14-07-2025
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
