Illustration by Marium Ali.

A few years ago, somewhere in Quetta lived a beautiful young woman with her two girls and a husband renowned across the city as among the best sonologists. The couple decided to have a third baby in the hopes of having a boy this time round. A few months into the pregnancy, however, it dawned on the woman that her life is not as precious as the foetus inside her womb. The baby on the way was a boy and things had changed for the mother. It was almost as if she had ceased to exist.

Doctors routinely take an oath to preserve life and to renew it. But in this case, the sonologist threw caution to the wind. Some months in, the woman’s consultant gynaecologist warned the family that continuing with the pregnancy would be risky for the mother. In fact, the mother-to-be threatened to abort the pregnancy herself if her doctor’s advice was not heeded. But the sonologist insisted on forging ahead, come hell or high water.

But the woman’s health did deteriorate over time. A few weeks before she was due, she was rushed to the hospital for an ultrasound. Doctors detected neither foetal movement nor a heartbeat; they advised an induced abortion to save the mother’s life and that too immediately. But the husband wanted to seek a “second opinion” — it was, after all, a male foetus.

The couple returned home that day only to return the next morning. But the woman succumbed to the unnecessary delay; her body was too frail to resist the toxins being released from the dead foetus a day more. Amid the sobs of her girls, she passed away, holding her peace and with it, her dreams and ambitions and perhaps those of her daughters too.

The best kinds of people are those with daughters whom they raise to be sons, but no one raises their sons to be their daughters. In fact, most don’t want a daughter to begin with

“It was outright murder and I believe her consultant was equally responsible in the crime, for she let her patient go home because of what her husband wanted,” says Dr Agha Xaher Gul, Head of Business Strategy at Marie Stopes. Dr Gul was completing his house job at the time; he says the incident shook Quetta. But then again, thousands of women have succumbed to their husband’s maddening pursuit to have a son. This case was no different.

Of late, the trend of aborting a pregnancy if it’s a girl has caught on across Pakistan. Although data on abortions because of the sex of the foetus remains scant, the Population Research Institute, a non-profit research group, released some worrying statistics: of the 24 million sex-selective abortions performed during 2000-2014 across the world, more than 1.2 million were estimated to have been carried out in Pakistan.

To put it simply: over 15 years, approximately 219 pregnancies were terminated every day on the basis of their sex.

While many doctors shrug off this statistics claiming it to be untrue and unsubstantiated, veteran gynaecologist Dr Shershah Syed expresses the likelihood of its legitimacy, adding however that some might have been done as family planning.

Babies are now being sold in the name of adoption,” claims Faisal Edhi, alleging that some NGOs and welfare organisations are also involved in it. This mafia lures the parents into selling their babies instead of dropping them in cradles. Then they sell these children on further for hefty amounts to adoptive parents.

“Sex-selective abortions are not uncommon and most likely these numbers are correct,” says Syed. “Nobody can give exact figures but educated and uneducated people both try to find out about the sex of the foetus and go for an abortion if it is not a boy. The picture is grim as far as the girl child is concerned. Nobody cares about them and they are the cause of tension in families.”

ANXIETIES IN ADOPTION

In the heart of the Karachi, in an old building, philanthropist Sarim Burney is sitting with a married couple. The woman is pregnant with her third daughter; they have just had an ultrasound done to confirm the sex. The couple is there to inform Burney that they will abandon their baby after birth if indeed it is a girl. In case the ultrasound sex prediction proves inaccurate, they will keep the newborn.

Burney tries to reason with the man not to discriminate between a boy and a girl. But the man insists he cannot afford another daughter due to lack of resources.

“The couple returned to the trust after a few months with an adorable baby girl,” recalls Burney. “We offered an adequate monthly stipend to keep their daughter at home with them but they left the baby at the trust. Had we forced him to take the daughter back, the father would have dumped her or sold her off somewhere. We felt it was better to keep her with us.”

Philanthropist Bilquis Edhi echoes the narrative.

