Abstract
Discrimination against the girl child has led to large-scale female infanticide and foeticide in the last few decades. Census 2001 data shows an alarming decline in female to male ratio. Sex selective abortion (SSA) represents not only violence against the unborn child but also results in domestic, social and sexual violence on women. In order to check female foeticide, the Prenatal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994 was enacted and became operational from 1st January 1996. Due to certain inadequacies, practical difficulties in its implementation and also due to scientific advances to select sex of a child before conception, the Act has been amended, with effect from February 2003. The main purpose of this Act is to regulate and ban the use/advertisement of sex selection techniques and misuse of pre-natal diagnostic techniques for SSA. This article critically examines the Act as it stands today.

Introduction
Denial to a girl child of her right to live is one of the heinous violations of the right to life committed by the society. It is an admitted fact that in the Indian society female child is not welcomed and discrimination against girl child still prevails. This may be because of prevailing uncontrolled dowry system despite the Dowry Prohibition Act, as there is no change in the mind-set or also because of insufficient education and/or tradition of women being confined to household activities. Sex selection/sex determination further adds to this adversity.1 Today many doctors practice sex determination facilities for easy money; others do so to spread family planning, thinking it to be a great social and national service. In the recent past, prenatal diagnostic centres have sprung up in the urban areas using advanced technology for determination of sex of the foetus and have become centres of female foeticide and hence affecting sex ratio. The misuse of modern science and technology by preventing the birth of a girl child by sex determination before birth and abortion thereafter is evident from the 2001 census figures which reveal greater decline in sex ratio in the 0-6 age group in States like Haryana, Punjab, Gujarat and Maharashtra, which are prosperous and economically better off. The states that have not been victims of this social menace are Pondicherry, West Bengal, Mizoram, Kerala and Sikkim because of better education of women and absence of ‘sex fixation’. In depth study of 2001 census shows that all districts in Haryana and Punjab are not only in D category (child sex ratio less than 900) but 25/36 districts have child sex ratio less than 800 (D3 category).2

Sex ratio at birth (SRB) is an indirect measure of female foeticide. There has been a decline in the sex ratio (number of males per 100 females) during the present century with substantial differences between states in sex ratio at birth. The observed sex ratio of 110 is much higher than the internationally accepted ratio of 106.3 The key factors responsible for SRB are female infanticide, sex determination and selective female foeticide.

We are now facing the tragic events of even the first daughter being eliminated in Punjab and Haryana. It is interesting to note that urbanised cities are bigger culprits in this menace. For example in Gujarat, Ahmedabad leads with child sex ratio of 809 per 1000 males, followed by Rajkot (821), Surat (830) and Vadodara (832). Ironically, districts like Mehsana (797), Gandhinagar (816), Rajkot and Ahmedabad enjoyed above average female literacy rate of 64, 65, 67 and 71 per cent respectively. In comparison, the so called backward, tribal districts of Dangs, Dahod and Narmada, with low female literacy rates of 49, 32 and 47 per cent respectively, have higher child sex ratios of 973, 964 and 952. A desire for a son continues to remain strong among couples. Indirect evidence of this comes from analysis of the NFHS data collected during 1998-994,5 and also from the Gujarat and Haryana study.6 In Northern India, women’s desired fertility has been seen to be positively associated with their level of son preference according to analysis based on data from two successive rounds of a nationally representative survey.7

The fast declining sex ratio of females in India may, in future, lead to serious sociocultural problems, including sex-violence and population imbalances.8 Marked spread of female foeticide is due to:

• Bias about small family norm
• Easy access to medical facilities
• Ability to pay the doctor and abortionist for the test and abortion
• A good network of roads to cut down the cost and time of travel
• Unholy alliance of traditional thoughts as reflected in the ‘son complex’
• Easily available technological advances for sex-determination in utero9

The MTP Act 1972 and PNDT Act 1994 are closely linked. A law, which was essentially passed to curb illegal abortion, has ended up being misused and doing exactly the opposite. Women undergoing (SSA) are most likely to attempt second trimester abortion. India’s second trimester abortion rate is thus increasing and is highest in the world. Illegal and unsafe abortions account for an estimated 6.7 million abortions per year performed by untrained persons in unhygienic conditions. This “double illegality” has severe consequences for women. The Indian Medical Association estimated that about five million female foetuses were aborted each year purely on the grounds that the children born would be of the wrong sex. Thus there was a dual agenda of promoting safe abortions and prohibiting SSA.

Various Non-Governmental Organizations working for the welfare and upliftment of women raised their heads against such an abuse. The Prenatal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994 renamed after amendment as “The Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act” referred to as PNDT Act thus came into force.

Definition
“An Act to provide for the prohibition of sex selection, before or after conception, and for regulation of prenatal diagnostic techniques for the purposes of detecting genetic abnormalities or metabolic disorders or chromosomal abnormalities or certain congenital malformations or sex-linked disorders and for the prevention of their misuse for sex determination leading to female foeticide; and for many matters connected therewith or incidental thereto”.

