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Indian Express
14-07-2025
- Health
- Indian Express
Want a boy? Now, ask the Haryana government's permission
My instinctive reaction to the news that Haryana has decided that couples with one or two living female children seeking another child through IVF will have to obtain prior permission from a District Appropriate Authority was that this is a clear case of administrative overreach. My interest in this area dates back to my doctoral work a decade ago, which was on the adverse sex ratio at birth for girls and subsequent higher childhood mortality in Haryana's Faridabad District. My studies showed that this preference is quite strong, and everyone knows that sex-determined abortions are happening but refuses to acknowledge it openly. A preference for boys is ingrained in Asian culture, where they are seen as essential for the family or 'kul' to continue. But two unrelated factors have made the crisis acute. The first is the desire to limit the number of children to one or two. Previously, couples would make four to five attempts to have a boy. Now they must get it 'right' within two attempts. The second is the availability of and easy access to technology to 'enable' sex determination prenatally and induce abortion of foetuses of unwanted sex, usually girls. Haryana and Punjab have the worst sex ratio in India, and clearly, they needed to do something. Central and state governments have tried addressing this in two ways — offering financial incentives to bear and bring up a girl child and restricting access to sex-determination technology. These are short-term measures, as the solution is a change in mindset. Of course, we have the example of China which curtailed the rights of its citizens by forcing them to have only one child. While the law has been relaxed to allow two children, the damage has been done. With schemes like Beti Bachao, Beti Padhao and its predecessor Ladli Yojna, parents of girl children are given timed incentives (deposited in an account in the child's name) when she reaches different milestones like immunisation, school enrolment, passing Class 10, etc. When she turns 18, the amount is topped up and granted for further education or marriage. In addition to the bureaucratic barriers, the long delay in action and benefit does not make it an attractive scheme for most. So while they welcome the money, it does not really change how much they value girls. Also, data clearly shows that the problem of adverse sex ratio is more common among richer and educated populations due to better awareness and affordability. This means that financial instruments are less likely to work. The second has been a regulatory approach of Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act, which mandates registrations and lays stringent restrictions on deployment of technologies, especially ultrasounds. One hears regularly of the prosecution of unscrupulous medical practitioners. The medical fraternity strongly resents the burden imposed on them for the installation of routine medical technology. There is no doubt that this law has affected access to ultrasound sonography (USG) for other purposes like screening for gastrointestinal or heart disease. Harassment by district authorities, and availability of newer, easier-to-use technologies like handheld USGs have further limited its effectiveness. The recent order has been justified as in Haryana, the sex ratio at birth dropped to 910 in 2024, after stabilising around 914-920 in the last seven years (an improvement from 876 girls per 1,000 boys in 2015). The focus is on parents of girls, as data shows that the practice of sex determination is more prevalent among them. This order does not apply to all who want second or third children or all who want an IVF, so only a small group of parents will be affected. However, it is the principle behind the action that is under scrutiny. India amended its prenatal sex determination act to include preconception testing to keep up with the changing technology. Thanks to modern screening and testing of embryos during in vitro fertilisation (IVF), one can determine the gender of a child before the implantation process via preimplantation genetic testing. Hence the focus on IVF centres. Genetic testing of preimplantation embryos created through in vitro fertilisation is often recommended to screen for genetic diseases and for sex-linked genetic diseases. So the question we should be asking as citizens of a modern democratic country is: When does a public health problem become so significant that it justifies a government's decision to impose restrictions on the rights of would-be parents to have a child? And if it is warranted, what are the inbuilt safeguards for preventing misuse of this law? Given that the population continues to prefer a male child and technology will keep evolving, how far can a government go to ensure the rights of an unborn or even unconceived girl child? While some would say as far as it is necessary to go; some would say never. But if demand is there, and technology is available, a way will always be found to meet the demand, especially for the rich and privileged. Parents are being sandwiched between society, which conditions them for male preference and demands a boy child, and the government, which also wants to have a say. There are no easy answers to this moral and ethical dilemma, but all of us and the government should keep asking these questions. In the meantime, as a modern society, we need to ponder how to address this deeply ingrained cultural heritage of boy-preference and how to regulate technologies which will always be a two-headed beast. The writer is Professor of Community Medicine at the All-India Institute of Medical Sciences, New Delhi. Views are personal
Indian Express
10-07-2025
- Health
- Indian Express
Haryana to mandate prior approval for IVF for couples with girl child
