May 21, 2011 vol xlvi no 21
Economic & Political
arbitrary, and corrupt rule o the babus isthe cause o many maladies. Transparency and accountability should not stop at thedistrict level or at the directorate level butmust be applicable to the secretariat leveland above.The progress report has clarifed that theregulatory ramework as proposed underthe systemic management reorms wouldbe applicable to the entire private sector, toensure quality o care, rational interven-tions and medication, as well as saeguard-ing o patients’ rights and ethical practices.Here one would add that the regulationshould not be thrust rom above by bu-reaucratic means but it has to be participa-tory, multistakeholder. Even then given thesocio-political culture in healthcare, suchregulation is going to be a Herculean task.Overall, given the various constraints,the
has done a good job. India hasone o the most heavily privatised andskewed healthcare systems in the world. Yet some people conceive
within theramework o such a system in which thegovernment is primarily a purchaser o private healthcare providing a huge marketor the corporate healthcare players. Atthe other extreme are people who wishaway the act that a majority o the quali-fed doctors are practising privately andthe public sector does not have even one-ourth o the doctors needed or
. It isheartening that the progress report steersclear o both these positions while keepingthe ocus on socialisation o healthcare. A more radical set o recommendations notbacked by a commensurate churning insociety at large would merely convert itinto a yet another radical report gatheringdust. Various inconsistencies and weak points in this report need to be correctedbut it is equally important to build astronger opinion in avour o
broadly on the lines ormulated by the
and inthe background papers
’snational meet on
1 “Towards Universal Access to Health Care inIndia”, Concept Note or Medico Friend Circle, Annual Meet 2011, Abhay Shukla, Anant Phadke,Rakhal Gaitonde,
Medico Friend Circle Bulletin
,342 to 344, August 2010-January 2011, pp 1-13,http://www.mcindia.org/curissue.pd 2 “Financing the Universal Access Health Care Sys-tem”,
, op cit, pp 19-23.3 http://www.mcindia.org/main/bgpapers/bgpa-pers2011/am/bgpapers2011am.html.
A Long Battle for the Girl Child
The Forum against SexDetermination and Sex Pre-selection began its campaign inMumbai against discriminatory abortions o emale oetuses in April 1986. In the 25 years sincethen, laws have been enactedagainst the practice but emaleoeticide continues. It is a majorchallenge to fght the use o pre-selection techniques or son-preerence without jeopardising women’s right to sae abortion.
he 2011 Census o India data has re- vealed that the child (0-6 agegroup) sex ratios have been steadily declining rom 971 in 1981 to 945 in 1991to 927 in 2001 to 914 in 2011. This deplor-able scenario is the result o the wide-spread use o sex determination (
) andsex pre-selection (
) tests throughout thecountry. Advances in medical scienceresulted in
techniques such assonography, etoscopy, needling, chorionic villi biopsy (
), amniocentesis and ultra-sound. These tests were well known notonly in urban India but also in the villages.The metros were the major centres or
tests with sophisticated laborato-ries. However, amniocentesis and ultra-sound were used even in the clinics o small towns and cities o Gujarat, Mahar-ashtra, Karnataka, Uttar Pradesh, Bihar,Madhya Pradesh, Punjab, West Bengal,Tamil Nadu and Rajasthan in the late 1970s.
Science in Service of Femicide
In 1972, when Amul Dairy introduced
to determine the sex o the oetus amongcows and bualoes, it was or sex selectiveabortion o the male oetus. Bullocks weregenerally not needed or agrarian choressince agricultural mechanisation andtractorisation had replaced them. My caste members, the Patidars o Kheda andMehsana districts quickly started usingthe
or identifcation o the sex o thehuman oetus and aborted the emale oe-tuses. Women members o my clan rom Anand and Vidyanagar would sharestories about selective abortion o emaleoetuses in their amilies with me.In 1975, the All India Institute o MedicalSciences (
) conducted a sample sur- vey o amniocentesis to fnd out about oe-tal genetic conditions and easily managedto enrol 11,000 pregnant women as volun-teers or its research.
The research teamound that the main interest o these volunteers was to know the sex o theoetus. Once they learnt the sex o theoetus, the women carrying emale oe-tuses demanded an abortion.
The newly ormed Centre or Women’s DevelopmentStudies (
) led by Veena Mazumdarmet the health minister and demanded animmediate ban on the use o
tests orabortion o emale oetuses. But duringthe Emergency (1975-77), the State wasinterested in population control and sawthe
tests as eective tools to attainpopulation stabilisation.
In the post-Emergency period, when women’s studies scholars connected sex-selective abortions with the continuoustrend o declining sex ratio as revealed by the census, the Union Health Minister, Raj
Vibhuti Patel (
) has beena women’s rights activist or over three decadesand is with the SNDT University, Mumbai.