I noted that Mrs. Lee was early in her third pregnancy when I was getting ready to see her in the office.
â€œHow are you today?â€ I asked
â€œVery well, thank you. The morning sickness is getting better,â€ was her accented reply.
My examination showed that the size of her uterus was compatible with her 14 week gestational age and the fetal heart rate was average at 140 beats per minute. Then she had a question that I did not expect.
â€œHow do I arrange an amniocentesis?â€ she asked.
Usually this procedure is done only if there is an increased risk of a genetic abnormality. It involves inserting a thin needle into the womanâ€™s uterus to remove a tablespoon or so of the amniotic fluid that cushions the fetus. An amnio hurts a little bit and carries a small amount of risk of miscarriage.
â€œI donâ€™t know why you should have an amnio. The blood test that could be done next weekâ€”the quad screenâ€”is cheaper and without risk.â€
â€œWe already have two daughters and I want to see if this is a boy.â€
Something clicked in my head. The Lees, being recent immigrants, wanted a son. â€œWhat would you do if you are carrying another daughter?â€ I asked.
â€œWell, we would have to think about it,â€ she answered evasively.
Many cultures favor males over females. In Hindu India, only a son is able to release a dead parentâ€™s soul to go on its journey of reincarnation. Without a son to perform the ritual, the parentâ€™s soul will be trapped forever in the corpse. Furthermore, since child mortality rates are very high in much of the developing world, it is safest to have two or three boys. Dowry is another motive. For a poor family a dowry can require a large proportion of the familyâ€™s wealth, making a girl child more of a liability than an asset.
When we traveled in China some fifteen years ago I photographed a beautiful tile picture, permanently imbedded in a wall at the railroad workersâ€™ housing compound in Guangzhou. It showed a proud couple with the smiling father holding a baby up in the air. The child was obviously a girl, and no writing was needed to know the pictureâ€™s message. Although China hasnâ€™t been very successful in convincing people to value girls as much as boys, South Korea has. Once females were treated inferiorly there, but now women have almost equal status with men. It is possible to change a societyâ€™s attitudes.
In some parts of the world one can pay for an ultrasound just to determine fetal gender. If female, it is likely that the mother will seek an abortion. Both India and China have outlawed these practices, but sex selection sonograms are still readily available.
Worse is what happens if a girl is born where female infanticide is still practiced. When a newborn is an undesired girl, she may be left outside to die. Even where femicide is not practiced, girls may be given short shrift. They may not be fed as well as their brothers, they are less likely to be taken for medical care when sick, and they are less likely than boys to go to school.
Without sex selection, more boys are born, but male infants are more likely to die than female. Overall, women live longer than men. Thus there should be more females alive than males, but sex selection has changed this. Males now exceed females worldwide by one percent.
In China there are 117 boys under age fifteen for every 100 girls. The ratio in India is slightly better at 113 to 100. Lots of young men will have difficulty finding wives!
The Chinese deal with their strong desire for a son in another way. Because of the limitations on most parents in China to raise only one child, many girls are abandoned to orphanages. They are usually well cared for there, but not all are able to go to school. Lucky American parents adopt a few of these Chinese children, who are almost all girls.
Back to my patient: should I do as Mrs. Lee asked?
â€œI will not do an amnio just to find out the fetusâ€™s gender, without a medical reason,â€ I told her emphatically.
For many reasons we need to honor and empower girls, not select against them. One is that who girls are educated and have control over their lives will have smaller families when they grow up.
Â© Richard Grossman MD, 2011