The Ethics of Sex Selection

The Ethics of Sex Selection
July 11, 2023 No Comments Gender Dvita Bhattacharya

(Un)conditional Love: The Ethics of Selecting and Designing on the Basis of Sex

By Dvita Bhattacharya

Since its birth in the 1890s, reproductive technology have changed our fundamental beliefs about life and procreation by giving parents and doctors the godlike power to select a fetus’s traits and determine a child’s characteristics. This paper will focus on the use of reproductive technologies in sex selection, which is the attempt to choose the sex of a fetus. I will explore the various principles and values used to support or oppose the practice of sex selection, and review the ethical differences between different methods of sex selection. When altering or selecting for sex, how do we balance parental autonomy over children and the principle of procreative beneficence with the threat of discriminating against embryos based on sex? Is it ever ethical to edit aspects of a human’s identity without their consent? What is the ethical difference between selecting preexisting embryos and designing them? 

Table of Contents

Abstract

Today, more than 140 million women are missing from the world (Gender Biased Selection). They aren’t victims of kidnapping or human trafficking or even murder – these 140 million women simply do not exist. So where did they go? This number refers to all of the daughters who were aborted, selected against, or even killed postnatally because of their sex. These are examples of sex selection, the practice of choosing the sex of a child, at play. Sex selective practices have been common throughout history, and not all of them are as sinister as murdering female infants. From ancient civilizations to the 21st century, mankind has always been interested in controlling the sex of offspring and achieving the “ideal child”, which is usually male. In Jewish tradition, for example, the timing of ejaculation was said to determine whether a child would be female or male. In Ancient Greece, men used to tie off their left testicle in order to conceive male children, since the left was believed to produce “female” sperm. If they wanted a daughter, Greek women would eat salads and wet, cold foods during pregnancy. Even today, many myths about sex selection persist, and everything from intercourse positions to a mother’s diet is purported to affect the sex of the child. Although these practices were largely pseudoscientific and ineffective, sex selection can now be achieved through newer, scientifically accurate methods.

In the last century, the advent of reproductive technology and genetic engineering has produced some concrete, scientific methods of achieving sex selection. These technologies have given parents and doctors the godlike power to actually select a fetus’ traits and determine a child’s sex. There are many ways to medically accomplish sex selection, but this paper will focus on two main methods: the use of Preimplantation Genetic Screening (PGS) in In Vitro Fertilization (IVF) and genetic engineering. PGS is a screening method which identifies chromosomal abnormalities in IVF embryos, as well as the embryos’ chromosomal sex. Parents can use this information to select an embryo for implantation – in many cases, this decision is made on the basis of sex (“Understanding Gender Selection”). Genetic engineering, on the other hand, directly alters the sex of an embryo by editing its genome, thus creating a “designer baby” with the desired sex. Although genetic engineering hasn’t been used to perform sex selection yet, the rapid development of the field suggests that it will be a viable option in the near future. This paper will explore the ethics of sex selection and the ethical differences between different methods of sex selection. How do we balance parental autonomy over children and the principle of procreative beneficence with the threat of prenatal discrimination based on sex? Is it ever ethical to edit aspects of a human’s identity without their consent? Is there an ethical difference between selecting preexisting embryos and designing them? 

Medical vs. Non-medical Sex Selection

Before assessing the ethical implications of sex selection, it’s important to distinguish between medical and non-medical sex selection. Medical sex selection is used to choose a male or female embryo in order to avoid the inheritance of sex-linked diseases. Sex linked diseases are caused by genes located on either the X or Y chromosome (typically the X chromosome). Thus, the probability of inheriting a sex linked disease varies based on sex. For example, hemophilia and Duchenne Muscular Dystrophy are X linked recessive disorders which are more likely to be inherited by males than females since males have one X chromosome. Some of these diseases can have severe long-term impacts on quality of life and patient health. Duchenne Muscular Dystrophy, which has no known cure, leads to progressive muscle degeneration, intellectual impairment and severe deterioration of heart muscle (Duchenne Muscular Dystrophy). If a family has a history of sex-linked disorders, especially severe ones, they will often select one sex out of medical concern or necessity. 

Medical sex selection is generally considered to be ethical, and many countries allow selection due to sex linked diseases. The American Society for Reproductive Medicine (ASRM) has condoned and even recommended the use of PGS for sex selection in order to avoid transmitting serious genetic diseases (Aghajanova and Valdes). ASRM states that medical sex selection is ethical in order to create healthy offspring and prevent disease-related suffering. In these cases, selection is not motivated by misogyny or parental preference, but by genuine medical concerns and complications. Medical sex selection is also less likely to disproportionately affect one sex since its occurrence is relatively limited. 

