Monday, February 20, 2006

They Call BIHAR as Backward-See PUNJAB the most backward State


Death Becomes Her

Punjab has the worst sex ratio in the country. Female foeticide is at an alarming high. The worst culprits are the affluent.


CHANDER SUTA DOGRA

Kulwinder Kaur Housewife: "I have two daughters and my mother-in-law is threatening to get another wife for her son if I don?t have a boy.


I got an abortion done last year when the scan showed it was a female foetus. This time I have been lucky."

Simran College Lecturer:

"I have one girl and cannot afford to have another daughter. It?s so difficult to marry them off as boys demand hefty dowries. I have undergone five abortions at a private nursing home as all of them were female foetuses. I may not be able to conceive again."

Kashmiri Devi Housewife: "I?ve two daughters, after which I had four abortions because the foetuses were female. Now, I want to have a son of my own so that he can take care of us in our old age."

Satinder Kaur Wife of a landed farmer: "I have one daughter, and I

know that if I don?t have a son soon my status in the family will come down.

Femicide is not an issue in our family. I got my last pregnancy aborted, it helped me to limit our family size. Otherwise I could be saddled with a whole lot of girls until I get a boy."

Satnam Singh Sarpanch, Nai Majara: "No matter what people might say, at heart everyone wants a son. Imagine the plight of a couple who has two daughters in a row. Life in Punjab is cruel for those with too many daughters."

Look hard and you won't find anything out of the ordinary in Dhanduha village in Punjab's Nawanshahr district. But anganwadi worker Harminder Kaur knows well the foul secrets her village keeps. As she produces her register, which maintains a record of all births which take place in the village, she says, "I've been telling these women not to go in for female foeticide as it's against the law and bodes ill for our society." Words which most anganwadi workers and health department officials in rural Punjab can mouth in their sleep.

Dhanduha's register shows that of the seven babies born in the last six months, there were six boys and just one girl. In the last one year, against 12 boys only three girls were born, and in the last five years, 34 baby boys were born as against only 18 girls. A sex ratio of just 529:1000!

But it's not fair to point fingers at Dhanduha. Everyone in the district knows of Nai Majara, the village where an on-the-spot survey conducted by deputy commissioner

Krishan Kumar a month ago, of children in the 0-1 age group, came up with a ratio of 437:1000. A local NGO staged an instant demonstration in the village but its sarpanch Satnam Singh wrings his hands in despair. "It's such a shame for our village, but what can I do? This happens everywhere." Sure it does. And much more than anyone previously imagined.

Gobindpura is a village just off the main road to Jalandhar, with pretty bungalows built with money sent home by its expatriate population. With its fields of yellow mustard, the wheat crop just beginning to ripen and the juicy sugarcane ready for harvesting, Gobindpura presents a picture of agrarian prosperity. A prosperity which many feel is responsible for the village's fast falling sex ratio. Out of the 24 baby boys born in the last one year, the village produced just 10 girls. A sex ratio of 416:1000. A few years ago it was slightly better, at 636:1000.

Nawanshahr district's gory secrets began tumbling out when Krishan Kumar took over as the deputy commissioner in May last year. Kumar took it upon himself to improve the female sex ratio of his district to a respectable level.

Nine months into the campaign and Nawanshahr has uncovered a sordid story of rampant female foeticide which goes on with the active participation of the state's health department officials. It all began when Kumar initiated a survey of all children from 0-6 years in the 477 villages of the district, to gauge the extent of the problem in his area. It turned out that there are 16 villages where the ratio is in the range of 500:1000. And 65 more villages recorded a ratio of below 700:1000. These are prosperous villages in the state's Doaba belt. Mud houses are a rarity in these parts, and grand mansions built by NRIs or even prosperous villagers are common. Incidentally, Nawanshahr had emerged as one of Punjab's better districts according to the sex ratio mapped in the 2001 census, in which it stood at 808:1000. By 2004, it had fallen to 775.

Kumar suspects the situation in the four towns of the district, still to be surveyed, would be much worse because of greater accessibility to scanning centres and clinics. Villages like Sekhopur, Kador, Sultanpur, Sajawalpur, Jatpura, Kherevewal and many others like them, all with a sex ratio below 700:1000, are a sad reflection of a chilling trend which, despite the 'efforts' of the government machinery to enforce the Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) (PNDT) Act, refuses to ebb.

