girlscount newsletter oct-dec 15

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NEWSLETTER | OCTOBER – DECEMBER 2015 | QUARTER 4 | ISSUE 7 girls count Dear Friends, With this seventh edition of Girls Count Newsletter, we welcome you all to the last issue of 2015. Girls Count takes this opportunity to wish you a happy, healthy and harmonious New Year. We are thankful to the authors for their contribution and extend our gratitude to all those who have been giving their valuable feedback and comments on the issues we have been raising though the Newsletter. Through this edition, we have once again tried to raise several debates around health and education of girl child, safety of women and girls, and concerns around surrogacy. We hope that you will like the issues and concerns we have raised through this edition. We look forward to your continuous support in engaging and contributing towards strengthening the ‘voice’ for the all-round development of girl child. Contributors You can share your views and opinion by writing to us at [email protected] Dr Vibhuti Patel Professor, Department of Economics, SNDT Women’s University, Mumbai Kalpana Vishwanath Co-founder, Safetipin New Delhi Anju Dubey Pandey Programme Specialist, Ending Violence Against Women, UN Women New Delhi Rakhi Ghosal Secretary, Forum for Medical Ethics Society Mumbai Given the predominantly patriarchal setup in the country, the health and education of a girl child is highly neglected. Special programmes have indeed been initiated to stop early marriages and reduce school dropout rates. But a lot more needs to be done. Health & Education of Girl Child in India: An Increasing Concern – Dr Vibhuti Patel During the South Asian Association for Regional Cooperation (SAARC) Decade of the Girl Child (1990-2000), for the first time in the post- independence period, issues related to “girl child” became a subject matter of special inquiry in India. Several baseline surveys, micro-studies, and region- specific case histories and narratives provided the database for a macro- profile on health issues concerning the girl child. According to the Sample Registration System (SRS), in 1997, more than 1/3rd (35.4 per cent) of the total female population are in the age group of 0-14 years. EDUCATION OF GIRL CHILD IN INDIA Today, there are over 200 million illiterate women in India. It is estimated that of the 10 girl children who enrol in Class I, only three reach Class X. There is ample evidence to show that girls remain educationally backward as compared to boys. Gender disparity in education still remains a serious issue in India. The girl child is also a victim of the culture of women being restricted to domestic work and burdened with family responsibilities at a very early age. Dropout rates for girls are very high particularly in rural areas. Recent studies have shown that in rural areas for every 100 girls enrolled in Class 1, there are only 40 in Class V, 18 in Class VIII and one in Class X. Low skill and inadequate training, lack of information and low social status are the 1

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Page 1: Girlscount newsletter oct-dec 15

NEWSLETTER | OCTOBER – DECEMBER 2015 | QUARTER 4 | ISSUE 7

girlscountDear Friends,

With this seventh edition of Girls Count Newsletter, we welcome you all to the last issue of 2015. Girls Count takes this opportunity to wish you a happy, healthy and harmonious New Year.

We are thankful to the authors for their contribution and extend our gratitude to all those who have been giving their valuable feedback and comments on the issues we have been raising though the Newsletter.

Through this edition, we have once again tried to raise several debates around health and education of girl child, safety of women and girls, and concerns around surrogacy. We hope that you will like the issues and concerns we have raised through this edition.

We look forward to your continuous support in engaging and contributing towards strengthening the ‘voice’ for the all-round development of girl child.

Contributors

You can share your views and opinion by writing to us at [email protected]

Dr Vibhuti PatelProfessor,Department of Economics, SNDT Women’s University, Mumbai

Kalpana VishwanathCo-founder, SafetipinNew Delhi

Anju Dubey Pandey Programme Specialist, Ending Violence Against Women, UN WomenNew Delhi

Rakhi GhosalSecretary, Forum for Medical Ethics SocietyMumbai

Given the predominantly patriarchal setup in the country, the health and education of a girl child is highly neglected. Special programmes have indeed been initiated to stop early marriages and reduce school dropout rates. But a lot more needs to be done.

Health & Education of Girl Child in India: An Increasing Concern

– Dr Vibhuti Patel

During the South Asian Association for Regional Cooperation (SAARC) Decade of the Girl Child (1990-2000), for the first time in the post-independence period, issues related to “girl child” became a subject matter of special inquiry in India. Several baseline surveys, micro-studies, and region-specific case histories and narratives provided the database for a macro-profile on health issues concerning the girl child. According to the Sample Registration System (SRS), in 1997, more than 1/3rd (35.4 per cent) of the total female population are in the age group of 0-14 years.

EDUCATION OF GIRL CHILD IN INDIAToday, there are over 200 million illiterate women in India. It is estimated that of the 10 girl children who enrol in Class I, only three reach Class X. There is ample evidence to show that girls remain educationally backward as compared to boys. Gender disparity in education still remains a serious issue in India. The girl child is also a victim of the culture of women being restricted to domestic work and burdened with family responsibilities at a very early age.

Dropout rates for girls are very high particularly in rural areas. Recent studies have shown that in rural areas for every 100 girls enrolled in Class 1, there are only 40 in Class V, 18 in Class VIII and one in Class X. Low skill and inadequate training, lack of information and low social status are the

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consequences of such gender differentials. (UNDP Report, 2006).

