BharatNotes Overview
Reproductive health and biotechnology intersect at one of the most ethically charged frontiers of modern science — from test-tube babies and surrogacy to gene editing and cloning. For UPSC, this chapter spans GS3 (Science and Technology) and GS2 (Social Issues — population policy, women's rights, sex ratio). Key legislative anchors are the Surrogacy (Regulation) Act 2021, the Assisted Reproductive Technology (Regulation) Act 2021, and the PCPNDT Act 1994, all of which are frequently tested in both Prelims and Mains.
Assisted Reproductive Technology (ART) — Key Techniques
In Vitro Fertilisation (IVF)
IVF (In Vitro Fertilisation) is a process where an egg is fertilised by sperm outside the human body ("in vitro" = in glass), and the resulting embryo is transferred to the uterus.
Steps in IVF: ovarian stimulation → egg retrieval → fertilisation in laboratory → embryo culture (3–5 days) → embryo transfer to uterus → pregnancy test
- First IVF baby globally: Louise Brown (UK, 25 July 1978)
- First IVF baby in India: Durga (born Kanupriya Agarwal, 3 October 1978) — just 67 days after Louise Brown
- India is now the world's leading destination for IVF treatment, with ~2,000+ ART clinics
Other ART Procedures
| Technique | Full Name | How It Works |
|---|---|---|
| IVF | In Vitro Fertilisation | Egg + sperm fertilised outside body; embryo transferred to uterus |
| ICSI | Intracytoplasmic Sperm Injection | Single sperm injected directly into egg; used when male infertility is the issue |
| IUI | Intrauterine Insemination | Sperm placed directly into the uterus around ovulation; less invasive than IVF |
| Gamete donation | Sperm / egg donation | Donor gametes used when patient cannot produce viable eggs or sperm |
| Gestational surrogacy | — | Embryo from commissioning couple implanted in surrogate's uterus (surrogate not genetically related to child) |
| Cryopreservation | Embryo/gamete freezing | Embryos, eggs, or sperm stored at -196°C in liquid nitrogen for future use |
Surrogacy (Regulation) Act, 2021
India was once the global hub for commercial surrogacy — a multi-billion dollar industry. Following concerns about exploitation of women, the Surrogacy (Regulation) Act 2021 was enacted and came into force on 25 January 2022.
| Feature | Details |
|---|---|
| Key provision | Bans commercial surrogacy; permits only altruistic surrogacy (no monetary compensation beyond medical expenses) |
| Eligible intending couples | Indian married couples with at least 5 years of marriage; wife aged 25–50 years; husband aged 26–55 years; must have a medical condition necessitating surrogacy |
| Eligible surrogate | Must be a close relative of the intending couple; married; has at least one child of her own; aged 25–35; can be surrogate only once in her lifetime |
| Prohibited | Commercial surrogacy; surrogacy for non-medical/social reasons; surrogacy by foreign nationals or PIOs/OCIs |
| Regulatory body | National Surrogacy Board (Central level) + State Surrogacy Boards |
| 2023 Amendment | Allows single women (widows and divorcees aged 35–45) to commission surrogacy; allows use of donor gametes for certain medical conditions |
Altruistic surrogacy means the surrogate receives no payment beyond medical expenses and insurance coverage during pregnancy. Critics have noted the "close relative" requirement is restrictive and may make finding eligible surrogates difficult.
