Yesterday’s Telegraph was, as most people will already have seen, awash with stories relating to a sting operation by the newspaper in which a couple of doctors were apparently caught turning a blind-eye to requests for sex-selective abortions.

Before we go any further, we should get the facts straight.

First, sex-selective abortions are not illegal in the UK under the provisions of the Abortion Act 1967, in fact the Act is entirely silent on the subject of sex-selection, as it is in regards to any social reasons that can, and do, influence women when they decide to terminate a pregnancy.

That we are compelled to address at least part of this issue in terms of the law is entirely due to the rather anachronistic nature of the law, as it governs the provision of legal abortion services in UK. Unlike much of the rest of Europe, and even the United States, our own laws insist that abortions must be justified on medical grounds regardless of the gestational age of the foetus. In the US, and in many European countries, the law treats abortion as a purely private matter between a women and her doctor at least until the pregnancy enters the second trimester, and it is only for abortions sought during the second trimester, or later in the case of serious foetal abnormality or serious risk to the life/health of the pregnant woman, that abortions must be justified, in law, on medical grounds.

The law is, therefore, does not present any barriers to the practice of sex-selective abortions where these can be justified on medical grounds, i.e. where there is a significant risk that a foetus may fall prey to a serious, sex-linked hereditary genetic disorder which is present, but dormant, in one of its natural parents or, perhaps more rarely, where the continuation of a pregnancy in which the gender of the child is known to the mother may place the mother at significant risk of developing serious mental health problems.

Second, both cases highlighted in the Telegraph in which is does appear that doctor was willing to accede to a request for a sex-selective abortion for purely social/cultural reasons occured in private clinics, even if at least one of the two doctors involved is also an NHS consultant. The Telegraph’s coverage of this story contains two particularly telling quotations:

One consultant, Prabha Sivaraman, who works for both private clinics and NHS hospitals in Manchester, was filmed telling a pregnant woman who said she wanted to abort a female foetus: “I don’t ask questions. If you want a termination, you want a termination”.

She later telephoned a colleague to book the procedure, explaining that it was for “social reasons” and the woman “doesn’t want questions asked”.

She said to her colleague: “This [the termination] will be under private, she doesn’t want to go through NHS. OK, so — that’s right, because you’re part of our team and she doesn’t want questions asked”.

This, of course, implies that the NHS does ask questions, while a second article on the same story notes that:

Initially, reporters contacted specific organisations by telephone to see if they were willing to arrange terminations due to the sex of the foetus. Some, such as Marie Stopes, made clear it was policy not to arrange abortions for that reason, but others indicated they could help.

Quite.

Third, prohibition has never been effective when it comes to abortion, least of all where women had the financial means to access private healthcare, as this fascinating memorandum on the history of abortion and abortion laws in the UK, by Dr Lesley A Hall of the Wellcome Library, indicates:

1.3.4 The extent to which registered medical practitioners performed abortions is impossible to establish. There was a long tradition of allegations concerning a group of specialists for whom it was a remunerative, if covert, area of practice. Some cases involving registered medical practitioners did reach the courts, and it was an offence for which a doctor could be struck off the register.

…

1.3.9 The provision of abortion by the medical profession remained to a great extent “Law For the Rich” and was not widely available under the National Health Service to any women who needed it, while birth control was still not routinely provided under the NHS (except in cases of severe threat to health from further pregnancies).

Questions of legality aside, the practice of sex-selective abortion raises significant ethical questions, questions that do not lend themselves well to the kind of black and white approach favoured by the anti-abortion lobby which, in recent years, has seen this as something of a ‘Gotcha’ issue.

Of the two cases featured in the Telegraph’s sting, one did not specify any reasons for seeking an abortion other than the fact that the foetus was female, although many of its readers will have guided toward particular inferences by the inclusion of the following infomation:

In 2007, two Oxford academics, Sylvie Dubuc and David Coleman, carried out a study into sex ratio using the annual birth registrations in England and Wales between 1969 and 2005 and found that there was “indirect quantitative evidence of prenatal sex selection against females performed by a small minority of Indian born women in England and Wales”.

