Canadian Obstetricians and Gynecologists Recommend Expanded Testing for Down Syndrome
By Gudrun Schultz

The Society of Obstetricians and Gynaecologists of Canada (SOGC) released a recommendation Feb. 5 calling for prenatal screening of all pregnant women, regardless of age, to identify more cases of possible genetic malformations in unborn children.
           
“All pregnant women in Canada, regardless of age, should be offered, through an informed consent process, a prenatal screening test for the most common clinically significant fetal aneuploidies in addition to a second trimester ultrasound for dating, growth, and anomalies,” the guidelines recommend. Current policy is to limit screening to women over 35.
    
Nowhere in the report does the SOGC mention increased abortion as a likely outcome of expanded genetic screening. The document refers to the need for adequate “genetic counseling” and uses the vague term “options” to indicate follow-up resources for women given a positive diagnosis of genetic malformation in their baby.
           
In fact, research has shown that a vast majority of women--as many as 85 percent--who are given the diagnosis of Down syndrome after prenatal testing do abort the child.
           
The SOGC defends the new recommendations as a means to avoid unnecessary use of the invasive screening techniques of amniocentesis and chorionic villi sampling, which carry a risk of miscarriage. “Invasive prenatal diagnosis would be limited to women who screen above a set risk cut-off level on non-invasive screening or pregnant women who will be 40 years at time of delivery,” the guidelines state.

The SOGC was more forthcoming about the probable increase in abortion that would follow expanded screening policies when the guidelines were first announced. Speaking to the National Post, executive vice president Dr. Andre Lalonde admitted the policy would lead to more abortions but said it would be “fair” in giving all women the choice to abort for genetic disorders.
           
“Yes, it’s going to lead to more termination, but it’s going to be fair to these women who are 24 who say, ‘How come I have to raise an infant with Down’s syndrome, whereas my cousin who was 35 didn’t have to?’”
           
The only ethical consideration, Dr. Lalonde said, should be whether an abortion was “what the woman wants. We have to be fair to give women a choice,” he said.
           
The Canadian Down Syndrome Society said the recommendations proposed by the SOGC “discriminate” against people with Down syndrome, in a statement to the press Feb.1. The CDSS said they were “greatly concerned” that information provided to parents should be clear, accurate and unbiased, saying they were particularly concerned about the negative language used in the screening process when referring to the possibility of Down syndrome.
    
“We know that information is important for prospective parents to make the best decisions for their family. For families undergoing prenatal testing, it is critical that value-neutral information be conveyed about the reality of Down syndrome,” said Krista J. Flint, executive director of CDSS. “Parents have told me that they heard this child with Down syndrome would “ruin their life” or ‘would never be toilet-trained’ – that’s not information; that’s a bias.”
           
The CDSS has launched a public awareness campaign to encourage parents to consider alternatives to abortion, emphasizing the positive side to raising a Down’s Syndrome child.
           
Flint says the CDSS is also gravely concerned about the possibility of a future without citizens with Down syndrome.
           
“People with Down syndrome enhance the learning, lives and citizenship in our schools, workplaces and families,” says Flint. “My children’s children may inherit a world without Canadians with Down syndrome – and that’s not a good future.”           

The only reference in the SOGC guidelines to concerns that increased screening for genetic abnormalities will lead to an increase in abortion is a paragraph recommending that screening programs should, “show respect for the needs and quality of life of persons with disabilities. Counselling should be nondirective and should respect a woman’s choice to accept or to refuse any or all of the testing or options offered at any point in the process.”

Gudrun Schultz is editor of LifeCanada News.