PREFACE

This handbook of guidelines discusses the issue of pre-birth elimination of females in India. The ever-growing incidence of female foeticide has led to a drastic decrease in the number of girls to boys in India in the 0-6 age group.

The handbook besides being a vehicle for policy/advocacy can be used as an important Educational tool on the issue for health personnel as well as policy makers, researchers and development workers.

The campaign has consciously used the terminology pre birth elimination of females as we found that using the word foeticide led to confusion with the issue of the right to life raised by the anti-abortion lobbies. We would like to clarify that this campaign is not against abortion. The right to abortion must remain as an essential right of women, a right

 
to determine their life, their life, their body and fertility. Our campaign is against sex determination and sex selection, which results in extreme forms of discrimination against women, as girls are not even allowed to be born. Secondly the terminology pre-birth elimination of females also covers the practice of sperm selection through emerging medical technology, an htmlect which is broader than the issue of female foeticide.

We would like to specifically acknowledge the contribution of Neelam Singh, a journalist with down to earth who volunteered to compile and edit this handbook of guidelines. The members of CAPF Rohini, Fakhra Siddiqui, Diksha Gupta and Rachita Rathi put in much labour of love in planning organizing and facilitating the printing of this handbook of guidelines.

This handbook would not have seen the light of the day had it not been for the guidance support and advice of Mr. Narayan Banerjee Director of center for women’s Development Studies (CWDS). The others we would like to thanks for their helpful contribution are Dr Sabu George, Dr. Shalu Nigam and Dr. Preeti Rastogi of CWDS.

We would like to acknowledge the support of Ms Suman Parasher of the Office of Registrar General and Census Commissioner of India, Geeta Malohtra of Population foundation of India (PFI), Rajesh of Indo German Service Society, Dr. Nalini Abroaham of plan India for their invaluable support.

We hope this handbook of guidelines will be a precursor to a vibrant nation-wide campaign against PBEF and all other forms of gender discrimination. With the publishing of this Handbook of guidelines we would also like to announce the revised name of our campaign i.e. CAPF. (Campaign against pre-birth Elimination of females)

NIPPED IN THE BUD…

…when girls go missing in society

…when a child is denied the right to life only because she is a girl

…when discrimination starts when a girl is in the womb and continues till the grave

…when a girl’s right to bloom and blossom is nipped in the bud

Can you sit back and ignore it_

This booklet is an attempt by the Campaign Against Pre Birth Elimination of Females (CAPF) to discuss the issue of pre-birth elimination of females, its causes and implications and the urgent need to protect the rights of the girl child and women


Let Us
JOIN HANDS AND PLEDGE
TO
END PRE-BIRTH ELIMINATION
OF FEMALES
AND
ALL FORMS OF GENDER
DISCRIMINATION

for a world which is not safe for women is not SAFE


1. What is pre-birth elimination of females (PBEF)_

The term refers to a practice of selective elimination of the female foetus after prenatal sex determination or se pre-selection, thus avoiding the birth of a girl child. It is commonly referred to as female foeticide.

2. If you practice pre-birth elimination of females, you deny the right of

  • the female child to be born
  • the women bearing the foetus to take a decision about her health and family
  • the woman to a satisfying and healthy sex life
  • the woman to decide about pregnancy – if, when and how often
  • the woman to have t access to safe, effective, affordable and acceptable methods of family planning
  • the woman to a safe pregnancy, child birth, and a healthy infant

3. What does the phrase ‘missing girls’ mean_

The child sex ratio is calculated as number of girls per 1000 boys in the 0-6 year age group. The 2001 census reported a child sex ratio of 927 girls per 1000 boys. Therefore, there are 73 ’missing girls’ for every 1000 boys in our country, and soon it may become very difficult to make up for them. The practice of eliminating female fetuses is believed to be one of the main reasons for the adverse child sex ratio. Millions of female fetuses were, and are still being, terminated creating a serious imbalance in child sex ratio in the country. PBEF seems to be more prevalent in urban areas than in the rural areas, but the gap is fast decreasing because of the easy availability of sex-determination tests in rural areas.

