A little over 48 hours after birth, doctors found a healthy newborn with no signs of life in the post-natal ward of a government medical college hospital in northern Tamil Nadu last month. The baby was rushed to the neonatal intensive care unit, but it was too late. Doctors suspected that this was no ordinary case and proceeded with a medico-legal investigation. Their doubts proved right as the post-mortem found adequate and “positive forensic findings” to prove that the death was “unnatural”. The baby was a girl; the second daughter for her parents.
In a neighbouring district, Anandhi, in her 50s, was arrested for the fourth time recently. Performing illegal sex determination and sex selective abortions for several years in Tiruvannamalai, Anandhi, who had earlier worked as an assistant to a gynaecologist, returned to the illegal trade after every arrest — in 2012, 2016 and 2018 — and established a network of her own.
The two-day-old baby girl and habitual offender Anandhi are part of an underlying problem in Tamil Nadu that often goes unreported. Female foeticide and infanticide — while officials say cases have declined considerably — are still alive in certain pockets of Tamil Nadu. The State’s sex ratio — the number of females born for every 1,000 males — has been improving slowly in the last few years, but Tamil Nadu has a long way to go in protecting its girls.
Suspicious deaths
Doctors and officials are coming across suspicious deaths of otherwise healthy baby girls in certain parts of the State.
Take Vellore district, for instance. Officials note that during death audits, one or two cases of deaths due to milk aspiration involving female babies are reported every month. “These cases have a pattern of narration. The baby sleeps with the mother and is found breathless in the morning. In many cases, the parents do not take the baby to a hospital but bury or cremate the infant soon. Hence, we have asked medical officers and village health nurses to consider second daughters as high-risk babies and follow-up every week for at least a month,” an official said.
In Tiruvannamalai district, official sources point out that at least one suspected case of female infanticide is reported in the district every three months. In a recent case, a baby, who was doing well till discharge, died a few weeks later. “The family cremated the baby and claimed she had diarrhoea. They did not seek medical help despite having a Primary Health Centre nearby. She was their second daughter. We are now working to lodge a police complaint,” an officer said.
Tiruvannamalai is one of the districts that has, in the last few years, stepped up enforcement of the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994 to curb female foeticide. Last year, a Central team closed a hospital for performing medical termination of pregnancy illegally, and sealed three scan centres. At least nine scan centres were closed down for violations in the last few years, K.S. Kandasamy, Collector, said. Five of the 22 quacks arrested between 2017 and 2019 were involved in sex selective abortions, he observed. “In fact, Anandhi was detained under the Goondas Act last year; a first of its kind decision for an offence of this nature. She had established a network that included auto drivers who would ferry patients to her illegal clinic,” he added.
The district is clawing its way back after recording one of its lowest sex ratios during 2016-2017 – 871. “Our present sex ratio is 917, and we are taking measures to steadily improve the figure. We take a closer look at second trimester abortions, which were at 319 cases during a period this year, and spontaneous abortions. We also mandatorily inspect scan centres every two months,” Mr. Kandasamy said.
A public health officer notes that certain proxy indicators point to the prevalence of female foeticide and infanticide in a particular district. “The sex ratio at birth will be low, the newborn mortality within 28 days of birth will be high and second trimester abortions will be high,” he said. While infanticide is difficult to ascertain unless deaths of female newborns are investigated, sex selection abortions are still rampant in certain districts, he adds.
The Tamil Nadu State Human Development Report 2017 observed that child sex ratio (CSR) was lower than the all India average of 919 in six districts – Ariyalur, Cuddalore, Dharmapuri, Namakkal, Salem and Perambalur and needed immediate attention.
Despite several interventions from NGOs and the State government in areas like Usilampatti and Chellampatti in Madurai district, child rights experts and officials from ChildLine say that incidents of female foeticide continue to be a prominent feature of the landscape in Usilampatti.
In June this year, three scan centres attached to nursing homes and hospitals in Vadipatti and Usilampatti violated the standards set under PCPNDT Act, leading to their closure. These busts are common, says a senior health official.
Valli Annamalai, national vice-president, Indian Council for Child Welfare, says that despite significant economic development since the 1980s, when the practice was common, the cultural sensibilities of the people in Usilampatti block have not changed drastically. Having worked in Usilampatti since 1988 and establishing Vasantham Community College in Muthupandipatti village in Usilampatti block, Ms. Annamalai says that though people are finally allowing women to study in schools and nearby colleges, the practice of foeticide continues.
C. Jim Jesudas, director, ChildLine, says the number of abandoned girl children in Madurai district has remained the same in the three years that ChildLine has been operational in the district but the mushrooming of illegal scan centres continues to remain a huge problem. “Every now and then, we hear cases of illegal abortions and scan centres that conduct these tests. Although we are happy that technology has penetrated into the villages and people are going in for institutionalised deliveries, the flip side is illegal abortions,” he says.
