Unplanned and therefore unwanted?

This week in our staff meeting, we had a brief talk from a local charity which provides counselling for women in crisis pregnancies. Our patient population has a very high number of women who have had abortions, and many of these have had more than one abortion (this, despite the fact that of the 7 doctors I work with, only 2 will refer for terminations). This charity is, I would say, pro-choice but their approach to choice is that it should be a considered choice, and they do play an important role locally in identifying women who are being coerced into abortion (at the point where the woman has already checked into hospital for the termination) and supporting them in keeping the baby should they decide to do so. They also provide counselling to those suffering the consequences of abortion: women, men and family members. One of the reasons I do not mention their name here is that I do not wish to endorse them - yes, some of the work they do leads women to choose not to have an abortion, and too often the long-term consequences of abortion are ignored or denied - but the fact is that they support a 'woman's right to choose' rather than recognising the evil of abortion for what it really is.

However, something very interesting (or possibly horrifying) which was mentioned during the presentation, were some statistics around abortion, namely:

- 34% of women under 30 have had an abortion

- 10% have had more than one

- one third of pregnancies end in abortion

and then the one which struck me as most interesting

- 50% of pregnancies are unplanned.

It wasn't so much that the proportion is fairly high (given our contraceptive mentality in this country) but that the person giving the presentation felt that this was a surprise, as she said, 'given everything we know'. Well, the fact is, that we surely must know by now that babies never come when they are planned. I don't know anyone who can say, yes, our baby arrived exactly when we wanted it to. I know couples who have waited years (regardless of whether they had previously used hormonal contraceptives or NFP and really wanted children), I know couples who decided not to and then went through IVF and still didn't end up with children, I know a couple who got pregnant having slept together only once, the fact is that what we actually should know is that the contraceptive mentality is not working. If it was, then there wouldn't be so many abortions and so many unplanned pregnancies. And the fact that whilst 50% of pregnancies are unplanned, only (God help us, it's still horrific) 34% are terminated means that an unplanned baby is not necessarily and unwanted baby, therefore why this conviction that planning is everything, that we must be in control of absolutely everything? 

I generally think that abortion debate comes down to the fact that people don't recognise that the unborn child is a person. But from these figures, and the accompanying attitude, it is presumably about our desperate desire to be in charge of the universe.

Whose conscience is it anyway?

I was browsing my September issue of Regula+e, published by the General Pharmaceutical Council, which is the regulatory body for pharmacies, pharmacists and pharmacy technicians, when I came across this article about a pharmacist who had had conditions placed on his practice, by the Fitness to Practise (FtP) committee, for 'imposing his beliefs on patients' (pp24-25).

The pharmacist, during the course of supplying the morning after pill (EHC), told a patient that it was "a chemical abortion, was ending a life, and that this would be on her conscience". The patient was shocked and felt "rotten and horrible". He did not give her the option to go to another pharmacy.

Recently I blogged, among other things, about the weirdness of the fact that while pharmacists do not have to supply EHC, they do have to tell the patient where they can obtain it. This pharmacist didn't tell his patient where they could get EHC, because he did not decline the supply. Yes, apparently he was in the habit of giving what the FtP committee deem 'an embarrassing and distressing lecture' and then giving the patient the morning after pill anyway.

 

There seems to be a whole lot of weird stuff going on here. The FtP committee, for their part, merely have to judge whether a pharmacist has breached the code of ethics and, if so, whether conditions should be imposed or the individual removed from the register, so I'm going to ignore them. It's the behaviour of the pharmacist in question which puzzles me. If it was for moral or religious reasons that the pharmacist gave these speeches to his patients, why did he then supply EHC? What was he hoping to achieve? Was he trying to absolutely prevent evil (ie the patient does not terminate her pregnancy) or just avoid co-operating (the patient gets upset and goes to another pharmacy instead). But if the latter, why did he then supply? It is a mystery to me (although I recogise that I don't have all of the information about the case). And then there is the patient, who reported the pharmacist because he made her feel "rotten and horrible". I'm not saying the pharmacist shouldn't have been investigated, as his actions come across as a bit odd, to say the least: was this his usual manner of advising patients? But as taking the morning after pill causes side effects of headache, nausea, abdominal pain, bleeding and fatigue (very commonly), and dizziness, diarrhoea and vomiting (commonly), the 'rotten and horrible' feeling was somewhat inevitable, if only on a physical level.

 

Whether you, healthcare professional, go with a straight refusal to supply or a slightly more in depth explanation as to why not, or an attempt to engage the patient in discussion as to the rights or wrongs of EHC (or whatever other substance), do so with charity and professionalism! Haranguing the inidividual is unlikely to achieve anything, and following the harangue with supply even less.

 

Interestingly, one of the conditions imposed is that the pharmacist is not to supply EHC in the future. Sounds like good news all round.

 

PS My viewing stats passed the 10,000 mark this week. The list of referring sites may suggest to me that a lot of these views are not real people, but to those actual people who are reading: thank you :-)

Wombs to let: £28,000

I suppose a baby factory is the obvious successor to the egg bank, but it wasn't something I was expecting to come across in last week's Metro.

 

The most ridiculous aspect (and now I've said that I am torn as to which bit is actually the most ridiculous) of this article is Dr Patel's claim that she is carrying out a feminist mission. As the Anscombe Bioethics Centre wrote in their review of the Human Fertilisation and Embryology Act:

 

Surrogate motherhood involves a further fragmentation and trivialisation of parenthood, in that a woman deliberately becomes a gestational mother with no intention of committing herself to caring for the child she gestates. This practice is exploitative of both the woman and the child, and damages the way conception and gestation are regarded in society as a whole. If surrogacy cannot be prohibited altogether (the option we would prefer), commercial surrogacy, at very least, should continue to be prohibited. We do not believe that agencies should be registered with the Department of Health, as the Brazier Committee recommends, as this would constitute official endorsement of such agencies. (An analogy might be with the case of prostitution: those opposed to prostitution are rightly unwilling to accept the official registering of brothels, as this effectively legitimises their existence.)

