It was Wednesday morning. I reclined against the richly upholstered sofa in Uma- masi’s sitting room. She sat cross-legged across from me, taking string beans from a splayed newspaper sheet and cutting them into a steel bowl at her feet. We chatted about how many routine antenatal patients would come to Nandini Clinic that afternoon for “big sonographies”—detailed fetal anatomy scans performed twice or thrice per pregnancy. Rocking side-to-side, Uma-masi exclaimed, “There will be so many patients!”
Then, shaking her head, she smiled mischievously and whispered, “All of them, infatuated with boys!” I was startled: for the first time in our countless conversations, Uma-masi was mentioning the pursuit of sons. I asked whether patients requested Dr. Dilip to “take a look at that.” Still smiling, she nodded emphatically: “Huh-uh! Of course. But Dilip-saheb doesn’t say anything. For that, you have to go elsewhere.” Picking up the bowl of cut vegetables and moving into the kitchen, she shouted over her shoulder, “I’ll explain later!”
Since the previous monsoon, in 2012, Uma-masi had welcomed me to Mahesana’s Nandini Clinic. But never in my many hours of clinical observation or my many evenings with her family had anyone even mentioned the ubiquitous but clandestine practices through which clinicians and families visualized and reacted to fetal sex.
A short time later, Uma-masi and I took a rickshaw to Nandini. During a lull in the morning’s patient flow, when we were alone in the consultory, she whispered conspiratorially, “Don’t tell Dilip-Saheb—I’m telling you this because you’re like my son!—but to earn money I take patients elsewhere. I’m telling you this because you’re like my son. My monthly earning ends up being 20,000.” I was flabbergasted. 20,000 rupees—more than twice her regular salary as a nurse.
The next evening, Uma-masi and I sat on her patio swing, swatting away mosquitos and slowly drifting through the stagnant, humid monsoon air. I moved our conversation back toward sex determination (SD), and she said, “Well, it’s gotten so that doctors do it inside-inside,1 secretly. They do it, but they don’t let it be known outside.
And people pay twenty-five!” Widening my eyes, I asked if the cost was as high as twenty-five hundred rupees.
Her response was swift and incredulous: “Are you serious?! Twenty-five thousand!” I was astounded. 25,000 rupees could purchase about $1,500 of goods, but lower salary levels for the Gujarati middle class meant that the figure was even larger
1 In Gujarati speech, reduplication like “inside-inside” is common, generally carrying an intensifying effect. I frequently reproduce it in my translations to convey something of the texture of the original Gujarati conversation.
than the comparison might suggest. 25,000 rupees was most of a senior government schoolteacher’s monthly salary. 2 For a household dependent on manual labor, it could easily represent the bulk of a year’s disposable income.
Before I could ask any more, Uma-masi peremptorily waved me into the house: “Come! Time for you to eat. We can talk later.” My curiosity remained in suspension.
*
Two days later, during a solitary moment in the consultory, I nervously asked Uma-masi whether we could chat at length about the “boy-girl test,” since it was the chief focus of my research. Given the topic’s sensitivity, I had not previously pressed it. But now, after her admission, I felt emboldened to raise new questions.
Cocking her head to the side, Uma-masi replied, “Of course! But not at the clinic—we should have that talk at home.” Then, she smiled and added:
And if you’d been there last night—oh, you’d have been able to see! I told the other saheb—a wonderful saheb!— there’s a boy from the U.S. who’s here to do a study, and he wants to talk, so will you talk? Well, he said, ‘Definitely, I will. Just bring him, Sundays or evenings. If he’s going to keep it secret, no problem. But you bring him yourself, and you take him away.’
I went to that clinic yesterday, and you would’ve gotten to see in person if you were there! It was a patient for what we were talking about—looking. Dilip-saheb refused, since we don’t do it. But then I explained to them, my way, and took them to that saheb—a wonderful saheb! Watch, you’ll get to see everything yourself. But everything secret, eh?
Now I was certain: I was already inside a sex selection referral network. The kindly, maternal nurse who had warmly welcomed me to Mahesana was a facilitator for the very services I had come to study. I was beginning a new, embedded engagement— enlightening, fraught, often wrenching—with the practices that permitted families and clinicians to recognize and react to a gendered fetal subject.
*
Two days later, after dinner, Uma-masi and I sat on opposite ends of her sofa, each with an arm up against the wall. It was already 11 PM. I timidly brought up the potential interview. In response, Uma-masi laughed, “Go ahead and ask! I’ll answer the best I know.”
