‘Typhoid Fiona’ and Sex-Selective Abortion

So, there I was looking through the public bills section of the Parliament website for the new Lords’ amendments to the defamation bill when what should I notice but a new bill, introduced less than a week ago, calling itself the Abortion Statistics Bill.

Hmm…

A quick search of Hansard later, what we find is that it’s a ten-minute rule bill introduced by the Tory MP Fiona Bruce, who’s also the vice-chair of the All-Parliamentary Pro-Life Group and currently chairing the sham inquiry into abortion on the grounds of disability that I started to pick apart only a few weeks ago – rest assured, there is more to come on that ‘inquiry’ in the near future.

If we cut through all the bullshit and rhetorical grandstanding, where we’ve got on the table is a proposed but, as yet, unpublished bill that would require the Department of Health to ‘compile statistics on gender ratios of foetuses aborted in the United Kingdom, and where available overseas; and for connected purposes’.

Why is Bruce chasing this information?

Again, ignore all the handwringing rhetoric about the situation facing women in China and India; Bruce may personally be sincere, or she may not, but in general the anti-abortion lobby is concerned primarily with digging out anything it thinks it can use to discredit legal abortion and sway public support behind its effort to disabuse women of their right to choice, and let’s face it, attitudes toward women one typically finds within the anti-abortion lobby are not that much different to the shitty, misogynistic, attitudes one finds in India anyway.

No, like I said, this is primarily about discrediting legal abortion and, as ever, the anti-abortion lobby and its parliamentary representative are not averse to a bit of bullshit quote mining, hence we get this observation from Bruce:

On 8 January, the Department of Health confirmed in a written answer to my noble Friend Lord Alton of Liverpool that there are discrepancies in the balance between the number of boys and girls born in the UK to some groups of women that

“potentially fall outside of the range considered possible without intervention.”—[Official Report, House of Lords, 8 January 2013; Vol. 742, c. WA2.]

That indicates that there may be evidence that a significant number of abortions are taking place on the grounds of gender or sex selection, a practice that is wholly illegal in this country. Any doctor who performed a termination on that basis would potentially be committing a criminal offence.

Okay, for starters sex-selective abortions are not ‘wholly illegal’ in the UK; the law as it stands does permit what amounts to a sex-selective abortion to be carried out where there is a significant risk of foetal abnormality/serious disability arising from a known sex-linked hereditary condition.

It also at least theoretically possible for a woman to sex-selective abortion on mental health grounds, and one has to consider how desperate some families can get in the face of a continuous run of boys, or girls, to see that in extreme cases, a doctor might very be persuaded that yet another disappointment might easily have a significant adverse effect on the mother’s mental health sufficient to justify an abortion under ground C. Whether or not any cases on that kind arise is an open question, but it is certainly possible.

Then there’s a bit of selective quote-mining to take into account. Bruce quotes a reply given on January 8 to a written question in the House of Lord, tabled by Lord Alton, noting apparent discrepancies in the gender balance in babies born to some groups of women in the UK but no mention of the fact that this is but the second of four related questions posed by Alton, the replies to which give a much more complete view of the issues here.

The trail starts on 17 December 2012, with this exchange between Alton and Earl Howe:

Lord Alton of Liverpool (Crossbench)

To ask Her Majesty’s Government, in the light of concerns about illegal abortions on the grounds of sex, whether they will require those undertaking abortions to include details of the sex of the aborted baby in the data reported annually by the Department of Health.

Earl Howe (Parliamentary Under Secretary of State (Quality), Health; Conservative)

The Government have no plans to change the way in which data on abortions are collected. The majority of abortions take place before 10 weeks gestation and it is not currently possible to identify a foetus’s gender at that stage.

Howe is quite correct here – based on the most recent figures from the Department of Health 77.6% of all abortions in England and Wales take place before 10 weeks gestation and a foetus at that stage in its develop can only be sexed by way of carry out a DNA test, so there is no prospect of any sex-selective abortions at that stage.

Alton’s next question comes on 8 January 2013:

Lord Alton of Liverpool (Crossbench)

To ask Her Majesty’s Government, further to the Written Answer by Earl Howe on 17 December (WA 268), whether they will collect data on the sex of unborn babies aborted after 10 weeks gestation; and why they do not collect that data already.

Earl Howe (Parliamentary Under Secretary of State (Quality), Health; Conservative)

Work is in progress to monitor gender ratios at birth following a recent report by the Council of Europe Parliamentary Assembly. While the overall United Kingdom birth ratio is within normal limits, analysis of birth data for the calendar years from 2007 to 2011 has found the gender ratios at birth vary by mothers’ country of birth. For the majority of groups, this variation is the result of small numbers of births and does not persist between years.

However, for a very small number of countries of birth there are indications that birth ratios may differ from the UK as a whole and potentially fall outside of the range considered possible without intervention. However, it is possible that this is also the product of natural variation. Monitoring of this issue will continue.

Identifying the gender of aborted foetuses over 10 weeks’ gestation raises ethical and clinical issues. We have no plans to introduce such a practice.