Assisted Reproductive Technology (Regulation) Act, 2021
Passed alongside the Surrogacy Act, the ART (Regulation) Act 2021 (Lok Sabha passed 1 December 2021) provides a comprehensive regulatory framework for India's ~2,000+ ART clinics and banks:
| Provision | Details |
|---|---|
| Eligibility for ART services | Married couples (infertile) or single women (21–50 years for woman; 21–55 years for man); no restriction on nationality — unlike Surrogacy Act |
| Gamete donation age | Sperm donors: 21–55 years; Egg donors: 23–35 years |
| Registry | National ART and Surrogacy Registry for mandatory registration of all clinics and banks |
| Donor limits | A single sperm donor can donate to maximum one woman at a time; egg donor can donate eggs not more than once |
| Prohibited activities | Sale/purchase of human embryos or gametes; import of human gametes; embryo transfer into male or animal; sex selection |
| Penalties | First offence: fine Rs 5–10 lakh; subsequent offences: 3–8 years imprisonment + Rs 10–20 lakh fine |
Stem Cell Therapy
Stem cells are undifferentiated cells capable of self-renewal and differentiation into specialised cell types. They hold enormous therapeutic promise:
| Type | Source | Potential Use |
|---|---|---|
| Embryonic Stem Cells (ESCs) | Inner cell mass of a blastocyst (early embryo) | Pluripotent — can become any cell type; most therapeutically powerful; ethically controversial (destroys embryo) |
| Adult Stem Cells | Bone marrow, blood, adipose tissue | More limited differentiation; used in bone marrow transplants (leukaemia treatment) |
| Induced Pluripotent Stem Cells (iPSCs) | Reprogrammed adult somatic cells (Yamanaka, 2006 — Nobel Prize 2012) | Avoid embryo destruction; patient-specific; promising for personalised medicine |
| Cord Blood Stem Cells | Umbilical cord blood at birth | Rich in haematopoietic stem cells; used in blood disorders; can be banked |
Current therapeutic uses: Bone marrow transplantation for leukaemia and lymphoma (the most established stem cell therapy). Future potential: Parkinson's disease, spinal cord injury, diabetes, heart disease.
Ethical issues: ESC research requires destruction of embryos — raises the moral status of the embryo question. India's ICMR guidelines (2017) permit ESC research under strict oversight but prohibit reproductive cloning.
Cloning — Types and Ethics
| Type | Description | Status in India |
|---|---|---|
| Therapeutic cloning | Somatic Cell Nuclear Transfer (SCNT) to create embryos for stem cell harvest — not to produce a baby | Permitted under ICMR guidelines (with restrictions) |
| Reproductive cloning | SCNT to produce a genetically identical organism (as was done with Dolly the sheep, 1996) | Prohibited |
| Human reproductive cloning | Creating a genetically identical human | Prohibited globally (India included) |
Dolly the sheep (1996, Roslin Institute, UK) was the first mammal cloned from an adult somatic cell. No verified human has been cloned. The UN Declaration on Human Cloning (2005) calls on member states to prohibit all forms of human cloning.
Genetic Screening and Ethics
| Technology | Purpose | Ethical Issues |
|---|---|---|
| Prenatal Genetic Diagnosis (PGD) | Screen embryos before implantation (IVF context) for chromosomal disorders (Down syndrome, etc.) | Could enable "designer babies" and eugenics |
| Non-Invasive Prenatal Testing (NIPT) | Screen foetal DNA in maternal blood for chromosomal abnormalities | Cannot legally include sex determination in India (PCPNDT Act) |
| Preconception screening | Carrier testing for recessive disorders (Thalassaemia, cystic fibrosis) | Voluntary; information asymmetry; potential insurance discrimination |
| CRISPR-Cas9 | Gene editing technology | "He Jiankui affair" (China, 2018) — edited human embryos' CCR5 gene; globally condemned |
PCPNDT Act, 1994 — Ban on Sex Determination
The Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994 (amended 2003 to include pre-conception) is India's key legislative tool against female foeticide.
| Feature | Details |
|---|---|
| Enacted | 1994 (original PNDT Act); amended 2003 as PCPNDT to cover pre-conception sex selection |
| Prohibition | Bans sex determination of foetus; pre-conception sex selection; advertisement of sex determination services |
| Penalty | Up to 3 years imprisonment and Rs 10,000 fine (first offence); up to 5 years and Rs 50,000 (subsequent offences) |
| Regulatory structure | Central Supervisory Board; State/UT Appropriate Authorities; mandatory registration of all ultrasound/genetic facilities |
| Context | India's child sex ratio (0–6 years): 927 girls per 1,000 boys (Census 2011); improved to 929 per 1,000 boys (NFHS-5, 2019–21) |
India's Sex Ratio and MMR Trends
Sex Ratio at Birth (SRB) — Trend
| Survey | Girls per 1,000 Boys (0–6 years) | Note |
|---|---|---|
| Census 2001 | 927 | Alarming decline; triggered stricter PCPNDT enforcement |
| Census 2011 | 918 | Further decline; "Beti Bachao Beti Padhao" launched 2015 |
| NFHS-4 (2015–16) | 919 | Marginal improvement |
| NFHS-5 (2019–21) | 929 | Improving trend; urban SRB improved from 899 to 924 |
Despite improvement, states like Goa (838), Himachal Pradesh (875), and Telangana (894) remain below 950 (NFHS-5), indicating persistent son preference in certain regions.
