Gender disappointment

“Is it a boy or a girl!?” 

Some parents experience sadness, distress, and feelings of shame when their baby’s gender does not match their preferences and expectations. In this episode, Lynsey and Chrissy discuss the individual, social, and cultural aspects of gender preference and gender disappointment. 

If you would like to learn more about this topic, you can read Chrissy’s open-access paper here: ‘It's a girl!’ Is gender disappointment a mental health or sociocultural issue? | BJPsych Bulletin

If you or someone you know is struggling with mental health difficulties, there is lots of help available. You can contact your primary care provider in the first instance, or if you are based in the UK the NHS perinatal mental health website will help you to find support in your local area.

Transcript

[00:00:00] Lynsey: Hi, welcome to the podcast. This is beyond baby blues, our podcast about maternal mental health. I'm Dr. Lynsey McAlpine. I'm a trainee psychiatrist based in east London.

[00:00:21] Chrissy: And I'm Dr Chrissy Jayarajah. I'm a consultant perinatal psychiatrist and clinical lead working in London 

[00:00:29] Lynsey: So Chrissy for today's episode, we're going to be talking about a phenomenon called gender disappointment, which is this phenomenon where expectant parents have all these preferences and hopes and expectations about the gender of their unborn child. But when they find out the gender of the child, it doesn't match up with their expectations. And they therefore experience lots of distress and disappointment. And I chose this topic because you actually recently published a paper about gender disappointment, which was a fantastic read. I really enjoyed it. And I've been eagerly waiting for an opportunity to pick your brains about it. 

So I thought this episode would be a good chance to talk through the subject in a bit more depth. 

But before we get into the discussion, I thought it might be helpful to include a word of explanation about what we mean when we're talking about sex and gender, so from reading your paper, I gathered the, what we're going to be talking about today is the biological sex that's assigned at birth based on the anatomical appearance of the baby. When it's born. Now, obviously gender is much more complex than that. And a sexist assigned at birth may not match up, but the gender identity that emerges when that child grows up and becomes able to express it. So in gender identity, But for the purposes of today's episode, we're focusing on the parent's experience of finding out the biological sex that's assigned at birth. 

So I'm curious, what was it that drew you to this subject in the first place?

[00:01:47] Chrissy: Yeah, so, I mean, from a personal perspective Lynsey , so I'm a mother of two little girls, uh, absolutely adore them and, and we love having our little girls, but I was really taken aback by the, the kind of comments that I got about having two girls, you know, things like, Oh, next time, don't worry, you can try for a boy and, Oh, how disappointing, you know, that you're having another girl and, just a lot of comments about gender and having a boy as if our family isn't complete without having a boy. 

And then the more I started talking to other mums about this, other friends, even work colleagues, and within my cultural group as a South Asian woman, I realized that this is quite a common situation and a common thing that people comment about having a boy or having a girl and particularly about wanting boys if you have lots of girls.

So yeah, I was quite drawn and I wanted to do a bit more research around the literature around it

[00:02:47] Lynsey: Yeah, it's interesting. It's in to. And it's so widespread. I mean, as you know, Chrissy, I'm one of six girls. I have five younger sisters. And I don't think it mattered to my parents at all, really, but it was something that other people felt entitled to comment on. So throughout my childhood, I was always being asked about whether my parents were disappointed about having so many girls or whether they were hoping for a boy next time. 

And I imagine that's part of the reason that your paper really resonated with me, because it was a question that came up a lot during my formative years. 

And it's so striking that people have all these preconceived ideas about what a family should look like. And they make these comments without really considering the impact on the parents and the children that they're saying it to.

[00:03:29] Chrissy: Yeah, absolutely. Absolutely. Absolutely

[00:03:30] Lynsey: So in preparation for this episode, as well as rereading your paper, I had to look online and I was really surprised to find that there's not really a lot of academic literature out there on the subject of gender preference and gender disappointment. Did you have a similar experience when you were researching your paper?

[00:03:46] Chrissy: Yeah, this was really interesting, Lynsey. So when you look at the term gender disappointment, it's quite common in terms of sort of unofficial literature, should I say, so like blogs, forums, online forums, even podcasts. Uh, you'll find quite a lot of articles around gender disappointment and, particularly in Western cultures, it's around gender balance. So, the idea of having one of each, so having a boy and having a girl. 

However, in the published scientific literature, the, if you type in the word, son preference, or the preference to having a son over a daughter, there are hundreds of papers around this, and it's a particular phenomenon in other cultures, such as in Southeast Asia, Africa, and Arab communities, uh, and It really blew my mind, actually, the amount of literature there is about, about son preference and the social and political elements to it as well.

