Social sex selection and the balance of the sexes: Empirical evidence from Germany, the UK, and the US

  • E. DahlEmail author
  • M. Beutel
  • B. Brosig
  • S. Grüssner
  • Y. Stöbel-Richter
  • H.-R. Tinneberg
  • Elmar Brähler
Original Paper


Preconception sex selection for nonmedical reasons is one of the most controversial issues in bioethics today. The most powerful objection to social sex selection is based on the assumption that it may severely distort the natural sex ratio and lead to a socially disruptive imbalance of the sexes. Based on representative social surveys conducted in Germany, the United Kingdom, and the United States, this paper argues that the fear of an impending sex ratio distortion is unfounded. Given the predominant preference for a “gender balanced family,” a widely available service for social sex selection is highly unlikely to upset the balance of the sexes in Western societies.


Sex selection Sex ratio Gender preferences Public policy 


  1. 1.
    Heyd D. Male or female, we will create them: the ethics of sex selection for non-medical reasons. Ethical Perspectives 2003;10:204–14PubMedCrossRefGoogle Scholar
  2. 2.
    Schaffir J. What are little boys made of? The never-ending search for sex selection techniques. Perspectives Biol Med 1991;34(4):516–25Google Scholar
  3. 3.
    Schulman JD, Karabinus D. Scientific aspects of preconception gender selection. Reprod BioMed Online 2005;10(Supp. 1):111–15PubMedGoogle Scholar
  4. 4.
    Gleicher N, Karande V. Gender selection for nonmedical indications. Fertil Steril 2002;78(3):460–2PubMedCrossRefGoogle Scholar
  5. 5.
    Egozcue J. Preimplantation social sexing: a problem of proportionality and decision making. J Assist Reprod Genet 2002;19(9):440–2PubMedCrossRefGoogle Scholar
  6. 6.
    Sills ES, Palermo GD. Preimplantation genetic diagnosis for elective sex selection, the IVF market economy, and the child – another long day's journey into night? J Assist Reprod Genet 2002;19(9):433–7PubMedCrossRefGoogle Scholar
  7. 7.
    Pennings G. Personal desires of patients and social obligations of geneticists. Prenat Diagn 2002;22:1123–29PubMedCrossRefGoogle Scholar
  8. 8.
    Berkowitz JM, Snyder JW. Racism and sexism in assisted conception. Bioethics 1998;12:25–44PubMedCrossRefGoogle Scholar
  9. 9.
    Ethics Committee of the American Society for Reproductive Medicine. Preimplantation genetic diagnosis and sex selection. Fertil Steril 1999;72:595–8CrossRefGoogle Scholar
  10. 10.
    Benagiano G, Bianchi P. Sex preselection: an aid to couples or a threat to humanity? Hum Reprod 1999;14:870–2CrossRefGoogle Scholar
  11. 11.
    Dai J. Preconception sex selection: the perspective of a person of the undesired gender. Am J Bioethics 2001;1:37–8CrossRefGoogle Scholar
  12. 12.
    Davis D. Genetic dilemmas: reproductive technology, parental choices, and children's futures. New York: Routledge, 2001Google Scholar
  13. 13.
    Fukuyama F. Our posthuman future: consequences of the biotechnology revolution. New York: Farrar Straus & Giroux, 2002Google Scholar
  14. 14.
    Hill DL, Surrey MW, Danzer HC. Is gender selection an appropriate use of medical resources? J Assist Reprod Genet 2002;19(9):438–9PubMedCrossRefGoogle Scholar
  15. 15.
    Sauer MV. Gender selection: pressure from patients and industry should not alter our adherence to ethical guidelines. Am J Obstet Gynec 2004;191:1543–5PubMedCrossRefGoogle Scholar
  16. 16.
    Warren MA. Gendercide: the implications of sex selection. San Francisco: Rowman & Allanheld, 1985Google Scholar
  17. 17.
    Savulescu J. Sex selection – the case for. Med J Australia 1999;171:373–5PubMedGoogle Scholar
  18. 18.
    Savulescu J, Dahl E. Preimplantation genetic diagnosis and sex selection : a response to the Ethics Committee of the American Society for Reproductive Medicine. Hum Reprod 2000;15(9):1879–80PubMedCrossRefGoogle Scholar
  19. 19.
