Gender preferences and demand for preconception sex selection: a survey among pregnant women in Pakistan

Psychosocial predictors of antenatal stress in Pakistan: perspectives from a developing country

Objective

Antenatal stress is highly prevalent globally and is associated with adverse physical and psychiatric morbidities and adverse neonatal outcomes. However, the burden of antenatal stress and its psychosocial predicators have not been explored in context of the Pakistani sociocultural environment. The present study explores the prevalence of antenatal stress and its association with gender of offspring, socioeconomic background, cultural beliefs, and access to healthcare in the province of Punjab, Pakistan.

Results

There was a total of 516 pregnant women. Antenatal stress was measured by the Perceived Stress Scale (PSS). The mean score of the respondents on the Perceived Stress Scale was 7.55 (3.43). A total of 218 (42.2%) respondents reported higher stress levels. Logistic regression analysis (backward method) yielded a significant model predicting high stress levels. According to it, low family income, unplanned pregnancy, increasing number of children, less autonomy in decision making, marital problems, harassment, desire to have a male offspring, and the history of birth complications, attended by midwives were associated with high stress levels.

Psychosocial factors of antenatal anxiety and depression in Pakistan: is social support a mediator?

INTRODUCTION

Pregnancy is generally viewed as a time of fulfillment and joy; however, for many women it can be a stressful event. In South Asia it is associated with cultural stigmas revolving around gender discrimination, abnormal births and genetic abnormalities.

METHODOLOGY

This cross-sectional study was done at four teaching hospitals in Lahore from February, 2014 to June, 2014. A total of 500 pregnant women seen at hospital obstetrics and gynecology departments were interviewed with a questionnaire consisting of three sections: demographics, the Hospital Anxiety and Depression Scale (HADS) and the Social Provisions Scale (SPS). Pearson's chi-squared test, bivariate correlations and multiple linear regression were used to analyze associations between the independent variables and scores on the HADS and SPS.

RESULTS

Mean age among the 500 respondents was 27.41 years (5.65). Anxiety levels in participants were categorized as normal (145 women, 29%), borderline (110, 22%) or anxious (245, 49%). Depression levels were categorized as normal (218 women, 43.6%), borderline (123, 24.6%) or depressed (159, 31.8%). Inferential analysis revealed that higher HADS scores were significantly associated with lower scores on the SPS, rural background, history of harassment, abortion, cesarean delivery and unplanned pregnancies (P < .05). Social support (SPS score) mediated the relationship between the total number of children, gender of previous children and HADS score. Women with more daughters were significantly more likely to score higher on the HADS and lower on the SPS, whereas higher numbers of sons were associated with the opposite trends in the scores (P < .05).

CONCLUSION

Because of the predominantly patriarchal sociocultural context in Pakistan, the predictors of antenatal anxiety and depression may differ from those in developed countries. We therefore suggest that interventions designed and implemented to reduce antenatal anxiety and depression should take into account these unique factors.

Gender preference and awareness regarding sex determination among antenatal mothers attending a medical college of eastern India

AIM

There are many women "missing" due to an unfavourable sex ratio in India, which has strong patriarchal norms and a preference for sons. Female gender discrimination has been reported in health care, nutrition, education, and resource allocation due to man-made norms, religious beliefs, and recently by ultrasonography resulting in lowered sex ratio.

METHODS

The present study attempts to find out the level of awareness regarding sex determination and to explore preference of gender and factors associated among antenatal mothers attending a medical college in eastern India. Interviews were done by predesigned pretested proforma over 6 months. The data were analysed by SPSS 16.0 software for proportions with chi-squared tests and binary logistic regression analysis.

RESULTS

Most women who were multigravida did not know about contraceptives; 1.8% of mothers knew the sex of the fetus in present pregnancy while another 34.7% expressed willingness; 13.6% knew of a place which could tell sex of the fetus beforehand; 55.6% expressed their preference of sex of the baby for present pregnancy while 50.6% of their husbands had gender preference. Gender preference was significantly high in subjects with: lower socioeconomic status (p=0.011); lower level of education of mother (p=0.047) and husband (p=0.0001); multigravida (p=0.002); presence of living children (p=0.0001); and husband having preference of sex of baby (p=0.0001).

CONCLUSIONS

Parental education, socioeconomic background, and number of living issues were the main predictors for gender preference. Awareness regarding gender preference and related law and parental counselling to avoid gender preference with adoption of small family norm is recommended.

