Restricting access to abortion services: a conversation with Dr. Suchitra Dalvie on the effects of sex selection in India

A woman sits in a doctor’s waiting room. She is almost 13 weeks pregnant and deeply worried about her future. She knows she cannot ask the sex of the fetus and that the Indian government has developed new technology to track the ultrasound medical reports.

I can’t manage another child, what will happen if it’s another girl, my husband will be upset, his family will respond, how will I raise them, will my girls be punished? Please be a boy! They are saying that there are too many boys but what about my family, who will take care of us later? I can’t afford another child! How will I access abortion services, I hope this doctor will not refuse me. If she does, then what, where will I go to terminate this pregnancy? I know a place but it’s risky! Some mothers never come back!

During an interview with, Dr. Suchitra Dalvie, a practicing obstetrician and coordinator for the Asia Safe Abortion Partnership (ASAP), shed light on the complex nature and competing forces behind sex-selection and gender inequality in India.

Abortion rights versus sex-selection: Is India missing girls?

The 1995 Beijing Platform for Action prohibits all forms of violence, calling upon participating States to combat violence against women and girls. The plan of action includes both women’s right to control their reproductive health and girl’s rights to equality and non discrimination against sex determination practices. Section 105 states that “the human rights of women include their right to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence.”1 Whereas, section 115 states that “acts of violence against women also include forced sterilization and forced abortion, coercive or forced use of contraceptives, female infanticide and prenatal2 sex selection.”3

Defenders of the reproductive rights of women and advocates against sex determination agree on the need to empower girls in India but drastically vary in their analysis of the problem and appropriate solutions towards this.

On the one hand, reproductive choice promoters argue that women should always have the choice to terminate an unwanted pregnancy, regardless of the reason. They place emphasis on the negative impacts that any unwanted pregnancy can have on women’s ability to protect herself against a wide range of social, political and economic disempowerment.

On the other hand, advocates against sex-selection contend that the government needs to protect the female fetus. They focus their efforts on restricting pregnant women from accessing information that could determine the sex of the fetus, sometimes including attempts to restrict access to second trimester abortions.

Since the enactment of the Medical Termination of Pregnancy Act 1971 (MTP), Indian women have had the right to have a pregnancy terminated by a registered medical practitioner under the following circumstances:

  • When the life of the pregnant woman is in danger

  • When the pregnancy would cause danger to the pregnant woman’s mental or physical health

  • When the pregnancy would cause danger to the fetus and result in its suffering from physical or mental abnormalities

  • If the pregnancy was a result of rape

  • If there was failure of contraception used by a married women or her husband.

These reproductive rights stemmed from government concerns with population control and public health issues, particularly the high amount of septic abortions in India. Although the above circumstances specify married women for contraceptive failure, many doctors have been interpreting this clause as applying to women in general. The reality is that the MTP Act was intended to protect doctors from the criminal clauses against causing a miscarriage as written within the Indian Penal Code of 1860.

Suchitra Dalvie (SD): “The MTP Act is geared towards protecting the doctor, not geared towards a woman’s rights to terminate a pregnancy or have control over her own body. In terms of control of one’s body, the Indian law has tended to articulate the ownership of the citizens body as belonging to the state. We still have a law in which suicide is punishable, so an attempted suicide can result in the person being put in prison because the body belongs to the state. In this context, it makes sense that a woman could not own her own body because nobody can.”

During the 1980’s and 1990’s, women’s rights organisations started noticing a trend to identifying the sex of the fetus. This tendency, accompanied with census reports, showed a change in the male to female population ratio. These organisations began prioritising strategies to prevent sex-selection since it was a form of gender discrimination. These concerns led to a wide ranging campaign and finally the enactment of the Pre-conception and Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994. Its primary function was to restrict the doctors from sharing any ultrasound results on the gender of the fetus.

According to the Indian Census of 2001 and the Indian Census of 2011, the child sex ratio of girls to boys dipped from 927 to 914 per 1000 between 2001 and 2011. This worried civil society about protecting the girl child and led to government initiatives which heavily personified the fetus. For example, posters where the fetus begs her mother not to terminate the pregnancy became commonplace in the public sphere. Ultimately, this anti-abortion narrative shaped public opinion and continues to be the dominant narrative in media and often in policy implementation.

Technology may change but discrimination against girls remains the same

As medicine advances, so do the different ways in which parents could determine the sex of the fetus during pregnancy. Be it Chorionic Villus Sampling, an invasive and painful procedure at ten weeks or an ultrasound of the fetus at 12 weeks, women and couples make the decision to keep or terminate a pregnancy based on a wide range of economic, social, political and cultural reasons, including sex-selection.

Although accessing information concerning the sex of the fetus is prohibited by the PCPNDT Act, statistics continued to show that fewer girls were being born. This data led to the development of a device that runs software on the ultrasound machine that automatically records the data and sends it to a centralised government agency for processing. The rigorous implementation of the Act also resulted in raids and heavy handed interference of the authorities directed towards clinics. Consequently, many doctors have stopped providing any abortion services in the second trimester for fear of problems with local authorities.

