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August 2004

by teja — last modified 17-08-07 22:20

Mumbai is recognized as India's finance and film capital

Mumbai is recognized as India's finance and film capital, the jewel that has attracted many an impoverished Indian in search of fame and fortune. The "City of Gold" as Gilian Tindall titled her book on the island city, is the largest Indian metropolis by the sheer number of people who live here - 12 million in the city, going to 16 million if neighbouring areas in Thane district are included. It contributed Rupees 28,000 crore in taxes, some 35% of the national collection for 2002-03. It has a per capita income of just under Rs.50,000, three times the national average. And a literacy rate of 90% for males and 83% for women make it a city of the literate and the informed.

Yet, in many ways, Mumbai is a city divided. Almost 49% of its citizens live in slums with limited water supply and poor sanitation. This is the visible divide, the glaring contrast that stands out in many a stark picture that has people living by the roadside against the backdrop of glitzy high rises.

But beyond this, the picture that you don 't see so obviously is dismal as well, particularly when it comes to health and population. Not many Indians would

Box-1
SEX RATIO AT BIRTH BY DISTRICT FROM RHS
MAHARASHTRA 1998-99
Mumbai ranks 4th from the bottom in sex ratio in Maharashtra
DISTRICT	MALE	FEMALE	SRB*
WARDHA	139	147	95
NANDED	327	332	98
JALNA	208	203	102
GADCHIROLI	280	266	105
AMRAVATI	204	192	106
CHANDRAPUR	255	239	107
NASHIK	239	223	107
RATNAGIRI	167	155	108
THANE	266	246	108
BHANDARA	172	159	108
LATUR	221	201	110
RAIGARH	258	234	110
DHULE	221	200	111
PARBHANI	309	269	115
YAVATMAL	301	262	115
AHMADNAGAR	196	166	118
SATARA	153	128	120
OSMANABAD	213	177	120
BID	287	237	121
NAGPUR	240	198	121
AURANGABAD	323	266	121
AKOLA	341	279	122
SOLAPUR	198	162	122
JALGAON	265	216	123
KOLHAPUR	291	235	124
PUNE	179	142	126
GREATER MUMBAI	140	107	131
SINDHUDURG	322	244	132
SANGLI	289	218	133
BULDANA	206	142	145
TOTAL	3266	3066	107
*Sex Ratio At Birth=Boys Per 100 Girls Born Source: Rapid Household Survey conducted by IIPS for the Health & Family Welfare Ministry Period: 1996-1998 with a sample size of 1,000 houseohlds in each district

know that one of Mumbai 's greatest shames is its poor sex ratio in the 0-6 age group.

According to the 2001 census figures, Mumbai city has 898 girls per 1,000 boys in the age group 0-6 years, a rank of 473 out of India 's 593 districts. Mumbai Suburban district has 919 girls for every 1,000 boys in the age group 0-6 years, and ranks 420 in the country 's districts list.

The census studies the sex ratio for the 0-6 group because it provides a true indicator of the survival of the girl child. The ratio in this group is influenced by sex ratio at birth and mortality. While the sex ratio at birth shows if there has been any untoward intervention against a particular sex even before birth, the mortality rates reflect the social factors which influence the survival chances of boys and girls.

Says Prof. Faujdar Ram of the International Institute of Population Sciences [IIPS], Mumbai: "The government takes an average - 105 to 106 boys per 100 girls [952 to 943 girls per 1,000 boys] as the natural sex ratio at birth. Anything drastically beyond this means that there is human intervention...these numbers should not happen biologically."

A rapid household survey conducted with a sample size of 1,000 households for 1996-1998 by IIPS shows that 131 boys were born per 100 girls in Greater Mumbai [763 girls per 1,000 boys][see Box-1 to the right].

Demographers say that the figures could be low in part because of the under-enumeration of the girl child, a tendency seen across the country when parents tend not to report the birth of a girl child when asked about the number of children in the family.

