Social Sex Selection Research Articles

High and growing disapproval of sex-selection technology in Australia

BackgroundIn Australia, the National Health and Medical Research Council has banned the use of assisted reproductive technology for social sex selection, but notes “there is limited research into the question of whether Australians support the use of sex selection for non-medical purposes”. This paper investigates Australian attitudes to sex-selection technology by different means (IVF, abortion, and a hypothetical pill), for different reasons (medical, family balancing, any reason), and by differing respondent characteristics (age, sex, education and religiosity).MethodsIn 2007 and 2016, the Australian Survey of Social Attitudes (AuSSA) collected data on the attitudes of Australian adults to sex selection through IVF, abortion, and a hypothetical pill. We calculate population-weighted distributions and 95% confidence intervals of responses, and carry out logistic regressions to investigate the demographic characteristics of Australians who strongly disapprove of IVF or abortion for sex selection.ResultsIn 2016, around three-quarters of AuSSA respondents were opposed to legalising sex selection through IVF for any reason, or for family balancing for a second or third child. Thirty-seven per cent were opposed to IVF for medical sex selection. Two-thirds of respondents in both 2007 and 2016 disapproved or strongly disapproved of IVF for sex selection, while the proportion who strongly disapproved increased from 31 to 40%. Disapproval/strong disapproval of abortion for sex selection increased from 74 to 81% from 2007 to 2016, while strong disapproval alone rose from 44 to 55%. More than 70% of respondents in both 2007 and 2016 stated that a hypothetical pill for sex selection should not be legal. Our analysis finds that female, young, more-educated, and more religious respondents are more likely to strongly disapprove of sex selection via IVF or abortion, and that the increase in those who strongly disapprove from 2007 to 2016 is statistically significant.ConclusionsAustralians generally disapprove of the use of sex-selection technology. If legislation is to be guided by community attitudes, then the prohibition against sex selection for non-medical purposes through assisted reproductive technology should be maintained.

Acceptable applications of preimplantation genetic diagnosis (PGD) among Israeli PGD users.

The use of PGD technology to select against genetic disorders and traits is increasing. Although PGD may eliminate some of the obstacles related to conservative options of prenatal diagnosis, it can raise personal, social and moral questions. Ethical issues concerning the justified uses of PGD are a subject of ongoing debate among medical and bioethical communities. Although attitudes toward the acceptable uses of PGD were evaluated among population groups worldwide, bioethics councils were criticized for ignoring public perspectives. In the last decade PGD has been widely used in Israel. The ethical guidelines were created solely by medical-bioethics experts and, some felt, totally isolated from public opinions. Semi-structured in-depth interviews of 37 users (carriers of autosomal recessive, dominant and X-linked disorders, and HLA-matching) were performed. The interviews explored attitudes toward ethical and sociological aspects of PGD. The overall results of this study show highly favorable attitudes of Israeli PGD users toward medical applications. Furthermore, our subjects demonstrate a more permissive stand toward the controversial application of social sex selection albeit with strong objection to esthetic means of selection. PGD users are coping with both genetic disease and load of the PGD procedure. Taking into consideration their opinion is important since it reflects the gains and burdens of these procedures alongside the demand for future optional services. Their attitudes should play an important role in the professional discussion concerning the justified uses of PGD and should significantly influence the design of policy making in this field.

“You Get the Baby You Need”: Negotiating the Use of Assisted Reproductive Technology for Social Sex Selection in Online Discussion Forums

As a result of developments in assisted reproductive technology (ART), it is now possible to choose the sex of a baby. However, the procedures are currently not allowed for this purpose in Australia. This article explores how the positions for and against the use of ART for social sex selection are constructed by parents and parents-to-be in online discussion forums. Critical Discourse Analysis is employed to identify the arguments, evidence and experience drawn upon in the negotiation of the topic. We identify an important distinction between the legitimacy of using ART procedures for social sex selection, and the appropriateness of individuals actually wanting to use the procedures. We further show that expectations about the parent/child relationship, the nature of parental love and implications for society are mobilized in the debate, much of which is underscored by traditional gender constructions.

