The March of Dimes has released their Global Report on Birth Defects, The Hidden Toll of Dying and Disabled Children. This comprehensive summary and analysis of the available global data on the causes and incidence of birth defects makes compelling arguments about the effectiveness of preventive care. In addition to identifying the many types of birth defects, their causes, and their prevalence in different countries in the world, it is clearly intended to motivate governments and health care systems to focus on providing the preventions and treatments available today.
The report explains that many of the highest incidences of genetic birth defects occur in the world’s poorest countries, with many of the lowest rates found in the wealthiest countries. It also explains that “experience from high-income countries shows that up to 70 percent of birth defects can either be prevented, or that affected children can be offered care that could be life saving or would reduce the severity of disability. These interventions include appropriate treatment, particularly surgery, and prevention, especially before conception or in very early pregnancy.”1
Three levels of prevention are described: Primary, Secondary and Tertiary. Primary preventions focus on women’s health prior to and during early pregnancy, so that birth defects never develop. These strategies include fortifying salt with iodine to prevent iodine deficiency disorder, fortification of the grain food supply with folic acid to prevent neural tube defects, educating women about the cause of fetal alcohol syndrome and pre-screening for common recessive disorders. The report explains, “With its emphasis on ensuring normal conception and early pregnancy, primary prevention is the most important of all three levels.”2 Tertiary prevention deals with early detection, treatment and cure of defects in children already born.
Secondary prevention “aims to reduce the number of children born with birth defects.”3 Although rarely stated explicitly within this carefully worded report, one potential “treatment” at this stage is frequently implied: abortion. Its sanctioned use as a method for reducing the rate of babies born with birth defects is embedded in the discussion of Secondary Prevention. This is achieved through medical genetic screening and prenatal diagnosis where birth defects are detected and the couple offered genetic counseling and therapeutic options. Secondary prevention requires prenatal diagnosis, which must be accompanied by genetic counseling that includes descriptions of the tests available, with their scope and attendant risks.4 The important point to note here is that prenatal diagnosis of birth defects does not “prevent” birth defects; it identifies them. Some birth defects are treatable in utero, many are not. Therefore, some of the implicit “prevention” at this stage involves preventing the birth of a child with defects via the “abortion treatment.”
This intention is more explicitly identified in two case studies. In the section called Prevention of Birth Defects, one case study is titled, The Power of Prevention: Family Planning and reducing the birth prevalence of Down syndrome. It states, “In the years 1995-2000 in most of Western Europe, approximately 50 percent of affected pregnancies were terminated following pre-natal diagnosis, and the prevalence of Down syndrome remains low at 0.8-1.1 per 1000 live births.”5 As presented, pregnancy termination is clearly defined as a successful scheme. In the same section, the report states, “family planning introduces women and their partners to the concept of reproductive choice, including the option of limiting family size or using prenatal diagnosis.”6 Here, “reproductive choice”, a pseudonym for the abortion option, is presented as an important tool in “reducing the burden of birth defects.”7
A second case study is entitled, Power of Prevention: Screening for thalassemia in Iran. Initially, this approach involved pre-marital genetic screening only, but just 20% of screen positive couples voluntarily separated. The summary states, “When asked, the remainder requested the option of prenatal diagnosis and selective termination of pregnancy. After inter-sectoral debate, a fatwa (law) was decreed recognizing the need for prenatal diagnosis and selective termination for serious birth defects.”8 Successes claimed in this study include a significant decline in the affected birth rate and “overcoming the implicit social, ethical and legal problems” of developing such services.9
After the discussion of Secondary prevention, March of Dimes clearly spells out its position: “The March of Dimes maintains a policy of neutrality on the issue of abortion. If termination of pregnancy is discussed with parents in the course of prenatal care, this discussion must be within the limits of the legal terms of reference of the country. Health care providers must not give directive or coercive advice, are obliged to respect the religious and moral beliefs of the parent, and should abide by and support their decisions.”10 In other words, March of Dimes supports staying within the laws of the country and does not advocate forcing anyone to have an abortion. However, the unmistakable message is that abortion is a feasible option for secondary prevention as long as it is legal and the parents are willing.
Throughout the report, it is clear that the primary goal of the March of Dimes is reducing the number of babies born with birth defects, through a variety of preventive and treatment programs. Unfortunately, it leaves no doubt that abortion is still a strategic part of their plan.
1. March of Dimes Global Report on Birth Defects, The Hidden Toll of Dying and Disabled Children; March of Dimes Birth Defects Foundation, White Plains, New York, 2006; Executive Summary, p. 3.
2. Ibid., Services For Care and Prevention of Birth Defects, p. 41.
3. Ibid., p. 41
4. Ibid., p. 41
5. Ibid., p. 47, box 2
6. Ibid., p. 47
7. Ibid., p. 47
8. Ibid., p. 54, box 6
9. Ibid., p. 54, box 6
10. Ibid., p. 41