- The Unintended Consequences of India’s War on Sex Selection
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PUNE, India—Dr. Meena Kharat has performed abortions in India and trained other doctors how to perform them for more than two decades. Women, she said, have the right to terminate pregnancies they don’t want or can’t continue, and giving women the power to control their own reproduction is a step toward gender equality in what she classifies as a stubbornly patriarchal society. These days, though, if a pregnant woman comes to her and needs an abortion in the second trimester of pregnancy, Kharat [End Page 71] gives her two options: Get sterilized along with the abortion procedure, or don’t get the abortion.
“Most of us have stopped doing second trimester abortions, because it can make trouble if this has been done for sex selection,” Kharat said about the other gynecologists and abortion providers she knows. “You do second-trimester abortions only if the woman is unmarried. If the patient does not want any more children, if she is interested in making an appointment for a sterilization, then we do a second trimester abortion. Not for temporary contraception.”
Sex-selective abortion was outlawed in India in 1994, after a stunning gender gap emerged in births of female babies versus male ones (the law was amended to close some loopholes in 2002). The victory was a feminist one, supported by many women’s rights organizations concerned about the millions of missing girls. The law remains a touch point for feminist activism in India, stoking outrage at the sheer number of girls never given a chance and galvanizing support from the United Nations, the Indian government, and local NGOs.
Actual progress in narrowing the child sex ratio has been sluggish—in every census since 1991, it’s actually gotten worse. And regulation of sex selection has at times come at the expense of safe abortion services, including for many women who weren’t trying to sex select in the first place. Now, more than two decades after sex selection was outlawed, a law that promised to increase gender equality and send the message that girls and women are valued in society is raising some tough new questions for doctors and women’s rights advocates. Primary among them: Can you promote the rights of women and girls and also restrict their family planning choices?
Kharat works in Pune, a city about two hours outside of Mumbai in the Indian state of Maharashtra. But the options she offers women in the face of the sex-selection law were echoed hundreds of miles to the north, by gynecologists and abortion providers in Udaipur, a city in the state of Rajasthan. “Fear is there,” Dr. Reena Mittal, a gynecologist at a public hospital in Udaipur, said. “The second-trimester abortions, no one is doing them.”
According to Mittal, Kharat, and several other abortion providers, doctors across the country are afraid of accidentally running afoul of the sex-selection law by performing an abortion on a woman who had a sonogram elsewhere, saw the fetus was female, and decided to terminate (in India, sonograms to determine the sex of the fetus typically cannot be performed until the second trimester).
Both Mittal and Kharat said they felt at less risk because they work at public hospitals, where abortion is free but more regulated than at private clinics and where, as a result, women are less likely to seek sex-selective abortions. But private providers, they said, are fearful—even though terminating a second-trimester abortion can mean a bigger payday.
While public hospital employees like Mittal and Kharat said they aren’t afraid of legal sanctions, that lack of fear comes at a cost: They aren’t afraid of legal reprisals, because they often simply refuse care to patients.
“It is affecting our services,” Mittal said. “Previously, we used to do some seven to eight second-trimester abortions in three months. Now we don’t do a single one in one year. That’s the difference.”
There are many reasons, aside from sex selection, why a woman might need an abortion in the...