Recent developments in abortion politics and prenatal genetic testing are currently on a collision course that has the potential to change the way we think about reproduction and reproductive rights. In the fall of 2011, the first noninvasive prenatal genetic test for Down syndrome entered the commercial market, offering highly accurate prenatal genetic tests from a sample of a pregnant woman’s blood without posing a risk to the fetus or the mother. In the last five years, over fifty biotechnology start-ups have been created to offer noninvasive prenatal diagnosis (NIPD) for an ever-widening range of genetic and chromosomal conditions. Because of its noninvasive nature, relatively low cost, and early timing, NIPD has the potential to become standard prenatal care for all pregnant women, providing them information on hundreds of genetic and chromosomal characteristics of their prospective offspring soon after they discover the pregnancy. Moreover, the technological development of NIPD has occurred alongside a significant political development: A handful of states have passed or attempted to pass legislation that restricts abortion based on the reasons for which it was sought. These laws have mainly prohibited abortions sought for sex- or race-based reasons, but proposed legislation would also restrict abortions sought for a wider range of genetic conditions.
The collision of these political and technological developments raises two questions regarding reproductive autonomy: (1) whether the Fourteenth Amendment protects a woman’s right to abort a fetus for any reason; and (2) whether that protection includes the right to access genetic tests that could inform the abortion decision. This Article argues for the reaffirmation of a woman’s right to choose to abort for any reason and grounds that right in strong principles of liberty and autonomy, rather than sex equality. In the context of reproductive genetic testing, the Article identifies a legitimate state interest, previously unrecognized in abortion jurisprudence, in avoiding significant harm to society based on widespread discriminatory selective abortion. The Article then proposes a new framework for examining the regulation of reproductive genetic testing that balances the relevant state and individual interests in a novel manner.