SEPTEMBER 15, 2007


Sex-selective abortion comes to Canada

Recent BC dispute sparks ethical debate
over abortion practice

Like it or not, sex-selective abortion has arrived in Canada.

The topic made headlines in August because of a protest in Surrey, BC against advertisements placed in South Asian-targeted newspapers. The ads were paid for by an American private ultrasound clinic owner, Dr John Stephens, who was offering sex-determination testing to BC's Indian community. Local community activists accuse him of providing scans at 12 weeks to parents who go on to terminate female fetuses because of a preference for boys.

Dr Stephens is furious about the brouhaha. "There is nothing unethical about the medical relationship between a patient and her doctor such that there may be a decision — made by the patient — that results in her electing to not continue her pregnancy," says Dr Stephens. "It's nobody's business — it's none of my business to even ask that question of the patient."

Dr Stephens says there's no evidence linking his exams to sex-selective abortions. However, circumstantial proof does exist: conservative magazine Western Standard published an article last year that examined the abnormal gender ratios of some BC and Ontario communities that have large proportions of Indian residents. In Surrey, where over 10% of the population is of Indian descent, there were 111 boys under the age of five per 100 girls in 2000. (The ratio should be 105:100 at that age.)

Dr Stephens says the statistics don't prove a thing. He calls the accusations against his patients "paternalistic" and "racist," and those against his practice unfair and untrue.

Dr Stephens complains he's been unfairly targeted. There are indeed similar clinics, offering similar services based in Canada that have not been singled out. One clinic, See3D, based in North York, ON, advertised their $65, 18-week sex-determination test in the August 17 edition of CanIndia News on the very same page as an article about Dr Stephens' ad being pulled.

One private company called UC Baby, however, refuses to do sex-determination testing before 20 weeks. (After 20 weeks most physicians will not perform elective abortions because of the risk to the mother's health.) "We don't want our service used for sex-selective abortion," says president Dr Tina Ureten.

Sex-selective abortion presents bioethicists and clinicians with a difficult ethical conundrum. Is it permissible to limit access to abortion services in order to combat systemic gender discrimination?

Canada's answer thus far has been no, despite the general public's opposition to sex-selective abortion and the majority of doctors' and hospitals' refusal to provide sex-determination testing to women who express a desire to abort a fetus based solely on gender.

The 1994 Royal Commission on Reproductive Technology recommended that prenatal sex determination for the purpose of sex-selective abortion "not be available for use," but the Assisted Human Reproduction Act, passed in 2004 as a follow-up to the Commission report, only restricts sex-selection in vitro, not in utero.

At the United Nations Commission on the Status of Women meeting in March, Canada helped force the withdrawal of a US-sponsored resolution against sex-selective abortion. "The bottom line was that some countries, including Canada, didn't want to put any limits on abortion," says former George H W Bush speechwriter and Christian activist Janice Shaw Crause, who attended the UN meeting.

Kerry Bowman, PhD, a clinical bioethicist at Mt Sinai Hospital in Toronto, says his physician colleagues refuse to provide sex-determination testing if the patient says they don't want the baby if it's a boy or a girl. However, such patients inevitably go elsewhere — like to the private sector. "Many people learn not to mention it," he says.

"The arguments for it are that this is simply a matter of choice, that our healthcare system is built on autonomy," he says. "But others say we'd be colluding with extreme discrimination, and that is my opinion as well. It really goes against the ethos of the society. In the medical world, we should stand together."



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