Down Syndrome, reproductive choices and the need for a social welfare state

On January 2nd, the Irish Times reported that Irish women have been advised to start having babies younger. The contextual hypocrisy aside (think housing crisis, sky-high childcare costs, poorly paid graduate jobs – the list goes on), one aspect of the story jumped out: Dr. Fishel, of a Dublin IVF fertility clinic, said that Down Syndrome occurs in one of 700 pregnancies in women aged 32, while the same figure for women ten years older is one in 67, and 70-80% of a 40-year-old woman’s eggs have a chromosomal abnormality. Why it’s important? Because Irish women aren’t having enough babies to keep society going with our ageing population. We need to keep producing healthy, productive sprogs.

Last weekend, Down Syndrome appeared in the media yet again, as the Citizens’ Assembly met to consider the medical, legal and ethical implications of ante-natal screening and foetal abnormalities. 40 Irish women, they were told, had abortions last year after screening showed that their babies would have Down Syndrome.

The assembly was also informed that no babies with Down Syndrome have been born in the past four years in Iceland, where highly accurate non-invasive screening procedures are standard, and the development in Denmark, where screening routines are similar, is going in the same direction. The point Professor Peter McParland, director of Foetal Maternal Medicine at the National Maternity Hospital, was trying to make was that “science has got way ahead of the ethical discussion”. And we don’t want that, do we?

This is nothing new. I wrote about my thoughts on the situation in Denmark back in 2012, when a Swedish opinion piece posed a question similar to McParland’s: How narrow can the perception of the perfect child get? It’s an interesting and important question from a philosophical point of view, but when asked in the context of the reproductive justice discourse it becomes puzzling at best – not least because monitoring pregnant people’s motivations is tricky. Do you qualify for a termination if there are multiple reasons behind your request, not a diagnosis alone? If you expressed a wish to terminate before you even got the screening results, will your motives seem noble enough? If you’re broke and lonely and depressed and have no one around to help, and the chromosomal abnormality is deemed extremely serious, do we sympathise enough to budge on the moral high ground?

More often than not, the answer is no, because these arguments have little to do with concern and compassion and a great deal to do with religious, dogmatic principles. The more you pick them apart, the more these concerns tend to fall into the ‘slippery slope’ category (‘if they can terminate for this, they’ll soon be terminating for that’), which follows on from the idea that women are both cold-hearted and hysterical at the same time and don’t know what’s best for them; that the right to choose is not absolute, but must be handed down to women on a case-by-case basis. The slope in the analogy leads straight down into an imagined promiscuous hell, where women can engage in sexual pleasures as they please, almost without consequences.

Of course, talking about the kind of society we want to live in is incredibly important – I reiterate this every time it’s time to go out to vote. But is a concern for babies with chromosomal abnormalities and the kind of society we want to live in really, in practical terms, naturally linked to the view that reproductive choice must be restricted, with forced pregnancy and parenthood suddenly being a-ok?

Two weeks, two stories. And the takeaway? We should start early to minimise the risk of Down Syndrome – but if we terminate a pregnancy due to a chromosomal abnormality, we’re ethically compromised. We should want to avoid it – yet struggling to embrace the reality if we fail to avoid it is just not on. The hypocrisy is mind-numbing.

What’s ironic is what these two unrelated news stories have in common. Firstly, neither really has anything to do with Down Syndrome; they just use it, crassly, for the benefit of their own argument. Secondly, they rope in women’s sexuality as a tool to get what they want. The goal of the first news piece is optimal reproduction and an increased birth rate, and Down Syndrome is used to convince women to reproduce as required – whether they want to or not. The goal of the second is continued restrictions on abortion access, and Down Syndrome is used to convince those on the fence that liberalised abortion laws are ethically questionable. Both are straw-man arguments, because the crux here isn’t that women aren’t aware of the risks involved with postponing trying to conceive, or that they view people with Down Syndrome as in any way less human or worthy. Still we keep having babies later, and more advanced screening programmes lead to fewer Down Syndromes babies being born – so why on earth is no one asking why?

