GE is committed to quality, health and safety, and reducing environmental impact throughout the product development cycle — and we extend these responsibilities beyond our manufacturing floors and research labs. GE has a social and ethical responsibility to adhere to the rule of law in the countries where our products are used, and address the negative implications of product misuse by customers, and an interest in averting the threats to the business posed by these situations.
For GE Healthcare specifically, product misuse can have severe social, legal and ethical implications. One example is in India, where allegations that ultrasound technology is being misused to facilitate female sex-selective abortions have impacted how GE ultrasound machines are sold, marketed and distributed to urban and rural customers. Addressing these allegations has required GE take a proactive approach to working with stakeholders to prevent misuse, and implement a long-term, multi-faceted approach to help encourage societal changes in support of human rights.
Background To Ultrasound Misuse In India
The misuse of ultrasound to facilitate female feticide in India has arisen despite government legislation and action. While the exact scale of the challenge in India — in terms of the numbers or statistics on female feticide — is unclear and contentious, reports suggest that this is a societal problem that is on the rise. Although the spread of ultrasound technology is not the root cause of increased reports of female feticide, the compact, portable and relatively low-cost nature of this technology does increase the complexity of administratively overseeing and prosecuting medical practitioners, companies or other individuals that misuse the technology to assist in sex-selective abortions.
The Indian government's Pre-Natal Diagnostic Techniques (PNDT) Act of 1994 is a law that prohibits the use of equipment or techniques for the purpose of detecting the sex of an unborn child.
In 2003, the government implemented the 2002 amendments to the PNDT Act, explicitly recognizing the responsibility of manufacturers and distributors, such as GE Healthcare India, to protect against female feticide. Manufacturers must confirm that their customers have valid PNDT certificates and have signed affidavits stating that the equipment shall not be used for sex determination. Manufacturers also must provide the government with a quarterly report disclosing to whom the equipment has been sold. GE’s observation is that these laws are not routinely enforced, that reports of female feticide are still commonplace, if not increasing, and that other reports point to declining numbers of female live births relative to male live births in many areas of both rural and urban India.
Understanding The Human Rights Implications
GE Healthcare, which had the benefit of experience addressing similar issues in China, worked with GE Healthcare India to increase awareness of the human rights issues at stake. Primarily, how should GE consider various human rights while still respecting cultural differences?
The selective abortion of female fetuses violates human rights protections against practices and customs based on prejudices against women. Given the multiple uses for ultrasound in obstetrics and gynecology, restricting access to the technology would conflict with the human rights goal of reaching the highest standards of health. In addition, while sex-selective abortion is technically illegal in India, there is evidence that non-compliant or unscrupulous practitioners still perform sex-selective abortions, sometimes outside of a hospital or through procedures that are performed by an unlicensed practitioner, putting a mother’s health at risk, if not their lives. There is also concern that women may be forced to undergo coercive abortions when they do not share the discriminatory views of their families or communities.
The human rights associated with female feticide are indirectly referenced by two of the eight UN Millennium Development Goals: “promote gender equality and empower women” and “improve maternal health.”
Indeed, the use of ultrasound goes well beyond obstetrics and gynecology, and GE has donated ultrasound technology throughout the developing world for many years in connection with established product donation programs in response to crises such as the Indian Ocean Tsunami and South Asia earthquake. An obvious paradox results: the same technologies that further some human rights can be misused in a way that greatly undermines other human rights.
The Challenge For GE Healthcare India
The first challenge for GE Healthcare India, which strenuously denied accusations of statutory or human rights violations, was to ensure and communicate that the company was taking all necessary measures to avoid even the appearance of any form of complicity. GE Healthcare India’s approach to this human rights dilemma has evolved over time and can be compared and contrasted to the company’s response to reports of misuse of ultrasound technologies for gender selection in China, which initially received greater focus due in large part to China’s “one child” policy.
Like in India, preferences for male children exist in some societies in China. And, like India, China passed legislation outlawing the use of ultrasound for gender selection (however Chinese law does not place liability for misuse on manufacturers). In both India and China, GE Healthcare took actions that went beyond what was legally required. However, when in 2006, Indian activists began linking GE with this human rights dilemma through international media outlets, the company understood that these criticisms posed even greater threats to its reputation and market growth and that more action was needed.
