The History of Abortion and the Demand for Prenatal Testing
Although there has always been a certain demand for prenatal testing, overall, the percentage of prenatal testing, excluding ultrasound, is only a few percent of the total, which is much lower than in the West.
Why were so few people using inspections when there has always been a demand for them?
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Clash of ideas over eugenic protection laws
One reason for the low rate of prenatal testing may be due to past conflicts with eugenic protection laws.
The Eugenic Protection Act is an ordinance that protects the life and health of the mother in matters relating to sterilization and abortion. Simply explained, the law permits sterilization and abortion when it is a burden on the mother's life. Incidentally, the name has now been changed to "Maternal Protection Law" along with the revision of the ordinance.
When the law was enacted in 1948, the thinking was more widespread than it is today, and sterilization and abortion of disabled parents was encouraged. This was partly because of economic and child-rearing difficulties, but also because, for eugenic reasons, it was believed that children of disabled people were more likely to become disabled. Also, fearing the economic pressures caused by population growth, abortion and other procedures for economic reasons were allowed, and at the same time, the procedures for sterilization and abortion became easier.
As a result, the number of abortions increased, and at one time there were over 1 million procedures per year. However, because of the sheer number of abortions, anti-abortion and religious groups submitted an objection to the National Assembly in the early 1970s to "ban abortion for economic reasons (abolition of the economic clause).
However, the proposal was not accepted and was repealed. The reason for the abolition of the law was an appeal by women who wanted to avoid unwanted births. If for some reason a woman has an unwanted pregnancy, it is very difficult for her to have a legal abortion.
And a long-running conflict over the revision of the ordinance ensued, with appeals from groups (mainly disabled people) who wanted to abolish economic abortions and women who could not do without them.
However, change began to occur as women with disabilities who deserved both positions began to speak out, understanding both sides. This led to the repeal of abortion laws and eugenic protection laws in the 1980s, as well as a shift from the idea of eugenic protection laws that women should decide whether or not to give birth to the idea that selective abortion of fetuses is not part of a woman's rights.
Furthermore, in 1996, the eugenics part of the Eugenic Protection Law was removed and the name was changed to "Maternal and Child Protection Law" along with the current content of the ordinance.
This history is probably closely related to the reason for the low rate of prenatal testing in Japan, as prenatal testing leading to abortion was questioned.
Increased demand for NIPT due to its development
Although the percentage of prenatal testing is lower than in other countries, it has been increasing in recent years. This is because NIPT is gaining attention as a new prenatal test.
Amniotic fluid and chorionic villus examinations have been performed for some time, but neither has been performed casually because of the burden placed on both mother and child. They are also expensive, and many parents do not wish to have them done.
NIPT, however, can be easily performed simply by drawing blood from the mother, and although NIPT alone is not a definitive diagnosis, and an amniotic fluid test or a trophoblastic test must be performed later, it can easily determine the fetal status (negative-positive), which can then be used to diagnose an amniotic fluid test or a trophoblastic test.
In recent years, as the population has aged, the age of childbearing has also increased, thereby increasing the percentage of children with conditions such as Down syndrome.
In the future, more and more parents will casually test with NIPT and, based on the results, make a definitive diagnosis with an amniocentesis or chorionic villus test.
Increase in the number of unlicensed clinics for NIPT
NIPT is becoming popular in Japan because it is an easy prenatal test. However, not all hospitals offer the test. Therefore, the increase in the number of unlicensed facilities that disregard accreditation in pursuit of demand has become a problem.
NIPT can be easily performed even if it is not licensed, since it only requires a blood sample to be taken. In extreme cases, as long as a blood sample is taken, NIPT can be performed even in an obstetrician-gynecologist's office.
The demand for NIPT is increasing, but the supply is not keeping up, and the number of unlicensed clinics is also increasing.
Shouldn't there be an unlicensed clinic?
The name "unlicensed clinic" may bring to mind the impression of "fraud" or "unscrupulous doctors," but this is not the case. Blood samples are taken by nurses and clinical laboratory technicians under the direction of a physician, and tests are performed by a professional company so that you can know the solid results.
In addition, unlicensed clinics have advantages unique to unlicensed clinics, such as "no age limit for testing," "no need for a letter of referral from a doctor or other health care provider," and "testing (blood sampling) can begin the next day if done quickly enough.
On the other hand, being unlicensed has its problems. Unlicensed clinics are often not staffed by clinical geneticists who specialize in genetic testing and lack expert advice in the event of a positive result, which is by no means the only advantage.
For these reasons, the Japanese Medical Association and the Japanese Society of Obstetrics and Gynecology, which determine authorization, do not recommend testing at unauthorized clinics.
While unlicensed clinics are not an absolute no-no, many parents have regretted the lack of genetic counseling due to the absence of a clinical geneticist, so it is recommended that testing be done at a licensed clinic whenever possible.
Choosing not to have prenatal testing
While some parents do prenatal testing, others do not. This is because parents who have decided to raise their children, even if they have Down syndrome, do not need to know the test results.
Some parents are also anxious to know the test results. This is because if the test results are positive, they must make a life choice. In Japan, more than 95% of couples choose to have an abortion if a genetic disorder is detected by prenatal testing. Even if they consult with others around them, they are advised to have an abortion, and considering the difficulty of raising a child, this is not an option.
But no matter what the reason, abortion is killing an unborn child. Many parents find it hard to take a life by their own choice, and many do not do prenatal testing so that they do not have to choose between life and death.
Some doctors are negative about prenatal testing. They do not think it is a good idea to sort out life, giving birth if the test is negative and aborting if the test is positive. We are well aware of the difficulties of raising a handicapped child, but we hope that you will cherish the life you have been given, and if you do decide to have an abortion, it will be after deep consideration and thought.
Prenatal testing can help many parents, but it can also be a source of anxiety for them.
Future demand potential
Prenatal testing is a means of learning about the genetic information of the fetus as well as a means of avoiding subsequent hardships. As NIPT becomes more widely used, which is less physically and financially burdensome, more people will use NIPT and other prenatal tests.
However, that does not mean that we should neglect the selection of life. It is necessary to decide "what to do" after careful consideration, including genetic counseling.
- Asahi Shimbun - Azumi TsugePrenatal Diagnosis, An Entwined History Between Two Movements, Disabled and Female."
- Reference for taking the NIPT test - Comparative table of implementation status between accredited and unaccredited facilities
- Asahi - New Prenatal Diagnosis: Five Years After Its Launch
- Diamond Online - 38-year-old elderly wife receives prenatal diagnosisけReasons for deciding not to
- NHKHARTNET - Special Feature] Prenatal Testing (1) How Information Should Be Provided