Sex Selection in America: Why It Persists and How We Can Change It

Preference for sons is a real problem, but a House bill to ban sex-selective abortion is the wrong way to solve it.

Son preference, missing girls, sex selection: We may seek to label these Chinese or Indian issues, but they exist here in America. And with anti-choice crusaders desperate to destroy the Planned Parenthood Federation of America, America's leading provider of affordable reproductive health care for women, the purportedly spreading practice of sex-selective abortion is back in the news. With the Prenatal Nondiscrimination Act up for a vote in the House Thursday, it's also back in full force on the legislative agenda.

The extent of sex-selective practices in the U.S. is hard to assess, since it's rarely something people will admit to doing. But we can make an educated guess by observing alterations in expected sex ratios. If nature has its way, women will likely give birth to 100 girls for every 102 to 106 boys (for a ratio of 1.02 to 1.06 boys per girl). And among first-time parents in the U.S., that's exactly what we see.

However, as birth order rises, apparently so does selection -- at least, in certain ethnic groups. With 2000 U.S. Census data, researchers investigating Korean, Chinese, and Indian communities found that, after having one girl, parents have as many as 1.17 boys per girl when their next child is born. With two girls at home, the ratio goes up to 1.51 boys per girl for the third child (meaning 151 boys are born for each 100 girls). These skewed ratios aren't present among other ethnic groups in America.

This intentional kid picking takes multiple forms. Today, Americans can learn -- and thus select for sex -- as early as seven weeks into a pregnancy, using a non-invasive blood test making big news in popular and obstetric circles. Far more reliable than urine-based guesses from Walgreen's and far safer than other early use options, this new technique is meant to minimize sex-linked genetic diseases, which disproportionately plague boys. But this product enters a market where some parents-to-be pine not just for any healthy baby; some want what they see as a particular kind.

Although alarmists hypothesize a rise in sex-selective abortions, more and more the interest (and well-marketed new product development) lies in meddling before implantation. Techniques like sperm sorting and IVF embryo selection are expensive. Even the most generous insurance package doesn't cover these procedures when not medically necessary. Yet as of 2006, half of American fertility clinics that offer embryo screening allow would-be parents some form of sex-selective add-ons ... and the market is growing. Never mind that the American College of Obstetrics and Gynecology has come out harshly against non-medically necessary sex selection, and even the American Society for Reproductive Medicine has issued lukewarm cautions about it.

These clinics advertise their sex-selective wares heavily in ethnic language media and enclaves where Asian Americans reside. Offering would-be parents soft focus images of white babies on pink and blue blankets, they couch their practices in the affirming language of "family balancing." Doesn't that sound much better than sexism, eugenics, or designer babies?

Some claim environmental motives. Citing opinion research that most parents desire one of each sex in their offspring, they offer to do this in the first two pregnancies and bring down the birth rate. Others say their services minimize sex-selective abortions, because picking the sex of your kid before pregnancy is better than doing it during. A few argue that this is an expression of reproductive freedom. And some proffer no reason for breaking their own professional ethical guidelines -- an unstated affirmation that the customer is always right.

In practice, sex selection means more sons. In most cultures, there's a preference for male babies. Whether the motivation is economic (because sons mean higher income potential), religious (because sons perform sacred rites), social (because sons confer status), or a messy mix of the above, son preference fuels the desire to take control of formerly unalterable aspects of impending parenthood.

Obviously, sex preference is a problem. It requires adherence to the fallacy that sons and daughters are biologically limited in what they can do and who they can be. People lusting after a son hardly have a hairdresser in mind. Likewise, the daughter dream is about playing princess, not baseball. Moreover, desperately wanting a specific sex requires us to believe in and thus perpetuate the notion of two genders.

Responses from our own surveys, individual interviews and focus groups among Asian Americans indicate sex preference is alive in America. While respondents generally didn't have first-hand experience with sex selection in the U.S., 96 percent felt that parents treat boys and girls differently, with boys getting a way better deal. Sex selection may be, to paraphrase one respondent, the operationalization of son preference, but the preference came first -- and left unaddressed, isn't going anywhere.

It is a bitter irony that regressive legislation like the Prenatal Nondiscrimination Act actually reinforces why it's disadvantageous to be a woman, especially a woman of color.

