ultrasound tests determine sex of fetus

From today's The Province: Nov-25-90

By Glen Schaefer
Staff Reporter
	 A California gynecologist will be in Vancouver tomorrow to defend his
practice of using ultrasound tests to detemine the sex of [fetus].
	 Stephens will appear tomorrow before the federal royal commission on
reproductive technology.
	 He came under attack recently for advertising his services among
Vancouver's East Indian community, where some pregnant women have been
known to seek abortions when told they are carrying girls.
	 "I don't do abortions, I don't offer abortions and I don't support
abortions -- they're pointing the finger at the wrong person," Stephens
	 If patients use his diagnosis to abort fetuses, "that is a dilemma for
the royal commission -- what to do when technology was misused," he said.
	 Stephens has a U.S. patent on his procedure and claims to be able to
determine the sex of fetuses as young as 14 weeks.
	 Once a month he travels to a clinic in Blaine, Wash., where he said he
sees about six B.C. patients a month -- all East Indian. He charges $500
per ultrasound sex test.
	 He applied last year to set up a clinic in Vancouver, but was turned
down by the B.C. College of Physicians and Surgeons.
	 "I don't offer it for sex selection -- it's just sex determination as a
component of fetal health," Stephens said.
	 Dr. Rajinder Sandhu, whose Vancouver family practice is largely East
Indian, said he tells patients wanting early fetal sex determination about
	 "There's no question about it, he's promoted himself very well," Sandhu
said, adding he makes no referrals to Stephens' clinic.
	 Royal commission chairwoman Dr. Patricia Baird, a Vancouver geneticist,
said East Indian community groups opposed to Stephens' techniques will
also appear before the commission.
	 In a telephone interview from Montreal, where the commission held
hearings last week, Baird said early sex determination "is not something
most people would like to see available."

From:    Ted Powell
Subject: Prenatal sex testing

	 May You Be the Mother of a Hundred Sons : A Journey Among the Women of
	 Elisabeth Bumiller
	 Random House, New York
	 ISBN 0-394-56391-3
	 HQ1742.B86  1990

(beginning on p 104)

It was the British who first documented the practice of female infanticide
in India in the late eighteenth century, chiefly among upper castes in the
north. In some areas, officials reproted discovering entire village
without even one female child. Lalita Panigrahi, in her book British
Social Policy and Female Infanticide in India, recounts the experience of
[a British official, who] "was told that the birth of a daughter was
considered a most serious calamity and she was seldom allowed to live. No
violent measures were however resorted to, but she was left to die from
neglect and want of food." Panagrahi says that a chief reason for the
murders was the exorbitant cost of dowries among the upper castes. Many
families also faced enormous difficulties in finding their daughters good
husbands from a limited supply of suitable bridegrooms. Not marrying off a
daughter was unthinkable and brought disgrace on a family.
	 The British outlawed infanticide in 1870, and a century later, educated
Indians believed that the practice, like sati, had all but died out. That
assumption was shattered in June 1986, when India Today published an
explosive cover story, "Born to Die," which estimated that six thousand
female babies had been poisoned to death during the preceding decade in
the district surrounding the town of Madurai in Tamil Nadu. Although it
was impossible to know how accurate this estimate was, the magazine
reported that the practice of female infanticide was prevalent there among
the two hundred thousand members of a poor subcaste called Kallars, who
fed their infant daughters the lethal oleander berries growing in their
fields. ...
	 People were stunned by the India Today story, although perhaps they
should not have been. After all, neglect of girl babies was commonplace.
Studies have consistently shown that girl babies in India are denied the
same food and medical care that boy babies receive. They also suffer more
from malnutrition. Girl babies die more often than boy babies, even though
medical research has long found that girls are generally biologically
stronger as newborns than boys. The birth of a boy is a time for
celebration, but the birth of a girl is often viewed as a crisis.

(beginning on p. 113)

[Description of Bombay, as the source of most of India's wealth, and
catching up to Calcutta as an internationally famous urban disaster.]
	 It didn't surprise me that Bombay had become, by the mid-1980s, the
center of two new medical techniques used by the city's business class to
avoid the birth of unwanted daughters. Both procedures were commonly
referred to as the sex test; in the United States they would be recognized
as either amniocentesis or chorionic villus sampling, two prenatal tests
developed for the detection of genetic abnormalities in a fetus. In the
Bombay of the mid-1980s, however, the tests were most often used to
determine only the gender of an unborn child. Most people did not even
know that the tests could diagnose birth defects.
	 In India, between the years 1978 and 1982, estimates put the number of
abortions of female fetuses after the "sex test" at 78,000. That, at
least, was the figure presented at a 1986 government hearing on the
subject and widely quoted in the press. I was never able to determine how
the figure was calculated or its original source, and it seemed to me
another Indian statistic that could never be verified. Undeniable,
however, was the fact that the majority of Bombay's private gynecologists
(84 percent of those surveyed, according to one apparently reliable
government study) conducted the test solely to determine the sex of a

