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Sex Selective Abortion in Haryana

A declining child sex ratio has been one of the important concerns of India's demography. Haryana is a developed state showing a falling trend in the child sex ratio over the last two decades. The present study aims to understand the magnitude of sex selective abortions and its reasons in Haryana. Interviewing a total of 2,590 households and 2,646 ever married women in the reproductive ages, the study provides indirect evidence of sex-selective abortions based on the data on pregnancy history of women, spontaneous and induced abortions and ultrasound status.

Sex Selective Abortion in Haryana

Evidence from Pregnancy History and Antenatal Care

A declining child sex ratio has been one of the important concerns of India’s demography. Haryana is a developed state showing a falling trend in the child sex ratio over the last two decades. The present study aims to understand the magnitude of sex selective abortions and its reasons in Haryana. Interviewing a total of 2,590 households and 2,646 ever married women in the reproductive ages, the study provides indirect evidence of sex-selective abortions based on the data on pregnancy history of women, spontaneous and induced abortions and ultrasound status.

SAYEED UNISA, SUCHARITA PUJARI, R USHA

T
he decreasing child sex ratio (F/M) has been an important concern in India’s demography in recent times [Kundu and Sahu 1991; Srinivasan 1994; Bhat 2002]. The 2001 Census of India shows an unusually low sex ratio (females per 1,000 males) for children less than seven years of age in the country as a whole. Though there has been an increase in the overall sex ratio from 927 in 1991 to 933 in 2001, which is good news, the worrying news is that the sex ratio figures of children below seven years has decreased markedly from 945 in 1991 to 927 in 2001. Worse still, child sex ratios are the lowest ever in some of the affluent states of the country situated in northern parts of India. In the country as a whole, the preference for a son is stronger in the north than it is in other parts of the country. The sharp decrease in the under seven sex ratio in the northern states of India is commonly assumed to be the result of the rapid spread of the use of ultrasounds and amniocentesis for sex determination, followed by sex selective induced abortions [Arnold et al 2002]. Haryana, a developed state, has one of the lowest sex ratios as well as a decreasing trend in child sex ratio in the last two decades.

Sex selective abortion is indeed a matter of great concern. The social and demographic implications of sex selective abortions are grave. In much of south Asia, sons are preferred over daughters for a number of economic, social and religious reasons including financial support, old age security, property inheritance, dowry, family lineage, prestige and power, birth and death rituals and beliefs about religious duties and salvation [Arnold et al 2002; Basu 1993; Kishor 1993; Bardhan 1988; Karki 1988; Das Gupta 1987; Das 1987; Miller 1981].

Sex selective abortion occurs in two steps. The first step is to assess the sex of the foetus. The second step is to obtain an abortion if the foetus is not of the desired sex. Three methods are commonly used for determining the sex of the foetus. They are amniocentesis (normally performed after 15-17 weeks of pregnancy) chorionic villus sampling (expensive and normally performed around the 10th week of pregnancy) and ultrasounds (the least expensive and normally performed around the 12th week of pregnancy). An ultrasound is a primary investigative modality for foetal diagnosis and therapy. Through the availability of high-resolution equipment, it is possible to see the details of foetal anatomy. An ultrasound typically costs between Rs 500 and Rs 1,000 and is considered by many couples to be a good investment in order to save dowry payment if the foetus is female [Fernandes 1998; Mallik 2002].

The technology, introduced to detect genetic abnormalities, in the 1970s became commonly available in India in the 1990s [Arnold et al 2002]. These techniques also came to be widely used to determine the sex of the foetus and for subsequent abortions if the foetus was female [Henshaw et al 1999]. Not only did its use spread in urban areas but also in rural areas. For example, in one large community-based study in rural Maharashtra, one out of every six married women who had an abortion in the previous 18 months said the abortion had been subsequent to a sex determination test showing a female foetus [Ganatra 2000].

Legal Aspects Concerning Abortion

Abortion has been legal in India since 1972, when the Medical Termination of Pregnancy (MTP) Act was passed. The act was implemented in the major states of India except Sikkim [Karkal 1991]. Under the act, abortion is legal if the pregnancy that it terminates endangers the life of the woman or causes grave injury to her physical or mental health or is likely to result in the birth of a baby with physical or mental abnormalities or is a result of rape or contraceptive failure. The act further stated that abortions could only take place in government approved health facilities specifically approved for conducting abortions and by a registered medical practitioner.

