The information is traded in whispers over cappuccinos in the cafés of South Delhi and in the locker rooms of seaside gyms in Mumbai.
That doctor won't tell. But this one will. For a price.
And once you know, call this clinic – they will help with the “problem.”
In India, it has been illegal for 15 years to tell a pregnant woman the sex of her fetus – and to abort based on gender.
And ever since a national census in 2001 found that millions of girls were “missing,” the government has been throwing money at the problem. There are cash payments to parents when a girl is born, bursaries to send girls to school and a cheque on a daughter's 18th birthday.
These measures, launched under the slogan Save the Girl Child, aim to give parents an incentive to have daughters, and a cushion for what is perceived as the exponentially greater cost (a girl will almost certainly need a dowry, and will join her husband's family, taking her earnings and property with her).
There are some early signs that these interventions may be working, in poor families.
But $100 on the birth of a girl – or even $2,500 at her marriage – means nothing to the country's wealthiest families. And that is where the gender gulf is yawning most deeply. The richest neighbourhoods in the country – the wealthy farming areas of the Punjab, the middle-class areas of Mumbai and other cities, and here, the leafy neighbourhoods in the south of the capital – have the biggest gaps.
High-caste families in urban areas of the Punjab have just 300 girls for every 1,000 boys, researchers financed by Canada's International Development Research Centre (IDRC) reported last year. In South Delhi, it's 832 girls born per 1,000 boys; in the state of Haryana, home to the high-tech hub of Gurgaon, it's 822. (In “normal” circumstances, demographers expect to find 950 to 1,000 girls born for every 1,000 boys).
Conventional wisdom has long held that as India develops – as more families struggle their way into the middle class, more girls go to school and more women join the work force – traditional ideas about the lesser value of girls will erode. The incentive to abort them would fall away.
Instead, the opposite has happened, and the reasons – and solutions – have government and activists stumped.
“These educated, well-off women, who still want sons – this is really the crux of the problem and the government has not caught on to it,” says Farah Naqvi, author of a major study on attitudes to “son preference.”
“Yes, you have these very modern women today – you see them in spandex at the local gym … but it's a complicated modernity. It's two worlds these women are straddling.”
Women with a Grade 10 education or higher are four times as likely to have a second child who is a son, after a first daughter, as are women who are illiterate. “These educated, employed women are earning very well, and yet they prefer a son,” says N.B. Sarojini, head of SAMA, a health organization that tries to help women resist sex-selection pressure. “Why are rich women worst? If you have a male child, you are more valued in society – it's true in any class.” The crucial question, she adds, is why that idea has proved so immutable.
One of the dark ironies of India's growing prosperity is that it seems, in many quarters, to have exacerbated traditional ideas about the cost of girls, rather than changing them.
“It's no longer okay to marry your daughter off at 13: You have to give her education, job prospects – the expense of a daughter has been heightened,” says Mary John, head of the Centre for Women's Development Studies in New Delhi and an author of the IDRC study. “It's an unintended consequence of modernity.”
NEW TECHNOLOGY FOR AN OLD PURPOSE
Son preference has ancient roots in India – as it does in many other countries. The earliest, colonial-era censuses from this region show skewed gender ratios. Until the 1970s, girls were eliminated through infanticide and neglect. Then, as now, women faced immense pressure to produce sons and undertook regular fasts or nightly temple visits in their quest for male children. Then ultrasound technology was introduced here in 1975 – at first, in an effort to diagnose fetal abnormalities and illnesses.
But almost immediately it began to be used for sex selection: a high-tech replacement for offerings made at the temple offering. Soon, there were newspaper advertisements offering pregnant women and their families the test: “Spend 500 rupees now to save 500,000 rupees later,” by avoiding a dowry.
Ultrasound technology kept getting better, and cheaper. Soon there were mobile clinics, which travelled among villages that lacked even clean water or electricity, to offer fetal scanning, and abortions. The mobile clinics performed a scan for as little as $12 – which can be a month's earnings for a landless agricultural labourer, but is viewed as a wise investment compared with the risk of an unwanted daughter.
