Aviana Zahara is a sophomore at Augustana College in Illinois. Before she was conceived, her parents hoped to have a girl rather than a boy. Gender selection might appear to be a frivolous option exclusive to elites, but for parents like Aviana’s, contemplating gender selection entailed weighing acute moral and medical concerns. Her mother, Renee Liva, was born with one of the 1,100 known chromosome X-linked genetic disorders that, if passed on to a son, would cause serious health problems. Renee discussed a variety of options with her husband, James Zahara, including gender selection through in vitro fertilization. There were additional factors to consider. Aviana’s dad is Catholic and is against abortion. Was it worth the risk of an abortion if Renee’s Alport’s Syndrome caused renal failure during pregnancy? Aviana’s maternal grandfather was then diagnosed with pancreatic cancer and told he had only a few months to live. The pressure to make a decision mounted.

Womanist theological ethics can help us take into account the complex social considerations, especially religious commitments, that inform gender-selection decision making. Instead of reducing reproduction to a private decision irrespective of faith traditions, womanism grapples with the challenges that Black women have historically faced in circumstances of coerced surrogacy and the struggle for survival sometimes necessitating bitter compromise. Although Aviana’s parents faced distinct social and health conditions, womanism illuminates the community component of reproduction, which is useful for reorienting contemporary discourse on the ethics of gender selection. Namely, womanist Delores Williams’s insights suggest we are not autonomous individuals contemplating hypothetical scenarios. Rather, medical and moral judgments are best explored within the particularity of persons ingrained within specific religious and political social networks. Within this framework, ethical discernment is a dynamic process in which individuals and communities calculate informed risks of reproduction.

Renee was diagnosed with Alport’s Syndrome at six years of age. Should she reproduce, a female child that inherited the “damaged” X chromosome could have proteinuria and hematuria (microscopic protein and blood in the urine), hypertension, a slow deterioration of the glomerular system, and cardiac issues related to renal dysfunction as she would be a carrier to this disease. Despite these risks, selecting a female child would be preferable because male children who inherit the “damaged” X chromosome of Alport’s Syndrome fair worse. Male children develop blindness, deafness, severe digestive disorders, and renal failure before ten years of age. These boys often require kidney transplants but are not always placed on donor lists due to their preexisting condition. This difference in gender efficacy of the disease can be attributed to the X chromosome that the father passes down during fertilization. An X chromosome contributed by the father would offer some protection against the disorder in a female child, whereas a Y chromosome would not offer protection against the complete expression and development of Alport’s Syndrome in a male child. With these medical concerns in mind, Aviana’s parents discussed adoption, surrogacy, and the use of Microsort—a company that facilitates gender selection through in vitro fertilization.

The weight of this decision is burdensome for hopeful parents because they experience conflicting pressure from family, friends, church communities, medical personnel, and their culture at large.1Puri Nachtigall, “The ethics of sex selection: a comparison of the attitudes and experiences of primary care physicians and physician providers of clinical sex selection services,” Fertility and Sterility, 93, 7, (2010): 2107–2114. The ethical basis for a decision to pursue sex selection takes into account the life that the child would have to endure, as well as the emotional, physical, and financial support the parents would be required to provide. James ascribes to Catholicism, and understands gender selection and abortion to be immoral interventions. Due to Renee’s hypertension, pregnancy could cause preeclampsia (hypertension in pregnancy), eclampsia (life-threatening form of hypertension in pregnancy), and renal failure. If that were to happen, doctors would recommend that Renee abort the fetus regardless of its gender. Without Microsort, Aviana’s parents might have to face social stigma for bringing a child into the world who would likely face severe medical challenges. Reproduction without medical intervention risks lifelong care-giving, financial strain, and emotional trauma. A risky pregnancy without the support of social networks would likely intensify the impact of unforeseen challenges. There was no clear path for Renee and James to make an ethical decision.

Ultimately, Aviana’s parents chose to risk pregnancy without the aid of Microsort. Renee had biweekly ultrasounds and was examined at a high-risk obstetrics clinic in a large university hospital. Additionally, she also had weekly examinations at her local clinic. Sixteen weeks into her pregnancy, doctors performed an amniocentesis test to determine the gender of her baby and whether they would recommend termination. Renee had weekly appointments with a nephrologist to monitor her kidney functioning. Her blood pressure medication was changed from an ACE Inhibitor to methyldopa to avoid inducing fetal fatality. Roughly six months into the pregnancy, and without warning, methyldopa was taken off the market. With no other medications available that did not pose a significant risk to the fetus or increase her chances of developing preeclampsia—a condition which has the possibility of threatening the lives of the fetus and mother—Renee had to petition the company to release any possible stockpile of the previous drug, which they did. The fluid back up in her tissue due to decreased kidney function caused Renee to gain 70 pounds during her pregnancy and her protein levels (proteinuria) reached 7 grams—for perspective, normal levels are under 150 micrograms. She suffered from pitting edema and was put on bed rest for the remaining three months of her pregnancy.

