MOHOPADA, India -- The arrival of Anu and Sanjay's first daughter brought happiness to the family.
During Anu's fourth pregnancy she and Sanjay went to a radiologist, who had been recommended by their gynecologist, in a town outside their village in Maharashtra in western India. For 600 rupees or about $14, the radiologist told the couple the bad news: a girl.
Anu returned to her gynecologist and aborted the fetus.
"My husband used to insist that he wants a son, that's why I decided myself that I wanted to wait for a boy," Anu said in Marathi through a translator during a recent interview. "So I aborted."
Anu and Sanjay, whose names have been changed due to the sensitivity of the story, tried again and again to have a son. By the end, Anu got pregnant eight times. She gave birth to four daughters and had four abortions.
As India develops and its middle class grows, the aborting of female fetuses is becoming more common. India's 2011 census showed that the country's child sex ratio, the number of girls to boys under age 7, is the worst it has been since India gained independence in 1947.
A natural sex ratio is 105 boys born for every 100 girls. This is to adjust for girls' slightly higher likelihood of surviving than boys. However, India's 2011 census showed that the sex ratio for children under age seven is 109 to 100. While not ostensibly a large difference, that ratio equates to 7 million fewer girls than boys under the age of 7 in India, which is home to 1.2 billion people.
Public health experts say the drastically skewed ratio is a result of couples having ultrasounds to determine the sex of their fetus and then aborting girls.
A recent study published in the British medical journal The Lancet stated that sex-selective abortions are up sharply during the last two decades, and most of the Indian population now lives in states where sex selection is common. It estimates that between 4 and 12 million abortions have occurred in the last three decades in India as a result of sex selection.
The study said that women from wealthier and more educated families are more likely to have a sex-selective abortion than women from poorer families, presumably because they can afford to use the technology.
"Recent increases in literacy and Indian per-person income might have thus contributed to increased selective abortion of girls," it said.
Gender discrimination is largely behind sex-selective abortions, but the phenomenon has also been exacerbated by a growth in organized crime among doctors who collude to evade restrictions against revealing the sex of fetuses to expectant parents.
As India faces a growing gender disparity, some activists feel that the government isn't doing enough to tackle the issue. Some organize sting operations on clinics to help identify doctors who are breaking the rules.
Sex-selective abortions represent "the dark side of social and economic development," French demographer and sex-selection expert Christophe Guilmoto told GlobalPost.
"You empower women, but at the same time old tradition comes back to the fore, and gender preferences are implemented in a much more effective way because of access to technology, information, [and] knowledge."
The practice of sex selection has begun to have dire effects on communities in India. In some parts of the country, like in the relatively wealthy states of Haryana and Punjab, families have been known to buy brides from poorer states.
The trafficking of brides across the country puts these women at risk because they become isolated and more vulnerable to abuse, said women's-rights activist Ranjana Kumari. The women also come from different cultural backgrounds and therefore struggle to adapt to their new village's dietary habits and customs, she said.
Pressure to have a son
There have long been religious, social and economic pressures on Indian families to have a son. Once daughters grow up, they will traditionally get married and go live with their in-laws. Sons, on the other hand, stay home and take care of the parents as they grow old.
Anu says she would have stopped having children after the first two daughters, but her husband and mother-in-law kept insisting the family needed a son. In many communities, Indian women who have a son are given more respect and status.
"Your security is your son," Anu said as she sat upstairs from her physician's clinic in Mohopada village, about 40 miles outside Mumbai.
Daughters are also more expensive. Sanjay earns 20,000 rupees, or about $450 a month, working at a chemical company in town, and that should be enough to provide the family with a decent middle-class life. However, he said that he has spent all his money on the daughters' education, daily expenses and now on marrying the girls off.
Sanjay said that when his first daughter got married, he did not have to pay a dowry because she is well-educated. But he did have to cover the majority of the wedding expenses -- and Indian weddings do not come cheap.
He wanted to give his daughter a proper wedding, including new jewelry for the bride, gifts for every relative and a large reception. He spent 4 lakhs on the wedding, about $9,000. That is Sanjay's salary for 20 months.
He said that he wants to provide each of his daughters proper Indian weddings, and will take out loans to pay for the others.
Sanjay has no savings left for retirement and does not get a pension or social security.
Some argue that sex selection is less a result of families disliking girls, and more an offshoot of them feeling a need for a son.
Statistics bolster this argument, as they have shown that Indian families like Anu and Sanjay are often content having the first child be a girl. The Lancet study published in June showed that sex-selective abortions rarely occurred with firstborns. The abortions occur in the second or third pregnancy when the first child is a girl, and the family wants to have at least one son.
However, others, like demographer Guilmoto, say the argument that families have nothing against girls is just rhetoric, given that many aren't just trying again to have a son, but are actually getting rid of unwanted girls.
"It's all very nice to say that people have nothing against girls," Guilmoto said. "But if they really want a son, there's no better way than to try again."
Women's rights activists say sex selection represents another example of India's pervasive discrimination against women. In some communities, daughters are more likely to be malnourished and less likely to be educated and taken to the doctor. Mothers face high rates of domestic violence and maternal mortality. And widows, no longer needed to support a husband or produce sons, face abandonment.
With sex selection, said public-health activist Sabu George, "we're dealing with an extreme form of discrimination where women are not allowed to be born."
