gender bias

Wanted: Pregnant decoys for sting operations to save the girl child

Ignoring societal pressures, a few brave women are helping activists nab doctors who assist in sex selection. Will their numbers increase?

Dr Sarawati Munde took less than five minutes to conduct a sonography and determine the sex of the foetus, recalls Prerana Bhilare of their meeting five years ago. When the doctor wrote “16” on the case papers, Bhilare asked her about her child’s sex. “Can’t you read the paper? It is good news. It is a boy,” came the reply.

Bhilare, pregnant then, was working as a decoy to catch doctors who assist in sex selection. Her testimony helped nail the doctor couple – Dr Saraswati Munde and Dr Sudam Munde – from Parali in Maharashtra’s Beed district. On June 17 this year, a Parali court convicted them to four years imprisonment for running a sex-determination racket. Had it not been for Bhilare, there possibly would have been no case. The couple had strong political connections, including with the family of a deceased senior Bharatiya Janata Party leader. There are now two more cases pending against them related to illegal sex-selective abortions.

Bhilare, 30, still remembers the disturbing sights at the Munde Hospital, especially the sight of the dogs which were allegedly meant to eat the aborted female foetuses. “One woman after me had a female foetus,” said Bhilare. “Dr Sudam Munde told her to get admitted. She said that she has come from a far-off village and could not take a foetus back. He told them not to worry and they would make arrangements.”

Besides the Munde case, Bhilare posed as a decoy in two other cases during her pregnancy in 2010. Due to her testimony and other supporting eyewitnesses, Dr Mohan Farne from Islampur in Sangli was sentenced to two years in jail and Dr Kavita Londhe-Kamble from Karmala in Solapur district to three years in jail.

After facing nerve-wracking cross-examinations, Bhilare is relieved. She is happy that she could use her pregnancy for a cause. The credit for her audacious work also goes to her dear friend Varsha Deshpande, an advocate and founder of the non-governmental organisation Lek Ladki Abhiyan, which works against sex selection and orchestrates the sting operations.

Assisted by law

As per the 2011 Census, Maharashtra has among the country’s lowest child sex ratios, which is defined as the number of females per thousand males in the 0-6 age group. As the start of the century, in 2001, the sex ratio was 913 girls for every 1,000 boys. By  2011, this was down to 883 girls. A series of crackdowns on sonologists and sting operations helped increase the sex ratio at birth steadily in the state.

“There were so many political pressures in this [Mundes] case,” said Deshpande. “We had to ensure that Prerana moved houses, just so that she could be protected... People would come to my house and offer inducements. It was a nightmare. No government agency offered any kind of support in this case.”

Section 24 of the Pre-Conception and Pre-Natal Diagnostic Techniques Act, 1994 ensures that the court presumes a pregnant woman is compelled by her husband and relatives to undergo sex determination, unless proven otherwise. Section 23(3) of the same law states that a woman who is compelled to undergo sex selection is not liable for punishment under the Act.

“This section helps us actively use decoy women for the purpose of catching doctors red-handed,” said Deshpande, who has conducted 42 sting operations in about two decades. “It protects the decoy women from prosecution.”

For anyone working in the field, finding a decoy to participate in a sting operation is an uphill task. Most expectant mothers refuse to become a decoy due to concerns for their safety or for fear of family’s disapproval.

“The women we mobilise worry where we are taking them,” said Rajan Choudhary, secretary of the Rajasthan-based NGO Shikshit Rozgar Kendra Prabandhak Samiti. “It is difficult to convince the family too. Of 10 women who initially say yes to participate in the sting, finally one may just become ready to actually go through with it.”

Dr Neelam Singh, who runs the NGO Vatsalya in Lucknow, Uttar Pradesh, echoes Choudhary. She says she has asked many of her patients and friends to become “decoy pregnant women” but “most of them back out. It is very difficult for a NGO to pursue this battle. We can try building the capacities of the government to sustain the campaign”.

Tapping into friends

Usually, in the stings conducted by Deshpande, her large circle of friends (“our large family,” she calls them) come to the rescue and agree to work as decoys. “We have to find someone who is 14 to 22 weeks pregnant. Many times, like in the case of Prerana, if a woman agrees to become a decoy, we start looking for information and conducting sting operations. There are also times when we have information about doctors but have no decoy pregnant women.”

One such friend, a feisty journalist from Satara, contacted Deshpande almost immediately after she realised she was pregnant in 2013. “I did not know I could help catch such doctors when I was pregnant with my first child,” she said on condition of anonymity. “When I realised that I was pregnant for the second time, I immediately contacted Varsha tai and told her that I want to help her conduct these stings.”

