I’ve never been one to leave a job half done so for this article I’m heading back to The Independent’s grossly overheated and incompetently executed ‘Lost Girls’ story to finish off the job I started last week by looking, albeit rather obliquely, at the two comment piece that the newspaper published to go with its main report.
Of the two, perhaps the most interesting is that by Rajendra Kale, an Indian neurologist now working in Canada who, for a brief period (3 issues), also served as the interim editor-in-chief of the Canadian Medical Association Journal (CMAJ) until his tenure ended shortly after the journal published an editorial on sex selective abortion which ‘generated a flood of commentary in the Canadian media’ – sound familiar?
It seems reasonable to assume that Kale is at least the inspiration for The Independent’s own campaign, if not its instigator – after all, we cannot be sure who first contacted whom – but having taken the liberty of digging out his CMAJ editorial (pdf) it’s patently obvious both that Kale has an agenda he’s keen to push – a little too keen, in fact – and that in pushing that agenda, scientific rigour seems likely to amongst the most prominent casualties. For example, in that editorial Kale states that:
Some readers might be skeptical about whether female feticide is in fact taking place in Canada and the United States. Research in Canada has found the strongest evidence of sex selection at higher parities if previous children were girls among Asians — that is people from India, China, Korea, Vietnam and Philippines.2
The superscript reference relates to a paper I’ll come to in more detail shortly but for now I’ll note only that Kale’s own reading of that paper appears to have been, to say the least, extremely sloppy as what it actually states is:
We find high sex ratios to be entirely driven by immigrants who are neither Christian nor Muslim, the highest sex ratio being found for Sikhs. For this group, there are more than 2 boys per girl for the third child if the two elder children were girls, implying a sex ratio that is 100% above the normal above for this group. By contrast, Asian immigrants who are Christian or Muslim (mainly from Pakistan, Bangladesh, the Philippines and Hong Kong) exhibit normal sex ratios, irrespective of parity and sex mix of previous children.
Kale then goes on to add:
A small qualitative study in the US involving 65 immigrant Indian women documents the pressure they face to have sons, the process of deciding to use sex selection technologies, and the physical and emotional health implications of both son preference and sex selection. Of these women, 40% had terminated pregnancies with female fetuses and 89% of the women carrying female fetuses in their current pregnancy pursued an abortion.4 Results from this study could be reasonably extrapolated to Indians in Canada.
The idea that one can reasonably extrapolate from a qualitative study of just 65 women to an entire population is nothing short of risible, although that’s not to say that it hasn’t been done in other fields.
The early qualitative studies of psychiatric injury in rape survivors, which date to the 1970s, found rates of PTSD in excess of 90% in women who sought psychiatric help after being raped and for over 30 years these were often treated if they were measures of actual prevalence of psychiatric injury in that group. It’s only in the last five years or so that well-designed epidemiological studies have looked at the actual prevalence of PTSD in rape survivors and found it to be around 33-35%, which is still extremely high compared to rates in the general population but nothing like as high as those early qualitative studies were taken to suggest.
Does it matter that for the last 30 years or so rates of PTSD in rape survivors have been grossly overestimated? Well yes it does because the assumption that women will almost invariably be severely traumatised by rape and suffer psychiatric injury as a result has filtered in the public consciousness, not least through the efforts of anti-rape campaigners in promoting that evidence in their campaign literature, creating misleading assumptions as to how rape survivors should present themselves and how they should behave when, for example, they appear in court to give evidence against their alleged assailant leading juries to doubt the veracity of the testimony given by rape survivors who don’t visibly conform to the trauma stereotype with the result that rapist are acquitted based on faulty assumptions rooted in invalid generalisations derived from what has otherwise been extremely valuable research – for such is the law of unintended consequences.
What little value there is in Kale’s contribution to The Independent’s campaign lies solely in the fact that his CMAJ editorial provides another couple of references to studies that have attempted to not only identify but also quantify the extent to which sex selective abortion may be taking place in certain minority communities, with the Canadian study I’ve already briefly mentioned being of particular important as this appears to be the study that the newspaper inexpertly attempted to replicate here in the UK and this gives us both more actual data to look and an opportunity to contrast the newspaper’s methods with those adopted by genuine researchers.
