1. Coproduction of technology and socio-political orders
Coproduction of technology and socio-political orders. Prenatal testing in Belgium and Argentina
Catherine FALLON

2. Presentation
Co-productionist approach imported form the STS : useful for policy analysis ?
Prenatal surveillance « apparatus » in Belgium and Argentina : a mature policy
Co-productionist analysis of NIPT (Non Invasive Prenatal Testing - a gene- based technology) in Belgium
Comparative analysis with another case study in Argentina
Conclusion

3. 1. Co-productionist approach imported form the STS
STS = discipline with a broadly ‘constructivist’ understanding of S&T as a social phenomenon.
ANT perspective (Latour) : socio-technical changes are indissoluble elements of the process of construction of the features of contemporary collective social life.
Co-production (Jasanoff) : science as a process in constant and indissoluble interaction with political, social and technological change. : S&T makes the ‘reality’ at issue visible and measurable to scientific analysis (and hence to power and control) in a performative way (as Foucault proposition of knowledge and power)
“Knowledge and its material embodiments are at once products of social work and constitutive of forms of social life: society cannot function without knowledge any more than knowledge can exist without appropriate social supports” (Jasanoff, Designs on Nature,2005)

4. How do the natural order and the social order develop together ?
S&T modify the social orders while socio-political order shapes the S&T developments
Jasanoff analyses the « practices of government » as socio-technical activities affected by the local normative institutions (law) and by the local citizens / consumers demands (private dynamics) with a comparative interpretative methodology to explore the interwoven themes of innovations and politics in the development of hybrid networks (human +non humans) in situated contexts.
In line with Foucault “apparatus” : discourse, institutions, regulations, scientific statements; techniques; .. “inscribed in a play of power” and “supported by types of knowledge”. The subject is subjected to discourse and regulation: he can also resist this normative framework in a process of subjectivation
How norms are embodied in technical standards and practices; in professional discourses and contributions and in public policies? What is the ST impact on “public reason” ?

5. 2. Prenatal surveillance in Belgium and Argentina (classic)
Prenatal screening for fetal diseases is designed to inform parents of the risk of having a child with a serious anomaly (Down Syndrom - T21) .
Belgium
Argentina
Public hospitals
Private practice
All mothers are tested
In case of positive test, an invasive amniosynthesis is used for diagnosis
If confirmed, an TOPFA is proposed (at no cost) and organised for 95% of cases
If confirmed,…
As abortion is NOT legal in this case

6. Co-productionist analysis of NIPT in Belgium as emerging
Users demands
The consumers : asked for the availability of the test (once available on Internet)
Medical professionals
Gynecologists propose the tests to all the women (350 euros) who can afford it
Human geneticists are working in university hospitals (genetic counselling and research)
Regulatory bodies :
- KCE : approved to finance the test at no cost for at risk women on the basis of CBA
- Health Council : approved the test & questioned the ethics of choice of the target group
- Committee for Human Genomics : propose to organize the tests at no cost in Belgium
The Federal Minister decided to make the test available to all women at 8€
Apparatus : Geneticist and Genomic research reinforce their position – center stage.
Subjectification : all regnant women are all invited by the state/medical authority to consider the risk level of their situation : their child might not match the ST-norm.
Machines bought for university
T21 « is » anomality RA
CBA
In-border
genetic data
Equality
as a political choice

7. Co-productionist analysis of NIPT in Argentina
Public hospitals
Private practice
Gynecologists remain « risk managers »  only for women at risk
Hospital-based funding
Women demand the test and pay the test
Gynecologists organise the test
Foreign laboratories make the test
« contre-conduite d’irresponsabilité »
Women rights NGOs enter in resistance
Women can enter in illegal action
At the same time, NGO fight to obtain depenalisation of abortion
for all women in the country.
NGO inform the women about the possibility for an abortion at home (under medication).

8. Belgium
Argentina
Users demand OK
 Equality of treatment
 More genetic infrastructure in universities (machines, databases)
Consumers satisfied at own cost
Hospitals support gyneco. as risk managers
 No direct link between the professionals and the federal authority
Nobody denies the quality of the test: the genetic information is more precise and the test improves the efficacy of the existing device.
Pregnant women are all invited by the state/medical authority to consider the risk level of their situation : their child might not match the ST-norm.
Hospitals patients are more prone to remain with a « ir-responsable » position
In private practice, women take their individual responsibility and enter in resistance
Who defines the anomal fetus ?
What is « informed consent » ?
What is the cost of avoiding false negatives?
Is TOPFA a right or not ?

9. Conclusion
Consider materiality; Consider the transformation of knowledge / power nexus in apparatus seriously Consider the transformation of the subjectification processes
Consider as well indirect and pervasive cases : we have seen distinctive sets of resource distributions, and variations in opportunity and constrain :  
Inequalities in hospital in Argentina
Inequality for the access to abortion
Whether a particular structure constrains or enables a particular scientific practice and how it does so is thus an empirical question

10. Thank you for your attention