"Most of India's population now live[s] in states where selective abortion of girls is common." This is the 24 May 2011 conclusion by The Lancet after it assessed sex ratios in India by studying three rounds of the nationally representative National Family Health Survey covering the period from 1990 to 2005 and the birth cohorts of children aged 0—6 years in the 1991, 2001, and 2011 censuses. Particularly focusing on second-order births—that is, studying the sex of the second baby when the first is a boy versus when the first is a girl—the study makes two especially telling findings: wealth and higher education do not remove gender biases.

The findings are no shock, they simply bear out what feminists have been pointing out for so long, so painfully: we need a holistic change in our attitude towards girls and women—in their birth, education, upbringing, marriages, employment, and death—if we truly care about the millions of 'missing girls' in India. Otherwise we will continue to make ineffective laws and policies; hold misdirected public advocacy campaigns; conveniently socially shame a few easy targets; and continue to have studies point out the obvious truth: our daughters are unwanted.

Baby girls are unwanted in even the most wealthy and most educated homes, so it is no surprise they are not wanted in homes that have less wealth and education and thus fear more insecurity in the first place. Girls—whose vulnerable modesties must be protected, wedding dowries must be paid, and socio-economic positions are insufficient to ensure parents' economic stability or security—are seen as burdens and liabilities for their families. The selective abortion of females both represents and reinforces this devaluation of girls and further entrenches gender prejudices. But sex-selective abortions are a mere symptom of the problem—girls become women, who have an entrenched unequal position in our society. It is neither likely possible nor desirable to improve the sex ratios without examining their underlying causes.

First, it is not possible to improve the numbers in isolation. From a policy perspective, there are three possible responses to a widespread social problem such as sex-selective abortions: criminalization, regulation, decriminalization.



Responding to embarrassing and alarming census figures, and pressure by NGOs, India criminalized sex-selective abortions in 1994 through the Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act ("PNDT Act"). However, as such abortions increased rather than decreased in the decade following the PNDT Act, it was amended in 2003 to the "Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection)" ("PNDT 2003"). PNDT 2003 imposed a limitation on the use of the newest pre-conception diagnostic procedures to those situations in which their use is medically necessary and also mandated the imposition of stricter registration requirements for ultrasound providers. Additionally, the amendment addressed the criticism levied at the 1994 PNDT Act that it targeted traditional clinics but failed to sufficiently take into account the portable "clinics," or battery powered ultrasound machines set up in the back of vans. But legal enforcement of even PNDT 2003 has been very difficult. Doctors often choose to ignore the mandate of the law in exchange for hefty fees. Results of sex-determinative tests are often given orally—any of us can take an informal survey of gynaecologists and learn signs such as "one thumb up, means a boy." Further, ultrasound machines, which are regularly used by physicians for legitimate purposes during the second and third trimesters of pregnancy, also divulge the sex of the child. Regulation of private communications between physicians and patients during ultrasounds is extremely difficult.



While policy makers have not yet entertained regulation as a legal response to sex selection, potential regulatory measures are easily imaginable. Sex-selective abortions have become an industry, and regulations could aim at curbing this industry by checking providers and better informing their clients. For example, regulations could ban public advertisements promoting sex selection, impose mandatory medical evaluations of women seeking sex-selective tests and abortions, and require counselling for couples considering abortion. But, regulation could be tantamount to decriminalization, given how laws are not uniformly enforced and corruption is rampant. Some of the above regulation methods have already been tested—the notorious "Spend 5000 now, Save 50,000 later" advertisements are more of an exception in recent years—and remain ineffective in the face of deeply engrained societal prejudice against daughters, as is borne out by recent studies.



Finally, decriminalization of sex selection would validate social biases against the girl child and would perhaps encourage more sex-selective abortions. Given the current trends, it would certainly not improve the numbers.



Moreover, it is not even desirable to improve the numbers, in isolation. Criminalization, regulation, and decriminalization are all inadequate feminist responses to sex selection. While the lack of enforcement of the law is a serious problem in the campaign against sex-selective abortions, the successful implementation of the PNDT Act and PNDT 2003 also poses troubling issues for the women involved. Women are thus in a double bind—on one hand, their families pressure them to produce sons; on the other hand, the law threatens them if they undergo sex-determinative tests or sex-selective abortions. Given that women are pressured not to birth girls, punishing women who undergo sex-selective abortions is punishing the very victims of the double bind. Besides, criminalization also threatens women's health by pushing them to illegal providers and also may encourage practices like infanticide. Similarly, regulation could also endanger women's health by limiting access to important information; threatening doctor-patient confidentiality; and opening women to harassment. And decriminalization of sex-selective abortions validates society's prejudice against the girl child and fails to provide legal protection to those women who might be coerced into sex-selective abortions by their families. Given the inadequacies of all these alternatives, it is not surprising that non-legal options, in the form of campaigns and public initiatives, have been pursued in an effort to eradicate sex-selection.

