Beti Vadhao (Save the Girl Child)
Health and Family Welfare Department

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
The practice of sex selective abortion has been a critical influencer of skewed sex ratios. It has, therefore, been sought to be legally regulated or termed illegal in some countries of the world, and India is one of them. There is little doubt that strong socio-cultural and religious biases and a preference for sons in some communities have shaped societal attitudes in preference of the son. In many parts of India, community customs such as the practice of dowry are perceived as a financial burden on the bride‘s family during and after marriage. Women bearing male children are treated with respect in the community and a son is considered as a security for old age. This preference is a common, widespread social characteristic. The technological assistance – from the mid-1980s onwards – created such a powerful opportunity for people who wanted to somehow not have a baby girl that a medical boon soon transformed into its other avatar, of a sinister machinery, even industry, that started to show the negative impact that the unnatural, human-aided sex selection could have on sex ratios in different parts of the country. Child Sex Ratio (CSR) (0-6 Years) Gujarat – 928 (Yr 1991), 883(Yr 2001), 890(Yr 2011) India – 945 (1991), 927(2001), 919 ( 2011) Source- Census of India It is evident from the above that Child Sex Ratio(0-6 years) was reasonably healthy in 1991 census. But, with increasing popularity & simultaneous misuse of Ultrasonography & resulting sex selective female foeticide, the Child Sex Ratio(0-6 years) in Gujarat dropped drastically by 45 points between 1991 to 2001 census. The PNDT Act was enacted in 1996 regulating & prohibiting sex determination. Every clinic doing sonography of a pregnant woman has to fill up Form F which contains details like Name of the Clinic, Details of the patient,no of children gender wise, last menstrual period, details of referring doctor, purpose of performing sonography, report of findings and whether the findings constitute an indication for medical termination of pregnancy or not. The details of Form F can lead to a strong suspicion of doctor/clinics participating in sex determination and/or indulging in female foeticide. So due to the regulations & checks, the decreasing trend in Child Sex Ratio (0-6 years was arrested & it improved by 7 points in last decade. Still the skewed sex ratio was a matter of concern which is due to social reasons as well as misuse of medical technology of Ultrasonography / Imaging equipments. Situation before the initiative: 1.The form “F” were sent in hard copy by every clinic/ Hospital which were to be checked & analyzed at District level by staff 2.There was no centralized data available for decision making 3.There was no centralized data available for identifying offenders of The PC & PNDT Act, 1994. 4.There was no State level database 5.No Real time availability of data 6.No Uniformity in data available 7.Difficulty in handling huge data

B. Strategic Approach

 2. What was the solution?
Department of Health and Family Welfare, GoG started “BetivadhaaoAbhiyan” in 2008. As a part of concerted efforts, the State of Gujarat developed a comprehensive Beti Vadhaao web portal "http://www.betivadhaao.gujarat.gov.in", to intensify effective monitoring & implementation of PC & PNDT Act. This project was launched in January 2013. With online reporting of Form F, available details of every sonography of pregnant woman & strong Analytical application for the Form F data, the culprits indulging in sex selective Female foeticide can be suspected/ identified & the Authorities can take legal action against them. A web portal was created and User Ids & Passwords were given to every clinic for submission of data of sonography of pregnant women as prescribed in the Act through an online ICT enabled Application Complaint lodging and monitoring has been included in the application to ensure better monitoring and grievance redressal along with status update facility for all the users. Analysis of the Non compliant clinics was earlier done manually and was not 100% accurate. In this ICT enabled solution, analytical modules were added which can analyze and can tabulate the data of Form F to extract information such as list of women with number of existing female children, women with pregnancy of 12-20 weeks which is the ideal period for termination and the total number of pregnancies terminated. Earlier, manual reporting and no analytical tool meant that generating MIS was extremely difficult and prompt identification and penalization for suspicious activities was not possible. The initiative helped to solve the problem to a large extent because all doctors using sonography equipments to examine pregnant women were updating the results of the examination in online forms. The data from this forms was available to district officials easily. Earlier, the form F was submitted manually and it was impossible for them to scan through all reports and come to a proper conclusion. With prompt availability of sonography results, CoH could scan through sonography results and identify trends or patterns which point towards illegal termination of babies. Through the comprehensive information contained in Form F, CoH experts could pretty much get all the data they need for monitoring and ensuring girl child survival.

