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United Nations Population Fund - India
Addressing Prenatal Sex Selection
The Issue
The ratio of men to women is a powerful indicator of the social health of any society. In socially
and economically advanced societies, sex ratios at birth are favourable to females (Source:
http://www.unfpa.org/culture/case_studies/india_study.htm
). The natural ratio is about 105 boys
per 100 girls, or above 950 girls per 1000 boys, as calculated in the Indian context. In India, birth
data being unevenly available, the Census 2001 child sex ratio (0-6 years) f igures are widely used
to understand the extent of the practice of prenatal sex selection. According to Census 2001, the
child sex ratio dropped from 945 in 1991 to 927 in 2001. The recent Sample Registration Survey
figures put the sex ratio at birth for India at 892 girls per 1000 boys (2004 – 06 moving average).
There are no firm statistics however at either the state or national levels on the practice of prenatal
sex selection. Various estimates put the figure at 5–7 lakh girls missing each year due to prenatal
sex selection.
The Cause
In India, family and social pressures to produce a son are immense. In most regions, sons are
desired for reasons related to kinship, inheritance, last rites, identity, status, economic security,
means of support for aging parents and lineage. The high cost of providing dowry to a daughter
also goes against her. These cultural, social and economic factors result in girls being viewed as
a burden and result in the practice of prenatal sex selection.
Surprisingly, ratios are highly adverse in urban and affluent areas. Even here, women are not
recognized as productive citizens in their own right, and are likely to face family pressure to have
a son. The practice of prenatal sex selection is most prevalent in regions that boast high levels of
educational attainment and relative prosperity. The illegal availability and affordability of
prenatal screening technology and a large number of private medical facilities willing to illegally
cater to this demand has abetted the practice. For example, a study by the Christian Medical
Association of India (CMAI) , taking into account 11 ,267 births for the year 2000–2001 collected
from one of the public hospitals in Delhi, showed the following trend:
Birth Order Sex of previous child Sex Ratio at birth (girls to
1000 boys)
One male child 959 2nd order
One female child 542
One male and one female child 558 3rd order
Two female children 219
Source : CMAI study 2001
Thus, it is increasingly evident that economic progress has not necessarily changed the traditions
of gender discrimination. The study also shows a second daughter is less tolerated than the first
and chances of having a third daughter are further reduced to 219 girls only for every 1000 boys.
The CMAI study reiterates the fact that the sex of the previous child often exerts a greater
influence on whether the family will tolerate a daughter or not, as compared to other factors.
United Nations Population Fund - India
Another important factor to note is that of the falling fertility in India. Couples today wa nt small
families with no more than 2 children. However, in a large number of these families, at least one
(if not both) children have to be a son. In states like Punjab , this phenomenon has gone a step
further where couples do not want a second child , if the first is a son. Families now seem to be
saying “we don’t detest daughters, but we need at least one son”.
Prenatal sex selection and crime against women
Evidence is also mounting that skewed sex ratios, combined with the traditional low status of
Indian women, is beginning to have an effect on traditional concepts of the family. Marriage
patterns themselves may undergo a change as cultural practices such as polyandry and exchange
marriages reappear in some states. For example, there is anecdotal evidence that in rural Punjab
and Haryana, polyandrous unions are occurring where one woman, often ‘purchased’ from poorer
regions or from lower castes, is forced to be ‘wife’ not only to her husband, but also to his
brothers. These women inhabit the very lowest rungs of the family hierarchy and are at the risk of
emotional, physical and sexual abuse.
Demographers warn that future deficits of adult women will affect the stability of the entire
marriage system. Not only will it impact quality of life and the rights of women, but many men,
particularly the poorest, may be unable to marry, creating potential social unrest, and conditions
are likely to increase sexual violence against women1
.
Legal recourse to abate prenatal sex selection
Through combined efforts of health and human rights activists, legal measures to ban the use of
prenatal diagnostic techniques for prenatal sex selection were first passed in Maharashtra in 1988.
Similar efforts at the national level resulted in the enactment in 1994, of the Pr enatal Diagnostics
Techniques (Regulation and Prevention of Misuse) Act. Though the law became operational in
1996, it proved difficult to enforce.
Amendments to the Act were made in 2002 following public interest litigation in the Supreme
Court of India, jointly led by civil society organizations, and health and human rights activists.
The amendment to the Act brought under the law pre -conception techniques as well . It made
mandatory the registration of facilities and clinics offering ultrasound services, laid down a
procedure to maintenance and scrutiny of their records, made it illegal to divulge the sex of the
child, and to advertise such services.
What needs to be done
While Act implementation is being strengthened , a simultaneous effort at mindset change is also a
must to uproot son preference. Most importantly, it is necessary to engage with the urban,
aspiring middle class through its role models. Along with awareness building activities,
partnerships must involve the media, college and school students, faith-based leaders, and the
art, entertainment and marketing industries.

1
http://www.empowerpoor.com/relatednews.asp?report=656 – prenatal sex selection to have sever impact :
UN body. Also refer country case studies for China, Nepal, Vietnam and India at :
http://www.unfpa.org/gender/case_studies.htm.

United Nations Population Fund - India
Looking towards the trend in birth data, it is clear that PCPNDT Act implementation has to gear up
further. Capacities of those responsible for Act implementation need to be strengthened. If there
are violations, cases need to be filed expeditiously and convictions need to be publicized for their
deterrent effect. Needless to say , son preference has existed for centuries in India. It is the
misuse of modern technology that has made it possible to actualize it. Therefore, Act
implementation has to be given due importance in the short term. In the long run, prenatal sex
selection and son preference need to become the community’s own concern so that it endeavours
to find local solutions, and in the process changes the long held patriarchal beliefs and
expectations that discriminate against daughters.
What UNFPA does
Eliminating the practice of prenatal sex selection requires changes in the way girls and women
are valued by society. In this direction, UNFPA supports the Government in a comprehensive
approach that includes building media interest, creating community-based networks to advocate
against the practice, sensitizing health providers , and other key stakeholders , like young people,
the medical community, and faith based organizations and leaders to act against prenatal sex
selection the medium of their work.
Following a phase of intensive multi-stakeholder advocacy from 2004-07, UNFPA has now
prioritized its actions towards three main objectives:

ß Strengthen Act implementation and addressing the supply side of prenatal sex selection
services
ß Address demand for prenatal sex selection services and change community mindsets
ß Sustain public debate – influence key audiences such as youth, media, medical
community, faith-based organizations, and others
Note : Please also refer to the publications section of this website to learn more about the issue,
details of law and advocacy efforts in the area of addressing prenatal sex sele ction
(http://india.unfpa.org/?publications).

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