“Everyone wants an inheritor,” says Bilquis. “We keep talking about Islamic values but do not follow them in our lives which teach us daughters are blessings,” she adds while expressing her resentment over gender discrimination that claims the lives of many born and unborn girls. Sitting cross-legged on her bed casually, she is talking to Irfana, a widow, who has flown to Pakistan from the US to adopt a boy.

Bilquis worked side by side with her late husband, Abdul Sattar Edhi. She has seen it all before — the beaten wives, the distressed children, the abandoned babies and numerous little dead bodies. She has many stories to tell, mostly heart-wrenching, of infants who were found dead from trash dumps nibbled at furiously by animals.

One such doctor is Dr Mahjabeen Khan. She discusses a case where a husband stood outside the labour room, threatening his wife of divorcing her if she delivered a girl. “The baby was not even completely out when the patient sat up to check its gender. She had given birth to her eighth daughter and went in shock soon after,” recalls Dr Khan. “It was a normal case till then but suddenly complications arose because of the husband and his desire to have an heir. I can still hear echoes of him screaming. It was quite traumatic.”

“But one of them survived,” she exclaims as the bitter-sweet memory strikes her mind, “she was very beautiful, had fair skin and long, curly eyelashes, but was cruelly bitten by dogs.” Moving her hand toward her cheek, she gestures that the baby’s right cheek was badly gnawed at. She underwent major surgeries and survived.

But while this baby was a warrior, the 12-hours-old girl found from a trash dump in the Gulistan-i-Johar locality earlier this year in April wasn’t. She died just hours after her birth despite receiving emergency treatment. The same month, an eight-month-old Eman was burnt alive along with her mother in Muzzafargarh by her very own father. She too survived miraculously unlike her mother, who met her fate for giving birth to an unwanted child — a girl.

The fact that the majority of babies recovered from garbage dumps are girls, the fact that most of the babies left in Edhi cradles, hospitals and maternity clinics are girls, the fact that less girls are born in Pakistan than boys and the fact that the primary and secondary school participation of girls is small in number in contrast to boys, is not just mere coincidence. They are all tied together and point to the mindset of our society — the obsession to have sons, and the savagery and discrimination that results as its consequence.

Of course, this is not the phenomenon of every Pakistani household – some are content with the children they have. There are some who avoid a family with no son, and then there are those who nip the problem in the bud to maintain their ideal family. They all are part of this society.

Pakistan’s sex ratio at birth (SRB) is fairly skewed. Typically the sex ratio at birth usually oscillates around 105 male births per 100 female births. In Pakistan, it is estimated to be 109.9. In other words, around 110 male births per 100 female births; this is close to India which is infamous for sex-selective abortions.

Our society runs on a skewed gender valuation system in which sons enjoy pre-eminence as they are economic resources, support for elderly parents and, most importantly, prolong the family’s patrilineal lineage. Those considered the best kinds of people are parents with daughters whom they raise to be sons, but no one raises their sons to be their daughters.

“Every strata and socio-economic segment of society is engulfed with this craze, regardless of their social, economic and educational background,” explains Faisal Edhi, Bilquis’ son. “The rich want an heir to continue their legacy and the poor want a future breadwinner for the family. In short, everyone wants sons.”

But is the desire for survival so intense that people would dump and dispose of their flesh of blood?

“The reason children are thrown in the trash is not that they are illegitimate,” argues Faisal, “nor is it poverty. It is their sex, it is because they are girls.”

Faisal believes that people are “exploiting” ultrasound technology to determine the sex of the child before birth and choose whether or not to bring a girl child to this world. Those who do not get a chance to abort the pregnancy throw them in garbage dumps, offering them as food to street animals and leaving them to die a cruel death. It was for this reason that Abdul Sattar Edhi had begun a cradle service, encouraging people with “unwanted” babies to let those newborns have a lease on life.

