THE anomalous sex ratio of India’s population, of fewer women than men, first came to notice when the synchronous decennial enumeration of people was conducted in the British-occupied parts of India in the late 19th century. This puzzled the British census commissioners since elsewhere in the world women outnumbered men in the population. Unsurprisingly, it became the subject of much speculation and investigation. Over the span of 12 decades, the deficit of women has progressively increased; the number of women per 1000 men more or less steadily declined from 972 in 1891 to 933 in 2001.¹

The number of ‘missing women’ has been variously estimated from 15 to 30 million.² Demographers and population analysts along with feminists joined the debate. The deficit of females was explored with respect to their under or incomplete enumeration in the census count – higher mortality among them due to epidemics (such as plague, malaria and influenza) or deficiency diseases, or neglect, premature cohabitation and unskillful midwifery; sex selective out-migration; and high masculinity at birth.³ Except for the persistent survival disadvantage that Indian women experienced from early infancy well into the reproductive period, evidence did not support any of the other factors.

The age-sex specific death rates estimated by India’s Sample Registration System (SRS) since the early 1970s have shown that women experience higher mortality from age 1 to about 34 or 39 years compared to men. The higher mortality among girls is due to their ‘neglect’ or ‘expendable character’, which has its origin in historical, cultural, ecological and sociological causes, and manifests in not providing timely health care to girls and women in the event of an illness, including at the time of difficult childbirth, or in seeking health care for them when it is too late. It was thus more or less convincingly established that India’s low sex feminine ratio stems from women’s inferior position in Indian society.⁴

 

Since 1981, when the Indian Census started publishing data on sex ratio of children 0-6 years,⁵ it became evident that deficit of young girls was worse than the overall deficit of women in the population. Between 1891 and 2001, the juvenile sex ratio declined by 4.5 per cent from 971 to 927 girls per 1000 boys, or at a much faster rate than about one per cent in the overall sex ratio of the population. The deficit of young girls was high not only in the traditionally and historically masculine states of Haryana and Punjab, but also became quite stark by 2001 in Himachal Pradesh, Gujarat, and parts of Rajasthan and Maharashtra. In Punjab the juvenile sex ratio declined by 13 per cent from 908 to 793 between 1981 and 2001 and in Haryana by nine per cent from 902 in 1981 to 820 in 2001. Himachal Pradesh and Gujarat also experienced a decline in the juvenile sex ratio of the order of 7.5 per cent, higher than the national average decline.⁶

The recently accelerating deficit of girls has been attributed to the fact that in addition to the old practices of neglect of girl child, female infanticide and sex differentials in the provision of medical care leading to higher female mortality, parents also started opting for pre-birth elimination of daughters by using sex-selection technology and resorting to female-selective abortion. Evidently, their use spread rapidly across many regions and social groups. Analysis of both macro and micro level studies showed that the deficit of girls was much greater among the second and third child, among women who were educated beyond primary level, who were not engaged in any economic activity or who belonged to the upper castes and whose families were landed, and could thus pay for the sex determination test and abortion, if needed.⁷

 

The spread of the use of new pre-natal diagnostic techniques for sex detection led some health and human rights activists in Maharashtra state to start a campaign in the mid-1980s against their misuse, eventually resulting in the imposition of a ban in 1986 on their use in the state. Subsequently, in view of the unprecedented decline in the juvenile sex ratio, and the mushrooming of private clinics that advertised and carried out sex determination tests, the Government of India enacted the Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act (PNDT Act) in 1994. The act banned using ultrasound imagery to determine the sex of the foetus and/or revealing it to the mother. However, despite putting monitoring systems in place both at the state and the central levels, having provision for punishing the violators, and sustained campaign and public debate in the print media, the act could not be effectively enforced. A further decline in the female to male sex ratio, evident from the 2001 Census, demonstrated that these measures did not have much impact on the prevailing practices.

 

In fact, the available evidence indicated that the practice of sex detection went underground; its cost went up. Since the two activities of sex detection of the foetus and abortion (incidentally, India legalized abortion in 1971 well before most other countries. It is another matter that this step was impelled more by population control concerns than the rights of women over their bodies) need not be linked at the stage of using the services, it became possible to evade the law in connivance with the practitioners with ultrasound facilities and willing to do sex determination tests.

