WORLD 24/01/15 Gestational age limits for elective abortions must be pushed back

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Gestational age limits for elective abortions must be pushed back

Artificial womb technology can now sustain the life of a fetus outside the mother’s womb

A nurse takes care of a newborn baby at a hospital in Taizhou, in China's eastern Jiangsu province. (Photo: AFP / CHINA OUT)

By Dr. Alexis Heng Boon Chin

Published: January 15, 2024 04:18 AM GMT

Elective abortion without valid medical reason is a highly controversial issue that has sparked much-heated debate worldwide, with many considering it a gross violation of the sanctity of human life.

To date, only a handful of countries permit elective late-term abortions beyond 20 weeks of pregnancy. These include Canada (no restriction in law but de facto limited to 24 weeks), China (no restriction in law), Netherlands (24 weeks), Singapore (24 weeks), United States (12 to 24 weeks in some states, banned or unrestricted in other states), Australia (16 to 24 weeks, depending on the state), Vietnam (no restriction in law), and India (24 weeks).

In some of these jurisdictions, the gestational age limit for elective abortion is predicated on the concept of fetal viability, which is the potential for the fetus to survive outside the mother’s womb, regardless of whether there is provision of medical care. 

For example in the case of the United States, the Supreme Court drew a line in the 1973 Roe versus Wade ruling based on fetal viability, which did not allow states to ban abortions before the fetus could survive outside the womb.

The general consensus among medical experts is that the human fetus gains the potential to survive outside the mother’s womb at between 23 to 24 weeks of pregnancy.

Likewise, Singapore’s abortion law is also predicated on the concept of fetal viability, as articulated by a recent news article that appeared in Singapore’s Straits Times titled, “Survival rate of premature babies born at 22 weeks close to zero: Sun Xueling” on Jan. 9.

Reviews by Singapore’s Ministry of Health in 2018 and 2022 involving local medical experts concluded that the survival rate of a premature baby born at 22 weeks is close to zero even after warding at neonatal intensive care units, while those born at 24 weeks are about 50 percent.

This is thus reflected in the Termination of Pregnancy Act, where elective abortion is not allowed for a fetus after more than 24 weeks of pregnancy unless the mother’s life is in danger.

Hence in jurisdictions where the gestational age limit of elective abortion is predicated on fetal viability, the question that arises is what if new medical technologies can extend the potentiality of life of the fetus (outside the mother’s womb) to before 24 weeks of pregnancy?

Should the gestational age limit for abortion be adjusted accordingly based on such a new medical reality?

The advent of artificial womb technology, medical devices that mimic the natural womb environment to better sustain the life and health of extremely premature babies, may thus provide the impetus for such amendments to current abortion laws predicated on fetal viability.

It was recently reported that the US Food and Drug Administration (FDA) will very soon approve human clinical trials of artificial womb technology within the United States in the near future.

At the current state of its development, artificial womb technology cannot be used on premature human babies born earlier than the 20th week of pregnancy, because blood vessel development is not mature enough to allow the transition to an artificial womb environment, which could severely compromise development of the fetal heart.

But it may confer the potentiality of life to fetuses after the 20th week of pregnancy.

Hence, the question that surely will arise, is whether it is ethically and morally acceptable to terminate pregnancies after the 20th week, given that artificial womb technology can now sustain the life of a fetus outside the mother’s womb.

In this case, whether or not the fetus can survive independently of medical intervention (in the form of artificial womb technology) is irrelevant to the argument based on it’s potentiality for life. Because earlier legislation based on fetal viability at 23 to 24 weeks of pregnancy is in fact based on sustaining the life of such premature newborns within neonatal intensive care units.

Take such medical intervention away, and it is very unlikely that a premature baby born at 24 weeks of pregnancy will ever survive.

An appropriate analogy here would be an adult human being who meets with a life-threatening traffic or workplace accident, but whose life can be sustained with medical technology, and can subsequently make a full or partial recovery from his or her injuries.

There is an ethical and moral obligation on the part of society, the government and medical professionals to use available medical technologies to help sustain the life and facilitate recovery of such individuals who meet with unfortunate accidents.

Likewise, would there not be similar moral and ethical obligations to sustain the life of a fetus that was electively aborted after the 20th week of pregnancy, based on its potentiality for life with artificial womb technology?

The point here is not to advocate for the use of artificial womb technology on all fetuses that are electively aborted after the 20th week of pregnancy.

Instead, the issue of contention here is to amend current abortion laws to push back the pregnancy termination limit to the 20th week of gestation, based on the potentiality of life of the fetus that can be sustained by new medical advances.

Perhaps in the future, with further improvements in artificial womb technology, the pregnancy termination limit can be pushed backward even more, as the potentiality of life is conferred on younger fetuses.

This is in accordance with universal values on respect for the sanctity of human life.

* Dr. Alexis Heng Boon Chin, based in China, had previously worked in the field of human clinical assisted reproduction research in Singapore and has authored 50 international journal publications on ethical and legal issues relating to new reproductive technologies in addition to publishing more than 250 scientific journal articles. The views expressed in this article are those of the author and do not necessarily reflect the official editorial position of UCA News.