On the morning of June 26, 2011, readers of Hindustan Times (HT) woke up to front page news of girls being converted into boys through surgical procedures in the city of Indore in Madhya Pradesh.
The news claimed that due to their fetish for sons, several families are getting the genitals of their new born daughters converted into male genitals.
This seemingly horrifying news led to shock waves with everyone from Prime Minister’s Office to National Commission for Protection of Child Rights (NCPCR) and Indian Medical Association (IMA) getting into action. Teams were sent, state government asked to take action and there were also suggestions for enactment of laws to deal with such medical practices.
HT then went into an overdrive highlighting the impact its “expose” generated and also getting celebrities like Sonam Kapoor to comment on sex change operations and gender discrimination.
The whole episode highlights the insensitivity with which media covers delicate health issues. Not only was the story incorrect with lack of supporting evidence, it was full of critical labelling. Let’s talk about non-medical issues first.
The story starts by depicting the city of Indore as ‘conservative’ thereby accusing the whole city of supporting gender discrimination through these “illegal” surgical procedures.
It further says: “The low cost of surgery and the relatively easy and unobtrusive way of getting it done in this city attracts parents from Delhi and Mumbai to get their child surgically `corrected.'’ This suggests that Indore is a better place than the metros for these surgeries not only due to low cost but also because citizens will not vehemently oppose such a procedure. On what basis such observations were made is not known.
It scores better than metros in gender parity. It has a sex ratio of 892 female children per 1000 boys which is better than 866 per 1,000 in Delhi and 874 for every 1,000 in Mumbai as per provisional data of 2011 census.
Another point: “The parents press for these surgeries despite being told by doctors that the `converted' male would be infertile.” This information defies the whole logic of the fetish for sons in Indian culture. It’s well known that parents who prefer a son want the family name to be carried forward and they also believe that in old age, a son is more likely to support them. So why would a family prefer an infertile son who can’t reproduce and hence will live a depressed life in comparison to a daughter who is born perfectly normal?
Now the medical part. The news report said: “The process being used to `produce' a male child from a female is known as genitoplasty. While genitoplasty is relatively common -it is used to correct genital abnormality in fully-grown patients.” It’s wrong to say that genitoplasty is being done in children because what they undergo is corrective surgery not sex change.
The fact is thousands of children across the world are born with ambiguous genitals. During the early phases of development in the mother’s womb, there is no distinction between the genitals of a boy and a girl. The development of both genders starts the same way, until male and female hormones kick in to determine shape of the external sexual organs or genitals.
If something goes wrong at this point, the parents end up with a child with abnormal or ambiguous genitals. A girl may be born with a noticeably large clitoris giving impression of a penis or lacking a vaginal opening. A boy may be born with a notably small penis or with a scrotum that is divided so that it looks like labia, a part of female sexual organ.
In absence of correct diagnosis these children either grow up as adults confused with their sexual identity or are spurned by the society and labelled ‘third gender’.
The fact is that if examination of external and internal sex organs is done properly this ambiguity can be resolved with help of a surgery. This is what the doctors quoted in the story were also doing but the writer went on to use it against them.
The news story reported: “They (the doctors) say these operations are done on children whose internal organs do not match their external genitalia….they claim a strict procedure is followed to determine the sex of the new born, after which the external appearance of the child is changed to match the sex. There is no system to monitor that claim and is completely open to abuse.”
If there is no system to monitor the claim on what basis do we reject the claim?
Only one anonymous parent of a child who underwent surgery was quoted as saying: “I think my child would not be confused over his gender when he grows up and can live a normal life as he would not have any memories of the surgery.“ Nothing in the quote suggests that sex change not corrective surgery was done.
Another point the story made is “The doctors accept that parents willingly convert girls to boys but opt out of the opposite procedure.” There are more than one reason for such a trend. While gender bias can be a major social factor that prevents parents from getting their seemingly male child surgically corrected into a female, another reason is medical.
As mentioned earlier genetic females may be born with a noticeably large clitoris (depicting a penis), or lacking a vaginal opening. In cases where enlarged clitoris is noticed, proper levels of hormones can be given through medication to shrink the tissue close to a normal size which is why surgery may not be required. Also, for girls with ambiguous genitalia, the sex organs often work normally. If vagina is hidden under her skin, the surgery to remove the skin can be performed during puberty if there is no other complication involved. Many a times, parents also approach the surgeons when these children reach the age of puberty and start to show signs of female growth.
Unfortunately, the awareness regarding such a procedure is low not only among general public but even among gynaecologists and paediatricians, who are mostly the first medical professionals to examine a new born. But this surgery is commonly done in multi-speciality hospitals. For instance, at Sir Ganga Ram Hospital in New Delhi, every month 2-5 cases of gential correction are done.
Luckily, the “seven paediatric surgeons associated with top private and government hospitals” in Indore knew about the procedure and were legally performing their duties thus saving so many lives from an almost certain misery. However, the HT news story and the negative impact it has generated will not only force such surgeons to put down their scalpels but will also push the already little-known procedure to further oblivion.
Dr S V Kotwal, one of the very few experts in the field of sex-change surgeries in India, categorically states that it's not possible to do sex change surgery in infants. “Such surgeries have never been done in medical history and hence no surgeon is qualified to perform them which is why the news that sex change operations were being performed in Indore is wrong,” he says.
In fact, this is what he had told the HT editorial team members who approached him to seek his opinion. “I was busy in a medical conference but did tell them that the facts don't seem to be correct and the cases seem to be gential correction and not sex change. I told them your reporter need to do more research, talk to family members and get medical records. However, they went ahead with the story despite my advice. What do you do? This is how media works,” he laments.
To make up for that, Dr Kotwal was asked to write an opinion piece on the issue which was published two days later on the edit page of HT. “Corrective surgeries done on infants should not be confused with sex-change and what Indore-based doctors were doing was absolutely legal,” he said in the comment.
However, on the same day the paper carried a front page follow up detailing the actions initiated by PMO and NCPCR on its ‘expose’ making it clear that it is not going to backtrack from its initial stance.
On June 30, HT did another follow up on the NCPCR exploring a possibility of forming a law on the subject. NCPCR has even asked the Madhya Pradesh government to take necessary action, including cancellation of licences and registration of doctors and hospitals involved and initiating criminal cases against them.
When a newspaper of the stature of HT raises an issue on its front page, everybody from a man on the street to the Prime Minister’s office takes note. But that is precisely why more research and more interviews might have been needed to put this “exclusive” on a firm basis. Can’t help but recall the message in a ‘Spiderman’ movie, “With great power comes great responsibility.” Something missing here.