IJFAB Blog

A recent large scale analysis of worldwide population data suggests sex-selective abortions have led to at least 23 million fewer girls being born, mainly in China and India. Sons are valued over daughters in many societies, for both social and economic reasons. As fewer children are being born worldwide, there has been an increase in families aborting female fetuses in an effort to have at least one son.

When examining data from 1970 to 2017 from 202 countries, researchers found excess male births had occurred in some years in Albania, Armenia, Azerbaijan, China, Georgia, Hong Kong, India, South Korea, Montenegro, Taiwan, Tunisia and Vietnam. These trends seem to be reversing, however.

In every nation except Vietnam, the team found that the skew in sex ratios is returning to normal. This seems to be true even in China, which the analysis says accounts for 51 per cent of the missing female births. In 2005, 118 boys were born in China for every 100 girls, but by 2017 this had dropped to 114. “Whether the downward trend in China continues remains to be seen,” says Chao.

Birth gender ratios have already returned to normal in Georgia, South Korea and Hong Kong. But Chao’s team found that the fall in excess boys in India – which the analysis suggests accounts for 46 per cent of the missing girls – is only slight. With 12 million girls born each year compared with 7 million in China, reducing the rate of sex selection in India is crucial for ending the practice worldwide, says Sabu George of the Centre for Women’s Development Studies in New Delhi.

Whether the trend towards normal continues is yet to be seen. The issue is complex as many parents in countries such as India rely on their adult male sons to support them in their old age. Thus, as is the case with many global bioethics issues, sex-selective abortion is interwoven with structural and economic problems in vulnerable nations.

A baby boy has been born in Greece as the result of an experimental form of in-vitro fertilization that uses an egg from the mother, sperm from the father, and another egg from a donor woman. The mitochondria–the small compartments inside almost every cell of the body that convert food to energy– from one donor woman’s egg are transferred into the mother’s egg.

This technique was originally developed to help families affected by deadly mitochondrial disease which can be passed from mother to baby. But some fertility doctors believe the technology could increase the odds of IVF too, although that claim has not been proven. These two different uses– infertility and disease prevention — are arguably ethically different.

Tim Child, from the University of Oxford and the medical director of The Fertility Partnership, said: “I’m concerned that there’s no proven need for the patient to have her genetic material removed from her eggs and transferred into the eggs of a donor.

“The risks of the technique aren’t entirely known, though may be considered acceptable if being used to treat mitochondrial disease, but not in this situation.

“The patient may have conceived even if a further standard IVF cycle had been used.”

A Malaysian man was arrested at Mumbai International Airport for “smuggling” a live human embryo into India. The man had a nitrogen canister containing a single live human embryo. Officials have determined that the embryo was destined for a top in-vitro fertilisation (IVF) clinic run by Dr. Goral Gandhi. The Directorate of Revenue Intelligence (DRI)
had previously raided Gandhi’s clinic on February 16 and seized alleged incriminating documents pertaining to smuggling of embryos.

Surrogacy is illegal in Malaysia which is likely why the embryo was on its way to India. India prohibits the import of human embryos except for research purposes. An Indian Bill passed in 2018 prohibits commercial surrogacy but permits altruistic surrogacy between relatives.

India has become a hub for both legal and illegal surrogacy. Some IVF specialists believe there is a market for babies with “non-Indian looks” that may be contributing to the smuggling of embryos from other countries. Specialists also indicate that there is an overall lack of laws surrounding assisted reproductive technologies in India.

Experts say illegally importing embryos from foreign countries to use for surrogacy is not that widespread, while others think this is feeding the market for surrogacy or for IVF procedures in which the parents want a child with “non-Indian looks”. The DRI believes there are other IVF clinics which may be involved in the alleged racket and have widened their probe.

IVF experts do think that there’s a gap in regulations and the need for framing laws is urgent. The Indian Express quoted Dr Jaideep Malhotra, president of Indian Society for Assisted Reproduction, as saying that:

“A law is required to regulate import in certain cases. Several Indian couples freeze their egg or embryos abroad. Once they move to India, they wish to continue IVF and bring it back.”

Another specialist reiterated the need for guidelines and said “it is one’s own property and own tissues. They should have free choice to take it wherever they want for IVF.”

The maternal mortality rate following a C-section in Africa may be 50 times higher than that of high-income countries, according to a study of more than 3,500 mothers from 22 African countries, published in The Lancet Global Health journal. Maternal deaths following C-section in African countries averaged 5.43 per 1000 operations while they average only .1 per 1000 operations in the UK. The study also showed African women were three times more likely to develop complications during surgery than women in the US.

The study also highlighted the lack of specialist care available, with an average of only .7 specialist per 100,000 people. Almost 1 in 4 women received anaesthesia from a non-specialist, which contributes to high mortality rates. The neonatal mortality rate after c-section in Africa was found to be double the global average.

These findings are very concerning for the key health care principle of justice. While some gaps in quality of care can be expected in low income countries, a maternal mortality rate that is 50x higher is an urgent problem that warrants immediate attention from the international community.

Commenting on the generalisability of their findings to Africa as a whole, the authors note that the study included fewer than half of the countries in Africa and two thirds of the study population were from middle-income countries, whilst several of the continent’s poorest countries were not included. The authors also note that their study includes a disproportionate number of government hospitals, compared with district ones. Government hospitals tend to provide a higher level of care and be better resourced than district hospitals, which typically act as the first providers of care for mothers when giving birth. These factors may mean the maternal mortality rates in the study are conservative.

Writing in a linked comment, Dr Anna J Dare, University of Toronto, comments on the importance of improving C-section provision in Africa: “Despite persistently low reported caesarean section rates in sub-Saharan Africa, caesarean section was still the most common surgical procedure performed in the larger ASOS cohort, making up a third of all operative procedures… As such, a strong argument can be made for coordinated efforts to improve and standardise the quality of care around caesarean delivery, while simultaneously working to improve access… Substantial progress has been made over the past 20 years in reducing maternal mortality, including in Africa, yet global disparities persist across all levels of obstetric care.”