Abstract
Recent decades have seen major advances in assisted reproductive technology, allowing couples to have more autonomy over their reproductive goals. However, new technologies have also caused disturbing trends in sex selection that have threatened the gender balance in large countries like China and India. This chapter examines the emerging challenges and ethical dimensions of technological developments in reproduction as well as their policy implications. Drawing from latest population data, the chapter highlights the impact of selective reproductive technology on demographic trends (in particular, on sex ratios at birth). It also assesses the influence and surprising backlashes of public policies that have been put in place to limit the negative aspects of these new technologies. The chapter is illustrated with country examples. Bioethics and gender have long focused on individual rights, but the larger demographic consequences of reproductive technologies are invisible at this level. The chapter calls on demographers to enrich the bioethical debate through a population lens on bioethics.
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Notes
- 1.
Deselection of daughters refers to prenatal fetal sex diagnosis followed by selective abortions of female fetuses.
- 2.
Medical abortion consists of taking two different abortion pills (using a combination of mifepristone and misoprostol) to end the pregnancy. It is usually available up to 10 weeks of gestation. Meanwhile, surgical abortions involve an operation to remove the pregnancy from the womb. Common methods using local or general anesthetic are aspiration up to 14 weeks of gestation or dilation and evacuation for second trimester abortions (see Chap. 28: The Role of Abortion in Population Policies of this Handbook [Crane & Maistrellis, this volume]).
- 3.
According to Reuters, the business of sex selection is estimated to be worth USD 150 million in 2013, with a growing demand of about 20% per year (Kaye & Jittapong, 2014).
- 4.
For example, one 1997 poster campaign read, “I want to be born with the blessing of mama and papa. I am frightened of abortion for being a girl. Please protect my life” (Rahm, 2020: 118).
- 5.
See Chap. 24: Measuring the Effectiveness, Efficiency, and Impact of Population Policies of this Handbook (Tarsilla, this volume).
- 6.
By political masculinities, we refer to both individual and institutionalized expressions of masculinity; see Rahm, 2019.
- 7.
Peters and Nagel (2020: 1) in their new book coin these failed persisting policy ideas as “zombie ideas”.
References
Beauchamp, T. L., & Childress, J. F. (2001). Principles of biomedical ethics (5th ed.). Oxford University Press.
Becker, G. (2007, December 2). Is sex selection of births undesirable? The Becker-Posner Blog. See http://www.becker-posner-blog.com/2007/02/is-sex-selection-of-births-undesirable-becker.html
Bennett, N. G. (Ed.). (1983). Sex selection of children. Academic.
Bhatia, R. (2018). Gender before birth: Sex selection in a transnational context (Feminist Technosciences). University of Washington Press.
Bicchieri, C. (2017). Norms in the wild: How to diagnose, measure, and change social norms. Oxford University Press.
Bien, C. H., Cai, Y., Emch, M. E., Parish, W., & Tucker, J. D. (2013). High adult sex ratios and risky sexual behaviors: A systematic review. PLoS ONE. (Edit. by D. Harper), 8(8), e71580. https://doi.org/10.1371/journal.pone.0071580
Bongaarts, J., & Guilmoto, C. Z. (2015). How many more missing women? Excess female mortality and prenatal sex selection, 1970-2050. Population and Development Review, 41(2), 241–269.
Brock, D. W., & Wickler, D. (2007). Population-level bioethics: Mapping a new agenda. In A. Dawson & M. F. Verweij (Eds.), Ethics, prevention, and public health. Issues in biomedical ethics (pp. 78–94). Clarendon Press & Oxford University Press.
Buchanan, A., Brock, D. W., Daniels, N., & Wikler, D. (2000). From chance to choice: Genetics and justice. Cambridge University Press; See http://ebooks.cambridge.org/ref/id/CBO9780511806940
Bumgarner, A. (2007). A right to choose?: Sex selection in the international context. Duke Journal of Gender Law & Policy, 14, 1289–1310.
