WASHINGTON — First birth control, now prenatal testing? Once again a fact of life for many American women has become a jarring issue in the presidential race.
Republican candidate Rick Santorum is making free screenings for birth defects part of his attack on President Barack Obama's health care law. Santorum, who has a young daughter with a serious genetic disorder, said rules requiring insurers to cover prenatal tests are designed to encourage more women to have abortions that will "cull the ranks of the disabled in our society."
Obama re-election campaign spokeswoman Lis Smith called Santorum's remarks "misinformed and dangerous." She said the tests are for the health of mothers and babies and help bring about safer deliveries.
Federal health officials and the nation's obstetricians recommend that all pregnant women be offered blood tests and an ultrasound exam that assess the risk of having a baby with various birth defects or genetic disorders, including Down syndrome. If the screening raises concern, a woman may choose further testing, such as amniocentesis.
How did these commonplace tests spark so much controversy?
—Some women don't want the tests because they know they wouldn't abort their fetus no matter what the results. Others who wouldn't consider an abortion still want the tests — seeking reassurance that all is well or, if not, the chance to adjust emotionally and prepare for a disabled baby's more complicated care. Babies with Down syndrome can need specialized attention at delivery that affects hospital selection.
—Some women avoid amniocentesis, which involves withdrawing amniotic fluid through a needle, because of the small chance it could cause a miscarriage. There are less invasive tests available, however, and newer ones on the way.
—As Santorum noted, studies show that in the vast majority of cases where amniocentesis reveals Down syndrome, women decide on abortion.
—Advocates for the disabled, including many parents of Down syndrome children, worry that couples are choosing abortion without considering that their child could lead a happy, fulfilling life. About one in 800 babies is born with Down syndrome, a condition in which having an extra chromosome causes mental retardation, a characteristic broad, flat face and, often, serious heart defects.
The prenatal testing issues have been debated by abortion foes and obstetricians and wrestled with by prospective parents. But the ethical quandaries and painful emotional decisions received scant public attention before the politically charged remarks from Santorum, who also opposes the government requiring birth control coverage for employees of religiously affiliated organizations.
Until now, perhaps the best-known personal reflections on the prenatal testing decision came from two well-known conservatives, each the parent of a Down syndrome child. They saw the issue differently:
—"I was grateful to have all those months to prepare. I can't imagine the moms that are surprised at the end. I think they have it a lot harder," Sarah Palin, the 2008 Republican vice presidential nominee, said about the amniocentesis results she received before her son Trig was born.
—"What is antiseptically called 'screening' for Down syndrome is, much more often than not, a search-and-destroy mission: At least 85 percent of pregnancies in which Down syndrome is diagnosed are ended by abortions," columnist George Will wrote in a 2007 column about his grown son Jon and the recommendation by the American College of Obstetricians and Gynecologists that all pregnant women be screened.
Santorum, whose daughter Bella has a different genetic disorder, Trisomy 18, said in a CBS interview on Sunday: "Almost 100 percent of Trisomy 18 children are encouraged to be aborted, so I know what I'm talking about here."