As regards Alibhai-Brown’s contribution, she would apparently wish us to believe that it would be racist not to intervene here and take some sort of action to prevent ‘gender’ selective abortions taking place in the UK, and as far as nomenclature goes I should point out here that the correct terminology to use here is ‘sex’ rather than ‘gender’ as we’re dealing solely with the biological characteristic of foetuses and not their personal sense of identity which, of course, they simply don’t possess at the point at which it’s possible for a pregnancy to be terminated. As a general rule of thumb, if it’s purely biology we’re talking about then its ‘sex’ but if we’re in the realms of identity, psychology, sociology, etc. then ‘gender’ is to be preferred, even if some people are in the habit of using the two words interchangeably.
But getting back to Yasmin after that brief digression, I’m not entirely sure of the logic behind her assertion that it would be racist not to intervene beyond the fact that it’s likely that she’s trying to pre-emptively counter any assertions that it would racist to intervene because moral and cultural relativism, privilege, colonialism or whatever other spurious arguments get thrown into the pot by some people in an effort to dishonestly deflect legitimate criticism but otherwise my response to her article is simply that before we start intervening in anything we need to be sure that there is indeed a problem that requires intervention and that any intervention we care to make is proportionate to both the nature and scale of the problem we’ve identified.
In 2012 there were just under 730,000 live births registered in England and Wales to go with just over 185,000 abortions.
The only credible research to date to find any evidence that sex selection using abortion may be being practised within migrant communities living in the UK [Dubuc & Coleman, 2007] identified an anomalous trend over time in the male-female sex ratio at birth in just one very small population sub group, women born in India, and only then at higher birth orders, i.e. where they were giving birth to their third child.
Women who were born in India accounted for just 14,621 live births in England and Wales in 2012, but that’s the figure for all birth orders and the ONS do not current publish a breakdown by parents’ country of birth and birth order as standard. Nevertheless, the general population data we do have on live births by birth order does suggest that around 10%, maybe even 11%, of those births will be a family’s third child giving us a pool of anything from 1,462 to 1,608 live births in our ‘suspect’ population.
The anomalous sex ratio found by Dubuc & Coleman in this population was 1,144 male to 1,000 female births, but this was for the period from 2000-2005 and there was a rising trend at the time (for 1990-2000 it was 1,125 male to 1,000 female birth) and we have no idea of the direction of this trend since then; it may have continued upwards but equally it may have stabilised or even reversed, so for now it’s perhaps best to stick with their figures while being aware that there will be some margin of error in any estimates we derive from them.
So, if we apply that ratio to our 2012 pool of live births we get a low-end estimate for the actual number of male and female births in that population of 780 males and 682 females with the high-end figure at 858 males and 750 females and to identify the number of potentially missing female births we need to adjust those figures for the more typical male-female ratio of 1,050 males to 1,000 females in which case the number of male birth remains the same but our low end estimate for the number of female births rises to 742 with a corresponding increase at the high end to 816 female births.
That gives us a discrepancy in the number of female births in this sub population of between 60 and 65 births on the back of which it is being suggested that information on sex of their foetus should be withheld from well in excess of 700,000 women who don’t belong to this small suspect population and who are under no suspicion whatsoever when it comes to the practice of sex selective abortion; and irrespective of you views on whether it may or may not be racist to intervene in such matter you’d have to say that intervention being proposed by The Independent looks rather disproportionate to the scale of the problem.
Now I mentioned a Canadian paper, which appears to be both the study which set Rajendra Kale off on his personal crusade against sex selection and the study that The Independent attempted to replicate, albeit in such a half-baked manner that they not only failed to generate any kind of usable data from their FOI request to the ONS but also wound up unjustly pointing the finger of suspicion at Muslim communities where there is absolutely no evidence that sex selective abortion is practised. You can read that paper for yourself by downloading it from this link (pdf) and the first thing you’ll notice is that its a working paper produced by three economists, two from Columbia University and a third from University of British Columbia, for the National Bureau of Economic Research. NBER is a private, non-profit, economic research organisation based in Cambridge, MA and easily the largest economics research organisation in the United States with a list of past and present research associates that is a veritable who’s who of US research economists. It’s list of Nobel laureates, 22 at the last count, includes Milton Friedman, Joseph Stiglitz, Paul Krugman, etc. so this is not an organisation that’s noted for publishing sloppy, ill-founded, research.
