Ann Furedi, chief executive of BPAS, reviews Sara Dubow’s book Ourselves Unborn: A History of the Fetus in Modern America.

Ourselves Unborn: A History of the Fetus in Modern America
Sara Dubow, Oxford University Press, 2011, 320 pp.

Recent discussions about the permissibility of later abortions have raised interesting questions about how we regard the fetus. How much value do we accord to life that has been conceived but not born? Has the way we assess this changed? Does our expanding knowledge of the science of fetal development mean that it should?

For decades, opponents of abortion have called on us to “confront the reality of abortion,” asking us to admit that the embryo is “human and alive” and that abortion “stops a beating heart.” They have accused the prochoice movement of devaluing the fetus, of denying that it is different than any other “blob of tissue” or of likening it to an unwanted growth, a “cancer” or a “parasite.” Their assumption, on the level of rhetoric or conviction, has been that prochoice politics is built on ignorance of what the fetus truly is. Today their challenge to us is this: as modern science tells us more about human development, as 4D scans show us the true face of the fetus, how can we allow its ending through late-term abortion?

Indirectly, implicitly, this book addresses that question.

Ourselves Unborn: A History of the Fetus in Modern America is not an argument about abortion, nor a vehicle for the beliefs of the prochoice movement. Sara Dubow, a historian at Williams College in Massachusetts, has written a detailed and scholarly study of the way value has been attributed to fetal life over the last century. “A fetus in 1870 is not the same as a fetus in 1930, which is not the same as a fetus in 1970, which is not the same as a fetus in 2010,” Dubow says. The change, she explains, is not driven by knowledge about the fetus, but by the emotional and political investment people have in it. Through their approach to the status, development and significance of the fetus, “people— individually and collectively—expressed their assumptions about personhood, family, motherhood and national identity.” How we understand and relate to the fetus is driven by social values and political circumstances far more than by biology or theology.

The book dismisses the idea that the advances in our knowledge about the developing fetus should shape our attitude to fetal status in respect to abortion. It shows that the fascination with fetal feeling, experience and appearance, which seems newly stimulated by today’s scientific discovery, has been a part of the medical, cultural, social and political discourse for more than a century. The form that this discussion takes and the conclusions that are drawn from it have been driven by cultural values and not by accumulated knowledge or new discovery. Throughout modernity, support for women’s choice about the future of her pregnancy was never built on ignorance of fetal life. Instead, it was based on the understanding of the fetus partnered with the concept of what pregnancy, giving birth and raising a child means for a woman.

Today’s commentators assume that, regarding fetal life, our trajectory has been to accumulate evidence that there is little difference between the unborn and the born. Dubow’s first chapter demonstrates how untrue this is. The progression of scientific thinking in relation to the fetus, from Aristotle until the mid-nineteenth century, was not so much a journey to discover how alike babies and fetuses are, bringing us closer to a view that the fetus is deserving of more respect. Rather, she illustrates that the voyage has been one to discover the differences between embryo, fetus and baby. A famous late-fifteenth century drawing by Leonardo da Vinci is generally regarded as the first accurate presentation of the fetus in utero (in “fetal position” ). While feminists have criticized the accuracy of da Vinci’s representation of the uterine context (which appears opened like a Fabergé egg), there can be little criticism of his rendering of the fetus. It is astonishingly similar to the photographs we see today in modern scans and medical textbooks—we are touched by how much it looks like a born “baby.” But in 1487, many would have been surprised by how un-like a man it was. Before then, the fetus was typically illustrated by various kinds of imagined homunculi—little humans—or cherubic infants. (A rich collection of illustrations is included in Karen Newman’s essay, Fetal Positions: Individualism, Science and Visuality, published in 1996 as part of Stanford University Press’s “Writing Science” series.)

Twenty-first century science’s knowledge of the fetus has not exposed the reality of fetal life, nor has it made public support for later abortions untenable. As Dubow reminds us, the Swedish photographer Lennart Nilsson first started to gain recognition for his photographic images of the fetus in the early 1950s.

Nilsson’s iconic series of fetal photographs, which first appeared in the 1965 Life magazine article “The Drama of Life before Birth,” have become the classical reference for feminist discussion of fetal imagery. They employ all manner of deliberate technical presentation and descriptive techniques to evoke “fetal personhood.” And yet, despite the photographer’s intent to dramatize life before birth, just two years later in Britain, and nine years later in the US, abortion was legalized.

In truth, the public has been exposed to, and fascinated by, accurate representations of the fetus for well over a century. Dubow cites the displays of anatomically correct wax models of human embryos, the centerpiece of an 1893 Chicago exposition that attracted crowds of visitors. Forty years later, the fetus was still a public draw, motivating exhibitors to go further to meet the audience for realistic representation. In 1933, some 20 million visitors paid 10 cents each to see a “graduated set of human embryos and fetuses” preserved in formaldehyde “to illustrate the development of an unborn baby from the first month to the eighth.” At this time they were seen as scientific curiosities—educational specimens. Times change, however, and Dubow recounts that, when a similar exhibition was mounted in 1977, the organizer was arrested and charged with the illegal transportation of human remains. Dubow discusses in some detail the changes that had occurred in the intervening decades—how the preserved fetus had turned from a scientific specimen to an emblem of the American family. My point is more straightforward: for more than a century people have known that in later pregnancy fetuses look like babies, and yet they have continued to make legal, moral and public policy decisions related to abortion regardless.