Calhaz-Jorge, C., De Geyter, C. H., Kupka, M. S., Wyns, C., Mocanu, E., Motrenko, T., Scaravelli, G., Smeenk, J., Vidakovic, S., & Goossens, V. (2020). Survey on ART and IUI: Legislation, regulation, funding and registries in European countries. Human Reproduction Open, 2020(1), hoz044. https://doi.org/10.1093/hropen/hoz044
Callahan, D. (2018). Bioethics and policy – A history. The Hastings Center; See https://www.thehastingscenter.org/briefingbook/bioethics-and-policy-a-history/
Cambridge Dictionary. (2020). Bioethics. In Cambridge advanced learner’s dictionary & thesaurus. Cambridge University Press; See https://dictionary.cambridge.org/dictionary/english/bioethics
Casado, M., & López Baroni, M. J. (2020). Handbook of secular bioethics (I). Key issues. Universitat de Barcelona.
Chahnazarian, A. (1988). Determinants of the sex ratio at birth: Review of recent literature. Biodemography and Social Biology, 35(3–4), 214–235.
Chao, F., Gerland, P., Cook, A. R., & Alkema, L. (2019). Systematic assessment of the sex ratio at birth for all countries and estimation of National Imbalances and regional reference levels. Proceedings of the National Academy of Sciences, 116(19), 9303–9311.
Chao, F., Gerland, P., Cook, A. R., Guilmoto, C. Z., & Alkema, L. (2021). Projecting sex imbalances at birth at global, regional and national levels from 2021 to 2100: Scenario-based Bayesian probabilistic projections of the sex ratio at birth and missing female births based on 3.26 billion birth records. BMJ Global Health, 6(8), e005516. https://doi.org/10.1136/bmjgh-2021-005516
Cislaghi, B., & Heise, L. (2018). Theory and practice of social norms interventions: Eight common pitfalls. Globalization and Health, 14(1), 83. https://doi.org/10.1186/s12992-018-0398-x
Cleland, J. (this volume). Chapter 27: The contraceptive revolution. In J. F. May & J. A. Goldstone (Eds.), International handbook of population policies. Springer.
Coale, A. J. (1991). Excess female mortality and the balance of the sexes in the population: An estimate of the number of ‘missing females’. Population and Development Review, 17(3), 517–523.
Conly, S. (2016). One child: Do we have a right to more? Oxford University Press.
Council of Europe. (1997). Convention on human rights and biomedicine. Council of Europe. See https://rm.coe.int/CoERMPublicCommonSearchServices/DisplayDCTMContent?documentId=090000168007cf98
Crane, B., & Maistrellis, E. A. (this volume). Chapter 28: The role of abortion in population policies. In J. F. May & J. A. Goldstone (Eds.), International handbook of population policies. Springer.
Croll, E. (2000). Endangered daughters: Discrimination and development in Asia. Routledge.
Daar, J., Benward, J., Collins, L. R., Davis, J. B., Davis, O., Francis, L., Gates, E., et al. (2018). Disclosure of sex when incidentally revealed as part of preimplantation genetic testing (PGT): An ethics committee opinion. Fertility and Sterility, 110(4), 625–627.
Daley, B. (2014). Oversold prenatal tests spur some to choose abortions. Harvard Medical School News & Research. See https://hms.harvard.edu/news/oversold-prenatal-tests-spur-some-choose-abortions
Das Gupta, M. (2015). ‘Missing girls’ in the South Caucasus countries: Trends, possible causes, and policy options (Policy research working paper WPS7236). World Bank Group.
Davin, D. (2007). Marriage migration in China and East Asia. Journal of Contemporary China, 16(50), 83–95.
De Jong, A., Dondorp, W. J., Die-Smulders, C. E. M., de Frints, S. G. M., & de Wert, G. M. W. R. (2010). Non-invasive prenatal testing: Ethical issues explored. European Journal of Human Genetics, 18(3), 272–277.
Dondorp, W., De Wert, G., Pennings, G., Shenfield, F., Devroey, P., Tarlatzis, B., Barri, P., & Diedrich, K. (2013). ESHRE task force on ethics and law 20: Sex selection for non-medical reasons. Human Reproduction, 28(6), 1448–1454.
Drèze, J., & Sen, A. (1990). Hunger and public action. Wider studies in development economics. Oxford University Press.
