In 1984, Germaine Greer observed of childbirth that it ‘has been transformed from an awesome personal and social event into a medical phenomenon’ (Greer, 1984). It is arguable that the transformation identified by Greer has been mediated by technological advances and the ethical dilemmas that can arise from their use.
For example, Browne (2017) asserts that prenatal sex determination is wrong in principle, not only because it mistakenly implies that sex is the same as gender, but also because the drawbacks of preventing parental knowledge of fetal sex ‘would be outweighed by the benefit of undermining gender essentialist beliefs which underlie sexism’ (Browne, 2017). Gender essentialism attributes fixed, intrinsic qualities to women and men. Davis (2017), however, acknowledges that sex is not a medical condition but suggests that if we accept the fetus as part of a woman's body, it would be as wrong to withhold information about the fetus as it would be to withhold information about a pregnant woman's genetic make-up.
While such ethical debates contribute to the development of those healthcare professionals helping to shape the fields of midwifery, obstetrics, and associated disciplines, sometimes there is an uneven interface between the ice block of reasoning and the realities of life. For example, in India from the 1980s, Guha (2007) notes that advances in medical technology accelerated a deadly prejudice: ‘Thus the new sex-determination test allowed parents to abort female fetuses. Although illegal in India, the test was widely available in clinics throughout the country.’
Expanding on this, Theerthaana and Sheik Manzoor (2019) explored factors contributing to gender disappointment, especially with females ‘which is pervasive in Asian countries’, and they found that ‘societal pressure, cultural factors, economic expectancy, and safety expectancy significantly explain the gender disappointment with girl child [sic]’.
But disappointment with the gender of a child is not necessarily an issue that is confined to Asian countries. For instance, in a study of online discussion forums on three Australian parenting websites, Monson and Donaghue (2015) found that from a total of 179 posts from 97 posters, 33 posts addressed the topic of gender disappointment. A typical comment that the authors identified was that ‘if someone is willing to use the technology to avoid gender disappointment then it matters too much to them and they are unfit for parenthood’ (Monson and Donaghue, 2015). The authors also note that while the use of assisted reproductive technology for social sex selection is prohibited in Australia, the UK, Canada, China and India, it is allowed elsewhere, such as the US and Thailand.
But in an age of medicalisation, might gender disappointment be incorrectly supposed to be a mental illness? This is a question that is considered by Hendl and Browne (2020), who suggest that the phenomenon ‘tends to be framed as a mental disorder on a range of platforms including the media, sex selection forums and among parents who have been interviewed about sex selection’ (Hendl and Browne, 2020). The authors, in addressing whether gender disappointment represents a unique diagnosis, acknowledge that while parental distress is real, and as such requires psychological support, nevertheless contend that gender disappointment ‘does not account for a unique, distinct category of mental illness, with distinct symptoms or therapy’ (Hendl and Browne, 2020). Interestingly, they also cite evidence in support of the argument that by placing potentially discrediting events within a medical context, individuals are seeking to avoid inviting the inference that their behaviour may be seen as morally disreputable.
Gender essentialism is thought by Hendl and Browne (2020) to lie at the root of gender disappointment. However, challenging this concept might be freighted with difficulty. For example, Theerthaana and Sheik Manzoor (2019) have made the point that there is a deep-seated preference for sons over daughters ‘in the minds of Indians as sons are viewed as income for their household due to their earning capacity … and girls are viewed as an economic liability’ due to the prevalent dowry system.
It seems that even when midwives have helped to deliver healthy babies, an awareness of gender disappointment may be needed to address the possibility of parental upset when the gender of their child becomes apparent to them.