The Abortion Trap

How America's obsession with abortion hurts families everywhere.

For nearly two decades, anti-abortion activists have been at work in a disingenuous game, using the stark reduction of women in the developing world as an argument for taking away hard-earned rights. Conservative theorists have written openly about how sex-selective abortion is merely a convenient wedge issue in the drive to ban all abortions, both in the United States and abroad. And now, conservative commentators like the New York Times' Ross Douthat, the Wall Street Journal's Jonathan V. Last, and the editors of the New York Sun have claimed that my book, Unnatural Selection, strengthens their case.

This does not surprise me. One of the themes that cropped up again and again in my reporting was the extent to which American abortion politics on both sides of the question has stalled action on issues of major global importance. But it is deeply unfortunate. The American obsession with abortion does not just hinder work on maternal and child health or access to safe birth control abroad -- two areas that have suffered because of domestic campaigns by anti-abortion activists. It's also distracting U.S. policymakers from what should be the real conversation in a country that leads the world in human reproductive technology: whether to allow parents to use a growing range of methods to select for characteristics like sex (or diseases that come on late in life and, perhaps one day, IQ) in their children. Because sex selection is not just a developing-world problem -- it's an American problem, too.

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Western influence and technology have caused their fair share of damage abroad, but often the damage is not explicitly foreseen, so that decades later it is still possible for trouble's architects to look back and say, "We just didn't know." But with fetal sex determination and sex selection, a good number of people knew. The 1960s population control enthusiasts who supported pushing along research into sex selection methods as a way to reduce the global birth rate knew those methods would occasion a reduction in the proportion of girls born, even if they did not envision the scale of that reduction -- the disappearance of 160 million females, by 2005, from Asia's population. As I delved into this history for my book, the tragedy for me became this cold foresight: the fact that some prominent activists and scientists actually anticipated the side effects of widespread sex selection -- that a massively imbalanced sex ratio at birth would result in rising instability, risks for those women who are born, and a social environment bordering on what one early proponent described as a "giant boy's public school or a huge male prison" -- and yet dismissed those effects as necessary ills in the quest to solve humanity's problems through technology. They knew, and still they plowed ahead.

The story behind sex selection should serve as a cautionary tale as we consider other technological quick fixes as solutions to our current global problems: dumping iron into our oceans in the quest to fight climate change, say. But the American response to my book has largely overlooked this point, glossing over the moral implications of sex determination technologies like ultrasound, amniocentesis, and add-ons to in-vitro fertilization (IVF), and instead homing in on abortion.

True enough, abortion is the primary method of sex selection in the developing world today. But it is hardly the most ideal method. Given the choice between a second-trimester abortion and a cheap and easy procedure performed close to the moment of conception, most couples would choose the second. That is why activists concerned about a reduction in the number of women in the world -- or in the number of disabled, red-haired, or short people -- are looking ahead to emerging technologies like fetal DNA testing, sperm sorting, and embryo screening.

The high-tech sex selection front-runner in both the developing and developed worlds for the moment is a technique called preimplantation genetic diagnosis (PGD), the add-on to in-vitro fertilization sometimes called embryo screening. Once a donor's eggs have been retrieved and fertilized with a man's sperm and the resulting zygotes have grown into embryos, a single cell can be removed and tested for sex.

Like ultrasound and amniocentesis before it, PGD can be used to diagnose much more than an embryo's sex. That is why most of the Western world regulates it instead of banning it outright. The United Kingdom has made perhaps the most ambitious effort at regulation in establishing the Human Fertilisation and Embryology Authority (HFEA), an agency under the Department of Health charged with regulating fertility clinics, sperm banks, and other businesses connected with assisted reproduction. Thanks to the HFEA, British couples may undergo PGD to avoid passing on debilitating diseases like cystic fibrosis --but not for what is called social sex selection, or simply because they want a boy or a girl. For that, many fly to the United States.

Because its health-care system is privatized and because techniques like social sex selection are a cash cow for the clinics that provide them, the United States has become the Wild West of assisted reproduction, home to Octomom and a host of less well-known ethical blunders. America also allows nearly unfettered use of the new sex selection technologies. The American Society for Reproductive Medicine issues guidelines for fertility clinics, but they are only voluntary -- and many clinics don't follow them.

