India needs daughters. Families want sons. What’s a ‘balanced’ approach?

When Satyajit Jadeja’s wife went into labor last December, the couple knew they were going to have twins, though their gender was still a mystery. The family was happy when Mr. Jadeja’s wife delivered two healthy baby girls, but one girl and one boy would have been ideal, he says. 

“It’s not that we are biased,” Mr. Jadeja quickly clarifies. “But when you think of the future, it is essential [to have a boy], because the girl goes [to another family] after marriage.” Sons, he says, act as a support system for aging parents.

A pervasive preference for sons has led India to have one of the most skewed sex ratios in the world, with approximately 108 men for every 100 women. The United Nations Population Fund estimates that India misses out on nearly 400,000 female births a year due to sex selection. The Indian government tried to end sex-selective abortions in 1994 by making it illegal to reveal the sex of a fetus, but the practice persists, and now the country’s booming and largely unregulated market of in vitro fertilization clinics is offering a new avenue for guaranteeing a son. 

Lawmakers have taken note, passing a bill in December to regulate assisted reproductive technology, including IVF. The act reiterates the 1994 ban on sex selection and prohibits IVF clinics from offering such services. Advocates for “family balancing” – a term some doctors use for selecting the sex of a baby through IVF – see this as an infringement on reproductive rights, while others see it as a step forward in the fight for gender equality. Either way, India’s poor track record on curbing sex selection reveals a need to address the underlying values that drive preference for a son. 

“We should address our patriarchy, our discriminatory system and culture,” says activist Varsha Deshpande, who’s been working to stop sex selection for more than two decades. 

Modern technology, archaic beliefs

Abortion of female fetuses – typically after bribing a doctor to determine the sex via ultrasound – remains the most common method of sex selection in India, but using IVF to have a son is increasingly popular.

When a couple gets pregnant through IVF, a preimplantation genetic diagnosis (PGD) test is carried out to check the embryo for genetic disorders. But it also determines its sex. In many countries, including the United States, the test is routinely used for sex selection – parents can decide whether they want to have a male or female embryo implanted. In India, PGD for sex selection is illegal, but activists and authorities say it happens discreetly in IVF clinics across the country.

Arun Muthuvel, an IVF specialist in the southern Indian city of Chennai, says he gets at least 10 couples per month inquiring about PGD for sex selection – 90% of them want a son. “They literally beg: ‘We will not tell anybody, please do it,’” says Dr. Muthuvel.  

Some wealthy couples sidestep the laws altogether, getting their IVF treatment in countries like the United Arab Emirates and Thailand, where sex selection is legal. There are dozens of family balancing clinics – like one in Dubai aptly named Select My Baby – that advertise to Indian couples specifically. 

In Delhi, Satyajit Kumar heads a special government team to enforce the ban on sex selection. For the past few years, he’s asked local IVF centers to submit records of how many procedures they’ve done, along with patient details – if the couple are relatively young or their previous children are all girls, that’s a possible red flag. 

Dr. Kumar says the new act will help monitor IVF centers more actively, and his department has plans to set up a new division dedicated to assisted reproductive technology. “If you implement it in a very good manner, you will get a very good result,” Dr. Kumar says.

However, implementation is not easy in a country where abortion and IVF are both legal. 

Finding the root cause

“When it’s a collusion between the client and doctor, it’s very difficult to find out what is happening within the IVF lab or the sonography room,” says Ms. Deshpande, who describes sex selection as “medical terrorism.” 

Activists have to rely on sting operations, sending pregnant women with recording equipment as decoys to catch doctors or technicians red-handed. But it’s not enough. Indian officials themselves admit that India’s sex ratio has worsened since the 1994 law.

In addition to banning sex-selective abortions, the Indian government has launched numerous schemes over the past few decades promising cash incentives to families with girls. But experts say these too have largely failed to improve the sex ratio, undercutting a common myth that poverty is the major motivator for female feticide. The IVF trend – in which educated and relatively well-off families are opting for sons over daughters – also challenges this assumption. 

In reality, activists say, the son preference is a product of deeply patriarchal social norms and laws, which altogether can make even the most educated or equality-minded couples wish for a boy. 

Until recently, daughters didn’t have equal rights to inherit property. When a woman is raped, her entire family carries the stigma, while the male perpetrators often walk free. Studies show that, despite being outlawed, dowry payments are still common throughout India, and even when a woman gets married, elders pray she’ll be “blessed with eight sons.” Until these things change, Ms. Deshpande says no law will stop families from seeking out a son.

In the meantime, some are calling for compromise. 

The right to “balance”?

Dr. Muthuvel believes the conditional legalizing of sex selection would reduce unsafe abortions, and says a blanket ban on sex selection through IVF goes against the reproductive rights of parents who lack resources to travel to places like Dubai. “If people who have money can go [abroad] without any issue,” he says, “why can’t people in India do it?” 

That includes Sandeep, a father of two girls who asked to be identified only by his first name. He worries for his daughters’ safety and wishes they had a brother to protect them. Sandeep says he’d like to take his wife abroad for IVF treatment, but they don’t have the funds. 

“For the rest of my life I will [have] the small pain of not having a son,” he says.

Shortly after his twin girls were born, Mr. Jadeja started researching if there was any way to guarantee a boy next time. When he learned that using PGD for sex selection is illegal in India, the new father launched into a tweet storm. He’s sent dozens of messages to political leaders and the media demanding an amendment to allow sex selection in certain cases. “Couples with 2 or more children, all of same gender, should be permitted to have gender selection through IVF,” he argues in one post.

Though Mr. Jadeja realizes that most people would be using IVF to have boys, he says the risk of misuse isn’t an adequate reason to ban the practice altogether. “If the government says we can’t check misuse, that’s the government’s fault,” he says. 

Just like the country needs a balanced sex ratio, so does his family, he argues. 

But when asked if he’d still be looking to balance his family if he’d had twin sons instead of daughters, he pauses. “Honestly, [I] might not,” he says.