Female feticide: The ethical issues of ultrasound in India and China

Female feticide: The ethical issues of ultrasound in India and China

The use of ultrasound has had a large impact on health care in resource poor countries. This article details some of the research that has been done overseas to look at the impact on bedside ultrasound by caregivers to deliver more appropriate care for injured and ill patients in Africa, Asia and Mexico.

Using an ultrasound to determine how dehydrated a child is, whether an injured person requires surgery, whether a person who has collapsed has a blood clot or a punctured lung or fluid around their heart and treat those things appropriately is incredibly powerful and, after paying for the machine, costs nothing but the time to train practitioners.

It is possible to find some of the most interesting and cutting edge uses for ultrasound in the literature from developing countries because they have the equipment and, lacking CT scanners and x-ray machines, they have ample motivation to use it to its greatest advantage.

In India and China, however, which both need low cost alternatives for diagnosis and treatment, ultrasound use is regulated because of the common practice of using it to determine sex of the fetus and then to selectively abort female fetuses. In China, the one child law combined with a preference for male children has led to female feticide, along with laws to prohibit use of technology to determine the sex of the fetus before birth. Apparently the law is difficult to enforce and so sex specific feticide continues there.

In India conservative estimates of the number of female fetuses aborted was about 250,000 per year.  There are campaigns by the government to encourage valuing female children, but the economic and social reasons that the problem exists in the first place are at the very basis of the issue.

When a woman in India is married it is still traditional to offer the family of the groom a hefty dowry. There are laws against dowries but that doesn’t seem to have changed the practice much. Women also work at jobs which are less prestigious than men and earn lower wages. At marriage, a woman customarily moves to the home of her husband and is no longer available to take care of her own parents. So girl children are expensive.

It is much cheaper to get an obstetrical ultrasound in India than in the US, but still very expensive in comparison to overall cost of living. Getting an abortion is also relatively inexpensive, but costs money, which poor families actually don’t have. It is far less expensive to have the baby and abandon it or kill it, and female infanticide is also pretty common in India. An article in the Atlantic Monthly looked at this problem and some strategies to deal with it, such as safe places where babies can be left, no questions asked, for adoption or care.

General Electric Healthcare, the company that makes the tiny pocket ultrasound that I use, and also makes a full range of amazing ultrasound equipment, was severely criticized and was even in legal troubles regarding the perception that they were complicit in sex determination of fetuses. This file describes their experience. Apparently they are actively involved in trying to enforce Indian law and have, according to some of my contacts, been less willing to donate equipment in India, which they had done before. The manufacturers are legally responsible for how their equipment is used, per a 2004 change in the laws about prenatal sex discrimination.

It seems to me that the attempt to regulate use of ultrasound in order to reduce the abortion of female fetuses is doomed to complete failure. It is just too easy to do an ultrasound and see a fetus’s genitalia. An economically motivated family certainly can arrange to sneak into an ultrasound clinic and have a sympathetic technician figure out the sex of the baby inside. There are also genetic means for determining sex which are becoming easier and more affordable. Sex specific abortion, the actual procedure, is also illegal in India and China, and so a significant proportion of such abortions are done unsafely, risking the life of the mother.

Women who can’t afford an abortion often take pills or poisons to end their pregnancy, risking not only their own health but the health of their baby should it survive. Clearly most women understand these risks, legal and physical, and still attempt to terminate their pregnancies. Ending this practice will take significant social change, including abandoning dowry practices and improving the status of women in the workplace.

Janice Boughton is a physician who blogs at Why is American health care so expensive?

Image credit: Shutterstock.com

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  • Doctor Who

    Would it have been that difficult to check the grammar on this article before posting? In just one example: “In China, the one-child law combined with a preference for male children and led to female feticide and then laws to prohibit use of technology to determine the sex of the fetus before birth.”

    It’s unfortunate as this subject sounds as one that could be very beneficial, yet the poor structure of this article makes it extremely difficult to actually tell what’s going on.

  • ninguem

    You know, this is either a personal choice between a woman and her doctor……or it isn’t. One or the other.

