Buying reassurance: uptake of non-invasive prenatal testing among pregnant women of advanced maternal age in China

Abstract

Despite much ethical debate concerning non-invasive prenatal testing to abort or to detect genes, research on the experience of those who choose this new technology in China is limited, especially after the introduction of the Two-child Policy. In this article I analyse qualitative data from 25 interviews with pregnant women of advanced maternal age (pregnancy after 35) under the Two-child Policy, conducted in 2014 to 2016, as well as observational data from a 6-month, in-hospital participant observation in 2016. These data were collected with the aim to examine how non-invasive prenatal testing affects pregnant women’s risk perceptions and why this technology is widely accepted by pregnant women of advanced maternal age in China. I conclude that the women in my study accepted their ‘high-risk’ identity within prenatal care, and that non-invasive prenatal testing was integrated in this care. Women’s interactions with genetic counsellors, their husbands and close friends and community doctors produced anxieties, with women feeling responsible for the health of their foetuses. Consequently, the women in my study were willing to ‘buy’ this test for reassurance. The consumption of this new technology by pregnant women after the Two-child Policy lays a foundation for the market development of this technology in urban China.

Keywords:

• non-invasive prenatal testing
• risk
• risk perception
• pregnant women of advanced maternal age
• urban China

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. In China, genetic counselling work commenced in the 1970s. In 1977, Peking Union Medical College Hospital built the first prenatal diagnosis laboratory, which then performed the first case of amniocentesis. Until 2017, 340 medical institutions were legally authorised to do prenatal diagnosis (NHC, National Health Commission of the People’s Republic of China). In 2018, Shanghai Municipal Health Commission put forward the ‘Regulations on Genetic Counselling Technology Service’, setting out the basic rules for genetic counselling and the guidelines for professional genetic counsellors. Most genetic counsellors are clinicians who receive further training. Data (Li, 2014) show that most genetic counsellors are women (72.3 percent) and have a clinical medicine background (53 percent).

2. Abortion was legalised in 1953 to control the birth rate and promote family planning (Wang, 2014). According to new regulations that came into effect in 2002 (‘Regulations forbidding non-medical foetal sex determination and selective abortion’), a selective abortion after 14 weeks of pregnancy should be approved by the Department of Family Planning with a medical birth-defect certification.

Additional information

Funding

This research was supported by the China Scholarship Council and NationalSocial Science Foundation of China (Grant Number: 14ZDB150 and Grand Number: 14ASH013).