National Steering Committee on the Pre-Conception and Pre-Natal Diagnostic Techniques (PC PNDT) Act feels that the present legislation has already triggered many medical professionals to discontinue performing ultrasound scanning on pregnant women due to fear of harassment by officials. The sudden closure of centres has resulted in huge revenue losses to them.

There are 70,000 ultrasound machines installed at about 50,000 locations but an estimate of number of centres shut down is still not indicated.

Typical PC PNDT non-compliance issue is related to clerical errors like not updating forms in a proper manner, absence of pregnant women registrations details, non-existence of scanned records and a paucity of dedicated qualified personnel to inspect facilities to differentiate the law-abiding clinics and violators, the Committee noted.

“The reasons for non-compliance is the cumbersome paperwork. The real culprits continue to get away, as is evident from the worsening sex ratio in many states,” Dr. Alexander Thomas, co-chairman, National Steering Committee on the PCPNDT Act told Pharmabiz.

Ultrasound is primary modality of care in obstetrics and gynecology to save lives of pregnant women. But in the effort to curb female foeticide, the country has gone overboard in regulating the usage of this life saving modality. The government and the NGOs have blamed this modality as the only reason for altering the sex ratio when it permits unrestricted medical termination of pregnancy (MTP) up to 20 weeks. Without plugging this loop hole, the sex ratio cannot be corrected, Dr. S Suresh, director, SS Mediscan the oldest centre in Chennai and past president, Indian Federation of Ultrasound in Medicine and Biology and member, National Committee PC PNDT told Pharmabiz.

The five amendments to the PCPNDT Act put forth by the National Committee are monitoring the Ob/Gyn scans, no restrictions on other scans, simplification of the Act for its uniform implementation and criminal provisions only against sex determination and female foeticide.

Unlike India, globally basic scans are done by sonographers who are trained non-medical persons before they are recommended to fetal medicine specialists / radiologists for second opinions. India accounts for 27 million birth annually. The  Ob/Gyn guideline mandates  a minimum of 3 scans for pregnant women. This results in 81 million scans to deliver good healthcare for pregnant women. “We have now moved from an era of obstetric ultrasound to an age of ultrasonographic obstetrics as this procedure is now indispensable. The recent judgment of the Delhi High court stated that prenatal sex determination is a moral and not a technical issue,” said Dr. Suresh.

Therefore it is crucial to categorize pregnancy terminations as STP  (social termination pregnancy) for a normal baby and a MTP for medical reasons. STP can be allowed before the 12th week at which time the sex cannot be determined. To terminate an unwanted pregnancy, a legal abortion can be sought immediately without waiting for 16- 18 weeks when the sex can be determined.  MTPs after 12 weeks need scrutiny and should be accounted for. The government will need to think out-of-the box and organise a meaningful debate to alter the sex ratio, said Dr. Suresh.

According to Dr. Thomas, the Act in its current form deprives the economically backward access to a life-saving and essential diagnostic tool. There are many restrictions and permissions to be obtained. Machines cannot be shifted. This dissuades medical teams not to use ultrasound scans at health camps to detect possible fetus abnormalities in pregnant women. We need to ensure that those engaged in sex selection and infant foeticide should be punished. However, clerical errors should not result in jail terms.

Improvement of sex ratio in India requires a change in mindset along with social schemes to encourage the girl child. The recent financial incentives for the girl child by the government are seen to already make a positive impact, he said.