But there is general agreement that under-enumeration cannot explain away the vast gap in numbers between the sexes, as reflected in the sex ratio at birth. Serious concerns have therefore been raised about misuse of pre-natal diagnostic techniques to opt for sex selective abortions in preference of a male child. It is believed that the proliferation of diagnostic clinics has made it easier, and increasingly cheaper to access such services.

In a city that is noted for the zeal of its markets and the energy of the services it provides, any demand will inevitably feed a service, and indeed, there are doctors who defend the practice that might lead to sex selective abortion [see Box-2 below].

If a literate population falls prey to sex selective abortion, wrecking havoc with the country 's population balance and violating the right of the female child to be born, then little can be said about districts in the interior where it has been argued that lack of knowledge, development or information might lead to such practices.

Worse, Mumbaities are not even willing to acknowledge the existence of the problem. Says Ms.Kamayani Bali-Mahabal, Senior Research Officer at 'Cehat', a NGO working on health issues: "We put up posters and sampled people at a shopping mall and the general response was that this couldn't happen in Mumbai...how educated people could do it. And we said 'it is happening right here'."

In January, 2004, the Federation of Obstetric & Gynaecological Societies of India [FOGSI] condemned prenatal sex determination and passed the following consensus statement: "FOGSI strongly condemns the practice of pre-natal sex determination and female feticide and all the discriminations against women. FOGSI shall contribute with all its resources to bring to an end to such abhorrent practice, a great social tragedy in India."

FOGSI President Dr.Sadhana Desai says the organisation has sent a circular to all its 18,000 members requesting them to refrain from any activity that leads to female foeticides and to comply with Pre Natal Diagnostic Techniques Act [PNDT].

Monitoring apart, one lesson that the adverse sex ratio of Mumbai teaches demographers and health workers is that development and economic well being unaccompanied by a change in social values or perceptions will only reinforce prejudices. This makes the case for pursuing population programmes within the overarching framework of gender equality and social development. Mumbai is also the heart of India's communications industry, and it'll be sad if communicators who sell all kinds of products to the billion plus of India can not sell the idea of valuing a female child. Mumbai should not tolerate this shame for long. Just as it leads in trade and commerce, Mumbai should also take the lead in ensuring a more gender equitable society. This could be achieved by effective communication programmes supported by stringent enforcement of laws.

Box-2
Some positions held in support of sex selection and their rebuttal by 'Cehat', a NGO in the health sector:
Position: "Couples should be free to decide for themselves what they choose to do with their embryo and this is compatible with the three basic foundations of medical ethics- beneficence, non-maleficence and autonomy." 'Cehat' responds: "The basic foundations of medical ethics- beneficence, non-maleficence and autonomy, do hold true but each of these principles is within the bounds of the other. Individual benefit cannot override its implications on society. Such a technology is not socially beneficial, as it would lead not only to further skewing of sex ratio that has dangerous ramifications for society as a whole but would also strengthen the sexist belief that females are inferior, disposable and have no right to exist. One also needs to put some thought into who is it going to be beneficial to. How is sex pre-selection going to be beneficial to a woman? The hormonal discomfort and psychological trauma that she would go through while she is subjected to these tests cannot be overlooked. Medical ethics is based on autonomy with the assumption that there exists informed choice. "Decisions here are not being taken by "autonomous people" but by those who are driven by social prejudices, pressures, biases and those who wish to preserve their superiority and by market forces that would ensure a flourishing business. "The World Health Organisation guidelines on Ethical Issues in Medical Genetics and The Provision of Genetics Services (1995) clearly state that pre-natal diagnosis for sex selection is not acceptable."	Position: "The basic purpose of technology is to give man more control over his destiny than he has had in the past. Of course, how he uses this technology is difficult to predict." 'Cehat' responds: "Not to the extent of controlling the destiny of women. Man has always had control over the destiny of women and this 'progress of technology' is another tool he uses to maintain status quo. "Civilized society has evolved a mechanism for regulating technology, taking into consideration its potential risk/ benefit assessment. Every technology with a potential market need not and should not be allowed to be used, especially if it has a potential of misuse and abuse. A case study of regulation of pharmaceutical technology can illustrate this point. "Every new chemical molecule invented/ discovered by a scientist has some potential beneficial action on the human physiology. But each such molecule is not allowed to be marketed as a drug. The past experience of collective working of policy planner, technologists, industry, academicians and public health advocates has resulted in evolving a fairly good mechanism which balances the interests of the different segments of society, including the industry and the consumers. Today, and industry has to spend around $ 100 million, 10 to 15 years of time and test over 10,000 chemical molecules on animals and human beings for efficacy and safety in order to allow one molecule to be marketed. Similar process of assessing the risk/ benefit to society should go before allowing a reproductive technology to be marketed."

