Analysis Abortion

Son Preference and Sex Selection in America: Why It Persists and How We Can Change It

Sujatha Jesudason & Anat Shenker-Osorio

Anti-choicers are now riding a wave of sex selection politics, finding new reasons to limit access to abortion in their quest control women’s autonomy, specifically to curtail reproductive decision-making for women of color. But these policies only make matters worse.

See all our coverage of the Prenatal Nondiscrimination Act (PRENDA) here and all our coverage of sex selection here.  See also this article on PRENDA by Miriam Yeung.

UPDATE: As of 11:00 am Wednesday, May 30th, the vote on PRENDA has been moved to Thursday, May 31.

Son preference, missing girls, sex selection: We may seek to label these Chinese or Indian issues, but they exist here in America. And with anti-choice crusaders desperate to destroy Planned Parenthood Federation of America, America’s leading provider of affordable reproductive health care for women, the purportedly spreading practice of sex-selective abortion is back in the news. With the Prenatal Nondiscrimination Act (PRENDA) up for a vote in the House, it’s also back in full force on the legislative agenda.

The extent of sex-selective practices in the U.S. is hard to assess, since it’s rarely something people will admit to doing. But we can take an educated guess by observing alterations in expected sex ratios. If nature has its way, women will likely give birth to 100 girls for every 102 to 106 boys. And among first-time parents in the U.S., that’s exactly what we see.

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However, as birth order rises, apparently so does selection — at least, in certain ethnic groups. With U.S. 2000 Census data, researchers investigating Korean, Chinese, and Indian communities found that, after one girl, parents have as many as 1.17 boys per girl the second time. With two girls at home, this goes up to 1.51 boys per girl for the third child. These skewed ratios aren’t present among other ethnic groups in America.

This intentional kid picking takes multiple forms. Now, we can know and thus select for sex as early as seven weeks into a pregnancy, using a non-invasive blood test making big news in popular and obstetric circles. Far more reliable than urine-based guesses from Walgreen’s and far safer than other early use options, this new technique is meant to minimize sex-linked diseases. But this product enters a market where some parents-to-be pine not just for any healthy baby; some want what they see as a particular kind.

Although alarmists cite an undocumented rise in abortion due to sex selection, more and more the interest (and well-marketed new product development) is on meddling before implantation. Techniques like sperm sorting and IVF embryo selection are expensive. Even the most generous insurance package doesn’t cover these procedures when not medically necessary. Yet as of 2006, half of American fertility clinics that offer embryo screening allow would-be parents some form of sex selective add-ons… and the market is growing. Never mind that the American College of Obstetrics and Gynecology has come out harshly against non-medically necessary sex selection, and even the American Society for Reproductive Medicine has issued lukewarm cautions about it.

These clinics advertise their sex-selective wares heavily in ethnic language media and enclaves where Asian Americans reside. Offering would-be parents soft focus images of white babies on pink and blue blankets, they couch their practices in the affirming language of “family balancing.” Doesn’t that sound much better than sexism, eugenics, or designer babies?

Some claim environmental motives. Citing opinion research that most parents desire one of each sex in their offspring, they offer to do this in the first two pregnancies and bring down the birth rate. Others say their services minimize sex-selective abortions, because designing your kid before pregnancy is better than during. A few argue that this is an expression of reproductive freedom. And some proffer no reason for breaking their own professional ethical guidelines — an unstated affirmation that the customer is always right.

In practice, sex selection means more sons. In most cultures, there’s a preference for male babies. Whether the motivation is economic (because sons mean higher income potential), religious (because sons perform sacred rites), social (because sons confer status), or a messy mix of the above, son preference fuels the desire to take control of formerly unalterable aspects of impending parenthood.

Obviously, sex preference is a problem. It requires adherence to the fallacy that sons and daughters are biologically limited in what they can do and who they can be. People lusting after a son hardly have a hairdresser in mind. Likewise, the daughter dream is about playing princess, not baseball. Moreover, desperately wanting a specific sex requires us to believe in and thus perpetuate the notion of two genders.

Responses from our own surveys, individual interviews and focus groups among Asian Americans indicate sex preference is alive in America. While respondents generally didn’t have first-hand experience with sex selection in the U.S., 96 percent felt that parents treat boys and girls differently, with boys getting a way better deal. Sex selection may be, to paraphrase one respondent, the operationalization of son preference, but the preference came first and left unaddressed, isn’t going anywhere.

