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India's 30-year-old ban on prenatal sex determination has spectacularly failed to prevent female feticide whilst potentially creating new harms - forcing unwanted girls to be born into families that resent them. Despite stringent legal provisions including imprisonment and medical licence revocation, the child sex ratio continued its cheerful decline from 945 girls per 1,000 boys in 1991 to 919 in 2011, even as only 617 convictions occurred nationally across 25 years. That's right - 617. In a country of 1.4 billion people. Over 25 years. You've got better odds of getting struck by lightning whilst simultaneously winning the lottery.
This raises a profound ethical dilemma that everyone's too squeamish to discuss properly: does preventing sex-selective abortion through legal bans cause more suffering by condemning unwanted children to lives marked by parental rejection, psychological harm, and systematic neglect - or does allowing such selection constitute an unacceptable form of gender discrimination that society must prohibit regardless of individual outcomes?
This question sits at the uncomfortable intersection of reproductive rights, child welfare, feminist theory, and population ethics. The Pre-Conception and Pre-Natal Diagnostic Techniques Act represents one approach to addressing son preference and female feticide, but mounting evidence suggests legal prohibition alone neither eliminates the practice nor addresses its root causes. Meanwhile, 35 years of longitudinal psychological research documents severe, lifelong harm to children born unwanted - precisely the outcome the ban may inadvertently force.
But sure, let's keep pretending the law's working because it makes us feel progressive.
India's PC-PNDT Act emerged from genuine crisis. When ultrasound technology spread across India in the 1980s and early 1990s, it coincided with deeply entrenched son preference to create what activists called "female feticide" on a massive scale. Advertisements explicitly marketed prenatal sex determination as cost-saving: "Spend Rs. 500 now on an ultrasound, save Rs. 50,000 later on dowry." Nothing says "civilised society" quite like advertising daughter elimination with a return-on-investment calculator.
The child sex ratio plummeted, with states like Haryana recording just 834 girls per 1,000 boys by 2011. For context, the biologically normal ratio is approximately 952 girls per 1,000 boys. Haryana wasn't just skewing the numbers - they were performing statistical genocide.
The original Pre-Natal Diagnostic Techniques Act passed in 1994, strengthened in 2003 to become the PC-PNDT Act. The law is comprehensive and looks brilliant on paper - the kind of legislation you'd frame and hang on your wall if you were into that sort of thing. It bans prenatal sex determination completely, prohibits sex-selective abortion, criminalises advertising of such services, and requires mandatory registration of all ultrasound facilities. Violations carry imprisonment up to five years and fines up to Rs. 1 lakh, plus permanent removal from medical registers. The law established three-tier oversight through Central and State Supervisory Boards and district-level Appropriate Authorities with search, seizure, and prosecution powers.
On paper, it represents one of the world's most rigorous regulatory frameworks. In practice? Let's just say the paper it's written on has more enforcement power.
Yet implementation tells a rather different story - the kind of story where everyone knows the punchline before you even start. In 25 years from 1994 to 2019, only 617 total convictions occurred across all of India. Six. Hundred. Seventeen. Eighteen of 36 states and union territories have neither registered any cases nor achieved any convictions. They've literally got a zero on the board. Not even one conviction for appearances' sake.
In Maharashtra, the most active state with 625 cases filed, acquittal rates reached 72% with only 20% conviction rates. So even when they actually try, they fail three-quarters of the time. The Supreme Court repeatedly admonished governments for "sorry and alarming state of affairs" and "total slackness by the Administration." When your own Supreme Court is reduced to using phrases like "total slackness," you know you've achieved a special level of governmental incompetence.
The law exists. Enforcement? That's more of a philosophical concept.
The most damning evidence against the ban's effectiveness comes from demographic data, and unlike policy documents, numbers don't lie to make themselves look good.
The child sex ratio stood at 945 in 1991, three years before the Act. By 2001, after seven years of the law supposedly being in effect, it had fallen to 927. By 2011, with both the original Act and strengthened amendment in place, it reached 919 - continuing its decline despite legal prohibition. The law was in effect. The ratio got worse. This is the equivalent of banning smoking and then watching cigarette sales increase.
Only recent data from the National Family Health Survey (2019-21) shows marginal improvement to 929, still well below the biologically normal ratio. After 30 years of supposedly tough legislation, we've managed to crawl back to roughly where we started. Stunning achievement, really.
Estimates suggest 500,000 girls are lost annually to sex-selective abortion in India, totalling more than 10 million since the 1990s. The Pew Research Centre calculated at least 9 million female foeticides occurred between 2000-2019. UNFPA estimates 46 million females are "missing" due to son preference practices. These numbers dwarf the 617 convictions achieved over a quarter century. At this rate, India's legal system will have achieved comprehensive justice sometime around the heat death of the universe.
