Against sex selection.

The phrase "sex selection" is generally used as an umbrella term referring not to a single practice, but to a great variety of practices, which differ according to the means used, the goal, and the context in which it is practiced. As we shall see, these differences are ethically significant. However, though there are differences in the degree to which different varieties of sex selection raise ethical problems, most actual or foreseeable sex selection is ethically wrong.

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Sex selection can be performed in several ways. Sex can be selected preconception, preimplantation, or via selective abortion. In the preconception stage, sperm can be sorted to produce an X or Y chromosome enriched sperm mixture, using flow cytometry. (1) Such techniques are already practicable and can be expected to improve in reliability. Postconception but preimplantation, embryos can be tested for sex and then selectively implanted. Finally, sex can be determined by an ultrasound and embryos then selectively aborted. This remains the most common technique for sex selection today.

Many people believe that these differences are in themselves ethically significant because it is morally more serious to end the life of an embryo than it is to fail to begin such a life. Though I do not have space to argue the point here, I think this is a mistaken view: there is no very significant ethical difference between ending the life of an early embryo and failing to begin such a life. Human beings become distinctively morally valuable only when they begin to develop some of the psychological complexity which distinguishes them from simpler organisms (2); an early embryo is unable even to sustain consciousness, let alone complex psychological states. Of course, physicians ought to be sensitive to the moral beliefs of patients; to that extent the difference in means ought to be borne in mind. Moreover, different means of sex selection are differently invasive, costly and time-consuming; these differences are sometimes ethically significant. However, I shall set these differences aside in what follows.

Sex selection can be used for different goals, and in different contexts, the means used need not matter. Most sex selection today is performed in Asian countries, especially India and China, usually via selective abortion of female fetuses (though sex selection is also practiced via the practice of abandoning female infants or by giving them up for adoption). The prevalence of sex selection in these countries is the product of a strong preference for male offspring. A decade and half ago, Amartya Sen (3) argued that more than 100 million women are missing from Asia; today the figure is much higher. In 1996, there were 121 boys for every 100 girls in China (4); in parts of India, the ratio is 140:100. (5)

This gender imbalance is the product of a confluence of religious and social practices, including the belief, common in parts of India, that sons must perform certain religious rituals on their parents' behalf to ensure their postmortem fate is a happy one, and the fact that sons are often seen as the best chance that peasants have of receiving material sustenance in old age. The latter belief, especially, ought not to be lightly dismissed: in regions of grinding poverty, it may be that sons are a better investment than daughters. However, a good part of the motivation for son preference is sexism: women and girls are seen as inferior for reasons that simply reflect cultural attitudes. In this context, sex selection is often held to be both the product of, and an element in, reinforcing gender-inequality. (6)

Some people have suggested that the problems of sex selection and the status of women can be expected to be self-correcting: as men begin to dramatically outnumber women, women's relative rarity will increase their value; their social status will rise and female offspring will become more desirable. However, studies of societies with high sex ratios (that is, with a high proportion of males) fail to support this prediction. In fact, when females become rare in high sex ratio societies that are also deeply sexist, they become valuable but only as commodities. They become goods to be traded and to be controlled by their male relatives. It may be that their value as commodities will help reverse the preferences for male offspring--though here, too, the evidence is not encouraging--but women will not be the beneficiaries of this process. (7)

There is also evidence that high sex ratio societies are disproportionately violent societies. Young, unattached males are more likely to turn to crime and to anti-social activities; this is especially the case in societies that are deeply sexist and associate aggression with masculinity. Since a high sex ratio is socially disruptive, countries with this population profile can be expected to look for an outlet for their young males. Hudson and Den Boer (7) point to a disturbing historical pattern: high sex ratio societies are more militaristic. Wars keep young males occupied; moreover, they typically play a part in lowering the sex ratio through their high casualty rate. Today, some of the highest sex ratio counties, such as India, Pakistan and China, share borders and also have histories of tension and actual conflict. High sex ratios may help inflame a volatile situation.

For the sake of women, today and in the future, for the sake of men, and for the sake of regional peace, we have very strong reasons to oppose the use of sex selection in Asia. But the situation in the advanced democracies is quite different. Sex selection in the West is used for different ends and in a different context; it calls for a different response.

Sex selection in the developed world is used for two main reasons: to avoid the birth of children with sex-linked congenital illness and as a product of a preference for a particular gender. (1) set aside the first kind of case for two reasons. First, it is apparently relatively rare: though no-one has, to my knowledge, collated statistics across the sex selection industry, those figures that are available suggest that sex selection is usually performed because a child of a particular sex is wanted, usually for family balancing reasons (ie, because a couple prefers to have a child of the opposite sex to their previous child or children). Those clinics performing sex selection in the United States and the United Kingdom report that between 80 and 90% of their clients cite family balancing as their prime motivation. (8) Second, sex selection for medical reasons seems to me to be ethically permissible since it is desirable to ensure that children have access to a range of opportunities and therefore to ensure that their health is good.

The kind of case of interest here, selection for gender as such, comes in two basic varieties: "family balancing" and cases in which parents simply have a preference for a particular gender. Couples engage in family balancing because they believe that having children of both sexes will be better for the family, or because they believe that there are distinctive parenting experiences associated with each gender. In the West, a preference for a child of a particular gender is most common when a couple wants to have a single child, and prefers, for whatever reason, that that child be a particular sex. Some women, for instance, believe that they will have a special closeness with a daughter.