Non-medical sex selection, on the other hand, is not medically necessary and is performed due to parental preference for one sex. In many cases, parents use non-medical selection in order to pursue “family balancing”, the practice of balancing the number of sons and daughters within a family . For example, if parents already have multiple sons, they may want to pursue sex selection in order to produce a daughter. In other cases, parents may feel better prepared to care for a child of one sex or may want to have a child of the same sex as one they lost. Non-medical sex selection can also be motivated by cultural beliefs and prejudices against one sex. This usually manifests as son preference, where families choose to have male children over females. In cultures where male children are prized and mothers are pressured to bear sons, many parents turn to sex selection as a means to produce one. Altogether, there are many reasons parents may prefer having sons or daughters, even when it isn’t medically necessary.

This paper will focus only on the ethics of non-medical sex selection and the implications of choosing one sex due to parental preference. Non-medical sex selection is a heavily contested topic, and is more directly related to issues of sexism and bias in healthcare. Medical sex selection, on the other hand, largely concerns disability ethics and whether children deserve to be born regardless of medical conditions or quality of life. 

“This is where you would write the quote.”

– Author, Source or Title

Stakeholders

When analyzing the ethics of sex selection, I will begin by examining the stakeholders who are impacted by non-medical sex selection, including the implanted and unused embryos, parents, the medical community, and society as a whole. For embryos, although they may not be fully developed individuals (further explored below), their bodily integrity and opportunity to live is at stake in the process of sex selection. Another stakeholder is the parents, who will be financially, emotionally and mentally invested in the child’s upbringing. Since they will be responsible for raising the child and will be a part of the family, parental autonomy and safety must be taken into consideration in this issue. The medical community (including the physicians and nurses who would be involved in sex-selective procedures) is another stakeholder, since the act of sex selection could place healthcare providers in moral distress and jeopardize their careers. Lastly, society as a whole is a major stakeholder in this issue. The decision we make regarding the ethicality of sex selection will set a medical precedent about how much power humans can have over the traits of their children. Since sex selection is essentially “choosing” the traits of a baby, this decision will impact future laws regarding genetic engineering, reproduction, and designer babies. There are also wide societal ramifications of sex selection such as an imbalanced sex ratio, which is when the proportion of males and females in a population is skewed. Having too many children of one sex can impact the birth rate of the entire population and jeopardize a society’s stability. Lastly, if sex selection is allowed, society (especially women) is also impacted by the possibility of reinforcing sexism and validating son preference. 

Current Laws

Currently, sex selection is legal in most countries of the world; however, some countries have taken steps towards regulating the use of abortion and PGS for sex selection. The UK, Canada, Australia and 28 other countries have banned sex selection for any non-medical purposes. However, other countries still allow non-medical selection with restrictions. Israel, for example, allows non-medical sex selection “only if a family has 4 children of one sex and desires a child of the opposite sex” (Aghajanova and Valdes), thus supporting family balancing. In countries with extreme rates of sex selection, the practice has been outlawed altogether and more severe policies have been established to regulate it. In India, for example, healthcare providers are not allowed to disclose the sex of the baby to the parent unless a sex-linked disorder is involved. China is another country which faced a spike in sex selective practices as a result of their one-child policy, which led to parents having only one opportunity to produce a male son. In order to mitigate these practices, the Chinese government placed a ban on sex selective abortions. 

 Many other countries have no clear regulations on sex selection, including the United States, where PGS and abortions can still be used for sex selection (although the recent overturning of Roe v. Wade has resulted in abortions being illegal overall in many states). Individual clinics make their own decisions regarding whether to provide sex selective procedures, rather than there being a national standard. The USA is not close to reaching a consensus, with the American Society for Reproductive Medicine having “waffled on the issue of social sex selection” (Hvistendahl 259). The USA does not even have an informal consensus on the issue, let alone any legislation regulating sex selection. As genetic engineering and reproductive technology advance, we need to take a clear stance on the ethicality of sex selection; we cannot afford to have weak regulation on such a monumental technological development.