States show dramatic variation, which is code for "some states pretend to care, others don't even bother with the pretence." Haryana and Punjab initially had ratios as low as 798 and 798 in the early 2000s, improving to 893 and 904 by 2019-21 - but only after intensive enforcement campaigns triggered by national embarrassment. Nothing motivates quite like international humiliation. Yet in 2024, Haryana's ratio dropped back to 910, attributed by officials to "relaxed enforcement." Translation: they stopped pretending to care once people stopped watching.
The practice hasn't been eliminated; it's been driven underground or shifted geographically. It's almost as if banning something without addressing why people want it just makes them sneakier about it. Shocking insight, that.
The conviction rate data reveals the enforcement challenge, if by "challenge" we mean "complete absence of political will masquerading as complexity." Maharashtra, the most aggressive prosecutor, achieved only 127 convictions from 625 cases - a success rate of 20%. That's not a justice system, that's a coin flip with worse odds. Other states perform far worse. Gujarat, Rajasthan, and Punjab have not filed a single appeal against acquittals. Not one. They've collectively decided that one loss in court is quite enough, thank you very much, let's not embarrass ourselves further.
The Delhi High Court noted "very low conviction rates" as fundamental failures of the justice system. Proving intent in sex-selective abortion cases remains nearly impossible when doctors and families collude, technology allows early sex determination, and portable ultrasound machines operate outside registered facilities. Meanwhile, rich families simply book a "medical tourism package" to Bangkok or Singapore, get their scan done at a five-star hospital, and come back with holiday photos and a convenient decision about whether to continue the pregnancy. Rules are for poor people who can't afford international flights.
Whilst enforcement data shows the ban's limited effectiveness at preventing sex-selective abortion, psychological research reveals what happens to children born unwanted. And spoiler alert: it's not good. The most comprehensive evidence comes from the Prague Study, a 35-year longitudinal investigation following 220 children born to women twice denied abortion for the same pregnancy - comparing them to 220 matched controls whose mothers wanted them.
The findings are striking and consistent across developmental stages, and they don't make for comfortable reading. By age nine, unwanted children were more frequently rejected by schoolmates, described by mothers as "naughty, stubborn, and bad-tempered," and showed behavioural problems - yet they didn't perceive their family situations as deviant. That last bit is particularly grim: the kids didn't even realise they were being treated differently. They thought this was normal.
By adolescence, school performance differences became statistically significant. Unwanted children were "substantially under-represented amongst students with average or above-average grades" and "practically never appeared on the roster of outstanding students in any subject." Critically, they scored equally well on intelligence tests, ruling out cognitive deficits. The problem was differential treatment, not ability. Same brains, different outcomes. Almost as if parental rejection has consequences.
In early adulthood (ages 21-23), the unwanted group required psychiatric treatment more frequently, appeared on rosters of drug addicts and criminal offenders, reported less job satisfaction, had fewer friendships, and experienced more romantic disappointments. By age 30, unwanted females showed more emotional disturbance than control females and were more likely to report their own pregnancies as unwanted - demonstrating intergenerational transmission. The trauma gets passed down like a particularly shit family heirloom.
At age 35, all differences "consistently disfavoured unwanted pregnancy participants," with only children (those without siblings to share the rejection) most severely affected.
Principal investigator Henry P. David concluded: "Denial of abortion for unwanted pregnancy entails an increased risk for negative psychosocial development and mental well-being in adulthood." Nancy Felipe Russo of Arizona State University noted the study's profound significance: "Even under the best conditions, you find long-term psychological consequences for these children" - and these children were raised in intact families under good socioeconomic conditions in Czechoslovakia, not facing active gender-based discrimination.
Let that sink in. These were wanted pregnancies in stable families in a developed country, and the psychological damage persisted into mid-adulthood. Now imagine the same scenario in India, except the child is female, unwanted specifically for being female, in a family that actively resents her existence, in a culture that systematically devalues daughters. The outcomes aren't going to improve.
The modern Turnaway Study from the United States (2008-2016) examined 956 women, comparing those denied abortion with those who received one. Children born after abortion denial showed higher rates of poor maternal bonding, more likely to live in poverty, and lower child development scores. Existing children of women denied abortion also had worse developmental outcomes - the negative effects rippled through entire families. Forcing people to have children they don't want doesn't just harm that one child; it harms everyone.
Cross-cultural research spanning 60 nations and 200,000 individuals through Interpersonal Acceptance-Rejection Theory confirms these patterns transcend geography and culture. Parental rejection consistently predicts hostility, aggression, impaired self-esteem, emotional instability, anxiety, and negative worldview. A 2021 longitudinal study following 1,315 children ages 7-14 across nine countries found parental rejection predicted both internalising behaviours (anxiety, depression, withdrawal) and externalising behaviours (aggression, bullying, disobedience). The effects held regardless of culture, race, gender, or socioeconomic status.
