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PUCL Bulletin,

September 1982
Sex prediction tests and womens health

-- By Ritu Mehrotra & Raminder Bhatia

Amniocentesis is a procedure undertaken with certain definite indications for diagnosis of certain foetal conditions. It involves inserting a needle into the uterus and withdrawing some of the amniotic fluid (liquid) in which the fetus floats in the uterus). Various tests of the fluid are used to assess (1) maturity of the fetus needed, e.g., before doing a cesarian section in cases where full maturity is doubtful, (2) condition of the fetus in cases of Rh-incompatibility, (3) generic diseases.

Besides these specific conditions for use of amniocentesis it is being used, or rather grossly misused, for doing antenatal sex determination (ASD). Knowing the implications of ASD in our present day society abortion of the fetus if found to be female), it is totally unethical for any doctor to undertake such a procedure. But today we have doctors who are openly advertising clinics for just this purpose (ASD) in our leading newspapers.

They also claim to be doing the nation a service by "keeping some check over the accelerating population as well as give relief to the couples requiring a male child."

Quoting further from literature provided by the New Bhandari Hospital, Amritsar:

Assessment of the sex of the fetus has been made possible by amniocentesis after completion of 16th week and uptil 20th week of pregnancy, when therapeutic abortion is medically feasibly and legally permissible.

The procedure involves withdrawing of amniotic fluid and transferring it to an autoclaved vial in aseptic conditions. This process has no side effects on the mother as well as on the unborn baby. (The last sentence is in bold print in the letter, with the next point given below here printed as a separate point much further down in the letter).

Inspite of all precautions, the procedures can be fraught with dangers of abortion in 0.1% of cases only.

The prediction of sex is done by conducting sex chromation studies (Barr body and Y-Chromatin body) of the withdrawn amniotic fluid cells.

Due to technical limitations as our trial studies indicate, our test is successful in 98.2% of cases.

Due to technical limitations as our trial studies indicate, our test is successful in 98.2% of cases.


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A charge of Rs.500 will be levied by the clinic for ………
….

ABO and Blood Groupings is essential and is done before the test on extra charges.

Sex determination is done in those patients having one or more female children.

No MTP is done in our antenatal Sex Determination Clinic however, safe facilities for the same are available.

Besides private practitioners, some government aided hospitals in Bombay and Lucknow are known to do ASD. The All India Institute of Medical Sciences was the first in the country to start it but has no restricted it use to cases of suspected genetic diseases only, after realizing its potential for selective female feticide and a ban by the Indian Council of Medical Research.

The condition of women in our country is reflected in the declining proportion of female to male population (972 per 1000 male in 1901 to 930 female per 1000 male in 1971) and the higher rate of female infant mortality to male infant mortality.

It is a fact that there is a definite demand fro ASD. It does help the individual couple who feel that they must have a son but would like to restrict the family size, or those families who are thinking of the dowry they will have to give 20 years hence. But should such demands be pandered to and social prejudices further strengthened? These doctors are only reinforcing the biased social attitudes towards women by aiding and abetting selective female feticide. Curtailing the demand in this case, requires revolutionary changes in the existing social structures and therefore the immediate answer lies in stopping the test.

What and how much, can the government do about it? The Punjab Government took 'prompt action'. The State Health Ministry said it had told the New Bhdari Hospital to stop doing the tests as well as MTPs. But the ASD tests are still going on. According to Dr. Bhandari himself, the government has not passed a legal ban on the tests and so they are continuing to do it. In fact the publicity in recent weeks has increased their clientele and they are now doing 4-5 amniocentesis per day instead of the previous 1 per day. For the MTP, Dr. Bhandari claims that they never had a licence for doing MTPs and so have never done them. But a patient told us that they charged Rs.500/- for the test and Rs.600/- abortion.

A meeting was organized by the All India Coordination Committee of Working and All India Democratic Women's Association on July 15, 1982 to discuss this issue. It finally passed a resolution demanding a ban on sex determination tests.

In recent months, attention has also been focused on the Hormonal pregnancy Tests (HPT) and their ill-effects. This has been due to the efforts of certain persons and agencies, specially Drs. Satyamala and Dr. Mira of Voluntary Health Association of India.

The tests, banned in many Western countries, are still widely used in our country - prescribed by doctors, chemists and laymen. The HPT involves administration of an estrogen-progestrogen (female hormone) preparation which causes menstrual bleeding within three to five days if the woman is not pregnant. If she is pregnant, no bleeding occurs.

There is well documented proof of the teratogenic effect (which causes malformations in the foetus) of these hormones on the foetus. Experiments in animals have shown a very high incidence of congenital defects in the babies of females to whom the preparations were administered, much more than could be accounted for by 'chance'. In human beings as well, retrospective studies among babies with congenital defects have shown that in the case of a large proportion of them, the mother had been subjected to the HPT. Conceding that the incidence of teratogenic effect noticed is very very small, is it fair to 'cause' even one defective child?

Even though we use a large number of other drugs with side-effects, the use of HPT must be given up because the only excuse for its use is convenience. At six weeks pregnancy, i.e., two weeks after the missed period, a doctor can diagnose pregnancy by examining the woman. Urine examination of the woman can further confirm the diagnosis. So the HPT is of any use only from the fourth to sixth weeks of pregnancy, i.e. for two weeks after the missed period. We feel sure that if a woman is aware of the danger involved she would prefer to wait for two weeks to confirm pregnancy rather than expose the fetus to risk.

Some doctors say they use HPT for early diagnosis only in those women desirous of Medical Termination of Pregnancy (MTP, i.e., legal abortion done after confirmation of pregnancy, upto twenty weeks after conception.). This again is not a valid reason because either Menstrual Regulation (MR, a simple out-door procedure done without confirmation of pregnancy upto two weeks after the missed period) soon after the missed period or an MTP after six weeks of pregnancy is appropriate. Using the test in these women may also be hazardous because of (1) the high rate (1 to 5) of false negatives (one out of five pregnant women is not detected by this test). This means the women is considered not pregnant even when she is pregnant and so no MPT is done, leaving the possibly injured embryo to continue to grow and develop. (2) the very high chance that the woman changes her mind and does not come back for MTP.

Thus weighing and balancing the adverse effects of the HPT against its uses, it is obvious that its use should be abandoned completely. While this has finally (after a lot of publicity in the mediate) been recognized by the office of the Drug Controller of India, they see to feel that another year of its use does not matter as long as the multinational and other drug companies are able to see off their stocks! The ban on sale and use of the estrogen-progesterone preparations comes into form only from 1983, while production is banned from August 1982. We wonder who is in a position to stand losses more easily, the multinationals or the public? And on whose side is the government?

 

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