But since assisted reproduction is typically carried out in private clinics that do not receive federal funding, the field gets far less oversight than many other areas of medicine. Some techniques have "moved from concept to clinic without systematic animal studies or reviews by any independent agency or committee," Marcy Darnovsky, associate executive director of the Center for Genetics and Society in Berkeley, California, wrote in a recent article for the website Science Progress. In many regards, international adoption is governed by stricter regulations than assisted reproduction.

That's why, some three decades after sex selection found its way to Asia, the United States has become a destination for couples from around the world seeking the latest techniques. Couples from China and India fly to Los Angeles to undergo PGD at Fertility Institutes, a clinic I visited last year. (A good number of healthy Americans shell out the $15,000-plus cost of PGD simply to get a boy or a girl as well. One out of every 100 babies in the United States is born through IVF, and fertility patients are often encouraged to tack on PGD. While clinics aren't required to report what PGD is used for, a 2006 survey of those that perform the procedure by the Genetics and Public Policy Center at Johns Hopkins University found 42 percent of responding clinics offered it for social sex selection.) The United States has also become an exporter of technologies with questionable ethical underpinnings. Jeffrey Steinberg, Fertility Institutes' founder, has opened an office in Guadalajara, Mexico, and clinics offering PGD are being set up in Asia, in some cases in countries with already severe gender imbalances.

Take South Korea, for example: Sex-selective abortion has gone out of style there, and the country's once-skewed sex ratio at birth is now balanced. But wealthy parents still turn to PGD, according to Sohyun Kim, a doctor who runs a small clinic in a tony part of Seoul. "These days, because of IVF technology, parents have a lot of different embryos to choose from," she told me. "They ask for the ones they don't want to be eliminated. The girls can be erased. And the boys remain."

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In his review of my book, Last contended the work is "aimed, like a heat-seeking missile, against the entire intellectual framework of 'choice.'" It is true that I don't believe absolute choice is a great framing point for the politics of modern reproduction. The range of options available to parents today is simply too great. The rhetoric surrounding abortion in the United States sorely needs to be updated. (I am hardly alone in this thought. While the term "pro-choice" lives on, it is no coincidence that the new buzzword is "reproductive justice.")

That said, selecting for sex -- or any other quality -- is different from a woman's decision not to carry a pregnancy to term. When parents choose to have a child because he is male, they may do so with the expectation that their son will turn out to be an upstanding heir or that he will carry on the family line. Or, should they want a girl, they may be seeking a child who enjoys wearing pink dresses and playing with dolls. Ethically, this is worlds apart from a woman's choice not to continue a pregnancy -- or not to get pregnant in the first place. One is the decision of a woman considering her own body. The other involves the creation of a new human being -- and expectations for how that human being will turn out.

Sex selection, indeed, represents a form of choice that looks a lot like willful manipulation. ("Sex control," the typically bold 1960s phrase used by those who proposed sex selection as population control, has turned out to be a good term for it.) It marks the dawn of what Harvard University political philosopher Michael Sandel calls "hyperagency" -- "a Promethean aspiration to remake nature, including human nature, to serve our purposes and satisfy our desires."

But the distinction between these two types of choices is not merely intellectual; it has legal grounding as well. Roe v. Wade came at a time when today's reproductive dilemmas were still the stuff of speculation, yet it explicitly protects a woman's right to decide whether to carry a pregnancy to term -- while also acknowledging that right can have limits. In crafting a framework for pre-pregnancy sex selection, the United States might look to countries like France, the Netherlands, and Denmark, where abortion rights are intact and yet sex selection for social reasons is prohibited.

The anti-abortion movement should agree that sex selection, along with many other forms of selection, is wrong, and indeed many in the religious community see what happens today as tampering with God's work. (The Vatican struck out against using PGD for trait selection in 2009.) But unfortunately the same people who would ban abortion in the United States are often allied with the very ones who advocate for free-market health care and lax oversight of industry -- the very ingredients that have made the United States a destination for the hyper-controlling parents of the world intent on getting a certain type of child. Conservatives who object to tampering with reproduction are rivaled in strength by those who favor letting market forces govern health care.

