Ultimately society in general pays the costs for the choices undertaken by parents whether in terms of future health costs, attitudinal changes towards the disabled, or even the possibility of eugenics. Society also plays a role in the formation of laws that determine the circumstances in which a pregnancy can legally be terminated. Therefore it is important that the view of society as a whole is in line with that of parents and vice versa.
There is currently very little research available on parental attitudes towards prenatal screening in comparison with non-parental attitudes i.e. the rest of society, therefore it is apparent that further research is required. The aims of this study are to examine the attitudes of parents and non-parents towards the subject of prenatal screening in order to evaluate if parental views parallel those of the rest of society.
H0 : Parents will have more positive attitude towards prenatal screening than non-parents.
H1 : Parents will not have a more positive attitude towards prenatal screening than non-parents.
Methods
Participants
A total of 247 participants were included in this study, 125 parents and 122 non-parents. The parental group ranged in age from 19-55 whilst the non-parental group encompassed a similar age range of 19-56.
Materials and apparatus
Two questionnaires were used in this study, one administered to parents (see Appendix i) and the other to non-parents (see Appendix ii). The two questionnaires were identical other than four questions at the start of the parental questionnaire specifically concerning their children. The data from these questions were not used in any subsequent calculations. Excluding these opening parental questions, there were eleven items on each questionnaire, each in the form of a Likert scale. The participants were each asked how strongly they agreed or disagreed with eleven statements encompassing attitudes towards prenatal screening, termination and disability. However only questions 1, 3, 5, 7, 10 and 11 were used to calculate data scores as they pertained specifically to prenatal screening.
Procedure
Researchers were part of a class of undergraduate psychology students. A non-experimental design encompassing two independent samples was applied to this study. Utilising an opportunity quota sampling method, each student administered the questionnaires to two participants, one to a parent and one to a non-parent. The two participants in each instance were matched for age i.e. born in the same decade. It was explained that a study of attitudes to prenatal screening was being conducted and that their answers would remain anonymous. The participant was then given time to complete the appropriate questionnaire before returning it to the researcher.
Results
Each of the six questions used in the data analysis were rated on a five point scale, the least favourable option being rated 1, the most favourable rated 5 (total scores for each participant can be found in appendix iii).
Table 1
Table 1 shows the similarity in mean scores for parents and non-parents. The difference between the two groups total scores is 110 (approximately 8%). The optimum score for each group was calculated using the highest rated answer, each individual participant’s maximum possible score being 30. The parental group scored approximately 38% of the optimum score for their group. The non-parental group scored approximately 36% of the maximum score for their group.
Table 2
The mean attitude scores for parents and non-parents were compared using an independent t-test. As indicated in the summary of statistical analysis conducted (see Table 2) there was no significant difference found between the two groups (t(245)=1.38; p≤0.05). With a one tailed hypothesis, a critical value of 1.645 was found, therefore the null hypothesis was rejected in favour of the alternate hypothesis (See appendix iv for t test calculations).
Discussion
The present study found no significant difference in attitudes between the groups, thus supporting the alternate hypothesis that parents will not have a more positive attitude towards prenatal screening than non-parents. This result indicates that parental attitudes towards prenatal screening closely mirror that of society as a whole. The actual scores recorded for each group indicates that both have a fairly middle of the road attitude to prenatal screening, neither heavily biased for or against its use (as both groups were near the 40% mark). This bodes well for the future as too high a score (from either group) could indicate that society in general holds a highly positive attitude towards the increasing trend for genetic manipulation and therefore might favour a future geared towards eugenics.
The study was originally only to include female participants but due to researcher error, the questionnaires were also administered to males. However as there was not an equal sample of males and females used in the study, the results cannot be generalised to the whole population. This however could easily be remedied by future studies. Another methodological implication, which could be remedied by future research, was that the questionnaires did not allow for personal experience of prenatal screening in any of the questions (for parents or non-parents) even though this could play an important part in the formation of attitudes towards prenatal screening.
Future research could delve more specifically into attitudes towards the trend for a ‘perfect’ baby, possibly questioning where the line should be drawn. At what point should technological and medical advancements stop interfering and let nature ‘take its course’. What diseases or impairments have such a negative impact on a foetuses future life that termination is the only humane option? Are such decisions made in terms of the quality of life that the foetus will have or in terms of the cost to society for its care? The answers to such questions are of great importance as increasingly genetic and technological advancements are overtaking the existing realms of public policies meant to control them and as such, new policies have to be created or old ones adapted. The attitudes of the majority will play an important part in the formation of such policies.
There is a need to avoid abuses of such screening, for non-disease conditions, such as sex selection, and for eugenic purposes. An extra insurance against such abuse is to continue to educate people away from discrimination that is based on any apparent difference. Such education measures can change social attitudes towards "handicapped" as shown by studies in Canada between 1975 and 1988 (Rees, Spreen and Harnadek, 1991).
Prenatal testing carries undeniable benefits. For expectant parents it offers improved chances of having healthy offspring, provides some reassurance of foetal health during pregnancy, and increases women's bonding with the foetus. It offers the medical profession a technique if not a treatment to assist parents, albeit imperfectly, in reaching their goal of a healthy child. It also offers society the promise of reducing the incidence of some genetic disorders. Yet in the real world the elusive goal of achieving a healthy baby raises pragmatic and ethical questions. Like all advances, the new knowledge and technology will entail costs as well as behavioural and attitudinal changes - some foreseeable, and others unintended and unforeseen. Using the technology wisely, controlling it lest it cause unintentional or unnecessary harm, requires that all of those involved contemplate both the process itself and its possible consequences.
References
British Medical Association (1998) Human Genetics: Choice and Responsibility, Oxford: Oxford University Press.
Burke, M.B. Caplan, A.L. and Kolker, A. (1998) Prenatal Testing: A Sociological Perspective, Bergin & Garvey: Westport.
Green, J. Snowdon, C. and Statham, H. (1993) “Pregnant women’s attitudes to abortion and prenatal screening”, Journal of Reproductive and Infant Psychology 11: 31-39.
Green, J. Statham, H. (1996) “Psychosocial Aspects of Prenatal Screening and Diagnosis”, in Marteau, T. Richards, M. (eds.) The Troubled Helix, Cambridge: Cambridge University Press.
Murray, T.H. (1991) “Ethical Issues in Human Genome Research”, The FASEB Journal, 5, 55-60.
Rees, L.M. Spreen, O. and Harnadek, M. (1991) "Do attitudes towards persons with handicaps really shift over time? Comparison between 1975 and 1988", Mental Retardation 29: 81-6.
Rothman, B.K. (1998) Genetic Maps and Human Imaginations, New York: W.W. Norton & Company Inc.
Russo, E. Cove, D. (1995) Genetic Engineering: Dreams and Nightmares, Oxford: W.H. Freeman-Spektrum.
Appendix i – Parental Questionnaire
AGE
PLEASE ANSWER THE FOLLOWING QUESTIONS IN CONFIDENCE, AS ACCURATELY AS POSSIBLE.
What are the ages of your children? Child 1 Child 2 Child 3
Were you or your partner offered any form of prenatal screening (e.g. amniocentesis, ultrasound scan etc) before the birth of your child? YES/NO
If yes, what form did this take?
Did you have the screening carried out? YES/NO
Please mark with a circle on the scale how you feel about the following statements.
- Women should be made aware of all types of prenatal screening available which would identify potential problems with a foetus.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
- No pressure should be put on a woman to terminate a pregnancy, if a problem is identified with the foetus.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
- Screening techniques should be used to ensure that as few people as possible in our society have to suffer disabilities.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
- Termination should not be offered on the basis of the potential suffering of the child, as it is not possible to measure the degree of another person’s suffering.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
-
More tests for foetal abnormalities should be available to every pregnant woman.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
- Women who endanger the foetus by their own behaviour (e.g. smokers, drug users) should be less entitled to more expensive forms of screening.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
- Prenatal screening is unnecessary, and nature should be left to “take its course”.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
- Termination should be advised if screening shows the foetus to be abnormal.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
- Being disabled is not necessarily a disadvantage.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
- More tests for foetal abnormalities should be available to women in high risk groups e.g. women over age of 35.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
- Prenatal screening is an essential part of modern development and should be researched and made available to its full extent.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
Thank you for your co-operation.
Appendix ii – Non-parental Questionnaire
AGE
PLEASE ANSWER THE FOLLOWING QUESTIONS IN CONFIDENCE, AS ACCURATELY AS POSSIBLE.
Please mark with a circle on the scale how you feel about the following statements.
- Women should be made aware of all types of prenatal screening available which would identify potential problems with a foetus.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
- No pressure should be put on a woman to terminate a pregnancy, if a problem is identified with the foetus.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
- Screening techniques should be used to ensure that as few people as possible in our society have to suffer disabilities.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
- Termination should not be offered on the basis of the potential suffering of the child, as it is not possible to measure the degree of another person’s suffering.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
-
More tests for foetal abnormalities should be available to every pregnant woman.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
- Women who endanger the foetus by their own behaviour (e.g. smokers, drug users) should be less entitled to more expensive forms of screening.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
- Prenatal screening is unnecessary, and nature should be left to “take its course”.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
- Termination should be advised if screening shows the foetus to be abnormal.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
- Being disabled is not necessarily a disadvantage.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
- More tests for foetal abnormalities should be available to women in high risk groups e.g. women over age of 35.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
- Prenatal screening is an essential part of modern development and should be researched and made available to its full extent.
STRONGLY--------AGREE--------UNDECIDED------DISAGREE-------STRONGLY
AGREE DISAGREE
Thank you for your co-operation.
Appendix iii – Total Scores for Participants
Appendix iv – T Test Calculations