The Government of India has started offering free education at high school level to all girls of single child families and those with two girls and no boys are entitled to receive discounts of up to 50 per cent. It has been accepted that investment in girls’ education is key to empowerment of women as educated women are less likely to be oppressed or exploited and more likely to participate in the political process. In addition, they are likely to have smaller families, and healthier and better-educated children. It is only through education that the girl child can arm herself to be independent and self-reliant. An immediate change is thus necessary to reduce gender disparity and eliminate illiteracy from India. Nonetheless, in both the centrally-sponsored schemes under the Union Budget of India—Sarva Shiksha Abhiyan and Secondary Education Campaign—it is mandatory to use 30 per cent of the total allocation for girl students.

HEALTH PROFILE OF GIRLS IN INDIAHealth challenges concerning a girl child cover mortality, morbidity, nutritional status and reproductive health, and linked to these are environmental degradation, violence and occupational hazards, all of which have implications in the overall health of girls. It is intricately related to the socio-economic status of the households to which she belongs and her age and kinship status within the households. Given the predominantly patriarchal set-up in the country, girls get a lesser share in the household distribution of health, goods and services compared to men and boys. Data shows that in a situation of extreme food scarcity, the adverse effect on the nutritional status of girls is greater than boys. Girls in the 13-16 age groups consume less food than boys. Similarly, in the intra-household distribution of labour, girls shoulder the major burden of economic, procreative and family responsibilities. Consequently, girls tend to neglect their health. Their lesser access to food coupled with negligence invariably leads to

poor health of most of the girls. Changing determinants in the struggle for survival of girls have created an alarming situation during the five decades of post-independent India. Declining Juvenile Sex Ratio (JSR) is the most distressing factor reflecting the low premium accorded to girl child in our country.

MALNUTRITION AMONG GIRL CHILDRENStudies conducted in three metropolitan cities—Bombay, Calcutta and Madras—indicate that a significantly higher proportion of girls compared to boys are in the grade II and III malnutrition category. The cumulative effect of poverty, undernourishment and neglect is reflected in their growth, poor size of their body and narrow pelvis, as they grow into adolescence, making child-bearing a great risk. Girls between 13-18 years of age have lower percentage of iron, protein, calories and Vitamin A. With the onset of menarche, an average Indian girl becomes highly susceptible to anaemia. A majority of poor adolescent girls are 12-15 cm shorter than their well to do peers. Conversely, eating disorders found among the upper class girls trying to attain the media image of ‘a beautiful woman’ who is extraordinarily thin, makes even upper class girls anorexic. The National Institute of Nutrition (NIN) studies have shown that 36 per cent of upper class girls had low Body Mass Index (BMI) due to their conscious attempts to maintain low weight.

EARLY MARRIAGES AND PREGNANCYOf the 4.5 million marriages that take place in India every year, large number are of girls from poor households who are pushed into early marriages. About three million girls marry by 15-19 years and the marriage is consummated almost immediately after menarche. Girls bearing their first baby between the ages of 14-18 are at obstetric risk and the subsequent result is low birth weight babies and pre-natal complications. These girls are at a higher risk for pregnancy-

Studies show that in rural areas for every 100 girls enrolled in Class 1, there are only 40 in Class V, 18 in Class VIII and one in Class X. Low skill and inadequate training, lack of information and low social status are the consequences of such gender diff erentials.

In a situation of extreme food scarcity, the adverse eff ect on the nutritional status of girls is greater than boys. Girls in the 13-16 age groups consume less food than boys. Similarly in the intra-household distribution of labour, girls shoulder the major burden of economic, procreative and family responsibilities.

COVERSTORY

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induced hypertension and eclampsia that includes seizure at delivery. The upsurge of female deaths in the age group of 15-19 years bears testimony to the high mortality rate of women.

The health of adolescent girls’ plays an important role in determining the health of the future population, because their health has an intergenerational effect. The cumulative impact of the low health situation of girls is reflected in the high maternal mortality rate, the incidence of low birth weight babies, high prenatal mortality and foetal wastage, and consequent high fertility rates. Unwed pregnant girls (victims of rape, incest or seduction) turn to abortion, whether or not it is legal. Faced with unintended pregnancy, they take desperate measures resulting in health risks from unsafe abortions, such as sepsis caused by unsanitary instruments or incomplete abortion, haemorrhage, injuries to genital organs such as cervical laceration and uterine perforation and toxic reactions to chemicals or drugs used to induce abortion.

It has been observed that many Indian girls enter motherhood because of not taking adequate precaution. It results in high wastage of human resources and increasing rate of maternal, infant and child mortality. The most relevant cause behind these problems is ignorance of the mother, inadequate preparation of adolescent girls for safe motherhood and various undesirable practices prevalent in Indian society.

Approximately 138 million of India’s population is in the 15-25 age groups. In UP, MP, Bihar and Rajasthan, about 50 per cent adolescent girls get married below the age of 20 which contributes to 40 per cent of India’s population. It is rather unfortunate but true that majority of girl children in India do not experience “adolescence” as they shift from childhood to adulthood and soon become a pregnant adult. In the rural and tribal areas also early child bearing has been the reason for high dropout rate among girls in the high schools.