Some more revealing statistics –

  • A large number of well off states like Gujarat, Punjab, Himachal Pradesh, Delhi and Haryana have recorded a decline of 50 or more points in the ratio since 1991

  • The ratio has declined to less than 900 girls per 1000 boys in states like Delhi, Gujarat, Haryana, Punjab and Himachal Pradesh

  • Some of the most prosperous regions have one of the lowest ratios like the south west district of Delhi – 845 and Ahmedabad in Gujarat – 814. The worst performing districts include Fatehgarh Sahib in Punjab – 754, Kurukshetra in Haryana – 770 and Mahesana in Gujarat – 798

(Source: Missing…, United Nations Population Found, Office of the Registrar General and census commissioner, India, and Ministry of Health and Family Welfare, June 2003)

4. Why is imbalance in the child sex ratio worrying_

A declining sex ratio has various socio-economic and health implications. A woman’s health suffers as she is forced to undergo multiple pregnancies and abortions. Decreasing number of females in the society can increase sex related crimes and violence against women. Imbalance is likely to cause a rise in social problems like dowry deaths, forced polyandry, rape, child marriages, bride-selling and kidnapping of women for marriage. For example, a recent newspaper article says that in Hathin (Haryana), two decades of female foeticide have caught up with the people. Men are resorting to the tactic of buying brides from other states like Assam and West Bengal. The price put on such a girl is much less than what people pay for cattle! After marriage, they are condemned to a life of slavery.
(Hindustan Times, July 12, 2003, New Delhi).

 

5. What are the different factors linked to the prevalence of PBEF_

Socio-cultural

  • Preference for a son by family and society (as he carries forward the name of the family, is considered a source of support during old age and performs last rites at the time of cremation)

  • Social and familial pressure on women to produce sons

  • Lower status of women in the society

  • Inheritance system where a girl child has no right to her father’s property

  • Social evil of dowry

Economic

  • Child rearing cost vis-à-vis benefits that may accrue when the child becomes an adult
  • Cost related to marriage, especially in form of dowry
  • Most women lack financial independence

Political

  • The issue does not attract attention of political parties
  • Weak enforcement of existing policies and laws aimed at curbing the practice
  • Little political interest in bringing innovative policies to deal with the problem

6. When did various sex-determination techniques came to India_

Technology for foetal sex determination came to India in the mind-70s in the form of Amniocentesis. Other sex selection techniques – both pre and post-conception - became available in the country as medical science advanced in later years. A study reveals that out of 15 million abortions carried out in the world in 1997, India alone accounted for 4 million, 90 per cent of which were intended to eliminate the girl child (Law Against Practice of female Foeticide and Infanticide, Shalu Nigam, Indian Social Institute).

7. What are the common methods of sex determination – before birth as well as before conception_

  • Amniocentesis (Amnion: membrane, Kentesis: pricking) - in this technique, amniotic fluid is drawn from the amniotic sac surrounding the foetus in the uterus through a long needle inserted into the abdomeM. Foetal cells present in the fluid help in determining the sex of the foetus. It is normally performed after 15-17 weeks of pregnancy.
  • Chorionic villi biopsy – this refers to the removal of elongated cells (called villi) of the Chorion, which is the tissue surrounding the foetus, through the cervix. The tissue cells are tested to determine sex of the foetus. This technique enables sex determination between the first 6-13 weeks of pregnancy and abortion can be carried out in the first trimester itself.
  • Ultra-sonography/ultrasonic – here inaudible (to humans) sound waves are used to get a visual image of the foetus on a screen. Normally, it is used to determine the foetal position or abnormalities, but it can also be used to find the sex if external genitalia ofa male foetus in seen on the screen. It is normally performed around the 10th week of pregnancy. It is the most commonly and rampantly used method for sex determination.

 

  • Pre-conception techniques to select sex –
    • Ericsson method (X and Y chromosome separation) – A male child requires an XY combination of chromosomes. Sperms may have either X or Y chromosome, but eggs have only X chromosome. In this method, sperms are separated into – those bearing X chromosome and those bearing Y chromosome – by filtration when put in a chemical solution’s denser bottom layers. The egg is then fertilized with a high concentration of Y sperms to produce a male.

    • Pre-implantation genetic diagnosis – one of the latest technologies to be used for sex selection, it involves chromosomal analysis of a few cells taken from a test tube embryo (fertilization is done outside the uterus) to determine the sex.

