ON A RECENT day, Maya Jagdeesh, 35, was wheeled out of a room at The Fertility Institutes in Encino, Calif., after undergoing an $18,000 procedure to ensure she will give birth to a boy. Jagdeesh (not her real name) had flown in from Vancouver with her husband to Dr. Jeffrey Steinberg’s clinic after seeing his online ad that characterizes his pre-implantation genetic diagnosis (PGD) service as “the world’s largest and most successful 100 percent sex selection program.”
Jagdeesh said that in her Indian community, people would likely see her choice as one forced by her husband or her in-laws, but she said she had the procedure done of her own volition.
“I know in our culture it’s good to have a boy,” she said. But she and her husband have two “lovely daughters” ages 12 and 8, she said, and she felt having a son would “complete” her family.
“That’s the word I hear over and over again from 98 percent of my patients,” said Steinberg during an interview at his clinic. “They want to ‘complete’ their family.”
PGD is a combination of in vitro fertilization and genetic screening. Developed by Dr. Mark Hughes in the early 1990s, it was earlier used by fertility clinics in the United States solely to screen embryos for genetic diseases so children could avoid the fate of their parents. It was only a few years later that some clinics began offering it to choose a baby’s sex.
In the procedure, the gender of a batch of fertilized eggs is determined in the laboratory, and only the embryo of the desired sex is implanted into the uterus.
Steinberg’s clinic is large, bright and cheerful. At the front desk sit receptionists who switch with ease from English to other languages. Floral bouquets line the walls of his waiting room, and two pairs of booties – one blue and the other pink – sit in a showcase. The bouquets were sent to him by “satisfied” patients, said Steinberg, who describes his practice as “happy medicine.”
Steinberg might call it that, but not all the women who come to his clinic or some of the other fertility clinics in the U.S. that offer the service for a sex selection procedure are brought there by happy reasons. Especially for women with roots in India, China, Korea, Africa and the Middle East, sex selection is not freely chosen, and the clinics are part of a subtle and more overtly coercive practice. Women go there seeking something that’s banned in their home countries: sex selection techniques to guarantee the prize their husbands desire above all else – a son.
Steinberg is aware of this. He targets patients from those countries with ads in newspapers and websites that they read. And lured by the “guarantee” he offers, women, especially the more affluent ones, flock to his clinic. Those of Indian and Chinese descent form 30 percent of his client base, he said. Other fertility clinics in the U.S. offering the PGD technique say they have been seeing a growing clientele from those countries, as well.
Steinberg said he works with some 270 clinics worldwide, a number of them in India. Those clinics administer the hormone shots that stimulate egg production and prepare his patients for the sex selection procedure in the U.S. He declined to identify the India clinics, saying he didn’t want to get them into trouble. “It’s a very hot issue there,” he said.
“Have a Boy, Have a Girl Guaranteed,” said an ad for The Fertility Institutes in India-West, a national weekly published from San Leandro, Calif. The ad features a picture of a row of diaper-clad babies. Other clinics that offer sex selection services are specific. “Desire a Son?” asked another advertisement, also targeted at Indian immigrants.
Steinberg said he even advertised for some time on Indian websites, until he was “banned” by Google from doing it because sex selection is outlawed in India, as are such ads. One doctor who had a sex selection clinic there was “shut down,” Steinberg said.
Many Indian-American publications, including the widely circulated India Abroad newspaper and the Silicon Valley-based magazine, India Currents, dropped Steinberg’s ad after South Asian women and women’s rights groups protested that they were offensive.
The South Bay-based organization Indian Women in Business wrote to India Currents that sex selection services offered by The Fertility Institutes and other such clinics were stoking inherent cultural biases that discriminated against women.
But Steinberg maintained that he empowers women by giving them the opportunity to choose the sex of their child. Most of his Caucasian patients want girls, he said, acknowledging, however, that, “from patients from India, China and the Middle East, the request is for boys.”
Critics of such clinics dispute his perspective. “Just because his Caucasian patients want girls and not boys, he’s still encouraging gender discrimination,” noted Sujatha Jesudasan, executive director of the Berkeley-based Generations Ahead. The nonprofit works to promote policies on genetic technologies that protect human rights.
Jesudasan cited research that showed that “even in American society, men are more likely to stay married to women who give them a son, and also more likely to pay child support to sons.”
While most countries have banned clinics from offering sex selection procedures, the U.S. is among only a handful of countries that allows it. Those clinics call it “family balancing.”
Of the more than 400 fertility clinics in the U.S., nearly three-quarters offer PGD, according to a 2006 survey by the Genetics and Public Policy Center (GPCC), in Washington, D.C. And of those that offer the PGD technique, 42 percent do so for gender selection purposes, said Susannah Baruch of GPCC.
“We have women who come here with genes that could cause breast cancer and who don’t want to pass that on to their babies,” Steinberg said, but “for every woman I see regarding the breast cancer gene, I see 400 women who want to choose the sex of their child.”
Hughes, the developer of the PGD technique, told ABC News that more than 400 gene-linked diseases could be detected through the technique, and that he was opposed to using it for selecting the gender of a child.
“I went into science and into medicine to diagnose and treat and hopefully cure disease, and the last time I checked, your gender wasn’t a disease,” he said.
The ethics committee of the nation’s fertility society said that couples should be discouraged from selecting some embryos and discarding others, solely because they have a child of one sex and want one of another.