Ethical Considerations for Fetuses and Embryos

In the last year, the overruling of Roe v. Wade and debate regarding abortion rights have brought up important questions regarding a fetus’s rights. Since fetuses are not fully developed persons and lack autonomy, what rights and ethical considerations do we give them? Do we treat them as full “persons” and give them complete rights? Fetuses are directly altered or selected as a result of sex selection, and they must be considered as a key stakeholder in the issue. Since Roe v. Wade was overturned, many states have introduced fetal personhood laws, which grant fetuses, zygotes and embryos constitutional rights and full protection under the law (much like any born human) under the belief that “personhood” begins at conception. Under this framework, discarding or selecting against an embryo on the basis of sex would be seen as sex-based discrimination and would be akin to “killing” a full person. Since the embryo has full rights, including bodily autonomy, genetically editing an embryo could be seen as subjecting a human to a medical procedure without their informed consent. However, others believe that fetuses and embryos are not entitled to full personhood until the point of viability (24 weeks), or even until birth. For example, the Universal Declaration of Human rights states that “[a]ll human beings are born free and equal in dignity and rights”, suggesting that a human only gains its full rights at birth. Children are born with equal rights, but not necessarily conceived with equal rights. 

Ultimately, whether or not the fetus is a true “person”, both of these ideologies agree that fetuses and embryos deserve at least some moral consideration and “rights”. In the US, for example, fetuses aren’t recognized as people under the law, but they are still given moral consideration during pregnancy. For example, the health and well-being of the fetus is considered when making any medical decisions during gestation. As the American Convention on Human Rights says, “Every person has the right to have his life respected. This right shall be protected by law and, in general, from the moment of conception”. Whether or not a fetus is a full person, it still deserves to be considered and respected when making ethical decisions which concern it. 

Altogether, sex selection is a nuanced, evolving topic which has widespread impacts on our society and the future of medicine. Despite being such a “hot topic”, many countries, such as the United States, have yet to take a definitive stance on the issue and many still debate the ethicality of this practice. As reproductive and genetic technologies progress, it’s crucial that we make a clear decision regarding sex selection; such a groundbreaking technology cannot be loosely regulated. We need to decide how much control parents can have over the traits of their children and weigh the “rights” of a fetus with the autonomy and rights of parents. In the next section, I’ll go over the various values and arguments used in support of and against sex selection, in order to provide a basic understanding of the ethics of this issue. 

Values Supporting Sex Selection

First, I will review some of the values and principles often used in support of sex selection.

Procreative Beneficence

Procreative Beneficence is the principle that parents have a responsibility to select the child who is most likely to lead the best life. It is a parent’s duty to “do good” for their child by selecting the one which is most likely to succeed and have a good quality of life. This principle is often used to justify sex selection, since in many cultures, male children are more likely to find financial, professional and personal success than females. For example, on average, women in South Korea earn 31.3% less than men, and Indian women earn 35% less than their male counterparts. Women are also far more likely to face sexual assault and rape than men, with 1 in 3 women worldwide being subjected to sexual violence. In 2016, 99% of human trafficking victims were women and young girls. If a parent knows that a son is more likely to find fulfillment and safety than a daughter, procreative beneficence would dictate that it is their duty to select the male child. Ultimately, a parent’s responsibility is to raise a child with the best quality of life which they can get and protect them from harm such as sexual violence, rape and discrimination. No parent wants to see their child suffer, and in heavily sexist cultures, it’s reasonable to expect that bringing a daughter into the world could be setting her up for a lower quality of life. 

However, the threat of procreative beneficence lies in the issue of deciding what is the “best life”. Who gets to make the decision of what life is worth living? Someone who disagrees would say that claiming that a female child’s life is less worth living is discriminatory, not beneficent. Additionally, the framework of procreative beneficence can be extended to select for many other characteristics, such as disabilities, height, skin color or eye color. In these scenarios, parents could argue that they are simply selecting for a child which they believe will have a “better quality of life”.  For example, selecting against a baby with a disability could be justified as a beneficent, virtuous intent. But at what point do we draw the line between procreative beneficence and ableism? Are we justifying creating designer babies for the sake of providing a “better quality of life”? And who determines what a  “good life” even is? Many disabilities, for example, are perfectly livable and individuals with the disability can still lead fulfilling lives. Yet, parents often choose to select against children with these disabilities due to societal stigma and discrimination. In cases like these, parental decisions are shaped by what society believes 

Safety

Another value used to support sex selection is safety, specifically the safety of the mother and child in sexist environments. In many cultures, women are often pressured to have male children, and can face physical, verbal or emotional abuse if they are unable to deliver a son. For example, a study in Xiangyun County, China found that male child preference was associated with prenatal anxiety for mothers, as well as lower self esteem, low family cohesiveness and poor relationships with husbands (Loo et al. 2010). In Confucian ideals, it is a mother’s duty to produce a male heir and her ability to do so affects her status and reputation within her community. In such cases, selecting for a male child would not only save the child from a sexist environment, but it would also save the mother from disgrace and humiliation due to social pressures. Through a utilitarian lens, allowing sex selection would result in the greatest safety and benefit to the mother and the child. 