Dubuc, S., & Coleman, D. (2007). An increase in the sex ratio of births to India-born mothers in England and Wales: Evidence for sex-selective abortion. Population and Development Review, 33(2), 383–400.
Duthé, G., Meslé, F., Vallin, J., Badurashvili, I., & Kuyumjyan, K. (2012). High sex ratios at birth in the Caucasus: Modern technology to satisfy old desires. Population and Development Review, 38(3), 487–501.
Ehrlich, P. R. (1975). The population bomb (Revised ed.). River City Press.
Eklund, L., & Purewal, N. (2017). The bio-politics of population control and sex-selective abortion in China and India. Feminism & Psychology, 27(1), 34–55.
European Union. (2015). Action document for the global Programme to prevent son preference and gender-biased sex selection. European Union. See https://ec.europa.eu/europeaid/file/48549/download_en?token=hyseRA9W
Frost, M. D., Puri, M., & Hinde, P. R. A. (2013). Falling sex ratios and emerging evidence of sex-selective abortion in Nepal: Evidence from nationally representative survey data. British Medical Journal Open, 3, e002612. https://doi.org/10.1136/bmjopen-2013-002612
Gammeltoft, T., & Nguyên, H. T. T. (2007). The commodification of obstetric ultrasound scanning in Hanoi, Viet Nam. Reproductive Health Matters, 15(29), 163–171.
Goodkind, D. (2017). The astonishing population averted by China’s birth restrictions: Estimates, nightmares, and reprogrammed ambitions. Demography, 54(4), 1375–1400.
Guilmoto, C. Z. (2009). The sex ratio transition in Asia. Population and Development Review, 35(3), 519–549.
Guilmoto, C. Z. (2015). The masculinization of births. Overview and current knowledge. Population, 70(2), 201–264.
Guilmoto, C. Z., & Duthé, G. (2013). Masculinization of births in Eastern Europe. Population & Societies, 506, 1–4.
Guilmoto, C. Z., Dudwick, N., Gjonça, A., & Rahm, L. (2018). How do demographic trends change? The onset of birth masculinization in Albania, Georgia, and Vietnam 1990-2005. Population and Development Review, 44(1), 37–61.
Guilmoto, C. Z., Chao, F., & Kulkarni, P. M. (2020). On the estimation of female births missing due to prenatal sex selection. Population Studies, 74(2), 283–289. https://doi.org/10.1080/00324728.2020.1762912
Guo, Z., Das Gupta, M., & Li, S. (2016). ‘Missing girls’ in China and India: Trends and policy challenges. Asian Population Studies, 12(2), 135–155.
Gupta, J. A. (2000). New reproductive technologies, Women’s health and autonomy: Freedom or dependency (Indo-Dutch studies on development alternatives 25). Sage Publications.
Hakim, C. (2015). The male sexual deficit: A social fact of the 21st century. International Sociology, 30(3), 314–335. https://doi.org/10.1177/0268580915569090
Hesketh, T., & Xing, Z. W. (2006). Abnormal sex ratios in human populations: Causes and consequences. Proceedings of the National Academy of Sciences, 103(36), 13271–13275.
Hudson, V. M., & Den Boer, A. (2004). Bare branches: The security implications of Asia’s surplus male population (BCSIA studies in international security). MIT Press.
Jejeebhoy, S. J., Acharya, R., Basu, S., & Francis Zavier, A. J. (2015). Addressing gender-biased sex selection in Haryana, India: Promising approaches. The Population Council.
Jha, P., Kesler, M. A., Kumar, R., Ram, F., Ram, U., Aleksandrowicz, L., Bassani, D. G., Chandra, S., & Banthia, J. K. (2011). Trends in selective abortions of girls in India: Analysis of nationally representative birth histories from 1990 to 2005 and census data from 1991 to 2011. The Lancet, 377(9781), 1921–1928.
Kaur, R. (2012). Marriage and migration citizenship and marital experience in cross-border marriages between Uttar Pradesh, West Bengal and Bangladesh. Economic and Political Weekly, 47(43), 78–89.
