The aim of the current study was twofold: first, to examine the relationship between participants attitudes and their decisions about selective reproduction; second, to examine the influence of information about Down syndrome (DS) on these same decisions. As a preliminary step in investigating the influence of attitudes and information presentation on selective reproduction decisions, the current study examined the hypothetical decisions of female undergraduate students. Although presenting more positive information about DS did not appear to influence hypothetical decisions about selective reproduction, participants attitudes were related to these decisions. Specifically, attitudes toward persons with DS were related to decisions about prenatal screening. For decisions about prenatal testing and selective abortion, though, perceptions of parenting a child with DS mediated the relationship between attitudes and reproductive intentions. These findings suggest that women may be more likely to personalize their decisions about prenatal testing and selective reproduction by considering their perceptions of parenting a child with DS. These findings also suggest that informed decision making may require the inclusion of different information at the different decision stages (i.e., screening, testing, and selective abortion). In order to facilitate informed decision making, and in an attempt to ensure that attitudes toward persons with DS are informed by multiple perspectives, expanded information about DS should be included in prenatal screening protocols. Similarly, because perceptions of parenting appear to play a role in later decisions, information about raising a child with DS should be included in prenatal testing and selective abortion counselling sessions.

The aim of the current study was twofold: first, to examine the relationship between participants attitudes and their decisions about selective reproduction; second, to examine the influence of information about Down syndrome (DS) on these same decisions. As a preliminary step in investigating the influence of attitudes and information presentation on selective reproduction decisions, the current study examined the hypothetical decisions of female undergraduate students. Although presenting more positive information about DS did not appear to influence hypothetical decisions about selective reproduction, participants attitudes were related to these decisions. Specifically, attitudes toward persons with DS were related to decisions about prenatal screening. For decisions about prenatal testing and selective abortion, though, perceptions of parenting a child with DS mediated the relationship between attitudes and reproductive intentions. These findings suggest that women may be more likely to personalize their decisions about prenatal testing and selective reproduction by considering their perceptions of parenting a child with DS. These findings also suggest that informed decision making may require the inclusion of different information at the different decision stages (i.e., screening, testing, and selective abortion). In order to facilitate informed decision making, and in an attempt to ensure that attitudes toward persons with DS are informed by multiple perspectives, expanded information about DS should be included in prenatal screening protocols. Similarly, because perceptions of parenting appear to play a role in later decisions, information about raising a child with DS should be included in prenatal testing and selective abortion counselling sessions.

The aim of this thesis is to analyse and examine the debate on prenatal testing in Western countries, with a special focus on my own country, Sweden. In the near future it might be possible for a pregnant woman to profile the DNA of her foetus with a simple blood test early in pregnancy. This method of prenatal testing – Non Invasive Prenatal Diagnosis (NIPD) – could potentially detect the genetic causes of almost every disease. I will argue that prenatal testing should be offered by society to all pregnant women, not only to those at highest risk of giving birth to children with severe conditions. I will do that from a perspective of reproductive freedom. Furthermore, I will argue that offering prenatal testing for some conditions (such as Downs’s syndrome) and not for others, is conflicting with the autonomous choice of the pregnant woman.

No description available.

Objectives: Advancements in womens reproductive technology have resulted in women having to face the decision whether to undergo prenatal testing (PNT). This study explored the factors involved in womens decisions around PNT and assessed the extent to which the decision making process differed between women that chose not to have PNT and those that chose to have PNT. The Self-Determination Theory (Deci & Ryan, 1985) was used as the theoretical framework. <p>Study Methods: 30 pregnant or recently pregnant women over the age of 35 participated in semi-structured interviews and completed a brief survey. Content analyses were completed on the interview transcripts, and correlational analyses were performed on the survey data. Results: Womens personal values, feelings of social support, and perceived competence played major roles in the decision process. Some women in this study indicated the PNT choice gave them a feeling of control and offered feelings of reassurance, while some said having to make the choice was a burden that they found difficult to bear. Women in the testing group appeared to place a great importance on the need for information, while women in the no testing group placed greater importance on the need for social support. Each testing group also appeared to differ in facets of their personal values, such as religiosity (only women in the no testing group discussed this issue) and need for a sense of control (only women in the testing group discussed this issue). The women in the no testing group showed higher levels of uncertainty and decisional conflict, and lower levels of decisional self-efficacy than women in the testing group. <p>Conclusions: Each testing group appears to be individual in their needs during PNT decision making. The study findings suggest women should be counseled differently depending on their supports, values, and need for knowledge regarding testing. The findings suggest that women opting against PNT experience elevated decisional distress, and perceive themselves to be less competent and more conflicted over the decision than women choosing PNT. Special attention to these women during the PNT decision may improve their feelings of being socially supported during the decision.