Without legal oversight into the health sector, parents dumping their babies into trash dumps evade charges of second-degree murder. But when it came to the Edhi Foundation’s cradle service, they came under attack for encouraging people to have kids out of wedlock.

“We have received severe backlash in the past and still face criticism from religious conservatives,” says Faisal irately. “They want these children to die as if they have no right to live.”

Of all the deserted babies found alive in the country, claims Faisal, about 90-95 percent were baby girls. He also notes that for every newborn boy left in an Edhi cradle, there are seven newborn girls.

The fact that the majority of babies recovered from garbage dumps are girls, the fact that most of the babies left in Edhi cradles, hospitals and maternity clinics are girls, the fact that less girls are born in Pakistan than boys and the fact that the primary and secondary school participation of girls is small in number in contrast to boys, is not just mere coincidence. They are all tied together and point to the mindset of our society — the obsession to have sons, and the savagery and discrimination that results as its consequence.

And yet, the Edhi Foundation claims to receive a drastically lower number of babies from their cradles across the country as they did a decade ago. But if you think that this indicates things are getting better, think again.

“Babies are now being sold in the name of adoption,” claims Faisal Edhi, alleging that some NGOs and welfare organisations are also involved in it. This mafia lures the parents into selling their babies instead of dropping them in cradles. Then they sell these children on further for hefty amounts to adoptive parents.

“Sometimes a third-party agent or a middleman is involved too,” explains Faisal. “They are not unwanted children. They are planned babies, brought to this world to make money, often by families stricken with poverty.”

To back his claim, he discusses a case of receiving an application for adoption, only to be withdrawn later. When asked why, the applicant told them that they had adopted a baby through an agent from a family in Ibrahim Hyderi, an impoverished locality in Karachi. “This was when I came to know about all this,” he says.

Faisal Edhi recalls the smuggling of newborn infants to Malta in the early 2000s and how millions were allegedly earned by selling Pakistani babies abroad. Bilquis Edhi also speaks about how an educated couple adopted a child from the Edhi Centre and sold the child on later. “The incidence of baby boys being sold is twice as much as baby girls,” states Bilquis Edhi.

EXPECTATIONS AND THE BLAME GAME

The society we all make, let alone the husband and in-laws, asserts immense pressure on women to give birth to a boy. A pregnant woman is often bestowed with prayers that she may be blessed with a son and never with a daughter. In cases where parents withhold information about the infant’s sex, expectations are associated with the mother based on old wives’ tales such as the shape of her baby bump or the way she walks. Silly it may sound, but it happens nonetheless.

If those blessings go in vain and a woman fails to meet the high expectations, she is lambasted and ridiculed so much so that it affects her mental health and well-being. Sharing the story of her distant relative who couldn’t sustain the torture after giving birth to her fifth daughter, Bilquis Edhi explains that it is men who determine the sex of a baby (by passing on either the X chromosome, which makes a girl, or the Y chromosome, which makes a boy). In Pakistan, however, women are routinely blamed for giving birth to a girl.

Source: Pakistan Bureau of Statistics

Given this dichotomy, it is routine for doctors to not disclose the sex of the baby in the first place. Almost all doctors interviewed agreed that parents insist on revealing the sex for shopping or naming purposes, but what happens after in case it’s a daughter proves to be something else. But since there is no law against foetal sex disclosure, doctors comply with the request if parents insist or are aware of it. “If parents are extraordinarily curious to know the sex of the baby, this puts us on guard,” says Dr Srah Sabah Khan, who is completing her house job at the Jinnah Postgraduate Medical Centre in Karachi.

Dr Shakira Parveen, associate gynaecology professor at the Civil Hospital Karachi, says she also rebuffs requests of revealing the baby’s sex. She says it can “create trouble for the doctor.” If the patient has a strong desire for a baby boy but is carrying a girl, she can get tense and hypertensive, which leads to complications in smooth pregnancy.

“Almost 70 percent of my parents are not happy when they get to know that their child will be a girl,” narrates Dr Parveen. The doctor adds that the reaction of parents after delivery is not as negative as when they get to know the gender before birth.

