Nearly 1.4 million girls were missing at birth in 2008. In India, half a million girls go missing at birth each year – more than the number of girls born annually in the UK . Missing girls at birth is a result of sex-selective abortions (SSA), which is the voluntary termination of pregnancy based on the anticipated or predicted sex of the child.
Sex-selective abortions: The global situation
Missing girls at birth is a result of sex-selective abortions (SSA), i.e. the voluntary termination of pregnancy based on the anticipated or predicted sex of the child. This measure of missing girls is estimated by comparing the sex ratio at birth with the sex ratio in comparable populations with no gender discrimination—typically, high-income countries (World Bank, 2012). The overall sex ratio at birth, conventionally measured as number of males per 100 female births in a population, is also used as a proxy measure to understand the magnitude of missing girls or sex-selective abortions in a country (Eberstadt, 2011).
According to a World Bank report (2012), approximately 1.4 million girls were missing at birth in 2008, a third of the total number of missing women in the world. In India alone, half a million girls go missing at birth each year – more than the number of girls born annually in the UK (Jha et al, 2011; Bhalotra and Cochrane, 2011).
However, globally, most countries (highlighted in blue in figure 1) have a low male to female sex ratio at birth, ranging 1.02 in Zimbabwe and Zambia, 1.03 in South Africa, Tanzania and Kenya, 1.04 in Finland and Argentina, and 1.05 in the USA, Canada and the UK. China and India (highlighted in orange) have the highest male to female sex ratios at birth at 1.17 and 1.11 (McKinsey Global Institute, 2015). Other Asian countries such as Vietnam, Singapore, and Taiwan also have skewed sex ratios with more males than females at birth.
Mara Hvistendahl in her book: Unnatural Selection: Choosing Boys Over Girls and the Consequences of a World Full of Men (2011) reports that there are over 160 million females “missing” from Asia’s population which is more than the entire female population of the United States. However, gender imbalance—which is mainly the result of sex selective abortion—is no longer strictly an Asian problem. It is found in Armenia, Azerbaijan, Macedonia, Eastern Europe and even some pockets in the United States (Hvistendahl, 2011).
Missing girls at birth in India
In India, the sex ratio is shown as the number of females per 1000 males at a specific point in time. Since the 1990’s, the country has recorded a skewed sex ratio, dropping to a low of 927 females per 1000 males (which is 107 males per 100 females) in 1991 (see figure 2). A recent study published in the Lancet (Jha et al, 2011) estimated that 4-12 million girls were aborted in India in the last 3 decades. The study also showed that selective abortion of girls had increased in last 20 years and is now common all over the country.
While the overall sex ratio has shown an improvement in the last 2 decades, it has however masked the inter-state variations especially between the north and south Indian states (see figure 3). According to the latest estimates (Census, 2011), the number of females per 1000 males in north Indian states such as Haryana and Punjab stand at 879 (114 males per 100 females) and 895 (112 males per 100 females), while south Indian states such Kerala and Tamil Nadu have recorded a sex ratio of 1084 and 996 (almost 100 males per 1oo females) respectively.
Geographically, the problem of sex selective abortion is more prevalent in the north and west Indian states (highlighted in red in figure 3 with a sex ratio of 900 and below), which are economically developed but also patriarchal and hence put enormous weight on having a son.
In 2011, 7 of the 29 Indian states (highlighted in red) showed a sex ratio of 900 and below, as compared to 4 states in 2001 and 2 states in 1991. The number of states highlighted in dark green (sex ratio of 976 and above) and light green (sex ratio of 951-975) has reduced over the last 3 decades.
The Lancet publication mentioned above (Jha et al, 2011) also reported that the risk of selective abortion of girls was highest in the second birth, especially in families where the first child was a daughter, and this practice was found to be more common among wealthy and educated households. While the female to male sex ratio in India has worsened over the years, other critical indicators such as maternal and child mortality rates have improved (Office of the Registrar General & Census Commissioner of India, 2011, 2012, 2014; MoHFW, 2011). The maternal mortality ratio (number of maternal deaths in 100,000 live births) has dropped from 2000 in the 1950’s to 167 in 2014. Infant (under 1 year) and child (under 5 years) mortality rates have also dropped over the years (see figures 5 and 6). A closer look at the sex-wise infant and child mortality rates does indeed show higher deaths of female children than male. While the overall infant mortality rate (IMR) is 40, the male IMR is 39 and the female IMR is 42. Child mortality rates (CMR) show a similar gap as the male CMR stands at 49 while the female CMR is 56. However despite the gender differences, it is important to note the trend that the mortality of the female child is also decreasing over time, although slower than the male child.
Amartya Sen (2003) rightly pointed out that in the past decade; there have been two opposite movements: female disadvantage in mortality has typically been reduced substantially (see figures 2-6), but this has been counterbalanced by a new female disadvantage—that in natality—through sex specific abortions aimed against the female fetus.
Government actions to address gender discrimination at birth
In 2015, the current government of India and the Prime Minister, Narendra Modi himself, launched the program, ‘Beti Bachao-Beti Padhao’ (BBBP – which translates to Save the Daughter – Educate the Daughter). This program was launched symbolically in the state of Haryana which has very highly skewed sex ratio in favor of males; and was done with much fanfare and press coverage before the arrival of US President, Barack Obama for the Indian Republic Day celebrations in the month of January, 2015. Seen in the image (Figure 7) below, is Prime Minister, Narendra Modi along with Smriti Irani, Minister of Human Resources Development (right) and Madhuri Dixit, a popular Bollywood actress, during the launch of the BBBP scheme in Haryana.
