NRL News

“Reducing” Twins to “Singletons”: the Erosion of an Ethical Demarcation

by | Aug 11, 2011

By Dave Andrusko

We first wrote about “selective reduction” a long, long time ago. A t the time I remember discussing how the logic behind “reducing” the number of unborn babies—while talked about exclusively in terms of a woman carrying many, many babies—could never stop there. It would be like approaching a stop sign: first a more-or-less full stop, then you roll through, and then you race through, pedal to the metal.

If you could insert a needle full of potassium chloride into the hearts of three or four or more babies, who’s to deny a woman the “right” to “reduce” twins to a “singleton”? Which is where we are at, as detailed in a well-researched and well-written piece that is already online and will appear in the New York Times Sunday Magazine.

“The Two-Minus-One Pregnancy” is written by Ruth Padawer. (Real veterans will remember her for doing first-rate reporting on the issue of partial-birth abortions. The number of partial-birth abortions, we were told, was negligible.  But with a few phone calls Padawer, then a reporter a New Jersey newspaper, discovered that in a single New Jersey clinic at least 1,500 partial-birth abortions were performed every year.)

The piece is over 5,000 words long, so Padawer is covering a lot of ground. And while it takes a while to read, the story is more than worth your time.

There are multiple babies in almost all cases either because of IVF or the use of powerful fertility drugs. Here’s an early paragraph that gives the reader a preview of what is to come. Padawer writes

For all its successes, reproductive medicine has produced a paradox: In creating life where none seemed possible, doctors often generate more fetuses than they intend. In the mid-1980s, they devised an escape hatch to deal with these megapregnancies, terminating all but two or three fetuses to lower the risks to women and the babies they took home. But what began as an intervention for extreme medical circumstances has quietly become an option for women carrying twins. With that, pregnancy reduction shifted from a medical decision to an ethical dilemma.

The history of selective reduction is the slippery slope on steroids. Patients and doctors persuaded themselves that it was safer for the mother and more likely to increase a live birth if “megapregnancies” were whittled down. According to Padawer those were “medical decisions.” Killing a twin’s sibling is an “ethical dilemma.” And although “No agency tracks how many reductions occur in the United States,” she writes, “those who offer the procedure report that demand for reduction to a singleton, while still fairly rare, is rising.”

A key player from the beginning was Mark Evans. Padawer tells us that “Early on Evans decided the industry needed guidelines, and in 1988, he and an ethicist with the National Institutes of Health issued them. One of their central tenets was that most reductions below twins violated ethical principles.”

But that dike could never hold, and Evans was again a key player in dismantling it. In 2004 “Evans publicly reversed his stance, announcing in a major obstetrics journal that he now endorsed twin reductions.” For Evans this was a function both of changing cultural mores and changing demographics (older women, single women, women having children with a second husband) and the conviction that having twins was sufficiently riskier than having a single baby.

“Many doctors, including some who do reduction to a singleton, dispute Evans’s conclusions, pointing out that while twin pregnancies carry more risks than singleton pregnancies, most twins (especially fraternal) do just fine.” But while Dr. Richard Berkowitz “insists that there is no clear medical benefit to reducing below twins, he will do it at a patient’s request. ‘In a society where women can terminate a single pregnancy for any reason — financial, social, emotional — if we have a way to reduce a twin pregnancy with very little risk, isn’t it legitimate to offer that service to women with twins who want to reduce to a singleton?’”

Be sure to read Padawer’s  powerful account of her own second pregnancy. Convinced that having twins would be exhausting, it turned out that she was carrying twins! She was afraid.

“There’s no doubt that life with twins and a third child so close in age has often felt all-consuming and out of control,” she writes. Note the next sentence: “And yet the thought of not having any one of them is unbearable now, because they are no longer shadowy fetuses but full-fledged human beings whom I love in a huge and aching way.”

Finally, there is an almost throwaway paragraph that is worth pondering, about a woman who aborted (“selectively reduced”) two of the three babies she was carrying.

Today, her daughter is 2½ years old. Shelby intends to tell her about the reduction someday, to teach her that women have choices, even if they’re sometimes difficult. “I am the mother of a very demanding toddler,” she says. “I can’t imagine this times two, and not ever knowing if I’d have another person here to help me. This is what I can handle. I’m good with this. But that’s all.”

This mother considers it a badge of honor to wear proudly—telling her daughter she’s the sole survivor. This came long after Padawer gingerly touched the topic:

Even if parents work hard to conceal it, the child may discover the full story of his or her origins, and we don’t know what feelings of guilt or vulnerability or loss this discovery might summon.

A riveting piece, which I hope you will read tonight.

Your feedback is important to improving National Right to Life News Today. Please send your comments to If you like, join those who are following me on Twitter at

Categories: Abortion