What's wrong with taking a steroid, while you're pregnant, to try to increase the odds that your female fetus will someday grow up to be a straight woman who gives you grandchildren, and not a lesbian daughter more interested in puppies?
I have a funny feeling I'm about to get hit by various versions of that question, since Ellen Feder of American University, Anne Tamar-Mattis of Advocates for Informed Choice, and I just submitted a new post to Bioethics Forum revealing what we think is the first organized medical "paradigm" for attempting to prevent homosexuality in the womb.
Let me give five answers to that question. Maybe six.
1. The specific drug we're talking about, dexamethasone, is not a benign drug for pregnant women, nor for the children exposed in utero. The studies we do have on the early prenatal use of "dex" are worrisome. The number of women and children missing from the follow-up studies of this drug use is more worrisome still.
This drug is unequivocally experimental and risky. That's why, back in February, I organized interested members of the Bioethics community to fight to make sure every woman offered dex for CAH knows the truth about its experimental and risky nature. (You can read about our efforts in Time magazine. And you can about the medical establishment's resultant mad scampering to make sure everyone knows this is experimental here.) Make no mistake: In spite of Dr. Maria New's outrageous FDA-regulation-flaunting claims that this off-label drug use "has been found safe for mother and child," it ain't been. New is a rogue pediatrician whom medical societies have been nudging (and sometimes yelling at) for years. Because she apparently wouldn't stop experimenting on these women and children without ethics oversight, in January I got called in to help by a few freaked-out clinicians. And I called in my colleagues to call out the feds. New just looks and sounds safe for mothers and children. Which is why she's really dangerous.
2. We know that gay and lesbian people suffer a lot of discrimination. And in theory, it seems reasonable to try to prevent a child from suffering discrimination. But an approach like prenatal dex for homosexuality prevention positions gay and lesbian people as the problem to be cured, where we ought to see that it's our society that's suffering from a disease. The medical establishment has long recognized that gay and lesbian people are not inherently diseased, even if Dr. New and her collaborators didn't get the memo in 1973.
3. Trying to prevent homosexuality in the womb is akin to cosmetic "medical" procedures in that it is inherently anti-democratic. I've ranted elsewhere about why medicine needs to be liberated from recent profoundly anti-democratic trends, so I won't go on about it here. But the bottom line is that an attempt to prenatally prevent homosexual orientation isn't just bad medicine (because it isn't necessary or safe), it's bad for American democracy, because it sends the message that you must conform to the most conservative social norms to count as acceptable and to be allowed to live, with full rights, free of discrimination and abuse in American society. In fact, the beauty of American history is that we have repeatedly changed our society to give oppressed people access to equal privilege.
A democratic medical establishment does not alter people's bodies to fit regressive social norms; it advocates for patients by demanding the social body get its act together. As a white woman who grew up with a black brother, I can tell you that the solution to my brother's suffering was not to have his skin bleached and his hair straightened, prenatally or postnatally. As I asked in One of Us, why not change minds instead of bodies?
4. The fact is that children are inherently unpredictable, and so (surely) what it means to decide to be a parent is to agree that you will accept the uncertainty that comes with being a parent. Having a child is not like taking a spouse; there is no mutual agreement entered into. It is up the parent to make the commitment. And to make the commitment by saying, "I'm willing to have you, but only if you are a boy, and a straight boy at that, and a straight boy with blue eyes and a very high IQ" is, frankly, to not really make the commitment that parenting requires.
Am I suggesting that people who want to engineer their children's sexual orientations are unfit to be parents? Yes, I am.Being gay is not a terrible, tragic disease that requires prevention or treatment chosen for you by your parents.
I am reminded here of a colleague who works as a social worker on a craniofacial team at a children's hospital. She was telling me one day, despairingly, of having a consultation with a pair of expectant parents. Their fetus had been diagnosed with a cleft lip, one that would be reasonably correctable without major trauma. It was true the baby would be born with the odd-looking mouth, and that the child might always have a noticeable lip scar. But this was not a child with a fatal disease or anything. Yet the father was flipping out, saying to his wife and the social worker, "I can't handle this! I can't handle this!" He wanted to abort for this.
My friend and I both were both thinking: Come on! If you can't handle this, what are you going to do when your kid smokes a little dope? What are you going to do if she ends up pregnant at 16? What are you going to do if she sucks at math or suffers from a lot of acne? Sure, abort. But don't have any children if you can't handle this.
The problem with such a parent is that he is planning to live his entire existence with his child on the shame-pride axis, where everything his child does is rated according to whether it makes her father proud or ashamed. You want a child who never makes you anything but proud? Please. Don't bother taking on parenthood if you can't handle the fact that sometimes your child's identity won't be what you would have chosen. And if you want to prevent a child from ever suffering? Well, then don't have a child. No one is born into the world never to suffer.
Is having a child with a less-than-idealized identity or anatomy sometimes really hard? Yup. And when you sign up for parenting, that's part of what you're signing up for. You can't seriously expect your whole parenting experience to consist of softball trophies and bumper stickers that brag about your Honor Roll child. It is not your child's job in life to make you proud. It is your job to make your children proud of you as their parent.
5. Relatedly, if you want to be a parent, start getting used to the fact that your children will change you as much as you change them. I now know far more than I ever thought I would about trains, airplanes, and Australian native species thanks to my son. I am also more patient, more organized, more disorganized, more sleep deprived, and more in love with him than I ever thought I'd be. If you would not have your child explicitly manipulate your identity as a condition of loving you, do not begin your relationship with your child by doing the same.
To paraphrase Ghandi, be the child you want to see in the world: open to possibility, open to love, open to learning what love really means.
6. Puppies make great grandchildren, not least because if your child goes away and you're too busy to care for them, you can put them in a kennel.