Sex-selective abortions punished in India; coming to America

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On June 19, a physician caught in the act of performing a sex-selection abortion was arrested in a town near New Delhi and remanded into judicial custody for 14 days, along with the woman’s husband. They were charged with violating the Pre-Natal Diagnostic Techniques and Medical Termination of Pregnancy Acts.

Because of frequent female infanticide and selective abortion of girls, the birth ratio was 927 girls born for every 1,000 boys in 2001, down from 962:1,000 in 1991. The severe shortage of brides in the Haryana region has resulted in a black market in women from other regions who are brought in and sold into marriage, according to a Meri News report.

Prime Minister Manmohan Singh called sex-selection abortions a “national shame.” He called such abortions “inhuman, uncivilized and reprehensible” (LifeNews.com 6/20/08).

As many as 200 million girls may have been killed worldwide in this way, mostly in Muslim and Asian countries. The rate is increasing because of ultrasound technology that permits sex identification around 18 weeks.

Using data from the U.S. 2000 census, researchers have noticed a male sex bias in U.S.-born children of Chinese, Korean, and Asian Indian parents. The effect of birth order is striking. There is a normal sex ratio, 106 girls to 100 boys, for first births. If the first birth is a son, the sex ratio of second children is also normal. But if the first child is a girl, the
second child tends to be a boy. And if the first two are girls, the third is 50% more likely to be a boy.

Authors Douglas Almond and Lena Edlund conclude that sex-selection abortion was being practiced in America as early as a decade ago.

According to a Zogby/USA today poll, 86% of Americans favor banning this practice, which is seen by many as the ultimate form of sex discrimination. Every year that he was in the U.S. Senate, Jesse Helms introduced a bill providing that “it shall be illegal to perform an abortion for the sole purpose of sex selection” (Population Research Institute Weekly Briefing 4/15/08).

The American College of Obstetrics and Gynecology (ACOG) states that “helping patients to choose the sex of their offspring to avoid serious sex-linked genetic disorders is considered ethical for doctors, but participating in sex selection for personal and family reasons, such as family balancing, is not.”

Since, however, it would be unethical to withhold medical information, such as the sex of the fetus, from patients who request it, it “may be impossible to avoid unwitting participation in sex selection.”

ACOG reassures physicians that “they are not obligated to perform an abortion, or other medical procedure, to select fetal sex” [emphasis added], according to a Feb 1, 2007, news release.

The ACOG Committee on Ethics Opinon No. 360, February 2007, is silent on the issue of whether physicians ought to refer patients to other providers who do not have qualms of conscience about such abortions.

A controversial later opinion, No. 385, issued November 2007, entitled “The Limits of Conscientious Refusal in Reproductive Medicine,” states that “conscientious refusals should be limited if they constitute an imposition of religious or moral beliefs on patients, negatively affect a patient’s health, are based on scientific misinformation, or create or reinforce racial or socioeconomic inequalities.” Pro-life physicians, it asserts, should not practice in “resource-poor areas,” but rather “in proximity to individuals who do not share their views.”

Parenthetically, this opinion is being reconsidered because of concerns that pro-life physicians could be decertified for “violation of ACOG rules and/or ethics principles,” say for failure to assure timely access to abortion or emergency contraception (AM News 4/14/08).

Trying to adhere to ACOG directives could create dilemmas. Sex-selection abortions would be unethical if they reflect the belief that males are “inherently more valuable than females” and thus violate the “ethical principle of equality between the sexes,” or perhaps because “the very idea of preferring a child of a particular sex may be interpreted as condoning sexist values and, hence create a climate in which sex discrimination can more easily flourish.” Yet, “it is often impossible to ascertain patients’ true motives for requesting sex-selection procedures.” Perhaps there are “financial” or “cultural” reasons that are not “personal and family reasons.” In any event, the committee concluded that the position of never participating in sex selection was “too restrictive.” And of course there is always the possibility that a woman also has a reason for abortion that is not related to sex selection.

Sex-selection abortion could create a major challenge for the hierarchy of ACOG values and “core” elements of the practice of medicine. According to Committee Opinion No. 385, these include patient autonomy; “maximum accommodation” to “authentic claims” of conscience; distributive justice; sexual equality; and safe, timely, and financially feasible access to abortion.

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2 Comments

  1. The ACOG stands are proof of what tortured logic goes into the imposition of morals by committe as opposed to letting individuals be guided by their conscience

  2. This is another reason why, when I was in diagnostic radiology practice, I did not try to identify the baby’s sex. The OB docs essentially agreed with this approach but parents often asked about the baby’s sex. This concern was answered when I included a statement “The baby’s sex is not identified” in the unltrasound reports.

    I never had a single patient referred for sex identification.

    I had adopted this approach because I had seen a medical article noting that parents accepted their newborn baby regardless of their prenatal desires for a boy or girl. Knowing the sex of their unborn baby caused some parents undue anxiety.

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