How Mumbai will track sex determination offenders

Mumbai: Alarmed at the declining figures of female population in Maharashtra, as revealed by the provisional census of 2011, the state health department has launched a crackdown on clinics, which illegally perform sex determination tests. According to department officials, they will deploy 'Decoy Sting Operation Teams' at the district level. This team, which consists of khabris (informants), will track down clinics performing sex determination tests. Local health NGOs will also be enlisted for the crackdown.

The authorities say legal action will be taken against  centres found guilty of conducting such tests . Sex determination tests are illegal in India. According to the provisional figures of the Census 2011 (between 0-6 years), the child sex ratio in the city had fallen from 922 in 2001 to a dismal 874 in 2011, well below the national average of 914.

Action will also be taken against individual sonographers flouting the law. "Apart from having sting operation teams and khabris to track down centres indulging in sex determination, the state health department will also check for multiple registrations of radiologist. As it is observed that mostly these radiologists are engaged in such illegal sex selection," explained Dr U Gawande, Deputy Director, State Health Services, Pune. He added, "We will first track sonography centres and closely monitor them. Also we will be on the lookout for centres indulging in sex determination which uses Pre-implantation Genetic Diagnosis (PGD) technique and chorionic villus sampling."

Alarming
In spite of the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act (see box), which makes sex selection an offence, the skewed sex ratio figures have alarmed authorities.  Any medical practitioner found violating the act  can be sentenced to three years  rigorous imprisonment and with fine up to Rs 10,000. In fact, experts said that they had already feared a decline in the sex ratio in Mumbai and other places in the state because of what they call "poor implementation of the PCPNDT Act".

Lingo
Experts believe it will not be so easy to nab the culprits, as they are finding ingenious ways to avoid violating the law. Doctors and activists say that code language is being used in clinics to pass on the information about the gender of the foetus. A doctor explained, "Start buying blue clothes means it is a boy; start buying pink clothes means it is a girl; come on Monday means it is a male foetus and come on Friday means it is a female foetus."

Technology
If this is not enough, new technologies, such PGD are being used for sex selection. Couples fly off to places like Thailand and the US, to undergo the process, which guarantees a boy child. "Even today there are patients who come to my clinic wishing for a boy. We completely refuse and discourage such patients. I don't even bother to attend to patients with preferences. My assistant doctors send them back," said gynaecologist Dr Duru Shah, who works as a consultant at Breach Candy hospital. Dr Shah admits that when doctors in the city refuse to entertain couples who want a boy they fly abroad to undergo surgery. "There are people who opt for PGD technique which is actually devised to check if the foetus is suffering from genetic disease. The technique is helpful for those people who have genetic disorders in their family. But the technique is misused to determine the sex of the embryo before inseminating it into the mother's womb." she said.

Desperate
Dr Indira Hinduja, a prominent city gynaecologist agrees, "Every day we have at least one couple walking into the clinic with a request for a boy. The sex ratio has been gradually falling and there is nothing natural about it, it is obvious that sex selection is being practiced unethically. There are couples who tell me that they will go to Thailand and other countries and get gender selection done through the PGD technique. Even when we counsel them, they fail to understand and we cannot stop them. It is a possibility that doctors must be indulging in chorionic villus sampling." Campaigners say parents desperate for male babies are not the only one to be held responsible. They want boys because the society still regards a son as an 'asset' and a daughter a 'liability'.
Explaining the male child desperation among urban people, Dr Hinduja said, "Recent news reports about suicides of educated women over dowry-related issues clearly indicate that dowry is a major concern among urban parents who prefer a male child only. Couples who read such reports start believing that it is better to have a boy, as the world is a cruel place for a girl child."

Implementation
Dr A L Sharda of the NGO, Population First, which runs an exclusive project for girl child called 'Laadli', puts the blame on the authorities too, "There is poor implementation of the PCPNDT Act by the state. The authorities too fail to keep a check on number of sonography machines that are being used in various clinics. Appropriate administrative mechanisms need to be put in place immediately all over the country," she said. Activists say there's a direct co-relation between machines and lower sex ratio. According to records available with the State Heath Department, the number of centres registered under the PCPNDT Act in Mumbai in the government sector has remained constant at 55 for the last seven months. But the number of private clinics has increased from 1429 to 1574 in Mumbai during the same period. "Though there has been an increase in the number of centres, the vigilance machinery seems to have failed as only three centres have faced action for breaching the PCPNDT Act in the last seven months," said an official requesting anonymity.

