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INDIA’S MISSING GIRLS

HEARING

BEFORE THE

SUBCOMMITTEE ON AFRICA, GLOBAL HEALTH, 

GLOBAL HUMAN RIGHTS, AND 

INTERNATIONAL ORGANIZATIONS

OF THE

COMMITTEE ON FOREIGN AFFAIRS 

HOUSE OF REPRESENTATIVES

ONE HUNDRED THIRTEENTH CONGRESS

FIRST SESSION

SEPTEMBER 10, 2013

Serial No. 113–99

Printed for the use of the Committee on Foreign Affairs

(

Available via the World Wide Web: http://www.foreignaffairs.house.gov/ or

http://www.gpo.gov/fdsys/

(II)

COMMITTEE ON FOREIGN AFFAIRS 

EDWARD R. ROYCE, California, Chairman 

CHRISTOPHER H. SMITH, New Jersey 

ILEANA ROS-LEHTINEN, Florida 

DANA ROHRABACHER, California 

STEVE CHABOT, Ohio 

JOE WILSON, South Carolina 

MICHAEL T. MCCAUL, Texas 

TED POE, Texas 

MATT SALMON, Arizona 

TOM MARINO, Pennsylvania 

JEFF DUNCAN, South Carolina 

ADAM KINZINGER, Illinois 

MO BROOKS, Alabama 

TOM COTTON, Arkansas 

PAUL COOK, California 

GEORGE HOLDING, North Carolina 

RANDY K. WEBER SR., Texas 

SCOTT PERRY, Pennsylvania 

STEVE STOCKMAN, Texas 

RON DESANTIS, Florida 

TREY RADEL, Florida 

DOUG COLLINS, Georgia 

MARK MEADOWS, North Carolina 

TED S. YOHO, Florida 

LUKE MESSER, Indiana 

ELIOT L. ENGEL, New York 

ENI F.H. FALEOMAVAEGA, American 

Samoa 

BRAD SHERMAN, California 

GREGORY W. MEEKS, New York 

ALBIO SIRES, New Jersey 

GERALD E. CONNOLLY, Virginia 

THEODORE E. DEUTCH, Florida 

BRIAN HIGGINS, New York 

KAREN BASS, California 

WILLIAM KEATING, Massachusetts 

DAVID CICILLINE, Rhode Island 

ALAN GRAYSON, Florida 

JUAN VARGAS, California 

BRADLEY S. SCHNEIDER, Illinois 

JOSEPH P. KENNEDY III, Massachusetts 

AMI BERA, California 

ALAN S. LOWENTHAL, California 

GRACE MENG, New York 

LOIS FRANKEL, Florida 

TULSI GABBARD, Hawaii 

JOAQUIN CASTRO, Texas

AMY PORTER, Chief of Staff THOMAS SHEEHY, Staff Director

JASON STEINBAUM, Democratic Staff Director 

SUBCOMMITTEE ON AFRICA, GLOBAL HEALTH, GLOBAL HUMAN RIGHTS, AND

INTERNATIONAL ORGANIZATIONS

CHRISTOPHER H. SMITH, New Jersey, Chairman 

TOM MARINO, Pennsylvania 

RANDY K. WEBER SR., Texas 

STEVE STOCKMAN, Texas 

MARK MEADOWS, North Carolina 

KAREN BASS, California 

DAVID CICILLINE, Rhode Island 

AMI BERA, California 

(III)

C O N T E N T S 

Page

WITNESSES 

Matthew J. Connelly, Ph.D., professor, Columbia University ............................. 7

Sabu George, Ph.D., independent researcher ........................................................ 22

Ms. Jill McElya, vice president, Invisible Girl Project ......................................... 27

Ms. Mallika Dutt, president and chief executive officer, Breakthrough ............. 37

LETTERS, STATEMENTS, ETC., SUBMITTED FOR THE HEARING 

Matthew J. Connelly, Ph.D.: Prepared statement ................................................ 11

Sabu George, Ph.D.: Prepared statement .............................................................. 24

Ms. Jill McElya: Prepared statement .................................................................... 30

Ms. Mallika Dutt: Prepared statement .................................................................. 39

APPENDIX 

Hearing notice .......................................................................................................... 62

Hearing minutes ...................................................................................................... 63

The Honorable Christopher H. Smith, a Representative in Congress from 

the State of New Jersey, and chairman, Subcommittee on Africa, Global 

Health, Global Human Rights, and International Organizations: Material 

submitted for the record ...................................................................................... 64

The Honorable Ami Bera, a Representative in Congress from the State of 

California: Material submitted for the record ................................................... 68

Sabu George, Ph.D.: Material submitted for the record ....................................... 73

(1)

INDIA’S MISSING GIRLS 

TUESDAY, SEPTEMBER 10, 2013

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON AFRICA, GLOBAL HEALTH,

GLOBAL HUMAN RIGHTS, AND INTERNATIONAL ORGANIZATIONS,

COMMITTEE ON FOREIGN AFFAIRS,

Washington, DC. 

The subcommittee met, pursuant to notice, at 3 p.m., in room 

2200, Rayburn House Office Building, Hon. Christopher H. Smith 

(chairman of the subcommittee) presiding. 

Mr. SMITH. The hearing will come to order, and good afternoon 

to everyone. 

Today’s hearing will examine the problem of India’s missing 

girls. While for most of us today our attention is drawn to the unfolding crisis in Syria—as a matter of fact, I began this morning 

on C–SPAN’s Washington Journal program and yesterday introduced a resolution calling for the establishment of a Syrian war 

crimes tribunal—other atrocities continue unabated around the 

world. We cannot ignore these atrocities, among the most egregious 

of which is violation of human rights of the girl child and women 

in India. 

Women in India are confronted with a compounding crisis. By 

most estimates there are tens of millions of women missing in 

India due to devaluation of female life beginning in the womb. 

Sex-selective abortion and female infanticide have led to lopsided 

sex ratios. In parts of India, for example, 126 boys are born for 

every 100 girls. This in turn leads to a shortage of marriageable 

women, which then leads to trafficking in persons, bride selling 

and prostitution. 

I point out as prime sponsor of the Trafficking Victims Protection 

Act we have seen the consequences of the missing girls play out 

with devastating consequences not only in India, but in the People’s Republic of China as well. 

Perhaps the best figures we have concerning the magnitude of 

the problem come from India’s 2011 census figures, which finds 

that there are approximately 37 million more men than women in 

India. Indeed Prime Minister Singh has addressed this issue head 

on, stating, and I quote him in pertinent parts, ‘‘The falling child 

sex ratio is an indictment of our social values.’’ He says, ‘‘Improving this ration is not merely a question of stricter compliance with 

existing laws. What is more important is how we view and value 

the girl child in our society. It is a national shame for us that deVerDate 0ct 09 2002 16:20 Feb 06, 2014 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 F:\WORK\_AGH\091013\82762 HFA PsN: SHIRL
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spite this, female feticide and infanticide continue in many parts 

of our country.’’

Even when they are not killed outright either in the womb or 

just before birth, the bias against girl children manifests itself in 

situations where family resources are limited and little food is 

available; in boys being fed before girls, leading to greater incidence of malnutrition among girls and a mortality rate that is 75 

percent higher for girls below the age of 5 than for boys. 

The desire for a male child can be so great that there is a trend 

toward sex-change operations for girls between the ages of 1 and 

5, a process known as genitoplasty. Each year hundreds of girls reportedly are pumped with hormones and surgically altered to turn 

them into facsimile boys. India’s National Commission for the Protection of Child Rights has correctly stated that this highly unethical procedure is a violation of children’s rights as well as a perpetuation of the age-old preference for boys and biases against the girl 

child. 

But the roots of the present problem lie not only with cultural 

factors, but also misbegotten policy decisions, including population 

control policies that were hatched in the United States and, as a 

matter of fact, right here in Washington, which have had a disproportionately negative impact on India’s women. 

We will learn from our witnesses that this includes policies advanced by the United States Agency for International Development, 

or USAID, and funded by foundations such as the Ford Foundation 

and the Rockefeller Foundation, and abetted by nongovernmental 

organizations such as the Population Council and the International 

Planned Parenthood Federation. 

During the debate in the U.S. House of Representatives on a bill 

to ban sex-selection abortion, I noted that for most of us ‘‘it’s a girl’’ 

is cause for enormous joy, happiness and celebration, but in many 

countries, including our own, it could be a death sentence. Today, 

the three most dangerous words in India and China are ‘‘it’s a girl.’’

One witness today, Dr. Matthew Connelly, in his book, ‘‘Failed 

Misconception: The Struggle to Control World Population,’’ traces 

the sordid history of sex-selection abortions as a means of population control. 

In her book, ‘‘Unnatural Selection: Choosing Boys Over Girls, 

and the Consequences of a World Full of Men,’’ Mara Hvistendahl 

elaborates, and I quote in part, ‘‘By August 1969, when the National Institute of Child Health and Human Development and the 

Population Council convened another workshop on population control, sex selection had become a pet scheme.’’ She goes on, ‘‘Sex selection, moreover, had the added advantage of reducing the number 

of potential mothers. If reliable sex determination technology could 

be made available to a mass market, there was a rough consensus 

that sex-selective abortion would be an effective, uncontroversial 

and ethical way of reducing the global population. Fewer women, 

fewer mothers, fewer future children.’’

At the conference, she goes on to say, one abortion zealot, Christopher Tietze, copresented sex-selective abortion as one of the 12 

new strategies representing the future of global birth control. 

Planned Parenthood honored Christopher Tietze 4 years later with 

the Margaret Sanger Award. And, of course, she wrote the book, 

3

‘‘Child Limitation,’’ and another book which I read called, ‘‘The 

Pivot of Civilization.’’ In chapter 5 had—was entitled ‘‘The Cruelty 

of Charity’’ and makes the case as to why pregnant poor women 

should not get prenatal care because you get more of those kinds 

of people who don’t meet certain criteria. And I have read the book 

twice. It is a devastating indictment, and it certainly comported 

with the eugenics of her time. 

Hvistendahl writes that today, and I quote her again, ‘‘There are 

over 160 million females missing from Asia’s population.’’ That is 

more than the entire population of the United States of America, 

female population that is. And gender imbalance, which is mainly 

the result of sex-selective abortion, is no longer strictly an Asian 

problem. In Azerbaijan and Armenia, in Eastern Europe, and even 

among some groups in the U.S., couples are making sure that at 

least one of their children is a son. So many parents now select for 

boys that that has skewed the sex ratio at birth of the entire world. 

In the global war against baby girls, renowned AEI demographer 

Nicholas Eberstadt wrote in the New Atlantis, and I quote him,

‘‘Over the past three decades, the world has come to witness 

an ominous and entirely new form of gender discrimination, 

sex-selected feticide implemented through the practice of surgical abortion with the assistance of information gained 

through prenatal gender-determination technology. All around 

the world, the victims of this new practice are overwhelmingly 

female; in fact, almost universally female. The practice has become so ruthlessly routine in many contemporary societies that 

it has impacted the very population structures, warping the 

balance between male and female births, and consequently 

skewing the sex ratios of the rising generation toward a biologically unnatural excess of males.’’

Many European countries, including the United Kingdom, as 

well as several Asian countries actually ban sex-selection abortion. 

Even four States in America—Arizona, Illinois, Oklahoma and 

Pennsylvania—proscribe it. 

Sex-selection abortion is cruel and discriminatory, and it is legal. 

It is violence against women. Most people in and out of government 

remain woefully unaware of the fact that sex-selection abortion was 

a violent, nefarious and deliberate policy again that was foisted 

upon us by the population control movement. 

While India has taken steps to curb these practices, indeed passing a law to ban sex-selective abortion, and tempered cultural facts 

such as the need for brides to provide a high dowry that contribute 

to parents looking at their daughters as a liability, these laws are 

largely—or irregularly, I should say, enforced. 

Moreover there are laws at the State level which exacerbate the 

problem, mandating that parents only have two children, penalizing those who exceed this number, and denying benefits. This 

leads inevitably to sex-selective abortion and particularly in poor 

areas female infanticide, as parents will opt to have a son over a 

daughter especially when their first child is a daughter. 

We hope that this hearing will help us better understand how we 

can play a role in curbing such horrific practices and abuses 

against the girl child and women. What, for example, can we do to 

4

ensure that companies based in the U.S., such as General Electric, 

whose ultrasound equipment is used to determine the sex of a child 

in utero, take steps to prevent what should be a tool to promote 

life for both mother and child from being used as an instrument of 

death? Given the past role of U.S. agencies such as USAID and coercive population-control policies, what oversight do we need to 

conduct and make sure that such abuses do not creep their way 

into existing programs? Similarly to what extent are organizations 

that receive funding from the United States Government implicated in such practices? 

What role can our State Department play beyond compiling information regarding what is occurring in India with respect to 

what some have labeled gendercide to influence positively the Indian Government so its reform laws and policies that exacerbate 

skewed sex ratios, such as two-child laws, two-child-per-couple 

laws. By shining a light on what is happening in India with its 

missing girls, we hope to move forward toward a world where every 

woman is valued and deeply respected because of her intrinsic dignity, and where every child is welcomed regardless of his or her 

sex. 

I yield to my good friend Dr. Bera. 

Mr. BERA. Thank you, Chairman Smith, and thank you for holding this hearing really addressing the incredibly important issue of 

gender inequity not just in India, but certainly gender inequity 

throughout the world. And I look at this issue not just as a Member of Congress; I look at this issue as a doctor. But also the focus 

of this hearing is India, and I look at the issue as an Indian American, but the most important title I hold today is being the father 

of a daughter. And on that day where ‘‘it’s a girl’’ was told to us 

by our doctor, that was an incredibly joyous day. 

When my wife and I think about how we are raising our daughter, we are raising her to be a strong woman. We are raising her 

to be in full control of her body and her choices. We are raising her 

to stand up against discrimination and not succumb to discrimination. And it is not enough that we are raising our daughter that 

way, but it is an imperative that every girl and every woman on 

this planet is empowered that same way. And at its core that is 

the purpose of why this is such a critical issue. 

Son preference and sex selection really are products of this gender discrimination, and to address them we really have to deal 

with the underlying causes of bias against women and girls, and 

these are incredibly complex issues. There is a complex web of socioeconomic and cultural factors that result in discrimination 

against girls. You know, the chairman identified a few of those. 

These then manifest in sex-selective practices. So we have to address those underlying causes. 

The only way to achieve long-lasting and real change is really to 

engage in community-level campaigns to change attitudes and 

change cultural norms that perpetuate this bias against women 

and girls. 

Other manifestations of gender discrimination are the abhorrent 

rates of sexual violence that occur; child marriage; domestic violence; honor killings; the denial of basic health care, including basic 

family planning and maternal health services. 

5

I just had the chance to visit India recently, and there are grassroots efforts, and there are some very strong Indian women that 

are addressing this issue at the root cause, and we will hear from 

some of these strong women today and our witnesses. But when I 

was recently in Mumbai, I had the opportunity to visit a group 

called SNEHA that was started by women doctors in India. The 

whole point was that they saw far too much gender discrimination, 

they saw far too much violence against girls in India. And they 

would go into the slums and start working with these girls to build 

up their self-esteem, to build up their strength. But they didn’t just 

work with the girls, they also worked with the young men to 

change their attitudes, these boys, to make sure that they understood that women were equal to them, and they grew up as boys 

into men with an understanding of this gender equity. 

So it is incredibly important that we empower organizations like 

this that are homegrown organizations that are working at the 

grassroots level with girls to empower individuals. 

The best role for the U.S. to play is to remain a strong supporter 

and leader within the global community in order to best promote 

women’s rights and the freedom of every woman to make personal 

decision about her health, her body and her future to really empower women. 

The U.S. is a global leader in providing investment in the health 

and rights of women and girls globally. USAID’s family-planning 

programs support healthy timing and spacing of pregnancies, community-based approaches, contraceptive security and integration 

with HIV and maternal and child health programs. 

The best way to empower a person and to prevent sex selection 

is actually to empower someone to plan when they are ready to 

start a family, to empower someone to plan when they are ready 

to get pregnant. That is just basic logic, and that is the best way 

to prevent sex-selective abortion. 

More than 222 million women around the world want to delay 

or prevent pregnancy, but they don’t have access to basic contraception. In 2012, nearly 300,000 women died because of complications due to pregnancy and childbirth. Fully meeting the needs of 

contraceptive access and effective birth spacing would annually 

prevent 1.8 million deaths of children under 5. That is 25 percent 

of all child deaths. We can do better than this, and we have the 

tools and the methodology to help reduce this. 

I also want to make clear when talking about women’s human 

rights, including reproductive rights, coercion of any kind is unacceptable in the provision of health care, and international leaders 

should oppose any human rights abuses by working to promote 

women’s health and rights globally. 

Women everywhere should have the right to determine if, when 

and how often they have children. Likewise, all women deserve 

quality health care during and following pregnancy for both themselves and their families. And as a physician, I know that when 

women have equal access to quality health care, they lead a more 

empowered and fulfilling life. 

While the goal is to mitigate gender discrimination and move toward equitable women’s human rights, it must be done so in a way 

6

that maintains her rights to make any reproductive health decisions that she deems appropriate for herself and her family. 

Finally, I would like to submit for the record an article written 

by Sneha Barot of the Guttmacher Institute regarding son preference and sex-selective abortion bans. 

Mr. SMITH. Thank you very much. 

I would now like to go to Mr. Weber. 

Mr. WEBER. Thank you, Mr. Chairman, for calling the hearing. 

I am not going to have any long remarks because they are going 

to be calling votes, I think, in about 35 or 40 minutes, and I am 

anxious to get started. 

Mr. SMITH. Mr. Meadows. 

Mr. MEADOWS. Thank you, Mr. Chairman, for holding this hearing, and this is something that is near and dear to my heart. As 

the chairman knows, I just applaud him on holding it. But as we 

start to look at the value that we place on life and little girls in 

particular, there is no greater tragedy than the story that is unfolding in India and in China as well, but particularly in India. And 

as we see this, it is something that we must stand up and be a 

strong voice internationally, and also be one that is unflinching in 

what we condone or don’t condone. There are many times that we 

look at the economic viability of a nation, and we condone behavior 

in another nation as a trading partner, and yet we wouldn’t condone it here in the United States. 

And I think that that same standard that we apply when we do 

not put value on life, and particularly in India on girls, not only 

does it create an imbalance, but it also goes further to just have 

horrific stories that are told day in and day out that touch my 

heart. 

It also promotes human trafficking, as we know. And my daughter, who has just turned 20, has made it a life goal to intervene 

in terms of human trafficking. And when you start to hear those 

kinds of stories on a daily basis where they have names, and they 

have parents, and they have grandparents, it is touching. It is 

something that I am committed to working with the chairman on 

to do all that we can do to stop this plague. 

And with that I yield back to you, Mr. Chairman. 

Mr. SMITH. Thank you very much, Mr. Meadows. 

I would like to now welcome our distinguished witnesses to the 

witness table, beginning first with Dr. Matthew Connelly, a professor of history at Columbia University. He has written two books 

and many articles. One of the books that he has written is entitled, 

‘‘Fatal Misconception: The Struggle to Control World Population,’’ 

published in 2008, and is particularly relevant to our discussion 

today. This book was widelyacclaimed when it came out and has 

been the point of much discussion since. Dr. Connelly has also 

served as consultant to the Bill and Melinda Gates Foundation and 

the International Assessment and Strategy Center. 

We will then hear from Dr. Sabu George. Dr. George is an expert 

in the field of female infanticide, girl child neglect, and female sex 

selection, and has worked on these issues for over 28 years. He has 

written one-child sex ratios—he has written on child sex ratios, 

genocide and sex-selection, and on emerging technologies of sex selection. He has undertaken extensive field research in India, was 

7

involved with the public interest litigation in the Indian Supreme 

Court to restrain the misuse of fetal sex determination. Dr. George 

has been appointed by the Government of India to monitor the 

issue of fetal sex determination and has spoken many times, again, 

on this topic. 

We will then hear from Ms. Jill McElya, who is an attorney 

whose experience includes extensive public service. In 2008, she 

moved to India to serve in a field office of an international human 

rights organization. While living in India for 2 years, Jill and her 

husband were exposed to the practice of female gendercide. After 

extensively studying the issue and forming relationships with Indian organizations that combat the problem, they founded the Invisible Girl Project to end gendercide in India by raising global 

awareness concerning the loss of female lives in India, pursuing 

justice for lives lost, and assisting Indian organizations in the rescue and care of vulnerable Indian girls. 

We will then hear from Ms. Mallika Dutt, who is a founder of 

global human rights organization Breakthrough. Working worldwide through centers in India and the United States, Breakthrough 

seeks to make violence and discrimination against women unacceptable by engaging in a diverse range of actors to promote values 

of dignity, equality and justice. Ms. Dutt is member of the Council 

of Foreign Relations and serves on several boards and communities 

including the World Economic Forum, Global Agenda Council on 

India, Games for Change and the Public Interest Project. 

Dr. Connelly, if you could begin, you all could come to the table, 

I would appreciate it. 

STATEMENT OF MATTHEW J. CONNELLY, PH.D., PROFESSOR, 

COLUMBIA UNIVERSITY 

Mr. CONNELLY. Chairman Smith, members of the committee, 

thank you for giving me this opportunity. 

I am a professor of history at Columbia University, and I spent 

some 10 years researching population control around the world. I 

worked in more than 50 archives, and I interviewed some key figures in USAID, in the Indian Government, in the United Nations 

and leading NGOs, and what I discovered is that sex-selective abortion is not something that we can blame on backwardness. Rather 

than a problem of benighted people who need to be developed, it 

was actually development professionals who first promoted the idea 

of helping people to have only sons. 