Such campaigns and public initiatives have adopted the tactic of "naming, blaming, and shaming." Those indulging in sex-selective abortions are made to feel guilty and thus encouraged (or at times forced) to give up this practice. For example, the much- acclaimed 'Nawanshehar model' to eradicate sex-selection in Punjab. Nawanshehar local authorities claimed that their efforts raised the sex ratio above 900 girls to 1000 boys in 77 villages. The Nawanshehar approach included public awareness campaigns by NGOs, students, and volunteers. NGOs were allotted vehicles to drive through villages, playing popular songs on loudspeakers and disseminating information about the value and worth of the female child. They denounced sex selection and warned people that engaging in sex-selective abortions has dire implications for women. Press releases and advertisements were used to encourage cooperation among doctors, journalists, politicians, and common citizens. Also, pictures of Indian female role models, such as the young tennis player Sania Mirza, were posted in some villages in this district to serve as inspiration. So far, so good. But the 'model' also involved vigorous shaming tactics. The District Commissioner, galvanized a team of informants that included his staff, NGO workers, village officials, health care workers, and various volunteers, including students. This group tracked pregnancies to ensure that no female feticide occurred in the district. Kumar's staff maintained a database of pregnant women which they used to call families and 'alert' them that the DC was aware of the impending pregnancy. A 'hotline' telephone number was set up so that villagers could call when they believed a woman was considering an ultrasound or an abortion. Citizens were paid Rs. 5000 for providing such information. The DC's office also employed college students to provide information in return for monetary rewards. Upon receiving information from any of the aforementioned sources, the DC's staff paid a visit to the woman to verify the information received. In one reported case, officials arranged a "mock funeral" outside the home of a woman who had had a sex-selective abortion, and volunteers chanted prayers for the fetus and shouted "girl-killers."



Although the strategy employed in Nawanshehar reportedly produced statistically favorable results, it must be critically evaluated. The Nawanshehar model does not threaten women's general right to abortion and seems within the legal bounds of the Medical Termination of Pregnancy Act (1971), under which, abortions are legal up to the twentieth week of pregnancy. Ultrasounds, which were policed in Nawanshehar, do not determine the sex of the child before at least the 26th week. This means sex-selective abortions of female children based on ultrasound results would otherwise be illegal because of the timing of the abortion. Despite its legality, the Nawanshehar strategy is potentially harmful to women. Women who undergo sex-selective abortions do so under familial and societal pressures. The shaming techniques used in Nawanshehar penalize the woman, who might be simply acting on her family's behest. They ostracize the woman, adding to her emotional turmoil. The system also involves the invasion of a pregnant woman's privacy for at least a few months. Villagers, including young children, are provided monetary incentives to "report" pregnant women. Further, monetary incentives raise the concern about false reporting and undue harassment. These programs realize success at the expense of women's rights and autonomy. Further, besides its negative consequences for women's privacy, the model is also likely unsustainable. Preventing sex-selective abortions through policing and shaming women and families may be a short-term solution, but it hardly changes the social and political forces in which women are devalued—the very forces that caused sex selection in the first place.



As women and families begin to feel the pressure of external campaigns, they may begin to resort to unlicensed providers and resist medical care, endangering the health of the women and their babies. Worse yet, in some areas women are returning to the age-old practice of infanticide. Thus, awareness campaigns focusing on the skewed sex ratios do not solve the problem, and in some cases they promote reactions that might hurt the women involved. The Nawanshehar efforts exemplify why the effective enforcement of the PNDT Acts may not be the best route for sustainable change.

Acts of resistance by women themselves provide the seeds for such change. Activists face many challenges in working to combat sex-selective abortion. Unlike dowry or child marriage, abortion—the new agent of patriarchy—is not itself an anti-feminist activity. To usher in true gender justice, activists all must attack all forms of patriarchy instead of simply locking horns with sex selection. To this end, activists need increased support from other women and men alike. It is generally accepted that India has always been patriarchal. Most times this patriarchy is accepted as 'culture'—whether in justifying the different standards applied while raising sons versus daughters; the different resources made available for education; the different expectations at weddings; the different allotment of household work for husbands versus wives and sons versus daughters; the different value placed on respective careers; the different demands on sons-in-law versus daughters-in-law; the different treatment of parents who live with married daughters versus sons; the different reactions to inheriting family name or property as a son versus a daughter. Given all the differences, it should be no shock that the girl, when she readies herself for mothering the next generation, does not favour birthing a girl.



If we are serious about responding to studies such The Lancet study, we have to adopt one solution: fighting against deeply ingrained societal prejudices. This fight begins at home—during our birthday parties, our weddings, our Lohris, our living-room conversations. This fight requires courage. This fight alone will help us find our "missing" girls, our missing balance and equality.

Mallika Kaur (JD/MPP, Berkeley/Harvard) focuses on gender issues in South Asia and the U.S. and is the author of "Lessons from Punjab's "Missing Girls": Toward a Global Feminist Perspective on "Choice" in Abortion," California Law Review, June 2009.

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