Mumbai – Fertility treatment test being misused to select male embryo


Shubhangi Bhostekar has complained to the Maharashtra child rights panel after a surrogate hired by her husband gave birth to a boy.

A complaint received by the Maharashtra State Commission for Protection of Child Rights early this year has raised concerns that fertility clinics might be misusing technology meant for screening genetic disorders to guarantee the birth of boys.

It is illegal in India to use any technology to select the gender of a foetus. But activists suspect that medical professionals have been using Preimplantation Genetic Diagnosis, or PGD as it is commonly known, to selectively implant male embryos. The PGD technique allows doctors to test an embryo for genetic abnormalities before transferring it to the uterus. It was introduced in India roughly two decades ago. A woman’s complaint to the child rights commission has only strengthened this suspicion.

Shubhangi Bhostekar, 35, said that a surrogate hired by her businessman husband, Prakash Bhostekar, 41, without her knowledge had in September 2016 delivered a male child. Shubhangi Bhostekar claimed the birth of the boy was made possible by sex selection at preconception. The couple have two daughters aged 5 and 14.

Mumbai’s Jaslok Hospital, where the surrogacy procedure was performed, has refuted the allegation of sex selection. A hospital spokesperson said the embryo was implanted into the surrogate’s uterus on the second day of its formation. “At this stage, embryo biopsy for PGD is not possible and hence there has been no misuse of a technology,” the spokesperson said.

The Maharahstra child rights body has asked the Mumbai police to investigate Shubhangi Bhostekar’s allegation. The police have referred the matter to a medical board, consisting of government doctors, for expert opinion, Senior Police Inspector at Mulund station Shripad Kale said.

The Pre-Conception and Pre-Natal Diagnostic Techniques Act of 1994 requires that every “Genetic Counseling Centre, Genetic Laboratory, Genetic Clinic, Ultrasound Clinic and Imaging Centre shall maintain a register showing, in serial order, the names and addresses of the men or women given genetic counseling, subjected to pre-natal diagnostic procedures or pre-natal diagnostic tests, the names of their spouses or fathers and the date on which they first reported for such counseling, procedure or test”.

The Indian Council of Medical Research also maintains a national registry of fertility clinics.

To help couples who are unable to conceive naturally bear children, doctors take reproductive germ cells called gametes from them or donors to create an embryo. The embryo may be screened for genetic abnormalities using the PGD technique before it is implanted into the uterus of the mother or the surrogate. The technique can also be used to determine the gender of the embryo. In fact, a study conducted in Iran, where PGD is widely used for gender selection, found that it was “100% successful in achieving the desired sex”.

This is what worries activists in India. Specifically, such procedures are difficult to monitor and, thereby, regulate, making them prone to misuse. “These clinics are offering such sophisticated treatments but are not being monitored effectively,” said Varsha Deshpande, founder of Lek Ladki Abhiyan, a non-profit that campaigns against sex selection. “It is not a mere coincidence that celebrities and rich people opting for surrogacy are only having sons.”

In 2013, Deshpande filed a case against the actor Shah Rukh Khan and Jaslok Hospital for allegedly predetermining the sex of his third child, who was born through surrogacy. Her petition was eventually dismissed by the Bombay High Court.

Suspicious case

On January 12, 2016, Shubhangi Bhostekar and her daughters were allegedly evicted from their home. In her complaint to the Mulund police, she said her husband had forced her to undergo multiple abortions following the birth of her second daughter because he wanted a male child. “He even took me to Jaslok Hospital in 2014 as he wanted me to undergo infertility treatment,” she told Scroll.in. “He told me treatment at the hospital will ensure the birth of a boy. I was tired of the harassment and decided not to undergo it.”

Jaslok Hospital confirmed the couple had visited infertility specialist Dr Firuza Parikh on August 6, 2014, but had not registered as patients or paid a fee. They wanted to plan for another child but the patient came with a history of having two daughters, two miscarriages and the husband had high blood sugar level, the hospital said. They were told to come back when his sugar levels were under control. Prakash Bhostekar returned after about 17 months, but as a single man who wanted a child through surrogacy. At that time, Parikh did not recall his previous visit, the hospital added.

On March 21, 2017, Shubhangi Bhostekar complained to the child rights commission, alleging that her husband, in pursuit of having a boy, had hired a surrogate through Jaslok and entered into an agreement with her on January 15, 2016, three days after throwing Shubhangi Bhostekar and their daughters out of his home.

Jaslok, however, told the commission they were not aware Prakash Bhostekar was married with two daughters since he had furnished an affidavit saying he was single. The Indian Council of Medical Research’s guidelines require a married person to take spouse’s consent before commissioning surrogacy.

The surrogate delivered a baby boy on September 28, 2016. A month later, Shubhangi Bhostekar approached the police after learning her husband had brought an infant home.