 3. How did the initiative solve the problem and improve people’s lives?
The online submission of sonography & invasive prenatal diagnostic procedures data through the Web Portal is efficient, creative & innovative. Real time information of Sonography & invasive prenatal diagnostic procedures is available through Centralized Data Base of Form ‘F’ in combination with the analytical tools available on the Beti Vadhao portal enable decision makers better assess the state’s situation . Defaulters can be easily identified. More importantly the data trend obtained through the numerous responses can be analysed and health 0fficials can easily point to suspicious activity or to cases where the women is likely to terminate the child. In both the cases, the promptness of data availability makes it easy for health officials to identify miscreants and take actions against them immediately, which discourages other doctors from pursuing any such activity. Apart from operational efficiency, this has helped CoH achieve a better male:female ration.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
Vision: - To maintain a balance of Sex Ratio at Birth (SRB) & ultimately overall sex ratio.. A Detailed study of skewed sex ratio, methods of misuse of technology, provisions of The PC & PNDT Act, 1994 (The Act for short), use of the information from sonography conducted of pregnant woman, Data of overall Sex Ratio, Child Sex Ratio (0-6 years) & Sex Ratio at Birth was done. Discussions were held between State Health Officials & NIC Gujarat regarding directions of Hon’ble High Court of Gujarat for on-line submission & details of form ‘F’. It was decided that a tool be developed which can be useful for better implementation of the Act and can help the administration comply with the directions of the High Court. Problems like motivating the Medical fraternity to fill Form F data online were identified. Initially the project was launched in Gandhinagar District of Gujarat in Jan-13 followed by roll out across all the district of the State in phased manner. A web portal was created and User Ids & Passwords were given to every clinic for submission of data of sonography of pregnant women as prescribed in the Act through an online ICT enabled Application Analysis of the Non compliant clinics was earlier done manually and was not 100% accurate. In the current system, analytics has been incorporated to ensure that the automated notices are being generated and sent to the non compliant clinics. Complaint lodging and monitoring has been included in the application to ensure better monitoring and grievance redressal along with status update facility for all the users. Active Sensitization & Problem solving exercises from District Appropriate Authority, District Information Officers (NIC) & State Officials are performed through workshops group meetings. Data is saved in a central server which can be analysed in various cross sectional mode. The Authorities can view the data for any desired period for specific clinic/ clinics and get the data exported in desired format. The data like total forms uploaded, clinics not reported, cases from outside Gujarat, Women with no. of female daughter wise, robust query module, etc. can be studied & printed. Even the form “F” of the woman concerned can be viewed & printed for necessary action.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
The initiative was led by the Commissioner of Health in the light of directions of the High Court of Gujarat. The project was implemented in January 2013. The stakeholders of the project are listed below : 1. Joint Secretary, Rural Health and Chairperson PNDT 2. Additional Director (Family Welfare), Commissionerate of Health 3. Assistant Director (Rural Health), Commissionerate of Health 4. Assistant Director (Family Welfare), Commissionerate of Health 5. Principle Systems Analyst, National Informatics Center, Gujarat 6. Systems Analyst, National Informatics Center, Gujarat 7. Medical Officer, PNDT Cell National Informatics Center provided all the technical support and assistance in development of the portal. The department provided the overall guidance and functional support in implementing the system.
 6. How was the strategy implemented and what resources were mobilized?
NIC state Centre Gujarat Officials prepared the Web Portal, analytical application, contact information & also put up a real time counter of total Form-F uploaded in the State "www.betivadhaao.gujarat.gov.in". It was done by the department at ZERO cost. The Appropriate Authorities & NIC Official at District level were oriented during the Workshops andMeetings regarding the methods of monitoring the data, trouble shooting, identifying the culprits form the data analysis and interpretation. Authorities were instructed to attend the complaint lodged in the complaint section and take necessary actions within the time framed also the authorities were instructed to compare physical and online form F & verify the details of sonography uploaded. The web portal was developed by in house support from National Informatics Center and hence financial resources required were almost negligible. At State level NIC State Level officials were involved in implementation. At the Commissionerate of Health, Assistant Director (FW) & Medical Officer, PC & PNDT Cell, Gandhinagar are responsible for administration of the web portal. At district level DIOs and Chief District Health officers are involved in rollout, monitoring and supporting the services.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The project on the whole helped to reduce manual work for CoH employees. Prompt availability of data ensured effective monitoring of sonography being performed across the state. The concrete outputs of the initiative have been listed below: 1)Creation of vast database of sonography with following add-ons. a.Data of Children with chromosomal disorder, metabolic disorder, congenital anomaly, Mental retardation, Haemoglobinopathy, sex linked disorders, single gene disorder. b.Mothers with pregnancy during advanced age (i.e >= 35 years) c.Mother/ Father/ Siblings having genetic disease. d.Pregnant women with history of genetic or medical disease in the family. e.Data of invasive procedures like amniocentesis, chorionic villi aspiration, foetal biopsy, cordocentesis etc. f.Data of laboratory tests and results of procedures like, chromosomal studies, biochemical studies, molecular studies and pre-implantation genetic diagnosis. 2)Analytical applications enabled the appropriate authorities to identify the culprits on co-relations of intelligence based information. 3)Real time availability of Sonography data with quick MIS generation. 4)Easy management and analysis of Form F data for district health officials 5)Tracking of pregnant women seeking the services of determination of sex of her foetus. 6)Long time defaulters in Online reporting can be enlisted and investigated for breach for breaching the PC & PNDT (Pre-natal Diagnostic Technique)Act. 7)Online Complaint sections facilitated any one to complain against the persons breaking the provision of the PC & PNDT Act.