“Suppose there are 100 women that come for a second trimester abortion, maybe only 20 of them had done sex determination, found out it’s a girl and don’t want it. The vast majority of them are making the decision to terminate the pregnancy for a variety of other reasons which have made this an unwanted pregnancy and also due to delays in seeking care in the 1st trimester.”Dr. Suchitra Dalvie

SD: “In a country like India, women have so many restrictions on their mobility and finances, even if she finds out she is pregnant at eight weeks by the time she makes a decision, gets the money, finds the time to leave her house without telling her family where she is going, finds a clinic in the public sector where there is a doctor or find a clinic in the private sector, she may well be 14 weeks.”

The PCPNDT does not mention nor prohibit abortion. However, one of the primary consequences of the implementation of the PCPNDT has been to limit access to safe abortions.

SD: “If a woman has an ultrasound and finds out it’s a boy, no one is targeting her. But everyone is targeting the abortion, because there are always background stigmas around abortions. It’s very easy to target because it is focused in a clinical setting. The woman who finds out it’s a boy, goes home and has the baby. She has also done a sex-determination which is against the law. She just happens to exercise a choice that does not require an abortion.”

The implementation of this monitoring technology also raises the issue of protection of private medical information.The mainstream focus on controlling women’s access to abortion in the second trimester rather than finding solutions to why people do not want girls has resulted in the violation of women’s rights at many levels.

SD: “Many doctors tell us that the government officials responsible for the monitoring and sex-selection data collection are accompanied by journalists. They demand and gained access to the records of the abortion cases. Under these pressures, many doctors have started to outright refuse to perform second trimester abortions, in order to avoid the trouble.”

Importantly, the focus on controlling women’s reproductive decision through technology is a slippery slope. As technology is able to better predict early pregnancies and consequently the sex of the fetus, abortion rights could be increasingly restricted.

SD: “The ultrasound machine got focused on as the evil thing in this whole picture. It is typical to blame the technology as this was the easiest thing to do, without seeing who the person behind the use of the technology is, and that someone is asking for it to be used. The ultrasound machine was seen as the focus of everything.”

How can the prohibition of sex-selection be harmful? Girls neglected and women’s bodies controlled

At first glance, the logic implemented by government should have positive effects on girls – if the sex of the fetus is monitored, there should be less sex selection. This can only be a good thing, no?

SD: “Still playing the numbers game, without looking at the quality and discrimination issue, you insist that this girl be born, which is in fact a forced pregnancy. This girl is brought into a family where she is unwanted, and we have no way to control what happens to her quality of life:

  • Will they abandon her?

  • Are they feeding her?

  • Are they immunising her?

  • Will she get medical care when needed?

  • Are they going to educate her?

  • How are they behaving with her? Is there psychological abuse?”

Too often, these matters fall within the private family domain. The government has no effective monitoring tools to deal with unwanted girls being born then neglected or women being abused because they brought a baby girl into the family.

SD: “When I started my practice, we used to have cases where if a woman had given birth and it was a baby girl, no one from the family would come to take them back home. We would have to send someone to their community area to explain that now it’s been three days and you have to come take them back. And one can only image how she (the woman) and child were treated upon their arrival at home.”

Baby girls are born into a society that advocates for their survival but not for their ability to exercise their human rights.(BB)

SD: “We want these girls to be born and then to grow up into women that have no control over their bodies… Earlier campaign slogans would say – If daughters are not born then how will you find brides. Again on the one hand, it sounds like you are doing it for the protection of girls but really it’s for the girl to fit into her role within the patriarchal system”

It’s about patriarchy, discrimination and inequality, not only about sex-determination

“It’s not only about reproductive rights, but about putting a stop to patriarchal norms that promote discriminatory practices.”Dr. Suchitra Dalvie

It is only when we exam the effects of patriarchal norms on the decision to terminate a pregnancy that we begin to develop a better idea about the challenges faced by women in India relating to the birth of baby girls. Economic, political, legal and cultural factors strongly weigh on a mother’s ability to protect herself and her children.

Economic factors are considered to be the primary reason for preferring a son. In essence, having a girl takes away resources from the family unit on two fronts:

  • Upon marriage, the girl’s family is required to give a dowry in the form of money or resources to her husband’s family;

  • Sons are considered to be social secure in old age, as the son is responsible for taking care of the family in old age and can bring financial resources to the family unit through marriage and employment.

Girls are considered to be a liability, ultimately reducing the family’s ability to survive economic hardship.

Although, officially, India no longer has a two children policy, the practice of incentive programs for families with two children is still commonplace in many states. These factors, accompanied with the second class status of women within the political decision making process as well as the inability to take personal decisions, reduces their capacity to shape a political climate that represent their needs.