Turns out, being unwanted fucks you up. Who knew? (Everyone. Everyone knew.)
In contexts of strong son preference, the psychological harm takes specific gendered forms that make the Prague Study look like a best-case scenario. Research from India shows gender disappointment is "strongly influenced by husbands' desire for a son" and lack of emotional and/or practical support. Studies document that unwanted girls in son-preferring societies receive less breastfeeding time, fewer vaccinations, less childcare, are less likely to be hospitalised, and suffer excess mortality. Girls with brothers show lower internal locus of control than girls with sisters - they believe success depends on external forces rather than their own efforts, reflecting the differential treatment they experience.
They literally internalise the belief that they have no control over their lives because, well, they've been shown they don't. That's not psychology; that's pattern recognition.
The psychological impact extends to mothers forced to bear daughters they fear will be rejected. Indian research shows women whose first child is female face "higher risk of severe physical domestic violence" starting soon after the birth. Women with first-born sons are "significantly better-nourished and have a larger role in household decision-making" than those with first-born daughters. The unwanted girl child and her mother both become targets of family disappointment and potential abuse.
So the ban "protects" women by forcing them to give birth to daughters, which then subjects both mother and daughter to increased violence and discrimination. Brilliant strategy. Really thought that one through.
Maternal-foetal attachment studies show that avoidant maternal attachment styles predict early childhood developmental delays. When mothers experience gender disappointment, particularly under pressure from husbands and in-laws, the attachment process is compromised. Research explicitly identifies that mothers experiencing son preference show differential emotional responses, vocalisation patterns, and investment in daughters versus sons - differences observable from infancy that accumulate over developmental time.
The rejection starts in the womb and compounds daily for years. This isn't a policy outcome; it's systematic psychological torture with a birth certificate.
This evidence base supports a consequentialist argument that makes everyone uncomfortable: forcing parents to bear children they fundamentally don't want - for whatever reason - may create more aggregate suffering than preventing those births. The Prague Study researcher noted that even children who don't consciously recognise their unwanted status experience measurable harms. They internalise rejection, develop maladaptive patterns, and carry psychological burdens into adulthood and the next generation.
In India's context, the PC-PNDT Act potentially creates a perfect storm of suffering. A woman discovers she's carrying a female foetus. If she lives in a son-preferring household - particularly if childless or with only daughters - she faces intense pressure from her husband, mother-in-law, and extended family. The law prohibits sex determination, but illegal underground providers offer the service for those who can afford it or have connections.
And here's where it gets properly dark: rich families simply book a "holiday" to Thailand, Singapore, or Dubai. Get a nice resort, maybe some shopping, and oh, whilst we're here, let's pop into this lovely private hospital for a comprehensive foetal health check. Complete with 4D imaging and, conveniently, sex determination. They come back with holiday photos and a decision about whether to "tragically miscarry" in a few weeks. Medical tourism: because laws are suggestions when you have money.
For those who cannot access clandestine services or international flights, the law forces the pregnancy to continue.
The daughter born into this context grows up experiencing subtle and not-so-subtle rejection. She receives less food, less attention, less educational investment than hypothetical male siblings. Her mother, blamed for producing a daughter, may herself withdraw or become harsh. The family's disappointment is palpable even if unspoken. The child develops the constellation of problems documented in the Prague Study - poor self-esteem, difficulty in relationships, underperformance relative to ability, eventual psychiatric issues. She may grow up to perpetuate these patterns with her own daughters, creating intergenerational transmission of trauma and rejection.
The trauma doesn't stop at childhood. The unwanted daughter grows up, marries, has children of her own. And what does she bring to that marriage? Years of accumulated rejection, internalised worthlessness, patterns of emotional volatility learned from parents who resented her existence. Her husband bears the brunt. Her children inherit the patterns. The in-laws who forced her birth aren't the ones paying the price anymore - it's her spouse, her kids, the next generation.
When the second daughter was born, the mother cried for weeks. Not postpartum depression - disappointment. The baby was the wrong sex. And that baby grew up knowing, on some level, that her existence was a source of grief. How do you develop healthy self-esteem when your mother's first response to your birth was weeks of crying? You don't. You develop problems that you'll carry for decades and likely transmit to your own children.
This cycle repeats across millions of families. The ban prevents sex-selective abortion but does nothing to prevent the maltreatment of unwanted daughters once born. Studies consistently show that families who would have selected against female foetuses demonstrate postnatal discrimination against daughters - the preference doesn't disappear, it just manifests differently. Research from China, Taiwan, and India all document that when prenatal selection is blocked, postnatal discrimination increases through neglect, reduced healthcare access, nutritional deprivation, and in extreme cases, infanticide.