[00:04:42] Lynsey: Yeah, I guess it's important to point out that lots of people don't really have any preference about what gender their baby is, or they might have a preference, but at the end of the day, they don't really mind as long as their baby's happy and healthy. 

But for those who do have a preference, there are lots of different factors at play. Uh, an individual level, but also a wider, societal and cultural level. So let's have a think about some of these different factors. 

[00:05:04] Chrissy: Firstly, just to say that it's not as simple as East versus West, as you can imagine, it's kind of a global phenomenon. But there are certainly trends that we see, not just in the Southeast Asian subcontinent, but also from families who have cultural ties or family ties to that region.

In terms of understanding the issues around gender disappointment there, it's really about this preference to have a son rather than a daughter. This could be because there's a financial, incentive for sons they may have more access to education, more, uh, access to getting a paid job and starting a business or carrying the family business forward whereas with women there's emphasis on marriage and actually having money for a dowry 

[00:05:50] Lynsey: yeah. And in patrilineal societies. So, um, societies where the family name and inheritance is passed down through the male line. Um, there's also this idea that having a son means the continuation of the family line and the family name. So there's a lot of structural reasons why there might be this sort of societal preference and the societal drive for having sons.

 Another thing that I found really interesting when I was reading your paper was the research looking at mothers in Southeast Asian cultures who described this perceived lack of emotional and practical support when someone has a baby girl compared with a boy, which would mean that their experience of parenting and the support networks available to them would be fundamentally very different depending on the gender of the child. And that really stood out to me because as perinatal psychiatrists, we know that people's support networks have a massive influence on their mental health, especially, um, during the perinatal period.

And then the other thing that stood out to me was the qualitative research, the explored women's subjective experiences as new mothers. Um, one of the themes that came up in this particular paper was the, in some cases, women felt strong feelings of shame or felt like they were being judged and pitied by others when they had the daughter. And I wondered how that would affect their self image and their perception of themselves as a parent and how that in turn might influence their parenting. experience. 

[00:07:10] Chrissy: Yeah, absolutely. I mean, I found that quite striking too when I was going through the literature. Interestingly, in Western cultures, there is a noticeable daughter. Preference. And it comes from the belief that girls are more empathetic, more caring, and more emotionally aware, and nurturing, and they tend to be closer to the family and have those family values.

Uh, whereas boys in comparison are seen to be more independent, less emotionally dependent on their family, and it's more acceptable for boys to quote unquote fly the nest.

But what I found really interesting in the research is that the same qualities, that are seen as desirable in some cultures, are less valued in others. So what it highlights is that even if you have the same gender stereotypes, it can lead to having different preferences, depending on your cultural background 

[00:08:05] Lynsey: And that brings us to my next point, which is, um, so in your paper, you talk about the tendency to have a preference for sons in a number of Asian and Arab cultures. And the literature suggests that those preferences are also present in diaspora communities. Um, but then in Western cultures, the literature suggests that there are these two different trends. 

So one is a tendency to have a preference for daughters. Um, for all of the reasons that you just described. But the other is this desire to have one of each and to have gender balance within the family. And I gathered the, a lot of this is driven by the idea that parenting a son is fundamentally a very different experience to parenting a daughter and there's this desire to have the experience of both.

And I suppose that brings us to the idea of gender essentialism, which is this idea that specific behaviors should be attributed to specific genders. It's an idea that's been critiqued and rejected by most branches of contemporary feminism, but we can still see traces of it in lots of different aspects of life, including here.

[00:09:05] Chrissy: Yeah, so gender essentialism is really thinking about the stereotypes that we have, uh, around gender. Um, so for example, thinking that if you're going to have a girl, they're going to be dressed in pink and going to ballet classes, whereas if you're having a boy, everything's going to be blue and it's all going to be about football and racing cars.

So, There's this idea that when we find out if we're having a boy or a girl, our brain sort of suddenly goes to the stereotypes of having a boy or a girl. Um, and thus the disappointment comes because you feel if you're having two boys, for example, it's going to be all about blue and football, etc.

Whereas we know in reality, obviously, it doesn't matter, you know, girls can play football and wear blue, and equally boys can dance and wear pink. But the idea of gender essentialism is when we're become kind of hooked on the stereotypical gender norms and ideals

 I'm sure many of the listeners, um, to our podcast today realise that actually , every child and every person is different and they can have different personality structures, different interests, etc. And just because you've got two girls, for example, doesn't mean they're both going to be identical 

[00:10:20] Lynsey: yeah, for sure. 

So we've talked about some of the cultural factors that might influence someone's preference. But as you say, Chrissy, the world's a lot more complex and a lot more multicultural than all of that. And I think it's probably a bit reductive to just break it down to Eastern and Western cultural influences.

[00:10:36] Chrissy: I totally agree with you, Lynsey, and I think, you know, we've talked a bit about sort of the Western world and Eastern world or whatever. But, as you said, in reality we live in a very multicultural society. I think I wrote in the paper that in London alone there are over two hundred and fifty different languages that are spoken, um, and even though we may be born and brought up in a certain culture, we do carry a lot of the cultural and society values around gender, around families

[00:11:04] Lynsey: Yes. And then in addition to this melting pot of different societal and cultural values, there's also individual factors at play too. So for example, I spend a lot of my time in clinic talking to people about their thoughts and their feelings about becoming a parent. And one of the most salient things that keeps coming up is that when people become parents themselves, it leads them to start reflecting on their own upbringing and their experience of being parented. And I think that can bring up a lot of thoughts about their own beliefs, about gender and family and what that means for them. 

And I do wonder how, how that influences people's feelings about the gender of their baby. 

[00:11:40] Chrissy: Yeah, absolutely. And you know, it's really, it's really important because gender disappointment can be the tip of the iceberg, um, for other things that are going on and. You asked me earlier, you know, why did I get interested in it? One, one is obviously my own personal experience of having girls.

But the second was that I was starting to see this gender disappointment coming through the perinatal clinic in the NHS. . So I started to think about it in terms of you know, not as a condition, but how it impacts in terms of someone's mental health.

Um, I can think of situations where patients have had particular preferences that's influenced by their past experiences. So for example, One that springs to mind is if someone was, um, sexually assaulted as a child, they might be fearful about having a daughter going through a similar experience to what they went through. So hence having a preference for a son in that instance.

[00:12:37] Lynsey: Yeah. And so I suppose when someone's expressing really intense feelings of gender disappointment, it is worth sort of sensitively delving into what's driving that and trying to understand where it's coming from. 

So another thing that I wanted to ask you about Chrissy. Um, so we can't talk about gender disappointment without talking about this growing trend of elaborate gender reveal parties on, on social media. What's your take on that?

[00:13:02] Chrissy: Yeah, I think, I think this is adding to the feeling of parenting perfectionism. You know, you've got this perfect mom, perfect dad, perfect gender balance family, one of each. But it's also this idea about, about control, isn't it? I think gender reveal parties and knowing the gender provides some sense of. control over what is essentially a very uncertain situation, which is pregnancy and birth.

[00:13:30] Lynsey: Yeah, I think there's something about the massive expectations that can be built up around a very public gender reveal which can set people up for disappointment.

[00:13:39] Chrissy: Yeah, and I think, you know, gender reveal parties, which are fun and you know, there's nothing, I have nothing against them. But it, they do sort of promote the gender stereotype and, you know, I remember for my own girls, I didn't reveal the gender for the purpose that I didn't want to have a whole bunch of pink things. You know, that's a minor point, but it sort of draws again on this idea around gender and what we believe about gender and, filling into the stereotype as it were.

[00:14:10] Lynsey: Yeah, that makes sense. 

[00:14:11] Chrissy: Um I think it, Lynsey, the broader point to be made about the impact of social media generally. This really intimate view of family life and how somebody parents, but often it's not a realistic view. As we know, it kind of carries this filter. It's all the highlighted reels of the good bits. And it comes back to the idea of , something I'm slightly obsessed about, which is parenting perfectionism.

Um, you know, and when I think about perfectionism, I also think about the other side to it. You know, there's these intense feelings of failure and shame that people can feel where they can't achieve perfection. Um, and I know that in some of my clinics, I've heard women talk about feeling shame and feeling pitied even by other people because they've not had the gender that they were hoping for.

[00:14:58] Lynsey: Yeah. And you make this really interesting point about how through social media, we're all experiencing parenthood and mothering through the virtual gaze of others. Um, which of course can be a positive thing. It can really help people to develop a sense of community and support. It can help people to develop their new identity as a parent, and it can affirm that identity. 

But the flip side to that is the social media. She was this very carefully curated and filtered portrayal of parenthood, which is not necessarily realistic. And I suppose the danger is that it can spark insecurities and contribute to those feelings of not being a good enough parents and not having that perfect family.

[00:15:36] Chrissy: It's absolutely fascinating because we, essentially, we don't have any control, do we, over the gender? But yet, not having the quote unquote right gender can lead to these really intense and upsetting feelings.