‘Pay Rs 500 now and save Rs 5,00,000 later’ is how these technologies are advertised!

8. Do sex-determination techniques cause any harmful effects_

There are several ill effects of these techniques, for instance, amniocentesis can lead to abortion or premature birth. The use of a needle while performing amniocentesis can lead to spreading of infection. In some cases, the foetus may suffer hemorrhage, bleeding or breathing problems. The needle can pierce the foetus causing death or permanent disability.

Though considered less painful than amniocentesis, chorionic villi biopsy is not free from risks either. It can also lead to abortion, spreading of infection, limb defects and in some cases the limb may even come out. There can be bleeding when the sample is taken leading to mental and physical defects in the baby.

The pregnant woman’s health may be affected and, in some instances her life may be threatened, due to complications during abortion like septic, gangrene and tetanus, hemorrhage due to incomplete abortion or injury to internal organs, poisoning from abortifacients (drugs used to induce abortion) resulting in kidney failure and tubal infections that may lead to infertility.

Other physical risks include excessive bleeding, ripping or perforation of uterus, anesthesia complications, convulsions, cervical injury, enhanced risk of miscarriages in future and long-term health complication.

 

Associated mental trauma, crying, nightmares, flashbacks to abortion, hysterical outbreaks, nervous breakdown, depression, loss of self esteem, self destructive behavior, sexual dysfunction, sleep disturbance and a feeling of guilt or punishment from god may become a daily reality for the woman.

Risks are increased manifold because foetus is terminated not necessarily in hospitals under proper care and supervision, but in private nursing homes, mobile ultrasound vans and also at homes. The methods used in such situations are often very crude.

9. What has been the response of the civil society and the state to such technologies_

The drive against female foeticide and sex-determination techniques gained strength in 1980s. The 1976 partial ban on sex-determination tests in government hospitals had only led to the proliferation of private clinics/hospitals offering the facility. The ban was imposed because amniocentesis’ advent in 1975 caused a dramatic increase in female foeticide cases. Since then, different parts of the country have witnessed several campaigns against the misuse of science and technology to continue discrimination against women. In 1982 the Center for Women’s Development Studies (CWDS) launched the first campaign. It was initiated by Dr. Veena Mazumdar and Dr. Lotika Sarkar in Delhi as a protest against an advertisement for Bhandari antenatal sex determination clinic, Amritsar, Punjab. The clinic was openly advertising its services through press, in railway compartments and other public places. The advertisement referred to daughters as ‘liabilities’ to the family and a threat to the nation, and exhorted expectant parents to avail the services of the clinics to rid themselves of this ‘danger’.

More campaigns like the Forum Against sex determination and sex pre-selection (FASDSP) in 1985 in Maharashtra and the Campaign Against Sex Selective Abortion (CASSA), Tamil Nadu came up. FASDSP lobbied to regulate the practice of sex determination in Maharashtra by formulating a separate legislation, instead of modifying the Medical Termination of Pregnancy (MTP) Act,1971, that had the danger of curtailing women’s right to abort. As a result, the Maharashtra Regulation of use of Prenatal Diagnostic Techniques Act, 1988, came into being.

Serious drawbacks in the state legislation and poor implementation caused the awakening of interest in the issue across the entire country. A move for an all-India ban on sex determination tests gained momentum, and the Pre Natal Diagnostic Tests (Regulation and Prohibition of misuse of misuse) Act, 1994 (called the PNDT Act) came into existence. Though the PNDT Act entered into force in January 1996, no evidence of decline in the practice of female foeticide came forth even after four years. Lack of concern and political will to implement the legislation by the center and state let to a public interest Litigation (PIL) in the supreme activist, Mahila Sarvangeen Utkarsh Mandal (MASUM), Pune, and Center for the Enquiry of Health and Allied Themes (CEHAT), Mumbai in February 2000. In May 2001, the SC directed the Center to implement the PNDT Act in all its htmlects and called upon all state governments to take necessary steps to implement the Act. However, a further dip in 2001 sex suggests that a lot more needs to be done in this regard.

In the light of new techniques available to determine sex before conception, it was felt necessary to amend the act from February 14, 2003, the Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Amendment Act, 2002 came into force. The PNDT Act 1994 was renamed as ‘the Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994.