Sex determination technologies arrived in India in 1975 for determination of genetic abnormalities after the enactment of the MTP Act. However, these techniques came to be widely used for determining the sex of the foetus and subsequent abortions if the foetus was female. In view of the widespread misuse of this technique, the Maharashtra government enacted the Maharashtra regulation of the Prenatal Diagnostic Techniques (PNDT) Act in 1988. This act was repealed by the enactment of a central legislation based on the Prenatal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994 by the government of India. Under this law, the availability of facilities for sex determination was banned and a doctor in an unregistered clinic conducting such a test was liable to be imprisoned for three years with a fine of Rs 10,000. Laws are not likely to be effective in societies where the preference for a son is strong and deeply embedded in patriarchal structures and hence, unless the patriarchal norms of the society are challenged, the desire to do away with girl children will remain [Kishwar 1993; Ashk 2006; Bhandari 2006].

Data providing consistent estimates of induced abortion in India are scarce; whatever is available is through government reports and surveys. Available abortion statistics shows that five to six million abortions occur annually in India and roughly 90 per cent of them occur in unapproved facilities [Ganatara 2000 and Arnold et al 2002]. Illegal abortions are eight to 11 times as high as legal abortions [Chhabra 1996; Jessani and Iyer 1995; Chhabra and Nuna 1994]. While government statistics estimate legal abortions at about 0.6 million annually [Ministry of Health and Family Welfare 1996], it is also reported that 16 per cent of abortions take place at gestations greater than 12 weeks [Ministry of Health and Family Welfare 1996]. The Indian Council of Medical Research (ICMR) estimated the induced abortion ratio to be 1.9 per 100 known pregnancies [ICMR 1989] compared to a ratio of 2.7 from government statistics. A study of abortions in Maharashtra estimated abortion ratios of 11 to 14 induced abortions per 100 live births [Ganatara et al 2000]. According to government records, most of the abortions are among women below 30 and the most common reasons for abortions are related to family planning including birth spacing and family limitation for economic reasons. Most of these abortions are also often preceded by sex determination tests [Arnold et al 2002].

There is a lack of evidence on sex selective abortions in India because most of the abortions are illegal and not reported and there is hardly any documentation on the magnitude of sex selective abortions in India. One of the many key factors that influence the child sex ratio in our country is sex selective abortions through easy accessibility and affordable procedures for sex determination during pregnancy. Apart from accessibility of these services, socio-economic factors, domestic violence, prevalence of the dowry custom and financial pressure on parents further contribute to the scenario of increasing sex selective abortions. The present paper provides empirical evidence of the practice of sex selective abortions in rural Haryana based on pregnancy history of women, spontaneous and induced abortions and ultrasound status. The paper is organised as follows: Section I provides a description of the study methodology and data sources. In Section II the results of the study are presented. The summary and conclusions of the study are provided in Section III.

I Methodology and Data

The data for the present paper is a part of a large-scale communitybased research study conducted in the Jind district of Haryana in the year 2001 [Unisa et al 2003]. As a first step to identify the clusters of high incident areas of induced abortion, a secondary data analysis of child population in zero to four years was carried out for 1981 and 1991 censuses by states and districts (at the time of the survey only 1981 and 1991 censuses were available although in the appendix figures are given for 1981 to 2001). While the child sex ratio for Haryana was 930 females for every 1,000 males in 1981 it fell to 886 in 1991 and further decreased to 867 in 2001 (Appendices A and B). Thus, there has been a massive decrease in the sex ratio of this age group, which is most likely because of sex selective abortions. The Jind district exhibited a very low sex ratio in 1981 and 1991, and was thus selected for the study. The district map was prepared using child sex ratios (zero to four years) at the village level. There were many villages with a sex ratio of 125 and above in the Jind district. One such cluster was selected. From the selected cluster of villages, five villages were randomly selected and a complete census of all the households in the selected villages was carried out. A total of 2,590 households in Jind were covered and a total of 2,646 ever-married women in the reproductive ages were interviewed for the study. Detailed information was collected on household characteristics, pregnancy history, antenatal care, deliveries, abortion history, reasons for abortion, place of abortion and obstetric morbidity for each pregnancy starting from the time of marriage.