The act was amended in 2003 after some health activists filed public interest litigation in the Supreme Court because of its weak enforcement. The amendment included a ban on the use of pre-conceptual techniques and made rules about sale and use of ultrasound machines more stringent. The medicos were directed to display prominently that no sex determination of the fetus was permissible or practiced in their clinics. In addition, the Ministry of Health and Family Welfare, that is responsible for the enforcement of the act, constituted a central supervisory board, appropriate authorities and advisory committees at state and district levels to monitor the implementation of the act.

 

International donor agencies such as UNFPA helped in developing national advocacy and communication strategies, and hosted brainstorming sessions with a wide range of stakeholders including health professionals, medical bodies, religious leaders, and law enforcement agencies such as the police. Posters on the consequences of practicing, aiding, and abetting sex selective abortions were displayed around the country, and compilations of writings on the subject have been made in a series of books. Films have been made – Atamaja and God’s Left Hand – in order to raise public awareness and discussions held to appeal to the sense of justice and basic rights of all, men and women. Debates have been organized on the likely consequences of the deficit of girls and women.

These multi-pronged efforts have indeed kept the issue of deficit of women alive. A number of states have come up with novel approaches such as making school children taking oath that they will not practice sex determination tests and female selective abortion. In Gujarat, for example, in 2006 a large community of landowners, among whom the juvenile sex ratio is reported to be quite adverse to females, took oath at a mass meeting that they would not practice sex selection.

Since the publication of the 2001 Census results, a huge amount of hype has been created around ‘missing girls’ and resources spent on awareness creation campaigns and implementation of the PNDT Act. However, instead of addressing the causes that have led to the deficit of women, the symptom itself seems to have become the focus of attention. This brief note examines the issue in a larger historical and demographic perspective to understand the limitations of both the legal measures and advocacy strategies adopted to address the issue of declining sex ratio and the challenges before us.

 

Demographically speaking, the explanation for India’s declining sex ratio lies in the somewhat higher female mortality than male mortality observed over a long period. If boys in successive cohorts experience higher rates of survival than girls, then even when there is an overall gain in survival among both sexes, the number of males will increasingly become larger than the number of females. The continuous decrease in the number of women that has been noted in the 20th century is thus an artifact of the persistent sex differential in mortality or differential in the improvements in life expectancy of the Indian population. When the country is passing through a demographic transition, if the sex differentials in mortality continue favouring boys, the deficit of girls would increase over time.

The recent reversal in sex specific life expectancy at birth (female life expectancy has become nearly two years longer than male life expectancy) is largely because women have experienced a much faster decline in mortality at adult ages compared to men. This is amply demonstrated by a simulation exercise undertaken to understand the sex ratio in India and a detailed examination of changes in sex ratio over time.⁸ The authors argue that indicators of women’s relative inferior position in society are not sex ratios or trends in sex ratios. Instead, direct measures such as education, employment, and relatively high mortality among women need to be examined and addressed. In other words, focusing on implementation of the act and punishing those who violate the act is most unlikely to bring about changes in the status of women.

 

Further, it is important to note that after the PNDT Act came into effect, information on how many sex detection tests are performed, who performs them, and the extent to which pre-elimination of female foetus actually takes place has become far more difficult to collect or even compile. According to a few in-depth qualitative studies, women in areas where the sex ratio is adverse to girls, are well aware that the test to determine the sex of the foetus before birth is not performed in government run facilities and that they would have to approach private facilities or practitioners for such service. While in order to get free abortion women go to government facilities where information about sex determination is not revealed, many private facilities also offer abortion services.⁹ Thus, it is relatively easy to circumvent the law. Similarly, although second trimester abortion in public facilities elicits more questions, there are ways to handle them. In any event, in private facilities there are far fewer restrictions.

