Chandigarh: The Indian Medical Association (IMA) Haryana unit has expressed concerns regarding the Haryana Government’s decision
that pregnant women should register with local Auxiliary Nurse Midwives (ANMs) before accessing free ultrasound services.

The IMA deemed the order inadequate and incomplete, highlighting several challenges and providing suggestions for effective implementation. Also Read:3.01 lakh new TB cases detected in 100-day campaign, says MoS healthThe 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 24×7 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.Also Read:IMA Nagpur Raises Concerns Over Strict Regulations Imposed on Small HospitalsThe 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.