However, before we go corralling this off as just an immigrant issue, let's look at how the majority of Americans view it. A Gallup poll from 2011 found that, when asked if they could only have one child, American men of all backgrounds responded that they'd want a boy by a margin of 49 percent to 22 percent, a finding fixed at this level since 1941, when Gallup started asking. Women today report no preference. But still, 40 percent of Americans overall think picking embryos to select for sex is an appropriate use of genetic-diagnosis technology. While the numbers attest most Americans aren't selecting for sex, throw new early-detection tests along with more and cheaper technology into the mix with society's gender-based preferences and myths -- and we should expect to see increased selection.

Aside from the long list of ethical, social, and political problems this poses, it's a consequential challenge for reproductive rights advocacy. Sex selection against girls is the religious right's wet dream. When opponents declare "abortion hurts women," they could not have dreamed of a better "we told you so."

They're riding this wave to new reasons to control women's autonomy, specifically to curtail reproductive decision-making for women of color. In 2008, anti-choice groups pushed for legislation to ban sex-selective abortions. Arizona Republican Rep. Trent Franks introduced the "Susan B. Anthony and Fredrick Douglass Prenatal Nondiscrimination Act" to ban sex-selective abortion and a new chimera he called "race-selective" abortion. Legislators in Georgia, West Virginia, Oklahoma, Michigan, Minnesota, New Jersey, and New York have tried the same at the state level. In 2010 and 2011, as those of us who support access to safe abortion care looked on in horror, Oklahoma and Arizona both banned sex-selective abortions.

In all cases, lawmakers pointed to the cultural attitudes and practices of Chinese and Indians as evidence of what could befall us all. Data about sex ratio disparities in specific Asian countries became proxy for sex selection amongst Asian Americans -- never mind that the latter group represents a huge range of origin countries and displays sex ratios pretty much identical to the rest of Americans. Details like math and geography need not interfere with a justification for passing this legislation, even in states where few Asians reside.

The complications of race-specific attacks aside, the central argument of the mainline reproductive rights movement has been that the right to continue or terminate a pregnancy is a "choice." An implicit, and often times stated, contention that all choices women make about their bodies and reproduction are private, to be made without state interest.

But now our slogans about individual rights -- "my child, my choice" -- have been appropriated as ad copy for the sex-selective clinics we find troubling. Even if people use new technologies to select for girls, and evidence suggests Caucasian women do, they apply the notion of "choice" to germinate restrictive notions of gender. When we fought for autonomy, this did not mean the right to engineer your own namesake or a pinkalicious-shopping buddy. What it meant was a right for women to define who they were and wanted to be on their own terms, on their own timeline.

Research shows that the language of "choice" has left audiences cold. Studies in cognitive linguistics, psychology, and even marketing contend this framework suggests action quickly considered and of little consequence -- hardly a rhetorical counterweight to "life" or apt description of how most women undertake this decision.

But the concept of choice no longer fits either. Not only did we not want government out when it comes to financial assistance to access the abortion, we're not vying for a mandate that says anything goes in the world of parenting.

Sex selection forces us to take stock of what we believe and start saying it. Here is our chance to leave behind the tired, consumer-led, conversation. "My choice," or even "my child," never described our community-supported ideals of child rearing. We must move from choice and it's inevitable follow-up -- "What kind of child do I want to have?" -- to the more meaningful question: "What kind of parent do I want to become?"

We need frank public discussion about parenting boys and girls and the often-unconscious biases we all have about gender and children. This is long overdue but is only one element of the efforts required to unseat the calcified ideas about sex and gender that permeates our society, across all races and ethnic groups.

We must also defeat discriminatory laws like the one up for vote today in the House. It is a bitter irony that regressive legislation like the Prenatal Nondiscrimination Act actually reinforces why it's disadvantageous to be a woman, especially a woman of color. These kinds of policies are part of a culture that makes sex selection a logical choice for women hoping to keep daughters from a sexist, repressive world that seeks only to limit who they are and what they are allowed to do.

Instead of curbing women's rights, our research specifically in South Asian American communities suggests the way to undo son preference is to address old assumptions. This would require raising awareness about, and also helping to hasten the dramatic changes underway in gender roles. Girls and women are assuming many of the roles only men once played, and men and boys can play and are now fulfilling many of the roles which have been considered a woman's domain. In the South Asian diaspora community, for example, boys aren't always staying around to take care of aging parents, girls are increasingly staying attached to their maternal families, and investment in girls' education is paying off richly. But to end son preference, old beliefs and practices, laws and policies, need to catch up to the new reality, both in the United States and in South Asia. Empowering families, communities, and societies to root out biases and alter their own behaviors without shaming, blaming, or curtailing the rights of women is our only real hope of tackling this issue.

A version of this article was first published at RH Reality Check.