This study examines the relationship between maternal emotional attachment to the fetus, beliefs about fetal health locus of control, and use of prenatal testing (i.e., amniocentesis and maternal serum screening). To date, no research has directly addressed the link between these psychosocial variables and prenatal testing uptake. Ninety-one pregnant women at risk for fetal abnormalities (i.e., 35 years of age or older) participated in the study, of whom 35 had no testing, 27 had serum screening, and 29 had amniocentesis in their current pregnancy. Results of a hierarchical multiple regression partially supported the hypothesis that internal and powerful others Fetal Health Locus of Control (Labs & Wurtele, 1986) and prenatal testing status would be predictive of attachment (Prenatal Attachment Inventory; Muller, 1993) over and above the effects of gestational age, maternal age and attitude toward abortion. Fetal Health Locus of Control beliefs regarding ones own role (FHLC-I) in determining the health of ones fetus were found to be predictive of prenatal attachment. Results failed to support the hypothesis that the role of health professionals (FHLC-P) would be predictive of prenatal attachment. As predicted, women who had not used prenatal testing or who underwent amniocentesis tended to have stronger prenatal attachment than those who underwent serum screening only. Results supported the hypotheses that stronger attachment to the fetus would be positively correlated with both FHLC-I and FHLC-P scores. Women who had no testing were found to hold less favourable attitudes toward abortion and rate their religious as stronger than those who had amniocentesis. Emotional attachment to the fetus was stronger among women who had previous miscarriages than those who had not, but did not differ between women who had a previous abortion and those who had not.

This study examines the relationship between maternal emotional attachment to the fetus, beliefs about fetal health locus of control, and use of prenatal testing (i.e., amniocentesis and maternal serum screening). To date, no research has directly addressed the link between these psychosocial variables and prenatal testing uptake. Ninety-one pregnant women at risk for fetal abnormalities (i.e., 35 years of age or older) participated in the study, of whom 35 had no testing, 27 had serum screening, and 29 had amniocentesis in their current pregnancy. Results of a hierarchical multiple regression partially supported the hypothesis that internal and powerful others Fetal Health Locus of Control (Labs & Wurtele, 1986) and prenatal testing status would be predictive of attachment (Prenatal Attachment Inventory; Muller, 1993) over and above the effects of gestational age, maternal age and attitude toward abortion. Fetal Health Locus of Control beliefs regarding ones own role (FHLC-I) in determining the health of ones fetus were found to be predictive of prenatal attachment. Results failed to support the hypothesis that the role of health professionals (FHLC-P) would be predictive of prenatal attachment. As predicted, women who had not used prenatal testing or who underwent amniocentesis tended to have stronger prenatal attachment than those who underwent serum screening only. Results supported the hypotheses that stronger attachment to the fetus would be positively correlated with both FHLC-I and FHLC-P scores. Women who had no testing were found to hold less favourable attitudes toward abortion and rate their religious as stronger than those who had amniocentesis. Emotional attachment to the fetus was stronger among women who had previous miscarriages than those who had not, but did not differ between women who had a previous abortion and those who had not.

Objectives: Advancements in womens reproductive technology have resulted in women having to face the decision whether to undergo prenatal testing (PNT). This study explored the factors involved in womens decisions around PNT and assessed the extent to which the decision making process differed between women that chose not to have PNT and those that chose to have PNT. The Self-Determination Theory (Deci & Ryan, 1985) was used as the theoretical framework. <p>Study Methods: 30 pregnant or recently pregnant women over the age of 35 participated in semi-structured interviews and completed a brief survey. Content analyses were completed on the interview transcripts, and correlational analyses were performed on the survey data. Results: Womens personal values, feelings of social support, and perceived competence played major roles in the decision process. Some women in this study indicated the PNT choice gave them a feeling of control and offered feelings of reassurance, while some said having to make the choice was a burden that they found difficult to bear. Women in the testing group appeared to place a great importance on the need for information, while women in the no testing group placed greater importance on the need for social support. Each testing group also appeared to differ in facets of their personal values, such as religiosity (only women in the no testing group discussed this issue) and need for a sense of control (only women in the testing group discussed this issue). The women in the no testing group showed higher levels of uncertainty and decisional conflict, and lower levels of decisional self-efficacy than women in the testing group. <p>Conclusions: Each testing group appears to be individual in their needs during PNT decision making. The study findings suggest women should be counseled differently depending on their supports, values, and need for knowledge regarding testing. The findings suggest that women opting against PNT experience elevated decisional distress, and perceive themselves to be less competent and more conflicted over the decision than women choosing PNT. Special attention to these women during the PNT decision may improve their feelings of being socially supported during the decision.

