Radiologists are up in arms against the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act 1994 which restrains and criminalizes the misuse of ultrasound machines for sex determination tests. They are seeking amendments to soften the law
By Dinesh C Sharma
Health activists and those demanding protection of the girl child are agreed that the malaise of sex selection tests needs to be checked if India’s skewed sex ratio is to be corrected. So the threatened agitation by medical professionals against the implementation of the sex selection law—Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act 1994—is a retrograde one.
Demanding changes in the law, a nationwide strike was launched by the Indian Radiological and Imaging Association (IRIA) from September 1 but they have deferred it for three months. They also plan to strike work if their demands are not met.
The threatened agitation seems unfair when we take cognizance of facts on the ground. The latest census data indicate that India’s sex ratio at birth (SRB) has fallen from 909 live female births for every 1,000 male births in 2011-13 to 906 in 2012-14. As per the 2011 Census, child sex ratio (0-6 years) had declined from 927 females per thousand males in 2001 to 919 females per thousand males in 2011.
SKEWED RATIO
The real picture about child sex ratio (CSR) will emerge only in Census 2021, but falling SRB is an indication that it could be worse than feared. Generally, SRB is in favor of boys and the difference is only marginal. But in India, the gap is much higher than in the West. A falling SRB and CSR indicate continuance of female feticide or selective abortion after sex selection and also infanticide after girls are born. Lower SRB is a definite indication of the rising trend of sex selection using ultrasound scanning.
The objective of PCPNDT Act 1994 was to arrest gender-based sex selection through regulation of the use of ultrasound machines. It has been implemented well in Maharashtra and Rajasthan.
The PCPNDT Act 1994 came into being following a public interest litigation and advocacy by health activists. The objective of the law was to arrest gender-based sex selection through regulation of the use of ultrasound machines. But the law remained on paper for many years as rules and regulations, as well as the mechanism necessary for its implementation were lacking. Meanwhile, the use of ultrasound proliferated and spread to rural areas.
It was only after the intervention of the Supreme Court in 2001 that measures and necessary structures for the implementation of the PCPNDT Act were initiated, and registration of ultrasound centers was started. The Central Supervisory Board (CSB), a monitoring panel, was established in the health ministry and appropriate authorities—as mandated in the law—were notified in various states.
Still, health activists say that the implementation of the Act is tardy and convictions for violations are rare. The Act has been implemented well in Maharashtra where violators have been convicted. Jail terms were awarded to two doctors from Pune in September. In Rajasthan, ultrasound machines misused for sex selection have been sealed.
AMENDMENTS DEMANDED
The Indian Medical Association (IMA) and IRIA have been demanding amendments to the rules and regulations under the law, saying that the doctors are being punished even for minor errors which don’t amount to actual sex selection. “Clerical errors in Form F, not wearing of apron, non-display of notice board, not keeping a handbook on the PCPNDT Act should not be equated with sex determination and criminal offense,” said Dr KK Aggarwal, secretary general of IMA. The Association has also demanded that punishment under the Act should be graded in line with the offence.
The Indian Medical Association and Indian Radiological and Imaging Association have been demanding amendments to the rules and regulations under the law.
In addition, the demand is that ultrasound machines should not be sealed and medical registration of radiologists should not be cancelled or suspended for “minor clerical errors”. The IMA also wants standardized implementation of PCPNDT Act throughout the country. Also non-pelvic ultrasonologists should be kept out of purview of the Act if they give an undertaking that they are not doing any antenatal work. The Association alleges that appropriate authorities in many states are harassing radiologists for minor mistakes, which are being equated with sex determination, added Dr Jignesh Thakker, National Coordinator for PNDT at IRIA.
Dr Sabu George, whose relentless activism led to the passage of the Act and its subsequent implementation, however, feels that medical lobbies want to stall implementation of the law. “Wherever the law has been implemented, cases booked and doctors convicted, it has had a direct impact on sex ratio in that region. Strict implementation of the law is the only ray of hope for the unborn girl child,” he said. By pointing out to the so-called clerical errors and asking for doing away with paper work, medical bodies are actually seeking to do away with crucial evidence which helps in conviction of violators, he explained.
“An amendment to the law at this stage will not only weaken the PCPNDT Act but also defeat the purpose of the government’s flagship program—Beti Bachao Beti Padhao (BBBP) that was launched in January 2015. The proposed amendments would allow tens of thousands of medical professionals to continue profiteering from gender-based sex selection and escape criminal prosecution,” a joint statement from health activists has warned. BBBP action plan mentions strict implementation of the Act as one of the key points of action in all the districts with skewed CSR.
Another contentious issue is the notification issued in June 2012 restricting radiologists from visiting more than two ultrasound centers in a district. Litigation is also on in some high courts about qualifications of ultrasonologists as laid down in the Act. The petitioners contend that the six-months training rule is beyond the scope of the PCPNDT Act and is inconsistent with the MCI Act, 1956 and Regulations.
The Delhi High Court in February 2016 had made it clear that Rule 3(3)(1)(b) of PNDT Rules which requires a person desirous of setting up a genetic clinic/ultrasound clinic/imaging center to undergo six months training imparted in the manner prescribed in the Act was ultra vires.
An expert committee was formed by the CSB to propose amendments to the Act and medical bodies were assured that their grievances would be redressed.
While the fine for indulging/assisting/aiding in sex determination is proposed to be increased, the amendments are soft on other violations as demanded by radiologists. The fine is proposed to be increased to Rs 50,000 and conviction will be a minimum of three years. But those not abiding by certain prescribed norms (such as not wearing an apron or keeping a copy of the Act), will be fined only Rs 1,000 and Rs 500 per day in case of repeat violations.
The Act lays certain conditions as well as prohibitions on the sale of ultrasound machines. It is proposed to extend these conditions to any kind of transfer which may or may not constitute a sale.
In order to make manufacturers of ultrasound machines accountable, it is proposed to bring them under separate entities in the Act. They will be liable to a punishment of not less than three years and a fine not less than Rs 25 lakh if they refuse or fail to provide details about sale of ultrasound machines to District Appropriate Authority on a quarterly basis.
The ball is now in the court of the Ministry of Health and Family Welfare.
Lead picture: Radiologists are demanding changes in the PCPNDT law. Photo: UNI