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Paper short abstract:

NIPT in Belgium is based on the premise of equity in access to testing. However, gender, race and class inequalities materialize at various stages of the test’s trajectory. Analyzed through the lens of care, these inequalities result from the valuation of some reproductive bodies over others.

Paper long abstract:

In 2017, Belgium became the first European country to offer first-tier noninvasive prenatal testing (NIPT) to all pregnant women for free. Without much public scrutiny, NIPT replaced long-standing and routinized screening practices for Down syndrome. The goal of the offer is to ‘enhance reproductive autonomy’ by informing women on the fetus’ health. Fetal DNA is accessed through maternal blood and then compared to a ‘normal’ data set of reference (the 'general population') to assess the risk of aneuploidies. The reproductive body thus plays a crucial role in the production of knowledge on the population, as well as its management.

Unlike commercial offers, NIPT in Belgium is based on the premise of equity in access to testing. However, I argue that various inequalities materialize at different stages of the test’s trajectory. Analyzed through the lens of care, these inequalities result from the valuation of some reproductive bodies and the negligence of others.

To illustrate this, I draw on my ethnographic fieldwork in a genetic center. First, I turn to the laboratory to show how some marginalized populations were not included in the establishment of the set of reference. Second, I turn to genetic counselling to show how the test fails to address women’s material conditions of life and the gendered division of reproductive labor. The test perpetuates an individualist discourse on choice that does not always align with practitioners’ notions of a ‘good care’. The implementation of NIPT is underpinned by gender, race and class biases in a neoliberalized healthcare setting.