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Canadian Study: Abortion May Be Behind Skewed Boy-Girl Ratio

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TORONTO — Indian-born women in Canada with two or more children give birth to a higher than expected number of boys, suggesting sex-selective abortion may be driving the gender imbalance within this immigrant population, researchers say.

The skewed boy-girl birth ratio has existed for at least two decades and can be seen across the country, according to an analysis of Statistics Canada data published Monday in the journal CMAJ Open.

"The national paper looks at the magnitude of the issue over time and across Canadian provinces," said Marcelo Urquia, an epidemiologist at St. Michael's Hospital in Toronto. He led the study and a companion investigation using Ontario data that delved into the possible reasons why the male-dominated gender imbalance exists.

That second study, published Monday in the Canadian Medical Association Journal (CMAJ), shows that in most of the world, 103 to 107 boys are born for every 100 girls. The gender split was consistent among Canadian-born women in Ontario, who gave birth between 1993 and 2012 to about 105 boys for every 100 girls.

However, Indian-born women who had immigrated to Canada and already had two children gave birth to 138 baby boys for every 100 girls. If they already had three children, they gave birth to 166 boys for every 100 girls.

Other findings from the study:

— The sex ratio rose to 326 boys for every 100 girls for Indian-born mothers with two daughters who had an abortion preceding the third birth.

— It rose to 409 boys for every 100 girls for mothers who had more than one abortion.

— And it rose to 663 boys for every 100 girls for mothers who had at least one abortion after 14 weeks' gestation.

"In cultures in which there is a preference for sons, some families will try to get a son at some point," said Urquia. "If they haven't got a son by the second (birth), then some may try additional pregnancies or some may resort to other methods to ensure they have a son after all."

In India, there is no social security for seniors and close to 90 per cent of marriages are arranged, with parents using the union as a means of making sure they are cared for in old age, he said. Sons are seen as providers, while daughters are an expense because they typically must take a dowry into the marriage.

'Missing' daughters of Indian immigrants

Urquia and his co-authors estimate there are 4,472 "missing" daughters of Indian immigrants to Canada over the last two decades, largely among couples of two Indian-born parents but also among couples that have one Canadian-born parent.

"The CMAJ paper suggests that a large part of these missing girls are probably due to induced abortions, but we don't know really exactly what is the number," Urquia said.

While it is illegal in Canada to use such assisted reproductive technologies as in-vitro fertilization to select the sex of a fetus, an ultrasound at 14 weeks can show the baby's sex, allowing a woman to choose to terminate the pregnancy and try again.

"Abortions are legal and free," he said. "It is not a crime to undergo an abortion and there are no questions asked regarding the reasons by which women decide to have an abortion."

The Ontario study also found a slight imbalance in the boy-girl birth ratio among Chinese-born women living in Canada, but it was not tied to abortion and seemed to be more about family balancing.

Alana Cattapan, a postdoctoral fellow at Dalhousie University whose research focuses on women's reproductive health and public policy, said concerns about sex-selective abortions and embryo implantation are not confined to the Indian and Chinese immigrant populations.

"When we focus on the genitalia of these babies, we're reinforcing all of the assumptions about what that baby might be or what that baby might want to do with its life."

"People talk all the time about whether or not to choose a boy or a girl or what they want," Cattapan, who was not involved in the study, said Monday from Halifax. "I think this study draws attention to the way we think about assumptions about sex and gender, not only in Indian culture — but in Canadian culture."

She questions why it's a matter of course in Canada to have ultrasounds that identify gender or why that information about the fetus is even needed.

"When we focus on the genitalia of these babies, we're reinforcing all of the assumptions about what that baby might be or what that baby might want to do with its life."

In-vitro fertilization for sex selection is legal in the U.S., and it has been suggested that some would-be parents travel there, or to other similarly lenient countries, to access this service, suggests an accompanying commentary in the CMAJ.

"The difficulty of enforcement and ease with which these laws can be subverted mean that the real question is not whether the practice of prenatal sex selection exists _ it is clear from the results of this study and numerous others that it does — but why this practice persists, particularly in a Canadian society that espouses sex equality," write Abdool Yasseen of the Children's Hospital of Eastern Ontario and Dr. Thierry Lacaze-Masmonteil of the University of Toronto.

"Further studies are needed to show whether transgenerational cultural biases persist post-migration.... Such research might point the way toward influencing the practice of prenatal sex selection in Canada and promoting equitable valuation of the sexes."

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