The widespread campaign around the PNDT Act has definitely created awareness about declining sex ratio among people, but has also resulted in some confusion among both the providers and clients. Some interpret the PNDT Act to mean that all abortions (whether sex selective or not) have become illegal. The distinction between abortion per se as a woman’s right and sex determination test and elimination of foetus on the basis of its sex as a violation of a girl’s right to be born and as an act of disempowering women becomes blurred. One of the consequences is reduced access to safe, legal and affordable abortion. Some clinics have even stopped doing abortions because of the fear of being criminalized or because of the elaborate monitoring mechanism and demands of record keeping.

 

Some advocacy activities and protests carried out by NGOs and women activists have tended to interlink the ban on sex selection with the need to regulate abortion that follows sex selection. A demand that a complete record of the age and sex of all cases of medical termination of pregnancy be maintained or that a medical committee give clearance in all cases where a pregnancy is terminated in the second trimester would further make access to regular abortion under the MTP Act that much more difficult.

The rapid developments in medical technology also complicate reliance on legislative strategies to control its use. Newer and easier tests that are being developed would enable women to determine the sex of the foetus from simple maternal blood test. These technologies will be much harder to police and regulate.

 

Equally important, the range and number of materials (including print, audio-visual and web sites) prepared for advocacy has largely focused on deficit of women in India’s population. One of the indirect or professed outcomes is a change in attitude towards girls and women. However, no rigorous studies have so far been carried out to understand whether the advocacy measures have actually achieved what was intended. Moreover, neither the premises on which the materials are based nor their content have been systematically evaluated through a gender lens or from a women’s rights perspective. A lot of advocacy material appeals to the emotions rather than intellect. For example, statements such as, ‘The decline in sex ratios has reached grave and alarming proportions and that India is on the brink of a demographic catastrophe’ need to be widely debated for the underlying assumptions.

In order to assess whether the communication strategies have produced any visible impact, UNFPA recently commissioned a study according to which sex selective elimination of girls was acceptable and justified among many stakeholders because of strong son preference, financial cost expected to be incurred in educating and marrying girls, and concern for the future well-being of the girls.¹⁰ These and other factors responsible for not wanting many daughters have been known for a long time. However, instead of addressing them, improvement in sex ratio has been made the focus.

One may argue that a reversal in the trend that undervalues daughters to that which values daughters as equal to sons, would require an overall structural change in the role, status and economic value of women. Measures such as improving access to education for girls or giving them skill-based training and thereby creating job opportunities, would enhance their value and status in the family need to be stressed, even when in the short run, it appears that educated women, because of a desire for small family, opt for sex determination tests more than the illiterate women.

 

It must also be recognized that the long-term consequences of sex selection in terms of an increasing likelihood of a womanless society or of the growing difficulty of finding brides for grown-up sons cannot seriously impact on the behaviour of the people. It is more their immediate concerns and fears, their own perceptions of reality and consequences of their decisions in the short-run that must be addressed while appealing to their emotions. Their immediate concern that investment in daughters, who upon marriage would become members of someone else’s household, is unproductive, needs to be addressed through advocacy and the real-life stories of girls and women who have made their parents proud.

There is a need to aim at consciousness raising among parents about the value of daughters and understanding the cultural factors that undervalue girls. We have focused too much on implementation of the PC/PNDT Act and too little on finding ways to bringing about attitudinal changes such that daughters are valued. Policies must attack the cultural bias against women that is the root of the problem. Changing ingrained attitudes about the value of women is a tough but necessary assignment.

Much of the above may appear self-evident. Advocates of a stricter implementation of the PNDT Act often argue that shifting the focus of the campaign to ‘attitudinal change’ only diverts attention away from the ‘evil’ of sex-selective abortion. The more disturbing possibility is that even well-meaning advocates often become prisoners of their favoured positions (this is as true of individuals as organizations which have heavily invested in a strategy) and thus reluctant to re-examine the implications of fresh research and data. It is no one’s argument that the prevalence of sex-selective abortion is not an issue of social concern. Merely that an obsessive focus on preventing it without simultaneously addressing the larger question of the ‘devaluation’ of women in Indian society may well be missing the wood for the trees.

