specific. Above all we must entrust the task of monitoring to competent organisations, preferably outside the government to study the trend and take appropriate action. Now that we have an effective decentralised system of governance at the local level through PRIs rdth(Panchayati Raj Institutions) and urban local bodies (as per the 73 and 74

    Amendments to the Constitution) we must take these organisations into confidence. But initially it would be difficult for the elected representatives to grasp the complexities of the task involved. The help of concerned NGOs must be sought in a big way. This seminar may deliberate on some of these intervention strategies and add to my list. Above all it is necessary to interact with people in a big way as statistical data alone may not give us a true picture. It is very important to conduct intelligent field surveys all over India. ISI could give a lead in this direction.

2001 Census and After

     Soon after the provisional results of the 2001 census were released, I did a quick analysis of the child sex ratio (0-6 years) and reported that the most dismal finding of this census was in regard to the sharp decline in the child sex ratio. Not many people are aware of the priority tables in the Census of 2001. In my view, census tables on child sex ratio were an unintended by product of the government’s concern for generating literacy tables on a priority basis. The

    calculation of literacy in the 2001 census excluded the age group 0-6 from the denominator; i.e. the rate was calculated for the age group 7+. Since all tables are required to give data separately by sex and also by rural-urban breakdown, in the very first Census paper of 2001, we have figures for child sex ratio (CSR) for the age group 0-6.

     Since the Census Commissioner, Mr. J. K. Banthia was conversant with Demography, he noticed the drop in CSR and presented districtwise data in Census

    Paper 1 of 2001 - Supplement: To quote him:

     “….the decline in child sex ratio is assuming an alarming proportion in certain districts of Punjab, Haryana, Himachal Pradesh and the decline in majority of the districts in other states and union territories across the country (Uttar Pradesh,

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    Madhya Pradesh, Chhatisgarh, Orissa, Karnataka, Assam, Delhi, etc) is rather intriguing. The social cultural bias against the girl child might have been possibly aggravated by recent medical support in terms of sex determination tests and requires further field investigation. Before arriving at any definite conclusion among other details we have to wait for single year age wise disaggregated population data for the 2001 Census”.

    This was no doubt a cautious approach of a bureaucrat. But even single year age data will not be enough for a proper analysis as CSR which is affected by mortality and migration. Analysis of CSR is not the best way to study female foeticide. It is more important to have trend data on the sex ratio at birth. Along with Dr. Mira Shiva, an eminent medical scientist, I did field work on female foeticide in three of the worst districts (with the lowest CSR) of Punjab, Haryana and Himachal Pradesh. This study was sponsored by one of India‟s leading NGOs, (Voluntary Health Association of

    India). The monograph was published in 2003, perhaps the first such study after the 2001 census results were published. ( Ashish Bose and Mira Shiva, „Darkness At

    Noon‟ ) It was dedicated to “all the unborn girls of Punjab, Haryana and Himachal

    Pradesh”.

    Following my earlier acronym BIMARU which covers the demographically sick

    states of Bihar, Madhya Pradesh, Rajasthan, Uttar Pradesh, I coined a new acronym DEMARU which stands for Daughter Eliminating Male Aspiring Rage for

    Ultrasound (in short, daughter killers).

    I will comment in some detail on my field work after I give a brief statistical background based on official data.

     Table 1 gives an idea of the unwanted daughters, state by state, based on the sex ratio at birth. It will be seen that the lowest rural sex ratio is in Punjab (781) while the urban sex ratio is even lower (757) in Haryana. It is a comforting thought to

    note that in West Bengal the rural sex ratio is the highest in India (957). It is even

    higher than in rural Kerala (913), demographically the most progressive state in India.

     In Table 2, we give data on Infant Mortality Rate (IMR) which is invariably higher in the case of girls: the highest being in rural Madhya Pradesh (84 per thousand live births) while the urban IMR for girls is highest in Orissa (61). We have also worked out the gap between female and male IMR in different states. The worst state in this regard is Haryana (gap of 21 points in rural areas). The urban gap is also highest in Haryana and Rajasthan (12 points). Here again, it is a comforting thought

    that there is no F-M gap in rural West Bengal (0 value) while in urban areas of

    West Bengal, the F-M gap is considerably high (7 points).

     In Table 3, we give an idea of the death rate of children below 5 years. Madhya Pradesh has the worst figure for rural areas (30.3 per thousand) while the worst figure for the urban areas is in Rajasthan (18.4). In Kerala the values are the lowest : 2.8 for females in rural areas and 1.4 in urban areas.

