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• W2912677670 abstract "Since its early stages, prenatal diagnosis has been balancing between the promises of safer pregnancies and healthier babies, and the dangers of its use for eugenic purposes. Ilana Löwy goes beyond this, and eloquently shows the limitations of such a dichotomised analysis. Her work documents the complex development of the ‘prenatal diagnosis dispositif’ (p. 2), in the Foucauldian sense, as a set of new medical technologies that have contributed to a reconfiguration of the social, medical, legal and moral representations of pregnancy. This has been accompanied by the resignification of the embodied experience of being pregnant, an experience in which the medical gaze has historically played a structural role. Löwy summons a wide range of disciplinary fields to solidly support this historical and comparative analysis of this field of research and medical practice, offering an unbiased yet critical approach. The preface of the book brief but powerfully exposes the largely invisible side of prenatal diagnosis: its implications as a diagnostic mechanism. The book is then divided into introduction, six chapters and conclusion, ranging from a pre-prenatal diagnosis era, to the recent developments in non-invasive prenatal tests (NIPT). Although presented diachronically, the chapters unfold a non-linear process, where detail and description were privileged over linearity and oversimplification. The introduction reveals how the discreet naturalisation of prenatal diagnosis established a new regimen of truth, diverting the focus of pregnancy from the pregnant person to the foetus, normalising a new imagery of the unborn that overcame the subjective experience of being pregnant, and radically challenged the concepts of choice and responsible motherhood. In the first chapter, Löwy offers an analysis of the diffuse entity of ‘monstrous births’. When abnormality came to be interpreted as an intrauterine development error, unpredictable ‘monstrosities’ were gradually redefined by medicine as birth defects. As a pathology, each birth defect could potentially be diagnosed and, ideally, prevented. This growing body of medical knowledge legitimised the authority of physicians over the early visual recognition and management of birth defects. Public health norms regarding antenatal hygiene were then defined to protect the ‘rights of the foetus’ (p. 21) from the mistakes and potential harm of uneducated women. Chapter two discusses the origin and expansion, from the 1960s, of prenatal diagnosis as it is today: a set of technologies to evaluate the risk of abnormality of the foetus and to assess the adequacy of abortion. After the discovery of cellular markers of sex, then chromosomes, and later with the association between some birth defects and an abnormal number of chromosomes, harvesting and studying foetal cells in the amniotic fluid were included in the prenatal diagnosis dispositif. Now penetrating further deep into the human cell, the medical gaze could see new microscopical traits of abnormality when it was yet invisible to society. The observation of physical traits, however, remained central to the development of prenatal diagnosis, and chapter three is dedicated to the history of morphological anomalies, the integration of ultrasounds in prenatal diagnosis, and the creation of birth defects registries for the detection of potential environmental causes. These registries gained public relevance with the discovery of the teratogenic effects of thalidomide, a drug responsible for severe limb defects in newborn babies, and later became a key instrument for supporting the research of rare genetic conditions. Chapter four analyses the implications of the process through which the description of serum and ultrasound markers of Down syndrome, and the advances in prenatal ultrasounds allowed a – mostly uncriticised – extension of the prenatal diagnosis dispositif to all pregnant women, despite significant variations across countries according with the social and legal context. Chapter five deals with the specific case of sex chromosomes aneuploidies, and the entanglements between their study and the distinction between sex and gender. Because most sex chromosomes aneuploidies are compatible with life and some people may lead ‘normal’ lives without ever being diagnosed, abortion or an early chemical or surgical treatment became highly controversial issues, compromising the right to self-determination. This chapter proves to be of great value for those interested in gender and queer studies, as it unfolds a brief but fascinating history of the interaction between medicine and intersex, transgender, and non-binary people. Chapter six analyses the new genomic advances and the recent history of NIPT, including the ongoing debate on their benefits over the combination of serum tests and ultrasounds. This chapter demonstrates the likelihood of a broader dissemination of NIPT in the next few years, submitting more and more conditions to the ‘tyranny of diagnosis’ (p. 144), regardless of the risks of increased ‘prenatal diagnosis-related anxiety’ (p. 189), and the consequences of incidental findings in families and the future child. Finally, the conclusion offers a lucid overview of the challenges and consequences of prenatal diagnosis today and in the future. The fear of having an imperfect pregnancy, a flawed foetus, and a disabled child, the author concludes, has been and continues to be exponentially more expressive than any residual wish for a perfect, ‘Gattaka-like’ baby by design. Throughout the book, Löwy is very specific regarding the local variations in the scope and degree of implementation of the prenatal diagnosis dispositif (e.g. p. 113). Still, this local specificity is understandably difficult to maintain at all time, particularly given the diffuse nature of such a ‘fast-moving target’ (p. 176), occasionally making it difficult to situate it, or contributing to a sense of a homogenous implementation when it was not the case. Moreover, it is worth mentioning that the impact of prenatal diagnosis on partners is mostly absent. Pregnant women are (rightly) at the centre of this work, but partners and their invisibility in the history of prenatal care could have been occasionally included. The implications for partners are, for the first time, mentioned in the conclusion (p. 182). Adding the roles and experiences of partners, particularly men, to this comparative analysis may have contributed to an even wider picture of prenatal diagnosis." @default.
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• W2912677670 date "2019-01-22" @default.
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• W2912677670 title "Löwy, I.Imperfect Pregnancies: A History of Birth Defects and Prenatal Diagnosis, Baltimore: Johns Hopkins University Press. 2017. 296 pp. ISBN: 9781421423630" @default.
• W2912677670 doi "https://doi.org/10.1111/1467-9566.12857" @default.
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