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Will Better Prenatal Screening Mean More Abortions?

There's a front-pager in today's WaPo about a new generation of prenatal screening for Down syndrome that promises to make existing methods obsolete. Currently, initial Down's tests consist of blood work combined with ultrasounds. If the results suggest an irregularity, women can opt for an amniocentesis or chorionic villus sampling (CVS). But amnios, the most common and definitive test, increase the risk of miscarriage and are not performed until the second trimester, when, as the Post notes, abortions are both harder to obtain and more traumatic. Thus far, the newer tests can be conducted earlier and appear more accurate--less prone both to missing cases of Down's and to returning anxiety-inducing false positives. If these tests, still in development, indeed turn out to be safer and more effective than current ones, it will great news for parents, right?

Except. Some pro-lifers and advocates for the disabled fear that diagnosing Down syndrome earlier and more easily will result in more abortions. On one level, this makes sense: The numbers suggest that, even with current screening methods, far fewer Down's babies are being born than one would expect. So if you're mission is to reduce abortions, I can see being less-than-thrilled about the arrival of better tests. That said, as is often the case in abortion-related debates, the objections tend to sound both condescending and coercive.


"We have a nation of physicians who are unprepared for explaining a diagnosis of Down syndrome," said Brian Skotko, a physician at Children's Hospital in Boston who works with the National Down Syndrome Society. "Many overemphasize the negative consequences or outright urge women to terminate their pregnancies."

This may be true. But in this case, I'm not sure what ill-informed physicians have to do with the price of whiskey in Ireland. It's not as though women aren't currently getting Down's screenings. It's just that these screenings can be imprecise or inaccurate and don't give women hard answers until relatively late in the game. (And that's not even taking into consideration all the women whose worlds are rocked by false positives.) Most women carrying a Down's baby will still have to talk with their doctors about the challenges, regardless of whether new tests come to market. So what we're really talking about here is whether we're going to give an expectant mom information about her baby's condition early in the game or have her wait until she is likely to have a harder time--legally, medically and psychologically--ending her pregnancy. If you want to launch a national campaign to educate doctor's, great. But don't blame newfangled testing for this problem. 

Of course, further remarks by Dr. Skotko, who has a sister with Down syndrome, suggest he has broader, arguably more high-minded concerns than keeping women well-informed:

"Every day my sister teaches me lots of life lessons--to laugh when others are mocking me, to keep on trying when obstacles are thrown my way," he said. "If there were a world with fewer people with Down syndrome, I think the world would miss all these important lessons."

Now we're getting somewhere: The anti-eugenics argument. The concern that once we start picking and choosing which babies are worth keeping, we will streak headlong down that slippery slope into a Mengelesque nightmare. I'm sympathetic to this fear. Hell, anyone who has noticed China's ugly embrace of gender-based abortions should worry about this sort of thing. 

But when it comes to Down's screening, the horse is long gone from the barn. These tests are already widespread and, for that matter, increasingly common as insurance companies lower the age for which they will pay for such screening. (The brutal financial calculus of the past few years seems to be that it's more cost-effective to pay for many superfluous screenings in younger women than to pay for the care of a few extra Down's babies.) The question is how much agony we want to put expectant mothers through on the way to making their decisions.

Even if you're one of those people who suspects that many gals today treat abortion with no more gravity than a bikini wax, in this instance we're talking specifically about a subset of pregnant women who, until their Down's diagnosis, were intent upon becoming mommies. And, in any event, are we really in favor of a medical system that approaches these women's dilemma from the perspective of: Well, to avoid having all these distraught, ill-informed women panic and kill all their Down's babies we should make sure they don't find out about the diagnosis until procuring an abortion will be be complicated and excruciating enough to dissuade many of them.

I have no doubt that some people will answer "yes" to this question. But let's make sure everyone is upfront about what we're advocating here.

--Michelle Cottle