UMM AL FAHM, Israel – Faten* has three daughters – four, eight and 12 years old. The two older girls are sitting cuddling their father on a wide leather couch in a three-story home in the northern Israeli city of Umm al Fahm.
Faten, who sits next to them holding her four year old, recounts going to the hospital for a routine ultrasound when she was pregnant with her youngest child. Her husband was at her side when the doctor pulled up a sonogram with a strong heartbeat. “You have a third queen coming!” the doctor said.
Faten’s husband smiled, but she immediately broke down in tears. He wanted to hand out sweets to people in the lobby, but Faten wanted to go home.
The next few months were the most difficult of Faten’s life. She was healthy. Her unborn child was healthy. But people around her treated her as if she had been through a loss.
“Maybe at the last minute she’ll turn into a boy,” Faten recalls people saying.
“I decided that I was not going to go through this again,” she says.
Faten made sure her next child would be a boy.
Faten is a Palestinian citizen of Israel. Like all citizens of Israel, she has universal healthcare coverage, which includes free fertility treatments for two children. Israel has one of the highest rates of in-vitro fertilization (IVF) in the world. But sex selection is highly regulated. A 2014 study by Israel’s National Ministry of Health found only 21 percent of applications for the sex-selection procedure over a period of six years were approved.
Across the border in the West Bank, sex selection isn’t officially regulated. So Faten crossed from Israel into the West Bank city of Nablus to see a doctor at Razan Medical Center for Infertility.
There, doctors use Preimplantation genetic diagnosis, or PGD, to screen the embryos for XY and XX chromosomes, which determine sex – boys have XY chromosomes, girls XX. After the chromosomes are sorted, male embryos are implanted using IVF.
At Razan, the procedure costs between $4,000 and $6,000. In the United States and elsewhere, the same procedure can cost around five times as much.
Each year, Razan’s doctors perform more than 500 sex-selection procedures. The clinic’s spokesperson Mohamad Qabalan said most of the couples choose boys. Like Faten, about 20 percent of them come from Israel. They aren’t Jewish, though.
Most Jewish Israelis can’t or won’t come to the West Bank because of security risks. But that doesn’t mean they don’t want to choose the sex of their babies; a study by Israel’s National Ministry of Health noted that two-thirds of all applicants for sex-selection procedures in Israel were Jewish.
Jewish and Islamic authorities interpret religious law regarding sex selection differently. In Jerusalem, Rabbi Mordechai Halperin, a former chief officer of medical ethics in the Ministry of Health, says Jewish law generally prohibits women from using “unnatural procedures” to choose the gender of their child when getting pregnant.
Meanwhile, in the West Bank city of Ramallah, Deputy Head of Islamic Affairs Mufti Sheikh Khamis says Islam has no problem with sex selection. Not having sons can be a source of tension for couples, he says.
“Islam expects couples to accept the will of God. By the same token, Islam expects couples to be happy.”
Faten’s doctor at Razan, Omar Abdul Dayan, says performing sex selection reflects the values of Islam because it can help keep families together. “Sometimes husbands divorce their wives because they have daughters,” he says.
Back at home in Umm al Fahm, Faten’s husband laughs at the idea of divorcing Faten over not having sons. He’s thrilled to have three daughters and wants more girls in the family. It’s Faten who wants a son, he says.
Faten looks at her husband. “My husband can be happy when he wants, and sad when he wants,” she says. “I’m the one who’s going to get pregnant again and again and again.”
When Faten was a newlywed, her sister-in-laws showed her around the house that she would raise her family in. They brought her to the second floor and pointed to the bedrooms. “They said, ‘This is the boy’s room and this is the boy’s room.’”
“I felt the pressure on me from that minute,” she says.
“The bottom line is a son carries the name of the family, and continuity of the name of the family is crucial.”
Faten has a graduate degree in education and works full-time at a nearby school. “A wife, a mother, is no longer someone who stays at home and keeps having children. I have a career to pursue, and therefore it’s not easy for me to stay at home and have more kids,” she says.
And she feels a lot of pressure from her community to have a boy. “When you meet a woman with three sons, you feel that she has the world. A woman with three sons is a complete woman, unlike a woman with three daughters.”
Faten went through three IVF attempts before she got pregnant. Each attempt required six trips into the West Bank, including lab tests, ovary examinations, hormonal treatments and an operation with full anesthesia to extract eggs.
But the most difficult part of the entire process, she says, is knowing that even though her family appreciates her for who she is, only a baby boy can give her the status she desires.
Faten is due to give birth in September.
*Name changed due to privacy concerns.