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Marge Berer: In defence of abortion on a woman’s request, including on grounds of fetal sex

24 Feb, 12 | by BMJ Group

Ach, what a furore. The Daily Telegraph is in its element and having a ball printing nasty allegations about doctors doing abortions illegally on grounds of sex selection. Let’s look at the issues a bit more dispassionately. First, is it actually illegal? Yes and no. The 1967 Abortion Act does not permit abortion on grounds of sex selection per se, it is true, and the law is framed so that anything that cannot be defended as coming under one or more of the named legal grounds is technically illegal. However, the question remains whether abortion on grounds of sex selection can be defended under the existing legal ground for abortions. I believe the answer is yes.

Sex selective abortion, like late second trimester abortion, lends itself to easy condemnation and stigma, and many otherwise pro-choice people are opposed to it. In India and China, where the laws on abortion are otherwise very liberal, sex selective abortion is subject to several laws banning it, all of which are totally ignored  ̶  both because women are under great pressure to have boys, especially women whose first child was a girl and who have only one or two chances, and because those doing the ultrasound scans are making a lot of money from them.

This isn’t a question of designer babies, though it is always the case that where something is possible technically, and is available for a range of reasons, e.g. determining whether there is a risk of sex-specific genetic anomalies, it will also be used in other ways. In this sense, finding out fetal sex during an ultrasound scan is inevitable and justified. This information belongs to the parents and should not be withheld. The baby is theirs after all. Preferring a baby of one sex over the other is nothing new, but has become more of an issue, according to the literature on sex selection in Asia, precisely because people are having so few children. But this is not just a cultural or ethnic issue. I watched someone I know treat her second child, a boy, badly throughout his childhood because she had wanted a second girl. She never forgave him for being born, at a time when there was no ultrasound for finding out fetal sex. Is this so uncommon?

I believe doctors faced with a request for abortion from women whose cultures practise discrimination against women and girls can justify it under the existing abortion law on the following grounds: taking the woman’s social situation into account, and because the woman’s physical and mental health and well-being may be at risk, and also her existing children. The potential for abuse of a woman by her husband and family, and poor treatment of and even purposeful neglect of girl children (leading to poor development and even death), are common outcomes in Asian cultures that demand that women produce boys. Women can be rejected and their lives made miserable. No one that I am aware of has ever investigated the existence or extent of such abuse and neglect in the UK among families from these cultures, but perhaps it’s time someone did. Moreover, it is also the case that a woman may not want another baby anyway, for other valid reasons, and fetal sex may be the only acceptable excuse she can give in her family situation for seeking an abortion.

Lastly, if anyone thinks that incrimination, condemnation and prosecution of pro-choice doctors is going to make this situation go away, they need to think again. Women will simply say they have a different reason and doctors will duly record it.

I believe health professionals and everyone who is pro-choice on abortion should support pro-choice doctors and women seeking abortions, whatever their reasons, even when sex selection may be involved.

The Daily Telegraph’s stories and the cowards who remain unidentified who went under false pretences to abortion providers and doctors who authorise abortions with the intention of incriminating them, should be condemned. Their aim is not to stop sex selection, which will not go away until discrimination against women and girls becomes history. Their aim is to stigmatise abortion and women who have abortions, to frighten women and abortion providers that they are breaking the law, and to seek to restrict the law on abortion. Their behaviour is unethical and under-handed, and constitutes harassment, which should be rejected and even subject to prosecution for wasting the Health Department’s and police time.

The UK needs to make abortion available legally on the request of the woman, and to decriminalise abortion altogether. This is an idea whose time would have come long ago if misogyny and harassment of women were illegal  ̶  and prosecuted  ̶  instead.

Marge Berer, editor, Reproductive Health Matters

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  • A Meldolesi

    100 million missing women is not enough?

  • http://profile.yahoo.com/7E65U3ORPPL762V3NXIEMTLPHU Joseph

    In a perfect world, a woman would have the privilege to make any decision she chooses to regarding her pregnancy.
    In this real, political, world, one question to consider is whether the issue of choosing the fetus's sex, is a wedge argument in the campaign to ban abortion  altogether; or whether it is a sacrificial concession in the campaign to preserve the legality of abortion.

  • Rory Weaver

    This is very convincing, but I wonder if legalizing sex selective abortion is a step too far. Is wanting your baby to be a boy or a girl really so different to wanting them to be tall or intelligent?  Taking the example of your friend's treatment of her son, is this really so different to if I treated my child badly because they show no interest or aptitude in sport or music, even though this may have been something that I desperately wanted from them. If a genetic indicator was easily available to predict these things, no one would support the idea of having an abortion to try and get the 'right' sort of child the next time around. The fact that it is easier to get information on a child's gender than on other characteristics shouldn't make a difference to the principle of having an abortion because a child isn't quite what you wanted.

    The argument for allowing sex selective abortions in order to avoid  mistreatment of the mother or daughter makes a lot of sense in the short term, but undermines the effort to overcome preference for boys among these cultures. In South Korea this was only achieved after a significant campaign, including many changes to the law, that promoted the principle of gender equality. This is one reason that sex selective abortion decreased in South Korea while continuing to increase in China, where women do well economically. The message of gender equality will be compromised if the government is seen as legitimizing sex selective abortion, and by extension the cultures that practice it. In this case I think that it is the principle of the law rather than its effectiveness that is important.

    While the right to an abortion is something I strongly support, I think that allowing it to take place on the grounds of fetal sex would set a worrying precedent, and could end up doing more harm than good to the status of women. 

  • Guest

    Is Berer a lawyer? If not, perhaps she should leave the interpretation of the Abortion Act to those with legal training…  I find it  a bit arrogant of her to determine what the “true” meaning of the Abortion Act is. This is best left up to legal professionals, not those who edit pro-choice journals.

    The Telegraph also reported last week on abortions carried out because the pregnancy would have interfered with the woman's holiday ('Pregnant women have asked for terminations because they did not want their holidays spoilt' ; Telegraph 23.02.12; link http://www.telegraph.co.uk/hea… )

    Would Berer also support abortion in cases where the only reason for abortion is because the pregnancy would interfere with  the holiday? She appears to be supportive of this as indication for abortion:

    “I believe health professionals and everyone who is pro-choice on
    abortion should support pro-choice doctors and women seeking abortions,
    whatever their reasons, even when sex selection may be involved.”

    So, abortion for any reason – is that what Berer advocates?

  • m oliver

    many of my patients are miserable, persecuted and rejected but i don't propose they go to the euthanasia clinic. Give them a chance!

  • Cassie

    The Abortion Act of 1967 requires doctors to interpret it on a daily basis. If we “left the interpretation of the act to those with legal training”, no one would be able to have an abortion at all. Which is the situation which many people would like to see come about.

    I think Berer is advocating abortion for any reason that the woman – the one carrying the pregnancy – feels to be strong enough to warrant a termination. And I think she's absolutely right.

  • Srford

    There are a number of problems with this blog piece.  Firstly, it's not unreasonable for undercover journalists to probe the integrity of doctors signing abortion certificates is there is a concern that they are breaking the law.  Sex selection abortion is currently illegal and so this is a legitimate subject for investigative journalism.  How else could this be done if not by going undercover? 

    Secondly, the Council of Europe has asked the medical profession not to give ante-natal gender diagnosis because of the risk of sex-selective abortion.  I can't see that body as having an anti-choice agenda.

    Thirdly, the author advocates a hardline attitude to abortion with which many people feel uncomfortable – essentially abortion on demand at any stage of pregnancy.  Do we really want a foetus to have no rights at all until it's born?  Or to have its rights made subservient to sexist cultures?  What would be the effect on gender equality if we allow sex-selective abortion?  Do we want to facilitate discrimination being brought in utero?

  • Saffy

    As a palliative medicine physician who opposes euthanasia because I see that all of a person's life is precious, even the struggles that may come as we leave it; I wonder at those who still reject the rights of the unborn. 

    When we are spending millions on terminating some lives and millions more on helping infertile people to have children; how does that make ethical sense to us as a community?

    It feels as if we are failing to look at the big picture; life is not fair and we do not have endless choices as to how we want to live it. We should consider that it is beyond us to choose when we arrive, what sex we are, how tall we are or even what terminal illness we contract and when we die.

    This life has suffering as part of the package, but in my practice I see that accepting the inevitable nature of this brings peace. To fight for your own choices all the way leaves many trampled beneath your desires.

    Fight neglect, shun discrimination, teach us all to recognise and reject age old cultural stigmas, but remember that you do not speak for all of us when you say that babies are expendable just because they are not yet ready to be born.

  • Guest

    Lord David Steel is on record as saying on the 40th anniversary of the Abortion Act that there were too many abortions and that abortion is being used as contraception.
    So I am not convinced that what happens now reflects the intention of the Abortion Act as originally drafted.

    “I think Berer is advocating abortion for any reason that the woman – the
    one carrying the pregnancy – feels to be strong enough to warrant a
    termination. And I think she's absolutely right” – really?
    so no right for the unborn then and absolute right for the mother?

    lets quote Dr Bernard Nathason on this, who, has been part of “both sides” of the abortion argument:

    “We must courageously face the fact – finally – that human life of a special order is being taken. (…) The fierce militants of the Women's Liberation evade this issue and assert that the woman's right to bear or not to bear children is her absolute right. (…) On the other hand the ferocious Right-to life legions proclaim no rights for the women and

    absolute rights for the fetus. (…) Somewhere in the vast philosophic plateau between the two implacably opposed camps- past the slogans, past the pamphlets, past even the demonstrations and the legislative threats -

    lies the infinitely agonizing truth. We are taking life, and the

    deliberate taking of life, even of a special order and under special circumstances, is an inexpressibly serious matter.” (Bernard Nathanson.

    Deeper into Abortion. New England Journal of Medicine. 28 November 1974.)
     
    link http://www.bmj.com/content/342

  • JHS

    There is one vital question which needs a clear answer in relation to abortion for whatever reason it is carried out. What is the nature of the being whose life is being destroyed in an abortion? The answer, which was known to Hippocrates, is a human life. To destroy that life because it is of the undesired sex or for any other reason is reprehensible in the extreme.
    One does not need to be a doctor or scientist to understand the true nature of what is now euphemistically called termination. Let us face reality even when it is painful to do so

  • cagedsky

    Dr Berer, you say: '
    The potential for abuse of a woman by her husband and family, and poor treatment of and even purposeful neglect of girl children (leading to poor development and even death), are common outcomes in Asian cultures that demand that women produce boys. Women can be rejected and their lives made miserable. '
    We need to stand up for women in these situations, to stand up against this domestic violence, not to appease the abusive husbands by getting rid of girl babies. Abusers very often succeed in abusing because their targets will do anything to avoid (often dangerous) conflict.

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