Birth rights: Is the fight against sex-selective abortion hurting women?

At Sundari Ravindran’s request, we have deleted the first two sentences of the last paragraph in this post and edited the third paragraph. Her explanation of the need for the deletion is at the end of the post. We apologize for misconstruing Sundari’s words, and commend CommonHealth for the efforts they’ve made to promote campaigns against the neglect of daughters and preference for sons, including but not limited to supporting the prevention of illegal pre-natal diagnostic techniques for sex-determination.

Sundari & Khushbu

Sundari Ravindran, one of our amazing program partners (pictured above with Asia Program Officer Khushbu Srivastava), joined us for a discussion at the IWHC offices recently. The topic: sex-selective abortion. Until meeting Sundari, a co-founder of CommonHealth, a group that promotes maternal health, safe abortion and neonatal health in India, I thought the issue was simple: favoring the birth of a boy over that of a girl is not only discriminatory, but it leads to gender imbalance and eventually undermines the future of entire communities. This week’s Economist—and many international agencies including the UN—have framed the issue this way.

Surprisingly, the truth is a lot more complicated and has sparked heated debate in India: the fight to stop sex-selective abortions has actually had a detrimental effect on women’s access to safe abortion services in that country.

Abortion has been legal in India since 1971, but in recent years, concerns over sex-selective abortions have led to unofficial restrictions for all women. Campaigns have been mobilized in the name of women’s rights calling for protection of “the unborn girl child”—language that eerily echoes that of the anti-abortion movement.

In rural areas of India as much as 50 percent of women who want to have an abortion are unable to find local services to terminate their pregnancy. Even when a skilled abortion technician is available, services are often denied because doctors fear being accused of performing sex-selective abortions. When a woman comes in wanting a second trimester abortion for whatever reason, she’s often seen as guilty of asking to terminate the pregnancy for sex-selection reasons—and there’s no way of proving otherwise.

*We must find ways of combating discrimination against female children that doesn’t endanger or restrict the rights of women who are alive in the world today. Through CommonHealth, Ravindran continues to stand for the legal rights of girls and women through all stages of their lives and spotlights the ways in which they are being violated or denied today. The organization has worked to educate decision makers including doctors, nurses, journalists, policy makers and health systems administration workers and does extensive outreach in areas where female birth rates are extremely low to inform women and their families of their rights. The thinking is this: education, not the denial of rights, is the path toward positive change.

*Sundari comments:

a) I did not talk about “high rate of post-partum depression, suicide and abuse of women”, because there is no such data available. I spoke of studies showing an association between post-partum depression and birth of a female child; of similar association between abuse and female births seen in every day life. The way this has been written up is really probelmatic.

b)  At no time did I ever say something to the effect “a sex-selective abortion could potentially save the life of the mother” – this appears to be an interpretation by the blog-writer based on the association of unwanted female births with depression, abuse etc. It is really unfortunate that such interpretations were drawn and then written up in a way that does not quite attribute it to me but nevertheless links it to me.



22 responses to “Birth rights: Is the fight against sex-selective abortion hurting women?

  1. Thanks Subhash for sharing your view on this very crucial issue. We at EKTA totally endorse your view point.
    We are planning for regional and State level consultations for creating greater awareness on both MTP , PC- PNDT Act and of course the views expressed by the advocates of Universal access to safe abortion. Let us collectively try and create enabling environment for women to access health care and not enhance their vulnerability in the name of rights.
    In solidarity
    Bimla and members of the women's network facilitated by EKTA

  2. Thanks Melaine, Sundari, Khusboo, Subash and Bimla,

    I am writing this in my capacity of president of Ekta, Madurai, India, Board member of Law trust, Nagapattinam and a panelist in a women's tribunal on MDG held in TN last month (where 300 dalit, adivasi and muslim women panchayat leaders came) organized by Tamil Nadu women's forum and WADA Na Todo campaign. I am not writing this in other honorary positions that i hold.