Parental Autonomy

Another principle used in support of sex selection is parental autonomy, which dictates that parents have the right to form and raise the family they want. This doctrine states that parents have the right to “make all decisions concerning [their] child” (“Parental Autonomy Doctrine”). A parent’s decision to select and raise a child of a specific sex is reflective of their personal beliefs and desires, and they have the right to form a family which aligns with these ideals. Parents also have autonomy over countless other facets of their children’s lives: they determine their religion, education, and general upbringing. Parental influence during childhood largely shapes how a child views themself and their sense of identity – it influences their psychology, their fundamental beliefs and their future. If parents can exercise so much control in these regions, why should sex selection be any different? Parents are able to “mold” their children in many different ways, so why does sex selection differ? 

Values Against Sex Selection

Now, I will review some of the opposing views on sex selection, including the values and principles used by critics of the practice.

Equality

One of the main arguments against sex selection is regarding equality and sex-based discrimination. According to the UN, gender equality is a “fundamental human right” which is essential to the development and prosperity of the modern world. Sex selection is problematic because it directly denies children a chance at life based on their sex. Should characteristics of identity, such as sex or race, ever determine whether an embryo deserves to live? Allowing the selection of sons over daughters sends the message that women’s lives are not worth living and are inherently inferior to men’s. Sex selection suggests that one sex is more worthy of life and allows parents to inflict society’s sexist beliefs upon their children. Women are already discriminated against during their life; however, sex selection would erase their voices entirely, by preventing these women from even being born. 

At the end of the day, sex is not a disease to be eliminated. It’s a fundamental part of identity and there is no medical reason (aside from sex-linked disorders) to edit or select the sex of a child. Sex selection is an entirely non-medical procedure done not out of necessity, but out of parental and cultural beliefs regarding sex. 

Unconditional Love

Another idea used against sex selection is the idea that parents should love their children unconditionally. Parents have the responsibility to love their children regardless of their identity. A parent should not value their child’s life based on its sex – rather, they have a responsibility to love and care for the child regardless. Sex selection violates this duty by suggesting that one child is more “worthy” of life. A parent’s desire to have a child should not be contingent on whether they have a daughter or a son. Sex selection can show a lack of respect for the inherent value of life, since, instead of cherishing their child as they are, parents value or devalue a child based on factors of identity such as sex. 

Sex selection can also be seen as a selfish practice since parents should not have children for the sake of personal gain, but out of an altruistic desire to nurture and care for their offspring. Mara Hvistendahl wrote in her book Unnatural Selection, “Preimplantation sex selection, some theorists now conclude, prioritizes the needs of one generation over another, making having children more about bringing parents satisfaction than about responsibly creating an independent human being” (Hvistendahl 260). Children should not be used as objects to be personalized to bring parents satisfaction. Rather, they should be welcomed and loved unconditionally regardless of their identity. Parents who view one child as less than another due to their sex violate this duty by judging a child’s worth based on its sex.

Slippery Slope and “Playing God”

Allowing sex selection leads to the slippery slope of allowing parents to choose their child’s traits. If non-medical selection for sex is allowed, then what stops parents from selecting for height, eye color or athletic ability? Condoning sex selection sets the precedent that it is ethically acceptable to create “designer babies” and select embryos on the basis of non-medical traits. Through sex selection, parents are essentially paying for certain traits in our children, thus commodifying their life as something to be customized and purchased to fit parental desires. Children shouldn’t be treated as objects to be molded and personalized; as a society, to respect life instead of reducing it to a product or commodity. 

Another slippery slope which may arise is unequal access to this technology, since not everyone can afford PGS or genetic engineering. Due to the high cost of IVF and (in the future) genetic engineering, it is reasonable to expect that only the wealthy would be able to select the traits of their children, thus “purchasing” perfect children. This may further inequalities between upper and lower classes by allowing parents to select for children who have greater intellectual, athletic or artistic abilities (eg. better vocal cords, height or strength). Upper classes would also be able to select for “healthier” children who are less likely to contract disease by eliminating disease causing genes.

Lastly, allowing sex selection in PGS and genetic engineering could also justify sex selective abortions or infanticide. Ultimately, allowing sex selective PGS and genetic engineering sends the message that it’s acceptable to choose a certain child based on its sex. This ideology may be used to condone sex selective abortions and could further entrench sexist beliefs. Instead of fighting the sexism which often leads to sex selective procedures, allowing sex selection would only facilitate these cultural beliefs. 