However, before we go corralling this off as just a race or immigrant issue, let’s look at how the majority of Americans view this issue. A Gallup poll from 2011 found that, when asked if they could only have one child, American men of all backgrounds responded that they’d want a boy by a margin of 49 percent to 22 percent, a finding fixed at this level since 1941, when Gallup started asking. Women today report no preference. But still, 40 percent of Americans overall think picking embryos to select for sex is an appropriate use of genetic diagnosis technology. While the numbers attest most Americans aren’t selecting for sex, throwing new early-detection tests along with more and cheaper technology into society’s gender-based preferences and myths -– and we should expect to see increased selection. 

Aside from the long list of ethical, social, and political problems this poses – it’s a consequential challenge for reproductive rights advocacy. Sex selection against girls is the religious right’s wet dream. When opponents declare “abortion hurts women,” they could not have dreamt of a better ‘we told you so.’

They’re riding this wave to new reasons to control women’s autonomy, specifically to curtail reproductive decision-making for women of color. In 2008, anti-choice groups pushed for legislation to ban sex-selective abortions. Trent Franks (R-AZ) introduced the “Susan B. Anthony and Fredrick Douglass Prenatal Nondiscrimination Act” (PRENDA) to ban sex-selective abortion and a new chimera he called “race-selective” abortion. Legislators in Georgia, West Virginia, Oklahoma, Michigan, Minnesota, New Jersey, and New York have tried the same at the state level. In 2010 and 2011, as those of us who support access to safe abortion care looked on in horror, Oklahoma and Arizona both banned sex-selective abortions. 

In all cases, lawmakers pointed to the cultural attitudes and practices of Chinese and Indians as evidence of what could befall us. Data about sex ratio disparities in specific Asian countries became proxy for sex selection amongst Asian Americans – never mind that the latter group represents a huge range of origin countries and displays sex ratios pretty much identical to the rest of Americans. Details like math and geography need not interfere with a justification for passing this legislation, even in states where few Asians reside. 

The complications of race-specific attacks aside, the central argument of the mainline reproductive rights movement has been that the right to continue or terminate a pregnancy is a “choice.” An implicit, and often times stated, contention that all choices women make about their bodies and reproduction are private, to be made without state interest.

But now, our slogans of individual rights, “my child my choice,” now double as ad copy for the sex-selective clinics we find troubling. Even if people use new technologies to select for girls, and evidence suggests Caucasian women do, they apply the notion of “choice” to germinate restrictive notions of gender. When we fought for autonomy, this did not mean the right to engineer your own namesake or a pinkalicious-shopping buddy. What it meant was a right for women to define who they were and wanted to be in their own terms, on their own timeline.

Research shows that the language of “choice” has left audiences cold. Studies in cognitive linguistics, psychology, and even marketing contend this framework suggests action quickly considered and of little consequence – hardly a rhetorical counterweight to “life” or apt description of how most women undertake this decision.

But the concept of choice no longer fits either. Not only did we not want government out when it comes to financial assistance to access the procedure, we’re not vying for a mandate that says anything goes in the world of parenting.

Sex selection forces us to take stock of what we believe and start saying it. Here is our chance to leave behind the tired, consumer-led, conversation. “My choice,” or even “my child,” never described our community-supported ideals of child rearing. We must move from choice and it’s inevitable path to “what kind of child do I want to have” to the more meaningful question: “what kind of parent do I want to become?”

We need frank public discussion about parenting boys and girls and the often-unconscious biases we all have about gender and children. This is long over due but is only one element of the efforts required to unseat the calcified ideas about sex and gender that permeates our society, across all races and ethnic groups.

We must also defeat discriminatory laws like the one up for vote today in the House. It is a bitter irony that regressive legislation like PRENDA actually reinforces why it’s disadvantageous to be a woman, especially a woman of color. These kinds of policies are part of a culture that makes sex selection a logical choice for women hoping to keep daughters from a sexist, repressive world that seeks only to limit who they are and what they are allowed to do.

Instead of curbing rights, our research specifically in South Asian American communities suggests the way to un-do son preference is to address old assumptions. This would require raising awareness about, and also helping to hasten the dramatic changes underway in gender roles. Girls and women are assuming many of the roles only men once played, and men and boys can play and are now fulfilling many of the roles which have been considered a woman’s domain. In the South Asian Diaspora community, for example, boys aren’t always staying around to take care of aging parents, girls are increasingly staying attached to their maternal families, and investment in girls’ education is paying off richly. But to end son preference, old beliefs and practices, laws and policies, need to catch up to the new reality, both in the United States and in South Asia. Empowering families, communities, and societies to root out biases and alter their own behaviors without shaming, blaming, or curtailing the rights of women is our only real hope of tackling this issue.