    If it’s just a personal choice……if society and government has no say in the matter, ever…..if it’s “hands off my womb” under any and all circumstances……if it’s just a blob of tissue……

    …..then I for one can’t see any reason why society should have an opinion on the woman’s choice to abort that blob of tissue because of XX chromosomes.

    • Guest

      It’s a #WarOnWomen thing. If it were male foetuses facing genocide in the womb, it’d be no big deal.

    • Chris

      There is either abortion on demand, with no questions asked lest the State be damned for interfering in “a woman’s right to choose”, or there is not. The country which lets the Gosnells of the world continue on unregulated and unchecked (until they catch the eye of the DEA – yay, ‘war on drugs’!) hardly has the moral ground to castigate other counties for their practices.

      • ninguem


        Any restriction, even if perfectly reasonable, gets the coathanger treatment by the abortion under any circumstances advocates.

        So they back off……all except the radicals that don’t mind throwing bombs.

        There were people aware of Gosnell’s practice, some duly reported AS REQUIRED BY LAW (complications of surgery includes abortion)……and they were ignored.

        The grand jury report is quite detailed, and none of it is surprising to me.

      • Guest

        Agree completely. Abortion on demand with no questions asked. I’m personally sick of these discussions about WHY women have abortions. Let them have their choice and leave them be. Abortion is not pretty, and the reasons for which will always be controversial.

  • Manisha

    I am from India and a female. Unfortunately, this is so true. This is not only prevalent in the economically weaker section but the practice exists among the urbane and economically rich people as well. It is just the mind set of people that is so difficult to change.

    It is still possible to enforce the laws against killing a girl child in the womb but what laws can be enforced to ensure that the girl child gets the same love, care, education and respect as the male child gets. Growing up she is dejected and made feel inferior in every step of her life journey. I am sure that these fortunate or unfortunate girls must sometimes be thinking “Why was I given the birth. Would have been better had I not born”.

    • Chris

      Americans, no matter how well meaning, cannot change Indian culture. A bad culture is up to the citizens of the country with the bad culture to change. America wastes her resources if she tries to intervene.

      • Manisha

        That is fine. Nobody is asking America to do anything. I am just putting a point across. This is not India problem , this is human problem. Just like a person doesnot choose his or her parents, sex or religion , they do not choose to take birth in certain country. Today you are American , may be in your next birth, you are Indian or Chinese:).

        Also lets not call it bad culture, it is a bad practice. It is as good as saying America is racist country which is not true but yes there are few people who are racists. There are lot of NGOs and people who have taken initiative to curb this practice.

        • DISQ_user9801

          someone from a culture which has an entire caste of people called (and treated as) “untouchables” probably has no business calling America racist.

          • Manisha

            Well, I am not denying the fact that some people in India are still racist when it comes to caste system. But the percentage has immensly gone done in last 40 years. I am not defending India as I do have the guts to look straight into the issue and I have not even said America is racist(please read my comment carefully), I only said few Americans are and they judge people from the country they belong to. The Article is highlighting a different and serious concern and someone started targetting the entire culture because of this issue. All I am saying is seperate the issue with the culture. Every country has their unique sets of problems .There is always a grey element , not black or white. If there is 5 bad things in a particular society there are 50 good things as well.

          • Molly_Rn

            America is racist, but that doesn’t excuse the Indian culture from its caste system and the treatment of women that is wretched. America is more subtle about its racism and not equivalent to India’s.

    • Guest

      This is not just an Indian problem. Females are devalued, abused, and have a much higher risk of death simply because they are female around the world. Sweeping cultural changes will take generations.

    • ninguem

      They had a small scandal in the UK over that very issue.

      The UK’s abortion laws are actually significantly stricter than ours. They look more liberal because basically, they’re ignoring their own laws.

      Two doctors have to sign off that there’s a legitimate medical “life and health of mother” indication for the abortion.

      If anyone actually proposed the UK’s abortion laws in the USA, they’d get The Mother Of All Coathanger Treatments in the press and Legislature. You’d be compared to the Taliban.

      Well, with the hidden camera and microphone, a woman of some Asian background, I think Indian, went to a UK clinic and read our a story. I’m pregnant, nothing wrong with the pregnancy, I’m fine, but I want a boy, I’m pregnant with a girl and I want to abort her (it?) .

