Tangled Diagnoses: Prenatal Testing, Women, and Risk by Ilana Löwy

Abstract

Reviewed by: Tangled Diagnoses: Prenatal Testing, Women, and Risk by Ilana Löwy Susan Lindee Ilana Löwy. Tangled Diagnoses: Prenatal Testing, Women, and Risk. Chicago: University of Chicago Press, 2018. 319 pp. Ill. $37.50 (978-0-226-53409-1). In this brilliant study, Ilana Löwy compares the story of contemporary prenatal diagnosis (PND) to “a classic detective story in which each protagonist attempts to hide something” (p. 212). Nearly all stakeholders are reluctant to discuss some aspect of PND, she proposes, because PND is a system that produces abortion, emotion, suffering, and confusion. Feminists for example downplay the liminal and unstable status of the fetus and the personal repercussions of selective abortion for women; health professionals avoid mentioning the high profit generated by PND; public health officials avoid calling attention to the savings produced by preventing the birth of people who will make demands on the health care system; and women choosing an abortion based on a diagnosed anomaly avoid the idea that their choices are “selfish,” framing their decisions instead in terms of preventing the suffering of [End Page 297] the (malformed) fetus. Meanwhile, advocates of late-term abortion rights obscure the material aspects of the actual medical interventions involved—the blood and the fetal bodies. And opponents of pregnancy termination in general, for any reason, downplay the real diversity of inborn impairments and disability, some minor, some devastating. There are, Löwy says, “wide zones of silence around PND” (p. 213). Her study helps us vividly see how these zones of silence function and why they matter. While many other scholars interested in reproductive technologies have noticed the selective silences in these systems, Löwy is the first to make them central to her analysis. The result is a sensitive and powerful study of a very special form of medical intervention. In general terms, the text is a study of contemporary practices of PND in France and Brazil, with a particular focus on some key medical specialists including fetopathologists, clinical geneticists, obstetric nurses, and genetic counselors. Löwy draws on ethnographic research, interviews, archival research, and a rich and compelling secondary literature in anthropology, history, and sociology, deployed well. Like Rayna Rapp, who looked at PND in the United States, and Charis Thompson who considered the social and medical worlds of the infertility clinic, Löwy provides a guide to the messy front lines of biotechnology, gender, and reproduction, where so many things are being negotiated at once in real time. But unlike many others who engage with PND and its social consequences, she thinks about abortion not as something negotiated inside the mind of the person choosing to undergo an abortion. Rather, it is a structural opportunity, common even in countries like Brazil where is it illegal, and shaped by class, law, the professional standards of different medical specialists, and the fine and varying details of the gender system. Ethicists who weigh in on the long-term risks of future designer babies, she says, are missing the point. PND is already a real-time ethics crisis, and it is not a hypothetical crisis of designer babies, nor the single, monolithic suite of practices that appear in public debates about “new eugenics” or abortion rights. It is rather, as Löwy suggests, “situated risk management” that produces wide disparities in the probability that a pregnant woman will learn anything actionable about the life/future life that is growing inside her. Löwy concludes that PND is a mass-distributed diagnostic technology and a feminist issue. This is the kind of book no newcomer to scholarship in this complex zone could manage to write. Löwy is an accomplished sociological observer who does not blink. Some of the text is painful to read, but if we are to understand what this system does and how it works, we have to be willing to see the very things that stakeholders turn away from. In her perceptive and careful reading, Löwy shows that PND is a realm of things not said, of secrets, evasions, quiet gaps, misdirection. These unsaid things appear in the ways that nurses handle aborted fetuses; in the protocols followed for talking to expectant...