Challenges in Stopping Sex Selection

In the post the mapping of India at the national level and of various states was done at different levels, districts and sub-districts to appreciate the changes taking place due to sex selection. These maps are important as they visualize the dramatic changes taking place in most parts of the country. Far too often, there is an unwillingness in the states to recognize the consequences of sex selection in the early phase itself. Whether it is Punjab in the 1990s, or Bengal and Kashmir in the 2000s or Kerala in the 2010s etc. there is a reluctance to believe that the child sex ratios have indeed declined.

Thus the declines continue to worsen and spread without any action by the Governments. Most regrettably, the rest of the country has not learned from the dismal context of Punjab and Haryana in Census 2001. If every District of the country has to follow their pattern; that is, child sex ratios have to decline to 700s or below 800s before ratios start improving than India will lose about fifty million girls over the next few decades. This presumes that the low levels observed are the worst and that other Districts will not fall below 758 (the worst level in Census at Districts among 2001 and 2011). India’s above 7 years of age sex ratios have been improving, becoming less masculine; whether in Punjab in 2001 or Andhra Pradesh in 2011. Therefore, if India does not stop the elimination of girls before birth, even the overall population sex ratios will start declining in the coming Censuses.

The Women’s movement recognized the significance of declining sex ratios and particularly child sex ratios. The Committee on the Status of Women, 1975, brought attention to the fact of declining sex ratio to the Country. Though feminist scholars and women’s activists had warned of the impending possibility of systematic elimination of girls before birth, from the seventies, by the misuse of sex selection techniques, the country at large ignored such warnings. Sadly, most academicians and scholars including demographers never took this alarm seriously. In fact, even when there were indications in the 1991 Census, NFHS survey of 1992-3 (Punjab state) etc. scholars did not consider sex selection as a possible explanation. Civil society also largely ignored this with the exception of some short lived campaigns like the Maharashtra Campaign of the mid-eighties. The most visible impact this Campaign had was in terms of the enactment of the PNDT Law in Maharashtra, 1988 and subsequently the National law in September 1994. The virtual non-implementation of the Law for six years is of course a blot on all of us who should have been pro-active earlier.

The poverty of academic concern on the impact of sex selection was broken by demographers Mari Bhat and Irudyarajan who had indicated in the late nineties and early 2000 about the masculinization of sex ratios at birth. This is the context that prevailed when the earliest Census results were available in the end of March 2001. The Census officials, particularly the Registrar General , Mr. J.K. Banthia should be commended for the systematic analysis of the data, forthright recognition of the emerging genocide of unborn girls, and public advocacy of the adverse child sex ratio findings. This of course spurred much interest among scholars, donors and activists and even towards global recognition of sex selection as a form of violence against women.

Sex ratios reflect the status of women and girls in the society. The various sex ratios used are defined here. This ratio is normally expressed as number of males per females as generally there are more women than men in most countries. However, in India, right from the early Censuses conducted, during the Colonial period, sex ratio was expressed as the number of females per thousand males in the population.

Sex Ratio at Birth (SRB)
Again, the world over, SRB refers to the number of male births per hundred female births. The Census has reported that this biological constant is 105 – 106 boys per 100. Since, in India sex ratios are defined as number of females per thousand males, in this publication for consistency, all sex ratios at births are converted to number of females per thousand males. Thus a sex ratio at birth of 105 boys per 100 girls is equivalent to 952 girls per 1000 boys. Countries which have a significant masculinity in SRB in 1980s-2000s include India, South Korea, Singapore and China (See Table-4a). The time trends for Taiwan, South Korea and China are given in Tables 4b, 5 & 6 respectively. These are the three major foreign countries which have had the largest practice of sex selection in the past few decades.

