The whispers were few and far between. They gave a sketchy but chilling account of a trend in Telangana’s Warangal district.
Still, nothing concrete was seen on the surface. The hushed voices — on and off — kept telling of girls being eliminated even before they are born.
Dr Venkat Ramana, the District Medical and Health Officer in Warangal, froze when the whispers reached his ears. He decided to get to the root of the matter. Months later, his efforts paid off.
He initiated a probe, albeit clandestinely, with the help of ASHA (Accredited Social Health Activist) and ANM (Auxiliary Nurse Midwife) workers, the department’s eyes and ears at the grassroots level.
“When something like this (largescale illegal abortions) happen, you hear murmurs about it. For two months we kept vigil with the help of our ASHA and ANM workers on the ground,” Dr Ramana told South First.
Meanwhile, Dr Ramana also noticed a skewed male-to-female sex ratio among the newborns in mandals bordering the Mahabubabad district. He found it disturbing since it cemented the suspicion of largescale illegal termination of pregnancies being conducted in parts of the district.
“The Nekkonda Mandal, situated in the Warangal district, shares its border with the Mahabubabad district. We noticed a significant disparity in the sex ratio of male and female children within the mandal,” he said.
The probe begins
The ASHA and ANM workers form the Health Department’s infantry. “They conducted a comprehensive door-to-door survey. The primary objective of the survey was to determine the number of male and female births in the area,” Dr Ramana explained.
The survey results were collated and compared with the KCR Kit records.
The KCR kit is an initiative in Telangana to provide comprehensive healthcare and support to pregnant women and newborns. The KCR kit is designed to ensure safe and healthy pregnancies, promote institutional deliveries, and empower women with the necessary resources.
The kit contains essential items that are beneficial during pregnancy and childbirth. It typically includes items such as clothes for the mother and newborn, baby care products, maternity essentials, nutrition supplements, and educational materials on maternal and child health.
They are provided free of cost to eligible pregnant women in government healthcare facilities.
He probed further. The department diligently monitored every nursing home and scanning centres. It checked the documents about all scans and abortions.
Results start showing
The surveillance soon gave results. The department unearthed grave discrepancies in the details Balaji Multi-specialty Hospital at Narasampet had provided.
“The hospital was served a notice. We asked for a written explanation about the discrepancies The hospital failed to provide a satisfactory reply. So, on 13 May, we served another notice and seized the scanning machine,” Dr Ramana explained.
Dr Ramana felt that it was merely the tip of the iceberg. He turned to the local police for support, and a plan was drawn up to root out the evil.
“The police, armed with our information, got to know of a broker who was in touch with the person at the scanning centre. The investigators sent a decoy customer — a pregnant woman — to the broker,” Dr Ramana said.
The broker led the women to the kingpin of the racket, Vemula Praveen. The police soon found that the racket involved registered medical practitioners and private nursing homes.
And on Monday, 29 May, in a joint operation by the Anti-Human Trafficking Unit (AHTU), Health Department officials, and the Kakatiya University Campus (KUC), the police busted the 18-member gang.
By then, the gang had conducted dozens of prenatal gender-determination tests and about 100 abortions.
The police said Vemula Praveen had worked as a technician in scanning centres. Together with his wife, Sandhyarani, he rented a house in Venkateshwara Colony, Gopalpur, and set up a sex-determination centre.
Prenatal sex-determination is illegal
Since the implementation of the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act in 1994, sex-determination tests have been banned in India.
However, despite strict regulations, some lab technicians circumvented the system and continued performing these illegal tests.
Meanwhile, the Health Department, responsible for enforcing the PCPNDT Act, has been actively devising strategies to combat these unlawful activities.
They face the challenge of navigating through various numbers and localities to identify instances of such crimes occurring in different towns.
Once identified, the Health Department is supposed to make dedicated efforts to apprehend the culprits involved in these unlawful practices.
This was once instance these efforts were made in a sustained manner — and finally bore results with the arrest of the gang.
The Health Department officials of the primary health centres (PHCs) concerned came to know of the skewed sex ratio through ASHA workers. They were also informed that local “brokers” were getting in touch with some illegal persons who conduct sex-determination tests and later facilitated abortions if the baby was a girl.
“Accordingly we checked the records and got suspicious about the hospitals where these abortions were taking place,” Dr Ramana explained.
