Resultados de la aplicación del instrumento Pos-Test

One of the most commonly cited references, which identifies the correlation

between older mothers and Down syndrome, is the publication by Hook (1981). The data for Hook's research was derived from three separate studies utilizing incidence rates from Massachusetts, New York State and Sweden (Hansen, 1 986). The studies, however, did not take into account the number of spontaneous or therapeutic abortions of fetuses that might have occurred. Hook's analysis detennined that the incidence of "clinically significant cytogenetic abnonnalities" increased as women got older.

In his article, Hook proposed that the incidence "rate", which the Oxford English Reference Dictionary defmes as " a stated numerical proportion between two sets of things" ( 1 996, p. 1 l 97), could be read to mean risk. Hook argued that while increased maternal age did not guarantee that a woman aged 40 would have a Down syndrome

baby W it did increase the chance that she might. Hook proposed that at the age of 30

years women have a one in 953 chance of giving birth to a baby with Down syndrome. At 35 years the "risk" becomes one in 378 and at 40 years of age a one in 1 06 chance (Johnson & Christianson, 1 999). Hook writes:

At least one assumption implicit in the discussion of live-birth rates is that the "rates" observed in past studies can be extrapolated as "risks"

for women seeking counseling in the future.

1981, p.285.

I would argue that Hook reflects the move from determinism to probability that

occurred from the nineteenth to the mid-twentieth centuries. Hacking (1991) suggests

that during the nineteenth century there was a change in the way events in the world were explained. At the beginning of the nineteenth century statistics were used to argue that there were "unequivocal and uniform" social laws which determined human behaviours. By the mid-twentieth century, Hacking observes, the use of determinism diminished. The statistical discourse of probability was increasingly deployed as an

explanation. Hook ( 1 98 1 ) reflects the discourse of probability in that he draws on

numerical data and statistical analysis to provide counsellors with a ratio of risk that they may pass on to women. While he implies that there is a relationship between maternal age and the incidence of babies born with Down syndrome, the actual certainty that an older woman's baby will have Down is indeterminate.

Risk, when employed by risk analysts in the process of determining statistical probabilities, can be depicted as neutral. Its common meaning however, is one that

implies danger, "it designates an objective threat" (Ewald, 1 99 1 ,p1 99). What constitutes

a risk is socially determined: "nothing is a risk in itself [ . . . ] it all depends on how one

analyzes the danger, considers the event" (p. 1 99). Hook's statistical evaluation of the

proportion of babies born with Down syndrome to women of specific ages becomes reconstituted as an event that can be predicted in terms of probability and also

instantiates a negative view of Down syndrome. In being given the meaning of a risk,

the act of giving birth to a baby with Down is fore grounded as an undesirable, dangerous event.

Lupton (1 995) distinguishes between an external and an internal health risk. The

former is one that is usually environmental over which a person has minimal control.

An internal risk is one that occurs as a result of a person's lifestyle. This latter concept

implies the notion of choice and infers that the person has some degree of control over the factors that have contributed to hislher risk. It may be assumed that older primigravidas have consciously chosen to delay having their first baby. For example, in

a recent article titled The late baby boom: gambling with fate Kalb (200

I) reports that

concern is increasing amongst various international medical fertility specialists about the trend for women to delay childbearing. These specialists plan to actively increase

women's awareness "educating women about how age can affect fertility - and what can go wrong" (p. A9), the increased likelihood of chromosomal abnormalities is one. The rhetoric of choice deployed in the article is used to enhance women's decision­ making regarding the timing of childbearing and to urge them to consider having their babies prior to turning 40. The degree to which a woman can exercise choice over the timing of childbearing is debatable. As one of the speakers in Kalb's (2001 ) article mentions, women may be delaying childbearing until they have a partner and fmancial security. The extent to which these reasons are determined by personal motives and not social expectations is left unanswered.

In identifying maternal age as a predictable risk factor, the incidence of Down (and problems of infertility) can be avoided if the woman disciplines herself and prioritizes her desire to bear children. Lupton (1 995) applies Ewald's ( 1 991 ) links between risk and enterprise. People are seen as individuals who are thought to be able to take responsibility for their lives and wellbeing, and to maximize their potential. Women should "plan for the future" and "take judicious steps to ensure protection against misfortune, retaining responsibility for their affairs" (Lupton, 1 995, p. 79).