Missing Daughters of Punjab
The jacaranda trees are in full bloom on the drive into Chandigarh, this early spring morning. The streets are wide and lined with tall, shady trees: mango, laburnum, gulmohur and eucalyptus. Bougainvillea plants grow in the concrete strips that divide the roads. There is nothing haphazard about the design of this city. Bus shelters and lamp posts complement the buildings nearby. The roundabouts have manicured gardens, each more spectacular than the last.
In the Sector Ten part of town, the market has shops with the latest fashions, bakeries that sell croissants, cafes where you can take away a cappuccino and a pastry. Two girls dressed in jeans and skimpy tops come out of a café called Coffee, Conversations & Beyond… and ride off on a scooter.
The smartly dressed women of the city, driving drive cars and scooters to work or college, might give an observer the impression that women in Chandigarh have gained full freedom of decision over their lives. That observer would be wrong. In Chandigarh, an Indian girl has one of her poorest chances of surviving – in the womb. Modern technology and ancient customs ensure that one-fourth of all the girls that are meant to be born in this thriving city do not live to see daylight. Here, today, there are 128 men for every 100 women. It is a matter of female foeticide.
After the division of Punjab in 1947, the historic capital, Lahore, was left in the newly created Pakistan. India's first prime minister, Jawaharlal Nehru, wanted Punjab's new capital to be a symbol of the country's faith in the future. The iconic modernist architect Le Corbusier was invited to come from Switzerland and give shape to the new city, a capital that would match the splendour of Lahore. In 1966 the Indian state of Punjab was divided once again, but Chandigarh remained the capital of both resulting states, Haryana and Punjab. It was already a city full of research institutions, technology parks, hospitals and schools.
Chandigarh was the first stop on my journey to discover whether the city's preference for sons was something that could be seen across the entire former state of Punjab, today divided into the Pakistani province of Punjab and the Indian states of Punjab and Haryana. The 'land of five rivers' has always had the dubious distinction of having fewer girls than other states in India. In 1901, there were 972 women for every 1000 men in India. Even at that time, that ratio worked out to just 832 women in Punjab. In 2001 that number had dropped to 927 nationally, but in Haryana the state average was 820, and in Punjab, 793. The district of Fatehgarh Sahib had the lowest child sex ratio – just 754 girls per thousand boys.
Abortion is legal in India, but the act regulating termination of pregnancy specifies the necessary existing medical and foetal conditions, as well as the establishments that can perform abortions. Determining the gender of the foetus and eliminating it based on that information is illegal. Nonetheless, easy access to ultrasound equipment since the early 1980s has led to an increase in sex selection and, consequently, a rapid decline in the Indian child sex ratio. Of the four million induced abortions that take place every year in the country, it is estimated that only around 500,000 are legal – the rest are illegal and unsafe operations, performed by untrained staff in improperly equipped institutions.
Mourning girl births
Above the market at Sector Ten is the office of the Voluntary Health Association of Punjab (VHAP), an organisation that has worked extensively on preventing female foeticide. As I walk in, volunteers are in the middle of organising a tribunal on farmer suicides in the state. On the walls are posters about girls that vanish from the womb. On the tables sit UNFPA bags with pictures of girls on them that say, starkly, Missing.
VHAP is holding a camp for women in the village of Khudda Jassu, on the outskirts of Chandigarh. There, about 20 women sit under a large, shady tree in the courtyard of a gurudwara. Two VHAP representatives are talking to the group about the importance of looking after girls. I ask them how many girls were born in the village in the last year.
"There were no girls born here last year," Paramjeet Kaur informs us. "Only boys, munde hi munde".
Did the women in the village go in for ultrasounds to find out whether they were going to have girls or boys?
"No, no one here that we know of had an ultrasound," she answers.
"Well, what do we know", says another woman, Harpreet Kaur. "They could easily have gone and done it without telling the village."
"When boys are born we celebrate; when girls are born we mourn," a third, Manjeet Kaur, says, then continues: "But it is actually much better to have daughters than sons. Sons go and live by themselves, or go abroad and forget all about you. The daughters stand by you."
Statistics show that a strikingly large proportion of people in the Subcontinent do not share Manjeet's point of view. There is a strong preference for sons throughout the region, and giving birth to a boy enhances the mother's status within the family. On the other hand, an inability to produce a male heir may result in humiliation, contempt, abuse and abandonment. In-laws threaten their daughters-in-law with dire consequences if they cannot produce a son. In abusive situations, a woman will be forced to undergo tests to identify the sex of her unborn child, and then forced into an abortion if the foetus is female. The Punjab government now offers an incentive of 100,000 rupees per case to villages that report a case of foeticide.
In a study published in the British medical journal The Lancet in January, an Indo-Canadian team of doctors estimated that at least 10 million female foetuses had been aborted in India over the past two decades by middle-class families to ensure that they had male heirs. In the course of a survey of more than a million homes, the researchers found that sex determination in pregnancy and selective abortion accounted for 500,000 missing girls each year. Researchers from the University of Toronto in Canada and the Post Graduate Institute of Medical Education and Research (PGIMER) in Chandigarh also found the sex of the previous child born affected the sex ratio of the subsequent birth. Fewer girls were born to families who had not yet had a boy. More than twice as many educated mothers were found to have had selective abortions, compared with those who were illiterate, a finding that did not vary by religion.