Important features of the PNDT Act, 1994¹⁰

Regulation of Genetic Counselling Centres, Genetic Laboratories and Genetic Clinics

On and from the commencement of this Act:

1. No genetic counselling centre, genetic laboratory or genetic clinic unless registered under this Act shall conduct or associate with or help in conducting activities relating to prenatal diagnostic techniques.
2. No genetic counselling centre, genetic laboratory or genetic clinic shall employ or cause to be employed any person who does not possess the prescribed qualification.
3. No medical geneticist, gynaecologist, paediatrician or any other person shall conduct or aid in conducting by himself or through any other person, any prenatal diagnostic techniques at a place other than a place registered under the Act.
4. No person shall sell any ultrasound machine or imaging machine or scanner or any other equipment capable of detecting sex of the foetus to any genetic counselling centre, genetic laboratory or genetic clinic or any other person not registered under the Act.

Regulation of Prenatal Diagnostic Techniques

1. No prenatal diagnostic techniques shall be conducted except for the purposes of detection of any of the following abnormalities, namely:
• Chromosomal abnormalities
• Genetic metabolic diseases
• Haemoglobinopathies
• Sex-linked genetic diseases
• Congenital anomalies
• Any other abnormalities or diseases as may be specified by the Central Supervisory Board
2. No prenatal diagnostic technique shall be used or conducted unless the person qualified to do so is satisfied that any of the following conditions are fulfilled, namely:
• Age of the pregnant woman is above 35 years
• The pregnant woman has undergone two or more spontaneous abortions or foetal losses.
• The pregnant woman has been exposed to potentially teratogenic agents such as drugs, radiation, infection or chemicals.
• The pregnant woman or her spouse has a family history of mental retardation or physical deformities such as spasticity or any other genetic disease.
• Any other condition as may be specified by the Central Supervisory Board
3. No person including a relative or husband of the pregnant woman shall seek or encourage the conduct of any prenatal diagnostic test on her except for the purpose mentioned in the indications.
4. No person including a relative or husband of the pregnant woman shall seek or encourage the conduct of any sex-selection technique on her or him or both.

Written consent of pregnant woman and prohibition of communicating the sex of the foetus
No person shall conduct the prenatal diagnostic procedures unless-

• He has explained all known side and after effects of such procedure to the pregnant woman concerned.
• He has obtained in the prescribed form her written consent to undergo such procedure in the language, which she understands.
• A copy of her written consent obtained given back to the pregnant woman.
• No person conducting prenatal diagnostic procedure shall communicate to the pregnant woman concerned or her relative the sex of the foetus by words, signs or in any other manner.

Determination of sex prohibited

1. Prenatal diagnostic techniques including ultrasonography should not be performed for sex determination.
2. No person shall, by whatever means, cause or allow to be caused selection of sex before or after conception.

Central Supervisory Board
For effective implementation of the Act, Central Supervisory Board is constituted which consists of minister in charge of the Family Welfare as Chairman, Secretary of Government of India for Family Welfare as Vice-Chairman, two members from Law and Judiciary Department and Women and Child Department and other eminent medical geneticist, gynaecologist, paediatrician, social scientist and representatives of women welfare organization.

Main functions of the board are as follows:

• To advise the Central Government on policy matters relating to use of prenatal diagnostic techniques, sex-selection techniques and against their misuse.
• To review implementation of the Act and the rules made thereunder and recommend changes in the said Act and Rules to the Central Government
• To create public awareness against the practice of prenatal determination of sex of the foetus leading to female foeticide.
• To lay down code of conduct to be observed by persons working at genetic counselling centre, genetic laboratory or genetic clinic.

To enforce the law in individual State, appropriate authority is constituted whose main functions are:

• Grant, suspend or cancel registration of the genetic centre, clinic or laboratory
• To enforce prescribed standards
• To investigate complaints of breach of provision of Act
• Summoning of any person who is in possession of any information leading to violation of the provisions of this Act or rules
• Issuing search warrant for any place suspected to be indulging in sex selection techniques or prenatal sex determination.

Offences and Penalties

1. Prohibition of advertisement relating to prenatal determination of sex and punishment for contravention. Advertisement in any manner including internet, regarding facilities of prenatal determination of sex available at any genetic centre, clinic or laboratory, shall be punishable with imprisonment for a term, which may extend up to three years, and fine which may extend up to Rs.10,000/-. “Advertisement” includes any notice, circular, label, wrapper or any other document including advertisement through internet or any other media in electronic or print form and also includes any visible representation made by means of hoarding, wall-painting, signal, light, sound, smoke or gas.
2. Any geneticist, gynaecologist, paediatrician or any other person contravenes any of the provisions of this Act or rules made there under shall be punishable with imprisonment for a term which may extend to three years and fine of Rs.10,000/-. On any subsequent conviction, imprisonment may extend to five years and fine may extend to Rs.50,000/-.
3. Presumption in the case of conduct of prenatal diagnostic techniques: Not withstanding anything contained in the Indian Evidence Act, 1872, the court shall presume unless the contrary is proved that her husband or any other relative compelled the pregnant woman, to undergo prenatal diagnostic technique. Such a person shall be liable for abatement of offence with imprisonment upto 3 years and fine of Rs.10,000/-.
4. All offences under this act are cognizable, nonbailable and noncompoundable.