The story begins in the 1960s when the U.N., the wealthiest 

foundations and a host of Nobel Prize winners agreed that population growth was one of the gravest threats facing humanity. Both 

the Democratic and Republican Party platforms of 1968 agree that 

population control should be an urgent priority. Paul Ehrlich’s ‘‘The 

Population Bomb’’ famously predicted massive famines, and he 

called for using food aid to force poor countries to control population growth. But Ehrlich was a Stanford biologist, so he also 

called for more research. And I am going to quote from ‘‘The Population Bomb’’: ‘‘If a simple method could be found to guarantee that 

first-born children were males, then population control problems in 

many areas would be somewhat eased.’’

8

The head of research at the Planned Parenthood Federation of 

America, Steven Polgar, is also an advocate of sex-selective abortion and for the same reason. Bernard Berelson, president of the 

Population Council, considered it one of the more ethical methods 

of controlling population growth. It is not surprising, considering 

some of the other methods that Berelson and Ehrlich were considering, such as introducing sterilizing agents into the food and 

water supply. 

The Population Council sent the head of its biomedical division, 

Sheldon Smith, to New Delhi, and it was Segal—or Sheldon Segal, 

I should say, who first introduced Indian doctors in how to determine the sex of a fetus, the practice that he promoted as a means 

to control population growth. 

The men who led population-control programs—and they were all 

men—gave no consideration to the consequences of reducing the 

relative number of women. In India, Pakistan, Bangladesh and Indonesia, Western diplomats helped pay people to be sterilized, and 

Western consultants advised denial of health care and education to 

those who refused. 

When in 1975 Indira Gandhi declared a state of emergency and 

used the police and army to march people to sterilization camps, 

foreign donors increased their support. In the span of 1 year, India 

sterilized some 8 million people and gave the green light to States 

to make sterilization compulsory. ‘‘At long last,’’ World Bank president Robert McNamara declared, ‘‘India is moving to effectively reduce its population problem.’’ Now instead, Indira Gandhi was 

voted out of office, and in 1978, Indian feminists succeeded in having sex-selective abortion banned from government hospitals. 

Now, India had long been a testing ground for population control, 

but popular democracy limited what could be done there. It was 

Communist China with its one-child policy who took population 

control to new extremes. Now here again Western advisers provided crucial support. The Chinese affiliate of the International 

Planned Parenthood Federation had 20 million volunteers. U.N. 

computers were crucial in calculating the number of birth permits 

for each commune, and U.N. centers trained 70,000 personnel to 

back them up. 

Periodic crackdowns peaked in 1983, when China sterilized over 

20 million people and carried out 14 million abortions. The U.N. responded by awarding the head of the program with the first U.N. 

Population Award. Indira Gandhi was the cowinner. 

A bit of resistance in rural areas gradually led Chinese cadres to 

allow farmers with one daughter to try to have a son, but a key 

element in this mutual accommodation was the ultrasound machine; ultrasound machines, which started to become imported 

abroad, at least some of them through international grants and 

loans. It is hard to know how many because the World Bank, for 

instance, won’t open up its files to let us find out what it was providing. 

But it is important to note that this wasn’t just a matter of international organizations and nongovernmental organizations. It was 

also a matter for the private sector, and especially General Electric. 

Producing ultrasound machines was GE’s first joint venture in 

China. 

9

Now, to be sure, both India and China have tried to stop the 

practice, but these governments long sought to make parents 

ashamed merely for having more than one or two children when 

they did not make actually make it illegal. Now, why should we be 

surprised when couples now ignore government decrees, especially 

when they would limit their ability to plan their own families? 

Now, similarly for decades American experts and activists advised Asian countries to adopt these manipulative and coercive 

measures, employed untested and risky medical technologies, and 

used Western loans and grants to pay for it all. Now, the results 

were so disastrous that in India the term ‘‘family planning’’ itself 

is completely discredited, and advocates must use euphemisms like 

‘‘family welfare.’’

Now, we should not, therefore, expect that Asian countries will 

be eager to hear our advice. But it is precisely because the U.S. 

took a leading role in population control that we cannot pretend we 

have no responsibility for the consequences. 

The first step is simply to acknowledge this history. It was only 

after a long, hard struggle that family-planning organizations rejected population control and rededicated themselves to the principles of reproductive rights and health. As long as these organizations refuse to come to terms with this history, they will be vulnerable to accusations that they are still trying to control people instead of empower them. 

Now, the world is a very different place, and these organizations 

are very different from what they once were, but the future will 

present radically new challenges and new dangers. Now, we know 

longer face a population explosion after all, and more and more 

countries are adopting incentives to boost birth rates, and they 

may be tempted to try more coercive measures. My great fear is 

that instead of population control to reduce population growth, we 

are going to see the return of pronatalist programs and policies like 

we saw in the 1930s in places like the Soviet Union and Nazi Germany. 

Now, many individual couples are desperate to have children, of 

course, and this is especially the case in African countries which 

have stratospherically high infertility rates. And in wealthy countries some are tempted to use biotechnology to have superior offspring, or even to outsource their pregnancies to India. 

These issues pose excruciating ethical choices, but none turn on 

intractable issue of when life begins. Instead, they turn on something no less fundamental: The quality of life and the way our 

choices can make life more or less meaningful. 

Now, my hope is that pro-life and prochoice people of good faith 

will begin to find common ground. We must work together to ensure that everyone has access to birth control and the help they 

need to bear and raise children without coercion or manipulation. 

We might agree that society has an interest in potential life to be 

balanced against the rights of the mother and together fight sexselective abortions worldwide, and we could demand that infertility 

treatment become part of comprehensive health care for all, in Africa no less than the United States. 

To conclude, it is not enough merely to insist on choice. Choices 

can be conditioned by design or default in ways that lead to new 

10

kinds of oppression. And the defense of life can also become a symbol without substance if the effect is to drive people to breed. Reproductive freedom is a cause that can and must stand on its own 

now more than ever, but it can only take flight if it is animated 

by a vision of social justice in which every one of us is conceived 

in liberty and created equal. Thank you. 

Mr. SMITH. Dr. Connelly, thank you very much for your testimony. 

[The prepared statement of Mr. Connelly follows:]

11


82762a-1.eps

CONFRONTING THE LEGACIES OF POPULATION CONTROL: HISTORICAL PERSPECTIVES ON 

THE GLOBAL SPREAD OF SEX-SELECTIVE ABORTION 

Written Statement to the House of Representatives Committee on Foreign Affairs, 

Subcommittee on Africa, Global Health, Global Human Rights, and International 

Organizations 

September 10, 2013 

Matthew Connelly 

Professor of History, Columbia University 

Chairman Smith, Ranking Member Bass, Members of the Committee, thank you for this 

opportunity to testify today about this terrible predicament, in which technologies that 

might serve women's rights and health are instead making them a persecuted minority in 

the largest countries in the world. 1 am a professor of history at Columbia University, and 

1 have spent some ten years researching population control around the world - both 

campaigns to control fertility, and eugenic programs to weed out the "unfit." To 

reconstruct this history, I worked in more than fifty archi ves, including government and 

private collections in Delhi, and I interviewed key figures from the Indian government, 

USAID, the United Nations, and leading NGOs. I've also spent time talking with 

ordinary people in India who paid the price for population control experiments, but still 

lack access to basic maternal and reproductive healthcare. 

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I devoted myself to this subject so as to better understand one of the great historical 

transformations of our time: More and more, world politics pivots not on the control of 

territory, but on the politics oflife and death. As members of this committee know full 

well, struggles over epidemic disease, clean water, and the protection of minorities and 

refugees are as important as any war. In fact, by contributing to the increase in lifeexpectancy, they have had a greater impact on world population than all the wars put 

together. And if you believe - as I do - that the struggle for gender equality is one of the 

defining issues of our time, there can be no more important question than why boys 

increasingly outnumber girls, and what kind ofworld they will inherit ifwomen have 

become a minority. 

Sex-selective abortion is just one of a host of new issues that are shifting 

reproductive politics into uncharted territory. So too is the global decline in fertility, 

the rise of international adoptions and surrogacy, and the prospect that wealthy 

people will use biotechnology to make themselves a breed apart. These emerging 

challenges will put abortion in a different perspective and present opportunities for 

pro-life and pro-choice people to work together. But that requires taking a global 

view, and recognizing how our current predicament is the result of past policies -

and how the future will present radically different dangers. 

When most people consider sex-selective abortion, they think of it as something that 

happens in faraway places, backward regions where women are undervalued and men 

still rule. If they think about it a bit more, they might begin to realize how the preference 

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for sons has also had an impact on our country, considering the growth of international 

adoptions, and the kind of children who are usually put up for adoption. And the 

prejudice against girls continues among Asians who migrate to the U.S., even among 

well-educated, more affluent citizens. 

But what I began to realize during my research is that these are just parts of a much 

bigger story, a story in which American scientists, aid officials, and activists played 

leading roles. Rather than a problem of benighted people who need to be "developed" 

and instructed in more enlightened ways, it was development professionals who first 

promoted sex-selective abortion as a potential solution to what they saw as the population 

explosion. 

That story begins in the 1960s, when many people believed that accelerating population 

growth was reaching the point of crisis. In 1968, virtually identical planks in the 

Democratic and Republican platforms held that population control should be an urgent 

priority It was that year that the Sierra Club commissioned Paul Ehrlich to write his bestseller, lhe Population Bomb. Soon Ehrlich began making regular appearances on the 

Tonight Show - he was the only author to ever be given an entire program - and he 

inspired a grass roots movement called Zero Population Growth. 

Ehrlich is usually remembered for his predictions that the world would suffer massive 

famines, hundreds of millions would die, and the US would have to cut off food aid to 

countries that could not control population growih. But Ehrlich was a Stanford biologist, 

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not just a prophet of doom, and he therefore called for more research: "if a simple method 

could be found to guarantee that first-born children were males, then population control 

problems in many areas would be somewhat eased." 

Ehrlich was only the most prominent advocate of sex-determination as a way to control 

population growth. The head of research at the Planned Parenthood Federation of 

America, Steven Polgar, also urged biologists to find a method for sex-determination. 

Bernard Berelson, the president of the Population Council, wrote a particularly influential 

article in 1969 that listed sex-determination as one of the more ethical methods of 

controlling population growth ifit proved necessary to go "Beyond Family Planning." As 

Mara Hvistendahl notes, it is not so surprising the Berelson and Ehrlich were untroubled 

by the ethics of sex-determination, considering some of the other methods they were 

considering, such as introducing sterilizing agents into the food or water supply. 

The Population Council had already sent the head of its biomedical division, Sheldon 

Segal, to New Delhi to help to set up the department of reproductive physiology at the 

country's leading medical school. The All-India Institute of Medical Sciences also 

received major funding for research in this field from the Ford and Rockefeller 

Foundations. It was Segal who first instructed Indian doctors in how to determine the sex 

of a fetus, and he publicly advocated the practice as a means to control population 

growth. The All-India Institute began offering amniocentesis tests in 1975, and by the 

late 1970s it was clear that it was being used systematically to abort female fetuses. 

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In this period, population controllers also worked to reduce the cost of abortion. The head 

of US AID's population office, Reimert Ravenholt, had plans to manufacture and 

distribute millions of abortion kits worldwide, even in countries where it was still illegal. 

He would have done it too, were it not for the Helms Amendment. Ravenholt thought 

that, eventually, even the poorest people would find the money to pay for an abortion, 

though it's not clear whether he was thinking of sex-selection. 

What is clear is that, at the height of their power and influence, the American men who 

provided most of the money for population control programs worldwide - they were all 

men - considered controlling population growth an overriding priority, and gave no 

consideration to the consequences of reducing the relative number of women. In India, 

Pakistan, Bangladesh, and Indonesia, Western donors helped pay people to be 

sterilized, and Western consultants advised denial of health care and education to 

those who refused. When, in 1975, Indira Gandhi declared a state of emergency and 

used the police and anny to march people to sterilization camps, foreign donors actually 

increased their support. In the span of one year, India sterilized eight million people, and 

gave a green light for states to make sterilization compulsory for those with three 

children. "At long last," Robert McNamara declared, "India is moving to effectively 

address its population problem." Instead, Gandhi was voted out of office in the first-ever 

national defeat for the Congress Party. And in 1978 Indian feminists succeeded in having 

sex-selective abortion banned from government hospitals. 

India had long been a testing ground for population control, but popular democracy 

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limited what could be done there. It was Communist China, with its one-child policy, that 

took population control to new extremes, provoking desperate people to start using 

abortion to guarantee a son. The Politburo was inspired by predictions of a Malthusian 

disaster from the Club of Rome - an elite group of environmentalist technocrats - but 

also by the idea that they could improve the eugenic quality of China's population. 

The specific methods they began to use in the late 1970s were much the same as those 

Western experts had been advocating across the rest of Asia: mobile IUD and 

sterilization teams, incentives and disincentives, and concerted peer pressure. But senior 

International Planned Parenthood Federation (IPPF) and U.N. staff feared that making a 

one-child policy ot1'icial would make it more dimcult to defend to the media. Their 

hesitation was overcome when Japan, a key donor, demanded that they help stop 

population growth in China. The IPPF directed aid to a voluntary association. Twenty 

million "volunteers" came forward, led by active or retired government otlicials. The 

U.N. Fund for Population Activities insisted its aid was "technica!." But UN. computers 

were crucial in calculating the number of birth permits for each commune, and U.N. 

centers trained 70,000 personnel to back them up. 

Periodic crackdowns peaked in 1983, when China sterilized over twenty million people 

and carried out fourteen million abortions. The U.N. responded by awarding program 

chiefXinzhong Qian - a Soviet-trained People's Liberation Anny general- with the first 

U.N. Population Award, complete with diploma, gold medal, and $12,500. Indira Gandhi 

was the co-winner. 

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Bitter resistance in rural areas gradually led cadres to allow farmers with one daughter to 

try and have a son. Those who had prospered with the coming of market reform could 

afford to pay fines or move to China's growing cities. The policy of granting exceptions 

was gradually formalized. A key element in this mutual accommodation was the 

ultrasound machine, which began to arrive in rural areas in the early '80s. They could be 

used to determine whether an intrauterine device (TIm) was still in place or to detect 

birth defects, thus serving both the quantitative and the eugenic goals of the one-child 

policy. But it could also be used to determine the sex of a fetus by the fifth month in 

order to abort females for parents who preferred sons. 

Initially, China depended on foreign sources for ultrasound machines. The second half of 

the 1980s marked the peak period of imports, with 2,175 aniving in 1989, though it is not 

clear how many came through international aid. In 1990 the Australian Agency for 

International Development shipped 200 ultrasound machines to China as part of a $4 

million dollar grant. Foreign Minister Gareth Evans was asked whether he would seek 

assurances that they would not be used for coercive abortions. "I am not," Evans replied, 

"going to ask anybody anything," retorting that the unregulated export of coat hangers 

could also be used for abortions. In 1994, a guide to doing business in China listed 

ultrasound machines as one of the "HOT items," and advised exporters to "monitor the 

medical research programs of the World Bank and other multilateral agencies." For a 

decade already the World Bank had been providing hundreds of millions of dollars in 

interest free loans for "Population-Health-Nutrition" projects in China, though the Bank 

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has not allowed researchers to examine the files and see whether it was paying for 

ultrasound machines. 

China gradually gained the capacity to make as many as 10,000 of its own machines 

every year. With prospective parents paying as much as $50 to determine the sex of their 

fetus, they could pay for themselves. In its very Erst joint venture in China, General 

Electric set up a plant to produce still more ultrasound machines. By this point, the 

combination of ultrasound and late term abortions was already known to be shifting the 

sex-ratio all across China. 

To be sure, both India and China have tried to stop the practice, both through law and 

public education campaigns. But after many decades of manipulative and even coercive 

population programs, these governments have a major credibility problem. After all, they 

long sought to make parents ashamed and embarrassed merely for having more than one 

or two children, when they did not actually make it illegal. They also presented family 

planning as a panacea for the problems of poverty and poor health. Why should we be 

surprised if couples now ignore government dictates, especially when they would limit 

their ability to plan their own families? 

Similarly, for decades American experts and activists advised Asian countries to adopt 

these manipulative and coercive methods, employ untested and risky medical 

technologies, and use Western loans and grants to pay for it all. The results were so 

disastrous that in India the term "Family Planning" itself is completely discredited, and 

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advocates must use euphemisms like family welfare. We should not, therefore, expect 

that Asian countries will be eager to hear our advice about how to deal with sex-selective 

abortion. 

But it is precisely because the US took a leading role in advocating population control 

worldwide that we cannot pretend that we have no responsibility for the consequences. 

The first step in taking responsibility is simply to acknowledge this history. It was only 

after a long, hard struggle that family planning organizations rejected population control 

and rededicated themselves to the principles of reproductive rights and health. As long as 

these organizations refuse to come to terms with their history, they will be vulnerable to 

accusations that they are still trying to control people, rather than empower them. 

Looking back at the era of the Population Bomb, when the abortion wars first began, we 

can see that the world is now a very difIerent place. Sex-selective abortion is just one of a 

host of new challenges that cannot be defined or even understood as a Manichean 

struggle between "pro-life" and "pro-choice" forces. We no longer face a population 

explosion, after all, and more and more countries are adopting incentives to boost low 

birth rates. Many individual couples are desperate to have children, especially in African 

countries with extremely high infertility rates. And in wealthy countries, some are 

tempted to use biotechnology to have superior offspring, or even outsource their 

pregnancies to India. 

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These issues pose excruciating ethical choices. What happens when governments 

find incentive payments don't persuade couples to have more children, and begin 

implementing more manipulative or even coercive measures? How can infertility 

treatment and adoption be regulated without prolonging the ordeal for childless 

couples? How should we consider abortion in places where women are pressured to 

bear only sons - or in a future in which everyone will feel pressured to have perfect 

children? But none ofthese questions turn on the intractable issue of when life 

begins. Instead, they concern something no less fundamental, the quality of life, and 

the way our choices can make life more or less meaningful. 

It may seem naive to think that challenges like sex-selective abortion, coercive pronatalism, and genetic "enhancement" might bring about a peace process in this 

bitterest of culture wars. But what is the alternative? Those who consider 

themselves pro-life must eventually realize that manipulating people so they will 

have more children - no less than coercing them to have fewer - cheapens all of our 

lives. And those who consider themselves pro-choice would be in a stronger 

position if they were at the forefront in opposing all manipulative and coercive 

practices designed to control populations. 

There are some encouraging signs. Family planning groups are beginning to speak 

out in defense of Chinese dissidents who protest the one-child policy. Some prolifers have recognized that promoting access to contraception is the best way to 

reduce the incidence of abortion. But a new agenda that can renew and revive the 

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cause of reproductive freedom will require much more, beginning with a greater 

effort to find common ground by pro-life and pro-choice people of good faith. We 

must work together to ensure everyone has access both to birth control and the help 

they need to bear and raise children without coercion or manipulation. We might 

agree that society has an interest in potential life, to be balanced against the rights 

of the mother, and together fight sex-selective abortions worldwide. Both sides 

could also join in recognizing international adoption - now anarchic and inequitable 

- as ripe for advocacy and reform. We can demand that infertility treatment become 

part of comprehensive health care for all, in Africa no less than the U.S. And if we are 

to permit new technologies to select out predispositions for health problems, or 

even "enhance" future generations, these choices too must be given to everyone 

equally. 

It is not enough merely to insist on choice. Choices can be conditioned by default or 

design in ways that lead to new kinds of oppression. And the defense of life can also 

become an idol, a symbol devoid of substance, ifthe effect is to drive people to 

breed. Reproductive freedom is a cause that can and must stand on its own, now 

more than ever. But it can only take flight if it is animated by a vision of social justice 

in which everyone of us is conceived in liberty and created equal. 

11 
22

Mr. SMITH. Dr. George. 

STATEMENT OF SABU GEORGE, PH.D., INDEPENDENT 

RESEARCHER 

Mr. GEORGE. I am most grateful to the U.S. Congress for holding 

this hearing. Particularly I thank the chair, Chris Smith, Representative Mr. Bera, and Mr. Weber, and Mr. Meadows and Mr. 

Marino for coming at this point despite a crucial debate on Syria 

in the House. 

I am greatly honored to be here, to be invited by a committee 

which was once chaired by a great Congressman like Tom Lantos 

of California. 

My name is Sabu George, and I have been working on protecting 

girl children for the last 28 years. I have had the great privilege 

of studying public health and nutrition. I lived in U.S. for 91⁄2

years. 

And I am delighted that a lot of the remarks which Mr. Chris 

Smith spoke about, the early history, is something I don’t need to 

repeat. And in terms of the challenges in terms of what population 

control faces today, Mr. Bera has addressed that, so I think we 

have many things which I need to state which has already been 

said. 

Yes, we are dealing with sex selection has become a genocide. 

More girls in India and China are eliminated every year than the 

number of girls born in America. Today you have 2 million girls 

born in America, but we have more than that being eliminated in 

India and China. Particularly in the Indian context over last decade, India eliminated more than 6 million girls. This is much larger than the number of Jews eliminated during the Holocaust. 

And I think what I would like to emphasize very clearly, we have 

a history of discrimination against women for several centuries, but 

the kind of magnitude of discrimination what we are seeing in the 

country today has no parallel. And I think Chris Smith has emphasized it, and therefore what I would like to emphasize is that what 

we are facing today in eastern India, southern India, in Kashmir, 

in Himalayan States, which does not have the forms of discrimination against women as in northwest India, we are seeing these 

parts. So the role of the medical profession, the role of corporations 

cannot be ignored. 

While I think we have seen emergence of consequences like 

forced polyandry, which is hardly talked about in northwest India, 

several men sharing one wife, which is common, the levels of violence against surviving women are increasing, and what is most 

disturbing for us is that in the coming decades, what progress 

woman had achieved in education and employment opportunities 

will indeed be very strongly affected because of the threat of violence in homes and outside homes. 