    I am a strong supporter of women's right to abortion (beyond what is said in MTP Act in India- not available on demand), but for purposes other than for sex selection in countries where daughter aversion or son preference exists like India.

    I disagree with the position that pregnant women have right to sex selective abortion in countries where there is daughter aversion exists as they are penalized in their martial homes or community otherwise. If one takes such a position adult women and adolescent girls other than the pregnant women who is seeking selective abortion also get affected.

    – there are evidences of poor dalit and adivasi adolescent girls from Kerala, Andhra, Assam and West bengal being sold off against their wishes to middle aged men form TN, Punjab and Haryana. In a context where honor killings are increasing when people marry outside their caste (now spreading to TN) that such marriages lead to equitable treatment of women as their co sisters from the same caste as husband can be contested. For evidence see prem chowdhury's article in EPW

    – there is evidence of of cases of women being forced to marry two male siblings have come up in the context of declining sex ratio in Haryana (where such practice traditionally existed in landed communities) and spreading to non landed communities. Evidence is also emerging from other states.

    – there is emerging evidence of increase in sexual violence against women and girls in public spaces in states with low sex ratio, though it is difficult to statistically correlate the two


    – evidence came from the tribunal of women committing suicide as they were forced to do sex selective abortion or live with guilt for doing the same

    – there are market imperfections and dowry/son preference will not come down with girl shortage and neither will caste barriers get broken with

    – Such a position violates principles of non discrimination in CEDAW and in Indian constitution

    – such an argument makes the case for mothers to keep adolescent girls inside house, not send them to high school, enter into forced marriage etc., give and take dowry as they are victimized otherwise.

    – While women are products of patriarchy, I do not believe that they are totally powerless. Women's rights to natal and marital property, decent work, legal aid and counseling (of also men and in laws) is a better alternative.

    – Data from 13 districts from TN shows no particular trend that such campaings have led to decline in abortion in public facilities- in some equal number of districts it has gone up, gone down and in few trends are unclear. Evidence from other states may be different and should be put into iwhc web site.

    One may ask is it the pregnant woman's responsibility alone to ensure that SRHR of other women is protected? I think apart from state, community, markets and households the broker who buys and sells poor girls/women and the person who procures such women and girls , it is also the pregnant woman's responsibility. Human rights are indivisible, universal and in inalienable. Personal is political.

    Having said this, I agree that campaigns against sex selection/sex selective abortion in countries where daughter aversion exists should not use the term feticide (even I used the term three or four years back when Sundari corrected me) or ally themselves with pro life people. They should ensure that abortion for other reasons are available.

    PCPNDT act should be amended so that at no cost women can be penalised. At present it says that women will be assumed to have acted under pressure from husband and in laws, unless proved otherwsie. This id difficult to prove, so amendment is necessary. The percentage of women booked under this act is minimal when compared to providers.

    Some (not all) of the opinions here are endorsed by the 300 rural women in the women;s tribunal. Their concept of feminism was also beyond the well being of the present generation and looking at the next. (while not endorsing that they had to adopt population control for saving the environment for future generation) .

    I hope this dialogue with lead to common grounds to be established that campaigns against sex selection/sex selective abortion, for safe abortion for other reasons and against daughter aversion/son preference should each look at the other two issues.


    Ranjani Murthy

  3. There is a lot that has been said in these forums. Here is my bottom-line.

    -Women have the right chose. If they are not in a position to have a child, or it is an infringment on their overall choices in life (career, health), they have the right to have an abortion. But, if it becomes sex selective – then it takes a different hue. Especially given India's declining sex ratio. Granting women (and in process the avenues for coercion for the extended family) the right to sex selective abortion, reinforces the bane of Indian society. If we let this happen, the age old malaise that dogs India will continue to thrive. India will resemble Haryana.

    So let us not mx up issues. The right to chose is diffferent from sex selective abortion.


