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Choice, control, responsibility

Adoption and the politics of gender selection

By Sarah Werthan Buttenwieser

Obstetricians are divided about the increased use of gender selection methods, either that can be done during in vitro fertilization or by sorting sperm. For example, the American College of Obstetricians and Gynecologists opposes sex selection except in people who carry a genetic disease that primarily affects one sex. In an opinion paper last month in its journal, Obstetrics and Gynecology, the college said elective gender selection could support "sexist practices."

The United Nations opposes gender selection and the practice is banned in many countries including Australia, Canada and Britain, and other nations in Asia, South America and Europe. Much concern about gender selection practices stems from countries with strong preferences for one gender (generally boys) and the extreme measures taken to assure specific outcome. China's one-child policy is thought to have made the situation for girls worse in that country. While some believe that gender selection is acceptable if it's to achieve "family balancing" while others believe that notion to be inherently sexist. And regardless of placing constraints on the practice -- only if there's also a medical reason or only after the first child is born -- what is clear in this era of access to a broader range of reproductive technologies that allow gender selection (and other traits as well) to be chosen, once it's possible, regulation becomes quite difficult unless the practice is banned entirely. Debora Spar covered these issues with great thoroughness in her book, The Baby Business.

Lisa Belkin wrote of her personal experience with sperm sorting in the New York Times Magazine ("Getting the Girl," July 25, 1999). Her desire to have a daughter is something that has been echoed by other women in other publications and news reports. Among preferences for American adopters, girls rank high, in part explaining at least partially why China is highly desirable as an international location for so many families adopting from the United States. Some obstetricians say that when asking for gender selection assistance in the United States -- unlike China or India -- prospective parents end up about fairly equally divided in terms of preferred gender.

As a feminist and reproductive rights activist, I believe deeply in the sanctity of abortion rights. I can think of no other choice that more completely delineates the sexes than the fact that a man's life isn't necessarily completed changed by pregnancy while a woman's is. For a woman who does not desire a child, an unintended pregnancy acts like a barrier to whatever she had envisioned next, a roadblock. Without the right to reject pregnancy -- whether to defer that experience until a later date when it is desired or to avoid it altogether -- women cannot function as equal participants in this society. I see the abortion issue as a simple one, one of equality.

Having become a mother and having crossed through my thirties, I also know that infertility can be an extremely difficult, painful experience. Not being able to have a child biologically also determines the course of some people's lives in very dramatic ways, whether they eventually have a child biologically or adopt a child or decide to forgo parenthood altogether. The possibilities to create pregnancies or children that are biologically connected to the intended parents in some way have become plentiful -- as extreme technologies allow surrogates to carry pregnancies that may have sperm or egg from a different donor than at least one of the intended parents -- and have greatly expanded possible routes to parenthood. There was even a short-lived television drama that centered upon stories in an infertility clinic ("Inconceivable" the show was called).

In some states (how many) insurance covers at least a certain amount of infertility treatment. In other states, all infertility treatments must be paid for out of pocket. Contracting with a surrogate is an expense that insurance never covers. Medicaid does not cover infertility treatments. Adoption in this country also carries a variable price tag, one that Spar documents in her book slides according to desirability: certain domestic and international arrangements are very pricey; finding an older child, perhaps one with disabilities through the foster care system can be cheap.

There are a few ways to look at it, but one might be that the simple fact of having a baby is, for those who can't just do it without assistance, potentially as tenuous a right as abortion.

Why, then, is an issue like gender selection even in play? Shouldn't the topmost priority for reproductive rights' activists and others who place reproductive freedom as a critical right be to ensure that saying "no" to a child at a specific time is as protected and possible as it is to say "yes" to parenthood at a specific time?

Desire outpaces concepts like equality; once technology rendered certain feats possible, those who could avail themselves of technology began to use it. It's human to try to get what you want. And here I am, too, trying to get what I want. We've got three boys and want a girl. Although I wouldn't have been willing to endure -- let alone believe it remotely appropriate for me to have attempted -- in vitro fertilization, I did think fleetingly about a relatively simple spin of the sperm (like a roll of the dice only with sperm?) before we tried for our third (boy). Even the idea that I'd have wanted in any way to alter Remy is completely unfathomable. He is perfect and our family is -- to date -- exactly as I want it to be. So, what are we doing? We're in the process of trying to adopt a baby girl.

It turns out that adopting a child of a specific gender isn't quite as easy as stating no preference, but it is possible. As I struggle with getting to choose this important trait -- after all, I had no control over particulars like that with the three I welcomed biologically -- I'm beginning to appreciate that gender is one of many choices adoptive parents get to weigh in on. Once you start reading and hearing other people's stories, you realize that adoptive parents review health histories and specify desired age and choose a country from which to adopt. For me, all of this choice leaves me feeling as if there's an uneasy balance between selfishness and altruism.

Those pressures already tug at me; I think perhaps those pressures characterize parenthood for most of us. We want to adopt across racial lines. Some view this choice as almost selfless and others consider this as a large challenge with huge responsibility attached and others deem our actions unequivocally selfish, as in, how good can a black girl feel in a white family in a heavily white town? It'll be years before I decide if our actions turn out to feel more selfless or selfish.

While I've thought -- quite a lot -- about what makes raising a girl seem compelling, my explanations -- justifications if you will -- matter not at all. Choosing to adopt is a privilege as is indicating a preference like gender. In fact, all of my experiences surrounding whether and when to parent have been marked by privilege. I was fortunate to say "no" to parenthood when it didn't work for my family or me so that the children had came when I was ready and with the partner of my choosing. Additionally, I've been fortunate to conceive without difficulty, have uncomplicated pregnancies, straightforward and intervention-free births, and extremely healthy children. So, as someone relatively inexperienced to considerations surrounding adoption, I at least see quite clearly that money -- as is true in terms of all health care, including infertility treatments -- figures in largely to how easily one can access what she or he wants.

Privilege has always factored into what options are available to people. Technology adds more choices, complicated by its interactions with privilege, and at times, ethicists and others see technology as a kind of runaway train; we can't figure out how to stop it or slow it down and be clear that we want to travel in these particular new directions. Part of what's hard -- as I have seen watching friends push the envelope with trying all available technologies in order to get pregnant and as I am experiencing with the option to choose desired or "acceptable" traits for our child through adoption -- is that desire speeds along, fast as a train, sometimes a runaway one. It's trying to slow down in order to see where you're heading that's required of us all. This may not always change the outcome in terms of the wants -- here we go with our adoption plan -- but it may alter how we are, because we've examined our desires, our biases, our expectations and can work hard to treat our daughter with the same openness and acceptance for who they are that we offer (I hope) to our sons.

mmo : march 2007

Sarah Werthan Buttenwieser is a regular contributor to the MMO. She is a former reproductive rights organizer and turned free-lance writer living in Northampton, Massachusetts.
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