Abortion for fetal abnormality

Part four of the spiked-paper ‘Defending abortion – in law and in practice’

Together with late abortion, another kind of abortion, where the procedure takes place because fetal abnormality of some kind is strongly suspected, has become increasingly contentious (1). In 1967, when abortion was made legal in the UK, fetal abnormality was construed a ‘good’ reason for abortion. Today the opposite seems the case. This kind of abortion is now considered at best ethically difficult, at worst eugenic. The problematisation of abortion for abnormality can be discussed with reference to three groups, whose views have, to differing degrees, shaped the debate.

(a) The medical profession

Under British law, one exception to the general prohibition of abortion after 24 weeks gestation is where it is agreed that: ‘there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped’.

The terms of this clause of the Abortion Act are in line with the way medical judgement is generally privileged in British abortion law. (In all instances, abortion is only legal if two medical practitioners agree that the woman meets one of the conditions for abortion specified in the Act, all of which are framed in medical terms). The clause that caters for abortion for abnormality is worded in an imprecise way. There is no specification of what is a ‘substantial risk’ or what is a ‘serious abnormality’. This vagueness reflects the outlook of the medical profession at the time the Act was passed, which was reluctant to allow parliamentarians to interfere with matters of clinical judgement.

Today, by contrast, many in the medical profession are uncomfortable with the onus placed on them under the law to make judgements about whether a particular request for abortion meets the terms of the Abortion Act. Rather than wanting to ‘play God’, many doctors would prefer it more specific guidelines were drawn up to guide them when they make decisions about whether a request for an abortion on the grounds of fetal abnormality is legal (2).

This has led to calls for the creation of lists, specifying which conditions are ‘serious’ and which are not. For example, some eminent professors have argued that abortion in the third trimester should be deemed ethically impermissible unless the fetus has an abnormality that can be diagnosed with certainty as leading to early death or cognitive developmental capacity, ruling out Down’s syndrome or spina bifida as conditions warranting legal abortion.

Whilst restrictions on the range of conditions for which abortion is legally permissible may relieve doctors from the pressure of having to make difficult decisions, it is important to note the implication of such a measure regarding a woman’s reasons for abortion. If only those conditions on a designated list are deemed sufficiently ‘serious’ to enable a woman to have an abortion, then other reasons, not included on such a list, are presumably deemed trivial in comparison.

We have to be careful about suggesting that a woman’s reasons for abortion are trivial. They may seem so to other people, but to her they may have a different meaning. A senior expert in fetal abnormality has commented about the distress he felt when presented with a request for abortion on the grounds that the fetus had a cleft palate. This expert made the point that he was horrified because he thought this to be a rather trivial abnormality – until he looked at the woman sitting in front of him and noticed she had a severe cleft palate herself. What he regarded as a quite trivial disability, this woman honestly regarded as being so serious that she was willing to put herself through the process of late abortion, and end what she already saw as the life of a child that she wanted (3).

(b) The disability rights movement

The movement for the rights of disabled people has become increasingly influential in recent years. With the completion of the mapping of the Human Genome, the prospect of the detection of a increasing number of genetic markers has generated a great deal of debate, which centres on the notion that ‘eugenic’ abortion may result (7). Many disability rights activists suggest that as knowledge increases about the human genome, it will bring with it attempts to ‘screen out’ embryos and fetuses whose genes are not ‘perfect’ (4).

The term eugenics is used very loosely, and often wrongly, in discussions of abortion and ante-natal screening today. Defined properly, eugenics is the view that society can be improved through the manipulation of genetic inheritance, and that social problems can be resolved biologically, largely through the control and shaping of human reproduction.

It could be argued that the abortion law in Britain, when first introduced, was motivated to some degree by a eugenic outlook. Some clauses in the Abortion Act were possibly motivated by a desire to tackle the social problems caused by poverty deprivation and hardship by shaping people’s reproductive patterns (i.e. making easier for them to limit family size), rather than by making greater social resources available to them.

But this was not the case with regard to the clause in the law about abortion for fetal abnormality, which was largely a response to the thalidomide tragedy, where the drug thalidomide was legally prescribed to thousands of pregnant women to alleviate the symptoms of morning sickness, but led to the birth of often severely disabled children. The clause was a response to women who feared they were to give birth to a severely disabled child and were unable to prevent it.

Regardless of the motivation of some of those who supported the legalisation of abortion in 1967, today it is definitely the case that abortion is not seen by doctors, policymakers, or women themselves, as an aspect of social engineering. The context for abortion today is one where its provision meets the request of a woman who no longer wants to be pregnant. That is the case when we are talking about the ending of unwanted pregnancies that have been conceived unintentionally, and is equally so where abortion for abnormality is at issue.

The overwhelming majority of women who discover that they are carrying a fetus affected by Down’s Syndrome currently choose to have an abortion. A study by ante-natal screening expert Professor Eva Alberman shows that just eight per cent of women who discover they are carrying a fetus affected by Down’s syndrome decide to continue the pregnancy (5).

