Eugenics Reborn: How Prenatal Testing Targets Children With Down Syndrome  (Part 1)

Today, the bloody results of selective abortion are horrifying. For example, in Iceland, women who receive a prenatal diagnosis of Down syndrome abort their children almost 100 percent of the time.[1] In Denmark, the rate exceeds 95 percent. In the United States, 18 percent of all pregnancies end in abortion, but when there is a Down syndrome diagnosis, this number jumps to sixty to ninety percent.^[2] Rather than protecting and cherishing the lives of people with disabilities, the world has sought to mark them in the womb to destroy them.

This essay is written to expose the silent genocide that is being carried out against children with Down syndrome. The goal is to galvanize the church to contend for the rights of the unborn and persistently labor to criminalize abortion. With this aim, part one of this essay details how prenatal screening works, along with societal and individual pressures that groom a woman to murder her child. Part two will give a biblical response.

From Sterilization to Prenatal Testing

How we live is determined by what story we believe we are in. One pervasive alternative story to the true story of reality—creation, fall, redemption, consummation—is Darwin’s theory of evolution. According to a naturalistic view of man, he is a product of his genes, which is the most important indicator of who he is and what he can do. If man’s great problem is not sin, but his genetic makeup, one can better understand how eugenics has been presented as the salvific answer.

Eugenics can be defined as “techniques and policies that allow for the reproduction of people with ‘desired’ attributes and reduce the reproduction of those with ‘undesired’ attributes.”^[3] This was once a common project to “improve” humanity. In the twentieth century, America had sterilization programs in thirty-two states and sterilized as many as 70,000 Americans. Targets included the disabled, minorities, and the poor. Hitler praised this and adopted similar policies in Germany after taking power. After World War II, eugenics did not go away, but was strategically renamed.^[4] The first prenatal diagnosis of a chromosomal disorder occurred in 1967, and a year later the first abortion due to a Down syndrome diagnosis was reported.^[5] Today, prenatal screening has risen in prominence to the point of being the assumed thing pregnant women should do. Even many in the church follow suit and are oblivious to the ideological beliefs that undergird these practices. So how does prenatal screening work today?

Inside Modern Prenatal Screening

First, it is crucial to begin with an important distinction between prenatal care and prenatal screening. Prenatal care treats both the mother and baby, and it can include screening for conditions in which there is an ability to provide treatment that helps both patients—whether through addressing vitamin deficiencies or making changes in diet or exercise to help the baby. On the other hand, prenatal screening views the mother as the only patient and screens for conditions or diseases which we do not have the ability to treat. When both the mother and baby are viewed as patients and are tested for conditions that can be treated, there can be great potential for good. One incredible example are surgeries for children with Spina Bifida which can occur in the womb and increase the likelihood of the child walking independently. Tragically, the predominant use of prenatal testing in obstetric medicine has been eugenic.

This is how prenatal screening works. A woman will be offered prenatal screening through a blood test or ultrasound as part of the standard treatment.^[6] Information from the screen is factored together with additional data, like the mother’s age, to assess the probability of the child having Down syndrome. A positive result on a screening only means one has a greater likelihood of having a child with Down syndrome, and is not a definitive diagnosis.^[7] If a woman gets a positive screen, then she will be offered a prenatal test which may be either Chorionic Villus Sampling (CVS) or Amniocentesis.^[8] These tests may be ninety-nine percent accurate; however, being invasive, they do pose a small risk of miscarriage. After a positive diagnosis, a doctor or genetic counselor can explain the mother’s options. More often than not, the “treatment” selected is to murder the child.

Additionally, there have been technological developments such as noninvasive prenatal testing (NIPT tests) and preimplantation genetic testing (PGT) which, unfortunately, intensify the attack on disabled children. NIPT tests are conducted by taking a sample of the mother’s blood which also contains DNA from the child. This is then sent to a lab and analyzed for congenital abnormalities. NIPT tests are a form of prenatal screening and are not a diagnostic test; however, this crucial distinction is often blurred in practice.^[9] Practically, this screen may replace invasive testing and can provide a diagnosis of genetic abnormality.^[10] NIPT can detect Down syndrome with around 99 percent accuracy and can take place earlier than invasive forms of testing.^[11] The abortion industry knows that the earlier in the pregnancy the abortion occurs, the more socially acceptable it is deemed; therefore, these newer tests will likely cause abortions to increase.^[12]

The Myth and Strategy of Neutrality

The tests are not neutral and neither are society’s deep-seated beliefs about people with Down syndrome. The existence of these tests presuppose people with Down syndrome have lives that are less valuable.^[13] Neutrality functions as both myth and strategy. For example, a cousin of Charles Darwin, Francis Galton, coined the term eugenics, and he did not believe that coercion was needed to get people to make the “correct” reproductive choice.^[14] Eugenicists have believed that if you teach people, they will make the “right” decision. For example, Mary Elise Huerter writes that “those that endorse prenatal screening typically offer nondirective genetic counseling, patient autonomy, and personal choice as distinguishing features from that of eugenics.”^[15] This conditions people toward eugenic thinking while absolving them of responsibility. Mary Elise Huerter puts the matter succinctly, “It is difficult to claim neutrality as a guiding ethic for a technology explicitly cultivated to identify and accordingly eliminate those with genetic flaws.”^[16]