Preferences for sex of firstborn child among primiparous Turkish women

Sex of the baby is an important fantasy object for pregnant women. The objective of this study was to assess the preferences of women for their infants' sex. In this study, 99 primiparous women were included, and accordance of their desires with the newborns' actual sex and feelings about it were examined. All of the mothers were newly delivered and had healthy newborns (53 girls, 46 boys). Before birth, 49 (49.5%) mothers prefered to have a daughter, 25 (25.3%) mothers prefered to have a son, and 25 (25.3%) mothers reported no preferences about the infant's sex, a statistically significant preference for girls. There was no significant difference in the reported emotions of women according to sex preference and its concordance with infants' actual sex after delivery. It is considered that the timing of the interview might be a strong predictor for this result.

Attitudes of graduating medical doctors toward using sex selection techniques in Jordan in 2009

OBJECTIVES

The aim of this study was to describe the attitude of graduating medical doctors toward the use of sex selection techniques in Jordan in 2009. MATERIALS AND METHODS (DESIGN): A self-administered questionnaire was used to assess attitude toward using sex selection. Demographic variables, gender preference of future children, and score on attitude toward using technology scale were used as independent variables.

RESULTS

A total of 254 doctors (178 males, 76 females) completed the questionnaire. Forty-one (16.1%) doctors thought that sex selection as PGD should be strictly prohibited and 45 (17.7%) thought it should be allowed freely. More than half (54.7%) of them thought it should only be available for medical reason. Only 59 (23.2%) reported that they may consider the use of sex selection technology to choose their future children. Participants who preferred their firstborn child to be a boy or those who preferred their first born child to be a girl were more likely to use sex selection than those without preference. Christian participants were more likely to use sex selection technology than Muslim participants, 9 (47.4%) versus 50 (21.3%). For each one-point increase in Attitude score, the odds of using sex selection increased by 20%.

CONCLUSIONS

The majority of graduating medical doctors believed that sex selection should be restricted and they were not willing to use it.

Sex preference and interest in preconception sex selection: a survey among pregnant women in the north of Jordan

BACKGROUND

Preconception sex selection for non-medical reasons is a controversial issue in bioethics. Little research has described preferences for preconception sex selection among Arab populations. This study describes the sex preference and interest in employing sex selection techniques among pregnant women in northern Jordan.

METHODS

A self-reported questionnaire was administered to 600 pregnant women in Irbid, Jordan. chi(2) test and binary logistic regression were used to examine the factors associated with interest in preconception sex selection.

RESULTS

In general, the interest in using sex selection was low. Women who preferred boys were more likely to be interested in sex selection, if paid for by the couple [odds ratio (OR) = 4.40, 95% confidence interval (CI): 1.75-11.11] or by health insurance (OR = 3.42, 95% CI: 1.94-6.06), or, if feasible, administered through oral medication (OR = 8.84, 95% CI: 5.05-15.63). Women with lower education were more likely to be interested in sex selection, if paid by health insurance (OR = 1.96, 95% CI: 1.10-3.45) and were more likely to believe that sex selection is legal (OR = 1.79, 95% CI: 1.06-2.86). Women who had no boys were more likely to be interested in sex selection, if paid by health insurance (OR = 1.94, 95% CI: 1.10-3.42) or, if feasible, through medication (OR = 3.03, 95% CI: 1.82-5.00).

CONCLUSIONS

The majority of participants were not in favor of using preconception sex selection. Those with a preference to have boys, with lower education, and those with an imbalanced family were more likely to be interested in using sex selection technology.

Antenatal depression and male gender preference in Asian women in the UK

OBJECTIVE

to identify the prevalence of antenatal depression among Asian women living in the UK in one antenatal clinic, and to investigate the possible association with a desire for a male child and other risk factors.

DESIGN

cross-sectional questionnaire-based study.

SETTING

general antenatal clinic in a hospital in Birmingham.

PARTICIPANTS

300 Asian women, irrespective of place of birth.

METHODS

consecutive Asian women attending routine antenatal appointments during the study period self-completed a questionnaire. The first part investigated socio-demographic, cultural and other possible risk factors, including gender preference. The second part comprised the Edinburgh Postnatal Depression Scale (EPDS).

MEASUREMENTS

EPDS score greater than or equal to 12 indicating probable depression.

FINDINGS

the prevalence of depression was 30.7% (92/300, 95% confidence interval 25.4-35.9%). Maternal male gender preference was not common and was not associated with antenatal depression. Family male gender preference, unplanned pregnancy, a history of depression and feeling anxious in pregnancy were independently associated with an increased likelihood of depression, whilst support from family and friends, being satisfied with pregnancy and being multiparous were associated with a reduced likelihood of depression.

CONCLUSION

rates of antenatal depression were very high in Asian women with some associated risk factors. However, male gender preference was not associated with antenatal depression.

IMPLICATIONS FOR PRACTICE

given the high prevalence, screening Asian women for depression may be indicated to allow treatment.