The analysis of the present paper is based on questions asked of the ever-married women about their pregnancy history, antenatal care, delivery and abortion history, gestation period and sonography status. In the section on pregnancy history, detailed information was sought on the outcome of each pregnancy starting from the first pregnancy until the 10th pregnancy. Details about live births, stillbirths, spontaneous abortions and induced abortions were recorded by order of pregnancy to see the changing patterns in the outcome of each pregnancy. In the section on antenatal care, detailed information was collected with regard to the week/month of pregnancy at which the woman went for her first antenatal check-up. Information on urine pregnancy tests, blood tests and ultrasound/sonography tests and in which month of pregnancy women underwent these tests was also collected. As regards ultrasounds, information was collected on the reasons for undergoing an ultrasound and who motivated them to take the ultrasound test. Further details about whether the sex of the baby was disclosed during the sonography and if the sex of the foetus was revealed were also collected. These questions were asked to see if the sonography test was closely followed by an abortion or not. Detailed information for each pregnancy was elicited. In the section on abortion history, details were collected about the gestation period of pregnancy when the abortion occurred by order of pregnancy, and whether abortion was spontaneous or induced.

II Findings of the Study

Profile of Respondents

Women’s health seeking and demographic behaviour is said to be closely linked with several background characteristics such as age, marital status, religion, caste and education. All these factors influence their fertility seeking behaviour. Table 1 gives a brief description of the respondents who were interviewed by their background characteristics. A large number of respondents fall in the high fertility age group of 20-29 years. More than half are in the early reproductive age group of 15-29 years (52 per cent) and very few are in the age group 45-49. Ninety-seven per cent of the women are currently married. A little more than one-third are literates (35 per cent) and the remaining are illiterates. Among those women who are literate, large proportions have completed primary but not middle school. With regard to the employment status, it is seen that almost half of the respondents (49 per cent) had not been working in the 12 months prior to the survey. Thirteen per cent

Economic and Political Weekly January 6, 2007 of women were employed with someone else. Most of the women in Haryana are engaged in their own family farm or business.

The investment in children’s education indicates to what degree the preference for a son is prevalent in a particular society. To capture this, along with the background profile, women were also asked about the perceived educational aspirations for their children. A large proportion of women (about 57 per cent) (table not shown) believed that a son should be given as much education as he desires compared to 48 per cent of women who believed that a girl should be given as much education as she desires. Even for educating children beyond higher secondary school, graduation and above, women were more desirous of educating their sons than their daughters. Thus, the inclination for educating a male child is stronger than the female child; quite possible in view of the social cultural norms prevalent in India where girls are considered a liability/burden and sons are regarded as a source of old age security. Therefore, investing in girls’ education beyond a certain level is not encouraged.

Evidence of Sex Selective Abortions

(1) Health facilities and availability of sex determination technologies: As a first step, to determine the practice of sex selective abortions in the study area, a survey of infrastructure of medical facilities in government and private hospitals/nursing homes and clinics was carried out in and around the villages and a nearby town. The town which catered to the needs of villages, with a child sex ratio below 800 was selected for the study.

In the selected town and its periphery, all-together 40 health facilities were found. Out of these, 18 were small registered medical practitioners (RMPs) consisting of allopathic, homeopathic, orthopaedic and dental clinics. In the remaining 22 health facilities, data on infrastructure was collected from the medical doctor in-charge of nursing home. There were four government health facilities and the remaining clinic were run by private practitioners. Out of the 18 private nursing homes, 12 were established during 1991-2000. (This was the time when the technologies introduced to detect genetic abnormalities became commonly available in India.) Interestingly most of these clinics were run by doctors from neighbouring states.

With regard to availability of sex determination technologies, it was found that out of 22 allopathic nursing homes/clinics operating in Jind, 10 were providing ultra sonography and three of them had colour sonography machines as well. Apart from regular nursing homes providing the ultra sonography, mobile ultrasound facilities were also available in the villages. The cost of an ultrasound was Rs 300 to Rs 500 which was quite affordable for the villagers.

It was found that the nursing homes had put up signboards displaying the availability of colour/black and white ultrasound facilities (in towns as well as in nearby villages) and at medical shops and RMP clinics. Information about the availability of an operation theatre, blood test/urine test facilities that are essential for antenatal and natal services was not displayed on the signboards. Thus, solely, displaying the availability of ultrasound machines indicates the ulterior motive of medical practitioners to lure the innocent villagers for an ultrasound, and if a female foetus is detected, to abort the foetus and thereby make large profits.