In 1994, after sustained campaigns by women's-rights activists, the government made it illegal both to use ultrasound to determine gender and to tell a parent what the gender is. The new law said all ultrasound equipment must be registered (with the hypothetical goal of auditing all those who provided the service based on the gender ratio of babies born to their clients) and threatened doctors who did sex determination with up to five years in prison.
But investigations of doctors, who form a powerful political lobby here, have been exceedingly rare – usually they follow “stings” by journalists – and fewer than a dozen doctors have been convicted. Meanwhile, it is common knowledge among families which doctors will disclose gender, either directly or by handing parents pink or blue candy, pens or booties after the scan.
The situation has become even more complicated today, with many of India's almost totally unregulated and ubiquitous fertility clinics offering gender determination of embryos – creating male embryos to implant in women who want to skip the hassle of getting pregnant, carrying a fetus for 16 weeks and then aborting. This practice was outlawed in 2004 – but is offered openly in three fertility clinics visited by The Globe and Mail.
In 2007, a wealthy Mumbai couple went to court to argue that the law against sex determination infringed on their right to “balance their family” and have a son, in addition to the two daughters they had. They said they were not going to “destroy” a female fetus, but rather use technology to “select” a male embryo. (The court ruled against them.)
In addition, sex-selection kits (of varying effectiveness) are now widely available in India for about $300, sold over the Internet from countries where they are legal.
In conversations in cafés and other social settings, 13 affluent women in Delhi confirmed that they were told the gender of their fetus by doctors at upscale private clinics; while some said they were seeking a different “family balance,” none would discuss whether she had broken the law and asked to terminate a pregnancy. (While the statistics show the practice is widespread, there is surprising reluctance to discuss it, which may indicate a change in attitude to sex selection.)
Two women said doctors who do not ask questions about the reason for a termination charge about three times as much – $600 – for performing the service.
There are many reasons Indian parents still feel they must have sons. When a Hindu or Sikh parent dies, a son must carry out the last rites; if not, the very devout believe they won't reach heaven. Sons are perceived to carry on family lineage in a way daughters cannot. They also live with their parents all their lives, and care for them when old.
And then there's cold, hard economics: In the words of a Punjabi proverb, raising a daughter is like watering your neighbour's garden. Girls leave home at marriage, taking whatever skills or assets they have accrued. And the practice of dowry, once restricted to the highest castes, has been adopted at all levels of society – as a sign of social status – and is nearly universally practised even though it was outlawed in 1961. (Like the law against sex selection, this one seeks to alter a widely accepted social practice, and there is little enforcement – in fact, many feminists argue, government is reinforcing the practice by offering cash to unwed girls on their 18th birthdays.)
In aspirant middle-class families in south Delhi today, a typical dowry provided to a groom's family can include a sports car, a large apartment, all its furniture including high-end electronics, and thousands of dollars in clothing. “Increasing materialism … and the emphasis on obtaining consumer lifestyle products has exacerbated the problem of dowry,” Ms. Naqvi says.
Navsharan Singh, who heads the gender program at IDRC's India office, noted that dowry was a way to allow girls to share in family property; although India's inheritance law was changed two years ago to allow daughters to inherit, this has yet to have had an impact.
SMALLER FAMILIES LOWER THE ODDS
Meanwhile, family size is shrinking across all sectors of Indian society – the “small family norm” is pushed aggressively by government. Son preference endures even though people in upper income brackets rarely have more than two children, and so go to great lengths to ensure they have a son.
“Sex selection followed by abortion is a difficult, painful practice that few if any women would seek out – so you need to look at the dynamic in this family that makes a woman so desperate to have a son that she will undergo this pain,” Ms. John says. “If you're only having one or two, you do need this boy, that's the perception – the boy is an investment worth making, and the girl, as much as you might love her, she's going to have duties in another family. Call it rationalization or justification, but these are the motives.”
Last month, the Delhi government released new data drawn from birth registrations and said triumphantly that the sex ratio had actually increased from 820 girls born for every 1,000 boys in 2005 to 848 in 2008 – which means 19,000 more female births in 2008 than the year before. The government attributed the gain to its “Laadli” scheme – the Hindi word for darling or beloved – which gives each family with an annual income under $2,500 that same sum when a daughter turns 18.
