Antenatal Anti-D - Who needs it?

A paper has appeared that asks the important question as to why all Rhesus negative (Rh-) women are offered and given Anti D in pregnancy when one third of them are carrying a Rh- baby and therefore do not need it?  Given that Anti-D Immunoglobulin is a blood product made from pooled plasma from North American donors, many women would probably prefer not to be injected with it unless it was of benefit to them i.e. their babies.  

15% of women are Rh- and approximately 1/3 are carrying a fetus who is also Rh-.  This means that up to 40,000 pregnant women a year in the UK are given anti-D immunoglobulin in pregnancy that they simply do not need.  A blood test can identify the baby's Rhesus status but is not currently offered.  This paper reviews the current situation and makes important points that all Rh- women should be aware of.

Routine administration of anti-D: the ethical case for offering pregnant women fetal RHD genotyping and a review of policy and practice. Julie Kent, Anne-Maree Farrell and Peter Soothill. 2014. BMC Pregnancy and Childbirth.

http://www.biomedcentral.com/1471-2393/14/87

Of course, a woman may know the blood group of the father.  I have known women who refuse Anti-D on the grounds that their partner is also Rh -.  The counter argument is about the uncertainty of paternity.  But surely that is for the woman to decide - if she is unsure of paternity, she has the option of Anti-D and/or genotyping?  To dismiss any refusal of Anti-D made on the grounds that the blood group of the father is known to be Rh - as unreliable is an insult to women.  Even in our liberal society, most women know who the father of their baby is.