Compelling Choices: Tensions in the Practice and Experience of Prenatal Screening in New Zealand
Recently there has been a shift in health policy in New Zealand, as internationally, away from prenatal screening for fetal abnormalities targeting specific 'high risk' groups of pregnant women, towards the implementation of population-based screening programmes. As a result, for the majority of pregnant women in Western countries, prenatal screening is now undertaken as part of the standard 'package' of maternity care. This thesis explores the constitution of prenatal screening as a now taken-for-granted aspect of contemporary pregnancy care. It considers tensions between popular and medical understandings of the value and purpose of this practice, in particular examining the contradictory nature of discourses which, on one hand, construct acceptance of prenatal screening as an empowering 'choice' available to pregnant women, and on the other hand, as an institutionally-endorsed, morally appropriate practice of risk management. Recent developments within the New Zealand context are presented as a 'case study' of the representational politics of prenatal screening within contemporary public health policy. The question of informed consent for prenatal screening is a key focus within the research. It examines the extent to which the scope of women's choices and the degree of consent possible are materially shaped and constrained within the context of current clinical practice, and the broader climate of contemporary pregnancy care. Empirically, the research investigates key themes in women's experience of prenatal screening decisions within this climate, and explores the private 'moral work' undertaken by pregnant women as they navigate the contradictory imperatives which circulate in mainstream screening discourse. The findings of the research suggest a need for clinicians and policy makers to recognise prenatal screening as an ethically complex 'special case', qualitatively distinct from other projects of population-based health screening. It is argued that ethical practice in prenatal screening requires an approach which acknowledges the discursive and material factors which problematise liberal conceptions of prenatal screening as an authentic, deliberative 'choice' available to pregnant women.