ON TUESDAY, THE Save the 8th Campaign launched a new campaign in relation to the upcoming referendum on abortion.

The national campaign to defeat the referendum on the Eighth Amendment involves two billboard posters which are being put up across the country.

The Save the 8th campaign said in a press release:

The billboards, launched after consultation with Disability Voices for Life, a group representing families that include somebody with a disability, reveal on [sic] the shocking increase in the numbers of abortions carried out, and the heart-breaking rate of babies with Down syndrome being aborted, after abortion was legalised in Britain.

Save the 8th adds:

The billboards capture some stark facts that are being hidden from the debate. One quotes the shocking statistic that 1 in every 5 babies is aborted in Britain, while the other features Joseph Cronin, a Donegal boy with Down syndrome, and gives a human face to the heart breaking fact that 90% of babies with the condition have their lives ended before birth in other jurisdictions.

One of the posters says:

In Britain, 90% of babies with Down Syndrome are aborted.

Where does the figure come from?

On this poster, the quote has a source (on the bottom right-hand side) beneath it: 2013 Bruce Enquiry (sic).

This appears to refer to a 2013 independent report into abortion on the grounds of disability, which was carried out by a cross-party group of MPs chaired by Fiona Bruce, a Conservative MP. She is the former chair of an informal cross-party British parliamentary pro-life group.

Though the report is called a ‘parliamentary inquiry’, it is not an official government inquiry.

The percentage of abortions

The Bruce inquiry report includes this line (words in bold are its emphasis):

A considerable amount of evidence was presented on the experience of expecting a child with Down’s Syndrome: approximately 90% of babies with a definite diagnosis of Down’s Syndrome are aborted; about 30% of births of children with Down’s Syndrome have no prenatal diagnosis.

It appears that the Save the 8th campaign billboard is quoting from this line.

However, the source material (pointed out in a footnote) to this line is the National Down Syndrome Cytogenetic Register (NDSCR) for England and Wales 2010 Annual Report.

This footnote reads:

After the prenatal diagnosis of Down’s Syndrome 91% of affected pregnancies are terminated and 9% are continued. Some of the continued pregnancies miscarry naturally, some end as still births, and approximately 6% of prenatal diagnosis of Down’s Syndrome end in live births. Quoted from page 4 of Morris JK, The National Down Syndrome Cytogenetic Register for England and Wales 2010 Annual Report. Queen Mary University of London, Barts and The London School of Medicine and Dentistry 2011 and Professor Joan Morris, Oral Evidence Session 4, pages 82-3

As the source material for the data quoted on the Save the 8th poster is not strictly the ‘Bruce’ inquiry but in fact the NDSCR, we will be dealing with the latter report.

The NDSCR annual report does not use the word “babies” or “baby“, but refers to “prenatal diagnosis” and uses the words “pregnancies” and “fetal”.

The use of the word ‘baby’ is significant as there is currently a case before the Supreme Court on the meaning of the word ‘unborn’ in the Constitution.

A ruling by the High Court in 2016 found that references to the “unborn” in the Constitution meant an unborn child. Now the Supreme Court is to examine the ruling, in which judge Richard Humphreys ruled that the use of the word “unborn” in Bunreacht na hÉireann meant an “unborn child”, with the unborn’s rights extending beyond the right to life.

While the Supreme Court wrestles with this, currently the word ‘baby’ is typically used to refer to a child that has been born. Under dictionary definitions, ‘baby’ refers to an ‘extremely young child’.

In essence, while the poster uses the word ‘baby’, what it really means is ‘unborn child’ or ‘foetus’.

However, the Save the 8th campaign told TheJournal.ie:

Everyone describes their preborn child as a baby.

As we will see, the poster also refers to “babies with Down Syndrome”, although what it is referring to is a percentage of pregnancies given a prenatal diagnosis of Down Syndrome.

Prenatal diagnosis and postnatal diagnosis

The 90% termination rate in the NDSCR report and the billboard poster only refers to prenatal diagnosis of Down syndrome.

The data shows that not all children with Down syndrome in England and Wales are diagnosed prenatally.

On page 7 of The NDSCR for England and Wales 2010 Annual Report, it says:

In 2010, 1,868 Down syndrome diagnoses were made, 1,188 (64%) prenatally and 680 (36%) postnatally

In the 2010 report, of the 680 cases where Down syndrome was diagnosed postnatally, there were 651 live births and 29 still births/foetal deaths.

There were 1,188 that were diagnosed prenatally. Out of this, 942 pregnancies were terminated; there were 63 live births; 37 still births/miscarriage; and 195 with an ‘unknown outcome’.

The report says that 6% of those with ‘unknown outcomes’ are likely to result in a live birth.

So the 90% referred to in the poster is 90% of those diagnosed prenatally.*

In 2010, that is in fact 90% of 64% (prenatal diagnoses), which equates to 57% of all pregnancies which have the potential to result in a Down syndrome diagnosis.