 

Dr Patel is clearly exploiting women; of the £28,000 a couple pay for a surrogate mother, the surrogate receives less than £5,000. For 9 months manual labour (a 'physical job') the mother earns approximately 73p an hour (based on a 40 week pregnancy). And paying a woman for the use of her body is definitely analagous to prostitution. But hey, at least facilities are sterile!

 

And then we have the desperate couples who choose this option and are willing and able to pay. Are they not also being exploited to a certain extent (albeit in a design of their own making)? This is not a good way to have a family: I know of one woman who regularly tells people how much her IVF twins cost her, apparently believing that their grades should be better than those of other children because they cost more. As they get older, will she dictate to them on the basis that she paid for them? Isn't that a form of slavery? As always it is the child who loses: exploited by both genetic and surrogate parents.

 

We are now way beyond the start of the slippery slope: there are those who are 'too posh to push', those who choose the gender or disability status of their children. It would not surprise me if there were also designer pregnancies, where the pregnancy happens to another person, whether a woman is fertile or not. Is this the new feminist ideal: the exploitation of one woman to spare another some nine months of inconvenience? Even organs are not commodities to be traded, selected, bought, sold or even rented, so why do we seem to think that children are?

A trip to the egg bank

On Tuesday the Mirror reported that an egg donor bank had opened in London; it has been operating on a trial basis since the beginning of the year. In my health news email digest, it stated that women would be able to choose characteristics of the baby, such as eye colour. (It has got a little more difficult to review these stories since the newspapers realised that people were accessing their articles free online and that they were clearly missing out and should start charging.)

 

Choosing eye colour might seem harmless enough, and I understand that a woman might well want a baby to bear some slight resemblence to her, but we have already seen the tragic consequences of sex-selection of babies, and allowing and encouraging any sort of picking and choosing definitely sets us on the path to designer babies. Having children is not a right, it is a privilege. Babies are not convenient: they do not sleep or smile or eat when we want them to, they are hungry and tired when we don't want them to be. They are people, and like all people they are creatures. We are created. We are fragile. We are dependent. There are some things that we don't get to choose because we are not in charge.

 

This was as far as I got when I actually went and read the Mirror's article. I was struck by the fact that the director talked about the 'needs' of people 'needing' donor eggs. Need is not the right word - children are a privilege, not a necessity. It would be more accurate to talk about desire and want. I also took note of the 53 year-old woman who said that she'd always wanted to have children but had never met the right person. There is in that statement a clear understanding that the 'right person' is a necessary part of the process of having children. There is no mention that she has now met that person, but she's decided to have a child anyway. In the same way that we have separated sexuality and procreation (see Humanae vitae and if you haven't read it, then read it) we have also separated the concepts of children and family. Sometimes there are ways of doing things which are just different. Other times there are right ways and wrong ways, and being created and finite we also don't get to choose what is right and what is wrong. We can choose whether to do right or wrong, between good and bad and frankly that is a complete misuse of the precious gift of our freedom. Right use of our freedom is using it to choose between good and better, not between good and bad.

 

It was at this point that I discovered the Telegraph's article on the same subject and realised how incredibly naive I am. It may be couched in terms of altruism, but this is not some benvolent institution, set up because of tragic needs which we cannot ignore (like, say, a food bank). The donors (something of a misnomer) will receive £750 for providing eggs. How long before we see young women funding their way thorough university by selling their eggs? And the profit margin is presumably quite high, as treatment (purchase of eggs) costs £10,000.

 

Whilst I have thrown words like right and wrong around, and asserted that children are a privilege and not a right, I do empathise with older women. And I do not wish to generalise or assume that it is only single women who seek IVF in later life, I know women who did not meet and marry their husbands until they were in their 50s and 60s and therefore never had children. My great uncle's second wife told me cheerfully that she had no regrets over not having met her husband sooner as he, a widower, had been married to someone else. There are also couples who are sadly, persistently infertile. Women are called to be mothers, whether biologically or spiritually, and the inability to answer that call for whatever reason must bring heartache. But we also need to remember that our actions always have consequences. The consequences of delaying children by prolonged, repeated use of contraceptives in order to advance a career, go on holiday more often and generally 'enjoy life' might be infertility. We are not in charge and we cannot have it all.

Not in my name

Whilst I try to mainly limit myself to writing about healthcare-related issues, one of the reasons I started blogging was because I was fed up with people telling me that as an [educated] woman there were things I should want (sex, drugs and the ordination of women) and things I shouldn't want (marriage, children, self-respect, and the right not to sing Shine, Jesus, Shine) and I was especially fed up with being told this by nominally Catholic women claiming to speak on behalf of all Catholics. I am therefore delighted to discover that I am not the only person who believes in, strives to live by and supports the teaching of the Church. Catholic Women Rising is 'a place for practicing Catholic women who support the Church’s teaching on sexuality, contraception, abortion, marriage and the ordination of women, to stand up and be counted.'

While I'm on the subject, I should just take this opportunity to plug the vastly improved website of the Women's Section of the Pontifical Council for the Laity. This is definitely a website with something for everyone, from philosophy to book reviews (and probably philosophical book reviews as well), from current affairs to anthropology.