    McCarthy D. Why sex selection should be legal. J Med Ethics 2001;27:302–7PubMedCrossRefGoogle Scholar
  20. 20.
    Robertson JA. Preconception gender selection. Am J Bioethics 2001;1(1):2–9CrossRefGoogle Scholar
  21. 21.
    Dahl E. Procreative liberty: the case for preconception sex selection. Reprod BioMed Online 2003;7(4):38–4Google Scholar
  22. 22.
    Dahl E. The presumption in favor of liberty: a comment on the HFEA's public consultation on sex selection. Reprod BioMed Online 2004;8(3):266–7PubMedGoogle Scholar
  23. 23.
    The House of Commons. Reproductive technologies and the law. London: 2005Google Scholar
  24. 24.
    Singer P, Wells D. The reproduction revolution: new ways of making babies. Oxford: Oxford University Press, 1984Google Scholar
  25. 25.
    Glover J. Comments on some ethical issues in sex selection. In: Sureau C, Shenfield F (eds.) Ethical aspects of human reproduction. Paris: John Libbey 1995;305–13Google Scholar
  26. 26.
    Pennings G. Family balancing as a morally acceptable application of sex selection. Hum Reprod 1996;11:2339–45PubMedGoogle Scholar
  27. 27.
    Ethics Committee of the American Society for Reproductive Medicine. Preconception gender selection for nonmedical reasons. Fertil Steril 2001;75:861–4CrossRefGoogle Scholar
  28. 28.
    Dickens BM. Can sex selection be ethically tolerated? J Med Ethics 2002;28:335–36PubMedCrossRefGoogle Scholar
  29. 29.
    Robertson JA. Gender variety as a valid choice. Reprod BioMed Online 2004;8(3):268–9Google Scholar
  30. 30.
    Dawson K, Trounson A. Ethics of Sex Selection for Family Balancing: Why Balance Families? Hum Reprod 1996;11:2577–78PubMedGoogle Scholar
  31. 31.
    Ruddick W. Prejudice Against “Unbalanced” Families. Am J Bioethics 2001;1:31–32CrossRefGoogle Scholar
  32. 32.
    Dahl E. Sex selection: laissez faire or family balancing? Health Care Anal 2005;13(1):87–90PubMedCrossRefGoogle Scholar
  33. 33.
    Etzioni A. Sex control, science, and society. Science 1968;161:1107–1112CrossRefPubMedGoogle Scholar
  34. 34.
    Vines G. The hidden cost of sex selection. New Scientist of May 1, 1993;12–13Google Scholar
  35. 35.
    Stoppard M. Should you get to choose your child's sex? Mirror of March 22, 2005Google Scholar
  36. 36.
    Jha P, Kumar R, Vasa P, Dhingra N, Thiruchelvam D, Moineddin R. Low male-to-female sex ratio of children born in India: national survey of 1,1 million households. The Lancet Online 2006; DOI:10.1016/SO140-6763(06)67930-0Google Scholar
  37. 37.
    Sheth SS. Missing female births in India. The Lancet Online 2006; DOI: 10.1016/SO140-6763(06)67931-2Google Scholar
  38. 38.
    Kusum. The use of pre-natal diagnostic techniques for sex selection: the Indian scene. Bioethics 1993;7:149–65PubMedGoogle Scholar
  39. 39.
    Hudson V, Den Boer A. Bare branches: the security implications of Asia's surplus male population. Cambridge: MIT Press, 2004Google Scholar
  40. 40.
    Benagiano G, Bianchi P. Sex preselection: an aid to couples or a threat to humanity? Hum Reprod 1999;14:868–70PubMedCrossRefGoogle Scholar
  41. 41.
    Dahl E. No country is an island: a comment of the House of Commons’ report ‘Human Reproductive Technologies and the Law’. Reproductive BioMed Online 2005;11:10–11Google Scholar
  42. 42.
    Serour GI. Transculural issues in gender selection. Int Congress Ser 2004;1266:21–31CrossRefGoogle Scholar
  43. 43.
    Dickens BM, Serour GI, Cook RJ, QIU RZ. Sex selection: treating different cases differently. Int J Obstet Gynecol 2005;90:171–77CrossRefGoogle Scholar
  44. 44.
    Dahl E, Beutel B, Brosig B, Hinsch K-D. Preconception sex selection for non-medical reasons: a representative survey from Germany. Hum Reprod 2003;18:2231–34PubMedCrossRefGoogle Scholar
  45. 45.
    Dahl E, Hinsch K-D, Beutel M, Brosig B. Preconception sex selection for non-medical reasons: a representative survey from the United Kingdom. Hum Reprod 2003;18:2238–39PubMedCrossRefGoogle Scholar
  46. 46.
