 "Why India's top medical body wants to 'legalise' gender tests for unborn child")
The head of India’s top medical body has called for changes to the country’s law on prenatal gender determination. Indian Medical Association (IMA) president Dr RV Asokan has reportedly called for legalising gender determination tests, arguing that banning them has not significantly impacted India’s skewed sex ratio.
Prenatal gender determination and sex-selective abortions are illegal in India under the Pre-Conception and Pre-Natal Diagnostic Techniques (PC-PNDT) Act. The IMA chief has questioned the efficacy of the law and its provisions of penalising the doctor, creating a stir.
What is the law in India? What has the IMA chief argued? What’s the debate around it? Let’s take a closer look.
India’s ban on prenatal sex determination
The Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 2003, also known as the PC-PNDT Act, bans the practice of determining the sex of the unborn child and using sex-selection technologies.
The law was introduced to prevent gender-based abortions. It was first enforced in 1996 as the Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994, to arrest the declining sex ratio in India. It came amid concerns about ultrasound technologies being used to determine the sex of the foetus.
The legislation was amended in 2003 to expand its ambit by prohibiting preconception sex selection wherein medical practitioners attempt to influence the baby’s sex before conception.
The Act states that “no person shall, by whatever means, cause or allow to be caused selection of sex before or after conception.”
It also bars ultrasound clinics, genetic counselling centres and genetic laboratories from carrying out the sex determination of the foetus. However, prenatal diagnostic techniques that help detect abnormalities in the unborn child like chromosomal abnormalities, genetic metabolic diseases, sex-linked genetic diseases and congenital anomalies are allowed.
Advertisements related to preconception and prenatal determination of sex are also illegal.
Those who violate the act could face jail and a fine.
IMA chief calls for ‘legalising’ sex detection
Dr Asokan said that lifting the ban on sex determination tests will help safeguard the unborn girl child. According to him, the IMA’s central working committee is in favour of sex detection and child protection.
“A meeting of the committee was held two weeks ago. We are demanding sex detection and protection of (the unborn) child…tag the child…carry that child to delivery. If anything untoward occurs, then hold people accountable. It’s possible as technology is available,” he said, as per Times of India (TOI).
Dr Asokan asserted this will help in safeguarding the girl child and improve the country’s sex ratio.
The IMA president also criticised the legislation for penalising doctors. “It is a massive failure and has not shown results. Instead, it has harassed obstetricians, radiologists and even cardiologists,”
“This is not the first time that I have been talking about this issue. We want the government to rethink this Act as it is crucifying the doctors for a social evil,” he was quoted as saying by Indian Express.
The PC-PNDT Act makes it mandatory for ultrasound centres, genetic labs and clinics to maintain records. “Assuming that all doctors are anti-life is very wrong. The IMA is aggrieved over certain rules in the Act and with doctors being pulled up for technical lapses and incorrect filling of forms,” Dr Asokan said.
He also pointed out that failure to fill Form F “is considered to be equal to female foeticide”. This form records the medical history of a pregnant woman and the reason for her ultrasound. The current law accords the same punishment to doctors who do not fill Form F correctly to those who carry out a sex determination test, as per Indian Express.
The debate over the law
There have been calls earlier to legalise sex determination tests in India. In 2016, the then Women and Child Development Minister Maneka Gandhi sparked a massive row as she proposed that “the woman should be compulsorily told whether it is a boy or girl child whom she is going to give birth to”. Her remarks about mandatory gender determination tests were severely criticised by activists and experts.
Experts oppose pre-natal sex determination as they argue it will increase female foeticide. They also say proposals like compulsory sex determination will push women towards unsafe abortions. “There will be greater pressure on the pregnant woman from her family if they find out early on that her second or third child is a girl,” Dr Sabu George, who had been calling for the effective implementation of the PMDT Act, told Indian Express in 2016.
The Act was brought to arrest India’s declining sex ratio and there has been progress.
India’s sex ratio at birth stood at 933 in 2022-23, a rise from 918 in 2014-15. But the ideal sex ratio is 960 or 970 girls per 1,000 boys. As per the 2011 census, there were 914 girls per 1,000 boys under the age of seven. In 1961, this figure was at 976 girls for every 1,000 boys.
Haryana, which has a historically poor sex ratio, continues to reel from the problem. The preference for male children is driving couples from affluent families to travel abroad to determine the sex of the unborn child and sometimes even abortion.
As per a TOI report in 2017, couples from Haryana were visiting Thailand, Singapore and Dubai for gender determination tests and medical termination of pregnancy, if required. Dubai allows only sex determination.
“A couple coming from rural areas or belonging to lower income groups pays anything between Rs 15,000 and Rs 30,000 to terminate a pregnancy, illegally, in India. On the other hand, the same procedure can be done abroad at almost the same cost. The travelling cost is the only additional expenditure. Moreover, things are done legally abroad and in more hygienic conditions with proper medical backup. So, those who can afford go out of the country to avoid legal hassles here,” a senior health official told the newspaper at the time.
Those in favour of legalising pre-natal sex determination claim that it could help in arresting female foeticide.
“Falling sex ratio is a concern, but prosecuting radiologists is not the solution. More out-of-the-box solutions are needed, such as an ultrasound done a day before an abortion can help determine whether there was a medical need for an abortion or not,” Dr Harsh Mahajan, former president of the Indian Radiological & Imaging Association, told Hindustan Times in 2016.
“The sex of the foetus can be determined in 11-12 weeks, and more than 90 per cent abortions in India are done in the second trimester but recorded as being done in the first (before 12 weeks). An ultrasound record before the abortion will help determine whether the abortion is sex-selective or not,” he added.
Experts say the problem is not with the PC-PNDT Act but its implementation. They say ultrasound clinics are not monitored properly and violators are let off with a fine.
Admitting there is a practice of sex selection, Professor PM Kulkarni, former professor at the School of Social Sciences, Jawaharlal Nehru University (JNU), New Delhi told Indian Express that Maharashtra and Gujarat need improvement but Himachal Pradesh and Punjab have seen changes. “What is required is a proper implementation of the Act and changes in attitudes,” he said.
Varsha Deshpande, a member of the National Inspection and Monitoring Committee, has opposed modifying the PC-PNDT Act. “If the IMA is worried about the Act, then let it expose the wrongdoers in the medical fraternity. Expose your own members and take disciplinary action against them,” she told the newspaper.
Besides India, sex selection is illegal in South Korea, China, Australia, Canada and Vietnam. The United Kingdom bans sex-based abortions with rare exemptions. The United States allows gender selection for medial purposes.
With inputs from agencies
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