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| Doctors in British Columbia have for several years refused to divulge sex information until 20 weeks into the pregnancy |
Two Canadian medical experts are calling for new guidelines that would bar doctors from telling parents the sex of their fetus until late in a pregnancy, calling it a subtle way to curb the practice of sex selection.
Writing in a major obstetrics journal recently, the bio-ethicist and doctor say physicians should delay imparting information on baby sex until it is too late for the woman to have an abortion with no questions asked.
They admit it is unfortunate doctors should have to play such a role, but say it is unavoidable because Canadian law does not address the sex-selection phenomenon -- or any other aspect of abortion.
"I think Canadians have a sort of visceral reaction to the idea that people would terminate a pregnancy based on gender alone," said Brendan Leier, a bio-ethicist at Edmonton's Stollery Children's Hospital and co-author of the recommendations.
"But we have no legislation that reflects those values.... The entire burden of upholding those values falls on clinicians."
One province, British Columbia, is already following the kind of policy he suggests.
Some doctors, however, say the idea violates their duty to divulge patient information, while abortion advocates argue the measure would be "paternalistic" and ultimately useless.
"The difficulty comes in the ethical agreement that the physician has with the patient," said Dr. Doug Wilson, head of obstetrics and gynecology, University of Calgary. "If they have information, I think they have an ethical obligation to provide it, if the patient asks for it."
Sex selection, fuelled by the widespread use of ultrasound scans that can often detect a fetus's gender, has been well documented in countries such as China and India. A 2006 study in the journal Lancet, co-authored by Prabhat Jha, head of the University of Toronto's Centre for Global Health Research, used lopsided birth statistics in India to conclude that 10 million female fetuses had been aborted there in the previous two decades.
There is evidence, though less conclusive, that the same practice is common in North America among some immigrant populations. A 2003 analysis of Statistics Canada data by the Western Standard magazine found that communities in B.C. and Ontario with large South Asian populations had disproportionate numbers of male births.
A 2008 U.S. study found that the ratio of boys to girls in families of Korean, Chinese or Indian background climbed steadily in favour of boys if the first child was a girl.
Mr. Leier and his co-author, Dr. Allison Thiele, an obstetrics and gynecology resident at the University of Saskatchewan, note that the official policy of professional groups such as the Society of Obstetrics and Gynecology of Canada (SOGC) condemns sex selection.
They say keeping back the information until a point in the pregnancy where abortions for non-medical reasons are difficult to obtain would abide by a doctor's obligation to reveal all patient information, while discouraging sex selection.
Parents who wanted to know their baby's sex in advance would still have time to plan for the birth, the authors argue.
In fact, doctors in British Columbia have for several years employed that approach, refusing to divulge sex information until 20 weeks into the pregnancy, said Dr. Alain Gagnon, an administrator at the B.C. Children and Women's Hospital. It seems to work, even if the policy strikes patients as strange, he said.
"Many of them find it a little silly that they have to wait to get the information," said Dr. Gagnon. "[But] the vast majority of people seem to be happy with it."
One critic, however, questions the measure's effectiveness, given that parents can mail order DNA tests that accurately predict fetal sex, and abortion clinics generally do not ask the reason for the procedure. The way to tackle sex selection is by combatting the social mores that lead people to want sons and not daughters, rather than by limiting abortion, said Joyce Arthur, coordinator of the Abortion Rights Coalition of Canada.
"To restrict people's freedoms, withholding information in that way, I think is unethical and unnecessary and is not going to prevent anything," Ms. Arthur said. "It's a little bit paternalistic and authoritarian."
Mr. Leier said the issue is ultimately one for government to handle, and Parliament should at least address ways of preventing sex selection. He noted, though, that most politicians in Canada tend to avoid any discussion of abortion because of the emotions around the question.