Last week, Karnataka Minister for Women and Child Welfare, Jayamala, told the Legislative Council that there have been no convictions in cases of female foeticide in the state since 2007. Minister Jayamala said that since 2007, 80 cases of female foeticide have been registered under the Pre-Conception and Pre-Natal Diagnostics Act (PCPNDT Act).
In 41 cases, the accused doctors were made to pay fines and 39 cases are still being probed by the officials of the health department. The Minister, however, added that based on data obtained from the civil registration system, the child sex ratio at birth was 896 in 2016 and has gone up to 927 in 2017.
Sex-selective abortions are an open secret in the country and the situation is not different in Karnataka. There is also a glaring suspicion that sex-selective abortions occur on a much larger scale than the official numbers suggest and that the cases that are detected, too, are not given enough importance in order to establish a strong case with evidence. In order to determine why there are no convictions, one has to look into how the nexus works.
The racket
Speaking to TNM, Swarna Bhat, a former member of the advisory committee for PCPNDT cases, says that the nexus of sex-selective abortions include both private clinics and in some cases, members of the district administrations.
"I have worked on numerous cases where there has been a suspicion of sex-selective abortions but the problem is that these doctors who perform them are tipped off by someone in the district administration even before officials go in for a raid. So when the raid takes place, it is very difficult to gather evidence," she says.
Swarna says that doctors involved in this racket do not trust middlemen to bring women who are forced to get the foetus aborted.
"Ever since the state government has been offering Rs 50,000 as reward money for informing officials about sex-selective abortions, the doctors have stopped using middlemen in most districts. Now, they blackmail ASHA workers into identifying women who are being forced to get the foetus aborted and refer such women to these doctors," she says.
Swarna recalls one such case in Mudhol, where an ASHA worker was approached by a male member of a family in Mudhol in Bagalkot district. She says that the family owned vast tracts of land and wanted a male child to take over the family's agricultural business.
"The local ASHA worker was approached by the family patriarch. She was threatened by the man. She was told that he would file a complaint against her stating that she persuaded them to perform the abortion. You see, ASHA workers who are deployed in these villages are local women, who are in desperate need of money and they do not have as much influence as the land-owning class in these regions. Fearing a backlash, the ASHA worker referred him to a doctor, who runs a clinic in Mudhol," Swarna says.
She says that more often than not, doctors who run such operations in their clinics too end up threatening ASHA workers to get more clients. "Each operation is performed for Rs 30,000. The sex-determination is not on paper, so there is no proof. The doctors generally say things like, "goddess Lakshmi is coming into your life" or point at the picture of a girl. The actual abortion happens in another clinic," she says.
Swarna, who has worked on numerous surprise raids at various clinics across northern Karnataka, says that not a single one was successful, simply because the doctors at these clinics were warned about the raids hours before it occurred.
"This gave them the opportunity to destroy or hide any evidence we were able to collect. In the Mudhol incident, we had seized two ultrasound machines, which were not renewed after the 2013 Amendment. Instead of probing the incident, the District administration just released these machines back to the clinics. There is a nexus between the government officials and such clinics," she adds.
Swarna says that the doctors involved in the racket have connections across the country and in recent cases, the doctors, who determine the sex of the child, refer the women to clinics in other states in order to avoid suspicion
So, why are there no convictions in such cases?
Dr Niraj, the District Health Officer of Chitradurga, says that in most cases, there is no material evidence that sex-selective abortion has occurred. Dr Niraj was responsible for raiding a clinic in the district's Challakere area and gathering circumstantial evidence against Dr Shankara Lakshmi, who allegedly confessed to the crime and said that at the request of the patient, sex determination was done and the drugs for aborting the female foetus were administered.
"This is the first such incident in Karnataka where a doctor has confessed to the crime," Dr Niraj says.
Dr Shankara Lakshmi, who runs Lakshmi Srinivas Nursing Home, on January 29 determined the sex of a six-month-old foetus of a patient from Vishweshwarapura village of Challakere.
Dr Niraj says that the woman was being tortured by her husband since her she was pregnant and had said he did not want another girl child as the couple already had two girls.
"She then begged the doctor to determine the sex of the child," Dr Niraj added.
Dr Niraj is all set to submit his probe report to the JMFC court in Chitradurga, where the case will soon be heard.
"This is the first time we have made some progress in such cases. Generally, the family members of the women pressurise them into aborting the girl child. When suspicion arises, everyone denies the allegations and there is no material evidence of foul play. One of the biggest hurdles is the lack of access to hospital records and the fact that people in these clinics do not cooperate in the health department's probe," Dr Niraj alleges.
According to Bringa Adige, a Bengaluru-based activist, the doctors also ensure that no evidence is available for officials to probe by either making women sign the Form F (the mandatory form which lists all the basic information and past obstetric history of the woman undergoing scans or tests), the consent form or by simply not maintaining any paperwork for an abortion.
"The consent form is written in English and these women cannot read English. There are cases where no consent form is signed. This is to ensure that the patient's medical history cannot be traced back to the said clinic," she says.
Laxmi Iyengar, a Supreme Court lawyer, says one major problem is that even if the investigators have witnesses to corroborate the incident, due to the inordinate delays in court proceedings or due to pressure from the families of the victims, the witnesses turn hostile.
"In most cases, the investigation itself takes years and at some point, when the probe takes too long to reach a conclusion, the evidence is found to be destroyed," she says.
According to a senior health department officials who work with PCPNDT cases, in most cases, the families allege that they have no knowledge about the abortion and that the doctor had informed them that the procedure was necessary.
"In rural areas, when a probe is conducted, the families, especially the husbands, are questioned. The families of these women who are forced to perform sex-selective abortions claim that they don't know anything about medical terms and do not understand much of what the doctors say. They claim that they only did what the doctor told them to. In such cases, there is no chance we can get evidence," the officer alleges.
How can these cases be curbed?
According to Swarna, the PCPNDT Act requires doctors to fill out form F and the doctors who carry out these illegal abortions do not fill it accurately.
"Most of the cases just gather dust because health department officials do not catch the actual culprits but some doctor who has made a clerical error in filling the form. District level authorities must be given access to these forms and hospital records. The question is – why are the courts not ordering the clinics to provide these records? If the courts take this issue seriously, there will be a precedent to look up to and more and more cases can be detected if there is room for a proper probe," she says.
Laxmi Iyengar says that if the district health officials are able to study and analyse the number of forms which are collected forms, they can look for patterns in the activities of certain sonography centres "Why is one centre receiving more patients than the others in that district? Are a majority of these patients from other states and districts which are far away. Though the PCPNDT Act is necessary, there is barely any effective implementation and the real culprits – the husbands or in-laws of these women get away," she says.