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Selective abortions hit the headlines

In the first case, reports early in the week that a 28 year old woman pregnant with twins was considering aborting one of them snowballed into a huge media storm. With one child already, the unmarried woman was said to be in "straitened circumstances" and felt she could manage one baby but not two. Antiabortion groups and well wishers pledged £60 000 to persuade her to keep the second twin, and the Society for the Protection of Unborn Children went to the High Court after the hospital involved, Queen Charlotte's in west London, refused to pass on the offers to her.

There is no legal right for a third party (or even the father of the child) to ask the courts to stop an abortion. But the prolife charity won a 24 hour injunction putting the abortion on hold, pending an application the following day for leave to apply for judicial review of the hospital's decision not to pass on the information. The case was dropped after the hospital was forced to admit, days after the story broke, that the abortion had taken place some time before.

The story started with a Sunday Express interview with the woman's obstetrician, Professor Philip Bennett of the Royal Postgraduate Medical School and Queen Charlotte's Hospital. Professor Bennett cited the case when asked about the most difficult ethical dilemma he had faced, but the report implied that the operation had yet to take place.

Jonathan Street, public relations consultant to North Thames regional office of the NHS Executive, said that the hospital had been concerned about confidentiality and had not wanted to involve the woman. "When the injunction was served, we had no option but to consult her." The woman was happy to confirm that the operation had taken place but did not want more details revealed.

Professor Kypros Nicolaides, head of fetal medicine at King's College Hospital and Medical School, said there was no question of the termination being done for social reasons. "The woman was thoroughly counselled by two consultants," he said.

The Human Fertilisation and Embryology Act 1990 clarified the law by specifically stating that selective reduction of pregnancy is permitted on the same grounds as an abortion which ends the pregnancy. Up to 24 weeks an abortion may be carried out if the risk to the physical or mental health of the mother or any existing child is greater if the pregnancy goes ahead than if it is terminated.

A twin pregnancy automatically carries a greater physical risk to the mother than a single one, and having two children to cope with instead of one could also pose a greater risk to her mental health.

The BMA's head of ethics, Vivienne Nathanson, said that reducing a twin pregnancy to a singleton one posed "no new ethical considerations."

Just as the story was winding down, the tale of Mandy Allwood, a 31 year old woman pregnant with eight fetuses, hit the headlines after her boyfriend released it to a Birmingham news agency. Last Sunday their exclusive story appeared in the News of the World, which has agreed to pay a reputed £100 000 provided that she has eight, or nearly eight, live babies.

Ms Allwood, who was having fertility treatment at a private clinic in the midlands, was given urofollitrophin and chorionic gonadotrophin but warned not to have sexual intercourse after she superovulated. Questions were raised as to why she was having the treatment when she not only had one child aged 5 but had since had an abortion and a miscarriage. Her boyfriend, Paul Hudson, does not live with her and spends several nights a week with his other girlfriend, with whom he has two children.

Ms Allwood has been referred to Professor Nicolaides, a leading expert on selective reduction, who advised her to have the number of fetuses reduced to two. But so far she has said she intends to try to deliver all eight babies.

Professor Nicolaides said: "There is a great risk that she will just miscarry. The only hope is that she will get to 26-30 weeks and then hopefully some of the babies will survive. But there will be a risk of handicap from prematurity. All of the complications of pregnancy are exponentially increased with an increasing number of fetuses." (See also p 374.)--CLARE DYER, legal correspondent, BMJ

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