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Sex Selection: New Technologies, New Forms of Gender Discrimination

by Rajani Bhatia, Rupsa Mallik, and Shamita Das Dasgupta
October 1st, 2003

With the advent of reproductive technologies that made it possible to detect the sex of a fetus developing in a woman's womb came a new method of discrimination against girls and women. Developed in the 1970s, prenatal diagnostic technologies like ultrasound scanning and amniocentesis proved profitable when marketed as a method of sex selection. Using prenatal diagnosis to detect sex, a person could choose not to have a child based on the sex of the fetus and opt for an abortion.(1) Availability of these technologies and their promotion as tools for sex selection spread fast, primarily in South and East Asia. Currently, they are the most commonly practiced method of sex selection around the world.

Where its use is most widespread, prenatal diagnosis for sex selection reveals clear discrimination against the girl child, leading to severe gender imbalances in the population. In India, for example, the 2001 census recorded a substantial decline in the child sex ratio from 945 to 927 females per 1000 males in just ten years. In urban areas the ratio declined even more dramatically from 935 to 903 girls per 1000 males.(2) In China, the sex ratio at birth since the mid-1980s is only 100 girls per 107-120 boys.(3)

For decades, women's rights groups in these regions and disability rights groups internationally led the struggle to expose the discriminatory use of these technologies. They sought, and in many cases succeeded, in getting laws passed to regulate their use. But, due to poor oversight and implementation, rampant misuse continues.

The U.S. Context

Adding to this climate, the powerful fertility industry (4) in the U.S. has recently developed and begun promoting even newer technologies for sex selection. These include sperm sorting and pre-implantation genetic diagnosis (PGD), both of which carry the "added value" of not requiring abortion, a politically contentious issue in the U.S. Both sperm sorting and PGD increase the likelihood of establishing a pregnancy with a developing child of the desired sex. Because they are applied either prior to conception of an egg by sperm (sperm sorting) or prior to implantation of a fertilized egg into a women's uterus (PGD), neither process necessarily involves abortion. However, because neither is 100 percent accurate, some couples using these methods may still resort to use of PND followed by sex selective abortion.

Both PGD and sperm sorting require the use of expensive assisted reproductive technologies commonly used in the fertility industry (like in-vitro fertilization or artificial insemination). The overall cost of sperm sorting and PGD is very high. For example, in 2001 the average couple using MicroSort, one method of sperm sorting promoted in the U.S. spent nearly $10,000. MicroSort costs $3,200 a try and most attempted it three times.(5)

Sex selection advocates in the U.S. promote the use of these techniques for what they call "family balancing" or "gender variety," a notion that presupposes families ought to have children of both sexes. In the U.S., arguments for sex selection seem to rest on the assumption that the only thing problematic about its use is the elimination of females through sex selective abortions in societies where there is a strong preference for sons, e.g., India and China. This, they say, is unlikely to happen in the U.S.

In recent months, sex selection ads have appeared in leading newspapers like The New York Times. Ads in the North American editions of Indian Express and in India Abroad have specifically targeted South Asians living in this country.(6)

The increased use and acceptance of sex selection in the U.S. would likely legitimize its practice elsewhere and complicate the effort by rights-focused constituencies to develop societal and legal mechanisms that can prevent current and future abuses, both here and abroad.

It is urgent that the unethical promotion and growth of an industry for sex selection is discouraged in the U.S. In particular the high social cost, abuse potential, experimental nature as well as limited efficacy of these methods need to be exposed. The practices of the profit-seeking fertility industry as a whole require oversight and regulation (currently seriously lacking in the U.S.), in order to ensure ethical use of all new reproductive technologies.

Sex Selection and Discrimination

Economic and social pressures to raise male children in the U.S. may be less than in other societies, but they are not completely absent. Furthermore, sex selection is by definition not gender neutral. While we would like to believe that our preference for one sex over another is not influenced by bias, almost all societies have internalized strong prejudices based on sex from which none of us are completely immune. A decision to have a girl over a boy, or the other way around, will be based on gender stereotypes. What if the child does not live up to our "boy" or "girl" expectations? Would the disappointed parents feel they had not gotten their "money's worth?" What does it mean to think of a child as a product with a price tag?

