In September 2025, Karnataka’s Health Department conducted a covert operation in neighbouring Andhra Pradesh to prevent a woman from undergoing illegal prenatal sex determination. The 30-year-old from Mandya district, already a mother of three daughters, had approached an agent across the State border after learning she could determine the sex of her foetus. When told the foetus was female, she planned to terminate the pregnancy in her fifth month. Officials from both States coordinated a decoy operation that dismantled the illegal network facilitating these cross-border procedures.
It was not an isolated case. In April, Haryana’s Rohtak district authorities busted a sex-determination racket operating out of neighbouring Bijnor in Uttar Pradesh. Over 120 FIRs have been registered this year in the State for illegal abortion practices, including unlawful sale of Medical Termination of Pregnancy (MTP) kits, while nearly 300 of Haryana’s 1,500 MTP centres have had their registration cancelled or voluntarily surrendered. In Ahmedabad, a June raid uncovered a radiologist and nurse conducting sex-determination tests and abortions at guesthouses and patients’ homes.
Even Delhi, which once showed signs of progress, has witnessed a steady decline. The capital’s sex ratio at birth has fallen for four consecutive years, from 933 girls per 1,000 boys in 2020 to just 920 in 2024. Alarmed, the Delhi government recently banned the transfer of genetic material outside the city for pre-natal testing and tightened restrictions on the over-the-counter sale of abortion pills.
The surge in raids this year has coincided with renewed legal scrutiny. On September 9, 2025, the Supreme Court granted States four weeks to respond to a plea seeking effective implementation of the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994, which prohibits sex selection before or after conception and regulates pre-natal diagnostic techniques to prevent sex-selective abortions. The bench of Justices B.V. Nagarathna and R. Mahadevan noted that while most States had filed affidavits, several had not, and that authorities often failed to prosecute cases properly—leading to acquittals without appeals being filed. The Court directed States to submit data from May 2015 to date and warned that future non-compliance could attract penalties.
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The petition had pointed out that conviction rates under the Act remained abysmally low, even though its rules mandate filing an appeal against every acquittal—a step many States have ignored. A 2021-22 report by the Parliamentary Committee on Empowerment of Women recorded that, over 25 years of the law, only 617 convictions had taken place. Eighteen of 36 States and Union Territories had not registered a single case.
Despite nearly three decades of the PCPNDT Act, sex determination rackets continue to thrive. In 2025 alone, crackdowns in Karnataka, Andhra Pradesh, Haryana, Gujarat, and Delhi have exposed inter-State networks that use sophisticated medical tools to violate the law. The practice has moved from metropolitan cities to their outskirts, becoming more clandestine and technology-driven. Enforcement remains patchy, and activists and doctors point to the same persistent problem: India’s enduring preference for sons.
Beyond the law
In July 2025, women’s rights activist Varsha Deshpande, secretary of the Maharashtra-based Dalit Mahila Vikas Mandal, received the United Nations Population Award in recognition of her decades-long work promoting gender equality and reproductive rights. For over three decades, Deshpande has fought to expose and curb sex selective practices across India, conducting decoy operations and training women’s groups to monitor violations of the law.
Deshpande believes the language around the issue is itself flawed. “The term female foeticide is wrong; we call it sex-selective medical abortions or eliminations,” she told Frontline. “There can be an abortion of a foetus, but there cannot be a foeticide. In India, we support the abortion rights of every woman, married or unmarried, under the Medical Termination of Pregnancy Act. What must be condemned is not abortion, but discrimination through sex determination and sex selection. When we discriminate against our unborn daughters, that is a violation of their constitutional rights prior to birth.”
For Deshpande, the real problem lies in the systemic violation of multiple laws—the PCPNDT Act, the MTP Act and the Drugs and Cosmetics Act—all of which intersect around the issue. “The foetus gets selected as a boy or a girl, and then eliminated using abortion drugs that are illegally sold across India,” she says. “These drugs are supposed to be restricted, unlike condoms and family planning pills that you can buy over the counter, yet you can buy them in every market. The problem is not one law, it’s the violation of all three.”
She points out that every technological advancement, from ultrasounds to IVF, has deepened the crisis. “Technology comes into the market for profit, not for ethics,” she says. “The medical profession has to have values rooted in the Constitution, but instead, there’s a political confidence in violating the law. People believe they can manage violations, whether it’s traffic rules or ultrasound or IVF misuse. That’s the culture we have created.” With the growth of reproductive technologies, the Assisted Reproductive Technology (ART) Act of 2021 now governs IVF, surrogacy, and egg and sperm donation, while linking with the PCPNDT Act to prohibit sex selection in ART clinics.
