May 20, 2002 Maternal health expert faults proposal to redefine 'child' to include unborn fetuses By Jennifer McNulty UCSC sociologist Monica J. Casper, an expert in maternal health issues, is taking issue with a proposal making its way through the Bush administration to redefine "child" to include unborn fetuses. Monica J. Casper suggests addressing the health needs of pregnant women rather than expanding insurance coverage to include "unborn children." Photo: r.r. jones The proposal would permit states to make fetuses eligible for medical coverage under their State Children's Health Insurance Program (SCHIP). By seeking to expand coverage to "unborn children" and not their mothers, the change has the potential to pit the health interests of fetuses against pregnant women, according to Casper, an associate professor of sociology at UCSC. "Fetuses are not separate people. They are part of pregnant women's bodies," said Casper, author of The Making of the Unborn Patient: A Social Anatomy of Fetal Surgery. "The best way to guarantee the health of fetuses and newborns is to expand prenatal care by providing health insurance to all women." The proposal provides no funds to expand coverage to embryos and fetuses, Casper noted. Under existing rules, states cover pregnant women over 18 under Medicaid and SCHIP. Casper and other opponents also fear the change will inflame the abortion-rights debate. "If the administration is serious about insuring healthy fetuses and newborns, it needs to do so by addressing the health needs of pregnant women regardless of age or income level, not by trying to redefine unborn fetuses as patients independent of their mothers," said Casper, who hopes to help educate the public about the risks of the policy change. Health and Human Services Secretary Tommy Thompson announced the proposal on January 31 of this year, highlighting advances in the field of "fetal medicine" as justification for the change. A leading expert on fetal surgery, Casper didn't need a crystal ball to predict that this still largely experimental technology would one day take center stage in the discussion of women's reproductive freedom. Fetal surgery is used to remove tumors and to correct life-threatening structural defects and abnormalities. It involves opening a pregnant woman's uterus, partially removing the fetus to correct an abnormality, and returning the fetus to the womb until delivery. Only a handful of hospitals are experimenting with fetal surgery, though proponents believe it could become a more routine treatment for some maladies. Casper's research at one of the hospitals pioneering fetal surgery, however, uncovered a fetal mortality rate that averaged about 60 percent and could exceed 85 percent for some procedures. Of those who survived, the infants typically arrived early, required additional treatment after birth, and many still faced lingering impairment. "Fetal surgery is no miracle," said Casper. "It's enormously risky for the fetus and the mother. To portray it as a medical miracle vastly overrates the record." In a letter to the Department of Health and Human Services, Casper and Lynn M. Morgan, professor of anthropology at Mount Holyoke College, write that the department's proposal "casually and blindly overstates the chances that treatments and surgeries performed on fetuses will result in successful outcomes." Most private insurers have opted not to cover fetal surgery because outcomes are usually no better than therapies performed after birth, they noted, and the surgery is very expensive. "It is inappropriate and indeed ignorant to base a major public health policy on a controversial and as yet unproven procedure that poses significant risks to pregnant women and their fetuses," wrote Casper and Morgan. Critics have further questioned apparent inconsistencies in federal policy that the proposal represents. Among them, the National Advocates for Pregnant Women (NAPW) asserts the proposal marks "a major shift in government policy regarding experimental medical procedures." "Fetal surgery is still considered experimental," said National Advocates for Pregnant Women executive director Lynn M. Paltrow. "And since the federal government has a long-standing policy of denying coverage for experimental treatments under Medicaid, the implication that the SCHIP expansion would cover fetal surgery either indicates a radical shift in policy, or it is deliberately misleading." Advocates have embraced fetal surgery as "pro-life." Casper believes the risks of fetal surgery are being downplayed in an ideological effort to help establish the fetus as a person and a patient independent of the mother. Casper's letter was submitted along with scores of comments from doctors, academics, activists, public health advocates, and women's organizations. The deadline for comment was May 6. All comments will be reviewed prior to approval or rejection of the proposed change in SCHIP regulations. Return to Front Page