Sex Selection and Gender Violence

Son-preference is a by-product of the ubiquitous patriarchal social system. Unfortunately, this favoring is hardly a harmless idiosyncrasy, as the valuing of male children is generally accompanied by the contrasting neglect and mistreatment of daughters. Historically, this degradation of girls has been expressed in various ways, from female infanticide, to denial of nutrition and health care after birth, to withholding education and empowerment opportunities to girls and women while they are growing up. With the advancement in reproductive technology, pre-natal diagnostics followed by sex selective abortion was added to this list of abuses.

Violence against girls and women often takes the form of deprivation and neglect. But, the dynamic of domestic violence can also involve control of women's reproductive capacity. This aspect of domination can become part of a batterer's pattern of abuse.

In the South Asian context, giving birth to a son enhances a woman's status within the family, whereas her inability to produce a male heir may result in humiliation, contempt, abuse, and abandonment. Men frequently blame their wives for not giving birth to a male child. In-laws may also openly threaten their daughters-in-law with dire consequences if they are unable to produce a son. In abusive situations, a woman may be forced to undergo tests to identify the sex of her unborn child, and then coerced to abort if the fetus is female. Women may be beaten and/or divorced for not giving birth to sons. An abusive spouse may use the birth of a daughter as a pretext for violence towards his wife, and then be violent towards the unwanted daughter. Such abuses occur in the U.S. context as well.

Sex Selection is Big Business

Since new techniques of sex selection require the use of assisted reproductive technologies (7) (like in vitro fertilization and artificial insemination), the fertility industry can use sex selection to expand their market to fertile couples. Fortune magazine estimates a U.S. market between $200 and $400 million per year for the sperm sorting method, MicroSort.(8) In spite of their high price tags, invasiveness, and risks, demand for these methods appears likely to be high. Surveys reveal that 25-35 percent of all parents or prospective parents in the U.S. would use sex selection if it were available.(9) One fertility specialist interviewed by the New York Times said he could fund all of his research until the day he died if he honored the requests he got for sex selection.(10)

American companies are already turning profits on sex selection in South Asia. General Electric (GE), for example, captured the largest market share for ultrasound scanners in India. GE sold a disproportionate number of these machines in Northwest India where the female to male child sex ratio is the lowest.(11) Another American company, Gen-Select, recently marketed dubious sex selection kits in the Times of India.(12)

New Reproductive Technologies Used for Sex Selection

Prenatal diagnosis (PND): Developed in the 1970s, PND through techniques such as ultrasound scanning and amniocentesis followed by sex selective abortion remains the most common method of sex selection practiced around the world for the last three decades.

Pre-implantation genetic diagnosis (PGD): First tested on humans in 1990, PGD has found increasing use during the last 5 years mainly by infertile couples undergoing in vitro fertilization (IVF) who are at risk of having babies with certain genetic conditions. After fertilization of a woman's eggs by a man's sperm takes place in the laboratory, genetic testing is performed on the resulting embryos (fertilized eggs) to determine sex. Only embryos of the "desired" sex are implanted in the woman.

Disability rights advocates have raised concern about whether and where to draw the line on acceptable uses of PGD. Screening out embryos of "the wrong sex" underlines how the method is already used without reflection about its impact on how people are valued (or devalued) in society. PGD has been used to screen out embryos carrying a gene indicating an increased likelihood of deafness in future generations of offspring.(13) Will PGD be used next to screen out undesirable hair and eye color? The issues of sex selection are strongly related to forms of oppression based not only on gender, but also on race, ability and class.

Since this method is experimental, it is not known whether the process of removing a cell from the embryo for genetic testing may result in long-term health consequences for the resulting child.(14) For women, IVF is an intrusive procedure that may have to be repeated a number of times before a successful pregnancy is achieved, if at all.(15) Risks include ovarian hyper-stimulation syndrome, a potentially life threatening condition, and multiple births.(16) Recent studies also suggest that infants conceived by IVF have a higher risk of low birth weight and birth defects than those conceived naturally.(17)

Sperm Sorting: Since it is the sex chromosomes of a man's sperm that determine the sex of offspring, sorting female from male bearing sperm is one method of sex selection. This is a pre-conception method because it is used prior to fertilization of a woman's egg, which is accomplished either by artificial insemination or IVF. There are currently two methods to sort sperm, which were originally developed to breed livestock of a particular sex. Since both are currently under experimentation for humans, health risks are not fully known. When sperm sorting is used in conjunction with IVF, the associated risks must again be taken into account.

