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Boy or girl? Prenatal selection of a child's gender

Her newborn was a product of flow cytometry sperm separation

"I want you to tell me what hope even means."

I didn't know what to say. I clutched my tea glass tighter, as I tend to do when I'm nervous. I wanted to take a sip, but when I panic I tend to hold completely still.

She was abrasive, combative. Perhaps, more than anything, defensive. Unintentionally, I had touched a nerve when I asked what her hopes for her child were. Her newborn was a product of flow cytometry sperm separation. She did not want to do it; she felt that she had to. I will call her Nisha.

The first thing I noticed about Nisha were her eyes — vacant, silent, and quietly angry. When we started speaking, she scoffed at me many a time: "Ha, you are such a confused little girl … it's clear you don't know that much about life. Do what is important. Do your work. Don't bother with things you can't change."

Nisha is a physician. While many people believe that abuse does not happen to "educated people," Nisha and her experiences are one of many examples to the contrary. Nisha was sexually abused by an uncle for several months while he lived with her family in western Uttar Pradesh, India. Nisha believes that her father knew what was going on but did not intervene; she was 12 years old. She never spoke to anyone about her ordeal until she finally "broke down" one day because she had a flashback about the experience. Even as she relayed her story to me, it was in starts and stops. Conversations circled around the topic until she finally, suddenly blurted it out.

"That is probably why I am so ... you know."

It was especially hard for me to keep my mouth shut during this interview because I know so many girls who have suffered through the same ordeal, and I have witnessed the tremendous effects that sexual abuse has on their self-perception, emotional development, and choices within romantic relationships. It was very hard for me not to engage with her on this topic, to ask her more about it. But it was clear from the way she spoke to me that she just wanted this set of information to hover in the background of our interview.

Nisha married a man who she thought was stable and could provide her with a supportive environment as she embarked on her career, but she did not realize that his family, while well-respected and educated, had very stringent ideas about the first-born grandchild being a son. Nisha was frightened by the way in which her mother-in-law insisted on having a grandson, but her husband did not vocally come to her defense or challenge his mother's opinion on the subject. "His not saying anything really said plenty," she told me. "I felt like I really didn't have much of a choice. Had I just hoped for a boy, I would have been in a lot of anguish, I think. At least this way, I did everything I could to ensure that we had a boy. I love him no matter how he was conceived, but I wish that there wasn't such pressure to have a boy. I wish I had more of my husband's support."

Nisha found out about flow cytometry sperm separation (a gender selection technology) through an advertisement in the paper, and through colleagues at work. "I didn't even see these ads in the Indian papers, I saw them in some other newspaper that I don't remember. I just called the number there, and made an appointment." Nisha describes the actual process of sperm separation and insemination as "so artificial. It took away the intimacy of having a child in a way. But it all worked out, I guess."

Because of Nisha's hesitancy, I did not ask this new mother much about her relationship with her husband. It seemed as though there was much to be said about their dynamic, but I hesitated to ask. We spoke instead about Nisha's plans for the future, particularly future children, and her career. She looked at me blankly. "To be honest, sometimes I don't even want to go back to work. I think that this whole pregnancy, this whole experience … I just need some time, I think."

Even though Nisha's nature was quiet in some ways, at certain moments she positively burst with emotion. All of a sudden, she erupted again.

"Why are you even doing this work? What good does it do to ask people to talk about such painful things? What do you hope to achieve? Nothing is going to change, you know. Life goes on. These things continue to happen. You are wasting your time. Finish medical school, accept life as it is, move on, let your parents get you married, don't worry about me, I'll be just fine, I'll deal with my mother-in-law and husband and baby boy."

The words blur in my mind. Sometimes, I too wonder what the point is. So what happens from here on out?

***

This summer project has been an amazing experience in some ways and a sad experience in others. It was enormously difficult to find people willing to speak to me about pre-conception gender selection. It is still a struggle to find physicians willing to talk to me, and this is a crucial part of my project. It is difficult to convince people of the importance of this topic without selling it as a sensationalistic, journalistic story. I have had many a person tell me that I should "go to the media" with my research and "publish an exposé," which I have absolutely no interest in doing. People's suffering is not a sensation or an exposé. I want to establish the legitimacy of this research apart from its ability to sell newspapers. I also desperately want this work to help in some way: but how?

One of the major questions I have thought about during this summer is how to translate research into change. I am not convinced that banning sex selection will stop it from happening or change people's attitudes towards having a child of one gender or another. This technology did not cause son preference; eliminating it will not eliminate son preference. Dialogue and thoughtful consideration and enactment of gender equality are all necessary, but how? By whom? In what way, and to what end? And how will this goal be achieved without the meaningful and sustained involvement of men who are dedicated to establishing gender equality both within and beyond the South Asian community?

