NS Special Report: . . . but what if it's a girl?

NS Special Report: . . . but what if it's a girl?
Carla Power
Monday 24th April 2006

Modern technology is helping parents in Asia indulge in a hideous practice - killing off their girl children. It's never been easier to identify a female foetus and abort it.

Grey hair pulled into a tidy bun, blood-orange sari crisp, Sangam Satyavathi marches into the hospital, her team scurrying after her. She is on a raid. As district health officer for Hyderabad, Dr Satyavathi is on a "sting operation" - a surprise visit to a maternity hospital to check its ultrasound records. A nervous knot of doctors and nurses forms around her, under a portrait of the baby Krishna and an advertisement for a General Electric ultrasound machine. This features a pregnant belly and the slogan "We bring good things to life". Satyavathi and her team frown over ledgers and a pile of Form Fs, required whenever a pregnant woman has an ultrasound scan. Like all the other hospitals in Hyderabad District, this one has been ordered, as part of a local campaign against female foeticide, to present detailed records of any such procedures. "No reports," says Satyavathi, frowning. "And no consent forms." "Consent form we are not taking, madam," ventures a doctor. More poring over ledgers. "You haven't submitted your forms on time." "Next time, madam." "Next time?" she asks. "Now we are going to seize the machine." Dr Satyavathi's men go to work. They shroud the ultrasound machine in a sheet, then wrap it in lashings of surgical gauze. They drip red molten wax on the knots. Satyavathi whips out a five-rupee coin and presses it to the wax, sealing the suspect machine with the design of the three-headed lion, symbol of the Indian government. "You see," she says grimly. "The act is so powerful." The Prenatal Diagnostic Techniques Act is powerful indeed, but rarely enforced. Passed after India realised that modern medical techniques such as ultrasound scans and amniocenteses were frequently being used to identify female foetuses - which are then aborted - the PNDT Act requires the registration of all ultrasound machines, and bans doctors from revealing the sex of the foetus to expectant parents.

The 1994 law was an attempt to reverse India's rampant use of sex-selective abortion, and the lopsided sex ratio this has produced. India's 2001 census showed that there were 927 girls to every 1,000 boys, down from 945:1,000 in 1991 and 962:1,000 in 1981. Until recently, no doctors had been put in prison under the PNDT Act. But late last month a doctor was jailed for three years after telling an undercover investigator that her foetus was female, and hinting that she could abort it. Arvind Kumar, Hyderabad district collector and Satyavathi's boss, sees the law as the only practical tool for tackling India's female foeticide epidemic. Doctors who practise sex-selective abortion, he says, "like any other criminals, should be treated like criminals". It is uncertain how many such crimes have been committed. A January study in the Lancet estimated that ten million female foeticides had occurred in India over the past two decades. Both the Indian Medical Association and anti-sex-selection activists disputed the findings, saying the numbers were too high.

While the numbers may be a matter of debate, the general trend is not: the ratio of girls to boys in India has been dwindling over the past two decades. In 1991, not a single district in India had a child sex ratio of less than 800:1,000. By 2001, there were 14. "What we're dealing with," says Sabu George, India's leading activist, "is a genocide." The prospects are even bleaker elsewhere in Asia. In South Korea and China, official numbers suggest that there are 855 girls for every 1,000 boys. In the case of China, independent experts put it even lower, at 826:1,000. Whichever is correct, the Chinese demographic picture is more unbalanced than back in 1990, when the statistics showed 901 girls for every 1,000 boys. Today, in parts of Hainan and Guangdong Prov inces, the ratio is 769:1,000. The Chinese scenario has already produced a glut of bachelors, which experts say will only get worse. A 2002 article in International Security magazine estimated that by 2020 there will be up to 33 million guang guan ("bare branches"), as these young, unmarried men are known. Some demographers have put the figure even higher, at 40 million.

The unwanted girl has a long history in Asia. The first written record of female infanticide dates back to Japan's Tokugawa period, between 1600 and 1868, when there were nine times as many boys born as girls. A British colonial official in India recorded cases of female infanticide as long ago as the 1780s. In rural India today, there are dais, traditional birth attendants, who still know how to get rid of unwanted baby girls. Classic methods include feeding the newborn rice or salt, or smothering the baby with a pillow. In recent decades, female infanticide has been eclipsed by modern methods of sex determination, including amniocentesis or ultrasound scan, followed by abortion. Activists say female foeticide is merely the first assault on Indian women, and cannot be seen as separate from the whole life cycle of anti-girl practices in India: girl-child neglect, early marriage, the dowry system, domestic violence and honour killings. "Being a girl," says Sabu George, "is considered a congenital defect." It is tempting to dismiss Asia's female foeticide problem as a product of the sexism of "backward" societies. To be sure, the problem stems from traditional belief systems favouring boys, but the prevalence of sex selection is an unexpected side effect of modernity. Female foeticide has been boosted by precisely the trends that make China and India the great success stories of the Noughties: economic liberalisation, growing affluence, increased access to technology, and controlled population explosions. Asia's dearth of girls, say researchers, is partly a function of official reproductive health policies. In the late 20th century, both China and India embarked on population-control programmes.