The Power of Medical Systems and Societal Pressure

After a basic understanding of how prenatal testing works, it is important to ask why is abortion is the chosen “treatment” the majority of the time. Professional societies of medical professionals like the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG) drive discrimination against children with Down syndrome. In the United States, Canada, and several European countries, professional societies have been a driving force in the widespread propagation of prenatal testing.^[17] In the United States, widespread use of screening was not accepted initially, but this changed after the American Medical Association warned doctors that they may be guilty of medical malpractice if they fail to offer screenings.^[18]

Additionally, in 1983, the American College of Obstetricians and Gynecologists recommended prenatal testing be given to women who would be at least thirty-five years old at their projected due date.^[19] This recommendation was made after two successful lawsuits in which a doctor was charged with medical malpractice for not advising prenatal testing with a patient over the age of thirty-five.^[20] In both lawsuits, the mothers had given birth to children with Down syndrome.^[21] Then, in 2007, the ACOG stated that all women should be offered prenatal screening after realizing most children with Down syndrome are born to mothers under the age of thirty-five and, therefore, were going undetected.^[22] In the instance of genetic abnormalities, these medical professional societies have woefully departed from promoting true medicine.^[23]

Not only do professional societies foster a hostile environment for children with Down syndrome, but the very structure of a country’s medical system can too. One study suggests that health care systems affect people’s decisions on prenatal screening.^[24] The three countries analyzed were England, France, and the Netherlands. In France, a woman is given no informational brochure about prenatal testing prior to her first appointment, yet she is expected to give an immediate answer. Furthermore, the medical practitioner uses language that encourages women to be screened. In England, a pregnant woman receives an information packet prior to her first appointment. Then, at her first appointment, she is expected to make a decision about screening. Medical practitioners do not use language as strong as those in France, but still cast the test in a positive light. Lastly, in the Netherlands, a midwife will give a woman a brochure about screening at her first appointment, asking her to take it and talk through it with her partner before making a decision. The woman is not asked to make a decision at her first appointment. The language used by the medical practitioner communicates to the mother that the tests are available, but not required. Is it any surprise that of these countries, France has the highest abortion rate for fetal anomaly, followed by England, and then the Netherlands? What this displays is that medical systems can condition people toward certain decisions. Language is never neutral.

Another pressure is money. Here are some ways the love of money drives the murder of disabled children. Denmark rolled out prenatal screening in the 1970s for the purpose of saving money and preventing the birth of children with disabilities. They realized that the cost of prenatal screening was less than the cost of putting a disabled child in an institution for the rest of his life, and so they began screening women over the age of thirty-five.^[25] This historical example displays the common belief of viewing a person’s worth strictly in terms of what that person can contribute (or draw from) the economy. When society views the value of a life through the grid of cost-benefit analysis, the weak are endangered.^[26]

Influences At The Individual Level

In the twentieth century the long-standing paternalism of the medical industry was replaced by personal autonomy.^[27] Informed consent is foundational to how medicine is practiced today. According to the American Medical Association’s Code of Ethics, “The process of informed consent occurs when communication between a patient and physician results in the patient’s authorization or agreement to undergo a specific medical intervention.” Additionally they note, “Patients have the right to receive information and ask questions about recommended treatments so that they can make well-considered decisions about care.”^[28]

Dr. Megan Best describes what a truly informed consent process would look like:

Fully informed consent requires a comprehensive explanation of the results at each stage of the screening and diagnosis process. This includes the meaning of genetic risk, the nature of the genetic abnormality diagnosed, the concepts of variation in genotype and phenotype (your genetic makeup versus how those genes are expressed physically), practical information about the impact of chromosomal abnormalities on the life of an affected person, and the opportunity to speak to someone who cares for them. Such information is known to increase the number of parents who are prepared to care for a disabled child. Currently, such information is not routinely given, despite some women voicing an interest in this information.^[29]

However, informed consent in the context of prenatal screening is not a reality. Best notes that consent is often assumed and many women have minimal understanding of what the test means.^[30] Other times, prenatal screening may be included via piggybacking, where it is lumped in with other routine tests a pregnant woman may receive. Ironically, some women will have prenatal screening in the belief that this will help their child.

Another obstacle is the power imbalance. The “choice” is the woman’s; however, if she decides not to be screened, she must decline the recommendation of a medical professional who she is used to receiving advice from.^[31] Furthermore, the fact that the test is a standard practice within the medical system, which is supposed to benefit people, adds another level of fog that can make it more difficult to see through.