10. Is abortion legal in India_

Yes, given certain terms and conditions as laid down under the MTP Act, 1971, are fulfilled. The Act provides for termination within 12 weeks of the pregnancy –

  • If continuing the pregnancy would involve a risk to the life of the pregnant woman or would be of grave injury to her physical or mental health, or

  • If there is a substantial risk that the child to be born would suffer from seriously handicapping physical or mental abnormalities

  • Pregnancy as a result of rape can be validly terminated

  • Failure of family planning methods could also be a ground to terminate pregnancy
Beyond 12 weeks, abortion can be done only on the written advice of at least two registered medical practitioners. Also this can be done only up to the end of the 20th week.

11. What are the main provisions under the amended and renamed PNDT Act to deal with PBEF issue_

The salient features of the PNDT Act 2002 are-

  • It prohibits sex-selection, both before or after conception

  • It regulates the use of pre-natal diagnostic techniques, like ultrasonund and amniocentesis by allowing their use only to detect
    • Genetic abnormalities

    • Metabolic disorders

    • Chromosomal abnormalities

    • Certain congenital malformations

    • haemoglobinopathies

    • sex-linked disorders
  • no laboratory or center or clinic will conduct any test including ultra-sonography for the purpose of determining the sex of the foetus
  • no person, including the one conducting pre-natal diagnostic procedure as per the law, will communicate the sex of the foetus to the pregnant woman concerned or her relatives by words, signs or any other method
  • any person who puts out an advertisement for pre-natal and pre-conception sex determination facilities in the form of a notice, circular, label, wrapper or any other document, or advertises through internet or other media in electronic or print form, or engages in any visible representation made by means of hoarding, wall-painting, signal, light, sound, smoke or gas, can be imprisoned for up to three years and fined Rs. 10,000

  • any medical geneticist, gynecologist, registered medical practitioner or any person who owns an genetic counseling center, a Genetic Laboratory or a Genetic Clinic where the test is conducted can be imprisoned for up to three years and be required to pay a fine of Rs 10,000. For any subsequent offence, the fine can go up to Rs 50,000 and imprisonment to five years.

  • the person who seeks the aid of a genetic or ultrasound clinic or medical geneticist for sex selection can face imprisonment for a three year period and be required to pay a fine of Rs 50,000. For any subsequent offence, the fine can go up to Rs 1,00,000 and imprisonment up to five years. However, the woman who was compelled to undergo such selection will not be fined or imprisoned. Additionally, the court will presume, unless otherwise proved, that the woman was compelled by her husband or relatives to undergo pre-natal diagnostic techniques
    • no pre-natal diagnostic technique can be conducted unless the person qualified to do so is satisfied that any of the following conditions are fulfilled -

    • age of the pregnant woman is above 35 years

    • the pregnant woman has undergone two or more spontaneous abortions or foetal loss

    • the pregnant woman had been exposed to potentially teratogenic (causing physical defect to foetus) agents such as drugs, radiation infection or chemicals

    • the pregnant woman or her spouse has a family history of mental retardation or physical deformities such as spasticity or any other genetic diseas
  • a pre-natal diagnostic technique cannot be conducted unless the person conducting the test –
    • has explained all known side and after effects of such procedures to the pregnant woman

    • has obtained the pregnant woman’s written consent to undergo such procedure in the language she understands, and

    • has given a copy of the written consent so obtained to the pregnant woman

  • ultrasound machines, including mobile ones, have to be registered and records of all pre-natal diagnostic tests conducted to be maintained

  • the central and state supervisory board will have representatives of woman welfare organizations, social scientists as well as medical experts

  • the Appropriate Authority (constituted by the state or central government) will have a women’s organization representative. The authority will possess powers to summon any person in possession of any information relating to violation of the act. It can also issue search warrant for any place suspected to be indulging in sex selection techniques

12. Who is the appropriate Authority and where is it situated in Delhi_

Appropriate Authority is appointed by the central Government under the PNDT Act to perform the following functions –

  • grant, suspend or cancel registration of the Genetic counseling centre,Genetic Laboratory or Genetic clinic

  • enforce standards prescribed for the Genetic counseling center, Genetic Laboratory or genetic clinic

  • Investigate complaints of breach of the rules and provisions of the Act, and take immediate action

  • Seek and consider the advice of the rules and provisions of the Act, and take immediate action

  • Seek and consider the advice of the Advisory Committee on registration application and on complaints for suspension or cancellation of registration

Appropriate Authority offices in Delhi where you can also lodge a complaint –

Entire Delhi Sate  

Central District

 

Note– In most other states, the Chief Medical officer acts as the appropriate authority.

