GENDER DREAMS: THE SOCIAL CONSTRUCTION OF GENDER

DISAPPOINTMENT AS AN AFFLICTION IN ONLINE COMMUNITIES

A Thesis

Presented to

The Faculty of Graduate Studies

of

The University of Guelph

by

ALISON J. DUCKETT

In partial fulfillment of requirements

for the degree of

Master of Arts

June, 2008

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While these forms may be included Bien que ces formulaires in the document page count, aient inclus dans la pagination, their removal does not represent il n'y aura aucun contenu manquant. any loss of content from the thesis. •*• Canada ABSTRACT

GENDER DREAMS: THE CONSTRUCTION OF GENDER DISAPPOINTMENT AS AN AFFLICTION IN ONLINE COMMUNITIES

Alison J. Duckett Advisor: University of Guelph, 2008 Professor P. Parnaby

On the basis of semi-structured e-mail interviews and online data, this thesis explores the ways in which members of an online health related support group construct gender disappointment as a legitimate illness. While highlighting the way in which computer mediated communication facilitates and allows for social interaction among members, it is argued that the environment of the online health related support group has provided members with a unique opportunity to construct their condition in ways that parallel the emergence of medicalized identities, specifically the discreditable chronic illness identity. Acknowledgements

Mary Ann, Sarah and Natasha - Your infallible support means the world to me! Table of Contents

Chapter 1: Introduction 1 Sex Selection Entrepreneurship 2 Chapter 2: Literature Review 15 Motherhood and Children: An Overview of Transitions 15 Gender Selection 21 Gender Ideology: Stereotypes and the Construction of Gender Dreams 27 Online Communities 36 Medicalization and the Social Construction of Illness 44 Conclusion 57 Chapter 3: Methodology 59 Content Analysis 63 E-Mail Interviews 64 Ethical Issues 68 Conclusion 70 Chapter 4: Results and Discussion 72 GD Communities 72 The Medicalization of GD 85 Gender Dreams 93 Living with GD 98 Conclusion 119 Chapter 5: Conclusion 121 Limitations of the Research 124 Implications for Future Research 126 Conclusion 128 Works Cited 129 Appendix List of Acronyms 143 Chapter 1: Introduction

This thesis concerns the social construction of Gender Disappointment (GD) as an affliction in the context of online communities. Highlighting the significance of Health

Related Support Groups (HRSGs) in the process of illness construction via patient to patient communication, it will be argued that through the sharing of experiences in online discourse GD has been conceptually medicalized. The online communities which focus their discussion on GD are located on websites concerning gender selection practices, thus drawing an audience of women who are interested in influencing the gender of their future child; as such, GD is situated within the context of sex selection practices.

GD, which refers to the experience of being disappointed that one does not have the child of a desired gender, is a socially constructed phenomena which is based upon the collective experiences of the women who are members of the GD online communities. This group of women communicate their experiences of wanting a child of a certain gender in online discussion groups which are associated with gender selection practices. These women locate the GD online community through their Internet searches for information regarding influencing the sex of the fetus prior to conception. Upon reading the content in the online communities, women recognize commonalities in their personal experiences with desiring a certain gendered child.

It is through the women's experiences in the real world, which are communicated online, that they recognize similarities in their experiences and counter their previously held belief that they were the only ones experiencing this collection of emotions concerning the gender of their child. Central in GD is the behaviour of women to attempt to influence the gender of their future child prior to conception; as such, GD is related to

1 gender selection practices, both natural and technological. The introduction to this thesis will consider the advancements in sex selection entrepreneurship in order to situate GD within the present capabilities to choose the gender of one's child and to acknowledge the potential global impact of the Internet marketing of gender selection by means of New

Reproductive Technology (NRT).

Sex Selection Entrepreneurship

The January 26, 2004 cover of Newsweek magazine displayed full cover pictures of a baby girl and a baby boy wearing pink and blue diapers respectively, with the bold headline, "Girl or Boy? Now You Can Choose. But Should You? The New Science of

Sex Selection." The inside article which adorns the heading, "Brave New Babies" discusses families who have used the advanced technology to conceive for reasons of genetic disease, infertility and the newly controversial gender selection, stating that, "No longer can science simply help couples have babies, it can help them have the kind of babies they want" (Kalb 2004).

This "new science" marks the present advancement in sex selection entrepreneurship which has seen a series of unsuccessful predecessors including

ProCare's Gender Choice Kit of the 1980s ("Deception Charged," 1987), the Ericsson method of sperm separation (Thompson 2004), AcuGen's maternal blood test, the Baby

Gender Mentor (Kaiser 2005) and GenSelect to name a few.1'2'3 These predecessors

1 The Gender Choice kit was marketed in the United States by ProCare. The kit was available over the counter in drugstores and claimed an 85% success rate which relied upon the position of sexual intercourse and the proximity of conception to a woman's ovulation time in order to predict the sex of the child (Achilles 1995). 2 The Ericcson Method which is available in clinics in the United States uses the albumen column and claims to have produced over 75% boy babies; however, tests of the separated sperm reveal ratios close to 50/50 (Holmes 1993). 3 The Baby Gender Mentor, sold in the United States and utilizing an 'at home' kit, claimed to detect the sex of the fetus from a maternal blood sample as early as five weeks after conception. Upon receiving the

2 which have acknowledged the long held social desire to influence and/or to determine fetal sex have had, for the most part, their promises to help couples choose the sex of babies discredited due to a lack of supportive scientific data. However, despite the failure of these gender selection methods to accurately influence and/or to determine the sex of the fetus, the public's interest in accessing these methods is a testament to the strength of the gender selection market. In 1968, Etzioni predicted that, "If a simple and safe method of sex control were available, there would probably be no difficulty in finding the investors to promote it because there is a mass-market potential. The demand for the new freedom to choose seems well established" (1968:1108). This prediction has been proven true. In a 2007 study, Seavilleklein and Sherwin revealed just how widely gender selection services are marketed, as well as how prevalent and accessible they are on the

Internet by searching "sex selection services" in Google which generated hundreds of thousands of websites in April 2004.

The desire to influence the sex of a future child and to determine the sex of the fetus during pregnancy has long held interest in North American society.4 The pre­ conception sex selection practices are considered to be 'positive' eugenics involving theories concerning the timing of intercourse with respect to ovulation or the separation of X- and Y-bearing sperm (Achilles 1995). The manipulation of semen to separate sperm for sex selection through Artificial Insemination (AI), as well as natural gender selection methods, have long been in practice. Natural gender selection methods, also

kit in the mail, women would send the company a blood sample (Kaiser 2005). The company would determine fetal sex from the sample and would notify the woman via e-mail. In 2005, this kit was banned from entry into Canada. 4 The geographical boundaries of this research are limited to the United States and Canada; therefore, while it is understood that sex selection is of interest in other countries, this thesis focuses on the United States and Canada.

3 known as gender swaying, refer to "at home low and high tech" methods which have been used by women in order to influence the sex of the fetus. These methods include, but are not limited to, the Shettles method, 0+12, pre-conception gender diet and timing methods with respect to ovulation (Kalb 2004; Holmes 2000). These methods, which supposedly favour one or the other sperm type, result in sex determination ratios "hardly better than chance" (Holmes 1993:368); for instance, due to the fact that Y-bearing sperm are smaller than X-bearing sperm, there are theories which claim that the Y-bearing sperm swim faster. As such, one unproven method for conceiving a boy suggests that intercourse should occur when the supposedly faster Y-bearing sperm can reach the egg as it travels down the fallopian tube. Furthermore, determining the sex of the fetus during pregnancy has often resorted to a consideration of how the woman's body was responding to the pregnancy and whether the woman was "carrying" the fetus low or high. This strong desire either to influence the sex of the fetus prior to conception, or to determine the sex of the fetus during pregnancy, coupled with methods not proven to be successful beyond those associated with chance, translated into a sex selection problem which had not yet been solved.

What was considered folklore has become, increasingly, a topic of scientific study

(Achilles 1995). An answer to the sex selection problem was brought forward by advancements in NRTs, as societal interest translated into scientific possibility, when women were able to receive confirmation of fetal sex during the routine ultrasound of the second trimester which can correctly identify sex approximately 90 percent of the time

(Holmes 2000), as Holmes (2000:343) asserts, "wherever "Western" medicine is practiced, pregnant upper-and middle-class women receive ultrasound scans of their

4 fetuses and are told the sex unless they assertively pre-empt the message by begging nurse, doctor, or technician to keep the secret". Increasingly, women began to gain knowledge of their fetus' sex during pregnancy and this sex determination continued to increase in popularity while being offered at different stages of pre-natal health testing, including Chorionic Villus Sampling (CVS) and amniocentesis where sex detection is usually incidental (Holmes 2000), ultimately resulting in increasingly fewer women learning the sex of their baby at birth (Gosden 2000).

This increasing popularity of determining fetal sex has revealed a clear market for sex selection in North America. While science was able to meet the societal demand to determine the sex of the fetus, there continued to remain the question of how to influence accurately the sex of the fetus prior to conception. After decades of attempts to influence the sex of the fetus through "folk remedies" and poorly cited theories regarding the behaviour of X- and Y-bearing sperm, science has extended the use of NRTs toward a non-medical application: gender selection.

Internet Marketing of Gender Selection

The Internet marketing of gender selection by private clinics in the United States

(Karlberg 2008; Leonard 2003; Seavilleklein and Sherwin 2007) is at the forefront of the advancements in sex selection. In the United States, for-profit clinics advertise sex selection technologies in the effort of pre-determining or selecting sex as well as detecting the sex of the fetus (Leonard 2003; Karlberg 2008). The Genetics and IVF

Institute in Virginia developed Microsort, which is a technology that allows parents to select the sex of their future children. Marketed as gender selection, the Institute claims a ninety-three percent success rate (Leonard 2003). As of January 2007, the Genetics and

5 IVF Institute claims that more than 1100 pregnancies have been achieved using Microsort and more than 900 babies have been born (Microsort Current Results). The cost of the

Microsort procedure ranges from approximately $5000 US to $20,000 US depending upon the specifics of the procedures (Microsort Fee Schedule). Interestingly, the Genetics and IVF Institute's Microsort is offered for the purpose of family balancing at one hundred twelve collaborating reproductive clinics across thirty-one states and eleven collaborating clinics in six international countries, including Argentina, Australia,

Belgium, Lebanon, Nigeria and Venezuela (Physician Collaborators). This rapid expansion of the family balancing concept during the clinical trials of the Microsort procedure illustrates the potential for a global market in gender selection.

Presently, the technology which is marketed towards parents who prefer a boy or a girl, is being accessed by couples who are choosing girls more often than boys in North

America (Leonard 2003). While current literature (Leonard 2003; Karlberg 2007;

Seavilleklein and Sherwin 2007) makes reference to Microsort and to the non-medical application of sex selection technology, it does not commonly engage in a discussion of how gender selection came to be marketed to the public.5 Further consideration of the literature (Wadman 2001) reveals that gender selection at the Genetics and IVF Institute was offered due to public demand. Microsort's flowcytometry technology was initially developed by the United States Department of Agriculture (USDA) for use with livestock and was adapted for human use in a clinical trial extending sex selection technology for couples who were at risk of conceiving a fetus with a genetic anomaly. ' This

5 Microsort is the name given to the technology employed in gender selection. 6 Flowcytometry involves the separation of X and Y bearing sperm. The X chromosome holds 2.8% more DNA; therefore, when the sperm is stained with DNA seeking fluorescent dye, the female sperm hold more dye and glow more brightly when subjected to the laser (Wadman 2001).

6 application of the technology reached a population who otherwise would not be able to conceive; therefore, a demand for the sex selection technology during the pre-conception phase emerged (Wadman 2001). What followed from this demand eventually brought forth the presently marketed concept of "family balancing" ("Microsort Medical

History," 2006; Scully et al. 2006), ultimately suggesting that families with children of only one sex are "unbalanced" in some regard (Sills and Palermo 2002). During the initial clinical trial, the clinic was receiving requests from couples who wanted to use the technology for non-medical purposes. These couples, who could conceive naturally, wanted access to the technology in order to select a male or female embryo for implantation. The clinic approached the USDA for ethical approval to extend the clinical trial to include couples who did not have a history of genetic disease. The approval was granted (Robertson 2001; Wadman 2001), but had to be controlled by the following boundaries: the couple had to be married, they had to have at least one biological child and they had to be sorting for the least represented sex of their children (so-called "family balancing") (Wadman 2001). With that, the non-medical application of sex selection technology was introduced to the United States and to the global market.

In the interest of sex selection entrepreneurship, NRTs, in particular the Assisted

Reproductive Technologies (ART) involved in sex selection, have rapidly evolved in technological form and purpose, questioning the distinction between medically determined necessity and social desire. In the wake of this change, individuals are inundated with consumer Internet marketing from private medical clinics, thus blurring the line between patient and consumer. Amidst arguments from a sector of the medical community that, "gender is not a disease" (Steinberg 2004), the unregulated marketing of

7 NRTs have commonly originated in the agricultural industry and have been adapted for human use.

7 NRTs in the United States raises concerns as to what the consequences will be for North

American society. While the non-medical application of NRTs is acknowledged in the literature and addresses concerns about the use of a medical technology in the perpetuation of gender stereotypes, it is significant to consider the potential strength of the gender selection market. The acknowledgement has been made that, "as with any new technology, sheer availability will probably create [a] demand" (Kolker and Burke

1994:144). Furthermore, Kolker and Burke (1994) and McDougall et al. (1999) have substantiated the claim that if sperm separation were to become inexpensive and reliable, that few couples would be able to resist the temptation to "custom design" the sex composition of their families. This projected popularity of sperm separation is similar to the use of contraceptives which made it possible to control the number and spacing of children (Kolker and Burke 1994). According to Wadman (2001), of the 3.9 million babies born in 2001, 25-35% of parents said that they would use sex selection if it were available; a possible 400 million dollar market.

The clear paradox of the word gender being used to market a sex selection technology is evident, but as the pink and blue double helix on a Genetics & IVF Institute advertisement (Darnovsky 2003) fallaciously suggests, one can determine the future

o gender of one's child by accessing sex selection technology. The NRTs which are designed to ensure that embryos, thus future children, have the chromosomes of a particular sex are clearly being marketed as offering children of specific genders. The private clinics which are marketing gender selection use the terms sex and gender interchangeably, despite the fact that sex is a biological state while gender is a social construction (Seavilleklein and Sherwin 2007). However, for the purpose of this research, The Genetics and IVF Institute is located in Fairfax, Virginia and offers gender selection.

8 the terms gender and sex are not used interchangeably and are understood to maintain different definitions. Gender is understood to be a socially constructed identity marker while sex is understood to denote biological differences in women and men (Lorber

1997); however, the term gender selection will be used to describe the technological process which couples engage in to determine the sex of their future child because this is how the technology is marketed.9 As well, the term gender will be used to direct the reader's attention towards the meaning that couples associate with the sex of the fetus and to extend an understanding of the reasoning couples maintain in accessing gender selection.

Gender Selection: A North American Ideal

Gender selection in North America concerns desires for either a girl or a boy and is different from the historical preference for male children (Kolker and Burke 1994;

Warren 1985) and more specifically, references to the preference for a male in such areas as India and Asia which predominate the sex selection literature. These discussions of sex selection do not maintain a direct role in the examination of the current practice of gender selection in North America. In North America, the preference for a "balanced family" prevails in which couples desire children of both sexes, not solely males, in order to fulfill parental experiences and expectations (Seavilleklein and Sherwin 2007). In gender selection, the emphasis which is placed upon "family balancing" suggests that it is not a child with different genitals which is sought, but a child who will conform to the opposite gender role to the children whom the family already has (Seavilleklein and Sherwin

2007). Apart from wanting a "balanced" family, couples may want to have a son to

9 The term couples will be used when referring to persons engaging in gender selection because as stipulated by the ethical guidelines, gender selection is offered only to those who are married ("Microsort Medical History Form," 2007).

9 inherit, to share a sex-typed hobby or sport, or to please the parental interests of the husband or the wife (Holmes 1993).

Couples who plan sex selection do so upon what is understood to be sexist notions as the parent desires a child due to specific gendered behavioural or character traits that, in any society, are tightly linked to sex (Holmes 1993). It is conclusive in the United

States and Canada that any preference for children of one gender is dependent upon parental desires and experiences and is supported by literature suggesting that the preference is for a sex-balanced family (Kolker and Burke 1994; McDougall et al. 1999;

Scully et al. 2006; Technologies of Sex Selection 1993). Furthermore, the present trend in the United States is towards accessing gender selection to choose for girls rather than boys. This distinction serves to separate the discussions of traditional sex selection and

"sex balanced" gender selection and to direct the reader's focus towards the present commodification of gender in North America and the resultant marketing of the

"balanced family" (Microsort Home Page 2008).

Legislation

Countries around the world have responded to the non-medical extension of

NRTs by instating legislation banning the use of the technologies for any purpose other than medical; for instance, Australia has banned non-medical sex selection while in North

America, sex selection for any purpose other than medical is not permitted in Canada, while in the United States, private clinics commercially market NRTs (Shanks 2005;

Technologies of Sex Selection 1993).

At the time of the Final Report of the Royal Commission on New Reproductive

Technologies (Proceed With Care 1993), there was no mechanism in place in Canada to

10 limit or to monitor the use of any of the methods of sex selection for non-medical reasons; however, in March 2004, the Assisted Human Reproduction Act (AHRA) was enacted (Assisted Human Reproduction Act 2004). The goals of the AHRA are to protect the health and safety of Canadians, to prevent the commercial exploitation of reproduction and to "protect human individuality and diversity and the integrity of the human genome". The prohibitions and regulations of the AHRA are to be overseen by the

Assisted Human Reproduction Agency of Canada (AHRAC). In Canada, sex selection, except in the instance of a sex-linked disease, is prohibited (Seavilleklein and Sherwin

2007). The Royal Commission on New Reproductive Technologies, in regard to sex selection, determined that Canadians do not want market forces to determine how reproductive technologies are used in Canada; however, currently in the United States, where there is no legislation against commercial activities, there are franchised sex selection clinics. Within this social and legal climate, some Canadian women are accessing NRTs for sex selection for purposes other than a genetically linked disease by traveling to for-profit clinics in the United States, as was confirmed by a doctor at an

American clinic, "We see people from every country, but Canada is over-represented"

(Steinberg 2004: Tobin 2006).

The initial stage of providing parents with greater control over the genetic composition of their children involves gender selection using Pre-Implantation Genetic

Diagnosis (PGD) and the screening of embryos. In the near future, it is expected that technology will be available to choose additional characteristics in an embryo, such as eye and hair colour. The technological developments in the life sciences are considered

11 by Fukuyama (2002:75) to be occurring at a speed which is "remarkable and largely unanticipated".

While research has long engaged in debate concerning what would ensue in society if and when NRTs advanced to a point at which couples were able to pre­ determine the sex of their fetus and while research presently acknowledges the practice of gender selection, there is no indication of research pertaining to what would ensue if a child of the "wrong" gender was conceived.

Gender Disappointment

GD, which has been identified in two Internet media articles, is described as something a woman may experience (Gender Disappointment 2007; Secretly Sad:

Overcoming Gender Disappointment 2007) and is presented as a discussion topic on websites on the Internet. Much is unknown about GD; however, it has been described in the media (Gender Disappointment 2007) to be "one of the many apparently

'controversial' parenting topics" which is "...rarely talked about" and is "discussed in a

'cone of silence'". Those who experience GD are considered to "usually [be] desperate to find people whom they can trust to talk to about the strong, real emotions they experience" (Gender Disappointment 2007). Further enlightening the reader concerning

GD, "Secretly Sad: Overcoming Gender Disappointment" (2007) explains that "The big statement is: 'As long as it [the fetus] is healthy'" and that "If you in any way shape or form have a preference to either sex, it is interpreted as you're not being a good person, that you are not a good mother." The media articles suggest that GD is related to gender stereotypes and causes the woman to experience strong emotions due to her concern with

12 the gender of her children; therefore, extending the question of what will happen when women have a child of the "wrong" gender.

This research focuses on a population of women who identify themselves as experiencing GD, and who participate in online communities which are centred around discussions of intense desires for a child of a particular gender. This research, which bridges the literature of motherhood, NRTs, gender ideology, Computer Mediated

Communication (CMC) and medicalization, serves to present the findings of the analysis of online discussion groups which centre around the topic of GD. Through content analysis of the online communities and through semi-structured e-mail interviews with women who experience GD, the following research questions were considered: What are

GD groups? What role do GD groups play in the construction of GD? How, if at all, do

GD groups suggest managing GD? It will be argued that, through the medium of the

Internet, GD has been medicalized on a conceptual level as an affliction from which one can suffer.

This argument will be made throughout the following five chapters. Chapter one has provided a discussion of sex selection entrepreneurship, lending focus to the societal interest in sex determination while situating GD within this overall context. Chapter two presents a review of the literature which is central in understanding the context within which GD is constructed. This literature review highlights relevant areas in the literature of NRTs and gender selection practices, gender ideology, CMC and medicalization which relate to this research concerning GD. Chapter three outlines the methodological approach of content analysis and e-mail interviews which were used in this research.

Chapter three further presents a discussion of the ethical debates and methodological

13 considerations in undertaking qualitative Internet research. Chapter four discusses the results of the research by arguing that GD mirrors the discreditable chronic illness experience and, as such, is socially constructed within the online community as an affliction from which one can suffer. The concluding chapter provides a summary of the research while drawing significance to the function of HRSGs as an environment within which individuals are able to medicalize their experiences on a conceptual level in the absence of medical authority. This chapter further highlights the decentralization of the medical profession in the medicalization of social problems in the context of online communities.

14 Chapter 2; Literature Review

This research regarding the social construction of GD within online communities relates to the transitional changes in the role of motherhood and the social value of children in society. The social construction of motherhood maintains a significant role in women's experiences with GD. This construction, which is associated with different historical periods, has experienced transitional changes in North America. Presently, in one regard, the choice to have a child is related to the societal understandings of gender stereotypes and the availability of NRTs for gender selection.

This research will draw on several bodies of literature including NRTs, CMC,

HRSGs on the Internet, gender ideologies, medicalization and the social construction of illness. The literature regarding NRTs will serve to explain the technology which is involved in gender selection, a service which is marketed on the Internet and which attracts the attention of women who have GD, as it lends focus to the technological possibilities to resolve GD. As well, the CMC literature is important in understanding the medium and the communication conventions which individuals use to collectively construct and manage GD on the Internet. The literature regarding HRSGs, gender ideologies, medicalization and the social construction of illness will play a central role in this research, as it will serve to establish the manner and the social processes by which women who have GD construct it as an affliction.

