Authors’ Response

Sir,

We thank the commentator for their interest in our article¹ published in the May issue of the Indian Journal of Medical Research and for acknowledging the significance of this large-scale public health initiative. We appreciate their reiteration of the challenges of attrition in maternal and paternal testing, as well as limitations in timely completion of prenatal diagnosis and decision-making².

However, upon careful review, we note that the issues raised in the comment have already been discussed in our article. In the discussion section, we explicitly highlighted the gaps related to test failures, coordinator performance, and logistical determinants, stating:

“At this stage, there still remain several questions, even from the current dataset since the outcomes for families who accepted the risks remain to be assessed. Further to this work is the reporting on the phenotypes and genotypes in different regions and provide more details on the diagnostic workflow. Reasons for failures and factors like location, coordinator skill level, and other determinants are also being evaluated”.

Additionally, we have contextualized the paternal testing challenge by referring to prior work. For example, Kulkarni et al³ have reported only ∼50 per cent paternal testing uptake during antenatal visits, while our experience demonstrated relatively higher receptivity. Similarly, Chawla et al⁴ reported substantial reluctance toward premarital β-thalassemia screening, which underscores the significance of our community-level engagement outcomes.

In this light, while the commentator has correctly drawn attention to programmatic challenges, they have not provided comparative data or novel references that would substantially add to or modify the interpretation already presented in the article. The comment largely reiterates limitations that were transparently acknowledged and contextualized by the authors themselves.

We remain grateful for the engagement with our work and reiterate that the intent of our paper was to provide operational insights from one of the largest cross-sectional datasets on antenatal hemoglobinopathy screening in India. The challenges acknowledged—attrition, timeliness, and socio-cultural determinants – are indeed the areas where we are undertaking further research and programmatic refinement.

In summary, while the comment restates acknowledged limitations, our article already recognizes these challenges and sets the stage for addressing them through ongoing programmatic improvements.