According to the National Family Health Survey 1998-99, in Haryana, only 60 per cent of pregnant women had gone for antenatal care, for at least one check-up. Percentage of births assisted by health professionals was only 42 per cent for Haryana, in comparison with neighbouring Punjab (62 per cent) and Kerala (90 per cent). This raises a question so as to what is the need for the existence of so many nursing homes and clinics in a place which does not serve a very large population and also where the level of antenatal and natal care is low. Why have so many new nursing homes come up in the small towns of Haryana?

(2) Abortions based on pregnancy history of the women: To determine the prevalence of sex selective abortions in the study area, an attempt is made to see what percentage of live births and abortions have occurred to women starting from their first pregnancy until their sixth pregnancy and above. Table 2 shows

Table 1: Per Cent Distribution of the Respondents by Their Background Characteristics

Background Characteristics Percentages

Age groups: 15-19 7.5 20-24 21.0 25-29 23.1 30-34 18.0 35-39 15.5 40-44 9.6 45-49 5.3

Marital status: Currently married 97.1 Widow 2.9

Education: Illiterate 64.7 Literate<primary school complete 2.2 Primary school complete 14.2 Middle school complete 8.1 High school complete 7.2 High secondary complete and above 3.6 Husband’s education Illiterate 31.2 Literate<primary school complete 2.8 Primary school complete 16.3 Middle school complete 16.0 High school complete 20.9 High secondary complete and above 12.8

Working status: Working in family farm/business 35.1 Employed with someone else 13.2 Self-employed 2.7 Not worked in the past 12 months 49.0

Source: Survey data (2003).

Table 2: Percentage Distribution of Pregnancies by Outcome,according to Order of Pregnancy

Order of Live Still Spontaneous Induced Total Sex Ratio Pregnancy Birth Birth Abortion Abortion Preg-of Live nancies Birth (F/M)

  • 1 91.4 2.8 5.7 0.04 2362 800
  • 2 92.9 1.5 5.1 0.34 2078 820
  • 3 93.2 1.4 5.0 0.26 1541 787
  • 4 90.4 1.8 6.7 1.01 890 847
  • 5 87.9 2.3 8.0 1.6 473 847 6 and above 89.0 1.9 8.0 0.98 410 800 Total 91.8 2.0 5.8 0.40 7754 820
  • Source: Based on survey data (2003).

    the percentage distribution of the outcome of pregnancies by order of pregnancy and sex ratio at birth. Out of the total of 2,362 first pregnancies, 91 per cent have resulted in a live birth and 6 per cent of the pregnancies ended in a spontaneous abortion whereas less than 1 per cent pregnancies turned out to be induced abortions. This percentage has more or less remained steady until the third parity after which there is a decline in the percentage of live births and subsequent rise in the percentage of spontaneous and induced abortion. From the table, it may be observed that with increasing parity the chances of having a live birth is decreasing and there is an increase in the reporting of spontaneous abortions. Two things can be deduced from this. One is due to the preference for a bigger family size, the percentage of women reporting induced abortions is perhaps low until the first three pregnancies and the increase in the reporting of induced abortions after the third parity could be most likely because of sex selective abortions. Sex ratio at birth is another important indicator of sex selective abortions. The sex ratio at birth given by Sample Registration System (SRS) 2002 is also the same as observed for the sample population, i e, 820 females per 1,000 males. From Table 2 it is seen that the overall sex ratio is low in all the orders of pregnancy but the sex ratio is the lowest for the third pregnancy. This shows that abortions have occurred mostly during the third pregnancy and these abortions certainly may have been sex selective abortions and may have been induced.

    (3) Level, trend and frequency of abortions: Abortion ratios are calculated for a five-year period starting from 1976 to 2001 to see the trend in the pattern of abortion in the study area in the past few years. The figures of induced abortion ratios for all the time periods are relatively less in comparison to spontaneous abortion ratios that have been quite high in the recent period (Table 3). There is a high possibility that most of the abortions that have been induced are reported as spontaneous. The total abortion ratios have increased markedly from 2.3 in 1975 and before to 10.6 in 2001 per 100 live births. However, the increase in the abortion ratio in the recent period is very high compared to earlier years. Some of the increase could be due to more complete reporting of recent abortions because of the difficulty of recalling abortions that occurred in earlier period.