The BBBP aims to improve sex ratio at birth by preventing sex-selective abortions, ensuring survival and protection of the girl child, and safeguarding education and participation of the girl child. The scheme is being implemented through a national campaign in 100 selected districts low in sex ratio. While BBBP states ambitious but much required goals and broad plans; since its launch, no concrete operational steps have been visible under this scheme. The only emphasis has been observed in the implementation of the already existing PCPNDT (Pre-Conception and Pre-Natal Diagnostic Techniques) Act launched in 1994, which regulates and monitors the use of ultrasound technology to prevent misuse for sex determination and selective abortion.
The BBBP scheme is being implemented by the Ministry for Women and Child Development (WCD) because the population group of child or girl child falls under this ministry. However, the very component of saving the daughter from SSA falls under Health (and requires involvement of Ministry of Health & Family Welfare) and the component of “Educate the girl child” requires the involvement of the departments of Education or Ministry of Human Resources. The nature of this scheme requires convergence and collaboration across departments and ministries, and multi-sectoral, multi-stakeholder engagement and involvement. The government is not very effective at this kind of work that requires collaboration within its own ministries. Also, the success of the program will require certain actions from public citizens, the lack of which may impede the goals of saving the girl child. However, to engage and move the public will require a greater degree of trust between government and public, which is currently at its lowest in India given all the corruption scams involving ministers and government departments.
Furthermore, addressing sex-selective abortion will require going against the grain of traditions and current cultural and social mores. This means it is not just about launching a program on the media but about implementing it seriously and honestly. And there is not much history or evidence to support the prediction that the BBBP program will be successfully executed.
Moreover, there is the larger issue of cultural transformation towards the equality of rights of every individual, whichever gender, class or caste groups they belong to. This cultural transformation has been extremely difficult in India, especially with respect to gender and status of women.
In a recent development, however, the Ministry of Health and Family Welfare has initiated the process of developing a mini media campaign (with at least with a set of TVCs or television commercials and radio spots) to publicize and influence the realization of the BBBP objectives in the country. The Ministry may also steer towards a more comprehensive 360 degree communication campaign that includes elements of Interpersonal Communication (IPC) for frontline workers and some mid-media components. Though, the Ministry’s budget has been cut in recent months and it is not too confident that incentivized frontline workers, who are mostly women from the villages they serve, will be able to address deep rooted cultural norms that determine the practice of SSA.
However, before we go into the details of sex selective abortion, we would like to step back and examine the larger context and frame of India’s development over the past few decades, especially after India became independent of the colonial rule of the British in 1947.
Larger context of India’s development and rapid change
India is changing rapidly with respect to the classical (economic) development indicators such as the increase in female literacy and urbanization, decrease in family size and poverty, and the rising adoption of media and technology (see figures 8-11).
Female literacy has increased from a mere 0.6% in 1901 to 65% in 2011. One in three Indians, lives in urban areas and the proportion of poor households has reportedly declined by half in the last 2 decades. Availability of media in India households has increased in the last 10 years, with almost 80% of urban households reporting access to televisions and telephones. Nearly 81% of Indians use mobiles phones, of which 10% use smartphones. As of June 2015, a total of 213 million mobile internet users have been recorded in the country (IMRB 2015).
These data highlight that while some of the classic indicators of development are in place – including greater access to and the use of technology, media and education of women – it is actually creating a paradoxical effect of increasing sex-selective abortions.
Education (especially of women), higher income for families, and easy availability of technology are the holy trinity of all traditional (economic) development initiatives. With greater numbers of educated or literate females, who have increased access to media and digital technology, it is assumed that attitudes toward women would change in a more modern direction and that there would be greater acceptance of the girl child compared to a few decades ago.
However, technology and education seems to have had a reverse effect – whereby greater the development and education or wealth of the family, the higher is the likelihood of sex-selective abortions, as corroborated by Jha et al, 2011.
If educated and wealthier couples are engaging in the practice of sex selective abortions of girls using the technology of ultrasound, then it indicates a failure of the current economic development model in bringing about a transformative human development and ensuring rights for all humans. SSA clearly indicates a low status for the girl child in Indian society and is ultimately an issue of justice and rights in the field of public health.
Factors that determine sex-selective abortions in India
High prevalence of SSA has been found to be associated with three (3) factors (UNFPA, 2012). These 3 factors, conditions for a perfect storm of sex selective abortion of girls, are:
1. Availability of (ultrasound or other) technology (and privatization of medical care)
2. Sub-replacement fertility
3. Male (child) preference
All three factors will be discussed in detail below. A note to the reader about ‘sub-replacement fertility’ – it is a total fertility rate (TFR) or children per woman that (if sustained) leads to each new generation being less populous than the previous one in a given area.
While the first two factors of access to technology and fertility cannot be controlled as access to technology will only increase and may also become affordable as in the case of mobile phones), and the desire to have fewer children is also growing and perhaps cannot be reversed. Controlling or eliminating the practice of SSA in India, will require work on the third, cultural factor of “male child preference” (see figure 12 below).
The Indian government has been addressing the first factor of “technology” and its misuse for SSA through the PCPNDT Act and associated mass media campaigns and other communication methods to inform people that there is a legal act, there are punishments and legal proceedings for misuse of ultrasound technology, and that the act is being implemented stringently across the country.
India also has a long running government program for family planning (since 1952), one of the oldest in the developing world, thereby addressing the second factor of sub-replacement fertility.