Table - 4a: Sex Ratio at Birth by Country




India (SRS)









South Korea




Table - 4b: Taiwan Sex Ratio at Birth by year











South Korea: SRB by YEAR













Table 6: CHINA: SRB by YEAR















Child sex ratio
In India, the impact of differential undercount of girls and relative under reporting of age of girls and sex selective differential migration is negligible as compared to the drops observed in the North and North Western Districts over the past decades. Therefore, the child sex ratio in the age group, 0 to 6 years will be principally influenced by sex ratio at birth and sex selective mortality due to girl child neglect; and female infanticide immediately after birth in a few Districts. In countries where there is no severe discrimination in care, nutrition and health; the sex ratio of surviving pre-school children increases from about 952 girls at birth to over 980 as the male infant and early child mortality is higher than female. Regrettably, in some parts of India because of neglect of girls, child sex ratios continue to decline after birth. However, by 2001-2011, sex selection has emerged to be the largest contributor to missing girls, almost all over India. Generally in social sciences the primary cause of violence against women is taken to be patriarchy. However, in the case of sex selection several other factors have contributed to this extreme form of violence against women. Population control ideology (family planning), unethical medical professionals, expensive private medical education and unscrupulous ultrasound manufacturers assisted in the expansion of sex selection.

Population Explosion and Population Control Ideology
The Western world was obsessed with the rapid growth of population in China and India in the 1950s-1960s. Their Governments and Foundations spentmoney and lot of effort to persuade these Asian countries to reduce their fertility rates.As US President Johnson said in a
1965 San Francisco event held to mark the 20th anniversary of the United Nations. “Less than five dollars invested in population control is worth a hundred dollars invested in economic growth.” By the late 1950s, the demographers recognised that Indians continued to produce children till they had the right number of sons. Sex selection was identified as a promising family planning method. In the 1960s western medical scientists developed foetal sex determination methods to prevent genetic diseases like sickle cell anemia. Note , in these kind of diseases, only males had the disease and females were merely the carriers. Determination of foetal sex enabled to identify male foetuses in womb and selectively eliminate the male foetuses to prevent disease. This medical technology
was found ideal by population control advocates to eliminate “unwanted girls” in
Asian countries. The first research on sex selection in India was sponsored by
Population Council New York, funded by Rockefeller Foundation and initiated in AIIMS, New Delhi in 1970. This research published in Indian Pediatrics journal in 1975 stated- “
In India cultural and economic factors make the parents desire a son,
and in many instances the couple keeps on reproducing just to have a son. Prenatal
determination of sex would put an end to this unnecessary fecundity. There is of
course the tendency to abort the foetus if it is female. This may not be acceptable to
persons in the West, but in our patients this plan of action was followed in seven of
eight patients who had the test carried out primarily for the determination of sex of the foetus. The parents elected for abortion without any undue anxiety”. Soon this
genetic test, amniocentesis, was offered free in other Government hospitals to pregnant women. Following protests by womens’ activists, in 1978 , the
Government of India banned this test in Delhi government hospitals. However,
practice spread into the private medical sector, the first Clinic was set up by Dr Lamba in 1979 in Amristar. Subsequently years later, the leading newspapers in Delhi carried advertisements for ultrasound sex determination in the late 1980s.
Punjab clinics opened sister clinics in Delhi asserting that they had ten years of
expertise in determining foetal sex.