      Anyway, the clinic was fine with performing the abortion, in violation of their own regulations.

      Actually, there is a push for “Abortion on Request” in the UK, I guess they’re too polite to call it abortion on DEMAND, Google the phrase and find the UK sites. Abortion on Demand…….by law,…..does not exist there.

      Effectively it exists, because they ignore their own laws.

      Try to do THAT in the USA with our contentious abortion politics.

      Still, if it’s Between The Woman, Her Doctor, And God, as the usual pious rhetoric goes, why complain if mother’s reason is The Ultimate War On Women?

      For the record, I support first trimester abortion on demand, with increasing regulation further on in the pregnancy, and any time I mention any regulation I get the coathangers waved at me so I don’t bother.

      Gosnell is a giant “I TOLD YOU SO”

      • Hillary

        Gosnell is just the type of predatory monster that women and girls end up turning to when legal access to safe care is restricted.

        • Guest

          Gosnell WAS a licenced abortion provider. Most of the abortions he provided were legal. Abortion up to 24 weeks 6 days is legal in PA. I don’t see your point.

        • ninguem

          The grand jury report belies all of that. The record is clear, we have Gosnell because every time someone tried to stop him, they got the coathanger treatment.

          I’m not convinced Gosnell was even an outlier. I for one think there are more like him out there.

          People who tried to report him were mostly ignored as evil Republican mysogynists.

          Which gets strange in Pennsylvania, because the Democrat Bob Casey was strongly anti-abortion, and Republican Tom ridge was pro-abortion.

          And I for one support availability of first-trimester abortion on demand. Strong restriction of abortion after that.

          That’s actually what most of the rest of the developed world does with this matter.

          Suggest that in the USA and you’re the Taliban.

          Sorry, we don’t have Gosnell because of the anti-abortion side, we have him because of the PRO-abortion side.

  • Molly_Rn

    Wait until all those wonderful boys become men and there are no wives for them. Maybe this is a new form, of population control.

    • Guest

      Aren’t they already having issues with this in China and India? More violence against women, more violence amongst men. Men are aggressive and violent by nature; without women to balance things out violence and aggression become the norm.

  • S Varadachary

    This issue about the girl child which is only in some pockets in India. And the impact is seen in places like Haryana where they are ‘importing brides from other parts of India irrespective of caste, language etc. And the women in all reported cases are treated well. And unmarried girls from poor families for example from kerala have been corresponding with girls who have moved to Haryana before looking for grooms. With education things are changing fairly fast.
    As for violence especially against women having lived in many countries(5 years in the US) I think it is common and it is something which needs to change. Both in the US and India the police need to act. And male children need to be taught good values from childhood . This may require a good family life and a sensible value based schooling. One which should give more importance to values rather than sports!
    As for discrimination, when I visited rural America in the 70s I saw enough but there wee signs of change. It is happening in India as well.
    The more serious problem is the change in Hinduism which is modelling itself (in some hands) on more intolerant monolithic religions. It is a complex question, but I can assert that the Hindu religion in its varied form encourages respect fro women. Ill treatment of women and foeticide are in my opinion are found mainly in certain groups and
    tribes and go beyond India’ borders
    As for caste there has been more positive discrimination In India than the US in the case of race . In any event it is going away slowly. It is far too complex a thing and ill informed remarks will only engender heat.
    What is quite unacceptable is the role of doctors in matters of infant sex choice! And governments need to act strongly!

  • Guest

    Who cares why women have abortions, really? Maybe they don’t want a girl, maybe dad skipped out and they have no money, maybe they’re too old, young, poor, have too many kids already, don’t want kids, or just don’t want a baby right now. Why oh why do we pass judgment on women (or entire nations) for choosing abortion for whatever reason? If we want to allow legal abortion then we must not ask why. Someone will always disgust us with their reason for wanting to abort.

    Sorry, but if a woman wants to abort because she’s carrying a female and doesn’t want a female, I believe she should be able to abort. Do I like her reason? Not really. Do I respect that despite the reason she should be able to have full control over her body and her pregnancy? Absolutely.

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