Commentary Economic Justice

The Gender Wage Gap Is Not Women’s Fault, and Here’s the Report That Proves It

Kathleen Geier

The fact is, in every occupation and at every level, women earn less than men doing exactly the same work.

A new report confirms what millions of women already know: that women’s choices are not to blame for the gender wage gap. Instead, researchers at the Economic Policy Institute (EPI), the progressive think tank that issued the report, say that women’s unequal pay is driven by “discrimination, social norms, and other factors beyond women’s control.”

This finding—that the gender pay gap is caused by structural factors rather than women’s occupational choices—is surprisingly controversial. Indeed, in my years as a journalist covering women’s economic issues, the subject that has been most frustrating for me to write about has been the gender gap. (Full disclosure: I’ve worked as a consultant for EPI, though not on this particular report.) No other economic topic I’ve covered has been more widely misunderstood, or has been so outrageously distorted by misrepresentations, half-truths, and lies.

That’s because, for decades, conservatives have energetically promoted the myth that the gender pay gap does not exist. They’ve done such a bang-up job of it that denying the reality of the gap, like denying the reality of global warming, has become an article of faith on the right. Conservative think tanks like the Independent Women’s Forum and the American Enterprise Institute and right-wing writers at outlets like the Wall Street Journal, Breitbart, and the Daily Caller have denounced the gender pay gap as “a lie,” “not the real story,” “a fairy tale,” “a statistical delusion,” and “the myth that won’t die.” Sadly, it is not only right-wing propagandists who are gender wage gap denialists. Far more moderate types like Slate’s Hanna Rosin and the Atlantic’s Derek Thompson have also claimed that the gender wage gap statistic is misleading and exaggerates disparities in earnings.

According to the most recent figures available from the Census Bureau, for every dollar a man makes, a woman makes only 79 cents, a statistic that has barely budged in a decade. And that’s just the gap for women overall; for most women of color, it’s considerably larger. Black women earn only 61 percent of what non-Hispanic white men make, and Latinas earn only 55 percent as much. In a recent survey, U.S. women identified the pay gap as their biggest workplace concern. Yet gender wage gap denialists of a variety of political stripes contend that gender gap statistic—which measures the difference in median annual earnings between men and women who work full-time, year-round—is inaccurate because it does not compare the pay of men and women doing the same work. They argue that when researchers control for traits like experience, type of work, education, and the like, the gender gap evaporates like breath on a window. In short, the denialists frame the gender pay gap as the product not of sexist discrimination, but of women’s freely made choices.

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The EPI study’s co-author, economist Elise Gould, said in an interview with Rewire that she and her colleagues realized the need for the new report when an earlier paper generated controversy on social media. That study had uncovered an “unadjusted”—meaning that it did not control for differences in workplace and personal characteristics—$4 an hour gender wage gap among recent college graduates. Gould said she found this pay disparity “astounding”: “You’re looking at two groups of people, men and women, with virtually the same amount of experience, and yet their wages are so different.” But critics on Twitter, she said, claimed that the wage gap simply reflected the fact that women were choosing lower-paid jobs. “So we wanted to take out this one idea of occupational choice and look at that,” Gould said.

Gould and her co-author Jessica Schieder highlight two important findings in their EPI report. One is that, even within occupations, and even after controlling for observable factors such as education and work experience, the gender wage gap remains stubbornly persistent. As Gould told me, “If you take a man and a woman sitting side by side in a cubicle, doing the same exact job with the same amount of experience and the same amount of education, on average, the man is still going to be paid more than the woman.”

The EPI report cites the work of Harvard economist Claudia Goldin, who looked at the relative weight in the overall wage gap of gender-based pay differences within occupations versus those between occupations. She found that while gender pay disparities between different occupations explain 32 percent of the gap, pay differences within the same occupation account for far more—68 percent, or more than twice as much. In other words, even if we saw equal numbers of men and women in every profession, two-thirds of the gender wage gap would still remain.

And yes, female-dominated professions pay less, but the reasons why are difficult to untangle. It’s a chicken-and-egg phenomenon, the EPI report explains, raising the question: Are women disproportionately nudged into low-status, low-wage occupations, or do these occupations pay low wages simply because it is women who are doing the work?

