What do medical breakthroughs slated to improve the health of premature infants have to do with abortion rights?
More than 20 years ago, I pursued this question in a master’s thesis for my bioethics degree. I was reacting to the claim by renowned philosopher Professor Peter Singer – made in his book The Reproduction Revolution – that technological breakthroughs that lowered the age of fetal viability would end the conflict over abortion.
Part of my research involved getting across state-of-the-art medical technology for nurturing human life outside a woman’s womb, including the problems that had to be solved to improve the prognosis for extremely premature infants.
“Miracle baby” stories abound in the news, but survival rates and long-term medical outcomes for extremely premature infants – those born between 22 and 26 weeks gestation – are grim. Just 1 per cent of those who are alive when labour begins at 22 weeks survive. Of those who survive birth and make it to the neo-natal intensive care unit, just 16 per cent will ever go home and only 5 per cent will be unencumbered by life-long health concerns.
Impairment associated with “micro-preemies” include cerebral palsy (1 in 5); learning difficulties (2 in 3); behavioural problems including autism-like symptoms (1 in 4); and a high incidence of respiratory problems, reflective of the incapacity of the extremely immature lungs of a premature infant to go on to develop properly.
Two decades ago, it was this latter problem that was seen as a natural brake on a continuation of what had been a steady decline in the age of fetal viability. I still remember the doctor who told me that 22 weeks was the lower limit for fetal survival outside the womb because of insurmountable problems with immature lungs: “There’s just no way we can get them to breath any earlier.”
He may have been mistaken. In a world first, Melbourne’s Monash Medical Institute announced last week that animal experiments suggest the administration of placental stem cells to micro-preemies may radically improve lung function and even reduce brain damage. The treatments will be trialled on 10 premature babies in Malaysian hospitals. If things go well, more trials are planned in Australia at Monash Children’s Hospital and overseas.
This is fantastic news for premature infants and the parents who desperately want them not just to survive, but to thrive. But the sting in the tail is one I and other feminist researchers identified decades ago – the risk that ever-lowering ages of fetal viability can serve as an excuse for anti-choice legislators to narrow the window in which women can legally choose abortion.
How would this work?
Singer’s thesis was that women choose abortion to end an unwanted pregnancy. The death of the fetus that resulted was an unintended consequence. Ever-lowering ages of viability broke the nexus between pregnancy termination and fetal death. Instead, women could evacuate unwanted fetuses as young as technology would allow – 6 weeks gestation, 12 weeks perhaps – into high-tech humidicribs where they could be matured, then adopted out.
The women whose voices can be heard in my book The Abortion Myth were appalled by this prospect, no matter which side of the abortion conflict they were on. For them, abortion was a solution to unwanted motherhood. Most saw themselves as obligated to gestate their own fetuses and, should they continue the pregnancy, to raise the resulting child. For them, the debate was about whether a pregnant woman still had time to reject these responsibilities by choosing termination, or whether once conception had taken place, it was already too late.
The prospect of mass incubation of extremely immature unwanted fetuses in humidicribs was reviled as unacceptably Brave New World and entirely irrelevant to how women on both sides of the debate defined the central moral conundrum posed by problem pregnancy.
But sadly, feminist pleading – including my own – for women’s moral perspective on abortion to ground public debate about reproductive law and policy has been ignored. In both the scholarly literature and public contest about reproduction, the obsessive focus on “when life begins” and its correlative focus on the biological attributes of fetuses that do – or don’t – grant them a “right to life” roll on.
Women’s experience of pregnancy, and the moral considerations in play for them when they make choices to have children or avoid them by means of contraception and abortion, as well as their evolving conception of what makes a good mother, fails to get a look-in.
This disregard of women’s moral perspective makes it virtually certain that every technological advance that results in the survival of ever-younger premature infants will give oxygen to those pushing fetal-centred reasons for further limiting the time period in which women can exercise what the international community has long agreed is the basic human right to control one’s family size.
So what should be done? One approach for activists keen to remove abortion from the criminal code in Queensland, NSW, SA and Tasmania is to take a leaf from the ACT and Victorian statute books. In both these states, lawmakers listened to activists who flagged the problem and responded by either dispensing with gestational limits on women’s reproductive freedom all together (ACT) or – where gestational limits were insisted on – ensured they weren’t pegged to fetal viability (VIC).
The public can also insist that public debates about abortion are grounded in women-centered ethics, not those focused solely on the fetus. Of course, contests over who is a good mother and when maternal obligations can responsibly be rejected are likely to be as contentious as current questions about “where life begins”. Indeed, sociological research consistently shows that contests over motherhood, and the related question of their proper role in society, are what are truly at issue for those who feel most passionately about the abortion issue on both sides of the debate.
However, making the friction over maternal obligations and the proper role of a “good woman” in modern society more explicit will increase the relevance of the contest to those who must negotiate the moral minefield of abortion ethics, politics and law because they are the ones who experience problem pregnancies – women.
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