Ethics of Gender Selection: Sex Ratio and Discrimination

Introduction: Historical Preference for Male Children

History attests to the fact that couples — from royal families down to rural peasants — have shown a preference for male children, leading to numerous problems for the girl child and creating sex-ratio imbalances in some traditional societies. When this preference is pronounced and obvious, any method that allows a couple to choose the gender of their unborn child carries tremendous potential for gender discrimination and sex-ratio imbalance. Sex selection, or gender selection as it is commonly known, is one such method that threatens to put female children at risk of being outnumbered by their male counterparts. Preconception gender selection techniques, along with other means of choosing the sex of an unborn child, have come under severe criticism because of the ethical issues they raise.

It must be understood that while preference for a specific sex is limited or mild in the United States and other Western countries, it is nonetheless present and may appear in several cases in subtle ways. By contrast, the preference for a male child is far more pronounced and unmistakable in the traditional societies of China and India.

Both contemporary medicine and folklore reveal a widespread social desire to attain children of a preferred sex. Discussions of sex selection have been traced as far back as 2000 B.C. in China. Until very recently, the only sure way to achieve it was through infanticide. This method was followed in the 1970s with fetal sexing and sex-selective abortion. By the 1990s it became possible to detect the sex of an embryo ex utero and, it is claimed, to sort male- and female-determining sperm.

From Infanticide to Preconception Technology

In many cases, sex selection per se is not the primary aim of contemporary reproductive technologies; rather, it is a necessary or accompanying factor in prenatal diagnosis and the identification of male fetuses or embryos at risk of sex-linked disorders. Worldwide, however, these technologies are increasingly being used to identify, select, and, in some cases, destroy embryos that display no other "defect" than the fact of being female (Mathiot-Moen, 23).

Sex selection raises serious ethical issues that cannot be dismissed as mere unfounded fears. There have been several cases, especially in Asian and African societies, that attest to the validity of these concerns. The first and most important ethical concern is the preference for male children exhibited by many societies and believed to exist across cultures. In India, for example, one author maintains that if given a choice, every couple would first want a male child: "No one wants girls" (quoted in Gargan, 1991, p. 1). Similarly, in China, the one-child policy led to severe sex-ratio imbalance, as couples were "fearful of 'wasting' their quota on a girl." Most people in rural China used ultrasound methods to discover the gender of a fetus and would abort if the child was found to be female. Since preconception gender selection was not largely available in these traditional societies, they relied on older methods. As one report noted, "Chinese peasants use ultrasound to have sons" (Kristof, 1993b, p. A1, A6).

The Ethics Committee of the American Society for Reproductive Medicine summarized these concerns in a 2001 report on preconception gender selection. The report clearly articulated the ethical issues raised by such techniques:

Core Ethical Concerns About Gender Selection

"One concern is the potential of such techniques to increase or reinforce gender discrimination, either by allowing more males to be produced as first children or by encouraging parents to pay greater attention to gender itself. A second concern is the welfare of children born as a result of gender selection, who may be expected to act in certain gender-specific ways when the technique succeeds and who may disappoint parents when it fails. A third concern is societal. Widely practiced, preconception gender selection could lead to sex ratio imbalances, as have occurred in some parts of India and China because of female infanticide, gender-driven abortions, and a one-child family policy." (Ethics Committee of the American Society for Reproductive Medicine, 2001)

Ethicist John Fletcher believes that new gender-selection techniques represent an abuse of advanced medical technology. No specific technique was originally developed exclusively for gender selection. Prenatal diagnosis was actually intended to discover possible health risks or genetic defects faced by the unborn children of parents with troubled medical histories. However, this method is now being used for non-medical purposes such as gender selection, which constitutes a clear abuse of medical technology. As Wertz and Fletcher argued, "Gender is not a disease. Prenatal diagnosis for a non-medical reason makes a mockery of medical ethics" (Wertz and Fletcher, 1989a, p. 24).

Fletcher (1980) cited his reasons for opposing sex selection as follows:

Conclusion

Clearly, gender selection is a controversial practice that not only raises serious ethical quandaries but may also prove to be a dangerous practice in the long run. Apart from sex-ratio imbalance, the practice might lead to social resentment and frustration, driving low-income groups to opt for less expensive — though more dangerous — means of gender selection, such as abortion. Prenatal diagnosis for medical reasons is itself an ethically complex technology, but when used for non-medical purposes it simply signifies the abuse of advanced medical technologies.