I think history of sex selection all of you have heard. But I think 

coming to the corporations that the chairman Chris Smith had 

talked about, the role of GE, I mean, you had the Wall Street Journal write about it. Now I think I would like to look at the role of 

Google, which today promotes new technologies of sex selection. 

Today they are advertising new products long before they are proven to be effective. 

23

We would appeal to all of you to ensure that the U.S. corporations respect Indian law. And recently we saw this case of online 

advertisement which Google was caught in a sting, and the Justice 

Department had a major settlement, got $500 million fined from 

Google. We hope that U.S. corporations will abide by the laws in 

our country, and I have a petition against Google in the Indian Supreme Court. We have heard the kinds of arguments like Google 

India tells us, you know, to the court, we don’t know who Google—

what—who owns Google America. So we hope, sir, that American 

corporations do not benefit from the holocaust what is happening 

in our country. 

We have a good law against sex selection, and I would like to emphasize, sir, that there is a State like Maharastra, which is one of 

the biggest States, where, because of the work of a good lawyer like 

Varsha Deshpande, more than 50 doctors have been convicted, 

which is a great thing in our Indian legal system, which goes on 

perpetually. 

And so law makes a deterrence. Unfortunately the rest of India, 

we don’t have that, and we do need to ensure that changing 

mindsets is one part, but ensuring in the context of a genocide that 

laws need to be followed. 

And so you had mentioned about funding USAID. You had mentioned about international organizations. I think what I would like 

you to be very, very clear, sir, is that the history, we should not 

forget the recent history. There are times when USAID was thrown 

out of the country because the Indian Government didn’t like it. 

And I think it is extremely important, sir, not just to focus on cutting funding to USAID, cutting funding to international organizations, but engaging with the government, dealing with what needs 

to be done, because ultimately, you know, it is extremely easy in 

our country to raise factions against any big powers and which will 

not solve the problems of millions of our poor women. 

And, sir, please do not see sex selection, which is an extreme 

form of violence against women, as a problem of abortion. It is extremely important in the Indian context where entire responsibility 

of contraception is put onto women, where men don’t accept any responsibility, that women do have to have rights for abortion in our 

country. 

And so we request that the American Government, the American 

Congress does indeed actively engage with the Government of 

India, with the Indian Parliament and ensure that, you know, this 

holocaust does not continue. Thank you. 

Mr. SMITH. Thank you very much, Dr. George. 

[The prepared statement of Mr. George follows:]

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Testimony by Sabu M George, MA(Johns Hopkins), PhD(Comell) 

Researcher and member of India's Campaign Against Sex Selection 

Hearing on India's Missing Girls by House Subcommittee on Africa, Global Health, Global Human Rights & International Organisations 

Appreciation 

I am most grateful to the US Congress for holding this hearing Particularly the Chair Chris Smith 

and the members for inviting me. Greatly honoured to be invited to this Committee (Foreign 

Affairs) which was once Chaired by a great Congressman like Tom Lantos of California. 

Who amI 

My name is Sabu George and been working on protecting girl children (against practices of 

deliberate girl child neglect, female infanticide and sex selection) in India for 28+ years. I had the 

honor of studying public health and nutrition at Johns Hopkins and Cornell Universities under well 

known American Professors. Our early work in India in the mid-80s resulted in recognition of 

female infanticide by the TamilNadu Government in 1991. Later, I documented the spread of sex 

selection in rural Haryana in mid-90s and been involved with public campaigns against female 

foeticide since late 90s. Subsequently T have worked for strengthened legislation against female 

foeticide by litigation in Indian Supreme Court and lobbying with Parliament (1998-2003). Finally, 

I have contributed towards creating public discourse in India since 200 1 on sex selection and 

continuing work with many partners to stop sex selection. 

Sex selection as Genocide 

Rampant Sex selection in recent decades has created a Genocide. As the Chair Smith has said at the 

screening of the film, "Its a Girl":- "(I)t is a crime against women, a gender crime that has no 

parallel or or precedent in all of human history" More girls in India and China are eliminated every 

year than the number of girls born in US. Over the last decade, 6 million+ girls were eliminated 

before birth in India; this is more than the number of Jews killed in the Holocaust by the Nazis. The 

intensitication and spread of sex selection, from fiercely patriarchal North West India to other parts 

of India which treated women better, has taken place over last two decades. East, South and North 

East, Kashmir and Himalayan States have all experienced sharp declines in child sex ratios against 

girls in the 2001 and 2011 Censuses. 

Long Term Consequences of extensive sex selection 

Four+ decades of practice of sex selection have led to the emergence of forced polyandry; ie., one 

woman being shared by several men in parts of Punjab, Haryana and Western UP. Violence against 

women has become worse in areas where sex selection has been extensive. Buying of women for 

marriage from other states has become an important reason for trafficking of women to North West 

India since 2000. In the coming decades, due to shortage of tens of millions of women, further 

progress in education and employment opportunities for millions of surviving women could 

possibly be affected; due to the increasing threat of violence against women inside homes and in 

public spaces. 

History of Sex selection and Medical Factors 

American researcher Mara Hvistendahl has highlighted the role of Americans and global population 

control lobbies in introducing sex selection in 1970 into India for population controL When foetal 

sex determination was banned in government hospitals in the late 1970s, the private medical clinics 

in India started promoting sex selection in North West and Western India. The role of unethical 

doctors and the collusion of medical associations in the spread of sex selection cannot be 

overlooked. They earn over hundreds of millions of dollars every year from the business of 

eliminating girls Medical education has become a bigger business than Defense in India. Sadly, 

admission into medical schools can be secured by paying money. Lucrative specialities like 

radiology can fetch at least $200,000 for the private institutions from each MD candidate. 

American Corporations Profiting from Sex selection in India 

The role of American ultrasound companies like GE, Sonosite is regrettable. In 2001, GE submitted 
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to the Indian Supreme Court the list of 6000 clinics to whom they sold ultrasound machines in the 

previous 5 years. The analysis of this data revealed that wherever GE had sold the most machines, 

those areas had the least girls born! Wall Street Journal's investigative journalism in 2007 also 

exposed the unethical business practices of GE. The violation of Indian law by Internet Companies 

like Google is also most unfortunate In the context of the genocide taking place in India, the US 

government should not allow Google to advertise and legitimise emerging technologies of sex 

selection to India; as this is a grave human rights violation. Sex selection tourism is worse than 

trafficking. Google carries advertisements targetting the privileged Indians for sex selection to 

Dubai, Thailand, US, Europe etc .. 

Indian Government efforts 

We have a good law against sex selection in India since 1994 thanks to the women's movement. 

The Indian Parliament strengthened it in 2002. Supreme Court has been directing the States since 

200 I to stop the crimes of sex selection. However implementation of the law is taking place only in 

Maharastra but not in rest of India; therefore the numbers of girls eliminated will increase in the 

coming years. It is likely that the child sex ratios will decline in the Census of 2021 if the present 

indifference to filing cases against the crimes of sex selection continues. 

Aggressive Population control will be at the expense of women and girls 

Families almost everywhere in India want to have fewer children today. But several political parties 

in India still advocate aggressive population control. Given that American government and 

foundations, institutions headed by Americans like World Bank have spent up to 60 years 

advocating & funding population control measures in India. I appeal to the US Congress to 

motivate India to stop targetting women for sterilisation and ensure that coercive family planning 

practices are abandoned. Smaller families will be achieved by even more elimination of girls if 

population control does not take place voluntarily. 

References 

1. Wall StreetJournal: Peter Wonacott; April 18,2007, page 1. 1ndia's Skewed Sex Ratio Puts GE 

Sales in Spotlight. (bttp:ilonline.wsj.com/article/SB 117683530238872926-

LiU9GakeaOizutC66 h JCWU kA 20080418.html) 

2. Aamir Khan Satyamev Jayate, Episode-I: Female Foeticide, Daughters are precious. 

(http://wwwsatyamevj ayatei n/i ssueO 1 0 

3. George SM: Sex selection/Detennination in India: Contemporary Developments. Reproductive 

Health Matters, Vol 10, no 19; 184-197,2002. 

4. George SM Millions of missing girls from fetal sexing to high technology sex selection in India. 

Prenatal Diagnosis, Vol 26 No 7 604-609, July 2006. 

5. George SM Sex ratio in India, Lancet, Vol 367, 1725, May 27,2006 

6. George SM, Dahiya RS. Female feticide in rural Haryana. Econ Political Wkly, 33: 2191-98, 

1998. 

7. George SM: The Government response to female infanticide in Tamil Nadu: from recognition 

back to denial? Reprod Health Matters, 1 0 124-32; 1997. 

8. George SM, Abel R & Miller BD: Female infanticide in rural South India. Econ Political Wkly, 

27: 1153-56, 1992. 

9. Raman A. Madhya Pradesh Family planning- Planning, Execution, Outllook, Mar. 12, 2012 

(http://vvww.outlookindia.com/artic1e.aspxo 280118). 
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10. Bloomberg Indian women choosing sterilisation sutIer rusty scalpel for Rs.600. Published in 

Mint Jun 12, 2013 (http://w>.w.livemint.com/Politics/vCvGPrnfddywr8y7wCOkGO/Indianwomen-choosing-sterilization-suffer-rustv-scalpel-for.html). 

11 Uppal L Sterlisation by default: Where's choice in family planning? Kashmir Times, Sept 4, 

2013. 

12. Chamberlain G UK aid helps to fund forced sterilisation of India's poor. Guardian: 14 April 

2012 (http://wwwtheguardian.com/world/2012/apr/15/uk-aid-foreed-sterilisation-india). 
27

Mr. SMITH. Ms. McElya. 

Mr. WEBER. Is it McElya? 

Ms. MCELYA. It is McElya. Thank you. Very good. I think you 

are one of two people I have ever met who actually pronounced it 

right. 

Mr. WEBER. Your husband and me. 

Ms. MCELYA. That is true.

STATEMENT OF MS. JILL MCELYA, VICE PRESIDENT, 

INVISIBLE GIRL PROJECT 

Ms. MCELYA. Chairman Smith, members of the subcommittee, 

thank you so much for inviting me to testify today about an issue 

that I have become very passionate about, and that is India’s missing girls. As you heard in my biography from Chairman Smith, I 

was living in India, I am an attorney, and I was working for a 

human rights organization. My husband is a pharmacist, and he 

was doing medical camps in India at the time. And that is when 

we were exposed in 2009 to the practice of infanticide, which Chairman Smith talked about, which is the killing of a little girl when 

she is born just because she is a girl. 

My husband was in a rural village in south India, and he noticed 

that there were all these little boys running around, and there 

were no little girls. He learned that in this village the boys outnumbered the girls eight to one because of the practice of infanticide. 

He met a young woman I will call Prima today. Prima was the 

twelfth daughter born to her parents. Her mother felt intense pressure to have a son, and so she would become pregnant, give birth 

to a little girl, and then she and her husband would kill their own 

daughter. Once again, she would become pregnant because there 

was pressure from her husband and her in-laws to bear a son. She 

would have a daughter, and she and her husband would kill their 

own little baby girl. They did this 11 times, 11 times, and then 

they had Prima. And they decided, well, I guess we are not going 

to have a son; I guess we will spare Prima’s life. 

This is a face, this is a name behind the reality of infanticide in 

India. And when we were exposed to it in 2009, my husband and 

I decided we must move to action to do whatever we can in a country that we grew to love to combat this terrible practice which is 

extreme discrimination against little girls that has resulted in this 

gendercide, which is the genocide of women and girls in India. And 

that is when we founded Invisible Girl Project, and our mission is 

to end gendercide in India. We do this through partnering with indigenous organizations that are already doing wonderful work. We 

support these Indian organizations to combat this gendercide. 

And so through our work we have learned, of course, that infanticide is just a small part of this gendercide. As Chairman Smith 

mentioned feticide, sex-selective abortion is also a huge part of it. 

I sit before you today, I am 81⁄2 months pregnant with my second 

daughter. If I were a woman in India today, I would receive intense 

pressure, strong-arming, most likely, from my husband and my inlaws, to receive a sex-determination ultrasound to determine 

whether I was having a boy or a girl. This is illegal in India. The 

Prenatal Diagnostic Techniques Act of 1994 made this illegal. It is 

28

illegal to have an ultrasound to determine whether you are having 

a boy or a girl. But the law is not upheld. So as a pregnant woman, 

if I were in India, my in-laws would likely be pressuring me to 

have this sex-determination test done. If I complied and then realized I was having a little girl, I would then receive intense strongarming to have an abortion just because I am pregnant with a 

daughter. 

This practice is so widespread throughout India. There are estimates there are 2,000 sex-selective abortions performed daily in 

India of little girls. There is an estimate that there are 2 million 

little girls who are aborted annually just because they are girls. 

And I talk about the coercion that these women face from their 

in-laws, from their husbands to bear a son, because coercion is a 

huge part of this. These women are denied any choice. They are 

forced to break the law, to have sex-determination tests done, to 

have sex-selective abortions performed, and this is against the law 

in India. 

The law even recognizes the coercion. As an attorney, of course, 

I have read through this act thoroughly. I have read through the 

Supreme Court decisions on this act. And it is important to note 

that the law recognizes the coercion by family members. Family 

members can even be found guilty of breaking the law. Unfortunately, though, this law is not upheld, and so sex-selective abortion 

is widespread, and it is proliferating. 

As such, gendercide, infanticide, feticide, neglect, as Chairman 

Smith mentioned, accounts for such a huge chasm in the population. There is trafficking, there is marriage of child brides, because 37 million men, as a 2011 census pointed out—there are 37 

million more men than women in India, and these 37 million men 

have no brides, they have no one to marry. So women are trafficked 

in from other countries, they traffic children to become brides, and, 

as you know, sex trafficking has become a huge issue in this country. 

People want to fight sex trafficking, but people don’t realize the 

route is gendercide, especially in India, because there is this chasm 

in the population. 

There are studies that also show that violence against women is 

a result of gendercide, of the chasm in the population. We are all 

familiar with the rape case that happened in Delhi where there 

was a young woman who was a student who was raped on the bus 

and later murdered. Well, she died because of the rape, this gang 

rape. I will argue before you today that violence such as this is because of this chasm in the sex ratio between men and women, 

which is all a result of gendercide. 

As Americans we have taken the lead in asking countries to report on how they are combating trafficking. Isn’t the murder of 

girls and women which leads to trafficking every bit as important? 

Countries must report on what they are doing to save the lives 

of their daughters, and that is what I ask you today. Just as my 

husband and I were compelled in 2009 to start Invisible Girl 

Project to save the lives of little girls in India, I ask that you take 

the lead, that your ears be open today, and that you fight to save 

the precious lives of voiceless little girls who cannot save themselves. 

29

Let us ask these countries that have these huge chasms in their 

sex ratios that are allowing this gendercide to go on to report what 

they are doing to save their daughters so that girls no longer go 

missing. 

Thank you. 

Mr. SMITH. Thank you very much for your testimony. 

[The prepared statement of Ms. McElya follows:]

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INVISIBLE GIRL PROJECT 

PO Box 301103, Indianapolis, IN 46230 

www.invisiblegirlproject.org 

Testimony of Jill J\1cElya,JD. 

Vice President 

Invisible Girl Project 

September 10, 2013 

I louse Committee on Foreign Affairs, 

Subcommittee on Africa, Global Ilealth, Global Iluman Rights, and 

International Organi7;ations 

INDIA'S MISSING GIRLS 

Chainnan Smith and Members of the Subcommittee, thank you for the opportunity to testify 

regarding Indi~l's lVlissing Cirls. 1 ;-lm the Vice President of Invisible Ciirl Project, ~l not-for-profit 

organization based in the United States that seeks to end gendercide-that is the genocide of the 

female gender, in India. Invisible Girl Project raises global awareness conceming the loss of female 

lives in India, pursues justice for lives lost, and assists Indian organizations in the rescue of and care 

for vulnerable Indian girls. 

THE GLARING TRAGEDY OF FEMALE GENDERCIDE 

My husband and I founded Invisible Girl Project in 2009, while we were living in India. 

am an attomey, and at the time, T was working as the Chennai Field Oftlce Deputy Director and 

Director of the Legal Departlnent for an international hurnan fights organlL;atioll that rescues 

indiyiduals from slavery and human tr'lftlcking. My husband, Brad 'ckElp, a doctor of pharmacy 

was assisting in 111Cdical catnps for the poor in South India. 

\Vhilc in Tndia, Brad and T recogni"ed a terrible reality: millions of baby girls in Tndia arc 

un\v,inted iU1d are murdered or itborted, simply beciUse they are girls. \"\Ihile visiting a rued village in 

South India, Brad noticed that d1e boys outnumbered the girls eight-to-one, which he learned was 

due to female infanticide (the murder of a hahy girl). In th'lt same village, he met a young woman 1 

will call Preema" who was the twc:lfth daughter born to her parents. Tn desperate efforts to have a 

son, her mother would become pregnant, h'lve a baby girl, ,md she and her husl"md would kill their 

daughter shordy after birth. Again, she would become pregrl<mt, have a baby girl, and once ag<lin, 

she and her husband would murder their own daughter. Eleven times, Preema's mother delivered a 
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daughter. and all eleven of Pre em a's older sisters were murdered before she was bom. Preema is the 

only one d1ey allowed to survive. 

WHY SO MANY GIRLS ARE MURDERED IN INDIA 

In my experience both living in India and working for Invisible Girl Project, 1 have learned 

that daughters in Indta are unwanted for several reasons. The Indian famIly is the foundation of the 

Indi;\11 culture. i"re'luently, early in the lives of the children born into the Indian family, the 

patriarchs of the prospective bride and groom will arrange d1eir marriage. Aliliough dowry is illegal, 

under the Dowry Prohibition "\ct of 1961, ilie culture expects d1e bride's family to pay a significant 

do"\vry to the grootn's family \vhcn the tnaniagc eventually occurs. 

This practice has continued t'or generations and is so deeply embedded in the culture that it 

prevails across the classes. iianlilies see the marriage of their sons as a means for making 1110ney by 

the payment of the dowry by the bride's family. In fact, I know one bride who is a lawyer, whose 

fathcr-m-law, a police officer, frequently rcrninds her that that he could have "gotten tIlOrc 1110nc)," 

from other families than the dowry he accepted from her tather. 

Families also prefer sons for ;mother reason. Boys (111U their brides are expected to Glfe for 

his parents. Effectively, the young bride leaves her family for her husband's, where it is her duty to 

care ~-or her t1e\v in-la"\vs and "\vhere she tTIay be treated as little tnore than a dotnestic slave. \\,Then 

the groom's parents attain old age, d,C bride and groom arc cxpected to cont1tlue to care for them. 

Parents of daughters not only "lose" some of d1eir wealth to dowry, but d1ey also lose their 

drtughters to another fan1ily, ,-vith no one to Clre for then1 in their old rlge. The culture, therefore, 

pcrcci\,cs girls as consurncrs, who take their fanlily resources and leave. lIenee, Eunilics want sons. 

Because daughters are perceived as liahilities, millions of families will do anything to ensure that they 

do not have the burden of a daughter. 

INFANTICIDE AND FETICIDE ARE ILLEGAL BUT WIDESPREAD 

\Vhile living in India, my husband, Brad and I read news headlines such as, "Mother, 

CiGU1dmother 11urder TV.lin Ciirls in Incubatornl1 just because they,-vete girls. In one vilhge in nILil 

'l'atnil Nadu, a lllothcr adrnittcd on fibn to 111urdcring eight of her newborn daughters.'" -LALnd, in our 

\vork \vith Invisible Cirl Project, \ve haye personally met "\vith "\vomen \vho helve detrliled stories of 

how gendcrcide has affected their families. 

For example, in South India, a young woman I will call ;\sha told us the tragic story of the 

murder of her own daughter. Pregn;U1t with her second child, her Erst child a girl, Asha desperately 

hoped that she was carrying a son. lIer husband and her in-laws d,reatcned d1at if she "d!d not 

produce" a son, she would have to murder her own daughter. When she gave birth to her newborn 

little girl. the whole family was disappointed, but ;\sha refused to kill her daughter. One night, 

during her daughter's tlrst week of life, Asha fell asleep on the dirt door of her home with her baby 

girl beside her. \\'hen Asha '.voke {l fe\v hours later, she irnnledirltely noticed her d~lUghter \vas gone. 

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She says she heard a baby cry in the distance. The next morning. Asha learned that her husband and 

his parents took her baby to a nearby pond and drowned her. 

Chandra's story is ~U1other that represents the plight of many \VOHlen in lndi~l. She ~ll1d her 

husband were rnarncd, but her fanlily did not provide the cust01nary dov,!ry, as Chandra and her 

husband fell in love and did not have d,e traditional arrang;ed marriag;e. She beGune preg;nant 

shortly there;,fter and gave birth to a daughter. \Vhen she was pregnant with her second child, her 

husband and mother-in-law told her they expected her to have a son. 'l'hey were disappointed when 

Chandra gave birth to a second daughter. They pressured her to kill this baby, but she stood linn 

and refused to do so. She soon became pregnant again. This time, her husband beat her frequently, 

demanding that she give birth to a boy. Her mother-in-law continually berated her, reminding her 

that because she did not bring any we;uth or Jewels (through dowry) into the marriage, she should at 

least giw them a son. \'Chen she gave birth to her third daughter, however, her husband and 

modler-in-Ltw demanded that she kill the baby. Afraid that they would abandon her with three 

young girls, Chandra murdered her own newborn baby girl. 

These stones of female infanticide represent only one ('orm of gendercide. \nother includes 

the deadly neglect of little girls. 1 i'or eX~1l11ple, Saachi's parents \vere "blessed" \vith their son Anll1, 

before S,uchi \vas born. Her parents live in a nltal yillage in India, They ,lfe poor, UneciUGlted, (U1U 

rely on seasonal ag;ricultural work to feed their family. 'l'he past few years have been difficult for 

agricultural workers, however, as a draught has inhibited farming. \Vhen they are employed, they 

support d,eir family on less than two dollars a day. \Vid, little money or food to feed their family, 

Saachi's parents ensure her brother is fed before she is. If they both become sick and need medical 

attention, her parents will rnal,,-e sure that their resources help Arun receiYe the nledical attention or 

medicines he needs before they ;lre concerned with S;wchi. They love their daughter, but they value 

tllClr son more. As such, Saachi has become malnourished and is failing to properly grow. 

