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High-Tech Sex Selection

A New Chapter in the Debate
by Marcy DarnovskyGeneWatch
December 31st, 2003

In the United States and a few other prosperous, technologically advanced countries, methods of sex selection that are less intrusive or more reliable than older practices are now coming into use. Unlike prenatal testing, these procedures are applied either before an embryo is implanted in a woman's body, or before an egg is fertilized. They do not require aborting a fetus of the "wrong" sex.

These pre-pregnancy sex selection methods are being rapidly commercialized - not, as before, with medical claims, but as a means of satisfying parental desires. For the assisted reproduction industry, social sex selection may be a business path toward a vastly expanded market. People who have no infertility or medical problems, but who can afford expensive out-of-pocket procedures, are an enticing new target.

For the first time, some fertility clinics are openly advertising sex selection for social reasons. Several times each month, for example, the New York Times' Sunday Styles section carries an ad from the Virginia-based Genetics & IVF (in-vitro fertilization) Institute, touting its patented sperm-sorting method. Alongside a smiling baby, its boldface headline asks, "Do You Want To Choose the Gender Of Your Next Baby?"

Recent trends in consumer culture may warm prospective parents to such offers. We have become increasingly accepting of - if not enthusiastic about - "enhancements" of appearance (think face-lifts, Botox injections, surgery to reshape women's feet for stiletto heels) and adjustments of behavior (anti-depressants, Viagra, and the like). These drugs and procedures were initially developed for therapeutic uses, but they are now being marketed and normalized in disturbing ways. When considering questions of right and wrong, of liberty and justice, it is well to remember that the state is not the only coercive force we encounter.

This constellation of technological, economic, cultural, and ideological developments has revived the issue of sex selection, relatively dormant for more than a decade, with new wrinkles and new urgency. The myriad concerns that have always accompanied debates about sex selection are being reassessed and updated: the prospect that selection could reinforce misogyny, sexism, and gender stereotypes; undermine the well-being of children by treating them as commodities and subjecting them to excessive parental expectations or disappointment; skew sex ratios in local populations; further the commercialization of reproduction; and throw open the door to a high-tech consumer eugenics.

Sex selection debates in the US

Sex selection is not a new issue for U.S. feminists. In the 1980s and early 1990s, it was widely discussed and debated, especially by feminist bioethicists. This was the period when choosing a boy or girl was accomplished by undergoing prenatal diagnostic tests to determine the sex of a fetus, and then terminating the pregnancy if the fetus was the undesired sex.

Ultrasound scanning and amniocentesis, which had been developed during the 1970s to detect, and usually to abort, fetuses with Down syndrome and other conditions, were on their way to becoming routine in wealthier parts of the world. Soon they were also being openly promoted as tools for enabling sex-selective abortions in South and East Asian countries where the cultural preference for sons is pervasive. Opposition in these countries, especially strong in India, mounted in the early 1980s and remains vibrant today.

Throughout the 1980s and early 1990s, feminists and others in the U.S. who addressed the issue of sex selection were - almost universally - deeply uneasy about it. Not all opposed it equally, but none were enthusiastic or even supportive.

Some, like Helen Bequaert Holmes, pointed out that the deliberate selection of the traits of future generations is a form of eugenics.[1] Many deplored the practice as a symptom of a sexist society, in effect if not always in intent. In a book-length treatment of these concerns published in 1985, philosopher Mary Anne Warrenasked whether the practice should be considered an aspect of what she dubbed 'gendercide' - "no less a moral atrocity than genocide. [2]

But there was also broad consensus among feminists that any effort to limit sex-selective abortions, especially in the U.S., would threaten reproductive rights. Warren, despite her misgivings, argued that choosing the sex of one's child was sexist only if its intent or consequence was discrimination against women. She concluded that "there is great danger that the legal prohibition of sex selection would endanger other aspects of women's reproductive freedom," and considered even moral suasion against the practice to be unwarranted and counterproductive.

By the mid-1990s, the discussion had reached an impasse. No one liked sex selection, but few were willing to actively oppose it. Sex selection largely faded as an issue of concern for U.S. feminists, especially outside the circles of an increasingly professionalized bioethics discourse.