The evidence available suggests that sex selection is unlikely to impact the sex ratio of Western countries in any significant way. (9) To the extent to which there is a preference for children of a particular gender, the preference seems to be slightly in favor of girls. (10,11) Liu and Rose (12) surveyed couples in the UK actually attending a sex selection clinic. Almost two thirds of the couples of European origin who utilized the clinic did so to have a girl, with the majority citing the mother's wish for a child with whom she expected to share a special closeness. It is unlikely that the specially pressing problems that make sex selection so dangerous in Asia apply in the West.

However, there are other reasons to be concerned about sex selection in the developed world. Sexism is a problem in all countries, not just in Asia, and it is widely feared that sex selection reflects and exacerbates such discrimination in Western countries as well as Eastern. (13) Some thinkers have argued that sex selection in Western countries is not sexist since it is as often, or more often, used to select girls as boys.' It therefore does not reflect the sexist belief that boys are superior to girls. However, there are sexist beliefs other than the belief that one gender is inherently superior to the other. There is also, and far more commonly today in the developed world, the sexist belief that though the genders are of equal value, they are specially suited to different roles and occupations. (14) It is true that there are differences between the cognitive styles of men and women, (15) but these differences are subtle, showing up at the level of groups. Though women are (for instance) better at certain kinds of linguistic reasoning than men, it is sexist to channel women in the direction of certain activities and certain roles because of this group-level profile. It is also sexist to have expectations of children because of their gender alone.

If people choose to have a child of a particular gender, for reasons of family balancing or because of a preference for one gender, it is because they attribute certain psychological qualities to the members of that gender. This belief is the product of sexism: it expects certain gendered characteristics of an individual based on their group membership. The effects of sex on psychological dispositions and abilities is far too subtle, and too uneven, to justify any expectation. Though sexist attitudes are objectionable, people ought to be free to hold and--within limits--to express them. But they are not entitled to impose them on their children because so doing violates the child's right to an open future, (16) the requirement that a range of significant life plans be available to the child, and that she be able to choose among them without undue pressure from parents or from society. By taking steps to raise the probability (or, as they might see it, to ensure) that their children have certain psychological dispositions, parents signal that they will channel their children in certain directions. Moreover, given that the generally prevalent gender stereotypes do not reflect the reality of subtle sex differences, we can be reasonably certain that the dispositions they expect their children to exhibit will themselves reflect sexist prejudices and to that extent are likely to be more constraining.

Of course, it is true that parents who are willing to impose sexist fantasies on their sex-selected children may impose them on naturally conceived children as well. However, we ought not to cater to their whims because we risk endorsing these practices. We ought to be combating sexism, not endorsing or otherwise encouraging it. In addition, we ought to be doing all we can to ensure that parents do not foreclose significant options for their children.

Sex selection is usually wrong. It is not intrinsically wrong: there are certain contexts in which it is, or would be, acceptable. However, in most cases in the world today, it is wrong. I have not attempted here to assess whether it is so significantly wrong that it ought to be banned. There are many things we, as a society and as individuals, can do that fall short of banning a practice: we can refuse to publicly fund it, we can impose tax burdens, we can express disapproval of it. It is a difficult question whether we ought to prohibit sex selection or, instead, choose one of these options. It is to that question which ethicists should now turn.

References

1. Robertson JA. Preconception gender selection. Am J Bioeth 2001;1:2-9.

2. McMahan J. The Ethics of Killing: Problems at the Margins of Life. Oxford, Oxford University Press, 2002.

3. Sen A. More than 100 million women are missing. New York Review of Books. December 20, 1990:61-66.

4. Glenn D. A Dangerous Surplus of Sons? The Chronicle of Higher Education 2004;50:A14.

5. Gajilan AC. Gender selection a reality, but is it ethical? CNN Web site. Available at: http://www.cnn.com/2005/HEALTH/conditions/11/16/pdg.gender.selection. Accessed April 14, 2006.

6. Bandewar S. Exploring the ethics of induced abortion. Indian J Med Ethics 2005;2:18-21.

7. Hudson VM, den Boer AM. Bare Branches: The Security Implications of Asia's Surplus Male Population. Cambridge, The MIT Press, 2004.

8. Parliamentary Office of Science and Technology. Sex Selection. POSTnotes 2003;198:1-4.

9. Dahl E. 2003. Procreative liberty: the case for preconception sex selection. Reprod Biomed Online 2003;7:380-384.

10. Steinbacher R, Gilroy FD. Preference for sex of child among primiparous women. J Psychol 1985;119:541-547.

11. Statham H, Green J, Snowdon C, et al. Choice of baby's sex. Lancet 1993;341:564-565.

12. Liu P, Rose GA. Social aspects of >800 couples coming forward for gender selection of their children. Hum. Reprod 1995:10:968-997.

13. Berkowitz JM, Snyder JW. Racism and sexism in medically assisted conception. Bioethics 1998;12:25-44.

14. Baron-Cohen S. The Essential Difference: Men, Women and the Extreme Male Brain. London, Allen Lane, 2003.

15. Kimura D. Sex and Cognition. Cambridge, The MIT Press, 2000.

16. Feinberg J. The child's right to an open future. In: Aiken W, LaFollette H (eds). Whose Child? Children's Rights, Parental Authority, and State Power. Totowa, Littlefield, 1980, pp 124-53.

What lies behind us and what lies before us are tiny matters compared to
what lies within us.
--Oliver Wendell Holmes

Neil Levy, PhD

From the Centre for Applied Philosophy and Public Ethics, University of Melbourne, Parkville, Australia, and the James Martin 21st Century School, Oxford University, Oxford, United Kingdom.

Reprint requests to Neil Levy, PhD, Centre for Applied Philosophy and Public Ethics, University of Melbourne, Parkville, 3010, Australia. Email: [e-mail]