— Dr Vibhuti Patel is the Director, CSSEIP & Professor and Head, Department of Economics, SNDT Women’s

University, Mumbai

Th e health of adolescent girls’ plays an important role in determining the health of the future population, because their health has an intergenerational eff ect.

Ninety three million Indians live in the informal settlements of the country, as per the latest census report. These slum-dwellers do not have access to proper sanitation system, clean water, uninterrupted electricity supply and other basic services, including law and order. The worst affected are women and girls who suffer due to lack of infrastructure facilities which in turn affects their health, education and security. Cities have better prospects and women from marginalised socio-economic backgrounds should be enabled to have access to places where there are opportunities for growth. But to bring in gender equity, it is also important to get rid of the infrastructural gaps in these thickly-populated neglected urban camps where the marginalised women population lives.

In low income neighbourhoods, inequality is not just restricted to access to services and resources. It is based on a patriarchal setup where women face barriers in economic and social mobility as well. Lack of infrastructure and services in the urban slums of India has its adverse effects on the lives of girls and women vis-a-vis their health, education, income and leisure pursuits.

Due to lack of toilets at homes, open defecation is often the only option for women living in the slums. But they feel embarrassed, are often harassed by the local youth

Infrastructure in Urban Slums & its Impact on Women’s SafetyThe total population living in the slums of India is 93 million. Read through the article to examine the infrastructural and service gaps that exist in the urban slums of India and the negative affect it has on the health, education and safety of women.

– Kalpana Vishwanath

INFOCUS

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and are a victim of ridicule by men. Consequently they wait till dusk to attend nature’s call. This results in serious health issues like stomach aches, urinary tract infections, skin diseases and bladder problems in them. Even in slums where there are community toilets, women face sexual harassment and often have to wait for hours in long queues for their turn. The health risks are thus both physical and psychological.

Another important factor that restricts the development of women and girls and reduces their standard of living is the lack of leisure time and space. The space for leisure activities in slum communities is severely restricted. The unplanned and congested residences are not built keeping public spaces in mind. There are hardly any open spaces or parks and those that exist are not accessible to girls and women. Various studies show that girls ‘disappear’ from playgrounds once they hit puberty. Social customs force young girls to behave in a certain way and ‘not act like boys’ by participating in sports. Adult women too are forced to stay indoors for fear of ridicule and sexual harassment in the streets.

Various studies have also revealed that in these slums, the responsibility of collecting water for drinking, cooking, bathing and other household chores, is on women and girls. As a result, they either miss classes or drop out of school altogether. The collection of firewood, cooking, cleaning and disposal of waste (mostly in open drains outside the homes) is also done by women due to the gendered division of work at home. If the time and effort wasted by women on these petty tasks could be saved through improvement in infrastructure, it would most certainly lead to upward social mobility and greater participation of women in other spheres. It would give them ample time and energy to complete their education and fulfil their other social aspirations.

Our social enterprise Safetipin, which provides a number of technology solutions to make cities safer for women, has introduced several mechanisms to identify and bridge this gap. One such attempt is through the setting up of Safety Chaupals, a platform where women and girls discuss with the local authorities about the safety issues faced by them in their daily lives.

In 2014, with an understanding on how infrastructure plays an important role in women’s safety, Safetipin collaborated with Jagori, a leading women’s rights NGO in India, to set up a Safety Chaupal in Badarpur. The women self help group (SHG) collected safety data using the Safetipin app, which showed that only 43 per cent of the Badarpur area had lighting and that too on the main roads; 53 per cent had no walkways for people to walk safely; and 80 per cent of the community had no visible policing.

A report with the analysis of the data collected was presented by the women in a stakeholders meeting that was attended by the police, people’s representatives and the larger community of the area. The advocacy report with its unique set of data that pinpoints the lacunae, like lighting, security, lack of clean and safe roads in the area, led to swift changes in the community. Today, we can see CCTV cameras in the area, increased police patrolling, proper street lights and construction work of two new community halls in progress. This endeavour of ours was a successful pilot project using technology to effectively bring visible changes in the infrastructure of a slum community.

Safetipin, a mobile app that collects safety data from various cities across the world, is yet another initiative. It is a tool to address the fear of violence that women face while commuting. At the core of the app is women’s safety audit (WSA). The app currently being used in nine cities of India and four cities overseas, collects data on nine parameters namely, lighting, openness, visibility, walk path, security, crowd, public transport, gender usage of the area, and the feeling of safety. The data collected is then used for advocacy with various organs of the government to initiate strong data backed change projects.

Safetipin is undoubtedly a strong advocacy tool for making communities safer for women. The process of capturing data on infrastructure and services of cities pinpoints the lacunae on nine parameters that have strong connections to feeling of safety.

Cities need to be built keeping in mind the diverse needs of its citizens and especially women, so that they can have access to the varied opportunities of growth that exist there. The infrastructure gaps in the urban areas of India once identified would be easy to fix. Hence our efforts should be towards creating a gender-friendly urban infrastructure which would ensure a safe and healthy life to India’s neglected women.