Lastly, sex selection also allows parents and doctors to “Play God” and meddle in a natural process. By performing sex selection, parents are intervening in the natural human variation of sex. Many argue that it is not the place of parents or doctors to select and edit a human life – rather, life should be respected as an independent force. As Dr. Michael Sandel, an American philosopher and professor at Harvard University, put it:

“The deeper danger is that [enhancement and genetic engineering] represent a kind of hyperagency—a Promethean aspiration to remake nature, including human nature, to serve our purposes and satisfy our desires.”

– Dr. Michael Sandel

 The idea of hyperagency suggests that there is a point where humans have too much control over the processes of nature. Human life, and nature as a whole, shouldn’t be manipulated and influenced to serve our own goals. When considering the idea of hyperagency and playing god, it’s also important to consider just how far parental autonomy truly stretches. Parents have the right to decide when to have a child, but should they have the right to determine that child’s traits? Mara Hvistendahl, an investigative correspondent at the New York Times, believes that they don’t.

“A woman should have the right to terminate a pregnancy, but she should not have the right  to shape the individual represented by that pregnancy to her own whims”

– Mara Hvistendahl

Under Hvistendahl’s framework, parental autonomy only extends to deciding whether or not parents want to have a child, but not to the child’s traits. Parents should have autonomy over when they want to conceive, but not over their child’s characteristics.

Ways of Achieving Sex Selection

Currently, there are several ways to achieve sex selection, including sex-selective abortions, Preimplantation Genetic Screening, genetic engineering (in the future), and sperm sorting. For the purposes of this paper, I will be examining the ethics of Preimplantation Genetic Screening and genetic engineering.

Preimplantation Genetic Screening (PGS) is a procedure used in In Vitro Fertilization (IVF) which screens the number of chromosomes of each embryo, allowing doctors to identify aneuploid conditions such as Trisomy 21(Down Syndrome). PGS also identifies the sex of the embryo, which can be used to select a certain embryo out of the fertilized set on the basis of sex. This procedure is widely used today in the process of selecting IVF embryos for implantation. The embryos which are not selected are either discarded, donated to another couple, donated to scientific research, or frozen and stored for later use. 

Genetic engineering, on the other hand, is the practice of modifying an organism’s genetic material to enhance its capabilities or alter its traits. Currently, genetic engineering is used to produce cancer therapies, genetically modify plants and animals, and produce hormones such as insulin and human growth hormone. Although it has not been used for sex selection yet, the rapid advances in genetic engineering technology suggest that parents may soon be able to use this method to select a male or female child. Genetic engineering works by incorporating “desired” genes into a viral vector, which is a specialized virus that can insert its genetic material into the infected cell’s DNA. The vector enters the target cell and inserts the desired gene into the target cell’s DNA, thereby editing its genome. For sex selection, the viral vector would carry and incorporate sex-related genes into an egg, sperm or embryo, thus causing it to express the traits of that sex. In genetic engineering, embryos would (hypothetically) not be discarded, since a single embryo would be edited to be a certain sex. 

Ethical Differences Between Methods

When considering the ethicality of sex selection, I also considered the ethical differences between the different methods of sex selection. PGS (through IVF) essentially creates a batch of embryos and then selects an embryo to implant based on its sex. Genetic engineering, on the other hand, edits the embryo’s genome to produce a child of a certain sex. Thus, the use of these two methods raises the question of whether there is an ethical difference between selecting and designing for a certain sex. 

The main ethical issue with PGS is regarding the bioethical principle of justice, which states that everyone should have an equal opportunity to receive care and that healthcare should not be provided or denied based on sex, race, sexuality, or other identity factors. PGS selects one embryo out of a batch based on its sex, thus “screening” out some embryos and denying them  a chance at life because of their sex. This practice is considered prenatal discrimination, since embryos are discriminated against based on whether they are male or female. Thus, some would argue that choosing embryos based on their sex is unethical.

Someone who disagrees might say that this is no different from any other IVF procedure, which would also discard or freeze any “unwanted” embryos. All IVF procedures “choose” certain embryos based on aspects of their traits, thus discriminating based on other genetic factors. However, in those cases embryos are often discarded based on severe genetic risks and disorders which could jeopardize the baby’s health. IVF usually selects babies through medical criteria, thus ensuring that there are no medical consequences to the fetus. 

Alternatively, one benefit of PGS is that it preserves the bodily integrity of embryos and does not meddle in their genetic material. The embryo which is selected is already either male or female,  embryos are not actually modified, thus preserving their bodily integrity. Instead of fundamentally altering a baby’s identity without its consent, PGS simply selects among embryos whose sex is unchanging. There is no alteration or modification involved.