This project considers how disability studies and rhetorical studies—specifically the area of medical rhetoric—might usefully inform one another. In particular, this project examines prenatal testing for Down syndrome as a rhetorical situation that initiates and circulates many different discourses about Down syndrome. Chapter One begins by examining a frequently cited statistic in critiques of prenatal testing—the estimated pregnancy termination rate after a prenatal diagnosis of Down syndrome. It explores the validity of this statistic and uses this discussion to suggest that the effects of prenatal testing on social understandings of Down syndrome are complex and largely unknown. Chapter Two argues that intellectual disabilities, like Down syndrome, are underrepresented in disability studies literature and that their absence can be partially attributed to models of disability used in the field. Chapter Three argues that rhetorical analysis provides a means of examining how Down syndrome is discursively constructed. Chapter Four describes the events of prenatal testing for Down syndrome and analyzes the events as a rhetorical situation. In addition, it reviews feminist, disability, and cultural critiques of prenatal testing demonstrating the strengths of each strand of scholarship and suggesting where rhetorical analysis might provide new information. Chapters Five and Six provide analysis of two commentaries on the rhetorical situation of prenatal testing—genetic counseling discourse and parent discourse. These chapters find that ideal genetic counseling discourse offers pregnant women some opportunities to resist medicalization but also exhibits tension between what counselors say they do and what their rhetorical practice affords, especially regarding disability. In addition, analysis shows that users of prenatal testing are concerned with several factors of decision-making that are either not emphasized or ignored entirely in genetic counseling discourse. This project concludes that although different discourses about Down syndrome are available, elements of the prenatal testing situation make it easier for participants to draw on some discourses rather than others. Furthermore, it appears that certain events in the prenatal testing situation—such as the offer of amniocentesis—operate rhetorically in tacit ways, obscuring the relationship between the choice to undergo genetic screening and perceived meanings of Down syndrome. / Ph. D.

Background: There are few studies on the uptake of non-invasive prenatal screening, but those available suggest substantial variation in uptake in the initial years in which it was offered. There is a need to update the earlier evidence and determine whether there has been any change in usage trends as the number of users have increased. This will help inform policy makers about NIPT uptake under currently existing policies and guidelines which can help inform whether to maintain or refine policies on NIPT. Objectives: The primary objective of this thesis was to investigate recent trends in NIPT utilization, and the secondary objective was to identify differences between pregnant individuals aged 40 years and above and/or with a history of previous aneuploidy who opted for first-tier (first-line screening) or second-tier (contingent screening) NIPT and pregnant individuals aged less than 40 years with no history of previous aneuploidy. Methods: This retrospective cohort study used a province wide birth registry from Ontario and the population studied comprised pregnant individuals with an expected date of delivery from August 1st, 2016 to March 31st, 2020. Results: Of 536,748 pregnant individuals resident in Ontario during the study period, 27,733 were classified as high-risk of giving birth to a baby with a chromosomal aneuploidy and 509,015 were classified as low-risk of giving birth to a baby with a chromosomal aneuploidy. Uptake of NIPT has increased every year since 2016. We found substantial variation in NIPT between regions within the province. Highest uptake was found in urban areas, highest neighbourhood of income and education quintiles, high-risk population, among those with a prenatal care visit in the first trimester, multiple pregnancy, multigravidity, body mass index within the normal range (18.5-24.9 kg/m2), and OHIP funding. Conclusion: Our results suggest a need to provide more education/training about NIPT and funding eligibility to health professionals and pregnant individuals, including low-risk pregnant individuals in the first-tier (first-line screening) NIPT funding policy, to ensure equitable assess.