We talked continuously for the next two hours, her detailed explanations of the local sex selection market tumbling forth in matter-of-fact descriptions, grand boasts, and clever quips. At some points, she lowered her voice and intimated that even her husband and sons did not know the information she was about to reveal. At others, she shouted
2 At the time of my fieldwork, the exchange rate hovered around sixty-to-one, and the purchasing power parity exchange rate just above fifteen-to-one. Thus, in terms of consumables, 25,000 rupees could purchase about $1,500 worth of goods. Put differently, 1,000 rupees exchanged to just under twenty U.S. dollars, and represented more like seventy dollars in terms of purchasing power.
proudly as her daughter-in-law sat next to us and listened, nodding along and smiling. In repeated asides, she told me she trusted me “because you are like my son”—“because Uma-masi always knows how to take the measure of people, and I know you’re not going to do anything bad with this information!”
We began by discussing the “wonderful saheb.” Uma-masi intimated that “the place for getting it looked at” was “a private clinic, just like Nandini,” located in a nearby subdistrict headquarters. The obstetrician’s sex selection practice was “a secret thing.” He only “looked” and provided abortions on Sundays and in the evenings; at those times, it was “safe” in the small town, since “there can’t be any government checking when the officials are off.”
The prior week, Uma-masi had taken two Patel families who had contacted her “via-via”—in a roundabout fashion, after obtaining her mobile number from previous clients. Rendezvousing in Mahesana, they had set off for the small town together. “Once we take them,” she added, “we can’t ever leave them alone there! We have to stay together. If they get it kenchhal, we have to stay.” Perplexed by the unfamiliar word, I asked for clarification. She elaborated, “If they don’t want to keep it. Then I have to stay till the termination is finished. That’s what you call“—and now, a clearer articulation, accompanied by a slashing gesture—“cancel.” As I would learn, the English word was her favored term for the erasure of pregnancy that followed recognition of female fetuses.
Lowering her voice, Uma-masi intimated, “That saheb only takes 10,000—very little! People are taking 25,000 rupees, but he takes less!” After a pause, she chuckled, “And I earn 25,000 every month!” Looking around shiftily—presumably for her husband—she held up three fingers. “Saheb gives me this many out of 10,000!” Astonished, I opened my mouth to say the number, but she hushed me. Still whispering, she explained that her earnings were “enough for all the household costs”: milk, vegetables, grains, spices, and sundry groceries; new clothing, jewelry, and shoes; cleaning supplies and toiletries; blankets, bedding, and small furniture; rags and mats; spending money for both sons; and “fashion” items for herself. While hiding the details of her earnings from family members, Uma-masi used her income to wield considerable domestic power and secure upward mobility in consumption and status for the entire household.3
Uma-masi and I continued talking until 1 AM. She drew me further into the world of sex selection than I could have imagined just days earlier, describing the slow rise, spectacular fall, surreptitious renaissance, and definitive end of the practice at Nandini; her own cultivation of a referral network for SD tests and sex-selective abortions; and the idiosyncrasies of various doctors who continued to furtively provide the illegal services.
Toward the end, she promised, “I’ll talk to Saheb about bringing you. We’re not looking to do him wrong, right? It’s not like we’re going to publicize—‘Such-and-such doctor is doing it in this place!’—or tell people. We can’t betray! Whatever house we eat bread and rice from, we can’t treat badly.”
*
3 A biographical analysis of Uma-masi’s work and earning as gendered economic tactics situated in patriarchal household, community, and economic structures is the focus of a separate essay, currently in preparation.
That first extended conversation was the definitive inflection point in my initiation into seeing the market for SD and selective abortion. Over the next two years, I would piece together the history and contours of the Mahesana-area sex selection market, gradually developing a picture of how it connected technologies, expert operators, clients, facilitators, government officials, and gendered fetal subjects in complex relations of sight and concealment, control and evasion. While Chapter 2 explores the gender-kinship meanings projected onto the fetal image, and Chapter 3 the actual clinical processes of recognizing and reacting to gendered fetuses, here I describe the local network in which clinicians, facilitators, and families attempted to visualize and act on fetal sex even as governance institutions attempted to visualize and act on the crime of SD.
What was (or was not) made visible and knowledge in the Mahesana-area black market? Certainly fetal sex, but also technologies, practices, expertise, and enterprises for identifying it; the public crisis of sex selection, as understood through sex ratios (SRs) and embodied in the threatened female fetal subject; the “perfect” crime of sonographic SD, which defied detection; government power and impotence, as seen in enforcement actions both spectacular and mundane; and, targets of blame for the problem of selective reproduction.
