By JENNIFER YANG
Special to Focus
A Toronto Star survey has found that six major hospitals in the GTA do not allow their ultrasound staff to reveal a baby’s gender to expectant mothers.
And, whether by coincidence or by design, all six hospitals are located in or near areas with high concentrations of South Asian immigrants — one of the ethnic communities at the centre of a mounting concern over female feticide.
Female feticide — the practice of aborting female fetuses due to a preference for sons — is a known phenomenon in countries such as China and India, where it has been deemed a “crime against humanity.”
But a growing body of research is stoking fears that the practice may have migrated to Canada. On Monday, a newly-released St. Michael’s Hospital study found “concerning trends” to suggest female feticide could be happening in South Korean and Indian communities.
The starkest finding was in the category of Indian-born mothers with two previous children. Among their third children, the male-to-female ratio was 136 boys for every 100 girls; by comparison, the children of Canadian-born women have a sex ratio of just 105 boys for every 100 girls.
In January, the Canadian Medical Association Journal published an editorial calling on doctors to stop divulging fetal sex to mothers until the 30th week of pregnancy, when an unquestioned abortion becomes virtually impossible. (Generally, few abortions are performed after 20 weeks.)
The radical stance was widely criticized, however, and the Society of Obstetricians and Gynecologists issued a statement reaffirming its belief in the patient’s right to know the gender of her child.
But for many expectant parents, it is their ultrasound sonographer — which most people erroneously refer to as an ultrasound technician — who announces the baby’s sex. Although sonographers technically are not allowed to (they are not supposed to diagnose and gender is considered a diagnosis), the majority of major GTA hospitals allow it.
“The technician staff is pleased to share that happy news with family wanting that information,” said Aaron Lazarus, a spokesperson for Lakeridge Health in Durham region. “We have a family-based model of care here.”
Doctors say that about half of prenatal ultrasounds are done at hospitals, with the other half performed at outside clinics.
Of the 16 major hospitals in the GTA that perform prenatal ultrasounds, only six prohibit their sonographers from divulging fetal gender: William Osler Health System (which has hospitals in Etobicoke and Brampton), North York General, Scarborough Hospital, Rouge Valley (with hospitals in Scarborough and Ajax), Toronto East General, and Humber River Regional Hospital (which has three locations in the Jane and Finch area that will merge in 2015).
Some of these hospitals will indicate gender on their reports, but only at the request of the referring physician who can then tell the patient during a follow-up visit.
All six of these hospitals are located in or near communities with large South Asian populations. But hospital spokespeople dismiss this as nothing more than a coincidence and say they are just adhering to policies that have been in place for decades.
“Our diagnostic imaging lead said it has been in place for the 30 years they’ve been here,” said Lorraine Lynch, spokesperson for William Osler Health System, in an emailed response. “We do not have any information or programs for the issue you are covering.”
“This procedure has nothing to do with the populations we serve, but rather with the (sonographer’s) scope of practice,” said Marcelo Gomez-Wiuckstern, spokesperson for North York General.
But at Rouge Valley, female feticide is very much a concern for Raymond Goh, manager of diagnostic imaging. He said the hospital’s policy has been in place for at least 13 years, so it isn’t reaction to the community’s population mix; that being said, however, the hospital takes the policy seriously because of the female feticide issue.
“From the radiologists’ side, we have been debating about this for years because we are concerned about the issue of gender selection,” said Dr. Raymond Goh. “We have been criticized, actually, by several of the referring doctors, the obstetricians and family doctors, for having such a firm stance on gender.”
Goh said sonographers at Rouge Valley can record a baby’s gender if they happen to notice it during the routine ultrasound. Their notes and scans are then passed along to a radiologist, who drafts a medical report for the referring physician.
Gender is not included on the report, however, unless a doctor has specifically requested it ahead of time. In Goh’s opinion, this is because the referring physician is best-equipped to decide what information should be shared with the patient.
But even at hospitals where sonographers can tell, female feticide is an underlying concern. Radiologist Dr. Ants Toi at Mount Sinai agrees the issue has complicated policies around gender disclosure.
“There are some ethnic groups in particular that create a problem with knowing gender and that’s highlighted things,” he said.
Toi said he frequently interacts with patients and often asks if they want to know the gender — after all, many parents want it to be a surprise. But he will steer clear of the question altogether if something seems amiss.
“It’s sort of a quiet patient assessment without asking any particular interview questions,” he said. If I have any concern at all that this information may be used in a harmful way . . . I’ll simply say I’m sorry, I can’t see clearly enough.”
Toi said he rarely finds cause for concern amongst his own patients but he does believe female feticide is likely occurring in Canada — and the issue puts medical practitioners in a tricky position.
“It’s a social issue, ethical issue, and an issue of many beliefs. It’s very difficult,” he said.
Some medical practitioners would like a higher authority to provide clarity on the issue, but spokespeople for the Ministry of Health and College of Physicians and Surgeons of Ontario said they are currently not looking into the issue.
Bernard Dickens, a professor emeritus of health policy at the University of Toronto, wonders if it is even ethical to implement a blanket policy due to concerns over one segment of the population.
“Note the paradox that abortion for no reason — because it’s untimely, unplanned, not wanted — that is acceptable. So then we’ve got the paradox that an abortion for no reason (is ok), but abortion for what seems to be a gendered or sex-based reason is not,” he said.
“Making policies to deny that population what is important to them — in itself, it is a difficult ethical and legal question. Is that racial profiling, is that a form of racial discrimination?”
If hospitals are worried about female feticide, they should be conducting community consultations before shaping any policies, said Kripa Sekhar, executive director of South Asian Women’s Centre in Toronto. While concerned about the possibility of female feticide, she believes more research should be done before conclusions can be reached.
“You want to protect women, but in the process are we looking at a small segment of women that might be profiled negatively and then a whole community becomes (stigmatized)?” she asked.
At Rouge Valley, Goh agrees there is no proof female feticide is being practised. But he believes there are enough red flags to warrant concern — and if female fetuses are being targeted, he would rather take a proactive stance than none at all.
“We need to find that evidence and if it is true, we need to help the girls,” he said. “Ultimately, I think (sonographers) not telling is really trying to err on the safe side to protect the unborn.”
Ultrasound at GTA Hospitals
Here are six major hospitals in the GTA that have a policy or practice restricting ultrasound sonographers from telling a patient the sex of the fetus:
Toronto East General Hospital
Sonographers cannot divulge gender because it is considered a diagnosis. Gender is also not included on the doctor’s report, unless requested by a physician for a medically-relevant reason.
Rouge Valley Health System
Sonographers cannot divulge gender to parents and the information is not included on the radiologist’s report for the doctor — unless a physician has requested it beforehand.
William Osler Health Centre
Sonographers will look for the fetal gender if requested by a physician or patient. The radiologist then notes the gender in the report for the doctor, who is responsible for informing the patient.
Humber River Regional Hospital
Sonographers do not provide gender results during the exam, nor is the information included on the radiologist’s report for the doctor.
North York General Hospital
There is no policy in place but patients are “strongly encouraged” to follow up with their physicians for gender information. Sonographers are not to divulge gender because it falls outside their scope of practice.
There is no policy but hospital practice says sonographers cannot divulge gender, or any other diagnosis, during an ultrasound. It is also not the radiologists’ practice to include gender on their reports.