Three years ago when Dr Tilat Rubina was appointed health officer of Athani taluka in Karnataka’s Belagavi district, she received complaints of illegal sex-determination tests being conducted by Dr S Ghodake, a homeopath at Kagwad village. Rubina reports having visited Ghodake’s clinic six times in the last three years but found nothing.

“It was always locked,” she said. “Once a boy, who I think was Ghodake’s son, opened the clinic for me and there was nothing inside except some bricks.”

Rubina said she was afraid to check on the clinic at night.

In March, police from Sangli district in Maharashtra arrested Ghodake in relation to the death of 25-year-old Swati Jamdade. Jamdade had allegedly had an illegal abortion at Bharti Hospital in Mhaisal, a town on the border of Maharashtra and Karnataka. The police contend that before the abortion, Jamdade had gone to Ghodake’s clinic, 7 km away from Bharti Hospital, for an ultrasound that would show her the sex of her foetus. Thirteen people including Jamdade’s husband and three doctors from Maharashtra and Karnataka have been arrested for running what police officials are calling an inter-state abortion racket.

Jamdade’s case shows that authorities in Maharashtra and Karnataka failed to monitor ultrasound clinics like Ghodake’s and facilities conducting illegal abortions like Bharti Hospital.

In 1994, the Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) or PC-PNDT Act made sex-determination illegal. Any individual, even a doctor, can be punished for revealing the sex of a foetus to prospective parents or members of the family. An amendment in 2004 bans gender-selection even before conception, such as by choosing embryos of the preferred gender before they are implanted in the uterus in an in-vitro fertilisation procedure.

Sex determination has been made illegal in India, because of the rampant practice of sex-selective abortions that has led to a gender imbalance. According to the civil registration system, 887 girls were born in India for every 1,000 boys in 2014.

Government officials like Rubina and the police are empowered to take action against individuals who perform, facilitate or encourage the practice of sex-determination. However, poor monitoring and enforcement of these laws have allowed clinics offering sex-determination and sex-selective abortions to flourish. For instance, the clinic run by Ghodake, who stands accused of performing a sex-determination test on Jamdade, seems to have been running a thriving business in plain sight of district authorities.

Operating with impunity

Ghodake is a 69-year-old homeopath who runs an ultrasound centre out of his bungalow in Kagwad village. People living near the facility say that, contrary to health officer Rubina’s claims, the clinic was open at all times of day and night. The landmark near Ghodake’s clinic is the Kagwad police station, less than 100 meters away.

Bungalow in Kagwad, from where Ghodake ran an ultrasound centre. Photo credit: Priyanka Vora

According to the health department records, while Ghodake owned the ultrasound centre, Dr S Patil, a radiologist from Miraj town, 30 kilometres away in Maharashtra, was registered to conduct the ultrasound tests. Health officials were never able inspect the clinic to check whether Patil or Ghodake carried out the ultrasound tests.

“I went there twice but the clinic was shut,” said Dr Appasaheb Narati, district health officer of Belagavi, reiterating his junior officer Rubina’s claim.

A rusted signboard outside Ghodake's clinic. Photo credit: Priyanka Vora.

Ghodake’s sonography facility was first registered in early 2000 and its licence was renewed twice. Since then, the centre should have submitted Form Fs to the the taluk health office.

To ensure regular monitoring, the PC-PNDT Act makes it mandatory for doctors to fill out and submit a Form F, which states the reasons for the test and the condition of the patient, every time they conduct an ultrasound procedure on a pregnant woman. Any mistakes in a Form F can attract punishment.

Inquiries by revealed that Ghodake’s clinic had never submitted any forms. Health officials could have taken action against the clinic based on this violation alone.

When contacted, Belagavi health officer Narati admitted that the department was at fault. “We should have gone and checked why he had not renewed registration, and what happened to the ultrasound machine,” he said. “I sent him a notice after I saw the news of his arrest.”