Media debates and ‘ethical publicity’ on social sex selection through preimplantation genetic diagnosis (PGD) technology in Australia

This paper offers a critical discourse analysis of media debate over social sex selection in the Australian media from 2008 to 2014. This period coincides with a review of the National Health and Medical Research Council's Ethical Guidelines on the Use of Assisted Reproductive Technology in Clinical Practice and Research (2007), which underlie the regulation of assisted reproductive clinics and practice in Australia. I examine the discussion of the ethics of pre-implatation genetic diagnosis (PGD) within the media as ‘ethical publicity’ to the lay public. Sex selection through PGD is both exemplary of and interconnected with a range of debates in Australia about the legitimacy of certain reproductive choices and the extent to which procreative liberties should be restricted. Major themes emerging from media reports on PGD sex selection in Australia are described. These include: the spectre of science out of control; ramifications for the contestation over the public funding of abortion in Australia; private choices versus public authorities regulating reproduction; and the ethics of travelling overseas for the technology. It is concluded that within Australia, the issue of PGD sex selection is framed in terms of questions of individual freedom against the principle of sex discrimination – a principle enshrined in legislation – and a commitment to publically-funded medical care.

Views of internists towards uses of PGD

Preimplantation genetic diagnosis (PGD) is increasingly available, but how physicians view it is unclear. Internists are gatekeepers and sources of information, often treating disorders for which PGD is possible. This quantitative study surveyed 220 US internists, who were found to be divided. Many would recommend PGD for cystic fibrosis (CF; 33.7%), breast cancer (BRCA; 23.4%), familial adenomatous polyposis (FAP; 20.6%) and familial hypertrophic cardiomyopathy (19.9%), but few for social sex selection (5.2%); however, in each case, >50% were unsure. Of those surveyed, 4.9% have suggested PGD to patients. Only 7.1% felt qualified to answer patient questions about it. Internists who would refer for PGD had completed medical training less recently and, for CF, were more likely to have privately insured patients (P<0.033) and patients who reported genetic discrimination (P<0.013). Physicians more likely to refer for BRCA and FAP were less likely to have patients ask about genetic testing. This study suggests that internists often feel they have insufficient knowledge about it and may refer for PGD based on limited understanding. They view possible uses of PGD differently, partly reflecting varying ages of onset and disease treatability. These data have critical implications for training, research and practice.Preimplantation genetic diagnosis (PGD) allows embryos to be screened prior to transfer to a woman’s womb for various genetic markers. This procedure raises complex medical, social, psychological and ethical issues, but how physicians view it is unclear. Internists are gatekeepers and sources of information, often treating disorders for which PGD use is possible. We surveyed 220 US internists, who were found to be divided: many would recommend PGD for cystic fibrosis (CF; 33.7%), breast cancer (BRCA; 23.4%), familial adenomatous polyposis (FAP; 20.6%), and familial hypertrophic cardiomyopathy (FHC; 19.9%) and a few for sex selection (5.2%); but in each case, >50% were unsure. Of those surveyed, 4.9% have suggested PGD to patients. Only 7.1% felt qualified to answer patient questions. Internists who would refer for PGD completed medical training less recently and, for CF, were more likely to have privately insured patients and patients who reported genetic discrimination. Physicians more likely to refer for BRCA and FAP were less likely to have patients ask about genetic testing. This quantitative study suggests that internists often feel they have insufficient knowledge and may refer for PGD based on limited understanding. They view possible uses of PGD differently, partly reflecting varying ages of onset and disease treatability. Internists should be made aware of the potential benefit of PGD, but also be taught to refer patients, when appropriate, to clinical geneticists who could then refer the patient to an IVF/PGD team. These data thus have critical implications for training, research and practice.