—Kalpana Viswanath is a researcher who has been working on issues of gender and safer cities for women for over

20 years. She is the co-founder of Safetipin, a mobile app developed to support community and women’s safety.

In low income neighbourhoods, inequality is not just restricted to access to services and resources. It is also based on a patriarchal setup where women face barriers in economic and social mobility.

INFOCUS

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Women’s right of reproductive choices must be safeguarded. In the communication and positioning related to ARTs and surrogacy, due care should be taken to avoid positioning infertility as a ‘flaw’, and ARTs and surrogacy arrangements as the ‘solutions’.

– Anju Dubey Pandey

Surrogacy: Major Issues and Concerns

The last few months once again witnessed many debates and discussions on the issue of surrogacy in the context of the draft Assisted Reproductive Technology (Regulation) Bill 2014 that was put on the website of the Department of Health Research, Ministry of Health and Family Welfare, for comments by concerned stakeholders and public at large.

A surrogate is defined as a ‘substitute’ or a replacement, a deputy for another person in a specific role. A surrogate mother is a ‘substitute mother’, a woman who bears a child on behalf of a couple unable to have a child, either by artificial insemination from the man or implantation of an embryo from the woman. This can either be done for altruistic purposes or for monetary gain, widely known as commercial surrogacy. While countries like France, Germany, Italy, Spain and Finland do not permit surrogacy, commercial surrogacy is widely practiced in India today. Certain countries partially allow surrogacy. For example countries like the United Kingdom, Belgium, Netherlands and New Zealand allow altruistic surrogacy but commercial surrogacy is illegal. Australia also recently recognised altruistic surrogacy. Some countries allow limited surrogacy, e.g. in the United States, laws on paid surrogacy vary widely from state to state. States which are generally considered to be surrogacy friendly include California, Illinois, Arkansas, Maryland and New Hampshire among others. South Africa does not allow surrogacy for parents from another country, even though they permit it for residents. The Israeli Government legalised gestational surrogacy under the “Embryo Carrying Agreements Law”, making Israel the first country in the world to implement a form of state-controlled surrogacy in which each and every contract must be approved directly by the state. In some

countries, commercial surrogacy is not only legal; it is also encouraged as a growing industry that attracts foreign visitors. Georgia, Russia, Ukraine are major destinations for fertility tourism.

Since the first surrogate delivery in India twenty-one years ago, the country has steadily emerged as an international destination for “commissioning parents”. The first gestational surrogacy took place in 1994 in Chennai. Thereafter, according to statistics, the number of surrogacy births doubled between 2003 and 2006. It is estimated that in the last decade there have been as many as 3,000 recorded births through surrogacy. Many factors have contributed to this growth, including relatively inexpensive medical services, know-how in reproductive technology, availability of women largely from poor socio-economic backgrounds willing to take up the ‘task’ and the lack of laws to regulate the practices. Indian surrogates receive $3000-$6000 (compared with an annual income per head of around $500), thus making surrogacy a potentially financially attractive option for poor Indian women (Palattiyil et al 2000). In fact, reproductive tourism or travel in India is ‘valued at more than $450 million a year’ and was forecast by the Indian Council of Medical Research (ICMR) to be a six billion dollar a year market in 2008. The boost is not only because of domestic but also of international demand.

Issues and concerns regarding surrogacy in India are several, layered and complex. These have obvious implications not just for the users and providers of these procedures, but also for policy-makers, practitioners and implementers. A seminal study by the women’s rights organisation, Sama, conducted in 2012, raised critical concerns. It drew attention to the fact that surrogacy has pushed pregnancy from the private to the public domain, from care to work, and in doing so, has raised many pertinent issues, including how women’s reproductive role is defined and understood by society. The research indicated that the feminist critiques of surrogacy have brought attention to the fact that the assisted reproductive

Since the first surrogate delivery in India twenty-one years ago, the country has steadily emerged as an international destination for “commissioning parents”

OPINION

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technology (ART) industry lies at the intersection of patriarchy and market, wherein these technologies meet rather than question the pressure on women to be mothers. Further, the study pointed out that the political economy context of women’s labour under globalisation presents a picture of informalised and sexualised work that is inattentive to women’s rights and health, while also destroying indigenous livelihoods.

There are divergent positions on issues relating to surrogacy in India. Anecdotally, altruistic surrogacy is seen as more humane and more easily accepted because it is positioned as a noble and generous act that helps a hitherto childless couple experience parenthood. The Sama study pointed out that in one way this imparts informality to the arrangement but in another it affects and weakens the bargaining power of surrogates in commercial arrangements. ‘The vocabulary of altruism also becomes a significant device when surrogates encounter stigma attached to this work’ (Sama; 2012). When this act of bearing children moves into the space of market, despite a price that is put on it, it is still deprived of the dignity and equal worth of being an economically and socially productive activity. Commercial surrogacy raises ethical concerns regarding the commercialisation of women’s womb. The positions present very interesting and curious contestations, including on definitions of ‘work’.

