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Indian Medical Association backs lifting ban on sex testing

BMJ 2016; 352 doi: (Published 09 February 2016) Cite this as: BMJ 2016;352:i814

Birth Registry Data: An opportunity to develop the evidence base for Pre-conception Pre-natal Diagnostic Techniques (PCPNDT) Legislation Monitoring in India

Bagcchi’s article on the PCPNDT legislation developments in India discussed an on-going debate on the possibility of lifting a current ban on sex determination in the country (1). The introduction of the Pre-natal Diagnostic Techniques (PNDT) legislation in the 1994, followed by an amendment in 2003, aims to prevent female feticide (sex selective abortion of female foetuses), and represent milestones for the Indian public health system (2). Female feticide is a cultural phenomenon that is closely linked with gender discrimination and violence against women, along with an irreversible impact on Indian demographics (3,4).

We have analysed 32-years (1980-2011) of longitudinal birth registry data from the Maharashtra State of India to examine the impacts of legislative changes over this period (5). The results indicated a significant increase in the ratio of female births to males from 2004 onwards, suggesting the benefit of implementation of the PCPNDT 2003 amendment in Maharashtra state. To our knowledge, this is the first study where sex ratio was calculated using state birth registry records, instead of using census data or under 5 years old children population data, which may be biased by female infanticide and differential neglect in a society where males are often valued more than females (4,6). Therefore, the use of birth records is a more accurate representation of any temporal change that is a consequence of legislation that targets the pre-natal period.

The implementation of such a monitoring approach is feasible across all Indian states using existing longitudinal birth registry records to study the effects of historical and future legislative changes on sex ratio at birth. Furthermore, the sex of stillborn babies is also coded in the birth registry to further strengthen surveillance of this challenging societal issue. Such an evidence-based approach would inform the on-going PCPNDT debate on future developments of the pre-natal sex screening legislation; an important step in view of the often conflicting social, political and medical agendas in India.

In conclusion, we recommend annual nationwide analysis and publication of sex ratio at birth using state birth registries to enable ongoing monitoring and evaluation of existing feticide prevention policies, while highlighting the need for further consolidation of the important initial public health improvements made so far.

1. Bagcchi S. Indian Medical Association backs lifting ban on sex testing. BMJ 2016;352:i814.
2. Government of India. The pre-natal diagnostic techniques (PNDT) act and rules (2003). Available at: (accessed 27th August 2016).
3. Deshpande J, Phalke D, Phalke V. Prenatal sex determination: Issues and concern. Pravara Med Rev. 2009;4:4-6.
4. Dewan B, Khan A. Socio-cultural determinants of female foeticide. Social change. 2009;39:388-405.
5. Ahankari AS, Myles PR, Tata LJ, Fogarty AW. Banning of fetal sex determination and changes in sex ratio in India. The Lancet Global Health 2015;3:e523-524.
6. Sahni M, Verma N, Narula D, Varghese R, Sreeniva V, Puliyel J. Missing girls in India: Infanticide, feticide and made-to-order pregnancies? Insights from hospital-based sex-ratio-at-birth over the last century. PLoS ONE. 2008;3:e2224.

Competing interests: No competing interests

08 September 2016
Anand S Ahankari
PhD scholar and Research Project Co-ordinator
Myles PR, Tata LJ and Fogarty AW
University of Nottingham, UK and Halo Medical Foundation, India
Epidemiology and Public Health, Clinical Sciences Building, Nottingham City Hospital, Nottingham, United Kingdom