Sex selection in practice among Hong Kong Chinese

Gender differences in the risk of depressive disorders following the loss of a young child: a nationwide population-based longitudinal study

BACKGROUND

Losing a child to death is one of the most stressful life events experienced in adulthood. The aim of the current study is to investigate parental risk of seeking treatment for major depression disorders (MDD) after a child's death and to explore whether such connection may operate differentially by parents' prior medical condition.

METHODS

We studied a retrospective cohort of 7245 parents (2987 mothers and 4258 fathers) identified in the National Health Insurance Research Database of Taiwan (NHIRD) who had lost a child with age between 1 and 12 years. For comparison, the parents of 1:4 birth year- and gender-matched non-deceased children were retrieved (16,512 mothers and 17,753 fathers). Gender-specific Cox regression analyses were performed to estimate risk.

RESULTS

Nearly 5.0% and 2.4% of bereaved mothers and fathers sought treatment for MDD within three years after a child's death, significantly higher than 0.8% and 0.5% in the non-bereaved parents. With covariate adjustment, the hazard ratio (HR) for maternal and paternal seeking treatment for MDD was estimated 4.71 (95% confidence interval [CI]: 3.35-6.64) and 1.93 (95% CI: 1.27-2.95), respectively. The increased risk of MDD varied by prior disease history; specifically, the increased risk of seeking treatment for MDD was especially prominent for those without chronic physical condition (CPC) (e.g., mothers with CPC: aHR = 2.38, 95% CI: 1.56-3.65 vs. no CPC: aHR = 9.55, 95% CI: 6.17-14.79).

CONCLUSIONS

After the death of a child, parental elevated risk of MDD was especially prominent for the women and those without prior medical condition. Effective strategies addressing bereavement may require family-based, integrated physical and mental healthcare and even extended counseling service.

Maternity migration and the recent normalization of the sex ratio at birth in Hong Kong

Hong Kong is characterized by very low fertility. However, over a period from 2000 to 2015, both the total number of births and the sex ratio at birth (SRB) increased and then declined dramatically. We analysed the increases in a 2013 paper in this journal, where we largely ascribed them to a rapid growth in the number of 'transient' mothers from Mainland China disproportionately giving birth to boys in the territory. In 2012, policies were implemented to halt this 'maternity migration'. Here, we explore the impact of these policies, both on births and the SRB in Hong Kong. We conclude that the rises and falls in births and SRBs in Hong Kong can, indeed, be broadly ascribed to the reproductive behaviour of transient Mainland mothers. However, the role of the Hong Kong government's policy interventions is much less clearly defined.

Death of a son is associated with risk of suicide among parous women in Taiwan: a nested case-control study

Background

The impact of the sex of a deceased child on maternal suicide has not been studied. We examined whether the death of a child, especially a son, increased the risk of suicide among parous Taiwanese women.

Methods

This matched case-control study was done within a cohort of 1 292 462 Taiwanese women who experienced a first and singleton childbirth between 1 January 1978 and 31 December 1987 and were followed up until 31 December 2008. From the cohort, 2701 suicide cases were identified and 2701 controls were randomly selected. Multiple logistic regression was used to estimate the risk of suicide associated with the death of a child.

Results

The adjusted odds ratios (ORs) for suicide among mothers whose son had died were 2.60 (95% CI = 1.18–5.73), 2.58 (1.28–5.20), and 4.20 (0.79–22.45) for death of a son aged younger than 1 year, 1 to 17 years, and 18 years or older. The ORs for suicide associated with the death of a daughter were not statistically significant: the respective adjusted ORs were 1.86 (0.82–4.62), 1.38 (0.54–3.49), and 2.48 (0.40–15.51).

Conclusions

The death of a child, especially a son, increased the risk of maternal suicide, which supports the notion that preference for a son is firmly rooted in traditional Chinese culture.

Social sex selection by preimplantation genetic diagnosis

A personal view is presented, exploring the issue of social sex selection by preimplantation genetic diagnosis from the dual perspectives of protecting the autonomy of the couple and the professional duty of care. It is concluded that sex selection by PGD is acceptable in certain circumstances.