Her lawyer, Siddh Vidya, claimed the police investigated her complaint only after she filed a Right to Information application about the status of the case. “There is enough circumstantial evidence indicating that Prakash opted for surrogacy to have a boy,” said Vidya.

The child rights commission agreed. After receiving Shubhangi Bhostekar’s complaint, it directed the Maharashtra government to “take appropriate action against Prakash Bhostekar and [his mother] Laxmi Bhostekar for sex selection, forceful abortion, for giving false affidavits to the effect that the [marital] status of Prakash Bhostekar is single and for obtaining a male child through surrogacy.”

Pravin Ghuge, chairperson of the commission, said Prakash Bhostekar has violated the rights of his daughters and newborn son. “We are not a medical body but from the submissions made to us it appears the surrogacy was opted for the sole purpose of having a male child,” he said.

Need for regulation

In 1998, Dr Anniruddha Malpani, who runs an infertility clinic in South Mumbai, argued in an article in the Indian Journal of Medical Ethics for allowing the PGD technology to be used for sex selection.

Twenty years later, Malpani said that the bannon the use of technology for sex selection was to be blamed on cases like the Bhostekars. “The ban has driven the operations underground,” he said. Malpani said that instead of a blanket ban, there could have been a regulatory mechanism to allow couples to select the gender of the child. “What if the couple just wants to balance the sex-ratio in the family?” he asked.

Infertility specialist Dr Kamini Rao, who practises in Bangalore, said discussions around using the PGD technology for sex selection were unwarranted. “The law does not permit it and we have to follow it,” she said.

Still, many couples do ask her to conduct sex selection procedures – “especially couples who are opting for infertility for a second child inquire about sex selection,” she said. “But it is not necessarily only for having a boy. Many couples want a girl.”

Amar Jesani, a researcher specialising in bioethics and public health, said artificial reproductive technologies have made it possible for doctors and couples to select several aspects of the foetus. “It is a well known fact that selection takes place and gender is only one part of it,” he said.

Both Jesani and Rao said legislative regulation of assisted reproductive technologies was required. “The Bill to regulate assisted reproductive technology was never introduced in Parliament,” said Jesani. “And without regulating the ART industry, having a bill for regulating surrogacy is not enough.”

Gita Aravamudan, author of Baby Makers: The Story of Indian Surrogacy, said it was not surprising that doctors were selecting the gender of embryos. “During my research, I learnt of cases where couples chose the gender of the child they bore using infertility treatment,” she said. “The entire industry needs to be regulated.”

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A Thai Surrogacy Case, With A 6-Month-Old Girl Caught In The Middle


JULY 15, 2015 
Manuel Santos feeds 6-month-old Carmen as biological father Bud Lake looks on. The couple is fighting for custody of the baby, born to a surrogate in Thailand who now wants to keep her.

Manuel Santos feeds 6-month-old Carmen as biological father Bud Lake looks on. The couple is fighting for custody of the baby, born to a surrogate in Thailand who now wants to keep her.

Michael Sullivan/NPR

Manuel Santos, from Valencia, Spain, is feeding his daughter, Carmen, a 6-month-old who was born to a surrogate in Thailand.

Father and daughter are in a temporary apartment in Bangkok, accompanied by Santos’ husband, Gordon Alan “Bud” Lake III, from New Jersey, and the couple’s 2-year-old son, Alvaro, who was born to a surrogate in India.

Carmen is stuck in the middle while his parents wage a legal battle to take her with them. The Thai surrogate who carried Carmen has backed out of her contract. And under a new law, Carmen belongs to her — not to Santos and Lake.

“We need two things to leave,” says Lake. “One thing would be [Carmen’s] passport. The second would be paperwork to get through immigration. And that requires special paperwork to let a baby leave the country.”

They were close to getting it. The surrogate who gave birth to Carmen signed a consent form that allowed Lake to take her from the hospital and put his name on the birth certificate. But the woman failed to show up at the last meeting at the U.S. Embassy to sign that last bit of paper.

So even though Lake is the biological father and the egg came from a donor — not the surrogate — the family is stuck.

“We’re having problems with our jobs and financially … and all this is [the surrogate’s] fault. We’ve done nothing wrong here,” Lake says. “We’ve done everything by the book, we had an agreement, we commissioned a surrogacy and she agreed to be a surrogate. She received the monthly payments. She’s the one who changed her mind.”

Lax Regulation

An adviser to the surrogate says Thailand’s commercial surrogacy business was wrong from the start. She calls it human trafficking. And she calls the surrogate in this case a victim — even though she willingly entered into a contract and was paid well by local standards.

When Carmen was conceived more than a year ago, commercial surrogacy was booming in Thailand. Thanks to lax regulation, commissioning parents could get babies more cheaply here than in other countries where commercial surrogacy is legal. Surrogates could earn about $15,000 for carrying babies to term.

