India’s anti-sex determination law faces new challenges

by Dinesh C Sharma

The Lancet, October 2016, 388(10055):1971

India’s 1994 law banning the use of ultrasound to establish fetal sex seems to be hampering the use of ultrasound for legitimate purposes while not necessarily improving the girls-to-boys sex ratio at birth.

Many medical professionals have been saying for some time that legal provisions are being misused to harass doctors, e.g. over details of record keeping and reporting of data, and that over-regulation is hampering use of ultrasound in general. “Radiologists are being harassed for minor clerical errors like not keeping a copy of the Act, not wearing an apron, or improper filling of forms. Such mistakes are being considered equal to sex determination and, in many cases, highly qualified doctors are being treated like culprits”, said Jignesh Thakker from the Indian Radiological and Imaging Association…

The Indian Medical Association has demanded that ultrasound equipment should not be sealed and medical registration of radiologists should not be cancelled or suspended for minor offences like these.

Mira Shiva from the Initiative for Health, Equity, and Society in New Delhi, said: “The need is to promote rational use of ultrasound rather than over-regulate it. In some places, even cancer diagnosis is suffering because doctors are refusing to do ultrasound, while crooked people in profession are prescribing three to five ultrasounds during pregnancy.

”In September this year, the dispute led to a two-day national strike by radiologists calling for reform of the Act; more strike action was averted following assurances given by the government. However, the Indian Radiological and Imaging Association says strike action will be resumed if the demands of the profession are not met soon.

The article talks about whether the Act is even preventing sex selection through banning ultrasound for sex determination. Some data indicate it is not. Moreover, a link between fertility decline and sex ratio at birth has been identified, that is, the fewer children couples are having, the more they try to have a boy as at least one of them (or the only one). The problem exists more in urban areas than rural ones as well. while ratios are worse in some places, they have improved in states like Meghalaya, Goa, and Tripura, where a substantial proportion of women with two daughters reported not wanting any additional children.

The Ministry of Women and Child Development, which is steering a national programme called Beti Bachao, Beti Padhao (Save the girl child, educate the girl child), is focusing on wider societal factors, i.e. socio-cultural mindset and gender bias against girls

“Adverse sex ratio is a social problem that needs change in the mindset that values sons and devalues daughters. The structural factors that continue to keep women in subordinate positions, and encourage unequal gender power relations have to be addressed if we are to make a difference”, said Jashodhara Dasgupta from Sahayog, an NGO working to promote gender equality and women’s health. “Women’s economic capabilities and women’s safety are fundamental factors that affect familial decisions to have sons rather than daughters.

PHOTO by Melanurya