Thus, a third component, an appropriate and effective communication program for addressing the social norms, cultural preferences for male child and the attendant attitudes, beliefs and behaviors has to be created. In short, India has to be modernized in terms of its values towards the girl child and the girl child has to be treated equally as any other rightful citizen of the country. In the following segments, the essay will examine and discuss the below given framework outlining the factors and process of SSA in India.
FACTOR 1: AVAILABILITY OF TECHNOLOGY (AND PRIVATIZATION OF MEDICAL CARE)
This segment explores the growth in business of ultrasound scanners and its link to sex-selective abortions in India.
The adjacent images (Puri, 2005) are newspaper advertisements for ultrasound test and sex determination of the child. Advertisements for clinics practicing sex-selection in Mumbai used to read, “Better pay Rs 500 now than Rs 50,000 later” (Desai, 1994). Rs. 50,000 refers to the dowry that the parents would need to pay when a girl is married.
Liberalization of economic policies had varying impacts on demands for various commodities. By the late 1980s many doctors in urban India had started advising routine ultrasonographic check-up of the developing fetus at least 2-3 times during the pregnancy, and those who could afford to pay for the private medical services began to opt for this ultrasonographic scanning. A demand was created for ultrasound scanners, and with the easing of import duties and increase in indigenous manufacturing capacity, the market for these scanners soared as compared to other equipment (see figure 13).
Simultaneously, domestic production of ultrasound scanners saw a dramatic increase. The graph below (Fig. 14) shows that over a period of 15 years the manufacture of ultrasound scanners has gone up 33 times whereas for the other three types of medical electronic equipment the increase has only been modest (Department of Electronics, Government of India, 2003).
In 2001, General Electric (GE) submitted to the Indian Supreme Court the list of 6000 clinics to whom they sold ultrasound machines in the previous 5 years. The analysis of this data revealed that wherever GE had sold the most machines, those areas had the least girls born (Wonacott, 2007). The adjacent figure (sales of ultrasound machines in India) below shows the increase in sales of ultrasound machines in India, an almost 20% rise in a span of 4 years (Frost and Sullivan, 2006).
Surveys by Population Research Centres in the Indian states of Maharashtra, Punjab, Haryana, Karnataka, Uttar Pradesh, Gujarat, New Delhi and Andhra Pradesh, found a direct correlation between sex ratio and the number of registered ultrasound clinics (Chandran, 2006). A case in point is Maharashtra, an Indian state in the western region with 4,345 registered ultrasound clinics, and a decline of 29 points in sex ratio from 946 in 1991 to 917 in 2001 (Mulay and Nagarajan, 2004). Districts with more than 100 sonography centers in this state had a distinctly lower child sex ratio than those with less than 100 sonography centers. The richer the area, higher the number of sonography centres. Gadchiroli, a poor district with the smallest number of sonography centres (five) had the highest female sex ratio (974) in the state. When the first ultrasound clinic opened in Punjab (a north Indian state with one of the lowest sex ratios) in 1979, there were 925 girls for every 1,000 boys younger than age 7. By 1991, it was 875, and by 2001, it had plummeted again, to 793 (Katz, 2006).
Some have argued that the privatization of medical care in India has played an equally important role in the increasing use of technology for sex determination and abortion. India initially adopted a public-sector–led model for health care provision, in which most services were to be provided free to all people. Then, the private sector’s presence was limited to individual practitioners and a few charity-run hospitals. When India became independent of British rule in 1947 the private health sector provided only 5-10% of total patient care. At first, small private clinics proliferated, but after India’s economy opened up in the early 1990s, large corporate hospital chains took hold. Today the private sector accounts for 82% of outpatient visits, 58% of inpatient expenditure, and 40% of births in institutions (Reddy 2013). Figure 15 illustrates the increasing share of private hospitals and beds in the country between 1974 and 1996. India also has one of the highest (86%) out of pocket expenses for healthcare (WHO, 2013).
The cost of sex determination and selective abortion has become affordable owing to increasing access to USG technology. It has been posited that greater privatization coupled with greater availability of technology has led to greater SSA (people are paying out of pocket to detect the sex of the fetus and then get it aborted).
Indian authorities have tried to regulate the sales of USG equipments and also monitor the use of this technology. In 1994, the government brought into effect the Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act (PNDT) that banned prenatal sex determination before or after conception to prevent the misuse of technology for sex selective abortion. This act outlawed sex selection and empowered Indian authorities to search clinics and seize anything that aided this practice.
The PNDT Act (1994), was amended in 2003 to the Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) (PCPNDT) Act to improve the regulation of the technology used in sex selection. The amendment of the act brought the technique of pre-conception sex selection within the ambit of the act, included ultrasound within its ambit, empowered appropriate authorities for search, seizure and sealing equipments and passing decisions, provided for more stringent punishments, and regulated the sale of the ultrasound machines only to registered bodies. Any clinic that has an ultrasound machine must register with the local government and provide an affidavit that it will not conduct sex selection. To date, more than 30,000 ultrasound clinics have been registered in the country (Wonacott, 2007).
Violation of the PCPNDT Act can lead to severe fines, cancelation of medical license and imprisonment (Ministry of Health and Family Welfare, 2015). According to the Maharashtra state health department, 523 court cases have been filed against doctors for violating the PCPNDT Act, 168 cases have been decided in court and 75 doctors have been convicted. A total of 142 names had been sent to Maharashtra Medical Council (MMC), a quasi-judicial authority for taking action against the medicos. The image below is a clipping of a national daily, covering a story on violation of this act, resulting in 4 years of imprisonment for a doctor couple (Mascarenhas, 2015).
