The Case of the “Two-Minus-One” Pregnancy

Back in August of 2011, the New York Times published a story on a reproductive choice which, unfortunately, is far too common in the United States. Here are some facts of the case:

• Jenny and her husband—already with children in grade school—decided that they wanted to have another child. Jenny, at 45 years of age and “after six years of fertility bills, ovulation injections, donor eggs and disappointment”, got pregnant via in vitro fertilization.

• But as often happens with IVF, Jenny discovered at 14 weeks gestation that she was pregnant with twins. But this was not in her plan. In the fact, the thought of “managing two infants at this point in her life terrified her”, especially given her worry that she could not provide for her older children, and both twins, at the same time. She and her husband made the decision to abort one of the twins.

• Her explanation is important and worth quoting: “Things would have been different if we were 15 years younger or if we hadn’t had children already or if we were more financially secure… If I had conceived these twins naturally, I wouldn’t have reduced this pregnancy, because you feel like if there’s a natural order, then you don’t want to disturb it. But we created this child in such an artificial manner — in a test tube, choosing an egg donor, having the embryo placed in me — and somehow, making a decision about how many to carry seemed to be just another choice. The pregnancy was all so consumerish to begin with, and this became yet another thing we could control.”

• Jenny found it difficult to admit what she was doing. The story mentions “she was grateful that the ultrasound tech had turned off the overhead screen” because she “didn’t want to see the two shadows floating inside her.” Jenny and her husband refused to tell anyone else, not even their closest friends, about their decision.

Perhaps understandably, almost all pregnancy “reductions” are clouded in this kind of secrecy. But we must lift the fog of secrecy and begin talk about them—not just because “two-minus-one” pregnancies are becoming more common (especially as more and more people with Jenny’s life situation and attitude try to have children via IVF), but because they are the logical extension of our problematic reproductive practices more generally.

Especially in post-Enlightenment secular bioethics, the default value has become the autonomy and choice of the individual. But Christian and Muslims traditions are, of course, skeptical of this shift. Unless we critically examine the social context and structures which shape and even coerce our “autonomous” and “free” choice, we cannot hope to adequately engage bioethical issues.

The unassailable nature of “free reproductive choice” has become something like a dogma of contemporary secular bioethics. But notice that even the word itself (re-production) is practically begging for us to go beyond this thin analysis and examine the social context of the choice. Jenny noted that, from start to finish, her pregnancy was “consumerish.” She and her partner purchased the eggs—perhaps from a clinic which charges on a sliding scale based on traits like the donor’s SAT scores, attractiveness, or athletic skill. She and her partner likely purchased technology and labor to examine the desirability of the eggs and sperm, to create the embryos in a laboratory, and then to examine the desirability of various embryos to implant. Finally, she also purchased the technology and labor to aim at the death of one of the twins inside of her.

The logic of consumerism drove each of these choices. Perhaps unsurprisingly, this process of re-production was not unlike buying other kinds of products. The child that she and her partner aborted—rather than seen as an end in herself—was understood as merely a tool of her parents’ will, and therefore subject to the quality control of products purchased in a market. Interestingly, we learn directly from Jenny about the direct connection between consumerism and her abortion. She said that if she had had twins “naturally” she wouldn’t have felt as she could have disturbed the “natural order.” But in this case the abortion was “just another choice.”

The traditions of Islam and Catholicism are in an excellent position both to identify this problem and propose correctives. In both traditions, procreation of children is understood as submitting to or cooperating with the Divine will. Children are gifts with inherent dignity, not products to be purchased in the Enlightenment-created “free market.” Indeed, both religions have well-developed traditions of thought about how markets exploit vulnerable populations: from children killed in abortion, to embryos discarded at the clinic, to women who serve as surrogate mothers and egg donors.

But there is another social structure at work here, and it is the peculiarly American (and secular) idea of the “closed home.” Jenny and her husband are culturally conditioned to believe that they are to raise their children by relying on their own resources. That their extended family members, their neighbors, their religious community, the government—or even their current children (especially as they get older)—will be there to help them through their struggles apparently isn’t even considered.

Again, the traditions of Islam and Catholicism are in a strong position to critique the secular American culture of the “closed home” given that it totally misunderstands the intrinsically relational and dependent nature of human beings. Individual independence and autonomy are false and dangerous myths, most often perpetuated by the wealthy and otherwise privileged.

But we must not end with mere critique. We must work to make our families, neighborhoods, religious communities, and governments better able and willing to be the communities that families like Jenny’s require. One of my good friends from high school, already a father, recently received the gift of triplets. It has been great to see how the various people in their community have come forward to offer support. But many others do not feel like they have this kind of community. Christians and Muslims, in addition to critiquing the social structures which allow for (and even coerce) increased numbers of pregnancy “reductions”, should be particularly driven to reorient our own lives away from the idolatry of freedom and autonomy. We must work to build communities which resist consumerism and support vulnerable populations—not least so that “two-minus-one” pregnancies become unthinkable.