|Year : 2016 | Volume
| Issue : 2 | Page : 107-110
Prenatal ultrasound sex identification: Some factors that influence pregnant women's requests in Enugu, South-East Nigeria
Joseph Okike Ezugworie1, Augustine Uchechukwu Agu1, Chimdimma Noelyn Onah2, Johnson Nto Nto1, Tochukwu Christopher Okeke3
1 Department of Anatomy, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
2 Department of Statistics, University of Nigeria, Nsukka, Nigeria
3 Department of Obstetrics and Gynecology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
|Date of Web Publication||24-Feb-2017|
Augustine Uchechukwu Agu
Department of Anatomy, College of Medicine, University of Nigeria, Enugu Campus, Nsukka
Source of Support: None, Conflict of Interest: None
Background: Mothers have always had cause to worry about the sex of their unborn child, but prenatal sex determination has continued to attract mixed feelings and reactions worldwide. This study was aimed at determining factors that influence pregnant women's requests for ultrasound sex identification of fetuses in Enugu, South-East Nigeria. Materials and Methods: A descriptive cross-sectional study of pregnant women attending antenatal clinic at University of Nigeria Teaching Hospital, Enugu, was done. A structured questionnaire was used to obtain information on the factors influencing their willingness to know the sex of their unborn children. Results: A total of 416 responses were obtained. Nearly 40.4% of the respondents were interested in knowing the sex of their children. Almost 56.3% preferred to have a male child, 8.7% preferred to have a female child while 25.5% of the respondents were indifferent. Those who had preference for a particular sex were more interested in requesting for prenatal sex determination than those who did not (54.2% vs. 24.0%). Those who had family pressure for a particular sex were more interested than those who were not pressured (65.9% vs. 33.1%). Other factors that influenced their desire to request for the prenatal sex of their children were preference for a male child, desire for more children dependent on the sex of the index fetus, and desire for more children (irrespective of the sex).
Conclusions: Preference for a particular sex, desire to have more children, and family pressure for a particular sex were found to be the major factors that influence the desire for prenatal sex determination by pregnant women in this study.
Keywords: Enugu, pregnant women, prenatal sex identification, ultrasound
|How to cite this article:|
Ezugworie JO, Agu AU, Onah CN, Nto JN, Okeke TC. Prenatal ultrasound sex identification: Some factors that influence pregnant women's requests in Enugu, South-East Nigeria. J Exp Clin Anat 2016;15:107-10
|How to cite this URL:|
Ezugworie JO, Agu AU, Onah CN, Nto JN, Okeke TC. Prenatal ultrasound sex identification: Some factors that influence pregnant women's requests in Enugu, South-East Nigeria. J Exp Clin Anat [serial online] 2016 [cited 2019 Aug 20];15:107-10. Available from: http://www.jecajournal.org/text.asp?2016/15/2/107/200913
| Introduction|| |
Even before the advent of orthodox antenatal care in Nigeria, mothers have had causes to worry about the sex of the unborn child. Then, the couples sought divine interventions to childbearing and determining a particular sex. Under normal circumstances, the chance of any child being a particular sex is around 50%: typically 102–106 boys are born for every 100 girls (Lamina et al., 2004). Since the introduction of ultrasonography in obstetrics by Ian Donald, its scope of application has expanded greatly that the machine has become a standard equipment in many modern obstetric units worldwide (Lamina et al., 2004; Adekanle et al., 2007). The possibility of establishing the diagnosis of fetal sex by ultrasound was first apparent during the scanning of a fetus with bilateral hydrocele (Okonta et al., 2004). Ultrasound is now the most common method for identifying sex prenatally and is used for medical indications such as sex-linked medical disorders and social reasons such as what wears to buy for the child (Shipp et al., 2004; Ekele et al., 2008). There is a demand for ultrasound sex determination by Nigerian pregnant women as it is in different parts of the world. Sex preference exists (Adekanle et al., 2007) in Nigeria, and the preferred sex among Igbos of South-East Nigeria is male. In some countries where male offspring are more desirable, fetal sexing during ultrasound examinations has been outlawed due to growing concern that large number of fetuses are being terminated (Hazel and Nigel, 2012). However, it is also known that many women want to know the sex either out of curiosity or help to plan for the new arrival (Olatunbosun et al., 1991). It has been argued that identification of fetal gender should not be performed on demand or as a matter of routine in developing countries because of the associated positive and negative parental attitudes (Winestine, 1989; Sjogren, 1988), limited resources, shortage of skilled workforce, and possibility of termination of the unwanted sex. Yet a number of obstetricians and radiographers offer prenatal ultrasound sex identification to their patients (Nzeh, 1996). Ultrasonography is not done routinely for most pregnant women in Nigeria (Lamina et al., 2004). This study was carried out to assess some of the factors that influence the pregnant Nigerian women to request for ultrasound sex identification of their unborn fetuses. This will enable obstetricians and radiologists to have a policy on prenatal ultrasound sex identification in Nigeria.
