Fetal Anomaly and Abortion

I became a mother at 35. I’d been somewhat ambivalent about having children, and Derek and I were married for six years before we had our first child, Diego. During those six years, I went to grad school, began teaching, and started writing a novel. Derek worked in commercial real estate with his dad by day and played guitar and wrote songs by night. He even asked me to learn how to drum, so that we could form a band. I did, and we did. Our lives were full and we were content, but we decided to try to have a baby. Born March 14, 2006, Diego became the love of our lives.

When Diego was nine months old, I got pregnant again, with intention. The conversation with Derek went something like, “Hey, if I conceive tonight, we could have a Virgo!” And it worked. Then when I was about 17 weeks pregnant, a blood test raised red flags. It was right before we were supposed to fly to Portland, Oregon, to see our friends Jake and Jackie. My doctor recommended an amniocentesis. I thought we would do it the following week when we returned from Portland, but my doctor conveyed to me that time was of the essence. In fact, he said it would be best if we could schedule it that afternoon.

The amniocentesis involves a long needle inserted into the uterus to remove amniotic fluid used to check for fetal abnormalities like Down syndrome, cystic fibrosis, or spina bifida; the accuracy of the test is high—about 98-99 percent. The procedure carries a small risk of miscarriage—less than 1 in 100—but the risk is still there. In my case, the doctor seemed concerned about Down syndrome, and if we did decide to abort the pregnancy, it would be a second trimester abortion at 17 weeks, which was why the doctor was adamant about timing. I talked to a friend who was, like me, an older mom. She’d given birth to her second child in her late 30s, and she told me that she’d foregone that same blood screening test, that she didn’t want to know anything, as she knew that she would go through with her pregnancy no matter what. I realized I did not share her resolve, and Derek didn’t either. We decided that it would be good to have information, even if we weren’t sure yet what we would do about it. I agreed to the amnio that afternoon.

Most abortions—about 90 percent—happen during the first trimester. A second trimester abortion is a lot more involved as there is much more fetal development. There are two options for women seeking to terminate a pregnancy in the second trimester, according to the British Pregnancy Advisory Service (BPAS): medical induction of labor, which usually means “using the drugs mifepristone and misoprostol to induce uterine contractions and cause the passage of the fetus and placenta intact” and can take up to 48 hours. The other option, surgical abortion, “involves instrumental removal of the fetus and placenta in small pieces through an artificially dilated cervix, under appropriate anesthesia, typically taking 10-15 minutes.” Both are safe, though the surgery is statistically a little safter. Women tend to choose a method “based on their individual emotional coping styles.”  

In the UK, 90 percent of pregnancies in the UK diagnosed with prenatal diagnoses of trisomy 21 (Down syndrome) are terminated. According to a 2018 Healthline article, in Iceland, all women are offered screenings, and about 80-85 percent of women choose to screen; of those, nearly 100 percent who receive a positive test for Down syndrome choose to terminate the pregnancy. In Denmark, about 95 percent do; in France 77 percent; and in the United States, 67 percent. (About 6,000 children with Down syndrome are born in the United States each year.)

The ethics of that decision—to terminate a pregnancy in the second trimester because of a diagnosis of Down syndrome or another fetal anomaly—are strongly debated. An article from The Atlantic in December 2020, “The Last Children of Down Syndrome,” ran with this subtitle: “Prenatal testing is changing who gets born and who doesn’t. This is just the beginning.” The article focused on Denmark, which has offered universal screening for Down syndrome since 2004. The author, Sarah Zhang, interviews Laura Hercher, a genetic counselor and director of student research at Sarah Lawrence College, who notes the health complications correlated with Down syndrome—early-onset Alzheimer’s, leukemia, and heart defects—but Hercher also asks: “If our world didn’t have people with special needs and these vulnerabilities, would we be missing a part of our humanity?”

As a genetic condition, Zhang tells us that Down syndrome “remains the most morally troubling because it is among the least severe. It is very much compatible with life—even a long, happy life.” Danes are apparently “quite open about abortion—astonishingly so to my American ears,” Zhang writes. But most are reticent about abortions for fetal anomaly because they “still carry a stigma.” That stigma has been reinforced by the media: Articles and news stories in the United States accused Iceland and Denmark of eugenics. In the Washington Post, George Will began an editorial with the line: “Iceland must be pleased that it is so close to success in its program of genocide…”

Eventually, the Icelandic Ministry of Welfare issued a press release in hopes of correcting the misconception that the Icelandic authorities are “preventing mothers from giving birth to children with Down's syndrome.” They wrote: “Clinical guidelines for healthcare personnel on pre-natal care emphasize the importance of enabling every woman to take an informed decision on the service which she receives during pregnancy, and it is the responsibility of healthcare personnel to explain clearly and objectively what options a woman has. The woman's decision is always to be respected.” It’s the last line that stood out to me.

The results of my amniocentesis were negative—no fetal abnormalities. We were in Portland when we got the results. So, there was no decision to make. Twenty-two weeks later, Charlie was born in late August, a Virgo as predicted, and surprise—a boy.

Years later when Diego and Charlie were on a basketball team together during elementary school, I chatted with another mom during one of their games. She told me she had three children, including a son with Down syndrome. “He’s my sweetest child,” she told me. As we were speaking, I wondered to myself how I would feel about her words and our conversation had the results for fetal anomaly been different and we’d decided to have the abortion. Then a couple of years ago, my student wrote an essay about his brother who has Down syndrome had taught him the true meaning of love. I asked him, “Who takes care of your brother?” He told me his mother did. I immediately thought: And she will continue to do so, for the rest of her life.

Five states have Down syndrome abortion bans—Arizona, South Dakota, North Carolina, Texas, and Ohio. In South Dakota, where abortion is already banned after 20 weeks, Governor Kristi Noem signed a bill into law that makes abortion of a fetus with Down syndrome a “felony for any person who performs or attempts to perform an abortion with knowledge that the pregnant woman is seeking the abortion because the unborn child either has been diagnosed with Down syndrome or has had a genetic screening indicating that the unborn child may have Down syndrome.” Republican lawmaker David Anderson said the bill “did not go far enough” and that “mothers should be criminalized for aborting a fetus with Down syndrome.”

These laws could soon be irrelevant, since today, on December 1, the Supreme Court heard arguments from Dobbs vs. Jackson Women’s Health Organization, a lawsuit challenging the Mississippi law that bans abortion after 15 weeks. If the Court upholds the Mississippi law, many Republican states will pass similar laws; or, as many of these states hope, if Roe v. Wade is overturned, they can ban abortion entirely.