In the first half of what follows, I trace the historical evolution of the Mahesana sex selection market. I examine the rise of technology, expertise, and social demand in the 1980s and 1990s; the rise of state prohibition and policing after 1994; and the market’s gradual underground retreat after 2005. The goal is to trace “a history of the present”4 for sex selection in a specific locale—a historical narrative with “an unequivocal and unabashed contemporary orientation.”5 In the chapter’s second half, I focus on the market’s contemporary workings. I begin with Chetna Clinic, my primary window for seeing how providers handled clients, evaded surveillance, distributed profits, and managed information around SD and selective abortion. After analyzing other obstetricians’ wariness regarding participation in sex selection, I fill out the local landscape by examining what circulating knowledge and rumors revealed about market participants. In concluding, I confront how different actors assigned blame for sex selection’s persistence and pervasiveness.
The Rise of Sex Selection: From the 1980s to 2001
Biomedical techniques of selective reproduction first became visible to Uma-masi during the 1990s. She would later recount:
I accompanied one of my in-laws when she went to get it looked at twenty-five years ago! We went to the hospital. They took the woman inside, and they looked by sonography. (That boy is now married, with his own boy!) Back then, I didn’t understand anything. How could I imagine this was a thing you could see? I didn’t know what we had gone to do. Then, when they had a boy, I got suspicious—‘They’ve done something.’
4 Foucault 1995: 31.
By the time of Uma-masi’s trip, the market for SD in North Gujarat had already evolved considerably, transitioning through several modalities for seeing sex.
In the 1980s, the region’s few private obstetricians began “looking at” fetal sex through amniocentesis, a markedly invasive procedure.6 During the fourth gestational
month, the doctor would pierce a patient’s abdomen, uterine wall, and amniotic sac with a long needle to extract amniotic fluid. He would send the sample to a pathologist’s laboratory for analysis of free-floating fetal cells. A few days later, he would relay the pathologist’s written report of sex chromosomes: XX or XY. Amniocentesis was a taxing method of SD, requiring invasive sampling, laboratory coordination, and a waiting period between testing and receipt of results.7
Early on, doctors sent samples to laboratories in Ahmedabad (seventy-five kilometers away) or even distant Mumbai, since local pathologists did not possess the requisite expertise in chromosomal analysis. But one senior practitioner cynically recalled, “Once demand here increased, the pathologists got smart. They learned quickly. Most of this chromosomal analysis—98%—was bound to be for SD!” For their roles in rendering fetal sex visible and actionable, obstetricians and pathologists each collected
between 500 and 1,000 rupees—substantial sums in those days.8
After amniocentesis, unwanted daughters-to-be had to be eliminated by initiating premature labor—what patients and practitioners called “kāchi [raw, premature, unripe] delivery.”9 For many women, kāchi delivery proved a harrowing ordeal, with ever-
6 Cowan (1994: 36-40, 2008) has anazlyzed social influences—and in particular, women’s roles—in amniocentesis’s development (through the 1970s) and diffusion (from the late 1970s onward) as a global technology. Of note here, Cowan has observed that pioneering work in both amniotic sampling and microscopic visualization of fetal chromosomes was motivated largely by a desire for a prenatal SD mechanism—interestingly enough, to identify potentially disabled male fetuses in women with family histories of X-linked diseases like hemophilia (1994: 36-39). Cowan has also noted that amniocentesis could not have moved from development to widespread diffusion in the U.S., Canada, and the U.K. without legalization of the only “therapy”—abortion—for “positive diagnosis” (1994: 40). Also see Rapp (1999: 23-29).
7 See Rothman (1986: 86-96) and Rapp (1999: 113-118) for detailed descriptions of women’s experiences with the test procedure in the U.S. Rapp has discussed women’s anxiety-ridden experiences of waiting for amniocentesis results in the context of disability testing in the U.S (1999: 103-118). She has proposed the notion of “liminal dread” to describe the multi-layered existential concerns relating to “fear of causing a miscarriage, fear of learning bad news, and, perhaps, fear of having unbalanced the forces of nature which are presumed to be protecting a pregnancy” (Rapp 1999: 105). Rothman has proposed the notion of “suspended animation,” noting how amniocentesis, whose results might not come back until after the start of fetal movement, fundamentally changed the meaning of such movement and the associated experience of attachment in pregnancy (1986: 100-115).
