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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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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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Kenny KS, Pulver A, O'Campo P, Guttmann A, Urquia ML. Do socioeconomic and birth order gradients in child maltreatment differ by immigrant status? J Epidemiol Community Health 2020; 75:22-28. [PMID: 32938615 PMCID: PMC7788479 DOI: 10.1136/jech-2019-212759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/29/2020] [Indexed: 11/25/2022]
Abstract
Background While literature has documented strong gradients in child maltreatment (CM) by socioeconomic status and family composition in the general population, how these patterns extend to immigrants remain inconclusive. Using population-based administrative data, we examined, for the first time, whether gradients in CM by neighbourhood income and childbirth order vary by immigrant status. Methods We used linked hospitalisation, emergency department visits, small-area income, birth and death records with an official Canadian immigration database to create a retrospective cohort of all 1 240 874 children born from 2002 to 2012 in Ontario, Canada, followed from 0 to 5 years. We estimated rate ratios of CM among immigrants and non-immigrants using modified Poisson regression. Results CM rates were 1.6 per 100 children among non-immigrants and 1.0 among immigrants. CM was positively associated with neighbourhood deprivation. The adjusted rate ratio (ARR) of CM in the lowest neighbourhood income quintile versus the highest quintile was 1.57 (95% CI 1.49 to 1.66) for non-immigrants and 1.33 (95% CI 1.15 to 1.54) for immigrants. The socioeconomic gradient disappeared when restricted to children of immigrant mothers arrived at 25+ years and in analyses excluding emergency department visits. Compared to a first child, the ARR of CM for a fourth or higher-order child was 1.75 (95% CI 1.63 to 1.89) among non-immigrants and 0.57 (95% CI 0.44 to 0.74) among immigrants. Conclusions Immigrants exhibited lower CM rates than non-immigrants across neighbourhood income quintiles and differences were greatest in more deprived neighbourhoods. The contrasting birth order gradients between immigrants and non-immigrants require further investigation.
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Affiliation(s)
- Kathleen S Kenny
- Department of Community Health Sciences, Max Rady College of Medicinea, University of Manitoba, Winnipeg, Canada
| | - Ariel Pulver
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Patricia O'Campo
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, St.Michael's Hospital, Toronto, Canada
| | - Astrid Guttmann
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Marcelo L Urquia
- Department of Community Health Sciences, Max Rady College of Medicinea, University of Manitoba, Winnipeg, Canada.,Institute for Clinical Evaluative Sciences, Toronto, 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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Castelló A, Urquia M, Rodríguez-Arenas MÁ, Bolúmar F. Missing girls among deliveries from Indian and Chinese mothers in Spain 2007-2015. Eur J Epidemiol 2019; 34:699-709. [PMID: 30891687 DOI: 10.1007/s10654-019-00513-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Abstract
Deliveries from Indian and Chinese mothers present a higher than expected male:female ratio in their own countries, in northern Europe, EEUU and Canada. No studies have been carried out in southern European countries. We explored whether the high male-to-female ratio common in Indian and Chinese communities, also exists among families from those regions who live in Spain. For that purpose we designed a cross-sectional population-based study containing data on 3,133,908 singleton live births registered in the Spanish Vital Statistics Registry during the period 2007-2015. The ratio of male:female births by area of origin was calculated using binary intercept-only logistic regression models without reference category for the whole sample of births and taking into account a possible effect modification of birth order and sex of the previous males. Interaction effects of sociodemographic mothers' and fathers' characteristics was also assesed. In Spain, the ratio male:female is higher than expected for Indian-born mothers, especially for deliveries from mothers with no previous male births and, to a lesser extent, for Chinese-born women, specifically for third or higher order births and slightly influenced by the sex of the previous births. Therefore, the increased sex male:female ratio observed in other countries among Indian and Chinese mothers is also observed in Spain. This reinforces the notion that culture and values of the country of origin are more influential than the country of residence.