Reproduction opportunists in the new global sex trade: PGD and non-medical sex selection

Regulatory differences between countries are an important driver of the cross-border trade in assisted reproduction as people move to seek services unavailable in their home countries. The development of a lucrative global trade in non-medical sex selection needs to be considered in ethical debates over its availability. I suggest that depictions of non-medical sex selection as a means of ‘family balancing’ or supportive of reproductive autonomy serve to distance the technologies rhetorically from the gender stereotyping inherent in their use and the commodification upon which they depend. They construct new social categories such as the ‘unbalanced’ family, the pathologization of ‘gender disappointment’ and a limited and highly individualized definition of reproductive freedom that permits medical interventions on healthy bodies. Orientalism pervades ethical debate depicting non-medical sex selection in the West as more acceptable to practices in ‘Asia’. A case study of the interconnections between Australia and Thailand highlights the global economy sustaining the practice. A lucrative trade exists as patients move across border to avail themselves of reproductive technologies that are unavailable in their home countries due to regulatory differences. This paper considers the trade in one such technology, preimplantation sex selection for non-medical reasons (social sex selection) which is banned or regulated in most countries, but in some settings is available due to a lack of regulations and has become a ‘market advantage’ for some clinics. I suggest that these technologies are inherently gender discriminatory and that our ethical discussions need to include considerations of the commodification of sex characteristics inherent in this new trade. I argue that descriptions of these technologies as a means of ‘family balancing’ or supportive of reproductive autonomy construct new social categories such as the ‘unbalanced’ family, the pathologization of ‘gender disappointment’ and a limited and highly individualized definition of reproductive freedom. They try to characterize sex selection in the West as more acceptable than that carried out in Asian countries. A final case study of the trade between Australia and Thailand highlights the global economy of these technologies.

Attitudes toward sex selection: a survey among potential users in Israel

Since 1995, Israel allows social sex selection (SxS) under certain circumstances. However, data regarding the attitudes of potential users are limited. The study population composed of a stratified sample of Israeli married men and women at the reproductive age (women aged 17-45, men aged 17-65), who had 1-2, 3, or 4+ children of the same sex. We conducted telephonic interviews with 687 Israeli residents using a structured questionnaire that included the following items: demographic characteristics, opinions regarding SxS, personal interest in expanding the family, and interest in choosing the sex of a future child. Among the group of respondents who wanted to have more children (true potential users of the technology), 42.6% wished to select the sex of a future child. Strong desire for family balancing was found. In a multivariable logistic regression model, being an ultra-orthodox was associated with a lower desire to choose (OR = 0.02; 95% CI: 0.01-0.06), while having more same-sex children was associated with a greater desire to choose (OR = 3.12; 95% CI: 1.54-6.32). It can be estimated that if SxS were to be freely permitted in Israel, less than half of those for whom SxS is truly relevant would want to use the technology.

Ethical aspects of pre-implantation genetic diagnosis

Pre-implantation genetic diagnosis (PGD) presents several ethical dilemmas, some akin to those found in prenatal diagnosis, and others more specific to the technique, which requires in-vitro fertilisation and creates embryos in vitro. Here, the status of the embryo is central to the dilemmas concerning its selection, possible destruction or use in research, and the fate of carrier embryos. Furthermore, the general question of eugenic practices is also a main ethical theme, as well as fair access to expensive technology. Finally, specific concerns are raised by PGD/human leukocyte antigen to find a ‘saviour’ sibling, PGD for late onset disorders, social sex selection or the replacement of affected embryos. A framework of moral acceptability is discussed.

SEXISM, SEX SELECTION AND ‘FAMILY BALANCING’

Traditionally reproductive autonomy meant simply the freedom (assuming it was a real freedom) to decide whether to try and reproduce with whom when and where. However now the issues include the questions of whether reproductive autonomy should extend to include for example social sex selection buying and selling eggs sperm and embryos the selection of the characteristics of possible future children or to having one child to save another (the so-called saviour sibling). While we would strive to encourage autonomous decision making we recogise that there may be problems with unfettered and unregulated choices.

Ethical aspects arising from non-invasive fetal diagnosis

Non-invasive prenatal diagnosis (NIPD) could significantly change the framework for testing and screening in pregnancy. This chapter reviews the ethical implications of this technology, including current issues in prenatal diagnosis, implications for informed consent, possible non-medical uses and options for regulation. The prospect of NIPD normalising screening and termination in pregnancy is raised as a concern. NIPD will also require monitoring to ensure women are making well-informed decisions, given that a risk to the pregnancy is absent. The question of whether NIPD will reduce anxiety needs to be established and the prospect that it will increase terminations on the grounds of disability should be recognised. The offer of NIPD external to any clinical oversight might give rise to wider social sex selection, paternity testing or testing 'for information'. The value assumptions of these uses of NIPD need to be addressed.