Okay, so this is the answer that Bruce partially quotes, but you’ll note that she omits Howe’s cautionary note that any discrepancies may still be down to natural variation and also makes no mention of the fact that identifying the gender of aborted over 10 weeks gestation, which is what her bill would require doctors to do, raises ‘ethical and clinical issues’ – I guess ethics must just be irrelevant to Bruce’s thinking here.

Alton then returned to the fray on 4 February 2013 with:

Lord Alton of Liverpool (Crossbench)

To ask Her Majesty’s Government, further to the Written Answer by Earl Howe on 8 January (WA 2), whether a biased gender ratio for the birth rate across the national population as a whole is the only phenomenon that would be considered as strong evidence that sex-selective abortions are occurring; if not, what other evidence would be considered; and how the relevant data are currently collected.

Earl Howe (Parliamentary Under Secretary of State (Quality), Health; Conservative)

The academic consensus is that a male to female birth ratio of around 105 (male births per 100 female) is normal and ratios above 108 are unlikely to be possible without intervention. However, some differences also occur as a result of random variation, with differing gender ratios appearing by chance. In the United Kingdom, the birth ratio is 105 and consequently, gender ratios alone are unlikely to provide strong evidence of sex-selective abortions and can only provide contextual information. Other evidence could include different gender ratios by mother’s country of origin though the above caveats would still apply. Birth registration, including mother’s country of birth is a legal requirement and data are compiled by the Office for National Statistics.

So, in answer to Alton’s question as to whether a biased gender ratio in births is ‘strong evidence’ of that sex-selective abortions are being carried out the answer is no, gender ratios alone do not provide strong evidence, only contextual information. It’s not that simple, a message that Bruce clearly hasn’t taken on board.

Finally, on 25 February 2013, we get Alton’s last question:

Lord Alton of Liverpool (Crossbench)

To ask Her Majesty’s Government, further to the Written Answer by Earl Howe on 4 February (WA 1), which mothers’ countries of origin display a gender imbalance in the birth ratio, and what in each case is the size of that imbalance.

Earl Howe (Parliamentary Under Secretary of State (Quality), Health; Conservative)

Recent analysis has shown that women from some countries had birth ratios different from that of the United Kingdom as a whole; i.e. 100 female births to 105 male births. There are many possible causes of these ratios. The department is carrying out further analysis of related data. We do not consider it is in the public interest to disclose details of the countries in question while this analysis is under way as it is not currently possible to conclude that these variations are the result of intervention rather than natural variation.

This is the question (and answer) that put the Telegraph in a snit over the reference to it not being in the public interest to disclose this information although, naturally enough, the Telegraph makes no mention of the exact reason why, which is that the analysis is ongoing and that it was not possible to conclude at that stage that any variations in gender ratios in a particular sub group of women were not due to nothing more than natural variations and random chance.

So, in all the DoH is doing nothing more here than trying to avoid the press setting off an ill-founded witch-hunt against women of particular ethnic and national backgrounds based on information that is wide open to misinterpretation – remember, back in the answer to the second question, Earl Howe points out that for the majority of groups any variations in gender ratios are “the result of small numbers of births and [do] not persist between years’. A single data point is not not sufficient evidence to justify the assumption that any variation in gender ratios outside the norm for other groups is due to sex-selective abortion.

Against all that, Bruce’s suggestion there “may be evidence that a significant number of abortions are taking place on the grounds of gender or sex selection” is frankly risible. Taken together, the information provided by Earl Howe’s answer to all four of Alton’s questions, all of which are on the public record, do not support any such assertion at this stage.

Now, when I last looked at the issue of sex-selective abortion in February 2012, I noted the existence of a paper by Dubuc and Coleman – ‘An Increase in the Sex Ratio of births to India born mothers in England and Wales: Evidence for Sex-Selective Abortion’ – which claim to have found some evidence of a discrepancy in the sex-ratio in births to women born in India but living in the UK, which they suggested provided some contextual evidence that sex-selective abortions were taking place.

At the time, the full paper was behind a paywall, so I could do nothing more than quote the abstract and note that the paper claim to have found a four point increase in the male to female ratio in that one sub group (women born in India) , which was attributable to a variation in the sex-ratio in higher order births, but that this did not extend to other South Asian sub groups, i.e. Pakistani and Bangladeshi women.

I’ve since obtained a full copy of the paper, which is now accessible without having to stump up any cash and what Dubuc and Coleman appear to have found, using birth data that stretches back to 1969, is a developing anomaly, starting in the 1990s, in the sex-ratio in births to women born in India but living in the UK but one specific only to higher-order births, i.e. where women are having third child or greater.

What their data indicates that up until around 1990, the male-female sex ratio in births in this subgroup was much the same as it was for any other group of women, given or take a bit of natural variation around the general ratio of 105 males to 100 females, which is observed naturally and appear to be the baseline ratio for our species. After 1990, the trend begins to diverge, year on year, until by 2008 the male to female sex ratio in births in this one sub group had reached 114.4 males to 100 females compared to the 104/105 to 100 ratio the researcher saw in other groups at the same birth order.