Saachi's story is not unique. This type of neglect often turns fatal. ".s such, because of 

female infanticide ;md deadly neglect of little girls, the mort;uity rate for girls under the age of tlve in 

India is 75% higher d,an that of boys.'" 

".Ithough infanticide and deadly neglect arc commonplace throughout India, they do not 

,lCcount for the brgest CiUse of gendercide today; Lither, fem(tle feticide (the sex-selective abortion 

of fcnlalcs) docs. --,~though scx-detennination tests and sc-x-sclective abortions arc illegal in India 

under the Pre-Conception and Pre-Diagnostic 'lechniques Act of 199-1 (PNUl' Act)" the law has 

been virtually disregarded throughout Tndia. v1 Tn spite of the la\v, it is COD1Dlon for a \votnan to be 

pressured by her husb;md and her in-b"\vs to have a sex-detennination test perfonned to learn 

whether she is pregnant with a son. If she is pregnant with a girl, the prospective mother is 

pressured to abort the unborn baby. In fact, because of the intense and widespread mtimidation 

WOlllen in India face fronl husbands and in-Iav.,ls that cornpcls thcrn to obtain sex-detcrtrunation 

tests, the PNUl ~".ct not only prohibits family members from seeking a s"-,c-determination test for a 

pregnant "\vom(t11, but it ,ilso creates the rebuttable presumption that brnily n1en1bers han: (ymzpe!!ed ,t 

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pregnant \.votnan to obtain a sex-detennination test.1'1l Additionally, recogni7.ing this comtnon 

coercion, it provides that a wornan who has becn forced to violate the law shall not be punished.,m 

The experience of lvlitu l<huLll1~l, ~l physician, det~lils the con11110n strong-~lrn1ing \VOn1en in 

India face fronl their fanl1hes to have sons. !\s docurnented in the filrn, "Tt's a Girl," \,litu reveals 

that her husb,md and in-laws tried to bully her into obtaining a sex-detennination test while she was 

pregnant. \'{7hile 'vlitn was sick ;U1d unconscious, her doctor performed ;m illegal ultrasound that 

revealed she \V~lS pregnant \vith nvin girls. Upon hearing the ne\vs, her husband ~l11d his parents 

insisted that she abort her Kvins. \\'hen she refused, they threw her down a t1ight of stairs so that 

she would miscarry. She and her Kvin daughters survived. however, and Mihl now lives as a singlcmother, caring for her girls. 

\Ithough Mihl detied the pressure from her husband and in-laws to obtain a sex-selective 

abortion, many women do not feel they have the choice to carry their daughters. Many are forced to 

succutnb to the societal or fatnlly pressures to abort their daughters in preference for sons. Tn an 

Indian Supreme Court opinion earlier this year, the court addressed this son-preference and the 

practice of sex-selective abortion, stating that "female foeticide (sic) has its roots in the social 

thinking \vhich is funch111entally based 011 certain erroneous notions, ego-centric traditions, peniert 

perception of societ;J nor111S, ;md obsession \vith ide(ls \vhich are totally individu(llistic S,ins the 

collective good." 

In this sarne opinion the court recogtl1L::ed the extensivc practice of sex-selective abortion 

across India, in spite of the hws that preclude it." The court noted th;lt despite the ];IWS in place, the 

"practice of elitninating fetnale foetus (sic) by the use of pre-natal diagnostic techniques is widely 

prevalent in this country."x It ,lddressed the central rlnd state governments th,lt have failed to 

effectively implement the P'\[DT ·\ct; and theretore noted, as a direct result that the 20 II Tndian 

Census detailed a "sharp decline in the female sex ratio" throughout the country.~ 

Sex-selective abortions of females are so widely pr;lcticed in India, the eN estim;ltes that 

2,000 arc performed daily.'" One estimate is that the lives of as many as two million female unborn 

babies are selectively tenninated annually after se~ detennination tests are perfonned.xlli T\vo tnillion 

fewer fernalcs a year arc being added to a population that already is suffering fronl a dranlatic chasnl 

in the sex [;ltio benveen its n1,11es and fen1'11es. In ft1ct, India's 2011 census reported that m(Jes 

outnumber females in the population by approximately 37 million.'" And, the lnited "ations 

estin1,ltes that 50 million \vomen ;-lre "missing" from Inoirl's population.X'\o 

INDIA'S SEX RATIO LEADS TO TRAFFICKING AND VIOLENCE 

This gender in1brlLl11ce bet\veen 111en and \VOn1en in India h,ls resulted in further proble111s 

for women and /prls, such as trafficking of brides, child marnage, sex trafficking, and violence 

against \vomen.x

\"! 

37 million Indian men will not marry because their potential wives have been murdered, due 

to female feticide, fe111rJe infanticide, and deadly forn1s of neglect. ll'or eXrtn1ple, in the st1te of 

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Ilaryana, there are fC\v"\vomen for the men to marry, as Tlaryana's gender imbalance is one of the 

worst in India, with 879 females to 1000 males.m Because of the shortage of brides, families bring 

in \.votnen ~rom other Indian states and other countries to becotne \.vives for their sons. l)ut of 

desperation for "\viYes, the tLlfficking of brides has resulted.1o·:vlli 

Because insufficient nurnbers of Wonlen are available to nurry, tnany Indian lllen seek young 

girls to marry. In fact, -l7(~/O of girls in Indi,l are nl,lrried before the rlge of eighteen, according to 

U:--JICEI'.'" The consequences of this child marriage include high maternal mort;uity rates, high 

inf~nt mort,uity rates, ~nd increased likelihoods of domestic violence and HIV for the brides. 

Consequently, young married girls arc denied the chance to receive educations, their health suffers 

and they frequently die in childbirth. Effectively, they arc child slaws expected to bIrth sons. 

Sex trantcking is another consequence of India's gender imbalance.:D:I \\,11en tnillions of tnen 

go unmarried because millions of potential brides have been killed, these single men are more 

inclined to purchase sex.i.hl1 Because of the detnand for sex-\vorkers and because large atnounts of 

tnoney can be tnade by brothel owners, girls and Wonlen are traHicked into the sex industry. 

In nly previous experience \vorking for a hunlrm rights org,mization in India, 1 le,lrned of ,1 

number of young \vomen \vho \vere sold into brothels in tnajor cities such rlS j\futnbai rl11d Kolkata. 

Ilcarned of fmnities who were tricked into sending their daughters a\\'a1' frorn their corntnunities for 

"jobs" that would help provide money to their families, only to have theIr daughters forced to 

service up to 20 men a day in dirty brothels, far from home. 

The 2013 'lrafiicking in Persons enp) Report ranks India on the Tier 2 Watch List, stating 

that "Indirl is ,1 source, destin,ltion r1nd tr,U1sit country)) for victinls of tfrlfficlcing.xxlll Trafficking hrls 

becornc a subject about which tnany }u:nericans ha\'e becorne fmniliar. j\Iy experience in raising 

awmeness about gendercide throughout the United States, however, has shown me that most are 

una\varc that fetna1c gendercide in India is a root cause for tnuch of the sex trafficking. 

~~nother consequence of fernale gendercide and the resulting skewed sex ratio is violence 

,lg,linst \vomen. Recent Indi,m governnlent reports det,lil rape and bnltality against \VOnlen ,U1d girls. 

Tn December 2012, a female ,",ew-Delhi shldent was gang-raped on a bus and later died.~"' Tn ,'\pril 

of this year, ,1 five-year-old girl "\VrlS raped ,md tortured, suffered d,lmage to her intern,ll and sexLul 

organs, mId was found serni-conscious. She had been abmIdoned to die.xxv These 1\vo cntnes arc 

exanlples of the evil frequently int1icted upon \vomen ,md girls in Indi,1. Such violence ,1gainst 

WODlen "occurs rnorC' frequently in areas where rnen outnurnber wornen,"'-'Vl and is a byproduct of 

gendercide. 

~'\.nother form of bmtalitv is dowry reLtted-the dowry death of a bride because the dowry 

her fan111, paid is perceived as inadequate. India's National Crime Records Bureau recently released 

statistics tlut 8,233 women were murdered in India last year due to dowry disputes.=" '1'hat is tl1e 

equivalent of one woman being murdered every hour. Reports of these dowry deaths often detail 

brutality, including not unconunon occurrences of husbands or in-laws dousing a bride with gasoline 

,md setting her on fire because they are dissrltistled \vith her do\vry.Xl-.T1l1 

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The various and too frequent fonns of violence perpetrated against girls and women in Tndia 

contribute to India's ranking as the worst of the G20 countries for \\'otnctl.XSL,{ India's gender 

imbalance, the direct consequence o~- ~-etnale gendercide, is the root for tnuch of the violence 

exrerienced by Indian \VOn1en. As long as female gendercide-infanticide, deldly forn1s of neglect, 

and feticide (lfe practiced and accepted in Indian society the violence against India's girls and \VOlnen 

will continue. 

CONCLUSION 

t\lthough laws in India arc intended to protect girls, both unborn and born, these lay\/s arc 

not enforced. Outside of India's Supreme Court, the politic;ll will to do so is minimal. In the same 

opinion mentioned erlrlier, the court noted that the governn1ent institutions th~lt should be enforcing 

the laws to protect unborn girls were deiicient in their duty. The court demanded Indian 

go\'ct1ltncnt authorities to uphold the law \\!ith "devotion, dedication and corntnitrncnt," stating that 

there nlust be an "awal,,-ened awareness with regard to the role of wOlnen in a society' ."X'.""X 

1 {tn1 currently eight 1110nths pregrunt \vith our second d~lUghter. H(lU 1 been born in Indicl, 

I, too, would likely experience the intense coercion to either abort my daughter or murder her after 

her birth. In India, she would become another statistic. Here, she will be born and have d,e 

opportunity to thrive. 

Tn the United States, we recogni7.e that the right to life and liberty are fundamental to all. '\s 

leaders of the civilized world, we already assert ourselves by demanding dut nations dlat accept our 

financial assistance tnust report annually about their effort to suppress traft-tcking of other hutnan 

beings. Should these countries dnt arc required to ensure that their girls arc not being trafiicked 

allow theIr girls to be systematically murdered without repercussion? No. 

\,?e must, therefore, require these recipient l1(ltions of our financial assistance to also report 

their efforts to prevent the killing of dIe most vulnerable among them and to preserve the lives of 

girls. Political will in Tndia must increase to uphold the laws and protect girls' lives. \'('omen in Tndia 

must be empowered, and Indian society must be educated to understand that daughters, born and 

unborn, are as valuable as sons, and women's rights are human rights. 

, Namcti ha\ c been changed lo prolcd Invisible Girl Project\; sources. 

ii TIMES OI" Ij\.,DIA, October 9, 2009, available at http://timesofindia.indiaumes.com/'\'ideos/ ne'\vs/Mothergrandmother-murder-nvin-gids-in-incub ator/ videoshow /510557 S.cms. 

'" "It\; a Gid-the Three Deadliest \"'\'onls in the \"x/odd," \v\v\\,.ibagidmovie.Loln. 

iv lHE lIMES OF l.:...1DIA, india l)Mdlies/ Pl(/ce in /J/orldfor &irl Child, 1 Febmary 2012, available at 

http://aTticle~.time~ofilldia.illdiatime~.com/20 12-02-0 1 /india/.11 0124Gg_l_child-mort:llity~-infallt-moTtality-illfantdeaths. 

v Pre-natal Diagnostic Techniques (Regulation and Pre\~ention of Misuse) Act, 1994, available at 

http://indiacode.nic.in/. 

Vl Volun t ary Health Ass. of Punjab "s. I Jnion of Tndia & Ors., Supreme C:OUTt of Tndia, 4 \hrch 201.1. 

\,11 Pre-natal Diagnostic '1'edlluques (Regulation ~Uld Prevention of J\'1isuse) Act (PNDl Act)_ 199-1-. Chapter Ill, 4.4; 

Chapter YII, 24. Availabk at http://indiacodc.nic.in/. 

v';; PN1YJ' /\ct at Chapter VII, 23.-1-. 

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IX Voluntary 11ealth Ass. of Punjab '\~s. Union of India & Drs., Supreme Court of India, -4 ~\larch 2013. 

x i"Tohmtary Health Ass. ofPtmjab vs. Umon of Imha 8.:: Ors., Supreme Court of India, -4 I\Iarch 2013. 

}.~ Voluntary 11ealth Ass. of Punjab ys. Union of India & Drs., Court of India,..J. March 2013. 

Xl! C'\THOLIC ONI.I'JF, r-1 Rct/nraran IFo?Jh!n, Ciri,Todtry, hnwlty IS, 201.1, ~l\Taihlhle ~lt 

http://w\vw.cathohc.org/intemational/inlemational_story.php?id=49326. - - .. 

}'~11 TIlE '1'L\tLS 011 INDL'\, l'elJlale Se.\,' &lfio1! (sic) 011 tbe Dedim in RilmlAlaJlmn, 27 July 2013, ayailablc at 

http://nrticle~.time~ofindia.illdintime~.com/20 1.1-07 -27/ m~ldumi/ 40S32(j9,1_1_952-female~-female-foeticide-fem:lleinf~mticide. 

XIV 2011 Census, Office of the Reh,:rislrar General, a\'ailable at http://w\vw.censusindia.gov.in/2011-provresults/data_files / india/ 11'inal_P P' 1'_20 11_chaptc 1'5. pdf. 

x, C. /\lhh~ldiah, The SO MillION ,lfi,LI'i!~g 117wJle/1,}OlJRKAI. OF /\SSISTFD REPRODUCTIOK AND CF'\"FTICS, vol. 

19, no. 9 (September 20(2): 411-16, a\'ailable at 

http://,,'',vw.ncbi.nlm.lllh.gO\T / pubmed/ 124\J8534?ordinalpos= l&itool = EntrezSys tem2.P Entrez. Pubmed.Pubmed_Re s 

ultsP~Ulel.Pubmed_RVDocSum, :lcce~sed 7 \hy 2009. 

A'Vl Rita Patel, 

GLOBAL 

CENTER FOR 

/ Jft' /1iJ the Cirh?, 27 August 201.1 

http://thediplomal.com/2013/08/27 /india-,vhere-are-all-lhe-t,>irb/. 

"'~;; "It's a Girl-the '1'hree Deadliest \X:ords in the \'(/orld," "\V\\'\v.itsagirlmm1,e.com. 

Xl}, IJ'JICEF 201 0, "Stati~tics" available at http://ww"\v.utlicef.org/itlfohycnuntry/india_~tati~tics.html. 

'"" Inkn~alional Ccnler for Ret-carch on \"'\'Olllen, "Child I\Iarnage Facts imd Figures" available at 

http://w',v\v.icl.''w.org/ child-marriage-facts-and -figures. 

lrafficking in Persons Report, Issued June 1~J, 2013. 

= Kristi LemOllle and John '1'anagho, &m&r Dir,filtlinatioH 1 '1II'iS Sex SI'it.tiIJI' Abortion: '1 hi' IlJJpad q/tbl' InditIH SltpTl'lJJe COllrt 

Jmi,kfflmhlnon alid }',nfon'eml'f;toltheJ'i'JJ'fAd,l~lER"lA'nONAL & COMl',\RAIIVE LAW REVIEW, VoL 15 

at 22.3-224. 

:=.uTraffickingill Persons Report, IssueuJune 19,2013. 

TIII:: IIllf7f7I::\"GTOI\" POST, <'Delhi Bus Gang Rape" archives, September 5, 2013, avaIlable at 

http://wv/\v.huffingtonpost.com/news / delhi -bus -gang-rape. 

:a.·v THE 'JF\X' YORK TIMFS, /1jIt'r Rap!:' am/i\Tegled, a SlIn·i,)()r',' Famifv Fad!:'.!" info Oblivion, Delhi, ~eple111her ?\ 2013, 

availahle al http://inuia.hlogs.nytimes.com/20 13/09 /03 /after-rape-ami-lleglecl-a-SuT\·ivors-Lunily-faues-into-ohliviollin-delhi/?_r=O 

C()ffri 

(Pall) 

"-,,,oi SJ YJ'H, Om' W OHl{ffl KillPJ /-:1/1':1' Hour /Jill' to OutknJ'l'd (·!f.ftOIJJ, September 3, 2(113, ~nTaihble nt 

http://w"\-.,,"'\v.shte.cnm/blngs/the_slatest/2()11/09/n1/mdian~ovemment_crime_statistics_shn"\v_one_indian_wotwltl_ 

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7 

13 June 2012, 
37

Mr. SMITH. Ms. Dutt. 

STATEMENT OF MS. MALLIKA DUTT, PRESIDENT AND CHIEF 

EXECUTIVE OFFICER, BREAKTHROUGH 

Ms. DUTT. Thank you, Chairman Smith; Representatives Weber, 

Meadows and Bera—oh, we missed Representative Meadows. He 

just walked out the door. But I thank the rest of you for being here, 

and really thank you so much for your attention to this very, very 

critical issue facing women in India and around the world. 

As you have all already pointed out, gender-based discrimination 

is a global pandemic. It is the largest human rights global pandemic, and it takes many, many different forms, including dowry, 

honor killings and sexual assault, rape. Just today the Delhi court 

handed down a verdict on the gang rape that my copresenter just 

referenced. And really all of these forms of gender-based discrimination and violence stem from this larger issue of patriarchy and 

son preference that plagues India and so many other parts of the 

world. And gender bias sex selection is just another pernicious form 

of gender inequity, a harmful practice, which, as we have already 

heard, has led to a very alarming decline in the number of girls in 

parts of India and, in fact, many parts of the world. 

I am president of Breakthrough, a human rights group that 

seeks to make discrimination and violence against women and girls 

unacceptable. Our approach is to use multimedia tools along with 

community engagement to really try and transform the cultural 

norms and social practices that violate human dignity, and that 

really underlie the many violations and abuses that women and 

girls face. 

We believe that human rights must begin in our hearts, in our 

homes and in our own practices; that human rights, as Eleanor 

Roosevelt so eloquently said, begin in small places close to home. 

Over the last 12 years, we have learned several lessons, and 

based on that, I offer the following recommendations to this committee: The United States must assume a position of global leadership in confronting the underlying factors that foster gender discrimination, first by sustaining and strengthening investments in 

global health and development, and, second, by advocating for the 

equity of women and girls to be at the center of the global development agenda. This approach, of course, is consistent with human 

rights instruments, such as the International Conference on Population and Development’s Programme of Action, which the United 

States has also endorsed. 

Breakthrough is currently working to address the issue of gender-based sex election in Haryana, which at 877 females to 1,000 

males has the lowest sex ratio in India. What we are doing in 

Haryana is to engage multiple community stakeholders that include government officials, that include media professionals, 

women and men in rural and urban areas, medical practitioners, 

educational professionals, young people, doing research for them to 

really look at the underlying causes of gender-based sex selection 

so that we can challenge patriarchal norms and son preference. 

This integrated approach is increasingly being viewed as an effective one by U.N. agencies, governments and many others. 

38

In order to figure out the best communications and advocacy 

strategy, we have conducted comprehensive baseline research. And 

what we found through our interviews with these different stakeholders is what all of you have already pointed out: There are complex factors, social, economic and political, that include dowry and 

inheritance laws; lack of women’s agency in relation to safety, security and sexuality; ineffective implementation of our existing laws; 

and lack of women’s financial independence that leads to genderbiased sex selection. 

To be clear, bans on access to reproductive health are not an appropriate solution. Similarly, research has found that while technologies used for sex selection have compounded the problem, they 

are not the root cause. So we believe very strongly that access to 

value voluntary family planning and safe and legal abortion remains vital to fulfilling women’s human rights. In other words, we 

should not take away the rights of women and girls to promote 

their rights. 

As was well documented by the professor to my right, gender 

bias in India is also rooted in historical acts of discrimination, including forced sterilization, coercive reproductive health programs, 

and many other violations. I have been part of the global women’s 

movement to ensure that these kinds of historical abuses are condemned, and that women’s rights are universally upheld. And I 

deeply believe that in India, the largest democracy in the world, 

the path forward to reducing widespread gender inequity and sex 

selection is through comprehensive and community-based culture 

change solutions that have to be driven by Indian stakeholders 

themselves. 

The most critical contribution that this committee can therefore 

make now is to sustain U.S. investments in global health and development. Current American aid to India has to ensure access to 

education, food, water, energy and health care, including safe childbirth and voluntary family planning for some of the most vulnerable women and girls in the country. 

All of these elements are vital to improving the status and rights 

of women and girls and, with it, to reduce the underlying causes 

of son preference. 

Once again I would like to extend my thanks to all of you for 

bringing attention to this very important issue. 

Mr. SMITH. Thank you very much, Ms. Dutt. 

[The prepared statement of Ms. Dutt follows:]

39


82762d-1.eps

Improving the Status and Equality of Women and Girls - Causes and 

Solutions to India's Unequal Sex Ratio 

Testimony Submitted to the Subcommittee on Africa, Global Health, Global 

Human Rights, and International Organizations, Committee on Foreign Affairs 

U S House of Representatives 

By Mallika Dutt, President, Breakthrough (US/India) 

September 10, 2013 

I would like to thank Chairman Smith, Ranking Member Bass, Representative 

Bera for the invitation, and the honorable members of this Committee for holding 

this hearing on a matter of critical importance to Indian women and women 

around the world. Gender-based discrimination is a global pandemic that 

manifests in many forms, including sexual assault, domestic violence, early 

marriage, honor killings and rape in conflict situations. Recently, several 

incidents of rape in India have captured international attention and sparked 

outrage - but they are merely examples of this pervasive form of gender 

discrimination. Gender-biased sex selection is another pernicious form of 

gender inequity, a harmful practice, which has led to an alarming decline in the 

number of girls in parts of India and other parts of the world. 