Motherhood and Children: An Overview of Transitions

Women who experience GD often make the choice to have a child based on the hopeful fulfillment of their gender desires. As such, the paradoxical process of gender selection by means of sex selection technology has shaped the choice to have a child,

15 promulgating the "myth of the gendered chromosome" (Seavilleklein and Sherwin 2007), no longer leaving the gender of one's child to chance. In a discussion of NRTs, Rothman

(1989) put forth that within a capitalist social system, people become a market for what they want and wanting to have a child is no exception. Furthermore, what it means to want to have children in a market-oriented society varies, and as such, there are a lot of ways in which to market parenthood, including surrogacy, infertility treatments (Rothman

1989) and the transition towards the non-medical application of NRTs. Surrogacy is presented in the literature (May 1991; Rothman 1989) as an example of the commercialization of parenting which, according to May (1991), turned into a

"substantial business"; in 1988, it was reported that the Infertility Center of New York had 238 children born, an approximate $2.5 million dollar revenue for the Center (May

1991). Interestingly, Conrad (2005) stated that as health care becomes increasingly commodified and subject to market forces, medical care will become similar to other products and services. The expanding non-medical use of NRTs in the choice to become a mother and to have a child is at the forefront of historical transitions regarding motherhood and children in the family.

The role of children in the family, as well as the relationship between parents and the child, has changed dramatically through each historical period (Hays 1996; Postman

1994; Reed 1978). As images and understandings of children are socially constructed, each historical period constructs different ideologies concerning childrearing and the role of children in the family (Hays 1996; Heywood 2001); for example, the role of the child shifted in the United States approximately a century later than in Western Europe when the value of children was officially "discovered" (Hays 1996). This discovery of the

16 importance and the value of children brought with it a trend towards having fewer children (Heywood 2001). Previously, children had been considered to be beneficial in terms of economic and religious prosperity (Hays 1996), as they provided labour in an agricultural economy. The high birth rates and high mortality rates of a pre-modern society (Margolis 2001; Reed 1978) transitioned towards fewer births and fewer deaths

(Reed 1978), as the overall health of children began to improve (Reed 1978; Pawluch

1996). The decline in fertility continued with the industrial revolution which further altered the role of children in the family, as children became more of an expense and less of an asset (Reed 1978).

At this juncture in time, the role of mother took on a new importance which involved the careful rearing of fewer children, who were no longer seen as workers (Hays

1996). The rise of pediatrics also contributed to the changing role of the child in the family (Hays 1996; Pawluch 1996). Furthermore, family planning was controversial in the first half of the 20th century, as the post-war baby boom saw an increase in births that slowed after the introduction of the birth control pill (Reed 1978). Within the past few decades, as more educated women have entered the workforce, the birthrate has decreased to meet the replacement level (2.1 births per woman), and women are having children later in life (Friedman et al. 1994).

Ideas concerning the correct maternal role have changed over the last 250 years in the United States (Margolis 2001). Since the 19th century, mothering has been considered to be the primary identity for most adult women, as a child's development and well-being came to be viewed as the mother's primary responsibility (Margolis 2001). Previously, in the 17 and 18th centuries, within an agrarian economy, children were expected to work

17 and childhood was considered to be a period of time which lasted less than a decade

(Margolis 2001). In the 19th century, ideologies concerning children and maternal care changed, as childhood became a distinct period in the life cycle (Margolis 2001). The concept of the mother role emerged and transformed, requiring unpaid labour which is full-time, demanding and time consuming (Margolis 2001). Corresponding to the emergence of the mother role, debates including abortion, women's empowerment and the use of reproductive technology have arisen in recent years (Arendell 2000).

Furthermore, these controversies within mothering concern the evolving conceptualizations of childhood, the consideration of children's needs, and whether or not those needs are being met (Arendell 2000).

Social Construction of Intensive Mothering

Intensive mothering is defined as the normative standard by which mothering practices and arrangements are evaluated (Bell 2002) regardless of cultural contradictions and diverse arrangements (Arendell 2000). Motherhood has been described as being child centred, emotionally involved and time consuming (Arendell 2000); as such, the mother is not subject to her own needs and interests, as she is held responsible for shaping the kind of adults that her children will become (Arendell 2000). However, the depiction of mothers as self-sacrificing, devoted to the care of others, and inspired by love is considered to idealize the work of mothers (Arendell 2000).

Mothering is understood to involve a tremendous amount of activity, as well as evolving relationships which are located in a broad societal context that are organized by gender in accord with prevailing gender belief systems. As such, the ideology of motherhood involves idealized notions of the family, which put forth the image of the

18 white, middle class, heterosexual couple with children in a self-contained family unit.

Furthermore, the mothering experience is considered to maintain controversy, as motherhood is a personal fulfillment with positive experiences, as well as distress, depression and anxiety (Arendell 2000; Rosenberg 1995).

Motherhood and Deviant Discourses

Deviant discourses, which are derived from the ideological construction of mothering, are directed towards mothers who do not conform to the normative construct and who resist the underlying assumptions and approaches to motherhood (Arendell

2000; Bell 2002; Miall 1986). These discourses include "welfare mothers", adoptive mothers, mothers of children with disabilities and mothers who assert their autonomy in the process of utilizing reproductive technologies. It is understood that mothers who do not conform to heterosexual marriage, the birth of healthy children and full-time, devoted motherhood deviate from the construct (Bell 2002).

In particular, ARTs are an emerging subject of deviant discourses in motherhood, as the technologies are rapidly expanding within a social context that has yet to address the conflicting values and objectives (Arendell 2000). ARTs further the medicalization of maternity in what Arendell (2000:1196) describes to be "dramatic and often unexpected ways" and to "stress the primacy of male genetic ties to offspring." Women who assert their autonomy through the process of utilizing ARTs are potential subjects for an expanded deviancy discourse; for example, rather than affording reproductive freedoms, the technology may dictate a woman's choices and behaviours, interfering with the natural processes of reproduction; therefore, differences arise between the ideologies of mothering and motherhood, and the experiences of "real" women (Arendell 2000).

19 Within deviant discourses of motherhood, the literature has extended the idea that

NRTs have heightened the contested nature of the term "mother" (Arendell 2000; Bell

2002; Landsman 2000). NRTs have created the possibility that more than one woman can be involved in reproduction through egg donors and surrogacy; moreover, the concept of

"real motherhood" exists as an issue for mothers of infants with disabilities, in part, because mothers hold themselves responsible or feel that they are held accountable by others for the health of their fetus (Landsman 2000). In a discussion of female accountability, Rapp (1991) concluded that pregnant women and those who interact with them believe that the behaviours which mothers define as healthy or unhealthy are responsible for the outcome of the pregnancy, and as such, genetics are not distinguished from social behaviour. Further, Collett (2005:328) states that, "mothers are seen as ultimately responsible for the way their children turn out"; therefore, mothers are held responsible for the health of the fetus and the development of the child, and as such, health and development is widely understood to be a primary concern for the mother.

The extension of NRTs to detect genetic anomalies in a fetus, which has changed the criteria upon which the choice to have a child is made, initially extended the opportunity to those who were carriers of genetic diseases (Rothman 1993). Altering the landscape of child-bearing even further has been the application of NRTs for non-medical purposes; thereby, meeting the public's demand to experience the "balanced family"

(Leonard 2003). This transition has offered parents the choice to conceive a fetus who will fulfill a gendered role within the family unit while simultaneously extending the deviant discourse of motherhood with respect to the use of NRTs. Gender selection advances the possibilities which are associated with conception and, therefore,

20 motherhood and serves to ignite further complex debates concerning motherhood decisions. This technological transition in conceiving children has brought a welcomed solution to families desiring a child of a particular gender and has ignited social scientific and biomedical debate (Dahl 2005); furthermore, this current transition is preparing the market for the future of enhancement technology (Fukuyama 2002; Naam 2005). As May

(1991) has stated, society will increasingly be tempted to reduce parenting to manufacturing and the commodification of children in the marketplace will move society towards the application of "designer genes".

Gender Selection

The most significant social process associated with ARTs is the further medicalization of women's reproductive experiences (Achilles 1995). This social process is considered to be ongoing and to represent the furthering of existing social trends

(Achilles 1995). As such, NRTs are understood to maintain a significant role in the lives of women who experience GD, as NRTs can serve to determine the sex of the fetus and to offer a way in which to pre-determine the gender of the fetus through gender selection.

NRTs, are broadly defined as including all forms of biomedical intervention and assistance that a woman may encounter when considering whether or not to have a child

(Achilles 1995; Leonard 2003).10 NRTs are part of a broader family of technological innovations, altering the manner by which individuals think about themselves and the

1 The first category of NRTs includes alternative means to heterosexual reproduction, including artificial insemination (AI), in-vitro fertilization (IVF)1 , Pre-Implantation Genetic Diagnosis (PGD) and cloning. These technologies are also known as Assisted Reproductive Technologies (ART) (Hollingsworth 2005). The second category involves fetal monitoring, which involves all attempts to safe guard, change or predetermine genetic characteristics of the fetus. This includes prenatal screening (ultrasound, amniocentesis and chorionic villi sampling), prenatal surgery, sex determination and sex selection. Prenatal screening technologies are involved in Pre-Natal Diagnosis (PND).The last category of NRTs involves the technologies that aim to prevent or to terminate pregnancies, including contraception and abortion (Achilles 1995; Leonard 2003).

21 society around them (Rothman 1989). In a discussion of amniocentesis, Rapp (1991) stated that the technology of Pre-Natal Diagnosis (PND) continues to evolve at a rapid pace; moreover, medical technologies, including NRTs, are considered to be advancing at a rate which is too rapid for society to maintain control over their use (Social Values and

Attitudes 1993), as social policy is considered to lag behind the rapid advancements

(Achilles 1995). In a similar regard, May (1991) explained that many medical controversies, such as the "Baby M" case, have resulted from advances in medical technology which do not correspond to advances in society's ability to manage the application of the technology.11 NRTs are commonly thought to facilitate and to enhance a woman's control over her body and her fetus; however, the availability of the technology, coupled with the socially constructed notion of what is genetically "normal", creates a "freedom which is illusory" (Technologies of Sex Selection 1993).

Women's dominant role in reproduction is understood simultaneously to be a source of power and powerlessness, as NRTs can empower or disempower women depending upon the context in which they are used (Achilles 1995). The role of these complex technologies in the childbearing process limits the control which women have over reproduction by investing a large amount of the decision making process in medical experts (Technologies of Sex Selection 1993; Asch 1996). As NRTs advance, it has been predicted that women may experience less community support to manage pregnancy, in so far as fetal testing for a variety of medically determined "problems" will become normalized (Asch 1996); furthermore, Arendell (2000) posits that scientific and medical experts are interfering with the definitions of mothers and mothering which can be

11 The Baby M case involved the surrogate mother wanting custody of the child that she was paid to carry to term (May 1991).

22 determined by legal contracts resulting in the commodification of motherhood. Canada has experienced the introduction of technologies which require in-depth knowledge to fully comprehend; therefore, while seemingly providing expanded choice for women, the technological advancements have created a greater dependency on medical experts

(Technologies of Sex Selection 1993).

Once NRTs have been developed, they create pressure for their own use

(Technologies of Sex Selection 1993). While NRTs do provide the opportunity for some women to have children, they simultaneously introduce new pressures and dilemmas for women (Achilles 1995); for example, a woman who is confronted with infertility will feel pressure to pursue every possible avenue to overcome her or her partner's infertility

(Achilles 1995). Similar to the use of PNDs which have become routine, the mere availability of NRTs may exclude the option of not using them (Achilles 1995). As suggested by Franklin (1990), when specialized technologies become available to accomplish a particular task, successful outcomes will encourage the further use of the technology, and the technology may be improved and adapted for other uses. Mirroring this idea, NRTs have been adapted to non-medical uses, as the NRTs involved in sex selection (including IVF and PGD) are now marketed on the Internet for the purpose of gender selection, which is also identified in the literature as Social Sex Selection (SSS)

(Scully etal.2006).12'13

1 The Royal Commission on New Reproductive Technologies (1993) distinguishes between medical and non-medical applications of sex selection technology. Sex selection can be accomplished by the following ways: sex pre-selection in which the fertilization of the ovum occurs in-vivo (in the body) and there is an attempt to influence the type of sperm cell which is involved in fertilization, sex pre-selection in which fertilization of the ovum occurs in-vitro and an embryo of the desired sex is implanted in the mother, sex selection by abortion after identification of the fetus' sex, selective adoption based on the sex of the baby and giving for adoption biological children based on the child's sex. 1 PGD, which was initially developed for use in the pre-detection of genetic anomalies, has since been extended towards a non-medical application (Naam 2005). Advancements in PND make it possible to

23 The sex selection literature (Singer and Wells 1985; Wadman 2007) acknowledges that people have long held a preference to influence the sex of the fetus prior to conception and a desire to know the sex of the fetus during pregnancy. The evolution of NRTs to determine the genetic health of the fetus has inadvertently provided women with the opportunity to determine the sex of the fetus at increasingly earlier stages of pregnancy (Rothman 1993). These technologies, including amniocentesis, CVS and ultrasound, are typically referred to as sex determination tests. Initially, these tests were used in the diagnosis of sex-linked diseases (Gosden 2000; Hollingsworth 2005;

Rothman 1993). As such, the determination of fetal sex was offered to women as an option.

Early literature (Kolker and Burke 1994; Rothman 1993; Warren 1985; Wertz and

Fletcher 1992) regarding sex selection discusses the implications of determining the sex of the fetus. As NRTs advanced, bringing forward earlier detection and less invasive procedures, the possibility of aborting healthy fetuses of the "wrong" sex was identified as a concern; furthermore, concerns existed that given the pressures of patriarchal societies that the aborted fetuses would be predominately female and that sex selection would result in "gendercide" (Warren 1985) or a war against females in utero (Kolker and Burke 1994). As well, the literature (Wertz and Fletcher 1992) has extended possible societal outcomes of what would become a male dominated society such as the perpetuation of sexism and the lowering of women's status; therefore, these possible societal outcomes extend from the understanding of sex selection involving a male

detect, pre-natally, a growing range of the fetus' attributes including sex. The use of PND was initiated to provide women and couples who are at high risk for a serious genetic disorder with information about their fetus (Rothman 1993); however, it is possible to use PNDs for non-medical reasons such as to discern the sex of a fetus for a couple who may have a preference.

24 preference and have been applied to the possibility of being able to pre-determine the sex of the fetus in North America. As such, there is a common idea that the opportunity for selecting sex will result in a disproportionate number of males in the population; however, there is no evidence in the Canadian population to justify that assumption

(Technologies of Sex Selection 1993).

Technological advances, however, have advanced beyond the determination of fetal sex and have brought forward the possibility of pre-determining or selecting the sex of the fetus before conception. The literature, while often making reference to the historical preference for a male, proposes that sex preferences have changed in recent years. Kolker and Burke (1994) cited that out of eighty-eight pregnant women who had a sex preference, those with one or more children usually wanted a child of the sex opposite to the existing children. This encapsulates the present trend in North America, the desire for a "balanced family", and for desiring the sex which is least represented in the family unit (Karlberg 2008). Wertz and Fletcher (1992) consider whether the

"balanced family" approach for gender selection has a sexist and therefore stereotypical basis. It was concluded that even when a couple wanted to balance their family to ensure that their children respect sex-based differences and to "learn fairness to the opposite sex by practicing it at home" (Wertz and Fletcher 1992:244), that the decision would still maintain sex stereotypes. That being said, the Royal Commission on New Reproductive

Technology (1993) concluded that Canadian society does not value one sex over the other; however, it was observed that those who did indicate a preference stated that, traditionally, males were preferred and are considered to be of more importance in the family unit. As well, in comparison to female respondents, some male respondents were

25 noted as citing passing on their name, continuing the familial line, and pride as reasons for wanting a son (Social Values and Attitudes 1993).

Sex selection for non-medical reasons, according to the Royal Commission on

New Reproductive Technology (1993), is considered to be contrary to Canadian values, to violate "the principle of respect for human life and dignity" and to be invasive, expensive and wasteful of medical resources (Proceed With Care 1993).14 The methods are considered to be intrusive and inefficient as they often require several cycles of IVF.

The practice of sex selection for non-medical reasons is considered by Canadian society to reinforce the idea that the sex of the child is important; furthermore, the use of PND and sex selective abortion, which favours one sex over the other, has been identified as contrary to the Royal Commission's guiding principles and incompatible with Canadian values.15 Additionally, sex selection for non-medical purposes is said to reinforce the idea that the sex of a child is important and encourages the view that families with all boys or all girls are less than ideal; furthermore, the practice of sex selection for non-medical reasons could cause existing children in the family to feel that their own sex identity is inadequate. Thus, the Commission (1993) concluded that sex selective insemination service should not be available in Canada for reasons of sex preference and that services be provided in situations only for which there is a medical need (such as an X-linked disorder) and only in licensed settings (Proceed With Care 1993).

Sex selection for non-medical reasons occurs in the following ways: through the use of PND to determine the sex and to abort the fetus of the "wrong" sex, by testing zygotes which are created through IVF and to only implant those of the desired gender and to treat sperm in order to enhance the X or Y bearing sperm. 15 The guiding principles of the Royal Commission on New Reproductive Technologies (1993) are individual autonomy, appropriate use of resources, non-commercialization of reproduction, equality, respect for human life, protection of the vulnerable and accountability.

26 Advances in NRTs have been described to have eliminated earlier difficulties with conception and pregnancy; however, as the technology becomes more sophisticated, the social problems which NRTs pose become increasingly complex (Achilles 1995). As such, gender selection in North America, which is based upon the desire for the balanced family, lends focus to the traditional understanding of gender which is associated with sex. These families who envision their future daughter or son do so with a particular gender identity in mind; thus, it is important to consider the social basis for choosing the gender of one's future child, to consider the possibility of gender non-conformity, and to further investigate what the outcome will be of having a child of the "wrong" gender.

Gender Ideology; Stereotypes and the Construction of Gender Dreams

The interchangeable use of the terms gender and sex provides the analytical context within which current gender selection practices prevail. This interchangeability is widely recognized and acknowledged in gender based literature (Howard and Hollander

1997; Hubbard 1998; Lorber 1994; Richardson 1988; Rothman 1993; Six and Eckes

1991; West and Zimmerman 1987). Sex is defined as being ascribed by biology, anatomy, hormones and physiology (Richardson 1988; Lorber 1994; West and

Zimmerman 1987); furthermore, sex is usually considered to be dichotomous, assuming that there are only two sexes, male and female, and is usually considered to be unchangeable in North American society (Howard and Hollander 1997). The term gender is noted in the literature to be a term which does not maintain consensus in the scholarly community (Howard and Hollander 1997). Gender is understood to be an achieved status which is socially constructed through psychological, cultural and social processes

(Richardson 1988; Lorber 1994; West and Zimmerman 1987); moreover, gender is

27 understood to be a characteristic which is associated with biological sex. As such, sex is assigned at birth and gender develops over time (Hubbard 1998).

Gender selection can be related to the statement that, "gender is so pervasive in our society that we assume it is bred into our genes" (Lorber 1994:13), as it is understood that particular gendered behaviours and characteristics are tightly linked to sex (Holmes

1993). Gendered behaviours refer to the assumptions and the beliefs on both individual and societal levels which influence the thoughts, feelings, behaviours and treatment of men and women (Howard and Hollander 1997); for example, the extent to which women and men dress, talk and behave differently because of societal expectations, means that their behaviour is gendered. The argument has been made that in order for one to recognize how gender is produced, a deliberate disruption of normative gender behaviour would need to occur (Lorber 1994; West and Zimmerman 1987).

Sex is a diagnosable chromosomal state; however, the process of pre-determining the sex of the fetus is marketed as gender selection (Rothman 1998). While this distinction is inaccurate in technical terms, it is accurate in the broader social sense.

Gender is what couples are considering when they select by sex, as people who say that they want a girl have specific personality characteristics in mind which they believe will not be reflected in a boy (Rothman 1998); for example, women express that they want the kind of relationship which they had with their mother; a relationship which they cannot experience with a son. Choosing and/or determining the sex of the fetus implies gendered meanings of personality and social role expectations; thus, it is not simply a matter of what sex the fetus is, but what social role the family expects the child to satisfy (Kolker and Burke 1994; Rapp 1996). In addition, couples are choosing the sex of their fetus, but

28 they are simultaneously extending a statement with respect to personality, lifestyle and what gender role they want their child to fulfill (Rothman 1998).

Gender is continually created and recreated through human interaction and social life (Lorber 1994). As such, gender depends upon everyone "doing gender" and is a human production (Lorber 1994). Goffman (1977) acknowledged that each society develops its own understanding of behaviours which are characteristic of sex categories and it is within this context that the ideals of masculinity and femininity are constructed.

Gender traits and the associated attributes which conceptualize gender identity are related to a sex category (Goffman 1977) and individuals learn through interaction how a girl/woman or a boy/man should feel, think and act in different social roles and environments (Richardson 1988).

Construction of Fetal Gender Identity

Gender is considered to be one of the major ways by which humans organize their lives and is considered to be a fundamental source of identity (Kane 2006; Howard and

Hollander 1997). The gendering of an individual which begins from birth, and in certain instances during pregnancy, occurs when a sex category is assigned to the fetus or to the child. The sex category becomes a gender status upon which the process of associating gender markers such as names, clothing, interactions with the child, mannerisms and spatial segregation are based (Kane 2006; Lorber 1994; West and Zimmerman 1987).

The knowledge or the pre-determination of fetal sex extends gendered meanings to the pregnancy (Rothman 1993). This social process occurs through the language which is used to describe the fetus, the future child, and by the familial role which is symbolically created in anticipation of the girl or the boy. Gender stereotypes continue to

29 have a role in the familial desire for a boy or a girl and the disclosure of fetal sex may contribute to gender stereotyping (Kolker and Burke 1994; Rothman 1993); as well, once the sex of the fetus has been determined, the fetus is personified. This personification is shown by avoiding colours considered appropriate for males if the fetus is female, by naming the fetus and by planning the future baby's room (Kolker and Burke 1994;

Richardson 1988). These gender markers serve to display a sex category, which signifies to others how to respond to the baby, as different gendered individuals are responded to accordingly. As such, children respond to this behaviour by feeling differently and by behaving differently from those of other gender identities (Kane 2006; West and

Zimmerman 1987).

Gender selection is predicated upon the belief that there are important differences which are attached to a child of one sex or the other. In North American society, the social expectations of men and women are different and these differences can be explained by the understandings of social roles including the behaviours, interests and practices which are considered appropriate for men and women (Seavilleklein and

Sherwin 2008). Gender identities are reinforced through socialization, as the child will be expected to conform to the expected gender roles which involve the conformity to sexual orientation and heterosexual ideals. As such, mothers are considered to be "constantly casting the roles of their children" (Collett 2005:330) which includes reminders concerning social behaviour and the management of physical appearance.

Gender Stereotypes

Gender categories, specified as either masculine or feminine, denote the attributes and behaviours that people develop as a result of social expectations (Hubbard 1998).