| Materials and Methods|| |
A descriptive cross-sectional study of 416 pregnant women attending antenatal clinic at University of Nigeria Teaching Hospital (UNTH), Enugu State, Nigeria, was done. Structured questionnaires were used to obtain biodata and other information on the factors influencing their willingness to know the sex of their unborn children using ultrasound. Descriptive statistics was used, and mean and frequencies were obtained. Test of association was carried out using Chi-square test while bivariate step-wise logistic regression was performed to identify predictors.
Approval of the study protocol was obtained from the Ethical and Research Committee of UNTH, Ituku-Ozalla, Enugu. Informed consent was obtained from all the participants.
| Results|| |
A total of 416 respondents were enrolled in the study. The mean age was 33 years. One hundred and sixty-eight (40.4%) respondents stated that they were interested in knowing the sex of their children during ultrasonography. One hundred and Sixty-six (39.9%) respondents as seen in [Table 1] had preference for a particular sex, 185 (44.47%) did not have preference for a particular sex while 65 (15.63%) neither specified whether they have preference for a particular sex or not. Two hundred and fifty (60.10%) respondents were of the Igbo ethnic group. Three hundred and seventy-nine respondents (91.11%) were Christians. Four hundred and three (96.88%) respondents were married, ten (2.4%) were single, one (0.24%) respondent was separated while the other two (0.48%) were widowed.
One hundred and fifty-five (37.26%) respondents were employed by the government, 53 (12.74%) were homemakers, 91 (21.88%) were self-employed, 24 (8.17%) were employed in private firms, 67 (16.11%) of the respondents were students, 6 (1.44%) were apprentices while the other 10 (2.41%) did not specify. Two hundred and forty-six (59.13%) respondents were nulliparous while 170 (40.84%) were multiparous. Seventy-eight (18.75%) had problem in the index pregnancy; 311 (74.76%) had no problem in the index pregnancy while 27 (6.49%) did not specify. One hundred and thirty-one respondents (43.3%) indicated that having more children was dependent on the sex of the index pregnancy while 189 (45.43%) did not mind and 96 (23.08%) did not specify. Three hundred and twenty-one (77.16%) respondents planned their pregnancy, 73 (17.55%) did not plan their pregnancy while 22 (5.29%) did not specify if they did.
On bivariate analysis in [Table 2], there was a significant relationship between interest in knowing fetal sex and some variables. A significant relationship (P = 0.001) exists between the variables and the desire to know unborn fetal sex as follows; those who had preference for a sex were more interested in knowing the fetal sex than those who did not (54.2% vs. 31.2%). Those whose desire in having more children depended on the sex of the index fetus were more interested than those whose desire was not dependent on the index fetus (43.55% vs. 38.9%). In addition, those who previously determined the sex of their child through ultrasound were more interested than those who did not (62.1% vs. 32.8%). Those who had family pressure for a particular sex were more interested than those who were not pressured (65.9% vs. 33.1%). Those who desired male child were more interested than those who desired female child or no preference to any sex (56.7% vs. 23.7%).
However, there are other variables whose “Pearson's Chi-square” values were greater than the level of significance (~ =0.001). Therefore, these variables did not have a significant association with knowing the fetal sex; those who planned their pregnancy were more interested than those who did not plan their pregnancy (40.2% vs. 41.1%), those who need more children were more interested than those who did not (41.5% vs. 23.7%), and those who detected problem in their pregnancy were more interested than those who did not (47.4% vs. 38.9%).
| Discussion|| |
Obstetricians and sonographers have varied comments/recommendations regarding prenatal ultrasound sex identification (Adekanle et al., 2007; Olatunbosun et al., 1991; Nzeh, 1996; and Eze et al., 2010). The true value of fetal gender determination at present remains uncertain (Olatunbosun et al., 1991), especially in Nigeria where sex-linked diseases are rare. The Society of Obstetricians and Gynecologists of Canada (SOGC) recommends that fetal genitalia be examined as part of the routine second-trimester obstetric ultrasound and that the examination should be prolonged or repeated if no abnormalities are seen but sex determination is inconclusive (SOGC, 2007).
This study conducted in Enugu, South-East Nigeria, showed that 40.4% of the respondents required prenatal ultrasound sex determination of the fetus. The pregnant women were predominantly of Igbo ethnic group. In similar studies done among Yoruba ethnic group, southwest Nigeria (Enakpene et al., 2009), Hausa ethnic group, northern Nigeria (Maaji et al., 2010), and in America (Thomas et al., 2004), majority of the respondents, i.e., 69.5%, 95%, and 95%, respectively, desired to know the sex of the unborn child. This study also showed that young mothers (<30) were more interested in knowing the sex of the fetus. This is in agreement with the study in southwest Nigeria (Adekanle et al., 2007). The younger women were more likely to be curious in knowing the sex of the unborn child.
