Promoting Ethical Ultrasound Use in India A BLIHR Emerging Economy Case Study from GE – January 2009 Introduction: The Benefits and Burdens of Ultrasound Technology The distribution of compact, portable ultrasound technology in India offers significant potential health benefits to millions who suffer from painful or potentially lifethreatening diseases, such as breast cancer, uterine fibroids, cardiac disease and gynecological disorders. Ultrasound technology also has the potential to increase efficacy and early detection in diverse medical fields such as anesthesia delivery, cardiac surgery, sports medicine, and emergency medicine. Ultrasound is also uniquely powerful in that it is the only imaging technology that can be transported to a patient or used where a patient might most urgently need it – whether on the side of a road after a serious motor accident or in remote communities where a patient may have to travel for several hours just to reach a basic primary health center. When one considers this vast scope of medical applications, along with the great need for imaging technologies among rural and urban populations in India, it is clear why India’s ultrasound market poses both a significant business and public health opportunity. Over the last decade, however, some civil society groups have focused on ultrasound technology as a cause of increased rates of female feticide in India. In India, as in certain other countries and cultures, there exist deeply rooted historical preferences for male children. Observers have noted that these preferences are driven by a combination of cultural and economic factors. Traditionally, Indian parents are expected to pay expensive dowries to their daughter’s future husband’s family to which the parents then “lose” her. In a country without a social security system, male children are often viewed as their parents’ long-term security when girls are expected to marry and eventually leave home. Yet, the economic concerns are only one part of the story. In fact, the numbers of female vs. male births have been dropping most quickly among wealthy, urban populations, specifically in northern Promoting Ethical Ultrasound Use in India A BLIHR Case Study from GE
India. This trend suggests that economic security alone will not safeguard female fetuses. Allegations that ultrasound technology is misused to facilitate female feticide in India have arisen despite government legislation and action to reduce rates of female feticide through prohibition of sex-selective abortions. In 1998, the Indian government authorized the “Pre-Natal Diagnostic Techniques” (PNDT) Act of 1994, a law that prohibits any person or body from using equipment or techniques for the purpose of detecting the sex of an unborn child. There are exceptions for diagnoses of specified sex-linked diseases or disorders. The law also prohibits anyone from communicating the sex of the fetus if it is detected during a pre-natal examination or diagnostic test. The law requires, among other things, that all practitioners, clinics, genetic counseling centers, etc. that perform pre-natal diagnoses register with the government, obtain a certificate of registration, and display a notice regarding the prohibitions on fetal sex detection. Then in 2004, the government implemented the 2002 amendments to the PNDT Act, explicitly recognizing the responsibility of manufacturers and distributors to assure proper use of ultrasound equipment, prohibiting them from selling, renting, permitting or authorizing the use of ultrasound machines for fetal sex determination, and imposing criminal punishment such as fines and jail time. Manufacturers must confirm that the customer has a valid PNDT Certificate and has signed an affidavit stating that the equipment shall not be used for sex determination. Manufacturers also must provide the government with a quarterly report disclosing to whom the equipment has been sold. GE has observed that these laws...
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