"Some demographers say we underestimate the amount of sex-selective abortions in our figures," says Dr Rajesh Kumar, head of the Community Medicine department at PGIMER, and co-author of the Lancet study. "But we don't want to enter the numbers game here. That will just divert the attention of people from the issue that is at stake. What we are saying is: take action."
Devaluing women
The child sex ratio for all the districts of Haryana dropped to below 900 girls in 1991. In 2001, almost all districts recorded a ratio of less than 850 girls to 1000 boys, with several well below 800. This drastic trend not only reflects the elimination of girl foetuses for being female. It also is a harbinger for severe social dislocation, already being faced, for example, in the 'marriage market'. "The situation is the same in Haryana as it is in Punjab," says Dr Kumar of PGIMER. "Both states face the same lack of girls. There is an obvious shortage of women – men don't find brides and can't get married. So, they bring in girls from other states, and not much is done to stop it."
Indeed, Haryana's men now pay touts to bring in women for marriage – when sold against their will, these women are known locally as paros. Social activists fear that most of these women end up being used as sex slaves, before being resold to other men in what looks to be a new, flourishing female-trafficking market. According to one media estimate presented this April, there are almost 45,000 paros in Haryana from Jharkhand alone. In addition to the increase in trafficking, the scarcity of women has also led to a revival of old customs like watta-satta, or bride exchange (literally, 'give-take'), where a brother-sister pair from two households marry simultaneously.
Access to education and higher literacy rates have largely failed to change attitudes. On the contrary, VHAP's Manmohan Singh says that the educational system tends to reinforce traditional thinking. "Our educational system is just a churning machine for certificates. Teachers don't make students aware of gender questions, and most textbooks have stereotype figures of males and females. If you look at the illustrations in schoolbooks, you'll see small girls looking after babies, boys playing, women in the kitchen."
Singh believes that the agricultural revolution in the 1960s and 1970s, which led to a rise in the living standard and an increase in wealth in Punjab, succeeded also in disempowering women. "Before the Green Revolution, women's participation in agriculture was very high," he explains. "They would select and purchase seeds, sow them, and reap the harvest. When the process was mechanised, people stopped preserving the seeds. You just buy them now. Using chemical fertilisers and combine harvesting is a male thing."
About fifty kilometres away is the district of Fatehgarh Sahib, where the sex-ratio figures are among the lowest in the country. We drive past golden fields of wheat and sugarcane. The smell of boiling gur lingers in the air. Large banyan and pipal trees, as well as stacks of cow dung line the road. Palatial houses sit in the middle of fields. As we near the village of Kalour, a young Sikh farmer stands next to his tractor, looking out at fields that are yellow with mustard.
At the Primary Health Centre in Kalour, Jasbir Kaur has worked as an auxiliary nurse and midwife for the last 20 years, overseeing five of the 169 villages that the Health Centre covers. Jasbir agrees with Manmohan Singh's suggestion: she too blames the Green Revolution for the low status of women in Punjab and Haryana. "When I started working, women used to work the fields. Now they sit at home while tractors and machines do their work. They don't earn money, even though there is a lot more money. This has affected the attitudes of men towards women." In essence, as the economic value of women has gone down in recent decades, the prevalence of female foeticide and infanticide has risen.
Skewed statistics, Lahore
As I catch a flight to Lahore to explore the situation in Punjab Province, I page through a newspaper from that city and find a letter to the editor entitled 'Gender selection in Pakistan'. A reader had written: "Coming across an advertisement on a cable channel, I was quite shocked to say the least. The ad was regarding gender-selection, now made possible in Pakistan."
The advertised hospital in question is the Akbar Hospital, in the area of Lahore known as Defence. How do they offer gender-selection services? After all, it has been a decade since both the Pakistan Medical Association, and the Pakistan Medical and Dental Council declared it unethical to tell parents the gender of an unborn child.
Dr Shabana, a medical officer and gynaecologist at Akbar, says that abortions do not take place in the hospital, as they are against the law. But she can let me in on an astounding open secret. "Dr Nosheen, who has put advertisements on cable TV, is a private practitioner who rents a clinic from us," she explains. "She does not do ultrasounds with abortions, but she uses a technique where you wash the chromosomes, and implant the male embryos in the woman's uterus."
In other words, sex-selection takes place before conception. This process, called 'Pre-implantational Genetic Diagnosis', or PGD, is a complicated gender pre-selection technique that first appeared in the 1990s. After a woman's eggs are fertilised in the laboratory, genetic testing is performed on the resulting embryos to determine their gender. Only embryos of the 'desired' sex are then implanted in the woman. The process of identifying and discarding the female embryo is banned in India. At PKR 150,000, this technique is too expensive for most people who want to ensure a male birth. Nonetheless, it is a prime example of technology flouting the letter of the law.
