The Pre-natal Diagnostic Technique (Regulation and Prevention of Misuse) Act 1994

There had been attempts to raise voice against and counter these practices for long in India. One major breakthrough was when the Government of Maharastra passed a state level legislation in 1988. It took another 6 more years to pass the central legislation. The Pre-natal Diagnostic Technique (Regulation and Prevention of Misuse) Act 1994 was enacted in the Parliament. The Act came into existence from 1st of January 1996. Rules have also been framed under the Act. The Act prohibits determination and disclosure of the sex of the foetus. It also prohibits any advertisements relating to Pre-natal determination of sex and prescribes punishments for its contravention. The person who contravenes the provisions of this Act is punishable with imprisonment upto five years and fine upto Rs.50,000. As per the Act pre-natal diagnostic techniques can be performed only by facilities and clinics registered under the Act. The use of these techniques is permissible solely for the detection of some abnormalities subject to some specified conditions.

Despite the Act being around for the last six years, sex selective abortions were on the rise. Implementation has been a total failure, resulting in the continuation of rampant malpractice in most areas. The failure of the Act was very visible as there were open advertisements through media, failure to charge a single case under the law etc. Finally the Judiciary intervened. Thanks to the Public Interest Litigation in Supreme Court filed by the activist Dr. Sabu George and NGOs, CEHET and MASUM. The Supreme Court in its order, instructed the central and state governments to adopt strategies to implement the act effectively. The court has also asked the government to look at amendments to the Act keeping in view the emerging reproductive technology. Finally our policy makers were on their toes and an Amendment to the original PNDT Act was passed in the winter session of the parliament in 2002.`

What does the law means to the Christian mission health care institutions?

As ethical torchbearers of the health care sector, our mission institutions have always keen in upholding of the ethical values within the society we serve. It can also be stated beyond doubt that none of the mission institutions indulge in such malpractices. However the situation warrants ensuring certain safeguards by us. The legislation makes it mandatory for the institutions to register their facilities and undergo certain procedure before undertaking any diagnostic tests on pregnant women. The appropriate authorities at the district or subdistrict level undertake the registration and the regular monitoring. It permits the pre-natal diagnostic tests for some indications under certain conditions. The new amended legislation requires the registration of all equipments capable of determining the sex of the child. This means the registration of all ultrasound machines, even if we do not use it for pre-natal diagnostic tests.

Checklist to assess the compliance to PNDT act Please check for the following Do you use a ultra-sound machine in your hospital or any facilities for Pre-Natal Diagnostic Techniques? If yes, Have you registered your centre/clinic/laboratory under the PNDT Act? If yes, have you exhibited the registration certificate in a conspicuous area in the premises? Whether you have exhibited a board stating ‘Disclosure of the sex of the foetus is prohibited under law’ at a conspicuous place in your premises? Do you get written consent from pregnant women in their known language and do you give a copy of it to them? Do you keep records of each of the services including name and address of the pregnant women, name of her husband, name and address of the referring medical practitioner and the specific reason for conducting the tests?

One of the major argument against the PNDT amended Act is that it would restrict the rational use of ultrasound in pregnancy. However the question before us is what is the rational use of ultrasonography in pregnancy. Contrary to the common belief and practice, routine use of ultrasonography in pregnancy is not justifiable. Many studies have pointed out the routine use of ultrasounds do not result in both better maternal and foetal outcome. The Act prohibits routine use of ultrasonagraphy in pregnancy and permits its use for 23 selected indications. The Indian Council of Medical Research carefully identified all these indications after a wide range of discussions.

Indications for the use of ultrasonography in Pregnancy 1. To diagnose intra-uterine and/or ectopic pregnancy and confirm viability. 2. Estimation of gestational age (dating) 3. Detection of number of foetuses and their chorionicity 4. Suspected pregnancy with IUCD in-situ or suspected pregnancy following contraceptive failure/MTP failure 5. Vaginal bleeding / leaking 6. Follow-up of abortion 7. Assessment of cervical canal and diameter of internal os. 8. Discrepancy between uterine size and period of amenorrhoea 9. Any suspected adenexal or uterine pathology / abnormality 10. Detecteion of chrosomal abnormalities, foetal structural defects and other abnormalities and their follow up 11. To evaluate foetal presentation and position 12. Assessment of liquor amnii 13. Preterm labour / preterm premature rupture of membranes 14. Evaluation of placental position, thickness, grading and abnormalities 15. Evaluation of umbilical cord – presentation, insertion, nuchal encirclement, number of vessels and presence of true knot. 16. Evaluation of previous Caesarean Section scars. 17. Evaluation of foetal growth parameters, foetal weight and foetal well being. 18. Colour flow mapping and duplex Doppler studies. 19. Ultrasound guided procedures such as medical termination of pregnancy, external cephalic version etc. and their follow up. 20. Adjunct to diagnostic and therapeutic invasive interventions such as chorionic villus sampling (CVS), amniocenteses, foetal blood sampling foetal skin biopsy, amnio-infusion, intrauterine infusion, placement of shunts etc. 21. Observation of intra-partum events. 22. Medical/surgical conditions complicating pregnancy. 23. Research / scientific studies in recognized institutions.

It is true that the PNDT Act adds to the quantum of work we are already doing. It also makes us accounts to an external agency. But by recognising the seriousness of the issue and its social consequences, our institutions should all heartedly welcome such initiative. The present scenario also suggests us to work with the community we serve to counter the practice of sex selection. Having a stringent law to curtail the practice of sex determination may be the first step against female foeticide. However, unless various community-targeted programmes supplement it, a law in isolation is unlikely to make any visible changes to the present scenario. These community targeted programmes can be awareness building, counselling young married couple, keeping a constant vigil against the practice of female foeticide etc. Again much of these depend on uplifting the status of women in our society.