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Wanigaratne S, Januwalla A, Bhangu M, Uppal P, Kumar-Ratta A, Brar A, Dennis CL, Urquia M. Gender-based discrimination and son preference in Punjabi-Canadian families: a community-based participatory qualitative research study. BMJ Open 2023; 13:e074276. [PMID: 37648385 PMCID: PMC10471870 DOI: 10.1136/bmjopen-2023-074276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES To conduct a qualitative study, guided by the principles of community-based participatory research, with the following objectives: (1) to provide a conceptual framework describing the drivers of son preference; (2) to understand experiences of son preference among Punjabi-Canadians and (3) with this understanding, identify and co-design an appropriate educational tool. DESIGN, SETTING, PARTICIPANTS, METHODS Qualitative study consisting of four bilingual (Punjabi and English) focus group discussions with 11 mothers, 4 fathers and 17 grandmothers in Toronto and Brampton, Canada. Participants were queried about experiences and perspectives related to reproductive decision-making, gender equity and son preference, and for appropriate approaches to reducing inequities. Transcripts were simultaneously translated and written in English and thematic analysis was conducted. An infoposter was identified as a feasible educational tool and was co-designed by researchers and community partners. RESULTS Participants identified patrilocality (ie, married sons reside with parents, married daughters with in-laws) and patrilineality (ie, sons inherit assets, daughters' husband receives a dowry) as structural precursors to proximal drivers (ie, old-age security) of son preference. Mothers' and grandmothers' value to their families depended strongly on having a son but did not guarantee security. Pressures (ie, internalised discrimination, reproductive coercion) to conceive a son were common after the birth of at least one daughter in the absence of sons. Participants did not know anyone who had a sex selective abortion in Canada; however, traditional sex selection methods (eg, herbal medicines) were mentioned. Our co-designed infoposter entitled 'Truths About Son Preference' addressed three misconceptions identified in discussions. CONCLUSION This study may be useful to health and social care providers in providing structurally competent and culturally humble counselling and care, particularly after the birth of daughters in the absence of sons. Community engagement is necessary for future intervention development.
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Affiliation(s)
- Susitha Wanigaratne
- Edwin S.H. Leong Centre for Healthy Children, SickKids Research Institute, Toronto, Ontario, Canada
| | - Alia Januwalla
- Knowledge Translation Program, Unity Health, Toronto, Ontario, Canada
| | - Manvir Bhangu
- Laadlilyan Celebrating & Empowering Daughters, Brampton, Ontario, Canada
| | - Pamela Uppal
- Catholic Family Services Peel Dufferin, Brampton, Ontario, Canada
| | - Amrita Kumar-Ratta
- Department of Geography & Planning, University of Toronto, Toronto, Ontario, Canada
| | - Amanpreet Brar
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomburg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, canada
- Lunenfeid-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Marcelo Urquia
- Department of Community Health Sciences, College of Medicine Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontaroi, Canada
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Meh C, Jha P. Trends in female-selective abortion among Asian diasporas in the United States, United Kingdom, Canada and Australia. eLife 2022; 11:79853. [PMID: 36165452 PMCID: PMC9514843 DOI: 10.7554/elife.79853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/28/2022] [Indexed: 11/18/2022] Open
Abstract
Preference for sons and smaller families and, in the case of China, a one-child policy, have contributed to missing girl births in India and China over the last few decades due to sex-selective abortions. Selective abortion occurs also among Indian and Chinese diaspora, but their variability and trends over time are unknown. We examined conditional sex ratio (CSR) of girl births per 1000 boy births among second or third births following earlier daughters or sons in India, China, and their diaspora in Australia, Canada, United Kingdom (UK), and United States (US) drawing upon 18.4 million birth records from census and nationally representative surveys from 1999 to 2019. Among Indian women, the CSR in 2016 for second births following a first daughter favoured boys in India (866), similar to those in diaspora in Australia (888) and Canada (882). For third births following two earlier daughters in 2016, CSRs favoured sons in Canada (520) and Australia (653) even more than in India (769). Among women in China outside the one-child restriction, CSRs in 2015 for second order births somewhat favoured more girls after a first son (1154) but more heavily favoured boys after a first daughter (561). Third-birth CSRs generally fell over time among diaspora, except among Chinese diaspora in the UK and US. In the UK, third-birth CSRs fell among Indian but not among other South Asian diasporas. Selective abortion of girls is notable among Indian diaspora, particularly at higher-order births.