But the roots of the problem go beyond medicine. “This is not just a technological issue—it’s an economic one,” Deshpande argues. “When women are denied property rights and economic recognition, when their work is invisible in our GDP, it’s no surprise that daughters go missing. From sati to sex selection, it’s the same logic—controlling women’s bodies and erasing their existence.”
Early warnings
Dr Neelam Singh, a gynaecologist and founder of Vatsalya, a Uttar Pradesh-based NGO working for women’s and children’s health, recalls witnessing the early phase of sex selective elimination. She traces it to the mid-1970s, when doctors began using amniocentesis to test foetal chromosomes. “Once ultrasound technology arrived, international companies targeted doctors, promoting these machines because they could identify the sex of the foetus. That’s when the misuse became rampant,” she says.
Singh founded Vatsalya in 1995 after repeatedly encountering patients who asked where they could get sex determination done. “The demand for a son was open and blatant then,” she recalls. The following year, the PCPNDT Act came into effect—but many medical professionals, she says, “still don’t grasp how serious the sex-ratio decline is,” partly because of conflicting government data.
She points out that the fall has been consistent for decades. Earlier, it was concentrated in urban areas; now two-thirds of the cases come from rural communities “where people don’t even know the Act exists.” The rise of IVF and non-invasive prenatal testing has further complicated enforcement. “Earlier, people went abroad, to Thailand or Indonesia, for sex selection packages. Now, even IVF clinics in India are suspected of selecting embryos by sex,” she says. “There was even a parliamentary question last year about the sex ratio of IVF births, but no data exists. The Ministry needs to bring IVF centres within the ambit of the PCPNDT Act.”
Officials in the Karnataka Health department, after carrying out covert operation in Andhra Pradesh. Coordinated operations with the State exposed illegal prenatal sex determination and highlighted persistent enforcement gaps.
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THE HINDU
Within the medical community itself, she notes, patriarchal attitudes persist. “Some gynaecologists argue that a woman with two daughters has the right to use technology to have a son. These are educated professionals saying this,” she says. “That mindset is the real challenge.”
Despite growing awareness, the preference for sons remains strong. “It has gone underground, not discussed openly but still widely practised,” Singh says. One of her own patients recently travelled to Varanasi for sex determination, revealing it only after delivery. For Singh, the gap lies in enforcement and political will. “People are not honest. Many enforcement agencies are corrupt, and senior officials don’t even understand how to use the Act effectively,” she says. “The law itself is strong, but the will to implement it is weak.”
The small family trap
The roots, Singh adds, are also economic and social. “As families become smaller and aspire for upward mobility, they want to ‘complete’ their family with a son. The small-family norm itself fuels the demand for sons. In a small family, it’s the girl who will be sacrificed. Social and economic progress hasn’t translated into attitudinal change.”
Census data support this: among women who had one child, 22 million had a girl while 28.5 million had a boy. Among families with two children, half have one boy and one girl, a third have two boys, and just one-sixth have two girls. Such sharply skewed sex ratios—well beyond the natural biological variation—indicate the use of prenatal sex selection. The pattern continues in families with three children, where households with all boys or two boys and a girl were far more common than those with all girls or two girls and a boy.
At large family sizes, however, this dynamic begins to shift, as families that cannot or do not practise prenatal sex selection often continue having children in their quest for a son. A study published in the Public Library of Science found that the sex ratio fell to 720 girls per 1000 boys when there was one previous daughter, and to just 178 girls per 1000 if there were two previous daughters. In contrast, in families with a previous son, 1017 girls were born per 1000 boys, suggesting sex selection is most prevalent when earlier children are girls.
Singh argues that consistent enforcement can shift this trend. “Whenever administrative will has been strong, we’ve seen the sex ratio improve—in Rajasthan, Haryana, Maharashtra,” she says. “But as soon as monitoring slackens, it dips again. It shows that if we are honest and consistent, change is possible. But the moment we relax, the cycle repeats.”
Dr Sabu George, a researcher who has studied gender discrimination and the implementation of the PCPNDT Act for decades, notes that while some States, such as Punjab and Haryana, which were infamous for illegal sex determination, have shown improvement since the early 2000s, the overall picture remains concerning. “Punjab seemed to improve from its worst in 2001, when nearly one in five girls were being eliminated,” he says. “But in many parts of India, the numbers are dropping again. In Odisha, there’s now a district with a sex ratio of around 750, worse than 2001. Similarly, Mandya in Karnataka is in the 800s, equivalent to Punjab’s earlier situation.”