I come to you today as the president of Breakthrough, a global human rights 

organization that seeks to make discrimination against women and girls 

unacceptable. Based on our work over the last twelve years, and lessons we 

have learned from community-level engagement across India, I would like to 

request that the Committee keep the following recommendation in mind: 

The United States must assume a position of global leadership in confronting the 

underlying factors that foster gender discrimination, by 1) sustaining and 

strengthening investments in global health and development and 2) advocating 

for the equity of women and girls to be at the center of the global development 

agenda, in accordance with human rights instruments such as the International 

Conference on Population and Development (ICPD),s Programme of Action, 

which the United States has endorsed. 

Breakthrough uses multi-media tools and community engagement to change 

cultural norms and social practices that violate human dignity. Our experience in 

working with women, men and young people across India and globally has taught 

us valuable lessons learned: that is, the only way to achieve long-lasting social 

change on issues of gender bias, especially sex selective practices, is through 

working to fundamentally shift attitudes and culture at the community level and to 

comprehensively address the underlying issues that propagate inequity. We 

believe that human rights begin in our own hearts, homes, and actions. 
40


82762d-2.eps

Breakthrough is currently working to eliminate gender-biased sex selection in 

Haryana, which at 877 females to 1000 males has the lowest sex ratio in India. 1 

This work engages multiple community stakeholders to challenge patriarchal 

norms and son preference, an approach that is championed by governments, UN 

agencies and others. Indeed, Justice Balakrishnan, Chair of India's National 

Human Rights Commission, at a recent conference on this issue stated: "The 

need of the hour is therefore to bring about a change in the mindset of the people 

whereby both girls and boys are treated at par.,,2 

In order to determine the best communication and community engagement 

strategy, in Haryana and other states, we have conducted comprehensive 

research. Through community, government and multi-sectoral interviews, we 

have found that there are complex interrelated social, political and economic 

causes that lead to gender-biased sex selection. These include dowry and 

inheritance laws, lack of women's agency in relation to safety, security and 

sexuality, ineffective implementation of existing laws, and lack of women's 

financial independence - all crucial requirements in eroding gender-biased sex 

selection. 

To be clear, bans on access to reproductive health are NOT an appropriate 

solution. Similarly, research has found that while technologies used for sex 

selection have compounded the problem, they are not the root cause of it. 

Access to voluntary family planning and safe and legal abortion remain vital to 

fulfilling women's human rights along with promoting access to education, 

political and social rights and economic empowerment. In India, a woman dies 

every 10m inutes because of pregnancy related causes, illustrating how acute 

the need is to improve reproductive and maternal health in the country. 

As is well documented, gender bias in India is rooted in historical acts of 

discrimination, including forced sterilizations, coercive reproductive health 

programs and other violations of women's rights. The government of India even 

today needs to do more to ensure full access to voluntary, comprehensive and 

rights-based reproductive health care. I have been part of the global movement 

to ensure that historical abuses are condemned, that women's rights are 

universally upheld and that governments must be held accountable to their 

human rights obligations. In India, the largest democracy in the world, the path 

forward to reducing widespread gender inequity and sex selection is through 

comprehensive and community-based culture change solutions driven by Indian 

stakeholders themselves. 

1 India Census data 2011 

2 Preventing gender-biased sex selection: an interagency statement. 2011 

Speech by Justice Balakrishnan, Chair NHRC, Conference on PreNatal Sex 

Selection in India: Issues, Concerns and Actions, 12 October 2010, IIC 
41


82762d-3.eps

Because gender discrimination is a global pandemic that requires multi-faceted 

interventions, the most critical contribution that this Committee can make now is 

to sustain US investments in global health and development, which are critical 

to delivering vital services to women and girls to secure their human rights and 

who might otherwise be overlooked by their health and education systems. 

Current U.S. aid to India helps ensure access to education, food, water, energy 

and healthcare- including safe childbirth and voluntary family planning - for 

some of the most vulnerable women and girls in the country. All of these 

elements are vital parts of a comprehensive strategy to improve the status and 

rights of women and girls in India and around the world - and with it, reduce the 

underlying causes of son preference. 

I would like to once again thank the Committee for having me here today and for 

your attention and interest in this important matter 
42

Mr. SMITH. Let me beginning the questioning if I could with you. 

You know, Jill McElya made a point in her testimony that some 

2 million girls’ lives are snuffed out through sex-selection abortion 

in India every year, which is a horrifying number. We, and I personally, with the killing fields that occurred in Darfur, which is 

probably about 500,000, spent an extensive amount of time, as did 

other interested Members of Congress and human rights organizations, to try to bring attention to and stop the slaughter in Darfur. 

Mr. WEBER. Mr. Chairman, it is 5,479 per day. 

Mr. SMITH. An extraordinary number of loss of girls’ lives simply 

because they are girls. 

So I find it a disconnect, if I could, with all due respect. I believe 

that pernicious bias and prejudice against a girl child and women 

in India or anywhere else begins in the womb, especially when 

such large numbers of girls are slaughtered either through chemical poisoning or through dismemberment. And I know methods of 

abortion are often encapsulated with phrases or sloganized into 

choice rhetoric, but the actual deed, with all due respect, is dismemberment; pills that make the girl child or a boy unable to continue living inside the womb, like RU–486, first starves them to 

death, and then the second action of that chemical combination is 

to cause the expulsion of the girl from the womb. And then there 

is dismemberment, which is either D&E—and I have been involved 

in the pro-life movement for 40 years, and I am steadfast about 

human rights being from womb to tomb. And I agree when you say, 

as you said so eloquently, gender-based sex selection is another 

pernicious form of gender inequity, a harmful practice that has led 

to an alarming decline in the number of girls in parts of India and 

other parts of the world, and then later on in your testimony you 

argue for continuance of abortion. 

We have that same argument going on here, as you know, and 

you are here, but in the United States Planned Parenthood was 

found through an undercover operation to be telling—and I have 

watched them all, all of the undercover women who were pregnant, 

went in, were told that if they wait until 5 months, do a 

ultrasound, and if it is a girl, kill it. And one of those Planned Parenthood clinics is right next to my office in New Jersey. 

I find a horrible disconnect there between empathy, love, compassion and respect for the girl child in utero, and then a willingness 

under the rubric of freedom of choice to say, but nevertheless you 

can be killed through dismemberment, chemical poisoning or some 

other way that is a an act of violence. So help me to understand 

how you can argue both, if you will. 

Again, and I will conclude on this before going, we have seen the 

devastating consequences. India itself has outlawed it as has the 

U.K., four States, as I noted. We are trying to do it here and have 

failed, and it is growing in its incidence and prevalence. It seems 

to me that if you treat the girl with such impunity and prejudice 

while she is in utero, why do we expect at the event of birth—and 

it is only an event that happens to a child, it is not the beginning 

of life—that somehow, poof, we are going to now show respect for 

that girl? That kind of prejudice then gets—continues because it 

has been—it began right from the start. 

43

Ms. DUTT. So thank you for raising all of those very, very important points. 

I would like to share a story with you, if I may. In 1985, a very 

dear friend of mine was in a car accident in Bombay, and she, because she was so badly injured, ended up in a public hospital which 

didn’t have the greatest of amenities. And so several of us who 

were friends spent time taking turns to be at the hospital with her, 

because that was the only way she could ensure the kind of care 

that she needed. 

And so I had night duty for 2 nights in that hospital, and she 

was placed in the women’s wing, because that is where all of the 

women were. And it was one of those sort of life-altering experiences for me, because the vast majority of the other women in that 

ward were young women who had been burnt for dowry. So there 

were—I mean, there must have been at least 200 women in that 

ward. I would say 80 percent of them were suffering from deep 

third-degree burns. They were covered with, you know, bandages, 

in enormous pain. Many of those women were on the floors on mattresses because there weren’t enough beds, and because I was on 

duty at night, I spent most of my time running around the ward 

chasing off rats that were trying to nibble at and eat the young 

women that were on the floor, or then trying to get nurses there 

to give them pain medication because they were in so much pain, 

and they were screaming so much. 

I shared this story with you to say that I believe that in order 

to empower women, and in order for women to be able to exercise 

the choices that they need to make about their lives and who they 

are, that the right to abortion has to be part of that narrative, because women are so deeply disempowered that to take away rights 

in order to give them rights just doesn’t—it just doesn’t make sense 

to me. 

I totally understand what you are saying about the problem of 

gender-based sex selection and how we are missing all of these 

young girls, but I am not agreeing with you on the cause and effect 

of this. It is not that that causes the kind of violence and discrimination that women and girls face. It is a lifecycle problem. If you 

come with me to Varanasi and meet the widows who live on the 

ghat and the bank, who have been sent there because they cannot 

live at home anymore after their husbands are dead—just today we 

saw the sexual assault rape conviction come down. I mean, I have 

worked with and dealt with young girls and women who have been 

raped and violated in all kinds of ways. And so this is my life’s 

work. And again, I would say that in order to promote women’s 

human rights, you can’t take away rights from them. 

Mr. SMITH. I would just say very briefly—and I, of course, respect you—many of us do see birth as an event. We look at people 

like that, like Bernard Nathanson, who founded NARAL, and was 

an—he did more abortions than perhaps anyone else in his time. 

And when he stopped doing them he wrote in the New England 

Journal of Medicine: ‘‘I have came to the agonizing conclusion that 

I have presided over 60,000 deaths.’’ He ran the largest abortion 

clinic in New York City at the time. 

Those of us on the pro-life side, with respect to your position and 

to you, do see abortion as a horrific form of violence. It is not a beVerDate 0ct 09 2002 16:20 Feb 06, 2014 Jkt 000000 PO 00000 Frm 00047 Fmt 6633 Sfmt 6633 F:\WORK\_AGH\091013\82762 HFA PsN: SHIRL
44

nign deed. It either dismembers, hacks to death, the Indian abortions, and they are done, you know, in mid to later term in the gestational cycle, and, of course, sex selection usually isn’t done until 

about the fifth month when a gender determination can be made. 

So these are big kids being dismembered, and they die suffering excruciating pain. 

We had a bill on the floor called the Pain Capable Unborn Child 

Protection Act, and the overwhelming body of evidence—and there 

is people who disagree, and there always will be—say that these 

children feel pain. So not only are their lives snuffed out violently, 

they do feel pain. And again, when it is being done for the sole purpose or overriding purpose of ridding that family of a girl, that is 

a form of discrimination. 

So I—again, I just convey that to you from my heart to yours as 

a deep concern. 

Did the Ford Foundation ever embrace—because I know you 

worked there—sex-selection abortions? 

Ms. DUTT. Oh, absolutely not. I mean, by the time that I got to 

the Ford Foundation, which was at the end of 1996, the foundation 

had a very strong reproductive rights program. And, you know, 

having been part of the women’s movement that was involved in 

the Cairo conference, where we actually challenged a lot of the population and coercive reproductive policies that were described by 

the professor earlier, I am very much a part of that movement, 

there is no way I would have gone to the foundation if that is what 

their policies were. 

One of the things that I did in Cairo was actually convene a tribunal where women from around the world testified as to their reproductive rights and the abuses that they had experienced either 

at the hands of government policies, or because of their denial to 

access to reproductive rights and reproductive health services, including, you know, so many of the issues that women face simply 

because of poverty and lack of access to basic health care. 

Mr. SMITH. I was actually at the population conference for a 

week and was part of the delegation under the Clinton administration, and I was shocked, dismayed and sickened that Madame Peng 

Peiyun, who I met with on another occasion in Beijing, who ran the 

Coercive Population Control Program in China and argued there 

was nothing coercive about the Chinese program, told me that, and 

said the UNFPA is here, and they give it a good, clean bill of 

health as well, in plain day reminded me of those who said during 

the Stalin years in Ukraine that there is no effort to destroy so 

many people through famine, a deliberate policy of extermination 

of Ukrainians, and then there were people who then say, oh, but 

that didn’t happen. Well, it was happening in China. She was feted 

and lifted up as a great leader at the Cairo Population Conference, 

even though she is one of the architects and was an aggressive implementer of the egregious one-child-per-couple policy. 

Let me just ask one final question because of time. I want everybody to—Dr. Connelly, you might want to comment on what I was 

saying. Yes, please. 

Mr. CONNELLY. Well, you know, as an historian I am not always 

well informed about the present, but I will say that, you know, for 

those who would like to do research, you know, on the history of 

45

how the Ford Foundation worked in the field of population control, 

and how the Ford Foundation changed in the ways that Mallika 

Dutt has explained to us, you can just go to the archive, and it is 

remarkably open, and you can read, you know, file upon file of internal memos and correspondence and so on. 

On the other hand, you know, if you want to probe the history 

of the Roman Catholic Church and its role in limiting reproductive 

rights and supporting pronatalist policies, as I have in Rome in trying to work the Vatican archives, you meet stonewall after stonewall. 

So I think as an historian, to be totally honest, I think the Ford 

Foundation has come a long way. The Vatican, I think, is less 

clear. 

Mr. SMITH. Let me go to Dr. Bera, and then if we have time, I 

will do a second round. 

Mr. BERA. I will try to keep my questions short so Randy can ask 

some questions. 

You know, I think there is general agreement across all of us 

that coercion in any form is wrong and should be unacceptable, 

whether it is done at the population level or whether it is done at 

the individual level. Coercing someone to do something that is not 

what they want to do, you know, is just a basic fundamental principle. And the opposite of coercion is how do you empower people 

to, you know, be strong, to be able to make their own decisions, to 

stand up to make their own decisions, to have the freedoms to 

make their own decisions. And, you know, the subject of this hearing goes to the most basic of fundamental freedoms: Control over 

your body, control over making the decisions that are most sacred 

to you, control over your reproductive freedom. 

So I think all of us are unanimous that any sex-selective practices are—you know, are heinous, and how they are put out there, 

and certainly we should as an institution do what we can to minimize sex-selective practices across the world. But these are complicated issues that have complicated roots. 

I think Dr. Connelly pointed out some of the historical background that talked about where we are today. And these are issues 

that, you know, are incredibly complex, that require local solutions, 

that require solutions that are homegrown, and whatever we can 

do as an institution to help empower that. 

You know, let me ask Ms. Dutt a question. You did point out a 

number of the weak causes and the complexity of why gender discrimination, why discrimination against women and girls in India, 

is so prevalent and so complex. Given your expertise in this area, 

can you speak about some of the best practices that are homegrown 

in India? You touched on your program, but those practices that, 

you know, are empowering women, that are, you know, providing 

reproductive health services to them, and, you know, really kind of 

from the ground up that are in India. 

Ms. DUTT. So in terms of some of the lessons learned—and I will 

also ask Sabu to weigh in, because he has done so much work in 

this area as well—I think that the best results really emerge from 

programs that involve the local community in making the program 

decisions and in making sure that the most marginalized amongst 

the groups have access to those services. 

46

I think that the other thing that is very important is that you 

have to take a rights-based approach to providing services to 

women. If you merely look at it as a health practice without actually looking at the underlying issues that may enable or prevent 

a woman from even being able to go to the doctor—I mean, you 

can’t just set up a clinic without looking at the factors that enable 

women and girls to visit the clinic in the first place. So it is those 

kinds of solutions that really take into account the entire community and also bring in multiple stakeholders. 

Let me give you another example. One of the campaigns that we 

did a few years ago was called Ring the Bell, which challenged domestic violence by engaging men and boys to become part of the 

solution. So we tried to shift men and boys’ engagement simply 

being seen as perpetrators to say, listen, you have a responsibility 

to be a part of the solution. And that reframing of the issue has 

led to a very different kind of conversation around domestic violence in the States in which we have been working. We have also 

seen a 15 to 20 percent increase in reporting on domestic violence 

and an increasing in awareness about the act as a result of taking 

a broader stakeholder approach. 

In our work on early marriage in Bihar and Jharkhand we have 

just launched a campaign where we are really talking to the fathers, because what we have discovered is that they are the ones 

who are making the decisions around when their girls and young 

women get married. And we just were having a lot of success in 

engaging fathers to come to the table and say, we are the ones who 

have to start making some of these differences in order to move forward. 

Mr. BERA. Dr. George, let me ask you a question. You touched 

on the history of some of the laws that India has enacted. What 

do you think the Indian Government has done well, and then conversely, what are the things that you would suggest the Indian 

Government should be doing? 

Mr. GEORGE. Thank you, Mr. Bera. 

As a doctor and as an Indian, I think you should look at the role 

of the medical profession in our country. Since they are so organized and so powerful, they tend to put a lot of pressure on the 

girls. So, you know, those of us who are campaigning against the 

misuse of the medical ethics and technology, et cetera, have—like 

in the case of Maharashtra, there has been quite an impact there 

because the law is upheld. 

So we cannot give up only, you know, judicial systems. It is a 

very slow process. I spent a significant amount of time in the 

courts, from the 3rd of September, you know, I was there in the 

Supreme Court. Now, the 17th I am missing because I am just taking a few days to go back home. 

So what I am trying to say is that, yeah, laws make a difference, 

just like what Mallika said today with, you know, the conviction of 

the people who were involved in the December rape. Now, in that 

case there is the public outrage in the country today that rape is 

unacceptable. But you do not see sex selection as a crime, so therefore—yes, sir. 

Mr. BERA. I was just going to say, just to make sure I am hearing this correctly. You know, I was just in India a few weeks ago 

47

when, you know, there was another rape case, in Mumbai, and you 

saw this huge outcry of how this was unacceptable. Is it accurate, 

then, you are not seeing that same level of public outrage on sex 

selection? 

Mr. GEORGE. Yes, sir. We have made some progress in terms of 

seeing this as an issue of—you know, of like if—like until 2001, 

there was not even much concern about the problem of sex selection. Then when the results of the census came out, you know, we 

did see. So there is some discourse in areas like Punjab, and it has 

been very badly affected. Like we are looking at ratios of 700, you 

know. We have much more discourse. But what we are frightened 

is the rest of the country, you know, have to follow reaching this 

levels before the society——

Mr. BERA. Would you suggest that is a starting point, though, 

that actually engaging the public, creating this public outrage, or 

this public—either one of you—is that the starting point where the 

public actually gets engaged and says this is unacceptable? 

Ms. DUTT. I think that is a very critical point. I think that we 

have to look at multiple intervention points. I think the law is very 

important, implementing the law is very important, but certainly 

creating public outrage is a critical piece of the story. 

I mean, that is one of the reasons why Breakthrough believes in 

a culture change approach, and so we are in the process of testing 

different communication routes, and are looking to actually launch 

a campaign that is India’s quest for its missing girls, and engaging 

young people in the sort of massive search where we really begin 

to question the underlying factors that are leading to this problem 

in the first place. 

Mr. BERA. Thank you. 

Mr. SMITH. Mr. Weber. 

Mr. WEBER. Ms. Dutt, this question is for you. I think you said 

that sex trafficking—or maybe it might have been you, Ms. 

McElya. The word is ‘‘gendercide’’? Which one of you all said that? 

Ms. MCELYA. I did. 

Mr. WEBER. Okay. That is an interesting comment when you say 

it is gendercide. 

So let me get back to you, Ms. Dutt. You said that some of the 

women in the hospital where you went that night were burned for 

dowry. Well, they were burned because they didn’t have one, they 

didn’t have enough of one, because they were going to have to come 

up with one? Explain that. 

Ms. DUTT. So, you know, for whatever cultural reason, the way 

in which many women who have been in their marital homes are 

disposed of are by being burned. I mean, this is always——

Mr. WEBER. So they are not shot with a gun or stabbed to death; 

they are burned to death. 

Ms. DUTT. Right. I mean, in the U.S., the homicide rates are 

with guns, so in India we have burns. So that is the phenomenon 

that I was referring to. 

Mr. WEBER. Okay, I got you. 

And then you said in your paper that you are for safe and legal 

abortion. Of course, as Chairman Smith pointed out, abortion is 

anything but safe for the unborn child. Would you agree with that? 

48

Ms. DUTT. You know, I think that this is one of those situations 

where, like I said before, I really deeply believe that for women, if 

we are going to ensure that they have access to their full human 

rights, that access to abortion, safe legal abortion, has to be a part 

of the full complement. 

Mr. WEBER. The right to kill that unborn child is a human right? 

Ms. DUTT. You know, this is one of those conversations where we 

could turn this into going around in circles. I really believe——

Mr. WEBER. Well, I am getting to a point here. It is about the 

volume that has been mentioned here today numerous times, that 

there is 786 women to 1,000 men, or 786 girls to 1,000 boys. Isn’t 

that about the accurate—wasn’t that about the right ratio? 

Ms. DUTT. Yeah, Representative Weber, but I think that the 

point that I am trying to make——

Mr. WEBER. Okay. 

Ms. DUTT [continuing]. Is that in order to deal with a wrong, you 

don’t do another wrong. And so you don’t take away the rights of 

women in order to empower women. 

Mr. WEBER. Well, but I would submit this: If truly the numbers, 

the discrepancies of marrying women, that is what is cited in the 

paperwork over and over again—that sounds like they are calling 

our votes—then would you be okay—if a woman wants to terminate her pregnancy because it is not handy, not good timing to 

have another child, it is inconvenient, do you think that is a legal, 

a human right? 

Ms. DUTT. I think that given the way in which—given the many 

ways in which women are controlled and exploited and abused, it 

is very, very important for women to have——

Mr. WEBER. Ms. Dutt, it is——

Ms. DUTT [continuing]. To have control over their own reproduction. 

Mr. WEBER. So she has full control to terminate that pregnancy 

because it is inconvenient timewise. 

Ms. DUTT. I think women need to make the decisions that they 

need to make about their bodies, and their lives, and the timing 

of their children, and that decision really needs to reside with the 

woman. 

