Fetal sex selection apparently happens in Canada

For would-be parents, the natural odds of having a boy or a girl are nearly fifty-fifty. But in some Asian countries, boys are preferred, and ultrasound and in-vitro fertilization or IVF.. has made prenatal sex selection available to many more couples. A study just published in the Canadian Medical Association Journal concludes that the practice is also taking place in Canada. 

How often does prenatal sex selection take place?  The short answer is that sex selection in specific ethnic communities in Canada is surprisingly common and surprisingly effective.  Researchers looked at more than 1.2 million births in women in Ontario between 1993 and 2012.  Of the total group, just over 150,000 were immigrant women from Asia.  

To tell this story, I have to throw out a lot of numbers, so bear with me.  In the study, the researchers focused on a very specific group of women:  those who already had two daughters and were having a third child.  When nothing is done to rig the game (as it were), for every 100 girls born, there are anywhere from 103 to 107 boys.  Among women born in India with two prior girls, for every 100 girls born, there were 196 boys  almost double the natural average.  Among parents from China, the odds of having a boy were increased by one and a half times.

How does this happen?  To my knowledge, there's no readily available technology that increases the number of embryos or fetuses with XY chromosomes. The only other obvious explanation is that the number of boys born is boosted by selectively aborting girl embryos or fetuses. Here are some more numbers.  If an Indian-born mother with two daughters had an abortion before the third child was born, for every 100 girls born, there were 326 boys; 409 boys if the mother had multiple abortions.  If the woman had an abortion at 15 weeks of pregnancy or later  when an ultrasound can determine the sex of the foetus  there were 663 boys for every 100 girls.

This study comes about as close as you can possibly get to proving that more boys are being born because girls are being aborted.  To be extremely clear, when I say abortion, I mean an induced abortion  not a spontaneous miscarriage.

What are some of the reasons that couples might be doing this?  In some Asian countries, there is overt preference for sons.  There may be religious or cultural reasons such as worship duties that fall upon men and the burden of dowry payments by the parents of females.  In China and India, lineage is passed from father to son.  There's a persistent belief in those countries that boys are more likely than girls to be able to support the parents in old age.  And let's not forget the 1-child policy in China that skewed sex preferences in that country  and made baby girls available for international adoption by couples here in Canada and around the world. 

The fact it's happening means that health care providers are carrying out abortions, no questions asked without asking about the motivation behind the request.  These women are undergoing medical procedures that I would certainly regard as unnecessary and potentially harmful to the mother.  Multiple induced abortions are detrimental to a woman's health and also to subsequent pregnancies.  

The most disturbing implication from this study is that sex selection meant that 4500 female fetuses in Canada and 100 million female fetuses worldwide were aborted and therefore not born.  

What should be done about it? A 2007 policy statement by the Society of Obstetricians and Gynecologists of Canada said medical testing should not be used to for sex selection, and pregnancy termination should not be permitted on that basis either.  A commentary that was published along side the current study (sorry, but the commentary is behind a paywall) notes that the later during pregnancy the province pays for abortions, the more likely the abortion can be used for sex selection. Reducing the window during pregnancy for funded abortions could make sex determination less decisive and more risky.  

Then again, there's in-vitro fertilization (IVF).  The Assisted Human Reproduction Act of Canada bans sex selection of implanted embryos.  However, the practice is permitted in the U.S.  We can't and shouldn't try to stop couples from traveling to the U.S. and elsewhere for sex selection.  But we can and should use public dollars to promote the notion that in this country, both sexes are equally valuable.

I believe the practice should be stopped, but how? I think it would be hard to have an air tight ban.  The big issue isn't the ban but how you enforce it without restricting reproductive choice.  The other obvious difficulty with a ban is that it will drive the practice underground and perhaps expose women who opt for sex selection to unsafe practices. The commentary says we need to focus on why sex selection takes place in a Canadian society that espouses sex equality. The author wonders if public health messages can be targeted at groups most likely to practice sex selection. To do that without offending cultural practices is very tricky.

A woman's right to reproductive choice is an important part of the discussion.  The study indicates that at least some women in Canada are choosing to abort female fetuses.  So, attempts to legislate that choice away might reduce sex selection but would also impact on a woman right to reproductive choice.  

It's a tricky dilemma.