Having One-Minus-One Choices

15 Aug

A guest post from Gretchen Sisson.

Last week’s New York Times Magazine featured an article “The Two-Minus-One Pregnancy” about the reduction of multiples pregnancies – that is, the selective abortion of one or more fetuses to reduce twins to singletons. Given the risks associated with higher order multiples births (triplets or more), it’s a fairly accepted procedure to reduce to twins. However, the focus of this article was reducing to one, even when the chance of having healthy twins is high.

As a medical procedure, selective reduction is different than abortion; it does not involve the evacuation of the uterus. However, the discussion around reduction has interesting overlaps with the discussion around abortion given that a) they both involve the death of a fetus and b) they both place a burden on the woman seeking the procedure to justify why she is doing it.

The article describes two doctors whose positions on reduction have shifted. The first, Dr. Evans first opposed twin reductions:

Two years later, as demand for twin reductions climbed, Evans published another journal article, arguing that reduction to singletons “crosses the line between doing a procedure for a medical indication versus one for a social indication.” He urged his colleagues to resist becoming “technicians to our patients’ desires.”

While the article goes on to say that Dr. Evans now endorses the practice of twin reductions, other providers remain adamantly opposed. One sonographer says:

“I told him [the doctor] I just wasn’t comfortable doing a termination of a healthy baby for social reasons, and that if we were going to do a lot of these elective reductions, I thought he should bring in someone else who was more comfortable. From the beginning, I had wrestled with the whole idea of doing reductions, because I was raised in the church. And after a lot of soul searching, I had decided there were truly good medical reasons to reducing higher-order multiples to twins. But I had a hard time reconciling doing reductions two to one. So I said to Dr. Wapner, ‘Is this really the business we want to be in?’ ”

I struggle with these doctors’ perspectives on reduction for several reasons. The first is that, while the article claims that at Dr. Wapner’s medical office “every one of them — the sonographer, the genetic counselors, the schedulers — supported abortion rights” their stance places the burden on the women to have “good” reasons, here defined as medical reasons, for wanting a reduction. “Social” reasons (finances, only wanting to have one child at this time, etc.) are, in their opinion, not good enough.

And, I’m sorry, but that’s not good enough for me. That’s not trusting women to make their own choices about the number and timing of their children. Many of the women in the article who choose to reduce twins are desperate to have only one baby: they consider aborting the entire pregnancy because they can’t obtain or can’t afford a safe reduction, and, as desired as these pregnancies are, they would rather have no children than two. Another woman carrying triplets says she “felt like the pregnancy was a monster” and eventually paid $6,500 for a reduction. She describes leaving the doctor’s office:

“I went out on that street with my mother and jumped up and down saying: ‘I’m pregnant! I’m pregnant!’ And then I went and bought baby clothes for the first time.”

Forcing a woman to carry twins when she is not emotionally, financially, or physically prepared to raise two children is no better than forcing a woman to carry a singleton pregnancy when she wants no children. It is a simple matter of choice.

The second reason I struggle with providers’ reluctance to do twin reductions is that they are often part of the reason women are pregnant with twins in the first place.

For part of my doctoral dissertation, I interviewed couples that were struggling with infertility. They visited doctors who could not explain why they were not getting pregnant, and could then not explain why their treatments were failing. Medicine offers few concrete answers to infertility, and in vitro fertilization will sometimes not work at all, or can work too well and end with a multiple pregnancy. (I spoke with one couple who had no healthy fertilizations one month, and 29 fertilizations the next – but no successful transfers from test tube to uterus. The doctor could not explain to them why this happened. Stories like this are common.) So much of fertility treatment remains, in the words of the women I interviewed, an “art rather than a science,” “a matter of luck”, or “just like rolling a dice.”

Furthermore, because of the high cost of fertility treatments, some couples will make decisions that seem counterintuitive: desperate for one baby, they’ll transfer two or three embryos in the hopes that at least one will implant, simply because they can’t afford another IVF cycle. Then they end up with triplets and find they aren’t prepared for multiples, and can’t find a doctor that will help them reduce to the one child for whom they are desperate.

Pregnancy reduction is only one of the more obvious areas where infertility treatment intersects with traditional, abortion-focused considerations of reproductive rights. The pursuit of pregnancy when faced with biological challenges (and the consequent financial and logistical barriers) should be as much as part of a broader “choice” framework as the avoidance of pregnancy. I’d like to challenge pro-choicers to include considerations infertility and access to safe, affordable, and respectful assisted reproductive technologies in their paradigm for reproductive justice.

Gretchen Sisson recently completed her doctorate in sociology, writing her dissertation on the “right” to parenthood: who has it, why some don’t, and how society enforces its ideal of an acceptable pursuit of parenthood. To examine these questions, she spoke with couples pursuing infertility treatments, teen parents and teen pregnancy prevention advocates, and birthparents who have placed infants for adoption.


3 Responses to “Having One-Minus-One Choices”

  1. Divine Oubliette August 20, 2011 at 6:26 pm #

    This is a very interesting article! My husband and I have had the discussion, ‘What if it was twins?’

    I am of the opinion that I couldn’t handle it – I would want a singleton pregnancy only! I don’t think I could handle more than one at once; not financially, emotionally, psychologically, the cost and RISKS to my body, the risks to the pregnancy (complications – cord entanglement, amniotic bands, growth restrictions, prematurity ect).

    To be fair I should disclose that my husband’s mother had triplets when he was 15, he helped raise those children and knows the investment it takes. He saw what it did to this mother and the absolute strain it put on her health and that of their family. And they were in the best position all around to care for them and to welcome them into their family.

    Since my husband cannot handle the idea of selective reduction, even if the option was available, I don’t think we would utilize it, we would simply terminate the whole pregnancy.

    This isn’t most people’s ideal parenthood but it’s a negotiation between what my husband and I believe that we are capable of and us trying to achieve OUR ideal parenthood and family.

    Pro-Choice Midwife


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