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If raising the status of women—something many population experts consider critical to lowering fertility rates—is challenging everywhere in our largely patriarchal world, it is especially challenging in India. There, according to United Nations figures, men outnumber women by 32 million. It's a frightening reality born of an entrenched societal preference for males, which leads to abortions and even infanticide of girl babies. Such favoritism for males has extremely deleterious effects on females' educational and economic opportunities. Yet as she reveals in this interview, Geeta Rao Gupta, president of the Washington, D.C.-based International Center for Research on Women, feels a change in the air regarding women's status in India. It's a change that could have enormous benefits not just for the country's women but for Indian society as a whole.

In women's hands

NOVA: Why do you think birthrates have fallen so dramatically in the past 30 years?

Rao Gupta: Primarily because of improved access to modern contraception. Also because of improvements in women's status globally, and by that I mean improvements in educational status, access to economic opportunities, and a new perception of women's role in society. Those changes have occurred in many, many developing countries, and that has contributed significantly to declines in birthrates.

NOVA: Why is population control an old-fashioned idea, and what has replaced it?

Rao Gupta: "Population control" is an old-fashioned term that was used by demographers when they had certain target fertility rates and population numbers in mind that they wanted to reach. But it's a term that puts women at risk, of course. It takes the control of fertility out of women's hands and puts it in the hands of the public policymaker, the demographer, and the doctor. Whereas in fact, fertility control should be in the hands of women.

It's for that reason that in 1994, at the International Conference for Population and Development in Cairo, there was a shift from the term "population control" to the term "reproductive health and rights," where the focus was again on women and women's ability to make informed choices.

NOVA: I've read that when women are given a real choice, they choose smaller families regardless of economic, social, or cultural barriers.

Rao Gupta: Women are the primary victims of multiple births and ill health when births are closely spaced. They also bear the burden of child care and child rearing. They're the primary caretakers of children who fall sick. So women understand the costs of multiple pregnancies in a very personal way. If women are allowed to make those choices, you will find that women will always express an ideal family size that is much smaller than society will for them.

A bias for boys

NOVA: In India, many couples continue having children to ensure they have enough boys. Why are boys shown preference in all areas of life, and what does that mean for girls?

Rao Gupta: India has for many, many years had a very strong norm of what we call "son preference." It's a norm that is closely associated with Indian society, with the majority religion, Hinduism. Sons are expected to play a major role in the family traditionally, according to the Hindu religion. It is the son who lights the funeral pyre for the parents when they die, it is the son who is thought of as the one who will support the parents when they are aged.

“India has something like 933 women for every 1,000 men. That’s not normal.”

The birth of a girl child in India is often a source of sorrow. It is the most tragic thing to see. I have been to villages in India where you can hear wailing from houses when a mother has delivered a baby, and you know immediately that a girl child must have been born. Here in the U.S., if you heard that kind of wailing, the child was probably stillborn or sick or handicapped. In India, the tragedy is that when you hear that kind of wailing, it's the birth of a perfectly normal, healthy girl child.

I'll tell you a little story about myself. When I delivered my baby in India, in a hospital in an urban site, the nurse would not tell me whether the child was a girl or a boy, because I had delivered a girl child, and she was nervous that I would be so upset with the news that I would hemorrhage and my health would be at risk. So they held the news from me till a few hours later, and told me that I had a girl child with great nervousness that I would be upset. When they saw how overjoyed I was and how terribly pleased my parents and my parents-in-law were, the nurse actually came to me and said, "You belong to a very strange family. Were you raised in India?"

NOVA: What are the consequences for girls of this son preference?

Rao Gupta: The most significant is the unbalanced sex ratio in India. India has something like 933 women for every 1,000 men. That's not normal. Biologically, you should have slightly more women in a society than men.

All the research that's been done on this issue in India has shown that there are some tragic practices going on because of son preference. Women use modern scientific technologies such as amniocentesis and sonography to determine the sex of their child before the child is born, and they choose to abort the fetus if it is a female child.

There is documented data that shows that girl children receive health care when they're sick much later than boy children. They receive less food within the home, and less nutritious food than their brothers, all of which results in them being more likely to fall sick and to die in infancy or childhood. Then there are some extreme cases of infanticide by parents and by the community when a girl child is born.

NOVA: What will it take to turn that tide?

Rao Gupta: It's going to take leadership in India at all levels—community leaders, political leaders—speaking up against it, talking about the value of girls to our society. Because the consequences will be quite negative. The age of marriage for girls, for example, is predicted to drop even further, and it's already pretty low. If there are very few women in any age cohort for men, they will look to a younger and younger age cohort. That will have all the consequences that child marriage has—it's going to take us backwards rather than forwards.

Consequences of imbalance

NOVA: According to United Nations charts, there are 32 million fewer women than men in India.

Rao Gupta: That's right. The imbalanced sex ratio, the 32 million women who are "missing" in India, is a tragic reality that is well known, just like it is in China. But I don't think the government of India has put that as a priority in its policies. I hope they will soon. I think that they have to actively design policies and programs that battle that continuing trend downward, because it is frightening.

NOVA: What are the potential consequences, sociologically and economically, of having a significant imbalance in the sex ratio in any given country, or in the world as a whole?

Rao Gupta: People hypothesize, but we don't have a clear-cut sense of what the consequences might be. Some people feel, "Oh well, then women will be more valued." In fact, some of the strongest cases show that women will be less valued. There will be a greater entrenchment of the dominance of men because of there being fewer women to speak up, fewer women to prove that they can be valuable to society.