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Affiliation(s)
- Catherine Meh
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto
| | - Prabhat Jha
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto
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Speeding Up for a Son Among Immigrants in Canada. POPULATION RESEARCH AND POLICY REVIEW 2022. [DOI: 10.1007/s11113-022-09723-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Simon-Kumar R, Paynter J, Chiang A, Chabba N. Sex ratios and 'missing women' among Asian minority and migrant populations in Aotearoa/New Zealand: a retrospective cohort analysis. BMJ Open 2021; 11:e052343. [PMID: 34732488 PMCID: PMC8572392 DOI: 10.1136/bmjopen-2021-052343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Recent research from the UK, USA, Australia and Canada point to male-favouring sex ratios at birth (SRB) among their Asian minority populations, attributed to son preference and sex-selective abortion within these cultural groups. The present study conducts a similar investigation of SRBs among New Zealand's Asian minority and migrant populations, who comprise 15% of the population. SETTING AND PARTICIPANTS The study focused on Asian populations of New Zealand and comparisons were made with NZ European, Māori, Pacific Island and Middle-Eastern, Latin American and African groups. Secondary data were obtained from the New Zealand historical census series between 1976 and 2013 and a retrospective birth cohort in New Zealand was created using the Stats NZ Integrated Data Infrastructure from 2003 to 2018. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was SRBs and sex ratios between the ages 0 and 5 by ethnicity. A logistic regression was conducted and adjusted for selected variables of interest including visa group, parity, maternal age and deprivation. Finally, associations between family size, ethnicity and family sex composition were examined in a subset of this cohort (families with two or three children). RESULTS There was no evidence of 'missing women' or gender bias as indicated by a deviation from the biological norm in New Zealand's Asian population. However, Indian and Chinese families were significantly more likely to have a third child if their first two children were female compared with two male children. CONCLUSION The analyses did not reveal male-favouring sex ratios and any conclusive evidence of sex-selective abortion among Indian and Chinese populations. Based on these data, we conclude that in comparison to other western countries, New Zealand's Asian migrant populations present as an anomaly. The larger family sizes for Indian and Chinese populations where the first two children were girls suggested potentially 'soft' practices of son preference.
