Sex selective Abortions happens in the United States, too

By Dave Andrusko

A few paragraphs into “’I Know It’s a Girl, and I Need Your Help To Get It Out of Me’: Sex selection happens in the United States, too—and doctors need better guidelines for dealing with it,” we read this paragraph from Sunita Puri:

“Mara Hvistendahl’s new book Unnatural Selection has sparked animated conversations about the frightening global consequences of sex selection, or the use of medical technology to ensure the birth of either a male or female child. Rising numbers of ‘missing women’ around the world are leading to increased cases of sex trafficking and rape, with excesses of restless, unmarried men expected to worsen societal violence.”

But what follows is not an out-and-out condemnation but a deeply conflicted account written by a woman (a resident physician in internal medicine at University of California-San Francisco) who says she has interviewed patients and doctors for six years on the topic of sex-selective abortions (

To get a feel for the piece, I’ll offer a few quotes. Some of her observations, well, you wonder where her editor was. Bear in mind that one of the two “hooks” in the story is that it is not only immigrant women, under pressure from husbands and in-laws, who are having sex-selective abortions in the United States.

Unlike their Chinese and Indian counterparts, who cannot legally offer sex selection, American doctors are left to decide on a case-by-case basis whether to perform these procedures, without any consistent ethical guidelines. The reasons American women undergo them are complex, from situations that don’t seem particularly troubling (the upper-middle-class woman who wants a daughter to “balance out” her three boys) to those that are deeply concerning (the immigrant woman who wants a son to avoid emotional abuse by her in-laws).

Think about that amazing statement. It’s no big deal—not “particularly troubling”—for an upper middle class (read white) woman to be implanted “with embryos of the desired sex,” or “abort fetuses of the unwanted sex.” That’s just “balancing” out the family.

But when an immigrant woman (read woman of color) does so to avoid emotional abuse that’s “deeply concerning.” Of course it is! As the story (and Hvistendahl’s book) makes clear, the coercion can be much, much worse.

But what does it say when a woman aborts for such trivial reasons as to have a matching number of boys and girls?

The other hook in the story is implied in the headline: there is not uniform advice from professional groups. According to Puri, “The American College of Obstetrics and Gynecology recommends that providers not meet requests for sex selection, given the risk of reinforcing sexist beliefs and practices, while the American Society of Reproductive Medicine states that it would be premature to prohibit such technologies without studies suggesting their potential harm in the United States.”

There are many reasons for the ambivalence.

Reproductive choice and patient autonomy are pillars of American medical practice, after all. Asking a woman for her reasons for wanting a boy or a girl, one doctor told me, is simply not a physician’s responsibility or business; educating her on the latest technology is. Doctors have to trust that patients know their lives, families, and needs best, he said. In some cases, a physician may know—and loathe—the reasons behind a patient’s choice, yet still believe that providing sex selection may help her.

But by the time we get to the end of the article we read this:

In cases involving sex selection, there are often no clear “right” or “wrong” answers. And to be sure, doctors have to make decisions about challenging cases all the time in the absence of concrete guidelines. But many doctors I spoke with had at times wondered whether they’d made the right decisions, and felt that further guidance—especially around how to screen for red flags in patients’ home lives without appearing invasive or judgmental—would have been helpful.

There really are NO right or wrong answers? How about abortionists saying I will not abort because the baby is a female and not a male? How about acknowledging that “autonomy” is a sick joke when a woman is under pressure to abort? Or how about the impossibility of ever treating women equally if 160 million+ can be disposed simply because of their chromosomal makeup?

Hvistendahl is very nervous that her book will be used by the “wrong” people (like you and me) for the “wrong” reasons (leading a charge against sex-selective abortions). Let’s hope she’s right to be apprehensive.

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