Historically, “women’s work” has always paid poorly. As scholars such as Paula England have shown, occupations that involve care work, for example, are associated with a wage penalty, even after controlling for other factors. But it’s not only care work that is systematically devalued. So, too, is work in other fields where women workers are a majority—even professions that were not initially dominated by women. The EPI study notes that when more women became park rangers, for example, overall pay in that occupation declined. Conversely, as computer programming became increasingly male-dominated, wages in that sector began to soar.

The second major point that Gould and Schieder emphasize is that a woman’s occupational choice does not occur in a vacuum. It is powerfully shaped by forces like discrimination and social norms. “By the time a woman earns her first dollar, her occupational choice is the culmination of years of education, guidance by mentors, parental expectations, hiring practices, and widespread norms and expectations about work/family balance,” Gould told Rewire. One study cited by Gould and Schieder found that in states where traditional attitudes about gender are more prevalent, girls tend to score higher in reading and lower in math, relative to boys. It’s one of many findings demonstrating that cultural attitudes wield a potent influence on women’s achievement. (Unfortunately, the EPI study does not address racism, xenophobia, or other types of bias that, like sexism, shape individuals’ work choices.)

Parental expectations also play a key role in shaping women’s occupational choices. Research reflected in the EPI study shows that parents are more likely to expect their sons to enter male-dominated science, technology, engineering, and math (often called STEM) fields, as opposed to their daughters. This expectation holds even when their daughters score just as well in math.

Another factor is the culture in male-dominated industries, which can be a huge turn-off to women, especially women of color. In one study of women working in science and technology, Latinas and Black women reported that they were often mistaken for janitors—something that none of the white women in the study had experienced. Another found that 52 percent of highly qualified women working in science and technology ended up leaving those fields, driven out by “hostile work environments and extreme job pressures.”

Among those pressures are excessively long hours, which make it difficult to balance careers with unpaid care work, for which women are disproportionately responsible. Goldin’s research, Gould said, shows that “in jobs that have more temporal flexibility instead of inflexibility and long hours, you do see a smaller gender wage gap.” Women pharmacists, for example, enjoy relatively high pay and a narrow wage gap, which Goldin has linked to flexible work schedules and a professional culture that enables work/life balance. By contrast, the gender pay gap is widest in highest-paying fields such as finance, which disproportionately reward those able to work brutally long hours and be on call 24/7.

Fortunately, remedies for the gender wage gap are at hand. Gould said that strong enforcement of anti-discrimination laws, greater wage transparency (which can be achieved through unions and collective bargaining), and more flexible workplace policies would all help to alleviate gender-based pay inequities. Additional solutions include raising the minimum wage, which would significantly boost the pay of the millions of women disproportionately concentrated in the low-wage sector, and enacting paid family leave, a policy that would be a boon for women struggling to combine work and family. All of these issues are looming increasingly large in our national politics.

But in order to advance these policies, it’s vital to debunk the right’s shameless, decades-long disinformation campaign about the gender gap. The fact is, in every occupation and at every level, women earn less than men doing exactly the same work. The right alleges that the official gender pay gap figure exaggerates the role of discrimination. But even statistics that adjust for occupation and other factors can, in the words of the EPI study, “radically understate the potential for gender discrimination to suppress women’s earnings.”

Contrary to conservatives’ claims, women did not choose to be paid consistently less than men for work that is every bit as valuable to society. But with the right set of policies, we can reverse the tide and bring about some measure of economic justice to the hard-working women of the United States.

Commentary Sexual Health

Parents, Educators Can Support Pediatricians in Providing Comprehensive Sexuality Education

Nicole Cushman

While medical systems will need to evolve to address the challenges preventing pediatricians from sharing medically accurate and age-appropriate information about sexuality with their patients, there are several things I recommend parents and educators do to reinforce AAP’s guidance.

Last week, the American Academy of Pediatrics (AAP) released a clinical report outlining guidance for pediatricians on providing sexuality education to the children and adolescents in their care. As one of the most influential medical associations in the country, AAP brings, with this report, added weight to longstanding calls for comprehensive sex education.

The report offers guidance for clinicians on incorporating conversations about sexual and reproductive health into routine medical visits and summarizes the research supporting comprehensive sexuality education. It acknowledges the crucial role pediatricians play in supporting their patients’ healthy development, making them key stakeholders in the promotion of young people’s sexual health. Ultimately, the report could bolster efforts by parents and educators to increase access to comprehensive sexuality education and better equip young people to grow into sexually healthy adults.

