India's "son complex" is visible in this prosperous market town on the rich plains of the Punjab. Girls, by the thousands, are missing.
For the last 20 years, local parents in search of a son, a prize in Indian culture, have taken advantage of a mixture of technology and tradition to bear their child of choice. They have used ultrasound machines to determine the sex of the fetus growing in the mother's womb. If the fetus is male, the parents keep it, census figures suggest. If it is female, they often abort it.
J.K. Banthia, the Indian census commissioner, estimates that several million fetuses have been aborted in India in the last two decades because they were female.
PHOTO: NY TIMES
Interpreting census figures of the last century showing widening divergences in the ratio of females to males, he estimates that as many as 25 million female fetuses and babies have been killed before, during or after birth in India.
In 1996 India banned the use of ultrasound machines for sex determination, but the government began to take broad action only after the 2001 census figures appeared. They showed 927 girls for every 1,000 boys under age 6, a precipitous decline from 962 girls 20 years earlier.
Since the latest census, some states have mounted stepped-up enforcement campaigns that include public education, inspections and edicts from religious leaders. But Banthia, the Indian census commissioner, said he believed that the government had only slowed the spread of the practice. "I wouldn't say it has decreased," he said.
The greatest disparity exists in this prosperous agricultural district of 500,000 people in northern India, where middle-class farmers work fertile land reminiscent of the American Great Plains. This district had only 754 girls for every 1,000 boys.
"The people in this part of the country, they prefer boys," said Benjamin Mathew, the principal of a private school here that has 473 boys and 292 girls, a ratio that also reflects families' unwillingness to pay for a girl's education.
Abortion is legal in India, but it is illegal to abort a fetus because of its sex, and so the determination tests are banned.
The country's health minister, Sushma Swaraj, recently proposed that the government begin an advertising campaign warning that there would not be enough women for men to marry if the trend continued, a situation that some say already exists here in northern India. Officials are also considering paying families a supplement if they have a girl.
Public health officials say that in the last two years they have registered 21,072 ultrasound machines, which are legal as long as they are not used to determine the sex of the fetus. The authorities have seized 199 of the machines and charged 405 doctors with performing illegal tests. No figure was available for the number of doctors convicted. Pregnant women who seek tests are generally not charged.
Health officials say they have some signs of success. Sprawling billboards and splashy newspaper advertisements that once openly offered sex determination ultrasound tests and mysterious preconception sex determination techniques have mostly disappeared here. Some gynecologists, who value their medical licenses as well as their images, are declining to perform sex determination tests.
"The people who are good guys, they have actually stopped," said Dr. Mira Shiva, director of women's health and development for the Voluntary Health Association of India, a nonprofit group that has campaigned against the practice. "They don't want to ruin their reputation."
Both economic and cultural forces drive the desire for boys, public health officials said.
In the traditional South Asian family, a son is expected to live with his parents, earn an income, inherit property, care for his forebears in their old age and light their funeral pyre. When a daughter marries, the bride's family pays the bridegroom's family a dowry and she moves in with her husband's family, leaving her parents with nothing or even a debt.
Baidyanath Sahu, a 37-year-old bicycle rickshaw driver in the city of Chandigarh, said he wanted sons. "He earns for the family," he said. "The daughter wouldn't earn anything."
Dr. Baljit Singh Dahiya, the director general of health services in the state of Haryana, said it would take decades to change time-honored attitudes that led to some mothers being demeaned if they failed to bear boys.
New TV and radio advertising campaigns in Haryana, Punjab and other states are trying to change attitudes, declaring "daughters are our pride" and "female feticide is illegal."
"We are just putting drops in the ocean," Dahiya said. "That's how huge the problem is."
On a recent morning, two of Dahiya's inspectors drove to Ambala, a city of 350,000 in the northern state of Haryana, to show off new tactics they are using to stop the sex tests. Haryana has the second most extreme ratio of girls to boys of any state in India, with 820 girls for every 1,000 boys under 6. Neighboring Punjab state has the worst, with 793 boys for every 1,000 girls. Both states are among the most prosperous in the nation. New Delhi, the Indian capital, also has a low rate, with 865 girls for every 1,000 boys.
Public health officials in Ambala told the inspectors, Dr. Gulshan Saluja and Girbhari Singal, that three women had asked for sex tests in a government hospital that morning.
The inspectors decided that after telling the women that the tests were illegal, they would ask the three to serve as decoys. A health department driver would pose as a husband, and together, they would ask a local clinic for the test.
Almost immediately, the plan unraveled. Two of the women refused to cooperate. The driver got cold feet. In the end, Paramjeet Singh, a 30-year-old maid, went into the clinic alone. "I asked for the sex of the baby," Singh said after having an ultrasound performed. "She didn't reveal it."
Public health officials say that may indicate how practitioners have become increasingly shrewd.
In some areas, doctors perform the test only if the patient is accompanied by an agent the physician knows. In others, officials say, they use hand signals, like a "V for victory" sign, or code words, like the name of a candy, to indicate a boy.
Some expensive fertility clinics will even implant male embryos instead of female ones if asked, public health officials said.
In India, middle-class women who already have one or two daughters are among the most likely to abort, officials said. Eager for a small family, like many Indians today, they have the resources for the test and an abortion, which together cost up to $200. India's average annual per capita income is $450.
Doctors, meanwhile, complain that the campaign against the testing is overzealous. After the failed raid in Ambala, inspectors revoked the clinic's ultrasound certificate because the office did not have a proper referral form for 4 of the 98 ultrasound tests it performed in September.
"All of the doctors are becoming clerks," said Dr. Namrata Madan, who runs the clinic and who refused to perform the ultrasound test on the decoy.
Here in Fatehgarh Sahib, the top local health official, Dr. Parshotam Lal Goel, said he had closed two clinics for improper record keeping, but said he did not use decoys. M.P. Arora, the district's No. 2 government administrator, questioned the validity of the census figures showing that the district had the greatest gender imbalance in the nation.
"There must be some technical error in the figure," Arora said.
On a recent afternoon, a young Indian woman working as an interpreter for The New York Times walked into the Sood medical clinic on one of Fatehgarh Sahib's main thoroughfares. She asked about sex determination tests.
Instead of telling her the tests were illegal, a male and female employee quizzed the young woman about where she was from and why she was asking. After several minutes of questioning, the man suggested the young lady return to the clinic in a few hours.
"Come later," he said. "We can talk later."
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