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’.
However, while Mikhalevich and Powell (2016) agree that gender essentialism, and its rigid associations with either ‘femaleness’ or ‘maleness’, risks violating the rights of women and the lesbian, gay, bisexual and transsexual communities, they also argue that Browne is too quick in dismissing the possibility that biological sex is a cause of gender, and that it can predict gender outcomes in a range of developmental environments. They note that ‘we can accurately predict the occurrence of a storm by reading a barometer, even though the barometer reading is causally irrelevant to, and does not explain, the occurrence of the storm’ (Mikhalevich and Powell, 2016: 1).
Davis (2016) questions Browne's attempt to enlist parents in her battle against gender essentialism, first stating the simple truth that boys are more likely to play football and girls more likely to play with Barbie dolls. But what Davis considers to be her more important point—given the context of the large number of single female parents, both unwed and divorced—is that ‘a parent who believes that her chances of being close to her grandchildren are greater if she has a daughter than a son is making a reasonable assumption’ (Davis, 2016: 1).
On the other hand, Browne's stance receives some qualified support from Kane (2016: 1), who warns of the so-called gender trap—‘a set of expectations and structures that inhibit social change and stall many parents' best intentions for loosening the limits that gender can impose on us’—and considers that Browne's approach would sidestep this. Kane also reveals a social phenomenon in the USA, where expectant parents convene ‘gender-reveal parties’ to announce to family and friends their unborn child's gender, based on prenatal testing. Kane contends that such festivities celebrate the unborn child's sex, and that ‘these parents and their invited guests are engaged in the social construction of the sex and gender binaries that Browne criticises as misinformed’.
But to what extent are Browne and Kane's misgivings simply postmodernist carping, especially when NIPT confers so many benefits over more invasive procedures? Lewis et al (2015) remind us of the importance of the media in shaping public views and promoting understanding of medical advances. Their study of the media portrayal of NIPT found that journalists present more of its benefits than concerns, and Lewis et al (2015: 426) recommend that health professionals ‘verify patient knowledge and address any misunderstandings to ensure informed decision-making about NIPT’.
So it is perhaps useful for midwives to be aware of some of the concerns over NIPT, even if—or perhaps especially if—the expressed concerns do not coincide with the midwife's own views of the procedure.
Finally, just how interested are parents in knowing the sex of their unborn child? When Kooper et al (2012) studied pregnancies at risk for Down syndrome, they investigated the reasons for parents wanting to know the sex of the fetus after invasive prenatal testing. Of 210 pregnant women who completed a questionnaire, 69% wanted to know the fetal sex. Of these, 77.8% said the main reason for wanting to know was simple curiosity.