A little over half a year ago, the Bureau of Health Promotion (BHP) announced out of the blue that the gender imbalance among babies born in Taiwan indicates that more than 3,000 fetuses are aborted each year just because they are female. BHP Director-General Chiou Shu-ti (邱淑媞) said the bureau was not equipped to investigate the matter, but she warned that prosecutors would be asked to investigate doctors suspected of practicing sex selection.
Chiou warned that doctors and women involved in such cases could be charged with illegal abortion. She also talked about “judicial abortion,” saying the Genetic Health Act (優生保健法) shielded abortionists through its provisions that allow abortion in case of rape or for medical or psychological reasons.
Chiou seemed to be accusing the Department of Health (DOH) of failing to find even one doctor who had carried out a sex selective abortion. Her comments attracted a lot of media exposure, but they also showed that she is an out-of-touch anti-abortionist with outdated personal ethics.
Unfortunately, the DOH has now announced that physicians are not allowed to reveal the sex of fetuses. This measure is meant to prevent selective abortions, but it is an impractical bureaucratic directive that has been formulated without consulting experts. It is an example of governance via illusory morals and shows that bureaucrats, while failing to grasp the true reason for the imbalance between male and female births, seek to tarnish the reputation of all women who need abortions, and of the doctors who assist them.
Statistics reveal a gender imbalance among babies born in Taiwan, but there are various possible reasons for it, including the long-term effects of pollutants, such as chemical plasticizers, environmental hormones and the growth hormones given to livestock. Another possible cause is the widespread problem of infertility. Infertile couples often turn to medical practitioners to assist them through artificial reproduction. If social and cultural factors lead infertile couples to use technology to select their preferred gender, be it male or female, modern scientific techniques make it quite a simple task to fulfill their wishes.
Statistics for test-tube babies conceived at the Reproductive Center at Kaohsiung Chang Gung Memorial Hospital show that male fetuses outnumber female no matter whether they are implanted at the embryonic cleavage stage or at the blastocyst stage. Figures from the hospital show that among the more than 500 test-tube babies created there between 2002 and 2007, of the 118 fetuses transferred at the cleavage stage 71 were male and 47 female, while of the 355 fetuses transferred at the blastocyst stage 190 were male and 165 female.
Lee Maw-sheng (李茂盛), former chairperson of the Taiwan Society for Reproductive Medicine, said that males outnumber females by about three-to-two among the nearly 1,000 test-tube babies transferred during the blastocyst stage at his clinic.
It is estimated that more than 3,000 babies are born using artificial reproduction each year in Taiwan. It would be a good idea for the DOH and BHP to analyze these figures before jumping to conclusions and banning doctors from telling pregnant women the sex of their babies. At present there is no conclusive research to prove Taiwan’s gender imbalance results from aborting female fetuses, so there’s no reason for the BHP and DOH to repeat each other’s arbitrary statements or to hurriedly issue poorly thought out directives.
The DOH has issued many directives over the years, warning doctors that aborting fetuses based on their sex is in contravention of the Physicians Act (醫師法), and now it has forbidden them to tell their patients the gender of their fetuses. It must be pointed out that telling a pregnant woman the sex of her fetus is a normal interaction between doctor and patient and the DOH’s latest ban contravenes the principles of honest information and respect for a patient’s self-determination, which are important aspects of medical ethics.
The DOH reportedly intends to strengthen its coercive hand through legislation making it a criminal offense for doctors to practice sex selection or sex-selective abortion. This is taking populism to an extreme. It is more a matter of being seen to be doing something, because the Physicians Act already provides grounds for the DOH to punish doctors who break the rules.
Until now, the authorities have not managed to catch a single rule-breaking doctor or woman, yet they think that they can solve the problem by changing the law. Coming nearly 30 years after the passage of the Genetic Health Act, any such new legislation would simply be a milestone marking the authorities’ ineptness.
Determining the gender of fetuses is a matter of medical ethics. It is not forbidden in the US. In the UK, the authorities are thinking of allowing doctors to determine and reveal the sex of fetuses when the parents have had two or more children of the same sex. The DOH would do well to consult public opinion.
In many clinical cases of sex selection, the parents want to use modern technology to have a daughter, for example when a woman has already given birth to two or three sons, or where the parents’ only daughter has died through accident or illness. Does the DOH really want its directives to be so rigid and insensitive as to forbid sex selection even under such humanitarian considerations?
Chiang Sheng is an attending physician in the department of obstetrics and gynecology at Mackay Memorial Hospital.
Translated by Julian Clegg
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