Techinues

Gender, Health and New Reproductive Technologies

Sub theme:-Assisted reproductive technology and its effect on women health (Socio- legal study)

As a mother they are respected

As a sister and daughter they are protected

As a wife they are prevented

Within a womb they are selected

* Gurmeet Kour

Ph.D Scholar (Department of Law)

Jammu University

Women of child bearing age fall into two categories; those who are trying to get pregnant, and those who are not. Development in the technology of sex selection techniques has a direct relation to the declining juvenile sex ratio in our country. The decline in the sex ratio can adversely impact the natural equilbrium of nature and destroy our moral and social fabric. Ironically the major reason for declining sex ratio is the proliferation of modern tecnology and easy and affordable access to such tecnology with its rapid expanding use for the purpose of pre and post conception sex selection followed by the elimination of foetus, if it found to be female. Rapid proliferation of the reproductive tecnologies in the latter half of the twentieth century has redefined reproduction in unprecedented as the technique to ensure fertility of unfertile woman, to control the excessive birth and to guarantee the birth control way. From the past sixty years, in India there is rapid devlopment in Science and tecnology. This new devlopment process produce new things, various tecnology are used upon plants to increasing the production, these devlopment process touches the human boby also.Some scientific techniques are used to cure incurable diseases; some are used to detect the diseases, some to increase the fertility and some to control the fertility. The most important questioin here to answer is that whether reproductive tecnologies are women friend or foe.Women health issue includes menstruation, contraception, maternal health, child birth, menopause and breast cancer.They also includes medical situations in which women face problems not directly related to their biology, for example gender differentiated access to medical treatment. The main area of the concern paper is to analyse the safety, effectiveness and acceptability of the reproductive tecnologies upon women health. Women health was one of the issues in Fourth World Conference on Women and also in Beijing Platform of Action that lay down that Women’s health involves their emotional, social and reproductive health. Reproductive health as per the CEDAW convention is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes.As per the Convention of Elimination of Discrimination against women, reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.Along with reproductive health, reproductive health care is defined as the constellation of methods, techniques and services that contribute to reproductive health and well- being by preventing and solving reproductive health problems.It also includes sexual health, the purpose of which is the enhancement of life and personal relations, and not merely counselling and care related to reproductiion and sexually transmitted diseases.At present new reproductive tecnologies NRTs are a broad constellation of tecnologies aimed at facilitating, preventing or otherwise intervening in the process of reproduction. This includes for example, Ultrasound, contraception, abortion, antenatal testing, birth tecnologies, and conceptive tecnologies. What started with tecnologies like ultrasound is that selection of the sex within the womb of mother, if female sex is detected the practice of female foeticide occurred in rampant, which effect the ratio of female in every part of the world, aminocentesis, and sperm sorting has the other part of these tecnology which acquired a new meaning with advanced tecnologies like pre- implantation genetic diagnosis(PGD).Initially this tecnology was used to detect genetic abnormalitries in the embryo prior to implantation, is now in rampant use to pre –select the sex of the embryo during IVF Procedure. These procedures are further resulted into gender discrimination and reduce in female sex as per the census.In India the practice of sex selection and female feoticied is still in excessive despite legislative restriction imposed by the Pre Natal Diagnostic Techniques Act, 1994. The Pre Conception and Prenatal Diagnostic Techniques (PCPNDT) Act was passed in 1994 making sex- selective abortion illegal. After the sex is determined through tests, the family decides whether to abort the child or not. Upto 15 weeks gestation, suction aspiration or vaccum aspiration are the most common surgical methods of induced abortion, Manual Vaccum Aspiration (MVA) consists of removing the foetus or embryo, placenta,and membranes by suction using a manual syringe, while Electric Vaccum Aspiration(EVA) uses an electric pump. These techniques differ in the mechanism used to apply suction, in how early in pregnancy they can be used, and in whether cervical dilation is necessary. Unsafe abortions result in approximately seventy thousand maternal deaths and million disabilities per year globally. In the Nothern state of India these technique are less in use but according to some research the sex selective abortion in these state are more as compare to other parts of India. The techniques used in Northen State are “induced abortion” and “unsafe abortion”.Unsafe abortion cause both short- term and long-term physical complications, and can significantly affect a woman’s ability to have healthy future pregnancies. Not only this abortion cause physical complications include cervical lacerations and injury, uterine perforations, bleeding,hemorrhage,serious infection,pain and incomplete abortion. Risk of complications increase with gestational age and are dependentn upon the abortion procedure. It have been indicated that induced abortion can adversely affect a woman’s future risk of breast cancer. Further, it has been clearly shown that abortion in young women causes the loss of a protective effect from a first, full-term pregnancy which when followed by the delay in child bearing, has the net effect of an increased risk for breast cancer. Assisted reproductive technology is used to achieve pregnancy by artifical or partially artificial means, it is reproductive tecnology used primarily in infertility treatment, otherwise known as ‘fertility treatment’. The International conference on population and Devlopment (ICPD) was held in Cario, Egypt from 5th to 13th September 1994, focuses on meeting the needs of individual women and men ratheer than on achieving demographic targets. Chapther xii of the conference deals with the adoption of new tecnology to control the fertility,but regulating that the new tecnology meet user’s need and are acceptable, easy to use, safe, free of side-effects, effective and affordable. Testing and introduction of all new tecnologies should be continually monitored to avoid potential abuse. The conference emphasis on control the population, but it does not mean control the female population by misusing new tecnology.According to the ICPD,1994 priority should be given to the devlopment of new methods for regulation of fertility for men, as well as to research on sexually tranmitted diseases (STD), including HIV/AIDSand on infertility. One scientific term for the State of Pregnancy is gravidity (adjective ‘gravid’) medically; a woman who has never been pregnant is referred to as a nulligravida, a woman who is pregnant for the first time as a primigravida and a woman in subsequent pregnancies as multigravida or multiparous. Here I like to express the assisted reproductive technology used upon nulliugravida to make her fertile.At present various Assisted Reproductive Technique (ART) are used to convert women from nulligravida to primigravida and multigravida.New devlopments in assisted reproductive tecnologies have enabled many people to have biologically related children who previously could not. These techniques are artifical insemination; in vitro fertilization and surrogacy have made achieving pregnancy possible without engaging in sexual intercourse. This approach may be undertaken sometime voluntary or some time forcely due to infertility. Artifical insemination includes:- a. Intracervical insemination (ICI) b. Intrauterine insemination (IUI) Some of the potential risks and effect of artifical insemination are; i. Minor cramping and lower abdominal pain for a short period of time following the artifical inseminatiion procedure. ii. Vaginal discharge. iii. Continued vaginal bleeding or spotting. iv. Infection in the uterus and/or fallopian tubes from contaminated semen or a non sertile catheter used during the procedure.At the same time, these tecnologies that are often difficult for individuals and society to resolve.