The paper itself, which is by Douglas Almond, Lena Edlund and Kevin Milligan uses data extracted from the Canadian census which, as we’ve already seen from looking at The Independent’s efforts, introduces all manner of potential sources of confounding that don’t come into play when working with actual birth data but unlike the Independent’s science editor, Steve Connor, Almond et al. have bothered put in the hours of background research necessary to understand the potential problems that could arise from working with census data and, crucially, introduced three specific controls into their own study in order to limit the extent to which confounding factors might bias their findings.
So what did our economists do that our science editor completely overlooked?
First, they limit their dataset, which is drawn from censuses carried out in 2001 and 2006, only to two parent families in which the three youngest children were born in Canada and this will help, to some degree, to limit the extent to which confounding from absent siblings might introduce bias although it won’t eliminate that possibility completely because the census won’t provide any information that can be used to control for the potential impact of infant mortality, adoption, siblings living with relatives of their birth parents and older, non-dependent siblings etc. on the dataset but it will substantially reduce the possibility of bias arising from cross-cultural confounding, e.g. differences in the infant mortality rates in Canada (4.78 deaths per 1,000 live births) and those in, say, Pakistan (55.9 per 1,000), India (44.6 per 1,000) or China (15.2 per 1,000). Sex selective abortion is not by any means the only way in which a cultural preference for male children over females can potentially lead to a surfeit of males in a population over and above anything that might reasonable result from natural variations in the sex ratio at birth; infanticide, whether actively practised or carried out by way of neglect and/or abandonment is equally capable of producing the same population effects, so limiting their dataset only to families with children born in Canada, where such practised are much more likely to be noted and lead to prosecution, our economists are also narrowing the range of possible explanations should they find any anomalous sex ratios in their data.
Second, they exclude from consideration any families with children over the age of twelve in order to minimise this risk that their data set could be compromised by the existence of non-dependent older siblings not recorded in the census data, this risk being greatest in families with older children, and this will go some considerable way towards eliminating the problem of male-female ratios being skewed by the practice of early, arranged marriages, which is relatively commonplace in most South Asian communities and, in the the case of the Independent’s own shambolic efforts, the most likely cause of the anomalous sex ratios their identified in the data they obtained for at least the Pakistani and Bangladeshi families included in their data set.
Our economists also go beyond looking at just the relationships between parental country of birth and sex ratios in third children born in Canada relative to the sex of the previous two children in the family as the descriptive statistics provided in the paper also indicate that sub group analyses were performed looking at everything from the possible impact of the age at which parents emigrated to Canada, i.e. whether they came to the country as children or adults, at whether any anomalies in family structures in 1st generation migrants carried forward to the second generation and at possible relationships to parental age(s), education and religion, even if the results of many of these sub group analyses are not explicitly reported in the paper because, one would assume, they generate null results.
In all, what this Canadian study looks to be is a pretty solid piece of research and while the limitations inherent in using census data rather data mean that it cannot provide a definitive assessment of the full scale and extent to which sex selective abortion may be occurring in migrant populations from South and East Asia now living in Canada, should it turn up any evidence of significant anomalies in the male female sex ratios in this sample population any of its analyses then this will be evidence that deserves to be taken pretty seriously although probably not to the extent, at this stage, of making substantive changes in health care practice and policy. Given the limitations of this statistical approach compared to that of looking for discrepancies in male-female sex ratios is birth data, an appropriate first response would be to seek to confirm this study’s findings by way of a detailed analysis of relevant birth records.
So, unlike The Independent’s half-baked efforts, the methodology adopted by our research economists for the Canadian study looks to be rigorous enough to make their results worth looking at, so what did they actually find?
