My Foetus

Short abstract

Channel 4, 20 April at 11 05 pm

Rating: ★

Termination of pregnancy is a difficult issue with rights and wrongs, whatever your personal perspective. It is difficult for patients, it is difficult for health-care professionals, and it is difficult for society. I work as an obstetrician in a city where one in three pregnancies is terminated. It is hard to rationalise an approach that promotes safe motherhood within an environment of high “wastage.” Termination of pregnancy is a bitter fact of life for many people in the United Kingdom and it affects us all in one way or another. I am confused about termination and I am not alone. There is tremendous scope for mainstream medical journalism to contribute to an informed debate, to educate, or even to provoke and challenge the values of sexually active people in this country. And so I watched this Channel 4 documentary with interest.

Figure 1.

Filmmaker Julia Black

Credit: CHANNEL 4

Julia Black, a filmmaker, is in the third trimester of pregnancy and having experienced a previous termination decides to address the “abortion debate.” She believes that a pervasive silence surrounds the physical reality of termination so that it has become easy to be pro-choice without challenging what that really means. The focus of her documentary was on the imagery of termination with graphic overblown images of aborted fetuses, heart warming shots of ultrasound scans at varying gestational ages, and filming of a day case termination procedure at four weeks gestation. These images were interspersed with frequent lingering close ups of the healthy growing abdomen of the narrator herself. What was perhaps shocking was that it wasn't very shocking at all. An approach that focused on fetal imagery was inevitably superficial and failed to address the issues that surround choice and decision making or the inevitable consequences of what may have seemed right at the time.

We heard the views of gynaecologists and of pro-life activists; we heard about women, but not from the women themselves. Apart from the filmmaker, who was hardly objective in the late stages of a wanted pregnancy, where were all the hidden women who have made this choice? What of their partners—must we perpetuate the concept of unwanted pregnancy being the exclusive responsibility of the woman? Many terminations of pregnancy in this country occur within stable relationships and are the result of shared decision-making. What of the mothers and fathers who counsel their daughters on unwanted pregnancy with the full knowledge of the challenges and joys of parenting? They were conspicuous by their absence. The complexities of termination cannot be addressed without exploring the perspectives of those most closely involved in the decision making. The silence of the protagonists made their plight all the more worrying.

The perception of termination of pregnancy as an “easy option” with the collusion of the medical profession and society in general was hinted at but simply not tested or explored. This was a missed opportunity. The only telling comment for me was that of the gynaecologist performing the suction termination of pregnancy under local anaesthetic. At the end of the procedure she said to the woman on the table, “How was that for you?” We didn't hear the answer. She moved into the next room and sifted through the products of conception for the film crew explaining that she wouldn't even look for limb buds until nine weeks. For some people termination of pregnancy is routine and even mundane or so it seemed. In fairness, we all protect ourselves by blunting difficult situations with routine behaviour and a degree of denial; however, it was an important warning shot.

Figure 2.

The focus on fetal imagery was superficial

Credit: CHANNEL 4

Do graphic images help in understanding why termination happens or what we can do to prevent it or its consequences? Can we address this issue in the same way for a couple with a malformed fetus or lethal condition, for a mother who may die in pregnancy because of underlying medical disease, a woman struggling with psychiatric disease, the pregnant drug user, the victim of domestic violence, rape, or the many situations that lead a woman to a desperate decision? It is a tragedy that our technical sophistication in imagery has not been matched by preventive measures or by alternative choices for women and couples who are not ready for a pregnancy or the challenges it holds. We saw a gynaecologist replacing embryos as part of an assisted conception procedure who then described his willingness to perform late surgical terminations of pregnancy. What is wrong with our society that we cannot support women in making the decision to place a baby for adoption? Why does it not even deserve a mention?

Termination of pregnancy is a difficult and complex issue. Sadly I fear that we are no further on following this one dimensional approach to a multi-dimensional issue.