In vitro fertilization
In vitro fertilization (IVF) is the technique of letting fertilization of the male and female gametes (sperm and egg) occur outside the female body.At the same time this technology continues to raise complicated ethical questions that are often difficult for individuals and society to resolve. These technologies interfering with the natural process of reproduction , that it harms children by treating them as means to ones whims rather that treating them as ends and at the same time it harms woman. Because in many countries woman body in particular reproductive functions are increasingly being subjected to techno medical interventions to satisfy non medical aspirations with regard to conceptions and procreations. What started with technologies like ultrasound, amniocentesis and sperm sorting is the pre selection of sex of the embryo during IVF procedure. The cases of sex selections and sex select abortions in India is a classical example of both non medical use of reproductive techniques and of the mis appropriations of the definitions of the reproductive child at present it is believed that education is necessary for integrity and dignity but education alone however doesn’t protect the woman against this religious and racial oppressions for example knowledge of the woman empowers them economically but it is necessary to give woman an opportunity to control or to enjoy the right to reproduce. Basically woman believes that new reproductive technology is magic bullet that will help alleviate woman’s reproductive burden. But the reality is that these techniques have many side effects not clearly brought to the knowledge of the user. New reproductive technology has redefined ‘traditional notions of conception and procreation’. The technology are misused in the name of right to bodily integrity-defined as inalienable rights of women to have control and autonomy over their bodies. Women of all classes use these techniques, but the main concern of the debates is; women belong to wealthy class use safe methods after consulting with medical practitioner, women of lower class after consulting with the medical practitioner some time they use contraceptives without any medical advice which adversely affect their health.

