'My Foetus'
Summary and Review by David Paintin
April 24, 2004

My Foetus is an exploration by Julia Black of her feelings about her fetus during a wanted pregnancy and, retrospectively, an unwanted pregnancy that had ended in an early abortion 13 years earlier. As a supporter of choice for women, she had been outraged by the pictures of aborted fetuses used by the pro-life movement but now began to wonder if the pro-choice movement had been less than honest about the humanity of the fetus, and if her attitude to abortion would change if she was exposed to the images of aborted fetuses used by pro-life groups. She was shown, very obviously in mid-pregnancy herself, viewing such images with pro-life activists. The first, in the USA, was a much magnified photograph of a fetus aborted at about 12 weeks. She was unconvinced by the US pro-life worker's claim that abortion is an offence against human rights and equivalent to Hitler's murder of the Jews, and abortion is the murder of babies. Julia felt that such views ignore the problems women face in unwanted pregnancy. The second image was in London was also enlarged and was of a fetus at about 16-18 weeks that had been partly dismembered during abortion by dilatation and evacuation. It was shown for several seconds. Both images caused her distress but did not change her original pro-choice stance.

She than interviewed John Parsons, a gynaecologist at Kings College Hospital who provides an NHS infertility service and as well as legal abortion up to the legal limit of 24 weeks. He strongly supports late abortion when a woman feels unable or unwilling to become the mother of an unwanted or of a disabled child - he emphasised that abortion was about helping women to have only wanted babies. It was awareness of woman's need that made him able to tolerate the distress he felt when removing the dismembered parts of the fetus during a late abortions by dilatation and evacuation. Julia appeared surprised by his honesty - it was apparent that he did not conceal the details of the abortion process from the women, that women found such abortions acceptable, and that he considered himself to be providing an ethical and necessary service.

Her next interview was with Professor Stuart Campbell at his private ultrasound clinic. He used sophisticated equipment to obtain a computer-generated moving video-image of Julia's 34 weeks fetus. This was so clear that it might have been made after birth. To him, it was obvious that such a fetus has the same moral status as a baby, and that abortion for social reasons should be limited to the first 12 weeks of pregnancy.

Julia appeared comfortable with Campbell's view. This led her to reconsider her own early abortion. She done this to maintain her life style and, at the time, had resented being told that this meant destroying a healthy 8-week fetus. She still saw the abortion as necessary but commented that the Abortion Act is patronising towards women and out-of-date - particularly, the need for a women up to 12 weeks pregnant to get two doctors to certify that the pregnancy is a threat to her mental health.

Julia is then shown taking a woodland walk, carrying her baby daughter, and accompanied by her father, Tim Black, the founder of Marie Stopes International. Tim said that abortion is grisly and there is a tendency to hide reality. They agree that that abortion should be available and is something that many women find necessary. She asks him if it is time to 'lift the veil of secrecy' around abortion and show all the details on television so that people can understand exactly what happens. He agrees and comments that early abortion is simple, safe and easy. This leads to a short film of an early abortion under local anaesthesia made at a Marie Stopes International clinic. The fragments of tissue sucked out of the uterus are shown in close-up but only a gestation sac was seen, and there was no attempt to investigate whether the sac contained an embryo - the doctor said that it was difficult to recognise fetal parts during naked eye inspection of abortion material much before 10 weeks, but seemed evasive about the details of the appearance of the fetus at this stage of pregnancy.

Julia ended the programme by concluding that it is possible to be opposed to what abortion is and still to be pro-choice. She said 'The facts are now in the open and people can decide which side they are on.'

What was the purpose of this programme? Julia Black was the presenter - we were invited to consider abortion through the eyes of an attractive and happily pregnant woman - but Tim Black and Marie Stopes International also featured. The stated aim of the programme was to show women the facts about the fetus and what happens to it during an abortion. This was done by showing pro-life images of abortions at 12 or more weeks - in effect, viewers were invited to consider how similar the fetus is to a baby after birth. But there was much more reticence about the fetus earlier in pregnancy - a fetus was not shown and viewers were assured that the fetus was very small and it was suggested that limbs were difficult to recognise. The message of the programme was that later abortions are morally questionable and that early abortions, such as those provided by Marie Stopes International, are more acceptable as well as being safe and easy. This was re-enforced by the suggestion that the law should allow abortion in the first 12 weeks without the need for two doctors to certify that the pregnancy is a threat to mental health. 'Lifting the veil' on the details of abortion ensured media coverage and high viewing numbers but did no more than confirm what woman having abortions already know - that the fetus is alive and becomes increasingly human in appearance and behaviour as it grows and matures. Only lip-service was paid to the genuine and serious reasons why a minority of women have to have later abortions and, for them, the programme will have increased their distress.

