When a woman attends the standard 20-week prenatal ultrasound appointment, it is usually with a sense of anticipation. You get to see your baby onscreen while the ultrasound tech takes measurements, and if you’re lucky, you might even get a good look at your preborn baby’s face.
So I was frustrated when I attended my 20-week pregnancy ultrasound in March and a new doctor I’d never met before came in and questioned whether it really made sense to add this latest person to my family. Because of some unknowns about my child’s genetic risk for cystic fibrosis (CF), she seemed focused on possible health risks that, she seemed to think, could convince me not to continue my pregnancy.
“You are a carrier for cystic fibrosis,” she said, “and we don’t have your husband’s results. If he came in for a blood test, we could know if he is a CF carrier too.”
“I know,” I responded. “I don’t really need it, because it won’t make a difference to me.”
But she kept pressing the issue. She seemed to think the relative probability of CF would be essential information for me to determine whether to continue this pregnancy.
“Would knowing the chance of CF for my child give us a head start in providing care for her?” I asked.
“No,” she replied, adding, “Your pediatrician would inform you of care options after birth.”
Later, I wondered if I had imagined that she was pressuring me to consider terminating my wanted child. But in the visit notes I later read in my online patient chart, I saw she had typed on my record, “the patient is committed to the pregnancy.”
Thankfully, she was not my regular OB-GYN but just one of the doctors to follow up after ultrasounds. But how many vulnerable moms had she counseled like this? If a mom was feeling anxious about the challenges of raising a special-needs child, would this doctor push her over the edge into ending the pregnancy based on possible CF, Down syndrome, or another estimated health risk, even if she wanted the child? We don’t normally recommend basing permanent health decisions on fears of the unknown. In my view, this doctor went beyond providing medical care to suggesting some lives are more worthy of a chance at life than others.
Eugenic Abortions Are Receiving Greater Scrutiny
According to a law in my state of Ohio, doctors are prohibited from performing abortions if the mother has informed the doctor the reason is fear of her child having Down syndrome. A panel of judges stopped the law from being enforced in the fall of 2020, but in April 2021, a U.S. Circuit Court of Appeals reversed the decision, allowing the law to be enforced again.
Laws like this are part of a trend of abortion restrictions for cases when the choice is made for eugenic reasons, such as the preborn child’s race, sex, or disability. According to the Guttmacher Institute, eleven states have similar laws restricting abortions for similar reasons. These laws bring into sharp focus the conflict between abortion advocates and disability-rights advocates. When abortions are permitted or encouraged because of a preborn child’s risk of disability, it suggests that the lives of people with disabilities are less valuable than those of people without disabilities.
Eugenic abortion made headlines when Iceland boasted that it has a near-zero rate of children born with Down syndrome. However, the country’s Down syndrome numbers are low not because of treatments or cures for the congenital abnormality, but because of prenatal testing and elective abortion. In a December 2020 Atlantic report, Sarah Zhang interviewed Grete Fält-Hansen, a mother of a Down syndrome child who makes herself available to share her experience with moms carrying children with Down syndrome who are considering terminating their pregnancies. While Fält-Hansen passes no judgment on those who choose to abort, Karl Emil, her high-functioning 18-year-old son, is acutely aware that people are judging whether lives like his are worth living. “The decisions parents make after prenatal testing are private and individual ones,” writes Zhang. “But when the decisions so overwhelmingly swing one way—to abort—it does seem to reflect something more: an entire society’s judgment about the lives of people with Down syndrome. That’s what I saw reflected in Karl Emil’s face.” In the United States, prenatal genetic testing has become a staple of prenatal care, especially for moms over the age of 35. The testing can identify if the preborn child has chromosomal abnormalities such as Down syndrome or other conditions, as well as estimating the risk that the child could be born with a disease like cystic fibrosis. While this is treated as a basic part of maternal and prenatal care, the increase in genetic testing has not correlated with advances in treatment for prenatal children conceived with these conditions; the only option many women are offered upon probable diagnosis is to terminate the pregnancy. This is why laws like the one recently reinstated in Ohio respond to a problem that exists not just in abortion clinics, where women are provided with abortions for any reason, but in mainstream OB-GYN medicine. While laws like Ohio’s prohibit doctors from aborting the child if the woman seeking abortion has disclosed a eugenic motive, they are based on the assumption that it is the mother who normally presses for eugenic abortion, rather than the doctor or healthcare professional. In other words, this abortion prohibition is premised on the belief that abortion for eugenic reasons is unbefitting of a medical provider and has no place in healthcare. Traditionally, this makes sense, since the medical profession is supposed to support the health of patients, without singling out some people as being more “fit for care” than others.