The team failed at three stings before they attempted to trap Dr Abhijeet and Sumit Devre from Malegaon. “We asked the rickshaw driver if he knows any doctor who can help us determine the sex of the foetus,” said the 33-year old journalist. “One man took us to this doctor and told us that we should give him money if it was successful.”

The journalist was six months pregnant and had to concoct an elaborate story to convince the doctor (as per Indian law, a woman is not allowed to abort her foetus after the gestation period of 20 weeks). “I was taken to a dark room. The doctor took a few minutes to realise I had a girl. I asked him if he was sure. He said he was 101% sure. After recording this, I had to while away some time in the clinic to wait for the health officials and the police to come. I lay on the sofa pretending to be dizzy.”

The journalist hasn’t mentioned her part in the sting to anyone in her office, nor to her parents and in-laws. “Only my husband knows about this. I vaguely got a hint that someone was trying to get in touch with me for inducement. I am not interested.” Her date to depose before the court is coming up later this month, two years after the sting.

Persistent gender bias

The delay in the trial causes many cases to fail. “We have done 21 sting operations since 2009, but not a single conviction,” lamented Choudhary. “Two of my decoy pregnant women turned hostile in court. The doctors keep giving inducements, whenever they meet them. The women slowly start sympathising with them and call them ‘bechare’, and that they made a mistake one time.”

In 2013, in a public interest litigation filed by Voluntary Health Association of Punjab, the Supreme Court ordered that the cases under the PCPNDT Act should be disposed off within six months. To expedite the process, Choudhary feels the police should record statements before a magistrate under section 164 of the Criminal Procedure Code soon after the sting. This statement will hold value in court, unless proven involuntary.

Choudhary welcomes the Rajasthan government’s recent decision to give a portion of the Rs 2 lakh handed out under the Mukhbir Yojana (the Informer Scheme) to decoy pregnant women. In Maharashtra too, since 2013, the government is supposed to give Rs 5,000 to the decoy woman in each case and Rs 20,000 to the informer. “The money is a small motivation,” Dr Padmaja Keskar, executive health officer of the Brihanmumbai Municipal Corporation. “But we have seen that the family refuses to let the pregnant woman participate in these operations.”

In some stings conducted by state health officers, the informants did receive the reward. However, for her stings, Deshpande says she hasn’t “got a single penny. I do not want it either. The defence can easily say that the case is a lie and it was concocted for the money”. More than the rewards, Deshpande feels the state should give protection to the witnesses and provide money for their travel and for the delivery of the decoys.

“I have spent so much money on travelling from Satara to Beed for the Mundes’ case,” said Deshpande. “Many cases fail because the government officials do not turn up or turn hostile. So many times, they turn up in the vehicles of defence lawyers. The system is hostile towards people like us who are trying to save the girl child. It has totally collapsed.” Of her 42 sting operations, she has been successful in getting convictions in 11 cases, while eight have resulted in acquittal.

This deep-seated indifference is what troubled most the journalist who worked as a decoy. She said she faced discrimination in her own family. “In front of the world, people pretend that they love girls and how girls and boys are equal. But, in my own family, I find so many examples of discrimination. My own father did not turn up to see my second daughter when she was born.”

Since the birth of her second girl, lots of people don’t invite her for functions, she said. “I can see the difference. Earlier I would be invited for someone’s baby shower or naming ceremony.”

Deshpande’s firebrand activism has made an impact among these women. “I tell the girls who come to my sewing class not to discriminate between boys and girls,” said Bhilare. “I will bring up my son, Kabir to respect and value women.”

So sickened is the journalist by the discrimination against women that she said she will happily do this again. “If I get pregnant the third time, I will start by nailing the quacks who claim to help produce a male child. Then I will get to the doctors. This will be my contribution to society.”

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Removing the layers of complexity that weigh down mental health in rural India

Patients in rural areas of the country face several obstacles to get to treatment.

Two individuals, with sombre faces, are immersed in conversation in a sunlit classroom. This image is the theme across WHO’s 2017 campaign ‘Depression: let’s talk’ that aims to encourage people suffering from depression or anxiety to seek help and get assistance. The fact that depression is the theme of World Health Day 2017 indicates the growing global awareness of mental health. This intensification of the discourse on mental health unfortunately coincides with the global rise in mental illness. According to the latest estimates from WHO, more than 300 million people across the globe are suffering from depression, an increase of 18% between 2005 and 2015.

