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Clinics flout PCPNDT Act

Health department admits to lax monitoring

All 40 registered sonography clinics in M-ward (Chembur west) of Mumbai, except one, are flouting various rules under the Pre Conception and Pre Natal Diagnostic Techniques (PCPNDT) Act. This was revealed in the recently conduced survey by Laadli Alliance, a network of 10 Mumbai based NGOs. Mandatory requirements like display of board stating sex determination as illegal, documents pertaining to qualifications, registrations, separate registers, referral letters and even F forms were missing. The survey’s findings raised questions on the implementation of the PCPNDT Act in face of the increasing skewed sex ratio in Mumbai and elsewhere. As per the BMC records for the year 2005, the sex ratio for M-east is 901 girls for 1000 boys and for the west it is 900.

The Laadli Alliance formed by the NGOs - Population First, Apnalaya, CORO for Literacy, FORCE, IIPS, NEWS, PATH, Pragatik, Pratham, Sankalp, Stree Mukti Sanghatna and Urban Health Centre – surveyed 40 of the 47 clinics registered with the Appellate Authority in M-ward of the city. Following a perspective building workshop, four teams covered 40 clinics between July 19 and August 8, 2007. Seven clinics could not be covered because they were either not operational or the addresses were incorrect.

What the survey revealed

Only 9 clinics of the 40 surveyed carried the board mentioning the illegality of sex determination tests. Only 6 clinics had displays of the doctor’s qualifications, while only 5 clinics maintained a separate register for ANC cases. Other mandatory requirements such as details of visiting sonologists were entirely missing in the clinics and hospitals. The F Form is a key document that gives information about the reason for performing the test, the tests conducted and the outcome of the tests. In a majority of the clinics signatures of the pregnant women and the doctors were missing on the consent forms, while 14 clinics had no F forms at all! “Even those maintaining their forms weren’t submitting the monthly summary reports on time”, said Pradnya Shinde, Program Executive Population First. Under the provisions of the law non-maintenance of records is a punishable offence under Sec 23 Rule 9 of the PC-PNDT Act with a sentence of imprisonment for three years and a fine of Rs.10,000/-.

“We are ignorant,” say doctors

Reasons mentioned by the doctors/ clinics ranged from ignorance to downright disregard of the law. “We do not know the law!”, “The Appropriate Authority never visits the clinics”, “Information is not communicated to the clinics”, “We have to make repeated visits to get the ‘F’ form, renewal procedure, IEC material, etc,” were some of the reasons mentioned by clinics to explain the breaking of rules.

“We have other priorities,” says BMC

While the clinics cited ignorance of the law as their excuse, the BMC cited shortage of manpower for lax monitoring. “The health department has a lot of work like monitoring monsoon-related diseases. We do not have additional staff to conduct raids,” said Dr. Jairaj Thanekar Executive Health Officer, BMC, in the Indian Express. However, he promised that “in spite of the limited infrastructure we will try to do surprise checks in four to five clinics in each ward every month.” Regarding the survey, Kishore Gajbhiye, Additional Municipal Commissioner told the Indian Express that “Notices will be issued to all the 40 clinics in Chembur area that violated the Act. If they do not comply, we will seize their machines.”

According to BMC officials Mumbai has 1, 164 registered clinics across the city - the highest concentration being in Andheri West with 101 clinics. However, only 501 clinics in the city have applied for renewal of their licences this year. This means that more than 500 sonography clinics are operating, without any kind of monitoring or checks being conducted by the BMC. Immediately after the media conference the BMC officials initiated action against some clinics in Kandivili,Malad, and other places bur not against 40 clinics in Chembur(W). This is unfortunate as the grounds for action are more or less the same as observed by Laadli campaign.

Tighter monitoring is key to effective implementation of Law

Apart from the traditional preference for a male child, unethical practices by the medical fraternity are the major reasons for the alarming decline in the number of girls. As S V Sista, Executive Trustee of Population First said, “the skewed sex ratio is directly proportional to the number of sonography clinics in a particular ward. Tighter monitoring and supervision would ensure that these clinics do not indulge in malpractices”. The Laadli Alliance meanwhile is planning to take up the next round of surveys in other wards of Mumbai. Among the recommendations made by the alliance on the basis of this survey are immediate investigations and action against the erring clinics. Prompt action by the Appropriate Authorities in implementing the law can send out the right message about the grave nature of the crime.

What can we do?

“We all can make a difference by being vigilant when we visit the clinics and doing our bit to create public opinion on the issue” says Dr. Sharada. When visiting a clinic look out for the following mandatory requirements. If they are not found, then inform the Laadli alliance at Population First (pradnya.s@populationfirst.org)

• Display board in local and English language stating ‘Determination of the sex of the foetus is banned and illegal’ (Rule 17(1)).

• Qualification certificate of the geneticists, gynaecologists, paediatricians, etc, to be displayed

• Registration certificate of the clinics to be displayed at a conspicuous place of business (sec19 (4) Rule 17(1)).

• You can also make a difference by

• Breaking the silence around the issue of sex selection and impressing upon people that it is against the law
• Not sympathizing with the perpetrators and justifying the crime
• Providing social support to vulnerable couples
• Be vigilant towards misuse of technology
• Value and celebrate her life in the family and community

Some reactions to our survey:

“I would like to congratulate you and your team for conducting a survey of sonography clinics in Chembur, Mumbai to see whether the procedures required under the PCPNDT act are being followed. The findings have forced the authorities to act. You have done pioneering work in an area which was hitherto ignored.”

- Julio Rebeiro (Former Mumbai Police Commissioner)

Findings of the survey

• Only 9 clinics have displayed the board stating that sex selection is banned and illegal
• Only in 6 out of 40 clinics displayed qualification Certificates of the doctors/ sonologists
• Only 22 clinics displayed the registration certificate of the clinic
• 7 clinics had not renewed their registration after it had lapsed
• Only 10 clinics had the mandatory copy of PCPNDT ACT available
• Except two, no clinic had records of referral letters
• Some sonologists are attached to 2-3 clinics and carry their own machines
• Only five clinics maintained a separate register for ANC cases No details of visiting sonologists were available in the clinics or hospitals
• In majority of the clinics signatures of the pregnant women and the doctors were missing on the declaration forms.
• F forms are also not maintained in the prescribed format
• Only 15 clinics had the ‘F’ form filled in prescribed format; But the reasons for the non invasive tests were not specified
• 14 clinics did not maintain ‘F’ form at all
• Also the summary reports giving the details of the ‘F’ form are not submitted on time to the Appropriate Authorities
• The summary reports are submitted once in 2 - 6 months
• The summary report gives only statistical information, but does not mention specific reasons regarding non invasive tests

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