Women’s accounts of the experience of an ultrasound scan prior to abortion

Summarised and excerpted from:Re-visioning ultrasound through women’s accounts of pre-abortion care in England,by Siân M Beynon-Jones, Gender and Society 2015;29(5):694–715.This in-depth study of women’s accounts of having an ultrasound scan prior to an induced abortion opens by saying: “Feminist scholarship has demonstrated the importance of sustained critical engagement with ultrasound visualizations of pregnant women’s bodies. In response to portrayals of these images as “objective” forms of knowledge about the fetus, it has drawn attention to the social practices through which the meanings of ultrasound are produced.”The introduction examines how the anti-abortion movement “has used developments in ultrasound imaging to claim that the fetus is visibly ‘a person’ and often draw on the accounts of women with wanted pregnancies who describe ultrasound as a pivotal moment of emotional bonding during which the “personhood” of an eagerly anticipated fetus is confirmed. They have therefore argued that “if women requesting abortion were shown ultrasound images of their pregnancies, they would inevitably share this emotional response and be dissuaded from the procedure”. Over time, this construction of ultrasound has become entrenched through antenatal care practices, and prevented the multiplicity of pregnant women’s encounters with ultrasound from being voiced and acknowledged.In England, where the study took place, an ultrasound scan is a routine part of pre-abortion care in order to confirm the number of weeks of pregnancy, even though both the Royal College of Obstetricians & Gynaecologists (RCOG) said in a 2011 guideline, as has the World Health Organization in 2012, that this is not clinically necessary. The practice became entrenched because medical abortion provision was initially restricted to 63 days of pregnancy LMP.The RCOG guideline says the woman should be asked whether she wishes to view the scan.This recommendation is based on previous studies in South Africa and Canada, which found that many women do wish to view the scan (although many do not), and that most who did described this as a positive experience – but one that did not alter their decision about abortion.The study is drawn from 23 semi-structured interviews conducted as part of a broader study of women’s experiences of abortion in England. There were no discernible differences between the accounts of women for whom abortion was a relatively recent event and those for whom it had taken place many years previously.Two of the women rejected “the act of looking at the viewing screen as inappropriate to their own pregnancies… Joyful recognition of fetal personhood, they argue, is not intrinsic to the experience of having an ultrasound. Rather, the pursuit of joyful visual encounters with the fetus requires the context of a “wanted” pregnancy, in which women actively seek to construct and develop maternal-fetal relationships. Second, these participants constructed experiences of ultrasound (whether ‘joyful’ or ‘difficult’) as inseparable from dominant social representations of its meaning.”Another woman contested anti-abortion framings of ultrasound visualisation as the ultimate “truth” of fetal personhood. Although she invoked this framing, she also subverts it by constructing the scan as a process that lends moral authority to her decision to end her pregnancy. Several other women said something similar to this, and also described the decision to view the scan because they wanted to acknowledge and apologise to the fetus prior to abortion.Several other women said that being scanned was a relatively unremarkable method of obtaining useful medical knowledge about their bodies as part of a series of medical assessments that helped to facilitate the ending of the pregnancy.Yet another woman described the act of viewing the interior of her pregnancy as a diagnostic process that rendered the fetus as a separate and alien presence within her own body. Far from personifying the fetus, her account of her experience of ultrasound locates the fetus as an invading, and removable, biological object… She also emphasizes the social context in which she found “the science” fascinating, connecting this to her feelings about her pregnancy at that time. Earlier in the interview she had described how, on finding out she was pregnant, she knew instantly that she did not want to be: Pregnancy was completely unsustainable and undesired at that time in her life. Correspondingly, she noted that if the circumstances were different and she wanted to be pregnant, then she would expect ultrasound to be a very different experience.”In her conclusion, the author says: “The depiction of pregnant subjects as central to the practice of ultrasound was a cross-cutting feature of participants’ accounts and represents one key way in which the interview data could be said to destabilize dominant depictions of the technology…. In the case of the repertoire of medical objectification, participants portrayed ultrasound as a tool of medical knowledge production de-coupled from processes of fetal personification. Drawing on this repertoire, participants described ultrasound as an opportunity to satisfy scientific curiosity about biological events taking place inside their bodies, as one of a series of medical assessments to which their own bodies needed to be subjected to enable their abortion, and as evidence that the embryo/fetus within their bodies was developmentally and morally insignificant. All such depictions represent a radical departure from the characterization of ultrasound as an experience of “maternal-fetal bonding.”These findings resonate with cross-cultural research concerning prenatal ultrasound, which highlights that this technology is not always linked to the personification of the fetus. Rather, in many contexts, ultrasound is primarily a medical tool used to objectify maternal/fetal bodies and generate knowledge about the “viability” (and potential non-viability) of a pregnancy… However, this article also extends existing studies by illustrating that in the context of abortion care, the repertoire of ultrasound as medical objectification can become actively enrolled in projects of fetal de-personification.”VISUAL: WindowtotheWomb Gender scan at 16 weeks, 3 days – a girl! [sic]