    Table 4 shows the frequency of abortions and their rates. A noticeable percentage of women have had two abortions, and a small percentage of women have undergone three or more abortions. There is a possibility that quite a significant number of these women may be undergoing repeated abortions, showing indirect evidence of the practice of sex selective abortions in the study area. Overall, 18 per cent of women have had abortions.

    Table 5 shows that 12 per cent of the women reported to have had at least one abortion. Most of these women had high standards of living, were educated beyond higher secondary level, and with husbands in jobs (other than daily wage labourers or cultivators). This shows that abortion seekers are women who are economically and socially well off. It has also been reported that educated women who have frequent exposure to the media are the ones most likely to seek a sex selective abortion [Retherford et al 2003].

    (4) Antenatal check-up and ultrasound before live births and abortion: It would be interesting to see in how many pregnancies out of the total live births that occurred or pregnancies

    Table 3: Percentage of Abortions in Comparisonto Live Births by Years

    Years Induced Abortion Spontaneous Abortion Total Live Ratio Number Ratio Number Abortion Births Ratio

    2001-1996** 1.3 23 9.3 165 10.6 1766 1995-1991 0.4 7 6.1 116 6.5 1913 1990-1986 0.2 2 4.5 77 4.7 1707 1985-1981 --5.4 58 5.4 1060 1980-1976 0.2 1 5.8 29 6.0 494 <=1975 --2.3 4 2.3 174 Total 0.4 33 6.3 449 6.7 7114

    Notes: * Abortion ratio: (No of abortions/live births)*100. ** Survey was carried out during January to March 2001. -Not available. Source: Same as Table 2.

    Table 4: Percentage of Women Who Had Abortionsby Its Frequency

    No of Times Abortion No of Women Who Abortion Rate** Had Abortions*

    1 199 7.52 2 83 3.14 3 19 0.72 4+ 14 0.53 At least one abortion 315 11.9 Total 482 18.22***

    Notes: * Total abortion: Induced + spontaneous. ** Abortion rate: (no of women who had abortion/total no of women in 15-49 age group)*100. *** (Total no of abortions/total no of women in 15-49 age group)*100. Source: Same as Table 2.

    Table 5: Percentage of Women Who Had Abortionsby Socio-economic Background Characteristics

    Background Women with at Least Number of One Abortion Women

    Standard of living: Low 12.5 512 Medium 11.2 1123 High 13.7 1011

    Women’s education: Illiterate 10.6 1712 Literate<primary 17.6 34 Primary school complete 15.8 400 Middle school complete 13.6 214 High school complete 16.8 190 Higher secondary complete and above 17.7 96 Husband’s occupation: Cultivator 11.5 1246 Daily wage labourer 12.6 720 Other 14.0 680

    Source: Survey data (2003).

    Table 6: Percentage of Women Who Underwent At Least OneANC and Different Test during Pregnancies before Live Birthor Abortion by Years

    Years ANC Urine Test Blood Test Ultrasound Test LBA LB ALB A LB A

    2001-1996 30.8 26.8 27.4 26.8 24.9 22.7 10.0 15.8 1995-1991 19.0 22.8 16.4 17.1 14.6 13.3 3.8 9.5 1990-1986 11.2 21.5 9.3 13.8 8.4 12.3 0.9 4.6 1985-1981 7.6 4.2 6.1 4.2 5.4 4.2 0.3 1980-1976 2.9 4.0 2.3 4.0 2.5 4.0 -<=1975 0.6 ------>1985 20.3 24.3 17.7 21.1 16.0 17.9 4.8 11.7 Total 16.7 20.4 14.4 17.8 13.0 15.2 3.7 9.3

    LB: Live births, A: Abortion Source: Same as Table 2.

