e-Ethics May 2002
Sex-Selective Abortion: Social, Cultural, and Religious Considerations
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An immigrant couple, recently
arrived from India, requests an ultrasound
procedure for their expected
third child (they have two daughters).
They tell the physician that
they are concerned about the health
of the fetus. The ultrasound detects
no problems.
"And is it a boy or a girl?" the
parents ask.
An alert physician might wonder
how best to respond to the
couple's question. Requests for
prenatal sex determination as a
potential prelude to sex-selective
abortion have surfaced among
Indian immigrants in the United
States and Canada.
1
Abortion for
the purpose of sex selection is
widely practiced in India. Sources
report that the sex ratio in India is
approximately 93 females for every
100 males, whereas in most societies
the ratio is about even. (In the
Indian state of Haryana the ratio is
83 females for every 100 males.)
Ultrasonography is commonly used
in India to determine the sex of
fetuses that are subsequently
aborted. Social and cultural factors
there conspire to favor male offspring,
thus placing female fetuses
at risk for selective abortion. "The
root of the problem is ancient and
economic. Male children are
favored since they carry the family
name and frequently get the family
inheritance. Girls are viewed as liabilities,
who will cost their parents
a dowry when they marry and
move into their husband's homes
[sic]…"
2
The Indian government
has attempted to stem the tide of
sex-selective abortions. A 1994 law
banning the use of prenatal tests
for sex determination has been
only marginally effective in the face
of traditional attitudes.
While no U.S. law prohibits prenatal
sex-determination
procedures, discussions about ethical
aspects of preconception sex
selection for nonmedical reasons
provide an apt analogy. The ethics
committee of the American Society
for Reproductive Medicine advises
that, if preconception sex selection
methods such as X- and Y-sperm
cell separation are established as
safe and effective, physicians may
perform these procedures "for gender
variety in a family" when
couples "are fully informed of the
risks of failure" and "affirm that
they will fully accept children of the
opposite sex if the preconception
gender selection fails."
3
This sec-ond
condition precludes aborting
fetuses solely because of their sex.
The AMA's Council on Ethical
and Judicial Affairs has taken a different
tack. Its policy statements
on artificial insemination advise
physicians against participating in
sex selection of sperm "for reasons
of gender preference. Physicians
should encourage a prospective
parent or parents to consider the
value of both sexes."
4
A related
statement on genetic counseling
holds, "It would not be ethical to
engage in selection on the basis of
non-disease related characteristics
or traits." Physicians who are
morally distressed by the possibility
that parents may request
abortions on the basis of genetic
information may "choose to limit
their services to preconception
diagnosis and advice or not [to]
provide any genetic services,"
including ultrasonography.
5
(The
physician in our opening scenario
might opt for this approach.)
These considerations would
suggest that healthcare professionals
are obligated to disclose only
the medically relevant information
that results from prenatal tests and
procedures. If, however, they disclose
to some patients
"nonmedical" information—such
as the sex of a fetus when no related
medical concern is present—and
withhold similar information from
other patients, they run the risk of
acting in an arbitrary and unjustifiably
discriminatory way. It is better
to establish a consistent stance
concerning such disclosure, and
stick to it.
At the same time, healthcare
professionals should not overdraw
the association between sex selection
and persons of Indian descent.
Sex selection and sex-selective
abortion are not unique to India
and immigrants from India. The latter
practice may be even more
prevalent in China and Korea than in
India. Worldwide, according to one
source, 42 percent of female fetuses are
aborted, compared with 25 percent of
male fetuses.
6
Further, although
Hinduism is the majority religion of
India, Hindu teaching does not support
sex-selective abortion but condemns it.
The cumulative weight of Hindu tradition
rejects abortion for any reason
other than jeopardy to the mother:
"[F]rom earliest times, … abortion (viz.,
deliberately caused miscarriage as
opposed to involuntary miscarriage) at
any stage of pregnancy has been morally
condemned as violating the personal
integrity of the unborn, save when it
was a question of preserving the mother's
life. No other consideration, social
or otherwise, seems to have been
allowed to override this viewpoint."
7
Avoiding unwarranted generalizations
about peoples, their culture, and
their religious traditions is important
because such generalizations can
become stereotypes that are applied
unjustly to persons from that cultural or
religious group. Not every couple of
Indian descent will ask about the sex of
their child-to-be; not every couple who
ask will be considering abortion.
(Conversely, some couples from non-Indian
backgrounds will seek the same
information precisely because they have
sex selection and possible abortion in
mind.) Moreover, unexamined cultural
generalizations can lead us to overlook
the differences within cultures and religious
traditions—especially when, as in
India, authoritative voices within the culture
and its traditions are seeking to
reverse a widespread, long-established
practice.
1. B. D. Miller, "Population Ethics: Religious
Traditions: Hindu Perspectives," in W. T. Reich,
ed., Encyclopedia of Bioethics, rev. ed., vol. 4
(New York: Simon & Schuster Macmillan, 1995),
p. 2001.
2. "Cover Story: Sex Selection in India,"
Religion and Ethics Newsweekly, June 1, 2001,
http://www.pbs.org/wnet/religionandethics/
week440/cover.html.
3. "Preconception Gender Selection for
Nonmedical Reasons," Fertility and Sterility 75,5
(May 2001), 863.
4. Current Opinions of the Council on Ethical
and Judicial Affairs, E-2.04 Artificial
Insemination by Known Donor, E-2.05 Artificial
Insemination by Anonymous Donor.
5. Current Opinions of the Council on Ethical
and Judicial Affairs, E-2.12 Genetic Counseling.
6. V. G. J. Rajan, "Will India's Ban on Prenatal
Sex Determination Slow Abortion of Girls?"
Hinduism Today 18,4 (April 1996),
http://www.hinduismtoday.com/1996/4/#gen241.
7. J. J. Lipner, "The Classical Hindu View on
Abortion and the Moral Status of the Unborn,"
in H. G. Coward, J. J. Lipner, and K. K. Young,
Hindu Ethics: Purity, Abortion, and Euthanasia
(Albany: State University of New York Press,
1989), p. 60.
Selected Resources:
S. C. Crawford, Dilemmas of Life and Death:
Hindu Ethics in North American Context (Albany:
State University of New York Press, 1995).
P. N. Desai, Health and Medicine in the Hindu
Tradition: Continuity and Cohesion (New York:
Crossroad, 1989).
R. Mutharayappa, M. K. Choe, F. Arnold, and T.
K. Roy, Son Preference and Its Effect on Fertility
in India (Honolulu: East-West Center, 1997).
A. Sharma, The Hindu Tradition: Religious
Beliefs and Healthcare Decisions (Chicago: Park
Ridge Center for the Study of Health, Faith, and
Ethics [forthcoming]).
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