Oommen C Kurian: Should India lift its ban on prenatal sex testing?

oommen_kurianBeti Bachao Beti Padhao (BBBP), the flagship scheme of India’s ministry of Women and Child Development (WCD), is trying to address a declining child sex ratio—919 females per thousand males in 2011—by focusing on the worst-performing states across the country. Earlier this week, the ministry announced a substantial expansion of the scheme, now covering quarter of the country. Revitalising the implementation of the pre-conception and pre-natal diagnostic techniques (PCPNDT) Act, which prohibits doctors from telling parents the sex of a foetus is a main component of BBBP. In the last decade, only 206 doctors have been convicted by courts across the country under the Act

Given this background, it was quite startling that at the event announcing the expansion of BBBP, the WCD minister made a proposal that finding out the sex of the foetus must be made mandatory instead. Interestingly, the minister also equated institutional deliveries to safe deliveries and said that home deliveries pose a threat to the newborn as there might be an attempt on its life. Given the overall context, there was a wide sense of disbelief that the minister made this proposal.

The Indian Medical Association (IMA) was quick to support this viewpoint. But a former member of the Planning Commission who had mooted a similar proposal in the past, spoke out against it, saying that policing a woman’s body is intrusive and harmful. The minister later clarified that she was making a suggestion, meant only to trigger debate. However since then, many stakeholders, such as the National Commission for Women (NCW), seem to be supportive of mandatory testing.

Apart from the issues of privacy and bodily autonomy, there are other issues at hand which need discussion. The proposal absolves the medical community of all responsibility and unfairly puts the onus on the pregnant woman. There will be tremendous pressure on many women to get rid of the pregnancy, once the gender is known. Many point out that such a proposal will also criminalise pregnant women who already bear the brunt of gender discrimination in our society.

Civil society groups have argued that it is possible that many women who need an abortion for medical reasons would find themselves being denied these services. According to a joint statement, such a policy will move back into an era where vigilante behaviour is encouraged and women’s bodies and lives are not in their control. If surveillance is imposed on pregnant women where the state and the family can potentially have diametrically opposite objectives, a lot of things may go wrong.

Currently, India’s thriving illegal sonography market specialises in locating and getting rid of unwanted daughters, unfortunately at the families’ request—where women may not have much say. News stories suggest that India’s preference for sons results in situations that can be bizarre. Some of the service providers reportedly con the “customers” by falsely passing off the male foetus as a female one so that they can recommend an abortion, making some quick money as commission.

Interestingly, India already has a fledgling Mother and Child Tracking System (MCTS) which tracks maternal and child health information (not the sex of the foetus), with the aim of improving service delivery planning and outcomes. MCTS can potentially play a major role in India’s monitoring of Sustainable Development Goals (SDGs), as it covers the whole country, and the data quality has been slowly improving. The introduction of mandatory sex determination in the system could potentially undo the slow achievements of the country’s administrative health data systems in one go.

The introduction of mandatory sex determination may discourage registration into the MCTS early on, since many families will now prefer to enter the system only if they are sure about the sex of the foetus. Given the state of healthcare regulation in India, voluntary tests can easily be done before mandatory ones, particularly when doctors and ultrasound technicians are not held responsible. India’s record of antenatal care coverage is quite bad, still we had twenty three million pregnant women registered in antenatal care (ANC) according to official data, which explains why the industry is excited about the idea of mandatory testing. They will be making money out of not just the official test, but the “unofficial” ones as well.

While it is important to think through public health policy suggestions with wide implications at multi-stakeholder platforms, the suggestion of a mandatory sex determination test does not seem to pass muster.

Oommen C. Kurian is a fellow in public health at the Observer Research Foundation.

Competing Interest: The writer has worked in the past with CEHAT, which was party to a public interest litigation demanding effective implementation of the PCPNDT Act.