Almost every day, in the course of my work, I meet a patient who has more than one or two siblings. Eight or nine seems to be the number for most, of which, not surprisingly, the majority are girls.
Of these girls, almost all are uneducated and married as soon as they are legal with many parents not even waiting for the legal age. On further questioning, they blushingly admit that the girls were born one after the other till their parents were granted that coveted son.
The preference and importance of a male child in our country is no secret. In the early 1990s, ultrasound gained momentum as a means to determine gender post conception, followed by the fast terminations of these pregnancies. This grew to a whopping multi-million business, giving an avenue for male preferring families to produce a male heir without the birth of multiple daughters first.
The Pre-Natal Diagnostic Techniques Act 1994 was amended in 2003 to the PC (preconception) & PNDT Act to bring ultrasound and sperm selection under its ambit. It was passed to prevent the misuse of prenatal diagnostic techniques as sex selection measures and thereby prevent female foeticide.
It has helped do that by precisely 10 women per 1000 males, i.e. the male to female ratio (calculated between the ages of 0-6yrs) went up from 933 in 2001, to 943 women to every 1000 males in 2011.
What the gender ratio might have been without the PCPNDT Act is anybody’s guess. I was unable to find any studies or demographic projections available for the country in the absence of the Act. Were the PCPNDT Act not in place, would we be facing a desolate landscape of male-only communities? One can only speculate.
The overall Indian population, on the other hand, has grown by leaps and bounds to stand at 1.34 billion (as of December 2017) at the time of writing this article and continues to grow. India is projected to be the world’s most populous country by 2022, surpassing the population of China. This growth from 361 million in 1951, i.e. 979 million in 60 years gives us some perspective.
When the Family Welfare department was started (rechristened from family planning by the central government), keeping family sizes small was also a priority for government policymakers. The reasons why that priority changed along with the name are numerous and fodder for a whole other debate.
With the advent of ultrasound technology, female fetuses were being aborted, and the strict implementation of the PCPNDT Act simply meant reverting back to an age where people kept on having daughters till they were either blessed with a son or exhausted trying.
As a matter of fact, the improvement in gender ratio has been in states like Kerala, Puducherry and Daman and Diu where maternal mortality, female literacy and family planning objectives have also been met. States with the worst gender ratios continue to be poor performers in these indices.
It is important that the laws of the country are implemented. The problem with enforcing this law is the unregulated growth in population that stems from it. Just raising the number of girls does not seem to be a solution to the much more deeply rooted social evils that come with the preference for a male child.
We have to understand that the preference for a male child is inherent in our culture. Thus, it is challenging to implement these laws when not just the general population but medical professionals and legal authorities as well come from the same culture. Moreover, practices, which are socially sanctioned but are considered offences in the eyes of the law, are not likely to be reported. Banning these practices just moves them underground, leaving room for exploitation and corruption done in a clandestine manner.
A prime example is the continuing practice of female infanticide. What makes it worse is that even the victims are likely to believe that the culture and customs mandate their suffering and such is the price they have to pay. There are those who think that changing the attitude of the people rather than stringent laws is the answer. However, changing cultural attitudes is a huge challenge in a vast country like India with more than one billion people and several hundred languages. It’s safe to say that it will not happen soon. It will require a lot of time, and we are running out of time.
These unwanted daughters are worse off – with poor resource allocation and poor outcomes. Considered a burden and a liability all their lives, they are hardly allotted enough resources to survive, let alone flourish. They are looked upon as free labour until they can be married off cheaply to start yet another household on an unequal footing.
Discrimination against girls and murder of women at all stages of life devalues women. An excess of the male population can lead to an aggressive and unhappy society. The economist Lena Edlund estimates, that every 1% increase in the sex ratio results in a 6% increase in the rates of violent and property crime. While this may seem good enough reason to forcibly increase the number of girl children born, it does not seem a good enough justification for the indiscriminate increase in overall population.
With average family size not decreasing and social disparity increasing, legislation like the PCPNDT Act, no matter how strictly implemented, seems to be counter-productive.
A slight modification may yet improve the benefits reaped from it.
After one daughter in the household, allow pre-natal gender selection by the parents. Instead of a household with multiple girl children born simply in the quest of an ultimate boy child, let families determine their resources and plan their size. What is wrong with replacing a household of four girls and a boy with a two-child household with one boy and one girl? This works both ways. Some parents want a daughter after a son and have no way of planning their families. Once again they have multiple children till a child of the desired gender arrives.
There will be many cons to this idea, as there are to every human endeavour. Who ensures compliance? Who guarantees ethical practice within the parameters of the legislation? What’s to stop the misuse of the diagnostic tests once again?
One way to go about it might be to launch pilot projects in chosen districts and slowly expanding the ambit of the modifications in accordance with the results.
The fact is that the issue of population expansion has been overlooked and under-addressed, despite being a pressing issue. It is time we use the law as a positive tool in population structuring. The fallacy of considering growth in population as the demographic dividend has led many a policy astray. We are but a third world state. If we keep growing at this rate, the already scanty resources for universal health coverage, education, job creation for the ever increasing yet unskilled and undereducated population, will soon drain out.
There are enough studies and projections to indicate the state of affairs in case of an over-populated, overburdened state machinery with not enough skilled labour, nor resources. We invite poor health and poverty and resultantly crime and anarchy. It is easy to forget we live in a world with more than 7 billion other humans, and the decision to add even one more child to the world has repercussions for the whole planet. Our population may not be finite, but our resources are.
This excerpt from India’s third five-year plan seems quite relevant here, “In an underdeveloped economy with very little capital per person, a high rate of population growth makes it even more difficult to step up the rate of saving, which in turn, largely determines the possibility of achieving higher productivity and incomes”. As is this quote from WWF founder Sir Peter Scott,” You know, when we first set up WWF, our objective was to save endangered species from extinction. But we have failed completely; we haven’t managed to save a single one. If only we had put all that money into condoms, we might have done some good.”
This time around, the species facing extinction soon might very well be ours.