  4. On behalf of Tamilnadu Women’s Movement, I wish to state that we are fully supportive of the view of Ms. Ranjani K Murthy. Women should have right to abortion, but definitely not sex selective abortion. From the knowledge of having discussed this with thousands of women, we at TWM are of the strong opinion, that women are forced to sex selective abortion by the inlaws and in saving her married life as against the female foetus, she prefers to tell a lie that she is doing it on her own free will. Only way to protect the rights of the women is to refuse sex selective abortion which can easily hide it self under the guise of right to abortion. Right to abortion is a must to Tamil women, as long as sex selection is not happening.

  5. I support the view that women and their partners should act responsibly for any conception that may ensue and be accountable for it. Abortion should be available to women who have medical problems, and to those who have conceived due to sexual violence. Getting rid of a baby for other reasons is not ethical as an unborn infant also has a right to life.. it is not a ” thing” to get rid of .

  6. hope you are in good health and spirit. This is request you to forward data regarding trends MTP services at the national level to Ranjani. She isnot in good health. she wants to use thedata as a response to the observations made by a blog. on women ‘s reproductive health care.

    thank u


  7. We had a discussion among our women members of Tamilnadu Pondy Fisher People Federation regarding this issue. We find that women are of the opinion that a girl who has suffered forced sexual relationship or a sexual relationship based on false promise to marry, should have the right to abort the foetus. However, in the case of married women, our women feel that the foeticide is largely to get rid of female foetus. Therefore we feel that care should be taken in allowing married women having right to abortion, so that it does not become a permitted means to get rid of female child on the make.

  8. On behalf of Sneha, an NGO working with the fishing communities for the 26 years, I wish to support the views of Ms. Ranjani K Murthy with regard to sex selective abortion. We have had several discussions with the members of the fisher women federation and we believe women should have right to abortion, but not sex selective abortion. Sex selective abortion definitly leads to decline in child sex ratios.

  9. Please delete the previous comment by gandimathi six hours ago

    hope you are in good health and spirit. This is request you to forward data regarding trends MTP services at the national level to Ranjani. She isnot in good health. she wants to use thedata as a response to the observations made by a blog. on women 's reproductive health care.

    thank u


  10. The issue under discussion is pertinent and certainly there are different points of view. But my take on the issue under discussion is that women must be able to access safe abortion services—-ie right to abortion is a non-negotiable. However on the issue of SSA I have a different view and do not prescribe to the view that there is a right to this, as having heard from the rural women both in the recently held TNWF and WNTA Women’s Tribunal and during my several visits to disticts, where women expressed that SSA in the first place will distort the sex ratio. Secondly SSA is largely done through coercion of the family, with the women having to face trauma and distress.. Further I endorse the views of my friends, Ranjini, Bimla, Gandhi, vasantha and several others who take a similar position on this.

    Aasha Ramesh

  11. Practice of Sex Selective Abortion (SSA) denotes the plights of women who do not have much say in their life .women still being the reproductive machineries has less or no right to sexual and reproductive relationships. SSA endorses the discrimination against women and will end up in extinction of women as per our countries declining sex ratio. We should not forget the fact that the women as the base of human existence Annihilation of women through SSA crack down the agricultural production of our country, as women are engaged in pre and post agricultural production process, and as a result the nutritional security of our nation will be at stake. Therefore SSA should be banned.

    josephine ,pen sakthi

  12. Dear all continuation

    The PNDT Act of 1994, later amended in 2002, was enacted with the objective as stated in the preamble
    …to provide for the prohibition of sex selection, before or after conception, and for regulation of pre-natal diagnostic techniques for the purposes of detecting genetic abnormalities or metabolic disorders or chromosomal abnormalities or certain congenital malformations or sex-linked disorders and for the prevention of their misuse for sex determination leading to female feticide and for matters connected therewith or incidental thereto. The pramble clearly says that sexdetermination leading to female feticide (SSA) is prohibited.

