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To Curb Sex Selective Abortion, First Regulate Private Healthcare

As long as healthcare is treated as a commodity, medical practitioners will keep catering to society’s paternalistic demands for sex selective abortions.

A majority number of abortion cases in India have been reported among urban women aged under 20, the National Sample Survey Office (NSSO) said. Credit: Reuters

A majority number of abortion cases in India have been reported among urban women aged under 20, the National Sample Survey Office (NSSO) said. Credit: Reuters

Recently, 19 buried foetuses were unearthed from the backyard of a homeopathy hospital in Mhaisal, Maharshtra.

I practiced as a private gynaecologist in a small town in Nashik for 20 years. Since my clinic had a sonography machine, it was common for patients to visit me, wads of notes in hand, to have the sex of their foetus determined. If the foetus turned out to be female, they often demanded an abortion. Seeing the helplessness of these women, declining to abort their female foetuses was an almost daily battle for me. Treating my patients, I became acutely aware of the societal burdens and bias women had to deal with. For example, a hysterectomy patient (about 50 years old) broke down on the day she was being discharged. She told me she’d been married off with a hefty dowry and even after that, her father had borne the expenses of three deliveries. And now her husband was compelling her brother to pay for the hysterectomy. Such stories were all around me.

I often found myself wondering if it would be better for me to perform sex selective abortions for women with two or more daughters given such horrible social realities. It took great determination to not succumb to such thoughts. After I declined to abort a young woman’s female foetus, her old father, who had accompanied her to the clinic, said, “If my daughter terminates her pregnancy without having the foetus’s sex determined in order to find out whether the foetus was a boy or a girl, your law doesn’t see any evil in it. But when she asks for a girl to be aborted, your law sees red. Even though it is this law that will cause her life to be destroyed! Her husband is going to expel her from his house if she delivers a fourth girl.” Whenever a Mhaisal-like incident takes place, I remember these anxious faces.

A pattern has been established for how to react when any Mhaisal-like incident comes to our attention. Social activists will conduct honest and sincere protest marches. The media will grab onto the issue to get higher TRPs. Politicians will make sermons and government institutes will start implementing the state’s only measure against sex selective abortions – Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994. After a few days, everything will settle down. A deceptive calm will descend. Somewhere else, a new Mhaisal-like incident will occur.

Unfortunately, our society seems unaware that the very tool meant to fight sex selective abortion– the PCPNDT Act – is not capable of catching the doctors who perform them. The Act anchors on doctors filling out a form-F. The doctors who do carry out illegal abortions either do not fill this form or fill it very accurately and hence escape being caught by the Act. Often, authorities end up catching doctors who have made clerical errors while filling the form under the Act. The simple question is – where was this Act as Mhaisal ran its business successfully for years?

Yet, the PCPNDT Act can be useful in one particular way. District level authorities could analyse all the collected forms, searching for identifiable patterns in certain sonography centres’ activities – for instance, one that receives a large number of patients from distant places. This should raise the authorities’ suspicions and the government machinery could catch the offending doctor. But in the last 30 years, public healthcare services have continued to be malnourished and have become corrupt. There is a shortage of human resources and the bureaucracy remains oppressively top down – making it nearly impossible for an honest officer to work there. It is naive to believe that the government authorities remain blissfully unaware of the existence of clinics where sex selective abortions take place when people from faraway places know of them.

Though the PCPNDT Act is necessary, it is a false belief that strictly implementing the Act will prevent another Mhaisal from happening. And those who still believe in the Act’s effectiveness, must ask themselves – why aren’t the husbands of the women seeking to abort female foetuses arrested along with the doctors who perform the abortions?

Root causes

Incidents like that in Mhaisal have two root causes. The first is Indian society’s debauched morality and the prevalent paternalistic culture. As long as girls’ parents have to pay dowries and pay for their weddings, as long as a son is needed to perform the last rites after a parent’s death and as long as sons remain solely responsible for caring for aged parents, Mhaisal will happen again and again. Along with erring radiologists and gynaecologists, a society that demands sex determination is equally guilty. The bitter truth is that the Indian continent has the highest number of sex selective abortions in the world.

We have to deal with the rituals and the deep seated moral and religious views embedded in our society if we want to prevent another Mhaisal from happening. Europe converted to modernity after 300 years of effort and social upheaval. In the 1700s, John Wesley, single-handedly fought the political and religious oppressive for over 50 years. He was able to miraculously achieve a bloodless revolution in British society. India too witnessed such movements after the British arrived. But now the clock seems to be rewinding. It is curious to see that self-esteem rooted in religion seems to be rising along with an increase in sex selective abortions. Why is it so? We need to engage with this question and begin a massive social movement. If we do not, Mhaisal will never stop.

The second problem is the enormous, nearly unregulated, and thus unaccountable, private healthcare sector. In the last 30 years, the private healthcare sector is being dictated by commercial interests. Many private medical colleges have opened up, while private homeopathy colleges – which require significantly lower investments – have proliferated in Maharashtra. As a result, doctors who are not trained to practice allopathy have started settling into private healthcare. The government has remained asleep, showed total apathy and done nothing to regulate this.

With growing confidence, homeopaths have built their own hospitals. These hospitals then obtain certificates to perform medical terminations of pregnancy. Out of a need to settle, hapless anaesthetists, radiologists and gynaecologists started visiting hospitals run by homeopathy doctors, like in Mhaisal. Such doctors succeed because they charge less than private healthcare providers, thus attracting more patients. These doctors earn their living from large turnovers. And no one has taken any pains to educate the masses about the legitimacy of different medical degrees.

Despite the societal demands, radiologists and gynaecologists are not free of blame where sex selective abortions are concerned. If all doctors say ‘no’, where will the people go? But healthcare is being treated as a commodity to be sold and bought in the market. This policy has generated a greedy medical fraternity, of which sex selective abortion is just one aspect. In such an unregulated and unaccountable healthcare market, wherever there is a demand, there will be a supply.

Dr Arun Gadre is the author of Dissenting Diagnosis.

  • Shirish Malgi

    Dear God,

    Please give me strength to pay my Income Tax, GST, VAT, CST, Service Tax, Excise Duty, Customs Duty, Octroi, TDS, ESI, Property Tax, Stamp Duty, CGT, Water Tax, Sbt tax,Professional Tax, Road Tax, STT, Education Cess, Wealth Tax, TOT, Capital Gain Tax, Congestion Levy etc etc etc. and don’t forget Hafta, Donations, Bribes, Chanda etc.
    If I have some money left after that I will buy something to eat to survive.

    _*Sincerely*_
    _*The Irritated Indian doctor