The result is nothing less than consumer eugenics. "Gender selection is a commodity for purchase," Steinberg, the Los Angeles clinic founder, reportedly told journalist Mimi Rohr in 2006. Sex is only the first non-medical or non-disability condition that can be tested using PGD, though the arrival of more sophisticated diagnostic techniques push the boundary of what constitutes a medical condition. (Adult-onset Alzheimer's? A future that may involve breast cancer? A propensity toward obesity?) In 2009, Steinberg announced on Fertility Institutes' website that his clinic would soon offer selection for eye color, hair color, and skin color. He retracted the announcement after a public outcry, but when I met him last year he told me it wasn't a change of heart -- he's just waiting for public sentiment to come around.

Others with less of a financial stake in the matter agree that unfettered reproductive selection is the way of the future. James Watson, co-discoverer of DNA's double-helix structure, told an audience in 2003 that he supported knowledge gleaned from his discovery being used to shape the outcome of reproduction on an individual level, while Princeton University molecular biologist Lee M. Silver has written on the inevitability of a Gattaca-like society split between the genetic haves and have-nots.

Whatever awaits us, it's clear that the issue of abortion is increasingly a red herring. Activists on both the right and the left might now be wise to abandon the abortion fray and consider speaking out for restraint in other areas. Governments in Asia have introduced measures to address sex selective abortion, and Western support for those measures is critical. But beyond that, the United States should now lead in addressing the new technologies emerging from within its borders. We owe as much to the world and to future generations -- so that next time it can't be said that we knew and yet chose not to act.

Mark Wilson/Getty Images


Stopping the Nuclear North

Kim Jong Il is rapidly building his doomsday arsenal. If Washington wants any shot to stop him, the time for negotiations is now.

U.S. Secretary of State Hillary Clinton's announcement this weekend that North Korean Vice Foreign Minister Kim Kae Gwan will soon visit New York City is the strongest indication yet that the six-party talks -- the negotiations over Pyongyang's nuclear program between the United States, China, Japan, Russia, North Korea, and South Korea -- could resume as early as this fall. If so, it would not only mark an end to what's been a two-year hiatus in the talks, but it could also signal the beginning of a new, and critical, phase of the negotiations. Indeed, while all the involved parties are by now deeply familiar with the basic issues at hand, the stakes are higher now than ever to salvage a palatable solution to North Korea's nuclear problem.

Right now, North Korea may well be at a critical transitional moment in the development of its nuclear arsenal. Pyongyang has already completed the first phase of developing such an arsenal, having built a small, minimal nuclear force consisting of a handful of weapons that it may or may not be able to mount on a few short-range missiles. The issue before us now is what dangers lie ahead if the North steps up that effort. If Pyongyang is anything like other small nuclear powers such as India, Pakistan, and Israel, we can expect it to move on to building increasing numbers of more sophisticated nuclear weapons mounted on a variety of missile delivery systems.

Imagine a world in which North Korea is armed with tens of weapons mounted on missiles able to devastate Seoul and Tokyo and, conceivably, even parts of the United States. Increasingly confident of its own nuclear prowess, Pyongyang would have free rein to indulge its worst international impulses. We could expect the North to provoke frequent confrontations with South Korea and peddle its nuclear know-how on the international black market without fear of serious reprisals.

It would also represent a strategic defeat for Washington. It would undermine the credibility of the U.S. regional nuclear umbrella, triggering escalating demands from South Korea and Japan that the United States reinforce its security commitment; it might also spur the breakdown of the entire regional nonproliferation regime, as Washington's allies move to acquire their own nuclear arsenals. All this would be happening at a time when U.S. domestic pressures to cut or redeploy conventional forces abroad would make it difficult or impossible to bolster American defense commitments. It would also seriously aggravate fault lines between the United States and China, particularly if Beijing stands aside as Pyongyang's nuclear posture grows.

While many experts are concerned about the security of Pakistan's nuclear arsenal, imagine the dangers of a politically unstable, nuclear-armed North Korea. Those weapons could become pawns in internal power struggles or even used by competing factions against each other. That may seem far-fetched, but because we are unlikely to know whether the North will have taken the proper precautions to prevent this from happening, these dangers would have to be taken seriously.