    ThePCPNDT Act has been upheld by the Mumbai High Court in the case of Mr and Mrs Soni vs. Union of India and CEHAT, 2005. The judgement states: "The right to life or personal liberty cannot be expanded to mean that the right to personal liberty includes the personal liberty to determine the sex of the child which may come into existence. Right to bring into existence a life in future with a choice to determine the sex of that life cannot in itself be a right." ,
    "Attitudes of medical practitioners reveal that they view sex determination tests as a 'humane' service they provide to couples not wishing any more daughters; as a regrettable but unavoidable result of the preference for sons in Indian society which they feel powerless to change," say S Sudha and S Irudaya Rajan in their research paper Intensifying Masculinity in Sex Ratios in India – New Evidence (1981-1991), supported by a grant from the United Nations Fund for Population Activities.
    They add that the preference for male children in India is unchanged by mortality decline and socio-economic development. The increase in the number of boys as compared to girls – as evidenced in sex ratios at birth – in urban areas, which have higher literacy rates and better coverage of vital registration and health services, suggests that the trend is due to the spread of prenatal sex determination and selective abortion of female foetuses rather than female under-registration or infanticide. The trend coexists with the high female child mortality rate and the practice of female infanticide persisting in many parts of the country. Besides, as many Indian women are anaemic, the test-abortion-test cycle is equivalent to committing physical violence on the woman, she adds.
    Is female foeticide still continuing in India? A survey conducted by the United Nations in 2007 revealed that over 2,000 unborn girls are aborted every day in India
    gandimathi, Researcher law trust ( to be continued

  13. dear all

    Is female foeticide still continuing in India? A survey conducted by the United Nations in 2007 revealed that over 2,000 unborn girls are aborted every day in India.

    A research conducted by Prabhat Jha, Canada Research Chair in Health and Development at the University of Toronto, and his colleagues from India indicated the deficit of over 10 million female births in India over the past two decades. The research, based on a national survey of 1.1 million households in 1998 and published in 2006 in The Lancet journal, said pre-natal selection and selective abortion were leading to the loss of 500,000 girls a year in India. However, the study was disputed by the Indian Medical Association (IMA) that claimed the number of female feticides is closer to 250,000 per year.Kamma arora, Zee news .com, May2010
    Thus Sex selective abortion leading to declining child sex ratio is a well established phenomenon .CASSA came into inception when there was an incresing trend of SSA after dex determination . the campaign hs moved to an other level where women as organs of reproduction are commercialised commodities under the new regime of ART. . Without understanding the history and evolution of the campaign it is highly unethical to say that the campaign is illegal .The campaign 's mission was to halt the declining child sex ratio and not against wome's right to abortion. We advocated against sex selective abortion as it had an adverse impact of CSR. Moreover wo locate this campaign in the overall campaign for women;s right to reproductive health care.

    Th e global position of exercising freedom of choice of sex selection and right to sex selective abortion needs a different strategy in a countries likeIndia and china where there is prevalence of son preference and girl child aversion.

    I have woked with SIRD , agrass root organisation who exposed the issue of female infanticide in Tamilnadu , a pioneer in buidlng a campaign against sex section and sex selective abortion.
    I ihave interviewed hundreds of women and done case studies for Chiristian Aid and BBC where we have listened to the agonies of women who have committed infanticide. Their testimonies revealed the depressions and guilt they carry . Many women told us that they havenot slept for years together.The state commission for women conducted a public hearing on female infanticide and female feticide.