Genetic engineering, on the other hand, directly alters the sex of a baby by editing its genome. This raises different ethical questions surrounding hyperagency and consent. We must consider how much agency and power humans can have over life itself. Through genetic engineering, humans can fundamentally alter life at an unprecedented scale by directly altering the genetic makeup of their child. Instead of simply selecting for preexisting traits, parents can now directly “personalize” a baby to fit a their ideals. This brings in important considerations about the child’s autonomy and consent. While PGS does not alter the embryo, genetic engineering would change a fundamental aspect of the child’s identity without their consent.

Consequentialism

I decided to view sex selection through consequentialism, which determines the ethicality of an action based on its consequences. I used this framework due to the broad consequences sex selection has, not just on parents and children, but on society as a whole. After researching the various stances on this issue, I found that the practice of sex selection is not ethical due to the threat of sex based discrimination, the impact on sex ratios and the precedent set regarding human agency in childbirth. In this section, I will review some of the repercussions considered before, as well as outlining some other consequences I found. 

The first consequence I considered was the threat of reaffirming sexism by condoning sex selective procedures. Many sex selective procedures are the result of sexist beliefs and cultural standards which make producing sons a priority. In historically patrilineal societies, sons are seen as the breadwinner of the family and the one to “continue the family line”, whereas daughters are temporary figures who leave the household once they marry. As a result, sons are highly desired and families often resort to sex selective procedures to secure male offspring. By allowing sex selection, we would be condoning these practices and facilitating the prenatal discrimination which denies daughters the opportunity to live. Someone who disagrees may say that allowing sex selection simply preserves parental autonomy to form a family based on their cultural, religious and personal beliefs. However, this approach sets the dangerous precedent of accepting sexism because it is a part of someone’s “culture” or religion. Sexism and son preference are forms of discrimination, and they should not be excused for being “cultural beliefs”. 

Allowing sex selection for family balancing also raises the threat of reinforcing traditional gender norms and heteronormativity, which is the belief that gender roles and the male-female binary define the human experience. Parents who choose family balancing often want the experience of “raising a boy” or “raising a girl”. But why do parents believe that these are such fundamentally different experiences? This preference perhaps indicates societal expectations regarding what a son or a daughter should act like – for example, believing that girls play with dolls while boys like dinosaurs or cars. Parents expect a biologically female child to act like a “girl” and a biologically male child to act like a “boy”. However, being male doesn’t mean a child will exhibit traditionally masculine traits, just as being female doesn’t mean a child will act feminine. Philosopher and researcher Arianne Shahvisi writes, “This, in turn, relies on the heteronormative idea that biologically female children afford parents a rearing experience that one would expect from a child who is gendered as a girl […] Any set of characteristics that one can think to list as being typical of a “girl” as opposed to a “female” generate immediate discomfort—they are very obviously rehearsals of stereotypes” (Shahvisi). Furthermore, family balancing also disregards intersex children and transgender individuals. Gender and sex are not a binary, yet family balancing treats them as an either-or situation and relies “on a binary in rearing experiences” (Shahvisi). Thus, the desire to family balance is often rooted in gender norms and stereotypes regarding differences between males and females. Allowing parents to family balance reinforces these gender norms and the gender binary by validating the idea that raising a “boy” and raising a “girl” are fundamentally different experiences.

Another harm I considered was the threat of disrupting the sex ratio of a country through sex selection. Sex ratio refers to the ratio of males to females within a population, which can be skewed by excessive sex selection. When countries like China, India, and South Korea faced high rates of sex selection, the male population rose rapidly and skewed the national sex ratio. In 2005, for example, China’s sex ratio reached 118.6 males per 100 females (“Sex ratio at birth, 1982–2017”), which is far from the natural sex ratio at birth, which is 105 males per 100 females (Ritchie & Roser). Firstly, this imbalance reduces the birth rate of a country, since the proportion of females decreases significantly. Furthermore, sex selection can lead to an increase in violence and crime, since, as a study noted, “an overwhelming percentage of violent crime is perpetrated by young, unmarried, low-status males” (Hesketh & Xing). As the relative amount of females in a population decreases, more heterosexual males are left without a partner or marriage prospects. In these cases, men from higher socioeconomic classes tend to find wives, while poor or uneducated men do not. In China, these men are called “guang gun”(“bare branches”), which refers to their inability to reproduce due to a short supply of female “mates”. This environment leads to the commodification of women, since they essentially become a scarce resource in the marriage market. In countries like India and China, an skewed sex ratio was linked to increases in human trafficking and sexual violence against women, as they were often trafficked into regions with few females (“Gender Biased Sex Selection”). Altogether, a skewed sex ratio due to sex selection negatively impacts all of society by commodifying women, reducing reproductive and marital capability, and increasing violence as a whole.

