Sex selection drugs cause tens of thousands of stillbirths in India

One fifth of the world’s 2.6 million annual stillbirths happen in India. Many fetuses die because their mothers take sex selection drugs to increase the likelihood of having a son.

Sex selection drugs (SSDs) contain oestrogen-like plant extracts and testosterone, and are taken in the early phase of pregnancy to determine the baby's gender. Or at least that's what some women in India think. Instead, the drugs can irrevocably damage the fetus’ organs, cause birth defects, and even kill them late in the pregnancy.    

Sutapa Bandyopadhyay Neogi of the Indian Institute of Public Health-Delhi, Public Health Foundation of India, studied the risk of SSDs on stillbirths in India. We ask her for more.  

ResearchGate: What did you find in your study?

Sutapa Bandyopadhyay Neogi: Our study was designed to explore the association of various risk factors for stillbirths, with a special focus on the intake of sex selection drugs (SSDs) during pregnancy. Of all the risk factors studied, we found prematurity (less than 37 weeks of gestation), previous stillbirths, any complication during labour, and the intake of SSDs emerged as significant risk factors. Mothers who had stillborn babies were 2.6 times more likely to have taken SSDs. Out of every 5 women who were exposed to SSDs, one had stillbirth.

RG: What’s in sex selection drugs that make them harmful to mother and child?

Neogi: We did a preliminary analysis on 30 samples collected from various parts of north India. Around 63 percent of the drugs were strongly positive for phytoestrogens, and 20 percent were positive for testosterone.

Phytoestrogens are plant derived edible items. They show oestrogen-like properties and are recognized as endocrine disruptor compounds. These compounds have a great potential to harm the actively growing foetus. SSDs are consumed during 6-10 weeks of pregnancy, which is the most critical period when various organs of the foetus – including reproductive organs – are formed. Any insult during this stage of development can have deleterious effect on reproductive organs, many of which may not be visible at birth.

RG: Are there other associated risks in consuming these drugs?

Neogi: There are risks of congenital malformations and stillbirths. Besides these, other risks are unknown.  There are theoretical possibilities of early onset of puberty, decline in fertility and masculinization of a female fetus exposed to SSDs during pregnancy; reduced masculinization, cryptorchidism and reduced sexual behavior if male fetuses are exposed to SSDs. These are, however, only presumptions based on the existing literature on exposure of growing fetuses to high levels of hormones.

RG: Why do women use sexual selection drugs (SSDs) in India?

Neogi: There is a strongly felt need by several communities in India to have a son. This is because the status of a woman in the society is often determined by her ability to give birth to male child. A son is seen as a torch bearer of the family name, property, and an heir. Only a son can lit the funeral pyre and release them from the travails of the world to ensure the salvation of the soul through its entry into heaven. This has necessitated the need to have a son by all means. Because of this societal pressure, people resort to different measures to fulfill their desire. There are various traditional and modern methods for sex selection measures available (most of them illegally) and the ultimate choice of the method is that of the family. Intake of SSDs is one of such traditional practice.

RG: How did you come to study stillbirths and SSDs?

Neogi: Stillbirth rates are high in India and there is a lot of commitment to reduce the burden. Identification of risk factors of stillbirths, and timely, appropriate management can avert many such cases.

Earlier, we had conducted a study to assess effect of SSDs on congenital birth defects. We found that there was a very strong association between intake of indigenous medicines during pregnancy for a male child, and congenital malformations. Previous researchers found in various stillbirth reviews that many women who gave birth to stillbirths had consumed SSDs during their pregnancy period. We presumed that if something was a risk factor for congenital malformations, it could be a risk factor of stillbirths as well. With these hypotheses in mind and on the request of National Health Mission, Haryana we conducted this study.

RG: What data did you base your study on?

Neogi: The National Health Mission (NHM), of the government of Haryana conceptualized and conceived a centralized online registry by the name of Maternal Infant Death Review System (MIDRS) to gather information regarding maternal deaths, infant deaths and stillbirths from the health facilities.  All this information is collected from multiple sources including health facilities, civil registration system, field workers of health and women and child development departments. Study subjects for the study were identified from the list obtained from MIDRS and the list was shared by NHM, Haryana.

RG: Your study was based in Haryana state in North India. Is the consumption of SSDs higher in this area – if so, why?

Neogi: Haryana is a state in north India and has one of the worst sex ratios in the country.  Anecdotal reports from the state indicated the rampant use of SSDs. National Health Mission, Haryana commissioned the study and therefore we restricted ourselves to Haryana only.  But this of course does not mean that the practice is absent in other states. A systematic documentation from other states is not there but we do know from informal sources that women in other states also take SSDs.

It is also noteworthy to add here that alongside the regulatory measures being undertaken, the sex ratio at birth has touched 900 for the first time in last 11 years in Haryana. That means there's just over 9 girls to every ten boys.

RG: What are you researching at the moment?

Neogi: We are moving towards the next step of exploring the other possible harms on the fetus if exposed to SSDs. For this we are conceptualizing a study on animal (rat) models to see the effect of the drugs on the fetus and also on the next generation of offspring.

Feature image courtesy of bnilesh.