PHA-Exchange> female feticide or female fetal loss

[S G Kabra]

The Editor
The Hindu

Sir,
Apropos "Where 'ladu' means a boy, 'barfi' a girl" (The Hindu, Sept. 25) the pertinent question that needs to be addressed is whether gender disparity is because of excessive female fetal loss or just female feticide? 

Female feticide is widely, almost universally extrapolated for female fetal loss in India. This is apparently based on presumptions that (A) the primary sex ratio (ratio at conception) will be equal unless distorted by medical intervention; (B) the secondary sex ratio (sex ratio at live birth) is bound to be equal unless fetuses of a particular sex are willfully eliminated and prevented from being born, and (C) the gender ratio in 0-6 yr. age group is just a continuation of the (permitted) secondary sex ratio at birth.

The other prevalent presumptions and misconceptions in this context are:
(a)that since amniocentesis and chorion villus biopsy methodologies when they came to the country, were used almost exclusively for fetal sex determination in 80 to 90 % of cases, sonography that  replaced those methodologies, is used for antenatal examination for the same purpose to the same extent;
(b) that the earlier used histochemical methodologies and the presently used physical sonography are similar and equally efficacious methodology for fetal sex determination; (c) that every woman who opts for MTP after having undergone sonography is for a female fetus; and
(d) that sonography can reveal the sex of a fetus at any stage of pregnancy.

Extrapolation of these perceptions to explain the emotive issue of gender disparity in population has completely distorted the investigation of the problem. Female fetal loss, as evidenced by sex ratio at live birth in the country, is much more than is reflected in the sex ratio in 0-6 age group and certainly much higher than can be accounted for by sex-determined female feticides.

Female fetal loss, as revealed by the sex ratio at birth, is 100 to over 200 less number of females born per 1000 males. It is too high to be accounted for by sex selective termination of female pregnancies alone. It has been present and prevalent in the country much before the sex determination techniques came to the country. Even today the female sex ratio at birth is much lower in rural areas than in urban areas where modern technologies are widely available. The trend analysis of sex ratio at birth in rural and urban areas do not correlate with the increasing availability of sonography. Over 75% of estimated four million abortions being done in the country today are in the first trimester of pregnancy i.e. in the period whence no sex determination is possible by sonography.

The inferences and conclusions of the study reported are same as reported in the oft quoted earlier studies. However, the grossly exaggerated and far reaching inferences are not substantiated in these studies. For instance take the study titled " The Social Context of Sex Selection and the Politics of Abortion in India" by Radhika Balkrishnan in "Power and Decision. The Social Control of Reproduction" (Cambridge:Harvard School of Public Health, 1994 p. 267) states: 
  In one hospital, from June 1976 to June 1977, 700 individuals sought prenatal sex determination. Of these fetuses, 250 were determined to be male and 450 were female. While all of the male fetuses were kept to term, 430 of 450 female fetuses were aborted. (Miller 1985). 

 A primary sex ratio of 250 males:450 females is impossible to believe on scientific probabilities. The normal accepted primary sex ratio is 100 females:105 males. The above quoted very low primary sex ratio for males has not been reported even in the studies where chemical disaster exposing the whole population to the effect that lead to low male primary sex ratio. 

 The article quotes no other figures or studies, is solely opinion/conjecture based and blames amniocentesis for 'sex selection'. 

 " In order to convey the complex nature of the crises of sex selection 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 M George and Ranbir S Kahiya (Economy and Political Weekly August 8, 1998  pp. 2191-2198) state: 

            " Female feticide over the last 15 years has distorted sex ratios at birth in several Asian countries. Fetal sex determination clinics have been established in India over the last 20 years in northern and western cities. Presented here is the outcome of an intensive study of the abuse of prenatal diagnostic techniques for sex selection in rural population of 13,000 in Rohtaka district . Parents tend to be calculative in choosing the sex of the next child and the decision is based on the birth order, sex sequence of previous children and number of sons. Transfer for reproductive technology to India is resulting in reinforcement of patriarchal values as professional medical organizations seem to be indifferent to ethical misconduct."

 However, the basis of the aforesaid conclusions/ inferences is " The pregnancy outcome reported by the women were 2,642 live borns, 48 still births and 272 abortions (243 spontaneous and 29 induced)". 

The aforesaid in a period of FIVE years." To reduce recall errors, we confined interviews to women who experienced a pregnancy outcome in the last five years rather than to all village women. There were 1,022 eligible women. The criterion of using pregnancy outcome in the last five years included almost all outcomes in the study villages in the recent past, as the average interval between successive births in Haryana is 28 months.".

 Even if it is presumed that all 29 induced abortions (MTPs) in 5 years amongst the 1,022 study eligible women of a total rural population of 13,000 were for female fetuses, the conclusions about the 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) From correspondent Gayle Young NEW DELHI, India (CNN) and quoted by Family Planning Association of India in its documents, state :

 " India officially banned gender testing last year, but the practice is still common. A recent government study showed that of 8,000 abortions performed in one Bombay Hospital, only one was of a male fetus. Neighborhood sonogram clinics crowd every city, and doctors take 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, even amniocentesis and chorion villus biopsy methods do not enjoy such a high accuracy (1 in 8000). Even direct visualization of fetal genitalia by fetoscopy will not give such high accurate results between 15 to 20 weeks of pregnancy whence the size of the fetal genitalia is not more than the size of a rice or wheat grain. External genitalia develop after 15 wks and MTP is permitted upto 20 wks. How did the hospital document the sex of the child ? How and where do they record it in the MTP register ? If it is recorded and done for the female sex of the fetus it is a criminal offence of homicide as MTP can not be done for this purpose under the MTP Act. (It can be done for contraceptive failure and not for a willingly conceived child).

Lastly the study "Will bill to ban sex test control medical mercenaries" By Usha Rai. It concludes:"Between 1986-87 about 50,000 female fetuses were aborted after sex test" based on the following evidence:

 "Fifteen years ago when the alarm was first sounded about the prenatal testing, the amniotic fluid was being extracted from the pregnant woman's womb and the chromosome pattern tested to determine the sex of the child. But now 95 per cent of the sex determination tests (SDTs) are by ultrasound equipment which innumerable other medical uses and has mushroomed to small towns and even villages."

 "According to evidence given to the select committee, between 1978 and 1982 78(XX) female fetuses were aborted after sex determination and between 1986-87 30,(XX) to 50,(XX)  were aborted."

 "Between 1982 to 1987 the number of clinics for sex determination increased from 10 to 248 in Bombay city alone."

 "In 1986 government sponsored study in Bombay revealed that 84 percent of the samples of doctors are performing amniocentesis for sex 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 for prenatal sex determination, therefore, ultrasound facilities that later replaced it did the same to the same extent.

2.      that all ultrasound examinations in pregnant women are done for prenatal sex determination.

3.      that all post-ultrasound MTPs are for female feticide.

The exaggerated inferences about sex selected female abortions and its projection as an exclusive cause of excessive female fetal loss totally distorts the issue of gender disparity in the population. Additional and larger causes of female fetal loss must be looked into and addressed.

Thanking you 

Yours sincerely

 

Dr.S.G.Kabra

15, Vijaya Nagar, D-Block, Malviya Nagar, Jaipur-302017

 

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