Claim: More than 90% of pregnancies diagnosed with Down syndrome are aborted.

Verdict: Official data is incomplete but studies show the rate of abortions in pregnancies where Down Syndrome is detected has increased, sometimes exceeding 90% in certain countries. The rate varies sharply from one country to the next, often in line with screening rates.

In an open letter published last week, pro-life NGO Doctors for Life told MEP Cyrus Engerer that “in numerous European countries, 90 to 100% of unborn children diagnosed with Down syndrome are aborted”.

Doctors for Life were reacting to Engerer’s support for abortion to be entrenched in the EU’s Charter for Fundamental Rights, urging him to clarify his position on “the widespread abortion of children with Down syndrome”.

The NGO described the practice of abortion when Down syndrome is detected as having “disturbing, eugenic overtones reminiscent of some of the worst chapters in human history”.

Engerer, in turn, accused the NGO of being on “a scaremongering campaign intended solely to rouse emotions by deceit", urging “the anti-choice doctors to start basing their arguments on science and evidence.

Doctors for Life addressed an open letter to MEP Cyrus Engerer. File photo: Chris Sant Fournier

Similar claims in the US and Ireland

Variations of the claim, often using similar statistics have been made around the world, particularly in countries where abortion rights are frequently fiercely debated.

Fact-checkers in the US have written about similar claims well over a decade ago, investigating statements by several Republican congressmen such as Rick Santorum and Richard Corcoran. More recently, a billboard carrying this claim in Ireland prompted fact-checkers from Irish news site The Journal to dig into the matter.

In all three cases, the claims were found to be substantially true, although they needed to be qualified to account for regional differences, amongst other things.

The topic has only become more contentious over the past decade. Pre-natal testing for congenital disorders has ramped up worldwide, with several European countries now showing that more than half of pregnant women now carry out pre-natal tests that can detect congenital anomalies.

What does official data say?

Official data on how many people choose to terminate a pregnancy after Down syndrome is diagnosed is hard to come by in many countries and outright impossible in Malta, where abortion is illegal.

Even in countries where abortion is permitted, comparisons can be tricky, as different countries tend to place different requirements on people to state the reasons why they are terminating their pregnancy.

Pro-life activists gathering in Valletta in 2019. File photo.

The most comprehensive official data comes from EUROCAT, a network of registries around Europe that monitors congenital anomalies. Nevertheless, EUROCAT’s data is incomplete, with its registries only covering just over a quarter of the births across the EU.

The data shows that the rate of Down syndrome cases detected around Europe has increased over the years, rising from 16 per 10,000 births in 1990 to 23 in 2015, mostly because people are now having children at an older age, increasing the risk of congenital anomalies.

Meanwhile, the rate of abortions because of congenital anomalies has more than doubled during the same period, from 5 per 10,000 births in 1990 to almost 13 by 2015. But, at the same, time, the number of children actually born with the condition has remained more or less stable throughout this whole period.

Nevertheless, EUROCAT warns, there are “significant regional differences” between different countries and even different regions within the same country, making it difficult to reliably identify trends.

A 2008 analysis of EUROCAT’s data in 12 European countries reflects this, finding that while 88% of all pregnancies where Down syndrome was detected were aborted, this varied from 73% in the Netherlands to 100% in Croatia.

Abortion rates higher where screening widespread

Given the dearth of comprehensive data, several studies have tried to get a clearer picture of the situation, often using different methods.

One wide-ranging study attempted to estimate what the population of people with Down syndrome would be in each country in Europe between 2011 and 2015 if there were no “elective terminations” (that is, if none of the pregnancies in which Down syndrome was detected were aborted).

The study found that live births of people with Down syndrome across Europe would be 54% higher, but figures varied wildly from one country to the next.

Unsurprisingly, the lowest rates were recorded in predominantly Catholic countries Malta (0%, since abortion is forbidden), Poland and Ireland (both at 8%). On the other hand, Spain recorded the highest rate at 83%, followed by Portugal (80%) and Denmark (79%).

Ultimately, the study found, rates were higher in wealthier countries and those where pre-natal testing was considered a routine part of healthcare or available through the public health service, such as in Denmark and the Netherlands.  

This suggests that abortion rates are shaped by whether screening for Down syndrome during pregnancy is widely available. In short, countries where screening for congenital issues during pregnancy is widely available generally have a higher rate of people opting to end their pregnancy once an anomaly is detected.

Pro-choice activists argue that abortion should should be viewed as healthcare. File photo.

Another 2017 study looked specifically at the case of Denmark, the first country in the world to offer pre-natal screening for Down syndrome to all women as part of its national health service in 2004. As a result, over 90% of pregnant women in Denmark carry out pre-natal screening.

The study finds that “the vast majority” of people who detect Down syndrome during their pre-natal screening choose to terminate their pregnancy, although it does not specifically put a number to this.

In parallel, the study found that the number of children born with Down syndrome virtually halved once pre-natal screening was introduced across the country in 2004, going from over 60 in 2003 to just over 30 the following year.

In practice, this suggests that more people were carrying out tests to detect Down syndrome and that “only very few parents choose to continue the pregnancy when Down syndrome is diagnosed during pregnancy”.

Pro-life campaigners protesting against proposed amendments to Malta's abortion laws in December 2022. File photo: Chris Sant Fournier

What about Malta?

Unsurprisingly, data about abortions carried out by the Maltese is non-existent, with the procedure still strictly forbidden.

A recent study found that the number of children born with congenital anomalies (including Down syndrome) in Malta decreased between 2016 and 2018.

This, the authors say, suggests that parents may be going abroad to carry out an abortion when they receive news of an anomaly being detected.

“It may be reasonable to assume that a proportion of abortions are carried out solely in view of the successful detection of a severe congenital anomaly,” the authors say.

What type of screening is available in Malta?

Options are slim on the national health service, but several private clinics offer some types of screening options.

While Mater Dei hospital offers an anomaly scan which can “detect certain congenital defects”, obstetricians who spoke to Times of Malta say that this has limited success in detecting Down syndrome.

Obstetricians told Times of Malta that some private clinics offer more comprehensive scans, such as the nuchal scan, a type of ultrasound usually carried out at around 12 weeks of pregnancy, as well as non-invasive blood tests.

An ultrasound taken during a nuchal scan showing signs of possible anomalies. Photo: Shutterstock

Other, riskier, tests such as amniocentesis and CVS, which involve removing samples of the amniotic fluid or placenta, are generally not carried out in Malta.

Curiously, scans carried out in public hospitals tend to be more accurate than those carried out by private clinics, and Malta is no exception to this.

Verdict

Reliable data about the issue is difficult to come by and often incomplete. Nonetheless, EU data suggests that the rate of abortions because of congenital anomalies (such as Down syndrome) is on the increase.

Studies show that the rate varies significantly from one country to the next, sometimes exceeding 90% in some cases.

People in countries with more comprehensive pre-natal screening services are generally more likely to end their pregnancy.

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