But, while the guidance provides persuasive, evidence-backed encouragement for pediatricians to speak with parents and children and normalize sexual development, the report does not acknowledge some of the practical challenges to implementing such recommendations—for pediatricians as well as parents and school staff. Articulating these real-world challenges (and strategies for overcoming them) is essential to ensuring the report does not wind up yet another publication collecting proverbial dust on bookshelves.

The AAP report does lay the groundwork for pediatricians to initiate conversations including medically accurate and age-appropriate information about sexuality, and there is plenty in the guidelines to be enthusiastic about. Specifically, the report acknowledges something sexuality educators have long known—that a simple anatomy lesson is not sufficient. According to the AAP, sexuality education should address interpersonal relationships, body image, sexual orientation, gender identity, and reproductive rights as part of a comprehensive conversation about sexual health.

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The report further acknowledges that young people with disabilities, chronic health conditions, and other special needs also need age- and developmentally appropriate sex education, and it suggests resources for providing care to LGBTQ young people. Importantly, the AAP rejects abstinence-only approaches as ineffective and endorses comprehensive sexuality education.

It is clear that such guidance is sorely needed. Previous studies have shown that pediatricians have not been successful at having conversations with their patients about sexuality. One study found that one in three adolescents did not receive any information about sexuality from their pediatrician during health maintenance visits, and those conversations that did occur lasted less than 40 seconds, on average. Another analysis showed that, among sexually experienced adolescents, only a quarter of girls and one-fifth of boys had received information from a health-care provider about sexually transmitted infections or HIV in the last year. 

There are a number of factors at play preventing pediatricians from having these conversations. Beyond parental pushback and anti-choice resistance to comprehensive sex education, which Martha Kempner has covered in depth for Rewire, doctor visits are often limited in time and are not usually scheduled to allow for the kind of discussion needed to build a doctor-patient relationship that would be conducive to providing sexuality education. Doctors also may not get needed in-depth training to initiate and sustain these important, ongoing conversations with patients and their families.

The report notes that children and adolescents prefer a pediatrician who is nonjudgmental and comfortable discussing sexuality, answering questions and addressing concerns, but these interpersonal skills must be developed and honed through clinical training and practice. In order to fully implement the AAP’s recommendations, medical school curricula and residency training programs would need to devote time to building new doctors’ comfort with issues surrounding sexuality, interpersonal skills for navigating tough conversations, and knowledge and skills necessary for providing LGBTQ-friendly care.

As AAP explains in the report, sex education should come from many sources—schools, communities, medical offices, and homes. It lays out what can be a powerful partnership between parents, doctors, and educators in providing the age-appropriate and truly comprehensive sexuality education that young people need and deserve. While medical systems will need to evolve to address the challenges outlined above, there are several things I recommend parents and educators do to reinforce AAP’s guidance.

Parents and Caregivers: 

  • When selecting a pediatrician for your child, ask potential doctors about their approach to sexuality education. Make sure your doctor knows that you want your child to receive comprehensive, medically accurate information about a range of issues pertaining to sexuality and sexual health.
  • Talk with your child at home about sex and sexuality. Before a doctor’s visit, help your child prepare by encouraging them to think about any questions they may have for the doctor about their body, sexual feelings, or personal safety. After the visit, check in with your child to make sure their questions were answered.
  • Find out how your child’s school approaches sexuality education. Make sure school administrators, teachers, and school board members know that you support age-appropriate, comprehensive sex education that will complement the information provided by you and your child’s pediatrician.

School Staff and Educators: 

  • Maintain a referral list of pediatricians for parents to consult. When screening doctors for inclusion on the list, ask them how they approach sexuality education with patients and their families.
  • Involve supportive pediatricians in sex education curriculum review committees. Medical professionals can provide important perspective on what constitutes medically accurate, age- and developmentally-appropriate content when selecting or adapting curriculum materials for sex education classes.
  • Adopt sex-education policies and curricula that are comprehensive and inclusive of all young people, regardless of sexual orientation or gender identity. Ensure that teachers receive the training and support they need to provide high-quality sex education to their students.

The AAP clinical report provides an important step toward ensuring that young people receive sexuality education that supports their healthy sexual development. If adopted widely by pediatricians—in partnership with parents and schools—the report’s recommendations could contribute to a sea change in providing young people with the care and support they need.