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The rise of gender selection among Middle Eastern couples

Sex selection is a dirty phrase in Western countries, but Middle Eastern couples are jumping on fertility technology as changing attitudes make it easier and more acceptable to 'make it a boy'.


Euphemistically called 'family balancing,' couples throughout the Middle East are turning to a technique called PGD, or pre-implantation genetic diagnosis to choose male embryos.

Yale University Middle East fertility expert, Marcia Inhorn, told Middle East Monitor PGD was needed in the Middle East thanks to the high degree of genetic diseases and male infertility caused, in part, by intra-family marriages.

But much to her dismay she is also seeing an increased use of PGD solely for sex selection.

"It could really get out of hand, and actually there probably will be a traffic of reproductive tourists coming for gender selection to places like the UAE, unfortunately. So that one is an ethical slippery slope. It doesn't make me happy to know people are selecting boys over girls."

Dr Inhorn said she was hearing rumours of clinics in Jordan and the UAE where most of the patients were there to conceive a boy. In her current research she was particularly seeing a rising trend of Emirati women using PGD to have boys.

PGD is used as part of in vitro fertilisation (IVF), and is designed to discover genetic diseases in embryos before they are implanted in a woman's uterus. It began to be used successfully from 1990.

Dr Ragaa Mansour, one of the pioneers who brought reproductive technology to Egypt in 1986, said PGD was desperately necessary in Egypt and the wider Middle East for rooting out genetic diseases.

"It is a method of preventing the transmission of genetic diseases to offspring. In Egypt [it] is highly needed for the prevention of [inherited blood disorder] Thalassaemia [and] the prevention of chromosomal anomalies," she told Middle East Monitor in an email.

She was the only Middle Eastern medical professional interviewed who did not agree with PGD being used for sex selection.

Having children is paramount in the Middle East, with women facing social ostracism and even divorce if they do not bear any children in a marriage. The need for boys however comes down to the desire to continue the patrilineal line.

A fatwa in 1980 from Al Azhar University in Cairo specified that Muslim families can use 'family balancing' when a woman has had three or four daughters (or sons) and it's in the best interests of her and her family that the next pregnancy should be her last. It can't be used to discriminate against either sex.

Nonetheless, it's not just the widening availability of the technology that is prompting Middle Eastern couples to skip the uncertainty and take control of the gender of their children.

Dr Bassam Elhelw, director of the Middle East Fertility Centre in Cairo and assistant editor of the Middle East Fertility Society Journal, said in Egypt peoples' attitudes towards family life and infertility had changed since the January 25 revolution in 2011.

"I think they [attitudes] definitely changed because what happened in the last two years was things were happening very fast. The pace of life in Cairo was very slow… people want things faster [now]."

Moreover, total fertility rates, or the number of children couples now have, is also influencing the swing towards sex selection because modern couples want to have smaller numbers of children.

Dr Inhorn said it was a matter of practicality.

"In the last decade or so the total fertility rates across the Middle East have just plummeted," she said.

"Because the numbers of children are declining and you need to have a son… Instead of putting a woman through more pregnancies where she might end up having more girls, let's just cut that short: 'We only want to have three kids, we've got two daughters, let's make sure we get a son'."

World Bank data shows the average number of children each woman in the Middle East (including Egypt) had in 1990 was five, dropping to 2.89 in 2011. The highest average in 1990 was in Yemen with women having on average 8.7 children each, dropping to 5.1; and Iran recorded the lowest rate in 2011 as Iranian women bore an average of only 1.6 children each.

The cost, however, will slow the take up of PGD in the Middle East solely for sex selection.

In Egypt the minimum cost of choosing the sex of a child is more than double that of regular fertility treatments.

Dr Ashraf Sabry, the director of three eponymous clinics in and around Cairo, put the price at EGP25-30,000 in his practices. The cost of regular IVF is between EGP8-12,000.

He said perhaps 10-15 women of the 200-400 patients who used his services used PGD for sex selection only.

Half of those were second wives or women with only girls, and the other half were couples concerned with inheritance issues. All were asking for boys.

"It's all Arabs. They love boys. I've only had two or three women in my whole life asking for girls."

Dr Elhelw would not elaborate on what he charged, but said simply that it was "very expensive", and often once he'd explained the process and success rate (the same for IVF – 80%) people chose not to go through with it.

And according to Dr Inhorn, deep down families throughout the Middle East prefer girls anyway.

"Women in the Middle East…really feel that a daughter is your lifelong best friend," she said.

"Then I started to hear that rhetoric from men as well. I've heard it from plenty of men in a variety of countries just say, well you know, you kind of need a son because of the lineage and all of that, but on an affective level you want a daughter… In terms of who you love to spend time with, usually it's the daughter!"

The views expressed in this article belong to the author and do not necessarily reflect the editorial policy of Middle East Monitor.

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