Selective abortions prompt call for ultrasound rules

A fetus's gender should not be revealed until after 30 weeks of pregnancy, says an editorial in the Canadian Medical Journal.

This change in procedure for a fetal ultrasound, where the sex is usually disclosed to parents at 20 weeks, would help prevent female feticide, says Rajendra Kale, editor-in-chief of the CMAJ.

In Canada, doctors rarely perform abortions after 22 weeks of pregnancy unless the baby has a lethal fetal abnormality or the mother's life is in danger because of the pregnancy.

Kale says that in countries such as India, China, Korea and Vietnam, female fetuses are commonly aborted because of a preference for sons. Though by no means widespread, the practice is carried out by some immigrants to Canada, Kale says.

His editorial cites a small U.S. study of about 65 immigrant Indian women that found 40 per cent had terminated earlier pregnancies, and 89 per cent pursued abortions in their most recent pregnancies after learning they were having girls.  Previous Canadian research has suggested that sex selection is occurring in Canada in certain groups when families have had girls and are seeking a son.

The practice has created a gender imbalance in these communities.

"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," writes Kale.

A study done in Canada found a distorted ratio of male to female births in the Indo-Canadian community, particularly among couples that already have two daughters.

"So clearly female feticide is happening, especially at the time of the third child," Kale said. 

In the editorial, Kale proposes postponing the disclosure of the gender, which he called "medically irrelevant information" in most cases, until after about 30 weeks of pregnancy.

Obstetricians group disagrees

Kale wants to see gender disclosure policies at 30 weeks adopted by the provincial colleges that govern doctors. "Such clear direction from regulatory bodies would be the most important step toward curbing female feticide in Canada."

The Society of Obstetricians and Gynecologists of Canada said Kale' s proposal is inconsistent with their policy, which states that "a patient's request for disclosure should be respected, either directly or in a report to the referring health professional."

In an email to CBC News, the obstetricians group said it believes it is the right of the patient to be informed of the gender of the fetus.

The editorial also did not consider tests on the market that give expectant parents a fetal sex determination of high accuracy as early as eight weeks into a pregnancy, the group notes.

People will always try to get around regulations but that's no reason not to have them, Kale counters.

The obstetricians group says it doesn't condone abortions based on non-medical reasons such as the gender of the fetus.

"The SOGC feels strongly that it is the cultural values and norms in specific segments of the Canadian population that must change to ensure that females are not confronted with procedures and intolerant environments before or after they are born," the association said.

Education call

Dr. Pargat Singh Bhurji, a pediatrician in Surrey, B.C., calls the practice of female feticide barbaric.

"People [do] not want to come forward to talk about this," Bhurji said. "But what I'm saying is this is definitely happening."

Couples can go to clinics in the U.S. that advertise early sex determination in Indian newspapers, Bhurji notes. Cultural factors such as dowry and the belief a boy is needed to carry the family name drive some, he adds.

The long-term goal has to be education, Bhurji says.

Dr. Samuel Soliman of the New Life Fertility Centre in Mississauga said some patients have told him they've had abortions after having a girl or two.

"I think it is part of the whole spectrum of violence against women, which starts from inside the uterus to the outside and the value of women," says Soliman.

While the rule against disclosing gender might work in Canada, Soliman said, it would not apply in the U.S., Soliman notes.