It looked like a bundle of rags, but the tiny parcel being thrust towards us was a baby.
Little Dipali’s appearance was shocking – twiggy legs, baggy skin and an oversized head that made her look premature at two months old. She was, warned Dr Subho Pal, so severely malnourished that she would die within weeks without treatment.
Dipali’s mother had died in childbirth aged 16 – a victim of India’s high maternal death rate. The infant’s condition was all too common in a country where 42% of children are malnourished, despite booming economic growth.
Dr Pal – a paediatrician with the Child in Need Institute, an NGO which runs clinics and education programmes in and around Kolkata – blames this crisis on the low status of women in Indian society.
“Malnutrition is a social problem, not a health problem,” he says. “This goes far deeper than the problem of underweight children. It’s going to hold India back unless we improve the status, health and education of women.”
India is home to more than a quarter of the world’s hungry – some 230 million people – according to the World Food Program, whose researchers found anaemia is also rising among rural women.
Underweight children can be sickly and their growth stunted. Healthy, empowered women raise healthier children.
Dr Pal says: “This is a cyclical problem that starts with early marriage and frequent pregnancy. Many women are in poor health. They eat last at home and are unlikely to eat well or to rest during pregnancy.
“They are prone to having low-weight babies and may struggle feeding them. And because they are uneducated they can’t look after their children properly.”
Such issues are symptoms of a society in which boys are valued and daughters considered worthless. As Indians become richer, dowries – outlawed but ubiquitous – grow bigger, putting families off having girls.
Sex-selective abortions are rife among the middle class, and female infanticide remains rampant. Sati – the burning alive of a Hindu widow on her husband’s pyre – is illegal but persists in some areas.
Unicef reports that under-five mortality rates are 40% higher for girls than boys. And one Indian woman dies through pregnancy or childbirth every five minutes.
When the 1990 census revealed that there were 25 million fewer women than men in India, the government introduced the Pre-Natal Diagnostic Techniques (PNDT) Act, outlawing gender detection. Despite this more than a million female foetuses continue to be aborted annually. Some say India’s gender gap may now be as high as 50 million.
In last year’s Disappearing Daughters report, researchers from ActionAid and the International Development Research Centre warned: “Given the enormous pressure on families to avoid having girls, the use of ultrasound technology is now considered a ‘rational’ way to plan a family.”
Researchers found it was easy to arrange the illegal tests and abortions for just a few thousand rupees – up to £30. The latest method of exterminating girls on offer is sex-selective conception.
Writer and activist Rita Banerji, who runs the 50 Million Missing campaign, is worried. “The way it stands, India’s social and cultural mechanisms are geared toward selectively weeding out women and girls en masse,” she says.
“Women in this country are lucky to escape being killed at almost every stage of their life – as a foetus, as an infant, as a little girl, a bride, a mother, and even a widow.
“The value system is saying we don’t want daughters, and that the lives of girls and women are easily dispensable. It is a massive, irreversible humanitarian crisis, and a disgraceful failure of law and order.”
Where legislation exists, enforcement is poor and corruption endemic. By 2007, 13 years after its introduction, only one conviction had been secured under the PNDT Act.
India is a signatory to the Convention on the Elimination of All Forms of Violence Against Women (Cedaw), and gender equality is enshrined in its constitution. But the issue cuts deeper – with the view of women as second-class citizens engrained in the Indian mindset.
In a 2007 report on Cedaw, the National Alliance of Women called on the government to tackle prejudice. “Doctors, police personnel, lawyers and judges believe in the subordination of women and the need to circumscribe their movements. “The absence of clear censor guidelines on sexual stereotypes results in the unhindered portrayal of the glorification of women’s subordination,” it warned.
Modest gains have been made. In 2005, pressure from women’s groups led the government to pass the Protection of Women from Domestic Violence Act. The new law embraces the UN’s definition of violence as being any form of abuse, whether emotional, physical, sexual or verbal. Marital rape has since been criminalised.
But many cases will go unreported, unless attitudes change. A 2007 UN Population Fund study found that 70% of Indian women believed wife beating was justified under certain circumstances, including refusal to provide sex, or preparing dinner late.
A handful of courageous women are using the law to fight for their rights. Delhi doctor Mitu Khurana is making history by suing her husband, in-laws and a hospital under the PNDT act after they tricked her into having a foetal ultrasound and pressured her to abort her twins – which she refused to do.
The government hopes that greater economic freedom will help. India’s 11th five-year plan, announced in March, aims to improve women’s legal rights to land and installing them on villages councils.
Meanwhile on a micro level, NGOs are bridging the gaps left by India’s creaking bureaucracy. At CINI’s clinics, women are given prenatal checks, and crucial family planning and nutritional advice. It recruits teenage girls to deliver key messages to young mothers, in the hope of breaking the cycle of despair.
Dr Pal says the government must do more. “I’m convinced we’re making progress, but we have to focus more attention on improving the status of women if we are to build a healthier and more equal society. Groups like ours are running a parallel health and social system because the government is not doing all it should. This has to change.”
This longlisted article was published on 23 July 2009. It was written for the Guardian’s International Development Journalism Competition between 1 April and 22 June 2009.