However, effective implementation of the PCPNDT Act varies from state to state. In recent years, a bench of the Supreme Court of India questioned the Ministry of Health and Family Welfare and called for evidence on the implementation of the PCPNDT Act in the last decade. In response, the Ministry furthered their communication efforts, developed a TVC or a PSA (public service advertisement) and aired it on national television – on multiple channels (see image below). This was an intensive attempt to inform and caution people about the misuse of USG technology and the punishments and legal proceedings that have been given out.
FACTOR 2: SUB-REPLACEMENT FERTILITY LEVEL
The total fertility rate (TFR), sometimes also called the fertility rate, of a population is the average number of children that would be born to a woman over her lifetime. Fertility rates, or the average number of children borne by women, have been falling in India, from 5.77 in 1901-10 to about 2.4 in 2011 (see figure 16). Although the mean total fertility rate (TFR) is still above the sub-replacement level of 2.1; few Indian states have recorded fertility rates of 1.6 (which is considered sub-replacement).
The age at marriage for both men and women has increased in the last few decades; the average household size and landholdings are decreasing as families become more nuclearized (Census, 2011). Indian couples (and families), in general, are reducing the number of children they have. Some authors have argued and presented the data that fertility is declining in India primarily because of its decline among illiterate women, and they are doing so because of the diffusion of a new reproductive idea of having only a few children but investing more on their future (Bhat, 2002).
Unlike the past where children or pregnancies were considered a gift of God; today, the situation has changed. Couples are planning families. There is a quantity-quality trade-off. Couples want fewer children but have greater aspirations for the child. There is a sense of intergenerational rise of the family – the succeeding generation has to do well or be better off than the previous generations. Thus, the onus or responsibility falls on the couple or the parents to ensure that their child has a better future and therefore couples are opting for fewer children and investing in the child. One of the investments is putting the child in an English medium school (with the hope that studying in an English medium school will give the child greater opportunities in the future).
FACTOR 3: MALE CHILD PREFERENCE
Data from the National Family Health Surveys (NFHS) in the last 2 decades shows a strong preference for at least one male child, among both men and women (see figure 17). In 2005-06, a third of all women wanted to have more sons than daughters. Over the years, a mere 2-3% of women have wanted to have more daughters than son.
Similarly, NFHS data for men also shows stronger preference for at least one male child, and more daughters than sons.
Qualitative insights on sex selective abortions (SSA) in India
In addition to a desk review of secondary data including national datasets, we also share findings from qualitative focus groups and interviews conducted with men and women in Uttar Pradesh and Haryana (2 north-Indian states with low female to male sex ratios) to examine the Indian couple and understand the key factors and decision-making processes that determine sex-selective abortions in the country.
While the Census and large datasets or macro pictures show certain trends, qualitative interviews and group discussions conducted with men and women helped to explore the micro-level dynamics, discussions, negotiations at the family and couple level and understand the practice of SSA. These qualitative discussions centered on factors that underlie this behavior. Themes that emerged from this qualitative investigation can be placed into the following 3 categories when discussing SSA: (i) Costs of the girl child; (ii) Benefits of a male child; (iii) the prosperity and continuation of the Family (or Cost-benefit calculation for the firm or organization called the family). The qualitative data shows how cost-benefit equations are used in justifying girl child SSA and the preference for male child. However, what we discovered was the underlying dominance of the notion or unit of “family” and the quest for prosperity of this unit. Although, the family unit has become increasingly nuclear in India; yet, young, educated males and females spend a lot of money on traditional weddings. Furthermore, most couples want a limited number of children (restricting family size) and are focusing on quality over quantity of children. The notion of continuation of family name (lineage) and the future success and prosperity of family (embodied by the child) is paramount in decision-making processes in the minds of couples.
1. Cost of the girl child
The immediate response as to why couple or families resort to SSA could be categorized as “fear” of having a girl child. The fear revolved around expenses incurred for dowry (an amount of property or money brought by a bride to her husband on their marriage). Any investment in the daughter was a non-return to the family because the daughter was “paraya dhan” (another’s wealth). Given the patriarchal society structure, the daughter would marry and move to the husband’s house and any investment in her education was seen as a gain for the in-laws family. Furthermore, despite getting the daughter an educational degree, families said they still had to spend on dowry or on the wedding.
Some respondents shared that violence against women in India was another factor for SSA. Daughters get harassed when travelling outside the house. They could get raped and this affected the family’s “izzat” or honor. Families were also worried that many educated girls tend to marry husbands of their own choice – and the husband could be someone from another caste or religion (inter-caste marriage is still viewed as a taboo is most Hindu communities) and once again this was a problem to the family “izzat.”
2. Benefit of the male child
Respondents spoke about benefits of having a male child in the family. Since the son lives with his parents even after marriage, they are guaranteed of their old age security in a country with no national welfare schemes for its senior citizens; they are supposed to be taken care of by the son and his wife.
According to Hindu religious traditions, the son is entitled to conducting the last funeral rites of his parents, ensuring them a passage to the afterlife.
Property is most often passed on the male heir of the family. A son also ensures that the family name/lineage continues.
These cost-benefit calculations with respect to having a son versus a daughter are often the first responses to be elicited when interviewing people on this topic. However, on further probing a third aspect was revealed.
3. The prosperity and continuation of the Family (or Cost-benefit calculation for the firm or organization called the family)
Couples are calculating cost-benefits, but for what? The ultimate allegiance of Indian couples, both men and women, is for the organization called the family. The family is seen as a more dominant (and sometimes oppressive) theme running through the discussion of their own lives, having children, family, family planning and sex-selective abortion.