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Affiliation(s)
- Rachel Simon-Kumar
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Janine Paynter
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Annie Chiang
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Nimisha Chabba
- School of Population Health, The University of Auckland, Auckland, New Zealand
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Sex ratios at birth in Australia according to mother's country of birth: A national study of all 5 614 847 reported live births 1997-2016. PLoS One 2021; 16:e0251588. [PMID: 34170929 PMCID: PMC8232452 DOI: 10.1371/journal.pone.0251588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/28/2021] [Indexed: 11/19/2022] Open
Abstract
Objectives Son preference and sex selective practices have resulted in a deficit of girls in several countries, primarily across Asia. Emerging evidence indicates that son preference survives migration to Western high-income countries. The objective of this study was to assess male-to-female (M/F) ratios at birth per mother’s country of birth in Australia 1997–2016, in total and by parity, and by states/territories and over time. Methods Data for this national population-based cross-sectional study were obtained from the National Perinatal Data Collection (NPDC) and included all live births in Australia 1997–2016 (N = 5 614 847). M/F ratios with 95% Confidence Intervals were estimated. Results The M/F ratio for births to Australian-born mothers was within the expected range (1.03–1.07) regardless of parity and time period. M/F ratios were elevated above the expected range for births to mothers born in China in the total sample (M/F ratio 1.084, 95% confidence interval 1.071–1.097) and at parity 2 (1.175, 1.120–1.231), and for births to mothers born in India at parity 2 (1.146, 1.090–1.204). Parity 2 births were the most consistently male-biased across time. Across states, elevated M/F ratios were identified for both groups in New South Wales (China parity 2: 1.182, 1.108–1.260; India parity 2: 1.182, 1.088–1.285), for births to Chinese-born mothers in Victoria (total births: 1.097, 1.072–1.123; parity 1: 1.115, 1.072–1.159) and Australian Capital Territory (total births: 1.189, 1.085–1.302) and births to Indian-born mothers Western Australia (parity 2: 1.307, 1.122–1.523). Conclusions Son preference persists in some immigrant communities after migration to Australia. The consistent pattern of elevated M/F ratios across the larger states indicates that sex imbalances at birth are largely independent of restrictiveness of local abortion laws. Drivers and consequences of son preference in Western high-income settings should be explored to further promote gender equality, and to strengthen support for women who may be vulnerable to reproductive coercion.
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Lebenbaum M, Stukel TA, Saunders NR, Lu H, Urquia M, Kurdyak P, Guttmann A. Association of source country gender inequality with experiencing assault and poor mental health among young female immigrants to Ontario, Canada. BMC Public Health 2021; 21:739. [PMID: 33863298 PMCID: PMC8052772 DOI: 10.1186/s12889-021-10720-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 03/28/2021] [Indexed: 11/21/2022] Open
Abstract
Background Gender inequality varies across countries and is associated with poor outcomes including violence against women and depression. Little is known about the relationship of source county gender inequality and poor health outcomes in female immigrants. Methods We used administrative databases to conduct a cohort study of 299,228 female immigrants ages 6–29 years becoming permanent residence in Ontario, Canada between 2003 and 2017 and followed up to March 31, 2020 for severe presentations of suffering assault, and selected mental health disorders (mood or anxiety, self-harm) as measured by hospital visits or death. Poisson regression examined the influence of source-country Gender Inequality Index (GII) quartile (Q) accounting for individual and country level characteristics. Results Immigrants from countries with the highest gender inequality (GII Q4) accounted for 40% of the sample, of whom 83% were from South Asia (SA) or Sub-Saharan Africa (SSA). The overall rate of assault was 10.9/10,000 person years (PY) while the rate of the poor mental health outcome was 77.5/10,000 PY. Both GII Q2 (Incident Rate Ratio (IRR): 1.48, 95% Confidence Interval (CI): 1.08, 2.01) and GII Q4 (IRR: 1.58, 95%CI: 1.08, 2.31) were significantly associated with experiencing assault but not with poor mental health. For females from countries with the highest gender inequality, there were significant regional differences in rates of assault, with SSA migrants experiencing high rates compared with those from SA. Relative to economic immigrants, refugees were at increased risk of sustaining assaults (IRR: 2.96, 95%CI: 2.32, 3.76) and poor mental health (IRR: 1.73, 95%CI: 1.50, 2.01). Higher educational attainment (bachelor’s degree or higher) at immigration was protective (assaults IRR: 0.64, 95%CI: 0.51, 0.80; poor mental health IRR: 0.69, 95% CI: 0.60, 0.80). Conclusion Source country gender inequality is not consistently associated with post-migration violence against women or severe depression, anxiety and self-harm in Ontario, Canada. Community-based research and intervention to address the documented socio-demographic disparities in outcomes of female immigrants is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10720-0.