    Glimpses of field work

    One often gets an impression from seminars and conferences on gender issues that husbands and their parents are pushing their wives and daughters-in-law to go for pre-birth sex determination tests and abortions. Our field surveys in North-Western States (referred to earlier) and focus group discussions do not lend support to this proposition. We find that many women themselves are interested in knowing the sex

    of the unborn child and they do not see any moral problem in undergoing these tests conducted by doctors: it is like getting blood tests for malarial parasites. Secondly,

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most women have an inherent son complex. They know for certain that their status

    in the eyes of their family, extended family, community and the village as a whole

    will go up with the arrival of a son. Gifts will flow in, there will be celebrations and relatives from far and near will call on them. On the other hand, if they give birth to a daughter, there is general gloom, no celebrations, no gifts and the image of the woman suffers badly.

    As one of our senior health activists in Punjab, Shri Manmohan Sharma told us : “women are conditioned by social norms and they do not have independent views, they tend to ditto what the husbands say or think and this is considered as proper behaviour for ideal wives”. In such a situation, enforcement of the PCPNDT Act becomes very difficult. We came across cases of collusion between doctors and clients. The modus operandi is as follows: A doctor from a city or even a small town goes to villages with his mobile ultrasound machine and in case the sex determination test shows a female foetus, gives the client an address in the nearest city when abortions are conducted in secrecy. There were cases in Punjab when the Police arrested some women for undergoing sex determination tests while the doctors went scot-free. This led to an agitation by several health activists and ultimately the women were set free. In the villages we surveyed, there was a lot of apprehension about our study.

    Even though we conducted our survey with great tact, it was clear to us that women respondents were not telling the truth when they said that they were not aware of female foeticide. At a well-attended meeting for focus group discussion in a village in Punjab, the district-level authorities pleaded helplessness with regard to enforcement of the PCPNDT Act. It was argued that doctors do not have any idea about the legal provisions of the Act and the Judicial Officer of the district who has to interpret and implement the Act is frequently transferred. Thus, there is no continuity in following up cases and, as a result, nothing gets done.

Networking of government doctors, private doctors, ANMs and dais

    During our fieldwork, we could sense a silent conspiracy between the government doctors, medical and paramedical staff and private doctors with regard to the illegal practice of sex determination tests leading to female foeticide. The dais and ANMs often act as go-between and collect their honorarium (roughly Rs. 200 per case). We also suspect that medical representatives are a party to the game of making quick money. One does not have to go to only big cities such as Chandigarh, Ludhiana or Shimla to undergo these tests and abortions. Within an ambit of 20-30 km one comes across clinics that undertake such work and have mushroomed under various cover names. The fact that an ultrasound machine is registered as required by law does not guarantee that it is not misused. A tragic aspect of this is that very often doctors

    show utter disregard for medical ethics. They know very well that through ultrasonography it is not possible to determine the sex of a foetus within 12 weeks of conception and yet they conduct these tests and indicate the results (invariably „it is a

    girl‟). The doctors know that it is just speculation and not scientific observation. In fact, we have come across reports of cases when after abortion it was found that the foetus was male, much to the agony of the parents.

    One could draw a distinction between a woman agreeing on the suggestion of her husband or in-laws to undergo a test and a woman who, having undergone the test and finding that it was a female foetus, agrees to go in for abortion. Generally, this test is conducted only during the second and subsequent conceptions. But in Punjab, we

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were told about the recent tendency to go in for these tests even for the first

    conception. There were also cases of murder within the family when the young daughter-in-law refused to go for abortion after the very first conception. According to Dr. Betty Cowen, who spent many years at the Christian Medical College (CMC), Ludhiana, „there was a time in Punjab when the first daughter was welcome, the second was tolerated and the third was eliminated‟. We are now facing the tragic

    prospect of the first daughter being eliminated, what to say of the second and third. Demographers have worked out the sex ratio by order of birth and it is observed that the higher the order of birth, the lower is the sex ratio. Our field data also confirm this. There is no doubt that if this trend persists for another two decades, States such as Punjab and Haryana will face disastrous social consequences.

