Lachlan de Crespigny

Who wants to be an abortionist?

By Lachlan de Crespigny

Dr. Evan James never wavered in his determination to become an abortion provider. But he is unusual – few trainee doctors have a driving ambition to become abortionists. The U.S. has seen a 40 per cent drop in the number of doctors who perform abortions since the early 1980s. Those in the field say there's likely a similar trend in Canada. Few Canadian hospitals provide abortions and numbers are dropping. Other countries, including Australia, have similar service provision problems.

Abortion is lawful in at least some circumstances in almost all western countries. Yet most have too few providers and current providers are aging with few replacements coming through.

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Survey on community attitudes on early and late abortion

Do Australians’ believe that women should be able to access abortion later in pregnancy? A new survey (Australian attitudes on access to early and late abortion. Lachlan de Crespigny, Dominic Wilkinson, Thomas Douglas, Mark Textor, Julian Savulescu MJA 2010; 193: 1-4) of 1050 Australians published in the Medical Journal of Australia shows that the answer is overwhelmingly yes; when there is good reason. These results have broad implications in both Australia and elsewhere.

The survey gives a detailed picture of attitudes in a wide range of clinical and social situations using personalized questions.

The findings contradict a previous Australian Federation of Right to Life Associations survey that suggested that Australians strongly oppose women accessing later abortion. They also contradict some data in surveys from UK, Europe generally and USA (also here). Surveys have tended to be simple yes/no polls asking impersonal non-contextualised questions. Contextualised personal survey questions in other countries may also show greater support for women being able to access late-abortion. The findings are relevant to calls – including from Prime Minister David Cameron –to further limit the gestational limits for abortions in UK.

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Court compels woman to go to bed

Jacob M Appel writes in the Huffington Post  that Samantha Burton was 25 weeks pregnant when she ruptured her membranes and started contractions. There was a risk of infection and premature birth, risking her health and the life of her unborn child. It could also risk the health of her future child who may survive but be disabled.                                                                                                             
Burton was ordered rest in hospital for the remainder of her pregnancy. She wanted to go home but wasn't allowed to leave.

The hospital successfully went to court forcing Burton to comply. 

Three days later she had an emergency cesarean, but the baby was stillborn.

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Of Mothers and Fetuses and Abortionists

Two recent articles highlight the powerful influence that language has over the way people think. Word choice is at the centre of an article about USA ‘abortionist’ Warren Hern . He hates the word abortionist: ‘the opponents of abortion have turned it into a degrading and demeaning word that has the same negative connotations as the most despicable racial epithet’.

But the author argues that it is the right word, an accurate word, and our discomfort with it is only a measure of how poisoned the language of abortion has become. The article does not refer to Hern by his name but uses the poisoned word, the ‘abortionist’, ignoring both the normal convention referring to people the way they want plus Hern’s abhorrence of the word. This produces an accusatory tone that suggests that the author is antagonistic towards Hern, although other that name calling the author does not seem unsupportive of him. Perhaps the author is expressing his mixed feelings. 

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Will Down syndrome disappear?

There are concerns about the impact of the improving accuracy and availability of low risk cheap prenatal tests such as for Down syndrome (DS). Introduction of a noninvasive maternal serum test is expected that might provide a definitive diagnosis of DS in the first trimester at no risk to the fetus. The authors report that the tests should be virtually universally available and allow privacy of decision making. The authors ask whether the new tests will decrease the birth incidence of DS even further. Indeed, might there be no more DS children born? If so, is that a problem?

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Should early non invasive prenatal testing be opposed?

It is now possible to detect fetal problems with just a sample of the pregnant woman’s blood. Women will probably be offered this test routinely in the first trimester. But the breakthroughs are said to raise serious ethical questions.

In 2008 Fan et al. (Proc. Natl Acad. Sci.USA 2008; 105:16266–16271) non-invasively diagnosed fetal chromosome abnormality from cell-free DNA in maternal blood. Recently, at least two companies have announced plans to introduce non-invasive prenatal diagnosis (NIPD) into health care.

The clinical role of NIPD is unclear. It could be used either as a screening test (with CVS or amniocentesis still required as a follow up diagnostic test) or it might replace invasive tests. Less likely, it might be interposed between current screening and invasive tests.

The most exciting, and potentially controversial, role of NIPD is if it can replace current invasive tests. Prenatal (cyto)genetic diagnosis could be achieved much earlier in pregnancy.

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In a world of low risk obstetrics, is home birth unethical

It is reported that women who give birth at home with an independent midwife are nearly three times more likely to have a stillbirth than those who give birth in hospital; many other outcomes were “significantly better”. 

 

Perinatal deaths following home birth were associated with an underestimation of the dangers of high risk pregnancies such as preterm birth, twins, vaginal breech births and fetal distress (Bastian H et al.  BMJ. 1998; 317: 384–388). Even some IVF pregnancies were managed at home.

 

Midwives are trained in carrying out normal deliveries, not complex high risk manipulative deliveries such as breech deliveries; these should not be performed by unskilled operators. In addition, caesarean section is advocated for most women with a breech presentation or twins. 

 

Home birth in high risk patients is inadvisable and experimental (Bastian) and is opposed by professional colleges and here and here. Women with an increased risk of complications should be delivered in hospital where obstetricians can spot those complications. Women should be told this – in the recent study there is no suggestion that UK midwives told them. 

 

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Prenatal sex selection – When prenatal testing can threaten social harmony

China has an imbalance in the sex ratio resulting from selective abortion of female fetuses. Predictions that it may result in social disharmony are eventuating sooner than expected – but the problem is different to the one that was anticipated. Stolen girls have become increasingly valuable commodities in a cruel trade. A 2½ girl is feared kidnapped after she went to the shop around the corner. She vanished; her heartbroken mother and father fear she was kidnapped (1).

As many as 20,000 children and young women are reported kidnapped every year. This is said to be increasing. Only a handful of cases are solved. Many girls are bought by farmers who want wives for their young sons when they come of age, or by men who want a child bride without a dowry. Police raided one village & found that babies were being raised for sale and families were acting as brokers for other peasants who wanted to sell off “surplus” infants (1). 

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Abortion for Fetal Abnormality?

Abortion remains a crime for most Australians. Laws are inconsistent between states. In contrast, long ago the UK Abortion Act 1967 repealed and replaced its antiquated legal statutes on which much of Australian abortion law is still based.

The government in the state of Victoria asked the Law Reform Commission to provide legislative options to decriminalize abortion. Law reform is expected later this year.

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