Misuse of Medical Technology by Ultrasound Manufacturers
Ultrasound emerged in India by the early 1980s in a few cities and by 1990s largely became the most common method for foetal sex determination. In early 1980s in China and South Korea, ultrasound companies led by GE exploited the desire for sons and created a huge market for ultrasound fetal sex determination. Following which, sex ratios at birth became masculine (See earlier section on sex ratio at birth data).
One child policy of China and the rapid fertility decline in South Korea also contributed to masculinisation of sex ratios at birth. In India declines in sex ratios at birth had a lag of about a decade as ultrasound availability increased only by 1990s after GE-WIPRO started domestic manufacture and vigorous marketing. The CEO of
GE made a specific commitment that the company will not exploit the market for sons before it started domestic manufacture of ultrasound. The President of WIPROGE, Vivek Paul also assured then that sex determination is a "very, very small
percentage of their usage." However, GE-WIPRO aggressively marketed the machines and even sold it to quacks and captured about 70% of the market share by late 1990s. The Indian Supreme Court had to intervene in 2002 to restrain such reckless promotion of sex determination. Following orders of the Court, the Government amended the law to make it mandatory for manufacturers to sell only to registered Clinics and to submit sales data quarterly. The company had submitted a list of 5000 machines it had sold in the past 5 years to the Court. Analysis of this data revealed that a disproportionate number of the machines were in North West India which had the lowest child sex ratios! Ultrasound has many legitimate medical uses but the manufacturers wanted to maximise profits by encouraging the lucrative practice of sex determination. In 2007, the prestigious Wall Street Journal carried a cover story on GE’s continued lapses. Vivek Paul, who helped build the early ultrasound business in India, first as a senior executive at GE and then at Wipro, says
blame should be pinned on unethical doctors, not the machine's suppliers. "If someone drives a car through a crowded market and kills people, do you blame the car maker?" This blame game on behalf of the manufacturer ignores one key difference, ultrasound machines were sold in China, India etc., with the deliberate intent to eliminate girls.
Unethical medical practitioners and relentless promotion of sex selection India has had discrimination against women for more than several hundred years. However child sex ratios from the earliest Census of India in 1870s were never so low as after the mass utilisation of sex determination in the 1980s-2010s in different regions of India. Unethical medical practitionersfound sex determination and sex selective abortions lucrative business which today has become several thousand crores annually. The diffusion of sex determination has followed relentless promotion by vested interests since 1970s. The numbers of papers in medical journals in India and outside by Indian doctors supporting sex selection since 1970s is asad violation of medical ethics; which forbids any formof discrimination.
Justification like it is better to eliminate a girl than allow dowry deaths etc., as an act of mercy, is most disgraceful. Even after the historic order of Supreme Court on May 4, 2001 against foetal sex determination we have come across medical practitioners
justifying the use of these illegal methods on the grounds of population control.
Sometimes promotion took bizarre ways; for instance, in Hissar in 1980s, glass jars which preserved female foetuses were exhibited by Doctors to encourage female foeticide. The steady growth from the early private genetic clinics in Amritsar in 1979 to over fifty thousand registered ultrasound clinics and several thousands of unregistered ones all over India today makes it imperative to regulate the prenatal diagnostic clinics. The initial phase of denial about the demographic consequences of this medical malpractice by scholars in the early 1990s assisted in the popularisation of this extreme form of violence against women. Thus it has taken relentless efforts on the part of tens of thousands of professionals over several decades to convert this act of discrimination before birth to an ongoing national genocide.

Public perceptions and emerging realities against girl children?
In popular discourse, it is common to hear about Indian mindsets which are antigirl. As if these are permanently cast in stone! The genocide of sex selection also brings other consequences apart from legitimisation of illegal practice of sex selection. For instance, when most families had 3 or 4 children, it was not uncommon to see even 2 or 3 girls in a family. Even in the mid 1990s not only in South India but even in rural areas of Haryana one came across families with multiple girls.But over the last decade, even in parts of rural Alwar or rural Western UP, in the NCR region; families with 2 or 3 girls are being mocked at! The perception that within communities, there are some people who feel that these excess girls should not even allowed to be born is frightening. From the mid-1990s there were anecdotes from rural areas of a few families which wanted one only son (and no girls) in Punjab, Haryana and Delhi. The 2013 annual civil registration data of Delhi revealed that 3% of girls were eliminated in families with one child (overall it was more than 5%). Thus, it appears we are seeing demographic impact even on the first born. Note in traditional forms of discrimination such as female infanticide or deliberate girl child neglect, it was almost always the higher order born girl.
Demographers in the 1980s-1990s had predicted that with the shift to smaller families less girls of higher order birth will be discriminated against. But if this intensification of discrimination against the first born happens in some other parts of North Western India, the consequences will be alarming. Then the restoration of
natural sex ratios at birth (952) will take many more decades. Here it is important to
highlight the gender insensitivity of India’s family planning programme in the 1980s
and 1990s. A happy family was shown to be “one girl and one boy” family. This kind
of “two child norm” was taken for granted. That a family could be happy with 2, let
alone 3 girls; was never even part of the family planning propaganda. Thus even
official messages have also contributed to public perceptions favouring sons over
daughters and indirectly facilitating crimes of sex selection.