Separating sex selection from abortion politics

The new technologies of sex selection (and, perhaps, their potential profits) have prompted some bioethicists to argue in favor of allowing parents to choose their offspring's sex. As in past debates on other assisted reproductive procedures, they frame their advocacy in terms of "choice," "liberty," and "rights." John Robertson, a lawyer and bioethicist close to the fertility industry, is one of the leading proponents of this approach. In a lead article of the Winter 2001 issue of American Journal of Bioethics, Robertson wrote, "The risk that exercising rights of procreative liberty would hurt offspring or women - or contribute to sexism generally - is too speculative and uncertain to justify infringement of those rights." [3]

Robertson's claims are based on a world view that gives great weight to individual preferences and liberties, and little to social justice and the common good. As political scientist Diane Paul writes in a commentary on Robertson's recent defense of "preconception gender selection," "If you begin with libertarian premises, you will inevitably end up having to accept uses of reprogenetic technology that are even more worrisome" than sex selection. [4]

Definitions of procreative liberty like Robertson's are expansive - indeed, they often seem limitless. They are incapable, for example, of making a distinction between terminating an unwanted pregnancy - that is, deciding whether and when to bear children - and selecting the qualities and traits of a future child. However, sex selection and abortion are different matters, especially when a pregnancy is not involved.

Since new sex selection technologies are used before pregnancy, political discussions and policy initiatives which address them need not directly affect women's rights or access to abortion. In fact, many countries already prohibit "non-medical" sex selection, with no adverse impact on the availability or legality of abortion. (One such nation is the United Kingdom. In November, 2003, after a comprehensive reconsideration of the issue, their Human Fertilization and Embryology Authority recommended that sex selection for social reasons continue to be prohibited, and that the Authority's purview be expanded to include regulation of sperm sorting technologies as well as other sex selection procedures.)

Even in the United States, where abortion rights are imminently threatened, the emergence of pre-pregnancy technologies should make it far easier than it was, when sex determination meant selective abortion, to consider sex selection apart from abortion politics.

Eugenics: Is the slope becoming more slippery?

When Mary Anne Warren considered sex selection in 1985, she summarily dismissed concerns of its contribution to a new eugenics as "implausible" on the grounds that "[t]here is at present no highly powerful interest group which is committed to the development and use of immoral forms of human genetic engineering." [5]

Not even two decades later, a disturbing number of "highly powerful" figures are in fact committed to the development and use of a form of human genetic engineering that huge majorities do consider immoral - inheritable genetic modification, or manipulating the genes passed on to our children. These scientists, bioethicists, biotech entrepreneurs, ideological libertarians, and others are actively advocating a new market-based, high-tech eugenics.

Princeton University molecular biologist Lee Silver, for example, actually anticipates the emergence of genetic castes and human sub-species. "[T]he GenRich class and the Natural class will become . . . entirely separate species," he writes, "with no ability to cross-breed, and with as much romantic interest in each other as a current human would have for a chimpanzee." [6] Nobel laureate James Watson is another widely respected scientist who has become notorious for his advocacy of redesigning the genes of our children. "People say it would be terrible if we made all girls pretty," Watson said in one such statement. "I think it would be great." [7]

Silver's and Watson's remarks (and all too many similar ones) refer to technologies that are being used routinely in lab animals, but have not been applied to human beings. The screening and selection of embryos-known as pre-implantation genetic diagnosis or PGD, is already with us [see sidebar]. PGD was introduced in 1990 as a way to identify and discard embryos affected by serious genetic conditions, and thus prevent the birth of children with particular traits. Though it is touted as a medical tool, disability advocates have pointed out that many people with conditions it targets live full and satisfying lives. PGD, they say, is already a eugenic technology.