30 Gender stereotypes are defined by Basow (1992:3) as "strongly held overgeneralizations about people in some designated social category"; consequently, gender stereotypes are defined as beliefs about the characteristics of women and men, which include physical characteristics, typical behaviours, occupational positions and personality traits (Howard and Hollander 1997). Stereotypes for male and female behaviours have a tendency to involve opposite characteristics. Wertz and Fletcher (1992) conclude that gender roles and stereotypes continue to be prevalent in North American society and to influence children's preferences at an early age.

Characteristics such as instrumentality, dominance, and assertiveness are believed to be associated with men, while characteristics such as warmth, expressiveness, and concern for other people are believed to be reflective of women. These divisions serve to widen the perception of difference between men and women and overlook the ways in which women and men are similar (Howard and Hollander 1997); moreover, gender stereotypes for sub-groups of women and men exist; for example, sub-groups of business women and homemakers. As well, gender stereotypes may vary by race, class or ethnicity

(Howard and Hollander 1997).

In regard to gender selection, stereotypes are considered by Davis (2001) to predict a couples' choice of sex. Davis (2001) states further that it is not likely possible to raise a child without the influence of gender stereotypes, but that minimizing the gendered expectations would provide a greater opportunity for an "open future", which does not involve notions of how the child is "supposed" to behave. While an individual may be socialized to adopt a particular gender identity, that identity may change over time and the individual may conform to a gender identity which is not traditional.

31 Gender Non-Conformity

The relationship between sex and gender is considered to be stereotypically related; however, the child may deviate from the gender identity which his/her parents want and the child may not develop the gender identity that he/she was raised to express.

Hubbard (1998) argues that the male/female dichotomy is socially constructed and that for people to be considered "normal" their gender identity must be binary and coincide with biological sex. The understanding that gender is constructed and reconstructed can be illustrated through examples of gender non-conformity which have been presented in literature pertaining to hermaphrodites, transsexuals, transvestites and homosexuality

(Bolin 1997; Bullough and Bullough 1993; Bullough and Bullough 1998; Howard and

Hollander 1997). For instance, Lorber (1994) considers that without gender differentiation, the roles of transsexuals and transvestites would be meaningless, as they would not be deviating from a normative gender identity; furthermore, Lorber (1994) states that there would not be a need to reconstruct the genitalia of intersexed infants if lifestyles were not gendered. Gender differences are considered by Hubbard (1998) to be apparent by that fact that males and females are considered in everyday language to be either more masculine or more feminine, and this degree of masculinity or femininity transitions over time and within different social contexts. Boswell (1998) contends that as culture evolves, the traits which are appropriate for either sex are redefined through the association of anatomy and gender. Further, it is understood that each culture assigns traits to anatomical sex, while leaving other traits in a neutral category (Boswell 1998).

Sexual orientation is considered to develop independently of gender, and is substantiated in literature concerning the assignment of sex to intersexed infants when the

32 sex is ambiguous, such as with hermaphrodites (Howard and Hollander 1997; Hubbard

1998). Hermaphrodites are defined as having ambiguous reproductive organs and chromosomal structures; for example, a child may be born with both male and female genitalia and thus would not conform to the binary nature of society; therefore, physicians frame the situation of a sex-ambiguous infant in terms of whether they can successfully construct a girl or a boy (Hubbard 1998). Interestingly, Fausto-Sterling

(1993) has suggested the categorization of five sexes which includes male, female and three types of hermaphrodites. North American society believes that there are two sexes

(Howard and Hollander 1997; Hubbard 1998; Lorber 1994), and as such, the ambiguity of infants who are born as hermaphrodites is "corrected" by surgical or hormonal means in order to assign the infant to one of the sex categories (Howard and Hollander 1997).

As Kessler (1995) explains, physicians maintain the belief that only two sexes exist, and thus promotes a culture of two genders. Another example of gender non-conformity is transsexuals - people who have changed their sex surgically and hormonally so that they appear to be a sex which is different from that which was assigned at birth (Howard and

Hollander 1997). Transsexuals do this in order to match their physical anatomy to their own sense of gender identity (Lorber 1994). Due to the fact that transsexuals have the physical appearance of one sex and the genetic structure of another, they are not easily classified as one sex or the other (Howard and Hollander 1997). Transvestites, however, are males who live as women and females who live as men, but do not have sex reassignment surgery. Instead, their dress, appearance and mannerisms fall within the range of what is expected from those of the opposite gender (Lorber 1994). In further consideration of deviating from traditional gender norms, it is important to consider the

33 possibility that the parent, who invests in gender selection, may have a child who will not conform to the idealized role which is desired by the parent.

Children of the "Wrong" Gender

Sex selection and, therefore, gender selection have been identified as problematic by researchers as difficulties may arise when a child does not conform to the gender ideal

(Wertz and Fletcher 1992). The concept of "family balancing" by which present gender selection practices prevail suggests that what is desired by families is not a child with different genitals, but a child who conforms to the opposite gender role to the children the parents already have (Seavilleklein and Sherwin 2008). Seavilleklein and Sherwin (2008) further consider the facts that couples are willing to pay thousands of dollars for gender selection services, and to spend the time and effort, as well as emotional and physical risks associated with gender selection procedures, which suggest a strong belief that important differences are attached to having a child of one sex over the other. This notion is succinctly surmised by Rothman (1998:205) who in regard to gender selection stated:

Can't you just see the disaster looming? That woman is not ready for a six-foot-tall, 300-pound daughter who wears nothing but denim and boots. People who want a son are probably none too pleased when he announces he wants ballet lessons. When people want a son or want a daughter, they want a host of characteristics that they believe are, and often believe should be, sex-linked.

The gender personality, which the parents desire, enforces gender appropriate behaviours which serve to extend the debate concerning the perpetuation of traditional gender ideals.

The "child's right to an open future" (Davis 2001) has been the subject of debate within social scientific and philosophical literature in regard to gender selection. The gender identity which the couples desire in a future child can be explained only in terms of assumptions about the different social roles (behaviours, interests and practices) that are considered to be appropriate for boys/men and girls/women. As such, couples expect that

34 from engaging in gender selection practices, their child will conform to the assumed and the desired gender roles (Seavilleklein and Sherwin 2008). Further, Davis (2001) argues that parents who use gender selection will have strong gender role expectations and that if parents go through the effort of sperm sorting and IVF, they are likely to make it difficult for the child to resist those expectations while pursuing their own future.

While scholars have expressed concern about conflicting gender ideals (i.e. between what the parents want their child to express and what the child may express in terms of gender identity), the gender identity of the future child is often constructed during pregnancy, and in some instances, before conception (Bayles 1984; Rothman

1998; Warren 1985; Wertz and Fletcher 1992). This construction of fetal gender leads to a pre-disposed gender identity, a gendered role within the family, which the future child is expected to fulfill. Sex selection, and therefore gender selection, has been said to perpetuate sexism and gender inequality (Hollingsworth 2005; Warren 1985; Wertz and

Fletcher 1992). Conversely, Wertz and Fletcher (1992) consider the parental desire for a child of the same sex and extend that this desire is not sexist, as it relates to sexual identification and companionship. Although, Bayles (1984) asserts that any normal pleasure that can be enjoyed with a child of one sex, including sports, vacations, hobbies, and games, can be enjoyed with a child of the other sex. According to Davis (2001), the ethical problem which arises from the practice of gender selection is the promotion of gender role stereotyping and the tendency of couples to heavily invest in having certain types of children.

Increasingly, women who are interested in influencing the gender of their future children turn to the Internet to seek answers to questions regarding gender swaying and

35 gender selection. These searches for information have resulted in the discovery of online communities in which women discuss their attempts at gender swaying, as well as their personal experiences and feelings regarding the gender composition of their families.

Online Communities

Online communities serve a crucial purpose in the lives of women who experience GD and are integral in developing an understanding of the virtual environment in which GD is constructed. It is within online communities that women, who identify with the experiences of others, collectively develop and construct an understanding of GD.

The symbolic construction of community within the context of cyberspace has been considered in previous research (Jones 1995; Slevin 2001). Scholars rarely acknowledge, however, the empathic nature of these communities. In regard to CMC communities, research has considered the nature of individual commitments, the symbolic connections that emerge from interactions, and individual identity and discourse patterns on the Internet (Cavanagh 2007; Jones 1995; Preece 2007).16

CMC extends a new understanding of community, with the existence of complex norms in the online world. This community formation which occurs within the medium of CMC allows for the customizing of social contacts as individuals seek to communicate with others, and these social relations are constructed by symbolic processes which are initiated and maintained by individuals and online groups (Jones 1995). Within the online communities, the discourse pattern is influenced by interaction in the real world, as the external context provides some of the language which is used online. As well, group and

1 CMC communities are referred to as virtual communities. Virtual communities are predicated upon knowledge, information, common beliefs and practices of a society which is removed from physical space (Jones 1995).

36 individual characteristics are said to affect CMC discourse. These characteristics include the size of the virtual community, the respondents' shared experiences, the hierarchical structure, the gender balance of the community and the unique experiences that individuals bring to the group (Baym 1995).

Early research, which considered online interaction and online communities, argued that because physical presence was lacking, meaningful discourse and relationships were not able to form online. As such, early CMC research considered discourse to be task-oriented and factual; however, much of CMC is primarily social, and meaningful relationships can be developed on the Internet (Baym 1995; Parks and Floyd

1996; Preece 1999; Wright 2000). Contrary to these earlier arguments (Baym 1995; Parks and Floyd 1996) which were largely influenced by social cues theory (Walther 1996;

Wood and Smith 2001) and which adopted the "cues filtered out" approach (Walther

1992), it is presently understood that CMC patterns emerge out of complex interactions which include external contexts, temporal structure, group purposes, and group and member characteristics (Baym 1995; Parks and Floyd 1996). The social nature of CMC developed from the intended purpose of CMC for business communication (Baym 1995;

Preece 1999). CMC usage has been transformed by becoming accessible to private users for recreational purposes. Thus, the use of CMC within the private sphere reflects the need for individuals to communicate informally with one another.

The temporal structure of CMC is organized either synchronously, asynchronously or by a combination of both (Walther 1992). Bulletin Board Systems

(BBSs) allow for asynchronous communication between members and are usually part of websites which provide a context and define the purpose of the BBS. Discourses on most

37 of the BBSs, which are increasingly being moderated, can be viewed by the public, and the community members must go to the BBSs in order to receive and to post messages

(Preece 2000; Wood and Smith 2001).

Rather than being constrained by the computer, members engage in new modes of expression and community, explore their identities, create behavioural norms and foster relationships which would be unlikely in the real world (Baym 1995; Galegher et al.1998). In terms of identity, anonymity is valued because it creates the opportunity for individuals to keep their real world identity private and to engage in new forms of interaction online. Identities are actively created online and are expressed through the individual's online name, message signature, role in the virtual community and level of self-disclosure. With respect to identity creation, the signature which appears on the respondent's messages is significant, as it is often an immediate, visual cue which can be used for identification purposes (Baym 1995; Bruckman 2007). Similar to communities in the real world, relationships with other members in virtual communities are formed with an understanding of the behavioural norms which emerge in relation to the purpose of the interaction (Baym 1995).

CMC is simultaneously situated in multiple external contexts, as individuals bring their experiences in the real world into their discussions online. These pre-existing contexts in which members communicate provide social understandings and practices through which interaction in the context of CMC develops; therefore, members maintain a shared experience or understanding in the real world (Wellman 1997; Wright and Bell

2003). As such, women who identify with GD maintain similar understandings of their experiences in the real world and these experiences manifest as health related concerns.

38 Health Related Support Groups (HRSGs)

People are increasingly accessing the Internet to gain information regarding health issues in order to acquire an understanding of their problem, locate information about diseases and treatments, gain support from others, and help fellow sufferers (Overberg et al. 2005; Preece 2000). Information that patients obtain from the Internet has been described by Rice (2001:21) to at times be "incomplete, misinterpreted or outright quackery"; however, this research concerns the social and emotional context of HRSGs and focuses on the sharing of personal narratives rather than factual, medical content.

Conrad (2005) stated that the Internet has transformed illness from a private experience to a public experience, as people who suffer similarly can connect and become empowered. Although websites offer health related information, online communities act as a more personal resource in which patients can interact with each other and possibly with health professionals (Preece 2000). Within these online communities people can share experiences and emotions with others who are neither professional helpers nor part of a local network of family or friends (Galegher et al.1998). HRSGs, which have been described as "disembodied but strongly connected communities" (Sharf 1997:70), are considered to be empathic communities, in so far as their members seek empathy and emotional support (Preece 1998). An advantage to HRSGs is the permeable boundary, as face-to-face support groups often have fees and requirements for membership; moreover,

HRSGs resemble face-to-face support groups as they are both likely to be populated by people who share a particular diagnosis or problem; however, HRSGs are different from face-to-face groups in significant ways and act as beneficial mechanisms of support (Finn

1994; Galegher et al. 1998; Wright 2002).

39 HRSGs offer enhanced access and support at all times. Unlike face-to-face groups which meet once a week or month, individuals are able to access support regardless of geographic location, scheduling/time constraints, lack of availability, distance, expense, care giving responsibilities or social differences (Finn and Lavitt 1994; Preece 1998;

Salem 1997). As well, information and knowledge from personal experience is available with the advantage of interacting with hundreds of participants who have varied experiences, therefore, providing a good opportunity to connect with people who share important commonalities in order to receive mutual support and to share information

(Finn 1994; Finn 1999; Salem 1997; Sharf 1997); furthermore, friends and family members are not always helpful to the sufferer, especially when they lack personal experience; therefore, efforts to help the afflicted individual are often mismatched

(Walther and Boyd 2002).17

The CMC literature considers physical presence to be a central difference between face-to-face groups and online groups. Within an HRSG, the absence of co- presence can be problematic or advantageous for members. On one hand, the inability to engage in visual and/or tactile communication can be limiting; however, the same conditions may encourage an uninhibited outpouring of feelings on the other (Jones et al.

2001; Sharf 1997). HRSGs may also provide a beneficial forum for people with a history of interpersonal difficulties, as CMC allows for the expression of thoughts and feelings without the interpersonal risks of embarrassment and/or anxiety which accompany face- to-face communication. Indeed, messages can be composed and revised before being delivered, making participation less risky. This delay in response time may reduce

17 Mismatched refers to difficulties which can arise when the efforts to help one in need are not well matched to the recipient's needs, resulting in ineffective or counterproductive assistance (Walther and Boyd 2002).

40 impulsivity and misunderstanding; therefore, face-to-face groups and HRSGs offer different opportunities for individuals to gain support (Finn 1997; Sharf 1997).

While face-to-face groups and HRSGs offer different opportunities for support, they are similar in that members share a common experience, as they all struggle with a similar problem in the real world (Walther and Boyd 2002). As members draw validation from one another, a collective belief concerning the problem develops in the online communities; furthermore, the information being discussed promotes the understanding of a problem for the individual (Walther and Boyd 2002).

As cited in the literature (Wright 2002), for individuals with compassionate friends or family, the relationship is often defined by time, expectations of reciprocity, reluctance to discuss personal problems or by the sense that only people in a similar situation can understand; moreover, locating people who are experiencing a similar situation can be difficult if the affliction is not widespread or if it is socially stigmatized

(Wright 2002; Wright and Bell 2003). CMC communities, however, offer a forum for individuals who feel stigmatized by their illness/affliction to disclose personal information with a sense of safety. In fact, the most frequently mentioned advantage of

HRSGs is that there is less stigma attached to one's illness/affliction by the other members because of the anonymity the medium affords (Wright and Bell 2003). In order to overcome or to supplement limitations in sources of social support in the real world, many people turn towards HRSGs (Galegher et al. 1998).

Strength of Weak Ties in Online Communities

As online communities and HRSGs flourish on the Internet, inevitably, social support is increasingly being exchanged via CMC in large networks among people who

41 do not know each other in the real world. As such, the process of communication is changed as most CMC support begins by discussing the topic of concern, immediately and often in very personal terms, rather than by leading up to these concerns after establishing relationships predicated upon other commonalities (Adelman et al. 1987); therefore, the strength of weak ties theory put forth by Grannovetter (1973) has been applied to CMC, as weak ties are developing within online communities (Adelman et al.

1987).

Communication on the Internet confirms that weak tie relationships are evident within online communities. Strong tie relationships are those that revolve around more than one topic and are known as multiplex. These multiplex interactions are characterized by friends, loved ones, work associates, confidantes and family, as social support is usually exchanged within these relationships. Weak ties, however, are structurally and socially different and are referred to as uniplex (Adelman et al. 1987). Structurally, weak ties are not originally known to the individual directly, but may be known through secondary associations. Within an online support community, the association with other individuals is offered through virtual space rather than a secondary social link, as individuals often enter the online community for support rather than to meet a specific person.

Those in weak tie relationships are less likely to know or to interact with an individual's primary social network; thus, weak ties provide people with access to information and resources beyond those that are available in their own social circles

(Granovetter 1982). Common practice in HRSGs is to ask if anyone else has experienced a particular situation or condition. When sensitive information is imparted to a weak link,

42 it is not likely to get back to those in one's close network. Thus, the distance afforded

through CMC enhances perceived anonymity and allows people to seek information and

support without having to deal with the uncertainty of how those in primary relationships

might respond. In other words, "weak ties facilitate low risk discussions concerning high

risk topics" (Walther and Boyd 2002:165) and, therefore, make HRSGs safe places for

the individuals to interact.

Weak social relationships provide a wider range of social support than what is traditionally experienced within closer relationships. Weak ties provide support when

stronger ties are disrupted, such as by an illness and weak ties assist people through times of crisis in ways that stronger ties cannot. As such, limitations can be found in strong ties, as they can act as barrier forces that limit the individual's freedom and action. An individual may seek support from "in-group" members in order to receive an understanding which is not available from his/her network of strong ties. In regard to chronic illness, support from weaker links has fewer expectations and is easily reciprocated. The interaction characteristic of weak ties is usually restricted to fewer topics than that of strong ties; moreover, the fact that weak ties can operate effectively with generalized information reduces the effort used to obtain support and, therefore, extends the range of people from whom one can draw support. As such, network distance enhances perceived anonymity and allows people to seek information and support without having to deal with the uncertainty of how those in primary relationships might respond (Adelman et al. 1987).

As weak ties are understood to extend an individual's access to information and to social support beyond what is gained from face-to-face interaction, Adelman et al. (1987)

43 put forth that weak ties offer the following support functions: extending access to information, promoting social comparison with dissimilar others, facilitating low risk discussion of high risk topics and fostering a sense of community. Because weak ties bring individuals, such as those who have GD, into contact with dissimilar others, social comparisons to weak ties play a significant role in the support process. Self-evaluation is facilitated by a comparison to weak ties because they provide a variety of information and a better ability for one to judge how typical or how "normal" one's own behaviour is in comparison to others in the online community.

In summation, HRSGs provide a forum in which individuals who may be experiencing isolation and stigmatization would feel comfortable identifying with others whose experiences mirror their own. In a society which is increasingly medicalizing woman's reproductive experiences (Bell 1987; Reissman 1983), these online communities provide an environment in which individuals can retreat from the real world and can disclose potentially discrediting (Goffman 1963) information concerning conception, pregnancy and child bearing while collectively constructing their experiences among those who understand.

Medicalization and the Social Construction of Illness

Aspects of individuals' social experiences are increasingly being defined within the scope of a medical context, extending credence to the assertion of "the medicalization of life" (Illich 1976:39). As such, it is presently considered suitable to seek advice from medical professionals for an increasing range of problems (Zola 1972), such as concerns regarding sexuality, fertility, childhood behaviour and old age memory problems

(Reissman 1983). Interestingly, the control of the medical professionals over a variety of

44 human conditions and behaviours extends beyond the profession's capacity to cure them

(Friedson 1970); furthermore, medicalization emphasizes that medicine maintains social involvement and is not solely scientific, as a biological manifestation is not necessary for an experience to be defined in terms of illness, portending that medical diagnosis is an interpretive process through which illnesses are constructed (Brown 1995; Reissman

1983). In this regard, the medical system can be viewed as a system of social relationships with sickness understood to be a social role and disease understood to be a biological state (Ehrenreich and Ehrenreich 1974). As such, Zola's (1972:487) seminal work on medicalization put forth "that medicine is becoming a major institution of social control" and extended that this process is "an insidious and often undramatic phenomenon accomplished by 'medicalizing' much of daily living, by making medicine and the labels 'healthy' and 'ill' relevant to an ever increasing part of human existence"

(Zola 1972:487). This understanding serves to reflect present trends in the medicalization of social behaviour.

Medicalization is defined as a social process in which behaviour that was previously not considered relative to medical concerns is redefined to fall within those concerns (Becker and Nachtigall 1992; Bell 1987; Conrad 1992). This process toward medical social control as a means to acquire power (Becker and Nachtigall 1992), is socially constructed through meanings which are produced about undesirable social conditions or behaviours (Pawluch 1993). As such, the medicalization framework has been applied to different areas of life as various health conditions, social statuses and behaviours have been relegated to the health care system to cure and/or to manage

(Becker and Nachtigall 1992). These non-medical problems which come to be defined in

45 terms of illnesses or disorders (Conrad 1992) represent a trend toward considering undesirable conditions, situations and behaviours as medical problems (Pawluch 1993).

These conditions, which have come to be defined in medical terms, were often previously attributed to a non-medical source. Current literature (Conrad 2005) concludes that medicalization is transitioning towards biotechnology, consumers and manage care organizations, as well as away from medical professionals.

Medicalization may occur when a social behaviour does not correspond to the normative construct of the behaviour in society. When a social behaviour is considered ambiguous, deviant or marginal to social norms and expectations, the legitimacy of the social behaviour becomes questioned. Relegating such a behaviour to the health care system has become a way in which to manage difference from the norm (Becker and

Nachtigall 1992); furthermore, in this regard deviance becomes a disease which requires medical treatment (Pawluch 1993). These conditions, which are presently defined within medical terms, were often attributed elsewhere in society (Lee and Mysyk 2004). The medicalization of these behaviours exists as a form of social construction, presenting

"reality and knowledge as socially constructed, shaped by its human constructors"

(Conrad 1992: 211). This trend toward medicalization has also involved non-problematic behaviours (Pawluch 1993). It has been contended that the "proliferation of disease categories has resulted in an increasingly restricted view of what is normal and has created a sick and deviant majority" (Becker and Nachtigall 1992:457).

