Product misuse

Misuse of company's ultrasound technology to facilitate female sex-selective abortions
GE Healthcare
GE Healthcare is a unit of the General Electric Company (GE) and is headquartered in the UK.
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Dilemma: Potential misuse of GE Healthcare ultrasound technology for female feticide

The challenge facing GE in India was the potential misuse of its ultrasound technology for selective feticide. While the company seeks to respect cultural differences in various regions of its operations, the company recognised that uncontrolled access to technology that can detect the sex of the fetus might be problematic in locations where discriminatory attitudes against women are prevalent. Selective abortions, assisted by GE technologies, could put the company at risk of not only breaching national law, which explicitly recognises the responsibility of manufacturers and distributors to protect against female feticide, but also poses serious reputational risks and makes it potentially difficult for the company to pursue other business operations in the country.

On the other hand, ultrasound has multiple uses in obstetrics, gynaecology and emergency medicine. The product is compact, portable, relatively low-cost, and serves a variety of unique purposes. As a result, restricting access to the technology altogether would have conflicted with the human right to pursue the highest attainable standards of health.

Good practice: Engaging stakeholders and influencing societal changes in support of human rights

GE Healthcare India has implemented successful practices – already developed by GE Healthcare China – through the establishment of policies that surpassed domestic legal requirements. GE Healthcare India has also worked to increase the stringency of the sales review process and to avoid post-sale misuse of ultrasound technology through a variety of initiatives. These include training programs for sales staff, amendments to legal contracts, regular auditing, and rigorous sales screening and tracking. These actions were taken prior to the imposition of liability on manufacturers and distributors like GE Healthcare India by the Government of India – and went beyond the manufacturers’ legally required controls.

Each transaction involving ultrasound equipment goes through up to five internal checks. Before a sale can proceed, GE Healthcare India verifies that the customer has a valid Pre-Natal Diagnostic Techniques (PNDT) registration certificate, as required by the PNDT Act of 1994. A valid certificate indicates that the user is registered with the local government and is aware that conducting fetal sex selection activities using the equipment is forbidden. Machines are labelled with a sticker warning that ‘fetal sex determination is illegal and punishable by law’.

Sales contracts and dealership agreements contain standard terms and conditions to ensure compliance with the PNDT Act. Sales people are trained on how to advise end users of the equipment on applicable legal requirements, and to alert their managers to cases of observed or suspected non-compliance. Absence of a valid PNDT certificate is considered a valid reason to terminate a sale, as is reasonable suspicion that equipment may be misused.

The screening process continues after the sale, as health practitioners are asked to present a valid PNDT certificate before having the equipment serviced by GE Healthcare India – or when purchasing accessories. Since 2004, GE Healthcare has consistently submitted its quarterly sales data and customer lists to the Indian government.

To further address the challenges, GE Healthcare India has launched various poster campaigns aimed at raising public awareness, as well as the status of women in India. It has also designed a new CSR program that, among other things, promotes education and equality among girls in India.

In addition, GE has initiated a dialogue with Indian officials to urge them to increase enforcement activities and education programs. Through the Confederation of Indian Industries, GE Healthcare India has engaged with other companies to address female-sex selective abortions. This includes working with healthcare trade associations to draft industry guidelines on ultrasound sales and usage.

Results: Changed perception of actions needed to mitigate the risk of product misuse

GE Healthcare India executives believe that the most effective approach to these kinds of challenges requires action on several levels. The first step is to obey the law, support human rights and demonstrate cultural sensitivity. GE Healthcare India believes the second step is to contribute to tackling the root cause of the challenge – and go beyond narrow oversight of the company’s own operations. The third step is to cooperate with the government and other stakeholders who can both help advance human rights, while keeping the company within the bounds of its commercial strategy. Together, these approaches can help reduce the risk that the company’s products will be misused to undermine human rights.