Certainly, the North has the wherewithal to expand its nuclear program if it's so inclined. Late last year, Pyongyang revealed a surprisingly sophisticated program that could eventually allow it to produce highly enriched uranium for more bombs. The North is also actively working on increasingly capable missiles at the new modern Dongchang-ri launch facility. News reports on Sunday, July 24, revealed that it had conducted rocket-engine tests late last year for those systems at that site. If North Korea is like any other small nuclear power, its scientists are probably also working on increasingly sophisticated bomb designs; the military establishment has almost certainly made plans for a bigger, more capable, nuclear arsenal.

Kim Jong Il may already have made the decision to expand his nuclear capabilities. And it's entirely possible that Pyongyang's diplomatic strategy could simply be a ploy designed to keep the world at bay while his plans move forward. But we have no way of knowing that, and only a concerted diplomatic effort will be able to find out for sure. That will mean being open to agreements, at least in the near future, that fall short of achieving full denuclearization, a negotiating stance that will no doubt be unpopular with a hostile Republican Congress in Washington and with U.S. allies nervous that America will tacitly accept a nuclear North if Pyongyang agrees not to export dangerous technologies.

The first key to successful negotiations will be to keep expectations in check. The initial task in New York and in the subsequent six-party negotiations will be both to rebuild a sufficient political foundation between the countries involved for continued talks and to outline steps to contain the expansion of North Korea's nuclear forces. On the first count one step would be to arrange for the early resumption of U.S. military missions to recover the remains of Americans missing in action during the Korean War. Pyongyang has already signaled that it is ready to do so. Washington should also push for more dialogue between the two Koreas on a range of political, economic, and other issues, including Pyongyang's provocations last year.

On the second count, some nuclear steps forward appear to be in reach, if not at the planned U.S.-North Korea meeting this fall, then soon after the resumption of the six-party talks. A temporary moratorium on nuclear weapons and missiles tests would not be a permanent solution, but it could delay the North's ability to develop more sophisticated weapons. A new package of measures could irreversibly and verifiably end Pyongyang's plutonium program. We should take the North up on its offer, made in Track II contacts, to ship out of the country its fresh fuel rods -- which contain enough plutonium for maybe five to eight bombs -- in return for some compensation, such as heavy fuel oil. Add to that the permanent disablement of its only plutonium production reactor, and Pyongyang's program will have been effectively ended.

The big nuclear elephant in the room, however, will be Pyongyang's uranium enrichment program, which it claims is only intended to churn out fuel for its new power reactors, but, in reality, is also a front for producing bomb-making material. Moreover, Pyongyang's plans to increasingly use its own natively designed and built reactors -- a prototype is scheduled for completion in 2012 -- could pose a serious nuclear safety hazard for the entire region. The United States' first priority should be to seek greater transparency for these programs. During recent Track II meetings, North Koreans said their country might be willing to share more information on its plans with the United States in the context of formal talks with Ambassador Stephen Bosworth, Washington's special envoy to the region.

But Washington should also be prepared to cut quickly to the chase or Pyongyang might use ongoing talks as cover to continue development of its enrichment program. Because demands from the United States that the North unilaterally suspend or end its programs are likely to fall on deaf ears, any hope of a solution will depend on providing significant incentives to Pyongyang. For example, the North Korean government has signaled in Track II sessions that it might be willing to trash its reactor and enrichment programs if it receives nuclear reactor assistance that could well cost billions of dollars. We don't know whether that demand is serious, set in stone, or subject to negotiation. But only through sustained, direct -- and what will no doubt prove to be politically controversial -- diplomacy will we find out.

Having charted a course that will hopefully lead back to talks, Barack Obama's administration and its allies will now have to address these tough questions. Although getting Pyongyang to give up its handful of bombs should remain the objective, the most pressing problem is stopping further expansion. Finding a way through this thicket will prove difficult and may well be impossible. But decision-makers in Washington, Seoul, and Tokyo don't have much more room to delay. It's time that they ask themselves just what they're willing to do in order to prevent North Korea from becoming an emerging nuclear power.