Medicalization has occurred for both deviant behaviour and "natural life processes" (Conrad 1992: 213). Medicalized deviance includes but is not limited to: mental illness, alcoholism, homosexuality, and opiate addiction (Conrad and Schneider

46 1985), hyperactivity (Conrad and Potter 2000), learning disabilities in children, eating problems, child abuse (Pfohl 1977), infertility (Becker and Nachtigall 1992; Scritchfield

1995), gambling (Rosencrance 1985), transsexualism, and compulsive buying (Lee and

Mysyk 2004). Some of the natural life processes which have become medicalized include sexuality, childbirth (Wertz 1977), pediatrics and child development (Pawluch 1993), pre-menstrual syndrome (Reissman 1983), menopause (Bell 1987; Bell 1990) and aging and death (Conrad 1992). As such, subcultures, groups or individuals have been known to vary in their willingness to apply, accept, or reject medicalized definitions (Conrad

1992). Technology has facilitated medicalization in regard to childbirth and controlling children's behaviour, and Conrad (2005) further stated that pharmaceutical and biotechnology industries are becoming central in medicalization. These behaviours and life processes reflect an increasing range of social behaviour which has been defined or described in terms of medicalization, as it is "widely acknowledged that illness has become a cultural metaphor for a vast array of human problems." (Reissman 1983:3).

Conversely, demedicalization is defined as a problem that no longer retains its medical definition (Conrad 1992). This process occurs when a problem is no longer defined in medical terms and medical treatments are no longer deemed appropriate.

Demedicalization has occurred in regard to homosexuality (Conrad 1992) and AI

(Winkler and Winkler 1991); furthermore, technology, such as pregnancy tests, can lead to a degree of demedicalization due to the reducing involvement of the medical community (New Reproductive Technologies 1993).

Processes of Medicalization

47 Medicalization refers to two interrelated processes: behaviours or conditions are given medical meaning and medical practice becomes a vehicle for controlling experiences which are defined as deviant. Behaviours or conditions are accorded medical meaning by being defined in terms of health and illness, while medically controlling deviant behaviour maintains the purpose of "securing adherence to social norms"

(Reismann 1983: 4).

Medicalization is stated to occur on three levels (Conrad 1992; Reismann 1983): conceptual, institutional and interactional. The conceptual level of medicalization involves the use of a medical vocabulary or a set of concepts to define the problem. Few medical professionals need to be involved within the conceptual level of labeling a social problem within a medical framework. Medical treatments are not necessarily applied

(Conrad 1992); for example, Alcoholics Anonymous (AA) does not involve medical professionals (Conrad 1979), as the members self-identify as recovering alcoholics (Best

2008). Conceptually defining a problem as medical is considered to be a significant transformation in the understanding of the problem, as once a problem is defined medically, a medical approach appears to be the only logical solution (Bell 1990). As such, prior to the medicalization of menopause, the most important condition of the

"problem" was social, reflecting a woman's adherence to or departure from her prescribed social role. In order to prevent symptoms, one was expected to "avoid being too educated, fashionable or sexually active" (Bell 1990:174). Once menopause was defined as a disease, treatment with estrogen became the only way in which to manage the problem (Bell 1990), lending focus to the understanding that a medical definition has the capacity to dominate any other way in which to view a problem.

48 The medicalization of a social behaviour has been known to occur only on the

conceptual level, in the absence of the authority of the medical professionals. Alcoholism

(Conrad and Schneider 1980) has been conceptualized as an illness through the

description of the social problem in medical terms. Alcoholism as a disease maintains the

symptoms of drinking and causing difficulties in the workplace and at home and, as such,

there are no biological symptoms which distinguish alcoholics from nonalcoholic

drinkers (Best 2008); furthermore, Best (2008:102) acknowledged that medicalization often "consists of little more than adopting a medical vocabulary". Conversely, Appleton

(1995) has challenged the notion that a social behaviour can be medicalized only on a conceptual level through a discussion of alcoholism as an example of medicalized deviance which did not involve medical professionals. Appleton (1995), through an analysis of alcoholism, argues that the medicalization theory which extends the conceptualization of a social problem, removing "medicine from medicalization"

(Appleton 1995:64), should be modified to be situated not only within the biomedical model of disease, but to involve alternative medicine.

The institutional level of medicalization involves physicians developing a program or an organization and legitimizing of a problem by the adoption of a medical approach to manage the problem (Conrad 1992). This level of medicalization can occur only after a social problem has been conceptualized as medical (Bell 1990). The interactional level of medicalization is the level within which physicians are most directly involved (Conrad 1992) and the medical profession legally controls the problem (Bell

1990).

49 Medicalization also occurs as part of the doctor-patient interaction during which time a physician defines or diagnoses a problem as medical or treats a social problem with a medical form of treatment (Conrad 1992; Reismann 1983). Adding to the arguments of Conrad and Schneider (1985), Bell (1990) clarified that within doctor- patient interaction, it is understood that not all medical professionals will respond in a similar manner to a medicalized problem. The conceptual, institutional and interactional levels are important in the medicalization of a social problem.

Medicalization of Women's and Children's Experiences

Women and children are considered to be particularly vulnerable to the medical labeling of their social and physical behaviours (Bell 1987; Conrad 1992; Pawluch 1993;

Reissman 1983). Medical professionals create and reinforce social norms when they define behaviours or conditions as pathological; such as childlessness in women or hyperactivity in children (Reissman 1983), thereby preserving a particular social order.

Women are considered to be scrutinized medically due to "deviation from some ideal biological standard" (Reissman 1983:7). Since women's biology, which involves menstruation, childbirth and menopause, is in contrast to the male standard, it presents

"an obvious place to look when illness strikes" (Lee and Mysyk 2004:1711). Women's biological processes have increasingly become subjected to medical intervention; for example, the process of childbirth (Lee and Mysyk 2004; Reissman 1983).

Women have not always maintained a passive role in the medicalization process

(Bell 1990; Reissman 1983). As such, women participated in the medicalization of childbirth for a variety of reasons which reflected a combined effort in the nineteenth century between physicians and women from the dominant class (Bell 1990; Reissman

50 1983); furthermore, it has been contended that as aspects of women's lives are increasingly placed within a medical context, women become more susceptible to adopting the sick role and will seek treatment from the medical profession for problems which they experience (Lee and Mysyk 2004). As Lee and Mysyk (2004) identified, women's experiences with the social behaviour of compulsive buying have become medicalized (Lee and Mysyk 2004).

Equally vulnerable, children have had their social and emotional experiences defined within a medical framework. As Pawluch (1993) revealed, a transition took place in medicine toward the medicalization of children's social and emotional behaviour which resulted in a shift in the way that society thinks about children; for example, medicalization replaced discipline as a way to manage children's behaviour (Pawluch

1993). Conclusively, the social and physical experiences of women and children are increasingly being defined within the boundaries of medical control.

Consequences of Medicalization

Medicalization of behaviours is understood to extend positive, as well as negative social consequences. The labeling of a behaviour within the framework of the medical model has demonstrated an impact in the lifting of moral condemnation from the individual; for example, the sick individual is not considered to be responsible or punishable for resulting social behaviour (Zola 1972). Conrad (1979) states that medicalization can serve to normalize deviant behaviour. As such, medicalization is at times understood to improve the status of the sick individual by providing explanations for the social behaviour, while attributing less individual responsibility for the condition than was previously associated (Becker and Nachtigall 1992); furthermore, the

51 medicalization of social behaviour leads to the "removal [of the individual] from religious and legal scrutiny and thus from moral and punitive consequences" (Zola

1972:489). Waitzkin and Waterman (1974) determined 'secondary gain' to be a latent function of medicalization, as the sick role can fulfill an individual's needs to legitimize one's personal failure. Further, Conrad (1979) presents alcoholism as an example of a medicalized behaviour by which the individual obtains secondary gain. Medicalization can serve to remove responsibility from the individual, as in North American society, the individual is often viewed as being responsible for behaviours which are thought to be deliberate. Conversely, individuals who are sick are not considered responsible for their illnesses (Best 2008).

Rather than reducing stigma toward the afflicted individual (Reissman 1983; Zola

1972), the label of illness may generate deviance (Reissman 1983). This can be contextualized by the labeling of a mental illness. As a result of the diagnosis, those in the individual's social network begin to comprehend the individual's behaviour within the illness framework, even when the individual's symptoms have subsided (Reissman

1983); furthermore, medical discourse regarding human problems serves to "remove them from public debate" (Reissman 1983:4). As well, the meaning and the interpretation of an experience becomes transformed when it is defined as a disease or affliction

(Freidson 1970; Reissman 1983). Significant in the medicalization of human problems, is that the awareness of the social causes of disease becomes diminished (Reissman 1983); therefore, the process of medicalization can serve to be detrimental to the social interaction of the labeled individual, as well as the social processes by which the affliction developed.

52 Medical Social Control

Medical social control has been defined (Conrad and Schneider 1978; Conrad and

Schneider 1985) as the definition and/or treatment of any phenomena of human existence in terms of their medical significance. The tendency to seek medical solutions to social problems reflects an "American cultural predilection for seeking mechanistic solutions to problems of everyday life" (Becker and Nachtigall 1992:468); moreover, by rendering a social problem a medical problem, certain life situations are characterized as abnormal, but curable.

Medical social control, as stated by Conrad (1979) involves medical technology, medical collaboration and medical ideology. Further, Conrad (1979) presented medical ideology as defining a behaviour as an illness due to the social and ideological benefits gained by conceptualizing it in a medical framework. This includes adopting medical language in framing and responding to the problem, and invoking medical authority through the use of language. The latent functions of medical ideology may benefit individuals and/or larger interests in society. As such, it is considered to be separate from a biological basis of illness or treatment. For the interests of socially powerful groups and organizations, the medical labeling of a behaviour can extend social control (Brown

1995).

Social Construction of Illness Experience

The social construction of illness begins with a social "discovery", lending focus to the manner by which people, organizations and institutions determine that there is a disease or a condition. Illness is a social construction (Conrad and Schneider 1985), reflecting a subjective phenomena (Brown 1995) which is based on human judgments of

53 a social condition; therefore, social judgment process maintains an integral role in the social construction of illness and disease (Conrad and Schneider 1985).

Illness is considered to be a type of deviation from a set of norms which represent health or normality. According to Friedson (1970:205), medicine is said to engage in the

"creation of illness as a social state which a human being may assume." What is considered deviant in human society is something that breaks a social rule or norm and whether the act is deviant depends on how other people react to the individual. As a form of social deviance, illness is thought to have a biophysical cause and to require biophysical treatment. Social evaluation of what is normal or desirable is considered to be central in constructing illness; furthermore, individuals in different societies may be labeled differently according to their symptoms; one may be labeled ill while the other is labeled lazy (Friedson 1970:209), extending the idea that social context is an aspect of any illness.

The social construction of illness encapsulates individual experiences which have been organized within categories and constructed in the context of illnesses (Conrad and

Schneider 1985). The definitions for the types of behaviours, dysfunctions and emotional responses which are labeled and managed as illnesses depend upon the particular society

(Friedson 1970); moreover, illness is related to an individual's inability to function normally which results in the marginalization and/or stigmatization of the individual by others (Conrad and Schneider 1985).

In consideration of the individual experience of illness, Parsons (1951) extended four tenets of the institutional expectation system relative to the sick role. The first is the exemption from normal social role responsibilities, which is considered to be relative to

54 the nature and severity of the illness (Parsons 1951). This exemption requires legitimation from those involved including the physician who often serves as a direct legitimizing agent; furthermore, the legitimization of being sick enough to avoid obligations is not only considered to be a right of the sick person but an obligation upon him/her, as legitimization maintains the social function of protecting against convictions of "malingering" (Parsons 1951). The second related aspect to the institutionalized definition considers that the sick person cannot be expected by "pulling himself together" to get well by an act of decision or will. This aspect furthers the notion that the individual who is sick is exempt from responsibility as he or she must be "taken care of (Parsons

1951). The third aspect to the institutionalized definition is that the state of being ill is considered to be undesirable and the sick individual should want to get well. As such, the sick role continues to be a relative legitimation as long as the individual makes an effort to leave that role as quickly as possible (Parsons 1951). The final aspect of the institutionalized definition of the sick role is the obligation of the sick individual to seek help, usually the help of a physician, and to co-operate with the physician in the process of getting well (Parsons 1951).

Critiques concerning the application of the sick role (Parsons 1951) have developed. Within Parsons' (1951) sick role framework, doctors become the agents of social control and are the gatekeepers who regulate access to the role. In regulating access, the doctor permits limited deviance for individuals who experience strain in their customary roles; however, Waitzkin and Waterman (1974) state that Parsons does not consider the actual strains which lead the individual to seek a medical diagnosis. The sick role (1951) has been further critiqued (Charmaz 1997; Gerhardt 1987; Segall 1976) to

55 suggest that the framework applies to a limited range of sickness, and does not apply to experiences of chronic illness or to disability, as those experiences are not considered to be temporary in nature.

The validation of diagnosis affects people's behaviour, the attitudes that they maintain towards themselves and the attitudes that others have towards them. Conrad and

Schneider (1985) argue that illnesses are human constructions, as they do not exist without someone proposing, diagnosing and recognizing them; therefore, without the social meaning that humans attach to the behaviour, they do not constitute illnesses.

Illness has been further defined by Lorber (1997) as a social experience which extends beyond physiology involving the social processes of social roles, power and conflict, social status, networks of family and friends, bureaucracies and organizations and social control.

Medicalization and the social construction of illness highlights an interesting aspect of societal response to deviant behaviour. Non-conforming behaviour is increasingly being identified in medical terms in part through the comparison of experiences among negatively stigmatized individuals; thus, medicalization is occurring not only under the authority of medical practitioners, but conceptually through individual and collective responses to negative stigmatization in society.

A wide range of new medical categories has emerged in the past four decades, including chronic fatigue syndrome and fybromyalgia (Conrad 2007); furthermore, patients have become more involved in their course of treatment and more demanding in what they require from physicians. There are numerous reasons for seeking new medical diagnoses. Conrad (2007:46) further extends that "Life's troubles are often confusing,

56 distressing, debilitating, and difficult to understand"; in relation, individuals who are suffering, for example, from chronic fatigue syndrome will seek a diagnosis that will legitimate and provide them with an understanding of their problem. Interestingly,

Conrad (2007) further explains that one of the most significant changes in medicalization has been the emergence of consumers and medical markets, as medical entrepreneurs have been marketing medical solutions for a range of human problems.

Conclusion

This research regarding the social construction of GD in online communities relates to transitional changes in the role of motherhood, which have led to the development of the ideology of intensive mothering. As a normative standard, the social construction of intensive mothering has presented the opportunity for deviant discourses to emerge in instances in which women deviate from the normative boundaries of motherhood. While there are a variety of behaviours which deviate from the normative mothering role, NRTs present a notable deviation from the ideology.

The rapid expansion of NRTs has evolved to gender selection, presenting a complex array of debates while calling to question the social motivations of women who engage in the practice, as well as what gendered expectations they have of their future children. Through an examination of gender ideology, it can be understood that there are gender characteristics which are linked to biological sex; furthermore, it can be understood that since gender is a social construct, it is possible for an individual to deviate from the normative standard. Since there are gender characteristics which are linked to biological sex, once the sex of the fetus is known, gendered meanings are associated with the pregnancy and the future child.

57 These gendered meanings which are associated with biological sex form the basis of GD, as women experience GD due to their desire for a child who exhibits the gendered characteristics they desire in a girl or a boy. In efforts to learn about gender selection and gender swaying, women are searching the Internet for information. It is through these searches that women are locating online communities in which gender selection is the basis of discussion. The communication patterns in these online communities lend focus to HRSGs and to the development of a supportive environment in which women can disclose their experiences to a non-judgmental audience.

Within the broader social climate which is increasingly medicalizing women's experiences, in particular their reproductive experiences, women are communicating with each other online regarding practical and empathic experiences with gender selection and gender swaying. It is within these communities that women who share a negatively stigmatizing attribute collectively medicalize their experiences; as such, GD presents as an emerging phenomenon among women who secretly suffer in silence in the real world.

In consideration of what is known concerning the function of HRSGs, communication patterns on the Internet, the increasing medicalization of women's experiences and the advancements in NRTs, research concerning the construction of GD within these contexts is needed, as the function of HRSGs by way of the social construction of illness has not been explored previously and most significantly, GD has not been researched previously.

This research utilizes qualitative Internet methods in exploring the discourse of online communities associated with GD.

58 Chapter 3: Methodology

The Internet provides a virtual social environment that is not bound by temporal spatial restrictions, where researchers can interact with participants in ways that may not be possible in the real world (O'Conner and Madge 2001). In this regard, an increasing number of women who experience GD are seeking support from each other in public, online forums. This relates to patient-to-patient communication which is increasingly taking place in HRSGs on the Internet (Overberg et al. 2005; Rice 2001; Sharf 1999;

Walther and Boyd 2002; Wright and Bell 2003) and to layperson groups which are organized around common interests of health or disease related subjects (Sharf 1997).

This research utilized the content of two websites that contain a Bulletin Board

System (BBS) which is centred around the discussion topic of GD. Websites were located by using the search engine Google on the Internet (see Hardey 2002; Overberg et al.

2006), and searching the terms "sex selection", "gender selection" and "gender disappointment". The criteria for the websites was that they have a BBS containing a forum for GD. Through these searches, three websites were identified that contained a

BBS with a forum for gender disappointment (or a variation of the term). Two of the three websites were chosen for this research on the basis of their practical organization, the high level of participant activity, and the limited number of threads which were labeled by the members as "OT" (off-topic). The two websites have been assigned pseudonyms (www.GDl.com and www.GD2.com) in order to protect the identity of the communities, as it is acknowledged that the security of an online community can be disrupted if a researcher identifies the website (see Finn and Lavitt 1994). Collectively, the websites are organized around content regarding natural gender selection, NRTs,

59 pregnancy and birth, and they all offer an extensive BBS. As well, the websites attract a stable community of respondents, who interact regularly on the bulletin boards, thus creating a reliable and socially engaging environment.

The grounded theory (Glaser and Strauss 1967) method employed in this online qualitative research required simultaneously engaging in the process of data collection, analyzing the data and developing a theoretical approach as it emerged (Strauss and

Corbin 1990; Glaser and Strauss 1967; Lee and Breen 2007; McCaughan and McKenna

2007; Wright 1997); therefore, grounded theory (Glaser and Strauss 1967) permitted the exploration of GD with the goal of generating theory as the data unfolded.

Concern exists (Eysenbach and Till 2001) that researchers may not be familiar with the online communities which they study, and this concern has been related to researchers who try to interpret the behaviour of cultures in the real world which they do not understand (Eysenbach and Till 2001). As well, it has been acknowledged that researchers cannot simply enter an online community and that they must gain member competence in order to establish commonality and trust (Ulingworth 2001); therefore, it was initially important for me to develop an understanding of the online community.

During the preliminary stage of this research, I gained member competence in the online community, as I recognized that I must be able to understand the meanings which underlie the various emoticons, abbreviations, acronyms and phrases which are used online (see Mann and Stewart 2000), in order to comprehend the respondents' ideas and experiences. A translation of the online language and of the community specific language must take place in order to understand the content of the messages, and by initially

60 gaining a sense of competence in reading the online language, I was able to assess the content accurately.

Researching women who suffer from GD in the real world may not be possible as a result of their geographic location, of the fact that they may have families, children or be pregnant and, importantly, that they may not openly disclose their experiences with

GD in real life; however, they are accessible online and as such, online research is useful in accessing respondents with limited mobility (O'Conner and Madge 2001). The BBS on the two websites attracts users predominantly from across the United States and Canada, allowing data collection on a widely geographically located population of women who suffer from GD.

The perceived anonymity of CMC alters the norms of discourse (Michaelson

1996) and provides "unrestricted freedom of expression that is far less hierarchical and formal than in real world interaction" (Kitchin 1994:394). As such, certain groups of people will be more open to discussing their ideas within this medium (Finn 1999; Mann and Stewart 2000). The women who interact on the GD BBSs may not feel as self- conscious discussing their experiences online as they may feel discussing their experiences in person, as in the virtual environment there is a tendency for individuals to be open with others, who are often complete strangers (Nguyen and Alexander 1996).

Individuals appear to enjoy relating narratives to those whom they have never met and the appeal to communicate one's "story" to many others is considered to be strong (see

Hardey 2002); furthermore, the lack of a physical presence in the online environment permits individuals to be more open about emotional or sensitive topics (Illingworth

2001; Mann and Stewart 2000 ). Individual representation in the virtual environment is

61 not predicated upon physical appearance, gender, social circumstance or geography (Finn

1999; Kitchin 1998); therefore, people can better control the presentation of the self and express themselves with little inhibition, allowing dialogue to develop quickly. This freedom of expression arises because the virtual environment allows individuals to say exactly what they feel without fear of reprisal, extending the virtual community as a safe space in which to interact ( O'Conner and Madge 2001; Wright and Bell 2003). In the case of this research, due to the secrecy of GD in the real world, women are likely to be more comfortable discussing GD through the medium of the Internet in the virtual context of supportive others.

While there are significant advantages to conducting GD research online, there are also disadvantages; for example, since information is relayed through text based communication and the sharing of pictures, there is an absence of body language and non-verbal cues. Emotionality can be difficult to assess over the Internet, as visual and audible details such as facial expressions, laughing or crying provide a considerable amount of information concerning the meaning of the data and human behaviour.

Emoticons, which are textual and/or pictorial icons used to convey emotion (Mann and

Stewart 2000), and other online communication conventions may provide additional contextual information about an informant's emotional state; however, they are not a substitute for real life, first hand interactions. In regard to this research, which will consider the construction and management of GD within the structure of an HRSG, the textual and pictorial icons will contribute to the development of an understanding of the online community and will not be a detriment to the data collection process.

62 Within Internet research, the respondents are limited to individuals with Internet access; therefore, the findings are not generalizable to society as a whole. However, this research concerns the construction and management of GD in HRSGs and it will not be necessary to direct a conclusion towards a broader population.

Content Analysis

Content analysis (Weber 1985) of the discourse in the GD forums was used in the first stage of this research in order to develop an understanding of the construction and management of GD, as well as the functioning of the online community. Discourse analysis has previously been used in the virtual environment to study online communities

(Finn 1994; Finn 1999; Sharf 1997; O'Conner and Madge 2001; Preece 1998; Wingert et al. 2005), permitting the observation of individual concerns and of the dynamics of the online community which arise from individual attempts to seek support (Galegher et al.1998).

The GD BBSs function through continual asynchronous meetings (Baym 1995) over extended periods of time. It is possible to lurk (Mann and Stewart 2000; Preece et al.

2004; Sharf 1999) in the GD forums without formally joining the community, although certain areas are restricted to members (O'Conner and Madge 2001).18 Passive analysis

(Eysenbach and Till 2001) was used to monitor and to observe the messages posted on the BBS. Passive analysis involves studying the interactions of the bulletin board participants without the participants knowing that they are being studied and without involving oneself in the interaction (Eysenbach and Till 2001). In order to collect data from the BBS, the threads of messages from the two websites were downloaded, a

18 Lurking refers to an individual reading the messages but not posting in the online community to which he/she belongs (Preece et al. 2004).

63 process which did not require transcription. The bulletin boards on the two websites were monitored and downloaded for a period of four months, January - April 2007, generating

214 files containing threads of discussion from the GDI website and 927 files containing threads of discussion from the GD2 website. The files containing threads of discussion from the GD2 website included a minimal amount of threads titled as OT. Threads titled

OT contain discussion which is not related to GD, but perhaps may relate to a parenting concern or a general frustration which the community member wishes to communicate.