Early this year, SamaKalvi Iyyakkam along with CRY (Child Rights and You), released a preliminary study on female foeticide in T.N. It analysed CSR data (2014-15, 2015-16 and 2016-17) from official sources including through the Right to Information Act, and field-level studies in 10 districts (Ariyalur, Chennai, Dharmapuri, Dindigul, Ramanathapuram, Salem, Tirunelveli, Tiruvallur, Tiruvannamalai and Thoothukudi).
While it found that CSR was on the decline in five districts, one major troubling factor was several inconsistencies in the data available. The CSR data provided by six districts did not tally with the number of child births provided in the same report, while it did not match the data from National Family Health Survey-4.
Facts suppressed
John Roberts, general manager-southern region, CRY, observes, “I do not think there has been positive progress in arresting female foeticide. Newer technology and newer methods are used to suppress the facts. We have a project in Salem through which we have created a model that covers 32 villages. Our team reaches out to pregnant women and counsels them. Female foeticide has reduced by almost half in the last five years, and we are looking at scaling up the model.”
Arivazhagan Rayan, a researcher supported by CRY, explains how sex determination of foetus happens in places such as Salem, Dharmapuri and Pappireddipatti. “After a scan, staff tell the pregnant woman to keep flowers on her head. Here, malli means girl and kanakambaram means boy. There are many such code words in use,” he adds. “A patriarchal mindset still exists in the society,” he notes. In districts such as Salem, cases of sex determination and sex selective abortions have reduced when compared to previous years, an official says. “The sex ratio at birth has increased moderately. It will take a few more years to see the results of efforts. For instance, second gravida mothers with female firstborns and cases of abortions at 16 weeks of pregnancy are reviewed every month,” the official notes.
In the central districts, the practice of female infanticide appears to be on the wane.“Parents, relatives have become conscious of infanticide and its consequences. There has been no case of infanticide in Tiruchi in the last two years,” said A. Subramani, deputy director of health services.
The Cradle Baby Scheme has been successful in the district with nearly one baby being taken care of at the Mahatma Gandhi Memorial Government Hospital (MGMGH) every month. “We consider this a success of the scheme but the number of unmarried and teenage pregnancies is increasing drastically. If not for the scheme, these babies would be abandoned and not cared for,” said a neonatologist at MGMGH.
Between January and September, only one baby was taken under the Cradle Baby Scheme at Ariyalur. From January to August, Perambalur district had taken three babies under the Cradle Baby Scheme. The Centre’s Beti Bachao, Beti Padao scheme, aimed at reversing the decline in CSR, is also being implemented in the State.
Vigilance needed
While the State Health department’s Pregnancy and Infant Cohort Monitoring and Evaluation (PICME) system has made tracking of pregnant women possible, there needs to be better investigations into unnatural deaths of infants, say officials.
Dharmapuri, in 2014, had set an example when the then Superintendent of Police Asra Garg reopened cases of unnatural deaths of infants. Six cases of infanticide were made out and cases of murder under Section 302 were registered. In a few cases, infanticide was made out three years after the murder. It pertained to deaths of infants from 2011 to 2013. The cases involved three deaths in 2013, two deaths in 2011, and one in 2012. The deaths were of infants as young as four days old and as old as three-and-a-half years, from varying causes, including poisoning and strangulation. All police stations were asked to reopen cases of unnatural deaths. Special teams were formed and cases registered.
However, such special teams have not been in operation since 2014. But, Village Administrative Officers are mandated to report cases of unnatural deaths as a rule, with no dedicated eye for potentially mala fide infant deaths. Primary Health Centres are also mandated to report cases of infant deaths.
The posts of Village Health Nurses, who were resident nurses in the villages tending to ante-natal and post-natal care, have fallen vacant on account of retirements and non-filling of posts. This has whittled away at the monitoring system at the village level, which is now left to reporting by revenue officials.
Infanticide may take other forms, including abandonment of newborns in dump yards, leading to eventual death as was seen in cases where the babies were mauled by dogs and rodents.
K. Kolandaswamy, Director of Public Health and Preventive Medicine, says all three ratios – sex ratio at birth, CSR and population sex ratio – should be taken into account. “Sex ratio at birth indicates care at the pregnancy/child birth level. CSR – 0 to 6 years – indicates equal treatment of girls and boys, and nutrition, while population sex ratio indicates crimes against women, social status of women and their care,” he explains.
“CSR is definitely improving in the State. We have been taking several measures that include implementation of the PCPNDT Act and monitoring mothers through PICME. Besides, we also create awareness on women’s empowerment and education of girl children. Our efforts will yield benefits,” he adds.
(With inputs from Sanjana Ganesh in Madurai, Kathelene Antony in Tiruchi and P.V. Srividya in Dharmapuri)
