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Proposals to strengthen ban on prenatal sex determination hide inaction, activists claim

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39570.359965.DB (Published 08 May 2008) Cite this as: BMJ 2008;336:1038
  1. Ganapati Mudur
  1. 1New Delhi

    Doctors in India who disclose fetal sex to would be parents could face harsher punishment under proposals by the Indian government to crack down on prenatal sex determination and selective abortion of female fetuses.

    The proposals are intended to strengthen India’s 14 year old law that prohibits prenatal sex determination and expand action to correct social prejudices at the root of India’s declining sex ratio, health officials said last week.

    India’s sex ratio in children up to 6 years of age had dropped from 945 girls for every 1000 boys in 1991 to 927 girls in 2001, the year of the last census. The figure was less than 800 in several states, including affluent urban districts.

    Health officials accept estimates that tens of thousands of female fetuses are still aborted each year throughout the country after expectant parents learn the sex of their fetus through ultrasonography aimed at spotting birth defects.

    The proposals include prison terms of as long as seven years instead of three years and fines of up to 700 000 rupees (£8800; €11 000; $17 000) instead of 100 000 rupees. District magistrates instead of district medical officers would have the mandate to build cases against errant doctors. Health officials think one reason that conviction rates have been low is because medical officers have often been unable to prepare strong cases.

    The government also plans to expand campaigns to generate awareness, which rely on members of parliament, religious leaders, social activists, and health workers to reduce preferences for sons.

    “Policing will succeed only when society as a whole begins to rebel against the practice of female feticide,” said Pravir Krishn, joint secretary in the ministry of health and family welfare.

    Although more than 400 cases have been filed against doctors or clinics for violations of the law prohibiting prenatal determination of sex, only about 20 have been convicted, Mr Krishn said.

    However, health activists and doctors campaigning against female feticide have said that the proposals and plans for awareness campaigns are attempts by health authorities to hide their failure to enforce the existing law.

    “Such actions only divert attention and resources away from strict enforcement of the law as it stands now,” said Sabu George, a health activist who has been campaigning against female feticide for 23 years.

    The low rate of convictions perhaps reflects a lack of will to act, Mr George said. Health officials and doctors have complained in the past that it is hard to convict doctors (BMJ 2006;332:257; doi: 10.11.36/bmj.332.7536.257-c).

    “Parliament enacted the law 14 years ago after social intervention failed,” said Puneet Bedi, a fetal medicine consultant in New Delhi who has been trying to help authorities identify errant doctors. “Doctors engaged in sex determination are criminals who need to be caught, treated, and punished as ordinary criminals,” Dr Bedi told the BMJ.

    The existing law requires ultrasonography clinics to maintain records of every pregnant woman who has a scan. A scrutiny of documents and tracking medical termination of pregnancy in hospitals could help to identify doctors who break the law, Dr Bedi said. “But detailed medical audits of documents have never been done,” he said.

    But some state officials think change is already visible. “We’ve had 11 convictions,” said Navraj Sandhu, health secretary in the northern Indian state of Haryana, where at least three districts had child sex ratios below 790.

    The child sex ratio in Haryana has risen from 816 measured in the 2001 census to 860 in 2007 based on civil birth registry data, Mrs Sandhu said. “We are now seeing progress,” she said.

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