Governments of states like Haryana and Gujarat have been reporting small improvements in sex ratios and attributing them to the effective implementation of the PNDT Act. However, without in-depth studies that examine a range of factors and carrying out rigorous statistical analysis, it is difficult to attribute improvement in sex ratios to a single factor. In the long run, fear of punishment cannot act as a deterrent; only behavioural change through education that values girls as equal to boys would bring about lasting change.

The fact is that child marriage continues to be practiced and dowry given and accepted in spite of the fact that laws and punishments for violating them have been in place for several decades. Social legislation serves the purpose only up to a point, but along with it if measures to attack the problem head on are not taken up, legislation will be without teeth and ineffective. Instead of being prisoners of our past, let us think afresh on the issue and even scrap the act if need be.

 

Footnotes:

1. There are pronounced regional differences in India’s sex ratio. In the northwestern Indian states of Punjab and Haryana, for example, the proportion of women in the population has been reported as low for over a century. In the southern states of Kerala and Tamil Nadu, the sex ratio did not show a similar deficit of women.

2. Ansley Coale, ‘Excess Female Mortality and the Balance of the Sexes in the Population: An Estimate of the Number of "Missing Females",’ Population and Development Review 17(3), 1991, pp. 513-527; Amartya Sen, ‘Many Faces of Gender Inequality’, The New Republic, 17 September 2001.

3. P. Visaria, The Sex Ratio of the Population of India. Monograph No. 10, Office of the Registrar General, New Delhi, 1972; Asok Mitra, India’s Population: Aspects of Quality and Control. Vol. 1, Abhinav Publications, New Delhi, 1978, pp. 371-397; L. Visaria, ‘Deficit of Women in India: Magnitude, Trends, Regional Variations and Determinants’, The National Medical Journal of India 15, 2002, pp.19-25.

4. Committee on the Status of Women in India, 1975; Barbara D. Miller, The Endangered Sex: Neglect of Female Children in Rural North India. Cornell University Press, Ithaca, New York, 1981.

5. In order to compute literacy rates for 6+ population, the Indian Census provides a count of children aged 0-6 by sex, assumed to be illiterate, which is used to calculate child-sex ratio for the age group 0-6 (and not the 0-4 age group, which is a standard practice).

6. According to 2001 Census there were 49 districts in the country where for every 1000 male children aged 0-6 years there were less than 850 female children. A majority or 38 of these districts were located in just three northern and western states of Punjab, Haryana and Gujarat. Census of India, 2001, Final Population Totals, Series 1-India. Registrar General and Census Commissioner, New Delhi, India, 2004.

7. F. Arnold, S. Kishor and T.K. Roy, ‘Sex-selective Abortions in India’, Population and Development Review 28(4), 2002, pp.759-785; L. Visaria. ‘Sex-selective Abortion in the States of Gujarat and Haryana: Some Empirical Evidence’, in Leela Visaria and Vimala Ramachandran (eds.), Abortion in India: Ground Realities. Routledge, 2007, pp. 133-167; A. Bose and M. Shiva, Darkness at Noon: Female Foeticide in India. Voluntary Health Association of India, New Delhi, 2003; B. Ganatra, S. Hirve and V.N. Rao, ‘Sex-selective Abortion: Evidence from a Community-based Study in Western India’, Asia-Pacific Population Journal 16(2), 2001, pp. 109-124.

8. P. Griffiths, A. Matthews and A. Hinde, ‘Understanding the Sex Ratio in India: A Simulation Approach’, Demography 37(4), 2000, pp. 477-487; P. Mayer, ‘India’s Falling Sex Ratios’, Population Development Review 25(2), 1999, pp. 323-342.

9. L. Visaria, 2007, op cit; A. Barua, ‘Availability and Accessibility of Abortion Care: Ahmedabad’s Urban Slums’, in Leela Visaria and Vimala Ramachandran (eds.), Abortion in India: Ground Realities. Routledge, 2007, pp. 27-61.

10. Josantony Joseph and Centre for Youth Development Activities (CYDA), Reflections on the Campaign Against Sex Selection and Exploring Ways Forward. CYDA, Pune, 2007.