Abortion and multiculturalism, two of the most contentious areas of Canadian public policy, were placed on a collision course Monday by the country's leading medical journal.
Rajendra Kale, interim editor of the Canadian Medical Association Journal, called for a ban on disclosing the sex of a fetus until 30 weeks, a point at which abortions are difficult to obtain. His editorial cited research that suggests some Asian immigrants are aborting unwanted females.
The move ignited opposition on several sides, from those who decried any curtailing of a woman's right to information about her pregnancy to those who questioned the accuracy of research that paints Asian immigrants as more prone to abort girls.
"Frankly I'm disgusted," Dr. Kale said in an interview, referring to sex-selective abortion. "There's no way this should happen in Canada. This is discrimination against women at its worst."
The national body representing Canada's obstetricians and gynecologists contends that Dr. Kale's proposal flies in the face of accepted standards for patient care and fails to acknowledge that changing deep-rooted cultural beliefs, not imposing heavy-handed restrictions, is the key.
The editorial was based in part on unpublished research by University of British Columbia economist Kevin Milligan and two colleagues at Columbia University.
The researchers found, using census data, that if Canadians of Indian descent have two girls, a third child is nearly twice as likely to be a boy than would otherwise be expected. The study also looked at religious background. Christian and Muslim immigrants from Asia whose first two children are girls have an almost equal ratio of male and female third children. But for Sikhs and a group the researchers called non-Christian, non-Muslim (primarily non-religious Chinese and Hindus), a third baby born after two girls was twice as likely to be male.
"This is quite clear evidence that the sex mix we're getting is not one that's happening naturally," Prof. Milligan said.
And the trend does not appear to dissipate with the Canadian-born second generation, he said.
Also cited in Dr. Kale's editorial is a U.S. study of 65 female Indian immigrants that found that 40 per cent had previously aborted a female fetus and 90 per cent of those currently pregnant with a girl had pursued the idea of abortion. Although research on the subject in Canada is still developing, scholars have long argued that India and China have a gender imbalance that suggests significant sex-selective abortion.
Despite a lack of conclusive Canadian figures, many health experts agree female feticide is a small, but serious, problem among some immigrant groups. Prabhat Jha, director of the Centre for Global Health Research at the University of Toronto, is conducting a study to pinpoint, for the first time, the rate of female feticide in Canada.
Dr. Jha said that until there is a clear picture of the scale of the problem and which communities are involved, it's premature to adopt the restrictive measures suggested by Dr. Kale's editorial.
"You need to think carefully if the solution does more harm than good," he said.
One or two of every 50 clients treated at the women's health clinic run by Progressive Intercultural Community Services in Vancouver has aborted a female fetus for gender reasons, according to Pardeep Sahota, director of communications. Ms. Sahota said many women face tremendous pressure to have sons and don't understand their rights here.
"We've had clients that have had repeat abortions based on sex selection," Ms. Sahota said. "We've had women tell us they've sometimes had a doctor encourage them to abort."
Balpreet Singh of the World Sikh Organization said he knows sex selection is an issue in Asia and suspects it exists in Canada as well.
"Sex selection of fetuses is reprehensible. The Sikh faith actually forbids the practice," Mr. Singh said. "Any steps to end the practice are good ones."
Other organizations, such as the South Asian Women's Centre and the Immigrant Women's Health Centre in Toronto, said they didn't know of a single case of a woman seeking a sex-selective abortion.
"I don't think that any one of our councillors in 30 years of serving immigrant women has had someone say I want to know the sex of the fetus before getting an abortion," said Ayesha Adhami, administrative co-ordinator at the IWHC. "We're a little concerned about there being racial stereotypes around this, and whether or not it's actually happening in Canada is hard to say."
Dr. Kale has been interim editor-in-chief at the CMAJ since last fall and has consistently made headlines with his editorials, including a piece that called for an end to hospital parking fees.
Originally from India, Dr. Kale worked as a senior editor at the British Medical Journal before taking a position with the CMAJ as senior deputy editor in 2008.
In the editorial released Monday, he said a ban on revealing the sex of a fetus until the 30th week of pregnancy – information he describes as "medically irrelevant" – would require only a temporary compromise from women of all ethnicities and could save thousands of girls.