The small selection of graphs above (which you can click to enlarge) summarise the paper’s key finding and yes there are some very substantial imbalances in the male-female sex ratio when looking, in particular, at Indian families where either or both of the first two children are female:
Panel A of Figure 1 considers country of origin. Most of the existing literature studies one country at a time or country of origin for immigrants, so the breakdowns in Panel A allow comparison of our results to the existing literature. Each country sample is chosen by keeping all families with at least one grandparent born in that country. We show the results for India, ‘China plus’ together with Korea and Vietnam, and the Philippines. Sex ratios for first births are only slightly higher than biological norms, coming in between 1.08 and 1.09 for all three of our country groups. The 95 percent confidence interval includes 1.05. The sex ratio for second children when the first is a girl is elevated for India at 1.19, which is statistically significantly different than 1.05. A much sharper contrast is evident for third children with two girls first. For India, the sex ratio is 1.90, with a 95 percent confidence interval reaching down to 1.67. For China plus, Korea, and Vietnam, the sex ratio is 1.39, which is statistically different than 1.05.
Now here the sex ratio in Indian families where the first two children are female, which is getting on for two male birth for every female birth, is far too large to be accounted for by a combination of natural variations in the sex ratio and any sources of confounding and bias that the researcher haven’t been able to full eliminate, so in this case the suggestion that sex selective abortions may account for a substantial proportion of the imbalance in male birth is highly plausible.
However, by way of complete contrast to the Independent’s piss poor efforts, if we look at the fourth graph in this figure, which looks at sex ratios in the sample population by religion, albeit using a somewhat smaller data set because religious affiliation is only captured in the Canadian census in years ending in 1 (Canada conducts a census every five years but uses a much shorter questionnaire in years ending in a 6) what we find is that it only migrant families in which the parents are neither Christian nor Muslim that exhibit anomalous sex ratios:
Finally, we turn in Panel D of Figure 1 to religion, where the sample includes families with at least one South or East Asian-born grandparent. Religion is only available in 2001, so sample sizes are smaller than the first two panels which included data from both 2001 and 2006. Strikingly, the sex ratios for families with Christian or Muslim parents show little indication of heightened sex ratios, with a ratio of 1.01 for third births after two girls. Approximately half of this sample originates from the Philippines, which features a non-patrilineal culture. However, the same pattern occurs for Asian Christians who are not Filipino. The middle set of bars displays results for immigrants who are neither Christian nor Muslim. This set of families displays a heightened 1.98 sex ratio for third births with two girls first.20 The right-hand set of bars pulls out Sikh families who have the highest sex ratio we observe among the religious groups, at 2.07.
About half the sample population of families who are either Christian or Muslim are Filipinos and that population actually exhibits a rather lower than normal sex ratio for third birth after two girls of 1,010 males per 1,000 females where 1,030 males per 1,000 is generally treated as being the bottom of the natural range, and yet as we’ve already seen Rajendra Kale’s CMAJ editorial incorrectly identifies Filipinos as being amongst the population groups that exhibit a higher than normal male-female sex ratio at higher parities, unless the thinking behind his editorial is that Filipino families, being non-patrilineal, are in the habit of aborting male children as a matter of cultural preference*.
*There is, of course, no actual evidence of this.
By the same token, the data here tends to refute the Independent’s claim to have found evidence indicative of sex selective abortion in their UK data for first generation Pakistani, Bangladeshi and Afghani families. Yes, there may a strong son preference in Muslim communities but when it comes to producing offspring the core Muslim belief is whether you get male children, female children or a mix of both is a matter for Allah and Allah alone to decide.
What this study doesn’t do, however, is provide any clear estimates for the likely extent to which sex selective abortion may actually be practised within those migrant populations living in Canada for which there is evidence that it probably does take place. What we do have in this study is a sample population of just under 49,000 families (48,920) each of which have at least one first or second generation migrant parent and three children under the age of 13 all of whom were born in Canada but beyond that, exactly how this sample relates to the actual scale of Canada’s South and East Asian populations is a little unclear thanks to the somewhat idiosyncratic manner in which this information is captured by the Canadian census, where census respondents are asked to self-identify the ethnic or cultural background of their ancestors which can lead to some slightly odd responses. In 2006, for example, one respondent put themselves down as ‘French Canadian’ was recorded twice in the ethnicity figures, once as French and once as a Canadian, while another respondent listed eight different origins – clearly there’s no ticky-box for ‘Mutt’ on the questionnaire.
