Girls are being 'converted' into boys in Indore - by the hundreds every year - at ages where they cannot give their consent for this life-changing operation.
This shocking, unprecedented trend, catering to the fetish for a son, is unfolding at conservative Indore's well-known clinics and hospitals on children who are 1-5 years old. The process being used to 'produce' a male child from a female is known as genitoplasty. Each surgery costs Rs. 1.5 lakh.
Moreover, these children are pumped with hormonal treatment as part of the sex change procedure that may be irreversible.
The low cost of surgery and the relatively easy and unobtrusive way of getting it done in this city attracts parents from Delhi and Mumbai to get their child surgically 'corrected'.
About 7-8% cases come from the metros, say doctors.
While genitoplasty is relatively common - it is used to correct genital abnormality in fully-grown patients - the procedure is allegedly being misused rampantly to promise parents a male child even though they have a female child.
The parents press for these surgeries despite being told by doctors that the 'converted' male would be infertile.
While genitoplasty experts of Indore say each of them have turned 200 to 300 girls into 'boys' so far, only one could cite an instance when a 14-year-old was converted into a girl. Listen to podcast
In that case, ironically, medical complications strictly forbade converting the child to a boy. The doctors accept that parents willingly convert girls to boys but opt out of the opposite procedure.
If that's not bad enough, Indian law, which has encountered nothing like this so far, allows these surgeries by its silence and grey areas.
About seven paediatric surgeons from Indore - who are associated with top private and government hospitals - perform these surgeries.
They say these operations are done on children whose internal organs do not match their external genitalia - most commonly, girls born with some internal male organs.
They claim a strict procedure is followed to determine the sex of the newborn, after which the external appearance of the child is changed to match the sex.
There is no system to monitor that claim and is completely open to abuse.
"When the child grows up, he or she would be confused about the gender he or she belongs to. This surgery can stop the child from having sex-determination disorder and psychological problems," said Dr Milind Joshi, a paediatric surgeon who performs the procedure at a city hospital.
A parent whose child underwent such a surgery at the age of two said on the condition of anonymity, "I think my child would not be confused over his gender when he grows up and can live a normal life as he would not have any memories of the surgery."
Another Indore paediatric surgeon performing this procedure, Dr Brijesh Lahoti, said, "In India, there is no problem in performing these surgeries as only the consent from parents and an affidavit is required. These are reconstruction surgeries where sex of the child is determined based on its internal organs and not just on the basis of external genitalia."
With no proper laws to protect rights of the child that young, the practice might have a larger social ramification, say medico-legal experts.
"The surgery can have profound, long-term psychological effects on an individual, who might not accept the gender assigned by parents and doctors before age of consent," said Suchitra Inamdar, a counsellor from Mumbai.
Calling it a highly sensitive issue, Dr Joshi said people should be sensitised about these surgeries. Asked about consent of the child, he said, "In India, consent is sought from parents till the child is 14."
This raises a lot of questions about rights of these children, who might grow up to believe that they wanted to be the way they were born and not corrected surgically.
There have been cases abroad in which such people - who had undergone the procedures at the ages when their consent could not be sought - have grown up and sued the doctors.
"In India, it is a completely virgin area," said medico-legal expert from Mumbai Shirish Deshpande, who is also chairman of the Mumbai Grahak Panchayat.
"The government needs to regulate these operations. They can't be called illegal right now, but if ignored, they can create a major imbalance in the sex ratio and have serious social implications."
The Indian Medical Association has a similar view.
"The Medical Council of India and the health ministry should look into the matter. There has to be some guideline or law on how a child who is barely old enough to talk can undergo a life-changing surgery at the parents' will," said IMA secretary, Indore branch, Dr Anil Bhadoria.