“Sometimes it is the mother who is unhappy with the birth of a daughter because of the stigma attached to it,” she says. “Mothers think that a son can help them get a strong place and respect among their in-laws.” Dr Parveen advises parents not to blindly trust ultrasound results as they can be inaccurate and create difficulties in accepting the fact later.

Every gynaecologist, at some time in their career, has witnessed prenatal and postnatal discrimination against newborn baby girls. One such doctor is Dr Mahjabeen Khan. She discusses a case where a husband stood outside the labour room, threatening his wife of divorcing her if she delivered a girl.

“The baby was not even completely out when the patient sat up to check its gender. She had given birth to her eighth daughter and went in shock soon after,” recalls Dr Khan. “It was a normal case till then but suddenly complications arose because of the husband and his desire to have an heir. I can still hear echoes of him screaming. It was quite traumatic.”

Discrimination can also be weighed with the amount of risk parents are willing to take to deliver their unborn child.

“Most parents do not take a risk if they know they are having a boy. Even if there is no need for a C-section, they insist to go for it to ensure zero threat to their unborn son’s life,” Dr Parveen says. “But many parents resist a C-section to deliver a baby girl despite doctors’ recommendations to the contrary.”

The senior gynaecologist also highlights that if two patients of the same name deliver babies at the same time, a boy and a girl, both families would be willing to claim the boy.

“I have seen a case where families were misinformed about the gender of their baby initially because of similar names of patients,” she recalls. “Later, when they were told the sex correctly, the family who had had a boy was over the moon while the other disowned their baby.”

THE CURSE OF CONCEPTION

Hilda Saeed is a founding member of Women’s Action Forum (WAF) and has seen more than most. She recalls a pre-Partition story that still rankles:

“There was a Hindu woman street vendor who’d sell purified butter and papadums, and at times handicrafts, in the neighbourhood. For some time, she’d stopped selling till one day, she reappeared. When asked about her prolonged absence, tears gushed down her eyes. The woman had given birth to her third daughter. But she wasn’t crying because of that little creature. It was the ignominy that flashed back in her mind, the humiliation of being forced to parade naked around the village on a donkey wearing a garland of black shoes around her neck. Her husband was behind that, as retribution for delivering a girl.”

Seventy years on and things seem at a standstill.

Pakistan’s sex ratio at birth (SRB) is fairly skewed. Typically the sex ratio at birth usually oscillates around 105 male births per 100 female births. In Pakistan, it is estimated to be 109.9. In other words, around 110 male births per 100 female births; this is close to India which is infamous for sex-selective abortions.

An in-depth analysis of the data from all five censuses conducted in Pakistan since 1951 also reveals that the male population has constantly dominated female population in numbers. As of the 1998 census, Pakistan’s overall sex ratio was 108.5 males per 100 females or 925 girl babies per 1,000 boy babies. When classified further, the distortion is found worse in Balochistan (114.6) and Sindh (112.2).

Although gender imbalances at birth are attributed to a set of local factors in each country, they are generally observed in regions with persistence of patriarchal norms and son preference. These are typically countries where people have easy access to sex-detection technologies and pregnancies are terminated on the basis of gender. This practice is known as female foeticide and is quite common in China and India. Pakistan, however, doesn’t have as skewed a SRB as its two neighbouring countries, but researchers suspect the problem is alarming because of the inordinate delay in carrying out the population census.

“With the advancement in science and technology, couples can choose the gender of their child before birth,” claims Mr Wajid of the Right Choice conception clinic. “Having a success rate of 95 percent, the procedure is not surgical.”

Right Choice sends a prospective couple a detailed chart mentioning the woman’s ovulation days and guidance to conceive their preferred gender after examining their initial reports. During a brief conversation over phone, Wajid claims to have been in business for more than 17 years and to have operated from an office in Zamama, Karachi, for one year where they received a tremendous response.