At the end of the four months, theoretical saturation occurred as common patterns of interaction had been identified and repetitive ideas in the content became apparent (see

Glaser and Strauss 1967). The research participants were the users of the BBS over the research period; therefore, the interactions of specific respondents were not monitored, but the community as a whole was the focus. I was able to analyze simultaneously the interactions of women in the online communities and to develop an understanding of the experiences of individual women in regard to GD. The content of the public BBS was analyzed and observations were made regarding the common patterns of interaction.

These observations facilitated an understanding of the community of women who suffer from GD and lent focus to the structure of the GD HRSGs.

E-Mail Interviews

Asynchronous, semi-structured e-mail interviews (IHingworth 2001) comprised the second stage of this research. These interviews, which were completed over the time period of two months, allowed me to gain a deeper understanding of GD and allowed me to understand the function of the HRSG in regard to managing GD in the virtual, as well as the real world. The e-mail interviews were concluded when theoretical saturation

64 occurred as repetitive ideas in the e-mail content became apparent (see Glaser and Strauss

1967). I sought consent from the moderator of the BBS on the GDI website to post a message recruiting participants for e-mail interviews. Participants were recruited from the

GDI website because it is a non-commercial website and has a moderator who created the website and who is active in the GD forum. In order for me to e-mail the moderator and to post on the BBS, I needed to create an account on the website. The moderator permitted me to recruit participants by posting on the GDI BBS and asked that I mention that I had received permission in my recruitment post. Upon gaining consent, I posted a recruitment letter and a letter of information in the forum which outlined the purpose of this study. Interestingly, in response to my recruitment post, a member thanked me for having gained permission from the moderator and stated that the community has had difficulties with researchers in the past and that she was certain that the women in the community would be helpful, thus signifying the importance of entering an online community with care.

I received e-mails from 18 women (including the moderator) who expressed interest in participating in an e-mail interview. Upon receiving an e-mail from a member of the community who expressed interest in participating in the interview, a confirmation reply was sent. All e-mails were answered by thanking the individual for her interest, acknowledging that her insight into GD would be appreciated and by providing notice that the interview process would begin within one and a half to two weeks. Within a week and a half, all interested participants received an e-mail announcing the start of the interview process and posing the question, "What is meant by the term gender disappointment?", followed by asking the interviewee to describe GD in relation to her

65 personal experience. The semi-structured interview schedule followed a pattern of questioning the interviewee's negotiation with disclosure in the real world, how the interviewee decides to tell others of her GD, why she feels that she has GD and what the role of the GD online community is for the interviewee. The structure of the responses followed a similar pattern among all interviewees, as they consistently provided lengthy responses to my questions, often providing information beyond what was asked and in return, they did not ask me questions, other than a few inquiries concerning reading the research results.

Central to the asynchronous e-mail interview process is that it involves the displacement of time and space, as the interviews are likely to be asynchronous and will take place at a distance, through the medium of the computer (Bampton and Cowton

2002). In an e-mail interview, the respondent is not committed to replying promptly and this is regarded as a benefit, as busy respondents and researchers do not need to agree on a mutually convenient time to talk to each other. As well, the interview does not need to be completed in a single block of time, permitting more than one exchange of information. The delay in communication can range from minutes to hours to days

(Bampton and Cowton 2002), allowing respondents time to reflect and to compose their responses. Correspondingly, the interviewees varied in their response times which ranged from a same day response to one or two weeks. The participants are able to edit the text to convey the meanings that they really intend (James and Busher 2006). As well, the time that the respondent has to consider a response may reduce the pressure that can be felt by nervous interviewees (Bampton and Cowton 2002).

66 A disadvantage to asynchronous e-mail interviewing is that respondents may lose interest in participating in the interview or may experience unexpected disruptions in their schedule which may influence response times (Illingworth 2001). This practical problem arises while waiting for a response from the interviewee. The respondent may be busy or may be reflecting on a response and a message will eventually arrive, or there may be a problem with the research process and the respondent may not be planning on responding (Bampton and Cowton 2002). The time frame of my responses to the respondents' e-mails was an important part of the asynchronous e-mail interview process, as there is a common understanding in e-mail communication that an unanswered e-mail may signify the end of a relationship (Holge-Hazelton 2002). During the e-mail interviews, it was common for a respondent to explain her delay in communication by providing a reason such as, not checking her e-mail often, that her baby has been sick or that she has been busy with social activities. During the first week of the e-mail interviews, five potential participants did not respond to my initial e-mail and throughout the course of the interviews, six participants failed to respond to my reply. After a few weeks with no response, I sent follow-up e-mails to those who had failed to respond asking whether or not they were still interested in participating. All of the respondents replied within a day, indicating that they had been busy or had forgotten and provided lengthy responses to my question, as well as indicating their desire to continue to participate.

A further disadvantage to e-mail interviewing is that the meaning of statements in the e-mails may become misinterpreted. A respondent may misinterpret a question or a comment and compose a lengthy response, and the researcher would not know that the

67 statement was misinterpreted until afterwards, whereas in face-to-face interviews, the misunderstanding could be intercepted sooner (Illingworth 2001); therefore, careful attention was paid to the phrasing and the use of terms and all my e-mail responses followed a similar format (Anderson and Kanuka 2003). Furthermore, the aspect of spontaneity may be lost through the respondent's process of drafting and redrafting responses; however, spontaneity may not be completely lost as some responses may arrive quickly and they may contain spelling and/ or other typographical errors reflecting that the response was not carefully composed (Bampton and Cowton 2002).

Ethical Issues

While computer mediated discourse is being broadcast to a large audience, consisting of discussions regarding issues that have belonged traditionally to the private sphere, universally accepted ethical guidelines for researching on the Internet have not been developed (Brownlow and O'Dell 2002; Ess et al. 2002; Finn 1999). The discourse is often publicly accessible for all Internet users, allowing non-participating observers to read the stored message archives for a discussion group or for bulletin board postings

(Bromseth 2002). As such, people's perceptions of what is private and what is public communication may vary; therefore, conducting qualitative research on the Internet lends focus to ethical issues regarding privacy and informed consent (Bromseth 2002).

The identities of those posting messages and participating in an e-mail interview will be protected by assigning pseudonyms. Within the context of this research, it is understood that even though the online BBS is a public forum, the respondents have not waived their right to remain anonymous (Mann and Stewart 2000). Pseudonyms will be used for the real names, the user names, the message signatures, the online forums and

68 the websites, as well as any reference made to other individuals and names of cities, states, provinces and medical clinics. The use of pseudonyms will, therefore, greatly reduce the potential for harm (Mann and Stewart 2000). The use of pseudonyms is important because if attention is drawn to the online bulletin board postings, the BBS may lose its intended function which would be detrimental to the patterns of interaction

(see Finn 1994); therefore, this use of pseudonyms will help to maintain the online forum as a safe space to discuss personal issues.

Because a researcher's interpretation of online communication can be questioned if the content is not quoted directly (Bromseth 2002), the content of the messages will be quoted verbatim. The messages which are posted on a BBS are stored in the message archives on the website for a limited amount of time; therefore, a possibility exists that the messages can be traced through an online search engine, thereby identifying the author of the message and the website (Eysenbach and Till 2001). The potential for this to occur is significantly reduced by the use of pseudonyms, and by the fact that the message archives are deleted over time as new messages are posted. As well, content that the respondents were discussing in their daily "conversations" and interactions was collected. As a passive observer of these interactions, the respondents did not provide additional information for my research purposes; therefore, the data which will be collected is already being broadcast to the Internet public (see Brownlow and O'Dell

2002).

Due to the public nature of the BBS, it is possible to conduct a passive analysis of the content. This process is significant because researchers who enter online communities may be perceived as intruders; furthermore, if the presence of the researcher is known,

69 the potential exists for the online community to be damaged (Eysenbach and Till 2001).

Informed consent depends upon whether the Internet community is regarded as being private or public. If registration is required to gain access to a group, then the respondents most likely regard the community as private in the sense that only group members or those with related issues are granted access (Brownlow and O'Dell 2002; Eysenbach and

Till 2001). The action of registering for membership in a BBS signals a sense of privacy to the outside world, which draws a boundary around the group of people who interact online (Eysenbach and Till 2001).

In the case of the BBSs which will be used in this research, registration is required to post messages on the bulletin boards, but not to read the messages. As well, registration to post messages on the BBSs is open to anyone on the Internet, as all that is required is an e-mail address and the creation of a user name; therefore, open access to the BBSs on the two websites exists. The BBSs on the Internet are therefore regarded as public information and informed consent will not be required for the first stage of this research. The passive analysis of the bulletin board postings can be conducted ethically if the identity of the respondents is anonymous and if there is no inconvenience to the subjects (Eysenbach 2001). In the case of this research, the security of the BBSs on the two websites will not be compromised, as the identity of the respondents and the website will remain anonymous; as well, the interaction of the respondents will not be interrupted.

Conclusion

Women who experience GD are seeking support on the Internet in HRSGs, extending the opportunity to research GD in the online environment. Content analysis

70 and e-mail interviews allow a collection of data in a manner which does not interrupt the

HRSG and which is through a medium of communication within which GD sufferers are comfortable discussing their experiences. This methodological approach, therefore, permits data collection within the online environment with the goal of understanding the construction and management of GD in HRSGs.

71 Chapter 4: Results and Discussion

The medicalization of a deviant behaviour (see Conrad 1992; Conrad 2007;

Pawluch 1996) changes the definition of the behaviour and the manner by which the afflicted individual identifies with the behaviour and interacts in his/her social world.

Furthermore, the medicalization of a problem results in a way for individuals to experience their stigmatizing behaviour in a legitimate manner, thereby alleviating guilt and notions of deviating from a normative role. In this regard, women who experience

GD have conceptually medicalized their condition by collectively constructing GD as an affliction within the virtual environment of the online community. Through sharing their personal GD stories and recognizing commonalities in their experiences, they form an understanding of what GD is, how GD is experienced and how GD can be managed in order to maintain a sense of normality in the real world. As GD is adopted as part of a woman's identity, the women of the GD online communities turn to each other for a common understanding which is not possible in the real world. Through their use of language and the manner by which GD is constructed, it is revealed that among the women of the GD online communities, GD is an affliction from which one can suffer.

GD Communities

Through social interaction and experiences in disclosing gender desires, both within one's primary social network and in the broader social structure, GD sufferers are taught through interaction in the real world that their experiences lack legitimacy and that they counter the normative bounds of conventional motherhood. Similar to individuals who possess unusual social traits and who are discredited in society (see Charmaz 1983;

72 Goffman 1963; March 1995; Susman 1994), GD sufferers1* feel alone in their experiences and feel isolated, as they know that they are having feelings about the gender of their child which are not openly accepted by those in whom they confide. These women who suffer in silence in the real world find solace, understanding, a sense of identity and normality in the virtual world when they enter the online community which parallels the socially constructed reality shaped by common experiences in online support groups (see Sharf 2003).20 The gender dreams and associated feelings that these women experience are collectively medicalized on a conceptual level, through online discourse.

These GD communities exist on the Internet as part of websites which are organized around content regarding pregnancy, childbirth, gender "swaying" and natural gender selection methods. Although these public forums can be located using an online search engine, the community members consider them to be private spaces where they experience anonymity from the real world. This belief in privacy is demonstrated by the sufferers' willingness to discuss personal information which is often kept secret in the real world (see Walther and Boyd 2002); for example, one community member stated:

I was devastated when I found out it was boy and I cried!!! I have my ups and downs but I can honestly say I think I am on the road to excitement now thanks a lot to this board and this board alone. I have been very secretive about my GD in the real world!!!

The sharing of highly personal information involving disclosing feelings of guilt, at times, is considered to be beneficial, serving a therapeutic function for the individual (see

Schneider and Conrad 1980; Williams 1987). In this respect, the individual shares the burden of these feelings with supportive others; however, this therapeutic function is dependent upon the availability of a receptive audience comprised of those who are

19 Women who identify themselves as having and/or experiencing GD will be referred to as sufferers. 20 The online communities refer to GD BBSs and are used by individuals who identify themselves as women who experience GD.

73 willing to be supportive, encouraging, empathetic and/or nonjudgmental (Schneider and

Conrad 1980). For GD sufferers, this receptive audience is found in the online community. As well, these occasions of disclosing feelings to similar others become grounds for individuals to develop definitions of their conditions as a "nonremarkable and neutral facet of the self (Schneider and Conrad 1980:40), as normalizing one's chronic illness identity is central in the experience of illness (Strauss 1975). Similarly, this neutralizing process is recognized in the online community through the assurance of normality in the GD experience and through the use of language which extends a collective understanding.

Individuals who identify with GD experience a situation in the real world for which they do not have a label; however, upon recognizing similarities with the sufferers who communicate in the online communities, they adopt the term GD to represent their experiences. Mirroring the understanding that deviant individuals tend to reorganize their sense of self and their relations to others, while often locating a specific subculture which can serve to normalize their experiences (see Anderson et al. 1994; Friedson 1970), GD sufferers adopt a label and organize themselves in the virtual world. In regard to the label of GD, the moderator of the GDI website stated that: "As far as I know I invented the term. I didn't really see it in use until after I had created the forum about it." Furthermore, the interview with the moderator of the GDI community revealed that when she built the

GDI website, she maintained the belief that GD affected many women intensely and that she wanted to reach out to them. In regard to experiencing GD personally, the moderator expressed:

...I did have some GD when my second son was born; although it was not the crushing depression or devastation that you see many women

74 here describe. But I never breathed a word of it to anyone; this was in 1997, before there were really any online forums.

In consideration of how the GDI online community grew, the moderator described that:

"...almost immediately people began using the guest book to post back and forth to one another, offering sympathy and support to other women who were going through gender disappointment, and forming friendships." This therapeutic sharing serves to externalize significant information about the self which has been kept private from significant others

(see Schneider and Conrad 1983). Similar to the experience of chronic illness, in which there are some people whom the sufferer can tell about his/her illness and others whom the sufferer cannot tell (see Schneider and Conrad 1983), GD sufferers often keep their feelings private in the real world. According to the moderator, the initial messages on the

GDI website suggested that the women were grateful to have found someone with whom to discuss GD and were relieved that they were not the only ones experiencing those emotions. In the real world, however, the women feel isolated. Similar to the social support available in HRSGs (see Albrecht and Goldsmith 2003) and to chronic illness sufferer's experiences of disclosing to safe audiences, revealing the importance of talk as therapy (see Bulow 2004; Overberg et al. 2006; Schneider and Conrad 1983), the moderator expressed that this behaviour was indicative of the importance of ongoing dialogue and relationship building, and that it was apparent that while there are no words to eliminate GD, that talking about it helped women enormously.

This development of a forum for GD sufferers lends focus to the fact that women who have GD have decided for themselves that a place in which to disclose their feelings without fear of stigmatization is needed in order to assist them in managing their feelings.

This necessity to manage one's feelings which are associated with GD lends focus to the

75 concept of feeling rules (Hochschild 1979; Hochschild 1983) which are associated with the conflicting nature of the feelings one is having in relation to the social guidelines which direct how one should feel. Furthermore, it is understood that feelings are discussed as though rights and duties apply directly to them (Hochschild 1979); for example, common in the discourse of GD sufferers, one may say that she should feel more grateful for the children that she has, one may post a discussion relaying positive feelings toward the fetus of the "wrong" gender in order to alleviate GD, or a fellow sufferer may warn that one should not feel so guilty for her GD. Likewise, in the real world, women who disclose their GD are often responded to with comments which suggest that they should be grateful for a healthy baby, which represents the sufferer's recognition of feeling rules (Hochschild 1983) through the assessment of how others respond to her gender dreams. The sufferers communicate that they are aware that their feelings counter the normative expectation of them as mothers, but do not understand why their feelings towards the gender of their children are responded to with conviction and misunderstanding (see Asbring and Narvanen 2002; Ware 1992). As this community member explained:

I do not think anyone can truly understand. GD can be the most lonely, painful thing to experience; particularly b/c it is so secretive/protected by most of us; and society judges (and we judge ourselves as women/mothers) with an iron fist. My husband is the only one who knows about this dark side of myself. I get angry about this; after all, even bleeping erectile dysfunction has its primetime moment - but our softer sides don't have a publicly accepted voice. We are supposed to be grateful to be given anything, love it to bits and give up ourselves for it - gender is not part of the deal, apparently.

These feeling rules, which become apparent when one focuses on the difference between

"what I do feel" and "what I should feel" (Hochschild 1983), are significantly represented throughout GD discourse and can be illustrated by this sufferer's response to the

76 "crushing sense of grief and loss" that she felt due to being pregnant with the "wrong"

gender: "The guilt about feeling this way is overwhelming, particularly after all my

miscarriages (I should be grateful, grateful, grateful)". As the sufferers experience

conflicting emotions, they seek to manage these feelings among supportive and similar

others.

The women who experience GD are able to communicate with one another and to offer each other support and an understanding that only a GD sufferer can maintain.

Sharing illness narratives on the Internet is a way for sufferers to find recognition in their experiences (see Hardey 2002; Overberg et al. 2005). As such, once a GD sufferer has entered the GD online community, she sees her experiences in those of others and develops the understanding that she is not alone, that she has not been falsely constructing her feelings, that her feelings are in fact valid and, most importantly, that she is normal. Individuals experience relief and a sense of validation when an explanation corresponds with their own experiences (see Ohman et. al 2003). This is evident when a sufferer first communicates with the GD community and divulges her relief that she has found them. The sufferer, experiencing GD as a discreditable affliction, can then maneuver within the real world knowing that she is part of a community of women who experience GD and that sense of belonging and knowing is a powerful tool in the experience: she is no longer one deviating from the broader normative structure, and she is part of a group of GD sufferers who will be able to assure normality within the boundaries of GD. This is further evident in the discussions of GD sufferers who relate that once they found the GD online community, they began to discuss their GD less with those in the real world with whom they had previously confided.

77 The community is considered by members to be a "safe" place in which to discuss

GD in relation to the real world. Stigmatized individuals experience a process through which they learn that they possess a particular stigma and the associated consequences of having that stigma (see Goffman 1963). As well, through "rule reminders" (Hochschild

1983), individuals learn how they should be feeling in a given situation, as these feeling reminders can be communicated by those who ask one to account for how one feels, as well as by the way that others react to how one is feeling. The sufferers in the online community have acknowledged that their gender desires and resulting GD counter the normative understanding of mother. As this community member discussed: "What is wrong with me. I feel like a horrible mother. DH [husband] has been so supportive and tells me I'm the best mom in the world...and what I'm feeling is normal". In response, a community member expressed:

You know why none of those mothers of all boys have ever said anything to you about being disappointed? For the same reason you cited - they feel like bad mothers for saying so! We all know we should just be grateful to be able to conceive at all and any child is a blessing.. .but that doesn't keep us from feeling disappointed when we have to let go.. .of our desired gender. That doesn't make us bad, it makes us human!

In the virtual world, these women find understanding and support by collectively constructing their experiences as normal, while in the real world they are often misunderstood and considered deviant. As this community member said in response to a post: "Here we would never look at your thoughts as 'evil', here you are our normal."

Similarly, written in response to a distraught member's post: "You're in the right place.

You're normal - or at least what passes for it here." This disclosure to supportive and nonjudgmental others permits feedback and the renegotiation of the perception of stigma; moreover, through the externalization of this negative feature of the self, the sufferer can

78 redefine the attribute as an "ordinary" part of the self (see Schneider and Conrad 1983).

The GD communities function as support groups for women who, due to negative stigmatization and a perceived lack of understanding among others, cannot discuss and/or receive support in the real world, as this post indicates:

This is a HUGE support group and they will help you get through this. It's tough...but soon you will see that it does work out, there IS a light for you... Do NOT make yourself feel guilty because of your feelings. While no one really talks about GD.. .it's real and it is there. Possibly after this you will also be able to counsel some poor woman afraid to admit it to ANYONE...[emphasis in original]

New members in the online community are often told that the community is a safe place and that their feelings are normal and understood among the members. This exchange offers acceptance into the community and provides the new members a forum from which to receive support (see Bulow 2004).

The members who sign their messages with their real names despite having screen names, communicate by using commonly understood acronyms and follow a group etiquette of being polite, providing encouragement and of avoiding flaming in their conversations.21,22 Similar to discourse behaviour in HRSGs (see Sharf 1997), new members introduce themselves to the community by posting their "GD story". Indeed, stigmatized individuals, when among their own, often develop a story or a narrative in order to account for their stigma (see Goffman 1963). Chronic illness sufferers, furthermore, have been known to develop narratives of their experiences which includes posting illness narratives on the Internet (see Charmaz 2002; Frank 1995; Hardey 2002).

These posts, in which a sufferer discloses her GD to the community of similar others, follow a pattern of introducing oneself as a new member or as someone who has lurked in

21 The term flaming refers to a message communicated on the Internet which is intended and/or interpreted to be hostile in nature (Wood and Smith 2001). 22 The term "members" refers to the members of the online community.

79 the boards for a period of time, by discussing one's family composition, experiences with childbearing including any miscarriage, and the nature of why one has gender disappointment, as well as any issue that is presently causing the sufferer difficulty in regard to GD.23

The GD communities are moderated in order to manage threads of discussion which may not correspond with the goals of the community. A thread of discussion may be locked or deleted by the moderator if the content appears to be causing a debate which has become out of control resulting in harsh language and jeopardizing the normative bounds of the community; for example, a thread discussing a woman who experienced

GD and then aborted the fetus was deleted from the BBS, as abortion is considered to be outside of the normative boundaries of how one should manage GD in the real world.

The community members commonly "sign" their posts with signatures which reveal information concerning the gender composition of their family, the gender of their dreams, and the use of NRTs; for example, this community member's signature reveals her desire for a daughter: "3 lovely sons and a place in my heart reserved for the daughter who will never be". Members also post pictures of their children and commonly post ultrasound pictures for second opinions from the community members when it has been determined that the fetus is the "wrong" gender. This action provides assurance, as they continue to hang on to their hope for their dream child.

The GD community members find security and safety in discussing their experiences online in a context in which they are supported, as in the real world, these

23 Lurkers are accepted and welcomed by the community members. The moderator of GDI commented that: "despite the very large number of posters on the site, the number of lurkers - those who read but never post - is many times larger." Lurkers begin their posts by introducing themselves as such and state the length of time that they have lurked before relaying their "GD story".

