Ultrasound technology is increasingly used in many countries as part of pre-natal care to help doctors assess the baby's health. But in India, where age-old traditions still run strong, the technology is being used for other reasons. The 2001 national census showed an alarming trend: males increasingly outnumber females in many parts of the country. The reason, many pregnant women are using ultrasound technology to determine the sex of their children and then choosing to abort, if it is female.
By nine o'clock in the morning, Dr. Geeta is at a New Delhi clinic ready to see her first patient.
Dr. Geeta is a gynecologist, and, as an educated professional, is a model of success in a society where many women find themselves at the wrong end of the social and economic ladder.
Dr. Geeta is like many Indian women, modern, yet under pressure to live up to the expectations of traditional Indian society.
Geeta is not her real name, but her story is real. "I'm 36 years old. My elder daughter is 12-and-a-half, and [my] son is 5-and-a-half. I have been pregnant three times. The first one was my daughter, which I delivered, and the second pregnancy, I got it terminated under such circumstances that I won't make a line of daughters, and my in-laws really wanted a son," she says.
The desire for a son is common in many societies, and it is certainly not new to India. Male children are preferred in large part for financial reasons. Sons are expected to take care of their parents in old age. A daughter can be a great financial drain on her family when she marries, because her family is expected to pay a large dowry to the groom's family, something which can, in some cases, lead to financial ruin.
Dr. Sharda Jain works at another clinic in New Delhi. She says what Dr. Geeta did happens every day. "It is a stigma here that, if you don't bear a male child, you are not respected in your family, in your society. And that is why more and more families are having sex determination done during pregnancy, and thereafter, if it is a girl, getting a sex selective abortion," she says.
Abortion is legal in India under certain circumstances, but not on the basis of gender selection. Dr. Sharda Jain says that is not stopping the practice. "Now, you find that, after everybody knowing that this is a criminal act, they're not coming openly. They're going to very reliable people where things are not known to anybody," she says. "Previously, it was very obvious. Now it is [hidden]."
Francois Farah is the representative of the United Nations Population Fund in India. He says alarm bells went off when officials and experts began to look at census figures, and realized there was a skewed gender ratio. "The problem of sex selection has gained increased importance, at least over the last 10 years. On the average, you have 950 to 955 girls for 1,000 boys. This is a universal sort of level. Between 1991 and 2001 we've seen situations in some states where this sex ratio had gone down [from] 950 to 900, to 850, even to 800, and in some districts below 800," he says.
Mr. Farah says there are no reliable data, but anecdotal evidence suggests there are as many as six-million abortions performed a year, solely because the fetus is female.
Dr. Sharda Jain says another all too common practice that continues to this day is female infanticide, killing a baby girl shortly after birth. "This is still very rampant in the lower strata [classes] of the society, in the rural areas and in the slums, where they cannot afford any sex determination test done, or an abortion, even by a [bad doctor]. It is a silent acceptance by the society. A girl is born in [a family's] house, and a week later, 10 days later, the male member [of the family] is carrying that dead baby. Everybody knows here the child has been killed," she says. "It is always with the girl child."
Dr. Geeta says pressure to have a son led her to the decision eight years ago to have an ultrasound test, and then abort the female fetus, a decision she now regrets. "Soon after the termination, I felt that I've got rid of it. But after some time, I thought that, no, it was not right. I felt that I should not bother about the in-laws or anybody in the society," she says. "Nobody can change the society. Alone, I cannot change the society. This mentality has to be changed, and it is not so easy."
Francois Farrah of the U.N. Population Fund believes gender selection is part of a larger social problem. "You know what is behind sex selection is not abortion as such, but it's the discrimination, the discrimination against the girl child. So, what one would argue is that a value system that is not based on equality is a value system that can only degenerate into discrimination," he said.
Some believe the government must do more to implement existing laws against these illegal abortions, and to crack down on doctors performing them. Others say the effort needs to focus on convincing Indians of all social and economic classes that girls are as valuable as boys, and deserve the same chance in life. But for now, there is nothing to indicate that change will come anytime soon.
This report is part of VOA's series on world health