Why in news?

A 45-year-old woman in rural Assam noticed a breast lump but refused to travel two hours to a cancer hospital. By the time she finally went, she had advanced breast cancer. She died six months later. A portable ultrasound at a community health camp could have given her a timely diagnosis.

But under India's current law, using an ultrasound machine outside a registered facility is a criminal offence — carrying a minimum three months' non-bailable imprisonment.

What’s in Today’s Article?

• The PCPNDT Act: Origin and Purpose
• Impact of the Act: Achievements and Unintended Consequences
• The Case for Reform: Technology Has Moved Ahead of the Law
• What Should Change: The Reform Agenda?

The PCPNDT Act: Origin and Purpose

• The Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act was enacted in 1994 to address a serious demographic and ethical crisis — the sharp decline in India's child sex ratio.
• This decline was driven by the misuse of ultrasonography for prenatal sex determination followed by selective abortion of female foetuses.
• The problem had become acute from the 1980s as imaging technology became more accessible.
• The Act was thus not merely a medical regulation — it was a response to deep-rooted gender discrimination.
• Key Provisions of the Act
  • All genetic clinics, ultrasound centres, and laboratories must be registered with district authorities.
  • Sex of the foetus cannot be communicated or disclosed under any circumstances.
  • Purchasing an ultrasound machine without prior registration of the facility is illegal.
  • Manufacturers must verify buyer credentials and obtain a written undertaking that the machine will not be used for sex determination.
  • Once installed, the machine must remain at the approved location permanently.
  • Strict patient-level documentation is mandatory for every scan.

Impact of the Act: Achievements and Unintended Consequences

• Following the Act, India's sex ratio at birth has shown gradual improvement at the national level.
• The law established a critical regulatory framework signalling societal and state commitment against female foeticide.
• Unintended Adverse Effects
  • Families with a firstborn girl — unable to use sex selection — tended to have more children to achieve a son.
  • This resulted in a 25% higher child mortality rate among firstborn girls compared to firstborn boys, likely due to reduced parental investment in girls' health.
  • Fertility increased in these families, diluting resources per child and widening gender disparities in education and healthcare.
• Continued Illegal Practices
  • Despite three decades of legal prohibition, sex-selective practices persist.
  • In October 2025, authorities uncovered an organised illegal racket in Karnataka conducting prenatal sex determination using portable ultrasound devices through informal providers and covert networks.
  • The problem is not confined to India — reports from the United Kingdom suggest son preference persists among some Indian-origin diaspora communities even in settings with stricter oversight.
  • This underscores a fundamental limitation: laws alone cannot drive social change where gender bias is deeply rooted.

The Case for Reform: Technology Has Moved Ahead of the Law

• Modern portable, handheld ultrasound devices — often connected to smartphones or tablets — make it technically feasible to bring diagnostic services directly to patients' homes and communities.
• This is particularly critical for early cancer detection in underserved rural areas where nearly 70% of India's population resides and access to specialist radiologists is severely limited.
• Currently, using such devices at the community level is illegal under the PCPNDT Act.
• High-frequency linear probes — used for detecting superficial conditions like breast cancer — are physically incapable of imaging a foetus for sex determination.
• Yet they are subject to the same blanket restrictions as conventional ultrasound machines. The law makes no such distinction.
• Role of Artificial Intelligence
  • Recent developments in AI-enabled ultrasound further strengthen the case for reform.
  • AI systems can assist with image acquisition and interpretation — in some configurations generating automated diagnostic reports based on pattern recognition without requiring full image storage or display.
  • This creates a pathway for purpose-specific, safeguarded use of ultrasound that substantially reduces misuse risk.
  • A pilot study demonstrated that portable ultrasound scans performed by individuals with minimal training, combined with AI analysis, could identify suspicious breast lesions with high accuracy — correctly flagging all confirmed cancer cases.
  • This means frontline health workers like ASHA workers or ANMs could potentially use AI-assisted ultrasound.

What Should Change: The Reform Agenda

• Technological shifts and India's high cancer burden together demand a regulatory update.
• Specifically, they recommend two changes to the PCPNDT Act.
• First, an amendment should legalise community-based ultrasound using high-frequency linear probes — since these probes cannot be used for foetal sex determination, their community use poses no threat to the Act's core purpose.
• Second, the Act should incorporate provisions addressing emerging technologies — including AI-enabled and technically safeguarded ultrasound imaging systems — designed to prevent foetal sex determination irrespective of intent.