In recent years, PGD has begun to be used to screen for more and more genetic attributes - late-onset conditions, tissue types suitable for matching those of a future child's sick sibling, and sex. Advocacy of greater permissiveness in the use of PGD is beginning to pepper the professional literature. Bioethicist Edgar Dahl recently published an essay arguing that if a "safe and reliable genetic test" for sexual orientation were to become available, "parents should clearly be allowed" to use it, as long as they are permitted to select for homosexual as well as heterosexual children.8 Bioethicist Julian Savulescu even baits disability advocates with the argument that we "should allow people deliberately to create disabled children." [9]

Concern about consumer eugenics and the commodification of children looms large for critics of social sex selection. As part of a recent campaign aimed at the Human Fertilization and Embryology Authority, Britain's regulatory agency, the UK-based Human Genetics Alert writes, "If we allow sex selection it will be impossible to oppose 'choice' of any other characteristics, such as appearance, height, intelligence, et cetera. The door to 'designer babies' will not have been opened a crack - it will have been thrown wide open." [10]

Another British NGO, Gene Watch UK [no relation to GeneWatch magazine-ed.] puts it this way: Allowing sex selection "would represent a significant shift towards treating children as commodities and [subjecting] the selection of a child's genetic make-up . . . to parental choice, exercised through paying a commercial company to provide this 'service.'" [11]

Some researchers, bioethicists, and fertility practitioners have publicly opposed such uses of PGD, and expressed alarm at what the new push for social sex selection seems to portend. In September of 2001, Robertson, then acting chair of the Ethics Committee of the American Society for Reproductive Medicine (ASRM), issued an opinion that overturned the professional organization's opposition to PGD for social sex selection. The New York Times reported that this "stunned many leading fertility specialists." One fertility doctor asked, "What's the next step? . . . As we learn more about genetics, do we reject kids who do not have superior intelligence or who don't have the right color hair or eyes?" [12]

In the US, several women's organizations and other NGOs drafted a letter, signed by nearly a hundred groups and individuals, urging the ASRM not to loosen its recommendations on sex selection. [13] Several months later, the ASRM affirmed its opposition the use of PGD for "non-medical" sex selection. (The organization does not oppose sperm selection to select the sex of a child for "family balancing.") The spread of social sex selection and the ASRM episode were described in an Atlantic Monthly article titled "Jack or Jill? The era of consumer-driven eugenics has begun." Author Margaret Talbot concluded,

[I]f we allow people to select a child's sex, then there really is no barrier to picking embryos - or, ultimately, genetically programming children - based on any whim, any faddish notion of what constitutes superior stock. . . . A world in which people (wealthy people, anyway) can custom-design human beings unhampered by law or social sanction is not a dystopian sci-fi fantasy any longer but a realistic scenario. It is not a world most of us would want to live in. [14]

A transnational issue & a preference for girls

In 1992, Nobel Prize-winning economist Amartya Sen estimated the number of "missing women" worldwide, lost to neglect, infanticide, and sex-specific abortions, at one hundred million. Similarly shocking figures were confirmed by others.

Many in the global North are distressed by the pervasiveness and persistence of sex-selective abortions in South and East Asia, and believe bans on sex selection procedures may be warranted there. At the same time, some of these people believe sex selection in countries without strong traditions of son preference may not be so bad.

This double standard rests on shaky grounds. The increased use and acceptance of sex selection in the U.S. would legitimize its practice in other countries, while undermining opposition by human rights and women's rights groups there. Even Fortune magazine recognized this dynamic. "It is hard to overstate the outrage and indignation that MicroSort [a sperm-sorting method-ed.] prompts in people who spend their lives trying to improve women's lot overseas," it noted in 2001. [15]

In addition, large numbers of South Asians now live in European and North American countries, and sex selection ads in India Abroad and in the North American edition of Indian Express have specifically targeted them. [16] South Asian feminists in these communities fear that sex selection could take new hold among immigrants who retain a preference for sons. They decry the numerous ways that it reinforces and exacerbates misogyny, including violence against women who fail to give birth to boys. If these practices are unacceptable-indeed, often illegal--in South Asia (and elsewhere), should they be allowed among Asian communities in the West?

In contrast to sex selection in South and East Asia, however, a preference for girls may be emerging in North America and Europe. Anecdotal evidence - based on reports from companies offering various methods for sex control and on perusals of the "Gender Determination" message board at www.parentsoup.com, which has over a quarter million postings - tends to confirm that of North Americans trying to determine the sex of their next child, many are women who want daughters.

