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Un-Natural Selection: Female Feticide in India | The Public Health Advocate

Un-Natural Selection: Female Feticide in India

This article was originally published in our Spring 2021 print issue.


India’s skewed sex-ratio due to mass sex-selective abortions is based on the perception that women should be valued less than men in society. 

The Issue of Sex-Selective Abortions

A pregnant woman sits alone with her thoughts inside the cold, empty hospital consultation room in India. She simply wants to make sure her baby is okay, but in the back of her mind, she knows there is a lot riding on whether the baby is a boy or girl. She knows it is illegal to ask the doctor to disclose information about the sex of her baby, but is desperate to please her husband and in-laws with the news of a son. In the United States, finding out the sex of a baby is simply another regular milestone that parents undergo during pregnancy. Normally, the moment is filled with excitement and love, but that is not the case for women in India.

A poll by the Thomson Reuters Foundation found that India is ranked the most unsafe country for women. Their culture of perpetuating female inferiority and subordination contributes to a vicious cycle of mass sex-selective abortions and female feticide, which has exacerbated crimes against women. Sex-selective abortions, also known as female feticides, occur when female fetuses are aborted due to a cultural preference for sons. In India, the cause for female feticide is the overwhelming belief that women have less societal value than men. A lack of education among women, insufficient female leadership, and negative perceptions of women as “economic burdens” contribute to this view.

History of Female Feticide

Professor Anibel Ferus-Comelo, a professor at the UC Berkeley Goldman School of Public Policy specializing in labor and gender studies in India, explained that “before technology, it used to be that births were just ‘hidden’ because of female infanticides. Baby girls were killed, and it continues among the population that cannot afford or do not have access to technology or medical clinics.”

In the 1970s, medical diagnostic testing using ultrasounds became available to determine the sex of a fetus during pregnancy. Using high-frequency sound waves, ultrasounds can display accurate images of a fetus within the mother’s uterus to understand fetal health, positioning, and visualize potential problems during pregnancy. However, a tool meant to help families prepare for a new life exacerbated India’s existing infanticide issue. Since sex determination technology became available in the 1970s, India is estimated to have about 63 million fewer women.

Female feticide based on sex-determination testing is a relatively new practice. It skyrocketed in India around the 1990s when ultrasound technology became widespread among upper-class and upper-caste society members. When the Indian government became aware of this technology, they passed the Pre-Conception and Pre-Natal Diagnostic Techniques Act (1994), which made it illegal to determine the sex of a fetus unless it was necessary for urgent medical reasons. Despite the illegality of sex determination testing in India, this policy’s efficacy varied upon jurisdictional enforcement, which resulted in the continuation of mass sex-selective testing and abortions. As a result, it is estimated that there will be 6.8 million fewer female births by 2030, precisely due to the consistent practice of sex-selective abortions.

Root Causes Behind Female Feticide

Sex-selective abortions and female feticide are rooted in Indian patriarchal perceptions. From a cultural standpoint, Indian boys maintain the family legacy as they carry the family name and typically perform funeral rites for their parents, allowing their souls to have safe passage. These perceptions have bolstered the mentality that parents should value their sons and treat them with more pride and respect than Indian girls who are less valued in society. Although this view has become outdated among more globalized nations, India’s urban and rural areas continue to believe that women should be confined to their roles as caretakers and mothers.

Economically, boys have always been viewed as the “breadwinners” of the family. They have held the burden of getting a job and providing for their family. However, girls have continually been viewed as an economic burden, especially during marriage. In India’s rural areas, it is still common for girls to get married at a very young age. According to Girls Not Brides, a global partnership that aims to end child marriage, about 27% of girls in India are married before turning 18. When girls are married, their parents are expected to pay a “dowry” to the groom’s family, which is essentially a payment in cash, food, household items, and clothes. Professor Ferus-Comelo mentioned that dowries are “a very degrading practice. It almost symbolizes that you have to pay someone to take your daughter.” She further elaborated that the practice continues to be maintained, except that “Dowries are not necessarily called ‘dowries,’ but sometimes they are called ‘gifts,’ and that there are many other nomenclatures and euphemisms for them.” Once married, daughters are expected to take their husbands’ last name and move in with their family to begin their role within the home. As a result, young girls are often not well-informed, confident, or financially independent enough to make educated decisions about pregnancy and children.

