Ethical attitudes of German specialists in reproductive medicine and legal regulation of preimplantation sex selection in Germany

Perceptions towards sex selection among Jordanian population: A survey study

Sex selection is becoming a more common practice in the society and worldwide. The current study aimed to examine the perceptions about sex selection options and possible association with sociodemographic factors and relevant characteristics. The study was a cross-sectional survey of adults in Jordan in January and February 2020 using a self-administered questionnaire. Results showed that 40.1% of respondents preferred male gender when having a child, 22.4% of respondents preferred the male gender when having a child, even if they have had children of both genders, and 71.3% preferred having children from both genders. On the other hand, 58.8% of participants preferred a male gender when there is one chance to conceive via assisted reproduction technologies. Also, among participants, 66% thought that sex selection is religiously acceptable, yet 78.0% did not support of the sex selection idea. The above factors were significantly associated with several sociodemographic variables such as gender, marital status, education, career, and place of residence, but not income. In conclusion, the current study shed a light on preferences towards sex selection in a large cohort to better understand the perception and attitude of the population towards this practice.

High and growing disapproval of sex-selection technology in Australia

BACKGROUND

In Australia, the National Health and Medical Research Council has banned the use of assisted reproductive technology for social sex selection, but notes "there is limited research into the question of whether Australians support the use of sex selection for non-medical purposes". This paper investigates Australian attitudes to sex-selection technology by different means (IVF, abortion, and a hypothetical pill), for different reasons (medical, family balancing, any reason), and by differing respondent characteristics (age, sex, education and religiosity).

METHODS

In 2007 and 2016, the Australian Survey of Social Attitudes (AuSSA) collected data on the attitudes of Australian adults to sex selection through IVF, abortion, and a hypothetical pill. We calculate population-weighted distributions and 95% confidence intervals of responses, and carry out logistic regressions to investigate the demographic characteristics of Australians who strongly disapprove of IVF or abortion for sex selection.

RESULTS

In 2016, around three-quarters of AuSSA respondents were opposed to legalising sex selection through IVF for any reason, or for family balancing for a second or third child. Thirty-seven per cent were opposed to IVF for medical sex selection. Two-thirds of respondents in both 2007 and 2016 disapproved or strongly disapproved of IVF for sex selection, while the proportion who strongly disapproved increased from 31 to 40%. Disapproval/strong disapproval of abortion for sex selection increased from 74 to 81% from 2007 to 2016, while strong disapproval alone rose from 44 to 55%. More than 70% of respondents in both 2007 and 2016 stated that a hypothetical pill for sex selection should not be legal. Our analysis finds that female, young, more-educated, and more religious respondents are more likely to strongly disapprove of sex selection via IVF or abortion, and that the increase in those who strongly disapprove from 2007 to 2016 is statistically significant.

CONCLUSIONS

Australians generally disapprove of the use of sex-selection technology. If legislation is to be guided by community attitudes, then the prohibition against sex selection for non-medical purposes through assisted reproductive technology should be maintained.

Global sex selection techniques for family planning: a narrative review

OBJECTIVE

To document the varying methods of sex selection, both primitive (traditional) as well as advanced forms available around the world.

CONTEXT

With the increasing desire of couples to choose the gender of their offspring, scientific sex-selection methods and techniques have evolved over time; unfortunately, the medical and social consequences have remained poorly emphasised.

METHODS

We searched electronic search engines and grey literature that included research articles from journals, books, websites and news articles in English until August 2016. We comprehensively compiled the findings such as underlying principles, time of use in relation to conception and others.

RESULTS

We classified the techniques into natural methods that rely on physiological conditions and artificial methods, including manipulation of seminal fluid for sex selection. Natural methods include Shettles technique, Whelan Method, Billings Ovulation Method, pre-conception diet, and gender selection kits such as GenSelect and Smart Stork, which rely on timing of intercourse, the vaginal environment, a selective diet and nutraceuticals. More advanced and artificial methods include sperm sorting or Ericsson's method, Microsort, Preimplantation Genetic Diagnosis and Urobiologics PreGender test. The markets for these techniques are prevalent in India where the birth of a son is desired. There is also widespread use of indigenous medicines for sex selection. The review reports side effects such as vaginal infections, hyperstimulation syndrome, multiple pregnancies, birth defects and stillbirths.

CONCLUSION

We conclude that sex-selection practices need urgent intervention in view of the social harm, unwarranted gender bias, and diversion of resources from genuine medical need.

Saving or Subordinating Life? Popular Views in Israel and Germany of Donor Siblings Created through PGD

To explore how cultural beliefs are reflected in different popular views of pre-implantation genetic diagnosis for human leukocyte antigen match (popularly known as "savior siblings"), we compare the reception and interpretations, in Germany and Israel, of the novel/film My Sister's Keeper. Qualitative analysis of reviews, commentaries and posts is used to classify and compare normative assessments of PGD for HLA and how they reproduce, negotiate or oppose the national policy and its underlying cultural and ethical premises. Four major themes emanated from the comparison: loss of self-determination and autonomy; loss of dignity through instrumentalization; eugenics and euthanasia; and saving life. In both countries, most commentaries represented a dominant position, with a few negotiated positions. We also highlight the decoding of a relatively less explored bioethical aspect of My Sister's Keeper's narrative, namely the meaning of euthanasia. We conclude by discussing how the findings relate to attempts of providing cultural explanations for the regulation of HLA-PGD.

What Israeli policy can teach us about elective sex selection

PIGD for gender selection for non medical reasons has been a subject of ethical, legal, and moral debate in many Western countries. This article discusses the background of elective sex selection, and highlights the impact of new technological developments on this dynamic discussion. The article published by Pessach et al., in this Journal, is an excellent study of Israeli health policy on non medically indicated preimplantation genetic screening for sex selection. In Israel, elective sex selection is prohibited, but exceptions can be made by application, for family balancing, and emotional and religious reasons. This review of a health policy over seven years is concordant with evolving views in many Western countries. The classic medical model for allowing sex selection for serious medical disorders may be too restrictive. There are different reasons that may be assessed in light of ethical criteria including a wider delineation of medical reasons, which may include emotional and psychological well being of the family, indirect medical reasons, as well as risk reduction for the following generations. The Israeli model may be a useful approach with wide application to reproductive health policies in many countries.