The preference doesn't vanish because you banned the technology. It just finds new expressions, and those expressions often involve a living child suffering them.
The partiality doesn't end at childhood. Decades later, when assets are distributed, guess who gets the house, the gold, the property? The wanted child. The unwanted daughter, who spent her childhood getting less food, less attention, less love, also gets cheated out of her inheritance. The discrimination that started in utero continues until the parents die, and sometimes beyond. The elder sister went abroad for education; the younger one, despite getting into a better university, was told to fend for herself. Thirty years of partiality, and people wonder why these women grow up damaged.
The unwanted daughter doesn't just carry her trauma alone. She marries, and her spouse becomes the new target for all that unprocessed rejection. She parents, and her child grows up in the shadow of grandmother's partiality and mother's unhealed wounds. The grandparents who forced her birth aren't the ones managing her emotional volatility, her trust issues, her anger - that's her husband's problem now. They're not watching their grandchild navigate a mother who's still processing being unwanted - that's the next generation's inheritance.
And here's where it gets properly obscene: the daughters who were wanted, who benefited from their position, who got the education and resources and love - they emigrate to countries where sex determination is readily available, and they do the exact same thing to their own daughters. The elder sister who was sent abroad for education whilst her unwanted younger sister was told to fend for herself? She's in the US now, checking foetal sex and aborting daughters. The system that benefited her was apparently fine; she just wanted to be on the winning side of it. Rules for thee but not for me, except it's your own gender you're eliminating.
The ethical question becomes: Is forcing these births - knowing the likely outcomes - truly more moral than preventing them? The ban treats female foeticide as an absolute evil requiring prohibition regardless of consequences. But consequentialist reasoning suggests we must also consider the lived experiences of unwanted girls who are born: their malnutrition, their higher mortality from treatable conditions, their psychological suffering, their disadvantaged life trajectories, and the trauma they may transmit to another generation.
Bioethicist Aksel Braanen Sterri argues on precisely these grounds that India should repeal the ban. The alternatives to sex selection - continuing pregnancies under duress, seeking dangerous black market procedures, bearing children who face abuse - are more harmful than allowing informed choice. Women risk divorce, violence, even death if they cannot deliver sons. The ban, he contends, makes the situation worse for mothers and daughters.
But of course, we can't have that conversation because it's too uncomfortable. Better to maintain the legal fiction whilst everyone suffers in reality.
If you know families like this - and statistically, you do - you know exactly what I'm talking about. You've watched the unwanted daughter struggle her whole life. You've seen the parents show preferential treatment decades later. You've watched her marriage strain under the weight of unprocessed trauma. And you've probably thought, at some point, "would it really have been worse if this birth had never happened?" You're not supposed to think that. But you've thought it.
Understanding why the ban fails requires examining why son preference exists so intensely. The psychological harm to unwanted children is the proximate consequence, but the ultimate causes lie in economic and social structures that the PC-PNDT Act doesn't touch. Banning the symptom whilst ignoring the disease is classic Indian policymaking.
Old-age security dominates the calculus. India lacks universal pension or healthcare systems, making elderly parents dependent on children for financial and physical care. Sons are expected to provide this support; daughters marry into other families and traditionally cannot support natal parents (doing so would be considered taboo in many communities). A Hiroshima University study found that even introducing pension systems may not eliminate son preference because family-based care is considered honourable whilst professional care is seen as abandoning one's duty. The National Bureau of Economic Research identifies old-age security as a fundamental driver and recommends public pensions as key policy intervention - but this addresses structural economics, not prenatal testing.
So we've created a system where having daughters is financial suicide, then act shocked when people try to avoid financial suicide. Brilliant.
The dowry system creates direct disincentives for daughters. Despite the 1961 Dowry Prohibition Act - another beautifully written, comprehensively ignored piece of legislation - dowry not only persists but has expanded, remaining near-universal at 94% of marriages. Average dowries historically equalled 3-8 times annual male income or two-thirds of household assets. The financial burden is enormous, and dowry-related violence remains common. Families with limited resources rationally calculate that sons bring resources whilst daughters drain them.
We've made having daughters economically irrational and then criminalised the rational response. This is policy as performance art.
Patrilocal marriage practices mean daughters leave their families, so investments in their education and health benefit the in-laws' family, not the natal family. After marriage, women lose autonomy and decision-making power - studies show 73% of unmarried women participate in household purchase decisions versus only 37% of recently married women living with in-laws. This system creates the perception captured in the common saying: "Having a daughter is like watering the neighbour's garden."