“We have a very nuanced position,” said Eleanor Nicoll, public affairs manager of the American Society for Reproductive Medicine. “Family balancing is a very worthwhile goal, but it’s not advisable to do in-vitro fertilization because it’s an invasive and complicated procedure.”
It is also a very lucrative procedure for the clinics that perform it. Steinberg has parlayed gender preference into a huge business opportunity. Besides his Encino flagship clinic, he has one in New York and another in Mexico. And despite the recession, “business hasn’t dipped,” he said proudly.
One reason is that the preference for male children in some cultures is deeply rooted among all classes, and the affluent are willing and able to pay for a son. In many Asian cultures, a boy is viewed as a potential breadwinner and one who will support his parents in their old age and continue the family line.
A girl is viewed as a burden because parents must pay a groom’s family a dowry – in cash or valuables – when she is married. As the saying goes in India, “Bringing up a daughter is like watering a plant in your neighbor’s yard.”
“I get calls from men in India who say they run a major corporation and they can’t leave it to their daughters,” Steinberg said.
Even though the giving of dowry was banned in India in 1994, it is still practiced with impunity in virtually every part of the country.
Dowry demands have financially ruined many families and even caused many newly married women to die in kitchen “accidents.”
While the son preference diminishes for many immigrants with assimilation, others, even the younger ones, continue to hold on to their cultural biases, even though they are less relevant here in the U.S.
A 2008 study, co-authored by economists Douglas Almond and Lena Edlund at Columbia University, found that the ratio of boys to girls among U.S. children born to Indian, Chinese and Korean parents is skewed. For the first children of these families, the sex ratio was similar to the general population – 1.05 to1. But when the first baby is a girl, the odds of the second being a boy rose to 1.17 to 1. And after the birth of two girls, the likelihood of the third being a son leaps to 1.51 to 1.
This is clear “evidence of sex selection most likely at the pre-natal stage,” wrote the authors, who relied on census data for their study.
So strong is the hunger for a male child in some communities in India, and so intense the pressure on women to produce a son that female infants are murdered there, sometimes by the frightened mothers themselves.
In some parts of Punjab, newborn girls are thrown into wells. In the southern Indian town of Salem, baby girls are fed poisonous potions or allowed to starve to death. An estimated 160,000 baby girls are reportedly killed in the state of Bihar every year.
The deep-rooted cultural bias against daughters has noticeably skewed the female-to-male ratio in some states in India, particularly in Punjab, Himachal Pradesh, Rajasthan, Uttar Pradesh and Bihar. The 2001 census data show there are about 35 million fewer females than males in India.
Part of the imbalance comes from abortions. Results of ultrasounds often lead to terminated pregnancies, which was why the Indian government yielded to pressure from women’s groups, and in 1994, banned the use of ultrasound to determine gender. Even so, over the past 20 years, sex-selective abortions continue to be practiced in India, resulting in 10 million “missing” female fetuses over the past 20 years, according to a 2006 report in The Lancet, the medical journal.
Steinberg said he is aware of the practice of female feticide and infanticide in India, and calls those practices “sickening and horrendous,” and he noted that, “in China, they abandon girl babies in the forest.”
But he does not think his clinic’s practice has any role in perpetuating a cultural preference for boys. “You don’t inject your own morals into what you want to do,” he said, “else you can’t be a good physician.”
Female feticide is one extreme end of a wide spectrum of cultural attitudes and practices toward females that includes sex selection and physical abuse.
Support groups for South Asian victims of domestic violence and women’s rights advocates talk of gender preference as being “part of the life cycle of violence against women,” Jesudasan said.
In the 25 years since it was started, Manavi, the New Jersey-based support group founded to end domestic violence among South Asians, “has helped at least 10 clients” who were abused by their spouses or in-laws for having produced a daughter and not a son, noted the group’s co-founder Shamita Das Dasgupta.
“I have talked to severely abused South Asian women in fertility clinics,” observed Dr. Sunita Puri, a final-year medical student at the University of California at San Francisco, who has been researching the issue of sex selection among South Asians in and outside the U.S. for the last six years for a medical anthropology study.
Steinberg said he has never heard one of his patients say she’s been abused, and if a woman indicated on his clinic’s intake sheet that she was, “We would not take her in.” But from many of his patients with roots in South Asia, he said, “I hear the words family pressure and social pressure.”
Steinberg generated more controversy last year when his website advertised that couples would be able to make “a pre-selected choice of gender, eye color, hair color and complexion.” In other words, they could have a designer baby.
Steinberg said he was responding to requests from couples, many of them wanting “green-eyed babies.” He said he saw no problem with it.
But others do. “He’s opening the door to a world of genetic castes,” asserted Marcy Donovan, associate executive director of the Berkeley-based Center for Genetics and Society. “Even those people who want to have a girl will now want a certain kind of girl. What happens if that girl doesn’t live up to their expectations?”
Jesudasan concurred. “Our ultimate fear was that sex selection would become a gateway for eugenics,” she said.
Steinberg has put his plans on hold because “the Vatican and ethicists” came down on him. “I’m not a mad man,” he said. “I’m sensitive to feedback.”
Meanwhile, by the time Jagdeesh is delivered of her baby, she estimates she will have spent close to $35,000, which would include all the hormone shots she had taken at the Vancouver clinic prior to coming to The Fertility Institutes, the air fare and hotel expenses for herself and her husband to fly over to Encino, and the monitoring the Vancouver clinic will provide her until her child is born. “It will certainly be an expensive baby,” she said.
This story was first published on the New America Media website.