In Pakistan, there are no restrictions on telling expectant mothers the gender of their unborn baby. Abortions are not legal, however, except in exceptional circumstances. But legal restrictions do not mean that abortions do not happen; they are simply driven underground, and become more dangerous.
"In Pakistan we have not focused on the issue of female foeticide at all," says Khawar Mumtaz, a social scientist who leads the advocacy organisation Shirkat Gah. "Abortion is illegal, so we don't know what is happening – how people are getting rid of a female baby if they know it is female and don't want it." Although Shirkat Gah runs a women's-resource centre in Lahore that focuses on reproductive rights and reproductive health, they have only recently begun to look at the incidence of foeticide in Pakistan.
"We do have quite a high incidence of unsafe abortion deaths," Mumtaz continues. According to WHO estimates, 2 to 12 percent of all maternal deaths in the country are due to induced abortions. "Our concerns have been with the mortality rates because they has been some of the highest in the region, even in the world."
Even if there is little research on the subject, however, sex selection in Pakistan is taking place. "Most patients who come for an ultrasound want to know the sex of the baby," says Dr Umera, an ultrasound operator in a small clinic she runs with her mother. "There is no ban on giving them this information here yet. If a woman already has girls and is depressed and under pressure from her family, of course I tell her what the sex of her child is."
Child sex ratios are alarmingly similar on the two sides of the border, with Pakistan also showing the same trends as India: in urban areas, more boys than girls are born. According to the latest census, in urban Punjab, Sindh and Balochistan respectively, 110, 114 and 118 boys were born per 100 girls. In Islamabad, that number jumps to 122. Female foeticide is a drastic highlight of the discrimination that females – infant, girls and women – face in Pakistan. In all countries, sex ratio at birth is naturally tilted slightly in favour of boys, and generally around 105 boys are born for every 100 girls. However, since males usually have higher lifelong mortality rates than do females, in most countries women end up outnumbering men. But in Pakistan, 1-in-10 live-born infants dies before its first birthday, and over half of these deaths occur in the first four weeks of life. The sex difference in child mortality is one of the highest in the world: death rates for girls aged one to four years are an astounding 66 percent higher than for boys in the same age group.
"In the rest of the world, the girl child is supposedly stronger than the boy child," says Khawar Mumtaz. She says that Pakistan's alarmingly skewed statistics "reflects a certain kind of bias or lack of interest in the way females are looked upon in the country. Now that the whole issue of foeticide has been brought up by Indians, it has made us also start to look at this issue."
Temple Road
A recent study by the international Population Council, conducted from 2001 to 2003, found that the abortion rate in Pakistan is 29 per 1000 women. Nearly a quarter of the women are later hospitalised for complications. "Although women are bothered about the morality of having abortions, if they weigh the cost of having an unwanted girl, or the fact that their husbands might marry again in order to have sons, against morality, to bachchi girva dete hai – they abort their daughters," says Shaheeda Asgar, with the women's-resource NGO Simorgh.
Outside Sir Ganga Ram Hospital, a respected institution in Lahore, a staff nurse and a Lady Health Visitor (LHV, a rural basic-health-care practitioner) are walking to a private hospital around the corner on Temple Road. Do people come to these private facilities to have sex-selective abortions?
"No, abortions are illegal, so people go to dais (traditional birth attendants) in all the 'Safiya clinics' on Temple Road," says Attiya, the LHV. "But they come to us when the dai has made a mess of things, and we have to clean up and save their lives." These clinics are named after a woman, Safiya, who had been a dai with a clinic on Temple Road 50 years ago. Today, the street is lined with clinics bearing her name, each offering the same services.
The first Safiya clinic I try to enter has a long line of women, both young and middle-aged, waiting for their turn. The next clinic is tiny, with dark glass doors. A lady in her late thirties sits behind a desk, while an elderly lady gets up from a charpai and moves to the backroom, to make room for me to sit. For PKR 12,000, Shabana, the lady who runs this clinic, will perform an abortion on a young unmarried girl the same day. She hands me a visiting card with three mobile numbers. "A lot of married women come to me if they have too many girls or feel they can't have the child they are bearing," she says simply.
And so it goes. Despite being vehemently separated for six decades, many of the same practices and attitudes towards women continue to flourish throughout the old, undivided Punjab, on both sides of its international border. Standing outside Shabana's clinic, here on the Safiya-lined Temple Road, I am reminded of what Manjeet Kaur told me earlier, in the shady courtyard of the Chandigarh gurudwara. "When boys are born we celebrate," she had said, "when girls are born we mourn." Despite hearing this refrain time and again in Lahore, Chandigarh and the surrounding countryside, Manjeet had been the only one to continue: "It is actually much better to have daughters than sons … It is your daughters that care for you, and make sure that you are all right."
At the moment, however, few seem to be taking care of the daughters themselves. If more women had access to contraception, and were given the freedom to restrict the number of children they bore, would lives be saved? How many women can we afford to lose to backstreet abortions? And how many more daughters of Punjab will die before they are born?