"Medically Necessary" Abortion

Prenatal screening for Down syndrome was widely introduced in 1989 (1), but the recent increase in this practice is due to the introduction of first trimester screening in 2010 (2). The first trimester screening uses maternal serum markers to identify abnormal levels of human chorionic gonadotropin (hCG) and pregnancy associated plasma protein (PAPP-2) which are indicators that the child will likely be born with Down syndrome (3). In the United States, as well as many other countries, it is legal to request an abortion solely because the baby screened positive for Down syndrome. The common term for abortion of this nature is medically necessary. This is surprising, as most often medically necessary abortions are considered to be preventative of the expected death of either mother or child. However, the U.S. definition of medically necessary abortion is “a continuation of the pregnancy that would endanger the life of the pregnant woman or a pregnancy in which the fetus would be very likely be born with a grave, permanent, and irremediable mental or physical defect” (4).

In Denmark and Iceland, first trimester screening is offered free of charge to every pregnant woman. Their governments require each pregnant woman be told about the screening. This has had the effect of a high termination rate for pregnancies that show a greater chance of Down syndrome. In Denmark this rate is 98% and in Iceland this rate is almost 100%. In the United States, this rate is 67% (5).

Though the performance of an abortion to dispose of a baby who is likely to be born with Down syndrome is legal, hospitals in the U.S. are not required by law to perform a medically necessary abortion. The only exception to this is in Alabama, Colorado, Connecticut, Washington D.C., New Hampshire, New York, Rhode Island, Vermont, and West Virginia (6). Medically necessary abortions also are not required by law in many international countries such as Denmark (7) and Iceland (8).

It is our policy at IWP Capital to fail any company that provides abortions to patients, regardless of reason, under our Abortion Provider screen.

(1) NHS Choices, NHS, 5 Mar. 2018, www.nhs.uk/news/genetics-and-stem-cells/downs-syndrome-qa/.

(2) Gillian M. Tringham, Tariq S. Nawaz, Stephen Holding, Jane Mcfarlane, Stephen W. Lindow, Introduction of first trimester combined test increases uptake of Down's syndrome screening, European Journal of Obstetrics & Gynecology and Reproductive Biology, Volume 159, Issue 1, 2011, Pages 95-98

(3) Karin M. Fuchs, Jeffrey F. Peipert, First Trimester Down Syndrome Screening: Public Health Implications, Seminars in Perinatology, Volume 29, Issue 4, 2005, Pages 267-271

(4) US Supreme Court. Doe v. Bolton. 22 Jan. 1973.

(5) Lajka, Julian Quinones Arijeta. “‘What Kind of Society Do You Want to Live in?": Inside the Country Where Down Syndrome Is Disappearing.” CBS News, CBS Interactive, 14 Aug. 2017, www.cbsnews.com/news/down-syndrome-iceland/.

(6) “An Overview of Abortion Laws.” Guttmacher Institute, 12 Nov. 2018, www.guttmacher.org/state-policy/explore/overview-abortion-laws.

(7) Berkman Klein Center, cyber.harvard.edu/population/abortion/Denmark.abo.htm.

(8) “25/1975: Lög Um Ráðgjöf Og Fræðslu Varðandi Kynlíf Og Barneignir Og Um Fóstureyðingar Og Ófrjósemisaðgerðir.” Alþingi, www.althingi.is/lagas/nuna/1975025.html.