 8. What were the most successful outputs and why was the initiative effective?
1)Regular cross verification of number of physical and online forms uploaded. 2)Comparing the details of Form F in physical and online forms uploaded. 3)Co-relations of intelligence based information gathered by the health personnel with the clinic suspected on the basis of online Form F information. 4)Cross checking of details of pregnant women, detection of discrepancies, field investigation regarding the breach of the Act or the MTP Act is done on a regular basis. If a breach is detected actions are taken immediately as per provisions of the ACT. 5)Every single complaint uploaded is acted upon. After a fact finding phase, necessary action is taken if essential. The actions taken are further updated on the portal which helps in monitoring progress. 6)Appropriate Authorities have been instructed to monitor the sex ratio at birth obtained from Civil Registration System & focus on the doubtful areas/ clinics. 7)Sex ratio in the deliveries conducted at the clinics every month is monitored to identify the wrongdoers.

 9. What were the main obstacles encountered and how were they overcome?
One of the biggest hurdles in implementation was to ensure that all doctors and radiologists using sonography to examine pregnant women comply with the online system and make efforts to upload all the sonography details online. This was to some extent overcome due to the fact that the implementation of the project was based on High Court directions which could not be defied without seriously endangering their medical practitioner’s license. It is however essential to applaud the spirit in which this initiative was accepted not just by public hospital doctors but by private ones too which was perhaps the biggest success. One of the pain points was to get doctors to fill both Form F and upload the data online. This was overcome through Workshops/ meetings with the concerned Professional Association to convince them that the efforts were directed towards a noble cause and that wholesome participation will benefit the state.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
. Real time information data of Sonography & invasive prenatal diagnostic procedures & availability of Centralized Data Base of From ‘F’. 2. Real time availability & analysis of data which help in Culprit identification. 3. Defaulters in reporting can be indentified easily. 4. District wise monitoring from State level. 5. Robust Query Modules to trek a pregnant woman moving around in the state to get sex determination test done. 6. Online Complaint Registration with/without declaring identify of the complainant & facility to view the status of complaint online. 7. Detection of Cross border violation of the Act by easy access and availability of tabulated Address data of pregenent women on going sonography . 8. The system creates a closed user group (CUG) of Gynecologists and Radiologists of the State having sonography machine which can be utilized for percolation of information en masse whenever needed. 9. All Stakeholders & citizens can have access to PNDT & MTP Act, Court judgments, Photo gallery, Relevant Government Resolutions, latest flash news, Sex ratio District Wise & contact information of administration officials at State & District level. 9. Availability of evidence of offence committed can be obtained from the discrepancy the details uploaded and facts obtained from the field investigation. 10. Prevention of F Feticide:- as the Appropriate Authorities constantly watching the activities of the Clinic, the Doctor refrain from committing sex determination test & female feticide. 