Bad ethics = bad business

There’s an aspect of Iviomics introducing its brand of non-invasive prenatal screening into India that has gone completely unreported. Separate from the ethical concerns, it’s just bad business.

Iviomics is the lab selling its brand of non-invasive prenatal screening, which it calls Non-invasive Analysis for Chromosomal Examination or NACE. Last week it was reported that Iviomics was offering NACE in India. But it’s another Iviomics’ genetic test that will end up costing the company millions of dollars in about 20 years.

India was one of the countries that inspired the invention of the word “Gendercide.” It describes the tens of millions of baby girls killed or aborted in countries like India, Southeast Asia, and Eastern European countries, where daughters are less desired than sons.

Mara Hvistendahl wrote of this imbalancing of the sexes in her book Unnatural Selection, which was a finalist for the Pulitzer and many other awards. The natural balance of the sexes is a few more men than women. But in countries where gendercide is occurring, the gap is widening in the number of boys being born than girls. Hvistendahl writes of the societal upheaval this imbalance causes: gangs of men raping women; women being sold into sex slavery; and other nightmares.

Gendercide largely occurred due to the advent of ultrasound. When a couple would see that their developing child was not developing a penis, they would have a sex selective abortion. This is happening in so many numbers that the Economist reported that there are over 100 million fewer baby girls.

Let that sink in for a moment.

According to U.S. Census Bureau, there were around 150 million women in the United States in 2011. Think of three American women you know and erase two of them.

To combat this, countries instituted a variety of different measures. They outlawed sex selective abortions. Authorities ran sting operations, where pregnant women would visit an OB’s office and tell them they were going to abort if their baby was a girl to see if the OB would tell them their child’s sex. In South Korea, proactive measures were taken to raise public awareness about gender equality. The United Nations convened a conference and condemned prenatal testing for sex selection.

In the United States, the American Congress of Obstetricians & Gynecologists issued an ethics committee opinion stating that prenatal testing for the purpose of sex selection was unethical, unless tied to sex-related chromosomal conditions. (Paradoxically, ACOG issued this opinion a month after its recommendation that all women be offered prenatal testing to allow for selecting against Down syndrome). And, some states have passed measures outlawing sex selective abortions.

There is an international consensus, then, that prenatal testing for sex selection is unethical. But what does this have to do with Iviomics?

Well, another offering of Iviomics is non-invasive analysis of chromosomal examination for sex. Their pamphlet for its test for Down syndrome states that if a patient “needs to know test results early,” Iviomics can do the testing as soon as 10 weeks. Why does this timeline and this product matter for a conversation about gendercide?

Ultrasound examinations for sex can only take place in the second trimester, when the genitals have formed and are visible. By that point, most pregnancies are showing. But, that is not the case with testing done in the first trimester. Indeed, as another NIPS lab highlighted, its testing is “months ahead of the curve” of a woman’s pregnancy showing. And, ACOG, in recommending prenatal testing for Down syndrome to all women, did so in part because of studies finding first-trimester diagnostic testing (CVS) was approaching the same risk as amniocentesis; therefore, women could get results earlier, before their pregnancy is visible and can make reproductive decisions more privately, i.e. aborting before their pregnancy is known.

Iviomics’ non-invasive testing for sex presents a significant threat for perpetuating gendercide because its results are available before the pregnancy is known. A woman can order the Inviomics test for Down syndrome and simply ask that the blood sample also be tested for sex. Should she live in a country that has outlawed sex-selective abortion, if the test comes back “female,” she can just tell the abortion provider that the test was positive for Down syndrome.

This would seem ethically objectionable for violating the international consensus against prenatal testing for sex selection. And it is. But, that’s not the reason Iviomics should be concerned. Rather, Iviomics should be concerned because its testing is bad for its business.

Right now, there is a growing demand for non-invasive prenatal testing, with that demand being nurtured by the marketing efforts of testing companies. It is in Iviomics’ interest to maximize the number of expectant mothers who order its tests. But, in those countries and cultures practicing gendercide, this will cause a prenatal testing bubble that will pop in the next generation. As more and more women accept non-invasive testing for sex, and then abort baby girls, it will decimate the next generation of mothers who would be ordering Iviomics’ Down syndrome test.

The marketing efforts of non-invasive testing companies risk drastically reducing their future market of customers. Right now there are millions of women to order non-invasive testing. And, if current gendercide trends continue, there will be millions fewer in twenty years, when the next generation of customers will enter child-bearing age. This is unethical, but it’s also just bad business.