Declare or Not To Declare; That is the Question ?
Maneka Gandhi ji’s comment that sex selection should be made mandatory has stirred a hornet’s nest. Feminists and social workers including politicians of various ilk have trashed the suggestion for varying reasons. Indian Medical Associations of various states have welcomed this move and resonate the demand to make sex determination mandatory during an obstetric ultrasound. They both demand that , intimation of female foetus to the appropriate authorities be done and thereafter the Government machinery should follow up the pregnancy and ensure delivery of the female child. From prosecuting sex selection to making it mandatory requires a complete policy reversal and hence brings forth a conundrum of passionate views on both sides.
Medical Associations have welcomed the move due to the 21 years of inspections, harassment and extortion faced by doctors for minor clerical errors in filling Form “F”, not having copy of PCPNDT Act available on display at a prominent place in clinic, not having notice board of a particular colour and size at an appropriate place declaring that sex selection is not done. Over enthusiastic Appropriate Authorities have gone beyond the scope of their powers under the Act and ordered mandatory ID proof of all women undergoing ultrasound, wearing white coat and asking police to register FIR following a sting operation for an unregistered echocardiography machine of a cardiologist.
There have been reports of organized corruption with ultrasonologist’s who would not cooperate being penalized with repeated raids, sealing of machine on frivolous grounds like not having signed a form F even though the patient’s ultrasound was still in progress, not having submitted report in his own handwriting etc. This lead to a sense of frustration among the ultrasonologists and they rightly in most cases felt that they have become victims of witch hunting. It was assumed in the media frenzy and political diabatre that all ultrasonologists and gynaecologists were criminals.
An Act which was made to penalize the act of seeking , assisting and doing sex selective abortions was somehow implemented only at the level of restricting ultrasound technology. Ultrasound has been the single most important tool responsible for decrease in maternal mortality world wide. It is extremely valuable investigative modality which has no side effects and is useful in wide variety of obstetric and other conditions. From echocardiography, endoscopic ultrasound and also to ophthalmic uses, ultrasound is an indispensable tool. Unfortunately ultrasound has been stigmatized under PCPNDT to the extent that instead of required 2.5 lac ultrasound centres we are having only about 55000. This has happened while we continue to loose 300 women per day from pregnancy related causes.
Also there is another issue of selective victimization. While 3000 cases have been filed against doctors on various ground No action in 21 years has ever been taken against any woman or her family for seeking sex selection or getting it done even though provisions of PCPNDT Act provide specific sections for the same. This is despite specific information including name and address being provided to appropriate authorities by some associations of doctors.
Sex selection and Abortion of female fetuses should be punished stringently, this is without dispute. However I personally do not believe that PCPNDT Act in its current form and its implementation will solve the problem of skewed sex ratio in the country. Prosecution for minor clerical errors has created resentment in the medical community and It has succeeded in alienating the very professionals who should be the front line soldiers in fight against gender bias. We are trying to find a “ bureaucratic pill for a social ill”.
Political bureaucratic powers pressurize the Civil surgeons of districts which show an adverse sex ratio. The civil surgeon / appropriate authority conducts few sting operations and raids, seals a few machines, arrests some doctors and publicize this widely via compliant media to demonstrate to their masters that they have taken action. Rarely however is the action taken against the real culprits who are in cahoots with them and the police. The clandestine , mobile sex determination centres which are manned by quacks, technicians and paramedical personnel who have gained some experience working with qualified sonologists continue to operate and flourish.
Any qualified and established gynaecologist working in even a small establishment or any reputed diagnostic centre cannot work without 5-10 employees. No such established centre can afford to do an obviously illegal action where so many employees work for the simple reason that any disgruntled employee can complain and cause problems for the owner. But sealing the machine of reputed centres is NEWS whereas catching the real fly by the night culprits does not provide the sensational story because they are not known figures in local circles as Without improving status of women in our society we are not going to solve the problem of adverse sex ratio.
It is impossible logistically for the Government to track 29 million pregnancies annually. This is specially because of customs like pregnant women going to parental house for delivery. This creates a discrepancy in the address of patient who for duration of pregnancy may not stay at address given in her address proof. This is assuming that all patients who come for ultrasound are forced to provide address proof.
As regards question of whether or not to declare sex of foetus is concerned, as doctors we first need to be clear what is it that we oppose. No responsible organization specially of doctors will support sex selective abortions. It is the unjustified harassment for minor clerical errors which is the crux of our problems. If this is settled then let us examine whether our harassment will decrease following the reversal in policy from no sex determination to compulsory sex determination.
The filling of forms will continue, maintenance of registers will continue, sending reports to appropriate authorities will continue. If the ANM, Female health worker visits the address provided by the ultrasonologist in his report and does not find the patient what is likely to happen ? It is the ultrasonologist who will be harassed and if the patient was from another state he will have to appear before the authority in that state.
Also after knowing female sex if patient aborts her baby either using over the counter pills or in clandestine unauthorized MTP clinics and on followup by ANM is found non pregnant, patient will now deny she ever went for ultrasound and doctor will be forced to prove it is the same lady whose ultrasound was done. If case goes to court charges of impersonation, fraud, and forgery will need to be defended by doctor as patent will try to defend herself from prosecution under charges of sex selective abortions.
Also the problem of “Spontaneous incomplete abortion” an euphuism for over the counter pill induced abortion or otherwise illegal abortion attempts with bleeding will increase. Gynaecologists will be in dilemma to treat or not to treat such patients. If on completing the abortion female foetus is delivered the gynaecologist is likely to be prosecuted for collusion , but if she does not treat a bleeding patient and patient dies she is likely to be prosecuted for criminal negligence.
The problem is poor status of women in our society. Son preference is ingrained and perpetuated by the socioeconomic milieu. Lack of social security, poor law and order situation and negative image of judicial system exacerbate the problem. One does not expect one’s daughter to deal with hospitals, police or courts for day to day problems of health, security or property disputes and pension issues. To try finding a solution by penalizing those who indulge in sex selective abortion is like striking blindly with a sword in the dark.
Medicos Legal Action Group suggests that we campaign for " Change in Class I Heirs of Hindu Succession Act" Remove all males from list, meaning thereby that property can be inherited only by females ; wives, daughters, daughter in laws, adopted daughters, mothers , sisters. A male can only acquire a self earned property but all inheritance should go to females. This enactment will in one stroke empower women tremendously and will increase their status within society. Within 5 years there will be no dowry, no female feticide and no need for PCPNDT Act, Form F and so on so forth.
Similarly we also suggest that those going for IVF (In Vitro Fertilization) should be forced to select female child. The clients seek IVF because they are infertile. Forced sex selection of females for those seeking IVF can also help improve the adverse sex ratio to some extent.
Unfortunately for things like these to happen it will take a lot of political will and in a country where Women’s Reservation Bill is Languishing interminably for decades it is unlikely that such a radical suggestions would see the light of the day.
Dr Neeraj Nagpal
Convenor,Medicos Legal Action Group,
Managing Director MLAG Indemnity,
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