Ultrasound – a killing machine in India?

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Ultrasonography has been used for sex-selective abortion. We need stringent laws to deter such practices. However, the laws should not become a deterrent for ethical use of ultrasonography.

India is one of those countries that have a negative female sex ratio. This simply means that the number of women in India is less than the number of men in India. There are only 943 women per 1000 men in India as per the 2011 census.

Some of the reasons for the negative female ratio in India include genetic or natural causes, preferential feeding habits in below poverty line (BPL) population, neglect of care of female children among BPL households, pregnancy-related complications among women and sex-selective abortions.

“Modern diagnostic technologies are used by medical professionals to diagnose the sex of unborn fetuses and abort female fetuses. This has to be strongly condemned.”

If ultrasonography (USG) machines were to be the sole reason for negative female sex ratio, the ratio should have fallen after 1986. Instead the statistics show that the female sex ratio improved after introduction of USG machines into clinical practice in India.

2011 943 949 929 10
2001 933 946 900 6
1991 927 938 893 -7
1981 934 951 879 4
1971 930 949 858 -11
1961 941 963 845 -5
1951 946 965 860 1
1941 945 -5
1931 950 -5
1921 955 -9
1911 964 -8
1901 972

 

The chart proves that the sex ratio that was 927 females per 1000 males in the 1991 census, improved after USG machine became popular and improved to 933 per 1000 in 2001. As USG machines have become ubiquitous in the new millennia, it further helped the female sex ratio to improve. It improved to 943 per 1000 men in the year 2011.

USG helped increase female population by helping to detect pregnancy-related complications early and treat them. The improving female sex ratio is also a reflection of improved medical care to women and USG machine is the revolutionary gadget that contributed to that.

What is ultrasonography?

There are a few revolutionary milestones in the history of modern medicine. Rene Laennac invented stethoscope in the year 1816 because he found it very uncomfortable to keep his ears on the chest to hear heart sounds especially of a woman. Wilhelm Conrad Röntgen invented X-Ray in the year 1895 which revolutionised modern medical practice such that it was the first investigation to give information on what is inside the body.

But the investigation that changed the medical practice is ultrasonography. It uses sound waves and hence is safe for humans of any age and unborn fetuses. It is also used for animals!

Ultrasonogram can give very valuable information about almost any surgical condition in the body in less than a minute, whether there is blood or free air in the abdomen. It can tell you how much blood is inside. It can tell you whe/ther one of the solid organs is injured. It is non-invasive and accurate enough in the clinical settings.

“Ultrasound machines can now diagnose virtually any fetal anomalies. USG examination is the essential investigation for all ante-natal mothers.”

Why USG machine has become a villain?

When USG machine came to India and became popular in the 1980s, few anti-social elements used the modern innovation to detect the sex of fetuses and abort female fetuses. It became a business and scan centers that overtly or covertly advertised that they would reveal the sex of fetus mushroomed.

“A handful of ‘civil society’ activists decided that USG machine is the single  cause of negative female sex ratio in India and went on to win a legal battle to regulate the use of ultrasound. Government of India (GOI) legislated to regulate the use of USG machine that has now been viewed as the ‘fetus killing machine’.”

Current scenario?

Ultrasonography has been used for sex-selective abortion. We need laws to deter such practices. However, the laws should not become a deterrent for ethical use of ultrasonography. Just because knives are used to kill people, use of knives cannot be banned.

“The GOI has come up with stringent laws to curb female sex-selective abortion. In practice, the laws are used to curb liberal use of USG in clinical practice. It is a wrongly directed move.”

USG will help save lives of women. It is the one and only gadget that can improve maternal health and improve female sex ratio.

The Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act in its present form is misdirected. What is more disheartening is that the medical professionals themselves are not standing up to protect the use of this essential clinical accessory. USG should be a gadget that can be used by any registered medical practitioner. Undergraduates should be trained to use USG in their clinics.

“The recent effort by the GOI to make the use of USG as a gadget for expert use is retrospective. It mandates that all undergraduate medical practitioners who are practicing USG should undergo an examination to validate their certification.”

It is not necessary. It is true that certification is the one way of ensuring quality. Definitely a person who has not studied MCh Cardiothoracic Surgery but has been performing open heart surgeries because of his work experience cannot and should not get legal validation.

However, USG is non-invasive. It is a matter of fact that doctors without a degree in radiology, but committed to USG practice for more than a decade are far more efficient than a fresh radiology graduate with less clinical exposure. Just to recall, the father of medical ultrasonography in Tamil Nadu, Dr. Suresh and his colleague Dr. Udayakumar still do not have any radiology degrees. They have taught more radiologists on ultrasonography than the biggest medical institutions in India.

“The recent order has put senior practicing sonologists into a lot of mental stress. I am surprised that our radiologist colleagues also see these practicing sonologists as their competitors.”

The questions for these examinations taken by doctors in their 40s and 50s appear to have been deliberately set tough.

The medical profession should fight its right to use USG liberally in its day-to-day practice. USG machines have evolved over time. The time when a gadget as small as an ear plug can be connected to your android phone and installing an application will turn your cell phone into an ultrasound machine, is not far. Then triage of road traffic victims can be effectively done and lives can be saved if a qualified doctor with a cell phone is available.

“Our country should prepare to make these scientific developments easily available for patient care. Laws governing the use of USG should be accommodative of these requirements. In India, PCPNDT is all about restricting the use of ultrasonography.”

The only way out would be to liberalise the use of USG machine akin to the use of stethoscope or knife. A different strategy based on scientific study on negative female sex ratio should be evolved to address sex-selective abortion.