Have a boy! How US clinics are courting Indians

Last Updated: Wed, Jun 22, 2011 09:41 hrs

"Have a Boy, Have a Girl Guaranteed!" read a three-column advertisement in an old edition of the newsweekly IndiaWest, I came across recently.
I'd heard about these ads. Similar ones often turn up in Indian American publications here, with taglines like: "Desire a Son?" "Do you want to know the gender of your baby?" or  "A Boy or a Girl, the choice is yours". But it threw me off a bit to chance upon one by accident.

Such ads would be illegal back in India, where we have struggled for decades to discourage use of medical technology to assure birth of boys. But here in the US, women's reproductive choice (whether or not to have a baby) is protected by law and technologies enabling sex selection are easily accessible.

As a result, Indians in the United States find themselves being courted by American clinics trying to cash in on our culture's bias towards sons (so do other ethnic communities, including Chinese and Korean, where sons are a big deal). These clinics peddle sophisticated new technologies that help couples choose the sex of their babies even before they are born. And what's more, desi clients are flocking to them in sizeable numbers.

Given the sensitive nature of the topic, it's hard to locate Indian women, or couples, willing to talk about their decision to "create" sons. But a young doctor in San Francisco, Sunita Puri, has had a measure of success.

Puri's research, based largely on one-on-one interviews with 65 Indian women in the East and West coasts who have undergone sex selection procedures, was published in the journal Social Science and Medicine earlier this year. Among other things, her report finds - small surprise - familial pressure to have sons, and verbal and physical abuse of the women involved.

Doctors who offer sex-selection services call it "family balancing" – helping a family with one or more child of one sex to conceive a child of the opposite sex. But, of course, they tend to gloss over increasing evidence that sex selection is affecting gender ratios among traditionally patriarchal immigrant communities in the US.
Several recent studies of the 2001 US census data, by Columbia University and the University of Texas, among others, show skewed gender ratios among Asian American, African American and Hispanic communities. The numbers aren't too high yet, but demographers say they are especially significant among Asian-American families.

They believe this trend reflects not only son preference, but also a growing popularity among these communities for abortion following sex detection of fetus, and new sex-selection techniques like sperm sorting and pre-implantation genetic diagnosis (PGD).
One of most popular destinations for such made-to-order babies is The Fertility Institutes in Los Angeles (whose ad I spotted in the newspaper). Situated on the fourth floor of a nondescript high rise on Ventura Boulevard, a short drive from Hollywood, the plush clinic is run by Dr Jeffery Steinberg, a rather controversial figure in the US reproductive medicine circles.
Steinberg's clinic specializes in pre-implantation genetic diagnosis, a technique that involves extracting several eggs from the mother and fertilizing them in-vitro (in a dish) with the father's sperm.

After three days, when several 8-cell embryos develop, one cell is extracted and screened for desired gender and genetic diseases. Healthy embryos of the desired gender are then implanted in the mother's womb. A single PGD attempt comes with the hefty price tag of $18,000-$27,000 (Rs 8 lakh to a little over Rs 12 lakh) and often requires several attempts. Yet business seems to be booming in most of these clinics.

The Fertility Institutes, for instance, handles an average of 600 sex selection cases a year. Half of these are for international clients, usually from countries where embryo screening for gender and other non-medical reasons is banned. Read that as "largely from India and China", though they also get clients from western nations like UK and Australia, where women tend to want daughters.
When I spoke with Steinberg, he said Indian couples are a big part of his client base. "About 35-40 percent of our clients are from India and probably an equal number are Indian Americans," he told me. In other words, more than two-thirds his entire patient base are Indians! And usually, they want sons.

While human rights and women's groups, accuse doctors like Steinberg of promoting a practice that's an exercise of sexism at the most profound level – choosing who gets born, the brusque doctor himself has no such qualms. His view - the problem is internal to the communities concerned and we need to "look at that" instead of focusing on the technologies used.

"I think [PGD] is a safer, more humane alternative to the other options. Of course, the other option is infanticide which is to me repugnant," he said. "Now if there was a moral outcry, unified, that says absolutely under no circumstances should this be done, I'm not a pig, I'm not a bullhead. I'll listen to that. But I've not received that."

Perhaps the good doctor hasn't been listening too hard.

But I have to admit, there certainly is a lack of public focus on sex selection practices in the US. The few American mainstream media stories on the subject that I've come across do touch upon "gendericide" data and millions of "missing women" in Asia, but then they go on to cite anecdotal cases of white couples choosing daughters. These "feel good" stories tend to neutralize an issue that really needs more vigorous public dialogue.

America's gender rights activists, who ideally should be crying foul over sex selection, shy away from the subject because of this country's complicated abortion politics that continually challenge women's hard-won right to reproductive autonomy.

(Earlier this year, the country's right-wing and anti-abortion Republican party tried to block government funding of Planned Parenthood, a nonprofit that provides reproductive health services, on grounds that it was one of the largest abortion providers in the US.)

"If abortion was a not contested issue... the reproductive rights movement might take a very different stance on sex selection," says Sujatha Jesudason, executive director of Generations Ahead, a California-based outfit that focuses on the social and ethical questions surrounding reproductive technologies.

"But right now when you start talking about [curbing sex selection] it raises the question – 'so does this justify limits on whether or not women can have abortions for a specific reason?' Which is why for the most part, many people avoid the conversation."

But Jesudasan is convinced that the conversation will peak eventually. As
doctors advertise more of these technologies, they create the demand and desire for it and that, conversely, will lead to more conversation and debate on the morality of such practices, she says. I hope she's right.

Going back to Puri's study, I found it interesting that over half the women she interviewed held jobs outside home and 23 percent of them had advanced degrees in medicine, law, business, nursing and scientific research.

Looks like neither education, nor moving to a westernized world can rid us of our traditional mindset. Instead, access to technology and certain new freedoms can actually help keep alive abhorrent discriminatory practices that are increasingly taboo back home.

Also read: Justice? Not for those I saw plunge to their deaths

Maureen Nandini Mitra is managing editor of Earth Island Journal, an award-winning US environmental quarterly based in Berkeley, California. In addition to her work at the Journal, she writes for several other magazines and online publications in the US and India.

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