Source: Pakistan Bureau of Statistics
Given this dichotomy, it is routine for doctors to not disclose the sex of the baby in the first place. Almost all doctors interviewed agreed that parents insist on revealing the sex for shopping or naming purposes, but what happens after in case it’s a daughter proves to be something else. But since there is no law against foetal sex disclosure, doctors comply with the request if parents insist or are aware of it. “If parents are extraordinarily curious to know the sex of the baby, this puts us on guard,” says Dr Srah Sabah Khan, who is completing her house job at the Jinnah Postgraduate Medical Centre in Karachi.
Dr Shakira Parveen, associate gynaecology professor at the Civil Hospital Karachi, says she also rebuffs requests of revealing the baby’s sex. She says it can “create trouble for the doctor.” If the patient has a strong desire for a baby boy but is carrying a girl, she can get tense and hypertensive, which leads to complications in smooth pregnancy.
“Almost 70 percent of my parents are not happy when they get to know that their child will be a girl,” narrates Dr Parveen. The doctor adds that the reaction of parents after delivery is not as negative as when they get to know the gender before birth.
“Sometimes it is the mother who is unhappy with the birth of a daughter because of the stigma attached to it,” she says. “Mothers think that a son can help them get a strong place and respect among their in-laws.” Dr Parveen advises parents not to blindly trust ultrasound results as they can be inaccurate and create difficulties in accepting the fact later.
Every gynaecologist, at some time in their career, has witnessed prenatal and postnatal discrimination against newborn baby girls. One such doctor is Dr Mahjabeen Khan. She discusses a case where a husband stood outside the labour room, threatening his wife of divorcing her if she delivered a girl.
“The baby was not even completely out when the patient sat up to check its gender. She had given birth to her eighth daughter and went in shock soon after,” recalls Dr Khan. “It was a normal case till then but suddenly complications arose because of the husband and his desire to have an heir. I can still hear echoes of him screaming. It was quite traumatic.”
Discrimination can also be weighed with the amount of risk parents are willing to take to deliver their unborn child.
“Most parents do not take a risk if they know they are having a boy. Even if there is no need for a C-section, they insist to go for it to ensure zero threat to their unborn son’s life,” Dr Parveen says. “But many parents resist a C-section to deliver a baby girl despite doctors’ recommendations to the contrary.”
The senior gynaecologist also highlights that if two patients of the same name deliver babies at the same time, a boy and a girl, both families would be willing to claim the boy.
“I have seen a case where families were misinformed about the gender of their baby initially because of similar names of patients,” she recalls. “Later, when they were told the sex correctly, the family who had had a boy was over the moon while the other disowned their baby.”
THE CURSE OF CONCEPTION
Hilda Saeed is a founding member of Women’s Action Forum (WAF) and has seen more than most. She recalls a pre-Partition story that still rankles:
“There was a Hindu woman street vendor who’d sell purified butter and papadums, and at times handicrafts, in the neighbourhood. For some time, she’d stopped selling till one day, she reappeared. When asked about her prolonged absence, tears gushed down her eyes. The woman had given birth to her third daughter. But she wasn’t crying because of that little creature. It was the ignominy that flashed back in her mind, the humiliation of being forced to parade naked around the village on a donkey wearing a garland of black shoes around her neck. Her husband was behind that, as retribution for delivering a girl.”
Seventy years on and things seem at a standstill.
Pakistan’s sex ratio at birth (SRB) is fairly skewed. Typically the sex ratio at birth usually oscillates around 105 male births per 100 female births. In Pakistan, it is estimated to be 109.9. In other words, around 110 male births per 100 female births; this is close to India which is infamous for sex-selective abortions.
An in-depth analysis of the data from all five censuses conducted in Pakistan since 1951 also reveals that the male population has constantly dominated female population in numbers. As of the 1998 census, Pakistan’s overall sex ratio was 108.5 males per 100 females or 925 girl babies per 1,000 boy babies. When classified further, the distortion is found worse in Balochistan (114.6) and Sindh (112.2).
Although gender imbalances at birth are attributed to a set of local factors in each country, they are generally observed in regions with persistence of patriarchal norms and son preference. These are typically countries where people have easy access to sex-detection technologies and pregnancies are terminated on the basis of gender. This practice is known as female foeticide and is quite common in China and India. Pakistan, however, doesn’t have as skewed a SRB as its two neighbouring countries, but researchers suspect the problem is alarming because of the inordinate delay in carrying out the population census.
