Haryana: Mandatory pregnancy registration for ultrasound sparks Ethical, Privacy concerns

The IMA deemed the order inadequate and incomplete, highlighting several challenges and providing suggestions for effective implementation.

The association has submitted a letter to the Director-General of Health Services in this regard. While extending their support, the association members stated that it is a great initiative of the Haryana Government, as there is a pregnancy loss of nearly 10-15% at 12 weeks, and this may help in identifying and preventing this loss. Similarly, active monitoring will stop the misuse of facilities and may help in stopping female foeticide.

However, the association found the order to be issued in haste and considered it ‘incomplete’ as it was issued without considering its implications and implementation problems. First, the association pointed out that there may be unwanted/unplanned pregnancies or pregnancy in unmarried females or someone wanting to undergo an abortion. Such patients may not be comfortable sharing details with ANM in their neighbourhood and may resist reporting to the formal system of medicine, and go to quacks, leading to a risk to their health and life.

Secondly, in urban areas, it may be difficult to locate concerned ANMs, and people may not be comfortable with putting in the effort to locate them. RCH (Reproductive Child Health) registration with ANM will not be a 24x7 service. They may be on leave, or their phones may be switched off at times. Moreover, the first trimester in pregnancy poses a lot of difficulties in diagnosis, like ectopic pregnancy, threatened abortions, etc, which are some life-risking events and need to be established by a qualified gynaecologist. "Ultrasound is also a basic investigation that establishes the diagnosis in such cases. Denying them services in the name of registration will be risky for their life," added the association.

Furthermore, if an unregistered patient comes in an emergency or bleeding, or a patient from out of district or state comes without an RCH ID, it will not be ethical to send the patient to ANM first to get an RCH ID. The association also pointed out that this may give an undue advantage and power to ANMs, and they may guide/misguide patients to go to a particular centre or ultrasound centre, thus leading to malpractices.

Pointing out the legal problems, the association stated that this order may require changes in the PNDT Act, which requires changes at the level of the Center, and without any Gazette notification, it may be open to judicial challenges. “This order totally negates the already existing MTP law, which was solely constituted to state that a woman's reproductive rights lie solely with her if she is not a minor. That is why MTP law does not require permission of even the husband or legal guardian and can be done on request of the woman alone,” the association mentioned in the letter.

The confidentiality clause in the MTP Act, which prohibits the law from disclosing the identity of a woman seeking abortion, cannot be maintained if she is forced to get mandatory registration with the local area ANM before performing these procedures, as they mandate an Ultrasound as a prerequisite.

The association suggested that online access for registration on the RCH portal must be given to treating doctors also. The doctor also suggested that, as sex determination usually takes place at 14-16 weeks of pregnancy, registration should be mandated for pregnancies more than 10 weeks. This will also prevent unwanted pregnancies from being terminated in the informal sector.

“Handling of an emergency case must be clearly chalked out in the guidelines. Sometimes, maybe given in such cases so as not to hamper their proper treatment. Sir, we are sure that properly formulated guidelines for registration of pregnant females will lead to a higher sex ratio and lower maternal mortality. We are totally in this endeavor with you all,” the association added.