Mr. WEBER. I am going to take that as a yes that you are talking 

about safe and legal abortion. And so if a woman decides that it 

is inconvenient to have a child because she is going to have a job, 

she is going on a trip, she has got other children that need her, 

whatever reason she deems it inconvenient, she terminates that 

pregnancy. That is what you have said, you have written it in 

paper, safe and legal abortion. 

So let us do this: 786 girls to 1,000 boys. Would you be okay if 

they went ahead and did selective abortion on males to try to even 

up those numbers? 

Ms. DUTT. You know, that is a really interesting question. I have 

never been asked that question. 

Mr. WEBER. I mean, if a mother says, look, you know what, our 

country has too many males, so here is a male, and so now the 

trend is going to go the other way. We are going to terminate the 

males. Would that be okay? 

49

Ms. DUTT. You know, you really opened a very interesting line 

of thought in my mind around this question. Like I said, nobody 

has ever asked me this question before. 

At the end of the day, I would just come back to making my earlier point. I really do not believe that taking away rights from 

women is the way to empower them. If you are going to support 

the human rights of women and girls, we have got to support the 

human rights of women and girls. 

Mr. WEBER. Do you support the human rights of men and boys 

as well? 

Ms. DUTT. Absolutely, and I——

Mr. WEBER. You would not be okay with swinging the pendulum 

the other way and aborting all of the males? 

Ms. DUTT. Absolutely not. And, you know, Breakthrough’s mission statement says that we seek to make violence and discrimination against women and girls unacceptable so that all of us can live 

lives of dignity, equality, and justice. 

Mr. WEBER. The violence against unborn women, or men, or children is okay. 

Ms. DUTT. You know, women really need to have the right to 

make those decisions for themselves, because the consequences to 

them when they cannot are enormous. 

Mr. WEBER. So if a woman wants to kill her baby because it is 

a boy, and she is aware of this discrepancy of numbers, that is 

okay, that is her choice. 

Ms. DUTT. Women must have access to safe and legal abortion, 

and full access to safe health care. 

Mr. WEBER. That, in essence, would be reverse sex selection; 

would it not? We would see the opposite of what you are here today 

to discuss. 

Ms. DUTT. I think that it should be clear from my remarks that 

the idea behind promoting women’s human rights is not at the expense of men, but to get us to a world where all of us can really 

live to our full potential. 

Mr. WEBER. Well, I would submit that there is 5,479 girls a day 

in India that aren’t getting any kind of world or any kind of life. 

Ms. DUTT. And you are absolutely right. I mean, I don’t think 

that any of us—and I certainly am not condoning gender-biased sex 

selection. We do have a crisis. We have a very serious problem, and 

that is one of the reasons why we are putting so many of our organization’s resources behind it. I think the only place that you and 

I are disagreeing, Representative Weber, are the solutions to it, but 

I think we are totally in agreement about the scale of the problem 

and what we need—and the fact that we really need to pay attention to it. 

Mr. WEBER. You have already testified here today that you have 

never thought about if it went the other way, where they were 

aborting baby boys. 

Ms. DUTT. You know, the thing is that nobody has framed the 

question that way, and I thought that was a very interesting way 

to ask it. 

Mr. WEBER. Well, think about that, because these are children, 

and if women decide that they have got too many males in India, 

50

then under the idea that women’s rights or to terminate their pregnancy for whatever reason, then it could go the other way. 

Mr. Chairman, I will yield back. 

Mr. SMITH. Thank you very much. 

Mr. Marino. 

Mr. MARINO. Yes, thank you, Chairman. 

Good afternoon, panel. I would like to explore a little bit about 

the government’s role from the national level down to the local 

level. I read an article not too long ago, and I just looked it up to 

make sure I had the facts right. Some time ago there was—I may 

have the ages wrong—a 5-, 7-, or 9-year-old, an 11-year old, three 

girls that were missing. They were found a couple of days later in 

a well, dead. The mother reported them the day that they went 

missing to the local police. The police did nothing about it, and the 

village then protested, actually blocked some type of road bypass, 

and got another level of government to look at it. And then it was 

determined that they were raped and then murdered. 

What is—let us look at the national level. Is there a serious attempt by the national government, by the Prime Minister, by the 

members of the legislature, and by law enforcement to address this 

issue, or is there a blind eye turned to this? Anyone? 

Ms. MCELYA. If I may, I want to respect and give Dr. George also 

time, but as I mentioned before, I am an attorney, and in my experience in working with a human rights organization in India, I 

couldn’t practice law, but I had a team of Indian attorneys who 

were working for me. And in this international human rights organization, what we did in the south of India was we rescued people 

from bonded-labor slavery. And so I became familiar with the judicial system, the whole process in India of what starts a case. I became familiar with the intense amount of corruption that exists 

and how you can get the public justice system to work for the poor. 

So to answer your question, the laws are in place on a national 

level. I mentioned the PNDT Act, which was very good law, that 

outlaws sex-selective abortion. In addition, these crimes against 

women are illegal in India. And so on a national level the laws are 

in place. 

Mr. MARINO. So why aren’t they enforced? 

Ms. MCELYA. So they are not enforced, I would argue, because 

the lack of political will on the State level, on the smaller level; because there is corruption that goes on. You can even——

Mr. MARINO. I was a prosecutor for 19 years, I was a district attorney in Pennsylvania for 10 years, and I was a United States attorney with George W. Bush. And I prosecuted cases myself, even 

as the U.S. Attorney, murder cases, rape cases, drug cases, organized crime. And I am sure the system works fairly similar in your 

country to the extent that money funnels down from the national 

government to the States, correct? 

Ms. MCELYA. Correct. 

Mr. MARINO. So what better way to force the lower levels of government to follow the law and to enact the law by saying funding 

is going to stop for this project for whatever money funnels down. 

So I am getting the impression that if the national government 

wanted this really to occur, they can have an enormous amount of 

influence over it, instead of saying, well, the problem is with the 

51

States. And the States are saying, the problem is with the smaller 

entities of government. I can’t imagine that—there are national 

prosecutors, correct? Please. 

Mr. GEORGE. Thank you, Mr. Marino. 

We have a Federal system like—you know, and there is always 

conflict between states’ rights, and unions’ rights, just like what 

you have in the U.S. But, see, our first difficulty, like what you 

talked about rape. Now, in the last few months, you know, like 

what we heard about the December rape and what Ami Bera said 

about the Bombay rape recently. You know, it is becoming unacceptable politically for the political parties to support these kinds. 

For instance, just recently one of the most well-known spiritual 

leaders was put in jail because he was involved in rape. So what 

I am saying, this would not happen, say, even a year ago, so therefore, we are seeing progress. But, you know, given the kind of, you 

know, injustice we have had for several centuries, and given the 

virtual absence of women in public life—like I come from State of 

Kerala who for 140 years have had the largest proportion of women 

in our State. We have women live 5 years longer than men, the 

longest life expectancy in a State. But the role of women in public 

life is very limited. We hardly have women in legislature. So what 

I am trying to say is that it is a process we have to struggle with 

in terms of we cannot just give up just because there is failure at 

many levels, but what is interesting today, and people have decided 

in our country, it is not acceptable. 

Mr. MARINO. Well, apparently the people from the village who 

protested and were—made it known that they wanted something 

done about this had an impact. Is there—and please don’t take this 

pejoratively, I am not criticizing. I am a firm believer that—I have 

said over the years that the United States cannot impose its form 

of democracy on other countries because of the simple ideology and 

the history of that country. Life is very valued here in the United 

States, very valued. Can you tell me from your perspective, Dr. 

George, in India, how does that—the value of life in India compare 

to the value of life in the United States? 

Mr. GEORGE. I think it is much more—let us look at the Holocaust. Now, when the Holocaust was happening, it took many, 

many years of denial. Like even in the late 1930s, for instance, no 

country was willing to take on the Jews. So what I am trying to 

say is, now, by the time when the American, you know, Government was informed of it, you had Justice Brandeis guessing going 

to meet the President, FDR, and talking about what is happening 

in these concentration camps. Still there was a lot of delay. So 

what I am trying to say——

Mr. MARINO. It wasn’t happening in the United States, not that 

that is an excuse, because I wrote an extensive paper on why did 

FDR wait so long to address this issue. But is it an issue of ideology? 

Mr. GEORGE. No, no. What I am saying is that what we dealing—

like today, for instance, like in China, there is active public discourse on the question of sex selection, which is very important. 

Like, in China there is still very little public dialogue. So what I 

am trying to say is that when Chris Smith talks about China, sir, 

and I think you need to recognize that it is different. And the only 

52

way to deal with these problems is to engage, and I think we can 

make a difference. 

Mr. MARINO. I am not arguing with you on the ideology, or the 

history, or the mind-set of people in India. I am trying to—I am 

asking you to educate me, to inform me as to is this a factor? 

Ms. MCELYA. I would argue today, and to be clear, just because 

there is good law in place does not mean that there is political will 

on the national level to enforce the laws. 

Mr. MARINO. That is my point. 

Ms. MCELYA. I agree with you that there is not, and the Supreme Court announced a decision in March 2013, this year, saying 

the political will on a union level and on a State level is nonexistent. So the Supreme Court acknowledges exactly what you 

said, but the political will is not there. There has to be a combination of political will as well as social demand; a social demand for 

justice, a social demand for change, a social demand to recognize 

that these girls’ lives are every bit as important as boys’. 

Mr. MARINO. Sure they are. There is no question about that. 

Mr. GEORGE. Again, I mean, I heard—I was in the Supreme 

Court. I intervened in this case that Jill is talking about. We had 

a hearing on the 3rd. So what I am trying to say is that in the 

State of Maharashtra, you know, the risk, the concerted efforts of 

this lawyer, the political parties are supporting the implementation 

of the law. So you have an example, sir, that the laws have been 

taken seriously, and it has made a fact of——

Mr. MARINO. Let me pose this, then. We are going through an 

issue concerning Syria, and the overwhelming, the overwhelming 

numbers, percentages in the country, in the United States, not to 

intervene is extraordinary. I have never seen numbers from Republicans, Democrats, Independents and people who don’t even vote so 

high as to say, we do not want to get involved. 

Now, you are looking for some help from the United States, and 

the United States, for the most part, is always there to try and 

help, but how do we sell to the American people the idea of aid of 

some type or another, whether that is monetary, or whether that 

is, you know, people on the ground through USAID or some other 

entity—how do we convince the American people if the national 

government in India does not appear to take this seriously? Why 

are we going to spend the time, the effort, the resources if India 

isn’t taking what I perceive as being the necessary immediate steps 

to implement the law? 

Mr. CONNELLY. Can I say something? 

Mr. MARINO. Please. 

Mr. CONNELLY. I mean, on the point of—and I agree with you, 

it is a fundamental point, how do we understand why it is that people apparently don’t value life. I mean, to be fair, it is an American 

idea to pay people money to agree to sterilization. That was an 

American idea. And not only that, it was an American economist 

working for the Johnson administration who calculated the numbers to come up with how much he should pay parents to agree to 

sterilization. And the reason for that is that he calculated the future value of an Indian life was less than nothing. And so it was 

for that reason that he thought that it would make sense not only 

for India, but——

53

Mr. MARINO. But sterilization is very, very different from murder. Okay? Very different. 

Mr. CONNELLY. A lot of people died through botched sterilization 

operations. 

Mr. MARINO. Granted, okay, I understand that, and I am not 

mitigating that at all, but not in the numbers you are talking about 

what is taking place in India. So that is a very tiny, infinitesimal 

amount. 

First of all, I can’t imagine, I bet there is nobody in this room 

that would agree with anything like that today. But let us deal 

with the facts today that are at hand. There is an abomination taking place in India. Just about every other country in the world, 

when they have problems, whether they like us or not, comes to the 

United States for help, and we are known for that. And I am proud 

of that. But again, it is a tough sell, given the financial crisis that 

we are in, given the state of affairs around the world, and it sounds 

to me that the national government can put pressure on the States, 

who can put pressure on the locals to address this issue, I think, 

seriously. Am I wrong? 

Ms. MCELYA. Yes, I think you are correct. And just as we require 

India to report on what they are doing to eliminate trafficking, because of the Trafficking and Person Protection Act——

Mr. MARINO. So what do we do? 

Ms. MCELYA. Let us institute something in our Government, 

again, that requires them and other countries where we see that 

there is a problem with gendercide to report on what they are 

doing to protect their girls, and what they are doing on a national 

level to put pressure on the States so that there is no more elimination, so there are no more missing girls. 

Mr. MARINO. Does this have anything to do—I am sorry, I am 

running way over my time, Chairman. Does this have anything to 

do with trying to stabilize the increasing population in India? Is 

there an ulterior motive here? Okay, this is a way to resolve one 

of the major problems that we have? 

Mr. GEORGE. That is a very shortsighted way, even if that has 

been an intended or unintended consequence, because what we are 

dealing with is incredible increase in violence against surviving 

women. So therefore, you know, to come up with one problem, you 

know, to resolve one problem population by creating more violence 

in the society is no way to——

Mr. MARINO. I agree with you. Don’t think I am taking an opposite side here. I am just asking, could that be a thought in the national government’s attempt to control the population? 

Mr. GEORGE. Yes, sir. I mean, that is within sections of the——

Mr. MARINO. So it goes to ideology. It goes to—we have problems 

in India, and I am just speaking generically, so in a way to deal 

with those, we are going to turn our head to this catastrophe that 

is taking place. We know it is an abomination, but it could help 

stabilize our growing population. I mean, is that—have you ever 

thought of this? Or has anyone ever talked about this? 

Ms. MCELYA. Absolutely, and I would argue yes. That is part of 

the reason why they are turning a blind eye. That and, as Ms. Dutt 

mentioned, just the preference for sons and the discrimination 

against girls. 

54

Mr. MARINO. This isn’t just a one-factor issue. I understand that. 

But thank you, you have educated me. And I yield back. 

Mr. SMITH. Let me ask each of our panelists, this would be a 

basic yes or no question, whether or not you support or oppose the 

Preconception and Prediagnostic Techniques Act of 1994, or the 

PND Act? 

Mr. CONNELLY. You would have to remind me, I am sorry. 

Mr. SMITH. Sex-selection abortions act. 

Mr. CONNELLY. Of course, I would support it, yes. 

Mr. SMITH. You support the act? 

Mr. CONNELLY. Yes. 

Mr. SMITH. I just want to get on the record. 

Mr. GEORGE. So let us be very clear. The Preconception 

Prediagnostic Techniques Act. The purpose of the act is on the act 

of determination, not on abortion. 

Mr. SMITH. Right. 

Mr. GEORGE. So let us be very clear. I don’t want to mislead you. 

The focus of the act is on stopping determination, because the act 

sees sex selection as discrimination. So we are not dealing with 

abortion. 

Mr. SMITH. So sex-selection abortion is not proscribed in India? 

Mr. GEORGE. No, determination of the fetus. 

Mr. SMITH. Please, so we know absolutely. Is there a law in India 

that says it is illegal to have a sex-selection abortion? 

Mr. GEORGE. No. What it says, the law, PNDT Act that you mentioned, is against discrimination. It talks about not just—it focuses 

on determination of sex. So it could be the fetal sex, it could be the 

embryo sex, it could be the preconception sex. The determination, 

because that is—because we also have a law [inaudible], which 

makes it legal, so the focus of this law is determination. So it is 

not sex-selection abortion. 

Ms. MCELYA. When you determine the sex of your child, and 

then you determine that she is a female and then go have an abortion, that is illegal because you have broken the act in determining 

the sex of the child. And so, yes, I am in favor of this act. 

Mr. SMITH. Ms. Dutt? 

Ms. DUTT. Yes, in favor. 

Mr. SMITH. Let me ask Dr. Connelly: Can you expand on the role 

USAID historically played in the course of population-control programs in India? You mentioned Australia’s AID agency in your 

written report, what they do. What about those other countries 

such as Sweden’s SIDA, and maybe other countries, too, if you 

want? 

Mr. CONNELLY. USAID played an enormous role in funding population control. In the 1970s, USAID provided more international 

aid for family planning, so-called, than the rest of the world put together. 

That said, USAID, unlike, say, Sweden, for instance, and a number of other foreign aid agencies, didn’t provide money for incentives for sterilization payments. On the other hand—now I have got 

three hands—the head of the——

Mr. SMITH. Dr. Connelly, on the coercive side. 

Mr. CONNELLY. Right. On the coercive side. Well, for me, paying 

poor people who are hungry for sterilization is coercion. 

55

Mr. SMITH. We did that in India? 

Mr. CONNELLY. No, actually USAID did not do that. They did, on 

the other hand, pay for incentive payments for the providers to 

carry out these procedures, which, as you can imagine, is ripe for 

abuse. 

Mr. SMITH. Historically the rural populations and castes targeted 

for population control, were the Dalits, for example, singled out for 

more abusive treatment? 

Mr. CONNELLY. That is a matter of, you know, great controversy, 

continuing controversy. If you look at the statistics, you know, from 

the emergency period, for instance, it does seem that the Dalits 

were singled out. And, you know, whether this is because they 

were often the poorest and most disenfranchised, or whether it is 

because they are Dalits, that part is not clear. 

Mr. SMITH. Without objection, the testimony submitted by Mara 

Hvistendahl will be made a part of record. She couldn’t be here 

today, but wrote an extensive submission for this subcommittee. 

She points out in her testimony that sex-selective abortion following ultrasound scans is by far the most common means of sex 

selection worldwide. Do you agree with that? 

Mr. CONNELLY. I don’t know that I can verify that about the 

present, but, you know, to my knowledge, that is consistent with 

what I have seen. 

Mr. SMITH. Dr. George? 

Mr. GEORGE. Yes, sir. Now if you look at—see, India is a big 

country. If you look at China also, you know, there are regional differences. So, you know, sexing started extensively in the private 

sector in Punjab in 1979. So when you look at, you know, some—

many of the other parts of India, southern India, eastern India, the 

sex selection started later. If you look at my State of Kerala, even 

10 years ago the rate of ultrasound usage was the highest in pregnancy. Hardly any misuse was being done for sex determination, 

but in recent years we are seeing. 

So it depends on when the sexing started, so when the ratios fall. 

So therefore, it—as the whole country we cannot see, but what I 

am saying is that it depends on where you are. So if you are looking at Punjab, Delhi, Haryana, yeah, you are right. Sex determination becomes the most important cost yet with postchild neglect. It 

is much less where infanticide is much less. 

So what I am trying to say is that in 1981, I came to the U.S. 

to study nutrition because we saw malnutrition of girls as a big 

problem. Those days the sexing was very little, and infanticide was 

very little, but today we see that as sexing becomes more and more 

of the norm, then these things become very different. 

Mr. SMITH. Ms. McElya? 

Ms. MCELYA. In the studies that I have done through our work, 

you can see the gender ratio dropping every 10 years in the census. 

I believe in 2001, between the ages of zero and 6, the girls were—

ratio was 927 to 1,000 boys. In the 2011 census, it is 914 girls to 

1,000 boys. And that is, once again, ages of zero to 6. And through 

experts in this field in India, they say that this is a direct product 

of sex determination through ultrasound, and that it is becoming 

much more prevalent. 

56

Now, granted in our work we deal with a lot of people who are 

very, very poor, and who cannot afford the sex-determination test 

through ultrasound, and so they are still committing infanticide, 

and these are people in the rural villages in India. But when people can afford it, they will have sex-determination tests done 

through ultrasound, and they will choose to abort their children, 

their daughters, because of what they have learned in ultrasound. 

Mr. SMITH. Ms. Dutt? 

Ms. DUTT. I am afraid I really have to look at the numbers. I 

mean, I am kind of lost a little bit of the track of what was——

Mr. SMITH. Her question—her declarative sentence was sex-selective abortion following ultrasound scans is by far the most common 

means of sex selection worldwide. Do you agree with that? 

Ms. DUTT. I really don’t. I would really have to look at the numbers. I don’t know. 

Mr. SMITH. Can you do that and get back to us for the record? 

That would be appreciated. 

Ms. DUTT. Sure. 

[The information referred to follows:]

WRITTEN RESPONSE RECEIVED FROM MS. MALLIKA DUTT TO QUESTION ASKED

DURING THE HEARING BY THE HONORABLE CHRISTOPHER H. SMITH

Identifying specific means of gender-biased sex selection is difficult because this 

phenomenon so often occurs outside traditional healthcare systems and without official reporting. But additionally, the question is flawed because it does not get at the 

root cause of gender discrimination of which son preference is one example. Gender 

discrimination is widespread and multi-faceted. 

A complex web of socioeconomic and cultural factors results in discrimination 

against girls, which manifests in sex-selective practices. Technologies used for sex 

selection have compounded the problem, not caused it. Therefore, change can only 

be achieved through a broad-based, multifaceted and dedicated effort to combat the 

underlying causes of son preference and gender discrimination. 

In India, ultrasounds for illegally determining the sex of the fetus are very common due to access and because the technology is inexpensive, reaching even the 

most interior areas of the country. Today in India itself there are over 1.2 million 

sex selective determinations through ultrasound and other technologies resulting in 

over 600,000 girls missing or prevented from being born. 

On the means of gender-biased sex selection, in many places abortion may be currently the most common form it takes, however research indicates that son preference will persist even where access to ultrasounds or abortion is not available. In 

some cases families will resort to female infanticide or long-term oppression and neglect of girl children.

Mr. SMITH. She also points out that there has been a spike in 

trafficking, prostitution and bride selling in India as an aftereffect 

of sex-selection abortions and sex selection in general. Mr. Weber 

just left. He wrote the law in Texas on combating sex trafficking. 

My good friend and colleague Mr. Marino enforced it as the U.S. 

Attorney, enforced my law, because I wrote the Trafficking Victims 

Protection Act of 2000. 

