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

Boy or girl? Choosing the sex of a child prior to conception

"Having a girl was another reason he beat me."

It was really difficult to listen to the experiences of the Mirpuri woman who sat before me, trying not to cry as she explained her slow emergence from her 10-year-long marriage. We sat together in a women's shelter in the Midlands of England, holding cups of cold chai that we didn't sip, the injustice of her experiences weighing heavily upon us both. At that point, I pressed the "stop" button on the tape recorder that bore silent witness to her words and that carried within its memory the stories of all the women I had been interviewing. She needed the space and the silence.

What I learned during these many interviews – they shaped my senior college thesis, which focused on domestic violence among South Asian immigrants – is that the gender of a baby can have fateful consequences. In some families in the U.S. and the U.K., female fetuses are aborted. Other families are selecting the sex of their children prior to conception. These are certainly not trends that are limited just to people from South Asia.

Currently, I am a medical student in the Joint Medical Program at UCSF and the UC Berkeley School of Public Health, and I am writing my master's thesis on the ethics and anthropology of sex selection. Although I intend to focus on the South Asian community, I also plan to speak with people of all backgrounds who make use of and offer sex selection technologies.

My work this summer, which begins an extended research project, involves interviewing physicians, women, and families in the Bay Area about the issue of pre-conception sex selection. I am interested in hearing and learning the perspectives of patients who undergo these procedures and of physicians who offer these procedures. Additionally, I will spend a good deal of time in libraries scouring South Asian newspapers and magazines (as well as mainstream newspapers and magazines) for advertisements by sex selection clinics. I am also planning trips to Los Angeles and New York to speak with individuals who have run sex selection clinics and fertility centers in these cities.

Prenatal sex selection in South Asia

I feel it important to give at least a bit of background information on sex selection in South Asia itself. For those unfamiliar with the term "South Asia," it denotes the geographical area encompassing India, Pakistan, Bangladesh, Nepal, Sri Lanka, the Maldives, and Afghanistan. Fetal sex determination and subsequent abortion of female fetuses is a complicated issue and a practice that the Indian government officially banned in its passage of the 1994 Prohibition of Sex Selection Act (also known as the Pre-Natal Diagnostic Techniques Act). Under this law, it is illegal for medical personnel in India to use pre-natal diagnostic technologies (including ultrasound and amniocentesis) to determine the sex of an unborn child, unless there are compelling medical reasons to do so. Even in routine pre-natal visits, gynecologists are not allowed to inform couples of the sex of their child. Despite the law, some clinics continue to provide these illegal services, particularly in Punjab and Haryana.

In these clinics, physicians and/or technicians use ultrasound machines and/or amniocentesis to determine the sex of the unborn baby, usually for a relatively high fee. They then may assist a couple in aborting an unwanted fetus, usually if it is a girl. In some rural areas, medical personnel take portable ultrasounds from village to village, offering to determine the sex of unborn children. Consequently, ultrasound machines have acquired a mobility that enables their use all over India, in rural and urban settings, in hospitals and small clinics, in wealthy and poor neighborhoods alike. A technology originally created to improve fetal health has thus become an instrument that can potentially be used to determine whether a fetus will even live.

In India, there has been a tremendous amount of activism around pre-natal sex determination, and it has become a cause that has rallied feminists, physicians, bioethicists, and students around the country. There are numerous articles about sex selection online to which many Indians respond, decrying the practice and demanding that the government and health care personnel assume a greater role in stopping it. And yet, since the passage of the 1994 law, the ratio of female births relative to males continues to decline. Not only does this indicate that enforcement of the law is inadequate; it raises the question of whether the law can reverse the attitudes that are responsible for these practices.

South Asian immigrants in America

While there has been much discussion of this issue in South Asia, there has been far less attention given to its occurrence among South Asian immigrants here in the Bay Area and around the country. Yet during my experiences working as a volunteer in several South Asian women's groups and doing research within the community, I came across surprising numbers of instances in which having a female child put a woman at further risk for mistreatment at the hands of her husband and/or his family. About half of these women came from affluent, educated families. "My mother-in-law said that I was the 'lesser' daughter-in-law because I had a girl and her other daughter-in-law had a boy," a family friend, born and raised in urban North India, recently told me. I knew of female infanticide and sex determination tests in India, and of the belief that having a girl was considered a financial burden because of the (now illegal) practice of dowry, making female children undesirable for economic reasons. Yet I was far less familiar with how and why immigrant South Asian communities viewed the birth of girls: Did the practice of dowry continue post-immigration, making female children a financial burden to those who chose to participate in dowry-giving? Or were there other, more complicated social, as opposed to the supposedly purely economic, reasons why the birth of girls elicited negative responses?

These anecdotal sketches coincided with my coming across ads in newspapers and magazines targeted at South Asian immigrants that advertise pre-conception sex selection to assist couples in having a child of "their chosen gender." The ads promise a variety of techniques, generally involving the separation of X and Y chromosome sperm followed by in-vitro fertilization using an egg fertilized with a sperm bearing the couple's choice of chromosome and gender. The more I learned about this issue, the more questions raced through my mind. I shall return to many of them, as well as to the exact science of sex selection, in later dispatches.

I want to be up front here in stating that in doing this fieldwork, I absolutely do not want to contribute to stereotypes about South Asian men, women, or the community as a whole. Time and again, I have come across writing and research, academic and otherwise, that is strikingly colonial in its depiction of South Asian men as oppressors of their women. I do not wish to participate in such characterizations of the community, nor do I believe that exploring the issue of sex selection within the South Asian community means that only South Asians make use of this technology. This technology is in increasing demands by all groups and my reports should be understood in that broader context. What I will be writing about this summer are the complex, multifaceted reasons why people choose to sex select, and the extent to which the women involved actually have a choice. I hope that readers will come away from these dispatches thinking of sex selection not as a phenomenon that affects "other" people, but as an issue that affects and involves people of all backgrounds, albeit perhaps in different ways.

I hope that my research project and the dispatches this summer will create important, needed spaces for dialogue within my community, while also raising vital questions about the relationship between medical technology, ethics, and human rights for the general public. I really look forward to doing the research and hope that my dispatches are both thought-provoking and fun to read. And I promise to keep the anthropology jargon to a minimum!

— Sunita