“With the advancement in science and technology, couples can choose the gender of their child before birth,” claims Mr Wajid of the Right Choice conception clinic. “Having a success rate of 95 percent, the procedure is not surgical.”
Right Choice sends a prospective couple a detailed chart mentioning the woman’s ovulation days and guidance to conceive their preferred gender after examining their initial reports. During a brief conversation over phone, Wajid claims to have been in business for more than 17 years and to have operated from an office in Zamama, Karachi, for one year where they received a tremendous response.
However, ever since they moved to Islamabad, they are now operating online. The calendar costs 80,000 rupees (excluding 5,000 rupees for tests) which is non-refundable and is made in advance. The company operates in collaboration with a US partner, who creates the chart for the couple based on their reports and details.
For those with infertility issues, there is a package of 100,000 rupees.
When asked what if the method fails, Wajid says: “You can confirm the sex through a 3D ultrasound within 90 days of conception and abort the foetus if it is a girl. As the foetus is not a living being before 120 days, there is no harm in doing that.”
Somewhat similar to female foeticide is female infanticide, when parents neglect their female child deliberately and let them die (of starvation or thirst), resulting in their premature deaths.
Researchers have observed higher rates of malnutrition in girls because of being weaned off breast milk earlier, either to feed the baby boy or in trying to get pregnant again in pursuit of a male child. This denial of breast milk/ sufficient food often results in the loss of many innocent lives.
“A female sweeper of our hospital delivers twins, a boy and a girl. As time passes by, the baby boy continues to gain weight while the girl grows frail and dies within four months. She is starved to death gradually, in front of my eyes, as the mother found it more important to breastfeed the boy,” recalls Dr Gul.
Female foeticide and infanticide, when combined together along with the number of females who died as a result of unequal opportunities or access to resources, lead to the “missing women” epidemic — a term coined by Nobel Laureate Amartya Sen to indicate the difference between the women present on the planet and those that would have been here had the sex ratio been “natural” worldwide.
Doctors, who are interviewed, however, do not relate this imbalance to prenatal sex selection. Some of them even think the SRB in Pakistan is not too distorted to worry about.
Dr Shershah Syed believes it is difficult to control and report gender selection in a disturbed and unorganised healthcare system such as ours. “You cannot stop it. The rich pay hefty sums of money to famous doctors and have abortions while poor people go to street abortion clinics. It’s not possible to control this.”
The fees of an abortion may rise with the stages in pregnancy. The later the pregnancy, the higher would be the charges, a source shares. “Some doctors even charge around 5,000 rupees more per month, making a rough total of 70,000 to 90,000 rupees to perform the service.”
Excluding a few doctors, none of the health professionals admit the prevalence of prenatal sex-selection in the country. Nor does the research conducted by the Population Council Pakistan in 2015 confirms it (suggesting only its possibility). Some, who believe that it happens, either decline to speak on record, citing lack of information or claim it to “have not reached epidemic proportions.”
Dr Hussain Abidi, medical insurance doctor, however, says that mothers try to self-abort babies when they do not want to continue their pregnancy and are later admitted to hospitals in debilitating situations. Doctors then have no option but to perform an abortion, for medical reasons. During his tenure, Dr Abidi has witnessed cases where expectant mothers were admitted in life-threatening conditions. Later upon investigation, the cases were either withdrawn or restated with purely medical reasons to get financial cover from insurance companies.
A Glimmer Of Hope?
The picture is gloomy, but a ray of hope is flickering on the dark horizon.
Speaking about the preference of adoptive parents, Sarim Burney and Dr Mubina Agboatwalla, chairperson of HOPE, both agreed that trends have been changing.
“Adoptive parents are really desperate to adopt a baby. Nowhere have I seen any discrimination,” argues Dr Agboatwalla. “Even if they have already adopted a baby girl they will still go for the baby girl if available.”
She confirms, however, that around 70 percent of the abandoned babies left at the HOPE hospital and maternal clinics are girls. Burney adds that prospective parents prefer girls because boys are no more considered a support system for parents in their old age.
Indian social scientist and feminist activist Kamla Bhasin describes the patriarchal system as a war of resources where the man is the ‘sun (the resource)’ and women are ‘planets’ dependent on him to sustain life. But perhaps, the stars will only align for girls if women are no longer financially dependent on anyone; and instead others are reliant on them.
The writer tweets @Tanzeel09
Published in Dawn, EOS, August 20th, 2017