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Letters Prenatal sex testing in India

PCPNDT seems to benefit India’s birth sex ratios

BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i5194 (Published 26 September 2016) Cite this as: BMJ 2016;354:i5194
  1. A S Ahankari, research project coordinator, Halo Medical Foundation, and scholar1 2,
  2. P R Myles, associate professor of health protection and epidemiology2,
  3. L J Tata, associate professor in epidemiology2,
  4. A W Fogarty, clinical associate professor and reader in clinical epidemiology2
  1. 1Halo Medical Foundation, At Post Andur, Block Tuljapur, Dist Osmanabad, Maharashtra 413603, India
  2. 2Division of Epidemiology and Public Health, Faculty of Health Sciences, University of Nottingham, Nottingham, UK
  1. dr.anandahankari{at}gmail.com

The possibility of lifting a ban on sex determination is an important ongoing debate in India.1 The introduction of prenatal diagnostic techniques legislation in 1994 and an amendment in 2003 aim to prevent female feticide (sex selective abortion of female fetuses) and represent milestones for the Indian public health system.2

We have analysed 32 years (1980-2011) of longitudinal birth registry data from the state of Maharashtra to examine the effects of legislative changes over this period.3 The results show a significant increase in the ratio of female to male births from 2004 onwards, suggesting a benefit from implementation of the 2003 (PCPNDT) amendment in Maharashtra. To our knowledge, this is the first study to use longitudinal state birth records, which are a more accurate measure than census data or population statistics on children under 5.4

Implementing such a monitoring approach is feasible across all Indian states using existing longitudinal birth registry data to study how historical and future legislative changes affect birth sex ratios. Such an evidence based approach would inform the ongoing PCPNDT debate on future developments of prenatal sex screening legislation—an important step in view of the often conflicting social, political, and medical agendas in the country.

In conclusion, we recommend annual nationwide analysis and publication of birth sex ratios, using birth registries to enable ongoing monitoring and evaluation of existing feticide prevention policies.

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