Numbers
Contrary to Mumbai, Ahmednagar district has filed 26 court cases against clinics, breaching the PCPNDT Act and Pune has 24 such court cases pending. Three years ago Population First had surveyed some 40 centres in Mumbai of which 39 were found to be flouting the law. "Even if the health officers go for inspection, the people running such centres are asked to pay a minimal fine for carrying out sex selection procedures. Instead every centre carrying out such procedures should be taken to court," said Dr Sharada.

Inspection
Dr Asha Advani, Special officer, family welfare Brihanmumbai Municipal Corporation (BMC) denies official incompetence and claims inspectors visit all the registered clinics every three months. "In the last one year we have served show cause notices to around 15 centres and three machines have also been seized." She further added that after the figures were released, "We immediately called for a meeting with the private doctors and the radiological association to press on the implementation of the PC PNDT Act."

Success
Health activist are now concerned about sex selection before conception. The Pre-Natal Diagnostic Techniques (PNDT) Act was amended to PCPNDT Act in 2003 to ban sex selection before conception. "IVF has a success rate of 30-40 per cent, and not all centres have PGD technique. Even if a few centres are offering it for sex selection, only a fraction of male kids will be born by using this technique. Only this technique cannot be the reason for the skewed sex ratio. There has to something more to it," argued a Mumbai-based IVF expert requesting anonymity

Ratio
Experts say that 950 girls per 1000 boys is considered natural, but when the sex ratio goes down more than this, it happens due to human interference.In fact Dr Shah, who has also written a book 'Fetal attraction' ”dedicated to all the 'missing girls', strongly believes that 'human interference' is the result of such dismal sex ratio. "When there is a boy born in a family, relatives dance in the corridors of the hospital but when it's a girl there is just a wry smile on their faces." she said.

Awareness
But Dr Ashok Anand, Professor of gynaecology at Grant Medical College, believes that people don't discriminate against the girl child anymore. He said,  "When I was a student, the desperation for a baby boy was visible among couples but that no longer holds true. At JJ Hospital we see patients from all strata of society and gender discrimination is not common anymore." In fact Dr Anand recalls an incident, where a mother of two sons was pregnant and was on the table and she delivered a baby boy. "She asked me ladka hai yah ladki and I told her that it's a boy expecting that she would be overwhelmed to have a third boy, but instead she started weeping on the table as she wanted a girl." Dr Niranjan Chavan, a senior gynaecologist at Sion Hospital, said, "Eight years ago people would ask for sex selection, but now people are aware that the law prohibits it. We have posters in the hospital emphasising that sex determination is prohibited and a girl child is no less than a male child."

Study
Campaigners quoting the study 'Trends in Sex Ratio at Birth-Estimates of Girls Missing at Birth in India' by the United Nations Population Fund -- India, estimate that the practice of prenatal sex selection has resulted in approximately 6 lakh girls being missed annually in India during the period 2001-07. Sex ratio at birth in India for the period (2006-08) was 904, while  internationally, observed normal sex ratio at birth is 952 or more girls born per 1,000 boys. This estimate shows that roughly 1,600 girls go missing at birth every day in the country.

It's just not sex selection before and after birth that is responsible for the skewed ratio. The death rate of girl child between the age group of 0-6 is higher.  "As parents do not want the child, they neglect her health ultimately leading to her death, and thus the sex ratio also gets skewed," said an expert requesting anonymity.

What is the PCPNDT Act?
The Pre-natal Diagnostic Techniques Act (PNDT) came into being in 1994 in order keep a check on female foeticide. The Act prohibits determination and disclosure of the sex of foetus.  It also prohibits any advertisements relating to pre-natal determination of sex and prescribes punishment for the violation of the act with three years rigorous imprisonment and a fine of Rs 10,000. The PNDT Act had been amended keeping in view the emerging technologies for selection of sex before and after conception. These amendments have come into operation with effect from  February 14, 2003 and the Act is now known as PCPNDT Act.