Explaining challenges in policy implementation concerning sex-selective abortion in India

Sex-selective abortion is an issue that is related to abortion rights, severe gender discrimination and maternal healthcare. This issue occurs mostly in Asia, including in India which has the highest level of excess female child mortality, declining fertility rates and strong son preference. Although legislation and policy interventions regarding the issue exist, the impact has been little. To gain more understanding regarding this puzzle, this thesis will explore the policy implementation related factors that underlie the slow progress in reducing sex-selective abortion in the North of India, with the use of qualitative research methods. Given the role of NGOs and medical professionals, this thesis will pay particular attention to these actors. The relevant theories that are needed to analyze and discuss the results are related to implementation and professionalism. The theories regarding implementation include the ‘top-down approach’, the ‘bottom-up’ approach and the theory of translation. By applying these theories to the situation in India, a more complete understanding and explanation of failure of implementation can be provided. How and why the implementation process exists in its current form can be explained as well. The theories related to professionalism address the behaviour, power and role of medical professionals. Through these theories, understanding and explanation regarding the role of medical professionals can be gained. The data for this research have been collected through qualitative research methods. After conducting a literature study a topic list was set up. Based on this list, respondents from NGOs were interviewed. Also, additional documents, such as e-mails from respondents and articles of their interventions were analysed. During the analysis, the data has been divided into three subjects, i.e. the perception and way of dealing with the issue of NGOs, interventions with long term goals and interventions with short term goals. The theories of implementation and professionalism, provided further categorization when analysing the interventions. In end it can be concluded that the current challenges in implementing policies concerning prevention of sex determination and sex-selective abortion in the North of India can be explained by taking into account the situational and cultural factors due to which the issue is very dynamic, divers and complex. NGOs act against sex-selective abortion as they perceive the issue to be a growing problem. They implement long term strategies as they frame the issue to be a social and cultural problem, which needs to be solved by targeting the gender insensitive norms of society. The interventions targeting these cultural and social norms are being implemented using a bottom-up approach. In addition, they frame the issue as failure of implementation of legislation and the lack of medical ethics, which results in short term strategies targeting proper implementation of the law and the control of ultrasound machines. A top-down approach, where the government can be seen as the central decision-maker, can be recognized. Although the interventions are not set up from a translation perspective, within all interventions, elements of translation are recognized which explain the changes of behaviour of actors and changes within the interventions. Eventually, the concepts of professionalism and countervailing powers provide modest insight into the role of medical professionals, which contributes to the challenges regarding policy implementation to prevent sexselective abortion in the North of India.