Bombay feminists ... settled on the sex-determination tests as one of their
most important causes. In May 1988, when the legislature of the state of
Maharashtra, of which Bombay is a part, passed a law that banned the tests
for the use of sex determination, they claimed their biggest
victory--raising all sorts of questions in my mind about how one controls
the practice without infringing on a woman's right to abortion. The cause
had been led by the Women's Centre, the leading feminist group in Bombay,
which in 1982 had brought out its first report on the use of amniocentesis
for sex determination. Although feminists in other Indian cities sometimes
dismissed prenatal sex determination as an elitist problem confined to
Bombay's business class, the Women's Centre countered that the tests were
common in other areas as well ... [reference to prosperous areas].
Prosperity, as in the case of the sati in Rajasthan, had not eliminated
old customs but seemed to be promoting them in alarming new ways. If
nothing else, the sex-determination tests were a powerful example of what
can happen when modern technology collides with the forces of a
traditional society.
	 Feminists also warned that the tests were seeping down to the middle
class and the poor. Although private Bombay doctors charged as much as
$125 for the test, clinics had sprung up in working-class areas and slums
that offereed amniocentesis at cut-rate prices and played on the fear of
dowry with such slogans as "Better 500 rupees now than 500,000 later." As
far back as 1977, Bombay's Hurkisondas Hospital, a private institution
catering to the middle and working classes, began offering amniocentesis
at one of the cheapest rates ever, eight dollars, in its new Prenatal
Sex-Determination Clinic. "This is the only institution in our country
whcih is carrying out this humane and beneficial test with such a high
accuracy of the results," the clinic's informatio sheet said. In the years
1978 to 1982, a study of the hospital by a Bombay women's organization
found that of 8,000 women who came from all over India for the test, 7,999
wanted a son.

(p. 118)

[The author describes watching a chorionic villus sampling operation, and
her reactions.]
	 ... As I watched the wire's journey on the screen of the ultrasound
machine, I slowly became disgusted. It had been building all week, but I
think seeing this woman with her legs spread on the examination table, so
exposed and, in a sense, so violated by the forces of her society, caused
something to snap in me. What right did India have, I thought, to take the
newest technology from the West and use it for something as reprehensible
as the slaughter of female babies?
	 "Slaughter" is an explosive word, and it was something of a dilemma to
find myself suddenly thinking of the abortion of a female fetus as
"slaughter" when I had for years believed in a woman's right to end her
pregnancy. If I thought of the abortion of a female fetus as "slaughter,"
then what was I to call the abortion of a male fetus? Was it intellectually
consistent to be in favor of a woman's right to abortion yet opposed to
sex-selective abortion? I honestly did not know what I thought. For the
rest of my time in India, I made a small career out of psoing the
question, whenever the topic came up, to feminists, doctors, lawyers and
friends. It would often provoke heated arguments, and there seemed no way
out of the moral dilemma.
	 It annoyed me that although the feminists were doing the right thing in
opposing sex-selective abortion, they were so unaware of the philosophical
traps [re "right-to-live" groups]. [... discussion of Bombay feminists'
arguments ...]
	 What I eventually concluded was that the feminists' sloganeering was
aimed more at emotional effect than at logical persuasion, and that it
reflected the differences in the issue of abortion in India and the United
States. Bombay feminists could freely make outrageous statements that
seemed to threaten a woman's right to terminate her pregnancy because the
right to abortion was not under siege in India as it was in the United

As I spoke to the [Bombay] feminists, I began to wonder if
sex-selective abortion had ever been debated in the United States, where
the ethical issues raised by advances in technology--such as genetic
engineering--are much more fully developed. I had noticed some references
to American essays on the subject in the library of a medical researh
fouondation during my trip to Bombay, and when I returned to Delhi I wrote
a friend in Washington and asked her to try to locate the material for me.
What she sent was fascinating: In the late seventies in the New England
Journal of Medicine, in what was apparently one of the first explorations
of the subject, a research group of the Hastings Center, a think tank for
biomedical ethics in Briarcliff Manor, N.Y., concluded that amniocentesis
for sex choice should be discouraged. But in a subsequent article in the
same journal, John C. Fletcher, a specialist in bioethics at the National
Institutes of Health and a codirector of the Hastings Center research
group, changed his mind, apparently because of the same moral dilemmas I
was experiencing. He argued that although "sex choice was not a compelling
reason for abortion," it was nonetheless "inconsistent to support an
abortion law that protects the absolute right of women to decide and, at
the same time, to block access to information about the fetus because one
thinks that an abortion may be foolishly sought on the basis of the
information." It was a persuasive point of view, but one that is easier to
hold in the United States than in a culture where tens of thousands of
fetuses are aborted simply because they are female. ...
	 Ultimately, I decided that the question of whether it was
intellectually consistent to be in favor of a woman's right to abortion
yet opposed to sex-selective abortion had, for me, a different answer in
the United States than in India. I can't resolve the contradictions and
can only conclude that there are no universally applicable answers in this
world. In the United States, although the principle of Roe v. Wade is
under attack, abortion is still generally available until the
twenty-eighth week of pregnancy; in effect, a woman does not have to give
her doctor a reason for her decision. Although the idea of terminating a
pregnancy simply because the fetus is femal is morally repugnant to me, I
believe that outlawing such a practice would fundamentally infringe on a
woman's right to choose.
	 In India, I felt, the situation was different. ...
	 ... I think the shocking number of aborted female fetuses in India
constituted so serious a problem that the state had an obligation to step
in and protect its interests, as the legislature of Maharashtra had done
in banning sex-determination tests. The language of Roe v. Wade may help
explain what I mean. In the majority opinion, Justice Harry A. Blackmun
wrote that although an abortion should be considered part of a woman's
right to privacy, that right was not absolute, and at the third trimester,
when the fetus had the potential to live outside the mother's womb, "the
state interests as to protection of health, medical standards, and
prenatal life become dominant." Laws are not made in a social vacuum but
reflect the societies they govern, and in India, I think, the right of the
state became dominant when prenatal tests developed for the detection of
genetic abnormalities in an unborn fetus began to be so widely and
grotesquely abused.
	 Not all Indian feminists agreed with this point of view. ...

[... and, I suspect, not all participants here will either. :-)
A full citation of this book appears a couple of messages back.