Edgar Dahl

In its recent statement 'Sex Selection and Preimplantation Genetic Diagnosis', the Ethics Committee of the American Society of Reproductive Medicine concluded that preimplantation genetic diagnosis for sex selection for non-medical reasons should be discouraged because it poses a risk of unwarranted gender bias, social harm, and results in the diversion of medical resources from genuine medical need. We critically examine the arguments presented against sex selection using preimplantation genetic diagnosis. We argue that sex selection should be available, at least within privately funded health care.

In a recent comment on the HFEA’s public consultation on sex selection, Soren Holm claimed that proponents of family balancing are committed to embrace a laissez faire approach. Given that arguments in support of sex selection for family balancing also support sex selection for other social reasons, advocates of family balancing, he asserts, are simply inconsistent when calling for a limit on access to sex selection. In this paper, I argue that proponents of family balancing are in no way inconsistent. Provided their advocacy of family balancing is aimed at preventing a severe distortion of the natural sex ratio, they are entirely justified in insisting on restrictions to sex selection. The real question is whether a concern for the sex ratio does indeed call for a limit on sex selection. Based on a recent survey on gender preferences and data from several Gender Clinics, I argue that a restriction on sex selection to family balancing is unwarranted. In the absence of any evidence for a pending sex ratio distortion, we are actually required to adopt a laissez faire approach to sex selection.

BACKGROUND Preconception sex selection for non-medical reasons is a controversial issue in bioethics. Little research has described preferences for preconception sex selection among Arab populations. This study describes the sex preference and interest in employing sex selection techniques among pregnant women in northern Jordan. METHODS A self-reported questionnaire was administered to 600 pregnant women in Irbid, Jordan. χ2 test and binary logistic regression were used to examine the factors associated with interest in preconception sex selection. RESULTS In general, the interest in using sex selection was low. Women who preferred boys were more likely to be interested in sex selection, if paid for by the couple [odds ratio (OR) = 4.40, 95% confidence interval (CI): 1.75–11.11] or by health insurance (OR = 3.42, 95% CI: 1.94–6.06), or, if feasible, administered through oral medication (OR = 8.84, 95% CI: 5.05–15.63). Women with lower education were more likely to be interested in sex selection, if paid by health insurance (OR = 1.96, 95% CI: 1.10–3.45) and were more likely to believe that sex selection is legal (OR = 1.79, 95% CI: 1.06–2.86). Women who had no boys were more likely to be interested in sex selection, if paid by health insurance (OR = 1.94, 95% CI: 1.10–3.42) or, if feasible, through medication (OR = 3.03, 95% CI: 1.82–5.00). CONCLUSIONS The majority of participants were not in favor of using preconception sex selection. Those with a preference to have boys, with lower education, and those with an imbalanced family were more likely to be interested in using sex selection technology.

In its recent report Human Reproductive Technologies and the Law, the House of Commons’ Select Committee on Science and Technology insisted that the United Kingdom ‘does not take a purely insular view’ on sex selection but to carefully consider the impact on other countries before allowing changes to current legislation. True, no country is an island, not even the British Isles. Still, outlawing a harmless practice in Great Britain because of its alleged harmful effects in other countries is bad public policy.

Preconception sex selection for nonmedical reasons raises important moral, legal, and social issues. The main concern is based upon the assumption that a widely available service for sex selection will lead to a socially disruptive imbalance of the sexes. For a severe sex ratio distortion to occur, however, at least two conditions have to be met. First, there must be a significant preference for children of a particular sex, and second, there must be a considerable interest in employing sex selection technology. Our objective was to ascertain such demand and preferences among the United States general population.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.