A few weeks ago, a daily published a news report alleging that baby girls were being subjected to sex-change procedures to turn them into boys. The racket was supposedly centred on Indore; seven surgeons operating out of various clinics were said to have performed hundreds of such sex-change operations.
The report asserted that every year, around 300 infants were first being pumped with male hormones and then made to undergo genitoplasty surgery to give them male sex organs. The cost was estimated to be Rs 1.5 lakh.
If true, it’s obviously sensational. However, many aspects of the story just don’t add up. The medical procedures involved, the costs, and in behavioural terms, the expected long-term utility for the parents just don’t make sense.
We can surely infer that Indians want male children and grand-children. The gender ratio is massively skewed in favour of males. The so-called 100 million “missing Indian girls” under the age of five, have been written about extensively. The sex-change racket was, supposedly, another data point underlining the Indian obsession with males.
India has a law against pre-natal gender determination. This specifically bans amniocentesis for that purpose. Abortion is legal and no reason is required for wanting an abortion, before week 20.
Quite possibly, unscrupulous Indian doctors and lab technicians ignore the law against sex determination.
Apart from that, it’s possible to buy DIY sex-determination kits (“Jack or Jill” on Amazon.com for example, costs $12), use them to send a sample of the pregnant woman’s blood to an overseas lab (the lab test costs $100-150) and get a foetus gender determination delivered online.
Abortion is also an easy and cheap procedure. The cost could be as low as Rs 300. Depending on the stage of pregnancy, it may vary between Rs 500 to Rs 3,000 according to a study by the Centre for Operations Research and Training, Baroda. A late-stage abortion with anaesthesia and invasive surgery would cost an absolute maximum of about Rs 15,000 at a high-end private hospital. The Consortium on National Consensus for Medical Abortion in India estimates that around 11 million medically-terminated pregnancies (aka abortions) take place every year.
Hence, Indians can determine the sex of the foetus and selectively medically terminate pregnancy, for a fraction of the alleged cost of genitoplasty. Moral considerations aside, this makes a sex-change operation worth it only if the parents think they will get a healthy boy-child, capable of reproduction, at the end of the process.
However, this is not possible. As mentioned above, foetal gender determination can be done by testing the pregnant woman’s blood. The test is 98-99 per cent accurate (amniocentesis is 100 per cent accurate). It checks for traces of foetal chromosomes in the mother’s blood.
A chromosome is a DNA strand containing the genetic material of the parent. Chromosomes are paired. Human beings have 23 pairs of chromosomes, of which 22 (“autosomes”) are not related to gender. The 23rd pair determines gender.
Boys have a set of two differentiated gender-chromosomes known as a XY pair while girls have two identical sets called XX. Once the chromosome set is fixed early in conception, they cannot be changed. Even in cases of genitoplasty surgery, a female who has grafted male organs or vice-versa, remains sterile.
The utility of genitoplasty lies in two other cases. Infants are sometimes born with abnormal genitalia. Some for example, have undescended or partially descended testes — Hitler was a famous example. Others have difficulty in urination and to put it crudely, need their plumbing fixed.
In such cases, genitoplasty surgery is undertaken to correct the shape, size and function of organs. These are well-known procedures, but not sex-change operations. A boy or girl with genital problems will undergo surgery to “normalise” respective organs, not swap them.
Sometimes called intersex surgery, genitoplasty can take years. It does involve hormone treatment (testosterone for male genitoplasty, and oestrogen for females). According to a study by Shilpa Sharma and Devendra Gupta, Male Genitoplasty for Intersex Disorders, 326 such intersex procedures were undertaken at AIMS, Delhi, between 1989-2007. The ages of the patients ranged from 2.5 years to 22 years with a median age of 5.5 years. Note — no infants.
In adults, this surgery is also carried out for transgender people, who do wish to undergo sex change. Again, it includes hormonal administration as well as intensive psychological counselling. The writer Jan Morris, for example, is a well-known individual who changed sex (from male to female) and so did the tennis player Renee Richards.
To qualify for such transgender surgery, the subject has to be a sane adult and undergo at least six months of hormone treatment and counselling. The waiting period before surgery ranges between 18 and 24 months with some US states insisting on three years of the individual living as the other gender.
The costs for this are well above Rs 4 lakh — much more than that report alleged. The entire process of sex change takes about two years to stabilise. The individual will always be sterile and doesn’t change at chromosomal levels.
Indian laws and identity documents such as passports and voter IDs now allow for a third sex identification of “other”. That’s a welcome change in official attitude. But it doesn’t translate into hundreds of baby girls being turned into sterile boys on an assembly line.
Indians do have reprehensible social attitudes that clearly favour boys over girls. But, given the consequences of surgery and the far cheaper simpler alternatives of gender-determination and selective abortion, the use of genitoplasty surgery for this seems unlikely.
