Between reproductive rights and sex selection in New Zealand’s abortion reforms: practitioner dilemma in institutionalising ‘choice’ and ‘agency’

Figures & data

Table 1. Sex Selection in abortion and assisted technology: comparative legislation in select multi-ethnic societies.

Abortion Legality and Sex Selection
New Zealand	United States of America	Great Britain and Northern Ireland (United Kingdom)	Canada	Australia
Abortion Legislation 2020 Legal: Up to 20 weeks. Sex Selection: Legislation states government ‘opposes’ abortion ‘solely’ for sex preference. S21(1).	Roe vs Wade 410 U.S 113 (1973), overturned in June 2022. Illegal: 14 states, (as at March 2023) Illegal with gestational limits: 4 states Ban blocked: 8 states Legal with limits: 10 states Legal: 15 states Sex Selection: 8 states have enacted laws prohibiting sex selective abortion. 21 states have considered such laws since 2009^a	Great Britain: Abortion Act 1967 Legal: Up to 23 weeks and 6 days. Sex Selection: Although not specifically mentioned in Abortion Act, it is illegal. Sex selection also assessed under the Serious Crimes Act (2015). Northern Ireland: The Abortion (Northern Ireland) Regulations 2020 Legal: Up to 12 weeks Sex Selection: Not specifically mentioned in legislation.	Canada Health Act 1985 Legal, but gestational limits different in each province; typically ranges from 12 weeks to 24 weeks and 6 days Sex Selection: Not specifically mentioned in legislation.	Legislation titles differ per state and territory. Legal in all states and territories: Gestational limits differ, ranging from 16–22 weeks. Sex Selection: Not specifically mentioned in legislation, however it has been banned by the National Health and Medical Research Council.
Sex Selection via Assisted Reproductive Technologies
New Zealand	United States of America	United Kingdom	Canada	Australia
Illegal: 2004 Human Assisted Reproductive Technologies Act. Section 11 (1) (2) (3)	The Fertility Clinic Success Rate and Certification Act Legal: No current laws banning sex selection for social reasons such as ‘family balancing’.	Illegal: Human Fertilisation and Embryology Act 2008 (HFEA), except for: sex selection in families where the risk of a genetic disorder is greater in one sex than the other.	Illegal: Assisted Human Reproduction Act 2004 (AHRA) Gender selection procedures illegal ‘except to prevent, diagnose or treat a sex-linked disorder or disease.’ (AHRA 5(1)e).	Illegal: Assisted Reproductive Treatment Act 2008, except in two situations (section 28): (1) to avoid the transmission of a genetic abnormality or genetic disease. (2) The Patient Review Panel has otherwise approved the use of the gametes or embryo … for purpose of producing … a child of a particular sex.

Source: various; ^aCitro, B., Gilson, J., Kalantry, S., & Stricker, K. (2014). Replacing myths with facts: sex-selective abortion laws in the United States.

Table 2. Ethnicity and place of birth of participants.

Ethnic Identity	Personal Biography	Participants
Ethnic minority	born and raised in NZ	GYN2, MW1, OS2
Ethnic minority	migrated to NZ	GYN4, GYN5, MW2, MW4, OS1
Majority group (European/Pākehā)	migrated to NZ	MW3
Majority group (European/Pākehā)	born in NZ	GYN1, GYN3, OB1, OS3

Acronym key: GYN-Gynaecologist; MW-Midwife; OB-Obstetrician; OS-Other Services.

Note: in the interest of confidentiality, we have not disaggregated identity by specific ethnicity or nationality of origin.

Table 3. Practitioner Responses to the use of NIPT for sex selection.

Discourse	Practitioner	Excerpt
NIPT is not misused for sex-selection	OB1	And the gender side of things is more just they can't wait or … they're curious to know rather than stating their preference … [a]t least what's been expressed to me is more of the concern about abnormalities than gender as being more important
	MW2	They can [find it sooner] if they pay $700 and do a blood test called NIPT test, but that's something people do. People who have money they do it. I have seen couple of ethnic families that had Down syndrome babies; the test came back positive, and they terminated. They didn't want to go ahead with it, but nothing to do with the sex, it was just the disability.
	GYN4	Not from where I see. The ones who go for the NIPT test only want to know that the baby is healthy.
	GYN2	There's been a demand for it (Int: Do you find that there's been a demand for this test by Asian communities?) [nods] … but more, I think, more for the purposes of finding out any chromosomal problems.
NIPT has potential to be misused
	GYN5 GYN1	I don’t think they’d have to disclose that it was because they wanted to select a gender. I think they just have to say, ‘I’m worried, I want to know’, and they would get the test. It (NIPT) does (make it easier to sex select) because it's a much easier termination than later on.
	MW4	… it (NIPT) is a tool now that women can use for gender selection because you find out early enough. Because it's still up in that time frame to get an abortion …
No clear evidence although the possibility for misuse exists	GYN3	if a woman now wants to know the gender of the baby because she wants to consider sex selection, it's really easy. Way easier than it was before we had NIPT. … To be honest, to be fair, I'm not hearing anything about it (sex selection) … I think it's an ethically challenging area that you're looking at …