80 women describe that they are faced with negative comments and a general lack of understanding by those in whom they confide. Respectively, stigmatization is considered to be the root of societal reaction to individuals who deviate from normative understandings (see Scheff 1999). Within this secure, online community, sufferers form friendships and keep track of each other's pregnancies, experiences and daily news. The immediacy of support is a significant aspect of the online communities, as one member commented: "Ugh, I am having another extremely bad weekend and I am glad, again, to have this board." As a noted advantage of HRSGs (see Preece 1999), when a sufferer needs to communicate about her experiences after having a difficult day or experiences a troublesome situation, she is able to post her feelings on the BBS at any time, and she will most likely receive timely responses from the other community members. The responses reflect positive support and assure the sufferer that the feelings she is experiencing are normal and that she is not to feel guilty. As well, the community members share similar personal experiences, which facilitate the construction of GD experiences as normal. The level of support, as well as the significance of the online communities, has been acknowledged by GD sufferers in their expressions that: "The women on the GDI forum are really the only people I have shared my true and honest feelings with. I feel safe there and know that no one will judge me", as well:

...I've learned the hard way that not everyone is going to understand my feelings or be supportive of my GD. It's limited mostly to my husband, sister, a few other relatives, a small handful of friends, and then all the ladies on [GDI] and some ladies on another gender swaying group I started. I probably wouldn't tell anyone else I know in real life, but I'll continue to talk about it on online forums.

On a similar note, in response to how she found the GD online community, Katherine explained that:

81 Gender disappointment could be helped if there was more support out there. My family doesn't understand it and neither does my husband, though he respects it. One day I was just so frustrated that I didn't have a girl I Googled, 'I want a baby girl' and all of these wonderful sites came up with women just like me. I had really thought that I was being selfish for having these feelings but soon found out that I wasn't alone. It has really helped me to be able to openly discuss my feelings in forums and I have made many close friends.

While members overwhelmingly state their gratitude and their appreciation for the GD

HRSGs, interestingly, for a minority of sufferers, the online forums do not always represent a way in which to manage one's GD. Ava disclosed that communicating with women who are feeling the same way can make her feel worse at times: "Though sometimes I feel it [GD HRSG] does more harm than good, for some reason, seeing other women who have all girls who are upset about it bothers me." This apprehension towards communicating with similar others can be related to chronic illness sufferers who feel that meeting fellow sufferers makes it difficult to focus on the positive aspects of their lives, since they do not need a reminder of what it is like to suffer (see Asbring and

Narvanen 2002).

In consideration of the collective social bonds which have formed among members in the GD online community, it is necessary to discuss a situation in which the sufferers who form the online community experienced flaming from women participating in another online forum. This particular discourse challenged the legitimacy of GD and of their identity as sufferers, while demonstrating the bonds of support and the collective understanding that the GD sufferers have created online. In this instance, a member of the

GD community discovered a thread of discussion on another website in which members were speaking negatively about women who are disappointed in the gender of their children. They referenced the GDI website and made comments to the affect that these women should be grateful for healthy children and should consider that there are women

82 who experience infertility and as such, GD sufferers should not be granted legitimacy in their trivial concerns. The GD sufferers felt that their safe community had been jeopardized and discussed their feelings as a collective group. After reading the posts on the other website, one GD sufferer stated that: "I feel so protective of all of us because this is our own little sanctuary where we can go to not be judged, and some women outside this board are sitting around talking about us and judging us..." Furthermore, another GD sufferer posted:

I feel very vulnerable right now. I mean I've always known that this is a public board and anyone can come here and read our posts, but I haven't previously put much thought into who could be reading. When I came here I felt like this was the first place I could actually talk about my longing for a daughter and not be stoned to death. I felt like this was a bubble, a whole other world where other people know how I feel and truly do not judge. Now I feel like that bubble has burst.

This demonstrates the level of support and comfort that GD sufferers gain from participating in the online community. While the GD community exists in the virtual world, the members' common experiences with stigmatization in the real world are able to unite them. Furthermore, when the GD sufferers were faced with a breach in the security of their community by women who experience infertility, they began to defend themselves collectively as sufferers of GD and sought validity in their experiences by explaining their feelings in terms of why they deserve legitimacy. As one GD sufferer relayed in response to the flaming which was posted on the other website:

Disappointed in gender can sound so much like 'disappointed in our children'. I am not now, nor have I ever, ever been disappointed in my children. I know that my feelings are not the same as every woman here, but I was never disappointed that I had boys. From the moment I learned they existed I loved them with every fiber of my being. I never would have traded them for anything else. They were the babies I was meant to have and once they were conceived, I wanted no other child than the one I was carrying. However, I WAS disappointed that I didn't have a daughter, too. I desperately, desperately wanted the baby girl I had always dreamed about. I wasn't disappointed with what I DID have. I was disappointed with what I did NOT have. Hmm... seems to

83 me those infertiles might say the same thing when describing their lives, [emphasis in original]

The numerous threads on the BBS in response to the flaming that the sufferers received demonstrated that they are a tight knit community who support each other and who will defend GD and their experiences in relation to women who experience infertility.

Sufferers feel that their experiences are valid; however, they are misunderstood by those who do not experience GD firsthand.

Collectively, the sufferers seek to analyze why they suffer from GD and individually, they share their stories and recognize commonalities in their collective experiences. Sufferers have discussed, in the online community, possible reasons as to why they have GD. They search for commonalities among themselves in order to determine why it is that they have GD in relation to women who do not share a similar experience. This behaviour of the GD sufferers to analyze the "why me?" aspect of their experiences lends focus to chronic illness sufferers who search for meaning in their illness experience by considering why it is that they have the illness and how they got the illness (see Madden and Sim 2006; Pierret 1992; Russell et al. 2006). The GD sufferers have communicated in a thread titled, "Why are we (nearly) all white women?", discussing the fact that they are mostly white women, in an effort to understand if GD is related to common experiences of white women; as well, the members have participated in a thread titled, "Who are we?", investigating their personality types in order to determine if GD sufferers share a common personality type, and if that may be a reason why they are susceptible to suffering from GD.

Individuals who experience a discreditable stigma, including stigma associated with chronic illnesses, manage their risks by dividing the world into a large group

84 representing those who are not aware of the stigma, and a small group representing those who are aware of the stigma and who are relied upon (see Asbring and Narvanen 2002;

Goffman 1963). Similarly, the GD sufferers seek a place to disclose their feelings, to understand their own experiences with GD and how they can manage individually, to collectively construct the norms and boundaries of what it means to suffer from GD, and to manage this construction through discourse and assurance of normality in each other's experiences.

Having constructed and adopted a sense of normality in relation to their GD, the members of the online community construct their experiences in a manner which will serve as a medical disclaimer (see Hewitt and Stokes 1975; Schneider and Conrad 1980).

By constructing their experiences within this framework, sufferers are able to frame their experiences in a manner which will illicit sympathy rather than negative stigmatization.

The Medicalization of GD

By associating a medical frame to potentially discrediting events, individuals attempt to reduce the risk that a morally disreputable interpretation may be applied to the behaviour (Schneider and Conrad 1983); furthermore, diagnosis is considered to preserve self-esteem and to protect or reduce stigma and the feeling of guilt (see Huibers and

Wessely 2006). In relation, GD sufferers, having organized themselves in the online community, conceptually frame their experiences within an illness context.

The sufferers who are negatively judged in the real world for expressing a strong desire for a particular gender are unable to access support and a label to define their experiences. Since sufferers experience GD continually until they have a child of the gender of their dreams, they are unable to simply "get over" their feelings and their

85 emotions. As a result, their experiences become symptomatic of GD, which requires them to build a defense against the negative stigmatization of the real world in order to manage in the normative social role of mother. This behaviour is similar to individuals who suffer from chronic illnesses who feel that the negative social meanings which are associated with the affliction are more difficult to manage than the disease itself (see Schneider and

Conrad 1983); furthermore, diagnosis is considered to offer a socially acceptable reason for failure to manage (see Huibers and Wessely 2006). These experiences, which become symptomatic of GD, mirror the social processes that chronic illness sufferers experience in regard to identity and stigma management.

GD sufferers express their relief when they find the online community and they make their experiences in the real world meaningful by labeling them as symptomatic of

GD. This expression of relief is similar to chronic illness sufferers who experience symptoms for a length of time without a diagnosis (see Huibers and Wessely 2006;

Madden and Sim 2006; Schneider and Conrad 1983). The ability of a sufferer to attach a label to one's experiences is of significant importance, as individuals transition from an

"unorganized" state of illness to one which involves order and a course of action (see

Schneider and Conrad 1983). As Kate shared: "I did not have a name for this [GD] until I came across the website [GDI] after the birth of my third son. I could not believe that there was an actual term and support for women who experience this." As new members introduce themselves to the online community, similar sentiments are conveyed.

Interestingly, through the discourse in the online community, it is revealed that some sufferers have applied the label of GD to their children, husbands, relatives and friends in instances in which the sufferer feels that the individual may have GD due to the

86 emotions which are being expressed in regard to gender. This transference of the label

GD is significant in the construction of GD as an affliction from which one can suffer, as the sufferer is "diagnosing" GD in others. This diagnosing of GD in others has occurred in instances in which a sufferer's child has communicated that he/she would prefer a brother/sister, when a sufferer's husband has communicated empathy with her GD and when a sufferer's friend has expressed a strong desire for a child of a certain gender. This further serves to separate GD from other experiences and to maintain GD as an affliction, as the sufferer constructs the gender desires of those around her as being GD.

The online community members agree that GD is a term which refers to the feeling of being disappointed in the gender of one's children, not in the child itself, as

Sharon explained: ".. .my definition of gender disappointment (or as we at the boards call it, GD) is hoping your baby is a certain gender, and being disappointed that he/she is not

(not meaning you won't love the baby, of course)". Sufferers feel that they will be missing out on an aspect of motherhood if they do not have the gender of their dreams.

As such, they are very clear in stating that they love the children whom they have and that their disappointment lies with what they are missing in their lives, as Isabel expressed: "Gender disappointment is a feeling of loss upon learning the gender of your baby. It isn't a sadness about what you have, it is a sadness about what you don't have."

Similarly, Meredith explained: ".. .Gender disappointment is being disappointed that the child you are pregnant with is not the gender you desired to have. The disappointment does not [bold in original] lie in the child itself, but in the dream you have of raising a certain gender." The condition of GD is defined and redefined by the members of the community through discussions of their personal experiences, as well as through their

87 efforts to assure new members that their feelings are legitimate. The sufferers express common understandings of GD and construct GD through the similar patterns and emotions which they express. Christine explained GD in relation to a commonly held belief by "outsiders" that sufferers feel indifferently to their children: ".. .1 would describe GD as a loss of a dream. I think it's important to remember that most women with GD do not love their children any less than any other mother, and we are not disappointed in our children. We are just disappointed in not having the gender we desire." By collectively agreeing upon a definition of the label GD, sufferers are able to identify their association with the online community and most significantly they maintain a sense of belonging, identity and legitimacy.

GD is revealed to maintain a complex understanding in the online community, as sufferers can experience the condition differently. GD is understood to occur in different forms depending on the family composition which is desired by the woman; as such, it can be experienced by a woman who desires a girl or a boy, who desires more than one girl or boy or who has children of both genders and who desires a girl or a boy. While considered to be equally valid and accepted in the community, experiencing GD when one has at least one child of that gender, or when one is expecting her first child, is considered to be less socially acceptable to members. As this community member shared:

I can understand why a first time mum can have GD. I don't think it matters whether it's your 1st, 2nd, 3,d, or whatever child or whether you already have a mixed gender family or not. GD to me is about a dream/wish of wanting it so bad when it doesn't happen it feels like a small part of you dies and you do grieve for the loss of your dream.

Similarly, Katherine explained that:

...[GD] can stem from several scenarios. For some women, they are afraid of raising one or the other gender and get GD if they find out they are expecting the gender they were afraid of. For others, they want

88 the perfect one son, one daughter family. If they end up with two of one gender, they get GD.

Furthermore, Christina shared:

I think most people suffering from GD do so because they, like me, want to experience both genders, and they only get one. More uncommon is GD due to never wanting any boys, or never wanting any girls.

Mirroring the concept of the sick role (Parsons 1951) extending the understanding that illness is one possible response to social pressure, GD sufferers gain legitimacy in constructing their experiences as something from which they suffer and something which is impeding their ability to feel at peace with the gender composition of their families

(see Conrad 2007). As illness interferes with the ability of an individual to perform within his/her social roles (see Parsons 1951), constructing GD as an affliction alleviates the individual from direct responsibility for deviating from the normative construction of motherhood. As such, a GD sufferer is not doing this to herself, but she is experiencing

GD as an affliction, as something she no longer wants to experience and she knows that the only way in which to alleviate her emotional turmoil is to have the gender of her dreams.

The language which GD sufferers use reflects a type of separation of GD from themselves, reflecting that if someone has an affliction, then responsibility is removed from the self and placed upon this affliction which has come into their lives. By externalizing GD, a sufferer is able to manage in her everyday life without the guilt that she is doing this to herself and without the guilt that others in society are communicating to her through "rule reminders" (see Hochschild 1983); therefore, the sick role (Parsons

1951) concept lends focus to the understanding that when one is in the sick role he/she is able to illicit understanding and sympathy from others and is granted a "break" from

89 his/her normal routine and behaviours. In regard to GD, the sufferers use the label of

GD to maintain a sense of normality and to gain understanding from others.

For Parsons (1951), illness is considered to be an undesirable state wherein sufferers maintain an obligation to want to get well. Since GD is described by the online community members as something that one has and experiences, it is not considered to be a favourable condition, as it interferes with a sufferer's ability to enjoy her pregnancies and her life experiences as one community member stated: "I hate GD." While Sara disclosed that: ".. .1 guess I fear [bold in original] the fact that this desire might never go away. I don't want to feel like this forever. Actually, I don't want to feel like this anymore. I wish there was a magic pill that could just make it go away." Further extending the notion that GD is something from which one can suffer, the experience of

GD is known to interfere with a woman's ability to bond with her child during pregnancy and during the first months of the child's life. One community member offered the following advice: "Consciously separate the Gender Disappointment from this baby.. .there is a difference. This baby is not the product or cause of GD. You must make a differentiation so that you can bond." Throughout the GD discourse, sufferers communicate that while their GD feelings are real and beyond their control, that they strongly desire to find a way to no longer feel GD.

An Emotional "Roller-Coaster"

GD is described by members as invoking a range of emotions and, for the most part, these emotions are accepted by the online community. When sufferers are

Rule reminders refer to communicative behaviours which signal to an individual that the feelings that he/she are expressing counter the broad social guidelines (Hochschild 1983).

90 experiencing difficulty in managing their emotions, they turn to the online community and speak honestly about what they are feeling, as this community member did:

I cannot believe that I will never have a girl. I feel like I don't want to talk to anyone because their comments send me in a tail spin full of anger. I cannot stop feeling bad and I am really depressed. I think I need help. I really don't like feeling this sad I find myself disconnecting myself from this baby growing inside of me. PLEASE HELP ME [emphasis in original].

The sufferers are often told by the community that their feelings are normal and that they should not feel guilty for the feelings which they are experiencing, which lends focus to the negative retribution which is often received by others in the real world. The emotions which sufferers feel tend to be described as a "roller coaster of emotion" due to the fact that they experience times which are more difficult than others, such as when they find out that their fetus is the "wrong" gender. As Ava shared:

I had found out that he was a boy at the 20 week u/s [ultrasound] and remember breaking into tears right in the exam room. I had just found out that the baby I was carrying was absolutely healthy and perfect.. .but he had a penis. I cried for weeks. This was supposed to be our last child, but I just couldn't fathom the idea of never having a bundle of pink.

Emotions of this nature are consistently shared and accepted by the members of the online community through discussions of their experiences; however, there are certain emotions which are not considered normal within the online community, such as extreme emotions which lead to discussions about aborting the pregnancy. Addison described the types of emotion a GD sufferer may experience: "Gender disappointment covers a range of negative emotions related to learning that the sex of your child is not what you had wanted it to be. These emotions can range from a slight 'oh well' to a feeling of

91 devastation and not wanting to continue the pregnancy or even one's life." She further shared that: "I cried for days and even said that I did not want this baby anymore. I contemplated abortion but did not tell anyone that. I did not know how I would be able to bond with another boy since I didn't really want one to begin with let alone two." While sufferers who reveal their thoughts of abortion are supported, sufferers who indicate that they are actively considering abortion are often condemned, which eventually leads to the targeted woman leaving the community. Jane divulged that: "After making my decision to end the pregnancy, I was basically out casted on the [GDI] forum, the [GD2] forum.. .1 no longer participate in many forums due to being flamed, personally attacked, threatened, etc." This understanding of emotions which are normative of GD lends focus to the definitional boundaries which the members have established for GD.

Understanding Through Experience

Similar to chronic illness experience (see Charmaz 1997; Schneider and Conrad

1980), GD is not considered to be understood unless it is personally experienced. Often, misconceptions are associated with the experiences of chronic illnesses (see Butt et al.

2008). Understanding is sought by illness sufferers in online communities (see Wright

2002); likewise, those who have GD feel that they can be understood by the members of the GD community, as these community members explained:

People like that will just never understand GD and it's not even worth trying to explain. A couple of my close friends know about my GD but other than that I don't tell people because of that reaction. All the ladies on this site understand and it's good to know that you are not on your own with these feelings.

25 Among the members of the online community, it is understood that while women who suffer from GD may experience depression, GD is separate from Post Partum Depression (PPD), as this community member shared: "I know that GD and PPD are 2 different things, but I have to think that the emotional side of things are somewhat similar." Sufferers who communicate their experiences with depression and GD are often encouraged by the community members to seek help in the form of counseling in the real world.

92 Similarly:

Unless someone has been where we have, they just don't understand. People can say some really mean and insensitive things to us. Its very hard to carry on a relationship with someone that hurts us so much. I'll be honest here, I have phased people out of my life because of GD. I'm not proud of it, but its so hard to watch someone gloat about their 'perfect' family.

Similar to individual experiences with discreditable chronic illnesses (see Charmaz

1997), sufferers of GD do not feel that one can truly understand GD unless it has been experienced first hand; furthermore, sufferers often suggest that if someone has a mixed gender family, then he/she could not possibly understand the desire for a particular gender. This assessment of one's family composition is used when deciding whom to tell and when determining who could possibly understand. The feeling that GD cannot be understood unless it is experienced personally is exacerbated by negative reactions that

GD sufferers commonly receive when disclosing their feelings to someone who does not have GD, or when they express how much they would like to have a child of the gender of their dreams. Acknowledging that others do not understand, further distinguishes GD as an affliction which mirrors the struggles associated with chronic illness.

Gender Dreams

The data suggests that there are a number of interrelated reasons as to why a sufferer experiences GD, which lends focus to both personal experiences and long-term desires for a particular gender. When met with adversity, these long term gender desires result in one suffering from GD. These gender desires become symptomatic of GD, as they are collectively discussed and acknowledged within the online community, maintaining a significant role in the construction of GD as an affliction. As such, GD sufferers are able to describe the reasons why they have GD and why their desire for a

93 particular gender is so strong. The overlying reason relates to the fact that the sufferer has envisioned a specific family composition for herself, including a certain number of children of a particular gender. As Callie shared:

All my life I looked forward to the time when I would have children. I always pictured myself with daughters. That didn't mean that I did not want to have a son.. .1 knew that if I did not have a daughter that my life would not be complete.

This dream family has likely taken shape over a number of years and when the sufferer has her first child of the "wrong" gender, her dream begins to dissipate, resulting in GD.

As Katherine shared: "As a child I always imagined what my little girl would look like and had my girl name picked out since I was 8!" The family composition that the sufferer has envisioned may stem from a number of conditions, as sufferers cite experiences with their parents and siblings, as well as experiences growing up as reasons why they desire a particular family; furthermore, sufferers commonly engage in discussions of the gendered relationships, and stereotypical gender activities, as well as the girl and boy "stuff that they feel they will lose out on if they do not have the gender of their dreams. As Ava shared:

I'm dying for the pink dresses, bows, and pigtails, but there is so much more. I just know that a relationship with a daughter is different than that of a son. I'm very close to my own mom and her mom, and want to share that with my own child. I think a lot about her wedding day, and I suppose there is a part of me that fears my own boys 'leaving' me to become part of their wives families.

Some sufferers have always felt a strong desire for a particular gender and they are not necessarily able to discuss a specific reason for why they maintain these feelings.

Sufferers discuss how they feel when they take their sons, for example, to hockey practice and that they imagine taking a daughter to ballet class. As this community member, who has a desire for the stereotypical girl and boy activities and "stuff relayed:

94 I think a lot of women on this board aren't disappointed in their actual children, but disappointed in what comes with the specific genders. For me, I'm not disappointed my son has a penis, I am disappointed in the things that come with having a son. I'm disappointed I won't be able to put hair bows in his hair or dress him up in girlie dresses. I'm disappointed I won't be able to shuffle him to ballet class or play pretend makeup. I'm disappointed that I will have to suffer through football games and soccer games and all the other types of games that have balls.

Some sufferers watch their sons spending time with their husband and wish that they had a daughter with whom they could spend time doing activities such as: "slumber parties, pink clothes, dolls, prom dresses, mother of the bride etc." which are stereotypically female. This association can lead to feelings that they will be alone in the future and that their sons will not maintain a close relationship with them, further triggering one's feelings of GD.

Gendered mother-child relationships are central to the sufferer's desire for a girl or a boy. Sufferers discuss the mother-daughter bond and the mother-son relationship in positive, as well as negative terms depending upon the gender of their dreams. Sufferers express wanting the closeness and the special relationship that mothers and daughters experience and cite this relationship as being unique and one that they cannot have with a son. Experiences with parents and siblings while growing up has shaped the gender desire for some GD sufferers. These sufferers cite wanting to either replicate the relationship bonds which they experienced in their families or wanting to create bonds with a future child which they did not experience themselves. Meredith shared that she wants to have the type of relationship which she has experienced with her mother with her own daughter: "Growing up I always wanted one child - a daughter. I believe that to be because my mom and I have such an amazing relationship." The type of family that a sufferer experienced as a child appears to be significant in the desire for a certain gender

95 composition of a family. As such, Addison described her family as "matriarchal" and cited her understanding of raising strong women to be central in her reasoning for wanting a daughter:

I come from a strong family of women, where men were expendable and exchangeable. I cannot be a role model for how to be a man. I don't really understand my purpose with sons. And, frankly, my sons and I don't have much in common other than some DNA.

Furthermore, some sufferers have experienced the death of their mother or having had a miscarriage and cite wanting to have a child of a certain gender in order to mirror the experience that they had or would have had with the gender which was lost. As this community member shared:

My Mom died around the time my youngest son was born. I am fighting with my dh [husband] a lot b/c [because] I so yearn for a dd [daughter] to carry on the close mother-daughter thing I had with my Mom.. .even my ds [son] #1 feels this girl is missing, he told me the other day 'we should have two boys and one girl' and it is never going to happen.

Some sufferers state that they feel that they have nothing in common or cannot relate to a gender and this, in part, dictates their desire for their dream gender. As Christina disclosed: "I know nothing about hair, clothes etc. I also hate shopping. I feel I'm so ill- equipped to deal with girls, and I just know that with my luck, they'll be 'girly-girls'."