That North Americans may not use new technologies to produce huge numbers of "extra" boys does not, however, mean that sex selection and sexism are unrelated. One study, by Roberta Steinbacher at Cleveland State University, found that 81% of women and 94% of men who say they would use sex selection would want their firstborn to be a boy. Steinbacher notes that the research literature on birth order is clear: firstborns are more aggressive and higher-achieving than their siblings. "We'll be creating a nation of little sisters," she says. [17]

Observers of sex selection point to another discriminatory impact: its potential for reinforcing gender stereotyping. Parents who invest large amounts of money and effort in order to "get a girl" are likely to have a particular kind of girl in mind. As a mother of one of the first MicroSort babies recalled, "I wanted to have someone to play Barbies with and to go shopping with; I wanted the little girl with long hair and pink fingernails." [18]

There are many reasons people may wish for a daughter instead of a son, or a boy rather than a girl. In a sympathetic account, New York Times reporter and feminist Lisa Belkin described some of the motivations of U.S. women who are "going for the girl."

"They speak of Barbies and ballet and butterfly barrettes," she writes, but "they also describe the desire to rear strong young women. Some want to recreate their relationships with their own mothers; a few want to do better by their daughters than their mothers did by them. They want their sons to have sisters, so that they learn to respect women. They want their husbands to have little girls. But many of them want a daughter simply because they always thought they would have one." [19]

Wishes and consequences

Compelling though some of these longings may be, sex selection cannot be completely understood or appropriately confronted by evaluating the rightness or wrongness of parental desires. The preferences of prospective parents are obviously relevant in child-bearing matters, but so are the well-being of future children, and the social consequences of technologies-especially those that are already being aggressively marketed.

Wishing for a girl, or for a boy, is cause for neither shame nor condemnation. But as legal scholar Dorothy Roberts points out, it is important to "scrutinize the legal and political context which helps to both create and give meaning to individuals' motivations." [20]

If wishes, choices, and preferences are to be appropriately balanced with social justice and the common good, they cannot be unthinkingly transformed into protected liberties, much less codified rights. Isolated from social consequences, both wishes and liberties are naïve at best.


Sidebar: Pre-pregnancy sex selection: How it works, what it costs

Prenatal screening followed by selective abortion remains by far the most common sex selection method around the world, with the pre-pregnancy methods described below still fairly rare. However, the new technologies are in the process of becoming commercialized, and could eventually be widely adopted.

Pre-implantation genetic diagnosis (PGD) is an embryo screening technique. About three days after fertilization, a single cell is removed from each embryo in a batch that has been created using in vitro fertilization (IVF). Technicians test the cells for particular chromosomal arrangements or genetic sequences; then one or more embryos that meet the specified criteria - in the case of sex selection for a boy, those with both X and Y chromosomes - are implanted in a woman's body.

PGD was introduced in 1990; since then about two thousand children have been born worldwide following its use. No one knows how many PGD procedures were undertaken for social sex selection. (In fact, the notoriously minimal US regulatory environment for assisted reproduction facilities means that there is no firm data on the total number of PGD procedures conducted here, or even on the exact number of clinics offering them.)

The use of PGD use adds between $3,000 and $5,000 to an IVF cycle. Because it requires IVF, women must undergo hormone treatment and egg extraction procedures that are burdensome, invasive, and possibly risky. The risks to the children born from screened embryos are unknown, both because of the small numbers involved so far and because of inadequate follow-up studies.

Assisted reproduction facilities advertise different reliability rates for sex selection using PGD. A US chain of clinics called the Fertility Institutes claims that PGD offers "sex selection with 99.9% guarantee of chosen gender" (see http://www.fertility-docs.com/fertility_fees.phtml). Sydney IVF, an Australian clinic that openly advertises social sex selection, acknowledges that PGD is "still fallible" and advises that "[i]f you are not prepared to accept a small risk of the opposite sex you must not proceed with this treatment" (see http://www.sivf.com.au/leaflets/Sex_selection_apr03_web.pdf ).