We have tried for years to get the U.S. Department of State to 

focus both on China and India, that there is a nexus between the 

two. Finally this year the administration—and I credit Luis 

CdeBaca for—the Ambassador-at-Large for being dogged in trying 

to ensure that this connection be made. The Trafficking in Persons 

Report for this year announced in June—I was at the announcement with Secretary of State John Kerry—made it absolutely clear 

that this is a major factor in what is becoming an outrageous phenomenon of commodifying women and selling them because there 

57

is a dearth of women. They have been exterminated systematically 

through sex-selection abortion. 

We have not had a corresponding acceptance of that notion in 

India. And I am wondering if any of you could shed light on—you 

know, as Ms. Hvistendahl points out, you know, she has a whole 

section on human trafficking and points out that India’s impoverished Northeast is a common source of trafficked women, and, of 

course, the lack of women, of course, leads to more bride selling 

and trafficking. 

Is it your view that—I am not here to talk about China, but is 

it your view or would any of you like to take a stab at the issue 

of trafficking, and sex-selection abortion, and sex selection in general leading to an exacerbated situation? 

Ms. DUTT. You know, I started working on the issue of trafficking and forced prostitution in India in 1982, and I actually did 

my senior thesis in college at Mount Holyoke on the subject. And 

at that time there was very little attention being placed on the 

issue of trafficking. And one was also looking at the phenomenon 

of mail-order brides to the United States from various Southeast 

Asian countries, and returning GIs and soldiers marrying women 

and bringing them back. 

And so, you know, my experience with the issue of trafficking 

and forced prostitution goes back, obviously, several decades, and 

I am not entirely sure that I would be willing to say that there is 

a cause-and-effect relationship between gender-biased sex selection 

and trafficking in women and girls, because my work on that started a long time ago, and that—the current statistics on that situation did not exist then. 

I think that the issue of gender-biased sex selection and trafficking in women and girls are both manifestations of gender-based 

discrimination, which has multiple roles, as we have discussed earlier in the testimony. And I think to make the connections, that 

sort of direct causal relationship between gender-biased sex selection and trafficking, you know, of course, the unequal sex ratio is 

leading to other kinds of consequences, but to say that this is a 

consequence of that rather than underlying patriarchy and genderbased discrimination, I think, is incorrect. 

Mr. SMITH. Let me understand. You would disagree with the U.S. 

Department of State’s findings that it is a cause of sex trafficking. 

The absence of women and the cause of their——

Ms. DUTT. I don’t think it is a cause. I think that the problem 

is gender-based discrimination and the objectification of women, 

and the fact that men are not raised to look at women and girls 

differently. I think the problem really is how men view women, if 

you really want to talk about the causes of the problems that we 

are facing today. 

Mr. SMITH. But with skewed ratios and the absence of women to 

marry—and, again, both India and China have enormously skewed 

ratios; others are joining those ranks, not quite as much so—you 

don’t believe that leads to entrepreneurs, nefarious entrepreneurs 

at that, who turn women into commodities and buy and certainly 

sell them? 

Ms. DUTT. The trafficking industry uses whatever factors it can. 

It uses poverty. 

58

Mr. SMITH. What about the dearth of women who then——

Ms. DUTT. Well, that is one of many, many factors. To say there 

is a causal relationship between one and the other and to ignore 

patriarchy and gender-based discrimination——

Mr. SMITH. Who is ignoring? That is a strawman’s argument. I 

am not ignoring any other issues. What I am suggesting is that 

when women don’t exist because they have been systematically 

exterminated through sex-selection abortion, and, again, Ms. 

Hvistendahl points out that that is by far the largest cause of the 

missing girls worldwide, it certainly leads to people looking for 

women who don’t exist, and then in come the pimps who sell these 

women to the nearest buyer. 

Ms. McElya, if you could speak to that. 

Ms. DUTT. But the trafficking is before that. 

Mr. SMITH. I am out of time almost. Of course it has gotten 

worse, demonstrably worse, because when I wrote that law, finally 

the State Department has recognized it, and we are hoping that 

they recognize it vis-a`-vis India, and they have not yet. 

Ms. MCELYA. Thank you, Chairman Smith. 

As I wrote in my statement and I touched on briefly in my oral 

statement before the committee, yes, you can see a correlation. 

There is—because there are 37 million men who will never find 

wives, there has to be a result, and the result is trafficking; studies 

show trafficking, violence against women, marrying of child brides. 

The percentage of young girls who get married in India, it is 47 

percent below the age of 18 who are married off to these men because they are looking for women to marry. 

And so there is a correlation. I mean, you can’t—I think that you 

have to recognize that trafficking is a result of what is going on in 

this discrimination against girls and women through sex-selective 

abortion, through infanticide, through feticide. 

Mr. SMITH. To borrow an inconvenient—or someone else’s word, 

it is an inconvenient truth, in my opinion. It is almost as plain as 

the nose on my face that when the women don’t exist because they 

have been exterminated in utero, that men who are looking for a 

woman, unfortunately, are more easily susceptible to those, again, 

nefarious networks of pimps who sell them. 

Dr. Connelly, do you want to speak on that? 

Mr. CONNELLY. You know, one thing I know about trafficking is 

that it is notoriously difficult to get accurate statistics. One thing 

about sex ratios is that we have very good data. You know, these 

are vital statistics, and so we can keep close track of it and track 

the change over time, whereas reporting on sex trafficking is a 

statistician’s nightmare. So it is a little hard, you know, to verify 

a causal relationship between the two. 

Mr. SMITH. Well, it took the State Department a long time on 

China, but they finally have come to that conclusion, and, again, 

it is in their most recent report. And the Obama administration absolutely does not agree with my view on the sanctity of an unborn 

child’s life, but nevertheless they came to that conclusion that 

there is a nexus between the two. 

I want to thank all of you for your testimony. I think it has been 

a very spirited and, I think, robust discussion. It is not the end of 

it. I do believe that violence against the unborn child, or the newVerDate 0ct 09 2002 16:20 Feb 06, 2014 Jkt 000000 PO 00000 Frm 00062 Fmt 6633 Sfmt 6601 F:\WORK\_AGH\091013\82762 HFA PsN: SHIRL
59

born child who happens to be female, or anyone else cries out for 

protection. It is human rights or nothing if they are not for all. You 

know, and so again, Ms. Dutt, I would respectfully disagree with 

you on your view, but I do believe passionately that abortion is violence against children, and it is injurious to women, and, again, it 

has made this issue of missing girls demonstrably worse. And that 

is, I think, a matter of statistics that are understandable. 

Thank you so much for your testimony. I am going to try to make 

that vote, which I might have missed. I really appreciate your providing the insights that you have today. 

The hearing is adjourned. 

[Whereupon, at 4:50 p.m., the subcommittee was adjourned.] 

(61)

A P P E N D I X 

MATERIAL SUBMITTED FOR THE HEARING RECORD

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SlJBCOMMITTEE HEARING NOTICE 

COMlVITTTEE ON FOREIGN AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

WASHINGTON, DC 20515-6128 

Subcommittee on Africa, Global Health, Global Human Rights, and International 

Organizations 

Christopher H. Smith (R-NJ), Chairman 

September 9,2013 

TO: MEMBERS OF THE COMMITTEE ON FOREIGN AFFAIRS 

You are respectfully requested to attend an OPEN hearing of the Committee on Foreign 

Affairs, to be held by the Subcommittee on Africa, Global Health, Global Human Rights, and 

International Organizations in Room 2200 of the Rayburn House Office Building (and available live 

on the Committee website at YioYjoJoreignai'fairs.housc.g{l.'C)· 

DATE: 

TIME: 

SUBJECT: 

WITNESSES: 

Tuesday, September 10,2013 

3:00 p.m. 

India's Missing Girls 

Matthew l Connelly, Ph.D. 

Professor 

Columbia University 

Sabu George, Ph.D. 

Independent researcher 

Ms. Jill McElya 

Vice President 

Invisible Girl Project 

Ms. Mallika Dull 

President and Chief Executive Officer 

Breakthrough 

By Direction of the Chairman 
63

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COMMITTEE ON FOREIGN AFFAIRS 

MINUTES or SUDCOMJ\11TTEE ON ..!!:'c{fl Glohal Health, Glohal "'lllum Rights, awl i11fematiol/(// Orgol1izafioJlS HEARING 

Date September lq, __ ~qf!~Roon1 2200 R([l'blll'lllIOB 

Stat'ting Time 1.00p III Emling Time 4.-51 p.m. 

Rec.,"., !J:.J ( __ to __ ) t-Io --l ( __ 10 __ ) ( __ 10 __ ) t-to __ ) ( __ to--l 

PresIding Mentb",,(,) 

Rep. Chris Smith 

Cileck nil ofthefollowing Illat nppl)': 

Open Scs!;iou [Z] 

Executive (closed) Session D Televised G'J 

TITLE OF HEARING: 

1n(/i(['s ],fissing Girls 

SUBCOMMITTEE MEMBERS PRESENT: 

Rlectl'onicully H.ecj)'·d~'a(led) [Z] 

Stenogl'aphic Record lLJ 

Rep. Rtllu(l' Webe/; Rep. Mark MelU/mvs, Rep. Tom ]'farino, Rep. Ami Bera 

NON-SUBCOMMITTEE MEMBERS PRESENT: (Ma,.k with all * if they ore 1I0t members offill! commlttee.) 

HEAIl.lNG WITNESSES: Sam. as meeting notice attached? Yes III No D 

(If "no 'i, please list helm!' and include title! agency, department, or organization.) 

STATEMENTS FOR THE RECORD: (List "'0' .·/a/elllel1ls submlltedfol' the I'ecol'd.) 

Response sllbmilfed by Ms. Mallika Dult 

Materia! submiltedlo/' the recor(/ by Rep. Ami Bel'll 

P/'epa/'ed statemelltli'olll Ma/'{{ HJ'istemillhl 

]}[ilte,·ia! ""hlllitted fiJI' the /'eCllrtl hy D/,. Sabll Geol'ge 

'j'IM~; SCHIWllLlW TO RECONV~;N~; ____ _ 

0" 

TIME ADJOURNED 4:51 IJ·IlI· 1'1 r) r~ . ," 

(yy'fy--"'C) t;, )' ;". ), '-- J 

SlIbcotilmittee Staff Di!'ector 
64

MATERIAL SUBMITTED FOR THE RECORD BY THE HONORABLE CHRISTOPHER H. SMITH, 

A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY, AND CHAIRMAN, 

SUBCOMMITTEE ON AFRICA, GLOBAL HEALTH, GLOBAL HUMAN RIGHTS, AND INTERNATIONAL ORGANIZATIONS


82762f-1.eps
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82762f-2.eps

India's impoverished northeast is a common source of trafficked women. Some women 

are easily duped with false job offers and other pretenses. Ambitious teenagers realize the 

opportunities available to them if they stay in their villages are limited, leaving them 

susceptible to tramcking. In other cases, parents may sell their daughters, making 

violations difficult to track. 

Trafficked women are often transported to the northwest, which is wealthier but, thanks 

to decades of sex selection, short of women. Regional differences in India can be stark, 

and trafficked women frequently arrive at their destination unequipped in local culture 

and often unable to speak the local language. Those sold into marriage often find 

themselves paired with a much older husband, with the age gap frequently extending to 

fifteen to twenty years. 

Fees paid for a young bride throughout Asia start at a few hundred dollars, but as women 

become more scarce, prices will likely rise. Meanwhile, the normalization of sex and 

marriage tramcking makes it possible for people living in areas where sex selection is 

widespread to ignore its consequences. Instead of facing up to the dearth of women, 

locals simply import women from poorer places-transferring the imbalance elsewhere. 

Prostitution 

Historically, prostitution thrives in places where men outnumber women. In nineteenthcentury France, industrialization spawned an urban migration that left cities full of men. 

Brothels flourished. A similar phenomenon occurred in 1930s Shanghai, where historical 

estimates hold that one in every thirteen women was a sex worker. Today too, female sex 

workers have proliferated in parts of Asia where the sex ratio is most skewed. Indian 

newspapers have also carried reports of an increase in acti vity by male sex workers. But 

because sex workers are trafficked domestically rather than internationally, the sex trade 

in India is very difficult to monitor. 

Medical researchers are now closely watching the skewed sex ratio in China and India for 

its effects on HIV infections. As the addition of millions of surplus men to the Asian 

population fuels the demand for sex work, a spike in HIV rates is expected. Surplus men, 

moreover, are a "bridging population"-a group that transfers the virus from a high-risk 

people to low-risk people. A surplus man may contract HIV from a sex worker, for 

example, and later transmit the virus to a bought bride. Public health strategies for HIV 

prevention and treatment must take into account the increasing influence of surplus men. 

Bride-selling 

Gangs sell women into both sex work and marriage. The majority of trafficked women, 

however, end up as bought brides. Demographers say India is in the grips of a "marriage 

squeeze"-a gap between the numbers of marriageable men and women. It can take a 

while before a squeeze is acutely felt. At the beginning, so-called leftover men may 

marry younger women. But later cohorts of men are left with few potential female 

partners. The effects of a squeeze trickle down. A sustained drop in the fertility rate, as 

has happened in India, can exacerbate a squeeze. 
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82762f-3.eps

Today, northwest India is at one of the later stages of a marri age squeeze. By 2020, an 

estimated 15 to 20 percent of men in the region will be surplus. This is a significant 

change in a society with a traditionally high rate of marriage; until recently, the 

proportion of Indian men who remained bachelors hovered around I percent. Despite the 

rapid increase in the proportion of surplus men, bachelors and their families remain under 

enormous social pressure to find brides. In some instances in China, men have also 

become victims of traffickers, who tricked them with promises of a wife and then 

delivered nothing. 

Once, families in India's northwestern states looked down on those who resorted to 

buying brides from poorer areas. The trade has gradually become normalized, and 

elaborate rituals have arisen to help families pretend that the unions they arrange are 

standard. Traditionally in India, it is the bride's family that should pay the groom's upon 

marriage, not the other way around. Today, that has been reversed-the groom buys the 

bride-but some families continue to pretend that they are following the old ways. The 

groom may give the bride's parents a symbolic sum of money, for example, with the 

bride's parents then handing the money right back to him. 

In some areas, locals have come up with even more extreme and inhumane solutions to 

the shortage of women. Cases of polyandry-women trafficked to a high sex ratio region 

to marry multiple brothers-have cropped up in both China and India. Child marriage is 

another recourse. India accounts for 40 percent of global child marriages. The recent 

deluge of surplus men has encouraged this unfortunate trend. 

In wealthier Asian nations with skewed sex ratios, the bride trade has become formalized. 

South Korea and Taiwan now have established agencies that peddle brides from poorer 

Asian countries, with the women's photos displayed in online galleries. On the other end 

of the international bride trade, families in Vietnam's Mekong Delta have gotten rich by 

selling women through these agencies. India may be expected to someday develop a 

sophisticated industry along these lines. At that point, it would face more scrutiny, both 

from governments and from organizations like the International Organization for 

Migration, which monitors trafficking. For the moment, however, a woman brought to 

northwest India from the northeast receives little to no assistance, legal representation or 

education, or language or cultural training. Likewise, there is scarce funding available for 

preventing the flow of women from sending villages. Both of these areas deserve more 

attention. 

Conclusion 

The above are only a few of the downstream effects of sex selection. Both news reports 

and my own research suggest that there has been an increase in sexual and domestic 

violence in high sex ratio regions as well. There are also signs that crime is on the rise in 

these areas. Finally, if history is any guide, it is very likely that an excess of young men 

in the population will ultimately yield instability and social unrest. 
67

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For now, the clear evidence that regions with extra men have seen a spike in trafficking 

of women, prostitution, and bride-selling-combined with the injustice inherent in the 

fact that the global population now lacks over one hundred million females who should 

be there-should present cause for action. Sex selection has received insufficient 

attention at the international level. Nations like India should be provided with support in 

addressing sex selection, both in stopping it and in dealing with its downstream effects. 

Ultimately, proposals for fighting sex selection should take into account existing and 

emerging sex determination technologies-including portable ultrasound machines, 

preimplantation genetic diagnosis, and fetal DNA tests. Many of these originate in the 

United States. 

Thank you for your attention to this critical issue. 
68

MATERIAL SUBMITED FOR THE RECORD BY THE HONORABLE AMI BERA, A

REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA


82762e-1.eps
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strict population policies that limit family size to 

one or two children. And, of course, new technologies such as ultr8sound imaging to determine 

fetal sex, together with sex-selective abortion, 

have facilitated the preference for and practice 

of choosing boys without having to resort to 

infanticide. 

At the macro level, the results of ontrenched son 

preference are highly skewed national sex ratios, 

which in turn can have decidedly negative social 

consequences-again, largoly for women .and 

girls. Societies with heavily lopsided sox ratios 

may face a dearth of won,en for marriage, which 

could increase the likelihood of coerced marriages or bride abduction, trafficking of women and 

girls, and rape and other violence against women 

and girls. A large cohort of young, single men 

m(1Y load to more crime-ridden, violent communities and general societal insecurity, especially 

in cultures where social standing is closely connoctod with marital.status and fatherhood, 

Under normal circumstances, the sex rCltio at birth 

usually rangos from 102-106 live male births per 

100 live female births. 1 (Boys are biologicallv more 

likely to suffer child mortality, so sex ratios at birth 

are naturally higher.lTho sox ratio at birth in China 

has been growing at ~n alarming rate over the 

last three decades. The ratio of boys per 100 girls 

jumped between 1982 and 2005, from 107 to 120.~ 

Atthe regional level, the disp(\rity is ovon sharper, 

as the ratio in some provinces is higilerthan 130.::: 

Tho Chinese Academy ofSoeial Sciences predicts 

that by 2020, China will have 30--40 million more 

boys and young men under age 20 than females 

of the sarno agc.4 India, too, is facing a national 

crisis with its sox ratios. The Indian census does 

not puhlish sex ratios (It birth, but rather child sex 

ratios, expressed as the number of females below 

age seven for every 1,000 males. The last four 

census surveys point to rapidly increasing dispafJties:The child sex ratio dropped from 962 (girls to 

1,000 boys) in 1981 to 945 in 1991 to 927 in 2001,' 

and according to the latest census, in 2011, the 

ratio decreased further, to 914.6 

As in China, India has conSiderable fluctuations 

across different regions cnd localities. For example, the northorn Indian states of Haryana and 

Gullmu"he. PoliGY Ravlaw I Volume 15, Number 2 I Sprin!l201? 

Punjab afA notorious for their exceedingly disparate ratios, at 830 and 846, respectively, with 

some districts dipping into the 7708. 6 In contrast, 

south India has normal sex ratios. In this regurd, 

it is worth noting that the status of women in 

parts of south India is higher than in the rest of 

the subcontinent; gondor discrimination-and 

thereby son preference-apparently is not motivating women and their families to use the same 

accessible technology for scx·solection purposes 

in these regions. 

Finally, a discernible pnttern among most countries with skewed sex ratios is th~t disparities 

increase with birth order. In other words, aven in 

China, the sex ratio is near normal for first-order 

births;3 however, it increases dmmatically for second-order births and sky-rockets for third-order 

or later births.'This evidence shows that families 

will accept a daughter ifshe is a first-born child, 

but then will take inordjnate steps to guarantee 

that the second one Is a son. For example, in 

cort\1in provinces in China, the sex ratio for thirdorder births exceeds a whopping 200 (boys per 

100 girls).3 

",And Effeclively Addressing It 

Women's rights advocates, researchers, multifateral agencies and affocted governments have 

been working on the problem of son preference 

and the outcome of imbalanced sex ratios for 

many years; however, with tho limited exception 

of South Korea (see box, page 21)' rolativoly little 

heCldway has been made. That said, recent international agreements provide insights into howand how not-to move forward. 

Tho consensus documents broke red by more 

than 180 United Nations (UN) member states EIt 

the 1994 International Conference on Population 

and Oevelopmont ([CPD) in Cairo and the 1995 

Fourth World Conference on Women in Beijing 

represent seminal agreements on women'g 

health and rights. Both the ICPD Programme 

of Action and the Beijing Declaration squarely 

identify sex selection as a manifestation of son 

preference and frame the problem of son preferonce as a form of gender discriminmion and a 

vlolation of women's human rights.B

•

9 And the 

ICPO Programme of Action urges governments to 

19 
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82762e-3.eps

20 

"eliminate all forms of discrimination against the 

girl child and the root causes of son preference, 

which results in harmful and unethical practices 

regarding female infanticide and pren<::ltal sex 

selection"€! a recommendation also echoed in 

the Beijing Declaration.9 

The most authoritative and instructive roadmap 

on how to understand and counter the prob~ 

lems of sex selection is a statement released 

last year by five UN agencies· -tho Offico of 

the High Commissioner for Human Rights, the 

United Nations Population Fund (UNFPA), the 

United Nations Children's Fund (UNICEF)' UN 

Women and the World Health Organization. This 

joint interagency statement outlines the less-ons 

experienced by different governments in ad~ 

dressing sex selection and lists five categories of 

recommendations for action, including the need 

for mor'e data on the magnitude of the problem 

and its consequences; guidelines on the use of 

technology in- obstetric care that do not reinforce 

inequities In access; support~ve measures for 

girls and worn on, such as edUcation and health 

services; laws and policies to strengthen gender 

equality and equity In areas such as inheritanCE! 

and economic socurity; and advocacy and communication activities to stimulate behavior 

change regarding the value of girls. Notably, the 

statement includes this caution: "Exporjoncc also 

indicates th<lt bro~d, integriltod and systomatic 

approaches need to be taken if efforts to eliminate son preference are to succeed ... [and] to 

ensure that the social norms and structural issues 

underlying gender discrimination are addressed. 

