Subject Area="Monitoring, evaluation and quality control."
Objective="To improve sex ratio and to reduce the incidence of female foeticide."
Details for Reform Option "Close Monitoring and Ante-natal Care of Pregnant Ladies, Puducherry"
The Union Territory of Puducherry is consisted of four districts; Puducherry, Karaikal, Mahe and Yanam. Though the overall sex ratio of 963 per 1000 male children (Year, 2006, IPPI data) children is a respectable sex ratio still there is a need to maintain it and to counter any growing trend towards female foeticide, especially in the districts Mahe and Yanam (701 per 1000 and 920 per 1000 male infants respectively). The couples with first female child may tend to go for pre-natal sex determination in the second pregnancy and are also likely to be misguided by those health professionals who are involved in unethical practice of sex determination and female foeticide. The pre-conception and pre-natal diagnostic techniques (Prohibition of Sex Selection) Act, 1994 is being implemented in the Union Territory of Puducherry with effect from May, 2001.
A meeting with an agenda of declining trend of juvenile sex ratio, held at the Directorate of Health and Family Welfare Services, Puducherry in March, 2006 was concluded with constructive steps towards effective monitoring of second trimester scans. Besides, it was complemented with the enhanced supervision of all pregnant ladies having first female baby, by the Auxiliary Nurse Midwife (ANM) and medical officer.
Registration of the genetic clinics and the ultra sonograph scanning centres in the Union Territory of Puducherry has been made mandatory. All the registered ultra sound clinics (government or private) performing the second trimester scan (13 to 28 weeks) are compulsorily recording the indications for performing the scan and forwarding the address proof (ration card/identity card) of the person undergoing scan to the Directorate of Health and Family Welfare. The name of the gynaecologist asking for the scanned dated copy of the ultra sonogram is also furnished. Dated picture of the sonogram has to be maintained by the respective genetic clinics for all medical termination of pregnancy (MTP) cases for cross verification by the enforcing authorities. No nursing home or private clinic is allowed to perform more than 12 weeks abortions. The hospitals providing family planning procedures have been accredited. The health authorities are carrying out routine as well as surprise inspection of the ultra sound clinics. To raise awareness about the PNDT act, hoardings displaying messages have been erected at hospitals, bus stand, railway station and beach road. Advertisements in Tamil language on television cable network and auto-rickshaws are also being done. Meetings by Nehru Yuva Kendra and Mahila Swasta Sangh (NGOs on youth and women health respectively) are being conducted in the villages to educate the public about the declining sex ratio. To complement the effective implementation of the PNDT act at both the ends; health providers and the health service seekers, ANMs have been asked to closely observe and provide the antenatal care to the pregnant ladies. Pregnant ladies who have had their first female baby are strictly watched by ANMs for any lapse in their antenatal check up near to the 12 weeks of gestation period. The ANM visits the house of the pregnant ladies and tries to find out the cause of not reporting for the antenatal check up and for any visit to any nearby gynaecologist or ultrasonologist. In case, the ANM gets any clue for sex determination effort, she reports it to the medical officer. The pregnant lady is then counselled by the medical officer to remove any inappropriate health or cultural belief or any mis-guidance she might have recived from any clinician with profit interest. Patients include second time pregnant ladies having first child; a female
Results: The initiative is in the process of implementation.
Information not available.
Union Territory of Puducherry
Improved Quality: It has enhanced the quality of the songraphic diagnostic services and outreach antenatal care.
Institutional Delivery: With improvement in antenatal care and accessibility to medical officers for qualified opinions, the number of institutional deliveries should increase.
Decrease in Maternal Mortality: It will help in reduction of maternal mortality with quality improvement in pre natal, natal and post natal health service delivery.
Low Registration of Pregnant Ladies: There have been cases where pregnant ladies with an intention of having male child started hiding their pregnancy from ANMs and have not registered with them.
Baseline demographic and epidemiological data
Refresher training of ANMs in foetal well being, antenatal check up, immunization and counselling.
Sustained awareness activities against female foeticides, its implications on society et large and the PNDT act
Strong will and motivated field health staff.
Who needs to be consulted
Key informants of a community,
Directorate of Health and Family Welfare Services.
It is sustainable with supportive Information, Education and Communication activities and positive cooperation from the private health sector
Chances of Replication
It can be replicated in similar settings where literacy level is high and outreach health workers are well trained with appropriate skills, knowledge and attitudes.
It should be well communicated to the pregnant ladies during counselling and awareness campaigns that there are equal probabilities of their being misguided by the profit oriented ultrasonologists and obstetricians who are involved in illegal practice.
Dr. Anil Bhola, Research Consultant, National Institute of Medical Statistics, New Delhi January 2007