The third thing the two stories have in common is the solution (hint: it’s not the policing of women’s bodies). Ask the parent of a severely disabled child what they want. Ask a woman trying to conceive aged 43 what she would have wanted years ago. Support and a solid welfare state would go a long way; the modern individualist mantras we are continuously sold today are likely to receive less praise.

What we need is a shift in attitudes and a hugely increased support system, where you don’t need two degrees and a handful of unpaid internships in the bag before you can get paid work, and an additional ten years of career building before you can buy a house; where you can become a parent and afford to return to work should you want to; where the rental market is regulated, secure and tenant-friendly enough that long-term renting is considered a perfectly good option for a family with kids; where we don’t have to talk about childcare costs as ‘a second mortgage’; where social services are built on social values, not financial measures and market logic; where being a single mother does not automatically equate to being the lowest rung on the ladder of society; where you can become a carer of your much-wanted, disabled child and society is there to get you through. Laws controlling women and making them into vessels for steady population growth just won’t work – nor will fake concern for children with Down Syndrome that does nothing but pit them against the people who love them most.





  • As the older sister of a much-adored brother with Down’s Syndrome, I want to sincerely thank you for putting so eloquently into words what I’ve been trying to articulate in the past few weeks- especially since the Citizen’s Assembly. The hypocrisy of the arguments put forward by a group claiming to ‘Love Both’ tends to be extremely frustrating.

    • I don’t know from where you get the idea that the repeal campaign sees rape and FFA as exceptional, or that the pro-choice movement won’t engage with the moral debate of the right to life. On my blog alone (which is of course just the tip of an iceberg) there are countless posts dealing with exactly this, highlighting that choice should NOT be exceptional and that my pro-choice views are independent of any stance regarding when life begins.

  • I totally agree that permitting abortion on a case by case basis isn’t going to work (rape, disabilities, financial issues etc.). It implies that the degree of the womans suffering is the main factor in whether they can get an abortion or not, which is actually quite cruel. The only solution is to be honest with ourselves; a child (unborn or not) cannot have its value and viability determined by how pitiful a woman’s plea is, there must be intrinsic protection for unborn children. If we can uphold the fundamental protection of the unborn, then the woman (if she doesn’t want the child) isn’t dependant on a doctor, weighing their story to see if its pitiful enough to permit an abortion. I disagree with the writer on the use of the words ‘forced pregnancy’. The only time someone has a forced pregnancy, if they’ve conceived from rape. Calling an unwanted pregnancy a ‘forced pregnancy’ implies that women have nothing to do with bringing about the lives that they want to destroy.

    • Whatever you want to call an unwanted pregnancy, I disagree strongly with the idea of parenthood as punishment for having sex, whatever the circumstances, and I find the worldview behind the idea that women should have to live like that – and their children growing up to unwilling parents just because we can’t face the realities of family planning – quite disturbing. I obviously also strongly disagree with the words ‘destroy lives’; yes, it’s impossible to draw the line, and yes, I’m happy to talk about a foetus as a baby if the pregnant person agrees, and yes, it’s complicated, but hey, we’re throwing away perfectly healthy zygotes all the time in IVF clinics, which is somehow deemed OK because the motives behind such procedures are seen as pure and right. But alas, I doubt we’re going to come to agreement on this, so I’ll leave it there. But thanks for taking the time to comment.

  • Great to see a proper dialogue starting on this. Science has indeed gone way ahead of ethics. Any person of wealth (or ones who can beg, borrow or steal) will tell you that discarding of screened embryos happens daily. These are the people who flock to Irish fertility clinics (unregulated area). Aside from that while we’re busy bickering acrimoniously about abortion CRISPR-Cas 9 has arrived. Aside from that and meanwhile back at the ranch DS is only one of DOZENS of chromosomal disorders that cause all manner of problems. In essence the horse has bolted long ago we’re just mired in old tired arguments and refusing to deal with reality.