It is not difficult to understand why women choose to abort abnormal pregnancies. Many women find that they feel differently about their condition when they find their baby would be born disabled. The discovery that the child is ‘not normal’ may challenge a woman’s hopes and expectations about what her future family life will be.

A woman whose attitude to her pregnancy changes when she finds it is affected by an abnormality is not making a social or political statement about the abnormality, or about born people with that disability. She is making a statement about herself; what she feels she can cope with and what she wants.

To accept the notion that the views of some disability rights activists should be able influence abortion law or policy is to privilege the views of those who experience a condition over women who carry fetuses affected by it. Why should one individual’s experience of, say, spina bifida entitle that individual to a voice in the most personal decision a woman has to make?

(c) The anti-abortion lobby

The argument that abortion on the grounds of abnormality is eugenic has also been promoted, disingenuously, by those who oppose abortion in all circumstances.

The anti-choice organisation LIFE produces a leaflet called ‘Pre-Birth Screening: Something Wrong With Baby?’ This argues that ‘…to destroy a child because he or she is not perfect is especially unjust and elitist. Of course it is not always easy to cope, but eugenic abortion recreates and legitimises primitive phobias against mental and physical illness just when society seems to be making real progress in outgrowing them.’ The leaflet asks ‘…are we not really sending a message to the disabled: you are inferior, you should never have been born?’ (6).

The Society for the Protection of Unborn Children makes the point that ‘…abortion of the handicapped is both a reminder of the inhumanity of abortion, attacking the most vulnerable, those most in need of help, and an offence to the disabled, sending them the message that they are inferior and of less value than the able bodied’ (7).

Does abortion for abnormality encourage discrimination against disabled people? No it does not, since it is possible to make a judgement or express an attitude towards a particular condition, without in any way imputing an attitude towards the value of people who suffer from that condition.

Most people would say they thought malaria was a bad thing, and that it would be better if people did not suffer from it. This does not mean they take a negative attitude towards people who suffer from that illness. The same applies with abortion for fetal abnormality. There is no reason to assume that a woman’s choice not to bear a child which suffers from spina bifida or Down’s syndrome implies she believes such people should not be born, or be supported. It simply implies that she does not wish to be a mother to one.

Issues relating to disability rights are completely different to those relating to abortion. At the heart of the issues of abortion (as the anti-choice lobby knows very well) is autonomy in reproductive decision-making, and, whether the fetus is abnormal or not, the ability for individuals to make such decisions must be primary. In a similar vein, the demand from some people with disabilities to be able to screen their pregnancies in such a way that a child with a disability results can also be defended on the same grounds. Since women, and their partners, disabled or not, have to live with the consequences of reproductive decisions, they must be able to make the decisions they perceive to be moral and appropriate.

Ultimately this is the issue which is at the heart of the abortion debate. However, the failure of anti-choice organisations to make a convincing argument against reproductive autonomy means they now try to duck the issue, and instead cloak their arguments in the language of disabled rights.

Ann Furedi is director of communications at the British Pregnancy Advisory Service (BPAS).

Dr Ellie Lee is lecturer in sociology at the University of Southampton, UK, and co-ordinator of Pro-Choice Forum.

Read on:

Part five: Is abortion a health risk?

(1) Daniel, Caroline. 1996. ‘Every baby a perfect baby?’. New Statesman 2 August; Jackson, Emily. 2000. ‘ Abortion, Autonomy and Prenatal Diagnosis’. Social and Legal Studies Vol. 9 (4) 467-94. Various contributors. 1998. Ethics and Abortion for Fetal Abnormality, available at Pro-Choice Forum (Resources / Abortion and Disability).

(2) Chervenak, F. A., McCullough, L.B. and Campbell, S.. 1995. ‘Is third trimester abortion justified?’ British Journal of Obstetrics and Gynaecology 102 (June):434-5; Green, J.M. 1993. ‘Obstetrician’s views on prenatal diagnosis and termination of pregnancy: 1980 compared with 1993’. British Journal of Obstetrics and Gynaecology 102 (March): 228-232

(3) Personal correspondence to Ann Furedi.

(4) Shakespeare, Tom. 1998. ‘Choice and Rights: Eugenics, Genetics and Disability Equality’. Disability and Society 13; Cunningham-Burley, Sarah. 1998. ‘Understanding Disability’. Progress in Reproduction June (2): 10-11; Deaf Worlds, Volume 13, Number 2, July 1997.

(5) Alberman, E. Mutton, D., Ide, R.G.. 1998. ‘Trends in prenatal screening for and diagnosis of Down’s syndrome: England and Wales, 1989-97’. British Medical Journal 317: 922-3.

(6) Life. Undated. ‘Pre-Birth Screening: Something Wrong With Baby?’. Leamington Spa: Life.

(7) SPUC. Undated. ‘Our aims, ethics and activities’. London: SPUC.