Contraceptive technology
Contraceptive technology or Birth control technology refers to the method or devices used to prevent pregnancy. In the western context, the woman’s movement make a clear demand for contraceptives which delinked their relations from procreations were seen s librating, and were welcome as they provided the key to gain control over the body but in the middle of this century it has been seen that the increased mediclizations of woman’s bodies and the consequent violations of their health. The techniques applied in conceptions are of different types viz injections like Depo-Provera and Norplant, sub dermal implants and anti fertility vaccines. These contraceptives are not free from health hazards the important side effects of the Depo-Provera are as follow:-
1) Changes in Body Image: - It affects the body image by increasing weight, hair loss, delayed hair growth and rashness
2) Bone Loss: - Over the long term use of Depo-Provera results in decrease in bone mineral density that can inhibit bone growth and substantially increases the risk of fracture and future osteoporosis
3) Emotional Side Effects: - The most serious side effects of Depo-Provera are depression and erratic behaviour resulted into suicide attempts.
4) Other Effects: - The other effects include backache, nausea, dizziness, weakness and chronic fatigue. According to medical practitioner these are minor, but it is difficult to imagine living normally while experiencing them. It also increases the risk of breast cancer.
Side effects of Norplant: are severe headache, depression, nervousness change in appetite, extreme weight gain, hair loss, nausea, dizziness, swelling of the ovaries and ovarian cysts, difficulty with insertion and removal including infection and even nerve damage. There is a connection between the Norplant use and stroke and heart attack
Development in the science and technology has a direct relation to the declining female sex ration in our country. New techniques like pre-implantation, genetic diagnostic, X-Y separation methods and the artificial insemination are largely being used for sex selection. The existing socio-cultural method of patriarchal structure and the skewered economic context that sees son as an investment and daughter as burden was further increased by new reproductive technology.
One of the method introduced by this technology are the method of surrogacy. Nature has bestowed the beautiful capacity to procreate a life within women and every woman cherishes the experience of motherhood. Unfortunately some women are not able to procreate due to certain physiological conditions; they cannot give birth to their own off-spring. The desire for motherhood leads them to search for alternatives solutions, and surrogacy presents itself as the most viable alternative. This method on one hand removes the stigma of female infertility from the status of infertile woman; on another hand it introduces the industry of surrogacy in developing nations like India. Though the unregulated surrogacy industry in India is booming, there hasn’t been a comprehensive effort to look at the health of the surrogate mother. Majority of the consented surrogate mother in India belongs to poor class having no knowledge of consequences of this technique upon their health. The information given to the surrogates at the time of making the decision to become surrogate was geared towards emphasizing that no relations were involved in the process of conception and the sum of money will be paid to them in return. These women not only suffer health problem but also social stigma. Some men particularly the husbands of surrogate mother react badly to this encroachment on their rights. Women who participate in surrogacy give information that their partners, initially agree to their undertaking the responsibility, often change their attitude after they take on their new role.
The surrogates weren’t given information regarding the various procedures conducted in the course of treatment. No consent was taken regarding the decisions such as multiple embryo transfer, fetal reduction ,caesarean section delivery .Additionally no information regarding possible effect on health or risk were provided. These woman at the time of entering into a contract were given information that their uterus is used for the growth of embryo belongs to other couple , the scientific procedure adopted by the doctors in clearing the gametes and using multiple solutions to change their original structure sometimes resulting in transmitting disease like HIV / AIDS. Besides this technology of artificial insemination the scientist had made attempts to develop human clones by taking DNA samples from prisoner woman who were sentenced. Rapid proliferation of reproductive technology in the latter half of twentieth century has redefined reproduction in unprecedented way. Women those who were working, congenitally used this technique to control their fertility by adopting the methods of induced abortion. Common reasons for purposely aborting an embryo include a desire to delay or end child bearing , concern over the interruption of work or education , issue of financial or relationship stability perceived immaturity and health concerns laid down by Supreme Court of India in Baby Mangi vs. Union of India that abortion causes both short term and long term physical complications , and can significantly affect a woman’s ability to have healthy future pregnancy various other risks involved in abortions are cervical laceration and injury , uterine perforation , hemorrhage , serious infections pain and incomplete abortions . It has been realised by various medical practitioners that abortion can adversely affect a woman in future with the risk of breast cancer .Further it has been observed that both safe and unsafe method used for abortion in young women causes health hazards. These abortions directly and indirectly resulted into decline in female sex ratio in the Northern parts of India. Directly the major cause behind the abortions was female feticide, and these female feticides was possible for the couple after the use of 3D ultrasound techniques. Initially this technique was developed to detect the hormonal imbalance to find out the growth of the embryo later on medical practitioners detected the sex and gave options to the couple either to continue or abort the child when female child was s detected. Indirectly this technique is responsible for declining sex ratio because numbers of females die every year due to anemia, unsafe abortion, breast cancer and infections. All these infections and diseases they intake at the time of following any one of the above mentioned assisted reproductive technologies, slowly these infections and disease become incurable and vulnerable and resulted into female mortality.Birth control methods are not one-size fits all. A method that perfect for one woman may not be right for another. Picking a birth control method that fits your like is the key. Only you can decide what is best for you. But sometimes figuring out which method to use can be bit overwhelming. Census Report itself speaks the truth of declining sex ration in our country. Census 2001 revealed that there were 933 female to that of 1000 males. Since decades India has seen a decrease in sex ratio. Current 2011 census further laid down that there are 930 females to that of the 1000 males, except Kerala (1084 female to that of 1000 males) and Pondicherry where the number of women are more than the number of men. In rest of states the female ratio is less than male. In various state like Himachal Pradesh, Punjab and Haryana, and in Jammu and Kashmir the female mortality rate is higher as compare to other southern state of India.