Maternal Mortality Ratio (MMR) — Trend
India's MMR (maternal deaths per 100,000 live births) has shown a dramatic decline:
| Period | MMR (per 100,000 live births) | Source |
|---|---|---|
| 1990 | 570 | UN MMEIG |
| 2010 | ~254 | SRS |
| 2017–19 | 103 | SRS Bulletin |
| 2021–23 | 97 | SRS (latest, 2025) |
India's MMR declined by 86% from 1990 to 2023 (570 to 97), compared to a global reduction of 48% over the same period (UN MMEIG Report, 2025). The SDG target is an MMR below 70 by 2030. The lowest MMR states are Kerala and Andhra Pradesh (30 per 100,000); the highest are in Assam and Uttar Pradesh.
Key drivers of MMR decline: institutional deliveries (NFHS-5 shows 89% deliveries in health facilities), ASHA workers, Janani Suraksha Yojana (JSY), Pradhan Mantri Suraksha Bima Yojana, and improved skilled birth attendant coverage.
Recent Developments (2024–2026)
Genome India Project — Genomics Ethics in India (January 2025)
The Genome India Project's completion (January 2025) — sequencing 10,074 individuals from 83 diverse populations — raised significant biotechnology ethics questions directly relevant to this chapter. The Indian Biological Data Centre (IBDC) and Framework for Exchange of Data Protocols (FeED) govern data access, addressing informed consent at population scale, genetic data privacy, risks of genetic discrimination in insurance and employment, and equitable benefit-sharing of genomic discoveries with sampled communities.
UPSC angle: Genome India is both a biotechnology achievement and a bioethics case study — tests understanding of data consent frameworks, genetic privacy, and the four principles of bioethics applied to large-scale research.
UCPMP 2024 — Pharmaceutical Marketing Ethics in Reproductive Health
The Uniform Code of Pharmaceutical Marketing Practices (UCPMP) 2024 (effective March 2024) specifically tightened norms around marketing of reproductive health products, contraceptives, and fertility treatments to medical practitioners — prohibiting gifts, travel sponsorships, and undisclosed financial relationships. This intersects with the ART Act, 2021's framework for regulating ART clinics, which also prohibit commercialisation of gametes and embryos.
UPSC angle: UCPMP 2024 connects pharmaceutical ethics to reproductive health biotechnology — tests awareness of the regulatory boundary between legitimate medical practice and commercial exploitation.
Exam Strategy
Prelims Focus:
- Surrogacy Act 2021: bans commercial surrogacy; altruistic surrogacy only; effective 25 January 2022
- ART Act 2021: regulates ART clinics and banks; National ART Registry; prohibits sale of embryos/gametes
- PCPNDT Act 1994 (amended 2003): bans sex determination; up to 5 years imprisonment
- India MMR (2021–23): 97 per 100,000 live births (SRS, 2025)
- Child sex ratio (NFHS-5): 929 girls per 1,000 boys
- iPSCs: discovered by Yamanaka (2006); Nobel Prize 2012
- Dolly the sheep: first mammal cloned from adult somatic cell; 1996; Roslin Institute, UK
Mains Focus (GS3/GS2):
- Ethical dimensions of ART: commodification of reproduction, exploitation of women, "designer babies" risk
- Surrogacy regulation: balance between infertile couples' rights and surrogate women's rights; critique of "close relative" requirement
- PCPNDT Act: successes and failures in improving India's sex ratio at birth; why enforcement remains a challenge
- India's MMR decline: institutional delivery success story; persistent regional disparities; steps toward SDG target of MMR < 70 by 2030
Sources: India Code (indiacode.nic.in — Surrogacy Regulation Act 2021, ART Regulation Act 2021); ICMR (icmr.gov.in — ART and Surrogacy Acts); PRS India (prsindia.org — ART Bill analysis); PIB (pib.gov.in — India MMR 2025, NFHS-5 sex ratio); Census of India 2011 (child sex ratio); NFHS-5 (2019–21) data; UN MMEIG Report 2000–2023 (April 2025); Pew Research Center (India sex ratio at birth trends)