The 10 most common objections to sex selection and why they are far from being conclusive: a Western perspective

After its review of the Human Fertilization and Embryology Act of 1990, the Department of Health concluded that the British Parliament ought to outlaw sex selection for any but the most serious of medical reasons. This paper reviews the most frequently expressed objections to social sex selection and concludes that there is simply no moral justification for prohibiting parents from using sex selection technology to balance their families.

Ordinary ethics: lay people's deliberations on social sex selection

This article summarises the results of a research project that used a scenario about sex selection of embryos for social reasons as a basis for discussion groups with lay people. The aim of the research was to examine the processes by which non-professionals make ethical evaluations in relation to a contested area in medical genetics. We note in particular the role played in the discussions by expressions of instinct; making distinctions; rational argument; reference to principles; use of personal experience; analogies and examples; slippery slope arguments and meta-reflections. The implications for developing processes of public consultation and debate are also considered.

Gender preferences and demand for preconception sex selection: a survey among pregnant women in Pakistan

In its recent report 'Human Reproductive Technologies and the Law', the House of Commons' Select Committee on Science and Technology called for greater efforts to establish the potential demographic impact of sex selection across all sectors of UK society. Given the well-known preference for boys over girls among some communities, there is concern that a readily available service for social sex selection may upset the balance of the sexes. Of particular interest are the gender preferences and the demand for sex selection among Pakistanis. We conducted a social survey on gender preferences and potential demand for preconception sex selection among 301 pregnant women in Karachi, Pakistan, using a self-report questionnaire consisting of 14 questions. About 41.5% wish to have a family with an equal number of boys and girls; 3.3% would like to have only boys, 1.0% only girls, 27.6% more boys than girls and 4.3% more girls than boys, and 22.3% stated that they do not care about the sex composition of their family. Whereas 6.3% could imagine employing cytometric sperm separation for social sex selection, 76.1% could not and 17.6% were undecided. About 27.2% felt that social sex selection ought to be legal, 48.8% thought it ought to be illegal and 23.9% were undecided. Although Pakistani women do show a statistically significant preference for boys over girls, the number of women willing to subject themselves to cytometric sperm separation appears to be too small to cause a severe imbalance of the sexes. However, further research among British citizens of Pakistani origin is needed to establish whether sex selection poses a serious threat to the sex ratio of UK communities.

Social sex selection and the balance of the sexes: Empirical evidence from Germany, the UK, and the US

Preconception sex selection for nonmedical reasons is one of the most controversial issues in bioethics today. The most powerful objection to social sex selection is based on the assumption that it may severely distort the natural sex ratio and lead to a socially disruptive imbalance of the sexes. Based on representative social surveys conducted in Germany, the United Kingdom, and the United States, this paper argues that the fear of an impending sex ratio distortion is unfounded. Given the predominant preference for a "gender balanced family," a widely available service for social sex selection is highly unlikely to upset the balance of the sexes in Western societies.

Gift not commodity? Lay people deliberating social sex selection

In this paper we explore lay people's discussions of the controversial topic of social sex selection (SSS). In the UK and many other countries, SSS is prohibited by law. In 2003 the UK Human Fertilisation and Embryology Authority, after an extensive public consultation, decided against changing the existing legislation. However, this initiative and similar consultation exercises have been criticised on the grounds that public opinion is poorly informed and reasoned. In our study, one of the most consistently expressed ideas was that children should be regarded as 'a gift' rather than 'a commodity'. In contrast, the 'gift not a commodity' argument is rarely cited positively in Anglo-American, secular-liberal bioethics. These metaphorical statements are condensed articulations of complex but coherent moral intuitions. Where much of the bioethics literature stresses parental autonomy, our lay discussants balanced this principle with ideas about the need to respect the personhood of the potential child, and the characteristics of a good parent. We conclude our analysis by considering the implications for expanding bioethics' knowledge base and improving the input of lay people in bioethical decision making.

