CMAJ’s recent editorial “It’s a girl!” — could be a death sentence,”1 highlights an important issue that has been under-addressed in Canada. Skewed sex ratios have indeed been documented in subgroups of Quebec.2 What is not clear, however, is the extent to which delayed disclosure of fetal gender would be sufficient to prevent sex selective abortion. Late pregnancy abortions are not unheard of in Canada,3 and parents who are motivated enough could paradoxically revert to this option. The long-term solution might instead lie in closer attention to gender inequality as a determinant of health at a global level. Forces worldwide are leading to greater intermingling of cultures with different perspectives on status of women, and it is unlikely that sex-selective abortions can be reduced without conscious efforts to raise awareness of gender equality at all levels of society.