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LETTER |
Requests for reprints should be sent to Abby Lippman, PhD, Department of Epidemiology and Biostatistics, McGill University, 1020 Pine Ave W, Montreal, Quebec H3A 1A2, Canada (e-mail: abby.lippman{at}mcgill.ca).
In his May 2002 editorial, Pernick1 missed an opportunity to note how the "complex connections between eugenics and public health" described eloquently in Stern’s article on better baby contests2 persist today.
One connection is found in state-supported programs of prenatal genetic screening and testing. These seem to be based on an underlying (implicit) assumption that people with disabilities not only cannot have a satisfying life, but are not welcome in society—and that parents will want to avoid their birth. Tightening the connection is a further assumption that there are important public health cost savings if people with disabilities are never born.3
Stern certainly suggests that similar arguments supported the better baby contests. And these persisting false assumptions about the "costs," social and financial, of disabilities perpetuate pronatalist eugenics in this century.
Public health programs should have the birth and development of healthy babies and the promotion of women’s reproductive freedom and choice as primary goals. However, a lowered birth prevalence of a condition for which prenatal screening is available only connects public health programs with eugenics; it is not an appropriate assessment of either health improvement or choice. What we need instead is yardsticks that assess the nature and extent of societal conditions that will allow women to make genuine choices about childbearing.
Some (e.g., Cuckle3) categorically reject attaching a "eugenics" label to prenatal genetic screening and testing because abortion based on the results of these exams is seen as the result of a woman’s private decision, not an overt public policy. But do women feel able to continue a pregnancy without any testing? Do they feel that there will be support, acceptance, and appreciation for a child predicted to have some disability if that child is brought into the world? Or, rather, does their awareness of the many hurdles placed in the way of those with disabilities push—even bully—women into undergoing prenatal testing and then into aborting fetuses found to have the condition tested for?4
Pernick correctly reminds us to take the issues raised by better baby contests seriously. Very seriously, I would add. Public funding of prenatal screening programs, which necessarily reflects the state-sponsored use of some genetic variation alone to value one group more than another, raises such issues. Whatever else this may be, this kind of valuation illustrates eugenics. And though "healthy" may have replaced "better" as the contemporary goal for babies, we need to be vigilant to ensure that today’s public health programs do not violate fundamental principles of human rights and social justice in the course of improving the health of babies and their mothers.
References
1. Pernick MS. Taking better baby contests seriously. Am J Public Health.2002;92:707–708.
2. Stern AM. Making better babies: public health and race betterment in Indiana, 1920–1935. Am J Public Health.2002;92:742–752.
3. Cuckle H. Extending antenatal screening in the UK to include common monogenic disorders. Community Genetics.2001;4:84–86.
4. Lippman A. Bottom line genetics: commentary to Cuckle. Community Genetics.2001;4:87–89.
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