In India, the National Mental Health Survey of India, 2015-16, conducted by the National Institute of Mental Health and Neurosciences (NIMHANS) revealed the prevalence of mental disorders in 13.7% of the surveyed population. The survey also highlighted that common mental disorders including depression, anxiety disorders and substance use disorders affect nearly 10% of the population, with 1 in 20 people in India suffering from depression. Perhaps the most crucial finding from this survey is the disclosure of a huge treatment gap that remains very high in our country and even worse in rural areas.

According to the National Mental Health Programme, basic psychiatric care is mandated to be provided in every primary health centre – the state run rural healthcare clinics that are the most basic units of India’s public health system. The government provides basic training for all primary health centre doctors, and pays for psychiatric medication to be stocked and available to patients. Despite this mandate, the implementation of mental health services in rural parts of the country continues to be riddled with difficulties:

Attitudinal barriers

In some rural parts of the country, a heavy social stigma exists against mental illness – this has been documented in many studies including the NIMHANS study mentioned earlier. Mental illness is considered to be the “possession of an evil spirit in an individual”. To rid the individual of this evil spirit, patients or family members rely on traditional healers or religious practitioners. Lack of awareness on mental disorders has led to further strengthening of this stigma. Most families refuse to acknowledge the presence of a mental disorder to save themselves from the discrimination in the community.

Lack of healthcare services

The average national deficit of trained psychiatrists in India is estimated to be 77% (0.2 psychiatrists per 1,00,000 population) – this shows the scale of the problem across rural and urban India. The absence of mental healthcare infrastructure compounds the public health problem as many individuals living with mental disorders remain untreated.

Economic burden

The scarcity of healthcare services also means that poor families have to travel great distances to get good mental healthcare. They are often unable to afford the cost of transportation to medical centres that provide treatment.

After focussed efforts towards awareness building on mental health in India, The Live Love Laugh Foundation (TLLLF), founded by Deepika Padukone, is steering its cause towards understanding mental health of rural India. TLLLF has joined forces with The Association of People with Disability (APD), a non-governmental organisation working in the field of disability for the last 57 years to work towards ensuring quality treatment for the rural population living with mental disorders.

APD’s intervention strategy starts with surveys to identify individuals suffering from mental illnesses. The identified individuals and families are then directed to the local Primary Healthcare Centres. In the background, APD capacity building programs work simultaneously to create awareness about mental illnesses amongst community workers (ASHA workers, Village Rehabilitation Workers and General Physicians) in the area. The whole complex process involves creating the social acceptance of mental health conditions and motivating them to approach healthcare specialists.

Participants of the program.
Participants of the program.

When mental health patients are finally free of social barriers and seeking help, APD also mobilises its network to make treatments accessible and affordable. The organisation coordinates psychiatrists’ visits to camps and local healthcare centres and ensures that the necessary medicines are well stocked and free medicines are available to the patients.

We spent a lot of money for treatment and travel. We visited Shivamogha Manasa and Dharwad Hospital for getting treatment. We were not able to continue the treatment for long as we are poor. We suffered economic burden because of the long- distance travel required for the treatment. Now we are getting quality psychiatric service near our village. We are getting free medication in taluk and Primary Healthcare Centres resulting in less economic stress.

— A parent's experience at an APD treatment camp.

In the two years TLLLF has partnered with APD, 892 and individuals with mental health concerns have been treated in the districts of Kolar, Davangere, Chikkaballapur and Bijapur in Karnataka. Over 4620 students participated in awareness building sessions. TLLLF and APD have also secured the participation of 810 community health workers including ASHA workers in the mental health awareness projects - a crucial victory as these workers play an important role in spreading awareness about health. Post treatment, 155 patients have resumed their previous occupations.

To mark World Mental Health Day, 2017, a team from TLLLF lead by Deepika Padukone visited program participants in the Davengere district.

Sessions on World Mental Health Day, 2017.
Sessions on World Mental Health Day, 2017.

In the face of a mental health crisis, it is essential to overcome the treatment gap present across the country, rural and urban. While awareness campaigns attempt to destigmatise mental disorders, policymakers need to make treatment accessible and cost effective. Until then, organisations like TLLLF and APD are doing what they can to create an environment that acknowledges and supports people who live with mental disorders. To know more, see here.

This article was produced by the Scroll marketing team on behalf of The Live Love Laugh Foundation and not by the Scroll editorial team.