Then came the case of Baby Gammy. An Australian couple commissioned twins, but balked when Gammy was found to have Down syndrome. They took his healthy sister home and left Gammy behind with his surrogate mother, who was happy to keep him.

The Thai media hit the story hard. And early this year, the military-led government pulled the plug: No more commercial surrogacy in Thailand. And no more surrogacy for foreigners, period.

There was supposed to be a grace period for parents who already had babies on the way, like Lake and Santos. And that’s worked for most.

So why did their surrogate, Patidta Kusongsaang, change her mind?

She lists a lot of reasons.

“First of all, they are not natural parents in Thai society,” she says through an interpreter. “They are same-sex, not like male and female that can take care of babies. Second thing is, when I tried to contact them to visit the baby, they didn’t want to talk to me. And the third thing is, I was begging them to see the baby but they didn’t allow me to see her. They treated me very badly and said I have no right to see the baby.”

The Fight Ahead

Lake and Santos deny all of this. They are getting ready to fight for Carmen in a Thai court. But Lake says the lawyers they’ve talked to say their chances of winning are less than 10 percent.

“The reason they gave us such a low percentage is because, despite the fact there are temporary provisions in the new law just published that say … parents can ask for their parental rights to be recognized in court, unfortunately, it’s worded as ‘husband and wife,’ ” he says.

Lake suspects the law was written to exclude gay couples deliberately. And he seems to be on to something.

“Thai law does not endorse same-sex pair. And [under] Thai law, a legal couple is husband and wife, man and woman,” says Dr. Arkom Pradidsuwan of the Thai Medical Council in the Ministry of Public Health.

Carmen’s legal status, he says, is that she belongs to Kusongsaang.

Santos says that’s not fair: He and Lake are legally married. Many other countries recognize this fact.

“We are married in the States, in Spain, in Europe, and I respect the law, but they have to understand that everything changed in our [world] when all these things about surrogacy [changed] … but we don’t have anything to do with that,” Santos says.

For years, commercial surrogacy in Thailand worked for many people — not only for couples who wanted but couldn’t have babies but also for surrogates who needed the money. Advocates argue that commercial surrogacy didn’t need to be banned; it just needed to be better regulated, in part to avoid problems like this one.

Stuck In Limbo

So where does this leave Santos, Lake, Alvaro and Carmen? For now, in limbo. Lake says the U.S. Embassy has told him its hands are pretty much tied.

“They’ve advised us that we need to follow judicial channels,” he says. “They’ve given us advice, they’ve lent an ear to listen, but from what they’ve told us, there’s really not much that they can do, that we have to follow the legal channels, that that’s our only option.”

An official at the State Department confirmed this in an email, saying, “U.S. citizens in Thailand are subject to Thailand law. Pursuant to U.S. law, the Department cannot issue passports to minor children without the consent of the legal parent/s or guardian/s.”

The couple has been switching apartments every month or so. They have reason to be afraid: Kusongsaang and her adviser have gone to the police and formally accused Lake of child abduction. He recently went to hear the charges. He left Carmen at home, just in case.

He and Santos say they’ll do everything they can to keep her. There’s no way, Santos says, they’re going home without their baby.

“No, no no,” he says softly, shaking his head. “Because she’s our daughter. By heart and genetically. If we have to move here and leave our families and work, we will do. But we will not leave Carmen. Because [she] is not her daughter; [she] is our daughter.”

Lake and Santos thought they’d be bringing the baby home six months ago, shortly after she was born. Back then, they were excited at the thought of Carmen meeting the family — especially Santos’ ailing 91-year-old grandmother, Carmen’s namesake.

 

She died a few weeks ago.

http://www.npr.org/sections/parallels/2015/07/15/423188769/a-thai-surrogacy-case-with-a-6-month-old-girl-caught-in-the-middle?utm_source=facebook.com&utm_medium=social&utm_campaign=npr&utm_term=nprnews&utm_content=20150715

Teenage egg donor’s death -Chargesheet filed against surrogacy specialist Dr Gautam Allahbadia


Dr.Gautam Allahbadia an IVF Fertility specialist is leading Infertility specialist in India running fertility centre named Rotunda – The Center For Human Reproduction. , pic courtesy http://community.medicaltourism.com/

Dr.Gautam Allahbadia an IVF Fertility specialist is leading Infertility specialist in India running fertility centre named Rotunda – The Center For Human Reproduction. , pic courtesy http://community.medicaltourism.com/


The Saki Naka police, probing the death of a 17-year-old egg donor, last week filed a chargesheet indicting the Bandrabased surrogacy specialist, Dr Gautam Allahbadia, and five others for negligence and kidnapping. The victim, Sushma Pande, died in 2010 allegedly due to complications arising from donating eggs at Allahbadia’s Rotunda Fertility Clinic.Investigating the complaint filed by the victim’s mother, Pramila Pande (pictured), the police said that Sushma donated eggs at Allahbadia’s clinic on at least three occasions in 2009 and 2010. As per the law, only women aged above 18 years can donate eggs.The state Medical Council, which issued a notice to Allahbadia oneand-a-half years ago, has said that it didn’t have the jurisdiction to suspend the doctor’s licence at this stage. The council president, Dr Kishore Taori, said: “Unlike the cases of Pre-conception and Pre-natal Diagnostic Techniques (PCPNDT) Act, we cannot suspend the doctor’s license based on a chargesheet. We will have to wait till conviction.”

The victim’s mother said that she was now confident that justice will be delivered. “It’s been four-and-a-half years since my daughter died and it is only now that I feel that something will move ahead in the case,” Pramila, 42, who resides in Mishra Chawl in Saki Naka, said. “I will chase the case till I get justice,” she said. Sushma worked at a scrap depot near her house, and went missing on August 7, 2010.

An ailing Sushma was found by her employer, Sunil Chaumal, on August 9, and she died the next day. Chaumal was arrested on the charges of poisoning her, but the high court discharged him in March 2012 and pulled up the police for not looking into the role of egg donation in her death.

Investigation revealed that Sushma was admitted to Allahbadia’s Rotunda Clinic on August 7, 2010, and on two occasions (October 22, 2009 and February 15, 2010). According to the chargesheet, a conclusive postmortem report said that Sushma’s death was caused “due to multiple injuries associated with shock”. The JJ Hospital’s expert committee said in its report that Sushma went into a shock due to excess hormones that were administered before egg donation.Allahbadia has submitted three ‘egg donor consent forms’ signed by Sushma to the police and to the Medical Council, which also state the risks of the procedure such as overstimulation of the ovaries, injury to the blood vessels or other internal parts, bruising from injections, etc. Sushma, who had studied till class 6, could not read the form. Also, she was signed at the clinic by the name Sushma Pramod Dube instead of Sushma Anilkumar Pande, and there was no mechanism in place to check if she was underage.

Allahbadia told the police that Sushma has given her PAN Card as proof to show that she was above 18 years of age. “A letter from Income Tax office revealed that there was no PAN Card in the name of Pramod Dube or Sushma Anilkumar Pande. Allahbadia has lied,” the chargesheet said.

Bandra doc charged for negligence, kidnapping

How doctors shield doctors ?

 ‘No negligence on part of fertility clinic’

Last year , A committee of doctors from state-run JJ Hospital has concluded that there was no negligence on the part of ‘Rotunda: The Centre for Human Reproduction’ in a case pertaining to the death of 17-year-old Sushma Pandey, an egg donor. Sushma died on August 10, 2010, two days after she donated eggs at the hospital.The opinion of the JJ Hospital committee was sought after the Bombay High Court discharged Sushma’s employer Sunil Chaumal and asked the police to probe the role of the hospital in which she had donated eggs thrice “in flagrant violation of the requirement that such a donor has to be between the ages of 18 years and 35 years.”The committee’s clean chit to Rotunda, informed to the court by the police Tuesday, brings relief to Dr Gautam Allahbadia, medical director of the centre. Allahbadia is also a member of the drafting committee of the Assisted Reproductive Technologies (Regulation) Bill, 2010, that is yet to be tabled in Parliament. 

While hearing the application for discharge filed by Sanaullah Mustakin, the man who allegedly accompanied Sushma to the Rotunda Centre two days before she died, Justice Revati Mohite Dere said, “It appears that no action will be taken against the doctors.” She, however, observed that the case was unfortunate and said, “This is something where not just one person is involved. The report (from JJ Hospital) does not stop them (police) from investigating who else is involved.”

In its report of December 9, 2013, the committee — comprising Dr G D Niturkar and Dr G S Chavan from the Department of Forensic Medicine and Dr Tushar Palve from the Department of Obstetrics and Gynaecology — stated that Sushma had died as a result of “brain hemorrhage and pulmonary hemorrhages due to ovarian hyper-stimulation shock syndrome.”

The report added, “Ovarian hyper-stimulation shock syndrome is a known remote complication of the process of egg donation. The same has been duly informed to the patient by written, witnessed informed consent.” It also said that Sushma, her relatives or friends had not turned to the Rotunda Centre on August 9, 2010 or August 10, 2010 when she complained of abdominal pain and vomiting and had hence, “failed to submit Ms Sushma to competent medical care”. “There is no evidence suggestive of medical negligence on part of the doctors of Rotunda Hospital,” it said.

It, however, deepens the mystery behind the circumstances that led to the egg donor’s death. Sushma’s mother Pramila Pandey, in October 2013, filed a complaint before the Maharashtra Medical Council demanding the termination of Allahbadia’s practice alleging medical negligence.

Denying allegations that Sushma was underage, the centre had said when she first approached them in February 2009, she submitted a PAN card which stated her name as “Sushma Pramod Dube” and mentioned her age as 19. The police’s probe with the Income Tax Department revealed that there was no PAN card in the name of “Sushma Pramod Dube” with a Saki Naka address, where she resided.

http://archive.indianexpress.com/news/teenage-egg-donors-death-no-negligence-on-part-of-fertility-clinic/1216617/0

Burden of surrogacy


  • GITA ARAVAMUDAN
There are more pregnant surrogates left in Nepal carrying Israeli babies and no one knows what their future will be.
AP

There are more pregnant surrogates left in Nepal carrying Israeli babies and no one knows what their future will be.

The gay/single parent fertility business has shifted to Nepal. With no proper legislations in place, being a surrogate is not easy.

“These are the intended parents,” said the doctor. She was an impeccably dressed, youngish woman seated in front of a computer. On the screen was a picture of two men; one balding and slightly paunchy, the other younger and dressed in jeans.

“They are from Israel,” she said. “Their surrogate is a young Nepali girl. She is due next week. We’ll email them the moment the baby is born and they’ll come and collect it. They’ll get the formalities done, pick up their exit visa and leave. And yes, the baby will be an Israeli citizen. There is no problem about that.”

So simple!  Most of the “transaction” had been done over email and Skype. The men had come down just once, carrying the frozen embryo. That’s when they met their surrogate for the first and last time and signed the contract. They had been in constant touch with the clinic, but never interacted with the surrogate again because obviously they could not communicate with her. And maybe they didn’t want to.

This was in 2011 and I was researching for my book Baby Makers: The Story of Indian Surrogacy. I was at this upmarket clinic in Mumbai because I knew it was a preferred destination for gay couples from all over the world who wanted to have babies through surrogacy.

That day I learnt a lot. I learnt for instance that some countries like Israel ban same-sex couples from hiring surrogates in their own country, but recognise children born through surrogacy in other countries. I also learnt that the sperm could come from one country, the eggs from another, the IVF could be done elsewhere and the frozen embryo could be shifted across continents to be implanted in surrogates in India.

And why India? Because India was cheap, the medical facilities were very good and clinics like the one I was sitting in had a large supply of young, healthy surrogates on call. More importantly, in India, there was no law and the entire fertility business was only regulated by the guidelines passed by the Medical Council. And these guidelines had nothing to say about same-sex parents.

But that was 2011. Everything changed after 2012 when the Indian government issued a notification disallowing single/same-sex parents from using surrogates. Hari G. Subramanian, Chief Consultant at the Indian Surrogacy Law Centre, Chennai, says, “Prior to 2012, a majority of the foreign nationals who came to hire a surrogate in India were either gay or single parents.” Though there are no proper statistics, he said that this category of intending parents from abroad formed a sizable part of the clientele for Indian clinics. Many clinics, in fact, serviced only gay or single intended parents.

Post-2012, these parents started looking for other options. Thailand, the other cheap destination, closed up after the Baby Gammy episode. The U.S. was very expensive. Then suddenly Nepal popped into the picture. Overnight, the gay/single parent fertility business shifted to Nepal. How did this happen?

Nepal allowed surrogacy for foreign nationals, but not for Nepalese.  This meant that neither the intended parents nor the surrogate mothers could be Nepali. Ironically there were quite a few Nepali surrogates carrying babies in India!  Nepal had no specific law or regulation. But, neither was it equipped for fertility tourism like India was. This was when our porous borders helped. Indian surrogates could be brought to Nepal, most probably after the embryo implantation was done. Since the whole business is shrouded in secrecy, the nitty-gritty of the transaction is known only to the Indian fertility clinics who probably masterminded the shift. The crucial exit document for the infant, which was no longer available in India, was now issued by Nepal. The child got the nationality of the commissioning parents. Simple!

Flash forward. April 2015. Nepal has been devastated by an earthquake. The media is full of pictures of rubble, of survivors sleeping on roads, of doctors bending over patients in makeshift clinics. And, in the midst of all this, emerge some startling pictures.

The international media zeroes in on the story of the week. Pictures of Air Force officers’ carrying pink-faced newborns aboard a rescue mission flight to Israel make front-page headlines and are flashed across TV screens. The babies being evacuated, we learn, belong to gay Israeli couples who had commissioned their birth through surrogates in Nepal. There are indignant murmurs, as we learn that the surrogates are left behind in their weak condition to fend for themselves amid the devastation. And then worse… that there are more pregnant surrogates left in Nepal carrying Israeli babies and no one knows what their future will be. Israel can legally evacuate and repatriate only its own citizens. Therefore the babies can be evacuated, but the mothers who bore them cannot.  And no one quite knew what would be the fate of the tiny Israeli “citizens’ still stuck inside their surrogate mothers’ wombs.

Israel recognises gay civil unions as well as surrogacy. But an Israeli surrogate can only be contracted by an Israeli heterosexual couple. However, babies born to gay couples through surrogacy outside the country are given Israeli citizenship. Many, even in Israel, have protested against this law and want it changed.

Perhaps Israel will address the issue and change the law.  But, even if that happens, it will be too late for the heavily pregnant women who are stuck in devastated Nepal with Israeli babies in their wombs. All the surrogate mothers are probably Indian.

What is striking about this whole issue is the layers of hypocrisy involved. Israel allows gay unions and children born to them through surrogates… but not on its own soil. India derecognises gay partnerships and bans surrogacy for such couples but turns a blind eye to surrogates who cross the border and deliver babies in another country, which is willing to give exit permits. Nepal doesn’t allow its women to become surrogates in their own land but looks the other way when they cross over to India to do so.

Sadly, the women who rent out their wombs in such situations are poor and ignorant and often have no idea of what they are getting themselves into. They are totally dependent upon the fertility clinics and the agents who often abandon them once the job is done.

This latest episode once more highlights the need of the hour. Fertility clinics and surrogacy arrangements are here to stay. The fertility business is booming and will continue to do so.  We need to recognise this reality and introduce proper legislation before disaster strikes.

IVF and ART centres that treat infertility listed under PCPNDT radar


No baby, this is wrong!
Several doctors have claimed it is sheer harassment for clinics that treat people to conceive to be targetted for sex determination tests; state admits to something being wrong (THINKSTOCK.COM)
, sending doctors into tizzy of outrage.

While the twisted use of sex determination tests for unborn children is being strictly challenged and remedied by a strong system under the Pre- Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, it turns out that the newest step of the state government under this umbrella might be headed into a slightly tangential realm.

In fact, doctors from Pune and beyond are making no bones about calling the government’s decision to include Assisted Reproductive Technology (ART) and In Vitro Fertilization (IVF) clinics in their list of places to crack down on under the Act as harassment and an unwanted intrusion, insisting that these have nothing to do with illegal sex determination, adding that they — in fact — treat infertility.

From this year on, the state has added ART and IVT centres and clinics to its list, putting them on the radar for frequent raids and visits from local PCPDNT teams. Ironically, even as Pune doctors outrage about what they say is an illogical decision, the state head for PCPNDT has agreed that the consideration of excluding the centres from the list will soon be discussed.

Dr Sunita Tandulwadkar, vice chairperson of the Maharashtra chapter for the Indian Society of Assisted Reproduction, told Mirror, “Visits of PCPNDT teams have already started for the year — we are confused as to how an IVF clinic or ART centre, both known for treating patients for infertility, can conduct sex determination tests. This addition to the list is most confusing.”

She explained that PCPNDT, known for nabbing miscreants who conduct sex determination tests, usually cracks down on sonography clinics. “Before implanting is done, a test called the pre-implantation genetic diagnosis (PGD) is done, which is very expensive and found with geneticists, not at ART centres. Besides, how are we supposed to fill Form Fs, which are only filled after we have a pregnant patient? These people have come to us for treatment to conceive! This is mere harassment.”

Dr Sanjeev Khurd, a member of the Federation of Obstetrics and Gynaecology Society, echoed, “A geneticist or sonography clinic needs to be compulsorily registered with PCPNDT — not us. We cannot be nabbed for not filling form Fs, as we are not meant to do so. A sonologist should keep those records. An IVF centre is not a sonography clinic. This move is impossible to support.” Dr Ritu Santwani, director of the Pune Test Tube Baby Centre, said, “A few days ago, my clinic was raided, but the team could find nothing so we came out clean. Unfortunately, this is sheer harassment. The state needs to exclude us from its PCPNDT list — we simply do not fit the bill. They cannot expect us to fill Form Fs, call unfilled portions a technical glitch and file cases against us. This is unacceptable.”

Dr Vaishali Jadhav, local PCPDNT head for Pune, failed to answer calls made to her on Wednesday.

Surprisingly, Dr Archana Patil, joint director of health services and head of the state PCPNDT cell, told Mirror, “It is compulsory for IVF and ART centres to be registered with us. But, if they are being harassed over sex determination tests or filling up of forms before patients get pregnant or tested for a sonography, it will be looked into. So far, we have never heard about any IVF clinic being shut or having lost its registration due to sex determination tests from our local PCPNDT cells in all districts.” She also admitted that IVF need not come under the PCPNDT radar, as it has nothing to do with sex determination. “Women who opt for IVF or ART treatment go there before getting pregnant, so a sex determination test or pregnancy test cannot take place at that stage. A discussion about these centres and clinics being included in our list will be carried out with policy makers at the state level,” she ended.

Contrived Confusions No Contradictions Between PCPNDT and MTP Acts


Ethical dilemmas surrounding abortion, particularly the conflict between human and legal rights of a childbearing woman and the so-called rights of an unborn child, are quite legitimate. However, the pro-life activists should desist from treating a woman as mere receptacle for the unborn child, taking away her inalienable right to control her own body.

Vandana Prasad is with the Public Health Resource Network.

In the first week of December 2014, participants of a large rally at Jantar Mantar against cuts in social sector spending were shocked to see an anti-abortion stall with a banner titled “Delhi Commission for Women, Archdiocese of Delhi”, suggesting a partnership between the orthodox religious organisation and the Delhi Commission for Women. The stall housed posters that seamlessly mixed up issues of sex-selective abortion with pro-life stands against abortion per se. As it transpired, the religious organisation itself claimed a commission for women that was leading an exercise many would find anti-women’s rights, and which caused such public confusion. Notwithstanding, the more important unresolved issue is the confusion that seems to prevail in government and civil society both between the intention of the Pre-Conception and Pre-Natal Diagnostic Techniques  (PCPNDT) Act, and the Medical Termination Of Pregnancy MTP Act, 1971, and which is being exploited by many “pro-life” organisations of all religious hues to rouse public support against the legal entitlement of abortion.

While no one might argue in favour of abortion as a desirable method of family planning or contraception from the public health perspective, safe abortion is considered a significant reproductive right of women and is upheld as a pillar of reproductive health services by the progressive countries of the world. This is specially the case in countries like India, where women often do not have the power within the family to determine when and how they might be pregnant. Further, as the recent tragedy in the Chhattisgarh sterilisation camps also demonstrates, there is a high unmet need for decent contraceptive services on the supply side that prevent women from accessing their choice of contraception. Unsafe abortions contribute significantly to maternal mortality, and it has been proved that having legislations permitting abortion prevents unsafe abortions and brings down maternal mortality.

Basic Right of a Woman vs Rights of a Unborn Child

Certainly, from the point of view of human rights, at first sight, there does appear to be some conflict between the rights of women to be allowed to determine whether to house a pregnancy in their bodies and the so-called rights of the “unborn child”. However, as correctly argued by feminists, the rights of the woman are to be given precedence as an “existing” human being as against the rights of a child that does not yet exist as an independent fully functional being. In other words, the foetus does not have rights.

Taking all these factors into account the right to safe abortion has been accorded to women after much struggle by women’s rights groups, by the law of the land as per the MTP ACT, which now stands to be amended with the intention to allow greater access to the highly neglected services for safe abortion.

The MTP Act permits abortions in certain conditions up to the 20th week of gestation, while fetuses beyond 37 weeks are considered “mature” for independent existence. This leaves a fair amount of time  between the permission for abortion and the consideration of the foetus as having the potential to live. However, this is somewhat confounded by the fact that modern science is able to save neonates born at gestations much preceding 37 weeks; as young as 28 week-old fetuses (7th month of pregnancy) may be kept alive with modern technology using ventilators, parenteral feeding etc. This narrows and blurs this boundary area somewhat in the minds of people applying a humanitarian rather than a legal perspective to the issue.

Nonetheless, the right to abortion must be differentiated from the laws against sex discrimination that are in no way in contradiction to each other. There is no conflict between the PCPNDT Act and the MTP Act. The MTP Act allows abortion, while the PCPNDT forbids pre-natal sex determination to stop female foeticide. By conflating the two, confusion is being created in the minds of the public against a basic right of women.

Even government posters for “awareness generation” of the public with respect to sex determination have been found to use the terminology of “bhroon hatya” or “foeticide” rather than “abortion” – a term that indicates a homicidal criminal activity of taking “a life”. Our engagements with the general public as well as public health activists as “trainers” reveals the depth of confusion caused when people are questioned on why the foeticide of a male foetus is acceptable but not a female one and whether there is some discrimination at play here with respect to the rights of the child.

Act of Abortion

Of course, the question itself is incorrectly premised; the only thing that is illegal, within the prescriptions of the MTP Act and the PCPNDT Act, is determining the sex of the foetus (in this context, prior to abortion). It is entirely a social construct that causes female fetuses to be selectively aborted, therefore creating a link with the falling sex ratios in our country. The aborted fetus may be male or female—as long as it is not known prior to the act of abortion and as long as the sex of the fetus is not permitted to influence the decision of abortion. A pregnancy may be continued or aborted as per the provisions of the MTP Act, and this must happen irrespective of sex determination, as pronounced by the PCPNDT Act.

While the government may be working from ignorance or carelessness, the pro-life groups have used this confusion to attack the act of abortion per se, raising slogans such as “one life is taken and another harmed”. While these groups have the freedom to take an anti-abortion stance, the government must be more careful to stand by the current laws of the land and eschew the term “female foeticide” entirely in its documents and public media.

It is hoped that people grappling with the legitimate ethical paradox between the rights (legal and human) of the child-bearing woman and the humanitarian concerns for unborn children will take into consideration the background arguments and factual legal elements, and arrive at a balanced view that safeguards against women being treated as passive hosts of unborn children. At the very least, such an exercise must not be carried out under the pretext of “saving the girl child”, who is neither to be selectively saved nor destroyed.

http://www.epw.in/web-exclusives/contrived-confusions.html

#India – Child sex ratio worsening faster among STs: census report


Author(s): Jitendra
Date:Nov 4, 2013, Down to Earth

Data also shows higher marginationalisation of the country’s Scheduled Tribes

Life on the margins (Photo by M Suchitra)Life on the margins (Photo by M Suchitra)

The latest data released by the Census of India shows that the child sex ratio (number of girls per 1,000 boys) among Scheduled Tribes (STs) in the country has declined faster than in other categories of the population between 2001 and 2011. But the number of girls born per 1,000 boys is still higher in the ST category than in the general population. The data also shows higher marginalisation of India’s Scheduled Tribes; the rate at which people are giving up cultivation is also higher in this category. But more number of Scheduled Tribe women participate in the work force than women in any other category of the population.

The census report data, released on October 28, shows a declining trend in child sex ratio across all categories. The national average has dipped to 919 in 2011 from 927 in 2001. The decline in child sex ratio of STs is higher—it has declined from 973 to 957, but the child gender ratio among STs is still better than the national average. The child sex ratio of STs is the best in Chhattisgarh at 993 and Odisha at 980.

The population growth rate of STs is more than the average population growth of the country, reveals the Primary Census Abstract SC & ST report of Census of India 2011. The growth rate of general population of country is 17.7 per cent whereas STs are growing at 23.7 per cent. Even in urban areas, the growth rate of ST population is more—the growth rate of STs is 49.7 per cent whereas the general population grew by 31.7 per cent.

The data shows another trend. The proportion of child population (0-6 years) of STs has been decreasing. The proportion of child population is overall 13.6 of total population. But the schedule caste child population and tribal child population is decreasing at faster rate in comparison to general child population.

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Overall sex ratio better

The census data shows overall improvement in sex ratio (adults and children combined) in all categories, including that of Scheduled Castes and Scheduled Tribes between 2001 and 2011. This improvement is more visible in urban areas. The sex ratio among STs is better than that of all categories. The ST sex ratio has improved to 990 from 978 per 1,000 males, whereas the national average has increased to 943 from 933. The census data shows ST sex ratio has increased to 980 from 944 in urban areas. On the other hand, sex ratio of general population in urban areas improved to 929 from 900. The national sex ratio of rural population is improving slowly in comparison to rural population of STs.

Odisha and Jharkhand, two of India’s poorest states with sizeable tribal population, are the best performing states when it comes to improved sex ratio of STs when compared to states like Rajasthan (948), Uttar Pradesh (952), Jammu and Kashmir (924) and Bihar (958), which also have tribal people. Goa tops the list when it comes to sex ratio of tribal population with 1,046 females per 1,000 males; it is followed by Kerala (1,035), Arunachal Pardesh (1,032), Odisha (1,029) and Chhattisgarh (1,020).

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There is minuscule increase in work participation rate (WPR) of Scheduled Tribes in the country. The rate of WPR is high in urban areas. Work participation rate of SCs and STs in rural areas is declining but increasing urban areas, the census report states.

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Work participation of ST women is the highest in the country and the participation of men is even better. Work participation rate of ST women is 43.5, whereas national average (for general population) is 25.5. Though the overall work participation rate decreased from 25.6 to 25.5, it is increased in urban areas.

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Fewer work days

The census data clearly reflects increasing marginalisation of workers. There is declining trend in percentage of “main workers” (those who are engaged in any economically productive activity for 183 days/six months or more during the year) and increasing trend of “marginal workers” (those who work less than 183 days/six months a year). But the rate of decline of “main workers” belonging to ST category is faster in comparison to the national average. This trend is there in rural areas as well.

STs are the most marginalised group in the country. The growth rate of marginal workers almost doubled in comparison to the national rate. Among STs, rate of marginalisation is greater in rural areas in comparison to urban areas.

As per data, the number as well as the percentage of cultivators is declining. The percentage of decline again is more among STs but they still constitute the highest percentage of cultivators. In rural areas, the decline in number of cultivators is more than 10 per cent whereas the national average is about seven per cent.

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As per data, there is increasing trend of people becoming agricultural labourers. Though Scheduled Castes, who by tradition constitute highest percentage of agricultural labourers seems to remain stagnant, but they still contitute highest percentage among all categories, followed by STs. The percentage increase of agricultural labourers is higher for ST population. Their rate increased by around eight per cent, whereas national average of growth in agricultural labour was four per cent. In rural areas, SC sconstitute highest number of agricultural labourers. But the rate of increase is highest among STs.

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The number of household industry (HHI) workers is increasing but their percentage is decreasing, says census data. The decline is across all sections. HHI is a non-registered industry, run by only family members.

The number as well as percentage of “other workers” has been increasing across all sections. More SCs are joining this category than any other section of the population.

 

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