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Affiliation(s)
- Michael Lebenbaum
- ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Therese A Stukel
- ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Natasha Ruth Saunders
- ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada.,Division of Paediatric Medicine, the Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.,Department of Pediatrics, University of Toronto, 555 University Avenue, Black Wing Room 1436, Toronto, ON, M5G 1X8, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, 686 Bay St, ON, M5G 0A4, Toronto, Canada
| | - Hong Lu
- ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Marcelo Urquia
- ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada.,Manitoba Centre for Health Policy, Community Health Sciences, Max Rady College of Medicine, 424 Brodie Centre, Winnipeg, Manitoba, Canada.,Rady Faculty of Health Sciences, University of Manitoba, 424 Brodie Centre, Winnipeg, Manitoba, Canada
| | - Paul Kurdyak
- ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada.,Center for Addiction and Mental Health, 33 Russell St, Toronto, ON, M5S 3M1, Canada
| | - Astrid Guttmann
- ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada. .,Division of Paediatric Medicine, the Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada. .,Department of Pediatrics, University of Toronto, 555 University Avenue, Black Wing Room 1436, Toronto, ON, M5G 1X8, Canada. .,Child Health Evaluative Sciences, SickKids Research Institute, 686 Bay St, ON, M5G 0A4, Toronto, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada.
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Pulver A, Guttmann A, Ray JG, O'Campo PJ, Urquia ML. Receipt of routine preventive care among infant daughters and sons of immigrant mothers in Ontario, Canada: a retrospective cohort study. BMJ Open 2020; 10:e036127. [PMID: 32737090 PMCID: PMC7398108 DOI: 10.1136/bmjopen-2019-036127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To explore gender disparities in infant routine preventive care across maternal countries of birth (MCOB) and by mother tongue among infants of Indian-born mothers. SETTING Retrospective population-based administrative cohort in Ontario, Canada (births between 2002 and 2014). PARTICIPANTS 350 366 (inclusive) healthy term singletons belonging to families with a minimum of one opposite gender child. OUTCOME MEASURES Fixed effects conditional logistic regression generated adjusted ORs (aORs) for a daughter being underimmunised and having an inadequate number of well-child visits compared with her brother, stratified by MCOB. Moderation by maternal mother tongue was assessed among children to Indian-born mothers. RESULTS Underimmunisation and inadequate well-child visits were common among both boys and girls, ranging from 26.5% to 58.2% (underimmunisation) and 10.5% to 47.8% (inadequate well-child visits). depending on the maternal birthplace. Girls whose mothers were born in India had 1.19 times (95% CI 1.07 to 1.33) the adjusted odds of inadequate well-child visits versus their brothers. This association was only observed among the Punjabi mother tongue subgroup (aOR: 1.26, 95% CI 1.08 to 1.47). In the Hindi mother tongue subgroup, girls had lower odds of underimmunisation than their brothers (aOR: 0.73, 95% CI 0.54 to 0.98). CONCLUSIONS Gender equity in routine preventive healthcare is mostly achieved among children of immigrants. However, daughters of Indian-born mothers whose mother tongue is Punjabi, appear to be at a disadvantage for well-child visits compared with their brothers. This suggests son preference may persist beyond the family planning stage among some Indian immigrants.
