Foetuses with abnormalities aborted in 'selective reduction': Japan

JAPAN - A maternity clinic in Nagano Prefecture has performed 36 selective reduction operations to abort fetuses with abnormalities in multifetus pregnancies, it has been learned.

The activities of Suwa Maternity Clinic in Shimosuwa, Nagano Prefecture, which is directed by Yahiro Netsu, will be described at a conference of the Japan Society of Fertilization and Implantation slated to start Thursday in Beppu, Oita Prefecture.

The Maternal Health Protection Law does not refer to fetus reductions, and the government has not mapped out relevant guidelines. However, this first-ever revelation of such a practice by the Nagano clinic is likely to invite controversy.

The clinic conducts reduction operations usually when a multifetus pregnancy increases the risk of health problems for the mother and babies in the early stages of pregnancies, usually before 12 weeks' gestation.

According to the clinic, the operation was performed in 25 cases in which fetuses tested positive for Down syndrome or other chromosomal abnormalities, and in 11 cases in which fetuses were diagnosed with such conditions as hydrops fetalis in the chest or abdomen. Thirty-one of the 36 women had become pregnant after infertility treatment.

According to the clinic, all the women and their husbands said they would have aborted all the fetuses if they were unable to terminate just the fetuses with abnormailites.

Netsu said he had no choice but to perform the operations, to save as many lives as possible. All the operations were performed after 12 weeks' gestation.

Babies were confirmed to have been born in 32 of the 36 cases. One woman eventually suffered a miscarriage, and the three remaining women are either still pregnant or further developments are unknown.

The law does not permit abortions because a fetus has been diagnosed with an abnormality. Therefore women usually have only two choices when a fetus is diagnosed with an abnormality in a multifetus pregnancy: giving birth to all the babies or aborting all the fetuses.

In 2000, a Health, Labor and Welfare Ministry panel said in a report that the reduction of fetuses should not be conducted in principle.

When a woman is pregnant with three fetuses or more, however, the government recognizes fetus reduction to protect the health of the mother and children. Still, the government does not permit selecting a fetus to be aborted based on sex or whether the fetus has an abnormality.

"The number of couples hoping to have fetus reductions because a fetus has an abnomality will increase in the future," Netsu said. "We should think on a societal level how we should define selective reduction, which can at least save some lives."

Technology brings new issues

By Kumiko Nakajima/Yomiuri Shimbun Staff Writer

Technological advancements in prenatal diagnosis have brought about a new issue--whether a fetus with an abnormality should be selected for abortion.

Technically, the law does not permit abortions because a fetus has been diagnosed with an abnormality. However, about 1,000 abortions are believed to be conducted annually after fetsus have been found to have abnormalities, mainly to protect the mother's health.

There is no essential difference between this and selective reduction of a fetus with an abnormality.

The issue of how to respond to the desire of couples who want to have at least one child from a multifetal pregnancy has been left unaddressed.

This issue does not just involve the clinic conducting the reductions. Most of the women who underwent the operation collected information and went to the clinic of their own volition, as they were shocked to be told they were carrying a fetus with an abnormality after conceiving multiple fetuses as the result of fertility treatments that are performed nationwide.

This begs the question of whether necessary measures were taken to prevent women from conceiving multiple fetuses at the facilities where they received infertility treatment. It is also important to determine whether they were given appropriate counseling on heredity when the fetuses were found to have abnormalities. But this is difficult to ascertain as long as selective reductions are performed in a secretive manner.

It is time to discuss how this practice should be positioned legally and socially.