A blot on Mother's Day

India’s nodal body of doctors, the Indian Medical Association (IMA), this past weekend has, for the first time in more than two decades, asked the government to repeal its Pre-Conception and Pre-Natal Diagnostic Techniques Act (PNDT Act) of 1994. 

Popularly known as the Act that bans sex detection in India pre-birth, the argument IMA is providing is that the paperwork doctors have to fill for every ultrasound visit to ensure no sex-detection activity is taking place is cumbersome and many a time, doctors mismanage the forms, but are inadvertently penalised as a result. 

Statistics from the Telegraph, Kolkata seems to indicate that 586 doctors have been convicted and the licenses of 138 have been suspended or erased in 1,377 cases registered against doctors under the Act in recent times. 

There is no evidence here, however, of how many of these cases are spurious and how many are genuine. Thankfully, the Supreme Court of India has dismissed a related recent petition regarding relaxing paperwork on this, but the winds of reversion to a pre-1994 era in this matter in India may not be far away. 

If that happens, it is a dangerous future India will craft for itself. This is because while there has been a rise in social support schemes for the girl child across states (like the United Nations awarded Kanyashree Prakalpa of West Bengal), gender ratios continue to remain skewed in India.

We all know the case of Haryana where there are thousands of single men awaiting women for marriage. Or the fact that India has the problem of ‘missing women’, a term first coined by Amartya Sen in his British Medical Journal article of 1992 in the context of India and China. 

We also need to remember here that a UN study two decades back showed that some 200 million women are missing in the world, India having a major share in those missing and certainly with recent worsening sex ratios, one would expect an increase of that number. 

More broadly, Asia at large has historical son preferences and in the last three decades, has implemented such sex test bans and has held on to those bans despite debates on enforcement and related transaction costs. 
South Korea, for example, banned this in 1987, China in 1989, Pakistan in 1990, Vietnam in 2003 and Nepal in 2002. 

However, the bans have also resulted in rising female feticide, as can be seen in prior research in some of these countries. If India repeals the 1994 PNDT Act, one wonders about the policy message and signals it may be sending to its peer countries around Asia.

Reverting domestically, the general societal impression in India seems to be that the PNDT Act 1994 has not really generated impact since either illegal methods of sex-detection continue or punitive measures on complicit doctors are few and far between. 

In addition, post-birth female feticide remains a pervasive problem. Also, the PNDT 1994 Act doesn’t seem to be addressing the problem structurally, which government schemes in recent times federally and by states seem to be trying to do. 

In addition inheritance laws for the girl child are also evolving in India, though if one looks at women’s representations for political candidates in the 2019 Indian elections across the political spectrum, there is not much to be optimistic about leaving an exception here and there. 

So is it then time for India to move away from the ban and rely on its structural environmental changes related to support schemes provided to the girl child?

The answer to this from the research is a clear no, at least not yet. First, even today, we see that women are disadvantageously placed in harassment cases against the high and mighty in India. 

In addition, it is also important to remember that popular perceptions about the 1994 PNDT Act may be wrong, as research by Anil Deolalikar and Arindam Nandi published in 2013 has shown. 

They find that the Indian PNDT Act of 1994 had positive effects, resulting in at least an additional 106,000 surviving girls aged 0-6 years in rural India, or else the counterfactual world of sex ratios might have been even grimmer. 

This estimate is potentially a lower bound considering enforcement challenges of the Act in India, but is optimistic from the standpoint of positive welfare consequence of the law.

Nandi, in a separate study of 2014, finds that the PNDT Act of 1994 was generally also associated with no change in the relative mortality of infant girls, indicative of continuing structural neglect of the girl child post-birth even if she did get born and there was no female feticide. 

Relatedly, Seema Jayachandran and Ilyana Kuziemko report in their seminal 2011 article that breastfeeding duration is lowest for daughters in India, evidence that is consistent with the structural neglect hypothesis. 

So clearly, India still has a lot to accomplish to empower the girl child structurally, culturally and behaviourally and the time to repeal the PNDT 1994 act ingratiating to whining doctors has not yet arrived.

Author is from IIM-A and Hoover Institution