Errors in deciding fetal sex from ultrasonography can lead to domestic abuse

BMJ 2007; 335 doi: (Published 06 December 2007) Cite this as: BMJ 2007;335:1176
  1. Roger Dobson
  1. 1Abergavenny

    Incorrect determination of the sex of a fetus from ultrasonography can result in marital conflict, domestic abuse, and economic hardship, says a study carried out in Nigeria, where male offspring are highly desirable.

    The psychological and physical health of the mother and the upbringing of the child can be affected by such misinformation, says the report (International Journal of Gynecology and Obstetrics: doi: 10.1016/j.ijgo.2007.09.021).

    “The failure rate of ultrasound scans to determine foetal sex should be made known to women and their partners,” the authors write.

    The authors, who cite other studies indicating that the accuracy of ultrasonography to determine fetal sex ranges from 87% to 99%, say that despite the widespread use of the technique little is known about the effect on parents of incorrect information.

    The authors looked at a total of 2860 deliveries and recruited 102 women into the study who had been given incorrect information about the sex of their fetus. They used questionnaires and in-depth interviews to gauge the women’s responses.

    Asked about their immediate reactions to their newborn, 28 of the 102 women reported positive feelings, 12 had mixed feelings, and 62 had negative feelings. All the women with negative feelings wanted a boy, and all had been told wrongly that the sex of the fetus was male.

    Thirty nine women reported marital conflicts as a result of the misinformation, and nine said they had been physically assaulted by their partner. All these women had incorrectly been told they had a male fetus. None of the women said that they had previously experienced violence from their partner.

    The authors wrote, “The issues identified as the immediate factors behind the marital conflicts included accusations from the women’s partners of forging the ultrasound report, increased economic pressure placed on the family by the incorrect result, and desire of the women’s partners to have more children of the preferred sex after tubal ligation had been performed.”

    All 11 of the women who had decided on getting the ultrasonography result to have bilateral tubal ligation at the time of caesarean delivery wanted a reversal. Twenty three women reported the need to buy alternative items and clothing appropriate for the actual sex of their baby.

    The authors say that Nigerians have a very high preference for male children, with 87% of parents preferring a boy. In the United States the percentage preferring a boy is 5%, they say.

    They say that the women affected by violence were those who had wanted male babies and had announced to their partners that the ultrasonography had confirmed a male fetus. “The disappointment experienced following the birth of a baby not of the preferred sex sets the stage for marital conflicts and domestic violence,” the report says.

    It says that some of the accusations made during the conflicts could have arisen from erroneous assumptions that ultrasonography is 100% accurate. “Pre-scan counselling of these women, possibly involving their partners, would be of immense value,” it concludes.

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