Lastly, condoning sex selection sets the dangerous precedent of allowing parents to select the traits of their children, even when there is no medical necessity to do so. If parents are able to select for sex, why shouldn’t they be able to select for height or skin color? Parents can argue that selecting a fair-skinned child is a “beneficent intent”, since that child would fare better in colorist or racist cultures. Similarly, other traits such as enhanced memory and strength can also be justified as improving quality of life for a child. Furthermore, this precedent could allow parents to select against certain conditions or disabilities in the name of providing their child with a better quality of life. Thus, the precedent set by allowing sex selection would also have a significant impact on disability rights and disability ethics. At what point do we stop parents from selecting the traits of their offspring? Allowing the non-medical selection of traits, such as skin color, height or nonfatal disabilities, could encourage eugenics and further discrimination against minorities. Parents would be able to select against “undesirable” traits, which could effectively eliminate traits seen as inferior within the population. For example, the use of prenatal screening in Iceland has almost eliminated individuals with Down Syndrome, with almost 100% of mothers choosing to terminate these pregnancies (Quinones & Lajka). Iceland is a perfect example of how an “undesirable” trait can be eliminated through the use of reproductive technologies, even though children with Down Syndrome are perfectly capable of leading healthy, fulfilling lives. Other traits, like dark skin and non-eurocentric features, could also be eliminated through selective practices. In countries where colorism is rampant (including much of Asia), gaining lighter skin is already a widespread obsession, with individuals going to extreme lengths to whiten their skin. It is reasonable to expect that parents would select for light-skinned children in these cultures. Thus, allowing parents to select for non-medical traits could facilitate the practices of colorism, ableism, and eugenics by wiping out traits which society sees as inferior. 

Altogether, I found that the harms of reinforcing sexism, disrupting sex ratios and condoning non-medical selection outweigh the benefits of sex selection. These consequences have broad impacts on society and the medical community, and increase suffering for women, minorities, and the population as a whole. Reinforcing sexism would deny countless female embryos the opportunity to live and alter human embryos without their consent, thus negatively impacting females as a whole. Furthermore, imbalanced sex ratios affect the entire population of a country and cause suffering by commodifying women, increasing violence, and preventing heterosexual males from finding a partner and having children. Lastly, allowing sex selection would set a standard as to how much agency parents can have over the traits of their children, which will affect future applications of genetic engineering and reproductive technology. Non-medical selection would also have important impacts on disability rights and could foster eugenics through the selection of “desirable” traits. In my eyes, the benefits of maintaining parental autonomy and procreative beneficence simply do not justify the widespread harms of sex selection. 

Future Solutions

When researching sex selection, I investigated some possible solutions to an imbalanced sex ratio and excessive sex selection. How do we prevent parents from selecting the sex of their children? In order to resolve this issue, we need to address the deeper sexism, cultural beliefs, and systemic discrimination which causes sex selection and disadvantages women. 

I began by investigating why parents tend to select male children in the first place. One of the primary reasons I found was that daughters are often seen as a financial burden to their families; they are seen as individuals who cannot continue the family name or earn a living for themselves. Women in sexist cultures receive fewer educational and professional opportunities, face discrimination in the workplace, and have fewer chances to earn money for themself. Sons, on the other hand, have access to far more job opportunities and are able to contribute financially to their families; they are culturally viewed as breadwinners, while women belong at home. In 2022, for example, India had 39 million women in its workforce compared to 391 million men (Pathi, 2023), which is a severely disproportionate figure compared to the total population. If we want to find a permanent solution to sex selection, we need to address the systemic disadvantages which prevent women from being independent and financially contributing to their families. We need to incentivize having daughters by allowing them to support themself instead of being reliant on their families for basic needs. 

When researching these solutions, I chose South Korea as a case study, a country which has managed to stabilize its sex ratio using a variety of strategies. In the 1990s, South Korea’s sex ratio reached 116.5 males for every 100 females. However,  over two decades they managed to reduce sex selective practices and brought their sex ratio close to the natural sex ratio, which is 105 males for every 100 females. 