Deeper probing during the qualitative explorations revealed that there is an almost fatalistic belief about forming a family in the Indian context– that one is helpless – an essential belief that we have to start a family that it has to be done – “Nibhana hai” – a duty that has to be done. Young men and women shared that they were groomed from an early age to marriage as the socially acceptable path to forming a family. They were told that it was their duty to start a family; that men were providers and women were the caregivers.
Marriage as a norm was pushed on both men and women to create a family and perpetuate the family name. This was the organization – the family – that was being upheld, continued and preserved or perpetuated through the decisions about what children to have. Couples are expected to prove their fertility almost immediately after marriage. People do not like couples to walk together, hand in hand or go and watch movies together. In fact there is very little life as a couple or very little overt romance between married couples in public places in India. The child becomes the “jod” in Jodi (Jodi means a couple and Jod means bond). A child is the bond that makes a couple socially legitimate in the eyes of the community. A couple that is childless is not seen as culturally legitimate.
And young Indians are taking this marriage and family thing seriously and celebrating it. There is a trend towards more lavish weddings. There are many stories of farmers taking debt to get their daughters wedded and then committing suicide because they could not repay the loans.
Using the metaphor of an organization to understand couple-hood in India (mainly north India)
Let us assume for a moment that the new bride entering the house of her in-laws after the wedding is akin to a new recruit in a large multinational firm. They are both trying to get a grasp of the organizational structure and culture. The structure of the traditional family is made clear to the bride as she grows up within her own family and in the entire wedding process. What is more important to her is to understand the organizational culture – both the overt and the tacit or hidden.
How does the newlywed understand the dynamics of the in-laws family and what schema or framework does she have in mind?
After the wedding the newlywed couple receives blessings from all elders of the family. These blessings, the words uttered, are a way for the young bride to understand the culture of her new organization (just like a new recruit or hire would do in a corporation). The new recruit in a corporation or bureaucracy would understand the culture by listening to the bosses and their formal and informal speech. The newly-wed bride understands her place in the organizational structure, and knows that she has to jump through some specific hoops in order to advance through it.
In the beginning, there is the probation phase akin to the recruit in the corporation. The young bride has no freedom of movement. She is always accompanied by someone, wherever she goes. The fertility (or the first birth) bestows freedom on the woman. She can now move out unaccompanied to a few places with the child in tow. Thus, in corporate terms, the new recruit has passed the probation phase and has received confirmation of position in organization.
However, the woman is looking for permanent status, and this can only be given through the birth of a male child. With the birth of a male child the position of the newly wed woman becomes entrenched and she gains more power within the organization.
As illustrated by NFHS data in the figure 19, most of the family planning burden in India is borne by the female. This is because men view anything with the reproductive arena as the sphere of females. Thus, all family planning burdens are passed on to women, including the responsibility of the birth of a girl or boy child. This too becomes the responsibility and burden of the woman. Female sterilization is the most commonly used form of contraception, and the mean age for women at sterilization has declined over the years. Women as young as 25 years are opting for permanent sterilization.
Over the years, while the total contraceptive use has slightly increased from 41% in 1992-93 to 56% in 2005-06, female sterilization has been the most commonly used contraceptive method over time.
What does this indicate? If the woman, age 25 years, is willing to undergo permanent sterilization, then has this woman thought about divorce or having a child from a subsequent marriage? The answers are NO.
This essentially means that the young woman is looking to stay in this family where she has gotten married and solidify her position. She wants to become more powerful within the family using the cultural norms and means available at her disposal. This means having a male child if required. These family/organizational dynamics perpetuate the practice of sex selective abortions.
Did Family Planning Communication in India (since 1952) also contribute to this problem of male child preference?
In this segment we examine development communication on family planning in India over time to understand its role in perhaps shaping the preference for a small family and subsequently the preference for male child in this smaller family. Mara Hvistendahl in her book: Unnatural Selection: Choosing Boys over Girls and the Consequences of a World Full of Men (2011) explains that part of the drop in birth rates in Asia can be attributed to “a history of population control, and a dark history at that.”
India’s family planning program is one of the oldest in the developed world. Starting in 1952, India’s family planning program widely advertised small-sized families and connected it to the family’s economic prosperity. The focus was on the target of family size. Reduce family size at all costs was the mantra – because small family means prosperity. The slogan was “Chhota parivar – Sukhi parivar” or small family = prosperous family). The large family was always associated with poverty and misery in the family planning communication.
Some clear and discernible trends in family planning communication in India since the 1950s:
- Focus on income and expenditure – family planning is required because it helps decrease expenses. Family planning was pushed as a pathway to material prosperity. Advertisements emphasized how much one could gain from adopting family planning. Perhaps it was the easy way to communicate about family planning.
Focus was on family size and not on family composition. As family planning was about material resources, gain or a cost-benefit calculus and reduction of population in connection with resource availability for the nation and the world; the focus was on the number of children. Each of the above images emphasizes two children in it because the desired family size in India (even now for some states) is 3 and it has come down to 2 for the more urban areas.
- A closer look at the posters or postage stamps until the late 1990s shows a tacit suggestion of family composition that includes one (usually elder) daughter and one younger male son. Jha et al (2011) found that families with one daughter were more likely to practice SSA for the second birth to ensure that they had a male child. Couples are customizing their family composition to the images disseminated through the family planning program (which was based on the desired family composition in India – and paid no attention to the various possibilities that emerge when nature is left to her devices).
