"The technology of prenatal care has been shifting rapidly: sonograms became standard in the 80's; many new genetic tests became standard in the 90's. Our ethical responses to the information provided has been shifting as well. As in many other realms, from marriage and its definition to end-of-life issues, those ethics and standards are being hashed out in the courts, in one lawsuit after another. And what those cases are exposing is the relatively new belief that we should have a right to choose which babies come into the world. This belief is built upon two assumptions, both of which have emerged in the past 40 years. The first is the assumption that if we choose to take advantage of contemporary technology, major flaws in our fetus's health will be detected before birth. The second assumption, more controversial, is that we will be able to do something — namely, end the pregnancy — if those flaws suggest a parenting project we would rather not undertake.

… Perhaps most important, the number of prenatal genetic tests is increasing exponentially — it jumped from 100 to 1,000 between 1993 and 2003 — and no regulations yet guide parents and doctors about fair reasons for terminating or going forward with particular births. Should it be O.K. to terminate a deaf child? What about a blind one? How mentally retarded is too mentally retarded? What if the child will develop a serious disease, like Huntington's, later in life?

… At this moment, we are fairly adept at finding chromosomal flaws and horribly inept at fixing them. There is no chemical or surgical remedy if you find out your child-to-be has cystic fibrosis, fragile X, Down syndrome, Tay-Sachs, anencephaly — the list goes on and on. As Leon Kass, former chairman of the President's Council on Bioethics, has noted, in prenatal cases, often the only way to cure the illness is to prevent the patient.”

"The truth is that even with all the knowledge currently available, genetic testing remains in its infancy.  Bounded not only by the limitations prone to all medical tests, genetic tests, particularly prenatal genetic tests, have to withstand the issue of penetrance, the rate of actual expression of the gene.  Not all genes are expressed 100% of the time.  Accordingly, patients can have an abnormal gene, but if that gene is not expressed, they will not suffer the disorder associated with it.  Two additional issues unique to genetic tests concern severity and onset.  Even if one could be certain about the positive findings of a test, it is impossible to know how severe the disorder will turn out to be.  For prenatal testing, assuming that a child can be conclusively diagnosed as having Down syndrome, we have no way of knowing how severe the disease will be; and there is a considerable continuum to be sure. With many genetic disorders, the time of appearance of the disease is unknown.  Without this knowledge, it is difficult—almost impossible—to make any therapeutic decisions based on a prenatal genetic test.

…We need to be very clear about what therapy is currently available for most diseases that can be diagnosed prenatally: none.  …The ‘Abortion Assumption’ is quite simply the presupposition, epitomized by the rhetoric above, that, if the results of a prenatal genetic test are positive for a severely disabling or terminal condition, that the parents of that child will—and perhaps should—abort that child.

…Until such time as we have therapies for each genetic ailment for which a test is designed, we have no business administering the test.  Furthermore, in the case where there is an existing therapy, such as with spina bifida, the prenatal testing must be determined previously to be medically indicated.”

Because they recognize the health benefits breastfeeding confers, pediatricians around the world recommend that new mothers continue the practice for at least the first six months of their infants’ lives. However, a study recently published in Acta Pædiatrica by a team of Swedish epidemiologists suggests that even when governments offer extensive benefits to unwed mothers, it is married mothers who are most likely to heed their physicians’ recommendation.

Without question, the authors of the study recognize what is at stake in doctors’ efforts to promote breastfeeding.

Stressing “the importance of breastfeeding” for both infant and maternal health, the Swedish scholars enumerate many of its benefits. “Besides nutritional benefits,” they point out, “breastfeeding reduces the risk of infectious and atopic diseases, improves visual and psychomotor development, and possibly reduces the risk of adiposity in childhood.” What is more, the benefits breastfeeding delivers to mothers “range from reducing the risk of postpartum hemorrhage ... to reducing the risk of breast cancer, ovarian cancer and osteoporosis later in life.” But the researchers find that not all mothers are securing these benefits for themselves and their infant offspring.

Unmarried mothers, in particular, often forfeit the health advantages that come with breastfeeding.  Examining data collected for over 1078 infants born to women registered at a Russian antenatal clinic, the Swedish researchers are heartened to see “almost universal initiation of breastfeeding,” interpreting it as the consequence of the recommendations mothers receive from local healthcare officials and of the range of government benefits available to these Russian women, regardless of their social circumstances. The Swedish analysts regard as “positive features of the current Russian system” the provision of “almost universal coverage of pregnant women by free-of-charge prenatal care services, a stay of six or more days in maternity hospital even after uncomplicated delivery, and paid maternity leave for 18 mo[nths].” This package of government benefits, the researchers reason, may “create positive attitudes toward breastfeeding, as well as for establishing and maintaining good breastfeeding practices.”

But this panoply of government benefits cannot erase the fundamental distinction between married and unmarried mothers. The data in this new study reveal a significant “risk for shorter breastfeeding in single mothers,” compared to married mothers (p < 0.01). In other words, unmarried mothers in this study (including — the researchers acknowledge — unmarried cohabitors) were significantly more likely than their married peers to cut their breastfeeding short, so depriving themselves and their children important health benefits.

It would appear that chances for breastfeeding are best for the mother who has found not only a good pediatrician to consult, but also a good husband to wed.