    Here CASSA not only presented the cases, but took out a strong position that women cannot be penalized under any cirmustances and these clauses need to be removed under the respective laws.
    I am surprised to learn that second trimester abortion service is not available. In a country where abortion is used as a contraceptive and family planning tool and the Indian drugs act is liberalized to allow nonsurgical abortion bills to be available over the counter and MTP act is liberalized to extend the services and registration under the act., will this observation of the speaker can be imposed as a overall trend .
    I am passing the dilemma of corporate company which recognizes implication pf Sex selective abortion on girl child status.
    UVAE0337GE health care in India an ultra sound strategyGe Healthcare in India: An Ultra(Sound)Strategy?JennyMead University of Virginia (UVA) – Darden Graduate School of Business AdministrationDarden Case No. UVA-E-0337
    This case outlines the dilemma of V. Raja, president and CEO of GE Healthcare India, when the company’s ultrasound machines were implicated in many cases of prenatal sex determination. Even in the 21st century, Indian society favored males and many in India saw females as a burden on their families. Studies had shown that fewer and fewer girls were being born, with potentially catastrophic results for future Indian society. The reason: Many women were relying on ultrasound machines to determine the gender of their fetus and, if it were a girl, having abortions. Raja knew that GE Healthcare and ultrasound machines were providing much better medical care for Indians, particularly those in rural communities, and that the company was following all the rules and regulations to prevent this type of abuse. But he also understood the social issues that were involved
    Ultrasound machine sales had enormous potential to help maintain GE’s market-leading position in India. But should the company step back from its aggressive sales strategy? How could Raja and the company alleviate the growing discontent among critics and the media against the practice of prenatal sex determination testing using GE’s ultrasound machines? What additional efforts did GE need to make to prove its intentions of promoting prenatal care? What other efforts should the company make to stop the illicit prenatal gender determination and resulting abortions? How could he protect the as yet untarnished image of GE as a responsible corporation going forward?
    In a country with an aversion to girl child, we cannot exercise the freedom of choice and right to sex selective abortion
    Law trust,
    Member, CASSA

  14. POSTING 1
    Dear All
    I am happy to hear that Sundari's words have been mis-constructed.
    Recently the National Human Rights Chairperson's (India's) inaugural speech during the recently held meeting on the Pre-conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act clarified:
    – para1. sex selection to include elimination of girls through abortion, infanticide and neglect.
    – para 6: PCPNDT regulates sex selection before or after conception.
    – para 8: makes it clear that the Medical Termination of Pregnancy (MTP) Act does not permit sex selective abortion.
    – para 8/9: not providing safe abortion for legally valid reason under MTP Act also constitutes discrimination.
    – para 12: rights of community (of women) over rides (women's) individual right to sex selection

    The problem of sex selection/sex selective abortion is not specific to India. UN estimates 60 million girls are missing in the world, with majority in Asia though there is an increase in SRB. The countries which have seen a masculinization of sex ratio after 1950-55 include Some of the countries where SRB is skewed are Republic of Korea, China, India, Armenia, Azerbaijan, Georgia, Nepal and Vietnam. These countries make 40% of the world today, and tomorrow this proportion could increase more.
    Some of the reasons for skewed SRB include poor implementation of legislation banning sex selection/SSA (it is rarely one off clinics, but an institutionalized money making racket in private sector), patrilineal/patrilocal residence, extended dowry (India), emphasis on staying married at all costs, misinformed religious beliefs on centrality of sons, privatization of health sector, growth process based on liberalization which economically marginalize women, increase in inequalities, and using dowry as a strategy for equalization and lack of adequate old age pensions and social security schemes for elderly.
    Consequences of skewed SRB in India shows that poor dalit and adivasi girls being bought against their wishes by the upper castes, resurfacing of polyandry and spreading of to new communities in India, bride trading, and increase in sexual violence. In China it is been noticed that there is increase in STIs, increased trafficking of girls and unmarried elderly men without family support. Both India and China are witnessing the crisis in agriculture and reduction in food security due to skewed SRB. That is prenatal sex selection and sex selective abortion affects SRHR of women and girls who are alive, and affects national food security. Women and girls bear the brunt of food insecurity in countries with daughter aversion.
    Hard data from Asia does not support that 0-4 SR is normal when SRB is below normal. Neither does evidence from Asia support the hypothesis that the first two children are more likely to be males. Link between decline in TFR and daughter adverse SRB in patriarchal societies is mixed. It may be true in India and China. But Bangladesh has also seen a decline in fertility, but not in SRB.
    At the same time unsafe abortion is a huge problem in Asia. It is estimated at 98, 00,000 which accounts for 50 percent of that in the world. Deaths due to unsafe abortion in Asia are 42 percent of total deaths across the world due to unsafe abortion. Unsafe abortion accounts for 12 to 13 percent of maternal deaths in Asia. MMR rounded of to 40-50 per 100000 live births for Asia as per WHO report, 2003.
    Availability of abortions is an issue. In only few Asian countries is abortion legally available on demand, it is available under more than 3 conditions out of 6 (threat to life of women, health of women, mental situation of women, rape, fetal abnormality, social reasons) and heavily restricted in others. Thus issue of women’s legal access to safe abortion is critical and central to reducing preventable maternal deaths.
    Unsafe abortions can be seen as arising out of legal barriers (based on particular interpretation of religion), less emphasis by governments on ensuring its availability in public facilities, provision of unsafe abortion services in some of the private sector clinics, unregulated-misuse of medical abortion beyond safe period, lack of availability of temporary methods and male responsibility, lack of skills and attitudes of designated providers, social stigma around abortion, women’s and girls lack of decision making power and persistent violence against them. In my opinion it is not true that campaigns against sex selective abortion where human rights activists and women's groups are involved have reduced access to safe abortion. It is true that abortion services are less available than institutional delivery and contraceptive services at PHC and CHC level in India, but where they available before the campaigns? I believe that the perception that women do not know of MTP Act all over India is not asked. My discussion with women and adolescent girls in slums in chennai with Center for Women's Development Research reveals that abortion continues to be available in tertiary hospitals, but quality of care and forced sterilization continues to be an issue. Confidentiality is an issue due to which unmarried adolescent girls go to private sector. 20% of 80 adolescent girls from slums knew personally cases of sex selective abortion of females (and they were not sex balancing) . Recommendations in next submission