When statistics tabulated by the 2001 census came out a few years ago, the country sat up and took note of the dismal sex ratio which the prosperous, green revolution states of Punjab (793:1000) and Haryana (820:1000) threw up. The government framed laws to deter would-be mothers from tearing out female foetuses from their wombs. The state machinery launched awareness drives, and researchers enthusiastically set off for the villages with satchels filled with questionnaires. But the mothers continued doing what they must in the gender-biased society which they inhabit. At Dhanduha, a clutch of mothers and pregnant women look the other way when asked whether sex determination testing is common in their village. The village midwife or 'dai', Jeeto, is the only one who speaks up. "It's quite simple. They all go to Banga (a nearby town) to get tests done. Most girl foetuses are simply aborted."

Everywhere in Nawanshahr, people talk about a well- entrenched network of educated 'dais', nurses, midwives and doctors, encompassing private practioners and those from the government's health department, who facilitate violations of the act with impunity. Paramjit Kaur, the child development project officer of Banga block, admits candidly, "Health department officials, particularly the auxiliary nurses and midwives (ANMs), lady health visitors (LHVs) supervisors and doctors are deeply involved in the business because these are the people who are intimately connected with pregnant women as part of their duties." A recently detected case of female foeticide in Naura village is revealing. Manjit Kaur and her husband Santokh Singh have been hauled up for allegedly aborting their female foetus at a nursing home in Hoshiarpur. Since Nawanshahr had become too hot to conduct a medical termination practice (MTP), because of the deputy commissioner's aggressive drive against female foeticide, Manjit simply went to a relative's place in nearby Hoshiarpur district and got her pregnancy terminated at Shashi Nursing Home and Scan Centre. Investigations have revealed that the nursing home is being run by a doctor couple, where wife Dr Shashi Bala is a former government doctor and husband Dr Gurdial Singh is none else than the district family planning officer in Hoshiarpur.

What's worse, Dr Gurdial also heads the district committee constituted to enforce the PNDT Act! A case has duly been registered against the nursing home. But it's common knowledge that government doctors in Punjab run private nursing homes and clinics on the sly in the name of their relatives or spouses. A sullen Manjit had only this much to say, "This is our fate. What can we do? Luckily the village is supporting us."

A few months into the campaign and Krishan Kumar realised that he needed to do some tough talking with the private and government doctors of the district. The meeting opened a can of worms. Private doctors accused doctors and staff of the government health department of indulging in large-scale sex determination scans and female foeticide. Says Dr Gurmej Singh Saini, a lady gynaecologist in private practice, "As vice-president of the Nawanshahr chapter of the Indian Medical Association (IMA), I pointed a finger at the wife of chief medical officer (CMO) Dr Kuldip Kumar, who is working as a radiologist at the government civil hospital at Nawanshahr." Dr Saini alleged at the meeting that the woman in question conducts sex determination scans and then refers those desirous of undergoing abortions to dais, ANMs and doctors known to her, for a commission. Dr Saini also alleged that she is being pressurised by the CMO to conduct abortions on women referred by his wife, and that her nursing home was sealed for two months on false charges when she refused to do so. Reacting to the allegations against him and his wife, Dr Kuldip Kumar told Outlook, "Let them prove their allegations, then I will see. They are making false allegations because their business is suffering due to our enforcement."

In villages located close to towns like Nai Majara, it's easy for pregnant women to catch a bus to town and get a scan done. But more remote villages are serviced by nurses, and dais, who scour the villages for pregnant women and work either as middlewomen for nursing homes or do the abortions themselves. The government and private nurses are generally girls from the local villages, and officials see a link between the presence of a nurse or trained dai in a village to its low sex ratio. These nurses or dais charge anything from Rs 500 to Rs 3,000 for an abortion.

The civil surgeon of Nawanshahr, Dr Dilip Kumar, estimates that nursing homes charge anything between Rs 5,000 and Rs 10,000 for a package which involves scanning the foetus and conducting an MTP if it's a female. The middlewomen pocket a hefty commission for every case brought by them. The PNDT Act has only pushed up the price?a sex scan now costs Rs 3,000 or so, as against the Rs 400 which a normal ultrasound costs.