The Sample Registration System (SRS) 2023 data, which tracks a sample population of about 8.8 million, shows the sex ratio at birth improving marginally from 904 (2017-19) to 917 (2021-23)—still far from the natural ratio of 952. With roughly 25 million births annually, around 3.5 per cent of girls remain “missing”. Rural figures (914) remain lower than urban (925). Chhattisgarh and Kerala report the highest ratios (974 and 971, respectively), while Uttarakhand records the lowest (868).
The Civil Registration System (CRS) 2023, released by the Registrar General of India on October 10, shows the highest sex ratio at birth in Arunachal Pradesh (1085), followed by Nagaland (1007) and Kerala (967). Jharkhand (899) and Bihar (900) recorded the lowest. For India overall, the ratio stood at 928 females per 1,000 males. However, the most accurate picture would only emerge after the 2027 census.
Enforcement gaps
George emphasises that sex ratio at birth reflects only births, while the child sex ratio also captures infanticide and early childhood deaths. This is critical in States with high tribal populations, like Odisha, Jharkhand, and Madhya Pradesh, where tribal communities tend to have more balanced ratios as they don’t engage in sex determination practices, pulling up State averages.
George points out that monitoring bodies often fail. “In some States, committees haven’t met in six years, though they’re supposed to meet every six months,” he says. The problem is compounded by the rapid growth of IVF and ART clinics. The number of facilities offering
related services is vast and unevenly regulated, with authorities focusing on regulating abortions rather than the actual act of sex determination. “Laws don’t enforce themselves—you have to visit, verify, investigate.”
According to the Ministry of Health and Family Welfare, the total number of ART clinics in India are estimated to exceed 40,000 as of 2021, but only 1657 were registered with the Indian Council of Medical Research.
Activists note that over the years, the practice has moved from metros to peripheral or rural areas. People travel to States that are less monitored and often internationally to get the sex determination done. Notably, George adds, skewed sex ratios can be seen among Indian births across the world—in the UK, US, or Canada—anywhere with large Indian or Chinese populations tends to have distorted ratios.
George is equally critical of the medical establishment and the State. “Medical associations often shield their members, and States end up targeting women instead of clinics,” he says. “The PCPNDT Act presumes women are innocent, but enforcement often reverses that, as in Haryana, where authorities tracked 300 abortions by following the women, not the clinics.”
Doctors’ associations have long argued that the law is unfair to legitimate medical professionals. In 2016, the Indian Radiology and Imaging Association went on a nationwide strike, supported by the Indian Medical Association and the Federation of Obstetric and Gynaecological Society of India. They claimed that the PCPNDT Act had become a harassment tool for honest doctors, and that nearly 95 per cent of the convictions under it were for clerical errors rather than actual violations. In 2024, the IMA again drew backlash for calling for the legalisation of pre-natal gender determination.
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Despite modest improvements in some regions, George warns that the underlying social attitudes remain unaddressed. “Even when campaigns like Beti Bachao, Beti Padhao spend millions, much of it is just posters and photographs. Haryana has shown impact because authorities acted seriously, but other States with the same double-engine governments have not.”
The Ministry of Health and Family Welfare recently convened a National Sensitisation Meeting on Strengthening the Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994, on October 6. Aradhana Patnaik, Additional Secretary and Mission Director (National Health Mission), highlighted that the country has recorded a “positive improvement” in the sex ratio at birth. “As per the Sample Registration System (SRS) Report 2023, the SRB has increased by 18 points—from 819 females per 1,000 males during 2016-18 to 917 females per 1,000 males in 2021-23,” she said, adding that the progress reflected “strengthened implementation of the PCPNDT Act and related interventions.”
For Varsha Deshpande, the deeper failure is moral and institutional. “I’m part of the National Inspection and Monitoring Committee and have seen governments come and go. I’m an insider, and despite that, I have to criticise. Every health minister, regardless of party, sides with doctors, not women. Doctors are voters. The unborn girl child is not. So the political will to implement the law is missing.”
Her critique extends beyond enforcement to the larger social mindset. “We are fighting not only for the law, but for a culture that normalises violence against women—from the womb to the tomb,” she says. “Our daughters are not unsafe because tigers are eating them. They’re unsafe because we don’t value them. Until there’s respect for the Constitution and equality within families, these laws will remain words on paper.”
