Revisiting India’s ultrasound laws, Pg10

Key Highlights:

• The Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act restricts the use and movement of ultrasound machines, inadvertently hindering early cancer diagnosis in rural areas.
• Enacted in 1994, the PCPNDT Act aimed to combat female foeticide and address the declining child sex ratio by prohibiting prenatal sex determination.
• The Act's stringent regulations have created a "chilling effect" on service provision, impacting access to essential diagnostic care, particularly in underserved regions.
• Unintended consequences include potential negative impacts on the health of firstborn girls and increased fertility rates in families seeking male children.
• Technological advancements like portable ultrasound devices and AI-enabled systems offer solutions for community-based diagnostics but are currently restricted by the existing law.
• Despite legal prohibitions, illegal sex-selective practices persist, often utilizing portable devices and operating outside formal health systems.

Detailed Insights:

• The PCPNDT Act mandates the registration of all genetic clinics and ultrasound centers, strictly prohibiting the communication or disclosure of the foetus's sex.
• Purchasing an ultrasound machine requires prior registration with the district government as a genetic clinic or imaging center.
• Manufacturers and dealers are required to verify buyer credentials and obtain a written undertaking that the machine will not be used for sex determination.
• Once installed, ultrasound machines must remain at their approved locations, with strict documentation and patient record-keeping for every scan.
• Evidence suggests families with a firstborn girl tend to have more children, and experienced higher child mortality rates among firstborn girls after restrictions on sex selection.
• These unintended effects were more pronounced in poorer, rural households that could not afford illegal sex-selective services.
• Recent reports, such as an illegal racket uncovered in Karnataka in October 2025, indicate the continued prevalence of sex-selective practices.
• The PCPNDT Act has not kept pace with modern ultrasound technology, including portable, handheld devices and high-frequency probes used for cancer detection.
• Modern high-frequency probes, which cannot be used for foetal sex determination, are still subject to the same regulatory restrictions as other ultrasound devices.
• AI-enabled ultrasound systems can assist with image acquisition and interpretation, potentially allowing safe, purpose-specific diagnostic use without the risk of sex determination.

Key Concepts Involved:

• Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act: An Indian law enacted in 1994 to prevent sex-selective abortion by prohibiting prenatal sex determination.
• Sex Ratio at Birth (SRB): The number of live male births per 100 live female births, serving as a demographic indicator of gender preference.
• Female Foeticide: The practice of aborting a female foetus, primarily driven by societal preference for male children.