Post Nirbhaya and “Beti Bachao Beti Padhao Yojana”
Finally, in the post Nirbhaya (after December 2012) era; it is necessary to examine sex selection in the context of violence against women. The protests against the failure to protect women’s safety following the Delhi gang rape in late December, by tens of thousands of young women and men is unprecedented. This resulted in Government appointing the Justice Verma Commission and led to subsequent changes in Criminal law in 2013. The following statement by women’s activist Eve Ensler summarises the protests and the response:
“having worked every day of my life for the last 15 years on sexual violence, I have
never seen anything like that, where sexual violence broke through the consciousness and was on the front page, nine articles in every paper every day, in
the centre of every discourse, in the centre of the college students' discussions, in
the centre of any restaurant you went in. And I think what's happened in India, India
is really leading the way for the world. It's really broken through. They are actually
fast-tracking laws. They are looking at sexual education. They are looking at the
bases of patriarchy and masculinity and how all that leads to sexual violence”.
Following decades of promotion of sex selection by vested interests, has resulted in
some troubling public perceptions. In several parts of rural North India, people
generally do not see sex selection as a crime. Some families even share with outsiders the clinics were sex determination services are provided. In this context,
the launch of “Beti Bachao Beti Padhao Yojana” flagship initiative of Govt. of India,
launched in 2014 is most welcome( Since coordinated and convergent efforts are needed to ensure survival, protection and empowerment of the girl child, the Government has announced Beti Bachao Beti Padhao (BBBP) initiative. This is being implemented through a national campaign and focussed multi sectoral action in 100 selected districts low in CSR, covering all States and UTs. This is a joint initiative of Ministry of Women and Child Development, Ministry of Health and Family Welfare and Ministry of Human Resource Development.

The objectives of this initiative are:
1. Prevention of gender biased sex selective elimination
2. Ensuring survival & protection of the girl child
3. Ensuring education and participation of the girl child
Finally, the list of things BBBP suggests: “What can we all do as individuals do” is exhaustive and even if a small proportion of Indians were to follow, it will have a lasting social impact in the coming generations towards creating a girl child friendly

PC-PNDT Act and Implementation
The law against foetal sex determination was made because of the foresight of the women’s movement. Though discrimination against women is constitutionally impermissible, the women’s movement felt that achievement of substantive equality promised by the Constitution required special laws to prevent discrimination against women. This Act was first passed by Maharastra in 1988 and later by Parliament in 1994 (which covered all States excepting Jammu & Kashmir).
Subsequently, the PNDT Act was amended by Parliament in 2002 and renamed as Pre Conceptional and Prenatal Diagnostics Technology Act. J&K also enacted PCPNDT Act in 2002. Historically, female infanticide had been prohibited through legislation in the pre-independence period (1870) and certain provisions were included in the Indian Penal code, 1860 for punishing those causing miscarriages and other such offences. However, with the advent of diagnostic technology to detect the sex of the foetus very early during pregnancy, a need was felt for a specific law to prevent the misuse of technology which could lead to female foeticide.
The vested interests involved in eliminating girls before birth are very powerful and organized and therefore a special legislation was imperative. The law regulates prenatal diagnostic technologies like ultrasound and prohibits foetal determination of sex for non medical reasons. Sex selection is forbidden whether at the pre conceptional stage or at the embryo stage. This law also sends a powerful message to the people also that these discriminatory practices are illegal.
Constitutional courts have repeatedly upheld the non-discriminatory provisions of the Act. For instance, a couple approached the Bombay High Court (obviously at the instance of a well known practitioner of embryo sex selection) that Article 21, Right to life includes right to personal liberty which includes the liberty of choosing the sex of the baby! The Judgment in Vinod Soni Vs. Union of India (2005) stated “The right to life or personal liberty cannot be expanded to mean that the right of personal liberty includes the personal liberty to determine the sex of a child which may come into existence”. “Right to bring into existence a life in future with a choice to determine the sex of that life cannot in itself to be a right.”
Strengthening the PNDT Act by Amendments was done in 2002 for:
i) bringing the technique of pre-conception sex selection within the ambit of the Act,
ii) Bringing the use of Ultrasound Machines within the purview of the Act more explicitly,
iii) Further empower the Central Supervisory Board for monitoring the implementation of the Act,
iv) Constitution of State level Supervisory Boards and a multi-member State Appropriate Authority for better implementation,
v) More stringent punishments,
vi) Empowering the Appropriate Authorities with the powers of the Civil Court for
search, seizure and sealing the machines/equipments/records of the violators, including sealing the premises and commissioning of witnesses,
vii) making mandatory the maintenance of proper records in respect of the use of
ultrasound machines.
viii) Regulate the sale of ultrasound machines only to the registered bodies
ix) explicitly bring advertisements in the internet under the purview of the Act.

