Cross-posted from Biopolitical Times, the online publication of the Center for Genetics and Society.

Sex selection technologies and sex-selective abortion are legally prohibited in India, where their use in the service of son preference has produced dramatically skewed sex ratios. But Indian immigrants to the US face no official barriers to using new technologies to ensure the births of sons. Their experiences and voices are explored in a pioneering article in Social Science & Medicine by UC San Francisco medical doctor Sunita Puri and colleagues.

Puri conducted in-depth, semi-structured interviews between 2004 and 2009 with 65 Indian women living in the US who had sought sex selection services. More than 40 percent of these women had attended college or graduate school; nearly a quarter worked as skilled professionals. More than three-quarters had terminated pregnancies following ultrasound determination of fetal sex; 15 percent had used sperm sorting and 6 percent pre-implantation genetic diagnosis. 

Both the women’s own comments and the authors’ summary statements reveal the fraught complexity of their reproductive decisions. While some of the women protested son preference, gender inequality, and their subordination in reproductive decision-making, the authors note that they were acutely aware of “the elevated status and security of women with sons….[T]hey recognized that having a son ensured respect, stability, and acceptance in their marital homes.”  

Most of the interviewees spoke of significant pressure to bear a son. About two-thirds experienced direct verbal pressure from a mother-in-law or sister-in-law; about 20 percent identified their husband as the primary source; and many noted their husband’s silence in the face of pressure from other family members:

My mother in law stopped eating… She said she would starve unless she had a grandson. My husband did nothing. He asked me every day, `Do you want my mother to die?’

A third of the women described physical abuse and neglect related specifically to their failing to produce a male child. They reported threats of divorce or abandonment; withholding of food, water, rest and medical care during pregnancies with a female fetus; and violence including being kicked in the abdomen in an attempt to terminate a pregnancy. 

Puri and her colleagues point out that “while reproductive technologies have traditionally been viewed as presenting women with increased reproductive liberty…technological advances can actually decrease the scope of women’s reproductive choice.” Their informants recognized this, acknowledging that “ultrasound technology not only allowed them to pursue sex selection, but its ready availability and legality in the U.S. increased the pressure and even obligation to use it.”

Their article’s title – “`There is such a thing as too many daughters, but not too many sons’: A qualitative study of son preference and fetal sex selection among Indian immigrants in the United States” – is echoed in their poignant conclusion:

By addressing these multi-dimensional social and medical-technological issues, we hope that the perceived burden of “too many daughters” may someday be referenced only in its historical context.