Burke Bindbeutel, University of Missouri School of Law

“The Two-Minus-One Pregnancy” is a disappointing recent New York Times article. Ruth Padawer describes a discomfited backlash to the medical procedure that allows a pregnant woman to opt for a single childbirth when she is carrying twins. Beneath a patina of thoughtful consideration, the author reverts to some tried and true anti-choice tropes: that the choice to abort will make a woman a social pariah, that she will never overcome her regret. The article casts a woman’s personal choice in a thoroughly negative light.

I am a fraternal twin, as well as an older brother, and a younger brother. I have never thought of myself as fifty percent of a natural, God-given package deal. Once born, a person is an independent entity and not a spectral reminder of a difficult choice, despite what the pundits believe.

Padawer’s waiting room is a coven of hysterical second-guessing and guilt. When parents exercise discretion in building their families, Padawer reasons, they are opening themselves to the frustration of too much choice. In a consumerist society, endless choice leads to bafflement, so judicious would-be mothers must naturally end up with the nagging dissatisfaction of discount shoppers.

The article points to a rift amongst abortion rights advocates by quoting from the comment board of urbanbaby.com. Reduction, this contingent insists, is less defensible than abortion because a woman ought not resist the number of fetuses that nature, or fertility drugs, has provided her. When a Philadelphia doctor in the early 1990’s agrees to reduce a pregnancy, “a stream of patients” quickly mobilizes to selfishly request reductions. This narrative stigmatizes not just the right to choose, but female empowerment in general.

I was haughtily summarizing the article to a fellow LSRJ member over lunch. She pointed out that the case for pregnancy termination is very strong when complications, or too many fetuses, jeopardize a mother’s health. But the decision to go from two to one probably turns on a parent’s preference rather than impending danger. The issue reminded my friend of sex selection, which does not appear to deserve the same legal protection as other controversial procedures.

Dismounting from my high horse, I started to see where my friend was coming from. The issue was not an easy one. Our campus events aim at coalition-building, and elective pregnancy termination wrinkles a lot of noses at Mizzou.

But reduction helps our LSRJ chapter to focus on just what sort of reproductive justice we advocate. If you support the right to choose, you should be prepared to disagree with someone’s choice. Access to family-planning resources is a human right, and how those resources are used is a personal decision.

And that’s what seems to disturb Padawer’s medical establishment most: the freedom of a woman deciding if and when to have children. The doctors in the article are more preoccupied with advancing their own ethical credentials than with serving their patients. “We were in the business to improve pregnancy outcomes, and those reductions didn’t fit the criteria,” says Dr. Ronald Wapner. A woman’s evaluation of economic and social limitations to child-rearing does not fit into Dr. Wapner’s career ambitions.

Reproductive justice allows people to determine how they establish their families. Medical technology facilitates that goal. Having a choice allows parents to allocate their priorities as compassionately as possible.

Introduction

While stereotyped as hyper-fertile African American women are affected by the opposite characteristic: we are more likely studies say, than white counterparts between the ages of 25 and 44 to be and remain infertile.

If you did not know this, do not be ashamed.  Most physicians don’t know it either.  A recent Centers for Disease Control report says 6.1 million U.S. women between the ages 15 and 44 had trouble conceiving; 2.1 million married couples experienced infertility, and 9.2 million women had made use of infertility services.

In a study of  US physicians’ perceptions of fertility, only 16% of the responding physicians correctly identified African Americans as the racial group most at risk for fertility, 82% thought white women were most at risk. While stereotyped as hyper-fertile most studies say that African American women are more likely than white counterparts between the ages of 25 and 44 to be and remain infertile.

The Research

Most fertility research involves wealthier white women, because they are the biggest consumers of fertility clinics whose patients or patients’ data are available for research studies. The story of African American women’s fertility, emerging from the most recent empirical research available seems to be this. (more…)

A recent NY Times pair of articles focuses on the human, medical, and social costs of implanting multiple embryos via IVF and IUI, resulting in a spike in both multiple births and a litany of health risks to these babies. The articles, and ensuing barrage of public comments, can be read here: “The Gift of Life, and Its Price,” “Grievous Choice on Risky Path to Parenthood.” In IUI, parents who conceive multiples also face the decision of whether to terminate some fetuses using the procedure termed “selective reduction”. IUI is much cheaper than IVF, and more readily covered by insurance, but the chance of success is lower and ability to control multiples non-existent.

The most startling assertion in the IVF article was an analysis by reproductive health experts and providers explaining the financial and business motivations on providers to disregard medical guidelines by implanting more embryos than may be safe for mom or her babies. Fertility practices want to boost their success rates and attract clientele in a highly competitive and lucrative medical field, and parents apparently think that implanting more, or rejecting selective reduction in IUI, will secure greater chances of a viable pregnancy and satisfy their emotional or religious needs to a degree that makes the risks worth taking. If the underlying reason for the increase in multiple implantations and subsequent births is really a symptom of our profit-based medical system, some suggest we utilize insurance schemes as a way to address this issue. If insurance companies are required to cover IVF, whereas many now only cover IUI, they could regulate the financial incentives by only reimbursing doctors for single implantations. (more…)