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Clinics' Pitch to Indian Émigrés: It's a Boy

by Susan SachsThe New York Times
August 15th, 2001

The pitch could not be more direct. The intended audience could not be more specific.

"Desire a Son?" asked an advertisement in recent editions of India Abroad, a weekly newspaper for Indian expatriates in the United States and Canada.

"Choosing the sex of your baby: new scientific reality," declared another in the same publication. A third ad ran in both India Abroad and the North American edition of The Indian Express. "Pregnant?" it said. "Wanna know the gender of your baby right now?"

Some people would call it niche marketing — an effort by companies to promote their products to one of the country's fastest-growing ethnic groups.

But the products in question are not chewing gum or financial services. They are procedures to preselect the sex of a child or, in the case of one advertiser, to identify the sex of the fetus as early as five weeks into a pregnancy. And the target market is immigrants from India, where sex-determination tests were outlawed seven years ago in a still unsuccessful effort to thwart the widespread practice of aborting female fetuses.

Such ads would be illegal in India, which has struggled for years to discourage women from exploiting medical technology to assure themselves of giving birth to boys. Now, Indians in the United States and Canada find themselves being courted by American companies that promise to help do just that.

It is a strange twist on the usual immigrant tug of war between old customs and new choices, the wrinkle being that new freedoms may help perpetuate an age-old preference for boys.

To be singled out as a market for sex-selection procedures distresses many Indian-Americans. So does the casual merchandising of techniques that claim to increase the odds of having a male child. The subject is so sensitive — and so evocative of painful debates about free choice and abortion back in India — that India Abroad abruptly dropped all three ads last week after the newspaper's owner learned about them.

In conversations prompted by the appearance of the gender-selection ads, many Indian and South Asian immigrants also said that traditional bias against female children ran deep. In India, it is responsible for a widening gender gap, with the number of girls per 1,000 boys dropping to 927 from 962 in just 20 years.

But while many people in India are trying to stamp out the tradition, the immigrants said, the openness of the American medical marketplace could help prolong it.

"As immigrants, we really had a chance of starting with a clean, fresh slate," said Shamita Das Dasgupta, a founder of Manavi, a New Jersey group that provides counseling for abused South Asian women. "But we also know that's not possible because we bring our own baggage with us.

"So it makes me scared when something like this happens with impunity, where people are saying, `We are offering a service the community will practice anyway,' " Dr. Das Dasgupta added. "These practitioners are taking advantage of a practice that is totally misogynous, and unless the good-thinking people of our community stand up and let their voices be heard, such practices will continue happening."

In many cultures, a boy is particularly valued as a breadwinner who will support his parents in their old age; often only a son can inherit property. A girl is seen as a burden who requires a costly dowry when she marries. The attitudes are so deeply ingrained that they often persist after immigration.

There is no sign yet that Indian immigrants seeking male children are flocking to the American companies that offer sex-selection procedures, which work on the assumption that sperm carrying the male chromosome can be separated before insemination from those carrying the female chromosome.

But doctors at clinics in the New York City area said that Indian immigrants, as well as immigrants from elsewhere in Asia, made up a fast-growing part of their clientele.

"The ethnic groups that are moving in — from the Asian subcontinent and China — have a tradition of wanting boys," said Dr. Andrew Y. Silverman, the medical director of gender-selection centers in Manhattan and White Plains. "Just from my own patient population, I'm seeing an increase in those kinds of patients. That's why I started advertising in India Abroad."

He said he performed four or five procedures a month at his Ericsson Method Centers, named for Ronald J. Ericsson, who developed a sperm- separation technique 25 years ago and has licensed its use nationwide.

Dr. Masood Khatamee, the executive director of the Fertility Research Foundation, said he also decided to advertise in India Abroad because he had seen an increase in the number of Indian clients coming to him for gender selection or, as he put it, "family balancing."

"I have not really put any ads anywhere before except in New Yorker magazine," said Dr. Khatamee, who is a professor in the obstetrics and gynecology department at the New York University School of Medicine. "I don't know now if I did the right thing or the wrong thing."

The cost for each insemination is $1,000 to $1,500, but neither Dr. Silverman nor Dr. Khatamee guarantees that a woman will conceive. And of those who do conceive, they said, about three out of four will achieve the desired results.