The suggested explanation for this is a conflict between a desire to limit family size in the Indian community living in the UK, where the total fertility rate (i.e. average number of children per family) has fallen since the 1950 to something close that of the general UK population, and a cultural desire for families to produce at least one male heir to carry on the family line. In families where the first two children have been girls, in particular, there can be pressure exerted on the mother to ensure that the third child is male which, in turn, may lead some to try and abort any subsequent pregnancy if its discovered that the foetus is female leading to a skewed male to female birth ratio at higher birth orders (3 or more) but not in the first two births.

That’s the argument here – whether it stands up given that it relies on one or two assumptions and estimates that may not be 100% reliable is another matter, not least as there are other methods of sex selection (e.g. sperm sorting) that could come in play in some cases, but perhaps the key thing to note here is that were are looking at an anomaly in the data relating to small sub group of women, specifically only those born in India but now living in the UK who are having at least their third child. There is NO evidence, at least in this paper, of any such anomalies in the data for second/third generation British Indian women, i.e. those born in the UK, or in women from the Pakistani and Bangladeshi communities or, indeed, at lower birth orders.

So, even is we assume that Dubuc and Coleman are correct, how big a problem are we looking at here?

Is there really evidence that a ‘significant’ number of sex-selective abortions are taking place in the UK, as Bruce claims there may be?

Well, with the figures from Dubuc and Coleman and a bit of data from the ONS, we can try an answer that question.

In 2011, there were 715,467 births registered in England and Wales of which 14,181 (1.98%) were to women born in India – and that’s the figure for all birth orders.

Although there’s no breakdown of births by birth order and mother’s country of origin, the fact that the total fertility rate in the Indian community in the UK is now very similar to that of the general UK population suggest that we can reasonably refine that figure for the number of births to women born in India using the overall figure for the number of child born at higher birth orders (9.7%) giving us an estimated figure of 1375 births for the year (0.191%) in that subgroup where a woman was having at least their third child.

So that’s our ‘suspect’ sub group – 1375 births – where, according to Dubuc and Coleman, we should expect to find that the male to female sex ratio is out of kilter, and by apply their figures (114.4-100) and then adjusting the number of female births to bring it back into line with the expected ratio (104-100) we get an estimate for the possible number of missing female births of just sixty.

That, assuming Dubuc and Coleman’s analysis is correct, is the potential scale of the ‘problem’ – if such a problem exists. Sixty missing female births that may possibly be attributable to sex-selective abortion against women born in India, and that out of a total of 189,931 abortions carried out in England and Wales in the same year.

On that basis, just 0.031% of all abortions may be suspect which in turn, amounts to just 0.31% of all abortions carried out on women recorded as being Asian or Asian British in the DoH abortion data.

That, of course, assumes that all these ‘suspect’ abortions are carried out in the UK, which is by no means certain as, anecdotally, its been suggested that some women may be travelling to the Indian subcontinent to have an abortion having failed to obtain one in the UK because their doctor suspects their reason for seeking an abortion may be down to sex-selection, and even if the majority of these suspect abortions were found to have been carried out and carried out in the UK then it doesn’t automatically follow that doctors will have been complicit in such activity.

Some women may, after all, seek out a private clinic and lie about their reasons for wanting an abortion, leaving the clinic and its doctors completely in the dark as to their real reasons for having the abortion.

That’s not to say that sex-selective abortion for purely cultural reasons is not a problem, but unless the DoH and ONS statisticians find something in their data that Dubuc and Coleman missed, then its unlikely to be a significant problem at the kind of scale that would warrant the intrusive measures that Bruce is seeking to introduce with her bill.

Moreover, the mere act of collecting statistical information about the gender of aborted foetuses may tell you whether its possible that sex-selective abortions might be taking place but one thing it will not do is prevent sex-selective abortions; that can be done only by interventions that take place prior to an abortion being carried out and that would necessarily lead to some women being subjected to highly intrusive and, in most cases, unnecessary questioning about their reasons for seeking an abortion based purely on their ethnic background.

That sex-selective abortion has become something of signature issue for the anti-abortion lobby in the last couple of years is hardly surprising; most of them are none too bright and mistakenly see it as something of a ‘Gotcha’ issue for feminist supporters of abortion rights when this is anything but the case.

As any genuine feminist will happily tell you here, the problem here is not the availability of safe, legal, abortion but the misogynistic culture in India that pressurises women into having such abortions, one that differs only marginally from the misogynistic culture in the United States that provides the anti-abortion lobby in this country with most of its ideas and campaign tactics.

Sex-selective abortions are only a symptom of a disease – cultural misogyny – that needs to be tackled, not the disease itself, and just about the last people you want to be taking you lead from is trying to tackle that disease are its main carriers.

On that score, I’d place no more value on Fiona Bruce’s views on tackling sex-selective abortion than I would on Typhoid Mary’s opinions on communicable disease control, and would happily commend this bill to the dustbin where it deservedly belongs.