In addition to the ethical issues, there are very obvious socio-economic concerns. The choices for women to become surrogate mothers are driven and determined by factors like poverty, unemployment, lack of awareness, illiteracy, etc. Anecdotal reasons shared by women for their choosing to be surrogates vary from getting treatment for ailing family members, marrying off their daughters, child’s education, paying out debts, buying or building accommodation, etc. There is evidenced research on multiple hardships/exploitation faced by surrogate mothers during the process of surrogacy. These include among others, ambiguous contracts, health consequences due to multiple invasive procedures, exploitation by middle men or hospital authorities, lack of enforceability of contract by mothers due to their socio-economic vulnerability, etc. As surrogacy is currently unregulated, medical/life insurance to surrogate mothers, medical facility for health concerns other than reproductive issues, etc. are not provided. Moreover, women choosing to be surrogate mothers experience social stigma. They have to stay away from their families for long duration of time, leaving their children in custody of relatives. In some cases, women have also reported desertion by husbands and/or abandonment by family members.

Surrogacy in India is largely practiced as a commercial arrangement in the absence of any statutory binding law. Currently, there exists a draft Assisted Reproductive

Technology (Regulation) Bill, 2014. The Indian Council for Medical Research (ICMR) had also issued guidelines in 2005 for regulation of surrogacy, though it is not binding. The Ministry of Home Affairs has issued instructions vide letter No.25022/74/2011-FI (Vol III) on March 11, 2015, regarding foreign nationals intending to visit India for commissioning surrogacy and the most recent instructions not to support commercial surrogacy have been issued by the Department of Health Research, Ministry of Health and family Welfare vide letter No. V.25011/119/2015-HR issued on November 4, 2015.

While the debate continues and the draft bill is being finalised, it is important to flag that the rights of surrogate mothers/women must be taken care of in the regulatory framework. Women’s right of reproductive choices must be safeguarded. In this context it is important to reiterate the recommendation made by UNFPA (United Nations Population Fund) in recent debates on the issue that in the communication and positioning related to ARTs and surrogacy, due care should be taken to avoid positioning infertility as a ‘flaw’, and ARTs and surrogacy arrangements as the ‘solutions’. Such positioning only serves to further reinforce the stereotyping associated with ‘motherhood’ and ‘childlessness’ which has negative implications for women.

Additionally, as advocated by UNFPA, infertility management should be integrated in primary healthcare provisioning. A major proportion of the infertility in India is secondary infertility. Therefore, it is important that the health sector is equipped to manage the underlying causes of infertility at the primary healthcare level to ensure that infertility management is accessible and affordable for all. Certain standards of care need to be laid out for antenatal and postpartum care of surrogate mothers especially not to be treated as patients restricted in hospital settings during pregnancy. Adoption should be universally and actively promoted.

Further, issues related to citizenship of the child, sex selection in case of a girl child, ‘twiblings’, i.e. the practice of multiple embryo transfers or multiple pregnancies among surrogate mothers i.e. two surrogate mothers at the same time to increase the success rate of surrogacy necessitate further dialogue and discussions in this context. More importantly, the idea of ‘surrogacy’ based on patriarchal premise that ‘having a biological child is most important for a woman’, needs to be challenged and revisited. Infertility as a social stigma should not be promoted. Child bearing and rearing may be promoted as an informed choice of individuals rather than a social compulsion.

—Anju Dubey Pandey works with UN Women Office for India, Bhutan, Maldives & Sri Lanka as a Programme Specialist on

Ending Violence Against Women (Disclaimer: This opinion piece does not reflect the official position of UN Women)

OPINION

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The state has been trying to regularise the arbitrarily growing fertility industry of the country, but vested interests and skewed priorities coupled with faulty understanding of gender issues keep sabotaging its intentions

– Rakhi Ghosal

Regularising the Fertility Market in India

In 2013, Bollywood actor Shahrukh Khan and his wife had a son through surrogacy. The news precipitated much furore. Varsha Deshpande, activist-lawyer and founder of Lek Ladki Abhiyaan, filed a case against the star couple and Dr Firuza Parikh of Jaslok Hospital. The Bombay High Court dismissed her petition, but at the same time the issue re-opened a trail of debates.

With the aid of technology we have moved from identification to elimination of foetuses considered underdeveloped and/or lacking. But amniocentesis, the procedure used to find chromosomal anomalies, and obstetric ultrasound which helped identification of foetal developmental anomalies, also facilitated the identification of the sex of the child much before it was born. As a result, in countries like India, known for its high son-preference, it is the female children who were eliminated in increasingly growing numbers.

Since 1961, the child sex-ratio has consistently gone from bad to worse. The fad is for designer babies—babies with the right bodies and the right sex. In order to curb this growing trend and criminalise foetal sex selection and sex selective eliminations, the Pre-Natal Diagnostic Techniques Act was enacted by the Parliament in 1994. Further

advancement in medical research unleased the potential of In-Vitro Fertilization (IVF): it was now possible to implant sex selected embryos in the womb, i.e., sex selection could be done prior to conception. Subsequently, the 1994 Act was amended in 2003 to become the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, which prohibits selection of the foetal sex prior to conception.

