There are many issues that have to do with women’s health. The incidence of mental illness, for example, is one of the most perplexing issues of our times. Statistics indicate that 25 percent of the population will experience diagnostic conditions meeting the definition of mental illness at some time in their lives, and that anxiety, depression and neurotic disorders are more common among women than men.
This presents the Department of Health (DOH) with a formidable task in relation to gender and health. However, in recent years, the DOH has been devoting its limited energy and resources to the often-controversial issue of the sex ratio of newborn babies. It has used a series of populist and heavy-handed means, such as investigating gynecologists and obstetricians, who should not be held responsible, and threatening pregnant women, as well as introducing a variety of short-term policies.
The DOH has not desisted from doing this kind of thing even after running into a brick wall in the case of National Taiwan University Hospital obstetrician Shih Jin-chung (施景中).
Taipei City Department of Health intended to send someone to investigate Shih because the proportion of boys born with his assistance during the first part of this year was high, but they ran up against a high-profile backlash from Shih.
The statement that Shih made was widely reported in the news media. He said that he was going to stop assisting in the birth of any boys and that he would refuse to register any pregnant women who were expecting boys.
Shih’s statement was more for show than a serious threat, but it had the intended effect, since the city health department, awed by Shih’s authority and influence as a doctor, decided to postpone its investigation.
The question must be asked: If the authorities do not dare investigate the hospital, how can they justify the numerous investigations they have already carried out with regard to other gynecologists and obstetricians? If the city health department is scared to stir up a hornet’s nest at the hospital, can it stir things up with other obstetricians in the future?
Yet it is not unreasonable for the authorities to be concerned about the sex ratio. The problem with the DOH is that it imposes a cast-iron standard of 1.06 for the ratio of male to female babies. Though experts do not agree on the figure, the department is sticking obstinately to it.
As the department sees it, if the sex birth ratio goes any higher than 1.06, it means that female fetuses are being aborted. This kind of inference has been made on many occasions. For example, the department keeps saying that 4,000 to 5,000 female fetuses are aborted every year in Taiwan, although it has not presented a shred of evidence to support this statement.
Even more laughably, as soon as the sex ratio fell from 1.09 to 1.079, the department claimed that it had saved 993 girl babies. Last year it launched a movement, seemingly in earnest, to “save little dragon girls” (meaning those due to be born last year — the lunar Year of the Dragon), but as soon as it discovered that the sex ratio for the first five months of this year had risen to 1.08 from last year’s 1.074, the department went into panic mode once again.
Setting a controversial standard for the sex ratio and having mood swings whenever there are short-term fluctuations in the ratio is treating the sex ratio as if it were the stock market index.
The department is behaving like Miguel de Cervantes’ Don Quixote, riding around on a skinny old horse, accompanied by his faithful but not very bright retainer, and challenging windmills that he imagines to be giants.
There is plenty of data available about sex ratios, and many studies prove that the ratio tends to fluctuate. It is affected by environmental, social and economic factors, and by climate, temperature, latitude and environmental pollution. Further variables include the ethnicity of the mother, whether she has given birth previously and the length of her pregnancy.
Historical sex ratios at birth for developed countries that do not allow gender selection are mostly between 1.03 and 1.08, so if the sex ratio falls between these two figures, it ought to be considered normal.
In Taiwan, reproductive technology and economic prosperity have at times led to a relatively high proportion of male babies. The sex ratio following the introduction of reproductive technology rose to 1.14. Over the last two decades, the male-to-female ratio for first and second babies has remained steady, but there have been variations in the ratio for the third baby and above.
There is also a connection between this and the economic cycle. For example, during the 2008 global economic crisis and the 1990 economic contraction, the sex ratio started to fall from previous peaks.
If 1.08 is a figure that experts find acceptable for sex ratio at birth, why is the department getting so flustered about what is evidently a bogus issue?
The department should avoid reacting to fluctuations in the sex ratio figures as if it were a patient suffering from anxiety, paranoia, obsessive-compulsive disorder or panic attacks; otherwise, its pronouncements, policymaking and implementation will all be out of tune with reality.
Last week, the department came up with yet another policy, announcing a ban on genetic testing of maternal blood, but then it changed its tune again, saying that the ban only applied to screening for sex-linked hereditary illnesses and not for Down syndrome.
This shows that the department has only a half-baked scientific and ethical understanding of pre-birth non-invasive chromosomal evaluation.
As always, its policies are highly populist, but thoroughly unconvincing.
Chiang Sheng is an attending physician in the Department of Obstetrics and Gynecology at Mackay Memorial Hospital.
Translated by Julian Clegg