By Sonal Matharu
Civil society groups working on the issue of female foeticide in India woke up to a rude shock this morning.
Women and child development minster Maneka Gandhi said in Jaipur on Monday that the results of child sex determination test during pregnancy should be made known to the parents and if the child is a female, the delivery should be tracked and recorded. Through this, it can be ensured that the foetus is not aborted.
By Tuesday afternoon, the ministry was quick to term this as a “point of view which has often been brought up by stakeholders before the [WCD] ministry” which the minister reiterated at the conference and asked for media persons’ suggestions on the same.
Her statement, however, has caused a stir in the circles of those social activists and doctors who have been trying to save the unborn girl children in the country. Their experience tells them that whatever efforts have been put into this issue so far will be reversed if the ban on sex determination of the foetus is lifted.
Their first concern is how the pregnancies will be monitored and tracked. The union government currently tracks pregnancies through its army of Accredited Social Health Workers (ASHAs) and anganwadi workers. Under the National Health Mission, Union Health Ministry’s flagship programme for maternal and child health, the pregnant women have to register at the nearest anganwadi centres and with the ASHAs who can then ensure that they are immunised and taken for delivery to a hospital.
But there is still a fraction of women who do not approach hospitals either for per- or post-delivery care or for deliveries. Home deliveries are very much a reality in all states in India and these may not be registered or monitored by the ASHAs. Besides, the flourishing private health sector, which falls under the purview of the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994 that checks sex selective abortions but do not have to report every delivery or abortion to the government,may provide a safe haven for sex selective foeticide.
The latest National Family Health Survey 4 (2015-16) data that has released provisional figures for 13 states and union territories show that in Haryana almost six percent of total deliveries are conducted at home by skilled health attendants. There is no data on the home deliveries conducted without any birth attendant present.
Also, only 52 percent institutional deliveries (out of 80.4 percent) are conducted in public facilities in the state and mere 19.5 percent women complete the ante-natal care required, indicating that women may not be constantly connected to the health system between their pregnancies and deliveries. The data is no different in other states.
But why pregnancies should be tracked at all, asked Ranjana Kumari from Centre for Social Research. She contended that tracking women’s pregnancies goes against their reproductive rights. A Delhi-based social activist who has worked on the issues across many states felt that tracking pregnancies will have a negative impact on a woman’s legal right to a safe abortion.
The PCPNDT Act makes disclosing the sex of the foetus punishable. It often clashes with the Medical Termination of Pregnancy Act, 1971 that gives women right to safely, medically abort the foetus.
Another issue which may be completely overlooked if the sex determination is allowed is the mushrooming of the ultrasound centres. “You will give a free hand to people for the work that they are doing discreetly till now,” said the Delhi-based activist.
The sex of the foetus can be known in 12 weeks, during which time many families do not even disclose the pregnancy. “The technology develops very fast in this field and now with new scanners, one can know the sex of the child in six to eight weeks. By legalising sex determination, we are only encouraging newer, faster technology without any monitoring mechanisms in place,” the activist added, stressing that the move will not address the issue of female foeticide at all.
Gandhi’s statement also completely overlooks the discrimination women face in households and how little control they have over their reproductive rights. Kumari felt that the situation for women will become worse when the family will find out that she is carrying a female foetus. “The kind of pressure she will have from the husband and the in-laws will be immense.” And it will not come as a surprise, given the patriarchal society we live in, if the women carrying female foetuses are fed less in homes.
Meanwhile, this is not the first time that the government is considering this move of making sex determination mandatory, the civil society members say, but it is the first time a Union minister has put this idea in the public domain. They are surprised that Gandhi made a statement public when the PCPNDT Act is not even a mandate of her ministry. The Act falls under the purview of the Health Ministry.
Dr Jignesh G Thakker, who is a member of Indian Radiology and Imaging Association (IRIA), said that the association had suggested the same to the Union Health Ministry five to six years back. But alongside, he wants the private health sector regulated where one can be sure that ultrasounds are conducted by qualified radiologists. “The radiologists can then keep the government informed who can track the required pregnancies and prevent female foeticide. This way the issue of unreported pregnancies can also be checked. The PCPNDT Act will have to be scrapped,” said Thakker.
The civil society is demanding a social impact study to show what kind of impact this move will have.“In our society, girls are not respected either inside the house or outside. The impact of the move should first be studied for at least five years before making such a statement,” said Dr Tajinder Pal Singh, a radiologist from Punjab.
The minister’s statement comes at a time when the NFHS 4 data shows some of the states with past history of poor child sex ratio with better numbers in the latest data. For instance, in 2005-06, Haryana with sex ratio at birth at 762 is at 836 in 2015-16. However, there are states like Uttarakhand, Madhya Pradesh, Sikkim and Karnataka that have seen a drop in the sex ratio in the latest data.
There are also unexplainable trends in the latest survey that question how foolproof the system of tracking pregnancies is. Take, for example Sikkim, which has 94.7 percent of all deliveries in health care institutions (institutional delivery in public facility: 82.7 percent). However, mothers who received full ante-natal care during pregnancy is a mere 39 percent. The case of Sikkim is peculiar because it has seen a drastic fall in child sex ration from 984 in 2005-06 to 809 in 2015-16.
Gandhi, in the past, has made similar ‘suggestions’ questioning the channel being followed in providing food to the anganwadi centres across the country. She had suggested that the food should be produced at a centralised kitchen, despite a 2004 Supreme Court order that says that children should be fed hot cooked meals prepared at decentralized kitchens prepared by local women’s self-help groups and mahila mandals.
“Instead of giving it to anganwadis to make food, mothers to make food, villagers to make food, why don’t we have it made at a central place by a company - whether government or not - and put into measured cups of whatever we intend to feed them [children] at whatever stage? And in them come the micronutrients – iron, folic acid – into millets, noodles made of millets and ragi. We change this everyday so that we get clean, machine made, proper, basic food. I am sure we can make the food good,” Gandhi had said at the launch of India Health Report by International Food Policy and Research Institute (IFPRI) and Public Health Foundation of India (PHFI) in December.