Sufferers consider the future and discuss that daughters stay close with their families, while sons move away. They discuss their future as a mother-in-law who will be kept distant from her child and her grandchildren, as it is felt that women have closer relationships with the grandchildren of their daughters than their sons. Their future experience as a mother-in-law is often based upon the relationship which they presently have with their own mother-in-law and some sufferers describe that they will make a

96 concentrated effort to maintain a positive relationship with their sons so that they will be in close contact in the future.

Sufferers feel that an experience with a daughter will bring long-lasting closeness and friendship, sharing social events such as formal events and marriage and gender markers such as pink items and ballet class. As Katherine, who desires a daughter, explained:

Every person has an overbearing reason why they have GD. Mine is friendship. I don't really have friends. Just my husband. I don't have a close relationship with my mother or mother-in-law and I really want that female presence in my life who I can talk to. It kind of sounds strange that I'm trying to literally create a friend, but that's basically what it comes down to. Of course, I want everything else that comes with it, like Barbies, pink, and beautiful dresses, but underneath it all, I want to be able to have the special bond of friendship that only a mother and daughter can share.

Some sufferers discuss their desire for a son and discuss his role within the family as protecting his sisters and being able to participate in activities with her husband. As Sara, who has three daughters commented:

...I just always pictured a miniature of my husband, that would be a momma's boy but that could do guy stuff with his dad. And I think boys clothes and toys are much more practical and cute. Girls things are just too full of fluff and don't get the job done or seem to have as much purpose. But for some reason I've always thought boys take better care of their Moms and girls are there for their Dads. Also I don't exactly expect my daughters to have a career or be successful in life, almost like that is optional for them. But a son would automatically go to school and choose a career and be dignified in my eyes. And from deep down inside somewhere I've just always seen myself being the mom of a little boy, I don't know where that one comes from but it's there and now it's very strong.

Collectively, the gender based desires which have not been realized by the sufferer, have resulted in her becoming disappointed in the gender of her children and consequently in her developing what has been constructed as GD. These stereotypical understandings of gender are understood by the online community members and represent an integral component of suffering from GD. Sufferers represent women who have a strong desire

97 for a child of a certain gender and this desire is based upon the hopeful reflection of stereotypical gendered personalities which they believe are attached to the biological sex of the child. While there are interrelated reasons as to why sufferers feel that they experience GD, the basis of the emotions are rooted in gender ideologies. The reasons that a sufferer maintains in her desire for either a girl or a boy often depends on experiences which she has had during her lifetime and as such, these gendered desires are expressed by the community members to have developed over a number of years.

As GD persists, the sufferers must learn to navigate a discreditable affliction while maintaining their role as mothers in the real world. They learn to live with GD by sharing GD events, discussing similar patterns of experiences and constructing ways in which to minimize the emotional suffering they experience in the real world.

Living with GD

GD online community members express their relief that they are part of a community after having suffered with their feelings alone in the real world. These women, upon disclosing their feelings to family and friends in the real world, are commonly reprimanded and learn that it is not normal and not acceptable to suffer from

GD. The sufferers gaining support in the online community reflects Goffman's (1963) understanding that the stigmatized individual will most likely find that there are sympathetic others who will adopt a similar standpoint in the world and extend the feeling of normality in spite of self-doubt. These sympathetic others include those who share the stigma with the individual. By knowing what it is like to have this stigma, they are able to provide the individual with instruction on how to maneuver and with a community from which to gain support and comfort by feeling accepted as a person who

98 is similar to any other normal person. In the online communities, GD sufferers describe their experiences and discuss significant phases in suffering from the affliction which include their experiences with disclosure, management of GD, trigger events, mourning/grief and their struggle to cure and/or overcome GD. These phases have become symptomatic of GD and dictate the affliction experience, as GD is conceptually medicalized within the online community. Each phase of the GD sufferers experience will be evaluated below.

Disclosure

Discussions of disclosure are of particular significance in the GD online community. The experiences which are communicated among the sufferers extend the understanding that the potential to become stigmatized is understood to "weigh heavily" on an individual's definition of the self; moreover, a potential deviant is further defined as an individual who recognizes his or her own behaviour, who is aware of relevant sanctions in the broader social environment and who surmises that disclosure will probably lead to discrediting and therefore undesirable consequences (Schneider and

Conrad 1983). The behaviour of the potential deviant is mirrored in the experiences of the GD sufferers who negotiate disclosure with the members of the community.

Stigma and processes of stigmatization have been identified as integral elements in the study of chronic illness experience (Ablon 2002; Adams et al. 1997; Berger et al.

2005; Butt et al. 2008; Pierret 1992; Scambler and Hopkins 1986; Schneider and Conrad

1980; Williams 1987). Similar to individuals who suffer from and who manage chronic illnesses (see Asbring and Narvanen 2002; Butt et al. 2008; Charmaz 1997; Pierret 1992;

Schneider and Conrad 1983; Weitz 1990) and individuals who experience a stigmatizing

99 feature of their identity (see Goffman 1963; Strauss 1975), sufferers hide their GD from the real world and often disclose their feelings only on a 'need to know' basis. GD sufferers have learned the "standpoint of the normal" (Goffman 1963) and have experienced the negative consequences associated with disclosing their gender desires to others. They make an effort to 'pass as normal' in the real world due to the negative stigmatization which they experience (see Strauss 1975). The stigmatizing experiences of

GD sufferers can be further related to individuals who suffer from a chronic illness and to the concept of stigma potential due to the knowledge of one's affliction being limited to relatively few others and that if the affliction were to become more widely known, social restrictions may result (see Schneider and Conrad 1983). According to Goffman (1963), negative stigmatization can be the result of behaviours which are discredited (visible and known by others) or discreditable (invisible, but maintain the potential to become discredited). As sufferers experience GD as a discreditable affliction, they need to consider to whom and how to disclose their feelings. GD sufferers have developed an understanding that their experiences and desires are not considered to be normal in the real world. They learn, based upon the reactions of others, that it is not acceptable for mothers to feel disappointment in the gender of their child and should be grateful for a healthy baby. Katherine shared that:

I tend not to share my GD feelings with women who have one of each or none at all. .. .a lot of people can be offended because there are so many women who can't even conceive one child and they view you as being selfish for not being satisfied with what you have. At first this made me feel guilty, but I've learned to appreciate that a sense of loss is a sense of loss no matter what it's based on.

26 It is understood that while generalizations can be made regarding the experience of stigma in relation to a chronic illness, that there are differences present in the types of stigma that the sufferer endures which depend on the particular illness (see Asbring and Narvanen 2002; Butt et al. 2008). The experience of chronic fatigue syndrome, fibromyalgia and epilepsy most directly relate to the construction of GD due to the misunderstanding, uncertainty and disclosure practices which are experienced.

100 As such, sufferers keep their GD private in order to avoid being judged and having others think negatively of them. Hiding a discreditable illness is a strategy employed by chronic illness sufferers {see Weitz 1990). The careful consideration of disclosure also serves to protect the sufferer from feelings of guilt which have been experienced previously (see

Huibers and Wessely 2006). Sufferers overwhelmingly receive comments that the health of the fetus is of central importance and that some women experience infertility; therefore, they should feel grateful to be able to conceive in the first place. These comments are made by outsiders in an effort to discredit GD while bringing the sufferer's attention to what is normatively considered to be of central concern during pregnancy: the health of the fetus.

Some sufferers discuss that they keep their GD private because they are concerned about the children they have learning about their strong desire for the other gender; moreover, sufferers tend to "feel out" the person before deciding whether to disclose their GD. This disclosure behaviour mirrors the concept of protective disclosure

(see Charmaz 1997) in which sufferers control how, what, when and who they tell about their illness; moreover, protective disclosure is considered to manage the emotions associated with the exchange of information. Sufferers explain that if they discuss GD before engaging in a conversation with another person concerning the gender composition of her family, that they are reprimanded for their feelings. However, if a sufferer is able to ease into a discussion of GD and/or of her strong desire for a particular gender after having a conversation about, for example, being a mother to three boys, then the other person tends to be accepting of the GD sufferer's desire. As Meredith commented:

101 Yep - society basically SUCKS! In essence, they have created (or at least heightened GD)... but if we as mothers were to ever express our disappointment BEFORE one of their comments [referring to gender composition of family] were made... well, we may as well be burned at the stake! [emphasis in original]

GD sufferers who have multiple children of one gender commonly receive gender

comments from family and friends, as well as strangers. These comments, such as asking

if the sufferer is going to keep trying for a different gender, draw the sufferer's attention to the gender composition of her family and play a role in the sufferer's decision to discuss her feelings. As Ava explained: "When people saw me with 3 boys and a pregnant belly, they would often ask if I was hoping for a girl." Sufferers do not

appreciate these comments, as they are hyper aware of the gender composition of their family and feel that they do not need the reminder.

Due to the negative stigmatization and lack of understanding which they experience, sufferers learn to hide their feelings and to disclose their GD to only a few close people, often a husband, mother, sister or close friend (see Charmaz 1997; Weitz

1990). The experiences of GD sufferers extend that they encounter the interactional risks

(Charmaz 1997) of being stigmatized or of not being able to cope with the response of others when information is disclosed. At times, the sufferer will be able to confide in these few people, or sometimes one person who knows about their GD, and at other times, they will not be able to receive continued support, because those to whom they have confided do not understand what they are experiencing. As Sandra shared:

It was a difficult thing for me to bring up with my husband. I didn't want him to think that I was shallow or jealous of others. The only people that know about my GD are my husband and my sister, however I don't think they truly understand the depth of my desire to have a daughter. The women on the [GDI] forum are really the only people I have shared my true and honest feelings with.

Katherine explained a response from family which many sufferers encounter:

102 My family.. .basically has the 'suck it up' attitude. If I make a comment that I really wish I had a girl, they say 'Oh stop it!' My mother and my aunts all have girls and boys so I'm sure they can't relate to what I'm going through.

Those who know may be supportive, but may not necessarily be willing to provide continual empathy. Due to the lack of understanding and negative comments which are often received, sufferers have learned to consider carefully to whom they will disclose their GD as Meredith explained:

You have to be picky about who you tell...you either have to hide it and pretend all is well and you don't have a care in the world. Then you appear 'normal' while you ache on the inside. OR you tell about your GD - but you have to be very prepared to take all the awful [bold in original] comments about how you should 'just be happy with what you have,' and have everyone tell you that you have no right to feel the way you do. It's just such a sticky situation. If I feel like I want to tell someone, I 'feel them out' first. I make mention to having boys and how wonderful it is -just kind of make conversation to see if I can tell how THEY feel about having a single gender family, [emphasis in original]

Sufferers do not want to be judged by those who do not understand. As Kate shared: "I guess I worry that people will think that I am ungrateful for what I have and that the main thing is they [her children] are healthy. I think people just really don't know what to say if you indicate/hint that you are disappointed in the gender you gave birth too!" Similar to the sick role (Parsons 1951) which states that an institutional definition exists that the sick person cannot be expected, by 'pulling himself together' to get well by an act of will, which reflects that a condition must be changed and not simply the attitude of the individual. GD sufferers, who are often expected by outsiders to simply "get over" their feelings, maintain that the feelings associated with GD are difficult and are often part of a lengthy process to obtain the gender for which they dream or to adjust to a life which they had not envisioned.

Management of GD

103 Similar to individual experiences with chronic illnesses (see Adams et al. 1997;

Charmaz 1997; Strauss 1975) and mirroring the concept of stigma management (see

Anderson et al. 1994; Goffman 1963), the GD sufferers seek to find ways in which to manage their affliction and to lessen the emotional pain that they feel in a day to day context. In relation to the sick role (Parsons 1951), it is understood that those experiencing an illness will seek help in order to attempt recovery to a normalized state; as such, within the online community, GD sufferers continually discuss their experiences with one another. Sufferers have developed an understanding of the triggers of GD generally, and most importantly in their own individual experience. Similar to chronic illness sufferers who avoid social activities as to not become discredited (see Strauss

1975), sufferers learn to become aware of when they may be entering into a trigger event and may avoid putting themselves in that position; therefore, they are organizing their days and activities in their lives in relation to the GD from which they are anguished.

Management of GD reflects an effort to manage one's feelings in order to alleviate the strong emotions which disrupt one's ability to function normally in life.

What is meant by normality is a subjective distinction, as sufferers relay how GD is interrupting their lives and what factors are playing the strongest role; for example, one respondent experiences a GD trigger when she sees her niece, so she manages her GD by avoiding situations in which her niece is the centre of attention. Sufferers actively seek to find ways to alleviate their feelings and to make it easier to live with GD.

Sufferers have confided that in order to alleviate and to manage their GD feelings, they converse in the online community, spend time with their children, spend time shopping for their children, concentrate on people who have same sex children, focus on

104 what the sufferer does have rather than what she does not, and avoid friends and family who have the sufferer's dream gender, because it can be painful to be reminded of what she may never have.

While some GD sufferers are extremely eager to determine the sex of their fetus, other sufferers manage their GD during their pregnancy by not determining the sex of their fetus. As this respondent shared: "We decided not to find out the sex to avoid any

GD I may suffer. I was convinced this was my girl and this helped ease my GD. Then he was born, my GD didn't really hit me until he was 6 weeks old. I dealt with it by finding the board, and finding support by my husband."

Sufferers also seek to manage their feelings in front of family members in order to uphold a certain image for their children and husbands. One respondent discussed how she managed her feelings during an ultrasound which revealed that she was not pregnant with her dream gender.

The technician told her:

Go ahead and go to [the] bathroom. I'll get your family because this baby is showing what it is all over the place. I knew at that moment. I went to the bathroom and literally gave myself a pep-talk that everything would be ok. I did fine during the u/s [ultrasound] - held up nicely for the family. ..then cried my eyes out in the car.

In the real world, some GD sufferers seek help from counselors or attend therapy sessions in an attempt to understand and work through their feelings. Some sufferers have discussed that a counselor would not be able to understand if she or he has a mixed gender family. In the GD communities, sufferers discuss ways in which to manage their

GD and post lists of what has helped so that other sufferers can possibly receive support.

In response to a list of GD management strategies which were posted on the BBS, a community member shared: "Thank you for this. Most could never understand.. .I'm so

105 glad I found this site. Whenever someone says something thoughtless to me about the gender I find myself back on this site looking for support." This further exemplifies the understanding that GD sufferers gain from the collective support in the online community and the relief that sufferers feel knowing that they have a forum in which to discuss their

GD feelings.

Members of the online community have presented management strategies which can be categorized into practical management strategies and emotional management strategies. Practical management strategies include but are not limited to: buying new baby items, reading pregnancy books, registering for baby items and having a baby shower. Emotional management strategies are more commonly discussed in the online communities and include but are not limited to: naming the baby in an effort to separate

GD from the baby, making a list of reasons why the "wrong" gender is good, framing the ultrasound picture in an effort to help the sufferer to accept the baby's gender role in the family, differentiating between children in an effort to acknowledge that children of the same gender are different, receiving regular support in the online community to express feelings of GD, talking to one's husband about GD, exploring the option of having another child because for some sufferers the hope of having more children helps manage

GD, considering "high-tech" NRTs since starting the paperwork has helped some sufferers to "give life" to the concept of having children in the future, personalizing the future baby's room in an effort to give the "wrong" gender a place in the home and saying goodbye to the gender for which the sufferer is hoping in an effort to reallocate the affection towards the baby of the "wrong" gender. These are management strategies that

106 the sufferers in the online community share in an effort to help each other live with the feelings of GD.

As stigmatized individuals, sufferers may make an effort to reduce the social tension associated with their stigma and attempt to refer to their GD by demonstrating that they are detached from the situation and accept their condition as something they manage; as such, sufferers who know that a trigger event is approaching may discuss their concern in the online community in order to receive advice regarding how to manage the event so as to minimize the feelings of GD. This pregnant community member, who attended her trigger event after discussing it in the community relayed:

...I went to the cousin's pink baby shower and survived! A few people asked if I knew what it was. I told them without a hint of disappointment in my voice. That really stopped all of those comments that we hate to hear! Denying it really works!!! Thank you to those who suggested it last week!!

This behaviour is similar to chronic illness sufferers who conceal their illness by maintaining a facade and displaying a self-presentation which is in accord with the expectations of others; furthermore, chronic illness sufferers have described that at social gatherings they may present a happy, healthy and normal self (see Asbring and Narvanen

2002). Sufferers often seek to manage their GD in the real world by discussing their concerns in the online community. The sufferers learn from each other's experiences and construct ways in which to hide their GD in the real world in order to manage the stigma which is associated with GD.

Mourning the Loss of a Dream

Discussions in the online community lend focus to mourning and grief as being symptomatic of GD, as it is understood that women who suffer from GD experience a continual mourning and grief cycle when it is determined that they are pregnant with a

107 gender they did not desire. Determination of the "wrong" gender is described by sufferers as a loss and is commonly equated to experiencing a death, as this community member shared: ".. .1 had to grieve this loss.. .the loss of a dream, which I thought was to be a reality. It never occurred to me that I may possibly NEVER have a baby girl... Part of me is scared to death .. .to ttc [try to conceive] #4.. .to experience the grief and disappointment all over again." Similarly, Addison revealed:

When I opened the envelope with my amniocentesis results, I was devastated. I couldn't believe I was having another boy-my final hope for a daughter now dead. I could barely breathe, didn't eat, and poured out my anger and frustration on the birth board and the gender determination board...When the doctor announced I'd given birth to a boy, I was numb. Since that time, I have learned that the numbness I felt is exactly the feeling I have when I find out someone I love has died-it's a painful numbness, a blow to the body and mind that leaves me reeling.

If the sufferer is going to have subsequent children, then her mourning and grief during her pregnancy with the "wrong" gender is somewhat alleviated by the knowledge that she may have her dream gender in the future; although for Sara, this grief lead to a different decision: "I chose not to try for another child, as I would have been doubly devastated if I had had another son and would not chance it." Most commonly before moving towards acceptance by the knowledge that she will have another child in the future, the sufferer often experiences distress and negative emotions for an undetermined period of time when she learns that she is not pregnant with the gender of her dreams. As Isabel shared:

To be honest, I probably would have had an abortion if I hadn't already told everyone I was pregnant. I felt like that baby was for everyone else, not me. Everyone assumes that you are happy no matter what after you have a baby but it was my deep private shame that I DID wish my son was a girl. I couldn't even call him by his name for a month or so, it felt so wrong on my tongue.

This community member explained that: "I am just so happy that I took the day off, the day after my ultrasound. I'll definitely need the weekend to mourn if I am in fact carrying

108 another boy for sure..." Sufferers who have experienced the mourning/grief cycle with previous pregnancies have developed the foresight to know how they will be feeling if the "wrong" gender is determined.

Sufferers often do not want to believe the results of the sex determination test during pregnancy and seek numerous confirmations of the sex of the fetus. As this respondent shared: "Throughout the pregnancy, I had 5 confirmations of the sex and still held out this ridiculous hope that it would be a boy." When a woman has finished having children and has not had the gender of her dreams, she often experiences GD in a continual and fixed state, as Sara shared: "What is strange for me is that my son is 18.. .1 am still angry about his gender and disappointed after all these years." This emotion is often not understood by the sufferer, as she does not want to continue feeling this way, but is unable to rid herself of the longing for her dream gender.

Many sufferers of GD have envisioned their dream gender by symbolically creating a role for that child in their family and by personifying the dream child. A sufferer may name the dream child and may imagine what it would be like for that child to be a part of her family including how her present children would relate to the child (a son may be cited as being a protector of a future sister and a daughter may be seen as being a best friend to a future sister) and the types of activities in which she would engage with her dream child (if she takes her sons to soccer, she may imagine taking her daughter to ballet). This symbolic child is illustrated through this GD sufferer's signature:

"Baby #3 6/30/07 Hoping for my little Sophia but expecting DS [dear son]#3." As well, the sufferer may buy clothing for her dream gender, as was described by Sara: "I still have boxes of girl clothes in my basement that I look at on occasion. My son [18 years

109 old] is aware that he is the girl I always wanted..." Sufferers experience a period of mourning and grief for the child whom they have symbolically created in their family every time that they do not have the child of their dreams. Sufferers truly feel that they experience a death. It is the death of their dreams and of a child who has existed in their thoughts and upon whom they have spent much time and focused energy, as exemplified by this community member: "Every time I go out and see little girls I feel a sharp pain in my heart. I feel like my little daughter is dead however she never existed but for me she was so real".

Sharing experiences with mourning and grief in the online community helps to solidify the bonds between community members. Mourning and grief becomes another common reference point which aids in the construction of GD as an affliction, as the members are able to see further similarities in their experiences which deviate from the normative construction of motherhood.

Triggers

Within the online community, women who have GD discuss that they experience

"triggers". Triggers are situations and experiences in real life which offset feelings of GD and act as continual reminders of the gender of their dreams. As this respondent described, she experiences unhappiness which can be exacerbated when a triggering event occurs:

I wouldn't call it a depression, but more of an unhappiness deep within your core; something you are always aware of but hide around others. It doesn't affect day-to-day activities, but gives you a tainted view on life and how unfair yours has become. There is not one day that goes by that I don't think about the little girl of my dreams. Some days are better than others until a trigger event comes along.

110 Women share their experiences with triggers in the online community in order to seek support and advice concerning how to maneuver in the real world, and as such, trigger management strategies are discussed in the online community. Triggers include: seeing one's dream gender in public, seeing one's dream gender composition of family in public, attending baby showers or birthday parties for one's dream gender, being subject to comments concerning the gender of one's children, seeing items for one's dream gender in a store, receiving a birth announcement for one's dream gender, knowing a friend or relative who is pregnant with one's dream gender, or sensitivity to gender stereotypes such as "all girls are horrible when they're teenagers and boys are much easier to raise". Trigger events have been described by the community members in the following ways: "My main trigger event is seeing my 1 year old niece... I love her [my niece] but I hate what she represents; something I don't and may never have", "I avoid any events, parties, weddings that I know will have a lot of little girls at them" and similarly:

One big effect of GD is noticing the gender of families wherever you go. If they have all one sex, I feel good, and if it's one of each, I feel bad, particularly if it's older girl/younger boy, since I feel that was 'supposed' to be my family. I know it's so ridiculous, and why the hell do I care about what gender children that strangers have?

These trigger events are managed in different ways by GD sufferers in the real world and sufferers share their experiences and discuss ways in which trigger events can be managed in order to share information and to gain collective support.

According to Parsons (1951), those who are identified as being sick experience exemption from normal social responsibilities; as such, in the real world, those who know about a sufferer's GD may act towards the sufferer in a manner which will facilitate the

111 management of GD; for example, a husband may help his wife get out of attending a birthday party for a niece if his wife's GD is resultant of wanting a daughter.

