A pregnant woman's abdominal sonography is underway. The doctor is listening to the baby's sounds and the husband too is right there. The doctor is perturbed by the sounds he hears and makes the to-be father listen to them. A tender voice is making an appeal, "Papa main aapki beti, mujhe mat maro." (Papa, I am your daughter, don't kill me.) The father is shaken, undergoes a change of heart and cancels the original plan of abortion after the sex determination test.

This recent TV ad has had a terrific impact and shaken people's conscience, making aspirant baby killers feel guilty of the crime they intend to commit. This is Behaviour Change Communication (BCC) and it has the potential to usher in a revolution in the patriarchic son-centric psyche of Indian society.

The Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act (PNDT Act), which was passed in 1994, and concerted efforts of the health ministry as well as various social organisations may have had limited success in curbing the practice of female foeticide. However they have definitely succeeded in creating all around awareness about this issue. And now the time is ripe to go beyond just this.

What is BCC?

Behaviour Change Communication (BCC) techniques are extensively used in HIV/AIDS campaigns world over. BCC uses a combination of techniques, designed to encourage and facilitate a voluntary adaptation of the behaviour that is being promoted. It includes market and social research, advocacy, social marketing communication, monitoring and evaluation. Mass media, community outreach and interpersonal communication are integral components of strategic planning for BCC.

A grim tale

Applying World (untampered) Sex Ratio of 1022 (1022 women per 1000 men), there are 36 million missing women according to Amartya Sen.

While all ages sex ratio is slightly lower at 933 in 2001 census as against 935 in 1981 census, juvenile sex ratio (0-6 age group) has declined astonishingly from 971 to 927 for all India.

In Punjab, Child Sex Ratio (CSR) has tumbled to 793 in 2001 (from 908 in 1981); Haryana 820 (902); Gujarat 878 (947); Himachal Pradesh 897 (971); Rajasthan 909 (954) and Maharshtra 917 (956).

Thus, till 1981 only Punjab and Haryana had very low CSR but the trend seems to have spread to Himachal, Rajasthan, Gujarat and Maharashtra too.

49 districts have less than 850 female children per 1000 male children out of which 38 are in Punjab, Haryana and Gujarat. In Morena district of Madhya Pradesh, CSR is 842 and in some blocks it is reportedly as low as 400-600.

 •  No country for women
 •  Keeping fingers crossed

During market and social research, the psychographics of the target are studied to identify the necessary triggers that stimulate behaviour change. The research begins with the individual, advances into the community and investigates societal factors such as demographics of the target population, economic and other factors that shape a society's basic values. It also explores the benefits of preventive measures and credibility and accessibility of potential sources of prevention messages. From the information collected, the target is encouraged to adopt the behaviour being promoted.

BCC occurs at three levels:
i) interpersonal communication, i.e., communicator to individual
ii) group communication, i.e., communicator to family/neighbour/peer group
iii) mass communication, i.e., communicator to community at large

Need for BCC

"There has been enough of mass communication on issues of missing women/declining sex ratio/sex determination tests and sex selective abortions," says Dr Nishikant Shrotri, eminent gynaecologist and ardent health activist from Pune. Of course it is very essential to avoid resistance to the revolution and hence mass communication has to precede all advocacy measures, Shrotri hastens to add, and cites this example.

A counsellor spent three hours urging a woman with three daughters to go in for family planning operation. She was convinced. But the minute the volunteer left, the woman's mother-in-law forbade her to undergo the operation, for a son had yet to be born! And the counsellor's three-hour work was debunked in thee seconds! So it is not mass communication or interpersonal communication alone but also group communication that is equally important. The communicator should have dealt with the family and peer group so that the mother-in-law's resistance could have been broken too.

Social awareness through mass communication creates a conducive atmosphere and brings down the resistance to progressive ideas that daughters are equal to sons, that they are not a burden, that they are not to be given away in marriage and that there is no need to give hefty dowry but girls can do equally well in education, can earn enough to support themselves and the family, etc. Above everything, it appeals to the conscience that girls have the right to be born and one cannot take away that right by killing them in the womb itself or after being born.

Mass advocacy is a necessary but not the only sufficient condition. Communicators need to hold group discussions among families, neighbours and community to prepare their minds to accept such changed perceptions. Demonstration effect is very strong in a peer group and one does not want to be singled out.

Thereafter, one-to-one communication would achieve the final result. At all the three levels, each entity wishes to break through the circles of influence. It is the right communication strategies, approaches and messages that need to be employed to help these entities to free themselves of the age-old shackles of beliefs and practices.