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Affiliation(s)
- Adela Castelló
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avenida Monforte de Lemos, 5, 28029, Madrid, Spain.,Cancer Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Avenida Monforte de Lemos, 5, 28029, Madrid, Spain.,Department of Public Health Sciences, Faculty of Medicine, University of Alcalá, Campus Universitario, Ctra. Madrid-Barcelona Km 33,600, 28871, Alcalá de Henares, Madrid, Spain
| | - Marcelo Urquia
- Manitoba Centre for Health Policy, Department of Community Health Science, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada
| | | | - Francisco Bolúmar
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avenida Monforte de Lemos, 5, 28029, Madrid, Spain. .,Department of Public Health Sciences, Faculty of Medicine, University of Alcalá, Campus Universitario, Ctra. Madrid-Barcelona Km 33,600, 28871, Alcalá de Henares, Madrid, Spain. .,Department of Epidemiology and Biostatistics, City, University of New York School of Public Health, 55 W 125th St, New York, 10027, USA.
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10
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Cabeza de Baca T, Albert MA. Psychosocial Stress, the Unpredictability Schema, and Cardiovascular Disease in Women. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2019. [DOI: 10.15212/cvia.2017.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Clarke AJ, Wallgren-Pettersson C. Ethics in genetic counselling. J Community Genet 2019; 10:3-33. [PMID: 29949066 PMCID: PMC6325035 DOI: 10.1007/s12687-018-0371-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 05/15/2018] [Indexed: 12/22/2022] Open
Abstract
Difficult ethical issues arise for patients and professionals in medical genetics, and often relate to the patient's family or their social context. Tackling these issues requires sensitivity to nuances of communication and a commitment to clarity and consistency. It also benefits from an awareness of different approaches to ethical theory. Many of the ethical problems encountered in genetics relate to tensions between the wishes or interests of different people, sometimes even people who do not (yet) exist or exist as embryos, either in an established pregnancy or in vitro. Concern for the long-term welfare of a child or young person, or possible future children, or for other members of the family, may lead to tensions felt by the patient (client) in genetic counselling. Differences in perspective may also arise between the patient and professional when the latter recommends disclosure of information to relatives and the patient finds that too difficult, or when the professional considers the genetic testing of a child, sought by parents, to be inappropriate. The expectations of a patient's community may also lead to the differences in perspective between patient and counsellor. Recent developments of genetic technology permit genome-wide investigations. These have generated additional and more complex data that amplify and exacerbate some pre-existing ethical problems, including those presented by incidental (additional sought and secondary) findings and the recognition of variants currently of uncertain significance, so that reports of genomic investigations may often be provisional rather than definitive. Experience is being gained with these problems but substantial challenges are likely to persist in the long term.
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Affiliation(s)
- Angus J Clarke
- Institute of Medical Genetics, Division of Cancer & Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, Wales, CF14 4XN, UK.
| | - Carina Wallgren-Pettersson
- The Folkhaelsan Department of Medical Genetics, Topeliusgatan, 20 00250, Helsinki, Finland
- The Folkhaelsan Institute of Genetics and the Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
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12
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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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13
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Brar A, Wanigaratne S, Pulver A, Ray JG, Urquia ML. Sex Ratios at Birth Among Indian Immigrant Subgroups According to Time Spent in Canada. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:459-464.e2. [PMID: 28462899 DOI: 10.1016/j.jogc.2017.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/10/2017] [Accepted: 01/12/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To examine whether son-biased male to female (M:F) ratios at birth among linguistically different subgroups of Indian immigrants vary according to duration of residence in Canada. METHODS We analyzed a retrospective cohort of 46 834 live births to Indian-born mothers who gave birth in Canada between 1993 and 2014. The M:F ratio at birth was calculated according to the sex of previous live births and stratified by (1) time since immigration to Canada (<10 and ≥10 years) and (2) mother tongue (Punjabi, Gujarati, Hindi, and other). We estimated adjusted odds ratios (aORs) using multivariate logistic regression to assess the probability of having a male newborn with 5-year increases in duration of residence in Canada for each language group. ORs were adjusted for married status, knowledge of English/French, maternal education at arrival and age and neighbourhood income at delivery. RESULTS Among all Indian immigrant women with two previous daughters, M:F ratios were higher than expected (1.92, 95% CI 1.73-2.12), particularly among those whose mother tongue was Punjabi (n = 25 287) (2.40, 95% CI 2.11-2.72) and Hindi (n = 7752) (1.63, 95% CI 1.05-2.52). M:F ratios did not diminish with longer duration in Canada (Punjabi 5-year aOR 1.03, 95% CI 0.81-1.31; Hindi 5-year aOR 0.94, 95% CI 0.42-2.17). CONCLUSION Among the Punjabi and Hindi women with two previous daughters, longer duration of residence did not attenuate son-biased M:F ratios at the third birth. Gender equity promotion may focus on Punjabi- and Hindi-speaking Indian immigrant women regardless of how long they have lived in Canada.