Miscellaneous

Maintenance of Records

• All records, charts, reports, consent letters and all other documents required to be maintained under this Act and the rules shall be preserved for a period of two years or for such period as may be prescribed.
• If any criminal or other proceedings are instituted, the records and all other documents shall be preserved till the final disposal of such proceedings.
• Every genetic counselling centre, genetic laboratory, genetic clinic, ultrasound clinic or imaging centre should send a complete report in respect of all pre-conception or pregnancy related procedures/techniques/tests conducted by them in each month by 5th day of the following month to the concerned Appropriate Authority.

Registration of Genetic counselling Centre, Genetic Laboratory and Genetic Clinic

• It is done by States Appropriate Authority after application and paying fees of Rs.3,000/- for genetic counselling centre, genetic laboratory, genetic clinic, ultrasound clinic or imaging centre and Rs.4,000/- for an institute, hospital, nursing home.
• The appropriate authority in duplicate grants certificate of registration. One copy of the registration certificate has to be displayed by the genetic counselling centre, genetic laboratory or genetic clinic at a conspicuous place at its place of business.
• Grant of certificate of registration or rejection of application is done within 90 days from the date of receipt of application.
• In the event of change of ownership or change of management of the centre a fresh application for registration certificate is mandatory.
• Certificate of registration is valid for a period of five years from the date of its issue.
• Renewal of registration has to be done thirty days before the date of expiry of the certificate of registration. The fees payable for renewal are one half of the original fees.

Discussion
The first state to enact laws against sex determination was Maharashtra, with the Regulation of Use of Prenatal Diagnostic Techniques Act, 1988. After this law, the number of sex determination clinics and the practice of sex determination in Mumbai reduced. This achievement was due to sustained campaigning and active monitoring of the Act by the FASDSP (Forum Against Sex Determination and Sex Pre-selection). The media also had a major role to play in the awareness campaign against sex-selection and sex-determination. But there was a need for national awareness and a national legislation. Hence the Supreme Court of India passed the Prenatal Diagnostic Techniques (Regulation and Prevention of Misuse) Act in 1994. This became operational from 1st January, 1996. Unfortunately the law was not implemented effectively and was a failure, resulting in continuation of rampant malpractice in most areas. Later the landmark Public Interest Litigation filed by two NGOS, CEHAT (Centre for Enquiry into Health and Allied Themes), Mumbai and MASUM (Mahila Sarvangeen Utkarsh Mandal) Pune, in 2000 bore fruit in 2003 when the Supreme Court gave the strict orders for implementation of the PNDT Act.

It is true that the PNDT Act adds to the quantum of work we are already doing. But by recognizing the seriousness of the issue and its social consequences, our institutions should whole heartedly welcome such initiative. The present scenario also suggests that we work with the community we serve, to counter the practice of sex selection. Having a stringent law to curtail the practice of sex determination may be the first step against female foeticide. However, unless various community-targeted programmes supplement it, a law in isolation is unlikely to make any visible changes to the present scenario. These community targeted programmes can be awareness building, counselling young married couple, keeping a constant vigilance against the practice of female foeticide. Again much of these depend on uplifting the status of women in our society.

We as doctors have an important role to play considering the future evils that may befall us. We must be careful and vigilant so that by our mistakes and greed, the society as a whole may not be affected. A time has come when we must take the vow to preach and practice - “A girl child is equally welcome” in the society and particularly in the family so that social and family harmony could be maintained. If we can ensure this, we will be respected and remembered by our next generation for saving them from this “man-made catastrophe”. Strict implementation of the above Act is very necessary for fast decreasing female/male ratio, which is female 927 : male 1000 at present in India. At the same time important practical implication of the Act is that no woman should be denied prenatal diagnostic tests if indicated fearing the Act.

Sex selection in the present context is a complex issue with several stakeholders - doctors, the government machinery looking after the implementation of the Act, health and women’s groups and civil society at large. Each has to play their part to deal with it at various levels. Implementation is what the Act lacks like most laws concerning women’s rights do. It is important to examine scientific, social, judicial, ethical economic and health consequences of the available new reproductive technologies. Our challenge today is to initiate a vibrant, effective campaign against female foeticide. Only if we are all committed can we reach out to the hearts and minds of our people.

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