Mixing up family planning with female foeticide

    As a result of 50 years of propaganda on the merits of a small family, there is today general awareness of family planning and the need for adopting a small family norm. Our fieldwork reveals that men and women in Punjab, Haryana and Himachal Pradesh do accept the idea of a two-child family but they are also aware of the technology of pre-birth sex determination tests. As in most parts of India, two sons constitute the cut-off point for accepting sterilisation. The people seem to be quite puzzled that while the government wants a small family norm to be practised and yet opposes the conduct of these tests and subsequent abortions. They argue that since every family

    wants at least one son, if not two, the best way to ensure a small family is to go for the test and act according to the results. A well-meaning and prominent doctor, having a

    flourishing private practice in Himachal Pradesh, told us that the government hospitals should allow pre-birth determination tests only in cases where the first child is a daughter. His argument was that in case the second child is a son, the family will be satisfied and will opt for sterilisation. This will help in stabilising the population. The doctor argued that the merit of this formula was that it would reduce quackery and maternal mortality, and would also achieve the national goal of population stabilisation. This doctor had a large private practice and was not at all keen to take up abortion cases, let alone conduct sex determination tests. In fact, he narrated how he was pressurised to conduct this test and abortions by several VVIPs, whose names he would not divulge. In the eyes of the people, there is a dichotomy between the

    government’s sustained advocacy of family planning and small family norm, with legislation prohibiting the conduct of sex determination tests and sex-selective abortions. This mix-up is the creation of circumstances and neither the government nor the people can be blamed. If an enlightened doctor, who commands great respect and is not a greedy person, genuinely believes that the government should allow such cases and abortions to be conducted on demographic grounds, his views deserve serious consideration. One must pause and think how best to counter such an argument. Under the PCPNDT Act, very often the appropriate authority is the Chief Medical Officer and it is very unlikely that a doctor will prosecute a fellow doctor. One must note the solidarity of doctors in remote areas where social life is confined in playing cards and drinking. Besides, it is often pointed out that since a person has to spend so much money in private medical institutions to get trained as a doctor, he is unlikely to forgo efforts to make quick money: sex determination tests and abortions provide perhaps the best opportunity to make such money. According to

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    rough estimates of people who are knowledgeable, in many places 90% of the income of several doctors (mostly those in small towns) comes from these tests and abortions. It was clear to us that the legal machinery in the districts was not equal to the task of effectively implementing the PCPNDT Act, while higher-level officials are busy with other pressing administrative problems.

Causes and consequences of female foeticide

    We also tried to ascertain the causes of female foeticide through our surveys. The general perception is that the cost of marriage and dowry has gone up and so daughters have become greater financial liabilities. The dowry system is invariably blamed. We are not convinced that dowry alone is the main cause of female foeticide. Families that are well-off and who do not have to depend on dowry to augment their income are also opting for female foeticide. The real reason seems to be the high

    status of families with several sons and the low status of families with no sons (at

    least in the states we surveyed). Another interesting factor for the preference for

    sons is that the prospect of migration of sons to, say the Gulf countries or western countries, is much higher for men than for women (except in special cases such as Kerala from where nurses who go all over the world). In the eyes of the local community, a family with children abroad has a higher status and certainly a higher income level than non-migrant families. Globalisation is thus adding to the miseries

    of the girl child.

    In short, there are numerous causes for the spread of female foeticide and it is not dowry alone which is responsible for this social malaise. Nevertheless, our perception surveys did reveal that people are aware of the upward swing in dowry demand and the rising cost of marriage. Greed has increased in our society and numerous TV channels and endless advertisements promoting mindless consumerism increase this greed further and motivate them to make quick money.

    Female foeticide will lead to increasing crime against women. It would be manifestly wrong if we conclude that female foeticide is a matter of medical technology alone. There is no doubt that easy access to ultrasonography has been largely responsible for the spread of female foeticide throughout the country. According to Dr. Mira Shiva, many women opt for female foeticide not because they are heartless but because they were genuinely concerned about the fate of their daughters who are being increasingly subjected to eve-teasing, molestation and sexual harassment and, after marriage, exposed to the risk of bride burning and dowry death, with the unending demand for dowry from our emerging consumerist society. This calls for a good look at gender issues in all their ramifications in our increasingly dysfunctional society. Female foeticide is a sign of our civilisational collapse.

     Reference Tables

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    Table 1 : Sex Ratio (females per 1000 males)

    at Birth, 2000-2002

    India/States Rural Urban Total (1) (2) (3) (4) INDIA 898 868 892 Punjab 781 757 775 Haryana 817 745 804 Himachal Pradesh 826 826 826 Uttar Pradesh 862 875 864 Gujarat 866 788 844 Rajasthan 886 917 890 Bihar 870 863 870 Maharashtra 904 891 899 Kerala 913 904 911 Madhya Pradesh 933 849 920 Andhra Pradesh 939 967 945 Tamil Nadu 946 883 926 Assam 947 913 945 Orissa 950 889 944 Karnataka 950 957 952 West Bengal 957 915 949 Note: The states are arranged in order of the rural Sex ratio at

     Birth (Column 2)

    Source: Registrar General, India, Sample Registration System,

     Statistical Report, 2002, New Delhi, 2004, p.31.

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