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Poor women have decreased access to screening tools for genetic conditions like Down syndrome, write Kathryn Phillips and Subhashini Chandrasekharan at Health Affairs' blog.

Noninvasive prenatal screening has become a more common tool to detect genetic conditions among fetuses early on, and they note that early detection enables women to undergo confirmatory testing sooner and help them in making reproductive decisions.

But Phillips and Chandrasekharan say that while private insurers typically cover screening for at-risk women, Medicaid coverage of screening varies by state. They found that 15 states don't cover noninvasive prenatal screening, even for high-risk women. Women who can't afford to pay for noninvasive prenatal screening out of pocket may then wait for an amniocentesis and find out later in their pregnancies that their fetus has a genetic condition. This, Phillips and Chandrasekharan add, could then limit their reproductive choices as abortion access and policies also vary by state, with states that don't cover noninvasive prenatal screening often also restricting abortion access.

Phillips and Chandrasekharan add that this could lead to what Laura Hercher called in Genome magazine in July the "ghettoization of genetic disease" in which it is limited to a segment of society. 

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