If you're going to water the neighbour's garden, you'd at least like the option of not planting the seeds in the first place.
Religious and cultural factors compound these economics. Hindu traditions emphasise that only sons can perform essential funeral rites, particularly lighting the cremation pyre, which is believed necessary for parents' salvation (moksha). Though modern progressive families accept daughters can perform these rites, traditional belief persists that sons are religiously essential. Sons carry forward the family lineage in patrilineal systems and fulfil religious duties beyond funerals.
So we've got economic dependence, financial penalties, lost investment returns, and eternal damnation all riding on producing a son. And then we act surprised when people really, really want sons.
These factors create a reinforcing system: economic dependence on sons for old-age security, financial costs of daughters through dowry, loss of investment when daughters marry away, religious significance of male children, and social status considerations. The PC-PNDT Act bans the technology that allows sex-selective abortion but does nothing to alter the underlying economic calculus that makes sons valuable and daughters costly.
It's the legislative equivalent of treating a brain tumour with paracetamol.
India has tried numerous interventions beyond legal bans, with varying degrees of success and spectacular failures. Conditional cash transfer programmes like Beti Bachao Beti Padhao (Save the Daughter, Educate the Daughter), launched nationally in 2015, provided financial incentives for families with daughters. The programme showed modest improvements in sex ratios - from 918 in 2015 to 930 in 2024 - and increased girls' school enrolment.
Yet a parliamentary committee found 80% of funds went to media campaigns rather than actual benefits. So they spent most of the money telling people daughters are valuable instead of actually making daughters valuable. It's the bureaucratic equivalent of Instagram activism: lots of visibility, minimal actual impact.
State-level schemes like Delhi Ladli and Madhya Pradesh Ladli Lakshmi provided cash payments tied to daughters' birth registration, immunisation, and education. Delhi saw dramatic improvements in birth registration sex ratios. Yet UNFPA's comprehensive 2010 review found these programmes showed "very little is known about their effectiveness" at changing underlying preferences. Most schemes targeted poor families, but son preference is strongest amongst wealthy and middle-class families who can afford sex-selective abortion - or a nice holiday to Bangkok with a medical detour.
The programmes provided compensation for having daughters but didn't change the patrilocal system that makes daughters "belong" to other families. It's like paying someone to dig holes they have to immediately fill in again. Sure, they're being paid, but the fundamental pointlessness remains.
More promising are structural economic interventions. Pension programmes show correlation with reduced son preference - a Chinese study found rural pension access associated with 9% lower sex ratio imbalance increases. India's old-age pension scheme showed benefits only when recipients were women, with 85% spending on their own needs and reporting increased financial autonomy. But current benefit levels (Rs. 200-500 per month) are insufficient to replace sons as old-age security, and only 8% of eligible elderly receive benefits.
So we've created a programme that works when implemented but then don't implement it properly. Classic.
Education-based norm change shows real promise. A rigorous randomised controlled trial of the "Taaron ki Toli" programme in Haryana found that interactive classroom discussions on gender equality produced 0.18 standard deviation increases in gender equality attitudes, with effects persisting two years later. The programme has scaled to 23,000 schools in Odisha and is being introduced in Punjab. Including boys proved critical since they have more freedom to enact behavioural changes.
Turns out, teaching children that girls are people too actually works. Revolutionary concept.
Mass media campaigns demonstrate measurable effects. Studies using quasi-experimental designs show television exposure in India reduces son preference and domestic violence acceptance. Mothers with TV access showed more equal treatment of daughters. Entertainment-education formats proved most effective - non-condescending popular media that shows gender-equal families.
But the most successful comprehensive approach comes from South Korea, and it's a masterclass in how to actually solve problems. Its sex ratio at birth peaked at 116.5 in 1990 (third births reached 120+) but normalised to 105 by 2007. Son preference amongst women dropped from 48% in 1985 to 10% by 2006.
What worked was not primarily the 1987 legal ban but a comprehensive transformation combining rapid economic development, legal reforms for gender equity (including ending the male-only family succession system in 2005), social insurance expansion (pensions and healthcare reducing son dependence), sustained mass media campaigns, and increased female education and labour force participation. The ban was part of this package, but research shows the normative change from comprehensive social transformation drove improvement, not legal prohibition alone.
South Korea fixed the economics, the social structures, and the legal framework simultaneously. India passed a law and called it a day.
Different ethical systems reach incompatible conclusions about sex-selective abortion bans, revealing why this dilemma defies easy resolution and why academic conferences on this topic must be absolutely riveting.