11. The form “F” includes recording the diseases in the patient, her family, other siblings. So, the system has created a huge database of sonography, invasive prenatal diagnostic procedures & the diseases in relation to the pregnant women which eventually can be used for research and analysis like: a.Data of Children with chromosomal disorder, metabolic disorder, congenital anomaly, Mental retardation, Haemoglobinopathy, sex linked disorders, single gene disorder. b.Mothers with pregnancy during advanced age (i.e >= 35 years) c.Mother/ Father/ Siblings having genetic disease. d.Pregnant women with history of genetic or medical disease in the family. e.Data of invasive procedures like amniocentesis, chorionic villi aspiration, foetal biopsy, cordocentesis etc. f.Data of laboratory tests and results of procedures like, chromosomal studies, biochemical studies, molecular studies and pre-implantation genetic diagnosis. g.This application puts in place system for enabling control, checks & balances on illegal practice of Sex determination. h.It generates awareness to ‘Save the Girl Child’. i.The System has been designed in such a manner so as to have Long Term Impact on improving Sex Ratio & overall impact on Society. j.System has generated Trigger all over the State to bring seriousness on the issue of Saving the Girl Child.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
The Web Portal "www.betivadhaao.gujarat.gov.in" is the property of government of Gujara.It can be sustained at minimum cost of operation and it can be replicated in other states of India. Financial sustainability comes from the fact that the cost of development is almost zero and inhouse development of the web portal facilitates this. It also helps to reduce the burden of work of CoH officials by providing them Form F data promptly. This made their job of monitoring easier. Further analytical tools meant that alerts could be generated on the basis of the data entered online. The portal is transferable to other states not just as an initiative that can help to save the girl child. Just as in this case, it is possible to develop a comprehensive database in almost any field and construct research data which can prove to be crucial in their respective fields. The number of data entry done leads to creation of a massive database which acts as a source of information for various studies and researches.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
The key lessons picked up from this initiative are: 1)Most of Medical Doctors are honest barring few undertaking sex determination test for monetary return. 2)The few Doctors indulging in illegal activities, if correctly identified and acted against, can help to set an example which would lead the other wrong doers from indulging in female feticide. 3)Constant review of the data and feedback to the concerned authorities can prevent the culprits indulging in illegal activities from distrubing the sex ratio in community. 4)Change in the patriarchal mind-set of populations in general is also very important factor for improving sex ratio in the community. If demand is reduced then supply will automatically cease. 5)Multisectoral coordination, efforts from the religious leaders, dedicated NGO’s & strong leadership can play vital role in improving the skewed sex ratio.

Contact Information

Institution Name:   Health and Family Welfare Department
Institution Type:   Government Agency  
Contact Person:   Rakesh Vaidya
Title:   Assistant Director (FW) & Member Secretary (SIMC)  
Telephone/ Fax:   9925472855
Institution's / Project's Website:  
E-mail:   pcpndtgujarat@gmail.com  
Address:   Block 5, Floor 3, Jivraj Mehta Bhavan
Postal Code:   382 010
City:   Gandhinagar
State/Province:   Gujarat
Country:  

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