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Indian Journal of Community Medicine

Sex Selection Through Traditional Drugs in Rural North India

Author(s): S Bandyopadhyay, AJ Singh

Vol. 32, No. 1 (2007-01 - 2007-03)

Abstract

Background: Repidly declining sex ratio has highlighted a strong son preference among many societies various methods are employed by people to get a son.
Objective: To determine the use pattern of sex selection drugs (SSDs) in rural North India.
Methods: An integrated qualitative and quantitative study was conducted in rural North India. A rapid population and hospital based survey of women in their early reproductive life was done in the study area to enlist the respondents. Few SSD samples were collected and analyzed.
Results: SSDs were freely available from grocers, chemist shops and specific people in villages. These contained Shivalingi (Bryonia Laciniosa) and Majuphal (Gtuercus infectoria). SSD use rate was 46% and 30% in community based and hospital based studies respectively. Use rate was significantly higher in women who did not have any son. Of the SSD samples and two individual ingredients analyzed by thin layer chromatography, 3 contained testosterone and one progesterone; one ingredient contained testosterone and the other natural steroids.
Conclusion: Use of SSDs seems to be very common in North India. Implication of presence of steroids in SSDs needs further evaluation.

Keywords: Sex Selection, Sex Ratio, Female Feticide, Sex Selection Drugs, Steroids, Son Preference

A strong son preference is seen in many societies, even today1,3. Most of the factors that compel people to favor a male offspring are social in origin. With the average family size decreasing rapidly and preference for male child remaining the same, the female population is showing a downward trend. North India has the lowest sex ratio in the world4.Various methods are adopted by people to get a son. Sex determination tests and female feticide are still reported from this region1,5,6, Our study on traditional practices on sex selection in North India had also documented the use of various Sex Selection Drugs (SSD) in this region for having a male child7 Present report documents the use pattern of SSDs in rural North India.

Material and Methods

The study was conducted from March to May 2003 in rural areas of North India. The respondents were selected from the villages visited by the investigators (resident doctors/ faculty of Community Medicine department) in their rural field practice area. Few key informants of the selected villages were interviewed regarding their knowledge and/or use of SSDs. Details on method and extent of use of SSDs were obtained from both individual and group discussions. A rapid population based survey was also conducted in the study villages to estimate the knowledge and prevalence of use of SSD in the community. In addition, a hospital based interview was also conducted on 140 women selected by systematic random sampling from immunization and antenatal clinics on randomly selected days during April-May 2003 to assess the parity-wise use rate of SSDs. Average attendance of these clinics was 30-50 per day. Every third woman was interviewed. It was arbitrarily decided to interview at least 100 women each in hospital and the field settings. A brief single page pre-tested interview schedule was used for the study.

The investigators also attempted to procure sex selection drug (SSD) from various sources like chemist shops, grocers, and faith healers during the survey. Information about these sources was obtained from the hospital staff and government/private doctors. The samples were analyzed in a laboratory. One sample SSD was analyzed by Thin Layer Chromatography (TLC). It was also found to be positive for anabolic steroids, which was subsequently confirmed by testing against an injectabie form of testosterone. Since testosterone or progesterone are the most probable agents that can effect the sex of a fetus in favor of males, rest of the samples were tested for testosterone and progesterone by TLC. Verbal consent of all the respondents was obtained. Reassurance was also given regarding confidentially of the information collected.

Results

A total of 22 key informants were interviewed during the study period, including traditional birth attendants (TBAs), health workers, Anganwadi (child care) workers, faith healers, Ayurvedic practitioners, Allopathic and homeopathic doctors. Some reluctance of the respondents was encountered initially since sex selection is illegal in the country. However, all agreed to reveal information about SSDs with the assurance of confidentiality. During the in-depth interview a local TBA revealed that use of SSDs was widely prevalent in this area (North India). She also told that this was an age old practice. Discussions held with two grocers (who allegedly sold the SSDs) revealed that they believed that SSDs played an important role in deciding the sex of baby. They told that they stocked such herbs in their shops because of the public demand.

Interactions with four allopathic doctors revealed that various types of SSDs were available from specific shops in the market. They referred the investigators to other people who in their opinion were likely to know about SSDs. One of the doctors even said, “some of my relatives have also taken such medicines. They claim 100% success rate. ‘Majuphal’ and ‘Shivalingi’ are the main constituents”. The issue was also discussed in a group meeting of 20 Anganwadi workers. All of them were aware of SSDs. Some of them had even taken SSDs themselves. They told that these were available in every village.

