Wednesday, February 28, 2007

Last of four parts

“A single death is a tragedy; a million deaths is a statistic.” — Josef Stalin

BANGALORE, India — The streets are cleaner here in the country’s tech capital of Bangalore than elsewhere in India; still, squalor surrounds the modern glass-walled offices of dozens of American and European corporations.

Security guards pursue anyone wishing to linger by the gates of General Electric’s walled-off compound in the exclusive Whitefields suburb east of town. In 1990, the giant American multinational teamed up with Wipro Ltd., a Bangalore software provider, to manufacture and distribute a low-cost ultrasound machine.

Why ultrasound machines? GE spokesmen have repeatedly refused to comment on the matter, but by 2000, according to, Wipro-GE had shipped out 6,500 of the machines in India. Wipro’s Web site,, claims it pioneered the manufacture of ultrasound equipment for India.

GE’s latest portable machine is the Logiq 100 model. Its American equivalent, the Logiq Book XP, sells for $16,900 new or $11,000 refurbished, according to the sales department at National Ultrasound, an American distributor based in Duluth, Ga.

Indian activists who oppose the widespread abortion of female fetuses say GE is among a handful of companies that manufacture the machines for the Indian market.

Under Indian law, doctors operating ultrasound machines must fill out forms showing the reason for each procedure, which is permitted only in the case of an abnormal pregnancy. But the government can only monitor the 25,770 machines that have been officially registered.

The actual number of machines is estimated at anywhere from 70,000 — by the London Daily Mail — to 100,000, according to the British Medical Journal. The portable ones end up in rural areas, where technology makes it possible for any woman to determine the sex of her child. The fetus can then be terminated at a government hospital, where abortions, like other procedures, are free for those who cannot pay.

Sabu George, a New Delhi activist who in 2000 filed a lawsuit against the government for failing to enforce its own laws against female feticide, said findings have revealed a disproportionate number of GE machines in northwest India, which has the lowest proportion of females to males.

“Those concerned with human rights [must] expose the transnational corporations involved in marketing ultrasound machines for these purposes,” he said, adding that Wipro-GE especially targets smaller towns with the help of cheap credit provided by GE Capital Services India.

The situation is only going to get worse, he added, as new technologies are now making it possible to select male embryos over female ones for implantation into a woman’s womb.

“In the United States, ultrasound is used to protect the fetus,” he said. “Here it is used to destroy it.”

Women in black

The airy two-story brick building set around a garden atrium in a Bangalore suburb offers no hint at the serious matters facing Vimochana, a women’s rights group based there.

Its leader, Donna Fernandes, blames doctors for India’s soaring male-female imbalance. “Doctors are a bunch of criminals,” she said, “but no one wants to see them as such. They are a powerful class, economically and politically.”

Although India has a well-established law forbidding doctors from telling women the sex of their unborn child, few physicians will turn in a guilty colleague. “It is,” Mrs. Fernandes said, “like setting a trap for a rat to catch another rat.”

“Female feticide,” the Indian term for the abortions of millions of baby girls over the past few decades, is a $100 million industry.

Although India’s prime minister, Manmohan Singh, termed female feticide an “unacceptable” crime in a press conference last summer, his own culture stands against him. One 1987 study by the Federation of Obstetricians’ and Gynecologists’ Societies of India showed that out of 8,000 abortions, 7,999 occurred after tests showed a female fetus.

A University of Bombay study done about the same time by professor R.P. Ravindra showed that out of 1,000 cases in Bombay, he could not find a single case of a male fetus being aborted. Ninety-seven percent of the aborted fetuses were female and the other 3 percent were of undetermined sex.

Bangalore, India’s third largest city at 7 million people, has 743 clinics with a registered ultrasound machine. The unofficial rate for a sex-determination test is 10,000 rupees or about $220.

Doctors are required to fill out a “Form F,” giving the reason for the ultrasound test, whether the woman has previously had children and including a signed statement by both the woman and her doctor saying they do not want to know — or divulge — the sex of the child.

These must be submitted to a district health officer, whose job it is to make sure illegal sex determination tests are not taking place. But doctors rarely turn in the forms and local government officials seldom ask for them.

In recent years, activist groups have conducted sting operations with pregnant women carrying hidden cameras, Mrs. Fernandes said, to showcase how brazenly the law is being broken.

“The doctors now use code language,” she said. “They will put a red dot — meaning ‘danger’ — on the form or green for a ‘go ahead.’ ” Red would signify a girl; green a boy.

Clinics found breaking the law have either had their machines briefly impounded or been let off by judges on technicalities. In one case, “the doctor bribed the judge,” Mrs. Fernandes said. “For the woman who wants a boy, the very survival of her marriage may depend on it.”

As bad as Bangalore is, the Mandya district to the west is even worse, she said. The mostly rural district of 1.7 million people has sex ratios as low as 600 girls to every 1,000 boys, suggesting that nearly two out of every five girls conceived are aborted.

On most Saturdays, Mrs. Fernandes’ group stages “women in black” demonstrations in front of ultrasound clinics in Mandya, a city on the main highway between Bangalore and the city Mysore, the seat of a former princely state.