    Economic and Political Weekly January 6, 2007 that resulted in abortions, women went for antenatal check-ups (ANC), the urine pregnancy test, the blood test and the ultrasound test. The ultrasound test is a part of ANC and is used for monitoring the pregnancy. However, it is misused to determine the sex of the foetus. The use of different tests during pregnancy will throw light on the association between these tests and its link to abortion. An ultrasound test was conducted for 10 per cent of the pregnancies during 1996-2001 (Table 6) and this figure is quite high from what it was in the previous periods. In addition, in more than one-fourth of the pregnancies the urine test, blood test and antenatal check-up was done and these figures have shown an improvement from what they were in the earlier years. However, a different picture emerges when these tests are linked with abortion. Although there is an increase in the percentages of urine, blood tests along with ANCs over the years, the increase has not been as rapid as observed for ultrasounds. There is a marked increase in the proportion of pregnancies with ultrasound tests from 1986-1990 (less than 5 per cent) to nearly 16 per cent in 1996-2001, which resulted in abortion. Thus, the percentage of women undergoing an ultrasound for pregnancies that are resulting in an abortion in the recent period is much higher than for pregnancies that resulted in live births for the same period.

    Overall, 12 per cent of women in the study area underwent ultrasounds. Nearly 8 per cent of women had undergone at least one ultrasound. A small percentage of women have undergone an ultrasound three or more times (Table 7). Detailed information has been sought about their ultrasound status, i e, who motivated them to have an ultrasound, the reasons for undergoing the ultrasound and whether the sex of the baby was revealed during the ultrasound by order of pregnancy and attempts have been made to see whether these in turn are associated with sex selective abortions. Table 8 gives detailed information about these issues.

    Use of the ultrasound test by order of pregnancies shows that nearly 4 to 5 per cent of women in their first order have undergone the ultrasound test and this has remained constant till the fourth parity after which there is an increase in proportion of women who underwent an ultrasound. Around half of the women (47 per cent) reported that it was on a doctor’s suggestion that they underwent an ultrasound during their first pregnancy. It is also observed that for the subsequent pregnancies the doctor’s influence has gradually declined. More than one-fourth of women and their husbands have turned out to be the primary decisionmakers for undergoing ultrasounds from the third pregnancy onwards. This shows that an ultrasound on a doctor’s suggestion could be primarily because of medical reasons whereas in other cases the test was done most likely to determine the sex of the unborn child.

    Over the years, the incidence of abortion has been increasing and one of the reasons for undergoing an ultrasound could be to know the sex of the baby and subsequently to resort to induced abortion if the foetus is unwanted. To throw more light on this issue, questions on the reasons for undergoing ultrasounds were asked of those women who underwent an ultrasound to know their intentions. Interestingly, as the order of pregnancy increases, the desire to know the sex of the baby has come out as the major reason for undergoing an ultrasound. Though a major chunk of the women reported that health of the baby was the main reason for undergoing an ultrasound, this looks quite dubious. This could be true for women who are going under the doctor’s initiation during their first pregnancy but not for later pregnancies (Table 8). Except abnormalities and position of the baby (to know the position of the baby, a test is conducted after seven months of

    Table 7: Percentage of Women Who Underwent an Ultrasoundas a Part of Antenatal Checkups

    No of Pregnancies No of Women Ultrasound Rate*

    1 155 5.9 2 42 1.6 3 15 0.6 4+ 10 0.4 At least one ultrasound in

    any pregnancy 222 8.4 Total no of ultrasounds for all women 330 12.5** Total no of ultrasounds for

    all pregnancies 330 6.1***

    Notes: * (No of women who underwent ultrasound/total no of women in 15-49 age group)*100. ** (Total no of ultrasounds/total no of women in 15-49 age group)*100. *** (Total no of ultrasounds/all pregnancies after 1985)*100. Source: Same as Table 2.

    Table 8: Percentage of Women by Reason, Motivation, Timingand Result of Ultrasound by Order of Pregnancy

    Reasons and Suggestion/Parity Order of Pregnancy 12 345+

    Percentage of women who went for ultrasound 4.6 3.7 3.8 4.3 5.4

    (112) (78) (59) (39) (42)

    Reasons for undergoing ultrasound Sex of the child 5.8 10.0 11.1 22.9 33.3 Position of the baby 2.9 1.4 -2.9 2.3 Child’s health 52.4 55.7 55.6 54.3 33.3 Abnormality 14.6 10.0 9.3 11.4 Mother’s health 24.3 22.9 24.1 8.6 7.1

    Persons who suggested they undergo an ultrasound Self 28.5 29.4 32.2 23.0 30.9 Husband 23.2 19.2 27.1 25.6 28.5 Family and relatives 7.1 5.1 5.0 7.6 16.6 Nurses 11.6 10.2 13.5 12.8 7.1 Doctors 47.3 37.1 32.2 30.7 19.0 Others -----

    Percentage of women who underwent ultrasound after three months gestation 57.1 58.3 64.8 59.5 61.9 Sex of the baby revealed after ultrasound 14.2 15.3 28.8 35.9 42.8

    -Not available. Source: Same as Table 2.