Nevertheless there look to be around 1.5 million people living in Canada of South Asian descent and the East Asian population of the country, the largest proportion of which are of Chinese descent, looks to be on or around the same scale, so somewhere around 3-3.25 million people in total.
For England and Wales, the total Asian population is around 4.3 million (and that for all Asian ethnic groups including nationalities not covered by any of these studies, i.e. those from the Middle East and Central Asia) albeit with a significantly different ethnic mix, i.e. a far higher proportion of South Asians and only about a quarter to the number of Chinese, within which, according to the data obtained by the Independent, a little over 58,500 families with at least one parent who is a first generation migrant and three dependant children.
From all that we can perhaps infer that while the Canadian sample obviously doesn’t include all South and East Asian families with three children, because we know that some families have been excluded from the sample and why, those that have been excluded are not going have too dramatic an impact on the overall figures were we to track them down and reintegrate then into the dataset. As a very rough estimate I’d say that the Canadian sample represents at least half and probably much closer to two-thirds of the total number of South and East Asian families with three children living in Canada, if not slightly more than that.
The reason I mention all that is because despite the limitations of the descriptive statistics provided it is still possible to derive an estimate from these figures for the number of missing girls in the data set and, therefore, estimate the possible number of sex selective abortions indicated by the sex ratio anomalies identified in the study and this figure comes out to 294 missing girls for first generation migrant families and another 79 for second generation families of which the vast majority are missing from Indian families – the 1,900 to 1,000 ratio in favour of boys born as the third child to Indian families with two previous female children alone account for anything from 241 to 257 of the total number of missing girls depending whether you take the natural ratio in your calculation to be the 1,050-1,000 human average or the 1,080-1,000 ratio for the first born Indian children in this sample.
That sounds like rather a lot but, and it’s an important but, we are not dealing here with birth data for a single year we’re looking at census data for families with aged anything up 12 years of age, which is a 13 year cohort and to compare the figures from this study to those I extrapolated using UK birth data and the birth ratio estimate from Dubuc and Coleman we have to divide our figure for the total number of missing girls in the dataset by the size of the cohort in years (13) which leaves us with an estimate for the annual number of sex selective abortions necessary to generate the anomalous sex ratios observed in the Canadian study of between 28 and 29 a year.
And, for the record, Canada’s total population of around 33 million or so, is a bit over half that of the UK as is the annual number of live births (370-380,000) while the annual of abortions (92,000) is a little under half that of UK – and so too is our estimate for the annual number of sex selective abortions compared to out earlier estimate for the UK.
Incidentally, I also managed to track down the US study by Almond & Edlund, which was Kale’s other key reference in is CMAJ editorial. This used the same basic methodology as the Canadian study with the same limits placed on its data set, i.e. two parent families with at least one parent who is first generation migrant with three children under 13, all born in the US. That produced an analysis sample of 18,557 children from 11,553 families in which the male-female ratio in third child for families with at least one Indian, Chinese or Korean parent was found to be 1,510 to 1,000. However, the total number of children in this group was just 324 resulting an estimate for the total number of missing female births of 57 across, again, a 13 year cohort and therefore an estimate of just 4-5 sex selective abortions a year. Despite the seemingly very high male-female sex ratio here the numbers in the sample group are rather to small to place too much reliance on this figure without further confirmatory research using actual birth data and, if possible, a much larger sample size.
So that’s Kale’s evidence and from it I have a couple of observations to make on both his comment piece for the Independent and his CMAJ editorial.
The first is that Kale is self-evidently operating far outside his field of expertise here. He’s a neurologist playing at being a public health statistician, which is often anything but a good idea and all the more so in this case for his apparent inability to interpret statistical information correctly.
The second is that there, sadly, appear to be one or two signs in his editorials of of incipient Linus Pauling Syndrome, a distressing, reputationally degenerative, condition known to affect some hitherto respectable scientists who suddenly and irrationally become so enamoured with their own cleverness that they begin to fancy themselves as a ‘maverick’ and over time manage to lose all track of reality. It is not clear as yet whether this condition has a genetic component as it does primarily seem to affect male scientists, although cases involving female scientist are not entirely unknown (see Greenfield CBE, Baroness Susan).
