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Should female feticide in Canada be ignored because it is a small problem localized to minority ethnic groups?” To this question Dr. Rajendra Kale firmly responds “no.”1 Disagreeing with him would be difficult given existing policies.
The Canadian Medical Association statement on abortion from 1988 indicates, that prior to viability, abortion should be made universally available throughout Canada.2 The sex of the fetus is typically not considered medically relevant; however, the policy statement does not state that abortion requires a medically relevant indication. There may be many nonmedical reasons abortion is procured, which could include poor timing of conception, not wanting more children, an abusive household environment, financial strain, sexual assault, fetal chromosomal abnormalities and defects.3
From a patient perspective, the most concordant statement is from the Abortion Rights Coalition of Canada. Their position statement from 2006 states that, in regard to sex-selective abortion, “it is important to remember that we cannot restrict women’s right to abortion just because some women might make decisions we disagree with.”4
As physicians, however, we are not obligated to provide nonmedical information regarding the fetus, and this is where I agree with Dr. Kale. The Society of Obstetricians and Gynecologists has already stated that they “do not support the termination of pregnancy on the basis of gender.”5 From a provider perspective, Dr. Kale’s proposal to provide sex typing at 30 weeks is a balanced way to provide information to future parents without actively being involved in the selection process. Whether this would need to be mandated or left to individual providers would be open to further debate.
Patient education is important because physicians cannot prevent patients from obtaining ultrasounds elsewhere — and we shouldn’t, if we are allowing patient autonomy as per the Abortion Rights Coalition of Canada statement. We must also be prepared to deal with an increase in child abuse and infanticide in at-risk groups. This will require the education of primary care providers in identifying susceptible patients, and the development of resources to which these patients can be referred.