    Table 9: Percentage Distribution of All Pregnanciesby Outcome, according to Ultrasound Statusduring Pregnancies, 2001

    Parity Ultrasound Live Still Spontaneous Induced Twins Total Birth Birth Abortion Abortion

    1 Yes 82.2 2.8 12.1 0.9 1.9 100 No 91.8 2.9 5.3 --100 2 Yes 86.1 2.8 8.3 1.4 0.4 100 No 93.2 1.5 4.8 0.3 0.2 100 3 Yes 86.2 1.7 12.1 --100 No 93.8 1.5 4.5 0.2 -100 4+ Yes 73.7 5.3 9.2 11.8 -100 No 90.4 1.9 7.0 0.5 0.2 100 Total Yes 81.8 3.2 10.5 3.5 1.0 100 No 92.3 2.0 5.4 0.2 0.1 100

    -Not available. Source: Same as Table 2.

    gestation) all other reasons look defensive. Further, more than 50 per cent women underwent an ultrasound after three months of pregnancy. This shows that the sex of the baby (which can be determined reasonably accurately after the first trimester) was the main reason for undergoing an ultrasound after the initial three months.

    Fourteen per cent of women reported that the sex of the baby was revealed to them during the ultrasound test conducted for their first pregnancy. It is surprising to note that 36 per cent of those women who went for an ultrasound during their fourth pregnancy reported that they came to know the sex of the baby during this test. Thus, the inquisitiveness to know the sex of the baby probably is more among women in the third or fourth pregnancies and this could be largely due to the preference for a son. Only nine women reported that they had an abortion after knowing the sex of the baby. Out of nine cases, seven reported the sex of the foetus as female and other two as male foetus. However, the possible reason for why many women did not report the sex selective abortions could be that women are aware of the fact that abortion due to sex selection is illegal.

    To arrive at any specific conclusions regarding sex selective abortions, pregnancy outcome by parity was observed for all pregnancies for those women who underwent an ultrasound test and those pregnancies for which women did not resort to an ultrasound (Table 9). Among the pregnancies for which women underwent an ultrasound, the percentage of live births is less than those pregnancies without an ultrasound test. The likelihood of termination of some pregnancies after the ultrasound test (on knowing that it is a female foetus) cannot be ruled out. Also after the fourth parity, the induced abortion rate has increased for all pregnancies for those women who underwent an ultrasound test. Similarly, the rate of spontaneous abortion is also found among pregnancies with an ultrasound than without an ultrasound test.

    It is expected that antenatal care is independent of the sex of the live birth and it mostly depends on the parity, unless there have been sex selective abortions which may be used to avoid births of children of an undesired sex after the sex of the foetus has been determined. To ascertain this, antenatal care by the sex of the live birth is examined and presented in Table

    10. For the first two pregnancies, antenatal care is almost same for male or female births. From third pregnancy onwards, a rise in the antenatal care was found for male births. A slightly different pattern emerges when an ultrasound is linked with the sex of the live birth and among those women who had at least one ANC, blood and urine test and the sex of the live birth. In the case of ultrasounds, it is seen that the use of an ultrasound was less for male births till the second order of pregnancy but there is a rise in the use from the third pregnancy

    Appendix A Sex Ratio (F/M) of Children (0-4 Years) for India and States for 1981, 1991 and 2001

    India and States 1981 1991 2001
    India 97 7 95 5 93 3
    Andhra Pradesh 1000 978 964
    Assam * 978 971
    Bihar 1003 978 957
    Chhattisgarh * * 975
    Gujarat Haryana 961 921 938 886 888 817
    Jharkhand * * 975
    Kerala 974 951 961
    Karnataka 980 962 947
    Madhya Pradesh 988 967 938
    Maharashtra 960 945 912
    Orissa 1003 974 959
    Punjab 925 874 794
    Rajasthan Tamil Nadu 978 973 936 951 913 946
    Uttar Pradesh 964 946 929
    Uttaranchal * * 906
    West Bengal 991 972 965

    *Not available.

    Sources: Census of India 1981, series 1, Part IV A Social and Cultural Tables. Census of India 1991, series 1, Part IV A C Series, Social and Cultural Tables Vol 2. Report and Series on Age, Series I, Census of India 2001.