My Foetus has not advanced the discussion on the morality of abortion and the balance between the interests of the woman and the humanity of the fetus. Abortion was presented as the less of two evils. People, when asked casually, usually say that abortion is wrong because it involves 'killing the baby': it is only when they have experienced the distress caused by an unwanted pregnancy that they understand that the fetus has little moral value compare to the woman herself. Julia's deepening relationship with her fetus happens in almost every pregnancy as the pregnant uterus becomes obvious and fetal movements are felt, even when the pregnancy is unwanted. As a result, fetus begins to be regarded as the baby it will be after birth. Bonding with the fetus is shared by those close to woman, and by the health professionals who provide medical care. It is this is, and not the abortion law, that makes women and abortion providers increasingly reluctant to terminate pregnancy as gestation advances - 87 per cent of abortions are obtained in the first 12 weeks of pregnancy, less than 2 per cent at 20 or more weeks, and less than 0.01% later than 24 weeks.

There are reasons why a fetus should not be regarded as a person with full human rights at any time during pregnancy. The fetus is a parasite completely dependent on the woman for continued existence. Biological life is a continuum - a living sperm unites with a living egg and triggers a process of implantation, growth and maturation that results in the birth of a baby. The process is inefficient - about 60 per cent of conceptions fail to implant or miscarry, often before the woman has missed a period and has realised she has conceived. The fetus becomes viable at 23 to 24 weeks - capable of independent existence if given a high level of intensive care - but with a major risk of death or developmental handicap if born at this time. Brain growth and maturation continues throughout pregnancy and during the early years of childhood. The woman, by giving birth, confers the status of person on her fetus.

Professor Campbell challenges this view. He believes that the appearance and behaviour of the fetus after viability are so like that of a new-born child that the fetus has the same moral status as a child. He joined the Americans Frank Chervenak and Laurence McCullough in writing a commentary that argued that obstetricians have separate moral obligations towards two patients: the viable fetus and the pregnant woman herself - (1). This is not a usually a problem because most women trust their advisors and are eager to optimise the well being of their fetus. But it can cause great distress when the woman believes the advice she has been given is unnecessary, incorrect, or has the potential to increase seriously her risk of complications. Views such as those held by professors Chervenak, McCullough and Campbell have influenced obstetric practice in the USA and have led to women being forced to have caesarean sections to which they were not willing to consent, and to being imprisoned for behaviour considered to have endangered their fetus. Fortunately, British law does not permit such prosecutions, and test cases have shown that the woman has a right to refuse treatment under such circumstances - even if this should result in harm to the fetus or a stillbirth. To give the fetus status as a person is to restrict the autonomy of the pregnant woman - in effect, to give the state and health professionals control over her life and the way she manages her body. Autonomy for a woman means giving her full responsibility for herself and her fetus throughout pregnancy - responsibility that should include the right to legal abortion.

A discussion of the morality of abortion must include the reasons why unplanned conceptions occur. Unintended pregnancy is very difficult to avoid because sexuality is only partly under rational control, relationships are difficult to manage, and contraception can be difficult to use and has a significant failure rate. These difficulties are increased by ambivalence about sexuality in society as a whole: sexual imagery is widely used in advertising and by the media - with the strong suggestion that sex is something all men and women should enjoy - yet the harmful consequences of sexuality are deplored, and there is reluctance to accept the value of sex education and assessable sexual health services. Unintended conceptions are a consequence of being human, and of the flawed and complex society in which we live. Continuing an unwanted pregnancy can result in permanent loss of educational opportunity and career development, and the birth of children who are often loved but whose lives and opportunities are limited by the inadequate resources available for their care. Forcing women to continue unwanted pregnancies that are an almost inevitable event in their lives is to deny them freedom to plan and live as they wish, and is wrong. For many women, abortion is a necessary choice about which they should not feel obliged to feel guilty. The value to society of the life of a woman is clearly greater than the moral value of a fetus.

David Paintin, Hon FFFP, FRCOG.
(A former provider of abortion services in the NHS in Paddington, and a former trustee and board member of the abortion providing charities PAS and BPAS)

Reference
(1) Chervenak FA, McCullough LB, Campbell S. Is third trimester abortion justified? British Journal of Obstetrics & Gynaecology, 1995; 102:434-435.