Consequentialist approaches focus on outcomes. Critics of the ban argue it forces women to unsafe illegal abortion, leads to multiple pregnancies harming maternal health, and condemns unwanted girls to maltreatment and psychological suffering. These harms, they contend, outweigh benefits. Defenders counter that demographic consequences are severe - 126 million missing women globally as of 2010, projected to reach 150 million by 2035. Sex ratio imbalances correlate with increased crime (34% of China's crime rate increase from 1988-2004 linked to imbalance), trafficking, violence against women, and social instability.
Yet consequentialist calculations face Derek Parfit's "different number choices" problem - abortion policy affects which people exist, making comparisons philosophically fraught. When your ethical framework breaks down at "but different people would exist," you know you've hit peak philosophy.
Deontological approaches examine rights and duties, which is code for "everyone has rights that directly contradict everyone else's rights, now fight." Reproductive autonomy arguments emphasise women's fundamental right to control their bodies without state interference in intimate decisions. Prohibiting abortion based on reasons requires women to justify private choices, violating privacy and autonomy. Multiple scholars note this maintains patriarchal control over women's reproductive capacity.
Yet Kantian non-instrumentalisation principles suggest using abortion to select sex treats foetuses as means to parental preferences rather than ends in themselves, violating dignity. Justice requires equal treatment - sex-selective abortion discriminates based on sex, violating equality principles. These rights conflict with no clear hierarchy for resolution.
So we've got the right to bodily autonomy versus the right to non-discrimination versus foetal dignity rights, and they're all equally valid and completely incompatible. Philosophy at its finest.
Feminist ethics reveals profound divisions, because apparently having shared oppression doesn't mean agreeing on solutions. Indian and Asian feminists like Farhat Moazam and Wendy Rogers argue that Western autonomy concepts don't account for women's lives in patriarchal societies where "choice" is illusory under intense family and cultural pressure. Women don't freely choose but respond to systemic oppression. They advocate for legislative prohibitions to protect women from violence and discrimination, combined with cultural change efforts.
Western liberal feminists emphasise that any restriction on abortion reasons opens doors to further limitations and violates autonomous decision-making. Reproductive justice frameworks from Black and intersectional feminists argue bans are ineffective and counterproductive - son preference is a symptom of deeply rooted social biases, and solutions require changing values that devalue girls, not restricting abortion. Bans place burdens on vulnerable women rather than addressing systemic discrimination.
Even feminists can't agree on this one, which tells you how comprehensively fucked the situation is.
Care ethics approaches contextualise decisions in webs of relationships and responsibilities. Jonathan Herring's relational care framework suggests pregnancies should be marked by reciprocity and mutuality, and unwanted pregnancies lacking caring relationships may justify termination to preserve capacity for other caring responsibilities. This framework considers women's existing children, partners, and community obligations. Yet it also suggests caring relationships require valuing children regardless of sex, and sex-selective abortion reflects failures of care and relationality.
The bioethics principles framework of autonomy, beneficence, non-maleficence, and justice creates further tensions. Autonomy protections support reproductive freedom. Beneficence toward women allows choices promoting well-being. Non-maleficence requires preventing harms of unsafe abortion and forced pregnancy. Yet justice demands equal treatment regardless of sex, beneficence extends to preventing discrimination, and non-maleficence includes preventing demographic and social harms from skewed ratios. These principles pull in opposite directions with no meta-principle for resolution.
When your ethical framework simultaneously demands and prohibits the same action, you've achieved philosophical stalemate.
The Prague Study's lead researcher never explicitly stated that non-existence would be better than life as an unwanted child - philosophers widely consider such comparisons impossible since the alternative is non-existence, not a different life. Yet the documented severity and persistence of harm (psychiatric hospitalisation, criminal involvement, relationship failures, intergenerational transmission continuing to age 35+) raises profound questions about whether forcing these pregnancies truly serves children's interests or society's wellbeing.
But we can't discuss that because it's uncomfortable, so we'll just pretend the question doesn't exist.
Despite limited enforcement success and the psychological harms to unwanted children, formidable arguments support maintaining and strengthening the ban. Because sometimes the right answer is the one that feels wrong.
The societal messaging argument carries moral weight. Nicholas Eberstadt articulates this powerfully: "The very fact that many thousands - or in some cases, millions - of prospective girls and young women have been deliberately eliminated simply because they would have been female establishes a new social reality that inescapably colours the whole realm of human relationships, redefining the role of women as the disfavoured sex in nakedly utilitarian terms."
Allowing sex-selective abortion sends a message that female lives are less valuable, that women's existence is contingent on family preferences, and that discrimination based on sex is acceptable when applied prenatally even if prohibited post-birth. The WHO states unequivocally that sex selection "reinforces discriminatory and sexist stereotypes towards women by devaluing females."
When you allow people to eliminate females for being female, you're not making a neutral policy choice. You're making a statement about what females are worth. And that statement is "less than males."