IVF, a technology under the larger gamut of assisted reproductive technologies (ARTs), is one of the most commonly used techniques to facilitate/assist reproduction—in one’s own womb or in a hired one, with one’s own gamete or donated ones. India has emerged as a leading player in the global fertility industry especially because of its cheaper costs, easy availability of surrogates, world class medical facilities, and lack of governmental regulation. In 2008, the surrogacy market in India was estimated to be worth $445 million. But owing to the lack of specific laws, India has also become a minefield of lapses, exploitation and contradictions. The state has been trying to regularise the market, but vested interests and skewed priorities, coupled with faulty understanding of gender issues keep sabotaging the intentions of these guidelines.

ART BILLThe Indian Council of Medical Research (ICMR) drafted the first guidelines to regularise the ARTs and fertility industry in 2005; revisions were demanded by civil society organisation in the wake of several lapses in the guidelines, and they were subsequently revised in 2008 and 2010. However, as on date, an Act is to still see the light of day–implying that unbound by law, vested interests and corrupt practices continue to influence the ART market.

It is demanded that the state mandates a reasonable and respectable payment for the surrogates, so that women who are often compelled by circumstances to act as commercial surrogates are at least compensated in terms of money. However, the debate on if at all such a service can be compensated, will continue.

FEATURE

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In discussing the demerits of the ART Bill, civil society organisations have overwhelmingly focussed on the issue of surrogacy, the rights of the surrogate and the lapses in the Bill vis-à-vis the surrogates negotiating powers and position in the contract. Even though surrogacy (especially in India) involves a woman who is at the receiving end in the power relation between her and the commissioning parent(s)-ART clinic, the Bill displays little concern for her rights, reserving much of it for those who pay for the surrogacy. However, in the absence of more definite laws, fertility clinics have developed their own contingent rules—of course in sync with their own interests and those of the ‘paying clients’. Surrogates are kept away from their families during the larger part of the gestation, not allowed to breastfeed, at times not even permitted to see the newborn. Some clinics even hold back the surrogates’ documents such as the voter’s or Aadhar card so that they cannot break the contract before the child is born.

These practices have been widely criticised by activists and civil society organisations, but not much has changed in terms of everyday reality. The profit-oriented fertility industry justifies its actions by claiming that at the end of the day surrogates are economically benefited and thus should have little to complain. The amount of money to be paid to the surrogate is negotiated on a case-to-case basis by the clinics, leaving much room for exploitation. It is demanded that the state mandates a reasonable and respectable payment for the surrogates, so that women who are often compelled by circumstances to act as commercial surrogates are at least compensated in terms of money. However, the debate on if at all such a service can be compensated will continue.

THE ARTs AND PCPNDTIn the PCPNDT Act, the government mandated all centres offering ultrasound tests, all USG machines, and all practitioners conducting any pre-natal or natal diagnostic tests, to be registered. Also, all records of tests conducted should be preserved for up to two years by the clinics. Despite all this, there is a spurt in unregistered fertility clinics and surreptitious sex selection continues unabated, where sperm sorting or chromosome segregation is used to ensure an XY embryo.

Media reports claim that the IVF and surrogacy industry has produced a disproportionately high number of male children—implying that surreptitious sex selection continues. Recently, the Disease Management Association of India (DMAI) urged the Central Government to set up a committee to enquire into the functioning of Artificial

Insemination (AI) and the IVF treatment industry. Such an enquiry is urgently required especially because there is to date no systematic evidence based study in the public domain which could say with certainty if the IVF and AI technologies are indeed being misused to feed India’s son-preference ideology.

THE ROAD AHEAD However, as is evident, notwithstanding the plethora of guidelines to regulate the fertility industry, we have a long way to go before the problem is smoothened out. It needs to be kept in mind that medical research and technology per se are not problematic; it is the intention behind using them that needs to be reworked.

In current debates on fertility, ‘technology’ has largely come to connote ultrasound and IVF, while the twin issues that generate much discussion are sex selection and surrogacy. There are, however, other challenges to be dealt with as well like the camouflaged ‘success rates’ flagged by the fertility clinics which try to disguise implantation rates as live birth rates; multiple embryo transfers in order to boost the success rates of the clinics at the cost of the woman’s health; exploitation faced by egg donors (the deaths of Sushma Pandey in 2010 and of Yuma Sherpa in 2014 for instance); the blatant violation of ethics by several fertility clinics, etc.

While the projected aim of the ARTs is to assist couples to have a child, in practice, the contemporary fertility industry in India is a capitalist market, lacking ethics and feeding into ideas of patriarchy and gender stereotypes.

—Rakhi Ghoshal is a bioethics researcher. She is Secretary of the Forum for Medical Ethics Society, and is associated

with the Indian Journal of Medical Ethics.

Th e Disease Management Association of India has urged the government to set up a committee to enquire into the functioning of artifi cial insemination and the IVF treatment industry. An enquiry is required as there has been no systematic study which could say with certainty if the IVF and AI technologies are indeed being misused to feed India’s son-preference ideology.