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Affiliation(s)
- Ariel Pulver
- Department of Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Astrid Guttmann
- ICES, Toronto, Ontario, Canada
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Deaprtment of Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Joel G Ray
- ICES, Toronto, Ontario, Canada
- Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Patricia J O'Campo
- Department of Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Marcelo L Urquia
- Department of Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- University of Manitoba, Winnipeg, Manitoba, Canada
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Pulver A, Guttmann A, Ray JG, O'Campo P, Urquia ML. Differences in Early Childhood Maltreatment by Maternal Birthplace and Child Sex. J Pediatr 2020; 218:184-191.e2. [PMID: 31955877 DOI: 10.1016/j.jpeds.2019.11.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 11/04/2019] [Accepted: 11/22/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To identify patterns of health system-identified early childhood maltreatment by maternal birthplace and child sex, within a multicultural society with universal access to healthcare. STUDY DESIGN This retrospective population-based cohort study included 1240946 children born in Ontario, Canada, between 2002 and 2012, and followed from birth to age 5 years using administrative data. Modified Poisson regression was used to estimate adjusted rate ratios for maltreatment-physical abuse or neglect-among the children of immigrant vs nonimmigrant mothers. Conditional logistic regression was used to estimate further the odds of maltreatment comparing a daughter vs son of the same mother. RESULTS Maltreatment rates were 36% lower (adjusted rate ratio, 0.64; 95% CI, 0.61-0.66) among children of immigrant mothers (10 per 1000) than those of nonimmigrant mothers (16 per 1000). Maltreatment rates were 27%-48% lower among children of maternal immigrant groups relative to that among Canadian-born mothers, except children of Caribbean-born mothers (16 per 1000). No significant differences were seen between daughters and sons in the odds of early childhood health system-identified maltreatment by maternal birthplace. CONCLUSIONS Health system-identified maltreatment in early childhood is highest among children of Canadian- and Caribbean-born mothers. Maltreatment did not differ between daughters and sons of the same mother. These data may inform strategies aimed at decreasing maltreatment among vulnerable groups.
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Affiliation(s)
- Ariel Pulver
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Division of Pediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joel G Ray
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, St Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Patricia O'Campo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Marcelo L Urquia
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada; Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada.
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Bowman‐Smart H, Savulescu J, Gyngell C, Mand C, Delatycki MB. Sex selection and non-invasive prenatal testing: A review of current practices, evidence, and ethical issues. Prenat Diagn 2020; 40:398-407. [PMID: 31499588 PMCID: PMC7187249 DOI: 10.1002/pd.5555] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/02/2019] [Accepted: 08/25/2019] [Indexed: 12/24/2022]
Abstract
Non-invasive prenatal testing (NIPT) can determine the sex of the fetus very accurately and very early in gestation. There are concerns that the ease, timing, and accuracy of NIPT sex determination will facilitate sex-selective termination of pregnancy (TOP). Here, we review current practices, the evidence for a link between NIPT and sex-selective TOP, and associated ethical issues. Sex-selective TOP, usually motivated by son preference, has had serious demographic consequences in countries such as India and China. Currently, ultrasound is the primary method by which parents determine the sex of the fetus. The diffusion of ultrasound technology has had a direct impact on the rates of sex-selective TOP. Although NIPT is currently more costly, it is feasible that increased uptake of this technology could have a similar effect. Partly because NIPT is a relatively recent development in prenatal screening, there is little data on the impact of NIPT on sex selection practices. Evidence that NIPT is playing a role in sex-selective TOP remains largely anecdotal. Further research is required to assess and quantify TOP resulting from NIPT sex determination. The use of these technologies for sex selection raises a number of ethical issues, in addition to practical demographic consequences.
