Testing Women, Testing the Fetus
The Social Impact of Amniocentesis in America
by Rayna Rapp
2003 J. I. Staley Prize
In 1983, cultural anthropologist Rayna Rapp set out to map the terrain of the emerging technology of amniocentesis, a prenatal diagnostic test used to screen fetuses for chromosomal anomalies and other problems. Over the course of fifteen years, she studied the primary constituencies involved with this new reproductive technology: geneticists, genetic counselors, lab technicians, pregnant women and their supporters who used or refused the test, women who ended their pregnancies following a positive diagnosis, and parents of children with prenatally diagnosable disabilities. Her book, Testing Women, Testing the Fetus, offers "invaluable insights" into the first generation of women-described by Rapp as moral pioneers-who had to decide whether or not to terminate their pregnancies on the basis of amniocentesis results. Prenatal diagnosis, Rapp writes, "forces each woman to act as a moral philosopher of the limits, adjudicating the standards guarding entry into the human community."
Throughout the book, Rapp remains cognizant of race/ethnicity, class, religion, immigration status, and other social factors that affect access to reproductive technology and that influence women's decisions. "This ethnography does what so much research about reproductive technologies fails to do—it shows clearly that decision making about the termination of pregnancy is a social act and not merely an individual decision," observed one nominator.
Rapp's "strong voice and intrepid analysis" center on three arguments. First, the practice of amniocentesis is consistent with the stratification of reproduction along social fault lines. Second, Americans use scientific knowledge in ways that reinforce stratification based on class, religion, ethnicity, education, and language. And third, society needs to foster better communication between the realm of genetic testing and that of disability rights. Lynn Morgan, reviewing the book for Medical Anthropology Quarterly, called Rapp "one of the most eloquent feminist anthropologists writing today," and Testing Women, Testing the Fetus, a "tour de force."
"One of the most pressing problems for anthropologists today is to come to grips with what our roles might be in contributing to commentary on the development, implementation, and assessment of new technologies of all kinds, such as genetically modified foods, organ transplants, and germ-line engineering, all of which will have far-reaching societal effects," said a nominator. "Rapp's book must already be counted as a classic in this challenge for future anthropological investigations."
Rayna Rapp, Professor of Anthropology, Department of Anthropology, New York University