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“It’s a girl!”— could be a death sentence
All editorial matter in
CMAJ represents the opinions of the authors and not
necessarily those of the Can adian Medical
Association.
CMAJ Editorial
© 2012 Canadian Medical Association or its licensors
CMAJ 1
See related News article by Vogel at
www.cmaj.ca/lookup/doi/10.1503/cmaj.1094091
When Asians migrated to Western countries they
brought welcome recipes for curries and dim sum.
Sadly, a few of them also imported their preference
for having sons and aborting daughters. Female
feticide happens in India and China by the millions,
but it also happens in North America in numbers
large enough to distort the male to female ratio in
some ethnic groups.
1–4. Should female feticide in Canada be ignored
because it is a small problem localized to minority
ethnic groups? No. Small numbers cannot be ignored
when the issue is about discrimination against women
in its most extreme form. This evil devalues women.
How can it be curbed? The solution is to postpone
the disclosure of medically irrelevant information
to women until after about 30 weeks of pregnancy.
A pregnant woman being told the sex of the fetus at
ultrasonography at a time when an unquestioned
abortion is possible is the starting point of female
feticide from a health care perspective. A woman has
the right to medical information about herself that
is available to a health care professional to
provide advice and treatment. The sex of the fetus
is medically irrelevant information (except when
managing rare sex-linked illnesses) and does not
affect care. Moreover, such information could in
some instances facilitate female feticide.
Therefore, doctors should be allowed to disclose
this information only after about 30 weeks of
pregnancy — in other words, when an unquestioned
abortion is all but impossible. A similar proposal
has been made elsewhere.
5.
Postponing the time when such information is
provided is a reasonable ethical compromise. It
would still allow prospective parents enough time to
prepare the nursery. The College of Physicians and
Surgeons of British Columbia states that testing to
identify sex during pregnancy should not be used to
accommodate societal preferences, that the
termination of a pregnancy for an undesired sex is
repugnant and that it is unethical for physicians to
facilitate such action.
6. The college in Ontario states that it is
inappropriate and contrary to good medical practice
to use ultrasound solely to determine the sex of the
fetus.
7. The Society of Obstetricians and
Gynecologists of Canada says that the problem of the
small number of pregnant women who may consider
abortion when the fetus is of unwanted sex is best
addressed by the health professionals who are
providing care for these women, but it does not say
how this can be done effectively.
8. These statements do little more than
provide lip service to tackling female feticide and
a band-aid for the souls of those who draft policy.
Fortunately, the Canadian Assisted Human
Reproduction Act of 2004 prohibits any action that
would ensure or increase the probability that an
embryo will be of a particular sex or identifies the
sex of an in-vitro embryo, except to prevent,
diagnose or treat a sex-linked disorder or disease —
thus closing this avenue for sex selection.
9. The colleges need to rule that a health
care professional should not reveal the sex of the
fetus to any woman before, say, 30 weeks of
pregnancy because such information is medically
irrelevant and in some instances harmful. Doing so
should be deemed contrary to good medical practice.
Such clear direction from regulatory bodies would be
the most important step toward curbing female
feticide in Canada.
Some readers might be skeptical about whether female
feticide is in fact taking place in Canada and the
United States. Research in Canada has found the
strongest evidence of sex selection at higher
parities if previous children were girls among
Asians — that is people from India, China, Korea,
Vietnam and Philippines.
2.
What this means is that many couples who have
two daughters and no son selectively get rid of
female fetuses until they can ensure that their
third born child is a boy. These researchers have
also documented male-biased sex ratios among US-born
children of Asian parents in the 2000 US census.
3.
A small qualitative study in the US involving 65
immigrant Indian women documents the pressure they
face to have sons, the process of deciding to use
sex selection technologies, and the physical and
emotional health implications of both son preference
and sex selection. Of these women, 40% had
terminated pregnancies with female fetuses and 89%
of the women carrying female fetuses in their
current pregnancy pursued an abortion.
4. Results from this study could be
reasonably extrapolated to Indians in Canada. We
should, however, avoid painting all Asians with the
same broad brush and doing injustice to those who
are against sex selection.
The execution of a “disclose sex only after 30
weeks” policy would require the understanding and
willingness of women of all ethnicities to make a
temporary compromise. Postponing the transmission of
such information is a small price to pay to save
thousands of girls in Canada. Compared with the
situation in India and China, the problem of female
feticide in Canada is small, circumscribed and
manageable. If Canada cannot control this repugnant
practice, what hope do India and China have of
saving millions of women?
Rajendra Kale MD | Editor-in-Chief (Interim) |
