The desire of Indians to have male progeny could be triggering stillbirths in the country, researchers from Delhi have found. Last year, an estimated 5 lakh babies were born with absolutely no signs of life at or after 28 weeks of gestation—the highest case burden reported from any country, according to a study published in Lancet, an international scientific journal last month.
In another study released in January, scientists from Public Health Foundation of India found that one out of every five mothers who consumed illegal selection drugs had a stillbirth. “These indigenously prepared drugs are routinely given to pregnant women so the gender of the child in the womb can be male. These drugs are known to be high in testosterone and some may also contain steroids which could be harming the foetus,” said Dr Sutapa Neogi, author of the study which was published in the Paediatric and Perinatal Epidemiology journal.
The study was conducted in Haryana which made headlines recently for crossing the 900 mark of sex ratio at birth. Haryana has the lowest sex ratio in the country, which the government claims has improved after the launch of ‘Beti Bachao Beti Padhao’ scheme by the Prime Minister, Narendra Modi.
In many hinterlands including Haryana, the preference for having a male child has not only imbalanced the sex ratio but also harmed the mother and unborn child’s health. The same group of researchers has found that these drugs were inducing birth defects in children. Their latest study has established that women who consume these drugs during their pregnancy had a higher risk of having a stillbirth.
Public health expert said that most developing countries have reduced stillbirths by improving access to care for pregnant women, foetal monitoring and by performing timely caesarean sections. However, the incidence of stillbirth in India has not changed significantly. In 2015, the country reported 23 stillbirths per 1,000 live births.
“The incidence of stillbirth in India has not significantly improved or increased. This, despite the gradual improvement in the access to healthcare,” said Dr Neelam Aggarwal, Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India and co-author of the Lancet study.
The population-based study was conducted in 15 districts of Haryana and around 327 women who had a stillbirth were interviewed by the researchers. Of them 47 mothers who reported stillbirths said that their child had a visible birth-defect and 19% of them confessed of consuming some type of sex-selection drugs (SSD).
“These drugs are consumed three to eight weeks after conception which is a very critical period for development of the foetus. The ingredients of these drugs trigger birth defects resulting in still births,” said Dr Rakesh Gupta, co-author of the study. Researchers said that intake of herbs during pregnancy has been associated with foetal malformations in a large study conducted in Taiwan. A study from Malaysia also established that herbs taken during the pregnancy can lead to still-births.
“India has 5,92,100 third trimester stillbirths every year and this is the highest number in the world - not a number 1 that India would want,” said Joy Lawn, lead author of the Lancet study. “Over half of these stillbirths happen during labour after nine months of pregnancy so the most important message is to improve the quality of care at birth, especially with better monitoring of fetal distress in labour and rapid response.”
Lawn added that India also has a challenge with sex selective termination of girls and the effect of sex selection drugs is important. “Overall these issues reflect lack of value for the girl child and gaps for women’s empowerment,” she said.
Apart from establishing the association between the drugs and still-births, the study found that in 20% of still births the mother had developed some complication during pregnancy. “Any complication during pregnancy increased the risk three times for a still birth,” said Dr Neogi adding that women who had a pre-term delivery had a 3.5 times risk of having a still birth compared to mothers who had a full –term delivery. “Such drugs have emerged as an important risk factor for having a still birth as well as birth-defects. In cases where the child survives with the malformations, there is long-term disability.”
Alarmed with the study’s results, the Haryana government has, in the past eight months, arrested 22 people involved in the production and sale of these drugs. “The local faith healers and medics practicing alternate medicine offer such drugs to patients. These drugs contain steroids, pearls, herbal products and peacock feather which are causing still births and birth defects,” said Dr GL Singhal, project coordinator of Haryana’s Beti Bachao Beti Padhao.
Dr Aparna Hegde, founder of ARMMAN, a non-profit working for maternal health, said that efforts to correct gender imbalance are focused more towards preventing doctors from performing sex-determination on ultrasound. “The fact that people are taking such illegal drugs to have a male child proves the ineffectiveness of prevalent policies in addressing the distorted sex ratio. It also underlines the fact that unless massive effort is made to bring about an attitudinal change in the community towards the girl child who is treated as a second class citizen by her family, community and the country on the whole, the sex ratio will remain distressingly biased.” said Dr. Hegde. “Yes in states like Haryana, where the sex ratio is skewed, banning sex selection drugs may help to reduce number of stillbirths to some extent. However, it must be remembered that unless the abiding causes like poor antenatal care and poor access to preventive care information, delay in reaching a facility in case of emergencies and poor infrastructure, lack of medication supplies and skilled birth attendants at the health care facility, are addressed, there will not be much dent in the woeful statistics.”