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management at all levels to remedy the major gaps in data,understanding, and implementation, which in 1976 wererecognised as needing attention if the glaring inequalities inresource distribution were to be rectified.

REFERENCES

1. Resource Allocation Working Party. Sharing resources for health in England. Reportof the Resource Allocation Working Party. London: DHSS, 1976.

2. McLachlan G, ed. A fresh look at policies for health service research and its relevanceto management. Report of a Nuffield Provincial Hospitals Trust Working Party.London: Nuffield Provincial Hospitals Trust, 1985.

3. 5th report to the Secretary of State: a report on the collection and use of informationabout services for and in the community. London: HM Stationery Office, 1984.

4. Report of the Advisory Group on Resource Allocation. London. DHSS, 1980.5. Godber G. Regional devolution and the NHS. In: Craven E, ed. Regional devolution

and social policy. London: Macmillan, 1975: 59-85.6. Maynard A, Ludbrook A. Applying resource allocation formulae to constituent parts

of the United Kingdom. Lancet 1980; i: 85-87.7. Alderson MR. Health information resources: United Kingdom-health and social

factors. In: Holland WW, Detels R, Knox G, eds. Oxford textbook of publichealth, vol 3 Oxford: Oxford University Press, 1985: 21-51.

8. Garstairs V, Redpath A. Ten years after reorganisation: changes in mortality measures1974-1983 in Scotland and Health Boards. Hlth Bull 1986; 44: 203-17.

9. Creese AL, Darby SC, Palmer SR, Partick DL. NHS and priorities. Br Med J 1978; ii:1446.

10. Holland WW. Teaching hospitals in crisis: expensive luxury or vital asset? Lancet1984; ii: 742-43.

11. Perrin JR, Magee M. Service increment for teaching. The costs, joint products andfunding of English teaching hospitals. Coventry: University of Warwick, Centrefor Research in Industry, Business and Administration, 1982.

12. Booth CC. The Stoker report and the future of Northwick Park. Lancet 1986; i:

372-74.

13. Swales J. What has happened to academic medicine? Lancet 1986; i: 1194-96.14. Bevan RG, Charlton J. Reviewing RAWP: Relationships between resources used by

health authorities and general medical services. London: Department of

Community Medicine, UMDS, St Thomas’ Hospital, 1986.15. Inequalities in health- the Black Report. Harmondsworth: Penguin, 1982.16. European communities. Atlas of ’avoidable mortality’ 1974-1978. Oxford: Oxford

University Press (in press).

Round the World

From our CorrespondentsIndia

PROTEST AGAINST FETAL SEX SELECTION

IN Bombay a group called Doctors Against Sex Determinationand Sex Pre-Selection Techniques has urged the Governmentto prevent misuse of sex choice methods. It suggests that amnio-centesis for detection of fetal defects should be allowed only inGovernment hospitals and that the sex of the fetus should not bedisclosed to the parents. The focus on selective abortion of femalefetuses was revived last April, when members of the women’smovement and some social scientists and doctors came together inBombay to launch a campaign against the proliferation of sex choiceclinics all over the country.The activists point out that newer methods of fetal sex detection,

such as chorionic villus biopsy, are being described as "safer" thanamniocentesis and are even more likely to be misused unless theGovernment adopts a firm policy to regulate sex choice research andaccess to sex choice techniques. Sex predetermination techniques,such as sperm separation and timed intercourse, are also beingpromoted, and these have even greater potential for breeding malesin a culture with a strong preference for sons.

Although the Medical Termination of Pregnancy Act (1971) doesnot permit abortion as a means of sex selection, abortion in general istacitly approved of as a birth-control method, and clinics notuncommonly advertise abortion services through posters andcinemas. The law allows abortion on grounds of contraceptionfailure, and abortion can easily be obtained on this plea even if thereal reason is unwanted fetal sex. Because the law on sex selection is

unclear, most clinics that offer sex determination do not also carryout abortions. So far, neither the Indian Medical Association, northe Medical Council of India, nor the Indian Council of MedicalResearch (ICMR) has condemned the use of sex choice techniques.

In 1982 questions were asked in Parliament about an Amritsarclinic which was advertising amniocentesis to couples who wished

to have sons. This year, after the widely publicised protest by theBombay activists, the deputy health minister gave an assurance thatsteps would be taken to prevent the misuse of amniocentesis. In Julya Bill was introduced in the Maharashtra State Assembly seeking tomake sex selection illegal. It is likely to be debated in the comingAssembly session in November. So far no similar move has beenmade centrally in the Lok Sabha.

Despite official disapproval of sex selection, the activist groupsexpect that no serious effort will be made to restrict the use of sexchoice techniques. In an interview published in a women’s

magazine, a reproductive endocrinologist suggested that precon-ception sex choice, by means of sperm separation or timed

intercourse, was ethically far more acceptable than sex-selectiveabortion. A leading article in the ICMR Bulletin suggested that sexselection might actually be a good thing for the status of women,since it would ensure that daughters were born out of choice ratherthan chance and would therefore be cherished more.

USA

REPRODUCTION AND RELIGION

THE Founding Fathers created a state in which all religious views,or none, could be held in peace and security. They had enoughknowledge of religious persecution and its evil effects to want tokeep their country free of such hazards, and in this the Constitutionhas been successful, for its tenets have been endorsed by the courts.The more self righteous and fanatical have never been happy withthe separation of religion from the State, though they rarely seem tospeculate on what would happen to them if a specific religious grouphad the power to persecute them, as some of them make clear theywould rather like to do to other such groups.

In recent years there have been increasing attempts to breakdown the barriers between Church and State. This would need

legislation of some kind, even if a reconstructed reactionarySupreme Court altered its rules. Increasing pressure for legislativechanges has emanated from some churches, but the variouschurches in the USA have all benefited from the freedom fromtaxation they enjoy while they practise and preach their

particular faith, and keep out of politics. But if the churches pressurepoliticians and engage in political propaganda, are they entitled tosuch freedom from taxation? This is a central criticism againstvarious Catholic organisations, and the new Supreme Court has justdecided that this issue should be fought out immediately in thelower courts. All this comes at a time when the Catholic Church is

trying to enforce rigid authority over its US adherents, discipliningpriests, nuns, academics, and bishops and considerably alarmingthe public.On the other hand on many issues the Fundamentalists, with

huge television audiences and extracted donations, are also trying toexercise political muscle-indeed one member may enter thepresidential contest. Their main thrust is at the schools, where theyaim to censor books, eliminate the teaching of "secular humanism",promote the teaching of "creationist science", and eliminate allteaching that conflicts with their ideas about the relationshipbetween, and roles of, men and women. In one court case it iscontended that boys should not be taught to cook, because this is thework of the female. They claim the right to define who is a"Christian"—almost always in terms of a person’s political views.While all this might be considered no matter of concern to

physicians, it is in reality of direct importance. While the main focusis on abortion-being fought by its opponents with bombs, fire, andviolence, as well as by the setting up of "clinics" deliberatelycontrived to deceive pregnant women (the operators of which arebeing prosecuted in several States under the Deceptive TradePractice Law)-the matter goes far deeper. It is clear that in

virtually all matters of scientific advances in human reproduction-abortion, contraception, artificial insemination, surrogatemotherhood, embryo culture, and so on-the scientists have vastlyoutpaced the lawyers, the governments, the moralists, and thetheologians. The medical profession, which puts into practice theresults of the scientists’ research, will have to watch all the responsesclosely.