An appropriate authority’s campaign in Haryana

A four month pregnant Amarjit Kaur was admitted to Madan Ultrasound and Test-tube Baby center at Ambala, Haryana, for an abortion that cost Rs12000. She died during the procedure. When the Director General of Health Services – Baljit Singh Dahiya got the news, he immediately swung into action and got violation of the PNDT Act added in the FIR against the doctor couple.

He has also earned praise for the most pro-active drive for the anti-female foeticide crusade. Since August 2001, when he registered three criminal cases under the PNDT Act - the first in the country - he has become a local hero.

13. The government has enacted the law. What is your responsibility now_

  • follow the law and keep yourself informed through newspapers, legal sources and organizations working on the issue

  • if you know any person who is violating the law, inform the legal authority (known as the Appropriate Authority) in your local area

14. What is CAFF_ Please tell about its work and activities_

The Campaign against Female Foeticide (CAFF) was initiated by Dr. Sabu George with Ms. Bijayalaxmi Nanda, Senior Lecturer in Political Science, Miranda House College, in Delhi in July 2002, with support from the Center for Women’s Development Studies (CWDS). A group of academicians, professionals and volunteers dedicated to the cause of protecting the rights of the girl child and women form CAFF. The campaign seeks to create a movement involving students and teachers to increase awareness about PBEF. It strives to makes our society a more secure place to live for the girl child by fighting against one of the most horrible forms of gender-discrimination. The CAFF is now to be known as CAPF.

CAPF’s main tasks are:

  • Networking with like-minded individuals, organizations and institutions
  • Generating awareness, sensitizing and mobilizing students and teachers on the issue of PBEF
  • Lobbying with all stakeholders, including policy makers, to bring about change
  • Advocacy through films, concept papers and discussions
  • To establish a resource center on the subject of PBEF which will also be available to other institutions

To achieve these tasks, CAPF organizes volunteer training programs for students, orientation programs and workshops for students and teachers, poster and painting competitions, exhibitions and choreography events on the theme of PBEF, film screenings, and seminars, debates and street plays on the issue.

15. Which organizations in Delhi are working in this field_

Some of the organizations actively working on this issue are CWDS (Center for Women’s Development Studies), Deepalaya, Human Rights Law Network, population Foundation of India, Christian Medical Association of India, Action Aid, Jagori, Action India, PLAN India etc.

16. Your contribution to the campaign as …

  • a student
    • Join us as a volunteer and contribute to its various activities
  • a citizen
    • Help in disseminating information on the issue of PBEF

    • Please participate in different activities that the campaign organizes from time to time

    • Report cases of PBEF to the appropriate authority in your local area
  • a teacher
    • You can become a member of the campaign and provide valuable information to students about the issue. Encourage them to join us as volunteers

    • Your ideas can help us work better in future. We would like you to attend our teacher training workshops and seminars
  • a mother
    • The safety of your child is a matter of supreme concern to you. You can make an invaluable contribution by not differentiating between a son and a daughter

    • If you are under any pressure from your family to ‘give’ them a son, we request you to resist it, and if necessary, report to the concerned legal authority or to us

    • Encourage gender equality at home

    • Do not seek medical intervention to conceive a boy child
  • a father
    • You can help by not putting pressure on your wife for a son

    • Support your wife if the family and relatives are pressurizing her to undergo foetal sex-determination

    • Do not force her to determine the sex of the foetus and undergo abortion if it is a female child, or coerce her into going in for pre-conception sex selection

    • The decision to have a child (not a son or a daughter) should be taken together keeping in mind your wife’s health

    • You can make a big difference by not differentiating between a son and a daughter

    • do not seek medical intervention to conceive a boy child
  • a family member/relative
    • Do not put pressure on women in the family to undergo pre-natal sex-determination or pre-conception sex determination

    • Please support her if other people in the family are insisting on sex-determination

