Ethics of knowing the sex of the fetus

Non-invasive prenatal testing (NIPT) is a relatively recent development, based on the detection of DNA fragments in maternal serum. Up to 20% of these fragments are fetal DNA shed from the placenta, and NIPT offers a new method of screening for Down syndrome. Although only available privately in the UK at present, researchers including a team from Great Ormond Street Hospital, London, are evaluating a screening role for NIPT in the NHS (Morley and Simpson, 2016).

While noting the important role that midwives are expected to play in ensuring that tests such as NIPT are implemented in practice, Oxenford et al (2013: 88) also highlight ethical aspects of such testing, pointing out, for example, that NIPT as a one-step test for Down syndrome ‘could reduce the decision-making time couples currently have with the two-step process of screening followed by a diagnostic invasive test.’ Browne (2016: 5) has introduced a further ethical dimension, by claiming that ‘in the absence of a desire to avoid sex-linked diseases, information about the sex of the fetus is only useful to parents if they associate it with certain assumptions about gender… that are not based on a biological reality.’ She argues that because there is a potential risk of NIPT expanding the market for sex determination and sex-selective abortion, the sex of the fetus should not be included in prenatal test reports. Making a distinction between the child's gender and its sex, one aim of Dr Browne's paper is ‘to show that parents are not concerned with their child's sex chromosomes, or even their genitalia, but the gender role that their child will espouse.’ Her contention is that the disclosure of the sex of the fetus conflates biologically determined sex with socially determined gender, which amounts to misinformation and ‘promotes sexism via gender essentialism’.