WJthln this framework, legal action is an important and necessary element but is not sufficient 

on its own."l 

On that note, three domn countriO$ have enacted 

laws or policies on sex selection.TD Both Indra 

and China out~aw prenatal testing-partrcularly 

ultrasound-to detect the sex of the fetus (except 

for medical reasons), and China additionally bans 

sex-selective abortions. Neither country's laws. 

however, have been effective in stopping S9X~ 

selective abortions,11 likely because enforcement 

is extremely difficult, affordable ultrasound servi-cos arc widely availablo and fetal sex informa~ 

tion can be relayed to potential parents without 

even saying a word. Moreovef, an ultrasound 

may be performed in one location and an abortion obtained in another, where a woman can 

provide alternative reasons for the procedure. 

An even more compelling argument against sexselective abortion bans is that restrictions on 

access to prenatal technologies and to abortions 

can create barriers to health care for women 

with legitimate medical needs; scare health care 

providors from providing safo, otherwise legal 

abortion services; ilnd forco womon who want 

to terminate their pregnancies into sidestepping 

the regulated health care system and undergo~ 

ing unsilfe procodures. Accordingly, tno jOint UN 

statement stresses that "States have an obligation to ensure that these injustices are addressed 

without exposing women to the risk of death or 

serious injury by denying them access to needed 

services such as safe abortion to the full extent of 

the law. Such an outcome would represent (] further violation of their rights to life and health."1 

Entor U,S. Abortion Politics 

While governments in Asia grapple with the seri~ 

DUS consequences of entrenched son preference 

and lopsided sex ratios, antiabortion lawmakers 

in the United States are working overtime to capitalize on the issue for their own ends. In February, 

the House Judiciary Committee approved legislatlon to ban sox·soloctivo abortions. Among other 

actions, the bH1 would arrow criminal prosecution 

of health care providers who perform such abortions, and of medical and mental h-ealth profes· 

sianals who do not report suspected violations of 

the law. It would make no exceptions to save the 

life or health ofthe mother, orto allow for mBdi~ 

cal, sex~Hnked reasons for an abortion. (The bill 

also bans so·called race-selective abortions, citing disproportionately high abortion rates among 

communities of color as evidence that abortion 

providers are "targeting" them, while ignorin9 

tho underlying racial disparities in unintended 

pregnancy rates; see "Abortion and Women of 

Color:The Bigger Picture," Summer 2008.) 

Rep.Trent Franks tR~AZ} originally introduced 

the Susan B. Anthony and Frederick Douglass 

Prenatal Nondiscrimination Act {PRENDA) in 

2008, and reintroduced it in 20n, as chairman of 

Spring 2012 I Volum8 15. Numb[)r2 I Gutln1i1cl1cr Policy Re'oliew 
71


82762e-4.eps

Multiprong Measures 

SoutlJ Korea srands as a IIsefuJ exempJIJ of a country tlICH lias made real 

progress in improving a h;ghlyimbalanced sex f8C;0. The countrys already 

oiDII{Jtcd sex fatio III birth climbed avon 

higherdur;ng the. 19808, wnen sex 

detectiolJ-Bnd t!Jerelore sekse/eculI8 

.abortions-becamE1 commonplace. 

the norma! biological range, and even 

greater imbalances persis! am.ong 

latGrordu( births.} Kurea's appraucli 

dustrializatiDn, fJrbanization and rapid 

economic development, which together 

pJayed ii major NJle if) fundamentallyaltaring underlying social numls, 1,7 Ollwr 

trends that increased the status of 

women included more female employment in the labor market, new laws and 

policies to improve gender equality fwd 

iiwarfJflf;J.ss-raising campaigns through 

tl1Bmedio. 

The ratio peak6d at almost /16 in the 

mid-IYYOs, bur declined to 1V7 by 2007/ 

to irs sex ratio problem is instructive 

because the government espoused 8 

mr/flifude of economic, socia/ana leg8/ 

weI/lies. Afthough the government 

pllrsued cOlJcerted attempts fo eurorce 

its laws against prenatal sex dfJtfJctionf 

researchers give much of tlie credit 

INonotholoss, rho ratio mml1ins outs/do fortflo turnaround to the country's intho Judiciary Committoo's Subcommitteo on the 

Constitution. In the interim, bills to outlaw sexselective abortion were introduced in 13 states 

and enacted in t\'\IO: Oklahoma andAriwna. 

Advocacy organizations, such as the National 

Asian Pacific American Women's Forum 

{NAPAWF), that work in these communities readily acknowledge that son preference is an Important global concorn that needs attontion wherever 

The "finciingsH included by Rep. Franks in the it continues to exist. But they also emphasize that 

preamble of his bill rely on international eVFcience "son preference is a symptom of deeply rooted 

of sex selection because U.S. data on the subject social biases and sterootypos about gendor" and 

are both limited and inconclusive. What is COI1- that "gender inequity cannot be solved by banelusively known is that the U.S. sex ratio at birth ning abortion. The raal solution is to change the 

in 2005 stood at 106 boys to 100 girls, squarely values that create the proforencG for 50ns:'16 

within biologically normal parameters. 1:!: Beyond 

that salient fact, two studies using 2000 U.S. census data to o)(smino sox ratios among Chinese-, 

Indian- and Korean-American families found that 

although the ratio for first-born children in such 

families was normal, there was ovidenco of son 

preference in second- and third-order births, if the 

older children ware daugilters. 13,14 Notably, the 

authors do not pinpoint the cause of the disparate 

ratios-whether prepregnancy techniques involving fertility Ueatments or sex-selective abortions. 

In addition, they comment that these three ethnic 

communities constitute a very smaH proportionless than 2%-uf the U.S. population. 13 A third 

analysis that supporters of PRENDA rely on Is a 

small-scale qualitative study involving interviews 

with 65 immigrant Indian women who practiced 

sox selection. either before prognancy or during 

pregnancy througn an abortjon.l~ Many of thoso 

women spoke of the social and cultural basis for 

son preference and the intense pressure faced by 

women in their communities to produce sons. 

Gllllmncher Policy ReVIew r Volume 15, Number 2 I Spri.')g 2012 

Reproductive justice and Asian women's rights 

groups, in fact, cite myriad problems that saxselective abortion bans coutd create, At the most 

practical level, such restrictions are neither enforceable nor effective, as already demonstrated 

rnternationally. And various attempts to enforce 

them, they stress, would only perpetuate further 

discrimination in their communities through 

stereotyping and raclal profiling of Asian women 

whose motivations for an abortion would be 

under suspicion, In a recont op-od oxplaining their 

opposition to PRENDA. the executive directors 

of NAPAWF nnd the National Latina InstitlJte for 

Reproductive Health wrote: "Immigrant women 

already face numerous barriers to accessing 

health care of any kind, including reproductive 

health care and abortion, and thiS ban would 

make an alrea.dy difficult situation far worse:'!7 

At the end of the day, these advocates are fiercely 

denouncing PRENDA and its copycats bocausQ of 

21 
72

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82762e-5.eps

22 

their deep-seated conviction that the trua motivations of the measures' proponents have everything to do with undermining abortion rights and 

nothing to do with fighting gender discrimination-and that, in fact, the measures themselves 

threaten only to exacerbate that very problem_ In 

written testimony opposing PRENDA, 24 organiL8-

tions from the reproductive justice community 

had this to say: "This anti-choice measure dressed 

as an anti-discrimination biIL.,further exacerbates 

inequities and diminishes the health, well-being, 

and dignity of women and girls by restricting their 

access to repruductive hearth care, We represent 

the women and people of color this bill purports 

to protect, and we are announcing our unequivocal condemnation of ft:TJ:8 www,gultlllRther,org 

REFERENCES 

1. World Health Organiza,iOIl, Prev.enling Cello'er·8i£!sed Sex 

Se1ectlOn:/Ln Interagency Stalemen( OHCHR, UNFPA, UNICEf; UN 

WOLl1$IJ<lr'ld WHO,?01 i, <hl1V!/whqlii)(ioc WhO.·11V,,)ubliL;;.liOJ1s! 

201119789241501460_Cr.9 pdt;., i!ccos,Scd May 1, 2012, 

2. Li S, Imbala-·ced sex ratio at birth and compreh3r'1sive inlerver'ltion 

in China, paper presented Elt the fourth Asi" end Pacilic Conference 

cn Sexual erd Re,:.roduc;[ve Health and Rights, nyderaood, Ind'a, Oct. 

29-31, ?Om, .::httn /,'WI.·/w.llnlpll oLglgf!l1~Jf'fld:x~ktlloiE'!,'l/d1in~ pdf::. 

6ccesscdMay1, "01", 

3. Lh'JV'lX, LuL<Jnd Hosl{CthT,Ch'n<J's-exces~m<Jles,se)(selectr .. e 

aWlllorl, <lndon<jehllu ool!cy <lnalfSisofuatafrom2005u<ldcnalilltercen:;us survey, BM), 2009, 33817700):9ZD-f/3G, <nttp.Il\'y\\lINbmj 

ccm/content/33B/bmj.b1211.abstract>, accessed Way 1, 2012. 

4. The worldv/;de WiJr 0:'1 baby girls, The [conomist, Mar. 4, 2010, 

<i".ttP://V1'/M',ccon!lmist.corrVrodo/15636231:-,.nccc3$CO Moy 1, 

?01? 

5. Government cf India, Ministry of Home Affairs, Office afthe Registra' Geneflll fln::i Census Commis.<;iorH, Cflnsus flnd ),O'.l-!jfln::ier 

composition, 2011, ..::http://ccnsuslnola.gov.ir'l/Ccnwsjl.n;:t'r'O\J/ 

gflndflU:ilf11flO.~itiQnaspx>,ar.cessp.di\'lav 1, :;Ol,} 

6. Whee of the Hegistrar lionBrai and Co.r;sus Commissiongr, Census 

oflnuid2011.2012,<http://csl15usir.dia.gov.inJ2011census/ 

cenausinfodaahbG<lrdlinoex.html>,e.ccessedWay 1,2012, 

7. ChungW and DoS Gupta M, Why is SOil prBfuence de:;I'ning'll 

South Korea? The rafe af de.eJopment ~f1d public policy, and the 

imp'i:::dlions fur China and India. Vlbrfd 8tink PoJ.'cy Re5eerch WO,*ing 

P.'Jper,Wasnmgtcn, DC: Wor'd E>ank, 200~, No, 4:;3'/:3, ..-:http'/lpa;>::<rs. 

<;"<;f(1 (:(I111/so13lpl'Il;PfS:.cf,)\?ahstracUd=10?0341>,.FIcx:e%B(J M(!\" 1, 

:L012. 

8. UN, Popu.ration and Development: Programme of Action tldo,oted at 

file International Conferencf! on PopufBrion and Deve.'opment, Csiro, 

Sept. 5-13, 1994, Ne'NYork: Department for ECQnomic arld Social 

Inforrralio.'" anei Polir:y AnAlys's, UN, 1995 

S, Ilniled NflOl.J').S (UN], De(,iafiliiun (If Iilf! FOlJrIJ~Vllb{/o:! C<lf/(w3n(:e ,m 

~\'omon. UO'I,ng,Scptcmbcr4 15-,1$5, Nm..,.Yol!-.: UN, 1995, 

10. D.amo\'sky lvi, CcuntriE-s with la\'va or poli8ies on sex S8 eotion, 

B~l/keley, CA: Canter for Genetics and Sacie-ty, 2009, -<http:,'/ 

genetj--..s~ndsoc;iaty.argido'A'nlo;.rfs!200904_5ex_se:eclion_memQ 

pdf>.accessedMayl,2012 

11.GanalraB,Mainta"uingaccasslosafaa·oolliorlaJll,iJeuucing 

SOX mIlO rrrbnlDnces in Asi;), ReproductiV6- Hoo!th MDftor:;, 2008, 

16(31SuppU:SO-B-S,-:,http:/AV'N\v.ip;:;s.org/-lmE'diatF'lss/ 

Ipas%ZOPubliC<ltions,lGan<JtraRHrv[2(}08.i1sh:<>,occ-assed 

Mayl,2012, 

1::!.MathewsTJ/Ind HamlltonBL,'lrcndana:ysisofthcs-cxratioat 

birth i/'J the Unite-d SiatE-s, National lIl/a,r SlfluStie::; Hepor/s, 2005, Vol 

5:), No, 70, <hllpil~vwwcJ~ !lOV/ncll::ifd~la/nv~r/rwSl!53ll)'/S'53_?'O, 

pcH>,accoc{lod May 1,2012 

13.A'f".ond D and Edlund L Son-biasE-d sex ratios in lhe 2000 Uni~ed 

States Census, Proceedmgs cf 'he N&flonal ILc<Jd&my of Sc.e.'lCGs-of 

'he Uniled ,<;rare,~ of AIJJeriCii, 700ft, 10!)(1fi):5681-56R?, <o1)ttrJ'll,.'/ww 

pnEls.orgfcontent/l05/1616681.ful'>,acces~(lo M/ly1,2012. 

14, Abreva·~.eo J,ftIe there missing girls in the United Statesi' [vidence 

trom birth dalD, working p~per, Austin, TX: Ur'livarsity ofT(lX~S <It 

Austin, 2008, <h-:tp:/fdx doi.c'rg!1O.2139Jssrn.824266~, <1JXessed May 

1,2012 

15. PIJ'i!'-i et (II, "Tllerl;l k; S(ll'h? thin:) ~s too fIl(lTIY (i(llJoJhtBrs, l)lll 

not too many sons": A qua'rWN-{) study of ~on prcicrcn:o arId fotal 

$flO; se!eetion amonOlndian "rrmiorants in the- Uniteo Ste-tes:, SOCigf 

&ieflc.e & Me(licim:', 2011. 720):1169-1176, "hll!-,"/Iwwv .. ,n~bi,r)[m 

nJh,go\l!pubmec'(21377778>,~cc9ssedM;:.y1,2012. 

16. NalionelAsian Pa:ifi-:; American Women's Forum, Te.stimonyofthe 

Mmam Yeung, MPA, NI)t/onal Asian PiJ!;rflC lImen'can WO.'1lens Forum 

rNAPAWF), D$c. 6, lOff, W"shin!)IOn, nc: NAPA\NF, <hu[,'!/judlc:'MY 

t:ouoo.~ovlhcarin~~/pdINctmg12V6Z()l1.pdf;., acccs.scd lVay 1, 2lJ12, 

17, Gomalez-Rojas J andYeur,g M, ,'lace and sex·based abcrtlon ban 

hi;<lc~s civil rights, comm9ntE;ry, Nl3wA"I19r'1Ca Media, Fe'::!. 2-1, 2012, 

<hrtp/!n6'mmenCllmedfl.mgl7.012i02/rflr.e.;,nd.s.ex'!::<lsed.;,bonion. 

bGn·hija::is-cvi'-right9,php::., flcce,~sed IY.fly 1, 2012 

16, ACC[SS WiJillOlU'S 11'=<lll'l JustL(;o;I O1lal" WriUtll! Ttlsl,'murw from 

Ilia trcproducl/vo J.;st,co Cvmmurilty, Vcc.5, 20", Wc-$hlr.gtOrl, UC: 

N",ioIl31 A5ill11 Pacific Arnslic:an Women's Forum, no datE<, <l1ttp 1/ 

napawf.org.~NIKOrltent/up!oadS/2{J11/12IPreNDA-Letter·RJ-OrgS.Ddb, 

-accesaedM-ay1,2012 

Spring 2012 I Volume 15, Number 2 I GUlImacher PDlicy Review 
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MATERIAL SUBMITTED FOR THE RECORD BY SABU GEORGE, PH.D., INDEPENDENT

RESEARCHER


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~b! 1iM!lo!ltl!limcp 

DealB%k Sorkin 

AUGUST 30, 2011, 9:30 AM 

Behind Google's $500 Million Settlement With U.S. 

By PETER J. HEIINING 

The Justice Department's settlement of a criminal investigation of Google for allowing 

Canadian pharmacies to adveltise drugs for distribution in the United States reflected an 

effOlt by prosecutors to extend the reach of federal dmg laws. This may present future 

challenges to Internet search companies over their advertisements. 

Google entered into a l1onprosecntion agreemellt with the government last week over the 

usc of its AdWol'ds program by Canadian pharmacies that helped them sell prescription 

drugs in the United States in violation of a fedel'allaw, 21 U.S.C. § 331(a). That law 

prohihits causing the "introduction or delivel'yfor introduction into interstate commerce 

of any food, drug, device, tobacco product, or cosmetic that is adulterated or 

misbranded." 

Google agreed to fotieit $500 million, representing both its adveltising revenue fr0111 the 

Canadian pharmacies and the revenue the pharmacies received from American customers 

buying controlled drugs. The company also agreed to enhance its compliancc program for 

drug ad verlisillg. 

For Google, the settlement puts an embarrassing investigation to rest and eliminates a 

distraction while it pursues its $12.5 billion acquisition of Motorola Mobility. By styling 

the settlement as a nonprosecution agreement, the company will not have a criminal 

record once it complies ,,'ith tIle te1111s. 

The Canadian prescriptions sold to American customers were considered "misbranded" 

under the statute because they were not approved by the Food and Drug Administration. 

In some cases, the drugs were obtained from countries other than Canada that lacked 

adequate regulation of pharmacies. 

The United States attorney for Rhode Island, Peter F. Neronha, whose office was 

responsible fO!' the investigatioll, said Google's conduct was nol the result of fl few rogue 

employees, according to The Wall Street Journal. Mr. Neronha said the company's chief 

executive, Larry Page, "know what was going on." 

The statute prohibits the "introduction 01' delivery" of the drugs, but Google was not 

involved in any way in their aChtaI transfcr into the United States, which is the usual 

means of proving a violation of the statute. Instead, the Justice Department viewed 

Google as an accomplice to the crime by enhancing the ability of the Calladiilll pharmacies 
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to reach American consumers. 

Can a search engine be held responsible for how consumers use the pl'Oducls or seTVices 

allowed to be advertised on it? That question goes to a core issue in the criminal law 

regarding the responsibility of supplicrs for the use of products they sell. 

There were negligence lawsuits in the early 1990S against Soldier of Fortune magazine for 

advertisements it ran for people willing to engage in criminal acts, including murder. 

These cases were brought by victims of attacks and involved a question about whether the 

magazine published ads that were a "clear and present danger" to the public, and 

therefore unprotected by the First Amendment. 

Unlike a private lawsuit alleging negligence, the Justice Depattment's nonproseclltion 

agreement with Google involved an assertion that the company aided a criminal violation 

- i.e., that it was an activc participant in a crime. 

To proye accomplice liability, the prosecution must show the defendant provided some 

assistance in the commission of the crime, which can include counseling or encouraging 

the offense. There is a fine line hetween supplying goods that are later used for the 

commission of a crime and actually assisting in its completion. 

Even if one does furnish some measure of assistance, the law flllther requires that the 

accomplice be aware of the user's intention to commit a crime and intend to give some 

assistance or encouragement in its completion. 

The Justice Depaltment's position in the Google case emphasizing the awareness of its 

ehief executive shows it took an aggressive approach about what can constitute aiding a 

violation of the drug impOltation laws. 

Google was not involved in the actual movement of the prescriptions, but the government 

viewed its role as sufficiently impOltant to the success of the Canadian pharmacy sales 

that it was similar to someone who actually suppl ied 01' shipped misbTanded drugs. 

The fact that the case was resolved by a nonprosecution agreement can be seen as an 

indication that the Justice Depaltment understood its position un accomplice liability 

could be open to challenge if criminal charges were filed in comt. 

Unlike a guilty plea, this type of resolution does not require any judicial approval, so a 

judge will not question whether the conduct rose to the level of aiding and abetting a 

crime. 

Google's $500 million payment was labeled as a forfeiture of the revenue that both the 

company and the Canadian pharmacies received, not a criminal fine 01' civil monetary 

penalty. While Google paid out that money, it did not experience any additional monetaty 

punishment for its conduct. 

The Internet allows messages to be better focused on patticular gl'OllpS of l)olenlial 
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customers. With that ability comes the growing possibiliLY that the Justice Depmtment 

will view search engines as more than mere passive conduits of informatioll, and instead 

as potentially active participants in conduct that may violate the law. 

This post has beelll'evised to reflect the following correction: 

COIo,-cetiam August 31,2011 

An earlier version Qf this post misstated what Google's $500 million settlement 

represented. The company fOlieited money that l'epl'esented both its advel'tising 1'evenue 

f/'Om CaHadian pha17Jwcies and the revenue the pharmacies /'eceivedj7'mnAmel'ican 

customer's buying contl'Olied drugs, notjllst Google's ad l'eueHlle. 

Copyright 2014 The New York Times Company I PrivclCY PoHt,;y I NYTirnes.com 620 Eighth Avenue New YQrk, NY 10016 
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NON-PROSECUTION AGREEMENT 

111e United States Attorney's Office for the District of Rhode Island, United States 

Department ofJustice (the "Govemmcnt"), and Google Inc. ("Google" or the "Company"), a 

California-based corporation with its principal place of business located in Mountain View, 

California, hereby agree as follows: 

The Investigation 

1. The Government has conducted an investigation into the Company's acceptance of 

advertisements placed by online pharmacy advertisers that did not comply with United States 

law regarding the importation and dispensation of prescription drugs. 

Statement of Relevant Facts 

2. The Government and the Company agree that the following statements are true and 

accurate: 

(a) Except under very limited circumstances, not relevant here, it is unlawfhl for 

pharmacies outside the United States to ship prescription drugs to customers in the United States. 

Such conduct violates the Federal Food, Drug, and Cosmetic Act, Title 21, United States Code, 

Section 331(a) and Cd) (Introduction into Interstate Commerce of Misbranded or Unapproved 

Drugs). Where these prescription drugs are controlled substances, such conduct also violates the 

Controlled Substances Act, Title 21, United States Code, Section 952 (Importation of Controlled 

Substances). 

(b) The Company is a publicly-traded Internet search and technology corporation. 

(e) The Company offers various advertising services that permit advertisers to have 

their advertising message, and a hyperlillk to their website, appear above and next to search