- While there has been some shift from 1999 onwards – where posters show two children and both daughters and also include messaging on more freedom for the woman, household prosperity messages are still built into the communication. The woman is now shown as free to be both mother to her newborn and wife to her husband. Despite the message of “freedom,” the role of the woman is limited to a “mother” and “wife.”
Both the above posters emphasize economic gains from the adoption of family planning.
The image of a poster below with the red triangle, which became the iconic symbol of family planning in India, indicates that this triangle is the brand for any family planning center. The poster also depicts the “ideal” Indian family: father, mother, and two children. On the right is an image of a man painting a family planning mural in Uttar Pradesh, the most populous state in the country, and the brand of family planning was disseminated all over the country from wall paintings, hoardings, postage stamps, to the back of trucks that traveled across the country.
Given below are postal stamps issued by the Government of India in the 1960s, emphasizing the ideal family size with 2 children.
Family planning communication in the 1990s continues to focus on the economic gain of limiting family size. Note that in the image below, in the ideal scenario on the right, the older child is a girl while the younger child is a son, bringing to mind one of the key findings from Jha et al (2011), that families with a first born girl were more likely to have a SSA to ensure that they had a male child.
Family planning communication posters from the year 2000 onwards saw a shift; emphasizing the use of temporary contraceptive methods such as intra-uterine contraceptive device to ensure that a woman could fulfill both the roles of a wife and mother. Interestingly those were the only roles for the woman – wife and mother.
The next set of posters contains messages on birth spacing of 3 years (left image) and female sterilization (right image). Note that in the left poster, both the children are girls, a shift from the previous communication.
This assessment of widely disseminated family planning communication in India highlights an overarching emphasis on economic gain and prosperity by adopting an ideal family size, without addressing the underlying cultural factors such as male preference, status of women, dowry, and violence against women, that is now used to explain sex-selection. Policy-makers prioritized livelihoods over quality of living, substituted financial in place of social transformation, and families took the cue. With increasing and affordable access to USG technology and privatized medical care, families customized their family size to ensure that they had at least one male child, often at the cost of SSA of the girl child. This one-dimensional view of development as economic created a culture which measures all human activity against financial returns and costs.
Factors in India’s current cultural climate that will make saving the girl child challenging and difficult
Kitna deti hai (How much does it give?)
A series of television commercials (TVC) for a popular Indian car brand have the tagline: For a country obsessed with mileage…
This represents the mind-set of a country that has made materialism its slogan and calculates all effort and activity on the basis of what it will give me, the costs and benefits.
In the end of one of the TVCs in the series titled – Juno, a bunch of Indian tourists are visiting NASA in the US. The scientist demonstrates an ambitious NASA project called “Juno,” which is a spaceship built to discover the secrets of planet Jupiter. When the scientist asks if there are any questions at the end of the demonstration, an Indian male tourist asks very typically, “Kitna deti hain”, which literally translates to – how much (mileage) does it give?
Similar advertisements in the same series show a man going to buy a super-luxury yacht; a man travelling in the latest jetliner; or a representative from the army purchasing a military tank, asking the same question: how much (mileage) does it give?
These series of TVCs illustrate very well the current climate of the consumerist, materially-oriented, cost-benefits type of thought process that is widely prevalent in India today. Everything is measured in terms of how much will this give me? The same perhaps holds true for having a child, or determining the sex of the child a couple plans to have.
Sex-selection has become a cultural norm in India in the most economically developed geographical states in the best economic times for the country. Indian families, analogous to a corporation, apply market principles to family-decisions as shareholders (relatives and community) pressurize for return on investment. The low-hanging fruit of cost-cutting and making economic gains has led to sacrifice of the girl-child to create a positive balance sheet. Indian families have created the first couples of the neoliberal era; measuring everything, including worth of a child’s life, in monetary terms. Ironically the country’s economic growth further justified the economic rationale for sex selection by highlighting the girl-child’s liabilities as every family wanted to join the prosperity party.
Cultural transformation seen through lens of money or economics alone
Part of this obsession with money and prosperity arises from the “poverty” mindset that exists in India even among the educated and wealthy. Bureaucrats, technocrats, public health programmers and communicators cannot seem to think beyond financial triggers or incentives for change. Bureaucrats see poverty as a singular cause of all Indian ills and seem to have become more impoverished intellectually about the processes of cultural transformation than the poorest person who is at least using its will to survive. The Janani Suraksha Yojana, a scheme that rewards mothers with a sum of Rs. 1500 (US$23) for delivery in a government health institution, is a case in point. All attempts at cultural transformation pass through the lens of economics or money. However, as money becomes the criteria for prosperity, the idea for any change translates into putting more money into people’s hands. And there is not that much money in the Exchequer’s office or the Treasury. Therefore, in recent years, Indian bureaucrats and economists have been found to be quibbling over varying poverty line estimates provided by different committees (Siddhanta, 2009).
The problems of juxtaposing tradition with technology without passing through the lens of values of modernity, especially equality and rights for all
The adjacent image of a sadhu with a mobile phone is often used in the popular and global press to represent contemporary India where the old
or traditional and the new or technological come together. Often, these types of images, said to showcase the hybrid culture that contemporary India possesses, also attracts a certain kind of tourism. It is often seen as something different from the sterile, clinical culture of many modernized and developed countries. Writers contrast the ancient temples of Benares with the modern glass towers of information technology (IT) towers in the cyber city of Bengaluru. The same writers forget to write that both Benaras and Bengaluru have congested, crowded streets, poor air quality, and probably no sewage systems.