The political culture in India further exacerbates the perception that women should be treated inferiorly. In the 1980s, political propaganda in India and the United States portrayed slogans such as “Pay 5,000 now, save 50,000 later” directed towards South-Asian communities to encourage them to pay the cost of sex-determination technology than having a daughter and bearing an economic cost in the future. Professor Ferus-Comelo remarked that, “The same ads, now decades later, have come back with the clinics offering the same possibilities, and it shows that there is still a market for sex-selective abortions even in the United States.” She also explained that the rise of the Hindu political right has furthered, “notions of womanhood tied exclusively to the heteronormative wife and mother roles. This then restricts women’s abilities to break out of these molds.”

Objectively, the preference for sons over daughters is further supported by data. Boys are more likely to receive higher quality medical treatment and food. On the contrary, girls have less access to quality healthcare, education, and work. The problem of female feticide in India is multifaceted with cultural, economic, and political factors, and each aspect reinforces the attitude that women’s lives should be valued less than men’s.

The Legality of Abortion in India

Both government and private entities provide healthcare services in India. However, government services are rare and lack the high quality of treatment, while private services provide a high standard of care but are not affordable to most of the population. Furthermore, Indian health insurance is not mandatory, and employers do not have a legal obligation to provide insurance to their employees. As a result, 70% of the population does not have health insurance, meaning that they have to pay for most services and procedures out-of-pocket.

Abortion is one of these procedures. Abortion is legal in India, but sex-selective abortions, abortions solely based on the sex of the fetus, are illegal. Legal abortions are performed strictly at the discretion of the physician. The woman does not have the right to choose whether she would like to have an abortion. A physician can perform a legal abortion if the fetus has any abnormalities, if the pregnancy is life-threatening to the mother or the fetus, if pregnancy occurred due to the failure of contraception in married women, and if the pregnancy resulted from instances of sexual assault or rape. In India, legal abortions can be performed within the first seven weeks of pregnancy using an abortion pill in the presence of a medical professional. However, after the first seven weeks have passed, surgery is required to abort a fetus to maintain the safety of the woman’s life. Insurance companies would cover some medical costs only if the pregnancy were terminated due to a medical threat to the woman’s life. Otherwise, the woman has to bear the total economic cost.

This raises an important question: why do women not have the autonomy to make decisions about having an abortion? Autonomy is not simply about making individual choices, but it also involves economic autonomy or independence. Even if a woman wants to have an abortion for medical reasons but cannot afford to, she may have to turn to unsafe or illegal options. Obviously, due to the illegal nature of sex-selective abortions, a woman’s only option is to use illegal or unsafe methods.

Exacerbation of Life-threatening, Sex-Selective Abortions by the Pandemic

Although abortion in India is legal, illegal abortions currently outnumber them because most abortions in India are solely based on the fetal sex preference for boys. Almost ten women die every day of unsafe, illegal abortions in India. According to India’s health ministry, nearly half of abortions are conducted in hazardous and unhygienic conditions and are often performed by untrained physicians or healthcare professionals.

Since sex determination tests are illegal within India, many women opt-in for diagnostic testing (conducted illegally by gangs), take sex selection drugs (SSDs), or try “old-wives tale” remedies to change the sex of the fetus after conception. Still, many women are unaware that the fetus’s sex is determined during the fertilization of the egg by sperm and cannot be changed after that. The mother donates an egg, which always contributes an X chromosome to the fetus’s genome, while the father’s sperm can contribute either an X or a Y chromosome. If the sperm contributes an X chromosome, the fetus will be a girl, while a Y chromosome indicates that it will be a boy. Not only are many women uninformed about this concept, but they take harmful drugs containing synthetic chemicals and heavy metals that often result in congenital disabilities and stillbirths.

