Most Americans have not yet internalized the lengths to which the forced birth lobby is prepared to go to ensure that women and others who become pregnant are prohibited from ending their pregnancies. In order to appreciate the dystopian vision that these people clearly have every intention of imposing, it’s necessary first to understand that for them, the overturning of Roe was simply the first step. Now that a right-wing majority on the Supreme Court has signaled its willingness to sign on to that vision—one that contemplates the absolute control of women’s and others reproductive autonomy—the vast and well-funded forced-birth lobby is preparing to move to the next phase.
In January 2022, 100 Republican members of Congress signed on to a letter addressed to Janet Woodcock, acting director for the Food and Drug Administration. The FDA is the government entity responsible for oversight and regulation of prenatal genetic testing, commonly sought by pregnant patients early in their pregnancy. Such testing is used to determine whether the fetus has any severe genetic or congenital abnormalities that could prompt the patient to terminate pregnancy. The letter, signed on its face page by Texas Rep. Chip Roy, Montana Sen. Steve Daines, and Minnesota Rep. Michelle Fischbach, purported to express concern about potential false positives in prenatal tests. This was based on a recent article in The New York Times and specifically demanded oversight of such testing to “protect vulnerable populations like persons with disabilities, pregnant mothers, and their unborn children.”
You might wonder why no Democrats signed on to such a seeming expression of heartfelt concern for “persons with disabilities, pregnant mothers, and their unborn children.” As proudly touted on Fischbach’s website, the letter was approved by a litany of forced birth organizations, including “Students for Life Action, Family Research Council, Susan B. Anthony List, National Right to Life Action, March for Life Action, Heritage Action, Family Policy Alliance, and the Ethics and [the] Religious Liberty Commission.” But both the letter and The New York Times article it is based on are premised on a misconception: The tests referenced in The Times article were screening tests, not diagnostic tests (which could trigger potential medical intervention). At best, a screening test indicates there “might” be a problem, and because the tests are calibrated to screen out extremely rare diseases, a high number of false positives is to be expected. In fact, that is the way screening tests for such diseases and conditions are designed.
But you wouldn’t know that from the Republicans’ letter, because that wasn’t the letter’s purpose. The letter, as evidenced by the forced-birther groups that signed onto it, was simply an opening salvo in what is very likely to become the latest assault on reproductive autonomy: the selective regulation and attempted prohibition of such prenatal testing in states that have otherwise outlawed abortion. Its purpose is to keep women and other pregnant patients ignorant and unaware of potential genetic problems with their fetuses that under normal circumstances would almost certainly result in the termination of the pregnancy.
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As explained by Jessica Valenti, writing for her “Abortion, Every Day” Substack, pregnant patients living in states in which abortion has been banned or severe restrictions imposed, are increasingly reliant on such early testing. And they’re reliant because, for them, the clock is (quite literally) “ticking.” Valenti notes that if a fetus is discovered to be abnormal after a state’s ban has kicked in, many states now would nonetheless force the mother to carry that fetus to term. She cites reporting in February of this year by Laura Ungar and Amanda Seitz, writing for the Associated Press, which describes how this phenomenon is unfolding in the wake of the Supreme Court overruling Roe.
As Ungar and Seitz report:
Since Roe v. Wade was overturned, many health care providers say an increasing number of patients are deciding the fate of their pregnancies based on whatever information they can gather before state bans kick in. But early ultrasounds show far less about the condition of a fetus than later ones. And genetic screenings may be inaccurate.
As Valenti explains, the fact that desperate patients seek out this information as early as possible in Republican-dominated states was well known to the forced-birth lobby.
The anti-abortion movement knew that all of this would happen after Roe was overturned—they knew that women would be desperate to get prenatal tests, and that the timing would be a big issue. That’s why prenatal testing is such a huge part of their campaign.
The AP article reiterates exactly the same conclusions as The New York Times article cited in the Republican-authored correspondence to the FDA: Namely, that due to their nature, the tests yield a high number of false positives. But it also explains that ‘[t]he accuracy of these tests varies by disorder, but none is considered diagnostic,” a critical point omitted in the GOP’s “concerned” correspondence.
As Valenti observes, the idea is to paint the screening tests as unreliable, the industry as tainted, and thus that “women need to be protected from genetic tests and ultrasounds.”
And after laying that groundwork, Valenti suggests that the forced birth movement will implement the following strategies through Republican legislation:
- Passing legislation that would require doctors to tell patients that “no test is 100% accurate” or that they might be ending a healthy pregnancy. (The cruelty is the point.)
- Requiring that hospitals direct patients who are given fatal fetal diagnoses to anti-abortion “prenatal counselors” and groups, who will then give those patients fake or misleading information about the reliability of prenatal testing.
- Spreading scare-tactics about prenatal tests to shame women out of taking them, using the language of “informed consent.” The idea is to dissuade patients who have gotten initial test results (like from bloodwork) from further testing. They’ll highlight the possible risk of miscarriage, and use language that suggests ‘responsible’ parents would never agree to tests like an amniocentesis.
To be blunt about it, this does not simply resemble the scenario suggested in “The Handmaid’s Tale,” it is “The Handmaid’s Tale.”
Valenti says she “absolutely” expects the forced-birth lobby and Republican Party to target prenatal testing in the same manner that they have targeted the so-called “abortion pill,” mifepristone: through misleading, biased pseudoscience. (In fact, a body of pseudoscientific, religious-based support for that strategy already exists.)
In a paper published in PubMed and currently in the database of the National Institutes of Health and titled “Prenatal genetics in a post-Roe United States,” the authors, Megan Allyse and Marsha Michie, note an important point: “Some prominent conservative activists in the U.S. argue against the offer of any prenatal testing on the basis that it suggests that abortion is an optional course of action in the event of a fetal anomaly.”
But even if such tests continue to be provided, the authors observe that the forced-birth lobby is prepared to utilize them as an enforcement and surveillance mechanism.
Even the earliest available prenatal tests—early ultrasounds, or cell-free DNA screening available at 9 to 10 weeks gestation—will not be early enough in many states to allow parents to make informed decisions about pregnancy continuation. One reason to encourage early prenatal care is to provide testing to make sure that both parent and fetus are healthy. But once a pregnancy appears in the medical record, any pregnancy loss could raise suspicion, and perhaps even more so if records indicate positive results from prenatal genetic testing. Some states have indicated they will prosecute even individuals who receive abortion care outside their borders, and the existence of medical records of pregnancy could provide evidence for such prosecution.
For its part, the FDA under the Biden administration has issued a “Safety Communication,” emphasizing to patients and providers that prenatal genetic testing may generate false positives. They also added, “They are not diagnostic tests, which are generally used to more definitively confirm or rule out a suspected genetic abnormality.” As Valenti notes, a regulatory framework for the evaluation of such screening tests is scheduled to be released by the FDA this spring.
But that is the action of an FDA as it currently exists under Biden. Under a hypothetical Trump administration, there is no doubt that the FDA’s regulation of such testing would conform to the dictates of the religious right. Roger Severino, one of the architects of Trump’s Project 2025 blueprint for a second Trump term, has declared that under a new conservative administration (presumably led by Trump), the FDA will be “ethically and morally obliged” to withdraw its approval of mifepristone, and plans to institute new surveillance and evaluation of prenatal care to improve so-called “infant outcomes.”
That is the cold bureaucratic language that—understood in its proper context—foreshadows a potentially unpleasant, stressful, and possibly terrifying experience awaiting anyone who is pregnant, or may become pregnant, during a renewed Trump administration.
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