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Should pregnant women be charged for non-invasive prenatal screening? Implications for reproductive autonomy and equal access
  1. Eline M. Bunnik1,
  2. Adriana Kater-Kuipers2,
  3. Robert-Jan H. Galjaard3,
  4. Inez D. de Beaufort4
  1. 1Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  3. 3Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  4. 4Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to Mrs Eline M. Bunnik, Medical Ethics and Philosophy of Medicine, Erasmus MC, Rotterdam 3015 GE, Netherlands; e.bunnik{at}erasmusmc.nl

Abstract

The introduction of non-invasive prenatal testing (NIPT) in healthcare systems around the world offers an opportunity to reconsider funding policies for prenatal screening. In some countries with universal access healthcare systems, pregnant women and their partners are asked to (co)pay for NIPT. In this paper, we discuss two important rationales for charging women for NIPT: (1) to prevent increased uptake of NIPT and (2) to promote informed choice. First, given the aim of prenatal screening (reproductive autonomy), high or low uptake rates are not intrinsically desirable or undesirable. Using funding policies to negatively affect uptake, however, is at odds with the aim of screening. Furthermore, copayment disproportionally affects those of lower socioeconomic status, which conflicts with justice requirements and impedes equal access to prenatal screening. Second, we argue that although payment models may influence pregnant women’s choice behaviours and perceptions of the relevance of NIPT, the copayment requirement does not necessarily lead to better-informed choices. On the contrary, external (ie, financial) influences on women’s personal choices for or against prenatal screening should ideally be avoided. To improve informed decision-making, healthcare systems should instead invest in adequate non-directive, value-focused pretest counselling. This paper concludes that requiring (substantial) copayments for NIPT in universal access healthcare systems fails to promote reproductive autonomy and is unfair.

  • non-invasive prenatal testing (NIPT)
  • reproductive autonomy
  • informed choice
  • equal access
  • funding policy

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • R-JHG and IDdB contributed equally.

  • Contributors EMB drafted the manuscript. AK-K, R-JHG and IdB offered substantial contributions to the conception of the work and critically revised it for important intellectual content. All authors have approved the final version of the manuscript.

  • Funding This study is a result of a research project ‘Towards an ethically robust scope of NIPT’, which was funded by ZonMw, dossier number 70-73000-98-116.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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