Table 1: Details on Sex Selection Drugs Collected by the Investigators

Form of
Medication (Rs.)
Cost How to take Other Instructions
A set of 6 Tablets 21 3 tabs stat, Repeat
1 week later
To be taken with milk
from a cow with a living male calf
Capsule 50 1 cap To be taken with milk
Capsule 150 2 caps in morning
and 1 in evening for
7 days
“gayatri mantra” to be written daily
Dried paste 50 Single dose
wrapped in
paper
Must lie down in left lateral position for 30 minutes
after ingestion
A set of 3 150 1 tablet to be taken daily for 3 days To be taken with milk
tablets from a cow with a ,
living male calf
A set of 3
tablets
60 3 tabs stat  
A set of 3 tablets 150 1 tablet OD daily for 3 days  

(All regimes to be taken at 6-8 weeks gestation)

Table 2: Profile of Women Taking SSDs

Number of children/
son in the family
Community based Survey (n=110) Hospital based survey (n=140)
Yes No Yes No
None 1 5 5 45
One or more children, at least
one son
0 55 5 28
One or more
Children no son
49 0 33 24
Total 50(45.5%) 60 (54.5%) 43 (31%) 97 (69%)

χ2 91.6, d.f =1, P<0.001 χ2 33.65, d.f = 2, P<0.001

An Ayurvedic doctor told that Hindus believed in Pumsavana karma (rituals observed for a male offspring), which coincided with 2 months of gestation and the time of sex differentiation. He told that ‘Shivalngi’ herb is commonly used as an ingredient in SSD preparations. A homeopathic doctor claimed that sex change during pregnancy was possible and that it had nothing to do with. Ayurveda but rather spiritualism was involved in the process. It was found that the SSDs were known as “sau badalne ki dawai” (‘medicines for bringing about a change in the female reproductive system so that the women start bearing male children). The grocers, chemists and some villagers from whom various SSDs were procured were also asked about prescription regimes of SSDs. The cost, dosage and instructions regarding intake of SSDs are described in Table 1 The community-based survey revealed that more than 90% of the women were aware of the availability of SSDs. Fifty (45.5%) of them reported to have used these. Of them, 48 (96%) reported giving birth to male babies after taking SSDs. Failure in two cases was attributed to consumption of SSD after 3rd month of gestation. All the male children were reportedly normal. Use rate of SSDs was significantly more in women who did not have a son as compared to those who did (Table 2). Of the 7 samples collected, 3 contained testosterone while one contained progesterone. ‘Shivalingi’ was found to be positive for testosterone while ‘Majuphal’ contained natural steroids.

Discussion

A concept of changing the sex of a baby post- conceptionally has been documented in ancient Ayurvedic texts; the ‘Pumsavana karma’ by Charaka (2nd century BC), Sushruta (5th century BC) and in the 12th century AD texts of Bhawa Prakasha. ‘Pumsavan’ means relating to son or a male child’ and ‘karma’ means a process’. “Puman Suyate Anena Karmana iti Punsavana karma” (Charak Samhita is defined in the Vedas as the rituals adopted for helping in procreation along with getting a healthy male child. The Ayurvedic procedure described to change the sex of the foetus at 2 months of gestation is as follows “milk boiled with the paste of herbs like “Apamarga” (Achyranthus aspara), “Shahachara” (Berleria prionitis), Jeevaka, “Rishabhaka”, all of them together or any one, two or three of them as per requirement should be given to the pregnant woman for the desired effect. This should be done only during astrological constellation of “Pushya nakshatram”, or under the timing of this particular star that occurs every 27 days. These methods, if adopted, in association with the excellence of locality and time invariably produce the desired effect. If there is any variation in these parameters, results become otherwise, i.e. a female child may be born9. Our study documents that such regimes are still being used in India.

While efforts have been made by people throughout history to encourage the birth of male children, these practices have attracted the attention of Indian demographers and legislators only recently. After independence, the Government of India exhorted people to adopt a two-child norm through National Family Planning Programme (NFPP) launched in 1950s. This had little impact initially. Later, probably as a byproduct of increasing industrialization and urbanization with attendant consumerism, people in India reduced their family size.

Now it seems that because of the strong desire to have a son, people wish to exercise some choice regarding the sex of their children in their small family by resorting to sex selection techniques. However, troubled by the exponential rise in incidence of female feticide the government enacted the PNDT Act (1994) to curb this practice1,2.

However, there were no clear provisions in the Act to control the sex determination and/or selection before conception. This was rectified in an amendment to the Act in 200210. Recently, in North India, there have been reports of criminal charges against Ayurvedic doctors and unqualified medical practitioners advertising pre and post-conceptional sex selection techniques/ drugs11. In 1991, the Government of Gujarat State, India, banned the manufacture and sale of an Ayurvedic drug called Select which was claimed to produce male fetus if a pregnant woman took it for 45 days after her last menstrual period,. The drug’s high cost did not deter the naive and gullible public from using it12.