8 A 1986 survey of forty-two amniocentesis practitioners in the metropolis of Mumbai (S. Kulkarni 1986) found that the fee for amniocentesis ranged from seventy to 600 rupees, with most doctors charging between 200 and 400. According to the survey, a vast majority of amniocentesis procedures were performed for the sole purpose of SD. Most practitioners also performed selective-abortions with a “female” result.
9 Doctors used one of two primary methods to initiate kāchi delivery: injecting a saline solution into the amniotic cavity per abdomen, or instilling ethacridine lactate—an abortifacient—between the amniotic membrane and the uterine wall via a catheter threaded through the cervix. Both caused cessation of the fetus’s vital processes and precipitated eventual expulsion. For a concise description of these methods in historical perspective, see Bygdeman and Gemzell-Danielsson (2008: 196-197, 198-199).
increasing labor pains stretching out for up to three days.10 In some cases (like those
narrated in gory detail by Asha-ben’s mother-in-law), fetuses remained un-expelled. Furthermore, as performed in Mahesana during the 1980s, kāchi delivery entailed considerable risk; every older obstetrician could recall instances of severe complications.11 A woman undergoing abortion after amniocentesis faced significant bodily suffering: hours to days of grim labor, and non-trivial chances of severe bleeding, life-threatening infections, or other fatal complications. The quest for a son could result in a woman’s incapacitation or even death.
By the early 1990s, the local advent and proliferation of ultrasound technology enabled SD by chorionic villus biopsy (CVB). Loosely paralleling amniocentesis, CVB entailed sending a sample from the developing placenta for chromosomal analysis. The procedure could be performed earlier—within the first trimester—but sonographic guidance was required to maneuver the needle around the delicate early-pregnancy womb and conceptus.
Though CVB was, like amniocentesis, a multi-step process, it quickly gained in popularity because of its first-trimester timeframe.12 Early detection allowed families to
more quickly move beyond a “tentative pregnancy.”13 Furthermore, CVB’s first-trimester
timing allowed doctors to perform abortion through manual surgical procedures, which were generally quicker, easier, and safer. Avoidance of the painful, protracted, and often- dangerous kāchi delivery proved highly appealing to women.
During a brief period in the late 1980s and early 1990s, when ultrasound technology had arrived but not yet advanced beyond the rudimentary, CVB became the primary method of SD. As Dr. Dilip said when recalling his residency training, “those who were not aware got amniocentesis done at four months, and those were smart got CVB at two months.”
The 1991 Census results showed the combined impact of amniocentesis and CVB on 0-6 child sex ratio (CSR) in Mahesana District. Among towns, Mahesana (868), Visnagar (861), Kadi (867), Vijapur (872), and Unjha (875) all exhibited CSRs below 900. The rural areas of some subdistricts also came in below 900. Rural and urban CSRs were nearly equally skewed in the subdistricts of Visnagar (869 against 861), Vijapur (886 against 882), and Mahesana (892 against 868), but overall there remained a
10 Rothman (1986: 189-216) and Rapp (1999: 238-248) offer moving descriptions of second-trimester abortion after “positive” amniocentesis results, including medical procedures, bodily and emotional pain, and aftermaths.
11 The most common complications were amniotic fluid embolism, hypernatremia, disseminated intravascular coagulation, or uterine rupture. Amniotic fluid embolism is a condition in which amniotic fluid enters the maternal bloodstream, triggering a severe reaction. Hypernatremia is an abnormally high level of sodium in the bloodstream. Disseminated intravascular coagulation is a serious condition in which clotting-related proteins in the blood become over-reactive, leading to clots in small vessels throughout the body, as well as the potential for paradoxical bleeding.
12 According to S. Kulkarni (1986), several Mumbai doctors had already started practicing CVB in the mid- 1980s, with charges ranging from 1,000 to 1,5000 rupees. Cowan (1994: 36, 40-44) has characterized CVB as still in late development or early diffusion by the early 1990s; this characterization may be more apt for diagnosis of genetic disease in the West than for SD in Gujarat. Also see Rapp (1999: 29-30).
considerable rural-urban divide; in Kadi Subdistrict, for instance, the rural figure (921) was more than fifty points higher than the urban. Urban living—associated with education, affluence, lower fertility, and medical consumerism—correlated with a higher likelihood of undergoing SD.
Despite its first-trimester timeframe, CVB eventually waned in popularity due to its logistical complexity, technical difficulty, and medical risks. Like amniocentesis, CVB