Unit 5: Kimberly Farmer
Access and Agency in Prenatal Testing
Transitioning from our topics on kinship and reproductive technologies, this week’s readings explore women’s outlook on unplanned pregnancy and the use of prenatal testing. Rayna Rapp’s book Testing Women, Testing the Fetus and “Blessing Unplanned Pregnancy: Religion and the Discourse of Women’s Agency in Public Health” written by Dr. Seeman and colleagues discuss these concepts primarily through the lens of the woman. Together, these ethnographies illuminate the complexity of decisions made after conception and the religious, social, moral, medical, and ethical considerations that accompany women’s decisions and beliefs about reproduction.
Testing Women, Testing the Fetus was the result of Rapp’s extensive research on amniocentesis, or prenatal testing, and the relationship between women and their caregivers. Through interviews with and observation of expecting women, physicians, geneticists, and other professionals, Rapp strives to gain an omniscient understanding of women’s decisions to seek or evade prenatal testing. In addition, Rapp has personal stake in the topic as her study was fueled by her own decision to terminate a pregnancy. Throughout her work, Rapp finds that responses to prenatal testing vary across racial and socioeconomic lines. Rapp writes, “middle-class patients (disproportionately white) usually accept the test while poorer women (disproportionately from ethnic-racial minorities) are more likely to refuse it (168). As Rapp proceeds, she uncovers that there is complexity to this statistic. For example, in two hospitals that each serve low-income areas one, Middle Hospital, had a higher rate of prenatal testing than the other hospital, City Hospital. Rapp explains that, “Middle’s prenatal clinic provides a stable and welcoming environment in which women tend to be very comfortable” while “City Hospital, by contrast, has been a site of struggle over services for many years, and the prenatal clinic is a difficult environment in which to receive healthcare” (169). This finding of inequity even within the same socioeconomic status brings the concept of access into the discussion. Access to properly funded medical services, professional patient-centered help, and available counseling appointments are crucial factors in determining the prevalence of prenatal testing. In the Dr. Seeman et al piece, the notion of access is furthered by introducing a discussion on agency. The article suggests that access is not always a limiting factor in the prevalence prenatal testing because often times agency is influenced by a spiritual or religious belief that impacts a woman’s view on her pregnancy. The article highlights a group of young African-American mothers in a shelter in the southeastern United Sates. Through interviews and participant observation, the researchers gathered that unplanned pregnancies we not viewed negatively and were actually seen as a blessing leading some to avoid terminating the pregnancy. The authors write that the women in the study, “experienced divine blessing as a kind of life-giving and life-affirming agency beyond their control” (Seeman et al.) which leads them to reject family planning models. This shows that even with access and education about ending pregnancies, a woman’s outlook on the pregnancy, be it a blessing or not, influences the type of treatments or procedures they may undergo.
These two readings attempt to explain the complexity of a woman’s decision regarding her pregnancy. I found the Dr. Seeman et al article to be particularly interesting in the way that it described how an unplanned pregnancy is a way of enriching a woman’s life in the sample population. As a human health and sociology major, I wonder what other societal factors could be responsible for such a finding—particularly that African-American women are able to find comfort in things that are out of their control. African-Americans and individuals of low socioeconomic statuses are often at the mercy of things outside of their control, be it inner city pollution, high unemployment rates, institutionalized racism or an overall lack of power as suggested by sociology’s Conflict Theory. Essentially, in order to survive these women are forced to accept things outside of their control. I wonder if we could view the women in the study’s acceptance of a pregnancy out of their control as an extension of a survival mechanism used in everyday life rather than a religious barrier that limits agency.
Overall, from these readings one can see that the responses to a woman’s pregnancy are not clear cut nor homogenous across demographics. In addition, the concepts of prenatal testing and unplanned pregnancies cannot be understood without addressing societal, religious, moral, medical and ethical implications. Mothers are the ones burdened with the duty of weighing each of these obligations in order to make the best choice for herself, her family, and her child.