Preference for a particular sex was found in this study to have a significant relationship with interest in prenatal ultrasound sex identification. This is expected in this part of the country where Igbo culture largely assigns the right of inheritance to the male child, and on the other hand, mothers attach importance in caring for their daughters during puerperium (Omugo). This was not the case in other studies. Just like in the study done in the southwest Nigeria, our study showed that desire to have more children dependent on the sex of the index fetus had statistically significant relationship with the desire to know the sex of the unborn child. An Igbo couple would want to have two of the genders. This is because the Igbos are of the opinion that the number “one” is as good as “zero” because if death befalls the only son or daughter, the couple has none. Previous children's sex determined by ultrasound was a significant factor prompting the desire to determine the sex of the unborn child in this study. This was not in agreement with other studies (Adekanle et al., 2007; Thomas et al., 2004).
We found that planned pregnancy and detecting of problem in the index pregnancy had no significant association with the desire to know the sex of the index fetus unlike in the study done among the Yoruba ethnic group of southwest Nigeria (Adekanle et al., 2007). Furthermore, maternal education did not have any significant association with the desire to have prenatal ultrasound sex determination. This agreed with the study in southwest Nigeria (Adekanle et al., 2007), but differed with that of America (Thomas et al., 2004).
| Conclusions|| |
Preference for particular sex, desire to have more children dependent on the sex of the index fetus, and previous ultrasound sex identification were the significant factors associated with the desire to know the sex of the fetus. Further qualitative study can be used to explore other factors, especially in other parts of the country. We recommend that where a fetal sex has been identified, a patient's request for disclosure should be respected. 
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
| References|| |
Adekanle D.A., Bello T.O., Odu O.O. (2007). Predictors of request for antenatal sex determination among pregnant women in Osogbo. Niger J Med 16 (4):324-9.
Ekele B.A., Maaji S.M., Bello S.O., Morhason-Bello I.O. (2008). Profile of women seeking fetal gender at ultrasound in a Nigerian obstetric population. Ultrasound 16:199-202.
Enakpene C.A., Morhason-Bello I.O., Adedokun B.O., Kalejaiya A.O., Sogo K., Marinho A.O., et al
. (2009). Client's reason for prenatal ultrasound in Ibadan, South West of Nigeria. BMC Womens Health 9:12.
Eze C.U., Ezugwu F.O., Agbo J.A. (2010). Sonographic determination of fetal gender in second and third trimesters in a private hospital in Enugu, South East Nigeria. Radiography 16 (4):292-6.
Hazel E., Nigel T. (2012). Social and practical implications of fetal sex determination using ultrasound. Ultrasoud 20:149-53.
Lamina M.A., Oloyede A.O., Adefuye P.O. (2004). Should ultrasonography be done routinely for all pregnant women. Trop J Obstet Gynaecol 21 (1):11-4.
Maaji S.M., Ekele B.A., Bello S.O., Morhason-Bello I.O. (2010). Do women want disclosure of fetal gender during prenatal ultrasound scan? Ann Afr Med 9:11-4.
Nzeh D.A. (1996). Ultrasound determination of fetal gender; accuracy and social implication. East Afr Med J 73 (94):225-7.
Okonta P.I., Okogbenin S.A., Adeoye Sunday I. (2004). Pregnant Nigerian women's view of her prenatal sex determination. J Obstet Gynaecol 24:875-7.
Olatunbosun O.A., Lokulo-sodipe O.A., Emuveyan E.E. (1991). Fetal sex determination by ultrasound. Trop J Obstet Gynaecol 9 (2):13-5.
Shipp T.D., Shipp D.Z., Bromley B., Sheahan R., Cohen A., Lieberman E., et al
. (2004). What factors are associated with parents' desire to know the sex of their unborn child? Birth 31:272-9.
Sjogren B. (1988). Parental attitudes to prenatal information about the sex of the fetus. Acta Obstet Gynecol Scand 67:43-6.
SOGC. (2007). Policy statement fetal sex determination. J Obstet Gynaecol Can 368:29-40.
Thomas D.S., Diane Z.S., Bryann B., Robert S. (2004). What factors are associated with patients desire to know the sex of their unborn child? Birth 1310:272-8.
Winestine M.C. (1989). To know or not to know: Some observations on women's reaction to the availability of prenatal knowledge of their babies' sex. J Am Psychoanal Assoc 37:1015-30.
[Table 1], [Table 2]