    Appendix B Sex Ratio (F/M) of Children (0-4 Years) by Districts for 1981, 1991 and 2001 (Haryana)

    State/Districts 1981 1991 2001
    Haryana 930 886 867
    Panchkula * * 881
    Ambala 940 887 826
    Yamunanagar * 882 849
    Kurukshetra 880 868 857
    Kaithal * 855 849
    Karnal 930 914 865
    Panipat * 899 862
    Sonipat 890 883 836
    Jind 880 867 876
    Fathebad * * 890
    Sirsa 940 896 883
    Hisar 920 865 868
    Bhiwani 940 901 881
    Rohtak 940 860 869
    Jhajjar * * 86 8
    Mahendragarh 950 893 869
    Rewari * 907 866
    Gurgaon 960 927 867
    Faridabad 920 894 898

    * Not available.

    Sources: Census of India 1981, Series 6, Haryana Part IV A, Social and Cultural Tables. Census of India 1991, Series 8, Haryana Part IV A – C Series, Social and Cultural Tables. Report and Series on age Series I, Census of India 2001.

    Table 10: Percentage of Women Who Underwent At Least One ANC, Urine Test, Blood Testand Ultrasound during Pregnancy by Sex of Live Births

    Parity ANC Urine Blood Ultrasound Male Female Total Male Female Total Male Female Total Male Female Total

    1 21.0 20.4 20.8 17.2 18.4 17.8 15.9 16.0 16.0 3.5 4.9 4.2 2 19.4 15.5 17.7 16.4 13.4 15.1 14.7 12.5 13.8 3.2 3.6 3.4 3 16.9 12.8 15.1 14.3 11.5 13.1 13.0 9.7 11.6 5.0 1.6 3.5 4 10.8 12.2 11.5 9.1 10.8 10.0 8.6 10.0 9.2 4.0 3.1 3.5 5 11.4 11.8 11.8 10.5 10.2 10.5 10.0 9.1 9.8 5.0 3.7 4.7 6 13.3 9.6 11.8 15.0 9.6 12.7 13.3 7.2 10.8 7.5 4.8 6.4 Total 17.8 15.7 16.8 15.0 14.0 14.6 13.7 12.4 13.1 4.0 3.5 3.8

    Source: Same as Table 2.

    Economic and Political Weekly January 6, 2007 onwards. Thus, it can be concluded that from the third pregnancy onwards the chances of a female foetus being aborted is more after the ultrasound.

    III Summary and Conclusions

    This paper focuses on some indirect evidence of the practice of sex selective abortion in Haryana. In rural Haryana, ample evidence of sex selective abortions is to be found. In the context of analysis and evidence presented above, we see that total abortions (including induced and spontaneous) have increased from 1971 to 2001. Although there is an increase in induced abortion this is insignificant, whereas, the spontaneous abortion increased from 2.3 to 9.3 per 100 live births (Table 3). Before 1975, medical technology to determine the sex of the baby was not available and in the subsequent years, spontaneous abortion increased three times. As with the advancement of medical technology and use of antenatal care, it is expected that spontaneous abortions will decrease or remain more or less constant over a short period. Therefore, we assume the level of spontaneous abortion in 2001 to be the same as in 1975. Consequently, the increase in the level of spontaneous abortions is due to some induced abortion being reported by women as spontaneous. Apart from that, the use of an ultrasound in the sample population is one out of eight women, out of which one-third had undergone the test to know the sex of the foetus. Similarly, around onefifth of the women had abortions, out of which more than onethird had sex selective abortions. The figures for ultrasound tests seem to be low as many women may not have reported the results because of awareness about the PNDT law. Thus, women may not have directly reported the induced as well as sex selective abortions, but may have reported it as a spontaneous abortion. Nevertheless, the study provides useful information on and insights into the clandestine practice of sex selective abortion in India.

    As we have entered the 21st century, there is a hope that our fight against patriarchy and violence against women would end. However, modern technologies have brought with them the creation of new hurdles for women.

    EPW

    Email: unisa@iips.net

    [An extended version of this paper was presented at international conference on ‘Female Deficit in Asia: Trends and Perspective’, organised by Asia Meta Centre and CPED-CICRED-INED at Singapore, December 5-7, 2005.]

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