Texas Senate Bill 8 stands as a groundbreaking and polarizing piece of legislation, effectively prohibiting nearly all abortions in Texas. While supporters applaud its stringency, opponents decry its lack of exceptions, such as in cases of rape or fetal anomalies — exceptions that are supported by a majority of Americans.
Gov. Greg Abbott has quixotically remarked that the rape exception won’t be necessary if Texas can “eliminate all rapists”; more accomplishable is a reduction of pregnancies affected by anomalies.
Terminations for fetal anomalies are common, with 1 in 8 abortions attributed to fetal health concerns. A familiar pregnancy refrain is “we don’t care if we’re having a boy or girl, as long as it’s healthy.” While such a view can stigmatize disability, the fear and compassion underneath this desire is understandable, as the heartache of parenting a newborn through a painful, debilitating and terminal illness is daunting for the most resilient of people.
In many cases, fetal anomalies are the result of genetic risk factors. Frighteningly, this genetic risk is often unrecognized until a pregnancy is found to have a problem, because nearly 90 percent of children born with inherited disorders have no similarly affected relatives.
As an OB/GYN, I cared for a couple who had watched their first child suffer for his only year of life before dying from an unexpected genetic skin condition. When their child would cry out in pain from the blisters covering his body, they couldn’t even pick him up without causing the blisters to rip open and worsening his pain. They watched helplessly as their baby suffered and died.
Whether abortion would have been a morally acceptable way for my patients to avoid this suffering is a matter of fierce debate. Everyone should agree, however, that Texans now need a non-abortive method to achieve healthier family-building outcomes. Fortunately, such a method is already available for many genetic issues; it is called genetic carrier screening. This screening simply needs to be made more readily available and with greater public awareness.
Genetic carrier screening is based upon the notion that everyone carries some problematic genetic variants. While these variants cause us no harm, they confer a 1 in 4 chance of severe disease in our children if we get pregnant with someone carrying a variant in the same gene. Familiar examples of such genetic conditions include cystic fibrosis and Tay-Sachs disease, but there are hundreds of recognized genetic disorders that cause profound disability and death. Genetic carrier screening is simply the lab test to identify these genetic variants before a family is affected with a sick child.
Many medical organizations support genetic screening of couples before conception to help them understand their risk of a genetically abnormal pregnancy, allowing for informed family-building. Armed with this knowledge, a couple doesn’t have to “just take their chances”; rather, they can choose to avoid pregnancy, to adopt, or to have a baby via IVF with embryonic diagnosis, a preventive intervention offered at fertility clinics across Texas.
In reality, however, most women do not obtain this genetic information until after they are pregnant. This leaves an at-risk couple with the limited options of acceptance or termination of a pregnancy with a severe health issue.
In the era of S.B. 8, this needs to change. Implicitly, couples and physicians have been counting on abortion as a “backup plan” in the event of an abnormal pregnancy. That backup plan is now gone. In its absence, Texans need to make universal preconception genetic carrier screening our new standard of care.
Couples should ask their physicians for genetic screening before they get pregnant. Primary care doctors and OB/GYNs should take the time to discuss this with their young patients. Legislators should mandate insurance coverage of this test before pregnancy; such a move would simultaneously help Texans gain a measure of reproductive choice and signal a commitment to reducing abortion.
Texans deserve to be empowered to make informed reproductive decisions. With the implementation of S.B. 8, we need to look to non-abortive strategies, such as preconception genetic screening, to accomplish this goal. Reproductive choice is about more than abortion, and reducing abortion requires more than legal barriers. With broader adoption of genetic screening, Texans on both sides of the abortion debate can move closer to their goals around reproduction.