Public opinion consistently opposes sex-selective abortion - 77% of Americans and 84% of UK adults support bans, with 80% believing doctors who authorise such abortions should be prosecuted. This reflects widespread intuition that sex selection crosses a moral line even amongst those who support abortion rights generally. People who are perfectly comfortable with abortion for socioeconomic reasons draw a hard line at sex selection.
The "missing women" crisis represents a humanitarian catastrophe that makes the enforcement failures look trivial by comparison. Current estimates suggest 126 million women are missing globally, with 23 million specifically due to sex-selective abortion. China faces 33 million more men than women; India has similarly severe imbalances.
These imbalances produce cascading social harms: increased violence and crime, human trafficking (women trafficked from Southeast Asia into China), kidnapping and bride-buying, and social instability. Rather than improving women's status through scarcity, research shows demographic imbalances lead to "masculinisation" that prevents female empowerment. Hillary Clinton warned that large populations of young men unable to find wives breed "potential social instability."
When you've got 33 million surplus men with no marriage prospects, you don't get feminist enlightenment. You get Mad Max.
The bioethics consensus articulated by Rogers, Ballantyne, and Draper argues sex-selective abortion "cannot be morally justified" because decisions cannot be regarded as truly autonomous in patriarchal contexts with intense son preference, and because serious harms to women and society outweigh individual choice claims. They emphasise perpetuation of discrimination, disruption of social networks, and increased violence.
The slippery slope toward designer babies concerns multiple ethicists. Harvard philosopher Michael Sandel warns sex selection is the "first step down the road to designer children" where parents choose height, eye colour, and ultimately IQ, athletic prowess, and musical ability. This transforms the question from "whether to have a child" to "what kind of child to have," creating commodification. The American Medical Association warns this threatens "the core value of parenthood" that is usually expressed by the commitment to unconditional love.
If sex selection is permissible, consistent reasoning would allow selection for any testable trait. Today it's eliminating daughters; tomorrow it's eliminating anyone who doesn't meet parental specifications. That's not a future anyone sane wants.
The argument that bans protect vulnerable women from coercion holds particular force in son-preference cultures. Dr. Sunita Puri's six-year study found women in the United States aborting daughters "because of pressure from family members." Studies identify reproductive coercion as a form of intimate partner violence, and research shows close to 70% of women who had abortions described them as coerced, pressured, or inconsistent with their values.
In communities with strong son preference, women face intense family pressure, potential abuse, and even death threats if they cannot produce sons. Bans provide legal backing for women to resist this pressure, addressing the root problem of "cultural and familial pressure to give birth to sons."
Of course, the ban also forces them to give birth to daughters who will then face that same cultural pressure, but at least it's technically illegal now.
Most importantly, evidence suggests comprehensive approaches combining bans with other measures can work. South Korea's dramatic success - sex ratio normalisation and son preference dropping from 48% to 10% of women over two decades - resulted from bans plus enforcement plus gender equity legal reforms plus social insurance expansion plus media campaigns plus economic transformation. The ban was part of a package that stigmatised the practice whilst addressing root causes. Research concludes the "normative change from comprehensive social transformation drove improvement," not bans alone, but bans contributed to the stigmatisation and provided legal framework for the broader cultural shift.
India's own evidence shows Maharashtra's 1988 ban had "small but significant effect" - raising child sex ratio by 1.4-2.6%. Researchers concluded: "The significant impact of the PNDT Act in improving the child sex ratio suggests that, with better enforcement, a ban on sex-selective abortions can not only halt - but even reverse - the declining trend." The problem is not that bans are inherently ineffective but that political will for enforcement has been lacking.
Bans work when you actually enforce them and combine them with structural change. Unfortunately, India has chosen to do neither whilst declaring victory.
The comprehensive evidence reveals no clean resolution, which is deeply unsatisfying for everyone involved. India's PC-PNDT Act has achieved limited success by any measure - 617 convictions in 25 years, continued decline in sex ratios until recently, widespread circumvention through illegal providers or medical tourism, and minimal deterrent effect given low prosecution rates. The ban has not prevented the practice it was designed to stop. Full stop.
Simultaneously, 35 years of psychological research documents severe, persistent harm to children born unwanted. The Prague Study's findings - psychiatric hospitalisation, criminal involvement, substance abuse, relationship failures, lowered achievement despite equal intelligence, intergenerational transmission of unwanted pregnancy patterns - paint a bleak picture extending into mid-adulthood. Modern studies from the United States confirm that children born after women are denied abortion show worse developmental outcomes, lower maternal bonding, and higher poverty rates. Cross-cultural research spanning 60 nations demonstrates parental rejection causes measurable psychological harm regardless of geography or culture.
Being unwanted fucks you up. This is not controversial. This is documented fact.
