WILL THE DEBATE ON COMPULSORY GENDER DISCLOSURE LEAD TO MORE TRANSPARENT PRE-NATAL DIAGNOSTICS, OR WILL IT MEAN POLICING OF WOMEN?
DR DILRAJ GANDHI//Disclosing gender on pre-natal ultrasound is something that the doctors’ fraternity has been asking for, for the past couple of years. Female foeticide is a social malady in which there are three stakeholders — the gynaecologist, who aborts; the radiologist, who helps in sex selection; and the society, which gets the tests done. But why is it that the onus is only on the radiologists? Just because they are soft targets? Ultimately, it is a scourge of the society and the solution has to be inclusive.
The law has been in force since the past 20 years or so, but has not worked so far. The skewed sex ratio is evidence enough. Innovative thinking is needed to find a solution. Throttling a technology and the radiologist is not a good solution.
There are black sheep in every community, including doctors, and as long as the society demands, they will thrive. The spirit of the pre-natal diagnostic technique (PNDT) law is well meaning, but it has become draconian in its implementation, with every district in the country having its own interpretation. The implementation is flawed and more emphasis is now placed on record keeping, where errors are common and prosecution easy. Courts keep asking the government and NGOs the number of doctors prosecuted and they have to show results. Thus, it is the law-abiding radiologists who have to bear the brunt and practice under the constant fear of having their clinic and machine sealed. In the current scenario, a law abiding doctor spends equal time and energy or employs separate staff to maintain the record of each patient, which includes a copy of the Aadhar card, the gynaecologist’s prescription and also a compulsory form “F” signed by both the doctor and the patient. Not only is the radiologist supposed to keep a monthly record of this, but he has to also send one to the appropriate authority (AA), in this case the district magistrate.
The AA is more like the income tax department, which can swoop down on the practitioner and question him on any clerical error or declaration given by the patient. Anything that even remotely points towards sex determination, which may or may not be true or a false declaration by the patient, is tantamount to unscrupulous practice or “violation of the act”. Clinics have been sealed where doctors are not found wearing a white apron or not having a name plate on the apron. There have been cases where receipts in which the consultation fee is high are automatically linked to sex determination, whereas they could have been for any other special test performed in the clinic. The doctor ends up paying a heavy price, having his machine and clinic sealed.
Union Minister for Women and Child Development Maneka Gandhihad, earlier in February, suggested that sex determination test should be made compulsory to track women pregnant with a girl child as a measure to check female foeticide. She was of the opinion that the woman should be told whether she is carrying a boy or girl child. “It should be registered to be able to check whether they have given the birth or not," said the minister.
PNDT Act 1994 provides for the prohibition of sex selection, before or after conception, and for regulation of prenatal diagnostic techniques for the purposes of detecting genetic abnormalities or metabolic disorders or chromosomal abnormalities or certain congenital malformations or sexlinked disorders and for the prevention of their misuse for sex determination leading to female foeticide; and, for matters connected therewith or incidental thereto. The Act was amended in 2003 to Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act (PCPNDT Act) to improve the regulation of the technology used in sex selection.
Doctors and diagnostic providers can be penalized for conducting sex determination test. The idea being that if the parents do not know whether the foetus is male or female, they are unlikely to go in for an abortion. This is to help bring down female foeticide.
Both can be unsealed only by a court of law. So, it is all or none. The black sheep walk away scot-free because they do not keep any records and so there is nothing to show or “get caught” as evidence, while the law abiding radiologist is deprived of his livelihood.
The PNDT Act entails that anyone who has done six months of training after MBBS can be registered as an ultrasonologist. It is these graduates who have half-baked knowledge, and who are indulging in malpractice. They keep no records and don’t issue any receipts or reports. Having got a sex determination test done here, the patient does not get a report so she goes to a lawful doctor, gets a routine ultrasound done as prescribed by the hospital or primary doctor. In case she decides to abort the foetus and it is reported, the chain of events is traced back and stops at the radiologist who has issued a report. It is taken for granted that he conducted a pre-natal test under the garb of a routine one.
No one from the general public has, until date, been implicated in getting the child aborted. The law applies equally to them, too. But the process is tedious and evidence difficult to get and prove.
The idea of a compulsory gender disclosure, however absurd it may look at first, is more likely to be effective than the law in the present state. As Maneka Gandhi had suggested, legalise pre-natal tests. Let the government gear up its own machinery and by all means punish the real offenders in the doctor community and the public at large if the pregnancy is terminated by sex selection.
Instead of targeting this set, the government should gather its act and utilise its energy in (a) promoting the girl child, bringing about a change in the mindset of society, thus obviating the need for gender bias; (b) conducting sting operations to create a fear among doctors; (c) tightening the noose around unregistered practitioners and machines , ensuring that only MD doctors are allowed to do ultrasounds; and (d) simplifying its implementation with graded penalties for minor offences and non-bailable arrest for actual offenders.