In California, voluntary mass prenatal screening

Abstract

A statewide program in California to detect neural tube and other birth defects may revive enthusiasm for mass prenatal screening. Participation in the program is voluntary, but all expectant mothers are asked to sign a statement of "informed consent/refusal." So far California's program seems to be working well, but questions for the future include the level of participation, the possibility that normal fetuses will be aborted, the kinds of information given to women, and the elusive nature of free choice.

KIE: Since April 1986, providers of prenatal care in California have been required to offer alpha-fetoprotein (AFP) screening as a first step in a state-sponsored program to detect neural tube defects. Participation is voluntary, but all pregnant women receive explanatory material and are asked to sign an "informed consent/refusal" statement. The program includes a statewide computerized data base and regulation of the laboratories and of the diagnostic centers that provide follow-up testing, medical evaluation, and genetic counseling of patients with abnormal test results. The program, designed to be self-financing, has been well received and seems to be working well. Issues that may surface concern the level of participation, the possible abortion of normal fetuses before follow-up testing is completed, the kinds of information given to the women, and the elusive nature of free choice in selective abortion.