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Affiliation(s)
| | - Susitha Wanigaratne
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON
| | - Ariel Pulver
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Joel G Ray
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON
| | - Marcelo L Urquia
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON; Dalla Lana School of Public Health, University of Toronto, Toronto, ON; Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB.
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14
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Kissoon N. Healthcare Costs to Poor Families: An Agonising Burden. Indian J Pediatr 2016; 83:1063-4. [PMID: 27272049 DOI: 10.1007/s12098-016-2170-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 05/30/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Niranjan Kissoon
- BC Children's Hospital, 4480 Oak Street, Room B245, Vancouver, BC, V6H 3V4, Canada.
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15
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Yasseen AS, Lacaze-Masmonteil T. Male-biased infant sex ratios and patterns of induced abortion. CMAJ 2016; 188:640-641. [PMID: 27067822 PMCID: PMC4902685 DOI: 10.1503/cmaj.160183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Abdool S Yasseen
- Children's Hospital of Eastern Ontario Research Institute (Yasseen, Lacaze-Masmonteil), Ottawa Ont.; Dalla Lana School of Public Health (Yasseen), University of Toronto, Toronto, Ont.
| | - Thierry Lacaze-Masmonteil
- Children's Hospital of Eastern Ontario Research Institute (Yasseen, Lacaze-Masmonteil), Ottawa Ont.; Dalla Lana School of Public Health (Yasseen), University of Toronto, Toronto, Ont
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16
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Urquia ML, Moineddin R, Jha P, O'Campo PJ, McKenzie K, Glazier RH, Henry DA, Ray JG. Sex ratios at birth after induced abortion. CMAJ 2016; 188:E181-E190. [PMID: 27067818 DOI: 10.1503/cmaj.151074] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2016] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Skewed male:female ratios at birth have been observed among certain immigrant groups. Data on abortion practices that might help to explain these findings are lacking. METHODS We examined 1 220 933 births to women with up to 3 consecutive singleton live births between 1993 and 2012 in Ontario. Records of live births, and induced and spontaneous abortions were linked to Canadian immigration records. We determined associations of male:female infant ratios with maternal birthplace, sex of the previous living sibling(s) and prior spontaneous or induced abortions. RESULTS Male:female infant ratios did not appreciably depart from the normal range among Canadian-born women and most women born outside of Canada, irrespective of the sex of previous children or the characteristics of prior abortions. However, among infants of women who immigrated from India and had previously given birth to 2 girls, the overall male:female ratio was 1.96 (95% confidence interval [CI] 1.75-2.21) for the third live birth. The male:female infant ratio after 2 girls was 1.77 (95% CI 1.26-2.47) times higher if the current birth was preceded by 1 induced abortion, 2.38 (95% CI 1.44-3.94) times higher if preceded by 2 or more induced abortions and 3.88 (95% CI 2.02-7.50) times higher if the induced abortion was performed at 15 weeks or more gestation relative to no preceding abortion. Spontaneous abortions were not associated with male-biased sex ratios in subsequent births. INTERPRETATION High male:female ratios observed among infants born to women who immigrated from India are associated with induced abortions, especially in the second trimester of pregnancy.
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Affiliation(s)
- Marcelo L Urquia
- Centre for Global Health Research (Jha), St. Michael's Hospital; Centre for Research on Inner City Health (Urquia, O'Campo, Glazier), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Dalla Lana School of Public Health (Urquia, Jha, O'Campo, Henry), University of Toronto; Department of Family and Community Medicine (Moineddin, Glazier), University of Toronto; Centre for Addiction and Mental Health (McKenzie), University of Toronto; Department of Psychiatry (McKenzie), University of Toronto; Institute for Clinical Evaluative Sciences (Urquia, Moineddin, O'Campo, Glazier, Henry, Ray), Toronto, Ont.