[00:15:50] Lynsey: So my, my next question for you is, well, what does this mean for our clinical practice? I always worry that we go too far in medicalizing, things that are part of a spectrum of normal experiences. At what point does this become an issue that we need to be thinking about as perinatal psychiatrists?

[00:16:07] Chrissy: Mean, I think it's such a good debate, right? when I started writing the paper, I must admit, I was very biased myself. I was thinking, you know, this is not a diagnosable mental health condition. There's no ICD 10 diagnosis. Um, so, I was thinking, is this even real, you know, , what is this that we're seeing?

 But what I did realize, though, was that, As I said before, it could be the sign of something else going on with the mother and with the family 

[00:16:40] Lynsey: yeah. And although it's not a diagnosable mental illness in and of itself. Um, one of the things that you've wrote by was trying to understand it as, as a type of grief reaction. So going through different Stages of grief and mourning. the loss of something that they never got to have. And I thought that was a really interesting way of conceptualizing and understanding the experience that might resonate with some people that have experienced it.

 And I know I go on about this a lot, but, um, it is important to remember that mental illness is caused by a really complex interplay of different factors. So biological and psychological and social and even wider societal structural factors. So we can't just look at a cluster of symptoms in isolation. We have to understand the whole person. And in some cases that might include exploring their expectations and their concerns about the gender of their baby. And what that means for them. And that could help us to formulate a really holistic view of the person and the problems that they're experiencing and give us some clues by, um, any psychiatric issues that might be emerging.

[00:17:41] Chrissy: Yeah, I think you're absolutely right, Lynsey, in terms of could there be an underlying medical condition going on a psychiatric issue? So, for example, you know, early phases of depression or anxiety that are showing up also around experience of bonding and attachment. Um, In most cases that I've seen, even if there is some gender disappointment during the pregnancy and some difficulties making a bond, um, during that time, once the baby's born actually, it sort of cures itself, as it were, and when they see they've got a healthy baby the disappointment fades.

However, there is a small group of women that I worry about where the gender disappointment continues even after the birth, and how that can affect the bond and attachment between the parent and the child, not just in the immediate term, but in the long term, you know, if you're feeling that way about your child, how is that going to affect their future self esteem if they felt, feel a disappointment, as it were.

[00:18:42] Lynsey: Yeah. I wonder if there's any potential impact on the child's emotional and social and cognitive development.

And I suppose that's where perinatal mental health services might come in to start thinking about how to support a mother and support them to develop that bond. Um, for example, through parent infant psychotherapy, through addressing any underlying psychiatric problems. And helping them to kind of think that through.

I suppose the other thing that springs to mind is what we were talking about around societal and cultural expectations and where there's the social support available? In some cases when, when someone has a baby girl, And so I'd also be asking about what their support network looks like and whether they're getting the, um, the love and kindness and support that they need to bring up a child.

[00:19:26] Chrissy: Yeah, absolutely. I mean, it's a double edged sword, so I've always felt that, you know, it's great to have support from family or from, you know, friends and this idea about it taking a village, but as long as your village is a healthy one, at that, you know, that I've seen where there are families who on the surface have a lot of support from relatives and in laws, etc.

But actually, when you scratch beneath that surface, those people in their life might be quite highly critical, quite judgmental of their parenting styles, or even be the, the people saying, Oh, you should try for a boy or you should try for a girl, etc. And kind of planting those ideas into their mind and bringing those traditionalist ideas around gender stereotypes. 

[00:20:09] Lynsey: Yeah. so just some final thoughts before we wrap up this episode. I know that a lot of people will have a preference for the gender of their child. I think it's pretty normal to speculate and to wonder and feel excited about the new child that's going to arrive. And I don't think that that necessarily makes you a bad person to have a preference. And in cases where people feel disappointed when they find out the gender of their child. And my experience for the vast majority, any disappointment that they feel usually dissipates. And that disappointment goes away completely when they meet their new baby. But if there is something that's troubling, you, you. You know, if you're struggling or if you're worried about your bond with your baby, there is a lot of support available and it's perfectly reasonable to speak to your GP to ask for help.

[00:20:56] Chrissy: well that brings us to the end of this episode. Thanks everyone for listening. You can check out the episode description for links to the resources for this episode, including the paper that I wrote. As always, thank you to the Royal College of Psychiatrists and the perinatal faculty for their support with this podcast.

And if you would like to hear more about maternal mental health, you can subscribe. and find all of our podcasts on Spotify, Apple Podcasts, or wherever you get your podcasts. See you next time.