Because such gender-selection methods do not always give the hoped-for results, the possibility exists that a desperate or especially determined woman may abort the fetus if it is not of the gender she wanted. Dr. Khatamee said he tried to screen his patients to avoid people who would go to such lengths to get the desired boy or girl.

"If I feel that a couple would be using abortion as a way of making this a 100 percent technique," he said, "I'd say no."

The third company that has been advertising in newspapers for Indian immigrants in the United States and Canada is Urobiologics Inc. in Livonia, Mich. It promised in its ads to determine the sex of a fetus as early as five weeks after conception by testing the pregnant woman's urine, a claim dismissed as implausible by several medical specialists.

Conventional ultrasound tests can sometimes detect the sex of a fetus after 12 weeks.

Kuldeep C. Verma, the Indian immigrant who owns Urobiologics, said he did not want to know why his clients were in a hurry to have such information or whether they intended to abort a fetus that was not the sex they wanted.

"It is their decision," Mr. Verma said in a telephone interview.

Mr. Verma, who said he was a biochemist and developed his sex- determination test in India before emigrating in 1987, requires each client to sign an agreement stating that she wants the information only "for family fun."

India Abroad has decided not to accept any more ads from Urobiologics or sex-selection clinics.

"We all felt a little queasy," said Ajit Balakrishnan, the chairman of Rediff.com India Ltd., which bought the English-language newspaper two months ago. "We don't want to be remotely associated with anybody that discriminates for a boy child over a girl child. It's wrong to discriminate. You know, some years ago many of my friends marched through Delhi and Bombay to get the government to get rid of these tests."

Mr. Balakrishnan said the paper had a circulation of about 65,000 in the United States and Canada.

In India, recently released census figures suggested that female fetuses were being regularly aborted despite efforts to restrict access to prenatal tests.

Enforcement of a 1994 law against sex-determination tests is feeble and abortions are virtually unregulated. The tests have become commonplace, with itinerant radiologists traveling the countryside from clinic to clinic with their compact ultrasound machines.

The desire for boys, experts said, cuts across lines of wealth and class and may have intensified with a trend in India, and among immigrants to the United States, toward having smaller families.

It is not possible to assess how popular sex-determination tests and gender-selection techniques might be among Indian-Americans or any other group. There are no official statistics, and people who wish to choose the sex of their child do not wish to discuss it publicly, according to Drs. Silverman and Khatamee.

But Indians are not the only immigrant group to be offered sex-selection procedures so directly. Chinese immigrants in New York City can find a gender-selection clinic right in Manhattan's Chinatown, where Dr. Robert M. Nyein started offering the Ericsson sperm-separation technique as part of his gynecological practice about four years ago.

Nearly all the Chinese immigrants who come to him, said Dr. Nyein, want boys.

He has installed a small sign outside his clinic that says, in Chinese, "You can select to have a boy or a girl before pregnancy." It is illuminated at night. That is as far as Dr. Nyein is willing to go to promote the procedure.

"I thought of advertising in the papers," he said, "but I was afraid it would turn out to be too controversial with the religious people and such."

China, like India, has a long tradition of favoring male children, a tradition that has been exacerbated by the country's current one-child policy. Last year, however, Hong Kong, which has its own legislature, banned sex selection except when parents want to prevent the transmission of certain hereditary diseases.

Counselors who work with South Asian families said that whether it comes from family or culture or personal desire, the pressure on immigrant couples to have at least one male child is as intense here as in their native countries.

"I find so many people crying and saying, `This is the second child and it's also a girl and now I'll have a big problem,' " said Nahar Alam, a Bangladeshi-born counselor for Andolan, a New York City advocacy group for South Asian women.

"You hear things anecdotally when there is violence in the home," added Sujata Warrier, the New York City program director for the State Office for the Prevention of Domestic Violence. "If the woman has no choice in sexual matters anyway, and the pressures to have a boy are very high, then the sex-selective process offers a way out."

Dr. Das Dasgupta said she had also worked with South Asian women who were victims of domestic violence and who said that their husbands harassed or abused them over giving birth to girls. Companies that promise to help such immigrants conceive male children, she added, only encourage such behavior.

"So maybe today some newspapers will drop those kinds of ads, but what can prevent them from appearing again somewhere else?" Dr. Das Dasgupta said. "In this country there is a free market."

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