Nowhere is this perhaps more apparent than in Kale’s characterisation of the reaction to his CMAJ editorial, which would be amusing were it not so abjectly tendentious:
Feminists painted themselves into a corner arguing that women had the right to abort female foetuses and reduce their own numbers. Pro-life groups were delighted to have found the Achilles heel of the pro-choice movement. Politicians dithered and refused to debate abortion in parliament. Concerned ethnic minorities agreed but worried that they had been shown in poor light.
I’m assuming that this relatively recent article by Sarah Ditum is an example of what Kale sees as feminists painting themselves into a corner:
When you talk about being pro-choice, sex selective abortion is often slung at you as the triumphant gotcha. “You love women so much you want them to be in charge of what grows inside their bodies, but what about the women who are aborted, have a go at answering that? ZING!”
The answer is actually remarkably simple, and it’s this: it doesn’t matter whether what’s growing inside you is liable to end up as a man or a woman. What matters is whether the person it’s growing inside – the person who is going to have to deliver the resulting baby, at not inconsiderable personal peril – actually wants to be pregnant and give birth to this child. In a world where it’s possible to end a pregnancy safely and legally, it seems like rank brutality to force anyone to carry to term against her will.
And as far as I’m concerned, it doesn’t matter why any woman wants to end her pregnancy. As the conscious and legally competent entity in the conception set-up, it’s the woman’s say that counts, and even the most terrible reason for having an abortion holds more sway than the best imaginable reason for compelling a woman to carry to term.
Implicit in Sarah’s argument is, of course, an understanding that given a genuinely free choice in the matter women will not be rocking up at abortion clinics in droves, herds or even flanges to demand the immediate removal of their female foetuses any more than they voluntarily queue up to dive headlong into crematoria ovens if their husband/wife/partner inconveniently succeeds in running up the curtain and joining the choir invisibule before they get around to doing the same thing.
Those kinds of things happen to woman only where you have men laying the heavy-duty patriarchal shit on them which is why feminists are entirely clear in their view that:-
A. it’s not women making choices in their best interests that’s the problem here, it’s the patriarchal crap that needs to go; and,
B. whatever the best way of getting shot of all this patriarchal crap might be it doesn’t involve giving doctors the chance to live out their Great and Powerful Oz fantasies.
If that’s painting themselves into a corner then at least they’ve picked the corner isn’t full of shit.
As for the self-deluded opinions of the anti-abortion lobby and its supporters, if you can manage to read Cristina Odone’s suppurating efforts to unilaterally absolve the medical staff who cruelly failed Savita Halappanavar of any responsibility without an acrid taste of bile rising in the back of your throat then maybe you’ll also buy her bullshit claim that feminists have been silent on the subject of sex selective abortion (they haven’t of course) while at the same time ignoring the fact that laying the responsibility for sex selective abortion at the door of women, which is what she’s doing there, is close to being the most egregious form of victim blaming imaginable. Seriously, is that worse or better than ‘well she was wearing a short skirt so she was obviously asking to be raped’? I honestly don’t know because there really doesn’t seem to be a lot to choose between the two.
I could go on, I suppose, but really why bother? Kale’s article simply reeks of the kind of tired old ‘doctor knows best’ medical paternalism that should have left the building somewhere around the time that Sir Lancelot Spratt ceased to bulldoze his way around the fictional corridors of St Swithin’s. Never mind that Britain’s apparent ‘share of this global social evil’ is maybe 60 or so possibly iffy abortions a year, which by our own historical standards makes us a complete bunch of amateurs in the global social evil stakes. There was a time, and it really isn’t that long ago in the grand sweep of history, where our colonial ancestors wouldn’t have thought twice about knocking off 60 of the locals before tiffin, so let’s and try and keep some sense of perspective here.
Whatever the answers to this ‘global social evil’ might be you can be absolutely sure of one thing, they involve empowering women and giving them more choice not less. The real social evil here isn’t women’s right to obtain a safe legal abortion or their ability to ask about, and be told, the sex of their unborn foetus, it’s the cultures which still insist on placing a value on male lives, male freedom and male children far in excess of that accorded to women and it’s there that change is desperately needed, and indeed, long overdue.
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