Meanwhile, Planned Parenthood Says It Is Disowning Eugenics
In April 2021, Planned Parenthood president Alexis McGill Johnson wrote an opinion piece for the New York Times whose headline exclaimed, “We’re Done Making Excuses for Our Founder: We must reckon with Margaret Sanger’s association with white supremacist groups and eugenics.”
McGill Johnson details concerns many pro-life advocates have raised over the years (concerns that a number of media outlets have wrongly “debunked” as false over the years!) that Margaret Sanger, the founder of Planned Parenthood, harbored racist and eugenic motives for some of her work promoting use of contraception and abortion.
“Sanger spoke to the women’s auxiliary of the Ku Klux Klan at a rally in New Jersey to generate support for birth control,” McGill Johnson notes in the New York Times. And “she endorsed the Supreme Court’s 1927 decision in Buck v. Bell, which allowed states to sterilize people deemed ‘unfit’ without their consent and sometimes without their knowledge—a ruling that led to the sterilization of tens of thousands of people in the 20th century.”
She goes on: “The first human trials of the birth control pill . . . were conducted with her backing in Puerto Rico, where as many as 1,500 women were not told that the drug was experimental or that they might experience dangerous side effects.” Again, this is a true and damning history that is all but ignored in birth control advocacy (even as many today still are not adequately informed of birth control’s dangerous side effects).
Many anti-abortion and contraceptive-critical groups have been vocal about these damaging facts for years. It’s stunning to see Planned Parenthood finally admit to its founder’s feet of clay on a large platform, even if in the same breath the organization attempts to move on from it.
“In the name of political expedience, [Sanger] chose to engage white supremacists to further her cause. In doing that, she devalued and dehumanized people of color But we can’t simply call her racist, scrub her from our history, and move on,” McGill Johnson writes. “We must examine how we have perpetuated her harms over the last century—as an organization, an institution, and as individuals.”
This would be a worthy effort, but I don’t think abortion providers like Planned Parenthood are remotely capable of detaching the organization’s services from eugenics.
Planned Parenthood is not the only abortion and contraceptive-providing giant attempting to distance itself from its founder’s eugenic motives. In November 2020, Marie Stopes International changed its name to MSI Reproductive Choices to downplay its association with its controversial founder Marie Stopes. The “MSI” in MSI Reproductive Choices clearly references the organization’s original name Marie Stopes International, so its nominal separation from its founder is thin, but nevertheless it is seeking approval for the effort. The BBC reported at the time, “Stopes was a member of the Eugenics Society and advocated for the sterilisation of people considered unfit for parenthood.” The BBC goes on: “She also corresponded with Adolf Hitler and believed in the creation of a super race.”
Similar to McGill-Johnson’s effort in the New York Times, MSI Reproductive Choices attempted to give context for Stopes’ eugenic thinking while also decrying it. Eugenic views, “though not uncommon at that time, are now rightly discredited,” the BBC quotes a statement from MSI Reproductive Choices.
While Planned Parenthood and MSI Reproductive Choices are attempting to distance themselves from eugenics just by saying so, there are many reasons to believe their words are hollow.
When the Services You Provide Inherently Discriminate among Which Lives Are Worth Living
Critics have long noted that Planned Parenthood locates nearly 80 percent of its surgical abortion facilities in walking distance of minority neighborhoods. In citing this statistic, prolifers have suggested that Planned Parenthood’s motivations are racist, while abortion advocates prefer to think Planned Parenthood is serving the underserved. But when the main service you’re providing is stopping a client from reproducing, it is hard to ignore racist and eugenic implications.
Black preborn babies were the most likely of all races to be aborted in 2018, according to the Centers for Disease Control and Prevention. And, in New York City, where Planned Parenthood is headquartered, Black children are more likely to be aborted than born alive.
