been crisscrossed with a hereditary variant of Down syndrome. Her grandfather and her mother were both carriers. Six years earlier, late in pregnancy, she had miscarried one child—a girl—with Down syndrome. In the summer of 1963, a second girl was born, a healthy child. Two years later, in the spring of 1965, she gave birth to another child—a boy. He was diagnosed with Down syndrome, mental retardation, and severe congenital abnormalities, including two open holes in his heart. The boy had lived for five and a half months. Much of that brief life had been miserable. After a series of heroic surgical attempts to correct his congenital defects, he had died of heart failure in the intensive care unit.
Five months into her fourth pregnancy, with this haunted history in the backdrop, J.G. came to her obstetrician and requested prenatal testing. An unsuccessful amniocentesis was performed in early April. On April 29, with the third trimester rapidly approaching, a second amniocentesis was attempted. This time, sheets of fetal cells grew out in the incubator. Chromosomal analysis revealed a male fetus with Down syndrome.
On May 31, 1968, on the very last week that abortion was still medically permissible, J.G. decided to terminate the pregnancy. The remains of the fetus were delivered on June 2. It bore the cardinal characteristics of Down syndrome. The mother “withstood the procedure without complications,” the case report states, and she was discharged home two days after. Nothing more is known about the mother or her family. The first “therapeutic abortion,” performed entirely on the basis of a genetic test, entered human history shrouded in secrecy, anguish, and grief.
The floodgates of prenatal testing and abortion were thrown open in the summer of 1973 by an unexpected maelstrom of forces. In September 1969, Norma McCorvey, a twenty-one-year-old carnival barker living in Texas, became pregnant with her third child. Penniless, often homeless, and out of work, she sought an abortion to terminate the unwanted pregnancy, but was unable to find a clinic to perform the procedure legally or, for that matter, sanitarily. The one place she found, she later revealed, was a closed clinic in an abandoned building, “with dirty instruments scattered around the room, and . . . dried blood on the floor.”
In 1970, two attorneys brought her case against the state to a Texas court, arguing that McCorvey had a legal right to her abortion. The nominal defendant was Henry Wade, the Dallas district attorney. McCorvey had switched her name for the legal proceedings to a bland pseudonym—Jane Roe. The case—Roe v. Wade—moved through the Texas courts and climbed to the US Supreme Court in 1970.
The Supreme Court heard oral arguments for Roe v. Wade between 1971 and 1972. In January 1973, in a historic decision, the court ruled for McCorvey. Writing the majority opinion, Henry Blackmun, associate justice of the Supreme Court, decreed that states could no longer outlaw abortions. A woman’s right to privacy, Blackmun wrote, was “broad enough to encompass [her] decision whether or not to terminate her pregnancy.”
Yet a “woman’s right to privacy” was not absolute. In an acrobatic attempt to counterbalance a pregnant woman’s rights against the growing “personhood” of the fetus, the Court found that the state could not limit abortions during the first trimester of pregnancy but that as the fetus matured, its personhood became progressively protected by the state, and abortions could be restricted. The division of pregnancy into trimesters was a biologically arbitrary, but legally necessary, invention. As the legal scholar Alexander Bickel described it, “The individual’s [i.e., mother’s] interest, here, overrides society’s interest in the first three months and, subject only to health regulations, also in the second; in the third trimester, society is preeminent.”
The power unleashed by Roe reverberated swiftly through medicine. Roe may have handed reproductive control to women, but it had largely handed the control of the fetal genome to medicine. Before Roe, prenatal genetic testing had inhabited an uncertain limbo: amniocentesis was permitted, but the precise legal stature of abortion was unknown. But with first- and second-trimester abortion legalized, and the primacy of medical judgment acknowledged, genetic testing was poised to diffuse widely through clinics and hospitals around the nation. Human genes had become “actionable.”
The effects of widespread testing and abortion were soon evident. In some states, the incidence of Down syndrome fell between 20 and 40 percent between 1971 and 1977. Among high-risk women in New York City, more pregnancies were terminated than carried to full term in 1978.II By the mid-1970s, nearly