Medical association wants doctors to be protected from punishment under sex determination laws

On Tuesday, the Indian Medical Association held a one-day protest against what it believes to be range of persecution against doctors, including violence against doctors and low health budgets. However, the association is also asking that the Pre-Conception and Prenatal Diagnostic Techniques or PCPDNT Act be amended so that doctors are not penalised under the law. This demand has alarmed the activists who work to prevent sex determination and sex selective abortions.

Doctors associations such as Indian Medical Association and Indian Radiological Association have been claiming that the PCPDNT Act has been ineffective in improving the sex ratio and so should be amended. However, activists fear that any amendment will lead to a dilution of the Act, which will actually render it ineffective.

Sabu George, a girl child activist, said that the activists view this demand as a serious threat as the doctors’ association has political influence.

Over the past two years, the Indian Medical Association has taken a sharp stand against PCPNDT Act, especially as it penalises what the doctors call “clerical errors”. Doctors conducting ultrasounds have to fill in a form called Form F with details of the patient and why the ultrasound is being taken.

“We are against sex determination and believe that any doctor indulging in it should be punished and be permanently barred from practice,” said Dr KK Aggarwal, president of the association. “But doctors conducting ultrasound who do not conduct antenatal checks should not be under the PCPDNT Act.”

He added that administrative and clerical errors – not filling Form F properly or not putting up a board stating that sex determination is illegal outside a clinic – should not be offences carrying a jail term.

But George countered this objection. “Record keeping is fundamental to the medical practice in the West,” he said. “Our country has only one requirement for record keeping before conducting an ultrasound.”

Besides, audits of these records have helped these activists zero in on doctors who conduct sex determination.

“Audits show where there is a fraud,” said Satish Agnihotri, a retired IAS officer who has studied the problem of India’s declining sex ratio. “Particularly if there are a large number of ‘clinical errors’ then it is an indication of suppressing evidence.”

Dr Neelam Singh, a gynaecologist in Lucknow who is also part of the National Inspection and Monitoring committee under the PCPDNT Act, said that that doctors have not opposed record-keeping under the Income Tax Act. “Why only this law?” she asked.

As per the census records, the sex ratio of children between 0-6 years dipped from 927 girls for every 1,000 boys in 2001 to 919 girls for every 1,000 boys in 2011. The Sample Registration System showed that the sex ratio has dipped from 909 girls per 1,000 boys in 2011 to 900 girls to 1,000 boys in 2015. The National Family Health Survey shows a slight increase in sex ratio at birth from 914 girls to 1000 boys in 2005-6 to 919 girls to 1000 boys in 2015-16. However, the survey showed that the progress is uneven and that the sex ratio is falling rapidly in many states.

Policing women?

Since last year, the idea that sex determination should be made compulsory and instead pregnant women should be tracked has gained ground.

In February 2016, Women and Child Development Minister Maneka Gandhi said that women should be told about the sex of the foetus and then be tracked through to childbirth. “We cannot keep catching people doing (illegal) ultrasound,” she said. However, after facing criticism, she withdrew the statement.

But in April this year, a Maharashtra Public Accounts Committee recommended that doctors, health officials and non-profit organisations track pregnant women with female foetuses to ensure that sex-selective abortions are not performed.

The Indian Medical Association continues to support this move. “We believe that every pregnancy should be tracked,” said Aggarwal.

Bijaylaxmi Nanda, who teaches political science and gender studies at Miranda House in Delhi said that any such move will burden women, who might already be victimised by families who want male children, twice over.

Meanwhile, Neelam Singh voiced a practical concern. “I want to know if the government has not been able to track 55,000 registered ultrasound machines in the country, how will they monitor 29 million women who get pregnant in this country?” she said.

Activists said that the doctors should be equal stakeholders in the campaign to work towards improving the sex ratio.

“The medical community should share responsibility in reducing the gender imbalance,” said Singh.