Conclusion

Though fog thickly covers our culture, the unfolding of God’s Word gives light. Thus far, we have seen eugenics has been renamed and repackaged. Under the guise of medicine, people with Down syndrome have been targeted. The very existence of prenatal screening teaches others that some children are more desirable than others. Furthermore, when one considers that abortion rates sky rocket when there is a Down syndrome diagnosis, it is clear that test results are weaponized. Prenatal tests are the abortion industry’s eugenic handmaiden and fuel the shedding of innocent blood. In response, the church must reclaim her prophetic voice and speak the light of God’s Word to combat and destroy the darkness of eugenic abortion. Every Christian is needed in this fierce battle. Part two of this essay will seek to help the church respond biblically to this great evil.^[32]

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1. Julian Quinones and Arijeta Lajka, “What Kind of Society Do You Want to Live In?: Inside the Country Where Down Syndrome Is Disappearing,”CBS News, August 14, 2017. ↑
2. “Down Syndrome and Social Capital: Assessing the Costs of Selective Abortion,” Joint Economic Committee Republicans, SCP Report No. 2–22, March 2022. ↑
3. Mary Elise Huerter, “Prenatal Screening: Quality Control and the Genetics Gateway” (MA thesis, Indiana University-Purdue University Indianapolis, 2007), 53. ↑
4. Huerter, “Prenatal Screening: Quality Control and the Genetics Gateway,” 20; Gareth M. Thomas and Barbara Katz Rothman, “Keeping the Backdoor to Eugenics Ajar?: Disability and the Future of Prenatal Screening,” AMA Journal of Ethics 18, no. 4 (April 2016): 406–415. ↑
5. Huerter, “Prenatal Screening: Quality Control and the Genetics Gateway,” 22. ↑
6. Jen Jacob and Mardra Sikora, The Parent’s Guide To Down Syndrome(Stoughton, MA: Adams Media, 2016), 33. ↑
7. Jacob and Sikora, The Parent’s Guide To Down Syndrome, 34. ↑
8. Jacob and Sikora, The Parent’s Guide To Down Syndrome, 37. ↑
9. Ethan Davis, “A Discerning Look at Prenatal Testing,” Intersections, August 20, 2021. ↑
10. David A. Prentice, “Written Testimony of David A. Prentice, Ph.D. in Support of Prohibiting Prenatal Discrimination,” submitted to the Arizona House Judiciary Committee, March 17, 2021; Megan Best, “The Dilemma of Prenatal Screening,” Ethics & Medicine 34, no. 2 (Summer 2018): 114. ↑
11. Prentice, “Written Testimony of David A. Prentice, Ph.D. in Support of Prohibiting Prenatal Discrimination.” ↑
12. Davis, “A Discerning Look at Prenatal Testing.” ↑
13. Gareth M. Thomas and Barbara Katz Rothman, “Keeping the Backdoor to Eugenics Ajar?: Disability and the Future of Prenatal Screening,”AMA Journal of Ethics18, no. 4 (April 2016): 406–415. ↑
14. Huerter, “Prenatal Screening: Quality Control and the Genetics Gateway,” 23. ↑
15. Huerter, “Prenatal Screening: Quality Control and the Genetics Gateway,” 43. ↑
16. Huerter, “Prenatal Screening: Quality Control and the Genetics Gateway,” 43. ↑
17. Carine Vassy, Sophia Rosman, and Bénédicte Rousseau, “From Policy Making to Service Use: Down’s Syndrome Antenatal Screening in England, France and the Netherlands,” Social Science & Medicine 106 (April 2014): 67–74. ↑
18. Huerter, “Prenatal Screening: Quality Control and the Genetics Gateway,” 25. ↑
19. June C. Carroll et al., “Maternal Age-Based Prenatal Screening for Chromosomal Disorders: Attitudes of Women and Health Care Providers Toward Changes,” Canadian Family Physician 59, no. 1 (January 2013): 39–41. ↑
20. Mary O’Callaghan, Teaching Human Dignity: Prenatal Diagnosis & Disability Selective Abortion: An Expert Guide (Notre Dame, IN: McGrath Institute for Church Life, University of Notre Dame, 2019), 6. ↑
21. O’Callaghan, Teaching Human Dignity, 6. ↑
22. O’Callaghan, Teaching Human Dignity, 6. ↑
23. O’Callaghan, Teaching Human Dignity, 7. ↑
24. Vassy et al., “From Policy Making to Service Use: Down’s Syndrome Antenatal Screening in England, France and the Netherlands,” 67–74. ↑
25. Sarah Zhang, “The Last Children of Down Syndrome,”The Atlantic, December 2020. ↑
26. Lucy Burke, “Hostile Environments? Down’s Syndrome and Genetic Screening in Contemporary Culture,” Medical Humanities 47, no. 2 (June 2021): 193–200. ↑
27. Huerter, “Prenatal Screening: Quality Control and the Genetics Gateway,” 22. ↑
28. American Medical Association, Code of Ethics, 2.1.1, Informed Consent. ↑
29. Best, “The Dilemma of Prenatal Screening,” 116. ↑
30. Best, “The Dilemma of Prenatal Screening,” 113–16. ↑
31. Huerter, “Prenatal Screening: Quality Control and the Genetics Gateway,” 42–44. ↑
32. Thanks to Adam Lang and MaryBeth Berry for their help with many improvements throughout the essay. ↑