  15. Posting 2 Recommendations:


    1.UN, governments and donors should uphold women’s and adolescent girls right to safe abortion in all countries but other than for sex selective abortion of females. Neither should sex selection of males or sex balancing be allowed as after all we want a society where there is no social difference between boys and girls (also view of adolescent girls) .
    2.The concept of reproductive rights in 1994 ICPD and women’s and adolescent girls control over bodies should not be extended to cover right to carry out sex selection of males before conception, sex selective abortion of females or sex balancing.
    3.Governments should address the common factors underpinning unsafe abortion and sex selection of males/sex selective abortion of females is several Asian countries with daughter aversion
    4.We need both implementation of Acts against sex selection/sex selective abortion and legalization of safe abortion (for other reasons) for women and adolescents girls and work on larger issue of preventing daughter aversion. One strategy cannot privilege the other, cannot follow an either-or approach. The three efforts must ideally go together.
    5. We need to strengthen provision of safe abortion in government facilities upto PHC level. Government is more accountable than private sector to implement both laws against sex selection/sex selective abortion and provide legal and safe abortion.
    6.Both symptoms and causes of sex selection and sex selective abortion need to be addressed. One cannot argue that only root causes of daughter aversion should be addressed, as it is a private good (not sundari's argument). In which case abortion is also a private good, unless it is argued that it is a population control agenda.
    7. Lastly, we need to combine 'individual' reproductive and sexual rights and 'choice' framework (which should not be over ridden by cultural values, like religious beliefs against safe abortion) with a broader concept of reproductive justice (coined by women of colour) which is interested in women's and girls collective rights and well being and located in the larger political economy of privatization, inequities, malnutrition, poverty etc..

    Citizen of India.

    for details of a consultation in south India on this issue please write to Bimla Chandrashekar, Director Ekta,

  16. One solution:
    Before using ultrasound patient should write down if patient choose to make an abortion if the baby is healthy or not. Showing an ID.
    At this point the patient do not know the gender.
    If the answer is "NO" and the ultrasound will show a girl, the answer is clear that this is about gender selection if the patient makes an abortion in the future.

    The missuse in this case will be that most patients out for gender information will write down "YES". This should be panished in some way to be prevented. But not taken to far, considering risk at stake.

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