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The solution to the problem of sex selection does not lie in criminalizing ultrasound and amniocentesis, or in withholding medical information from women. (Cheryl Ravelo/Reuters)
The solution to the problem of sex selection does not lie in criminalizing ultrasound and amniocentesis, or in withholding medical information from women. (Cheryl Ravelo/Reuters)

Second Opinion

Sex selection is a complex issue with many nuances Add to ...

The notion that sex selection – selective abortion of fetuses of female gender – is being practised in some ethnic communities in Canada comes as a shock to many.

In response, Rajendra Kale, interim editor of the Canadian Medical Association Journal, has called for a ban on disclosing the sex of a fetus until 30 weeks, at which point it is difficult to obtain an abortion.

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While well-intentioned, the proposal is impractical, unethical, and fails to address the root problem.

Female fetuses are being aborted because, in some cultures, girls are not valued; the birth of a girl is considered a financial burden because she has few prospects of a good income, and a dowry can drain a family’s finances.

The solution to that problem is not criminalizing ultrasounds and amniocentesis, nor is it withholding medical information from women, practices that would be patronizing and unethical.

Besides, how would you enforce a law like banning the disclosure of the sex of a fetus?

A universal ban would be unnecessarily broad as sex selection is practised only among a small minority of Asian immigrants. And, if you try to apply the new rules only to select communities, well, that’s at best racial stereotyping and, in effect, offensively racist.

Yes, there is evidence showing pretty convincingly that sex selection is practised by some Canadians of Sikh, Hindu and Chinese descent.

But there are also Canadians of all religions and races who practise other forms of “family balancing.” Couples who have a girl and want a boy, or have two boys and want a girl. So they choose to abort a fetus and try again.

“You may disagree or feel uncomfortable with the practice but people who practise family balancing are not evil or nefarious,” said Tim Caulfield, the Canada Research Chair in Health Law and Policy at the University of Alberta in Edmonton.

He stressed that he is not endorsing sex selection, just underscoring that it is a complex issue with many nuances.

After decades of pitched battles, Canada effectively has no abortion law. It is a medical procedure that, like others, depends on the ethical practice of medicine. The last thing we need is to have women who are making an already-difficult choice, to be grilled about why they are having an abortion. And we know, historically, that when you put restrictions on abortion, you merely drive the practice underground, where it is less safe, and endangers women.

Besides, technology is changing so rapidly that it’s becoming virtually impossible to prevent people from learning the sex of a fetus. Ultrasounds are cheap and portable, you can mail away a blood sample to a lab and, who knows, maybe the iPhone will soon have an app for that.

India, where the practice of sex selection is much more widespread and problematic than in Canada, has had a law in place since 1994 that bans medical professionals from disclosing the sex of a fetus.

“There’s quite a debate about whether it works. There are a lot of loopholes,” said Anant Bhan, a physician and bioethicist at the Sandra Rotman Centre at the University of Toronto.

Dr. Bhan said the solution ultimately is to eradicate the systematic neglect of girls and women that exists in large parts of the world “but that kind of profound societal change is not going to occur overnight.”

In the meantime, you need a whole host of approaches. You need education – and, above all, you need to allow girls to get an education, which opens up economic opportunities. You need to make practices like dowries socially unacceptable. And you need to continue to publish data like the CMAJ has done, drawing attention to these practices so they can be discussed openly, not practised furtively.

We’re not going to legislate our way out of this problem.

Follow on Twitter: @picardonhealth

 

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