The entry of untrained dais and nurses into the female foeticide business is also because abortion techniques have changed and now become much simpler. The earlier invasive surgical techniques for abortion, such as suction aspiration or syringe methods are fast becoming obsolete. Popular among Punjab's army of trained and untrained medics is the trend of chemical abortion wherein M cradil, a dye, is injected into the uterus which leads to intra-uterine death of the foetus, followed by its expulsion. Some prefer to give two injections of Prospadil, a hormonal formulation which leads to uterine contractions and expulsion.

Even with the kind of abysmal figures which Nawanshahr has turned up, the district has some good news to report too.

The entire state is watching with wonder the results of the rigorous anti-female foeticide drive undertaken by the district administration. Results of strict enforcement have begun coming in places like Khothran already. According to a government assessment in 2004, the ratio in the 0-6 years group in this village was 787:1000. Strict monitoring had increased it to 904:1000 by the end of 2005. Satisfying yes, but Kumar feels that even the better villages cannot be taken for granted because the socio-economic conditions which led to the problem in the first place remain. As Channan Singh at Nai Majara says: "It's all very well for the DC to launch a campaign, but will he help us to marry our daughters when the time comes? Boys nowadays ask for huge dowries. If it's an nri groom the amount doubles."

The emergence of the two-child norm and even the trend of one male child preferred by rural landed families nowadays are other factors encouraging female foeticide. Dr Renuka Dagar, a senior fellow with the Chandigarh-based Institute of Development and Communication, studied the phenomenon in 2003 and found that in one village of Bhatinda district, 40 per cent of the couples over 35 years of age had only one offspring, a male. With land holdings shrinking, people don't want too many children or even too many sons. Ensuring that the one child that they have is a male, she points out, is one more reason for the increase in female foeticide.


Death Becomes Her




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The entire state is watching with wonder the results of the rigorous anti-female foeticide drive undertaken by the district administration. Results of strict enforcement have begun coming in places like Khothran already. According to a government assessment in 2004, the ratio in the 0-6 years group in this village was 787:1000. Strict monitoring had increased it to 904:1000 by the end of 2005. Satisfying yes, but Kumar feels that even the better villages cannot be taken for granted because the socio-economic conditions which led to the problem in the first place remain. As Channan Singh at Nai Majara says: "It's all very well for the DC to launch a campaign, but will he help us to marry our daughters when the time comes? Boys nowadays ask for huge dowries. If it's an nri groom the amount doubles."

The emergence of the two-child norm and even the trend of one male child preferred by rural landed families nowadays are other factors encouraging female foeticide. Dr Renuka Dagar, a senior fellow with the Chandigarh-based Institute of Development and Communication, studied the phenomenon in 2003 and found that in one village of Bhatinda district, 40 per cent of the couples over 35 years of age had only one offspring, a male. With land holdings shrinking, people don't want too many children or even too many sons. Ensuring that the one child that they have is a male, she points out, is one more reason for the increase in female foeticide.


A couple at the Baba Budha shrine near Jalandhar seeking a male child
It's not surprising to find that the overall sex ratio for Punjab is dipping further. According to data from the latest sample registration system of the office of the registrar general, the overall sex ratio at birth (considered a more accurate indicator of female foeticide) for Punjab is now 776:1000 (in 2001 it was 793:1000). In Nawanshahr district alone, the ratio fell from 810:1000 in 2001 to 775:1000 in 2004. Again, a state-wise analysis done recently by an Indo-Canadian team, which appeared in the latest issue of British medical bible Lancet, has found that if the first birth in a family is a female child, the figures for Punjab show a dismal sex ratio of 614:1000. This gets worse in urban areas, where it goes down to 560:1000. Described as the first systematic and scientific study on female foeticide, it was carried out by Prabhat Jha, formerly of the World Bank who is now with St Michael's Hospital, University of Toronto, and Dr Rajesh Kumar of the Post-Graduate Institute of Medical Education and Research in Chandigarh. Dr Rajesh Kumar observes that their study reveals a cruel paradox: "Since our study shows higher incidence of female foeticide in well-off and better educated segments of society, we feel that Punjab registers the lowest sex ratio because of the relative prosperity of people here. This signifies that as prosperity levels go up, the problem will worsen in the years to come."

As for enforcement, out of the 77 cases registered in the last four years under the PNDT Act, there have been only two convictions so far?measure that against the estimated 10 million foeticides in 20 years. Health department officials say convictions are difficult to come by because there are no complainants. Consequently, evidence is difficult to get because both the patient and doctor have a nexus. A convenient nexus, which is fast catapulting Punjab towards sociological disaster.
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