This presentation outlines how the women's rights' activists in India are seeking to address the issues around declining sex ratio without compromising women's access to safe abortion services

1. Declining Sex Ratio and Effects on
Women’s Access to Safe Abortion
Renu Khanna
SAHAJ and CommonHealth
May 21, 2013

2. Declining Sex Ratio

3. EFFECTS (Source IPAS)

4. EFFECTS - At the state level
(Source IPAS)

5. EFFECTS - The backlash
(Source IPAS)

6. Women’s movement and women’s
health movement
• Concerns about alarmingly low sex ratio and
sex selection
– PNDT Act – 1994 amended to PCPNDT Act in 2002
• Concerns about unsafe abortions – 9 to 13%
of all maternal deaths

7. Gender
Sex
selection
Safe
Abortion

8. n
Gender
Safe
Abortion
Sex
selection
Patriarchy
Son
preference
Daughter
unwanted
Access, safety,
quality, sexual
and
reproductive
rights

9. The PCPNDT Act regulates use of prenatal diagnostic
techniques (PDT) in the following ways:
• Lays down the regulatory framework within which PDTs can
be used (registration etc)
• Lays down qualification of personnel who can conduct PDTs
• Lays down the reporting framework for use of PDTs
• Lays down the conditions for conducting PDTs
• Says that PDTs cannot be used for the purposes of sex
determination
• Designates the implementing authority
• Prohibits any kind of publicity of use of PDTs for sex detection
purposes.
• Calls for proactive steps by clinics- Display of boards

10. What does this Act mean in
operational terms?
• No person conducting pre-natal diagnostic procedures shall
communicate to the pregnant woman concerned or her
relatives the sex of the foetus by words, signs or in any other
manner
• All clinics conducting ultrasound must be registered and only
doctors qualified under the Act can use diagnostic techniques
such as ultra sound.
• All clinics should display prominently ‘ disclosure of sex of the
foetus is prohibited under the law’ in English as well as local
language

11. Contd.
• Doctors or clinics advertising sex determination test
in any form are liable for punishment
• The amendment has brought the newly emerging
modern pre- conception sex selection techniques
used by infertility clinics along with ultrasound
machines under its regulatory purview.
• It has made it mandatory not only to register all
types of techniques but also maintain records of
every scan done

12. Critique of the PCPNDT Act
• Is there any way to ascertain that sex detection is not
carried out in facilities which follow all legal
requirements?
• Can the Act ever keep up advancement of
technology where tests will leave no evidence?
Currently IVFs are hubs of sex selection.
• Even though the law mandates reporting of cases,
conditions under which PDTs were conducted,
patient details (Form-F) etc, both clients and service
providers record reasons that fit within the legal
framework

13. Contd.
• Sex of the fetus is disclosed through non verbal
gestures and verbal codes …hard to establish that sex
of the fetus was disclosed.
• Often ultrasound test and abortion are done at two
different places……….making it difficult to establish a
link between the two.
• Proving that a particular abortion is sex selective is as
difficult as proving that USG test was conducted for
sex detection.
• In practice, it is impossible to identify sex detection
test. So the focus shifts to preventing abortion
following that.
Regulatory Frameworks are necessary……. but
not sufficient

14. MTP Act
An enabling act which addresses a public health
priority
 Aims to improve the maternal heath scenario by
preventing large number of unsafe abortions and
consequent high incidence of maternal mortality &
morbidity
 Legalizes abortion services
 Promotes access to safe abortion services to women
 De-criminalizes the abortion seeker
 Offers protection to medical practitioners

15. Effects of PCPNDT Act
• PCPNDT Act makes the act of sex-selection
illegal. Silent on the issue of abortion.
• But, through the anti sex selection campaign,
right wing anti-abortion groups have suddenly
discovered a love for the girl child. The unsaid
message is that abortion itself is unethical and
immoral.
• The anti sex selection campaign has been
derailed by media sensationalism – language
of ‘female foeticide’, visuals conferring
‘personhood’ on foetus.

16. Reduced access to safe abortions
• Government health personnel in Maharashtra
interviewed for a 2009 study confirmed that
second trimester abortion services were not
provided in most public facilities (CEHAT
2010).
• In Tamil Nadu, official statistics show a 13%
decline during 2003-08 in the number of
MTPs provided in approved facilities (Govt. of
TN)

17. Perspective within CommonHealth
We agree that
• gender issues are important
• and gender discrimination exists
• our work is against gender discrimination, for
gender equality
• The rights based approach is non negotiable
• Sexual and reproductive rights are integral to the
fulfillment of Human Rights

18. • There are many complex issues -- such as,
individual rights and demographic goals, what
constitutes violation of rights, right to choose,
‘personhood’ -- require ongoing discussions,
involving macroethics (social obligations to
prevent societal discrimination of girls) and
microethics (individual’s ethics).

19. We
• do not believe in denying an abortion to a woman
who needs it and is eligible as per the law of the
country.
• do not accept sex selection as a valid indication
for an abortion by itself.
• do however understand that denying a woman
for fear of consequences, may lead to a denial of
safe abortion services.

20. We believe that….
• Denying safe abortion just by suspecting her of
having done a sex determination test, can also
lead to unsafe abortions
• We cannot close our eyes to sex selection and we
must put our efforts to stop misuse of technology
• Changes in the community mindset are crucial
since it is patriarchy and traditional practices
such as dowry etc which are responsible for
unwanted-ness of girls.

21. Perspective within CommonHealth
• The MTP Act follows the logic of public health
and personal & family necessity in creating
space for women to access safe abortion.
• The PCNDT Act follows the logic of preventing
gender-based discrimination
We need to keep the two separate and work on
both.

22. • Above all, we need to create common
ground between the discourse on women’s
right to safe abortion and the discourse on
prevention of sex selection.

23. • Position abortion and sex selection as women’s issues
• Gender equality and rights approach
• Strategic priorities for the Campaign
– Public messages on legal abortion and gender equality
– Clarification of the Acts
– Introduce MA for First Trimester in public health facilities
– Expand allies among development partners
Campaign for Gender Equality and
Safe Abortion- IPAS

24. Acknowledgements
This presentation draws from discussions at
1. Consultation to plan a National Campaign on Safe
Abortion, April 2008, YMCA Mumbai
2. Gender, Sex Selection and Safe Abortion: Creating
Common Ground, Short Course organized by
CommonHealth, St. Pius’ College Campus, Mumbai,
13-16 April, 2009
3. Round Table on Safe Abortion and Sex Selection,
ICPD+15 Review Process
4. CommonHealth General Members Meeting, March
22-23, 2013 Vadodara