Test creates moral dilemma

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JAPAN'S PRENATAL DETECTION: Will it nurture the perception that a Down's syndrome baby is a misfortune to be avoided?

NEWLY pregnant women and their spouses in Japan now face a new, significant challenge.

It is not a concern about miscarriage or delivery risks; it is a prenatal detection test made available from this month at several hospitals.

The prenatal blood test, developed in the United States, is capable of precisely detecting three types of chromosomal irregularities, including Down's syndrome.

It is safer than the previous amniotic fluid tests -- called amniocentesis -- where a thin needle is inserted into the abdomen. This carries a slightly higher risk of miscarriage. Such tests also have to be done strictly between the 15th and 18th week of pregnancy.

However, with the new detection test, doctors can analyse DNA of pregnant women from the 10th week of pregnancy.

It is also more accurate than the maternal serum multiple marker test -- Afp4 screening -- which tells the probability of chromosomal abnormalities by comparing the protein amount in the blood.

Is this new test good news or what? Views are divided for different reasons, stirring hot debate.

For one, such a test will be in high demand. Figures show that more women choose to be pregnant for the first time later in their life in Japan.

According to the latest government report, released in June this year, the average age of new mothers was 30.1 years old, exceeding 30 for the first time. In 1975, it was 25.7 years.

Last year, 1,050,698 babies were born, the lowest number since l947 and down 20,606 from the previous year.

Women younger than 34 years old are producing a smaller number of babies, while more women over 35 are having babies. It is known that women aged 35 or older face a higher risk of bearing children with chromosomal irregularities.

The new detection test is expected to attract such concerned pregnant women and consequently drive them to induced abortions. In research in the US and Britain, 90 per cent of parents-to-be tend to choose abortions if they learn that the foetus has signs of Down's syndrome.

The new prenatal detection screening is made available at the National Centre for Child Health and Development, Showa University Hospital, and a few other medical facilities. They claim that the test will be provided cautiously on the basis of counselling and continued monitoring.

But should babies expected to be born with irregularities or challenges be identified for exclusion in the prenatal stages?

I remember the shock I had many years ago when one of my girlfriends chose to get rid of her foetus as soon as doctors told her the baby might have hearing problems from the measles she had. To my surprise, she was sure it was the best decision for everyone.

As soon as news of the new detection method was received a few weeks ago, concerned groups raised a furore.

The Japan Society of Obstetrics and Gynaecology warned that it would possibly cause serious confusion if such screening is applied widely. The society plans to produce guidelines for such screening, in consultation with paediatricians and genetics specialists.

A louder protest was made by the Japan Down's Syndrome Society, a 5,500-member support group for children and adults with Down's syndrome. It protested that the test would nurture the perception that a Down's syndrome baby was a misfortune that should be avoided.

"I was thrown into despair when I first heard my baby had the problem 25 years ago," said a 50-year-old mother of a Down's syndrome girl in Tokyo. Doctors told her the baby would live only about 20 years.

Now, the daughter, Yuko, makes cookies and pastries at a workplace for the challenged in a Tokyo suburb. "She is a blessing and she educated me and the family," the mother says.

It is believed that there are about 60,000 Down's syndrome people in Japan. Although some bias and discrimination remains, the handicapped are better understood and better accepted in communities than decades ago, the mother and her friends say.

The parents' networks and support system as well as the education system are much improved, too. And yet, how the Japanese society applies the latest screening technique will have a lot of implications for their future.

Japanese children at the start of a football match between Japan and Iraq for the World Cup Asia qualifying round in Saitama, near Tokyo recently. Last year, Japan had the lowest number of babies born since 1947. AP pic


Writer is a Tokyo-based veteran journalist

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