But activists scoffed, calling the numbers bad statistics (the total number of births reported was down, when in fact it is believed to have risen considerably) and saying they actually represented a gross under-reporting of boy births – many poor women do not give birth in hospitals or clinics, and never register their babies' births, but the Laadli scheme gives families with girls a powerful incentive to do so, distorting the numbers.
Either way, the Delhi statistics confirmed that gender ratios are skewing with growing affluence: Muslims, the poorest residents, registered 1,040 girls per 1,000 boys. Sikhs and Christians, the two wealthiest groups, had 873 girls and 875 girls per 1,000 boys.
Ms. Naqvi noted that positive attitudes about modern women, who are earning their own income and contributing to families, exist simultaneously with concerns about women's increased independence and autonomous decision-making, seen by many as negative changes that clash with traditional Indian values, which link family honour to the sexual purity of daughters.
Her research found that young women were most receptive to challenging sex-selection, but Indian women of any class rarely make decisions about their reproductive choices themselves: Husbands and in-laws are usually intimately involved.
At a south Delhi abortion clinic this week, for example, five of six patients booked for appointments had been accompanied by their mothers-in-law. The clinic director, who did not wish to be quoted by name because of the sensitive nature of the subject, noted the large sign – which must, by law, be posted – saying sex determination was illegal and not offered there. Five of the 200 patients she sees each month are well into their second trimester, when fetal gender can be confirmed, and claim to already have daughters. She turns them away, fearing sex-based termination is their primary motive.
“But others lie, and how can we check? They say they have sons already, and came because of contraceptive failure, and that entitles them to abortion … and there is nothing I can do about that,” she adds.
Abortion has been legal in India since 1971, and safe and cheap terminations are available in government hospitals and private clinics, an accepted part of government's “small families” population-control practice. But the campaign to protect female fetuses presents complicated moral questions for defenders of reproductive rights: It uses language such as “defending the rights of the girl child,” but Indian feminists debate the issue uncomfortably: Is the implication that male fetuses do not have rights? Or have different ones?
Ms. Singh notes an “incoherence” between a woman's right to abortion and the state's restricting her from choosing her child's gender: “We've been struggling with these questions. Choice is individual but the consequences are societal, when the rights of those who survive are also compromised – I'm rendered less wanted and my claims as a citizen are less valid.”
HUMAN TRAFFICKING MEETS THE NEED
The shortage of potential wives is a subject of frequent coverage by the Indian media. And there are alarming stories – particularly from Punjab and Haryana – of human trafficking. Lower-caste women are bought in states such as Jharkhand, where the sex ratio is roughly equal, and then sold for a few hundred dollars in higher-caste communities.
There are also reports of a surge in polyandry – of a single woman “married” to all the brothers, or to brothers and uncles, in a family, and kept, essentially, as a sex slave with the sole function of producing sons. Media coverage of the “feticide” issue here is inevitably accompanied by dire predictions that violence against women and other crimes, even terrorism, will rise as frustrated young men lose outlets for their sexual urges.
But activists say this analysis misses the real problem. “I hate this argument – I don't care if men don't find brides; we're talking here about missing women,” Ms. Singh says. “What matters are the social and political entitlements of the women who survive – those of us who made it. It's a devaluation of women manifest in such violent form: Your very sex is so worthless it's being eliminated.”
India's government seems to be waking up to the idea that sex selection is not only a practice of the poor: “Growing economic prosperity and education levels have not led to a corresponding mitigation in this acute problem,” Prime Minister Manmohan Singh said last year. Yet currently there are no policy initiatives – other than soap operas with “feticide” plot lines – aimed at middle or upper-class women.
Ms. John of the Centre for Women's Development Studies argues that clinic raids, bursaries and television ads are not going to stop the sex-ratio slide, when the roots of the problem lie in people's rational decision-making. “If we have no social security system or public health care, and health and education are getting more expensive; if you don't query marriage norms in our society as the successful outcome of parenting; if you don't want to enable daughters to be strong – these are the things that have to change.”
Stephanie Nolen is The Globe and Mail's correspondent in New Delhi.