The NDSCR annual reports show that every year, not all diagnoses of Down syndrome are made prenatally.

But of these prenatal diagnoses, the vast majority are terminated:

For example:

2009 : Prenatal diagnosis: 1,171 (terminations – 876), postnatal diagnoses: 716

: Prenatal diagnosis: 1,171 (terminations – 876), postnatal diagnoses: 716 2010 : Prenatal: 1,188 (terminations - 942 ), postnatal: 680

: Prenatal: 1,188 (terminations - 942 ), postnatal: 680 2011 : Prenatal: 1,211 (terminations – 931), postnatal: 662

: Prenatal: 1,211 (terminations – 931), postnatal: 662 2012: Prenatal: 1,259 (terminations – 983), postnatal: 723

(*Just to note – you’ll see that these numbers don’t add up to a 90% termination rate or over for prenatal diagnosis. This is because at the time the report was published, the registry did not have the full numbers, it says. However, the reports all project a termination rate of prenatal diagnoses for the specific year, based on the rate in previous years, and they are always 90% or above – you can read all of the annual reports here.)

What about Ireland?

What we can’t infer at this point is whether these outcomes in England and Wales would be reflected to the same percentage in Ireland, should abortion legislation allow terminations up to 12 weeks (the timeframe which has been put forward by the Eighth Amendment Committee).

This is due to a number of factors.

Firstly, the timing of tests for Down syndrome.

The HSE says that ideally, people will have antenatal screenings by the end of the first trimester, which is 13 weeks and six days. Most women are screened between 11 to 13 weeks, and screenings are possible up to 20 weeks of pregnancy.

Down Syndrome Ireland says that:

Sometimes babies with Down syndrome are identified during pregnancy as a result of pre-natal tests. In the majority of cases, the presence of Down syndrome is identified soon after birth from the baby’s clinical features and confirmed with a blood test.

There are two types of diagnostic tests – chorionic villus sampling (CVS) and amniocentesis. Of the two, CVS can be performed after 10 weeks of pregnancy. Approximately one woman in 100 will have a miscarriage after having either of these tests.

However, testing is continuing to get better in this area.

For example the NIPT test for Down Syndrome, which is offered by the NHS in the UK, tests cell-free fetal DNA (cffDNA), which comes from the placenta. An NHS factsheet says that cffDNA “reaches the required level needed to test for Down syndrome by 10 weeks’ gestation in most pregnancies”.

With regard to Irish women currently travelling abroad, the Irish Independent reported this week that 83 Irish women ended their pregnancy over Down syndrome over the period of two years.

Because not all diagnoses of Down syndrome are given prenatally, we simply cannot say at this point if in Ireland the rate of termination in every case of Down syndrome diagnosis would be 90%.

By comparison, in the USA, according to a study of 24 studies on the topic:

The weighted mean termination rate was 67% (range: 61%–93%) among seven population-based studies, 85% (range: 60%–90%) among nine hospital-based studies, and 50% (range: 0%–100%) among eight anomaly-based studies. Evidence suggests that termination rates have decreased in recent years. Termination rates also varied with maternal age, gestational age, and maternal race/ethnicity.

What does the Save the 8th Campaign say?

In answer to an email query, the Save the 8th campaign said that the statistic on the poster:

This is an annual report by the same people who carried out the 2010 report that is referenced in the inquiry report chaired by Fiona Bruce MP, just for a different year.

The outcomes are similar in the two reports – in 2013, it says that the termination rate for prenatally-diagnosed Down syndrome remains high:

The proportion of women having a termination after a prenatal diagnosis of Down syndrome has decreased from 92% in 1989-2010 to 90% in 2011, 2012 and 2013.

So although the billboard poster itself refers to the 2013 Bruce Enquiry (sic), their report itself refers to the 2010 NDSCR report.

And the details differ very little between this and the 2013 NDSCR report which the Save the 8th campaign referred us to in answer to our query about the source for the statistic.

The termination rate in prenatal diagnosis of Down syndrome is at least 90% in both reports.

The NDSCR for England and Wales‘s final report was in 2014. That year, 65% of all diagnoses of Down syndrome in England and Wales were made prenatally. There were 1,886 diagnoses of Down syndrome in those countries that year.

The majority – 78% – were diagnosed after the first trimester in England, compared to 26% in Wales.

Is the statement on the billboard correct?

The statement on the billboard poster is:

In Britain, 90% of babies with Down Syndrome are aborted.

On a basic level, the statement does not clarify that the 90% rate refers to prenatally diagnosed Down syndrome.

In order to be fully correct, the poster could say:

In England and Wales, 90% of pregnancies with prenatally diagnosed Down syndrome are terminated.

The statistic of 90% is correct when referring to prenatally diagnosed Down syndrome.

However, this is not a clarification available to members of the public passing by these billboards.

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