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Prenatal Diagnostics: Caught Between Horror and Hope

October 5, 2023


Several years ago, someone who works in Down syndrome advocacy at the international level told me a horrific story. A woman in an African village had given birth to a child with Down syndrome and went to visit the local healer for advice. She was told to place the baby on the riverbank in the evening. If she returned the next day and the baby was alive, it was indeed a human child. If she returned and the child was gone, it had reverted to its true form as a serpent and slithered away. Needless to say, in the morning, the child was gone.

I remembered this story when Father Steven Grunow, the CEO of Word on Fire, recently shared an article from First Things with me and a few others on our staff. The article, written by Louise Perry, was titled “We Are Repaganizing,” and it reflected on the consequence of the loss of Christian culture in the West—namely, the expansion of prenatal diagnosis that results in the abortion of unwanted children and the increasing push for infanticide.

Many aren’t aware of the more barbaric pagan practices common in the Roman Empire. The stories of the “games” played out by gladiators and of Christians being thrown to the lions are well known. We even make movies about them for entertainment. Less frequently discussed are stories of unwanted babies who were tossed aside, thrown down banks, or left on the roadside to die. Perhaps these stories are a part of our cultural past too horrific to discuss. The coming of Christ and the Apostles’ life-changing response to his Great Commission ended these horrific practices and many other pagan assaults on human dignity too.

Barbarians and their pagan practices have evolved, not vanished.

Even though infanticide is not yet legal in the United States, anecdotally, we know it happens quietly. About fifteen years ago, when a friend of mine and his wife who live in the Houston area gave birth to a son with Down syndrome, the doctor offered to ‘take care of the problem’ for them. He and his wife were told they could leave the hospital and forget the birth ever happened. A more sophisticated version, I guess, of the Roman solution but no less horrific. Of course, my friends took their child home and have loved him dearly ever since.

Whether they be in white lab coats or Roman togas, barbarians and their pagan practices have evolved, not vanished. Our advanced and medically sophisticated culture somehow has sanitized these practices and made them culturally acceptable—to some, even celebrated. The difference between the ancient world and now is that parents don’t have to wait for birth to decide they don’t want their child. They can now find out as early as eleven weeks’ gestation that their child might have Down syndrome or a small group of other genetic anomalies.

Prenatal screening technologies have opened a Pandora’s Box. To use it prudently, there are three critical points to consider: 

What is the intent for going through the procedure? 
How is the trustworthiness of the test conveyed to the couple (i.e., are they fully informed regarding any risk and the efficacy of the test before consenting)? 
How is the result delivered by the doctor or genetic counselor to the parents?

The USCCB has written a document, now in its sixth edition, called the Ethical and Religious Directives for Catholic Healthcare Services. It is the guiding document for all Catholic healthcare in the United States. The bishops acknowledge that prenatal screening can have a beneficial purpose by providing “information to guide preventative care for the mother or pre- or postnatal care for the child.” However, the bishops clearly state that “prenatal diagnosis is not permitted when undertaken with the intention of aborting an unborn child with a serious defect.”

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All pregnant women will be presented with the suggestion that they undergo prenatal testing. The American College of Obstetricians and Gynecologists (ACOG) recommends that “prenatal genetic screening . . . should be discussed and offered to all pregnant patients regardless of maternal age or risk of chromosomal abnormality(emphasis added). Of course, women can refuse the recommendation if they wish.

The first thing for parents to understand is that a test that screens for abnormalities is not diagnostic. The most common form of early prenatal testing is something called non-invasive prenatal testing (NIPT), also called cell-free DNA testing. These tests first became available in the US in 2011 and can be used as early as eleven weeks into the pregnancy. When these tests first hit the US market, they were hailed as revolutionary. The marketing promised that with just a sample of the mother’s blood, the tests were 97% to 99% effective in identifying trisomy 21, or Down syndrome, and a few other genetic anomalies like trisomy 13 and trisomy 18.

Problematically, these statistics are misleading. They are based on the sensitivity of the test and do not indicate the probability that a woman is truly carrying a child with an extra chromosome. Additionally, there is a one in five chance that the test result yields a false positive—and they can also yield false negatives (see Mark Leach’s excellent explanation of the accuracy of these tests). These facts should be part of the process of informing mothers of what these tests offer before they consent to the test. There is a critical difference between probability and certainty. All that these tests can provide is a probability that a child may have a disability.

So, how far have we come since Ancient Rome?

A critical factor for couples who receive an unexpected prenatal screening/diagnosis is how the results are delivered to them by medical personnel. An article was recently published in Disability and Health Journal called “The Impact of Implicit and Explicit Bias about Disabilities on Parent Experiences and Information Provided during Prenatal Screening and Testing.” A long title that delivers what the title suggests—the amount of bias in the physician’s delivery of the results of prenatal testing.

The authors, researchers from the Human Development Institute at the University of Kentucky, noted that doctors were most likely to discuss medical issues and “reproductive options” (read “abortion”) rather than psychosocial outcomes, support, and services. Respondents to the survey reported that 61.3% of the doctors who delivered the diagnosis as bad news or who said “I’m sorry” were “significantly less likely than their counterparts to provide information about life outcomes, supports and services, condition-specific resources, or more comprehensive prenatal care.” That percentage closely tracks the result of a 1995 survey of members of ACOG in which 63% of the members who responded said that they believed abortion was a justifiable “treatment option” for fetal anomalies compatible with life. 90% thought abortion appropriate if the diagnosis was incompatible with life.

So, how far have we come since Ancient Rome? I would guess that we’re probably killing many more babies now than then—even factoring in the increase in population.

What should Catholics do in the case of prenatal testing? Please don’t think I am recommending against it if done for the right reasons. It is a matter of conscience for each couple. Couples should, however, prepare themselves with knowledge of the test that is recommended to them and not be alarmed by the result. False positives are frequent. If the screen is confirmed by a true diagnosis, be prepared for what you may hear. Statistics say that the modern pagans will likely offer to relieve you of your “burden.”

To end with a positive story, I’ll close with another from Africa that was shared with me by my colleague and the Senior Director of the Word on Fire Institute, Matt Petrusek. A former adult student of his from Nigeria told him that the custom of her tribe was to kill every set of twins at birth by leaving them out in the jungle because giving birth to two babies at the same time was taken to be a curse. Strangely, the villagers never found any remnants of the babies’ bodies. It was thought that the jungle animals were completely consuming the bodies at nightfall. However, she later discovered, after moving out of the village, that an old eccentric woman who lived by herself at the village outskirts—the “town crazy” who avoided contact with others—would wait until night every time twins were left in the jungle, pick them up, and carry them over ten miles away to the nearest Catholic orphanage in the dark. She would drop the babies off with the sisters and then immediately return. She had no formal education. Since no missionaries had, at that time, made it to the village, she had also never been catechized. However, at grave risk to her life (the villagers would have executed her if they found out) and without payment, she still chose to save the children.

Yes, Louise Perry is right, we are repaganizing. The modern pagans will think we’re crazy for defending life, but Matt added his own comment at the end of his story: “Paganism can never completely extinguish the Logos, try as it might!” And that really is the end of the story.