To complicate the issue further, constituents of many Ayurvedic SSDs are readily available in many grocers shops, including Shivalingi (Bryonia Laciniosa), Majuphal (Quercus infectoria). These are included in the formulations of various ayurvedic medications used for the treatment of other medical conditions as well. Therefore, it will be difficult to selectively ban any individual herb even under the amended PNDT Act. So these will continue to be sold by the grocers.

In our community based survey, almost all the women with no previous male child, opted for SSD while 57% did so in the hospital based survey. Difficulties encountered by us during the process of procuring SSDs imply that people want to maintain secrecy about the use of SSDs because of fear of legal action. A high use rate of SSDs in our study reveals a rather dangerous “felt need” of the community to have male children in contradiction to the government’s noble intent to curb female feticide. This incongruity needs to be urgently resolved.

Apart from SSDs many other methods of sex selection have been used all over the world13 including dietary alteration, Shettle’s coital techniques, Ericsson’s method of sperm separation with insemination of only the separated XY sperm. A recently available product is the “Gen Select Fully Integrated Program” to control the gender selection process. The program uses “specially balanced nutraceuticals” and assures 96% success rate. Advertisements of GenSelect in leading newspapers of India as well as on the internet had evoked an enthusiastic response from couples wishing for male offspring. However, legality of the marketing of this product and program was challenged, and petitions were filed in courts in some parts of the country14. Over and above there are serious public health implications of use of various sex selection measures/ regimes. SSDs are consumed between 1-1/2 and 2 months of pregnancy – a very critical period of fetal development during which fetal sexual differentiation occurs under influence of both genetic and hormonal factors15,16. Exposure of a female fetus to testosterone during this phase can lead to masculinization of genitalia. In fact, androgenic stimulation at any time during fetal life can cause clitoral hypertrophy15,16. Incidentally, the authors have anecdotal reports of an apparent increase in congenital malformation in the study area (as reported by private nursing homes). Whether this is true and whether such use of SSDs produces only hermaphrodites or whether it leads to some congenital malformation should be the subject of further scientific inquiry. In addition, public at large, medical practitioners (both allopathic and Ayurvedic) also need to be educated on relevant aspects of this problem.

References

  1. Singh AJ and Arora AK. Status of Sex determination tests in North India Villages. Indian Journal of Community Medicine, 2006:31:41-3
  2. Kishwar M. When daughters are unwanted- sex determination tests in India. Manushi 1995; 86:15-22.
  3. Khanna SK. Prenatal sex determination- a new family building strategy. Manushi 1995;6:23-9.
  4. Provisional population and sex ratio. Available at: www. censusindia.net/resultsJ2001census data index.html Accessed 15th May 2004.
  5. Singh A. The practice of Sex determination test in rural north India. Bulletin PGI; 2005; 39:112-4.
  6. Singh A, Arora AK. Spontaneous and induced abortion in rural north India. Available at: http://pgimer.nic.inJbulletin. htm Accessed 24th March 2004.
  7. Bandyopadhyay S, Singh AJ. Traditional practices for sex selection in rural north India vis-a-vis west. In: Proceedings of one day consultation on emerging issues on declining sex ratio; 23rd August 2003, Chandigarh VHAI.
  8. Anonymous. Charaka Samhita- Pancham khanda. Jamnagar, Sri Gulab Kunwarba Ayurvedic Society 1949.
  9. Asar ML. Sivlingi ka gun karmatmik adhyayan evam is ka pumsavana- karma par prabhav 9991. M.D. (Ayurveda) Punjabi University, Patiala (unpublished).
  10. PNDT Act. Available at: www,mohfw.nic.in/ PNDT Accessed 15th May 2004.
  11. Anonymous. Action to follow on ad ensuring male child. Indian Express. May 20, 2003, vol. 242, no.26.
  12. Unnikrishnan PV. Banned- Select: “A drug to alter the sex of the foetus”. Health Millions, 1993;1:29-30.
  13. Reubinoff BE, Schenker JG. New advances in sex preselection. Fertility and Sterility, 1996;66:343-50.
  14. Das A. US sex selection product targets market, ministry unaware. Indian Express. November 20th, 2000.
  15. Grumbach MM, Conte FA. Disorders of sex differentiation. In: Williams textbook of Endocrinology, 9th edition. (Eds) Wilson JD, Foster DW, Kronenberg HM, Larsen PR. WB Saunders Company, Philadelphia, USA 1998.
  16. Grumbach M, Kaplan S. Sex determination. In: Fetal and neonatal physiology. (Eds) Polin RA, Fox WW. WB Saunders Company, Philadelphia, USA 1992.

Deptt. of Community Medicine, Post Graduate Institute of Medical
Education and Research, Chandigarh-160012
E-mail: [email protected]
Received: 21.11.05

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