ANTHROPOLOGY

Anthropology

Anthropology

Introduction

When first developed, prenatal diagnosis was employed for conditions generally regarded by physicians as serious and for which there were no treatments. It is now available for conditions with little or uncertain impact on postnatal health and functioning, conditions that will appear—if at all—only in adulthood, and conditions for which effective treatments exist. Clearly, the number of complications that can be discovered with prenatal testing is expanding: the earliest time period when attempts to detect problems are made is being moved back from the 14-20 week period when amniocentesis is employed to the

10-12 week slot allotted to chorionic villi sampling (CVS).

Indeed, a woman need not even be pregnant now to obtain "prenatal" diagnosis because embryos procured following in vitro fertilization can be examined before they are implanted.

The expansions being made in the definitions of the categories of subjects, objects, and timing of prenatal diagnosis are troubling. But even without those issues, many thousands of women, pregnant or not, are already confronted by the need to consider how much, if at all, they want to know about a fetus during pregnancy, what wanting or not wanting this information entails and implies, and how they feel about disability. The very availability of those technologies necessarily forces every woman at least to consider if she desires genetic testing—or if she even desires that testing be available for use by other women—and merely facing this choice is itself difficult, and often painful (cf. Lippman-Hand & Fraser, 1979a, 1979b).

Prenatal genetic testing is not just another improvement in obstetric care, despite the tendency of some to call it routine, or even banal (Dumez, 1989). Rather, deciding for or against testing makes many women feel they will be making a terrible mistake regardless of the path chosen. With the application of genetic testing earlier and earlier in fetal life, and with the growing number of variations now detectable (some of which may only increase susceptibility to the later development of a treatable medical problem), it seems urgent that we directly examine the real reasons we are testing women and fetuses, what it means to test them, how testing establishes boundaries for what we call normal, and how changes in us, our relationships, and the children we bear may be embedded in testing. To start this examination it is useful to look at some of the stories told about health, disease, and prenatal testing.

Discussion

In our contemporary Western culture, we tend to cling to the seemingly unproblematic belief that the pursuit of biomedical knowledge of health and disease is a sign of progress. We all too often forget that despite their biological reality, human diseases, disorders, and disabilities—the objects of prenatal screening— are not just physical or physiological states with fixed contours. Rather than merely being "out there" awaiting our discovery, they are social products with variable shapes and distributions that we fashion, interpret, and give meaning to via our beliefs, attitudes, values, and interests. Western biomedicine is our ethnomedicine, and it does not ...