The sperm sorting method known as MicroSort has been available since 1995. In it, a fluorescent dye added to a sperm sample binds to chromosomal DNA. Because sperm that carry X chromosomes contain slightly more DNA than those with Y chromosomes, the sample can be sorted using a process called "flow cytometry." The Genetics & IVF Institute (GIVF) obtained an exclusive US license to apply the technique in humans from the US Department of Agriculture, where it was developed to sort bull sperm.

In late 2002, GIVF said that about three hundred babies had been born after MicroSort procedures. The company claims success rates of 88% for girls and 73% for boys. It reports that about 15% of its customers say they are trying to avoid the birth of a child who has inherited a sex-linked disease from the parents; the rest just want a boy or a girl.

GIVF is well aware of the widespread uneasiness about sex selection, and accepts only "qualifying patients"-couples who are married, have at least one child, and want to "sort for the less represented sex of children in the family." The bioethical term of art the company wields - "family balancing"-is now widely used as an ethical justification for proceeding with the routinization of social sex selection.

In 2001, an analyst at OrbiMed Advisors, an asset management firm for the global healthcare industry, estimated the sperm sorting market in the US alone as "between $200 million and $400 million, if [it] is aggressively marketed." (Wadman, Fortune). But the potential market could be significantly greater.

GIVF's base charge for MicroSort is $2300; couples try an average of three times before a pregnancy is achieved or they drop out. A number of polls have found that 25% to 35% of US respondents say they would use sex selection if it were safe and reliable. If the parents of 5% of the four million babies born each year in the United States were to use MicroSort at $6,900 each, the annual revenues would reach close to $1.4 billion.

These sums are understandingly tempting for the fertility industry. For those of us unsettled by the prospect of sex selection as a consumer choice, they are a wake-up call.


Footnotes

1 Humber and Almeder, eds. "Sex Preselection: Eugenics for Everyone?" Biomedical Ethics Reviews, 1985
2 Mary Ann Warren. Gendercide: The Implications of Sex Selection. Rowman & Littlefield, 1985
3 John A. Robertson. "Preconception Gender Selection," American Journal of Bioethics, Winter 2001
4 Diane Paul. "Where Libertarian Premises Lead," American Journal of Bioethics, Winter 2001
5 Mary Ann Warren. Gendercide: The Implications of Sex Selection. Rowman & Littlefield, 1985
6 Lee Silver. Remaking Eden. Avon, 1997
7 Shaoni Bhattacharya. "Stupidity should be cured, says DNA discoverer," newscientist.com, February 28, 2003 http://www.newscientist.com/news/news.jsp?id=ns99993451
8 Edgar Dahl. "Ethical Issues in New Uses of Preimplantation Genetic Diagnosis," Human Reproduction, Vol.18 No. 7, June 1, 2003
9 Julian Savulescu, from the title of a November 25, 2003 presentation in London. See http://www.progress.org.uk/events/ChosenChildren.html
10 "The Case Against Sex Selection," December 2002 http://www.hgalert.org/sexselection.PDF
11 "GeneWatch UK Submission to the HFEA Consultation on Sex Selection," January 2003
12 Gina Kolata. "Fertility Ethics Authority Approves Sex Selection," New York Times, September 28, 2001
13 The January 2002 letter to the ASRM was jointly drafted by the Center for Genetics and Society; the Committee on Women, Population and the Environment; Manavi, Inc; Andolan; and Our Bodies Ourselves. See http://www.genetics-and-society.org/resources/cgs/2002_asrm_sex_selection.html
14 Margaret Talbot. "Jack or Jill? The era of consumer-driven eugenics has begun," The Atlantic Monthly, March 2002
15 Meredith Wadman. "So You Want A Girl?," Fortune, February 2001
16 Susan Sachs. "Clinics' Pitch to Indian Émigrés," New York Times, August 15, 2001
17 Lisa Belkin. "Getting the Girl," New York Times Magazine,
July 25, 1999
18 "Choosing Your Baby's Gender," www.cbsnews.com, November 7, 2002
19 Belkin, op. cit.
20 Dorothy Roberts, Killing the Black Body: Race, Reproduction, and the Meaning of Liberty, New York: Vintage Books, 1997, p. 287



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