Despite the many questions I have, one of the major things my interviews acutely illustrated is that sex selection and sex determination are issues that are deeply personal and, as such, are extremely difficult to discuss. While I knew this would be the case at the outset, it was an entirely different experience to actually feel the truth of that prediction.

Vandana told me that one of the reasons she was hesitant to speak with me was that she did not want to leave the interview feeling as though her attitudes were somehow wrong, as though she had backwards views on issues related to gender equity. Because individual and family views on this topic are so profoundly personal, they are understandably deeply complex and not always "logical" and "rational" in the ways that "family planning" is expected to be. But, disturbingly, sometimes coercion around reproductive matters takes on its own twisted logic, as my interviews taught me. One of the more disturbing components of that "logic," I learned, was the equation of infertility with not having a male child — an association that several women pointed out in interviews. This is a finding that I really hope to explore more, because it is a type of constructed infertility — a set of social consequences for a supposed biological "fault." And where fault can be found, punishment can be levied. Needless to say, the consequences are deeply painful, for mothers, children, and families at large.

I fear that the issue of sex selection extends well beyond the South Asian community. This technology has real consequences for our entire society. If we allow social (that is, non-medically indicated) gender selection, what is to stop us from selecting other features of our children?

Studies have shown that, for example, the majority of CEOs of companies are white men who are around six feet tall. If parents truly want the best for their children, isn't it foreseeable that more and more parents will pay to give their children the genes that will make them most likely to succeed in this world? Will gender selection give way to a new eugenics? Where do we draw the line in terms of both technological advances and the money expended to fund the research leading to these advances? In the end, after all, such complex technological advances will only benefit those who can afford to make use of them, while tremendous amounts of money will be spent on the scientific processes leading to these advancements. Some may scoff at this "slippery slope" argument, stating that the possibility of entirely designer babies is misguided. But then again, I personally never thought that science would clone a sheep, and it has. Who can predict what we will be able to do next?

Having worked at La Clinica de la Raza (an Oakland-based community clinic) this summer, I was constantly struck by how many people were in need of the most basic medical resources and advice. It was interesting, therefore, to contrast my experience at La Clinica with my research on sex selection, which is such a specialized branch of medicine that some would call it "luxury medicine." As Mark V. Sauer cites in an editorial I referenced earlier, is this how scarce medical resources should be spent?

On the other side, Jennifer Merrill Thompson, a freelance writer-editor, believes that hose who choose to sex-select "don't have to apologize for wanting something more [than a healthy baby,] for hoping to influence gender." Her book, Chasing the Gender Dream, is one of the few accounts available of a woman's first-hand experience of the sex selection process. Her self-termed "obsession" with having a girl led her to investigate available methods of sex selection, and to write a book on her experience that also catalogues her interviews with scientists and entrepreneurs promoting sex selection technology, and with women who have undergone sex selection with different experiences and results.

In the acknowledgements to Thompson's book, she thanks her daughter for wearing pink and for allowing her to play with her using hair clips and bows. Ms. Thompson seems to have a very clearly defined idea about what it means to be a girl and to parent a girl. Which brings me to another major question: what are the risks to children who are products of sex selection? While some physicians may argue that they must trust parents to be able to raise their children in a responsible, healthy manner, is it possible that choosing a child's gender could influence parenting in potentially unhealthy ways? How does sex selection technology contribute to a rigidifying of what defines "maleness" and "femaleness," let alone what it means to parent boys and girls differently? Should this be a consideration in the formulation of public policy?

For me, the next year of my research will be interesting. I have been given a wonderful opportunity to work with the Center for Genetics and Society on their sex selection work, and will be presenting at a conference in September on violence against South Asian women, looking at the intersection between sex selection and gender-based violence. I will also be presenting my summer work at the Fall Conference of Human Rights Fellows at UC Berkeley, and am really excited about being able to share this work and the experiences and challenges of doing it.

I want to thank the UC Berkeley Center for Human Rights and the California Academy of Family Physicians for making my work financially possible this summer. I am also thankful to the online Student Journal project for serving as a space where I could reflect and really think about what I am doing. A big thank you to my friends, family, and well-wishers out there who have taken the time to send me supportive e-mails and communicate an interest in my project. It means the world to me, because this work is difficult and at times impossible. I welcome any comments on my project as it continues through the next year and a half!

—Sunita

Sunita Puri is a 2005 Summer Fellow of UC Berkeley's Human Rights Center.