LALITUR, Uttar Pradesh, India-The weak light above the operating table flickered for 15 seconds and died. The doctor shouted at the watchman outside Emmanuel Hospital Association (EHA), and while we waited for light to return, I quietly asked the pregnant, prostrate girl on the table her age: "I don't know."

The light blinked on again as a generator roared to life at the facility in northern India's Uttar Pradesh province. Praying under her breath, the doctor drew an 8-inch cut across the girl's abdomen. "These cases are the most frustrating," physician Asangla Biswas said as she alternated between scissors and scalpels: Five month ago she told the girl to come in for regular checkups: "She's anemic and her blood pressure is far too high. She never came and began having seizures 24 hours ago. Now they bring her in and expect us to fix everything. The baby is in severe distress."

Twenty minutes later, Biswas pulled a blue baby girl from the womb. The doctor let out a sigh of relief as the baby began to cry. But the new mother was crying, too. "We just wasted so much money for a . . . girl," she said angrily. "If I had known, I would have let it die. A girl is worthless. Worthless!"

India is scheduled to complete its 2011 census this month and the results-due in spring-are likely to reflect the effects of abortion and female infanticide on that country's culture. Studies suggest that up to 50 million girls and women are missing from India's population, according to UNICEF. One typical situation: Neha, a young village girl, delivered twins, a healthy boy and girl, in August at Lehman Hospital in Herbertpur, but hours after delivery she told a nurse, "If you force me to feed this girl in the hospital, I will do as you say. But . . . as soon as I get home, this girl will die. She should not take milk from the boy."

At the EHA hospital, a sobbing, terrified woman with three daughters requested a tubal ligation: "Every night my husband comes home drunk and beats all of us because he wants a son. I have failed my duty as a woman, but I will not risk bringing another girl into such misery."

Why such bias? "In India, boys have all of the advantages," said Asha Biswas, a community health nurse who has spent the last 15 years working in villages near the Himalayas. Boys carry on the family name and build up the family wealth. Girls drain resources through dowries. "Families will argue, 'What is the point of raising a girl who will spend most of her life serving someone else?'"

EHA medical officer Tony Biswas said, "It's hard to judge a woman who is crying because she just delivered a girl when you know that she is probably going to be beaten or abused by her husband or mother-in-law as soon as she gets home. . . . It's a problem with the family and community."

Female infanticide is prevalent enough to generate open newspaper debate. The Daily News & Analysis reported last October that "Deepika" gave birth to twins, a boy and a girl, in a government hospital in Mumbai, but at night tossed her infant daughter out the window onto the street. The baby died of skull injuries and blood loss, and caregivers discovered rats had chewed through one ear when they found her. Doctors suggested that Deepika had postpartum psychosis syndrome, a diagnosis that exempts her from murder charges, but the newspaper noted that she had thrown out the girl twin, not the boy.

The paper also detailed cases where girls had been abandoned, injured, or killed, concluding, "It can't be a coincidence that whenever a child is kidnapped in the city, it's a boy, and whenever abandoned, it's a girl." EHA doctors agree: To avoid baby switching, they match newborns with parents using the baby's footprint, blood sample, and markings with a permanent pen.

Government agencies have been fighting female gender discrimination and banned gender-revealing ultrasounds in 1994 (although they're still available-"Spend 600 rupees now and save 50,000 rupees later," boasts a popular advertisement for black-market services). Officials have kept up a campaign to convince the public that girls are valuable, from celebrating national "Girl Child Day" to giving monetary gifts to parents upon the birth of their baby girl.

These initiatives get lots of press coverage, but the International Center for Research on Women reports that "decades of policy efforts have not achieved positive change." One ray of hope: Adoption is rare in northern India, but Heather Broadbent, a British nurse who has spent the last 10 years working in India, says she discovered "all but one family living in the hospital compound had adopted an abandoned girl. Those families raised them like their own children. You never would have known."