Sex Selection in India* A Complex and Conflicting Agenda

1. Sex Selection in India* A Complex and Conflicting Agenda Gender and Justice in the Gene Age A Feminist Meeting on New Reproductive and Genetic Technologies May 6-7, New York City Rupsa Mallik Center for Health and Gender Equity (CHANGE) * Focus on the use of pre-natal diagnosis (PND) for sex determination followed by sex selective abortion. Currently, the most widely used method.

2. Sex Selection in India – the opposing viewpoints If couples have the reproductive freedom to choose how many children to have and when to have them, and to terminate unwanted pregnancies, then why should they not also have the freedom to select the sex of their child if they can do so? – Dr Aniruddha Malpani, Malpani Fertility Clinic, Mumbai, India, Roundtable/Reproductive Health Matters 2002; (19):184-197 Sex selective abortion is not the result of an unintended or unwanted pregnancy. It is a gendered preference for a certain type of pregnancy that guides the decision to undergo sex selective abortion. - Rupsa Mallik, Center for Health and Gender Equity, Roundtable/Reproductive Health Matters 2002; (19):184-197

3. Sex Selection in India – the context (1.) • SON PREFERENCE • son preference directly translates into discrimination against to be born/new born • female infants (both historical and contemporary evidence) • – son preference guided by perceptions of economic utility of having sons • (wage earners, old age security, ability to get dowry). • son preference guided by socio-cultural (patrilineal descent, other aspects • of kinship building) and religious considerations (only sons can perform the last rites • for deceased parents). • Quantifying son preference. 83% women with two sons and 76% with one did not • want more children. Only 47% of women with two daughters said they did not want • more children (National Family Health Survey II, 1998-99)

4. Sex Selection in India – the context (2.) POLITICAL ECONOMY OF DIAGNOSTIC TECHNOLOGIES • Three types of PND technologies available for sex determination of the fetus • (amniocentesis, chorionic villious sampling and obstetric ultrasound) • Currently, ultrasound the most widely used method. PND to monitor maternal and • fetal health has high acceptability, become almost a routine component of prenatal care. • With the spread of clinics price of obtaining tests fallen (currently approx $12-34). • Campaign against sex determination and sex pre-selection (FASDSP, 1986-94) resulted • in enactment of law to regulate PND and ban sex determination [The Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994; mainly for the private sector, the govt banned sex determination in public facilities in 1975-76.] • Non-implementation resulted in public interest litigation. Demanding implementation of • the law plus its amendment (law amended in 2002 to include pre-conception techniques, etc.)

5. Sex Selection in India – the context (3.) FERTILITY TRANSITION/TWO CHILD NORM • Over three decades of a targeted approach to promote contraceptive use (emphasis on • female sterilization) to catalyze population control. Again a renewed emphasis on promoting a • two child family, use of law, incentives and disincentives. • Evidence shows that a small family norm (voluntary or as a result of coercive population • policies) not accompanied by a preference for fewer number of sons. • Total fertility rate is approx 3 for India, third birth order strongly mediated by sex • preference, mainly for sons. Worrying trend, in some parts of the country and urban • areas sex linked abortions at lower birth orders including the first. • Fertility transition can be said to be a factor in intensifying son preference and the use • of PND for sex selection.

6. Activists/Doctors - Arguments/ Counter-Arguments (1.) GENDERED TECHNOLOGIES/SCIENTIFIC PROGRESS • Using a gendered lens allows us to place RTs as part of a broader issue that centers on • two things - political control as well as that of morality and ethical standards. • RTs continue to be largely seen as magic bullets, little or no effort to reduce unequal • societal arrangements and reduce the disproportionate burden that women bear with regard • to reproduction. • RTs allow doctors to play God by altering what was once seen as immutable processes • of procreation (in particular PGD)

7. Activists/Doctors - Arguments/ Counter-Arguments (2.) REGULATION/ NO REGULATION • Does regulation undermine reproductive freedom ? In particular the right to abortion? • (The Indian government is currently discussing making second trimester abortions more • restrictive to prevent sex selective abortion) • Also in the view of some regulation serves to legitimizes a practice – in this instance • the huge private industry that has sprung up around PND and PGD. • Regulation prevents rampant growth, limits unethical use and highlight the negative • role currently being played by the medical community. • Law and effective use of the judiciary (in India) can bring pressure on the executive • branch of the government. • Economic motivation that guides the promotion of some of these technologies makes it impossible for the industry/doctors to self-regulate

8. Activists/Doctors - Arguments/ Counter-Arguments (3.) SEX SELECTIVE ABORTION/RIGHT AND ACCESS TO SAFE ABORTION • Tendency to conflate the two. Results in demands to tighten the law that makes abortion • legal in India. • Need to view the use of PND for sex determination and sex selective abortion as a • continuum. Restricting PND for sex detection can reduce sex selective abortion, placing • restrictions on abortion does nothing to address sex preference for children – push it • underground, result in higher rates of unsafe abortion • Untangle the two in the way we define strategies to curb the former and advocate for the • latter. SSA needs to be seen as a gendered family building strategy and rests on the easy • availability of PND; unsafe abortion can be reduced through access to contraception, • emergency contraception, promoting MVA and medical abortion, etc.

9. “Can sex selection be ethically tolerated ?” * • Stigmatized as a culture-specific problem (where there is strong son preference) –deemed unethical and sexist • `family balancing’ has greater legitimacy; often argued as been an ethical choice. Why? Because often families chose daughters ! • Limited discussion on other gendered and social aspects of the use of PND and PGD. Need to move away from son preference as the only measuring yard stick of the use of these technologies; disability rights issues need to be brought in (largely absent in the Indian debate/activism) • Also, need to highlight the high failure rates and limited efficacy of some of these methods. • - Need to define a new moral consensus with regard to the use of NRTs * Title of guest editorial by Bernard Dickens in the Journal of Medical Ethics