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

The role of a respectful researcher exploring the hotly emotional field of prenatal sex selection  

The past few days have been filled with the pulse of research, humorous reunions with old friends from home, and animated conversations with family, aunties, and uncles about what, exactly, I hope to do with my life. Writing has defined the past week: from short dialogues and conversations that I always want to remember to academic pieces that I must hand in to editors. With Jassi Sidhu's latest (wonderful) album blaring from my computer, I wrote and wrote—and read and read through piles of articles about fertility, infertility, modern medicine, and genetics.  

I have realized the enormity of my project over the past week—and am thankful that I have quite a bit of time to work on it, to absorb it. I have also realized the storm of emotions that this issue of prenatal sex selection triggers for physicians, families, and the public. This past week, I have spoken with a number of people about how best to do my research in a way that gives utmost respect to all the parties I will be interviewing. I truly do want to understand all points of view, because as the written debates have made clear to me, there is not one "right" answer to a consideration of this issue.  

This aim is also what I believe distinguishes my research and work from a more journalistic approach. I have found that articles from the mainstream media covering sex selection have been pretty judgmental about the issue, and the last thing I want to do is to conduct research that could be interpreted as an exposé of sorts. There has already been so much judgment and negativity about assisted reproductive technologies of all kinds, and in this political moment, exposés and the like will do nothing to provoke thoughtful discussion about technology, ethics, and society. My readings and conversations, which have allowed me to engage with a range of people and points of view, have pushed me to ponder what my place as a respectful researcher and medical student should be within a hotly emotional field. At a time when the term "morality" and the concept of "morals" is seemingly synonymous with the meanings given to both by the Christian Right, it is understandable that many physicians offering assisted reproductive technologies, termed "immoral" or "morally questionable" would feel extremely defensive of their work. The language of these debates is a project in itself!  

The American Journal of Obstetrics and Gynecology in particular has been a fruitful source of opinions on the issue of sex selection (those absent a medical cause). I have found that many authors do not perceive shades of gray in this debate. Most pieces are written by individuals that either staunchly defend the right of medical practitioners to provide services that responsible couples want, or that ask, "Given the broad range of novel techniques that have been introduced and developed throughout the history of in vitro fertilization, it is not too surprising that couples commonly ask health care providers whether gender selection is possible … However, why do patients ask us to manipulate gender?"1

Other editorials and letters have taken what some physicians term a "pro-patient" advocacy stance towards new reproductive technologies and sex selective abortion, arguing that "[Sex-selective abortion] is an important issue not only from a patients' rights advocacy situation, but also from a genetic counseling standpoint. Until the U.S. Supreme Court changes the patient's/couple's First Amendment right to exercise the reproductive option as indicated in the Roe v. Wade landmark decision in 1974, we as obstetricians and gynecologists should not make distinctions."2 Yet another article from the Canadian Medical Association Journal stated, "Our primary ethical guide remains unchanged: assisted reproduction creates new relationships and must always be understood in that context. Choosing which child to have is very different from choosing whether to have children at all."3

In addition to raising questions about the meanings of "patient advocacy" and "patient autonomy," many writers note that the advent of new reproductive technologies raises questions about the proper use of medical resources, how such technologies change the meaning of having children, and whether "family balancing" is a good reason to allow the use of non-medically indicated sex selection. The American Society for Reproductive Medicine produced a statement of ethics regarding sex selection that considered many of these factors, and that readers may be interested in perusing.

I am currently preparing for another week of conversations, a few interviews that I have scheduled, and more and more reading and writing. As a postscript of sorts, I just saw a short clip on the "Today" show this morning about an at-home gender determination test that allows couples to find out the sex of their child using a "Baby Gender Mentor" test that supposedly determines fetal gender as early as five weeks into pregnancy. Every day brings more and more information to digest, more and more opinions to assimilate. I marvel at the sudden surge of interest (in the U.S.) in determining fetal gender, and hope that the next week (and next few years!) bring me closer to understanding it.

– Sunita

[1] M.V. Sauer, MD

[2] J.D. Stephens, MD, ‘Morality of Induced Abortion and Freedom of Choice,’ American Journal of Obstetrics and Gynecology, 158, 1 (1988), p. 218

[3] L Shanner and J Nisker, Response to letter from A. Malpani, Canadian Medical Association Journal, 166 (3), February 5, 2002

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