People forget to ask: how does a combination of the old, traditional India and new, technological India contribute to the practice of sex selective abortions or even other health related problems? The unchecked use of technology, often outdated, has led an environmental health crisis in India with its extremely poor air and water quality (interestingly, the sadhu in the image is also holding a cigarette in his left hand). How does the “hybrid” mix of traditional cultural norms, the new practices of economic development (at all costs) and adoption of any and every technology impact on the status of the girl child? Does it help the girl child or hinder the equality of gender?
To some extent, the image also represents the “problematic” of the cultural change that is required for elimination of sex-selective abortion (SSA) in India. As India tries to realize its ambition of being in the group of the big players – the economy or the UN Security Council – it has to realize that some changes in its culture are necessary. It has to demonstrate that it values all life and is a country committed to the human development of all humans where each person, boy or girl, can realize their potential.
However, India has been resistant to cultural change especially with respect to gender; and has been hiding behind economic development. The sub-test operates at two levels: one is that economic development and money will solve all the problems and a second more dangerous line of thought, more apparent in the last two decades of the neoliberal economy, is that for the sake of money, no one, either from India or a foreign investor, will talk about cultural change at all. The making of India as a favored destination for investment, rather for high return on investment, will stop all talk of cultural transformation or even rights for all. Thus, India struggles to try and fit the traditional and the modern together. The Supreme Court often asks uncomfortable questions about protection of the girl child, the departments run helter-skelter trying to find cases, and the political side makes excuses or even end up tacitly or openly supporting groups that hold values tending to favor SSA. Cultural norms are not challenged by democratically elected leaders who fear losing vote-banks in the Indian political context. Today, in India many educated wealthy people look back to the ancient past of India as a treasure trove of not only wisdom but scientific knowledge and there are large scale attempts to explain all scientific discoveries or thought as having existed in India before. Everything that is significant in the world today has already happened or was already invented in ancient India.
Political push for traditions as scientific
A case in point are articles from the Indian Express and the Guardian as well as various other Indian newspapers, that describes how the economically progressive, Indian Prime Minister credited the existence of plastic surgery in ancient India for explaining how the revered elephant god, Lord Ganesha, got the elephant head and also discussed the happenings and events in the epic Mahabharata crediting them to the existence of genetic sciences in ancient India.
We the people… Aren’t our leaders just giving us what we want?
However politicians today are not leaders of men and women, they are often followers, who mimic and reflect popular values and aspirations. As has been said, people often deserve the leaders they elect in a democracy. The problems of democratic politics globally, be it interest groups, lobby groups, vote-banks, coalitions are also seen in the Indian context. Leaders, who emerge as popular figures, are able to accurately capture the popular mood. And one of those popular moods is reflected in the trend of “mahurat C sections.”
What are these mahurat C-sections?
Mahurat, according to the Oxford Advanced Learner’s Dictionary is an auspicious time for an enterprise to begin or for a ceremony to take place. The sentence given as an example for use of this word is: the pandit (priest) selects the best mahurat for the wedding. Cesarean delivery — also known as a C-section — is a surgical procedure used to deliver a baby through incisions in the mother’s abdomen and uterus.
Most educated, wealthy couples in India want a limited number of children. We have already seen the reduction in fertility rates in India. Couples are restricting family size and focusing on quality over quantity of children. The notion of continuation of family name (lineage) and the future success and prosperity of family (embodied by the child) is paramount in decision-making processes in the minds of couples. And in order to ensure greater success for this future child and carrier of the family name, couples, mostly well-to-do, are having ‘Mahurat C-sections’, where astrologers are paid to determine the astrologically best or most fortunate (lucky) time of birth for this child, and couples request their doctors to plan the surgery in such a way that the child will be born at this chosen opportune time as determined by horoscopes. If the same couple has engaged in SSA, then this mahurat C-section is for the male baby, which is the only taken to the full term of pregnancy.
The hybridity of culture or strange mix of old and new is not just demonstrated through the architecture but the everyday practices of people in India. And despite the charms that hybrid cultures represent to many outsider eyes or the pride in one’s ancient culture that it represent to insider minds; often the values of the traditional and the modern do not go together very well for individual humans, especially demonstrated by the case of sex-selective abortion of females where old habits and norms of entrenched gender inequality and male preference clash with modern notions of equal rights and justice for all human beings. This makes the entire exercise and effort of changing the cultural preference for a male child extremely challenging.
Development communication, rather than changing minds, contributed to the crisis by messaging economic development as social change while disregarding cultural transformation. Factors such as male preference, status of women, dowry, violence against women, now used to explain sex-selection, were not addressed from the start. Even India’s family planning program, starting in 1951, widely advertised small-sized families (two children) connecting it to the family’s economic prosperity. Policy-makers prioritized livelihoods over quality of living, substituted financial in place of social transformation, and families took the cue. This one-dimensional view of development as economic created a culture which measures all human activity against financial returns and costs.
Indian families, analogous to a corporation, apply market principles to family-decisions and as shareholders (relatives and community) pressurize for return on investment the low-hanging cost-cutting sacrifice is the girl-child. Ironically the country’s economic growth further justified the economic rationale for sex selection by highlighting the girl-child’s liabilities as every family wanted to join the prosperity party. Sex-selection has become the cultural norm in the best economic times for India.
How do we change this situation? Traditionally, social change has always been placed on one side of the spectrum or the other – either change has been seen as a function of changes in the larger structure or individualism which attempts to explain all social phenomena in terms of individual actions. Sherry Ortner, anthropologist, builds on French theorist, Pierre Bourdieu’s work on “practice theory” – which places social change within the dialog or dialectic that occurs between the larger social structure and individual human agency working back and forth in a dynamic relationship. Sherry Ortner’s work on rules and resistance posits that rearranging roles, social institutions or even reordering the whole economic structure will not address female subordination.