Implementation of PC-PNDT Act
Like all social legislation, implementation of this special Act has been grossly inadequate. A general impression has been created that this law is toothless and weak. In fact, the penalties under the Act are very stringent as mentioned below. The fact that medical associations have not only opposed the enactment in 2002 and have been involved in large number of litigations against the Act in Constitutional courts around the country itself is proof of stringency of the law. Apart from their ceaseless advocacy with the Government, political parties and media should not dilute and undermine the objective of the Act.

Penalties under the Act
• Breach of any provision by the service provider: 3 years imprisonment and/or a fine of Rs. 10,000/-For any subsequent offence: 5 years imprisonment and/or fine of
Rs. 50,000/- (Section 23 (1));
• Medical Professionals: Appropriate Authorities will inform the State Medical Council and recommend suspension of the offender’s registration if charges are
framed by the court and till the case is disposed off; removal of name from the register for 5 years on 1 st conviction and permanently in case of subsequent breach
(Section 23 (2));
• Persons seeking to know the sex of the foetus (A woman will be presumed to have
been compelled by her husband and relatives): Imprisonment extending up to 3 years and a fine of up to Rs.50,000/-; For subsequent offences: Imprisonment upto 5
years and or a fine of Rs. 1,00,000/- (Section 23 (3));
• Persons connected with advertisement of sex selection/sex determination services: Imprisonment up to 3 years and/or a fine of Rs. 10,000/- with additional fine of continuing contravention at the upto 5 years and or a fine of Rs. 1,00,000/- (Section 23 (3));
• Persons connected with advertisement of sex selection/sex determination services: Imprisonment up to 3 years and/or a fine of Rs. 10,000/- with additional fine of continuing contravention at the rate of Rs. 500/- per day (Section 22 (3));
• Advertisement for the purpose of Section 22 (3) includes any notice, circular, label,
wrapper or any other document including advertisement through internet or any other media in electronic or print form and also includes visible representation made by means of any hoarding, wall painting, signal, light, sound, smoke, gas, etc.;
• Contravention of provisions of the PC & PNDT Act, 1994 for which no specific
punishment is provided in the Act are punishable with imprisonment up to 3 months and/or fine of Rs. 1,000/- with additional fine of continuing contravention at the rate of Rs. 500/- per day (Section 25);
• Such contraventions can be presumed to be the non-maintenance of records, noncompliance with standards prescribed for the maintenance of units, etc. [13] The PCPNDT Act prohibits a person, including a specialist or a team of specialists in the
field of infertility, from conducting or causing to be conducted or aid in conducting
by himself or by any other person, sex selection on a woman or a man or on both or on any tissue, embryo, concepts, fluid or gametes derived from either or both of them.

Impact of Implementation of law
Maharastra has led the country in implementation of the law. Haryana is another state which over 1 year has again woken up. Note because of the early efforts in 2001 and 2002, convictions under the Act took place in Faridabad and Gurgaon after 5+ years including the first conviction in the country in 2006. The initial efforts in Maharastra started in 2004 by Advocate Varsha Deshpande. Her organization filed hundreds of cases against violators all around the State. One major strategy used was using decoys for sting operations. And as convictions started happening slowly deterrence against illegal practices started growing. There was increased commitment to implementation from about 2009 onwards till 2014 by the State Government. Sex ratios at birth also started improving as a consequence of less girls being eliminated because of more than 70 convictions of medical professionals and others involved. Gains of about 30 points in sex ratio at birth is a testimony to the impact of law; 868 to 901 over 2009-13 (source Civil Registration Report of India for 2013). If the new State Government continues to prioritise implementation than Maharastra for the first time since 1981 Census, will show improvement in Child sex ratios in 2021.