In China, from the 1950s to the 1970s, when the government needed female workers, female infanticide dropped to the lowest levels the country had ever known, a 2004 study in the Journal of Population Research reported. After 1979, however, when the infamous one-child policy was introduced, female infanticide and foeticide became more common. In India, the muscular public health campaigns of the 1970s and 1980s drummed home the official line: happy families were small ones. Abortion, legalised in 1970, "was pursued with an almost patriotic zeal", recalls Dr Puneet Bedi, a Delhi obstetrician and anti-sex-selection activist. Tellingly, the Indian states that did particularly well in curbing population growth - the Punjab, Delhi and Haryana among them - are today those with the most skewed sex ratios. "A large part of the small-family ideal is achieved by eliminating girls," says George. Pressurised by the government to keep their families small, and by society to produce boys, Indian women turned to modern technology to ensure that they got their treasured sons. India's new open markets have made it easier. Economic liberalisation in the early 1990s brought not just foreign cars and the outsourcing boom, but the rise of what Bedi calls "medical entrepreneurship". Easy credit and aggressive marketing by foreign companies made it possible for thousands of clinics to buy ultrasound machines. "The ultrasound machine was marketed like Coca-Cola," Bedi says.

Between 1988 and 2003, there was a 33-fold increase in the annual manufacture of ultrasound equipment in India. Doctors advertised their possibilities widely. "Boy or girl?" asked adverts, before the PNDT Act outlawed them. A 2005 report by the Geneva Centre for the Democratic Control of Armed Forces noted that sex selection had become "a booming business" not only in India, but also in China and South Korea. In India, the recent Lancet study found sex-selective abortion was far more prevalent among the urban middle classes than the illiterate poor: the more educated the mother, the less likely she was to give birth to a second child who was a girl. Though the practice has recently begun to spread to remote areas and to the south, it has been most widely practised in cities, particularly in the north. It is rare among Dalits and remote tribes and common among Sikhs and Jains, historically wealthy business communities. In Delhi, the leafiest suburbs have the worst sex ratios. Shailaja Chandra, a top-tier civil servant, says that preference for boys is common among the capital's elites. "They want to keep property in the family," she says. "Because boys traditionally inherit the wealth, people want boys." For many activists, India's female foeticide problem is entwined with the consumer society the country has become over the past 15 years. If one can order a BMW, goes the mindset, one can order a boy. Mira Shiva, a member of both the National Commission for Women and the National Commission on Population, sees the issue of female foeticide as just one example of the rise in violent crime against women, created by India's quicksilver modernisation. "We're going through a time of increasing consumerism and materialism, where our values are changing," she says. "Market-wise, things that are deemed not of value are expendable." Other traditions have helped make girls seem expendable in Asia. Usually boys, not girls, carry on the family name. In Hinduism, it is the son who lights the funeral pyre when his parents die. In China and South Korea, ancestor-worship rituals are performed by sons and grandsons. In both China and India, boys are viewed as pension schemes, supporting their parents in old age. If boys are a boon, girls are a liability. In India, the birth of a girl eventually entails a dowry, an increasingly expensive proposition. Where the grandmothers of today recall going to their husbands' homes with a pot or two and a few rupees, a modern dowry can cost hundreds of thousands of rupees. Girls are viewed as both an economic drain and a hassle. The protection of their virginity - central to family honour - creates further stress for parents. Boy-preference is so ingrained in the Indian family system that many women don't feel they have done their wifely duty until they produce a son. "They want to bend their heads, like sheep being slaughtered," observes Dr Soubhagya Bhat, an obstetrician-gynaecologist in Belgaum, Karnataka. "The only way they feel their life is fulfilled is if they produce a son." Governments are trying to change the conventional mindset. In 2003, India's national government launched a policy of paying homeless women money to help with their newborn babies: girls get double the rupees boys do. In Delhi, the Directorate of Family Welfare has recently come out with a clutch of "Respect the Girls" advertisements, with slogans such as: "If you kill daughters, you will keep searching for mothers, daughters and wives" and "Indira Gandhi and Mother Teresa: your daughter can be one of them!" They haven't worked. The latest statistics suggest that Delhi's sex ratio stands at roughly 814 girls to 1,000 boys. This is down from 845:1,000 in 2003. If such trends continue, the future could be nightmarish. In their 2004 book Bare Branches: the security implications of Asia's surplus male population, the political scientists Andrea den Boer and Valerie Hudson argue that the existence of all these millions of frustrated Asian bachelors will boost crime and lawlessness. They speculate that, to find an outlet for the continent's sex-starved males, Asian governments might even need to resort to fomenting wars. Indian activists also fear that the girl shortage will create a hyper-macho society. Spiralling numbers of rapes and rates of violence will lead to the increasing sequestration of women. Men with money will be able to afford wives, who will quickly become a status symbol. "Powerful men would maintain zanankhanas [harems] to demonstrate their power and influence," writes the activist R P Ravindra. Poorer men, "finding no companions, might resort to any means to force a woman into a sexual/ marital relationship". In pockets of India, this has already begun. In Haryana and the Punjab, home to India's most unbalanced sex ratios, trafficking in women has skyrocketed. Men from these wealthy areas are purchasing wives from impoverished eastern states such as East Bengal and Bihar. This trend of "killing girls in the womb in western states is hurting girls in eastern states who have survived in the womb", argues Kamal Kumar Pandey, a lawyer with the Shakti Vahini network, an anti-trafficking NGO. Rishi Kant, the network's founder, brandishes a recent snap-shot showing a bloody, decapitated corpse: a 12-year-old bride wearing a yellow dress. The girl was murdered by the man who bought her for 25,000 rupees, says Kant, because she had refused to sleep with his brother. Tales of violence against bought women, and of brothers sharing wives, are increasingly common in parts of northern India. The spectre of millions of lawless bachelors seems a far cry from the bureaucratic world-view of Arvind Kumar in Hyderabad. If India's officials could just implement the PNDT Act, he believes, the demographic tide could be reversed. He is just 18 months into the campaign, and so he sounds cautious, but the latest figures suggest that Hyderabad's sex ratio might be tilting back into balance. He tells of a letter he received recently from a 13-year-old girl who was being belittled by her family for not being a son. Just hearing of his work, she had written, had given her strength enough not to be ashamed of being a girl. Carla Power is a London-based writer