    • Be an advocate of gender equality in your family
  • A medical professional
    • It is your responsibility to give correct information to your clients, and assist them in making the right decision. You can help the campaign immensely by
      NOT carrying out sex determination tests

      NOT revealing the sex of the foetus to parents or family

      NOT performing abortions beyond the permitted time limits under the law

      NOT providing assistance in pre-conception sex selection

      Reporting any such instances or doctors practicing any of the above to the concerned legal authority

    • Help us by realizing the important role physicians can play in improving the sex ratio in the country

  • a media person
    • Do not publish advertisements offering sex determination facilities. Instead, make a positive contribution by publishing articles in your magazine or newspaper to generate awareness about the heinous practice of PBEF the law prohibiting it and difficulties in the implementation of the law. Support the cause of the girl child through your writing, photographs films, documentaries or any other medium

Female foeticide is happening in your neighbourhood…..

A CAFF volunteer told us about a woman in her neighbourhood who had undergone 3-4 abortions. The abortions were force upon her because the sex determination revealed the sex of the foetus to be female. Everybody in the neighborhood knew about her trauma, but nobody came to her help.

…but you can make a big difference

Another young CAPF volunteer was faced with a similar problem in her family. Her elder sister had a baby girl and she was expecting again. The in-laws as well as her own parents were pressuring her to undergo a sex determination test.

Our active campaigner intervened- she cajoled pleaded and even threatened the family members by telling them that sex determination is a crime. After a lot of discussion and debate, she was able to convince her sister and other family members to not to find out the sex of the foetus.

The elder sister gave birth to a baby girl after a few months. The child was welcomed by frowns, grudges and criticism by the family members. The campaigner however stood her ground and gave moral support to her sister. She also discussed the matter with her brother-in-law. Now the elder sister has a happy family, and she attributes it to our campaigner’s sincere and persistent efforts. The two daughters are adored by everyone. The grandparents are happy.

The Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994

“An Act provide for the prohibition of sex selection, before or after conception, and for regulation of regulation of pre-natal diagnostic techniques for the purpose of detecting abnormalities or metabolic disorder or chromosomal abnormalities or certain congenital malformation or sex-linked disorders and for the prevention of their misuse for sex determination leading to female foeticide and for matters connected therewith or incidental thereto”.

The Salient Features of the Act are:

  • Sex determination of unborn child is not permissible under Pre-conception and pre-natal Diagnostic Techniques Act, 1994.

  • Utilization of ultra-sonography, amniocentesis to determine and communicate the sex of an unborn is punishable under the law since January 1996.

  • Doctors and radiologists conducting or soliciting patients for sex determination tests can be imprisoned up to five years and fined upto Rs. 50,000.

  • All clinics conducting ultrasounds scans must be registered and must display prominently a notice in English or in local language that sex determination of foetus is prohibited under the law.

  • Use of Pre-natal Diagnostic procedure Techniques are allowed only on medical grounds for detecting abnormalities, disorders and congenital anomaly etc. and not for determining sex of the foetus.

  • No person conducting pre-natal diagnostic procedure under the law shall communicate to pregnant women concerned or her relative the sex of the foetus by words or signs or any other method.

  • Pre-natal Diagnostic techniques can be conducted only by genetic clinics, genetic laboratories, and genetic counseling centers which have been registered under the PNDT Act.

  • Clinics involved in sex determination tests or advertisements by doctor or a clinic for conducting the sex determination test of an unborn baby are equally liable for punishment under the PNDT Act.

  • Cognizable, non-bailable and non-compoundable are the offences under PNDT Act. Cognizable is an offence for which police may arrest without a warrant. Under non bailable offence, bail may be granted only by competent court. Non-compoundable offence is an offence in which no settlement between the parties is possible to drop the criminal proceedings.

  • No person, including a specialist or a team of specialists in the field of infertility, shall conduct or aid in conducting sex selection on any tissue, embryo, conceptus, fluid or gametes derived from either or both of them.

  • Any person conducting ultrasonography on a pregnant woman shall give a declaration on each report on ultrasonography that she/he has neither detected nor disclosed the sex of the foetus of the pregnant woman to any body.
Source: CAPF (Campaign Against Pre-birth Elimination of Females)