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Respect women, promote health and reduce stigma: ethical arguments for universal hepatitis C screening in pregnancy
  1. Marielle S Gross1,
  2. Alexandra R Ruth2,
  3. Sonja A Rasmussen3,4
  1. 1Berman Institute of Bioethics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
  4. 4Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, Florida, USA
  1. Correspondence to Dr Marielle S Gross, Johns Hopkins University Berman Institute of Bioethics, Baltimore, MD 21205, USA; mariellesophiagross{at}


In the USA, there are missed opportunities to diagnose hepatitis C virus (HCV) in pregnancy because screening is currently risk-stratified and thus primarily limited to individuals who disclose history of injection drug use or sexually transmitted infection risks. Over the past decade, the opioid epidemic has dramatically increased incidence of HCV and a feasible, well-tolerated cure was introduced. Considering these developments, recent evidence suggests universal HCV screening in pregnancy would be cost-effective and several professional organisations have called for updated national policy. Historically, universal screening has been financially disincentivised on the healthcare system level, particularly since new diagnoses may generate an obligation to provide expensive treatments to a population largely reliant on public health resources. Here, we provide ethical arguments supporting universal HCV screening in pregnancy grounded in obligations to respect for persons, beneficence and justice. First, universal prenatal HCV screening respects pregnant women as persons by promoting their long-term health outside of pregnancy. Additionally, universal screening would optimise health outcomes within current treatment guidelines and may support research on treatment during pregnancy. Finally, universal screening would avoid potential harms of risk-stratifying pregnant women by highly stigmatised substance use and sexual behaviours.

  • health care economics: interests of woman/fetus/father
  • ostetrics and gynecology
  • public health ethics: drugs and drug industry

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  • Contributors MSG conceptualised the project, performed literature review, wrote primary draft of the manuscript and contributed to final manuscript edits. ARR performed extensive literature review, assisted in ethical analysis, and manuscript preparation and editing. SAR contributed to the conceptualisation of the project, provided subject-specific expertise and critically revised the manuscript. All authors approved of the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement There are no (new) data in this work; all can be found in referenced publications.

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