However, ever since they moved to Islamabad, they are now operating online. The calendar costs 80,000 rupees (excluding 5,000 rupees for tests) which is non-refundable and is made in advance. The company operates in collaboration with a US partner, who creates the chart for the couple based on their reports and details.

For those with infertility issues, there is a package of 100,000 rupees.

When asked what if the method fails, Wajid says: “You can confirm the sex through a 3D ultrasound within 90 days of conception and abort the foetus if it is a girl. As the foetus is not a living being before 120 days, there is no harm in doing that.”

Somewhat similar to female foeticide is female infanticide, when parents neglect their female child deliberately and let them die (of starvation or thirst), resulting in their premature deaths.

Researchers have observed higher rates of malnutrition in girls because of being weaned off breast milk earlier, either to feed the baby boy or in trying to get pregnant again in pursuit of a male child. This denial of breast milk/ sufficient food often results in the loss of many innocent lives.

“A female sweeper of our hospital delivers twins, a boy and a girl. As time passes by, the baby boy continues to gain weight while the girl grows frail and dies within four months. She is starved to death gradually, in front of my eyes, as the mother found it more important to breastfeed the boy,” recalls Dr Gul.

Female foeticide and infanticide, when combined together along with the number of females who died as a result of unequal opportunities or access to resources, lead to the “missing women” epidemic — a term coined by Nobel Laureate Amartya Sen to indicate the difference between the women present on the planet and those that would have been here had the sex ratio been “natural” worldwide.

Doctors, who are interviewed, however, do not relate this imbalance to prenatal sex selection. Some of them even think the SRB in Pakistan is not too distorted to worry about.

Dr Shershah Syed believes it is difficult to control and report gender selection in a disturbed and unorganised healthcare system such as ours. “You cannot stop it. The rich pay hefty sums of money to famous doctors and have abortions while poor people go to street abortion clinics. It’s not possible to control this.”

The fees of an abortion may rise with the stages in pregnancy. The later the pregnancy, the higher would be the charges, a source shares. “Some doctors even charge around 5,000 rupees more per month, making a rough total of 70,000 to 90,000 rupees to perform the service.”

Excluding a few doctors, none of the health professionals admit the prevalence of prenatal sex-selection in the country. Nor does the research conducted by the Population Council Pakistan in 2015 confirms it (suggesting only its possibility). Some, who believe that it happens, either decline to speak on record, citing lack of information or claim it to “have not reached epidemic proportions.”

Dr Hussain Abidi, medical insurance doctor, however, says that mothers try to self-abort babies when they do not want to continue their pregnancy and are later admitted to hospitals in debilitating situations. Doctors then have no option but to perform an abortion, for medical reasons. During his tenure, Dr Abidi has witnessed cases where expectant mothers were admitted in life-threatening conditions. Later upon investigation, the cases were either withdrawn or restated with purely medical reasons to get financial cover from insurance companies.

A Glimmer Of Hope?

The picture is gloomy, but a ray of hope is flickering on the dark horizon.

Speaking about the preference of adoptive parents, Sarim Burney and Dr Mubina Agboatwalla, chairperson of HOPE, both agreed that trends have been changing.

“Adoptive parents are really desperate to adopt a baby. Nowhere have I seen any discrimination,” argues Dr Agboatwalla. “Even if they have already adopted a baby girl they will still go for the baby girl if available.”

She confirms, however, that around 70 percent of the abandoned babies left at the HOPE hospital and maternal clinics are girls. Burney adds that prospective parents prefer girls because boys are no more considered a support system for parents in their old age.

Indian social scientist and feminist activist Kamla Bhasin describes the patriarchal system as a war of resources where the man is the ‘sun (the resource)’ and women are ‘planets’ dependent on him to sustain life. But perhaps, the stars will only align for girls if women are no longer financially dependent on anyone; and instead others are reliant on them.

The writer tweets @Tanzeel09

Published in Dawn, EOS, August 20th, 2017