Female feticide in India
Sex ratio is historical
I read Dahal and Tripathi’s article with interest.1 Unfortunately, this article contains several problematic assumptions typical of the discourse on sex selection in India.
Firstly, the authors refer to the sex ratio of children, a demographic measure that is often used in studies of sex selection
in India. However, they neglect to mention that the low female to male sex ratio is a historical phenomenon. It was present
in the first Indian census, in 1871, and has been present ever since.
Also, several demographers have refuted the claim that sex selective abortion has had an impact on the present sex ratio.2 No mention is made of alternative explanations for the sex ratio in India, such as studies of environmental factors, which
may favour the birth of boys.3 The proposed consequences of “extreme” sex ratios are pure conjecture, with little evidence behind them, especially when
the history of the sex ratio is considered.
Secondly, the statement that the reasons for sex selective abortion are “deeply rooted in Indian society” is also problematic.
This assumption is based on a preference for sons in India, as a result of the increased social and economic value of men.
However, this ignores the fact that sex selective abortion is occurring in regions where there is no historical record of
female infanticide or neglect. Similarly, the statement that the practice of dowry is “still common” seems to describe the
dowry as a historical custom. Yet this takes no account of the spread of the practice of dowry to areas and social groups
where it was previously unknown.
Finally, the concluding paragraph’s claim that sex selective abortion is a “gruesome tradition” that is “incompatible” with
India’s social and economic development is perhaps the most problematic of all. Sex selective abortion did not occur until
the introduction of prenatal diagnostic techniques to India. Techniques such as amniocentesis and ultrasound were not widely
accessible until the late 1970s at the earliest. Therefore, sex selective abortion is a recent practice and cannot be referred
to as a “tradition.”
More importantly, the claim that it is “incompatible” with development ignores evidence that social and economic development
in India, as well as the adoption of “Western” values, have substantially contributed to sex selection. Urbanisation and the
adoption of the Western model of the small family have meant that instead of continuing to have children until they have a
boy, parents who want to limit the size of their families might now abort female fetuses.
Also, increasing disposable incomes mean that more people can afford to use sex selection technologies. Perhaps most importantly,
it has been convincingly argued that “development” has in fact had an adverse effect on the status of women in Indian society.4 Industrialisation and economic growth have only served to increase sex inequalities in employment: men are thought of as
more efficient and better suited to working with technology, and these biases have become institutionalised in powerful commercial
organisations.
Sex selective abortion is a practice that undoubtedly has adverse effects, and efforts should be made to stop it. However,
to do so we must deconstruct several false assumptions surrounding the problem to truly analyse and understand what is happening.
James MacKay fourth year medical student University of Cambridge
jwm37@cam.ac.uk
- Dahal KB, Tripathi S. The unwelcome sex. Student BMJ 2008;16:190-1. (May).
- Basu A. Culture: the status of women and demographic behaviour. Oxford: Clarendon, 1992.
- Teitelbaum MS. Factors affecting the sex ratio in large populations. J Biosoc Sci 1970;2(suppl):61-71.
- Sudha S, Rajan SI. Female demographic disadvantage in India 1981-1991: sex selective abortions and female infanticide. Dev Change 1999:30;585-618.
Examination Ethics
Lecturers in Asia hint at exam answers
It seems to be common practice in many schools in Asia for lecturers to hint to students what to focus on for exams and also
to talk openly about the type of questions that they might ask in an upcoming exam.1 Professors put emphasis on certain points in lectures so that students know that something related will be asked. The “lecture
manuals” that some schools require students to buy are more like keys to examinations because nothing other than what’s written
in these manuals is ever asked. Students seldom find it necessary to read books, therefore, to pass exams. Although such schools
have been producing talented doctors, I still agree with the writer that it is an unethical practice that “defeats the purpose
of examinations” and learning.
Azuddha first year MBBS College of Medicine, Our Lady of Fatima University, Philippines
azuddha@yahoo.com
- Sokol DK. Tricky exam questions. Student BMJ 2008;16:198-9. (May.)
Think beyond exams
When it comes to exams, the main goal for a medical student becomes to pass them, and in this process, cramming substitutes
understanding of the subject matter.1
There are many ways a student adapts to cope with exams. In many parts of the world the most popular ones are studying from
class lectures and extensively practising past papers.
As the senior teachers or professors tend to stick to their old lecture notes, even when preparing questions for exams, it’s
safer to study what they teach. But this practice is dangerous because it can lead to a poor understanding of the subject
matter, which is a deviation from what the curriculum intends.
Teachers should use teaching time to help their students understand and learn, not merely handing out old lecture notes that
are to be crammed for the sake of passing exams. And students should realise that cramming may help them pass but will not
make them good doctors.
Students should think beyond the exams because our main aim is to give patients good care, which comes from the foundations
of really understanding what we learn.
Bibhuti Neupane final year medical student Institute of Medicine, Kathmandu, Nepal
bibhuti_neupane@iom.edu.np
- Sokol DK. Tricky exam questions. Student BMJ 2008;16:198-9. (May.)
Scalpel injuries
Evidence on scalpel injuries
The operating theatre is not the only environment where there is a risk of injury from scalpel blades.1 Dissection of a human cadaver remains an integral part of learning anatomy for many medical and dental students. Among other
benefits, this typically introduces the student to surgical instruments that need to be handled in a safe and coordinated
manner.
In a recent retrospective review of dissecting room injuries during 2001-6 at the Otago School of Medical Sciences, University
of Otago, injuries were found to be uncommon and minor (fewer than four injuries per 1000 hours of dissection).2 But cuts from scalpel blades were the commonest type of injury, accounting for at least 38 (69%) recorded injuries. Nine
of the scalpel cuts occurred while removing or mounting the blade.
The risk of injury, adjusted according to exposure risk, was not associated with sex but may have been related to dissecting
experience because third year medical students had a significantly lower overall rate of injury compared with second year
medical students. This study has encouraged us to highlight the “culture of safety” advocated by Amber et al, particularly
in relation to mounting and removing blades, passing instruments, and disposing of sharps. Encouraging medical students to
be more vigilant may offer yet another way of reducing these injuries.
This editorial is reproduced in the July issue of the Student BMJ (2008;16:263).
Mark D Stringer clinical anatomist Otago School of Medical Sciences, University of Otago, Dunedin, New Zealand
mark.stringer@anatomy.otago.ac.uk
- Watt AM, Patkin M, Sinnott MJ, Black RJ, Maddern GJ. Scalpel injuries in the operating theatre. BMJ 2008;336:1031. (10 May)
- Cornwall J, Stringer MD. Physical injuries in the dissecting room. Clin Anat 2008;21:82-5.