| | - Rahim Moineddin
- Centre for Global Health Research (Jha), St. Michael's Hospital; Centre for Research on Inner City Health (Urquia, O'Campo, Glazier), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Dalla Lana School of Public Health (Urquia, Jha, O'Campo, Henry), University of Toronto; Department of Family and Community Medicine (Moineddin, Glazier), University of Toronto; Centre for Addiction and Mental Health (McKenzie), University of Toronto; Department of Psychiatry (McKenzie), University of Toronto; Institute for Clinical Evaluative Sciences (Urquia, Moineddin, O'Campo, Glazier, Henry, Ray), Toronto, Ont
| | - Prabhat Jha
- Centre for Global Health Research (Jha), St. Michael's Hospital; Centre for Research on Inner City Health (Urquia, O'Campo, Glazier), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Dalla Lana School of Public Health (Urquia, Jha, O'Campo, Henry), University of Toronto; Department of Family and Community Medicine (Moineddin, Glazier), University of Toronto; Centre for Addiction and Mental Health (McKenzie), University of Toronto; Department of Psychiatry (McKenzie), University of Toronto; Institute for Clinical Evaluative Sciences (Urquia, Moineddin, O'Campo, Glazier, Henry, Ray), Toronto, Ont
| | - Patricia J O'Campo
- Centre for Global Health Research (Jha), St. Michael's Hospital; Centre for Research on Inner City Health (Urquia, O'Campo, Glazier), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Dalla Lana School of Public Health (Urquia, Jha, O'Campo, Henry), University of Toronto; Department of Family and Community Medicine (Moineddin, Glazier), University of Toronto; Centre for Addiction and Mental Health (McKenzie), University of Toronto; Department of Psychiatry (McKenzie), University of Toronto; Institute for Clinical Evaluative Sciences (Urquia, Moineddin, O'Campo, Glazier, Henry, Ray), Toronto, Ont
| | - Kwame McKenzie
- Centre for Global Health Research (Jha), St. Michael's Hospital; Centre for Research on Inner City Health (Urquia, O'Campo, Glazier), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Dalla Lana School of Public Health (Urquia, Jha, O'Campo, Henry), University of Toronto; Department of Family and Community Medicine (Moineddin, Glazier), University of Toronto; Centre for Addiction and Mental Health (McKenzie), University of Toronto; Department of Psychiatry (McKenzie), University of Toronto; Institute for Clinical Evaluative Sciences (Urquia, Moineddin, O'Campo, Glazier, Henry, Ray), Toronto, Ont
| | - Richard H Glazier
- Centre for Global Health Research (Jha), St. Michael's Hospital; Centre for Research on Inner City Health (Urquia, O'Campo, Glazier), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Dalla Lana School of Public Health (Urquia, Jha, O'Campo, Henry), University of Toronto; Department of Family and Community Medicine (Moineddin, Glazier), University of Toronto; Centre for Addiction and Mental Health (McKenzie), University of Toronto; Department of Psychiatry (McKenzie), University of Toronto; Institute for Clinical Evaluative Sciences (Urquia, Moineddin, O'Campo, Glazier, Henry, Ray), Toronto, Ont
| | - David A Henry
- Centre for Global Health Research (Jha), St. Michael's Hospital; Centre for Research on Inner City Health (Urquia, O'Campo, Glazier), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Dalla Lana School of Public Health (Urquia, Jha, O'Campo, Henry), University of Toronto; Department of Family and Community Medicine (Moineddin, Glazier), University of Toronto; Centre for Addiction and Mental Health (McKenzie), University of Toronto; Department of Psychiatry (McKenzie), University of Toronto; Institute for Clinical Evaluative Sciences (Urquia, Moineddin, O'Campo, Glazier, Henry, Ray), Toronto, Ont
| | - Joel G Ray
- Centre for Global Health Research (Jha), St. Michael's Hospital; Centre for Research on Inner City Health (Urquia, O'Campo, Glazier), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Dalla Lana School of Public Health (Urquia, Jha, O'Campo, Henry), University of Toronto; Department of Family and Community Medicine (Moineddin, Glazier), University of Toronto; Centre for Addiction and Mental Health (McKenzie), University of Toronto; Department of Psychiatry (McKenzie), University of Toronto; Institute for Clinical Evaluative Sciences (Urquia, Moineddin, O'Campo, Glazier, Henry, Ray), Toronto, Ont
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