Further, overseas contraception and abortion providers like Planned Parenthood and MSI Reproductive Choices continue to do work that parallels their founders’ unethical histories. As Nigerian biomedical scientist Obianuju Ekeocha recounts in her informative book Target Africa, Western “reproductive rights” groups continue aggressive campaigns to sterilize African women and inject into them contraceptives to this day—even while African women continue to report in surveys that they value their fertility and children. Ekeocha concludes that underlying such efforts is an outlook of cultural imperialism. As she compellingly explains in her book, Africa’s woes do not stem from a population problem but from poor access to basic needs. Instead of helping to improve access to clean water or medical care, Western philanthropic groups prioritize family-planning efforts, and Western governments tie pivotal aid to aggressive contraceptive campaigns.
What contraceptive campaigns look like in reality, Ekeocha explains, is “mobile clinics” driving into poor African towns and administering contraceptive shots, devices, or implants to women who are uninformed about the risks and side effects, and who have little access to healthcare when complications arise. Sound familiar to Sanger’s uninformed patient sterilization campaign, or the Puerto Rico trials?
What Real Anti-Eugenic Abortion Reform Would Look Like
If groups like Planned Parenthood or MSI Reproductive Choices really wanted to remove eugenic thinking from their operations, they would support laws banning eugenic abortion. But of course that’s not on the docket. In fact, when it comes to Ohio’s law against eugenic abortion in the case of Down syndrome, Planned Parenthood was among the plaintiffs bringing the case to court—in particular Planned Parenthood Southwest Ohio Region and Planned Parenthood of Greater Ohio.
In court documents, the plaintiffs stated that criminalizing abortions sought because of a Down syndrome diagnosis would disrupt women’s access to unencumbered abortion, leading pregnant women to hide their reasons for seeking abortion, resort to doctor-shopping, and so on. Nowhere did the Planned Parenthood plaintiffs express concern about the possibility of eugenic motives affecting the decision to get an abortion; all that matters, apparently, is making sure the procedure can take place.
While Planned Parenthood likes to present itself as a medical organization, court documents reveal that it showed zero interest in stopping eugenic, antiDown syndrome thinking from infecting the medical field at large. People will abort these children anyway, their argument goes, and making it harder to do so will just hurt abortion access, so let’s scrap these laws and stop worrying about eugenic motives altogether. It’s a policy that has worked for Planned Parenthood since Sanger’s founding; it just doesn’t seem to match McGill-Johnson’s stated commitment to “examine how we have perpetuated her harms over the last century—as an organization, an institution, and as individuals.”
Ultimately, the Ohio court ruled against the plaintiffs and Planned Parenthood, stating in its opinion: “when unborn children exhibiting a certain trait are targeted for abortion, that sends a message to people living with that trait that they are not as valuable as others,” and “by involving the doctor in her personal decision to abort her pregnancy because the forthcoming child would be born with Down syndrome, the woman places the doctor in a position of conflicted medical, legal, and ethical duties.”
I can understand if some doctors already feel this conflict; it certainly infected my 20-week ultrasound experience. Perhaps the OB-GYN who lingered too long on the suggestion of abortion was conflicted between serving both patients in the room and avoiding “wrongful birth” lawsuits. But it made for a disturbing patient experience—not only because her concerns created an “us versus them” vibe between the extra-uterine humans in the room and the preborn human she viewed as potentially “unfit to be born” and disposable. It also made for a disturbing experience because the doctor’s apparent conflict in care interfered with her listening to me as a patient. My clearly expressed health goal was to continue with this pregnancy and take care of the child no matter her health conditions; however, the OB-GYN in the room seemed to be stuck in a loop of “is-or-isn’t-this-child-defective” thinking that distracted her from hearing me. In a way, her divided attention disabled her from serving both patients in front of her.
It all comes down to logic. Eugenics has no place in medicine, and abortion providers cannot detach themselves from eugenic implications. As a result, abortion providers will never enjoy a secure place in the medical field, despite their claims and efforts. If eugenics and racism have no place in a fair society, one wonders when we will notice the emptiness of abortion providers’ claims that they’ve eschewed their founders’ problematic principles.
Mary Rose Somarriba is editor of Verily Magazine and lives with her husband and children in Cleveland, Ohio.