Female feticide

Perspective on female foeticideFemale feticide is widely, almost universally extrapolated for femalefetal loss in India. This is apparently based on presumptions that(A) the primary sex ratio (ratio at conception) will be equal unlessdistorted by medical intervention; (B) the secondary sex ratio (sexratio at live birth) is bound to be equal unless fetuses of aparticular sex are willfully eliminated and prevented from beingborn, and (C) the gender ratio in 0-6 yr. age group is just acontinuation of the (permitted) secondary sex ratio at birth.The other prevalent presumptions and misconceptions in this contextare:(a) that since amniocentesis and chorion villus biopsy methodologieswhen they came to the country, were used almost exclusively for fetalsex determination in 80 to 90 % of cases, sonography that replacedthose methodologies, isused for antenatal examination for the same purpose to the sameextent;(b) that the earlier used histochemical methodologies and thepresently used physical sonography are similar and equallyefficacious methodology for fetal sex determination;(c) that every woman who opts for MTP after having undergonesonography is for a female fetus; and(d) that sonography can reveal the sex of a fetus at any stage ofpregnancy.Extrapolation of these perceptions to explain the emotive issue ofgender disparity in population has completely distorted theinvestigation of the problem. Female fetal loss, as evidenced by sexratio at live birth in the country, is much more than is reflected inthe sex ratio in 0-6 age group and certainly much higher than can beaccounted for by sex-determined female feticides.Female fetal loss, as revealed by the sex ratio at birth, is 100 toover 200 less number of females born per 1000 males. It is too highto be accounted for by sex selective termination of femalepregnancies alone. It has been present and prevalent in the countrymuch before the sex determination techniques came to the country.Even today the female sex ratio at birth is much lower in rural areasthan in urban areas where modern technologies are widely available.The trend analysis of sex ratio at birth in rural and urban areas donot correlate with the increasing availability of sonography. Over75% of estimated four million abortions being done in the countrytoday are in the first trimester of pregnancy i.e. in the periodwhence no sex determination is possible by sonography.The inferences and conclusions of the study reported are same asreported in the oft quoted earlier studies. However, the grosslyexaggerated and far reaching inferences are not substantiated inthese studies. For instance take the study titled " The SocialContext of Sex Selection and the Politics of Abortion in India" byRadhika Balkrishnan in "Power and Decision. The Social Control ofReproduction" (Cambridge:Harvard School of Public Health, 1994 p.267) states:In one hospital, from June 1976 to June 1977, 700 individualssought prenatal sex determination. Of these fetuses, 250 weredetermined to be male and 450 were female. While all of the malefetuses were kept to term, 430 of 450 female fetuses were aborted.(Miller 1985).A primary sex ratio of 250 males:450 females is impossible tobelieve on scientific probabilities. The normal accepted primary sexratio is 100 females:105 males. The above quoted very low primary sexratio for males has not been reported even in the studies wherechemical disaster exposing the whole population to the effect thatlead to low male primary sex ratio.The article quotes no other figures or studies, is solelyopinion/conjecture based and blames amniocentesis for `sexselection'." In order to convey the complex nature of the crises of sexselection I will describe an incident from a recent visit to India."The anecdote narrated is a talk with an NGO representative.Another study titled " Female Feticide in Rural Haryana" by Sabu MGeorge and Ranbir S Kahiya (Economy and Political Weekly August 8,1998 pp. 2191-2198) state:" Female feticide over the last 15 years has distorted sexratios at birth in several Asian countries. Fetal sex determinationclinics have been established in India over the last 20 years innorthern and western cities. Presented here is the outcome of anintensive study of the abuse of prenatal diagnostic techniques forsex selection in rural population of 13,000 in Rohtaka district .Parents tend to be calculative in choosing the sex of the next childand the decision is based on the birth