FEATURE

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The report card is based on assessment of the court cases filed, inspections done and action taken by state medical councils in 12 sex ratio critical states of the country

Civil Society Report Card on PCPNDT Act......Calls for Consistent Engagement & Action

With an intention to help the state governments review the implementation of the Pre-Conception and Pre-Natal Diagnostics Technique (PCPNDT) Act and introspect about the work done since its enactment till now, Girls Count in December 2015 released its Civil Society Report Card on PCPNDT Act. The report card is based on assessment of the court cases filed, inspections done and action taken by state medical councils in 12 sex ratio critical states of the country.

Affidavits submitted by the state governments in the Supreme Count of India by September 2014 were reviewed and quantitative data on PCPNDT since the inception of the Act were compiled for the purpose. The Report Card is an attempt to showcase what the data implies in terms of what the states are doing, what they are not doing and what more they should do. It considers absence of actions such as inspections, court cases and convictions as the indicators of non-implementation of the Act and not merely the absence of violations.

The Report Card highlights on the major gaps in the enforcement of the Act in states like Bihar, Delhi, Gujarat, Madhya Pradesh, Haryana, Punjab, Odisha and Rajasthan, mainly in the area of inspections, suspension/cancellation of registrations, filing of court cases, acquittals, convictions, sealing and de-sealing of ultrasound machines/centres, reporting of cases to state medical councils, etc.

The Report Card indicates that the cases filed under the Act are pending since years in many courts of the country and presumes that the ignorance of the officials on duty during inspections about the offences and poor drafting of the cases could be the reason for more number of acquittals.

The Report Card was released on December 9, 2015, by Justice Hemant Laxman Gokhale, former Judge, Supreme Court of India, in Delhi. Among the other dignitaries present during the release were: Bindu Sharma, Director, PCPNDT, Government of India and Dr Satish Agnihotri (IAS), former Secretary Coordination, Cabinet Secretariat, Government of India. Representatives of many civil society organisations from Delhi and neighbouring states were also present.

Justice Hemant Laxman Gokhale stated that the PCPNDT Act is based on Article 15 of the Indian Constitution and questioned: “Why do we see a decline in the sex ratio at birth (SRB) in spite of the existence of law?” He said that it is very unfortunate that in India girls are not born free and in many cases it is made sure that they are not born at all.

RESEARCHSTUDY

Th e Report Card highlights on the major gaps in the enforcement of the Act in states like Bihar, Delhi, Gujarat, Madhya Pradesh, Haryana, Punjab, Odisha and Rajasthan

Amitabh Behar, member Girls Count; Justice Hemant Gokhale, former Judge, Supreme Court and Bindu Sharma, Director, PCPNDT, Govt. of India

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Govt-CSO Partnership Critical for Success of BBBP SchemeThe series of consultations organised by the coalition partners of Girls Count provided a platform for consolidating the efforts of various organisations and networks in different regions to create substantial ways to support the BBBP initiative. It helped discuss and identify local issues prevalent in the states, which lead to the decline in child sex ratio.

A series of Regional Consultations on the theme “Beti Bachao Beti Padhao (BBBP): Building a Collective Response-Strengthening Civil Society Engagement and Community Action” organised by coalition partners of Girls Count, brought together more than 400 representatives of civil society organisations from 28 states and union

RESEARCHSTUDY

WAY FORWARDThe Report Card highlighted on the following measures that needs to be taken for the proper implementation of the PCPNDT Act and check further decline in sex ratio at birth.

• Proper documentation of the records, data and follow-up action by the concerned department under the PCPNDT Act is an area which needs to be addressed on a priority basis.

• The process of the implementation of the PCPNDT Act should not be connected to abandoned foetus. It is important to implement the Act itself by conducting inspections and checking records on a regular basis rather than taking random action against the centres after an abandoned foetus is found.

• Tracking of pregnant women through a device like ‘Active Tracker’ or any other means to prevent gender-biased sex selection is not advisable.

• Ensuring that women register for ante-natal care on time and undertake all check-ups during pregnancy is a constructive measure, but the monitoring should not be based on the assumption that they are ‘conduits’ to sex selection.

• The implementers must recognise the consequences of the declining child sex ratio, the context in which discrimination takes place and realise that they need to play an effective role in tackling gender discrimination through law.

– Girls Count Secretariat

Bindu Sharma, Director, PCPNDT, Ministry of Health and Family Welfare, Government of India, said that sex selection is carried out with the consent of two mutual parties i.e. the service providers and the family members of the pregnant women. Therefore, the onus is more on the service providers not to reveal the sex of the foetus. But as the act encroaches upon their profession, she stressed that the service providers should be included in the discussion on the misuse of technology. Sharma further added that the Ministry is looking into the flaws and problems in the implementation of the PCPNDT Act and is working hard on bringing in the best possible solutions.

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territories across the country. The objective of the consultations held across the country from October-December 2015, was to build a collective response to BBBP initiative and ensure civil society engagement with this initiative in a more cohesive and consistent way.