Future for missing Indian girls: From public discourse to turn around in child sex ratios
Over the last 15 years, public discourse on sex selection and missing girls has enhanced considerably thanks to Census findings, government schemes and media
sensitivity. Even mainstream political parties BJP, Congress, CPM, AAP etc. made
public commitments on missing girls during the 2014 Parliament elections.
Advertisements promoting sex selection have virtually disappeared from the print
media and the countryby 2002 thanks to intervention of theSupreme Court.
Companies like Google have been directed by the Supreme Court in 2014 to stop advertisements in internet. Are these measures adequate for the country, for a turn
around in child sex ratios given formidable promotion of sex selection by vested interests? Child sex ratios have been declining for several decades. Normalization to
nature’s level of 952 girls per thousand boys at birth is perhaps a long way off given the present level of commitment to girl children. But let’s hope at least now for a
turn around from the long declining CSR (based on Census data). Based on analysis of SRS birth datathere are claims that sex ratio at birth is improving (From 892 to 909 over 2004 to 2013). It will be welcome if indeed this forecast turns out to be true, as evident from other data sources. Post Census 2011 data for SRS suggests it is
plausible if these levels are maintained in the coming years. One major concern from the SRS series is the continued stagnancy of UP levels; Over 2006-13, no sign of improvement (remaining at 870s). The other concern is the SRS series for Bihar, 2006-13, stagnancy around 910 levels. These 2 states are crucial for any substantial
improvement in ratios as more than one in three girls are born in these two states of
India. PC-PNDT implementation, expansion of ultrasound clinics and declines in family sizes are other relevant factors which have a bearing on the potential rate of
change in child sex ratios. Since both these states are heading for lower fertility rates, it’s imperative to prevent intensification of son preference. These states also have good potential for further increase in ultrasound clinics thereby increasing
access of communities to and utilization of foetal sexing. Therefore, in the context of relatively poor implementation of the law, based on field visits to these states; that any significant improvement in CSR in this decade in this part of India seems unlikely. Therefore, even if states like Maharastra or Haryana or Punjab….reduce their levels of elimination of girls, the inertia of UP & Bihar could prevent any significant improvement in national child sex ratios in this decade. Though in BBBP
Scheme, there is expression of intent to implementation of law, most states ignore
this important and effective strategy to prevent declining CSR. Prime Minister Modi’s involvement with BBBP is an encouraging sign. Without implementation of
law, to create deterrence to the providers of sex selection; it will be difficult for India
to achieve significantly improved levels in this coming decade.

· George, S.M. "Sex Selection/Determination in India," Reproductive Health Matters, 2002; 10(19):190-92
Businessweek : An Ultrasound Foothold In AsiaNovember 07, 1993 Cover Story


Did You Know
Satyameva Jayate
Female foeticide was the first episode of the First season (2012). This incredibly well received talk show by Aamir Khan reached out to about 9 million people of age 4+. Over a billion impressions were garnered on the net in the first season. The fact that Aamir chose sex selection (female foeticide) as the first episode, of the various sensitive issues chosen for the first season, is the outcome of meticulous preparation which started more than a year before the telecast. That this was not a one time tear jerker is evident from the follow up undertaken after the telecast on May 6. Aamir met the Chief Minister of Rajasthan on May 10, 2012 and special courts were set up to try the cases which were pending following Shripal Shaktawat and Meena Sharma’s powerful expose of over 100 Doctors on Sahara TV, Rajasthan in 2006. The web site ( has links to several initiatives of other organisations. For instance, Action Aid’s “Beti Zindabad” campaign. The original telecast of 2012 can be viewed in Hindi or English (sub titles) or Marathi or Bengali.


unwillingness or disinclination to do something.
Genocide-the deliberate killing of a large group of people,especially those of a particular nation or ethnic group.
Unscrupulous-having or showing no moral principles not honest or fair.
Amniocentesis-a process in which amniotic fluid is sampled using a hollow needle inserted into the uterus, to screen for abnormalities in the developing fetus.
Lucrative-producing a great deal of profit.
Bizarre-very strange or unsual.
Litigations-the process of taking legal action.
Contraventions-an action which offends against a law treaty or other ruling.
Plausible-of an argument or statement seeming reasonable or probable.
Stagnancy-not flowing or moving and often foul-smelling or stale.

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