The ethical minefield of 'pregnancy reduction'

Kylie Orr
Kylie Orr 

 In 2011, it shouldn’t be too extreme to admit publically, in black and white, that I support abortion. More specifically, I support a woman’s (or couple’s) right to choose without judgement or vilification.

That being said, now I have four living children, I would find it almost impossible to abort any baby, unless there were extenuating medical or life circumstances.

Thankfully I’ve never been in a position where I’ve had to make such a life-altering decision and hope I never ever have to consider it (and given my husband should now be shooting blanks there’d be a load of questions about paternity!).

An article in the NY Times has deepened the debate on an already controversial subject matter. What happens when couples that fall pregnant with twins after undertaking IVF want to terminate one of those fetuses to reduce the pregnancy to a single fetus?

“Pregnancy reduction” is the polite phrase used to alter the pregnancy in a way that suits the couples’ circumstances more appropriately.

Most of us are aware there are increased medical risks with multiple pregnancies.

The justification for eliminating some fetuses in a multiple pregnancy was always to increase a woman’s chance of bringing home a healthy baby, because medical risks rise with every fetus she carries.
Dr. Mark Evans, obstetrician & geneticist

Reducing medical risk is perfectly reasonable and is generally accepted by society without backlash. When the motivation strays from medically-driven to socially indicated, this is where society’s moral compass spikes.

Terminating for potential financial or relationship strain that a multiple birth may bring?

I’m not the mother of twins or same-age babies, and as much as my husband thought it would be “cool” to have two babies at the same time, my stomach churned with dread before each 12 week scan, hoping that there was a healthy SINGLE baby in there. I would have accepted and eventually embraced the outcome, but I’m under no illusion that twins would be a walk in the park, albeit in a double pram.

A new baby in the house is hardly a piece of cake for anyone, so stresses, relationship strains, fatigue and some hard times are surely par for the course? I appreciate this can be doubled with two new babies but how on earth do you choose which baby to keep?

Consider the choice of which fetus to eliminate: if both appear healthy (which is typical with twins), doctors aim for whichever one is easier to reach. If both are equally accessible, the decision of who lives and who dies is random. To the relief of patients, it’s the doctor who chooses — with one exception. If the fetuses are different sexes, some doctors ask the parents which one they want to keep.

“Eliminating” a twin for gender selection purposes? Already have a boy and would just like a girl, so terminate the male twin and leave the female twin to thrive? I cannot even contemplate.

The women in the article describe their fear at the prospect of raising two babies:

Jenny’s decision to reduce twins to a single fetus was never really in doubt. The idea of managing two infants at this point in her life terrified her.

And another,

My No. 1 priority was to be the best mom I could be, but how was I supposed to juggle two newborns or two screaming infants while my husband was away [deployed in Iraq]?

I understand their apprehension for their ability to provide, emotionally and financially but do I empathise enough to agree with their choice to abort? To lessen the load? To ease the burden?

Sadly not.

Dr. Richard Berkowitz, a perinatologist at Columbia University Medical Center remarks,

In a society where women can terminate a single pregnancy for any reason — financial, social, emotional — if we have a way to reduce a twin pregnancy with very little risk, isn’t it legitimate to offer that service to women with twins who want to reduce to a singleton?

I see his point. There is not logical reason for resisting the idea of reducing a twin pregnancy to a single foetus if you support the idea of abortion in the first place, which I do. My struggle is about blurred ethical boundaries.

“Ethics evolve with technology,” one obstetrician commented. I’m not sure ethics has quite evolved in this case. I think we’ve taken choice, technology and science, and our own personal desires way too far.

I really want to be modern and neutral about this. I want to say it’s none of my business what other couples do to plan their family. But I can’t. It makes me uneasy. It tests my pro-choice values and forces me to ask myself, when is it OK to reduce a twin pregnancy down to a single? Would I baulk at a triplet pregnancy being reduced to twins? Aside from medical reasons, I can’t come at the designer baby, easier lifestyle argument.

I’ve tried to convince myself that perhaps it is a more responsible decision to terminate one child when you don’t have the resources to raise both. It hasn’t worked. Particularly when we are talking of couples who have invested thousands of dollars in IVF, and thousands more in the subsequent procedure to terminate.

It reeks of selfishness, an overinflated sense of entitlement where the desire for just one more is their right but any additional child needs to be eliminated. Surely, the more responsible decision would have been to transfer one embryo and risk no pregnancy.

Above all else, I don’t comprehend how they could embark on the incredibly straining, emotionally draining, costly and intrusive process of IVF with an overwhelming desire to bring a child into the world, only to retreat when they are told they got a bonus child, and then choose to terminate the very life they were so desperate to create. Would they not have known the risks of multiples when they agreed to have more than one embryo implanted?

Have we warped our right to make our own decisions? Should that choice be removed because the majority of society finds a decision of this nature morally bankrupt? I disagree with their preference to abort but I’m unconvinced I’d settle for a society where the choice is eliminated. It is they who must sleep each night with their decision and that is none of my business. I feel sad for the child who is lost, I feel sad for the child that lives on without their twin but ultimately it is not my choice.

As one of the 500 commentators on the article said,

I’m not sure what I’d have done if I’d had trouble conceiving or if I had become pregnant when I was not ready to care for a child. Of one thing I am sure: I would have wanted the choice, and I want my daughter, and all women, to have that choice.

I couldn’t have said it better myself.

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