Both medical and Christian ethics, when contemplating abstract scenarios, frequently fail to account for the complex emotional, social, and physical toll of utilizing gender selection technology. Partners contemplating reproduction do not make their choice as autonomous individuals, but rather feel compelled to anticipate and choose among various forms of backlash. Their decision affects them as individuals, a couple, a family, a church community, and a part of society. Medical providers would be tasked with keeping both mother and baby alive throughout the pregnancy and treat the aftermath of health-associated conditions. Should the child require social services, their decision could impact taxpayers due to the practice of dropping members from healthcare plans once they develop a serious health condition, commonplace in the United States prior to the Affordable Care Act. Were doctors to recommend an abortion in order to save the mother’s life, hopeful parents would have to cope with potential stigma within their church community. Couples understandably fear repercussions due to perceived societal norms and judgment from those whose religious views disallow particular medical interventions. They depend upon these networks for survival and wellbeing.

We argue that womanist theological ethics enable people of faith to understand the social and political components of reproduction in particular, concrete terms. Gender selection is crassly reduced to the pursuit of “designer babies,” even though many who seek this kind of intervention do so in order to avoid life-threatening diseases. In Delores Williams’ Sisters in the Wilderness: The Challenge of Womanist God-Talk, she examines the biblical story of Hagar in Genesis 16 and 21, which is useful for understanding the medical and moral ethics of gender selection. Black liberation theologians, such as James Cone, read Moses in the book of Exodus as endorsing the liberation of African Americans. However, Williams provocatively points out that liberation is promised to the Hebrew people, but not all persons in the Bible. She sees herself in Hagar, Abraham and Sarah’s surrogate, who after having been mistreated and turned out into the wilderness is told by an angel of God to return to enslavement. Williams wrestles with this painful interpretation as a contemporary African American Christian woman. According to Williams, the reason the angel of God instructed Hagar to return to slavery was to ensure the survival and quality of life for herself and her son Ishmael. Unlike Hebrew patriarchs who led their people out of bondage, Williams sees herself and other Black women more like Hagar—not necessarily liberated by God, but worthy of blessing and life.

This disquieting biblical story challenges the sort of divine intervention that people of faith understandably desire—that God will rescue and protect them from reproductive hardship. Couples may resonate with Abraham’s hope, Sarah’s laugh, or Hagar’s demand for a blessing. The temptation to utilize gender selection for the sake of avoiding illness and death is relatable. Williams’s understanding of pursuing survival and quality of life should not to be mistaken for pragmatic utilitarianism. Rather, Williams provides insight into the unique challenges that enslaved Black women faced—lack of autonomy over one’s body and reproduction, homelessness, lack of capital, and often a lack of family structure in a traditional societal view.2Although it is beyond the scope of this article, pregnancy among transmen is another disenfranchised population in reproductive ethics. Upon first blush, gender selection might appear to be an immoral choice. However, Williams’s insight into contemporary ethical dilemmas reminds us that we are not autonomous individuals contemplating hypothetical scenarios, but rather that medical and moral judgments are best explored within the particularity of flesh and blood persons who are ingrained within religious and political social networks. Womanist theological ethics suggest that discernment is a dynamic process in which individuals and communities calculate informed risks of reproduction.

As gender selection technology continues to advance and expand in accessibility, an ethical controversy connected to abortion can be expected. While many would view gender selection technology as a medical breakthrough in genetic disease prevention, others perceive in vitro genetic modification in preconception as a selfish failure to view all children as gifts from God. We suggest here that Delores Williams powerfully grapples what it means to be a person of faith in a tradition where God does not promise to liberate all persons, but who can be called upon to bless survival and quality of life. Her life-oriented theology offers a rich resource for assessing systemic injustices that complicate reproductive ethics. Although Aviana’s parents did not use Microsort, womanist theological ethics resist the urge to make that position a blanket good and instead reorient discourse in reproductive ethics to account for the particularity of diverse social, political, and religious contexts.