Better Prenatal Testing Does Not Mean More Abortion

Although prenatal testing did not exist in the form it does today, the desire to identify physical and intellectual fetal abnormalities contributed to the eventual legalization of abortion state by state and on a federal level.

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In more recent years, with the advent of ultrasound technology, amniocentesis, and prenatal screening tests, more and more women have been able to identify fetuses with atypical characteristics in utero. Ultrasound technology emerged in the 1960s, though it was not used in a routine manner until the 1980s. Blood tests that offered a probability of a fetus having Down syndrome or other conditions emerged in the late 1980s, and again, the link between these tests and abortion continued. In the past, definitive diagnosis of chromosomal conditions could only come via chorionic villa sampling (CVS) or amniocentesis, both procedures that pose some risk to the life of the fetus. As a result, doctors and women always considered the risk of miscarriage or harm to the fetus, and many women who didn't want the option of abortion declined the tests.

Now women can choose a noninvasive blood test, which researchers claim can diagnose Down syndrome and other trisomies during the first trimester of pregnancy with 99 percent accuracy. (Doctors still recommend a follow up diagnostic test, which is 99.99 percent accurate.) 

As Erika Check Hayden wrote for Nature, "Observers expect the advantages of the non-invasive tests to expand the pool of women who opt for prenatal genetic screening in the United States each year from fewer than 100,000 to as many as 3 million." These new tests bring up the same ethical questions that have existed around abortion and genetic conditions for years, and yet they do so in an unprecedented way because the test is both safe and available early in pregnancy.

Currently somewhere between 70 and 85 percent of women in the United States with a prenatal diagnosis of Down syndrome choose abortion. But even though prenatal testing has advanced in accuracy and availability, the number of women who aborted used to be higher. Perhaps more women are using prenatal testing for the purpose of preparation -- medically and emotionally -- rather than as a route towards termination.

The same liberal social forces that led to the legalization of abortion forty years ago have also led to social progress for many individuals with disabilities, including those with Down syndrome. Due to legislation such as the Americans with Disabilities Act (ADA) and Individuals with Disabilities Education Act (IDEA, and its predecessor, The Education for All Handicapped Children Act), children and adults with disabilities have rights they never before could have imagined. Medical advances have also led to significant gains for individuals with Down syndrome. In the past thirty years, their life expectancy has doubled. With Early Intervention and inclusion in schools and other social settings, individuals with Down syndrome have also made cognitive gains that have led to greater independence as adults.

Certainly people with Down syndrome and other genetic conditions still suffer social stigma and physical difficulties. But life for a person with Down syndrome has never been more promising than it is today. Knowing the personal reality now that I didn't seven years ago -- of a daughter who loves reading, who squabbles with her little brother and tries to take care of her little sister, and has braces on her ankles and glasses on her nose and loves to dance -- I've come to see that my fears were largely unfounded.

Recent demand has led to market gains for biotechnology companies like Sequenom, which developed the blood test to detect Down's syndrome, and most insurers cover prenatal screening and subsequent diagnostic tests. So it is in the midst of these historical, economic, and medical forces that parents must consider the proper place for these tests in offering the information they need to care for their children.

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