As India modernises its health services, the age-old practice of sex selection seems to be getting easier. Despite strict regulations, scans are readily available and more female foetuses are being aborted.
An alarming drop in the number of girls born in India is being blamed on a strong cultural preference for sons -coupled with cheap and widely available medical tests that can tell parents the sex of their unborn child.
Data from India's 2001 census shows the sex ratio for 0-6 year-olds fell from 945 females per 1,000 males in 1991 to 927 in 2001. The new figures give India one of the world's lowest ratios for women to men; the statistical norm is 1,050 females for every 1,000 males.
The drop is largely due to the widespread but illegal practice of using ultrasound scans to identify female foetuses and then aborting them.
In 1994, the Pre-Natal Diagnostic Technologies (PNDT) Act banned the practice. But it has proved toothless – seven years after enactment, not a single conviction has taken place.
Data from states such as Punjab, Haryana and Gujarat -the first to ban the use of sex determination tests – point to the PNDT failure. "It is precisely in these states that the ratio of baby girls has declined dramatically," says noted feminist Madhu Kishwar.
In 1991 two states had child sex ratios below 880; today there are five states and union territories in this category: Punjab (793), Haryana (820), Chandigarh (845) Delhi (865) and Gujarat (878). The Punjab-Haryana-Himachal Pradesh belt in the north is called by some 'India's Bermuda Triangle' -where girls vanish without a trace.
Even states with better socio-economic indicators, like Karnataka, have shown a dip in the child sex ratio – from 960 in 1991 to 949 in 2001.
A pronounced skew in sex ratios has long been a feature in India. Girls and women routinely suffer from poorer health and nutrition, infanticide and high rates of death from pregnancy and childbirth. And experts say that ultrasound technology simply compounds an age-old prejudice.
"India is catching up with other sexist, modern societies like South Korea and China in sex selective abortions," Nobel Prize-winning economist Amartya Sen has said. "It's a technological revolution of a reactionary kind."
The government is finally taking action, spurred by a Supreme Court directive in May mandating the government to crack down on unscrupulous medics who continue to determine foetal sex for their patients.
"The roots of the problem can be traced to deep-rooted patriarchy and anti-women attitudes in the country," says Dr Sabu George, an activist and researcher on foeticide who petitioned the court in 2000.
Since their introduction in the 1980s, ultrasound clinics have mushroomed all over the country. No village is too remote for enterprising doctors who ferry portable equipment in vans.
"Villages might not have clean drinking water but they have an ultra-sound machine," notes Dr C M Francis of the non-governmental organisation Community Health Cell.
Although the PNDT Act makes registration of ultrasound units mandatory, until the Supreme Court ruling few states complied. In Punjab, "not even one clinic of the approximately 3,000 with ultra-sound facilities has been registered," says Manmohan Sharma of the Voluntary Health Association of India, an NGO.
Clinics openly advertise their foetal sex determination techniques, charging on average about 500 rupees (just over $10). If the foetus is female, doctors or midwives are on hand to conduct an illegal abortion -for an additional fee.
Abortion is legal when a woman's life or health is at risk, or in cases of foetal impairment, rape and contraceptive failure.
Impoverished parents' reluctance to raise large amounts of money for a girl's dowry is often cited as the reason for son preference. Parvathi, a mother of two daughters in Bangalore, says: "Better to spend 5,000 rupees [$106] now, than raise 500,000 rupees later for the dowry," echoing clinic flyers that brazenly propagate sex determination technologies in Belgaum town.
She adds she will have the foetus scanned next time she gets pregnant to avoid having another daughter.
But son preference cannot be blamed on poverty alone, since the drop in the number of girls is sharpest in prosperous states like Maharashtra and Punjab. Some wealthy communities are enthusiastic clients of expensive new techniques which use genetic manipulation to select male foetuses.
"The rich are most keen to know the sex of the unborn child, for they want a male offspring to take care of the family business. They see no use for a daughter," says Dr Hema Divakar, a leading gynaecologist in Bangalore active in the campaign against sex-selective abortion.
Family and social pressure on women is so great that even some educated and working women prefer to have a male child. "That way, I can stop after one child," says 26-year-old Asha, who works in a bank. "If not, I will have to have more children. That will jeopardise my career," she worries.
Sex-selective abortions have their defenders. Dr Divya Kulkarni, a gynaecologist in Belgaum, argues that it is "more humane than the practice of female infanticide". She believes that parents have the right to know the sex of the foetus and make their choices. In doing so, she says, she helps women avoid going through many pregnancies.
The Court directive to halt illegal sex selection procedures takes into account emerging technologies. The Indian Medical Association (IMA), which regulates the medical profession, pledges to revoke licences of doctors who continue the practice.
India's religious leaders have condemned sex selective abortion as "shameful and inhuman". They have pledged to help their followers shun the practice. In April the Akal Takht, the highest religious authority among the Sikhs, issued an edict that any Sikh who indulged in sex selection and abortion would be ex-communicated.
But some are wary of the move. "It is the fear of the law and not some religious leader's sermonising that will eventually have an impact," says P R Vakil, a leading criminal lawyer based in Mumbai. "The laws are in place," he points out. "What we need to do now is to implement them."