+

Gender Discrimination Before Birth and Before ConceptionDr. Priya Bhave Chittawar

+

Dr. Priya Bhave Chittawar

Associate Professor and Head,Reproductive Medicine UnitDepartment of Obstetrics and GynecologySri Aurobindo Institute of Medical SciencesIndore

Subspecialist in infertility management and minimal access surgery

Heading the IVF clinic at Mohak Hi Tech Hospital Indore

Special interest in gender sensitive healthcare

+

Gender Discrimination Before and at the beginning of life….

+What

Why

How

When

Where

WhichScope of the presentation

+

The Shining India

OpportunitiesSafetyEducationEquality

+Leadership

+ Social Work

Social work

+ Corporate Sector

+ Media

+The Female Gender

Less nutrition

Less education

Less medical care

Less employment

+

“Bringing up a girl child is like watering a plant in the neighbours garden”

+Gender discrimination: when does it start?

“ May you be the mother of eight sons”

Gender bias predates birth, it predates pregnancy and even conception

Girls are being systematically eliminated from our society, by denying them the most primal of rights, the right to take birth.

+WHAT?

BMJ Volume 304, March 1992.

+

The Case of the Missing Women

+

Usually, the sex ratio (numbers of boys born divided by the numbers of girls born) is slightly greater than one. World-wide about 106 boys are born for every 100 girls. This number is also reported as the male proportion of total births, or 106/206 = 0.514 = 51.4%.

This is compensated by the slightly lower age specific mortality rates in females resulting in a balanced population

+

Crude death rates in India

+The SEX RATIO

+

+No geographical limits!

+

INDIA :SEX RATIO

Ultra

+

HOW MANY “MISSING”?

Prof Amartya Sen calculated missing women in China to be 44m, in India 37m, and so on, with a total that easily exceeded 100m worldwide (1992)

95 girls being born per 100 boys (in Europe and North America), Singapore and Taiwan have 92, South Korea 88, and China a mere 86 girls born per 100 boys

India: ratio of girls to boys among young children (below 6) the female:male ratio has fallen from 94.5 girls per 100 boys in the census of 1991 to 92.7 girls per 100 boys in the census of 2001 and 91.4 girls per 100 boys in 2011.

+

Where did they go?

There have been two opposite movements: female disadvantage in mortality has typically been reduced substantially, but this has been counterbalanced by a new female disadvantage—that in natality—through sex specific abortions aimed against the female fetus

UN estimates that 2000 sex selective abortions are carried out daily in India.

Sex selective abortions are threatening to eliminate the very existence of women.

+

+The Biology of Gender

Sex is decided at the time of fertilization

Sex of the conceptus is determined by the sperm and if the sperm carries the ‘X ‘ gene, the embryo will be female. If ‘Y’ bearing, the embryo will be a male embryo.

The external genitalia of the fetus can be identified by ultrasound in the late first or second trimester.

+Diagnosing the sex in utero

At 20 weeks of pregnancy, the accuracy of ultrasound in diagnosing the sex is 95 to 100%

Abortions are legal in India and India has one of the most liberal abortion laws in the world

The abortions are carried out by different doctor, often under pretext of ‘failed contraception’ , a perfectly legal reason for abortion as per Indian law

+Aborting a female fetus

The family planning program of the nation demanded that abortion be tolerated.

The leniency towards abortion has meant that we have not viewed this selective elimination of female population as a massive human right violation or great evil

The small family norm means that families with son preference have only 2 chances at having a child of the desired sex.

+Ultrasound; The villain?

Ultrasound is helpful in diagnosing and managing the conditions that are top killers of pregnant women.

Ultrasound is the proverbial ‘eye’ of the obstetrician .

Portable ultrasound machines are life saving and are used in critical care setting

+

Who is the villain?Act before it is too late!

+Who is to blame?

+

Obstetrics before ultrasound

+Prevention of preconception and prenatal sex determination ( PCPNDT act 1994 and amendments)

Requirements of ultrasound centers and genetic centers

Qualifications of doctors

Registration and documentation

+

Total number of ongoing cases under PCPNDT in the country (till September 2011) 1,040.

28 of the 35 States and Union Territories have 0 convictions (till September 2011).

The ones that secured convictions : Chandigarh – 1, Rajasthan, Delhi, Gujarat – 4 each, Maharashtra – 18, Punjab – 23, Haryana – 29.

+Why the low rate of conviction?

Most cases are for incomplete or erroneous documentation

Most often the offenders carrying out sex determination and abortion are never brought to the book at all.

There are few or no ‘sting’ operations carried out by PNDT officials

The Collector is already handling numerous administrative issues besides PNDT.

+Restrict access to technology?

Is it ethical to restrict access to technology to prevent sex selective abortions?

Does it not threaten the rights to life, health and well-being of citizens if access to technology is restricted?

What is the impact of restricting access on the sex ratio?

+

+ Science is a magnificent force, but it is not a teacher of morals. It can perfect machinery, but it adds no moral restraints to protect society from the misuse of the machine. (William Bryan)

+

Major difficulties incurred by doctors in the implementation of the PNDT Act were: excessive clerical work (85.29%), administrative difficulties (44.1%), and excessive police interference (29.4%). Harassment of doctors of diagnostic centers by health officials in Ludhiana was reported by the Ludhiana Tribune( Dhaduk, IJCM,2009)

+ Where did all the girls go?

+……Someone will never feel the thrill of dancing

in the first shower of

rain, never breathe the air of freedom, will never be the person

she could have been, without any fault of hers

but only because she was a girl, a

woman in the making…..

+

Gender discrimination before conception

By creating embryos outside the body, selecting

the male embryos and transferring them, pre implantation genetic

diagnosis has the potential to the skew the ratio even

further I.V.F. P.G.D.

+

Pre Conception sex selection….Worse is yet to come…..

+The stories that end badly are sad. Sadder are the stories that never begin.

+MISSING NO MORE!

“The change begins with us. Each one of us. It begins with how we respond to this issue. The first thing we need to do is to abnormalise what our history has normalised for us. We must refuse to allow this normalcy. So the next time you hear of a case of female infanticide, or foeticide, or dowry murder—please speak up. Speak loud. Rant, rave, protest, resist, but do not say—'this happens,' and look away. ” - Rita Banerjee