Sperm sorting techniques remain unreliable. MicroSort, for example, had an average purity of 88 percent for female bearing sperm and 66 percent for male bearing sperm in 916 sorts conducted between June 1994 and April 2000.(18)

Legal Status Regulating Sex Selection in Selected Countries

In the UK, stringent guidelines by the Human Fertilization and Embryology Authority (HFEA) regulate the use of PGD. The HFEA recently held a public consultation to decide whether or not to regulate sperm sorting.

The Council of Europe's Convention on Human Rights and Biomedicine states in Article 14, "The use of techniques of medically assisted procreation shall not be allowed for the purpose of choosing a future child's sex except where serious hereditary sex-related disease is to be avoided."(19)

In Canada legislation was introduced in May 2002 to make sex selection a crime if used for purposes other than to prevent, diagnose or treat a sex linked disorder or defect.(20)

In India, the use of PND, PGD and preconception techniques such as sperm sorting for sex selection have all been banned by the Pre-Conception and Pre-Natal Sex Selection/Determination (Prohibition and Regulation) Act, 2001.

In China, a law was passed in March 2003 to ban PND for sex selection.

In the US, there is currently very little regulation of the fertility industry. The American Society of Reproductive Medicine (ASRM), a trade association, issues policy recommendations on ethical use of technologies, but clinics are not required to follow them. The ASRM issued guidelines in 2001 that considered sperm sorting under certain conditions ethically allowable. Last year the ASRM confirmed its policy recommendation against the use of PGD for sex selection. In spite of this, some U.S. fertility clinics, such as the Tyler Medical Clinic in Los Angeles and the Sher Institute for Reproductive Medicine in Las Vegas, perform and advertise PGD for sex selection.(20)

Rajani Bhatia is Coordinator of the Committee on Women, Population and the Environment (http://www.cwpe.org). Rupsa Mallik is Program Director - South Asia at Center for Health and Gender Equity (http://www.genderhealth.org). Other contributors represent Manavi, Inc. (http://www.manavi.org) and the Center for Genetics and Society (http://www.genetics-and-society.org).


Footnotes

  1. The authors believe that all women should have the right and access to safe abortion services.
  2. Government of India; Census of India, 2001.
  3. Banister, J. `Shortage of Girls in China Today: Causes, Consequences, International Comparisons and Solutions.' 2003; presentation at PRB, Washington DC.
  4. Dickens, B.M. "Can Sex Selection be Ethically Tolerated?" J Med Ethics; 2002; 28:335-36. Robertson, J.A. "Pre-conception Gender Selection." American Journal of Bioethics, 2001; Vol. 1(1).
  5. Wadman, Meredith, "Sex Selection: So You Want a Girl?" Fortune, February 8, 2001.
  6. Sachs, Susan, "Clinics' Pitch to Indian Émigrés," New York Times, August 15, 2001.
  7. IVF - in vitro fertilization and artificial insemination
  8. Wadman, Meredith, "Sex Selection: So You Want a Girl?" Fortune, February 8, 2001.
  9. Ibid.
  10. Kolata, Gina, "Fertility Ethics Authority Approves Sex Selection," New York Times, September 28, 2001.
  11. George, S.M. "Sex Selection/Determination in India," Reproductive Health Matters, 2002; 10(19):190-92
  12. Ibid.
  13. Weiss, Rick, "Screening Embryos for Deafness," The Washington Post, July 14, 2003, p. A06
  14. Goldberg, Carey, "Screening of embryos helps avert miscarriages," Boston Globe, 6/13/03.
  15. IVF success rate is around 25%. (Simoncelli, Tania, "Pre-Implantation Genetic Diagnosis and Selection," Political Environments #10, forthcoming)
  16. "Sex Selection: Choice and Responsibility in Human Reproduction, Human Fertilisation & Embryology Authority, http://www.hfea.gov.uk.
  17. Simoncelli, Tania, "Pre-Implantation Genetic Diagnosis and Selection," Political Environments #10, forthcoming.
  18. Wadman, Meredith, "Sex Selection: So You Want a Girl?" Fortune, February 8, 2001.
  19. Dickens, B.M. ` Can Sex Selection be Ethically Tolerated?' J Med Ethics; 2002; 28:335-36.
  20. Ibid.
  21. Zitner, Aaron, "Testing Embryos," Los Angeles Times, July 23, 2002; Marcus, Amy Dockser, "Embryo Screening Test Gains In Popularity and Controversy," The Wall Street Journal, July 25, 2002.

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