Selecting for Sex: US entrepreneurship in the baby market

Via Al Roth: Choosing sex of children: repugnant in Britain but not in U.S. 

The Times reports: US clinic offers British couples the chance to choose the sex of their child

A new clinic in Manhattan is appealing to British couples who want to pick the sex of their next child — a process that is banned in the United Kingdom.

Pre-implantation genetic diagnosis (PGD), which can reveal the sex of an embryo, is prohibited in Britain except when it is used to screen for genetic diseases.

The United States relaxed its regulations on sex selection in 2001 and American medical centres report interest from British patients who find out about their “family balancing” services through online advertisements.

A less controversial, but less reliable, method of gender selection relies on sperm sorting. 

As I discuss in Altruism And Intermediation in the Market for Babies (which, unless otherwise indicated, is also the source for all facts and quotes in this post), preimplantation genetic diagnosis (PGD), originally developed as a means to screen embryos for a variety of devastating genetic childhood diseases, weds two nascent fields— assisted reproduction and genetic testing—by removing and genetically testing one cell of a three-day-old, eight-cell embryo.  Only those embryos possessing the desired genetic variant—such as the absence of a chromosomal mutation associated with a particular hereditary disease—are implanted. 

But increasing numbers of customers seeking PGD do not carry genetic diseases—some are not even infertile.  Instead, critics charge, they are purchasing a custom-made baby that meets their genetic specifications, such as a particular gender.

The relevant question, of course, is whether this aspect of the baby market is one with which we feel comfortable.  And if not, why not.  Objections to sex selection tend to fall into three categories: (1) slippery slope concerns, (2) gender imbalance concerns, and (3) sexism concerns. (In addition, some ethicists, including the ASRM Ethics Committee, differentiate between pre- and post-conception sex selection methods.  For more on this, follow the Modern Medicine link at the end of this post)

Harvard political philosopher Michael Sandel articulates the slippery slope concern as follows: "sex selection is one step down the road to designer children, in which parents would choose not only the sex of their child, but also conceivably the height, hair color, eye color, and ultimately, perhaps, IQ, athletic prowess and muscular ability."  Sex selection defenders counter that such “doomsday scenarios” have been raised since the dawn of IVF, and have not come to pass, nor are they likely to.

Given the traditional use in some countries of sex screening and abortion to discard female fetuses, PGD for gender selection has been banned in many countries. In the United States, however, gender imbalance concerns are a less persuasive rationale for limiting gender selection techniques.  In the U.S., gender selection is legally unrestricted, yet -- except within certain minority ethnic groups -- parents request girls as often as boys (by some reports, more often).  Moreover, many parents seek “family balance” (i.e. one boy and one girl, or a child of a different sex than their existing children.) 

Finally, some critics worry that sex selection practices will reinforce sexism or traditional gender roles.  The most sophisticated of these arguments focus not on outright preferences for males, which, as noted, is not a fear generally warranted in countries such as the U.S., but on more subtle effects.  For example some are concerned about birth order consequences or fear that, by choosing one sex over another, parents may reinforce gender stereotypes.

This month’s Elle magazine article on mothers who suffer “gender disappointment,” or GD, drives home the stereotyping concern about sex selection in a quite visceral way.  The piece’s quotes from mothers who invested in pink, fluff, jewelry, and ballerina outfits in the expectation of daughters, only to later suffer suicidal depression upon giving birth to boys, will doubtless appall sex selection critics concerned with gender stereotyping.  Moreover, the featured mothers cross what some believe should be an ethical line in writing about the parenting experience.  As noted by KJ Dell'Antonia at XX: “But there's one line I've never crossed—one thing I think you should absolutely never say to or about your child: I didn't want you. I wanted somebody else.”

I’m unpersuaded that any of the three rationales justify restrictions on sex selection techniques, especially here in the U.S. where population gender imbalance is not a pressing issue.  Moreover, one might plausibly contend that many of the Elle stories stem from false hopes raised by less effective sex selection techniques, rather than by sex selection per se.  But, to borrow Al Roth’s terminology, even my repugnance reflex (a fairly high bar) was triggered by the article.   

For more on sex selection techniques, ethics, and governing laws see:

Modern Medicine -- Q&A: Controversy: Gender selection via preimplantation genetic diagnosis: ethical pros and cons of the controversy (Aug. 1, 2009)

Legal Affairs -- Debate Club 3/27/06: Choosing Your Child's Sex? Featuring a debate between John A. Robertson and Barbara Katz Rothman.

For my articles on baby markets, also with some discussion of sperm sorting and PGD, including PGD for nonmedical purposes see:

Price and Pretense in the Baby Market

Altruism and Intermediation in the Market for Babies

Comments

[Impotence causes]

I think the statistics presented here reveal, to some degree, the way the cities are desing in different parts of these countries; in some U.S. Cities, for example, would be a real nightmare being without a car, because the distances are long, and there is not efficient public transportation systems, again, in some cities. But yea, I am an advocate of good health.