A poster lying inside Ghodake's ultrasound facility that says "Sex-selection is illegal". Photo credit: Priyanka Vora.

Where homeopaths own ultrasound centres

A homeopath is not allowed to conduct ultrasounds under the PC-PNDT Act. But in Karnataka, homeopaths and practitioners of alternative medicine are allowed to run ultrasound centres if they have registered radiologists or gynaecologists performing the ultrasounds. The radiologists or gynaecologists have to sign undertakings stating as much. In Karnataka, 21 privately owned ultrasound centres are registered under the names of doctors practicing alternative medicine.

“Radiologists have to lock the ultrasound machine and keep the key with them so no one misuses it in their absence,” said Narati who went on to say that the district had no mechanism to ensure that this practice was followed.

Following Ghodake’s arrest, Belagavi health officials sent a notice to Patil, the radiologist. “He told us that he never came to Ghodake’s clinic,” said Rubina. Neither Rubina or Narati can explain how Ghodake managed to submit an undertakings signed by Patil on three different occasions to obtain his registration and renewals.

Maharashtra does not allow homeopaths to run ultrasound centres. “In such clinic type set-ups, the gynaecologist or radiologist has to be the owner to get a registration to have an ultrasound machine,” said Dr Satish Pawar, head of the directorate of health services in Maharashtra.

Along with Ghodake, the Sangli police have arrested Dr Ramesh Devgikar from Vijayapura in connection with Jamdade’s death. Devgikar had already been booked by local health authorities last year for allegedly performing sex-determination tests. The arrests have shaken up clinics in north Karnataka. Several radiologists and gynaecologists attached to homeopath-run ultrasound centers are withdrawing their undertakings. “We will now inspect clinics and if they don’t have a radiologist’s or gynaecologist’s undertaking, we will seal their centre,” said Narati.

So far, 11 ultrasound machines have been seized in Vijayapura and eight machines have been seized in Belagavi.

Revealing information

Athani is the largest in taluk Belagavi but does not have a single government centre offering ultrasound services. The only ultrasound machine in the government hospital is not operational. This, activists said, forces people to go to private ultrasound clinics. While doctors at government hospitals are likely to keep the sex of a foetus hidden, several private practitioners like Ghodake offer ultrasounds along with information of the sex of the foetus for a premium fee. Ghodake would charge anywhere between Rs 3,000 and Rs 5,000 for such ultrasounds. An ultrasound at private clinic in a place like Athani should not cost more than Rs 500.

In Karnataka, only 189 government ultrasounds are functional as against 3,174 privately owned centres, according to the health department.

Doctors in Sangli have their boards in Kannada because thousands of patients from Karnataka travel to Miraj in Sangli for treatment. Photo credit: Priyanka Vora.

The only government ultrasound facility available in neighbouring Sangli district is at the medical college in Miraj town close to the Karnataka border. Sangli has 100 registered private ultrasound centers. Walva block in Sangli district has almost 40% of these private centers. Six people including three doctors were arrested in Walva in 2012 for allegedly performing illegal sex-determination.

“Many would still be offering sex-determination even today,” said a doctor practicing in Walva.

Sabu George, who is on India’s national inspection and monitoring committee for the PC-PNDT Act, said, “There is always a nexus between government and private doctors who would like that government ultrasounds machines don’t work. Irrespective of where the ultrasound centre is located, what we need is regulation and not just registration.”

Health authorities shift blame

Bharti Hospital, where Sangli police say Jamdade had an illegal abortion, was run by a homeopath, Dr B Khidrapure. The doctor would charge between Rs 25,000 and Rs 50,000 for an abortion, the police investigation has revealed.

By city standards Bharti Hospital is small facility but it is one of the biggest in Mhaisal. Khidrapure has a good reputation among the local populace by virtue of heading this facility and also because of his regular donations to village festivals, said Nana Kamble, a local activist and a resident of Mhaisal. The owner of the hardware shop located just opposite to Bharti Hospital described Khidrapure as a good man who was only helping sick patients.