Ortner states: Social transformation must also be cultural transformation or it will be nothing.
So, how do we bring about cultural transformation in India that will help reverse the skewed sex ratio?
Using ‘Betigiri’ to save the girl child in India: a communication concept and introducing a new term in the popular vocabulary
Keeping in mind the cultural difficulties and insights gained from the research, the concept and term “Betigiri” was coined by us as a communication method for large scale campaigns that reach out to the population and influence the realization of the goals of the Beti Bachao – Beti Padhao scheme (save the girl child) in India.
We suggest this new term or word (Betigiri), coined from existing words in the commonly spoken Hindi language, to influence everyday actions that then push for changes in structure. Thus, we attempt to connect everyday language with everyday actions. The language creates a language of positive action or actions to protect the girl child. It provides a language of opposition against being quiet or remaining silent on various issues and in various situations that affect the girl or daughter negatively. It is designed to enter popular lexicon and anyone – male or female – can use it. The television campaigns (TVCs) model and encourage appropriate behaviours for community members in different situations where a daughter may be in danger (of any age group).
Betigiri (actions towards honoring, protecting, respecting the girl child)
Although we understand that this is a complex, layered, multi-dimensional issue that is difficult to address, we introduce and discuss the communication concept of “Betigiri,” which means acting and behaving in ways that protect, honor and respect the girl child and implies empathy towards the girl child. Betigiri, as a communication concept, provides an operational and do-able construct for the “Beti Bachao” (Save the girl child) program, and a handle for specific everyday practices and behaviors with respect to girls and gender.
We seek to introduce ‘Betigiri’ into the everyday lexicon, and popularize the practice of doing something on an everyday basis to help daughters in this country, thereby creating a better environment of respect, honor, pride in the girl child, which we hope will ultimately contribute to addressing obstinate gender-related cultural norms and gender inequalities that follow.
‘Betigiri’, refers to everyday actions that can help to save the girl. Beti stands for daughter in Hindi. Betigiri can be understood in relation to a similar term called ‘Gandhigiri’, which refers to the practice of the teachings of Mahatma Gandhi (including non-violence, and speaking the truth); or ‘neta-giri,’ which connotes behaving like a neta or leader. The suffix – giri – has an implied component of actions or acting towards something.
While the BBBP government scheme urges citizens to save the girl child – ‘Beti Bachao’, the use of the term “Betigiri” operationalizes this goal and shows people actions that can be used on an everyday basis to care for our girls. In tests with lay audiences, the concept and practice of “betigiri” was very well understood by them. They used the word “betigiri” not only to refer to actions that prevent SSA, but also in everyday life such as keeping a girl in school, preventing and stopping early marriages, standing up for any girl being harassed, or even acting against domestic violence. Test audiences were moved by the concept emotionally and felt that they could have thought of this simple notion earlier and done simple things in everyday life to protect daughters. The word “beti” was not interpreted as a small girl or fetus; every woman (young or old) could be seen as a beti (daughter) according to both male and female test audiences. They reported that “Betigiri” can be used in different contexts, situations and provide simple, do-able steps that everyone can take to protect our girls.
Betigiri offers a chance to every Indian to contribute and make the country a better place for girls. Practicing Betigiri will also ensure applause and support from others around.
From a communication standpoint, long-term interventions are needed that range from the mass media, to community dialog and interpersonal and social media communication. Although the concept of “Betigiri” may spark some scattered action among a small minority and that too may fade away soon, we hope to start and sustain “conversations of conscience” among people.
These very conversations (of conscience) helped reduce sex selective discrimination in South Korea – the only country that has been able to stem and reverse SSA trends. However as Eberstadt (2011) writes:
“Available evidence suggests that South Korea’s reversal was influenced less by government policy than by civil society: more specifically, by the spontaneous and largely uncoordinated congealing of a mass movement for honoring, protecting, and prizing daughters. In effect, this movement — drawing largely but by no means exclusively on the faith-based community — sparked a national conversation of conscience about the practice of female feticide. This conversation was instrumental in stigmatizing the practice, not altogether unlike the way in which nationwide conversations of conscience helped to stigmatize international slave-trading in other countries in earlier times. The best hope today in the global war against baby girls may be to carry this conversation of conscience to other lands.”
There may be hope yet for the girl child in India. It starts from everyday conversations, and everyday practices. And it is the very leaders of tradition and guardians of temples who may have to become the guardians of the girl child. They can do so by incorporating “betigiri” in their everyday vocabulary and everyday practice. Betigiri is not just about having conversations of conscience; it allows individual Indians to practice actions of conscience. And there is nothing more traditional and nothing more modern than that. It is just human.
And so is the girl child.
© Nilesh Chatterjee and Dharmendra Singh, 2015
Note: A shorter version of this paper was presented at the Global Fusion Conference 2015 at Texas A&M University on Development Communication. The purpose of the Global Fusion Conference series, which began in 2000, is to promote academic excellence in global media and international communication studies. The conference is sponsored by a consortium of Universities: The University of Texas at Austin, Texas A&M University, Ohio University, Southern Illinois University, Temple University and the University of Virginia
A 2 year old girl in India, (2010, 4th Dec), Retrieved from: https://commons.wikimedia.org/wiki/File:A_child_in_India.jpg on 9th November, 2015
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