GD triggers can also occur when family members pay special attention to a child in the extended family who represents the gender of the sufferer's dreams. This special attention causes the sufferer to become acutely aware of the fact that she does not have the gender of her dreams, as her children who represent the "wrong" gender are missing the attention from their extended family members. Katherine discussed how her niece receives a lot of attention from her family members while her sons do not: "It's just another example [family favouring her niece] of how I face GD on a day-to-day basis. I feel like I'm constantly trying to force equal treatment for my boys. I'm very careful of what I say around my family now, although they do know that I'm hoping this pregnancy is a girl." Since the attention that family members focus upon a child in the extended family can act as a continual reminder of one's GD, in some instances, this can cause the sufferer to separate herself from the family in order to manage her feelings of GD.

Some sufferers' GD is exacerbated by family members who are described by sufferers as experiencing GD. The GD that is experienced by family members is a function of the sufferer's condition, suggesting that the family members feel strongly about the gender of the sufferer's children. Sufferers have discussed the feelings that their husbands, mothers, mothers-in-law and children have towards her having another child.

Some of the sufferers have extended families who have a significant number of children of the same gender and she is expected to conceive a child of the opposite gender in order to fulfill the gender desires of the family. Most notably, sufferers feel that their own GD becomes heightened during times when their family members make comments or behave

112 in ways which signify their disappointment in the fact that the sufferer has not had the gender of their dreams. Favouritism of other children in the extended family, social distance from the sufferer's family and negative comments toward the sufferer's husband have been described as resulting from the "wrong" gender being born.

Furthermore, sufferers have cited that they feel that in comparison to boys, society markets girls by selling clothing, toys and paraphernalia which are designed for girls, and that this acts as a trigger for their GD if they desire a girl. They find that when they go to stores that they are bombarded with "girl" clothes and items. They state that the stores carry more items for girls than boys and that the selection for boys is quite minimal. As

Callie explained:

I also think that there is a certain societal expectation or bias that families with mixed gendered offspring are more valuable and complete. I believe that society plays a strong role in GD and that marketing and economics are also factors. I feel that as a mother I am bombarded with images of cute and perfect little girls. Girls clothes are everywhere and there are more of them because moms want to decorate and dress up their girls and feel pressured to do so. The mother/daughter relationship is also valued in our culture and that is difficult to face as a mother with no girl.

Therefore, some sufferers feel that society plays a significant role in the desire for a daughter. This further acts as a trigger to one's GD, as the sufferer is continually reminded of the gender she desires.

In contrast to trigger events, women who suffer from GD also experience "reality checks" which are described as situations in which the sufferer feels grateful for the children she has and does not focus on her GD. A reality check is said to be a temporary situation which may occur when a sufferer hears about a woman having a baby who has health problems or who has lost her baby. As well, a reality check may occur if a sufferer's child is in jeopardy, as discussed by Katherine:

113 One recent even with my youngest son gave me a GD reality check. .. .my GD was flaring. My youngest son somehow got out of my grip and ran ahead to his brother. I could see a black pick up truck coming down the road. I started panicking and in my mind I actually saw his body being hit like a rag doll. I sobbed for hours about what could have been.

While GD sufferers may experience times when they are not focused on their GD, the

feelings do return. These reality checks represent moments in the sufferers lived

experience during which they are temporarily removed from the GD state and focus

solely upon the health of their children, which corresponds with the normative

construction of motherhood. Interestingly, these experiences counter the medicalized

understanding of GD that the sufferers have created by presenting times during which the

sufferer is able to "get over" GD; however, this ability to alter her focus is presented by

the sufferers as being temporary in nature and as masking, rather than curing GD, as this

community member posted:

"Listen to this reality check. So, I am LITERALLY on the table for my U/S [ultrasound] scan to do the health check and see gender. The tech tells me about a lady that had been in earlier in the day. She had her 20 week scan [and] the baby was full of abnormalities. The brain and heart were defected—I don't know what else. We.. .find that we are having another baby boy.. .that is COMPLETELY HEALTHY!!! My GD made me feel like a total ARSE at that point. BUT, I do want to say that we cannot help our emotions and disappointments EVEN when we are faced with the total truth of reality. Nothing will invalidate those feelings—because they are real. While we can use these experiences to UNDERSTAND and APPRECIATE the total value of the blessings that we are experiencing—-we cannot nullify our desires to have a 'little girl' or whatever you are dreaming for." [emphasis in original]

While the sufferers do not discuss for how long a reality check lasts, the discussions in

the online community suggest that the reality check is quite temporary as she returns to relating to discussions of GD in the online community. In a sense, reality checks act as a

type of trigger towards the sufferer behaving in accordance to the normative construction

of motherhood, which does not involve a preoccupation with the gender of her children.

114 Curing GD

Individuals who experience an illness seek ways by which to cure or to alleviate the symptoms associated with the illness. Similarly, in the online community, GD sufferers seek ways by which to alleviate the emotional distress brought on by GD and ultimately seek to cure their GD by having the gender of their dreams. In accordance with the sick role (Parsons 1951), those who adopt the sick role seek to find ways by which to return to normal as being sick is understood to be undesirable and as such, GD sufferers try to rid themselves of GD.

The long and often difficult process of curing GD lends focus to gender selection methods, NRTs, emotional distress and for some, counseling in the real world. Typically, women seek to cure their GD by having subsequent children in an effort to conceive the right gender. This process often means negotiation with one's husband, as sufferers often discuss that they want to continue to have children in an attempt to have the "right" gendered child. Sufferers discuss conversations with their husbands which centre around the idea that if the women had already had their dream gender, they would not be continuing to have children. As Ava shared:

After 2 miscarriages, we had a perfect low tech Shetties girl attempt, and 9 months later, my 4th son was born. I was devastated when I found out that I was carrying another boy.. .1 didn't need another baby after all, I only needed a girl. Had I known for sure that it would have been a boy, we probably wouldn't have made the attempt in the first place.

Sufferers are aware that their interest in subsequent children is solely to fulfill their strong desire for their dream gender which will result in curing GD. Sufferers have agreed that the only way in which to cure or to overcome GD is to have one's dream gender.

Maintaining relationships with children of the dream gender of family or friends does not cure GD, but in fact, often acts as a trigger.

115 Some women are able to cure their GD by eventually having the gender of their dreams, while others finish having children without having the gender of their dreams and enter into a perpetual state of GD. As this community member, who identified herself as "disappointed and done [bearing children]", stated:

I'm not sure if I will ever be able to give her [dream daughter] up. I imagine myself on my deathbed... and saying, 'well maybe in the next life me and dh [husband] will find each other and have our precious daughter' I love my sons and REFUSE to let this affect my enjoying every part of their childhood.

Other women do have the gender of their dreams, but only after having more than one child of the "wrong" gender, thereby altering the "family of their dreams", as described by Christina: "I would still experience some GD whether I have a daughter or not because my dream of the family that I have been programmed to believe is perfect can't happen." Therefore, those sufferers continue to grapple with GD feelings because their family is not what they had envisioned. Conversely, Miranda explained that: "I no longer have GD. The cure was a surprise pregnancy that resulted in a beautiful baby girl."

Sufferers often engage in a variety of natural gender selection methods in order to influence the sex of the fetus. Katherine discussed that:

.. .1 really have a feeling that this one is a girl. I swayed like crazy to get one... To prepare myself in case it is a boy though, I have found the cutest boy nursery set to act as a small treat so I don't get too upset. Once again though, this will just act as a band-aid. I'm sure I'll love my son to death when he's born but will once again be mourning the loss of my dream daughter months later...and I doubt I'll ever get over it.

Sufferers have an understanding that their GD will not be cured, but only temporarily alleviated by the birth of a child of the "wrong" gender.

NRTs are considered to be technologies which create pressure for their own use

(see Leonard 2003); as such, some sufferers contemplate the use of "high-tech" NRTs to act as a cure for their GD, while other sufferers do access "high-tech" NRTs. NRTs are

116 accessed by women who suffer from GD in attempts to determine the sex of their fetus when they are pregnant, as well as to pre-determine the sex of their fetus in order to have their desired gender. Sufferers may have multiple ultrasounds in order to determine the sex of the fetus when they do not want to believe the sex they have been told.

GD sufferers may access NRTs at the private reproductive clinics in the United

States in order to pre-determine, with certainty, that they will have the gender they choose. As Ava stated:

The only thing that I am doing so that I will no longer 'suffer' is to continue to have children until I have a girl. Fortunately, technology is such that as long as we have the money to pursue it, we are guaranteed to conceive a girl with our next pregnancy rather than wind up with our own baseball team!

This technology, marketed on the Internet as gender selection, fulfills a false ideology that a certain gendered child is guaranteed when choosing the sex; however, some women who suffer from GD access the technology and in some cases have experienced failed attempts at conceiving the gender of their dreams. While gender selection is illegal in

Canada, sufferers who are Canadian have expressed interest in traveling to the United

States in order to access the technology.

The technology, in some way, can impede upon a woman's ability to resolve her

GD, as the technology offers a way in which to cure one's GD, by extending the possibility that one day the sufferer may be able to have her desired gender. Technology is considered to redefine problems and to be difficult not to use when available (see

Franklin 1990); therefore, due to the existence of the technology, the problem of GD is redefined in regard to what the technology has to offer: a direct solution to conceiving the gender of one's dreams. Meredith discussed her desire to be at peace with her family and with the fact that she does not have a daughter. She further discussed that her ability to be

117 at peace was interrupted by the prospect of receiving a phone call from a reproductive clinic accepting her into the gender selection program: "what do I do if/when one day in this upcoming new year my phone rings, and the caller ID says, ['Reproductive

Clinic...'] Is that my daughter calling?", this exemplifies the understanding that NRTs create pressure for their use depending upon the needs and desires of individuals. The advances in NRTs are providing GD sufferers with another way in which to cure their

GD; however, sufferers have commented that in order to access IVF/PGD for gender selection, they need to consider the financial burden that they will endure. This limits the opportunity for many GD sufferers to engage in the use of IVF/PGD.

Sufferers, who have finished having children and who have not had the gender of their dreams, experience GD in a continual state and no longer directly relate to GD sufferers who are in the child bearing process. Sufferers consider the nature of their feelings associated with GD and consider that GD may be chronic. Addison expressed her emotions when she acknowledged that she would not have her dream gender:

I felt like my world ended when I read the results [amniocentesis]. I was broken. I don't know how else to describe my feelings. I didn't care about the pregnancy any longer. I couldn't believe my bad luck. I couldn't believe this was IT. My "daughter," the very reason I became a mother in the first place, had died for a final time.. .I'm finished having children. My dream has died. I will never have a daughter. And, no, it's not something one 'gets over'. It's something one lives with. Every day. [emphasis in original]

Similarly, Katherine pondered what a future without her dream gender will be:

Unfortunately, I don't know if the hurt will die down as I get older. I'm only 31 and the boys are still little. Although I know women with teenage sons who still have GD. I imagine if I had a granddaughter it may make me feel better although that takes me on another whole tangent. The saying goes that the mother of the "mother" always has a close relationship to the grandchildren than the mother of the "father". That's because most households are run by the women. And women feel the most comfortable around their own family versus the in-laws. If the mother-in-law tries too hard to have a relationship with her grandchildren, it may be construed as trying to intrude or being pushy and the mother will try to distance the children further from the in-laws.

118 Sufferers who have finished having children without having had their dream gender learn to maneuver into a new phase of GD and do not necessarily continue to feel a strong interest in participating in the GD online community, as they do not have as much in common with sufferers who continue to bear children. Some sufferers find support elsewhere by joining other online communities.

The ability to cure one's GD or to make concentrated efforts to cure one's GD by actively engaging in natural or technological gender selection methods and by participating in the GD online community is significant in the ability for this social experience to be medicalized. Central in the sufferers' understanding from what they suffer and how it is experienced both socially and emotionally, is the collective knowledge that a sufferer will make an effort to change her GD state by conceiving the gender of her dreams.

Conclusion

Women who identify with and who experience GD communicate in online communities where they find safety and understanding by collectively constructing GD as an affliction from which they suffer. Within the online community, the women create normative patterns of discourse, confide their feelings and provide social support for each other. The varying aspects of GD become evident within the online community through the threads of discussion. While countering the normative bounds of motherhood in the real world within the online community, sufferers experience a normative state.

GD sufferers maintain a collective definition of what it means to have GD and accept the varying levels of emotion which the women in the community experience.

Those who live with GD identify shared triggers in the real world, develop management

119 strategies for the triggers and for living with GD, experience cycles of mourning and grief, and find ways by which to attempt to cure GD. The online community is central in the sufferer's ability to manage her experiences in the real world and to maintain an understanding of normality and legitimacy in her GD. These individuals who suffer in isolation in the real world, are able to retreat into the online community in order to adopt normality among those of a similar status.

The medicalization of GD as an affliction from which one can suffer occurs as a response to the negative reactions which are commonly received from others in the real world. The GD online community, which mirrors the structure of HRSGs, is the environment within which these stigmatized individuals are able to experience a safe environment in which to disclose their feelings and to receive the support offered with mutual understanding.

120 Chapter 5; Conclusion

The technological advancements in NRTs, specifically those technologies which are involved in sex selection, have increased at a significantly rapid pace, and thus it is important to establish an understanding of the social impact of gender selection in North

America rather than applying previously established sex selection frameworks. In particular, the literature has not indicated what would ensue if a child of the "wrong" gender was conceived. The societal interest in knowing and/or pre-determining the sex of the fetus, which has translated into a mass market potential, has been met with the presently marketed practice of family balancing through the advent of gender selection.

Extending from the societal interest of choosing and/or determining the sex of the fetus, this research focused on the construction of GD in online communities. Framed within literature which concerns motherhood, NRTs, gender ideology, CMC and medicalization, as well as through the application of the chronic illness experience, it was argued that within the online communities, GD is conceptually medicalized as an affliction from which one can suffer.

NRTs have technologically advanced to a point at which it is presently possible to pre-determine with accuracy the sex of the fetus and, more notably, NRTs have advanced socially to being marketed on the Internet by private reproductive clinics in the United

States. These clinics, fallaciously marketing a sex selection technology for the purpose of choosing gender, use the term family balancing in their gender selection entrepreneurship. Women, who are interested in determining the gender of their fetus, turn to the Internet for information regarding gender swaying and gender selection. These searches for information have lead to the discovery of GD online communities. Through

121 recognizing commonalities in their experiences with GD, the members join the online community where the discourse patterns lend focus to the collective construction of GD as an affliction from which one can suffer. These online communities follow the structure of HRSGs and serve a therapeutic and social support function for the sufferers where they find solace, understanding and a sense of identity; furthermore, these GD online communities serve as places where sufferers can disclose highly personal information in the absence of a support network in the real world.

Through the content analysis of two GD online communities and through e-mail interviews with eighteen GD sufferers, GD was presented as countering the normative construction of motherhood which extends that mothers are to be devoted full time to the needs of their children and that the health of the fetus is of central concern. In a social context of intensive mothering, deviant discourses emerge, one of which is the use of

NRTs. Echoing a comment of a GD sufferer, mothers are expected to want any child and to give themselves up for that child, with gender apparently not being part of the arrangement. These women, who can naturally conceive a healthy fetus, learn through disclosing their feelings that their preoccupation with gender is considered to be trivial, deviant, and not worthy of empathy. Through their interactions in the real world, these women are further taught that they are to overcome their feelings and be happy with the children whom they have. This misunderstanding and negative stigmatization in the real world causes the women to keep their feelings to themselves or to selectively disclose their emotions.

Upon entering the online community, sufferers are able to associate the label GD to the emotions which they have been experiencing regarding gender. This label serves to

122 legitimize their experiences, which deviate from the normative construction of motherhood in the real world. Through the sufferer's sharing of her GD story, which mirrors chronic illness narratives, she is welcomed by the members of the online community and is recognized as sharing a similar experience in the real world. The sufferers discuss experiences with disclosure, management of their feelings, triggers of

GD, experiences with mourning and grief upon learning that the fetus is the "wrong" gender, and attempts to cure GD. They offer each other support and a sense of normality.

Within the understanding that a social behaviour can be medicalized apart from medical professionals and solely through the conceptualization of the behaviour, it became apparent that the sufferers speak of GD as something that they have which affects their role as a mother. In consideration of the social construction of the illness experience, the experiences of GD sufferers mirrors the chronic illness identity and experiences. This conceptual medicalization of GD acts as a medical disclaimer, providing the sufferers with a defense against the dominant understanding by outsiders that they should simply

"get over" their feelings concerning the gender of their children. Through the discourse of the online community, the sufferers define and redefine what it means to have GD, and have created normative boundaries around the label, extending deviancy; for example, to sufferers who actively seek abortion if they are carrying a fetus of the "wrong" gender.

This collective medicalization of a social behaviour among individuals in the GD online communities relays the significance of the ability of individuals to access support and health information on the Internet. In regard to the dissemination of health information, this research extends the understanding that apart from the factual health information, sufferers are able to connect with each other online and are able to compare

123 their experiences which they have in the real world. This possibility to connect online with similar others has changed the manner by which some illness sufferers experience illness, as social isolation is no longer as prominent a factor in the illness experience. The social isolation which is often experienced by chronic illness sufferers acts as a barrier which impedes upon the sufferers' abilities to socialize. Through participating in HRSGs, this barrier becomes permeable as the Internet acts as a forum for similar others to connect. In consideration of the medicalization process, this research lends focus to the function of HRSGs in the decentralization of the medicalization of social behaviours from the medical professionals and medical authority towards patient-to-patient communication based within the Internet, lending focus to the increase in the medicalization of behaviours.

This increase in information sharing through CMC permits individuals to legitimize their experiences in the absence of medical authority, to locate similar others, and to join together to promote their affliction and to construct their experiences in a manner which will best suit their needs. Rather than depending upon the medical system to fit their experiences into a pre-existing medical framework, sufferers are able to make connections through CMC and to develop an understanding that the experiences which they are having in the real world are shared by others. Rather than being one deviating from a social norm, these individuals are able to locate a community and to normalize their deviant social behaviour.

Limitations of the Research

This research, which is based in qualitative Internet methodology, is met with limitations in regard to the communication process, as challenges are present in

124 researching within the context of the Internet. Most notably, the absence of a physical

presence which includes body language and non-verbal cues presents a challenge to the

researcher who is required to relate information and to derive meaning through text based

communication. Emotionality is understood to be difficult to assess through CMC, as

visual and audible details such as facial expressions and laughing provide significant

insight concerning the meaning of human behaviour. While Internet communication

conventions do lend focus to emotionality, they are not considered to be a substitute for

real life interactions. In consideration of this limitation, the direct sentiments in which the

discourse concerning GD was conveyed was not able to be assessed relative to face-to-

face interactions. The meaning of the content had to be interpreted through the use of text

based communication conventions, rather than by the assessment of body language and

verbal cues, extending the possibility of misinterpreting the meaning.

The displacement of time and space in e-mail based interviews is considered to be

a significant challenge to the process, as respondents are not committed to responding

promptly; as such, it is possible for the interview participants to lose interest in the

interview, or to experience unexpected disruptions of which the researcher would not be

aware. Interestingly, the lack of a response to an e-mail is considered to mean the end of

the relationship; therefore, in the context of e-mail interviews, it is impossible to know

whether a respondent has lost interest in the interview or has experienced a disruption in

his/her life. This displacement of time and space reflects as a limitation of the e-mail

interviews with the GD sufferers, since a number of the respondents did vary in their response times, and in certain cases, while it had been assumed that the interviewee was

125 no longer interested, in actuality, the respondent had experienced an exceptionally busy schedule and continued to participate after an extended period of time.

Throughout the exchange of the e-mail interview, a limitation was present in regard to the continuity and flow of the dialogue due to the asynchronous nature of the interview. The respondents in the GD e-mail interviews often wrote responses which mirrored the framework of an illness narrative rather than as part of an on-going dialogue. Due to the quantity of content which was being written in response to a question, combined with the length of time between responses, it became difficult to probe for more information regarding a specific point which the interviewee had mentioned, as the interviewee was no longer thinking along the same line. Conversely, face-to-face interviews would have lent continuity to the discourse and would have permitted the opportunity to engage in further questioning concerning the respondent's experiences and to clarify points in the discourse.

Implications for Future Research

This research, which concerned the construction of GD, focused on women who identify themselves as having GD and who represent one member of their family unit in the real world; as such, future research could lend focus to the experiences of the sufferer's husband/partner and her children in regard to how the sufferer's GD affects her family members. Within the GD online community, the sufferers discuss their relationships with their husbands/partners and their children, which include discussions of having another child specifically to alleviate GD; therefore, in order to understand the impact that GD has on the family, it would be necessary to conduct research with the husband/partner and children as the participants.

126 The potential impact of the implications, which are associated with gender selection, has been discussed in relation to the child's right to an open future, suggesting that if the parents maintain a preconceived gender role for their children that the children may not have the freedom to develop their own personalities and interests without the admonition of their parents; therefore, future research could extend the possibility of investigating the dynamics of the parent/child relationship when the mother has experienced GD, and has finally had the gender of her dreams. This would be significantly important, as the theories which are presently being applied to the potential social impact of gender selection are associated with traditional forms of sex selection in contexts in which there is a preference for a male, and in which females are subjected to neglect and abuse, therefore, highlighting the importance of developing an understanding of why individuals are accessing gender selection in North American and how they will negotiate the relationship with their children.

Situated within the broad context of the global impact of advances in NRTs and the resulting social consequences in regard to the individual consumer and the medical profession, future research concerning GD could extend consideration of the relationship between the patient and the doctor in the context of using a medical resource for a commercialized, non-medical application. The nature of the doctor's work role could be examined in regard to its changing nature, the changes in the doctor-patient relationship and the extension of medical authority when a medical resource is marketed on the

Internet and the patient becomes the consumer.

127 Conclusion

NRTs have long evoked speculation concerning the state of society if and when the technology advanced to a point at which the process of pre-determining the sex of the fetus became not only accurate, but easily accessible. Interestingly, possibility has become reality as gender selection has entered the Internet market, alerting society to the fact that social policy concerning the use of NRTs is lagging far behind the rapid technological advancements. The Internet, while acting as the environment in which gender selection is marketed, houses communities of individuals who share similar experiences in the real world and who are able to connect in ways which, until the recent past, has not been possible. This ability to communicate with others and to construct experiences as being legitimate is powerful in the construction of illness experience, since the medicalization of social problems and the management of the illness experience continues to evolve.

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142 Appendix

List of Acronyms

AA Alcoholics Anonymous

AI Artificial Insemination

AHRA Assisted Human Reproduction Act

AHRAC Assisted Human Reproduction Agency of Canada

ART Assisted Reproductive Technology

BBS Bulletin Board System

CMC Computer Mediated Communication

CVS Chorionic Villus Sampling

HRSG Health Related Support Group

GD Gender Disappointment

IVF In-Vitro Fertilization

NRT New Reproductive Technology

OT Off Topic

PGD Pre-implantation Genetic Diagnosis

PND PreNatal Diagnosis

SSS Social Sex Selection

USDA United States Department of Agriculture

143