How Haryana turned around sex ratio at birth, now close to national average

Behind Haryana’s best sex ratio in five years lies a decade-long campaign, involving law-enforcement measures, inter-state raids and roping in of medical officers to monitor ultrasound centres.

In the 2011 Census, the state ranked among the worst performers in terms of sex ratio at birth, at 834 girls per 1,000 boys. In 2025, this stood at 923, close to the national average of 933 (as per a reply in Parliament by the government in 2023), and a big jump from 910 in 2024. The 2024 numbers, which marked an eight-year dip, had set alarm bells ringing.

More than 65,000 girls have been “saved” on account of the push to improve sex ratio since 2015, officials say (an estimation of the number of girls who may have been killed due to foeticide otherwise).

Says Additional Chief Secretary (Health) Sudhir Rajpal: “It was a concerted and focused approach, with strategies refined as needed. We monitored the initiatives weekly, and involved departments across the board, including police, shifting our approach from just the implementation of the PNDT and MTP Act. We had full support of the government, from the Chief Minister to the Health Minister and everybody else.”

One measure of the efforts made by the state, which was chosen by Prime Minister Narendra Modi to launch his ‘Beti Padhao, Beti Bachao’ campaign in 2015, are the number of FIRs filed under the PNDT (Pre-Natal Diagnostic Techniques) and MTP (Medical Termination of Pregnancy) Acts.

Between 2015 and 2025, Haryana registered 1,375 FIRs, against medical practitioners and ultrasound centre owners, under the two laws, with records showing a sustained campaign even during the Covid-hit year of 2020. If around 100 FIRs were registered in that period, the number stood at 142 in 2021. There was a dip in 2023-24, but in 2025, Haryana officials filed 154 cases.

Action has been spread across districts, including urbanised districts such as Faridabad (126 FIRs over the decade, the highest in the state), followed closely by Sonipat with 115 and Gurugram with 112, and Tier II ones such as Ambala, Hisar, Rohtak, Sirsa, Karnal and Kurukshetra. Faridabad, Sonipat and Gurugram, incidentally, continue to have sex ratios below the state average, at 916, 894 and 901, respectively.

The top three districts as regards sex ratio at birth are Panchkula (971), Fatehabad (961) and Panipat (951).

With Haryana residents who want sex determination tests visiting centres in bordering states, raids were also conducted by the Haryana administration in these areas. Haryana shares borders with four states: Uttar Pradesh, Delhi, Punjab, and Rajasthan. In 2025, 218 inter-state PNDT raids were conducted in Uttar Pradesh, the highest, followed by 89 in Delhi, 83 in Punjab and 26 in Rajasthan.

“There were times when raiding teams faced challenges, including leaks about the action and logistics issues. But our counterparts in other states have been very receptive and cooperative,” a senior officer told The Indian Express.

Explaining the coordination within the state at the ground level, Dr Arun, a nodal officer for the PNDT in Panchkula, says, “There are around 57 ultrasound centres in Panchkula. All are part of our WhatsApp group. We hold regular inspections, quarterly meetings. Last year, we also introduced ‘RCHID’ or ‘Reproductive and Child Health Identity’, a 12-digit unique ID issued to every pregnant woman who is examined at any private or government healthcare institute. That resulted in a 37 percentage point increase in registration of pregnant women. Each and every abortion was tracked, recording reasons, from hospitals to MTP centres to ultrasound centres.”

Another project, Saheli, launched in April 2025, roped in anganwadi or ASHA workers to specifically monitor pregnant women who have at least one daughter, says Dr Arun. “That resulted in a 57 percentage point drop in trimester abortion rate in one year.”

The monitoring measures also led to the cancellation of licences of ultrasound centres found to be violating rules, as well as seizure of equipment and prosecution of doctors. Special task forces were empowered to track illegal medical termination kits. District officials were made directly accountable for any sudden dips in local sex ratios.

Dr G L Singhal, a PhD in Generic Medicines who is a consultant for coordinating the ‘Beti Bacho Beti Padhao’ programme, says the Haryana government’s offer of Rs 1 lakh for tips on illegal sex-determination centres or illegal abortions also proved decisive. “So far, we have given out around Rs 5 crore to such informers in approximately the last 10 years,” Dr Singhal says.

One of the measures police use are decoys, who visit such centres pretending to be in need of abortion. They often involve women police constables, but also others. A Sonipat-based widow and mother of four who has been working as a decoy with the state government says: “I have been associated with the Sonipat team for eight-nine years and been part of at least a dozen raids. Because I have four daughters, I realise the importance of a girl child, which is why I voluntarily joined this programme.”

Officials are worried now of challenges such as portable ultrasound machines available online. “An MTP kit that costs Rs 50-60 is now being sold in the black market for as high as Rs 2,000-2500,” Dr Singhal says, adding that operators also try to escape the noose by frequently changing location or doing sex-determination tests in places other than registered centres. “We have been able to curb these malpractices to a large extent. Of course, there is much more to be done.”