Regulating post‐implantation fetal sex selection: a UK perspective

This article reviews the current and potential laws relevant to post-implantation fetal social sex selection and considers whether they could provide an effective deterrent and control of the practice, if the United Kingdom decided that such control were desirable. It concludes that enacting, drafting and enforcing of any legislation throws up many difficult practical and ethical issues. These issues need to be debated and further information collected before any legislation is rushed into.

Chance, choice and control: Lay debate on prenatal social sex selection

Assisted reproductive technologies are typically positioned as increasing the range of choices open to the healthcare consumer, thereby enhancing ‘reproductive freedom’. In this paper, we question the equivalence of reproductive choice and personal freedom in ethical theory, using results from a project investigating how lay people make ethical evaluations about the new genetic and reproductive technologies. We took the topic of social sex selection by preimplantation genetic diagnosis (PGD), and used group discussions and interviews in the north-east of England to trace how lay people develop and express their ethical evaluations, and to identify the implicit or explicit normative framework that gave rise to their opinions on prenatal sex selection. There was a striking level of ambivalence towards choice in general and reproductive choice in particular. Participants offered few positive statements and numerous reasons why reproductive choice might be problematic. Our participants’ argumentation shares with mainstream bioethical analysis the weighing of the possible harms of prenatal sex selection for social reasons against the harm of restricting reproductive freedom. However, unlike most secular–liberal bioethicists, many of our participants concluded that prenatal sex selection is undesirable because it is an expression of parental preference instead of a response to the future child's need. Our interpretation of their reasoning is that they work from an ideal of “good parents”, one of the features of which is the relinquishing of control over their children, except to protect them from harm. This voluntary self-limitation does not indicate reduced autonomy, because parental autonomy can only operate within the limits set by this relational framework. We suggest that a model of relational autonomy captures our lay participants’ framing of the problem better than a more traditional understanding of autonomy. Our study also shows that in appropriately structured discussion of bioethical issues, lay people can articulate reasons for their opinions that are grounded in sophisticated and morally relevant concepts.

Preimplantation Genetic Diagnosis—An Overview

Since the early 1990s, preimplantation genetic diagnosis (PGD) has been expanding in scope and applications. Selection of female embryos to avoid X-linked disease was carried out first by polymerase chain reaction, then by fluorescence in situ hybridization (FISH), and an ever-increasing number of tests for monogenic diseases have been developed. Couples with chromosome rearrangements such as Robertsonian and reciprocal translocations form a large referral group for most PGD centers and present a special challenge, due to the large number of genetically unbalanced embryos generated by meiotic segregation. Early protocols used blastomeres biopsied from cleavage-stage embryos; testing of first and second polar bodies is now a routine alternative, and blastocyst biopsy can also be used. More recently, the technology has been harnessed to provide PGD-AS, or aneuploidy screening. FISH probes specific for chromosomes commonly found to be aneuploid in early pregnancy loss are used to test blastomeres for aneuploidy, with the aim of replacing euploid embryos and increasing pregnancy rates in groups of women who have poor IVF success rates. More recent application of PGD to areas such as HLA typing and social sex selection have stoked public controversy and concern, while provoking interesting ethical debates and keeping PGD firmly in the public eye.

Procreative liberty, or collective responsibility? Comment on the House of Commons report Human Reproductive Technologies and the Law, and on Dahl's response

The matter of social sex selection is of universal interest. It is argued that it is so important that an insular response by the select committee on the subject must be replaced by one founded on an international human rights stance, in which light sex selection may only be seen as sexist per se.

Sex (IST) Selection?

Sex selection has been practised since the start of time, but developments in science and in reproductive technologies in recent years have made sex selection reliable and more accessible to parents. Although concerns are raised about the activities involved in different methods of sex selection, and about the eugenic implications of its use to avoid the birth of a child suffering from a sex-linked disease, particular concerns are raised about its use to secure the birth of a child simply on the basis of its sex. This article considers the practice of so-called social sex selection, and its regulation in the United Kingdom. Consistent with the conclusions of the Human Fertilisation and Embryology Authority in their recent review of the subject, this article concludes that restrictive regulation is required, and suggests that some reforms are required to achieve this result.