Prohibiting sex determination:Regulating misuse of technology

March 22, 2011

March 2011

Determining the sex of a foetus is ethically and morally despicable. The current sex ratio in various regions of the country sparks a debate. Formulating a policy may not only help in eliminating the practice but will also send out a strong message that such abortions are atrocious.

The Ministry of Health and Family Affairs correctly notes that, “The social, cultural and religious fibre of India is predominantly patriarchal, and this contributes extensively to the secondary status of women. The patrilineal social struc

ture based on the foundation that the family line runs through a male makes man a precious commodity and is given a special status.” Women also suffer from having limited, or often, no say in decisions pertaining to marriage, managing their lives or bodies or bodily integrity.

Such is the social fabric and allied tradition that even the birth of a girl child is considered to be an unfortunate event, since it is deemed certain to drain the family of finances (marriage expense, dowry, etc), besides potentially hampering progress (financial set back, social and class-based humiliation). Whereas, birth of a male is rejoiced considering that they can potentially take charge and lead the family forward (carrying the family name and legacy, performing last rites, etc).

Consequently, female infanticide and foeticide are stark realities that need immediate and decisive action. The current female:male ratio in Haryana is 861:1000, leading to deleterious effects like polygamy. Overall, the current national sex ratio stands at 933:1000. Rural ratio is at 946:1000 males, whereas urban ratio stands at 900:1000. (Source: www.censusindia.gov.in)

It is noteworthy that the urban sex ratio is more skewed than the rural sex ratio. The development and recent advances in imaging and other diagnostic devices and their easy availability in urban settings may account for this bias. The Ministry of Health and Family Affairs observes that ‘instead of being a great deterrent in effectively countering female foeticide, the continuous demand and easy money has led medical practitioners to collude with parents and relatives to carry out sex determination’.

The Pre-Conception and Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) (PCPNDT) Act is born out of the urgency to deal with this precarious situation before more harm is done. It is the only Act besides the Medical Termination of Pregnancy (MTP) Act that addresses female foeticide. Inspite of a few shortcomings, it is a potential intervention, which prescribes criminal punishment for contravention, and aims at checking the rampant sex determination done at various levels – from technicians with mobile ultrasonography units to research institutes with standard ultrasonography protocols.

Understanding the fine print

‘Sex selection’ includes any procedure, technique, test, administration or prescription or provision of anything for the purpose of ensuring or increasing the probability that an embryo will be of a particular sex. ‘Pre-natal diagnostic techniques’ include all pre-natal diagnostic procedures and pre-natal diagnostic tests. Again, ‘Pre-natal diagnostic test’ means ultrasonography or any test or analysis of amniotic fluid, chorionic villi, blood or any tissue or fluid of a pregnant woman or conceptus conducted to detect genetic or metabolic disorders or chromosomal abnormalities or congenital anomalies or haemoglobinopathies or sex-linked diseases.

3A. Prohibition of sex-selection: No person, including a specialist or a team of specialists in the field of infertility, shall conduct or cause 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, conceptus, fluid or gametes derived from either or both of them.

3B. Prohibition on sale of ultrasound machines, etc, to persons, laboratories, clinics, etc not registered under the Act. No person shall sell any ultrasound machine or imaging machine or scanner or any other equipment capable of detecting sex of foetus to any genetic counseling centre, genetic laboratory, genetic clinic or any other person not registered under the Act.

The PCPNDT Act

The PCPNDT Act is inclusive of imaging and diagnostic services and does not differentiate between a technician’s work and a gynaecologist’s prescription, citing similarities in modus operandi. This necessitates dissemination of knowledge about the Act, its implications, its consequences and penalties for contravention. The Act also specifies the indications for ultrasound in both pre-conception and pre-natal states and undermines the penalties for contravention.

Registration: It is also imperative by law for every institute, nursing home or any facility with diagnostic techniques to register themselves with the appropriate authorities. Failure in doing so can lead to sealing of the premises, seizure of equipment, criminal charges and penalties. And failure to register may lead to teh following:

The appropriate authority or authorised officer may seal and seize any ultrasound machine, scanner or any other equipment, which is capable of detecting the sex of foetus, and is used by the organisation inspite of not being registered under the Act. These machines of the organisations may be released if they pay penalty equal to five times of the registration fee to the appropriate authority concerned and gives an undertaking that they shall not undertake determination of sex of foetus or selection of sex before or after conception.

Cognisance of offences (I) No court shall take cognizance of an offence under this Act except on a complaint made by:

(a) The appropriate authority concerned, or any officer authorised in this behalf by the Central Government or State Government, as the case may be, or the appropriate authority; or

(b) A person who has given notice of not less than 15 days in the manner prescribed, to the Appropriate Authority, of the alleged offence and of his intention to make a complaint to the Court

Maintenance of records: Person conducting ultrasonography on a pregnant woman shall keep complete record thereof in the clinic/centre in Form F and any deficiency or inaccuracy found therein shall amount contravention of provisions of section 5 or section 6 of the Act, unless contrary is proved by the person conducting such ultrasonography.

Code of conduct: The Act obligates the society and the medical fraternity in particular to implement it by informing the appropriate authorities about any contraventions.

In a nutshell

The aim of the Act is not only about creating awareness and educating society about the immorality of female foeticide, but the larger goal is to preserve the natural equilibrium of societal existence and proactively avoid deleterious impacts of skewed sex ratios. Empowering the medical fraternity would further expedite measures against female foeticide, which threatens the very fabric of our society. If severe and immediate measures to check abuse of diagnostic techniques are not implemented, then the status of women and the gains that have been made over the years are at stake. If there are fewer women in society, the violence against women in all its forms would go up and the resultant atmosphere of insecurity would lead women again being confined within the four walls of the home. Thus, it is an absolute need of the hour to come forward, come together and stand united against female foeticide.