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Affiliation(s)
- Hilary Bowman‐Smart
- Bruce Lefroy CentreMurdoch Children's Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| | - Julian Savulescu
- Bruce Lefroy CentreMurdoch Children's Research InstituteMelbourneVictoriaAustralia
- Uehiro Centre for Practical EthicsUniversity of OxfordOxfordUK
| | - Christopher Gyngell
- Bruce Lefroy CentreMurdoch Children's Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| | - Cara Mand
- Bruce Lefroy CentreMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Martin B. Delatycki
- Bruce Lefroy CentreMurdoch Children's Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
- Victorian Clinical Genetics ServicesMurdoch Children's Research InstituteMelbourneVictoriaAustralia
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Edvardsson K, Axmon A, Powell R, Davey MA. Male-biased sex ratios in Australian migrant populations: a population-based study of 1 191 250 births 1999-2015. Int J Epidemiol 2019; 47:2025-2037. [PMID: 30052991 PMCID: PMC6280923 DOI: 10.1093/ije/dyy148] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2018] [Indexed: 11/22/2022] Open
Abstract
Background The naturally occurring male-to-female (M/F) ratio at birth is 1.05. Higher ratios found primarily in countries across Asia have been attributed to prenatal sex selection due to son preference. There is growing evidence that sex-selective practices continue following migration; however, little is known about these practices following migration to Australia. Methods In this population-based study we assessed M/F ratios at birth per mother’s country of birth for all registered births 1999–2015 in Victoria, Australia (n = 1 191 250). We also compared the M/F ratio among births to mothers born elsewhere to that of mothers born in Australia, stratified by time period and parity. Results Compared with the naturally occurring M/F ratio as well as to the M/F ratio among births to mothers born in Australia, there was an increased ratio of male births to mothers born in India, China and South-East Asia, particularly at higher parities and in more recent time periods (elevated M/F ratios ranged from 1·079 to 1·248, relative risks of male birth ranged from 1·012 to 1·084 with confidence intervals between 1·001 and 1·160 and P-values between 0·005 and 0·039). The most male-biased sex ratios were found among multiple births to Indian-born mothers, and parity of two or more births to Indian and Chinese-born mothers in 2011–15. Conclusions The male-biased sex ratios observed in this study indicate that prenatal sex selection may be continuing following migration to Australia from countries where these practices have been documented. The excess of males among multiple births raises the question as to what role assisted reproduction plays. Findings also suggest that systematic discrimination against females starts in the womb.
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Affiliation(s)
- Kristina Edvardsson
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia.,Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Anna Axmon
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Rhonda Powell
- School of Law, University of Canterbury, Christchurch, New Zealand
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
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Wanigaratne S, Uppal P, Bhangoo M, Januwalla A, Singal D, Urquia ML. Sex ratios at birth among second-generation mothers of South Asian ethnicity in Ontario, Canada: a retrospective population-based cohort study. J Epidemiol Community Health 2018; 72:1044-1051. [PMID: 29929953 PMCID: PMC6227816 DOI: 10.1136/jech-2018-210622] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/08/2018] [Accepted: 05/28/2018] [Indexed: 12/03/2022]
Abstract
Background Son-biased sex ratios at birth (M:F), an extreme manifestation of son preference, are predominately found in East and South Asia. Studies have examined sex ratios among first-generation migrants from these regions, but few have examined second-generation descendants. Our objective was to determine whether son-biased sex ratios persist among second-generation mothers with South Asian ethnicity in Ontario, Canada. Methodology A surname algorithm identified a population-based cohort of mothers with South Asian ethnicity who gave birth in Ontario between 1993 and 2014 (n=59 659). Linking to official immigration data identified births to first-generation mothers (ie, immigrants). Births not to immigrants were designated as being to second-generation mothers (ie, born in Canada) (n=10 273). Sex ratios and 95% CI were stratified by the sex of previous live births and by whether it was preceded by ≥1 abortion for both first-generation and second-generation mothers. Results Among mothers with two previous daughters and at least one prior abortion since the second birth, both second-generation mothers and first-generation mothers had elevated sex ratios at the third birth (2.80 (95% CI 1.36 to 5.76) and 2.46 (95% CI 1.93 to 3.12), respectively). However, among mothers with no prior abortion, second-generation mothers had a normal sex ratio, while first-generation mothers gave birth to 142 boys for every 100 girls (95% CI 125 to 162 boys for every 100 girls). Conclusion Son preference persists among second-generation mothers of South Asian ethnicity. Culturally sensitive and community-driven gender equity interventions are needed.
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Affiliation(s)
- Susitha Wanigaratne
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Pamela Uppal
- Ontario Non-Profit Network, Toronto, Ontario, Canada
| | | | - Alia Januwalla
- Knowledge Translation Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Deepa Singal
- Department of Community Health Sciences, Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marcelo L Urquia
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Community Health Sciences, Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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