Population FAQs Population First launches 'Frequently Asked Questions' on health & population issues shortly. Here are excerpts from the upcoming document - questions related to son preference in India. What 's wrong with preferring a male child? Indian society has a marked preference for a male child, both for economic and traditional reasons. Apart from being seen as the rightful and capable heir to family property and name as well as an important means to carry the lineage forward, sons are also seen as providing support to parents in their old age. A male child is also valued for the perceived final salvation of the parents through the performance of the last rites. Girls are often seen as a burden because of the social evil of dowry that requires parents to spend vast amounts on the marriage of the girl child. Investments in a daughter are thought to be wasteful as she leaves for her husband 's home after marriage. Where such a preference exists, parents tend to make more investments in a male child than in the female child, be it on education, health , nutrition or a career. Such discrimination, overt or covert, is bound to limit the development opportunities of the girl child, which further reinforces gender bias. The obsession to have at least one male child places tremendous psychological pressure on women, with many undergoing frequent abortions following sex-determination tests. The felt need, indeed demand, for a male child is also an important trigger for domestic violence, with women bearing the brunt for their perceived inability to have a male child. This is often the reason for bigamy and desertion. It is comparatively easier to address the issues related to economic support provided by a male child because girls, once they are educated, are as equipped to look after their parents. But traditional beliefs are too deeply entrenched and need to be addressed through innovative communication campaigns. How is the preference for a son an impediment to population stabilisation? Son preference is a major impediment to population stabilisation as it makes couples opt for larger number of children in order to ensure at least one male child in the family. Data from the National Family Health Survey (NFHS II) report indicates a consistent preference for sons over daughters. 85.1% women desire at least one son. Data shows that 33.2% want more sons in the family than daughters while only 2.2% want more daughters than sons in the family. Son preference was found to be more among women from rural areas, who are poor, with little or no literacy, and whose husbands are not literate. Son preference is evident in every state. However it is more pronounced in Uttar Pradesh, Rajasthan, Bihar, Haryana, Madhya Padesh, Orissa and Arunachal Pradesh. These are also the states with high population growth rates. The weakest son preference is found in Meghalaya, Mizoram, Tamil Nadu, Kerala, Karnataka and Goa, which are also the states that have achieved or are near achieving replacement level fertility, and have better male-female ratio and higher female literacy levels.
POPULATION FIRST
Population First is a communications based initiative that embraces the government objective of achieving population stabilisation by the year 2045. Working to support the government's programmes, Population First builds the communication foundations for partnership between government, civil society, the corporate sector and the media, creating a common ground for the sharing views and perspectives that will help lead change in society. The whole idea evolves around the belief that empowering women to exercise their rights	helps achieve social development and provides a refreshing and appropriate framework for addressing issues related to health and population. A focus area of the organisation is reproductive health, which is closely connected with decisions on family size and must be seen within the context of equal rights for women and children. In this endeavour, Population First counts on the responsible participation of the community, a response which we hope to kick start at least in part by our communications initiatives. More....

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