So it's difficult to say which way it will go, but it's clear that the world won't be the way we know it if you have a predominance of men. Women play significant roles in society, and if there were no women, if there were just two women for every 100 men, what would that mean? One can only imagine.

“Traditionally, when a young woman gets married she has to first ‘prove her fertility.’”

But it is frightening that in two countries that have such large populations—India and China—the sex ratio is so imbalanced. It's true for a couple of other countries as well, but those two, which have more than a billion people each, can make a significant difference in the dynamics of population worldwide. I don't want to try and hypothesize on what that might mean.

NOVA: Is it true that most women of India, aside from the very elite class, do not have control of their reproductive lives? It seems like birth control decisions are controlled by the mother-in-law and husband.

Rao Gupta: The reality in India is that while many, many women are very empowered, the majority are not. Friends of mine who travel to India and meet with elite families or educated women often return saying, "Indian women are so powerful. They're so assertive. They've managed to achieve so much." They have employment and hold the highest positions in industry and government. Indeed, we've had an Indian prime minister who was a woman.

Yet the reality is that the majority of Indian women are very disempowered. They have a much lower status with regard to education and literacy, with regard to income and economic opportunities, with regard to access to health care and health-care services. That is the reality.

Women, especially young women, have very little control over reproductive decision-making for themselves. Traditionally, when a young woman gets married she has to first "prove her fertility." So delaying the first child is the most difficult decision to get social acceptance for. There's a lot of pressure for a young couple to prove their fertility.

Then, after that first child, to be able to space the second is also typically a family decision. It's usually made by the elders in the family and not by the couple themselves. The center that I lead, the International Center for Research on Women, has done research in five different sites in India on adolescent married couples and have found, in fact, that both the young man and the young woman want to delay the first child and space the second—they want at least a three-year gap between the first and the second child. Yet they are not allowed to make that decision on their own.

Changing the status quo

NOVA: Is the status of women changing for the better?

Rao Gupta: I left India 18 years ago, but I travel there at least twice a year, and I can tell you that there has been significant change in women's status and women's roles over the period of time that I have lived in the United States. It's palpable. It's visible. Obviously that change has occurred at a faster rate in some states than in others, and for a wide variety of reasons—economic, sociological, and political—the southern states have a much better status of women than the northern states.

So yes, if you visit Uttar Pradesh, if you visit Bihar, if you visit Rajasthan, where women are at today is quite dismaying. It feels as if it will take India a long time when you see the way in which women are still expected to behave and the restrictions that are placed on their mobility and on their opportunities. But because the change has already begun in other parts of India, I do believe that momentum will carry forth even to the other states.

NOVA: What is the best way to change the status of women?

Rao Gupta: I believe that you can trigger social and cultural change in women's status by giving women increased economic opportunities. I think that to gain control over income is one step. It can help women achieve the social status that can bring about those cultural changes that might otherwise take a long time.

“Investing in girls’ education has been talked about as being the single best investment any development planner or policymaker can make.”

That's already beginning to happen with globalization and all of the employment opportunities in India. It is women's employment that is increasing most rapidly. Incomes are still low for women, significantly lower than what men can earn, but there are many more women earning today in India than ever before. And if they can have control over that income, that's a significant piece of it: not just being able to earn the income but control over how they spend it. They can bear a lot of the costs of the social changes that they might then want to bring about.

Because often, when women want to change the way their roles are defined, they cannot do that if they're economically vulnerable and dependent. The price then is that if you are left destitute, if you're abandoned, if you're thrown out of the house, if you're alienated from society, you have no way to survive if you have no income. So income in the hands of women allows them to become change agents.

NOVA: Better education for girls would certainly help, right?

Rao Gupta: Investing in girls' education has been talked about as being the single best investment any development planner or policymaker can make. That's because the returns to that investment are very high for women themselves and for their families, their communities and entire nations.

There are data to show that when investments are made in girls' education, there is a drop in fertility rates, and there is increased income for families because women are more likely to earn an income. There is a drop in infant mortality, because educated mothers are more likely to access health services for their children. There are improvements in the nutritional status of children, because educated mothers are more likely to be informed.

A significant fact that we have recently written about at our center is that if you want education to benefit women themselves, women need more than primary education—they need secondary education. All along, the focus in policy discussions on girls' education has been on primary education, and rightfully so, because the gaps between girls and boys in primary education were significant. But the progress we have made now in primary education has been great. It's one of the success stories in development—the closing of the gender gap in primary education. So we're trying now to get policymakers to focus on the next level.

NOVA: Do you ever have Americans ask you, "Why should we care?"

Rao Gupta: Working in the field of international development in the U.S. always results in people asking us, "Why should we invest in the work that you do? What's in it for us, to spend our taxpayers' money on improving the lives of women and children and families in the developing world?" The answer is very simple: It's a small world, and it's shrinking by the minute. Borders are porous, and infection knows no borders at all. Markets are necessary for even the richest countries in the world for their products, and the developing world is going to be that market.

So there are completely self-serving reasons why Americans must see investments in poverty alleviation, in education of women, and so on as good investments. But there are also altruistic reasons. The U.S., as the "supreme power" now in this world, has always played a leadership role in rebuilding societies, in helping societies become more stable. There's a value of freedom, of justice, of equality that the U.S. promotes worldwide. It's a value that it wants to see spreading to the rest of the world.

If you want that to happen, you have to do something about inequality and injustice and poverty. I think that if the U.S. wants to be seen as a leader in this world in bringing about and promoting the values that it is based on, that its democracy is based on, Americans must value investments in the developing world.

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