Sex Selection: A Gender-based Preference for a Pregnancy

The article by Oomman and Ganatra raises important ethical, moral and legal questions with regard to the non-medical (mis)use of antenatal diagnostic technologies for sex selection. The focus of my discussion will be on sex determination and sex selective abortion and the meaning and consequences these technologies have for women, who are its direct users.

While I will be addressing the non-medical use of fetal diagnostic technologies, it is important to point out that all practices – medical or non-medical – of these technologies are deeply influenced by subjective notions of “normalcy” and adult preference for certain kinds of offspring. Futhermore, most abortion decisions are not a consequence of fetal diagnosis. Sex selective abortion, however, is solely on the basis of the use of diagnostic technologies for sex determination. This is different from the medical use of antenatal technologies and abortion related to fetal malformation. This is important, because the failure to make these distinctions can result in condemnation of the use of these technologies and abortion as a whole, and result in quick-fix legal and ethical prescriptions that can further restrict women's reproductive rights and autonomy.

For the past two decades feminist scholars, women's health advocates and bioethicists among many others have examined and identified the medical use of antenatal diagnostic technologies as dramatically transforming the experience of pregnancy and gestation. There has also been concern amongst some that these technologies have served to sustain and deepen medical control over birth to the detriment of women [1][2]. Additionally, there has been recognition that these technologies often place women and their partners in a position of making difficult emotional and moral decisions related to abortion based on fetal detection of genetic abnormality or mental or physical disability.

However, the more contemporary phenomenon of non-medical use of antenatal technologies for sex determination is distinct, and based solely on a gender-based preference for a pregnancy. Only when the pregnancy is the “right kind”, which in regions like South Asia, means the birth of a boy, is it continued. The decision is not based on “unconditional acceptance” of the child but rather children are “treated as custom-ordered commodities to satisfy personal or social preferences” [3].

Antenatal sex determination through ultrasonography leads to a heightened visibility and gender-based characterisation of the fetus. The resultant importance accorded to the male fetus is in inverse proportion to the interest and concern for women and their well-being. In India, for example, women's experience of pregnancy and the duration of her pregnancy is often reduced to being one kind of “tentative pregnancy” [4].

However, this does not in any way imply the lack of women's role or agency in obtaining sex determination and undergoing sex selective abortion. These technologies and the “choice” they offer have gained considerable validity in the eyes of women, who are the direct users. Many women have described the process of decision-making as being empowering, allowing them to negotiate the terms of their existence and to gain status. However, it is important to recognise that though women are the direct users of these technologies, the decision to undergo sex selective abortion is never only an individual decision. It must be understood and evaluated through family and community practices that make it appear to be a desirable and for many, the only viable option [5].

More importantly in societies where giving birth to sons defines women's status and rights as wives, daughters-in-law and mothers, sex determination and sex selective abortion allow women to gain control over what has earlier been seen as an immutable process of birth and kinship-building [6]. To many families, these technologies are seen today as cost-effective tools for patrilineal kinship-building by eliminating the expense of rearing unwanted daughters.

In describing the nuances behind women's encounter with sex determination and sex selective abortion, the purpose of this note has been to present it as a process that facilitates gendered selection of pregnancy. The focus in countering this dangerous trend, I believe, lies in addressing socio-cultural devaluation of women that results in discrimination. Additionally, women's unequal access to and control over economic resources needs to be recognised and altered. In that changed context, reproductive technologies can be reclaimed as tools of empowerment and not of oppression.

Acknowledgements

I am grateful to Jodi Jacobson, Priya Nanda and Anna-Britt Coe at CHANGE for comments.