Legal measures to protect the women reproductive rights
1) According to World Health Organisation significant knowledge and information has been generated about the status of woman and the conditions under which they live. Throughout their entire lifecycle, woman’s daily existence and long term aspirations are restricted by discriminatory attitude, unjust social and economic structure and lack of resources in most countries that prevent their full and equal participation. In number of countries, the practice of prenatal sex selections, higher rate of mortality among very young girls results in decline in female sex ratio. Internationally, antiquity of International Law emphasizing equality between male and female sex. In India the constitution guaranties equality as a fundamental rights .There are provisions specifically made for the protections of woman under Article 15(3), further efforts were made in under Article 51 A (g) to stop the practice deliberately against women. At present no specific law was enacted to restrain the new scientific technology and its applications upon woman body. Scientifically only in one system women and men were distinct that is reproductive organ. According to my research most of the new developed reproductive technologies are used upon woman body as compared to men.
Woman reproductive role is the only cause for the decline in sex ratio this role was protected under Statues like Maternity Benefit Act 1961. This Act was basically meant for protecting the pregnant woman against unemployment by imposing duty upon the employer not to terminate pregnant woman employee from their job. The Pre-conception and Pre-natal Diagnostic Technique Act 2001 restrained the practice of misusing Ultrasound and MRI techniques to determine the sex.The legal provision are not cover the area of use of women body for techno-medical purpose. No record is available in any where that preventive technology prohibits the use of new reproductive technique. The traditional notion of son preference in India is the root cause of misusing the new reproductive tecnology,by misusing the ultrasound technique to determine the sex within the womb, using artificial insemination in which male gametes has been inserted inside the women body.
Conclusion: Legally various legislation were passed to stop all the practices responsible for the considering women as inferior, responsibility, a burden etc.Legislation like Dowry Prohibition Act ,1984 was passed with the object to free the parents from the burden to arrange for the marriage (dowry) of daughter that they started feeling from the very birth of daughter. This legislation not directly stop the practice of female feticide, indirectly it play a great role in little less exercise of the practice of female feticide. Maternity Benefit Act, 1961 is another social legislation which directly support and respect the pregnancy of woman, by removing the tension of dismissal from employment due to pregnancy existing in the mind of working women. The new reproductive technique are used in large number by the working women are more as compare to house wife, the basic reason given by the working women to more use of new reproductive is fear of being discharge or dismissal from job. Equal Remuneration Act, 1976 is yet the other welfare laws to secure women role as house wife as well as working women. This legislation empower them in social, economic and other area, but these laws does not directly put restriction on new reproductive technology.