In India's context, these harms compound with gender-based discrimination. Unwanted daughters face not just parental rejection but systematic devaluation, receiving less nutrition, healthcare, educational investment, and emotional support. Studies show women with first-born daughters face higher domestic violence rates and worse health outcomes than women with first-born sons. The unwanted girl and her mother both become targets of family disappointment and potential abuse.
The consequentialist argument against the ban gains force from this evidence: if the ban cannot effectively prevent sex-selective abortion whilst forcing unwanted children to be born into environments of rejection and potential harm, the net suffering may exceed what would occur from allowing informed choice. The alternatives - continuing pregnancies under duress, seeking dangerous black-market procedures, bearing children who face abuse - may cause more aggregate harm than prevention.
Meanwhile, rich families continue their medical tourism unabated, because rules are for people who can't afford Bangkok holidays.
Yet the counterarguments carry profound moral weight. Allowing sex-selective abortion sends an unambiguous message that female lives are less valuable, that discrimination based on sex is acceptable prenatally even if prohibited post-birth, and that society tolerates the elimination of females simply for being female. The 126 million missing women globally and the cascading social harms from skewed sex ratios represent humanitarian catastrophe. The slippery slope toward designer babies and commodification of children threatens fundamental values about unconditional parental love and human dignity. Public opinion in democratic societies consistently opposes sex-selective abortion as crossing a moral line.
Most critically, South Korea demonstrates that comprehensive approaches combining legal bans with enforcement, gender equity reforms, social insurance expansion, and sustained cultural campaigns can work. The problem may not be bans per se but India's failure to implement comprehensive transformation. The ban provides legal and moral framework, but it must be part of a package addressing old-age security (universal pensions), the dowry system (rigorous enforcement of existing prohibition), patrilocal marriage norms (cultural campaigns), inheritance inequality (implementing equal rights), and fundamental patriarchal structures (girls' education, female workforce participation, political representation).
But that would require actually doing things instead of just passing laws and declaring victory, so it's unlikely to happen.
The tension reveals limits of law as social engineering tool. Legal prohibition can stigmatise practices and provide framework for enforcement, but it cannot by itself eliminate demand rooted in economic rationality, religious belief, and centuries of cultural practice. The PC-PNDT Act's failure stems not from wrong intent but insufficient recognition that technology bans address symptoms whilst leaving causes intact. A woman denied sex determination still lives in a system where sons provide old-age security and daughters require massive dowry payments. The law changes her options but not her incentives.
It's the legislative equivalent of unplugging the warning light and declaring the problem solved.
The psychological harm to unwanted children represents a genuine cost of prohibition that must be acknowledged. Forcing births whilst doing nothing to address the social structures that make daughters unwanted creates suffering that is preventable, measurable, and morally troubling. Yet allowing sex-selective abortion also creates suffering - to the females eliminated, to remaining women who face intensified discrimination in male-surplus societies, and to social fabric strained by demographic imbalance.
There may be no ethically clean position. Each choice - prohibit or allow - creates distinct harms. Prohibition forces unwanted births with documented psychological consequences whilst failing to prevent underground practice. Permission enables discrimination, creates demographic catastrophe, and sends messages about female worth that corrode gender equality. The question becomes not which approach is morally pure but which creates less total suffering and moves society toward greater gender equity.
And the answer to that question depends entirely on which suffering you're willing to acknowledge and which you're willing to ignore.
The evidence tentatively suggests comprehensive transformation as the only viable path forward. This means maintaining legal prohibition as moral statement and framework, but the real work lies in structural change: universal pensions eliminating son-dependency for old-age security, ruthless enforcement of dowry prohibition with social stigma for families demanding it, inheritance equality with active implementation, cultural campaigns promoting daughters' value through entertainment-education media, female education and workforce participation as economic imperatives, and political representation quotas creating role models.
South Korea achieved this transformation in two decades. India, with larger population and deeper regional variation, faces longer timeline but has the South Korean precedent as proof comprehensive approaches can work.
The psychological harm to unwanted children cannot be dismissed as collateral damage. But neither can the devaluation and elimination of females be accepted as inevitable consequence of cultural preference. The path forward requires acknowledging both harms whilst committing to structural transformation that makes the choice itself obsolete - creating societies where daughters are valued equally to sons not because law demands it or cash transfers incentivise it, but because economic systems, social structures, and cultural norms no longer make son preference rational.
Until that transformation occurs, India faces the uncomfortable reality of choosing between imperfect options, each carrying moral costs that cannot be avoided, only minimised through comprehensive action addressing root causes rather than symptoms alone.
Or we could continue pretending the law's working whilst everyone suffers and rich people fly to Singapore for ultrasounds. That's always an option.