Individual Decision and Unexamined Group Patterns

It should be clear from the above examples of sex selection preferences in India that what appear to be individual familial choices may often be better understood as empirical social patterns reflective of the social and cultural hegemony. For example, in early 1994, Nature published "China's Misconception of Eugenics," an article that portrayed the Chinese government's policy of trying to prohibit couples with certain diseases from procreating as having a distinctively distasteful eugenic quality. While the article was forthright in denouncing the use of state power as the vehicle for discouraging procreation, it implied that a personalistic and individualistic decision to interrupt a pregnancy. Health Minister for China, Chen Minzhang, announced the plan to enforce a new law that would not only prohibit screening of the fetus for sex determination, but also ban marriages for people "diagnosed with diseases that may totally or partially deprive the victim of the ability to live independently, that are highly possible to recur in generations to come and that are medically considered inappropriate for reproduction"— as reported in the New York Times on November 14, 1993 in an article titled "China to Ban Sex-Screening of Fetuses."

The logical and empirical extension of the technology can be made explicit: Once it is possible to determine in time for the termination of a pregnancy whether the fetus has a condition that is regarded as a defect, who is entitled to make the decision about carrying to full term, or aborting? As noted, this should not be seen as a simple binary matter of voluntarism versus state power. There is considerable evidence to support the observation that what are characterized as personal or individual decisions in Western societies are upon closer inspection (just as with sex selection in India) actually very remarkably socially patterned.

In an influential treatise on reproductive choice titled Children of Choice, John Robertson acknowledged that social and economic constraints such as access to employment, housing and child care might play a role in the decision to have a child. However, the overarching theme, to which he returns again and again, is that reproduction "is first and foremost an individual interest" (p. 22). Because this is not reducible to an either/or formulation, it should be clearer why a continuum is a better analytic device for arraying an understanding of strategies and options—from individual choice to embedded but powerful social pressures (stigma and ridicule)—and from economic pressures (fear of loss of health insurance, or even of inability to obtain such insurance), and only then to the coercive power of the state to penalize.

When framed as individual choice, debate about a reproductive choice is set into the arena of individual rights: to have a child or not, then to have a male or female child, to have a child with Down Syndrome, cleft palate, or to choose to produce a clone. Such discussions of individual rights are typically de-contextualized from systemic concerns such as affordability. But amniocentesis is a relatively expensive procedure for the poor. The state often provides assistance to women seeking amniocentesis. In the 1980s California's Department of Maternal and Child Health noted with alarm that primarily wealthier women were getting state support for amniocentesis. Mindful of the state's eugenic history, officials embarked upon a program to try to get poorer women to accept the service. However, because the poor tend to have their children at an early age, this has become moot as a visible issue in the eugenics debate.

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Diabetes 2

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