In many cases, a woman aborts her female fetus in response to societal pressure, but there are also instances when the woman herself makes the decision. In order to better understand the phenomenon of sex selection, it is crucial that these cases also be taken into account, according to Mara Hvistendahl, who recently wrote a book on the issue, "Unnatural Selection."
"Yes, gender discrimination is there," she told GlobalPost. "But we also need to talk about the personal decisions that are being made."
"We have to confront the fact that there are women who are making these choices," she said.
In an attempt to prevent sex-selective abortions, India has banned doctors from using ultrasounds or other technology to tell women the sex of their fetus, and gynecologists are not allowed to perform abortions for the purpose of sex selection. Abortion is only legal in India up to week 12, with the exception of extreme cases, and a fetus must be at least 14 weeks before an ultrasound can detect its sex.
There have been a string of other government efforts to crack down on this practice, particularly after the release of the 2011 census data triggered countless reports in the local media on sex selection. The national and state governments have suggested requiring the registration of ultrasounds, monitoring doctors, making abortions subject to checks, and providing incentives to families to have girls.
Maharashtra's state public health minister, Suresh Shetty, proposed using spy-cams to catch doctors.
However, like most issues in India, the law is not the problem -- enforcement is. Few violators of the law have been prosecuted, and regulation of private clinics is limited.
"Actually, you can have an abortion whenever you want," said public health activist Sabu George, who has been working on the issue of sex selection for 25 years. "There's no regulation."
George says the law has not been enforced because of a lack of political and social will. Furthermore, most people are not ashamed of breaking the law, and corruption enables many doctors to avoid getting caught or facing penalties.
"Doctors are highly organized, and they are doing everything to spread the promotion of the practice," he said. "What you are seeing is organized medical crime."
In April, after the discouraging census figures, the health ministry drafted new personnel for the central supervisory board tasked with ensuring that the laws against using ultrasounds for sex selection were strictly implemented. Though the board is supposed to meet every six months, the previous members had not met since 2007.
Parliamentarian Mabel Rebello, one of the new members, is not convinced that this time will be all that much different. "For a short while [the country will focus on this], after that they will forget," she said in an interview with GlobalPost.
"Our rules are not strict enough to punish them. If we have to punish a few doctors and put them behind bars, they would be scared," Rebello said.
"In all the district hospitals, the government should tell all the 28 state governments and seven union territories that they should oversee things very strictly, and all the 600 district collectors should be instructed, and wherever there is a skewed sex ratio, the collectors should be punished," she added.
However, the limitations of federalism prevent that kind of strong action.
"The central government can only start schemes and give money," Rebello said. "Implementation has to be done by the respective state governments."
Civil-society groups, seeing what they consider a lax effort on behalf of the government, have also stepped in to help enforce the law and change mindsets.
A lawyer and women's-rights activist in Maharashtra, Varsha Deshpande, has organized dozens of sting operations on clinics to try to catch doctors who tell women the sex of their fetus.
Deshpande and activists like her enlist a pregnant woman to collaborate and then send her into a clinic to ask for information on the sex of her fetus. Once the doctor tells the pregnant woman the sex -- either outright or by using a trick like pointing to something blue or pink -- the group announces the sting and catches the doctor.
Deshpande says the sting operations are widely publicized and serve to scare other doctors in the community. But they have only had limited success, since some activists say they do little more than advertise to the community the doctors who provide gender information.
Waiting for the transition
Demographers like Guilmoto say that India will reach a transition point in which the child sex ratio begins to stabilize and then work its way back to equilibrium. The question is how long that will take, and how badly society will be affected in the meantime.
He says that the census data and birth registrations have shown that while states with large populations, like Bihar and Uttar Pradesh, have seen an increase in the child sex ratio, smaller and more prosperous states -- like Delhi, Punjab and Haryana -- have begun to show signs of improvement. The sex ratios continue to be distorted in these states, but they are not getting worse.
He said families in states showing slight improvements still have a strong preference for sons, and face the pressure of wanting a smaller family, but they might have also realized that such uneven sex ratios are unsustainable.
"Probably these are people who have realized they are going to get themselves into a serious mess by overproducing sons," Guilmoto said.
Another reason could be that a slow but gradual process of greater gender equality has had an effect on people's attitudes and views. Such a transition will come to the rest of India when families in other states likewise realize that a distorted sex ratio is unsustainable, and as more women delay marriage, become better educated, have more bargaining power and take up more space in society.
"These women are the forerunners for what's in store for India," Guilmoto said. "How long it will take, we don't know."
He says the government should monitor this issue more closely and conduct annual surveys, rather than waiting for the census.
"Once in a while we have census data, and once in a while we start worrying and say, ‘Oh my god, look what happened,'" he said. "It would be like if you checked your team report every 10 years."
Accelerating the process
In order to more quickly bring back a sex-ratio equilibrium, public health and women's activists say there needs to be a change in mentality about the role of women in society.
The state must also strengthen the monitoring of doctors and regulation of technology. And a social-security system should be created so elderly parents need not rely on sons for support.
"Let's hope that there is political leadership. Let's hope that there is civil society [pressure]. Let's hope that people will wake up," George said. "It will happen. The question is, will it happen in the next 10 years? Will it happen in my lifetime? I don't know."
Jason Overdorf contributed to this report from New Delhi. This story was done in collaboration with Round Earth Media, which is a news source that partners with early-career journalists to cover important issues from overlooked parts of the world.