Non-invasive fetal sexing: medical test or a new tool for sex selection?

Recent scientific developments in prenatal testing, based on fetal DNA in maternal blood, now allow non-invasive fetal sexing in pregnancies at risk of a sex-linked disorder. In such cases, these novel noninvasive tests can improve prenatal care by avoiding the need for invasive procedures such as amniocentesis, with their associated risk of fetal loss. The tests available for medical use are characterized by high levels of accuracy (> 99%) and early fetal sex determination (from week 7 of gestation). Many countries now offer families at risk of a sex-linked disorder this new form of clinical fetal sexing. At the same time, further developments in fetal DNA technology are making antenatal sex determination possible via a finger prick sample mailed anonymously to a commercial organization. Direct marketing to future parents of such non-invasive tests for social sex determination will bypass a woman’s physician. This could allow termination based on sex selection while women ostensibly present to physicians, who will have no access to the test result, for a termination on social grounds. If test results are available at 7 weeks gestation, online purchase of products for non-surgical abortion at home early in pregnancy could also enable some parents to bypass a health system altogether. Female feticide, linked to son preference and widespread ultrasound diffusion, has already led to significant gender imbalances in India and China. Certain ethnic minority communities in the west are also now displaying evidence of fetal sex selection. Currently, mail-order fetal sexing, based on fetal DNA in maternal blood, is still an emerging market. However, before any widespread diffusion, discussion about the implications of this new technology and associated issues is important and timely. This article considers evidence of technology development, existing demographic and social changes, corporate responsibility in product marketing, and the role of community engagement and education.