The ability of women to exercise their human rights, particularly when it comes to reproductive choice and safe abortion, is greatly limited by the mechanisms available to them when challenging practices that are prohibited by law. For instance, it remains difficult for a woman to contest the decision of a doctor to refuse abortion services in the second trimester.

Similarly, if a woman wants to challenge the loss of her resources upon marriage and land distribution to male relatives, she risks isolation and violence. Although there are laws that make it illegal to practice dowry exchange upon marriage and women are legally able to inherit family land, women often lose control over family resources during the negotiation of marriage with their husband’s family. Women are penalised if they attempt to exercise their right to land against male family members. Women are often unable to challenge norms that consider girls to be less valued due to restricted access to legal counsel either because of financial means or real fears of violence and abuse from husbands or other family members.

Culturally, women are considered to belong to the male members of their family, most commonly to their fathers, brothers or husbands. In reality, the rhetoric for the protection of the girl child seems to be based on cultural norms that stress that girls must be born in order for there to be enough women to fulfill obligations as a wife and as a sexual object. Girls are handed over from their parents’ family to her husband’s. In this sense, these cultural values limit the role of women, to providing for the needs of men, to reproducing family and cultural norms that do not consider women as equally valuable as men.

SD: “I was recently at a meeting, a conference of Obstetricians / Gynecologists, where the ratio of 1000 boys to 800 girls was brought up. I asked everyone: why is this important, so what if there are 200 more boys? Immediately two responses were presented:

a) Who will the boys marry?

b) This will increase the cases of sexual violence against women!

Men without sexual partners will become violent. Women are blamed for not having girls; women are blamed for rape and violence against women (…) There has been an alarming increase in the government’s use of this type of rationale to limit responsibility for violence against women in India.”

In numerous different types of societies with variant levels of patriarchal control and women’s rights to reproductive choice, women’s bodies are considered the most effective way to reproduce societal norms. As a result, any woman that deviates from the predetermined gender stereotypes is considered to be responsible for the violence that follows.

‘Saving’ girls without denying women’s rights to abortion: Recommendations for the future

During this heartfelt interview, Dr. Suchitra Dalvie described a future where women’s reproductive rights were not sacrificed in the name of the protection of the rights of girls to be born within the Indian society. She spoke of government initiatives, such as the Saving Certificate Program for Girls and religious actions by church and orphanages entitled Baby Cradle Scheme, having their merit but failing to challenge the root cause of violence against girls and women.

She put forth the following recommendations that challenge patriarchal norms and provide women with alternative tools to sex-selection abortion, infanticide or violence against women, including:

  • Establish an overarching, national reproductive policy that clearly states that women have complete control over their reproductive rights. This policy must include accountability for doctors who refuse abortion services in private practice and ensuring safe services in the public sector.

  • Protect privacy and confidentiality of medical information of women

  • Increase government investments in the empowerment of girls as economic actors. This would include accessing education, training and business development in order to provide real alternatives.

  • Focus on the roots of patriarchal norms and values that cause gender inequality and discrimination in Indian society instead of targeting technology and services alone.

  • Separate the work being done against the sex determination and for improving access to safe abortion

  • Develop and maintain space where women and LGBT communities can challenge norms that reduce women’s worth to motherhood alone and reshape the gender roles and responsibility.

  • Focus on issues of social justice and government accountability that penalise intimidation, rape and violence against women.

  • Ask questions beyond simply stating numbers: who are those 200 girls, why are they unwanted? Who are these 200 boys who are unable to find a marriage partner and will turn violent? Why do women find themselves in situations where they need to make a sex-selection choice? How do policies against sex-selection affect women’s everyday lives? Are we penalising individual women instead of a society that undervalues girls?

SD: “While a co-facilitator in ASAP’s reproductive rights workshops was interviewing a pregnant woman from a small community about her need to access to abortion services, she explained that she was 14 weeks pregnant, she had two girls already and was denied her abortion because her doctor said that he could get in trouble so late in the pregnancy. When asked, the doctor explained the present conflict about sex-selection abortions and the impacts on the sex ratio in India. To which she replied, what does that have to do with me? Let them (government) sort it out! I need an abortion! I cannot have a third child. In the end, she said she should have lied and said she had two boys already.

Interested? Want to find out more about the issue or the work of ASAP?

ASAP be posting a daily blog from September 7 to September 28, 2015 on key points from their workshop, including protection and security of information on the internet and best practices in social media. ASAP also conducts regular capacity building programmes for young people and healthcare professionals from across Asia.

Image source: @AsapAsia

[1] United Nations, Beijing Declaration and Platform of Action, adopted at the Fourth World Conference on Women, 27 October 1995, available at:

[2] Term defined in the Beijing Declaration and Platform of Action, our interpretation of the word prenatal does not personify the fetus and cannot be used to justify restrictions of reproductive rights or abortions

[3] Ibid. United Nations, Beijing Declaration and Platform of Action