Social Impact of a Skewed Sex Ratio

Studies show that countries with imbalanced sex-ratios tend to have a more violent culture. According to Professor Ferus-Comelo, “crimes against women, particularly by upper-caste on the lower-caste, continues when the signal goes out from the top-down that violence is okay and that they deserve it because they are beneath our level.” This can be observed in India’s north and northwestern states where the highest gender disparities exist and power is centralized among criminal gangs called goondas. Studies have shown that when there is an enormous surplus of men within countries with a skewed sex ratio (30+ million within India), they are unlikely to obtain stability economically through labor or socially through marriage. To gain economic stability, men are more likely to join criminal gangs. In order to gain social stability, men seek out marriage. However, in some areas where the ratio of women to men is alarmingly low, men cannot find girls to marry. As a result, brides are “purchased” from other areas leading to forced marriages and human trafficking. Professor Ferus-Comelo remarked that, “one would think, logically, that if there are fewer women, their value actually rises. Their value in the marriage market should increase. But, that is not the case.”

COVID-19 has exacerbated this issue as women are more likely to seek unsafe or illegal abortion options since medical professionals and resources have been redirected to help combat the pandemic. Even before the pandemic, domestic violence has been an immense problem in India. In 2018, “Cruelty by Husband or His Relatives” accounted for 32% of all crimes against women registered by the police amounting to over 100,000 cases. Due to quarantine orders, women are more likely to be trapped with abusive partners or lack access to contraception. Many Indian women who are victims of domestic violence have limited education and are usually unable to be financially independent. They have inadequate options and resources because they cannot turn to their parents due to social stigmas, or their parents cannot take them in due to financial burdens. However, the future looks optimistic as more organizations such as Shakti Shalini, Rise Up, and SNEHA Crisis Helpline are working to provide health and sexual education to girls and women in India to inform them about safe sex practices, contraception, and resources for domestic violence survivors.

Solutions

Professor Ferus-Comelo explained that as more young people become exposed to other cultures and lifestyles, “people have higher expectations of one’s own culture.” She continued to explain that, “there has been a very positive, inspiring awakening of women when their worlds have been constrained, and they know there is greater potential.” The only way to combat the issue of such a complex problem of female-feticide is to solve the root causes: skewed political propaganda, and a lack of economic opportunities, and unenforced legislation.

South Korea, which also faced a severely skewed sex-ratio, implemented solutions that have shown promising results, and many Indian government officials are looking to emulate their approach. They improved, enacted, and strictly enforced laws that prohibited female feticide, encouraged and provided opportunities for more women to enter the labor force, and used the media to mobilize support for their initiatives.

India should work to allocate more resources to better enforce the Prohibition of Sex Selection Act. Although the government launched a similar campaign in 2015, it was unsuccessful. To improve their efforts, experts recommend that the government should charge doctors who conduct illegal sex determination testing with hefty fines and strengthen detection for illegal clinics and services provided by gangs.

Most importantly, the government should promote women’s education, provide better opportunities for women to enter the labor force, enable more women to serve political positions, and enact equal inheritance laws. Furthermore, health education on domestic violence awareness and safe sex practices should also be provided for men. Female education is one of the most influential factors in reducing gender discrimination and sexual violence. Studies prove that exposure to female leadership leads to a significant decrease in the gender gap for educational attainment (32%). Moreover, introducing cable television to India’s rural areas and playing shows that had strong female characters or women in power caused preference for sons to decrease by 12% and school enrollment for children to increase by 5%. If women have better access to quality education, they can have better opportunities to enter the workforce and become financially independent. Professor Ferus-Comelo expressed that, “economic independence leads to less discrimination. If girls and women had equal access to wealth and income and legal inheritance rights, they could have a sense of economic independence, then these kinds of norms are going to change.”