“They all say only a few quacks are doing this,” she said, “but hundreds of doctors are involved. There’s a total denial of this happening.”

Official response

Dr. G. Shivaram, district health officer for Bangalore, oversees the city’s health care out of a rundown hospital off Old Madras Road. Behind him is a poster: “Female feticide is cruel and barbaric. It is illegal and punishable under the PNDT Act,” referring to the 1994 law barring the use of ultrasound for sex determination.

Although the penalty for breaking the law was increased in 2002 to three years in jail and a $230 fine for the first offense and five years jail and $1,160 for the second, it is almost never enforced.

Although it is Dr. Shivaram’s responsibility to check the two-page “Form F” to make sure women are telling the truth about their ultrasounds, he admits he doesn’t read them.

“We assume they are filled out correctly,” he said. “We just get the numbers of women.

“Each clinic has hundreds of patients. Doctors are busy,” he added. “They don’t have the time to fill them all out and the people who help the patients fill them out only have a secondary school education.”

However, a copy of the form obtained by The Washington Times showed it contained questions any pregnant woman should be able to answer.

“Not that many” doctors are illegally telling women the sex of their child, Dr. Shivaram maintained, admitting this is a guess as his office has conducted no sting operations. He said he personally visits 15 to 20 clinics each month, which would mean he gets to each clinic at most once every four years. Licenses must be renewed every five years.

Doctors attest to him that they are not revealing the sex of the fetus, “and I do believe them,” he said. “Doctors will say the truth because of professional ethics. Maybe some doctors are lying, but how can we assess that?”

On a national level, government efforts to combat prenatal sex selection are limited primarily to print and broadcasting advertisements, sponsoring workshops and seminars and providing financial aid to some advocacy groups.

Last month, however, Renuka Chowdhury, the Cabinet minister for women and child development, announced plans for a nationwide network of orphanages where women could drop off unwanted baby daughters.

“We want to put a cradle in every district. What we are saying to the people is: ‘Have your children, don’t kill them,’ ” Ms. Chowdhury told the Press Trust of India news service.

When asked if the scheme could backfire by giving women an easy way to get rid of unwanted girls, she replied: “It doesn’t matter. It’s better than killing them.”

Mr. George, who has battled female feticide for the past two decades, scoffed at the scheme.

“Most of the girls are killed before birth, not after birth. So where is the option of abandoning girls if they are not born at all?” he told Agence France-Presse after the announcement.

Activists warn that nothing will change until authorities begin enforcing the law.

Hyderabad success

Arvind Kumar was a government official in Hyderabad, a city of 6.1 million in south India, when he saw the 2001 census figures showing the country’s skewed birth ratios. In Hyderabad, the ratio was 933 girls to every 1,000 boys. The wards of the cities with the worst ratios were the ones that had the most ultrasound machines registered there.

He also noticed a religious divide; the Sikhs of northern India had the worst sex ratios, followed by the Jains and then the Hindus. Christians had the best ratios and in highly Christianized areas such as the southern state of Kerala, there were more women born than men. Kerala’s matrilineal family system among all religious groups also encourages education and empowerment of women.

This was not so in Hyderabad, a city with a mix of Hindu and Muslim communities. Mr. Kumar began cracking down on the city’s doctors, ordering the 389 clinics with registered ultrasound machines to show up for a workshop. Some 124 centers failed to show. He then ordered them to turn in “F Forms” for every ultrasound given, copies of referrals from doctors and documentation on whether the woman who got the ultrasound ever gave birth.

Fifty-three centers refused to give him any information at all.

Of the paperwork he did receive, he found that in 67 percent of the cases, the woman arrived at the clinic without the required referral from a doctor; a sign, he said, that she intended to abort the child. In 72 percent of the cases, there was no documentation of whether the woman already had children. Statistics show the percentage of abortions rise with each successive daughter.

Sixty-nine percent of the forms he got did not mention the address of the ultrasound center and 56 percent did not mention how far along the woman was in her pregnancy. Sex-selective tests tend to occur around the fourth month.

He went on local TV, threatening to send pregnant women into clinics for sting operations. He found no shortage of women willing to do so; “They’d tell me, ‘It’s for a good cause,’ ” he said.

By January 2005, he had sent out 374 notices to ultrasound clinics threatening to suspend. One hundred two clinics had their registrations suspended, 112 ultrasound machines had been seized by police and three suppliers, including Wipro-GE, had been prosecuted in court for supplying machines to clinics without registering them with the government.

After only one year, yearly birth statistics for girls in Hyderabad had shot up 4,000 from 58,422 in 2004 to 62,654 in 2005. The number of boys born hovered at 61,539 in 2004 and 61,770 in 2005.

Mr. Kumar is reluctant to credit himself with the births of 4,000 extra girls.

“The [1994] act was dormant,” he said, “and all I did was implement it. All I did was catch those who weren’t maintaining the records and prosecute them. Other cities say, ‘Oh, we can’t do this.’ But we did it.”

India’s imbalance of sexes

Brides bound by tradition

Lots of stings, no pain

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