Just as there has been a long-standing interest in what the fetus looks like, so there has been similar interest in what fetuses feel and know. Dubow writes of research at the Samuel S. Fels Research Institute for the Study of Prenatal and Postnatal Environment in the late 1940s, which attempted to address social, psychological and physiological aspects of fetal behavior. She documents studies of “prenatal life” reported in the popular press of the time, such as a magazine article suggesting the new questions being researched: “What happens to a baby before he is born? Is he sometimes uncomfortable? Does he feel motions? Can he hear? Can he think? Is he capable of learning?” Dubow suggests that “prenatal psychology” got a stamp of approval as early as the 1940s, though without any implication of a protected status or fetal life.

The controversies regarding second trimester abortion in the 1970s illustrate most clearly how politics and advocacy are not framed by scientific or medical perception—it is politics that drives perception.

On April 11, 1974, Boston City Hospital physician Kenneth Edelin was indicted for manslaughter following a second trimester abortion. Although the Supreme Court Decision in Roe v. Wade had provided a relatively liberal framework for abortion, this case was complicated by tensions around race, class, ethnicity and concerns about the unchecked authority of doctors and scientists. In a hysterical environment excited by allegations that elective abortions were producing a supply of fetuses for research purposes, some of which were supposedly “kept alive” for experiments, Edelin was accused of causing the death of a fetus. He was said to have deprived a 24-week-old fetus of air after he had carried out an abortion by hysterotomy— by making an incision in the uterus. Edelin denied he had asphyxiated the fetus after delivery, but he was unashamed about his actions as an abortion doctor, which were not intended to result in a live birth. Under cross-examination he confirmed his belief that he owed no duty to the fetus. He was not concerned whether the fetus was live or dead at the start of the procedure since his only concern was for “the mother,” and even if he had thought that the fetus was alive after delivery he would not have called a pediatrician because “this being an abortion before viability,” he thought that an attending pediatrician would have been “number one, contrary to the patient’s wishes, and number two, contrary to good medical practice.”

Edelin was convicted following a sham of a trial, which Dubow describes in detail. The account is fascinating, but even more astonishing were the media reports, which gave unequivocal backing to the abortion doctor. The Boston Globe described Edelin as “a victim of judicial inadequacy that no society should tolerate.” The Washington Post wrote that the Edelin conviction brought “‘disgrace and shame’ to the State of Massachusetts and the entire judicial system … and warned that the impact of the decision ‘on the practice of medicine and on medical research in Boston, and elsewhere, is likely to be enormous.’” The New York Times called the decision “unbelievable” and feared that “it will now become more difficult than ever for women to obtain abortions when they are in the second trimester after conception.”

The case caused the American College of Obstetricians and Gynecologists (ACOG) to issue a statement reaffirming their support for “unhindered access by women to abortion services,” and warned that the profession, “must guard against local jurisdictions or vocal minorities imposing their ethical positions for medical care on family planning and abortion on patients and doctors who do not hold those positions.” The Planned Parenthood Federation of America worried that the decision “will make doctors fearful of performing abortions.” The National Abortion Rights Action League (NARAL) was concerned about the affect on “women with no financial means or alternative options.”

Edelin’s conviction carried with it a maximum sentence of 20 years, but he was sentenced to one year of probation, suspended until the anticipated appeal. In 1976, a unanimous ruling by the Supreme Judicial Court of Massachusetts overturned the conviction.

We can ask—if Edelin were to come to trial today, what chance would there be that the media, ACOG, Planned Parenthood and abortion lobbyists like NARAL would stand together in unequivocal, unapologetic support for a second trimester abortion doctor found guilty of manslaughter?

Sadly, I think we have to concede that many would say—even if convinced of the righteousness of the doctor’s actions—that public support would be unwinnable. Today, late abortion is something even some who call themselves “prochoice” will no longer defend. Their retreat is not because they have learned more about the fetus, but because they have failed to learn what they should about women’s lives.

Dubow’s work shows that, from the late nineteenth century to the early twenty-first century, “the fetus has been a vehicle through which people have wrestled with assumptions about science and religion, anxieties about demography and democracy, beliefs about feminism and motherhood, and ideas about conservativism and liberalism.” This will be as true for the future as it has been for the past. Ourselves Unborn: A History of the Fetus in Modern America tells a story beginning a century ago, when the fetus was framed in a historical context during which, “embryology became a science, obstetrics became a profession, abortion became a crime, birth control became a movement, eugenics became a cause and prenatal care became a policy.” The challenge we face today is to understand the context in which our appreciation of the fetus is currently framed, and our task is to shape that context and not passively accept it.

In 1996, Edelin, who went on to become a chairman of Planned Parenthood, addressed the matter of whether the loss of a fetus in abortion was always a tragedy. He wrote: “Many women choose abortion because of the tragedies in their lives and in the circumstances surrounding their pregnancies. For these women, abortion is not a tragedy; instead it liberates them from tragic circumstances. Women must never be left out of the abortion debate, or the debate about fetal research, medical progress or moral politics.” He was right. Dubow provides the evidence: it is not fetal science that teaches us what we know to be right. Instead, through the years we interpret and understand that science in the context of what appears right from our own and society’s perspective.

Ann Furedi is chief executive of BPAS, and author of Unplanned Pregnancy: Your Choices.

This review is published in Conscience magazine, Volume XXXII, No 2, 2011. Reprinted with kind permission on Abortion Review: