The problem became clear to Sunil Khanna one hot, humid day in 1993 in a northern Indian village near Delhi. He was sitting in Dr. Mahavir Singh’s office, preparing to interview the local physician, when someone interrupted them.
It was a man, frantic, looking for someone to perform an ultrasound on his wife.
“Ultrasound is not available at this clinic,” Singh told the man. “But I can refer you to a nearby specialty diagnostic clinic that has ultrasound. Tell me, when would you like your appointment?”
“As soon as possible,” the man said. “The other doctor already said it was too late.”
“Is it so? How late is it?” Singh asked.
“It’s my wife’s fourth month,” he said.
“I don’t think it’s too late. I will speak to a doctor next door. You can come at 10 in the morning. We will take care of your problem,” said Singh.
“How long does the procedure take?” he asked.
“It will only take an hour,” the doctor told him.
“And if we need to get an abortion?” he asked.
“That will also be an hour,” the doctor said.
Slideshow by Celene Carillo; photos by Lakshman Chandra Anand and courtesy of Sunil Khanna.
In fact, the man next told Singh he already had two daughters. And if this child was to be a third, they would almost certainly abort her. Once the prices were settled (about $36 for the ultrasound, $24 for the abortion), the man left, and Singh turned to Khanna to resume their interview, as if nothing momentous had taken place.
Later, as he was interviewing parents and measuring boys and girls at the village school, Khanna started hearing shadowy suggestions that female-selective abortion was happening in the village. Occasionally, women mentioned village girls who had been born — and ones who hadn’t. Or they mentioned “other women” who had undergone abortions. But never had the practice been revealed so frankly as it was that day in Singh’s office.
This story appears in Khanna’s book, Fetal/Fatal Knowledge: New Reproductive Technologies and Family-Building Strategies in India (2009, Wadsworth Publishing Co.). Before he interviewed Singh, he spent two months in Shahargaon (a pseudonym he created to protect the identity of his subjects) studying how the cultural practice of son preference affected child growth and development. Son preference, he says, reflects a patriarchal system that “ensures the inheritance of family name, property and decision-making power in the male line.”
What occurred in the village was a turning point for Khanna, now an associate professor of anthropology at Oregon State University. The stories he heard set him on a path to confront practices ingrained through centuries of tradition. Today he specializes in the cultural circumstances that affect women’s health.
By 1995, Khanna turned his attention entirely to the practice of using sex-selective screening and abortion as family-planning tools. And he found significant evidence that it was widespread, not only in Shahargaon, but nationally. From 1993 to 2003, Khanna collected census data among the dominant Jat ethnic group in Shahargaon. He found not only an imbalance among males and females in the village but a declining trend in sex ratios of females to males, even as the Jat population was increasing.
He also found that families in both rural and urban areas were less inclined to care about the sex of their first child, but if that child was a girl, they would test the second pregnancy. One of the major differences between educated urban parents and uneducated rural parents was access to contraception. Women in rural areas were more likely to have more children, as well as more abortions, to reach the desired number of boys and girls.
Tradition and modern technology often clash, Khanna points out in his book, but in this case, they are complementary. “What I found is that traditions of son preference are being realized through technology. And technology is being used to perpetuate that tradition,” says Khanna.
A Growing Disparity
Although abortion has been legal in India since 1971, the use of prenatal screening to determine the sex of a fetus has been illegal since 1996. Still, the sex ratio in the northern Indian state of Haryana, surrounding Shahargaon, is 861 females per 1,000 males. “Imagine the complication of implementing a law that makes female sex selective abortion illegal in a country where abortion is legal,” says Khanna. “Doctors have to be on board not to use ultrasonography to identify the sex of the fetus. Ultrasonography machine sellers must be on board to not sell machines without registering with an agency. And parentts must be on board that they will not seek this kind of information.”
Girls, says Khanna, are often seen by families as economic liabilities. Even though dowries have been illegal in India since 1961, the practice is still widespread nationally. And doctors have their own coded language when it comes to sexing babies. Often doctors will tell parents they are very lucky if the baby is a boy — and to start saving money if the child is a girl.
Shahargaon was the perfect place for Khanna to perform his study. Over the past 20 years, the ancient village of about 1,400 has been engulfed by the city of Delhi and its approximately 15 million people. The village has retained its autonomy and rural ethos, only due to an archaic rule that protected its residential boundaries. Its narrow lanes, fragrant with charcoal smoke and crowded with old buildings, are evidence of that character.
Still, Delhi encroaches.
“This is a rural enclave stuck in the middle of this roaring metropolis where everything is happening, and where you can find Nike and Adidas shoe stores, McDonald’s and open access to the Internet,” Khanna says.
You can also find clinics where ultrasound technology is available. It was this intersection between old and new that intrigued Khanna. Shahargaon’s size, too, meant that Khanna could understand everything that was going on in the community. But what really clinched the deal for him was how receptive Shahargaon’s leaders were to his being there. “They were very inquisitive to what I was doing and why I was there,” Khanna says. “But at the same time they were open to it.”
Over time, Khanna won the trust of villagers as well. But it did not come easily. During his first visit, his research assistant often had to conduct the interviews while Khanna waited outside villagers’ homes. It wasn’t until two years after his visit to Singh’s office that Khanna felt comfortable bringing up the subject of female-selective abortion directly.
“It was terrifying to bring up this topic, risking that I would be thrown out of the community. It was only through establishing long-term, significant relationships that you begin to ask them,” Khanna says.
Stories To Be Told
Later, though, women insisted on having him in the house. They would ask Khanna to make sure his tape recorder was working and asked him to play back portions of their interviews so they could be sure. They wanted to be heard.
Ultimately, Khanna’s goal is to raise the status and role of women in Indian communities. “Khanna’s work exemplifies one of the pioneering long-term community studies that go beyond just examining the contentious issues from an academic perspective,” says Dr. Sunil Mehra, head of MAMTA Health Institute for Mother and Child, an Indian non-governmental organization. “Instead, his work involves building community-level opinions against this practice and developing meaningful linkages among key stakeholders in the community, government agencies and non-governmental organizations.” MAMTA provides reproductive health care to impoverished women and, through Khanna, maintains a formal working relationship with OSU.
In Oregon, Khanna’s research also finds its way into the classroom, where he relates his experiences in undergraduate anthropology courses on South Asia. His graduate students are studying access to abortion services in the state, in addition to son preference among Indian immigrants in the United States and Canada. And Khanna has completed several projects on the availability of health care to uninsured Oregonians.
“I continuously strive to produce knowledge that is meaningful and relevant to real people doing real things,” Khanna says. “My research and teaching allow me to engage in a continuous and critical conversation between the ‘theoretical’ and the ‘applied’ contexts of my discipline.”
Options for Women
In India, Khanna hopes to generate a community dialog that will help parents think differently about daughters. Such discussions, he adds, could influence policies on female-selective abortion.
Meanwhile, community leaders in Shaharagoan have encouraged people to talk openly about the reproductive and emotional consequences of female-selective abortion. They have highlighted the disproportionate sex ratios that result from the practice. Leaders have also been able to set up support for women experiencing domestic violence or intense pressure in their homes to have abortions. Khanna plans to implement this approach in both rural and urban areas.
“I want to develop programs, which are state or federally funded, but which are sustainable, so that people can look at their daughters not as financial liabilities, but as assets. And to think of them as equal to their sons in terms of ability and income potential,” Khanna says. “This project has been one of the most challenging and fulfilling experiences of my life.”
OSU News release, March 2007, “OSU researcher: Sex-selective abortion issue in India needs a ‘culturally relevant’ approach”
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