Couples in Haryana who have at least one living female child and wish to have another child through in-vitro fertilisation (IVF) must now obtain prior permission from the District Appropriate Authority. This requirement also applies to couples who already have a girl and a boy as children. The decision was made at a meeting Tuesday of the State Task Force (STF) for improving sex ratio, chaired by Sudhir Rajpal, Additional Chief Secretary, Health and Family Welfare. The meeting, held under the direction of Health and Family Welfare Minister Arti Singh Rao, focused on improving the state's sex ratio under the 'Beti Bachao-Beti Padhao' campaign. 'Right now, it is just at the stage of being an idea. We have to formulate the guidelines and modalities. The idea is that people can still use IVF, but it should not be misused,' Rajpal told the Indian Express on Thursday. Haryana's sex ratio improved to 904 (903 females per 1,000 males) as of July 7 this year, up from 903 in the corresponding period last year, reflecting the impact of ongoing initiatives, the government claims. In the meeting, Rajpal directed the chief medical officers to reverse track abortions conducted up to 24 weeks of pregnancy to identify medical practitioners involved and take strict action against violations. A detailed procedure for reverse tracking has been shared with all chief medical officers. The meeting also reviewed efforts to curb illegal abortions. Rajpal instructed officials to revoke the licenses of doctors found to be complicit and take action against Ayurvedic practitioners and quacks involved in such activities, with weekly reports being mandated. Two nursing homes in the Nuh district were recently sealed for illegal abortion practices, it was discussed. Around 500 illegal medical termination of pregnancy (MTP) centres have been shut down statewide, leading to a notable decline in legal MTPs over the past two months, the body observed. Officials reported a rise in birth registration figures for June compared to May. Rajpal directed senior officers to collaborate with Accredited Social Health Activists (ASHA) and Anganwadi workers to identify and register unregistered children in slums and low-income areas of Palwal, Nuh, Gurgaon, and Faridabad, with the goal of completing pending registrations within a month. The Woman and Child Development Department highlighted ongoing awareness campaigns in public parks under the 'Beti Bachao, Beti Padhao' initiative, with telecom companies engaged to spread the message via mobile alerts. Rippudaman Singh Dhillon, Secretary of the Health Department and Mission Director of the National Health Mission, also attended the meeting.
Time of India
10-07-2025
- Health
- Time of India
Couples with daughter trying for 2nd baby via IVF need prior govt approval
Gurgaon: Couples living in Haryana who have a girl child will now need prior govt permission should they seek the IVF (in vitro fertilisation) route for a second child. According to a directive from the additional chief secretary health, couples opting for IVF need to file an application with the District Appropriate Authority (DAA) along with supporting documents like birth certificates of children, documents related to childbirth or miscarriage, and reasons for seeking IVF. The decision was taken at the latest weekly review meeting of the state task force (STF) established for course correction after Haryana's annual sex ratio at birth fell from 916 in 2023 to 910 in 2024, setting off alarm bells in the state with a history of female infanticide. The meeting was chaired by health and family welfare minister Arti Rao and ACS health Sudhir Rajpal. You Can Also Check: Gurgaon AQI | Weather in Gurgaon | Bank Holidays in Gurgaon | Public Holidays in Gurgaon The directive to seek prior IVF permission will be applicable to couples with one or more daughters and also to those with a son and a daughter. Officials said the measure aims to prevent misuse of assisted reproduction for sex selection. DAA, whose chairperson is the deputy commissioner and member secretary is the chief medical officer (CMO), has been tasked with reviewing applications and monitoring IVF centres. DAA plays a key regulatory and enforcement role under various health-related laws and programmes, notably the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act that Haryana health teams have operated under for years to track down illegal abortion rackets. Officials said IVF clinics that don't follow this directive will face penalties under PCPNDT Act, cancellation of licence and criminal prosecution. "District authorities must ensure strict scrutiny in such IVF cases to avoid any possibility of gender discrimination through assisted reproductive techniques," Rajpal said. Calling for "zero tolerance" towards illegal abortions, Rajpal ordered CMOs to reverse-track all abortions performed up to 24 weeks to identify medical professionals involved. "A detailed protocol for reverse-tracking has already been circulated, and strict action, including licence cancellation, will be taken against violators," he said. IVF centres will also have to submit monthly reports to the health department. Explaining the reason behind the directive, a senior health department officer said, "During IVF, embryos are created outside the body. Before implantation, clinics may offer Preimplantation Genetic Testing (PGT) to screen embryos for genetic diseases. PGT can also reveal the sex of the embryo, even though this is legally restricted in India. Some unethical clinics may use this technology to select only male embryos for implantation. Clinics or couples may choose to implant only male embryos, discarding or freezing female ones, even when both are healthy. While revealing the sex of a foetus or embryo is banned under PCPNDT Act in India, some clinics illegally inform couples about the gender during or after IVF procedures, leading to sex-selective abortions." Among other measures, STF has directed all districts to carry out more than 10 raids every week targeting illegal abortion centres and unauthorised practitioners including BAMS (Bachelor of Ayurvedic Medicine and Surgery) suspected of carrying out unlawful terminations of pregnancy. CMOs have been told to submit weekly reports. STF is also pushing for stronger coordination between health authorities, police and district administrations to enforce these directives effectively so that sex ratio gains made by the state over a decade since it began the 'Beti Bachao, Beti Padhao' campaign are not lost. Data shows a slight improvement in state's sex ratio, which stands at 904 girls per 1,000 boys as of July 7, an increase from 903 during the same period last year. Last year, 13 of Haryana's 22 districts saw a fall in sex ratio at birth, leading to the 6-point fall.