Kaye, B., & Jittapong, K. (2014, July 15). In Thailand, Baby Gender Selection Loophole Draws China, HK Women to IVF Clinics. Reuters. See https://www.reuters.com/article/us-thailand-ivf-gender-selection/in-thailand-baby-gender-selection-loophole-draws-china-hk-women-to-ivf-clinics-idUSKBN0FK2H020140715
KIHASA and UNFPA. (1996). Sex preference for children and gender discrimination in Asia. Korea Institute for Health and Social Affairs (KIHASA).
Kippen, R., Gray, E., & Evans, A. (2018). High and growing disapproval of sex-selection Technology in Australia. Reproductive Health, 15(1), 134. https://doi.org/10.1186/s12978-018-0577-5
Klasen, S., & Wink, C. (2003). ‘Missing women’: Revisiting the debate. Feminist Economics, 9(2–3), 263–299.
Klitzman, R. (2019). Designing babies: How technology is changing the ways we create children. Oxford University Press.
Kumar, D. (1985). Should one be free to choose the sex of One’s child? Journal of Applied Philosophy, 2(2), 197–204.
Le Bach, D., Bélanger, D., & Khuat, T. H. (2007). Transnational Migration, Marriage and Trafficking at the China-Vietnam Border. In I. Attané & C. Z. Guilmoto (Eds.), Watering the Neighbour’s garden: The growing demographic female deficit in Asia (pp. 393–425). CICRED.
Lee, H. K. (2013). Marriage migration. In I. Ness (Ed.), The encyclopedia of global human migration. Blackwell Publishing Ltd..
Leiter, G. (2014). What Israeli policy can teach us about elective sex selection. Israel Journal of Health Policy Research, 3, 42.
May, J. F. (2012). World population policies: Their origin, evolution, and impact. Springer.
Nanda, P., Datta, N., & Das, P. (2014). Impact of conditional cash transfers on girls’ education. International Center for Research on Women.
Nandi, A., & Deolalikar, A. B. (2013). Does a legal ban on sex-selective abortions improve child sex ratios? Evidence from a policy change in India. Journal of Development Economics, 103, 216–228.
Ossareh, T. (2017). Would you like blue eyes with that? A fundamental right to genetic modification of embryos. Columbia Law Review, 117(3), 729–766.
PACE. (2011). Prenatal sex selection. Resolution 1829. Parliamentary Assembly Council of Europe. See http://assembly.coe.int/nw/xml/XRef/Xref-XML2HTML-en.asp?fileid=18020&lang=EN
Papadopoulou, A. (2013). Gendercide: The missing women? (2012/2273 (INI)). European Parliament, Committee on Women’s Rights and Gender Equality. See https://www.europarl.europa.eu/sides/getDoc.do?reference=A7-2013-0245&type=REPORT&language=EN&redirect
Peters, B. G., & Nagel, M. L. (2020). Zombie ideas: Why failed policy ideas persist. Cambridge University Press.
Rae, S. (2018). Moral choices: An introduction to ethics (4th ed.). Zondervan.
Rahm, L. (2017). La Convergence des Politiques de Lutte Contre la Sélection Sexuelle Prénatale : Corée du Sud, Inde et Vietnam. Critique Internationale, 4(77), 11–31.
Rahm, L. (2019). Protect, track, emancipate: The role of political masculinities in India’s fight against sex selection. Men and Masculinities, 22(3), 529–562. https://doi.org/10.1177/1097184X18768873
Rahm, L. (2020). Gender-biased sex selection in South Korea, India and Vietnam: Assessing the influence of public policy. In Demographic transformation and socio-economic development. Springer.
Rapp, R. (2017). The egg imaginary. In A. Wahlberg & T. Gammeltoft (Eds.), Selective reproduction in the 21st century (pp. v–viii). Springer.
Roberts, J. C. (2002). Customizing conception: A survey of preimplantation genetic diagnosis and the resulting social, ethical, and legal dilemmas. Duke Law & Technology Review, 1(1), 1–21. PMID: 15709286.
Rogers, E. M. (2003). Diffusion of innovations (5th ed.). Free Press.
Saxena, B. N. (1996). Reproductive health in India. Advances in Contraception, 12(4), 265–270.
Sekher, T. V., & Ram, F. (2015). Conditional cash transfers for girls in India: Assessment of a girl child promotion scheme from beneficiary perspective. International Institute for Population Sciences (IIPS) & United Nations Population Fund (UNFPA).