However, Shrotri observes that whenever they hold workshops for BCC counsellors to create awareness about the issue of sex selection tests and deter people from these practices, most of the government and social organisations send AIDS counsellors or just any counsellor. There are no specific posts created at various levels of counselling. This results in an unprofessional cadre of counsellors, motivators or change agents. Counselling as per BCC techniques needs to be learnt after serious training and thinking.

Besides, under PNDT Act, there is no space for BCC. Under its advocacy and communication strategy there are only workshops, talks, posters and TV ads. Also the messages going through most of these communication are that if sex ratio goes down, there will be scarcity of women and a time will come when men will have to buy women or that the practice of polyandry will come in vogue. The argument has little to do with the right of the unborn girl child to be born!

Practices may have changed, but the mass psychology that prefers sons has not. The shift is in the method of elimination of daughters - from female infanticide earlier to female foeticide now. Before the PNDT Act was passed in 1994, the sex selection was done openly through advertisements of the ultrasonic clinics. After the ban on sex determination tests under this act, it is done all the same but clandestinely involving a chain of middle-persons, medical practitioners and sonography centres. And there have been no cases of punishment as per the law till a sole case in 2006.

Toothless legislation

The centre passed the Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act (PNDT Act) in 1994. Operationalised in 1996, this act was violated right, left and centre and was amended in 2003 to cover sale and use ultrasound machines. And yet the practice flourishes underground with greedy medical practitioners giving excuse of demand for these services.

Why has the PNDT Act remained just another toothless legislation? Is it needed or is there some other approach? "Of course, it is needed," strongly opines Shrotri. "There have been many laws for women's welfare like prohibition on Sati, child marriages, dowry, and the PNDT Act, I would say, is a feather in the cap." Policies and laws strengthen the efforts to usher in a change in attitudes and mindset of the people to deter them from a particular practice. However, just a piece of legislation cannot be expected to bring in the desired social change. "Sati came to an end not merely because of the ban by Lord Hastings but more because of social awareness created by Raja Ram Mohan Roy," elucidates Shrotri. The act thus strengthens the hands of changemakers.

At a recent workshop on 'Improving Child Sex Ratio: A Step to Counter Missing Women' held at the National Institute of Rural Development, Hyderabad, Dr Leela Visaria brought forth the issue of advocacy measures taken up by the health ministry, UNFPA, UNICEF and many other development agencies and social activists. These multi-pronged approaches have kept the issue alive and the advocacy efforts have created awareness about the Act and galvanised many not to violate the law, says Visaria.

However, admittedly, there are limitations in advocacy measures and so far no study has been made on the effectiveness of the strategies and communication methods. Even the contents of the print, audio-visual materials have not been analysed, says Leela Visaria whose studies highlight much greater deficit of girls as the second or third child among somewhat educated, upper class women. Instead of focusing on the girls' right to be born, most of these materials depict i) mother-in-law as the villain and not her internalised patriarchal values, ii) declining sex ratio leading to grave situation of such low stock of women that many men will have to share one woman.

The sex ratio is a manifestation of interplay between biological and social and cultural factors, opines Visaria. By and large, first child – male or female – is welcome but mostly women themselves want at least one son and hence elimination practice starts from second or third child onwards till the son is born.

Application of BCC

BCC's demonstration effect is very strong in a peer group and one does not want to be singled out. Thereafter, one- to-one communication would achieve the final result.

At all the three levels, each entity wishes to break through the circles of influence. It is the right communication strategies, approaches and messages that need to be employed to help these entities to free themselves of the age-old shackles of beliefs and practices.

 •  No country for women
 •  Keeping fingers crossed

In Maharashtra, appalled by the fast depleting number of women and especially in the age group of 0-6 solely on account of new technology for sex detection, activists groups had led strong protests against the misuse of these techniques. Dr Veena Mulgaonkar, gynaecologist and health activist from Mumbai, came out with some novel ideas of interventions to improve child sex ratio. No one with one or two sons generally goes in for sex selection tests. It is the families with only daughters who may resort to female foeticide after sex determination. She suggested that a register of such 'high risk' families (with only daughters) should be prepared to observe and follow up through counselling families or peer groups. This would fall in the second level, i.e., group communication under BCC strategy.

"You do not practise mercy-killing just because there is demand for euthanasia," argues Shrotri. To curb such unethical practices by their own fraternity, local chapters of Indian Medical Association have taken up various steps to convey the message to these erring practitioners. "We get to know about such doctors and we send them warnings that we will not refer patients to them or we boycott/ostracise them," says Shrotri.

All these measures and many more current advocacy measures fall under BCC. Only it needs to be methodically structured and effectively implemented. The first step towards using BCC in improving child sex ratio would be to include it in PNDT/PC-PNDT Act as one of the advocacy and communication strategies and make provision for a trained and dedicated cadre of change agents armed with BCC techniques.