Family Choice, New Prenatal Diagnosis, and Artificial Pregnancy Termination

Surprisingly High Artificial Pregnancy Terminations

In Japan, approximately 168,000 pregnant women underwent artificial pregnancy termination in 2016. Half of these were due to economic reasons and similar causes. Breakdown: 63% were aged 20-34, nearly 9% were under 20, and about 23% were 35 or older.

Only obstetricians at designated hospitals can perform artificial pregnancy terminations. The 1948 Eugenic Protection Law (Maternal Protection Law) legalized abortions only for unwanted pregnancies or economic reasons. However, abortions are not legally permitted if the fetus can survive outside the mother after 22 weeks. Economic reasons are prominently cited among those aged 20 and older for artificial pregnancy terminations.

Previously, the Eugenic Protection Law allowed abortions for reasons such as hereditary diseases in parents or children, but these provisions were removed by the 1996 Maternal Protection Law. Even before 21 weeks, abortions are not permitted solely due to fetal abnormalities.

However, many pregnant women think, "If a genetic abnormality like Down syndrome is detected through amniocentesis before 21 weeks, abortion is possible." In Japan, the new prenatal diagnosis began in 2013 and awareness and patient numbers undergoing tests have increased yearly.

Approximately 1 million births are reported annually, and considering 1% of these show abnormalities through NIPT, this would lead to 10,000 abortions if all positive cases resulted in termination. Currently, 170,000 individuals undergo abortions due to unwanted pregnancies or economic reasons. Views on whether this 10,000 is high or low vary among individuals. The Japan Society of Obstetrics and Gynecology seems to ignore these 170,000 abortions, and actual terminations are performed by obstetricians. Is it only the author who feels it's irrational to oppose increased abortions due to positive NIPT results based on these numbers?

Family Choice

About 95% of couples who find fetal diseases through new prenatal diagnosis (maternal blood fetal chromosome test or NIPT: non-invasive prenatal genetic testing) choose artificial pregnancy termination, leading to criticism of "increasing casual abortions" and "selecting life." Economic or physical reasons make artificial abortions legal and publicly acceptable.

There are no couples who choose abortion lightly; they agonize over their decisions. Particularly, pregnant women's sorrows and pains are immeasurable, feeling no different from those who have miscarried or given birth to stillborn infants due to illness. Furthermore, deciding to conceive another child requires determination. I don't believe anyone thinks they are "casually aborting" or "selecting life."

If the general view is that it's understandable to abort a baby with an illness, it not only hurts those living with disabilities but also their families. It makes those with disabilities feel their lives were not worth starting. On the other hand, if 18 Trisomy is detected in early pregnancy, many cases cannot survive outside the womb, and sometimes cesarean sections are avoided to prioritize the mother. Some children are cared for in hospitals or at home, which might also feel like a denial of life.

Future of Prenatal Diagnosis

Prenatal diagnosis technology is advancing significantly, and the next generation of prenatal diagnoses has begun in Europe and the United States. As new prenatal diagnosis becomes less "new" internationally, there seems to be no reason for Japan to avoid expanding this new prenatal diagnosis.

Couples who undergo new prenatal diagnosis hope their unborn child will be born healthy, regardless of any illnesses. They eagerly await the birth while imagining the life of the child in their womb.

Regardless of illness, all parents hope for the same. When considering undergoing new prenatal diagnosis testing, I hope couples thoroughly discuss what they would do if an illness is found.

If an illness is found, I hope they consider undergoing testing, and if they choose to give birth, I hope they discuss with determination during the preparation period until birth how the child and their family can live happily, which might change their perspective a little.