South Korea used two main strategies to lower the rate of sex selective practices: outlawing revealing the sex of a fetus before birth and encouraging women’s participation in education and the workforce (“100 Women”). Firstly, sex selective procedures in PGS, genetic engineering and abortion can be lowered by preventing physicians from revealing the sex of the fetus before birth, as South Korea did. Other countries, such as India and China have adopted similar policies to prevent sex selective abortions in the past. While this method may prevent daughters from being selected against, it fails to address the deeper societal issues which cause parents to choose sons in the first place. It doesn’t solve the son preference, sexism and societal disadvantages which disincentivize having a daughter, and is akin to putting a bandaid on a bullet wound. Daughters may still be abused, neglected or killed after birth since the underlying sexism causing sex selection has not been addressed. In order to find a more enduring, thorough solution to sex selection, we must look to South Korea’s second strategy.

The second approach South Korea used was to encourage women’s participation in education and the workforce. With increased job opportunities and education, women are able to earn a living for themself and contribute financially to their families. They can be independent members of their community instead of relying on their families for financial support. This approach incentivizes having a daughter by removing the societal barriers which prevent women from leading self-sufficient, individual lives. Governments can use many strategies to increase girls’ education, such as ensuring that girls are enrolled in school from a young age, emphasizing the development of foundational skills like literacy and numeracy, and developing curricula which are inclusive and free of gender stereotypes (Spivack, 2021). Working conditions could be improved by decreasing the gender pay gap, encouraging mothers to stay in and return to the workforce, and improving the valuation of women’s work (“Tackling the Gender Pay Gap”). Altogether, we need to change society to be more fair to women instead of altering our children to fit into an unfair society. Daughters should not be selected against due to systemic disadvantages; rather, those disadvantages should be removed to produce a safer environment where women can thrive personally and financially. 

Conclusion

Sex selection challenges us to consider how much control parents should have over the bodies of their children, as well as how much control humans should have over life itself. How do we balance parental autonomy and procreative beneficence with the threat of prenatal sex discrimination? Should parents ever be able to simply “correct” their child’s sex? Is it ever ethical to edit fundamental aspects of an individual’s identity without their consent? Over the course of this paper, I have explored some of the stakeholders, values and principles involved in making these decisions. On one hand, proponents of sex selection frame their decision through the values of procreative beneficence, safety, and parental autonomy. They argue that performing sex selection can provide a child with the “best life”, maximize the safety of the mother and child, and preserve parental autonomy. Opponents of sex selection, on the other hand, claim that it furthers sex discrimination, violates parental responsibility to love unconditionally, and sets a dangerous precedent of allowing parents to “play god” with their children’s traits. 

As outlined above, I viewed sex selection through the lens of consequentialism, and came to the conclusion that it is unethical to select children on the basis of sex. The harms of sex selection, including reinforcing sexism, disrupting sex ratios and condoning nonmedical selection, far outweighed the smaller benefits of preserving parental autonomy and procreative beneficence. Overall, sex selection undermines women’s rights and safety more than bolstering them. In order to create a safe, enduring future for women, we need to dismantle the systemic disadvantages which harm women instead of selecting against and altering our children to fit into a patriarchal society. It is vital that governments take action to support women and improve their quality of life in the long term.

The ethicality of sex selection is part of a larger conversation about reproductive tecnology and the role of genetic editing in medicine. How do we regulate the use of these technologies in order to preserve the sanctity of life? At what point does genetic modification become unethical? With the rapid development of gene editing technology, it is essential that governments begin taking legislative action on the issues of genetic engineering and reproductive technology. The use of these technologies could reshape medicine and humanity itself, and they should not be left unregulated. I recommend that the use of genetic engineering and reproductive technology to alter nonmedical traits be outlawed in order to prevent eugenics, maintain sex ratios and support the genetic diversity of the population. For PGS, this ban could be implemented by not informing parents of the sex of the fetus while deciding which embryo to implant. For genetic engineering, it could be implemented by limiting the kinds of genes which can be modified through sex selection to only disease-causing genes. 

Due to the complexity of this issue, there were some topics which I could not address in this paper. For further research, I would like to more deeply explore the accessibility of PGS and genetic engineering, and examine how financial constraints could exacerbate socioeconomic inequalities in our society. What would happen if only the wealthy were able to select the traits they like in their offspring? I would also like to research the impact sex selection and nonmedical selection could have on disability rights and the treatment of embryos/fetuses with disabilities. Specifically, I would like to examine the impact reproductive technology had on the Down Syndrome population in countries like Iceland and Denmark, where selection has almost eliminated the occurrence of the condition. Lastly, I would be interested in conducting more in-depth studies of how the economic, political, cultural and religious environment of India and China have influenced the high rates of sex selection in these countries. How did deep-rooted son preference develop in these societies, and how do current laws and beliefs allow it to persist?

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