However, the flourishing hospital did not have the required permissions, according to the district health authorities. “He had applied for registration in 2012 but it was rejected as he did not have the required number of doctors, nurses to operate,” said Dr R Hankare, the district health officer of Sangli.

Investigations into Jamdade’s case showed that prior to 2012, Khidrapure invited doctors from Miraj to operate in his facility. The operation theatre inside Bharti Hospital had accreditation from the Sangli district civil surgeon’s office to perform family planning operations such as vasectomy and tubectomy procedures.

Sangli’s district health officer Hankare is also unsure how the hospital’s operation theatre received accreditation when the hospital itself was illegal. “The civil surgeon’s office gave the accreditation, not us,” he said.

Sangli’s District Civil Surgeon Dr Sanjay Salunkhe, who accompanied the police during the raid in relation to Jamdade’s death, said that records of some caesarean sections, hysterectomy and appendectomy surgeries were found in Bharti hospital. “Doctors working with the government medical college were operating there. They should have checked, whether the hospital was legal before operating on patients there,” said Salunkhe.

In May 2016, the civil surgeon’s office conducted an inquiry into Bharti Hospital on the basis of an anonymous complaint. Dr Vijay Jadhav, medical superintendent of a rural hospital near Mhaisal who conducted the inquiry filed a report stating: “There was nothing in Bharti Hospital which suggested that there were illegal abortions.” Jadhav did not check whether Bharti Hospital had a valid registration. He also did not question nor mention the presence of the operation theatre and three rooms in the basement, which police have now established were used as a waiting area for women who had come in for abortions.

“Unfortunately, he [Jadhav] went there expecting to see pregnant women and abortions being conducted, said Salunkhe. “But, he just found some patients and Khidrapure.

Towns and villages on the Maharashtra-Karnataka border mentioned in this story.

Varsha Deshpande, an activist with the Lek Ladki Abhiyaan, has demanded that health officials who conducted the inquiry and allowed the illegal hospital to operate be made co-accused in Jamdade’s case. “If they had sealed the illegal hospital, the woman would have not lost her life,” she said.

Sangli police are also blaming the district’s health authorities. “The police can’t go and look for illegal abortions,” said Deepali Kale, deputy superintendent of Sangli police. “Here, the woman died, so it is a crime and we are investigating that. The health department is responsible for monitoring [to ensure] that unqualified people do not conduct abortions.”

The Sangli police are also attributing abortion deaths to lax health and drug regulatory authorities. “The drug used for abortion cannot be sold without a gynaecologist’s prescription,” said Kale. “Only if these drugs were not so easily available to doctors like Khidrapure, such abortions would have not occurred.”

Maharashtra’s Food and Drug Administration commissioner Dr Harshdeep Kamble blamed the Delhi drug regulator for the abortion drugs found at Khidrapure’s hospital. “We have found that the drugs were supplied from Delhi to Mumbai and then couriered to Sangli,” he said.

Even as Sangli police continue to investigate Jamdade’s case, The Hindu reported the death of another 25-year-old woman from Tumakuru district in Karnataka following complications of an abortion. The deceased, like Jamdade, had two daughters and activists have linked the death to abortion following sex-determination.

In Khanderajuri, a village 20 kilometres west of Miraj, Jamdade’s grandmother Kusum Jadhav mourned her death. A few lanes away, a family prepared to sacrifice five goats to celebrate the birth of their first male child. “But no one sees that they sacrificed so many daughters to have a son,” said the aanganwadi worker, hinting that the woman of the family had had sex-selective abortions earlier. In this village, like in several others in the area known for their rich agricultural produce of sugarcanes and grapes, one sentiment refuses to die down: “Vanshacha diva pahije.” Everyone wants a boy to carry forward the family name.

This is the second story in a series about sex-selective abortions and the continued preference for male children in Sangli. Read the first part here.

This reporting project has been made possible partly by funding from New Venture Fund for Communications.