Dubuc and Coleman’s full paper, ‘An Increase in the Sex Ratio of births to India born mothers in England and Wales: Evidence for Sex-Selective Abortion’, is – unfortunately – stuck behind a paywall, however, the paper’s abstract does provide some additional, useful, information:

Male preference in many Asian cultures results in discriminatory practices against females, including neglect and infanticide. This preference, together with the availability of prenatal sex determination and sex-selective abortion, has led to an increase in sex ratios at birth in China, India, and South Korea. The resulting expected gender imbalances raise ethical, demographic, and social concerns. We analyzed birth statistics to see whether similar trends are apparent among births to foreign-born mothers in England and Wales. Before 1990, sex ratios at birth were consistently nearly one point lower (104) for the three major Asian groups in Britain compared with mothers born in Western countries. This is inconsistent with previous suggestions that Asian populations have a higher “natural” sex ratio at birth. In the birth statistics since 1990, we find a four-point increase in the sex ratio at birth for mothers born in India, attributable particularly to an increase at higher birth orders, mirroring findings reported for India. This suggests that sex-selective abortion is occurring among mothers born in India and living in Britain. By contrast, no significant increase was observed for Pakistan-born and Bangladesh-born mothers, among whom male preference also exists. It seems that male preference in different cultures does not necessarily lead to sex-selective abortion.

Sex-selective abortion, if this is indeed the cause of this apparent trend, appears to be limited to women who were born in India and to kick-in after the birth of a second child, which suggests that driver behind this trend may be traditional marriage practices and, in particular, the payment of dowries; a practice that has been outlawed in India – although the system continues to operate illegally – but not in the UK.

That this same trend does appear to affect women born in Pakistan and Bangladesh is rather interesting, even if the abstract gives no indication as to whether or not Dubuc and Coleman have attempted to account for this difference in the full paper. The obvious explanation would be that abortion is much less common in Britain’s Pakistani and Bangladeshi communities due to stronger religious prohibitions within Islam but it could also be the case, at least for the time being, that disparities in wealth between Pakistani and Bangladeshi communities in the UK and those in Pakistan and Bangladesh could be taking much of the financial sting out of the dowry system, not least as much of the inward migration to the UK from these countries has come from extremely poor rural areas. e.g. the Mirpur district of Kashmir and the Sylhet region of Bangladesh.

In the second case highlighted by the Telegraph, a specific reason was given to the doctor:

Another consultant, Claudine Domoney, who works with 132 Healthwise clinic in Harley Street, central London, agreed to arrange for a woman to abort a boy after being told that she and her husband already had a son from his first marriage. The practice is known as “family balancing”.

In a consultation room in the Chelsea and Westminster hospital, the woman, who was about 18 weeks pregnant, explained her reasons for the termination “It’s a boy, and that’s the reason, we don’t want to have a second boy.”

Regardless of the legality, or otherwise, of ‘family balancing’, I strongly suspect that this is a practice that many view in a much more sympathetic light than the practice of aborting female foetuses due to cultural prejudices linked to rather archaic marriage customs. Indeed, family balancing may conceivably have contributed to a rather interesting long-term trend in the male-female sex ratio in live births in England and Wales.

What you’re looking at in this graph is the male/female sex ratio in live births in England and Wales for the 50 years from 1957 to 2007 (red) plus the 3 and 5 year moving averages (grey and blue) and what interesting about this graph is:

a. More male children were born than female children during this entire period during which there were, on average, 1,056 male live births for every 1,000 female live births.

b. There has been one significant and sustained shift in the overal trend, a downward trend between 1973 and 1990 which saw the average male to female ratio fall from 1.06:1 (1957-73) to 1.052:1 (1991-2007).

Does sex-selective abortion explain this trend?

Probably not – a lot of things changed between 1973 and 1990 that will have impacted on the male-female ratio; birth, stillbirth and abortion rates, pattern of family building, the average age at which women start families, etc.

What we can say from this data is:

a. Although culturally driven sex-selective abortion may exist, there is no real evidence that its a significant problem or that its having any significant impact on the overall male to female ratio in live births, and

b. If sex-selective abortions are having any kind of measurable impact on the male-female sex ratio – and this is doubtful – then that impact is coming from abortions which are being sought for the purpose of family balancing and because, overall, the odds for any given pregnancy slightly favour male over female by 51:49, the net effect of family balancing, which can amount to nothing more than stopping having kids once you’ve got one of each, actually seems to work in favour of women, not against them.

What the Telegraph’s investigation demonstrates is nothing more than the fact that the law, as it stands, is entirely out of step with the reality of abortion and, worse still, the insistence on dealing with abortion purely in terms of a limited range of clinical justifications in law serves only to inhibit public understanding of the issues.