order, sex sequence ofprevious children and number of sons. Transfer for reproductivetechnology to India is resulting in reinforcement of patriarchalvalues as professional medical organizations seem to be indifferentto ethical misconduct."However, the basis of the aforesaid conclusions/ inferences is " Thepregnancy outcome reported by the women were 2,642 live borns, 48still births and 272 abortions (243 spontaneous and 29 induced)".The aforesaid in a period of FIVE years." To reduce recall errors, weconfined interviews to women who experienced a pregnancy outcome inthe last five years rather than to all village women. There were1,022 eligible women. The criterion of using pregnancy outcome in thelast five years included almost all outcomes in the study villages inthe recent past, as the average interval between successive births inHaryana is 28 months.".Even if it is presumed that all 29 induced abortions (MTPs) in 5years amongst the 1,022 study eligible women of a total ruralpopulation of 13,000 were for female fetuses, the conclusions aboutthe female feticide would be grossly exaggerated.Yet another report:"India's preference for boys tips sex ratio":September 17, 1995. Web posted at: 12:36 a.m. EDT (0436 GMT) Fromcorrespondent Gayle Young NEW DELHI, India (CNN) and quoted by FamilyPlanning Association of India in its documents, state:" India officially banned gender testing last year, but the practiceis still common. A recent government study showed that of 8,000abortions performed in one Bombay Hospital, only one was of a malefetus. Neighborhood sonogram clinics crowd every city, and doctorstake the machines on tours of countryside."Something scientifically unbelievable. How does the hospital do it ?It seems the hospital was undertaking only female abortions (MTPs?)after pre-natal sex determination. Let alone sonography, evenamniocentesis and chorion villus biopsy methods do not enjoy such ahigh accuracy (1 in 8000). Even direct visualization of fetalgenitalia by fetoscopy will not give such high accurate resultsbetween 15 to 20 weeks of pregnancy whence the size of the fetalgenitalia is not more than the size of a rice or wheat grain.External genitalia develop after 15 wks and MTP is permitted upto 20wks. How did the hospital document the sex of the child ? How andwhere do they record it in the MTP register ? If it is recorded anddone for the female sex of the fetus it is a criminal offence ofhomicide as MTP can not be done for this purpose under the MTP Act.(It can be done for contraceptive failure and not for a willinglyconceived child).Lastly the study "Will bill to ban sex test control medicalmercenaries" By Usha Rai. It concludes:"Between 1986-87 about 50,000female fetuses were aborted after sex test" based on the followingevidence:"Fifteen years ago when the alarm was first sounded about theprenatal testing, the amniotic fluid was being extracted from thepregnant woman's womb and the chromosome pattern tested to determinethe sex of the child. But now 95 per cent of the sex determinationtests (SDTs) are by ultrasound equipment which innumerable othermedical uses and has mushroomed to small towns and even villages.""According to evidence given to the select committee, between 1978and 1982 78(XX) female fetuses were aborted after sex determinationand between 1986-87 30,(XX) to 50,(XX) were aborted.""Between 1982 to 1987 the number of clinics for sex determinationincreased from 10 to 248 in Bombay city alone.""In 1986 government sponsored study in Bombay revealed that 84percent of the samples of doctors are performing amniocentesis forsex determination alone.Each of the doctors was doing on average 270 tests per month."The above conclusion is based on presumptions/conjectures:1. that since 95% of amniocentesis examinations were done forprenatal sex determination, therefore, ultrasound facilities thatlater replaced it did the same to the same extent.2. that all ultrasound examinations in pregnant women are done forprenatal sex determination.3. that all post-ultrasound MTPs are for female feticide.The exaggerated inferences about sex selected femaleabortions and its projection as an exclusive cause of excessivefemale fetal loss totally distorts the issue of gender disparity inthe population. Additional and larger causes of female fetal lossmust be looked into and addressed.Thanking youYours sincerelyDr.S.G.Kabra15, Vijaya Nagar,D-Block, Malviya Nagar, Jaipur-302017EMAIL kabrasg@...Phone :91 0141 2721246