Warangal Commissioner of Police AV Ranganath said that decoy operations were conducted to gather evidence on the health department’s complaint.
“The gang operated by conducting a large number of abortions at various hospitals, and they charged between ₹20,000 and ₹30,000 for each abortion. An estimated 100 illegal abortions have been performed,” the commissioner said.
Dr Ramana also said that the accused Vemula Praveen was earlier arrested for indulging in illegal activities when he was a technician. He later went to Warangal Rural district where he set up an illegal sex determination scanning center.
He allegedly partnered with registered medical practitioners (RMPs), hospital public relations officers (PROs), private hospital management, medical staff, and some doctors to establish the nefarious network.
Steps to keep vigil
Every month, district health officials collect data on patients who undergo scans at scanning centers.
“After they become pregnant, they have to register with us and undergo Anti Natal Checkups (ANC). We verify their registration on the KCR Kit Portal and cross-check their history,” Deputy DMHO of Mahabubabad district Dr. C Uma Gowri told South First.
“We maintain their records. They have to come three times for ANC and we maintain the data,” she said.
She added that if some women fail to turn up for the ANC on time, the department tries to get information on them through the ASHA or ANM workers.
If a woman seeks the help of private nursing homes after her second or third ANC, it would be a red flag for the department, Dr Ramana added.
These are the parameters officials have been employing to draw conclusions. If pregnant women fail to turn up for follow-up visits, it may indicate two possibilities: Abortion, or seeking care in the private sector.
For abortions, scanning centers and nursing homes should fill out forms and inform district officials about the circumstances under which they are performing MTPs (Medical Termination of Pregnancies), such as the health condition of the foetus.
“Typically, patients who undergo MTPs will have to undergo scanning. We gather the necessary information, such as dates and hospitals, and directly communicate with the beneficiaries,” Dr Gowri said.
“We also enquire with the hospitals. In cases where nursing homes show signs of exclusively conducting female foeticide, we double-check,” she added.
If pregnant women approach the private sector, health officials keep vigil. “After birth, they have to register it on the e-birth portal from where we provide the KCR Kit to these women,” Dr Ramana said.
Dr Gowri added that when women register early at PHCs, it becomes easier to track them. If they don’t show up and visit scan centers and nursing hospitals, there will be a paper trail leading to the truth.
Monitoring is key
Dr Ramana said monitoring the number of male and female children born is important for district medical officers.
“To aid this process, we will seek assistance from NGOs. Additionally, we will hold monthly meetings for ASHA workers in PHCs. During these meetings, medical officers educate the workers about sex-determination, the PCPNDT Act, and the MTP Act,” he said.
“We also inform them about how to report any instances of illegal practices to the medical officer and the importance of remaining vigilant if pregnant women are not coming for follow-up visits,” Dr Ramana explained.
“We collect data on the number of patients who come for antenatal check-ups, the gestational age, and the number of deliveries in each center. This data will be reported to the district authority every month and entered into the e-birth portal,” he added.
To accurately determine the number of male and female children, and whether they were delivered naturally or via Caesarean section, the details will be entered into the portal. It provides an accurate census of male and female children. Both private and government facilities should update the portal.
Dr Gowri said women often confirm pregnancy through urine tests and avoid government facilities.
“Through the help of some Registered Medical Practitioners (RMPs), they want to determine the sex of the baby. So the RMPs don’t inform the PHCs that a woman is pregnant,” she said.
They maintain secrecy until the sex of the baby can be confirmed around 16 weeks. Then they visit the nursing centres. These activities involve a nexus of scan centres and RMPs,” she explained.
Some centers terminate the baby between 16 to 20 weeks. They terminated the baby if the foetus turns out to be a female. And if it is male, they register at government facilities,” she added.
Dr Ramana added that the installation of ultrasound machines requires proper authorisation from the authorities concerned. It is illegal to install them without permission.
“Furthermore, the accuracy of ultrasound results may vary if conducted by unqualified doctors. Proper resolution and quality are essential for clear ultrasound images,” he said.
“Mistakes could occur due to the inaccuracy and lack of clarity in ultrasound images. There are cases registered where RMPs diagnosed a foetus as female and later during the abortion, it turns out to be male. It has led to tension involving the scanning centres and the woman’s relatives,” he said.
“It is important to note that these individuals are not RMPs, but brokers. This is a business that should not be supported,” Dr Ramana asserted.