From Iran to Latin America: must prenatal diagnosis necessarily be provided with abortion for congenital abnormalities?

Prenatal diagnosis and antenatal screening (PND/S) refer to various methods to identify before birth or conception the genetic conditions known to affect the neonate. In their recent article, Angela Ballantyne and colleagues examine a disturbing practice taken place in the Latin American region, according to which PND/S are offered despite legal prohibitions to terminate pregnancy in case of severe genetic abnormalities. The following article examines the question of whether it is ethical to introduce and provide prenatal diagnosis and antenatal screening in areas where termination of pregnancy for congenital abnormalities is legally prohibited. The article further explores the various reasons according to which people seek prenatal genetic information and the factors affecting their decision to continue pregnancy despite congenital abnormalities. It concludes that with a proper emotional support and cultural sensitivity it is ethically justifiable to introduce prenatal diagnostic tests and screening, and that taken as a whole, the benefits of such an introduction outweigh the general harm already associated with restrictive abortion laws. Resting on a disputed assumption that these services are offered for every woman upon request (Penchaszadeh and Beiguelman 1998; Rivera-Lopez 2002, 16), it is argued that the introduction of such tests appears to harm poor women of that region by forcing them to carry a fetus with congenital conditions to full term (Ballantyne et al. 2009). As it was previously illuminated in the context of Sri Lanka (Simpson 2007), the discussion of such a practice reflects how essential it is to evaluate technology in its action and to regard it as one actor among many in changing and coordinating clinical and organizational aspects of health care (Latour 1987). It also sheds light on the false assumption that detection of disease is and should be separable from designing a treatment or a medical course for such a disease, including the termination of pregnancy, thereby freeing the first from pragmatic considerations such as social factors, values, culture, religion and so forth (Mol and Elsman 1995). Although the authors’ ambition seems worthy of consideration their only practical conclusions are to argue for a “greater attention” (Ballantyne et al. 2009, 48) to such a practice and encourage geneticists, physicians and policy makers to “represent the plight of [these] poor women”