The consultations were organised on behalf of Girls Count by Dalit Mahila Vikas Mandal (DMVM), Maharashtra; Ekta, Tamil Nadu; Foundation for Social Transformation (FST), Assam; Mayaram Surjan Foundation (MSF) Chhattisgarh; Reach India, West Bengal; Vatsalya, Uttar Pradesh and Voluntary Health Association of Punjab (VHAP), Chandigarh, in collaboration with the BBBP initiative of Government of India, National Foundation for India (NFI), Ipas India, UN Women and United Nations Population Fund (UNFPA) at Bhopal, Chandigarh, Chennai, Guwahati, Kolkata, Lucknow and Mumbai.

Representatives from community based organisations (CBOs), non-government organisations (NGOs), state officials and experts on women and gender issues deliberated on different aspects of sex ratio at birth (SRB), child sex ratio (CSR) and various forms of discrimination against women and girls. The progress made in BBBP districts, the challenges faced, and the role of networks and individuals were also discussed. The dialogue provided a platform for consolidating the efforts of various organisations and networks in different regions to create substantial ways to support the BBBP initiative. The consultations helped discuss and identify local issues prevalent in the states, which is often a reason for the decline in child sex ratio.

CONCERNS RAISED AROUND BBBPParticipants at the consultations expressed concern over several issues and stated that civil society organisations should work in tandem with the government departments in the implementation of this flagship programme of the government. They said that inter-departmental convergence at the state and district level under BBBP is not visible and hence NGOs should be included in the state, district and block level task force, and their selection process needs to be clearly laid out. The mapping of civil society organisations (CSOs) should be the first step towards effective implementation of the BBBP scheme, they felt.

In order to strengthen the BBBP programme, the representatives suggested that the campaign against gender-biased sex selection should be expanded to all the districts of the country and not just the 100 gender-critical

Participants at the consultation expressed concern over several issues and stated that civil society organisations should work in tandem with the government departments in the implementation of the Beti Bachao Beti Padhao programme of the government

COALITIONINITIATIVE

Representatives of civil society organisations, state government departments, academicians and activists at the Regional Consultation held in Guwahati

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3/42, 2nd Floor, Jangpura-B, New Delhi-110014T +91-11-24379452E [email protected] W www.girlscount.in /girlscount

Girls Count is an independent national level coalition of more than 200 civil society organizations and individuals across India, working to address factors that lead to declining child sex ratio. Members are united in their commitment towards creating a more gender equal and gender just soci-ety by challenging patriarchy and stopping gender-biased sex selection. At present, the coalition secretariat is supported technically and financially by UNFPA and NFI, while it continues to raise resources for its various campaigns and activities.

districts. Further, a fact sheet to monitor the indicators under the BBBP scheme should be released by the District Collectors every quarter to inform and educate people about the developments. This will also help maintain transparency in the utilisation of funds under the BBBP scheme at the district level.

ISSUES IDENTIFIED AND SUGGESTIONS MADESeveral roadblocks which lead to the non-implementation of the PCPNDT Act were identified during the consultations. The participants stated that in many states, the statutory bodies are not functional and hence they recommended that to begin with, services providers should be discouraged to communicate the sex of the foetus and the mapping of ultrasound centres and their registration needs to be ensured. They said that engagement of men in addressing domestic violence and promoting value of women and girls is necessary, and promotion of the ‘One-Stop Crisis Centre’ is necessary as many women are still unaware of its existence and the ways to access those.

The civil society representatives further made the following suggestions to ensure the effective implementation of the BBBP programme:

• Review the school curriculum of states running BBBP scheme to know if it is gender sensitive.

• Develop a comprehensive gender, sexuality and life skills module, similar to the one developed for HIV/AIDS and implemented by schools affiliated to Central Board of Secondary Education (CBSE) and the state board.

• Target youth, teachers and the community members to spread awareness about various schemes and Acts related to women and gender issues.

• NSS units in colleges and government initiatives such as Kudumbashree, Janashree Bima Yojana and Jagritha Samithi must have a gender perspective built

in, with special focus on gender-biased sex selection.

• Start free legal service centres for women at panchayat level.

• Regularise capacity building of Self Help Groups (SHGs) and youth groups on gender-biased sex selection and its consequences.

• Work on safe motherhood and safe birth and provide mothers with healthy and nutritious food including medicines. This would be important for the survival of the girl child.

• Girls in many BBBP districts are more vulnerable to trafficking. So 3Ps – prevention, protection and prosecution should be made effective in combating child trafficking.

• Address the increasing trend of ‘honour killings’ in many BBBP states. Moral policing and hyper vigilantism restricts the mobility of girls and women.

• Evolve effective long-term strategies to address the economic reasons for son preference.

• Make sure greater involvement of the community in monitoring and tracking gender-based discrimination and crimes against women.

• Ensure critical review and monitoring of the BBBP scheme and participatory community assessment.

• Highlight positive stories of change and interface with CSOs and media.

– Girls Count Secretariat

A fact sheet to monitor the indicators under the BBBP scheme should be released by the District Collectors every quarter to inform and educate people about the developments. Th is will also help maintain transparency in the utilisation of funds under the BBBP scheme at the district level.

COALITIONINITIATIVE