The Print
17-05-2025
- Health
- The Print
How a procedural lapse led to acquittal of Haryana doctor-couple in a 19-yr-old PNDT Act case
Justice Jasjit Singh Bedi emphasised that under Section 17(3)(b) of the Act, the District Appropriate Authority (DAA)—which is responsible for regulating and enforcing the provisions of the Act within a district and filing such complaints—must be a three-member committee appointed through an official notification. In its order pronounced Thursday, the HC observed the complaint against Dr Mahender Kamboj and Dr Renu Kamboj, the directors of M/s Kamboj Ultrasound and Diagnostic Pvt Ltd, was not instituted by a competent authority as required by the Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act, or the PC & PNDT Act. Gurugram: A doctor couple from Haryana's Hisar booked under the prohibition of sex selection act 19 years ago has been acquitted by the Punjab and Haryana High Court on the grounds that proper procedures were not followed while filing the case against them in 2006. 'In the instant case, the complaint was filed by Dr S.K. Naval (then civil surgeon) alone and it ought to have been filed by a three-member Committee, appointed by a Notification under Section 17 of the PC and PNDT Act. The same not having been done, the very complaint itself is not maintainable and therefore, the subsequent proceedings and conviction stands vitiated,' Justice Bedi stated in the judgment. The case dates back to October 2006 when, following reports in various media outlets, the then civil surgeon of Hisar constituted a team that inspected the premises of Kamboj Ultrasound and Diagnostic Pvt Ltd. The team seized records and sealed four ultrasound machines, alleging multiple violations of mandatory record keeping requirements through Form F under the PC & PNDT Act. Both the doctors were convicted by the Hisar Chief Judicial Magistrate in January 2008. They were sentenced to three years of rigorous imprisonment and fined Rs 5,000 each for the alleged contravention of the Act's Section 4(3)—prohibits sex determination, read with Rule 9, which mandates keeping a record of the procedure in a prescribed manner. The doctors received an additional two years of imprisonment and Rs 5,000 fine for violating Section 5(1)(b) of the Act, which mandates written consent from the pregnant woman in a prescribed format before conducting a sex determination test. Although their sentences were reduced to two years by the Sessions Court in August 2008, the doctors challenged the conviction in the high court, where their sentences were suspended pending the final verdict. The high court's ruling hinged on several earlier judgments, particularly the 2014 decision in the Help Welfare Group Society versus State of Haryana case which clarified that even when appointed for part of a state, the District Appropriate Authority must be a multi-member body consisting of three officials. The court rejected the state's argument that this interpretation came only in 2014 and should not apply retroactively to these cases. Justice Bedi cited Supreme Court precedents to establish that 'the interpretation of a provision relates back to the date of the law itself and cannot be prospective of the judgment'. 'When the Court decides that the interpretation given to a particular provision earlier was not legal, it declares the law as it stood right from the beginning of its promulgation,' the judgment noted, referring to Supreme Court decisions in the Lily Thomas versus Union of India and the Sarwan Kumar versus Madal Lal Aggarwal case. The court further pointed out that the Special Leave Petition filed by the state against a similar judgment in the Dr Ritu Prabhakar versus State of Haryana case had been dismissed by the Supreme Court in November 2016, reinforcing the interpretation that complaints under the PNDT Act must be filed by a properly constituted three-member authority. With this judgment, the 19-year-old case against the doctor couple finally comes to a close, establishing an important precedent regarding procedural requirements for prosecution under the PNDT Act. (Edited by Ajeet Tiwari) Also Read: Ultrasound that doesn't reveal sex of foetus in the works & what it means for pregnant women
