RISK, MEDICINE AND WOMEN: A CASE STUDY ON PRENATAL GENETIC COUNSELLING IN BRAZIL MARIA CRISTINA R. GUILAM AND MARILENA C.D.V. CORRÊA Keywords risk discourse, genetic counselling, women, reproductive health, reproductive rights ABSTRACT Genetic counselling is an important aspect of prenatal care in many developed countries. This tendency has also begun to emerge in Brazil, although few medical centres offer this service. Genetic coun- selling provides prenatal risk control through a process of individual decision-making based on medical information, in a context where diagnostic and therapeutic possibilities overlap. Detection of severe foetal anomalies can lead to a decision involving possible termination of pregnancy. This paper focuses on medical and legal consequences of the detection of severe foetal anomalies, mainly anencephaly and Down syndrome, and in light of the fact that abortion is illegal in Brazil. The discussion is based on the literature and empirical research at a high-complexity public hospital in Rio de Janeiro. GENETICS AND RISK DISCOURSE Although medicalisation is a widespread social phe- nomenon in the West, women’s bodies are the focus of more medical intervention (in practice and dis- course) than men’s. Childbearing is largely respon- sible for this gender differential, since pregnancy is one of the most medicalised moments in a woman’s life. Genetic counselling – whether pre-conceptional (prospective) or prenatal (retrospective) – uses information and communication to control risks in the human reproductive process. As a result, preg- nant women are now held responsible not only for their own health, but also for producing a healthy foetus, making the prenatal period a privileged locus of risk discourse. 1 In fact, the notion of risk constitutes a major subject for life in contemporary societies, in parti- cular for the phenomena of health and disease. The spectacular expansion of medicalisation to all aspects of individual existence and social life enables medical discourse to embrace virtualities (risks) thus fundamentally altering the discursive topology to encompass not only diseases but also (and espe- cially) ‘lifestyles’ and a wide variety of ‘health risk factors’: air and water quality, cultural traits, social behaviour, individual preferences, etc. 2 In a risk-oriented society, each individual is morally committed to seeking ‘global’ information 1 M.C. Guilam. 2003. O Discurso do Risco na Prática do Aconselha- mento Genético Pré-natal. Rio de Janeiro: Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro. 2 D. Lupton. 2000. Risk and Sociocultural Theory: New Directions and Perspectives. Cambridge: Cambridge University Press; S. Nettleton. 1997. Governing the Risky Self: How to Become Healthy. In Foucault Health and Medicine. A. Petersen & R. Bunton, eds. London: Rout- ledge: 207–221; D. Armstrong. The Rise of Surveillance Medicine. Sociol Health Illn 1995; 17: 393–404. Address for correspondence: Maria Cristina R. Guilam, Rua Humaitá 12 ap. 303, Rio de Janeiro, RJ, cep 22261-001, Brazil. guilam@ensp.fiocruz.br Marilena C.D.V. Corrêa, Rua General Glicerio 486 ap. 302, Rio de Janeiro, RJ, cep 22245-120, Brazil. mcorrea@ism.com.br Developing World Bioethics ISSN 1471-8731 (print); 1471-8847 (online) doi:10.1111/j.1471-8847.2007.00193.x Volume 7 Number 2 2007 pp 78–85 © 2007 The Authors. Journal compilation © 2007 Blackwell Publishing Ltd., 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA.