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The Problem of Spontaneous Abortion: Is the Pro-Life Position Morally Monstrous?
Abstract
A substantial proportion of human embryos spontaneously abort soon after conception, and ethicists have argued this is problematic for the pro-life view that a human embryo has the same moral status as an adult from conception. Firstly, if human embryos are our moral equals, this entails spontaneous abortion is one of humanity’s most important problems, and it is claimed this is absurd, and a reductio of the moral status claim. Secondly, it is claimed that pro-life advocates do not act as if spontaneous abortion is important, implying they are failing to fulfill their moral obligations. We report that the primary cause of spontaneous abortion is chromosomal defects, which are currently unpreventable, and show that as the other major cause of prenatal death is induced abortion, pro-life advocates can legitimately continue efforts to oppose it. We also defend the relevance of the killing and letting die distinction, which provides further justification for pro-life priorities.
... Relevant here is that this might also seem to undermine pro-life Body Count Reasoning: maybe body counts really support prioritizing miscarriage over everything else, not induced abortion. Common responses in favor of prioritizing intentional abortion over miscarriage involve denying that much can feasibly be done to significantly reduce the number of miscarriages and stressing the claim that induced abortion is more morally urgent since it involves, not just death, but killing (e.g., Tollefsen 2008;Dodsworth et al. 2008;Friberg-Fernros 2015;Blackshaw & Rodger 2019;cf. sec. ...
... A different approach is inspired by work from Thomas Pogge (2010) and by Bruce Blackshaw and Daniel Rodger (2019). Pogge (2010: 126) denies that it is more important to prevent others from being unjustly killed than to prevent them from naturally dying. ...
... . A few authors (e.g.,McMahan 2002: 165-85, esp. 165-66;Dodsworth et al. 2008;Friberg- Fernros 2015;Blackshaw & Rodger 2019) have also considered the claim that death is not as bad for a fetus as a way of justifying the claim that problems affecting already born humans might deserve greater priority. This option also rejects 3m. ...
The Embryo Rescue Case asks us to consider whether we should save a fully-developed child or a tray full of many embryos from a fire. Most people pick the child. This allegedly provides evidence against the view that embryos have the same moral status as developed humans. Pro-life philosophers usually grant that you should save the child, but say that this doesn’t undermine the claim that embryos possess full moral status. There may be reasons besides differing moral status to save the child. Meanwhile, many ordinary pro-life people think that stopping abortion is far and away the most morally urgent socio-political issue. They reason that since abortion (in their view) consists in the unjust killing of so many human persons, fighting it should be an overwhelming priority. Here I argue that this way of reasoning about the urgency of combating abortion (given the pro-life view) conflicts with the usual response to the Embryo Rescue Case. If the fact that you should save a developed human rather than many more embryos doesn’t imply that embryos lack personhood, then embryonic personhood doesn’t imply that you should save embryos rather than many fewer developed humans.
... This criticism seems unwarranted. As we have noted, a very significant research programme into spontaneous abortion already exists (Blackshaw and Rodger 2019). 15 Further, consider an analogy. ...
... Colgrove (2021) here refers to spontaneous abortions as miscarriages.18 Blackshaw and Rodger (2019) explain that induced abortion is the most common preventable cause of prenatal death. ...
Opponents of abortion are commonly said to be inconsistent in their beliefs
or actions, and to fail in their obligations to prevent the deaths of embryos
and fetuses from causes other than induced abortion. We have argued that
these ‘inconsistency arguments’ conform to a pattern which is susceptible
to a number of objections, and that consequently they fail en masse. In
response, Joshua Shaw argues that we misrepresent inconsistency arguments,
and that we underestimate the extent to which our opponents have
anticipated and addressed counterarguments. In this essay we draw on
aspects of Shaw’s alternative formulation of inconsistency arguments to
present an improved inconsistency argument structure. While we agree
with Shaw that inconsistency arguments must each be examined on their
merits, we reject Shaw’s assertion that our objections are dependent on misrepresentations. Our initial objections remain largely successful, therefore, in
dealing with the inconsistency arguments of which we are aware.
... They assert that this obligation entails strongly counterintuitive, if not absurd, implications that demonstrate that the substance view is implausible. Defences have been made against these claims (Friberg-Fernros 2015, Blackshaw and Rodger 2019, but many critics seem unpersuaded so far. ...
... 3 Amy Berg responds by claiming that substance view proponents are bystanders with respect to induced abortion, and so these are also cases of letting die (2017, p. 1222). Blackshaw and Rodger (2019) counter this by citing Thomas Pogge's view that in a democratic society, all citizens are responsible for a legal system that permits induced abortions, and so all citizens participate to an extent in killing (Pogge 2010, p.127). Pogge suggests an analogy with slavery, arguing that all citizens were similarly morally responsible for laws permitting slavery. ...
Recently, the substance view of persons has been heavily criticized for the
counterintuitive conclusions it seems to imply in scenarios such as embryo
rescue cases and embryo loss. These criticisms have obscured the considerable
success of the substance view in supporting other intuitions that are
widely shared, and that competing accounts such as the psychological view
have difficulties accounting for. Here, I examine common intuitions regarding
identity, human exceptionalism, the moral equality of children and adults,
infanticide, and prenatal injury. I conclude that when we broaden the range
of intuitions examined, the substance view emerges as just as plausible an
account of our nature as the more widely accepted psychological view.
... As Blackshaw and Rodger explain, induced abortion is the leading preventable cause of death of human beings, as spontaneous abortions are largely unpreventable. 5 If OAs sincerely believe these claims, then they are acting consistently with their beliefs, and the Other Beliefs Objection succeeds. ...
... Induced abortion is the leading preventable cause of death for all human beings, however, so charges of inconsistency seem dubious. 5 Relatedly, as Colgrove notes, the number of lives affected is not the only relevant factor-PAC theorists must also consider the probability of success in their efforts. 6 Preventable causes can reasonably be preferred over apparently intractable ones. ...
William Simkulet has recently criticised Colgrove et al ’s defence against what they have called inconsistency arguments—arguments that claim opponents of abortion (OAs) act in ways inconsistent with their underlying beliefs about human fetuses (eg, that human fetuses are persons at conception). Colgrove et al presented three objections to inconsistency arguments, which Simkulet argues are unconvincing. Further, he maintains that OAs who hold that the fetus is a person at conception fail to act on important issues such as the plight of frozen embryos, poverty and spontaneous abortion. Thus, they are morally negligent. In response, we argue that Simkulet has targeted a very narrow group of OAs, and so his criticisms are inapplicable to most OAs. We then explain why his responses to each of Colgrove et al’s objections do not succeed, even for this restricted group. Finally, we note that Simkulet fails to provide evidence for his claims regarding OAs’ supposed failures to act, and we show that OAs veritably do invest resources into these important issues. We conclude that Colgrove et al ’s reasons for rejecting inconsistency arguments (en masse) remain intact.
... To help explain my position, consider another feature of Marquis' argument: it implies that the wrongness of killing is closely tied to the badness of death, which is widely variable. As Blackshaw and Rodger (2019) note, the badness of death differs a large amount between persons. But, if killing is wrong primarily because it deprives someone of a future life of value, then the wrongness of killing can vary from extremely wrong (in the case of embryos) to minimally, or perhaps not wrong at all (in the case of people killed near the end of their lives, or in the case of severely disabled people who are not able to enjoy much). ...
Several recent papers have suggested that the pro-life view entails a radical, implausible thesis: that miscarriage is the biggest public health crisis in the history of our species and requires radical diversion of funds to combat. In this paper, I clarify the extent of the problem, showing that the number of miscarriages about which we can do anything morally significant is plausibly much lower than previously thought, then describing some of the work already being done on this topic. I then briefly survey a range of reasons why abortion might be thought more serious and more worthy of prevention than miscarriage. Finally, I lay out my central argument: that reflection on the wrongness of killing reveals that the norms for ending life and failing to save life are different, in such a way that could justify the prioritization of anti-abortion advocacy over anti-miscarriage efforts. Such an account can also respond to similar problems posed to the pro-lifer, such as the question of whom to save in a "burning lab" type scenario.
... Treating frozen embryos as neighbors requires securing them a life like ours through adoption and gestation, and as well as opposing abortion, Christians must work toward this goal for the vast numbers of frozen embryos that would otherwise be discarded. Blackshaw and Rodger (2019) attempt to justify OA disinterest in spontaneous abortion, claiming that most cases of spontaneous abortion are not currently preventable; but notes that "if we regard all human life as equally valuable, we have at least some obligation toward helping reduce deaths from spontaneous abortion where possible". This paper argues that inconsistency arguments matter. ...
Most opponents of abortion (OA) believe fetuses matter. Critics argue that OA act inconsistently with regards to fetal life, seeking to restrict access to induced abortion, but largely ignoring spontaneous abortion and the creation of surplus embryos by IVF. Nicholas Colgrove, Bruce Blackshaw, and Daniel Rodger call such arguments inconsistency arguments and contend they do not matter. They present three objections to these arguments — the other beliefs, other actions, and hypocrisy objection. Previously, I argued these objections fail and threaten to undermine ethical inquiry. Colgrove et al. have recently replied, but here, I argue their reply fails as well and raises a new criticism of the other actions’ objection. This essay sets out to show, as well as any philosophical argument can, that inconsistency arguments are morally significant.
... In response, pro-life philosophers have pointed out that a high percentage of miscarriages are not preventable, and shown that induced abortion is the most significant preventable cause of death prior to birth. 62 They have, however, acknowledged that miscarriage is an important issue that deserves more attention from pro-life advocates. 63 Clearly, on the view that fetuses are persons, if induced abortion is a public health crisis that requires quite drastic action in the form of abortion prohibitions, it must be agreed that miscarriage is also a public health crisis. ...
Pro- life advocates commonly argue that fetuses have the moral status of persons, and an accompanying right to life, a view most pro- choice advocates deny. A dif-ficulty for this pro- life position has been Judith Jarvis Thomson’s violinist analogy, in which she argues that even if the fetus is a person, abortion is often permissible be-cause a pregnant woman is not obliged to continue to offer her body as life support. Here, we outline the moral theories underlying public health ethics, and examine the COVID- 19 pandemic as an example of public health considerations overriding individual rights. We argue that if fetuses are regarded as persons, then abortion is of such prevalence in society that it also constitutes a significant public health crisis. We show that on public health considerations, we are justified in overriding individual rights to bodily autonomy by prohibiting abortion. We conclude that in a society that values public health, abortion can only be tolerated if fetuses are not regarded as persons.
... [24][25][26][27][28][29][30][31][32][33][34][35][36] OAs have continued these discussions through 2019 as well. [37][38][39][40][41] ii Typically, the main concern of these projects is to undermine the view that embryos and fetuses possess the moral status of persons. But each argues that OAs are hypocritical (or inconsistent) in some way, as a means of trying to show that OAs' views are implausible. ...
Opponents of abortion are often described as ‘inconsistent’ (hypocrites) in terms of their beliefs, actions and/or priorities. They are alleged to do too little to combat spontaneous abortion, they should be adopting cryopreserved embryos with greater frequency and so on. These types of arguments—which we call ‘inconsistency arguments’—conform to a common pattern. Each specifies what consistent opponents of abortion would do (or believe), asserts that they fail to act (or believe) accordingly and concludes that they are inconsistent. Here, we show that inconsistency arguments fail en masse. In short, inconsistency arguments typically face four problems. First, they usually fail to account for diversity among opponents of abortion. Second, they rely on inferences about consistency based on isolated beliefs shared by some opponents of abortion (and these inferences often do not survive once we consider other beliefs opponents of abortion tend to hold). Third, inconsistency arguments usually ignore the diverse ways in which opponents of abortion might act on their beliefs. Fourth, inconsistency arguments criticise groups of people without threatening their beliefs (eg, that abortion is immoral). Setting these problems aside, even supposing inconsistency arguments are successful, they hardly matter. In fact, in the two best-case scenarios—where inconsistency arguments succeed—they either encourage millions of people to make the world a (much) worse place (from the critic’s perspective) or promote epistemically and morally irresponsible practices. We conclude that a more valuable discussion would be had by focusing on the arguments made by opponents of abortion rather than opponents themselves.
... The high number of spontaneous abortions is problematic, thoughcritics such as Simkulet (2017) have suggested that at a minimum equal resources should be directed towards both preventing spontaneous abortions and preventing induced abortions, perhaps moreand yet substance theorists rarely even raise spontaneous abortion as an issue. I have explored this incongruence elsewhere (Blackshaw and Rodger 2019), and here note two key points. Firstly, considerable healthcare resources are already invested into preventing miscarriage, as this is a widely experienced issue for couples wishing to conceive, both naturally and by in vitro fertilization (IVF). ...
The substance view is an account of personhood that regards all human beings
as possessing instrinsic value and moral status equivalent to that of an adult
human being. Consequently, substance view proponents typically regard abortion
as impermissible in most circumstances. The substance view, however,
has difficulty accounting for certain intuitions regarding the badness of
death for embryos and fetuses, and the wrongness of killing them. Jeff McMahan’s
time-relative interest account is designed to cater for such intuitions, and
so I present a proposal for strengthening the substance view by incorporating
McMahan’s account – the Dual-Aspect Account of the morality of killing. I show
that it resolves some important issues for the substance view while preserving
its central premise of moral equality for all human beings. I then compare the
Dual-Aspect Account with McMahan’s Two-Tiered Account of the morality of
killing, which he derives from his time-relative interest account.
... For a response to Räsänen (2018), see Kaczor (2018). Lastly, while this paper was under review, Blackshaw and Rodger (2019) published a response to Ord's style of argument. Blackshaw and Rodger come the closest to offering the same type of response as me (particularly with respect to the first of three responses I develop), though as I note below, there are several ways in which our arguments are importantly different. ...
Some opponents of abortion claim fetuses are persons from the moment of conception. Call these “Personhood-At-Conception” (or PAC), opponents of abortion. Amy Berg (2017, Philosophical Studies 174:1217–26) argues that if fetuses are persons from the moment of conception, then miscarriage kills far more people than abortion. Thus, PAC opponents of abortion must “immediately” and “substantially” shift their attention, resources, etc., toward preventing miscarriage or admit they do not believe that personhood begins at conception (or, at least, they should recognize they are not acting in ways consistent with this belief). Unfortunately, Berg’s argument fails at every step. After outlining her argument, I show that her claim—that “miscarriage . . . is much deadlier than abortion”—is false (when taken literally) and misleading otherwise. Further, Berg’s argument is identical in structure to a criticism sometimes levied against the “Black Lives Matter” movement. In the latter context, the argument has been vehemently rejected. Berg’s argument should be rejected for the same reasons. Finally, Berg cites no evidence when claiming that PAC opponents of abortion are “not doing enough” to prevent miscarriage. And, even if PAC opponents of abortion are not diverting substantial funds toward miscarriage prevention, Berg fails to notice that this may be for good reason.
... I am not denying that they could be solved without Schrödinger's fetus. Attempts have recently been made to solve the spontaneous abortion problem (Friberg-Fernros 2018;Blackshaw & Rodger 2019) and the embryo rescue case (Hendricks 2019), and I am confident that the last word on these topics has yet to be said. My proposal simply is that with Schrödinger's fetus, we don't even have to solve these problems, because with Schrödinger's fetus these problems do not arise in the first place. ...
This paper defends and develops Elizabeth Harman’s Actual Future Principle with a concept called Schrödinger’s Fetus. I argue that all early fetuses are Schrödinger’s Fetuses: those early fetuses that survive and become conscious beings have full moral status already as early fetuses, but those fetuses that die as early fetuses lack moral status. With Schrödinger’s Fetus, it becomes possible to accept two widely held but contradictory intuitions to be true, and to avoid certain reductiones ad absurdum that pro-life and pro-choice positions face. It also gives a simple solution to the problem of prenatal harm.
The frequency of death from miscarriage is very high, greater than the number of deaths from induced abortion or major diseases. Berg (2017, Philosophical Studies 174:1217-26) argues that, given this, those who contend that personhood begins at conception (PAC) are obliged to reorient their resources accordingly-towards stopping miscarriage, in preference to stopping abortion or diseases. This argument depends on there being a basic moral similarity between these deaths. I argue that, for those that hold to PAC, there are good reasons to think that there is no such similarity. There is a morally relevant difference between preventing killing and letting die, giving PAC supporters reasons to prioritize reducing abortion over reducing miscarriage. And the time-relative interest account provides a morally relevant difference in the badness of death of miscarriages and deaths of born adults, justifying attempts to combat major diseases over attempts to combat miscarriage. I consider recent developments in the literature and contend that these new arguments are unsuccessful in establishing moral similarities between deaths from miscarriage and abortion, and deaths from miscarriage and disease.
This essay defends the asymmetry between the badness of spontaneous and induced abortions in order to explain why anti-abortionists prioritize stopping induced abortions over preventing spontaneous abortions. Specifically, it argues (1) the distinction between killing and letting-die is of more limited use in explaining the asymmetry than has sometimes been presumed, and (2) that accounting for intentions in moral agency does not render performances morally inert. Instead, anti-abortionists adopt a pluralist, nonreductive account of moral analysis which is situated against a backdrop that sees the limits of our ability to control the process of fertility as themselves valuable. Although this view is complex, the paper concludes by arguing that it has the advantage of explaining features of the anti-abortion outlook that have sometimes been overlooked. First, it accounts for why the pre-Roe regime of abortion restrictions primarily imposed penalties on doctors who induced abortions rather than the women who seek them. Second, it explains why the advent of ectogestation will not prompt anti-abortionists to compromise on 'disconnect abortions,' which putatively let the embryo die by extracting it from the mother's womb.
Recent publications debate the value of inconsistency arguments. Here, I argue that ‘Cause of Death Arguments’ — inconsistency arguments that claim miscarriage causes death far more often than induced abortion — are unsound or invalid. ‘Miscarriage’ ambiguously refers both to intrauterine death, an outcome that does not itself cause death, and preterm delivery, which only sometimes causes death. The referential ambiguity also obscures actions people do take to prevent ‘miscarriage.’ When using the most plausible versions of each premise, these arguments equivocate. Thus, they cannot prove anything. However, missing the equivocation also causes those responding to Cause of Death Arguments to make unconvincing arguments; they inadvertently make or grant false claims themselves. To avoid such mistakes and expose the merely rhetorical power of Cause of Death Arguments, philosophers should replace ‘miscarriage’ with disambiguated terms. Doing so should lead people across the abortion debate to finally abandon the Cause of Death Argument.
One of the most influential philosophical arguments in favour of the permissibility of abortion is Judith Jarvis Thomson’s violinist analogy, presented in ‘A Defense of Abortion’. Its appeal for pro-choice advocates lies in Thomson’s granting that the fetus is a person with equivalent moral status to any other human being, and yet demonstrating—to those who accept her reasoning—that abortion is still permissible. In her argument, Thomson draws heavily on the parable of the Good Samaritan, arguing that gestating a fetus in some circumstances is what she calls a Good Samaritan act, and claiming that we are not morally required to be Good Samaritans. Here, I argue that Thomson has subverted the parable to justify an action that is the antithesis of its meaning. I contend that Christians are required to be Good Samaritans, and explain that for Christians, this entails abortion is impermissible in all circumstances. Further, I argue that the parable shows the fetus is our neighbour in need of our mercy and assistance, and consequently Christians should be actively involved in helping to ensure the unborn are protected, whether they are fetuses in danger of induced abortion or miscarriage, or surplus frozen embryos.
Purpose
To clarify the associations of the maternal age, history of miscarriage, and embryonic/fetal size at miscarriage with the frequencies and profiles of cytogenetic abnormalities detected in spontaneous early miscarriages.
Methods
Miscarriages before 12 weeks of gestation, whose karyotypes were evaluated by G-banding between May 1, 2005, and May 31, 2017, were included in this study. The relationships between their karyotypes and clinical findings were assessed using trend or chi-square/Fisher’s exact tests and multivariate logistic analyses.
Results
Three hundred of 364 miscarriage specimens (82.4%) had abnormal karyotypes. An older maternal age was significantly associated with the frequency of abnormal karyotype (ptrend < 0.001), particularly autosomal non-viable and viable trisomies (ptrend 0.001 and 0.025, respectively). Women with ≥ 2 previous miscarriages had a significantly lower possibility of miscarriages with abnormal karyotype than women with < 2 previous miscarriages (adjusted odds ratio [aOR], 0.48; 95% confidence interval [95% CI], 0.27–0.85). Although viable trisomy was observed more frequently in proportion to the increase in embryonic/fetal size at miscarriage (ptrend < 0.001), non-viable trisomy was observed more frequently in miscarriages with an embryonic/fetal size < 10 mm (aOR, 2.41; 95% CI, 1.27–4.58), but less frequently in miscarriages with an embryonic/fetal size ≥ 20 mm (aOR, 0.01; 95% CI, 0.00–0.07) than in anembryonic miscarriages.
Conclusions
The maternal age, history of miscarriage, and embryonic/fetal size at miscarriage may be independently associated with the frequencies or profiles of cytogenetic abnormalities in early miscarriages.
In a recent article, William Simkulet has argued against the anti-abortion view by invoking the fact that many human fetuses die from spontaneous abortion. He argues that this fact poses a dilemma for proponents of the anti-abortion view: either they must abandon their anti-abortion view or they must engage in preventing spontaneous abortion significantly more than at present—either to the extent that they try to prevent induced abortion or at least significantly more than they do today. In this reply, I acknowledge that, if the latter would follow, the anti-abortionist view would imply implausibly strong obligations. My aim with this reply is to demonstrate that anti-abortionists can hold on to their view without having implausibly strong obligations to prevent spontaneous abortion. My conclusion is that Simkulet clearly overstates his position by not sufficiently considering the differences between the act of killing versus death by natural causes and between positive and negative rights.
How many human embryos die between fertilisation and birth under natural conditions? It is widely accepted that natural human embryo mortality is high, particularly during the first weeks after fertilisation, with total prenatal losses of 70% and higher frequently claimed. However, the first external sign of pregnancy occurs two weeks after fertilisation with a missed menstrual period, and establishing the fate of embryos before this is challenging. Calculations are additionally hampered by a lack of data on the efficiency of fertilisation under natural conditions. Four distinct sources are used to justify quantitative claims regarding embryo loss: (i) a hypothesis published by Roberts & Lowe in The Lancet is widely cited but has no practical quantitative value; (ii) life table analyses give consistent assessments of clinical pregnancy loss, but cannot illuminate losses at earlier stages of development; (iii) studies that measure human chorionic gonadotrophin (hCG) reveal losses in the second week of development and beyond, but not before; and (iv) the classic studies of Hertig and Rock offer the only direct insight into the fate of human embryos from fertilisation under natural conditions. Re-examination of Hertig’s data demonstrates that his estimates for fertilisation rate and early embryo loss are highly imprecise and casts doubt on the validity of his numerical analysis. A recent re-analysis of hCG study data concluded that approximately 40-60% of embryos may be lost between fertilisation and birth, although this will vary substantially between individual women. In conclusion, natural human embryo mortality is lower than often claimed and widely accepted. Estimates for total prenatal mortality of 70% or higher are exaggerated and not supported by the available data.
In my articles 'The Substance View: A Critique' and 'The Substance View: A Critique (Part 2),' I raise objections to the substance view (naturally), a theory of intrinsic value and moral standing defended by a number of contemporary moral philosophers, including Robert P. George, Patrick Lee, Christopher Tollefsen, and Francis Beckwith. In part one of my critique of the substance view, I raise reductio-style objections to the substance view's conclusion that the standard human fetus has the same intrinsic value and moral standing as the standard adult human being, among other human beings. In part two, I raise objections to some of the premises invoked in support of that conclusion. Here, in part three, I raise objections to Henrik Friberg-Fernros's attempt to rebut some of the aforementioned objections.
Opponents of abortion sometimes hold that it is impermissible because fetuses are persons from the moment of conception. But miscarriage, which ends up to 89 % of pregnancies, is much deadlier than abortion. That means that if opponents of abortion are right, then miscarriage is the biggest public-health crisis of our time. Yet they pay hardly any attention to miscarriage, especially very early miscarriage. Attempts to resolve this inconsistency by adverting to the distinction between killing and letting die or to the difficulty of preventing miscarriage fail, leaving a dilemma. Opponents of abortion should either advocate a substantial shift in our political and medical priorities or else give up the view that fetuses are persons from the moment of conception.
A longstanding debate exists in population policy about the relationship between modern contraception and abortion. Although theory predicts that they should be substitutes, the empirical evidence is difficult to interpret. What is required is a large-scale intervention that alters the supply (or full price) of one or the other and, importantly, that does so in isolation (reproductive health programs often bundle primary health care and family planning?and in some instances, abortion services). In this article, we study Nepal?s 2004 legalization of abortion provision and subsequent expansion of abortion services, an unusual and rapidly implemented policy meeting these requirements. Using four waves of rich individual-level data representative of fertile-age Nepalese women, we find robust evidence of substitution between modern contraception and abortion. This finding has important implications for public policy and foreign aid, suggesting that an effective strategy for reducing expensive and potentially unsafe abortions may be to expand the supply of modern contraceptives.
Electronic supplementary material
The online version of this article (doi:10.1007/s13524-016-0492-8) contains supplementary material, which is available to authorized users.
Background:
Information about the incidence of induced abortion is needed to motivate and inform efforts to help women avoid unintended pregnancies and to monitor progress toward that end. We estimate subregional, regional, and global levels and trends in abortion incidence for 1990 to 2014, and abortion rates in subgroups of women. We use the results to estimate the proportion of pregnancies that end in abortion and examine whether abortion rates vary in countries grouped by the legal status of abortion.
Methods:
We requested abortion data from government agencies and compiled data from international sources and nationally representative studies. With data for 1069 country-years, we estimated incidence using a Bayesian hierarchical time series model whereby the overall abortion rate is a function of the modelled rates in subgroups of women of reproductive age defined by their marital status and contraceptive need and use, and the sizes of these subgroups.
Findings:
We estimated that 35 abortions (90% uncertainty interval [UI] 33 to 44) occurred annually per 1000 women aged 15-44 years worldwide in 2010-14, which was 5 points less than 40 (39-48) in 1990-94 (90% UI for decline -11 to 0). Because of population growth, the annual number of abortions worldwide increased by 5.9 million (90% UI -1.3 to 15.4), from 50.4 million in 1990-94 (48.6 to 59.9) to 56.3 million (52.4 to 70.0) in 2010-14. In the developed world, the abortion rate declined 19 points (-26 to -14), from 46 (41 to 59) to 27 (24 to 37). In the developing world, we found a non-significant 2 point decline (90% UI -9 to 4) in the rate from 39 (37 to 47) to 37 (34 to 46). Some 25% (90% UI 23 to 29) of pregnancies ended in abortion in 2010-14. Globally, 73% (90% UI 59 to 82) of abortions were obtained by married women in 2010-14 compared with 27% (18 to 41) obtained by unmarried women. We did not observe an association between the abortion rates for 2010-14 and the grounds under which abortion is legally allowed.
Interpretation:
Abortion rates have declined significantly since 1990 in the developed world but not in the developing world. Ensuring access to sexual and reproductive health care could help millions of women avoid unintended pregnancies and ensure access to safe abortion.
Funding:
UK Government, Dutch Ministry of Foreign Affairs, Norwegian Agency for Development Cooperation, The David and Lucile Packard Foundation, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.
Heritable human genetic modifications pose serious risks, and the therapeutic benefits are tenuous, warn Edward Lanphier, Fyodor Urnov and colleagues.
Pregnancy loss prior to viability is common and research in the field is extensive. Unfortunately, terminology in the literature
is inconsistent. The lack of consensus regarding nomenclature and classification of pregnancy loss prior to viability makes
it difficult to compare study results from different centres. In our opinion, terminology and definitions should be based
on clinical findings, and when possible, transvaginal ultrasound. With this Early Pregnancy Consensus Statement, it is our
goal to provide clear and consistent terminology for pregnancy loss prior to viability.
Basically, the commented upon book is the result of the writer's reaction to the absence of serious biological science that for years is reigning in the bioethics of the human embryo. The embryology used by bioethicists, both in their theoretical studies and in their interventions before public policy drafting committees, has consisted essentially not in primary research materials, but in text-book descriptions, with which resulted easier to support the theory of the pre-embryo. In this way, biologists were able to provide philosophers and jurists with a number of apparently scientific ″arguments″ so convincing that no one felt the need to review them critically. The lack or inferior condition of the biological status of the human supported by the arguments on the irrelevance of fertilization; on the numerical predominance of the extraembryonic cell population over the proper embryonic one; on the formation of monozygotic twins along the first two weeks of development; on the formation of tetragametic chimeras by fusion in one of two previously independent dizygotic embryos; on the totipotency of the cells of the young embryo; and, finally, on the massive spontaneous wastage of early embryos. Those arguments sought to consolidate the thesis that the biological entities exhibiting those behaviours were so precarious biologically that they couldn't claim a full ontological status of humanhood and, therefore, they cannot demand from us the ethical full respect due to human beings. Throughout the book I try to refute, in a reasonable and convincing way, and, more importantly in my view, with biological data, the above arguments. The author warns that the book can not be read without effort, but he considers that to get rid of the prevailing prejudices in embryoethics is a worthwhile goal.
Recurrent miscarriages are postimplantation failures in natural conception; they are also termed as habitual abortions or recurrent pregnancy losses. Recurrent pregnancy loss is disheartening to the couple and to the treating clinician. There has been a wide range of research from aetiology to management of recurrent pregnancy loss. It is one of the most debated topic among clinicians and academics. The ideal management is unanswered. This review is aimed to produce an evidence‑based guidance on clinical management of recurrent miscarriage. The review is structured to be clinically relevant. We have searched electronic databases (PubMed and Embase) using different key words. We have combined the searches and arranged them with the hierarchy of evidences. We have critically appraised the evidence to produce a concise answer for clinical practice. We have graded the evidence from level I to V on which these recommendations are based. KEY WORDS: Aspirin, antiphospholipids syndrome, immunotherapy, low molecular weight heparin, recurrent pregnancy loss, recurrent miscarriage, unexplained to generate most relevant results. The evidence was searched using individual subclass of etiology of recurrent pregnancy loss. Different key words were used such as recurrent miscarriage, recurrent pregnancy loss, habitual abortions, pregnancy failures, unexplained, and idiopathic miscarriage; and these words were combined with various factors known to cause or treat miscarriages. The search results were combined and most relevant results were grouped together for critical appraisal.
Sporadic miscarriage is the most common complication of early pregnancy. Two or three consecutive pregnancy losses is a less common phenomenon, and this is considered a distinct disease entity. Sporadic miscarriages are considered to primarily represent failure of abnormal embryos to progress to viability. Recurrent miscarriage is thought to have multiple etiologies, including parental chromosomal anomalies, maternal thrombophilic disorders, immune dysfunction and various endocrine disturbances. However, none of these conditions is specific to recurrent miscarriage or always associated with repeated early pregnancy loss. In recent years, new theories about the mechanisms behind sporadic and recurrent miscarriage have emerged. Epidemiological and genetic studies suggest a multifactorial background where immunological dysregulation in pregnancy may play a role, as well as lifestyle factors and changes in sperm DNA integrity. Recent experimental evidence has led to the concept that the decidualized endometrium acts as biosensor of embryo quality, which if disrupted, may lead to implantation of embryos destined to miscarry. These new insights into the mechanisms behind miscarriage offer the prospect of novel effective interventions that may prevent this distressing condition.
Pregnancy is a significant event in a woman’s life, and emotional attachment to the pregnancy and developing baby may begin
early in the first trimester. For most women, experiencing a first trimester loss is a difficult and vulnerable time. When
it occurs, the grief can be as profound as for any perinatal or other major loss [1]. Spontaneous abortion (a pregnancy that
ends spontaneously before the fetus has reached a viable gestational age) is among the most common complications of pregnancy.
Approximately 12–15% of recognized pregnancies and 17–22% of all pregnancies end in spontaneous abortion [2, 3].
According to the theory of intrinsic value and moral standing called the 'substance view,' what makes it prima facie seriously wrong to kill adult human beings, human infants, and even human fetuses is the possession of the essential property of the basic capacity for rational moral agency - a capacity for rational moral agency in root form and thereby not remotely exercisable. In this critique, I cover three distinct reductio charges directed at the substance view's conclusion that human fetuses have the same intrinsic value and moral standing as adult human beings. After giving consideration to defenders of the substance view's replies to these charges, I then critique each of them, ultimately concluding that none is successful. Of course, in order to understand all of these things - the reductio charges, defenders of the substance view's replies to them, and my criticisms of their replies - one must have a better understanding of the substance view (in particular, its understanding of rational moral agency) as well as its defense. Accordingly, I address the substance view's understanding of rational moral agency as well as present its defense.
Never before have parents in most Western societies had their first children as late as in recent decades. What are the central reasons for postponement? What is known about the link between the delay of childbearing and social policy incentives to counter these trends? This review engages in a systematic analysis of existing evidence to extract the maximum amount of knowledge about the reasons for birth postponement and the effectiveness of social policy incentives.
The review followed the PRISMA procedure, with literature searches conducted in relevant demographic, social science and medical science databases (SocINDEX, Econlit, PopLine, Medline) and located via other sources. The search focused on subjects related to childbearing behaviour, postponement and family policies. National, international and individual-level data sources were also used to present summary statistics.
There is clear empirical evidence of the postponement of the first child. Central reasons are the rise of effective contraception, increases in women's education and labour market participation, value changes, gender equity, partnership changes, housing conditions, economic uncertainty and the absence of supportive family policies. Evidence shows that some social policies can be effective in countering postponement.
The postponement of first births has implications on the ability of women to conceive and parents to produce additional offspring. Massive postponement is attributed to the clash between the optimal biological period for women to have children with obtaining additional education and building a career. A growing body of literature shows that female employment and childrearing can be combined when the reduction in work-family conflict is facilitated by policy intervention.
Some of the human embryos generated by in vitro fertilization (IVF)[WU1] are treasured by the couples whose gametes were fused to create [OK?[WU2]] them; they may fulfil the prospective parents' wish to have a child. and wWe call these ‗wanted embryos'. It would be wrong to destroy such embryos in research. But, not all embryos are wanted. We, and we believe that it is, with the consent of the parents, morally permissible to conduct destructive research onthat destroys embryos that are not wanted—perhaps because the parents' reproductive wish has been fulfilled or abandoned—with the consent of the parents. Moreover, we will also argue that it is morally permissible to produce embryos specifically for research. Our arguments are intended to apply only to embryos – not foetuses or foetal tissue – and we assumeIn this context, we are talking only about embryos, and we assert [OK?] that an embryo becomes a foetus at eight weeks after fertilisation. We will have nothing to say about the use of foetuses or foetal tissue for research. * We would like to thank Katrien Devolder and Holger Breithaupt for their comments on a draft of this article.
A comprehensive study of the ethics of killing in cases in which the metaphysical or moral status of the individual killed is uncertain or controversial. Among those beings whose status is questionable or marginal in this way are human embryos and fetuses, newborn infants, animals, anencephalic infants, human beings with severe congenital and cognitive impairments, and human beings who have become severely demented or irreversibly comatose. In an effort to understand the moral status of these beings, this book develops and defends distinctive accounts of the nature of personal identity, the evaluation of death, and the wrongness of killing. The central metaphysical claim of the book is that we are neither nonmaterial souls nor human organisms but are instead embodied minds. In ethical theory, one of the central claims is that the morality of killing is not unitary; rather, the principles that determine the morality of killing in marginal cases are different from those that govern the killing of persons who are self‐conscious and rational. Another important theme is that killing in marginal cases should be evaluated in terms of the impact it would have on the victim at the time rather than on the value of the victim's life as a whole. What primarily matters is how killing would affect that which would be rational for the victim to care about at the time of death. By appealing to various foundational claims about identity, death, and the morality of killing, this book yields novel conclusions about such issues as abortion, prenatal injury, infanticide, the killing of animals, the significance of brain death, the termination of life support in cases of persistent vegetative state, the use of anencephalic infants as sources of organs for transplantation, euthanasia, assisted suicide, and advance directives in cases of dementia. In particular, the book defends the moral permissibility of abortion, infanticide, and euthanasia in certain cases and argues that brain death is not the appropriate criterion of death either for a person or a human organism.
In his article ‘The substance view: A critique’, Rob Lovering argues that the substance view –according to which a human person comes into existence at the moment of conception – leads to such implausible implications that this view should be abandoned. I responded to his reductio arguments in ‘A critique of Rob Lovering's criticism of the substance view’ and concluded that his arguments did not justify a rejection of the substance view. Now Lowering and William Simkulet have both responded to my criticism, claiming that my criticism of Lovering's article did not refute his original arguments. In this article I respond to their criticism and conclude that, while the substance view has some less plausible implications, none of them justify a complete refutation of this view.
Bleeding during pregnancy is not a rare phenomenon and has been associated with significant maternal and fetal morbidities and even mortality. Although vaginal bleeding occurs mainly during the first trimester, it can appear at any stage of pregnancy and during the post-partum period. This sometimes life-threatening event requires an extensive work-up in order to recognize its cause and establish a rapid and effective therapeutic approach. Bleeding During Pregnancy: A Comprehensive Guide draws on evidence-based data and brings together updated information on all aspects of pregnancy-related bleeding. Chapters were contributed by a multidisciplinary team of international experts, including obstetricians, gynecologists, anesthesiologists, hematologists, oncologists and epidemiologists. Topics covered include: bleeding during early pregnancy (early pregnancy loss, ectopic pregnancy, gestational trophoblastic disease, and cancer of the reproductive tract during pregnancy; bleeding in late pregnancy (preterm delivery, placental abruption, placenta previa, vasa previa and uterine rupture); and post partum-hemorrhage. Intensive care of a patient with excessive bleeding and coagulotherapy during pregnancy or the post-partum period are also discussed. This book is an essential guide for a broad spectrum of clinicians and health care professionals who treat pregnant patients.
Many people believe human fetuses have the same moral status as adult human persons, that it is wrong to allow harm to befall things with this moral status, and thus voluntary, induced abortion is seriously morally wrong. Recently, many prochoice theorists have argued that this antiabortion stance is inconsistent; approximately 60% of human fetuses die from spontaneous abortion, far more than die from induced abortion, so if antiabortion theorists really believe that human fetuses have significant moral status, they have strong moral obligations to oppose spontaneous abortion. Yet, few antiabortion theorists devote any effort to doing so. Many prochoice theorists argue that to resolve this inconsistency, antiabortion theorists should abandon their opposition to induced abortion. Here, I argue that those who do not abandon their opposition to induced abortion but continue to neglect spontaneous abortion act immorally. Aristotle argues that moral responsibility requires both control and awareness; I argue that once an antiabortion theorist becomes aware of the frequency of spontaneous abortion, they have a strong moral obligation to redirect their efforts towards combating spontaneous abortion; failure to do so is morally monstrous.
The distinction between the consequences of an act and the act itself is supposed to define the fight between consequentialism and deontological moralities. This book, though sympathetic to consequentialism, aims less at taking sides in that debate than at clarifying the terms in which it is conducted. It aims to help the reader to think more clearly about some aspects of human conduct—especially the workings of the ‘by’‐locution, and some distinctions between making and allowing, between act and upshot, and between foreseeing and intending (the doctrine of double effect). It argues that moral philosophy would go better if the concept of ‘the act itself’ were dropped from its repertoire.
Doing harm seems much harder to justify than merely allowing harm. If a boulder is rushing towards Bob, you may refuse to save Bob's life by driving your car into the path of the boulder if doing so would cost you your own life. You may not push the boulder towards Bob to save your own life. This principle—the Doctrine of Doing and Allowing—requires defence. Does the distinction between doing and allowing fall apart under scrutiny? When lives are at stake, how can it matter whether harm is done or allowed? Drawing on detailed analysis of the distinction between doing and allowing, Fiona Woollard argues that the Doctrine of Doing and Allowing is best understood as a principle that protects us from harmful imposition. Such protection against imposition is necessary for morality to recognize anything as genuinely belonging to a person, even that person's own body. As morality must recognize each person's body as belonging to her, the Doctrine of Doing and Allowing should be accepted. Woollard defends a moderate account of our obligations to aid, tackling arguments by Peter Singer and Peter Unger that we must give most of our money away and arguments from Robert Nozick that obligations to aid are incompatible with self-ownership
Moral Dilemmas is the second volume of collected essays by the eminent moral philosopher Philippa Foot. It fills the gap between her 1978 collection Virtues and Vices and her acclaimed monograph Natural Goodness, published in 2001. Moral Dilemmas contains the best of Prof. Foot's work from the late 1970s to the 1990s. In these essays, she develops further her influential critique of the ’non‐cognitivist’ approaches that have dominated moral philosophy over the last fifty years. She shows why it is a mistake to think of evaluations in general (or moral judgements in particular) as distinguished from ‘statements of fact’ by a special connection with the feelings, attitudes, or commitments of an individual speaker. Instead, she portrays thoughts about the goodness or badness of human action as like (though also unlike) the evaluation of other operations of human beings, and those of all living things. She also discusses moral relativism, utilitarianism, and moral dilemmas, as well as some subjects of special relevance to medical ethics. This work contains a select bibliography of the publications of Philippa Foot. With Prof. Foot's other two books, these essays present her distinctive and lasting contributions to twentieth‐century moral philosophy.
Defending Life is the most comprehensive defense of the prolife position on abortion ever published. It is sophisticated, but still accessible to the ordinary citizen. Without high-pitched rhetoric or appeals to religion, the author offers a careful and respectful case for why the prolife view of human life is correct. He responds to the strongest prochoice arguments found in law, science, philosophy, politics, and the media. He explains and critiques Roe v. Wade, and he explains why virtually all the popular prochoice arguments fail. There is simply nothing like this book.
Reproductive failure occurs in all forms of life, plant and animal. I have been asked to make a few introductory or general remarks about the problem in man. Whatever I have to say is based upon 35 years’ experience in obstetric and gynecologic pathology, seasoned by interest in the early embryology of the human and interspersed with a nine-year interval as clinical obstetrician. These remarks are in no sense an exhaustive review of reproductive anatomy, physiology and pathology, even as applied to the human, let alone to mammals in general. Comments will be confined to my observations on the early or potentially abortive phases of human development and a pathologic evaluation of a thousand consecutive human abortions, most of them spontaneous.
Pregnancy loss occurs in about 15% of recognized pregnancies. In the vast majority of cases, the loss is the consequence of an abnormal fetal karyotype. Hence chromosome analysis of spontaneous abortus material should be part of the standard clinical evaluation of miscarriage. In a small subset of couples experiencing pregnancy loss, especially those with younger women and a history recurrent loss, other factors may be involved and these are presented along with their significance.
Appealing to reason rather than religious belief, this book is the most comprehensive case against the choice of abortion yet published. The Ethics of Abortion critically evaluates all the major grounds for denying fetal personhood, including the views of those who defend not only abortion but also infanticide. It also provides several (non-theological) justifications for the conclusion that all human beings, including those in utero, should be respected as persons. This book also critiques the view that abortion is not wrong even if the human fetus is a person. The Ethics of Abortion examines hard cases for those who are prolife, such as abortion in cases of rape or in order to save the mother’s life, as well as hard cases for defenders of abortion, such as sex selection abortion and the rationale for being “personally opposed” but publically supportive of abortion. It concludes with a discussion of whether artificial wombs might end the abortion debate. Answering the arguments of defenders of abortion, this book provides reasoned justification for the view that all intentional abortions are morally wrong and that doctors and nurses who object to abortion should not be forced to act against their consciences.
Introduction Miscarriage is the most common complication of pregnancy, with as many as 15-20% of clinically recognised pregnancies ending in spontaneous failure. The main causes of miscarriage are sporadic lethal chromosomal abnormalities and these pregnancies are destined to fail from the outset. In fact, if all conceptions were included in the definition of miscarriage, around 40% would end in failure, with the majority occurring before the pregnancy could be clinically recognised. However, in some couples, miscarriage can be recurrent, which is defined as three consecutive pregnancy losses before fetal viability at 24 weeks of gestation. The prevalence of this condition is approximately 1%. As the most common cause of miscarriage is aneuploidy, which is directly related to maternal age, the risk and prevalence of early pregnancy loss rises with increasing maternal age. The overall prevalence of recurrent miscarriage in the population is higher than would be expected by chance alone. Statistically, the prevalence should be only 0.34%, indicating that in some couples there may be an underlying cause that puts them at higher risk. However, the calculation of the risk of three consecutive losses is based on the assumption that the baseline risk of miscarriage is 15%. This calculation does not take into account the fact that the risk of miscarriage increases with advancing maternal age. For example, the risk of miscarriage in a 40-year-old woman is at least 45% and therefore the expected prevalence of recurrent miscarriage in this age group is approximately 9%.
Sporadic miscarriage is the most common complication of early pregnancy. Two or three consecutive pregnancy losses is a less common phenomenon, and this is considered a distinct disease entity. Sporadic miscarriages are considered to primarily represent failure of abnormal embryos to progress to viability. Recurrent miscarriage is thought to have multiple etiologies, including parental chromosomal anomalies, maternal thrombophilic disorders, immune dysfunction and various endocrine disturbances. However, none of these conditions is specific to recurrent miscarriage or always associated with repeated early pregnancy loss. In recent years, new theories about the mechanisms behind sporadic and recurrent miscarriage have emerged. Epidemiological and genetic studies suggest a multifactorial background where immunological dysregulation in pregnancy may play a role, as well as lifestyle factors and changes in sperm DNA integrity. Recent experimental evidence has led to the concept that the decidualized endometrium acts as biosensor of embryo quality, which if disrupted, may lead to implantation of embryos destined to miscarry. These new insights into the mechanisms behind miscarriage offer the prospect of novel effective interventions that may prevent this distressing condition
To identify modifiable risk factors for miscarriage and to estimate the preventable proportion of miscarriages that could be attributed to these.
Nationwide observational follow-up study.
Denmark.
Ninety-one thousand four hundred and twenty seven pregnancies included in the Danish National Birth Cohort between 1996 and 2002.
Information on potentially modifiable risk factors before and during pregnancy was collected by means of computer-assisted telephone interviews and linkage with Danish registers, ensuring almost complete follow-up of pregnancy outcome. Modifiable risk factors for miscarriage were identified by multiple Cox regression analysis, which provided the background for our estimations of population attributable fractions. In all, 88 373 pregnancies had full information on all covariates and were included in this analysis.
Miscarriage before 22 completed weeks of gestation.
The potentially modifiable pre-pregnant risk factors associated with increased miscarriage risk were: age of 30 years or more at conception, underweight, and obesity. During pregnancy the modifiable risk factors were: alcohol consumption, lifting of >20 kg daily, and night work. We estimated that 25.2% of the miscarriages might be prevented by reduction of all these risk factors to low risk levels. Modification of risk factors acting before and during pregnancy could lead to prevention of 14.7 and 12.5%, respectively, of the miscarriages. Maternal age at conception and alcohol consumption were the most important risk factors.
Miscarriage risk is increased by multiple potentially modifiable risk factors and a considerable proportion of miscarriages may be preventable.
The frequency with which congenital malformations occur varies considerably from country to country and, within countries, from area to area and social class to social class. For example, neural-tube malformations are five times commoner in England and Wales than in Japanl and nearly three times commoner in the coalmining valleys of South Wales than along its coastal plain2: in Scotland they are three times commoner in infants born into social class v than in infants born into social classes I and II.1 From these and similar observations it has been inferred that environmental teratogens must be at work, but in making such an inference few research workers stop to consider what relation, if any, the prevalence of malformations at birth bears to their incidence at the time they are laid down-early in the first trimester of pregnancy.
Extending work of Cook et al. (1999, 1996), this paper examines abortion funding cutoffs for poor women in North Carolina, a unique setting allowing for a strong quasi-experimental design. Using vital registration data and additional administrative data from North Carolina, we decompose program effects on the abortion/birth ratio into two components: coverage (i.e., the proportion of all abortions that are state funded) and substitutability (the proportion of state funded abortions that would have been births in the absence of the state program). We show that both components are crucial for understanding the effects of fund cutoffs and that both components vary by age and by race. We offer explanations for these differences. Overall, we conclude that: the North Carolina State Abortion Fund (SAF) had powerful and pervasive effects: i.e., the SAF cutoffs reduced abortions and increased births.
Abortion legislation in Singapore has gone through dramatic changes in the past 25 years. In this paper, we studied the effect of abortion legislation on abortion trends in Singapore.
The Ministry of Health, Singapore, collects data on all abortions performed in Singapore. These data have been analyzed and are presented in this paper.
The liberalization of abortion legislation resulted in a dramatic increase in the number of abortions performed beginning in 1974. The rate peaked at 23,512 abortions in 1985, and in fact, 35% of all pregnancies were terminated in 1985. The introduction of mandatory abortion counseling in 1986 resulted in a decline in the number of abortions to 16,476 in 1993 with only 24.6% of pregnancies being terminated. The teenage abortion rate was 0.2 per 1000 female teenagers under 20 years of age in 1970. With the liberalization of abortions, the rate reached a peak of 13.7 per 1000 female teenagers in 1985. In 1993, the teenage abortion rate was 9.5%. The proportion of nulliparous women seeking abortion has increased phenomenally from 0.5% in 1976 to 40.6% in 1993. Close to 95% of the women seeking abortions in 1993 did so for social reasons, 3.7% for medical reasons, and 2.0% for failed contraception (Table 3).
Mandatory abortion counseling and a change in the government policy which now encourages Singaporeans to have more children if they can afford it, have resulted in a decrease in the number of abortions being performed. The problems of teenage abortions, nulliparous abortions, and repeated abortions need to be further addressed.
Production of the pregnancy-specific protein early pregnancy factor (EPF) was monitored by the rosette inhibition test in a group of 13 nulliparous women. EPF could be detected in serum within 48 hours of fertilization; of 28 cycles in which intercourse took place at the time of ovulation, EPF was detected in 18. However, EPF production continued for more than 14 days in only four cases. Successful pregnancy was maintained in two of these while in the other two, disappearance of EPF preceded miscarriage. In the remaining 14 cases, EPF disappeared from the serum before the onset of menstruation. A high incidence of early embryonic loss is suggested.
This paper re-examines some well-known and commonly accepted arguments for the non-individuality of the embryo, due mainly to the work of John Harris. The first concerns the alleged non-differentiation of the embryoblast from the trophoblast. The second concerns monozygotic twinning and the relevance of the primitive streak. The third concerns the totipotency of the cells of the early embryo. I argue that on a proper analysis of both the empirical facts of embryological development, and the metaphysical importance or otherwise of those facts, all three arguments are found wanting. None of them establishes that the embryo is not an individual human being from the moment of conception.
Theory suggests that abortion restrictions will influence fertility outcomes such as pregnancy, abortion, and birth. This paper exploits the variations in abortion policy generated in Eastern Europe in the late 1980s and early 1990s to examine their impact on fertility outcomes. We distinguish among countries with severe, moderate, and few restrictions on abortion access and examine the impact of changes across all three categories. As we hypothesize, the results indicate that countries that changed from very restrictive to liberal abortion laws experienced a large reduction in births. Changes from modest restrictions to abortion available on request, however, led to no such change in births despite large increases in abortions, which indicates that pregnancies rose in response to more liberal abortion availability. This evidence is generally consistent with the situation that was brought about by changes in abortion access in the United States.
. Through the use of ancient healing techniques, such as ora-cles, astrology, shamanism and collective ritual, contemporary therapists and counselors can enhance their work with women clients, whose natural condition may predispose them to "letting nature take its course." Tapping into unseen, energetic and magical realms can be the source of deep heal-ing and illumination in the therapeutic process. Using nonrational knowl-edge techniques takes the pressure off the individual therapist to figure everything out and relieves the client of helplessness and despair. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: <getinfo@haworthpressinc.com> Website: <http://www.HaworthPress.com> © 2001 by The Haworth Press, Inc. All rights reserved.] The focus of my healing work, whether individual or group work, has always involved an attempt to find and then follow the natural process that is trying to occur. Although that's easy to say, in our maddeningly modern civilization, with all of its high-tech approaches to intervention and "crisis resolution," it is much harder to do. I have only now and then Vicki Noble is a healer and teacher and is affiliated with Motherpeace in Freedom, CA.
It is often claimed that from the moment of conception embryos have the same moral status as adult humans. This claim plays a central role in many arguments against abortion, in vitro fertilization, and stem cell research. In what follows, I show that this claim leads directly to an unexpected and unwelcome conclusion: that natural embryo loss is one of the greatest problems of our time and that we must do almost everything in our power to prevent it. I examine the responses available to those who hold that embryos have full moral status and conclude that they cannot avoid the force of this argument without giving up this key claim.
The New York State Early Pregnancy Detection Study was a prospective study of early pregnancy loss, between implantation and
menses, in 217 women attempting to become pregnant during 1989–1992. Women collected urine samples on three consecutive mornings
during the late luteal phase of their menstrual cycle, for up to 12 cycles, contributing samples for 1253 menstrual cycles.
Urinary human chorionic gonadotrophin (HCG), measured using an immunoradiometric assay, was the biomarker for pregnancy. We
observed a range of early pregnancy loss (EPL) rates, from a low estimate of 11.0% to a high estimate of 26.9%, depending
on the definition used and the subgroup analysed. Based on a definition of 3 days of HCG concentration > 4.00 pmol/1, 2 days
3=533 pmol/1 or the last, day of HCG 2 = 6.67 pmol/1, we identified 115 positive cycles; 95 cycles were clinically confirmed
pregnancies and 20 cycles were EPL, giving an EPL rate of 17.4% [95% confidence interval (CI) 11.0-25.6]. In addition, we
observed an EPL rate of 19.5% (95% CI 113-30.1) for samples collected within a 15 day window around menses, and a rate of
203% (95% CI 113-32.2) for samples limited to the first three menstrual cycles. Because studies use urine collection schemes
other than daily sampling, the definition of pregnancy will be crucial in defining EPL.