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Apr-Jun2002-10(2)
COMMENT
Gender disparity: need to look
beyond 'female foeticide'
S G Kabra
The latest census figures have re-focused attention
on gender disparity in the population. Changes in the female sex ratio in the 0
to 6 year group are cited to substantiate the theory that female foeticide is an
added influence on an already skewed sex ratio. Though sex-selective abortion is
an undeniable fact of life in India, especially in its urban population, what
has not been analysed is how much this practice has added to the gender
disparity in the population.
Data from a leading private hospital in Jaipur
provide some leads. Of the live births in this hospital, for every 1,000 males
there are about 830 females, (1) indicating an excessive loss of female foetuses
in the antenatal period. Spontaneous abortion, ectopic pregnancy, still births
and medical termination of pregnancy (MTP) are cited as the various causes of
foetal loss during pregnancy. Compared to 80 foetuses lost per 1,000 live births
due to natural causes, there were 65 foetuses lost by MTP for every 1,000 live
births in this hospital. (1) The ratio of spontaneous abortion to live births
will be higher in the general population with poorer nutrition and access to
care. Moreover, only spontaneous abortion cases that develop complications are
admitted to hospital.
A one-year survey of the labour room register of
the two maternity wings of SMS Medical College Hospital, Jaipur, reported 724
still births and a total of 15,346 live births - a still birth rate of 50
for every 1,000 live births. (2) A two-year study of hospital records reported
791 stillbirths for 14,928 live births (3), a stillbirth rate of 53 for
every 1,000 live births. The 1999 figures for Mahila Chikitsalaya reveal a still
birth rate of 69 for every 1,000 live births. (4)
The predominant known cause of spontaneous
abortions and still births is congenital anomalies, in which neural tube defects
are predominant. In the two studies mentioned above, 65 per cent (2) and 74 per
cent (3) respectively of children born with neural tube defects were females;
the female foetus is apparently more vulnerable and sensitive to teratogenic
environmental insults.
Folic acid deficiency is a well known cause of
neural tube defects (5) and a preventable cause of predominantly female foetal
loss. Folic acid must be available peri-conceptionally since the brain is formed
in the first six weeks of pregnancy. Other causes of prenatal foetal loss must
also be investigated and corrected.
Female foeticide: a misnomer
It is a woman's fundamental right to terminate a
pregnancy by asking a doctor to induce an abortion under the Medical Termination
of Pregnancy Act. This right is recognised under Article 21 of the Constitution
(protection of life and personal liberty). The foetus' right to survive under
Article 21 is subservient to the mother's right and is available to the foetus
only in the later part of the pregnancy.
Though called Medical Termination of Pregnancy,
this is a non-therapeutic, non-medical abortion. A woman approaches a
gynaecologist for termination of her pregnancy on the ground of contraceptive
failure. If she has got the foetus' sex determined by a sonologist, she does not
have to disclose the foetus' sex to the gynaecologist, who has no discretion in
this matter. This legal provision to terminate a pregnancy is different from the
provisions for therapeutic abortion under the Indian Penal Code 312 - on medical
grounds to save the mother's life.
Second, over 80 per cent of abortions are performed
in the first trimester of pregnancy (6) when foetal sex cannot be determined by
ultrasonography. The right to abortion on demand is extended up to the 20th week
under the MTP Act, on certification of the pregnancy's duration, by two doctors.
Sonography - the currently prevalent and easily available mechanical method of
sex determination - can determine foetal sex only around the 15th week of
pregnancy. Restricting the right to abortion to the first 12 weeks of pregnancy
would automatically curtail sex-selective abortion. For rape-induced pregnancy
and congenital anomalies, therapeutic abortion is available under IPC 312.
Ultrasonography is a very powerful and essential
diagnostic method in medicine. Its use should not be restricted by the Prenatal
Diagnostic Technique (Regulation and Prevention of Misuse) Act.
References
1. Personal communication, Santokba Durlabhji
Memorial Hospital, Jaipur, Rajasthan.
2. Kabra SG. Medicine Deranged, Panchsheel
Prakashan, Jaipur, 1998, pp.6-36.
3. Babineau AJ. Preventing neural tube defects
in Rajasthan, India: A paper prepared in partial fulfillment of the requirements
of degree of Masters in Public Health (MPH) and submitted to the Faculty of the
Department of Health Policy and Administration, University of North Carolina at
Chapel Hill, USA, through The Indian Institute of Health Management Research,
Japiur, India. 1998
4. Kabra SG, Gupta Rajeshwari and Paliwal
Sunita. Negative indicators of quality of reproductive health care. Journal of
Health Management 1999; 1: 2.
5. Medical Research Council Vitamin Study
Research Group. Prevention of neural tube defects: results of the Medical
Research Council Vitamin Study. Lancet 1991; 338: 131-137. 6. State-wise
distribution of MTP cases by duration of pregnancy, 1996-97. Family Welfare
Programme in India Year Book 1997-98. Department of Family Welfare, Ministry of
Health and Family Welfare, Government of India. New Delhi. p.
137.
Dr SG Kabra, 15 Vijay Nagar, D Block, Malviya
Nagar, Jaipur 302017. Email:sgkabra@sancharnet.in