Indian Express 16 Apr 2018

Here are the consequences of linking women’s medical records to their Aadhaar 

by Ramya Chandrasekhar

#GenderAnd: Aadhaar has been pitted to solve another problem, that of gender-biased sex selection…but the suggestion is flawed

Over the past couple of years, Aadhaar has been viewed as the “ultimate solution” for a range of problems, be it leakages in the PDS system or the cumbersome KYC procedures. Continuing this trend, Aadhaar has been pitted to solve another problem, that of gender-biased sex selection.

In 2016, Maneka Gandhi, the Women and Child Development minister proposed that the biological sex of the foetus should be mandatorily disclosed to pregnant women and pregnancies tracked to deter people from engaging in the practice of gender-biased sex selection. In February this year, two doctors, in an editorial in a business daily, proposed that all medical records be digitised and linked to the patient’s Aadhaar, to monitor women’s pregnancies and thereby curb gender-biased sex selection. The doctors say that every abortion undergone by a woman should be recorded against her Aadhaar details, along with name and details of the doctors who perform the abortion. These records of the doctors’ participation will disincentivise and deter their participation, the editorial argued. Linking women’s health records to Aadhaar, monitoring their prenatal and antenatal health along with the at-risk girl child, the doctors argued, would aid in eliminating this practice.

Eliminating gender biased sex selection and ensuring women’s health are certainly desirable goals. But at the heart of the proposal by Maneka Gandhi and the doctors is the surveillance of women and girls, through the tracking of their bodies, data and decisions. While the Supreme Court last year emphatically recognised privacy as a fundamental right, the value of privacy for women and girls has not trickled down.

For women, control and autonomy over their bodies as well as data and decisions associated with their bodies is an important aspect of privacy. In many cases, for example, women do not wish to involve their families when choosing to undergo an abortion, owing to fear of being stigmatised or bringing “disrepute” because an abortion is considered “immoral” in certain communities, or because their families might disagree with their decision to undergo an abortion. By recording every abortion and tracking this information through the woman’s Aadhaar details, a digital trail of choices exercised about one’s body is created under State vision. This hampers women’s autonomy to make decisions related to their bodies and life.

Already, there exists a complex tension between women’s right to abortions and gender-biased sex selection, which must be taken note of when trying to find a solution to curb the latter. As Nivedita Menon notes, women’s right to abortion in India, from Nehruvian times, has largely existed within discourses on population control, sex ratios and maternal health, and not within discourses on autonomy and privacy. In the 1970s, civil society organisations actively sought to bring women’s right to bodily and decisional autonomy within the mainstream. However, some of these groups and public authorities also advocated for a restriction on this right in favour of the future-girl child. To partially address this dichotomy, the Pre Conception and Pre Natal Diagnostic Services Act (PNDT) was passed in 1994, which regulates sex determination without explicitly criminalising certain kinds of abortions, namely sex-selective abortions.

If formal medical institutions become spaces that monitor women’s pregnancies and their health, more women might opt for abortions conducted “outside” the system, which in most cases lead to unsafe abortions. A study conducted in 2015 revealed that 5 per cent of all abortions performed that year were unsafe, and this statistic is only bound to increase. Additionally, in the absence of any positive change in the mindsets of communities, it is likely that practitioners who engage in sex selection will find more loopholes in the law or create alternate black market-like spaces, where this practice can continue.

In this context, consider the end result of the constant tracking proposed by Maneka Gandhi and the two doctors. Would it be the end of sex selection based on gender, or would it be a situation where more and more women would be hesitant to undergo an abortion at all, thereby restricting the exercise of civil liberties. The constant tracking of women’s medical records would become another way of controlling women who choose to “rebel” by undergoing an abortion. Already, in the status quo, women can be punished for undergoing an abortion if the conditions specified under the Medical Termination of Pregnancy Act have not been satisfied. This leads to an element of fear being associated with abortions, which will only be exacerbated if a digital trail of women’s pregnancies and abortions is created.

But even if this form of tracking was to curb gender biased sex selection, at what cost? Instead of instituting schemes that seek to change perceptions surrounding the girl child, such as the perception of them being financial burdens, women’s bodies are used as a tool to increase the sex ratio. The burden is implicitly cast on women, by constantly “watching” what they do with their bodies. This fear then leaves very little room for women to exercise any choice and agency in any aspect of their pregnancy, or even in relation to their general health. As it is, many sexually active women and girls do not visit hospitals or clinics for check-ups for STDs and non-sexually transmitted diseases, because of the taboo associated with such visits. If a digital trail exists that documents each visit to a doctor, the number of women and girls who do undergo check-ups is only likely to fall.

But Maneka Gandhi’s proposal raises another concern as well. If the biological sex of the foetus is mandatorily disclosed to women at the time of detection of their pregnancy, how then can sex-selective abortions be identified and distinguished from legitimate abortions? Her proposal leaves no room for women to exercise the choice to undergo an abortion at all, because it is extremely likely that all abortions might be treated as sex-selective abortions.

There is a problem with using existing technologies like the Aadhaar as a panacea to social problems. The manner in which a technology is operationalised and the outputs generated, moulded by social norms and institutions, have not been taken into account. If the Aadhaar is to ever succeed as an empowering ID-system for women and sexual minorities, their unique privacy interests vis-a-vis bodies and data must be acknowledged and addressed. Till the time these unique privacy interests are considered at the stage of designing and implementing a technology like Aadhaar, any use of it under the garb of ensuring welfare of women and sexual minorities, will only lead to more oppression and exclusion.

Originally published in Indian Express.