Categories
Population Public Health Women's Issues

Honor Girls–4-2011

I noted that Mrs. Lee was early in her third pregnancy when I was getting ready to see her in the office.

“How are you today?” I asked

“Very well, thank you. The morning sickness is getting better,” 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.

“How do I arrange an amniocentesis?” 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 woman’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.

“I don’t know why you should have an amnio. The blood test that could be done next week—the quad screen—is cheaper and without risk.”

“We already have two daughters and I want to see if this is a boy.”

Something clicked in my head. The Lees, being recent immigrants, wanted a son. “What would you do if you are carrying another daughter?” I asked.

“Well, we would have to think about it,” she answered evasively.

Many cultures favor males over females. In Hindu India, only a son is able to release a dead parent’s soul to go on its journey of reincarnation. Without a son to perform the ritual, the parent’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 family’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 workers’ 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 picture’s message. Although China hasn’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 society’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?

“I will not do an amnio just to find out the fetus’s gender, without a medical reason,” 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.

© Richard Grossman MD, 2011

Categories
Action Contraception Family Planning Media Population Public Health Reproductive Health

Take the Next Step

It was an accident. In 1994 I spent a day with the political reporter, Robert Fisk, in Egypt. I had never heard of Fisk before, but the experience changed me.
We were part of a press tour organized by the Egyptian government to look at family planning clinics during the International Conference on Population and Development. Fisk inspired me to become an activist instead of just a doctor.
The tour started in a room crowded with real journalists. Although the Durango Herald provided me with the necessary credentials, I had little idea what a journalist actually did. Fisk told me about his experiences as a war correspondent. He has been in the middle of hostile fire in Bosnia and other hotspots. I remember his stories of reporters with less experience—and less luck—who were caught in crossfire and killed. “It’s a dangerous, lonely life,” he said in a recent interview. If I’m not wrong, Fisk himself has taken a few bullets. He could have been a professor of history, the field of his PhD. “You’ve got to feel the passion,” he exclaimed about his choice of career.
As a man who has experienced war personally, he comments: “War is primarily about the total failure of the human spirit. It is about death. Forget Hollywood.” Although British, Fisk has made his home in Beirut, Lebanon, for over 30 years. He told me that it had been a beautiful city before civil war tore it apart.
The tour showed just what I would expect to find in a developing country. In one women’s clinic I asked (through an interpreter) some of the women in the waiting room if they breastfed their babies. They looked at me as though I was from a different planet! “Of course our babies are breastfed! The Qur’an says that we should nurse for at least seven months.”
Although I had traveled to and practiced medicine in some rudimentary places, this clinic left strong memories. One was a woman arriving for her prenatal visit in beautiful clothes—by oxcart. The posters on the wall were similar to what we might see in this country, except for the Arabic script. There are many differences between our societies other than just the alphabet, however.
The clinic’s doctor spoke excellent English. During her years of service in that clinic she had done an informal survey of female genital mutilation. This cruel procedure is also known as “female circumcision,” and is performed in parts of northern Africa and of the Middle East. Usually a barber or other non-medical person does the cutting using unsterile instruments. The victims are children. FGM can lead to serious infections and even death. Survivors will enjoy sex less and may have serious problems during childbirth due to scarring. The doctor said that, of a hundred women she had asked, 98 had suffered this traumatic maiming.
Fisk put this visit into another perspective. He had been to Egypt many times before and had pushed the frontiers of freedom of speech. On one trip he explored the slums up in the hills surrounding Cairo. This huge city of 17 million people in the metro area has at least a million commuters who venture onto the crowded streets every day. Most commuters live in squalor in the poor areas surrounding the city. Fisk spent a day, he said, documenting people living in those miserable living conditions. Someone evidentially tipped off the officials that a stranger was snooping around, and the police exposed all of his film to the Egyptian sun.
Shortly after this experience in Cairo, I started working less so that I could do other things. Now I have time to write this newspaper column, teach a class at Fort Lewis College and be involved in leading a Quaker environmental group. Many friends in Durango have helped me step into this expanded role.
I now read the Independent of London, Fisk’s paper, online every day. His column on 9/11 reminded me of that accidental day in Egypt and how he inspired me to go beyond the usual role of a physician—to become an activist. The title of that article summarizes his viewpoint: “Nine years, two wars, hundreds of thousands dead – and nothing learnt.”
I am happy that I stepped out of my “comfort zone” sixteen years ago to learn more about family planning in Egypt. In addition, I accidentally learned about the risky life of a war journalist—and was propelled into being more of an activist.

This article may be copied or published but must remain intact, with attribution to the author. I also request that the words “First published in the Durango Herald” accompany any publication. For more information, please write the author at: richard@population-matters.org.