Abortion and the Genetic Counselor: The Impact of Restrictive Legislation on Genetic Counseling Practice
Creators: name: Hercher, Laura
name: Brown, Jordan
Publisher: name: Center for ELSI Resources and Analysis
Year: 2022
Subjects: subject: Genetics
subject: FOS: Biological sciences
subject: Ethics
subject: Science
subject: ELSI
subject: abortion
subject: genetic counseling
subject: prenatal diagnosis
subject: NIPT

description: The first class of genetic counselors graduated with an M.A. from the Sarah Lawrence College in 1971; less than two years later, the Supreme Court decision in Roe v. Wade legalized abortion in all fifty states. In the U.S., the field of reproductive genetic counseling came of age against a backdrop of legal abortion, and the option of terminating a pregnancy after a prenatal diagnosis has always been an integral part of the standard of care. In 1992, the Supreme Court decision in Casey v. Planned Parenthood allowed states to pass laws that made obtaining an abortion more difficult, so long as it did not create what the Court described as an “undue burden” on the pregnant individual. Research has shown that, in aggregate, these laws disproportionately affect vulnerable populations: younger people, poorer people, individuals with disabilities, and people at risk of domestic violence. The erosion of access to abortion care that began with a steady trickle of laws in abortion-unfriendly states has become a flood. An average of 59 abortion restrictions were enacted every year from 2011 to 2021. In 2021, that number peaked at 108--a record that will no doubt be eclipsed in 2022 if, as expected, Roe v. Wade is overturned. Naturally, these laws affect people seeking abortions following prenatal diagnosis. Perhaps less obviously, they impact care for every prenatal patient in states with restrictive laws. Restrictions on abortion force pregnant individuals to make decisions earlier to comply with gestational age limits or waiting periods or handle the financial and logistical challenges of traveling out of state. Studies have also shown that this time pressure affects genetic counseling practice. Thirteen laws have been passed that forbid abortion if the motivation for the abortion is related to a ‘genetic defect or anomaly’. These so-called ‘reason bans’ can alter how a genetic counselor approaches the subject of abortion. Texas Senate Bill 8 (SB8) and subsequent copycat laws penalize any conduct that aids or abets abortion, which can be interpreted to mean that any discussion of abortion subjects a genetic counselor to legal jeopardy. Other questions loom. How should genetic counselors adapt conversations about carrier screening and prenatal screening if abortion restrictions limit the utility of testing? Will the association between abortion and prenatal diagnosis result in laws that limit access to genetic testing? Will insurance companies become resistant to paying for prenatal testing? A handful of studies have documented the impact of a rapidly changing abortion law landscape on genetic counseling practice. These studies, each, perforce, only a snapshot in time, are collected here. In addition, we suggest papers that examine the relationship between abortion and prenatal diagnosis. There is no question that this is only a beginning, and researchers from multiple disciplines will be needed to track the impact of impending changes.