    Dahl E, Gupta RS, Beutel M, Stöbel-Richter Y, Brosig B, Tinneberg H-R, Jain T. Preconception sex selection demand and preferences in the United States. Fertil Steril 2006;85:468–73PubMedCrossRefGoogle Scholar
  47. 47.
    Williamson NE. Sons or daughters: a cross-cultural survey of parental preferences. Beverly Hills: Sage, 1976Google Scholar
  48. 48.
    Westoff CF, Rindfuss RR. Sex preselection in the United States: some implications. Science 1974;184:633–36CrossRefGoogle Scholar
  49. 49.
    Brosig B, Dahl E, Beutel M, Tinneberg H-R, Jain T, Grüssner S. Gender preferences and demand for sex selection: a survey among pregnant women in Germany. Prenatal Diagnosis 2006 (manuscript under review)Google Scholar
  50. 50.
    Steinbacher R, Gilroy FD. Preference for sex of child among primiparous women. J Psychol 1985;119:141–47Google Scholar
  51. 51.
    Statham H, Green J, Snowdon C, France-Dawson M. Choice of baby's sex. The Lancet 1993;341:564–65CrossRefGoogle Scholar
  52. 52.
    Westoff CF, Potter RG, Sagi P. The third child: a study in the prediction of fertility. Princeton: Princeton University Press 1963Google Scholar
  53. 53.
    Sloane DM, Lee CF. Sex of previous children and intentions for further births in the United State, 1965–1976. Demography 1983;20:353–67PubMedGoogle Scholar
  54. 54.
    Yamaguchi K, Ferguson LR. The stopping and spacing of childbirths and their birth-history predictors: rational choice theory and event-history analysis. Am Sociol Rev 1995;60:272–98CrossRefGoogle Scholar
  55. 55.
    Hank C, Kohler H-P. Gender preferences for children in Europe: empirical results from 17 countries. Demogr Res 2000;2:1–21CrossRefGoogle Scholar
  56. 56.
    Pollard MS, Morgan SP. Emerging parental gender indifference? Sex composition of children and the third birth. Am Sociol Rev 2002;67:600–13CrossRefPubMedGoogle Scholar
  57. 57.
    Liu P, Rose GA. Social aspects of >800 couples coming forward for gender selection of their children. Hum Reprod 1995;10:968–71PubMedGoogle Scholar
  58. 58.
    Khatamee MA, Leinberger-Sica A, Matos P, Weseley AC. Sex selection in New York City: who chooses which sex and why? Int J Fertility 1989;34:353–54Google Scholar
  59. 59.
    Beermink JF, Dmowski WP, Ericsson RJ. Sex preselection through albumin separation of sperm. Fertil Steril 1993;59:382–86Google Scholar
  60. 60.
    Fugger EF, Black SH, Keyvanfar K, Schulman JD. Births of normal daughters after MicroSort sperm separation and intrauterine insemination, in-vitro fertilization, or intracytoplasmic sperm injection. Hum Reprod 1998;13:2367–70PubMedCrossRefGoogle Scholar
  61. 61.
    Dahl E, Hinsch K-D, Brosig, Beutel M. Attitudes towards preconception sex selection: a representative survey from Germany. Reprod BioMed Online 2004;9:600–03PubMedGoogle Scholar
  62. 62.
    Krones T, Schlüter E, Manolopoulos K, Bock K, Tinneberg H-R, Koch MC, Lindner M, Hoffmann GF, Mayatepek E, Huels G, Neuwohner E, El Ansari S, Wissner T, Richter G. Public, expert and patients’ opinions on preimplantation genetic diagnosis in Germany. Reprod BioMed Online 2004;10:116–23CrossRefGoogle Scholar
  63. 63.
    Meister U, Finck C, Stöbel-Richter Y, Schmutzer G, Brähler E. Knowledge and attitudes towards preimplantation genetic diagnosis in Germany. Hum Reprod 2005;20:231–38.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • E. Dahl
    • 1
    Email author
  • M. Beutel
    • 3
  • B. Brosig
    • 2
  • S. Grüssner
    • 1
  • Y. Stöbel-Richter
    • 4
  • H.-R. Tinneberg
    • 1
  • Elmar Brähler
    • 4
  1. 1.Center for Gynaecology and ObstetricsUniversity of GiessenGiessenGermany
  2. 2.Clinic for Psychosomatic Medicine and PsychotherapyUniversity of Giessen, GermanyGiessenGermany
  3. 3.Clinic for Psychosomatic Medicine and PsychotherapyUniversity of Mainz, GermanyMainzGermany
  4. 4.Department of Psychology and Medical SociologyUniversity of Leipzig, GermanyLeipzigGermany

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