Similar to GE Healthcare in China, GE Healthcare India wanted to demonstrate that it was stringently screening potential ultrasound sales and taking precautions to avoid the post-sale misuse of the ultrasound technology. Since 2000, GE Healthcare India has worked through a combination of training programs, amendments to legal contracts, regular auditing, and rigorous sales screening and tracking, to increase the stringency of the sales review process. These actions were taken well prior to 2003, the year when the PNDT Act’s amendments imposing liability for manufacturers were implemented, and go beyond the manufacturers’ legally required controls.
GE’s Actions To Prevent Ultrasound Product Misuse
At present, a single sale of GE ultrasound equipment goes through up to five internal checks — from the initial sales contact to equipment installation — to verify that the customer has a valid PNDT registration certificate. As noted above, a valid PNDT registration certificate means that the clinic or the user is registered with the local government and provides an affidavit that it will not conduct fetal sex selection using the equipment. Machines are labeled with a sticker that warns that “fetal sex determination is illegal and punishable by law.”
Sales people are trained on how to advise end users of the equipment on the implications of the PNDT Act and to escalate any concerns about observed or suspected non-compliance to their managers. They are also encouraged to balance their desire to increase equipment sales with the caution to not participate in sales that may end up in the hands of unscrupulous or unlicensed practitioners. Even if a potential customer has a valid PNDT certificate — but the sales person senses from a customer’s comments or behavior that the equipment may be used unethically or fall into the wrong hands — the sales person is required by GE Healthcare to terminate all sales discussions.
This screening process does not end after the equipment’s sale. A practitioner must also present a valid PNDT registration certificate before having the equipment serviced by GE Healthcare India or purchasing updated accessories. These internal policies and trainings were seen as necessary steps in increasing safeguards during the sales process to lower the risk that the equipment would be misused.
Raising Public Awareness Of Female Feticide
In an effort to further address the issue of female feticide, GE Healthcare India recently launched a poster campaign that encourages the public to think proactively about how to change attitudes about female feticide, the status of girls and women’s rights. GE Healthcare India has also designed new CSR programs, among them, social investment in initiatives that promote education and equality among girls in India. GE is sponsoring a young, female, Indian tennis star who can set a positive example for a more progressive role for women in Indian society.
GE Healthcare has also taken the initiative to meet with government officials to share information about its internal controls and sales practices that go beyond the PNDT Act’s requirements. GE has called upon the government to increase enforcement activities and education programs and pushed for industry-wide action. With the support of activists, GE Healthcare India executives have reached out to other companies through the Confederation of Indian Industries (CII) to address the problem of female feticide. GE Healthcare believes this type of engagement has paid off by boosting the company’s reputation among reputable practitioners and by changing activists’ attitudes toward GE Healthcare India and its sales practices.
Since 2007, GE Healthcare India executives have met with many of the critical activist group leaders. Through these meetings and through GE Healthcare India’s systematic efforts to increase safeguards in the sales process, executives feel they have been successful in engaging and educating these stakeholders about what GE Healthcare is doing to lower the risk of misuse of its ultrasound equipment.
In reflecting on their experiences in India, GE Healthcare executives focus on the idea that the most effective approach to these types of challenges requires action on several levels.
The first step in approaching human rights challenges requires an internal look to make sure that GE is not only obeying the rule of law, but also conducting itself in a way that is both supportive of human rights and culturally sensitive. The second step, GE Healthcare India has learned, is to move beyond vigilance of one’s own operations and think creatively about how GE can contribute to the wider societal change that must take place in order to tackle the root cause of these challenges to human rights.
GE Healthcare India’s ongoing experience demonstrates how a major corporation can, through collaboration with the government and other stakeholders, help to advance important human rights, while at the same time, work within the bounds of its commercial strategy. It also provides examples of steps a manufacturer can take to reduce the risk that its products will be misused in ways that violate human rights.