Sen, A. (1990, December 20). More than 100 million women are missing. The New York Review of Books.
Sen, A. (2003). Missing women: Revisited. British Medical Journal, 327(7427), 1297–1298.
Shijith, V. P., & Sekher, T. V. (2017). ‘Unwanted’ is my name: Culture, patriarchy and gender bias surrounding the Nakusa girls of Maharashtra. Sociological Bulletin, 66(1), 58–74.
Singh, K. (2013). Laws and son preference in India. A reality check. United Nations Population Fund India.
Sinha, N., & Yoong, J. (2009). Long-term financial incentives and Investment in Daughters: Evidence from conditional cash transfers in North India (Policy research working papers). World Bank Group.
Sleeboom-Faulkner, M. (Ed.). (2010). Frameworks of choice: Predictive and genetic testing in Asia. Amsterdam University Press.
South, S. J., & Trent, K. (2010). Imbalanced sex ratios, Men’s sexual behavior, and risk of sexually transmitted infection in China. Journal of Health and Social Behavior, 51(4), 376–390.
Srinivasan, S., & Li, S. (2018). Scarce women and surplus men in China and India: Macro demographics versus local dynamics. Springer.
Stachowiak, S., Lynn, J., & Akey, T. (2020). Finding the impact: Methods for assessing the contribution of collective impact to systems and population change in a multi-site study. New Directions for Evaluation, 165, 29–44. https://doi.org/10.1002/ev.20398
Steinbock, B. (2002). Sex selection: Not obviously wrong. The Hastings Center Report, 32(1), 23–28.
Tarsilla, M. (this volume). Chapter 24: Measuring the effectiveness, efficiency, and impact of population policies. In J. F. May & J. A. Goldstone (Eds.), International handbook of population policies. Springer.
UNFPA. (2012). Sex imbalances at birth: Current trends, consequences and policy implications. United Nations Population Fund, Asia and the Pacific Regional Office.
United Nations. (1995). International conference on population and development (ICPD) Programme of action. United Nations.
Urdal, H. (2006). A clash of generations? Youth bulges and political violence. International Studies Quarterly, 50(3), 607–629.
Verma, I. C., Joseph, R., Verma, K., Buckshee, K., & Ghai, O. P. (1975). Prenatal diagnosis of genetic disorders. Indian Pediatrics, 12(5), 381–386.
Vishwakarma, M., Shekhar, C., & Yadav, A. (2019). Variations in marriage squeeze by region, religion, and caste in India. Journal of Comparative Family Studies, 50(4), 313–330.
Wahlberg, A., & Gammeltoft, T. (Eds.). (2017). Selective reproduction in the 21st century. Springer.
Whittaker, A. (2011). Cross-border assisted reproduction Care in Asia: Implications for access, equity and regulations. Reproductive Health Matters, 19(37), 107–116.
WHO. (2011). Preventing gender-biased sex selection: An interagency statement OHCHR, UNFPA, UNICEF, UN women and WHO. World Health Organization.
WHO. (2022). Abortion care guideline. World Health Organization.
Woetzel, J., Madgavkar, A., Ellingrud, K., Labaye, E., Devillard, S., Kutcher, E., Manyika, J., Dobbs, R., & Krishnan, M. (2015). The power of parity: How advancing Women’s equality can add $12 trillion to global growth. McKinsey Global Institute.
Yang, X., Wang, S., & Eklund, L. (2020). Reacting to social discrimination? Men’s individual and social risk behaviors in the context of a male marriage squeeze in rural China. Social Science & Medicine, 246, 112729. https://doi.org/10.1016/j.socscimed.2019.112729
Zhao, Z., & Zhang, G. (2018). Socioeconomic factors have been the major driving force of China’s fertility changes since the mid-1990s. Demography, 55(2), 733–742.
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Rahm, L. (2022). Bioethics, Sex Selection, and Gender Equity. In: May, J.F., Goldstone, J.A. (eds) International Handbook of Population Policies. International Handbooks of Population, vol 11. Springer, Cham. https://doi.org/10.1007/978-3-031-02040-7_33
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