The Pre-Conception and Pre-natal Diagnostic Techniques (PCPNDT) Act of 1994 goes by the premise that non-disclosure of gender of an unborn child will ensure prevention of female foeticide. Union minister for women and child development Maneka Gandhi thinks otherwise. She sought to turn the two-decade-old law on its head, arguing for a better way to prevent abortion of the female foetus. According to Gandhi, her idea was bound to click as parents would be informed about the sex of the child after which the condition of the foetus would be tracked till the baby is born.

Though Gandhi soon ‘clarified’ that no formal proposal was made and that it was just a thought, she did not explain what would happen if the child is not born. Will the parents go to jail or will the doctor be arrested? And how would the state monitor 26 million pregnant women? Under the current Act, only 55,000 registered ultrasound machines in the country need to be checked.

Despite a ban on sex determination, census numbers indicate that people have been practising sex selective abortions across the country rather comfortably. The implied sex ratio at birth (ISRB) dipped in the latest census (2011) with half the states showing a decline. The ISRB was estimated to be 923 girls for every 1,000 boys born in the country, down from 935 in 2001. The district-wise data is even more alarming with a quarter of them (161) showing ISRB of less than 900. These districts also had poor child sex ratios, indicating both pre- and post-birth discrimination. Gandhi’s constituency Pilibhit, in Uttar Pradesh, too has not been a safe place for the girl child in the past decade.
The child sex ratio there plummeted from 941 in 2001 to 912 in 2011.

A pregnancy usually involves three sittings of ultrasound scans during the nine-month term. It is easy for parents to find the gender of an unborn child if the doctor is not too scared of the law. The radiologist stands to earn and so does the gynaecologist who could make a tidy sum for every abortion. The rates go higher wherever enforcement of law becomes stringent. Maharashtra is a case in point. Here, law enforcement has led to an almost tenfold increase in rates of scanning and abortion. About 600 cases have been filed against doctors, registration of 37 doctors has been cancelled (with 70 in the pipeline), and 92 convictions been made since 2004, says Varsha Deshpande, an activist of women’s rights, who has been part of the national inspection and monitoring committee of the ministry of health and family welfare. “In Kolhapur district, where sex ratio improved from 839 to 863 this census, revealing the gender of the foetus and abortion comes for a ‘package offer’ in '80,000. We know the rates as we pay them during decoy operations and get the money back after arrests are made,” says Deshpande. “The amount of money a doctor used to make from aborting nine foetuses a decade ago now comes from just one foetus. Though it doesn’t make the gynaecologist poorer, at least we are able to save nine lives from the lower-middle and middle economic strata who can’t shell out that kind of money,” she adds.

Kailash, an associate of Deshpande, has been part of the decoy operations since 2004 to catch doctors red-handed. He recalls an incident of 2012 when he had gone with his friend’s pregnant wife to a doctor in Thane, near Mumbai, for an abortion. “A poster was stuck at Thane railway station giving the doctor’s contact details. At first the doctor declined but eventually agreed and said the procedure would be expensive – asking up to '60,000. When we expressed inability to produce such an amount, he came down to '25,000 – the discounted price for locals. For people coming from other states, he used to charge more.” Kailash paid the amount and agreed to come the next day.

The whole drama was captured on a spy camera by a TV journalist who had accompanied them. Later, a case was filed against the doctor.
Many doctors, however, reject such arguments supporting the PCPNDT Act. They contend that the law is just a tool to harass them and that it has not helped prevent female foeticide. In fact, the Indian Medical Association has been, for the last two decades, calling for precisely the same approach which Gandhi is espousing (see interview).

Enforcing the Act involves setting up committees at state and district levels which regularly check forms filled by patients before they go in for a scan. This helps in monitoring pregnancies, something Gandhi too proposed in her formula. So far, the states have been going easy in enforcing the law. Only a collective effort of the concerned authorities can improve the situation. According to Deshpande, this understanding exists in Maharashtra. “But poor implementation in other states has adversely affected people here. Families from Maharashtra are crossing over to Karnataka to get scanning done at cheaper rates and then coming back for abortions in their own state.”

Social activist Sabu George, who is also a member of the national inspection and monitoring committee, feels that doctors cannot shirk responsibility for the prevalence of female foeticide. And if sex determination is made mandatory then the pressure would shift from doctors to pregnant women who are already under pressure from society to produce male progeny. Gandhi has been misled by doctors, he feels.
According to data cited by United Nations Population Fund, 5.9 lakh female foetuses are aborted annually in India. Four percent of the girls who should have taken birth go missing each year as per this data.

The sex ratio is as much about selective genocide as about a thriving medical industry where every abortion is a source of considerable income. The sooner Gandhi realises this, the easier it would be for the government to revisit the Act with the intent of plugging the holes.


(The article appears in the February 16-29, 2016 issue)