Britain's state-funded health service has published plans to ensure hospitals know where their surgical instruments are coming from, after acknowledging that some may be produced by child laborers in Pakistan. Many of the scalpels and forceps used in Britain, the U.S., and other Western countries are manufactured in the Pakistani city of Sialkot. Surgical instruments are among Pakistan's major exports, but labor activists say many are made in workshops by child laborers. The proposed National Health Service guidelines call on hospitals to introduce "ethical procurement" policies and to consider labor standards when they are buying goods.