It isn’t widely known, but a high proportion of human pregnancies end in miscarriage, also known as spontaneous abortion. The majority of these miscarriages occur very soon after pregnancy, often before the pregnancy is known, and for this reason, precise figures are difficult to obtain. Estimates for the rate of miscarriage vary widely, but many are in excess of 60%. These estimates are usually based on some very old studies, together with data obtained by observing in vitro fertilisations (IVF), which may not reflect what occurs in nature.

Let’s tentatively accept a 60% rate of miscarriage. What’s the main issue for the pro-life position? Many philosophers have pointed out that this means hundreds of millions of human beings are dying by miscarriage, and according to pro-lifers, these are all human beings with moral value equivalent to any adult. But these numbers are far in excess of any other cause of death. In fact about 56 million human beings die each year, while perhaps 200 million miscarriages occur. The question has been asked, why don’t pro-lifers care about this huge loss of human life? They are certainly concerned with preventing induced abortions, which account for far few human lives, about 56 million. But their lack of concern about the 200 million deaths from miscarriage seems to indicate they don’t really believe their own claims about the moral value of embryos and fetuses. In fact, their stance has been criticised as ‘morally monstrous’.

It’s an important question for pro-lifers to answer, and the PA and Daniel Rodger have just published a comprehensive reply in The New Bioethics entitled The Problem of Spontaneous Abortion: Is the Pro-Life Position Morally Monstrous?. I’ll summarise our response below. If you don’t have access to academic journals and would like a copy of this paper, please request it from here.

The underlying question is what moral obligation do pro-lifers have towards combating miscarriage, and how does this obligation compare to their obligation to oppose induced abortions. Certainly, on a pure numbers basis, there is a prima facie obligation to do something about miscarriage—it certainly seems to trump induced abortion in this regard. But we identify two important considerations that should influence our obligations:  the preventability of death and the moral badness of death. If deaths are not preventable, this reduces our obligation towards these deaths, and if certain deaths are morally worse than others, we should prioritise them.

Preventability of miscarriage

It is too simplistic to directly compare deaths by miscarriage to deaths by, say, cancer, or even induced abortion. Miscarriage is not a cause of death, but rather refers to all natural deaths prior to birth, irrespective of cause. It has a variety of underlying causes, and these must be examined to determine which are the most prevalent. The most common cause of miscarriage turns out to be chromosomal abnormalities, accounting for perhaps 70% of all miscarriages. These abnormalities are mostly aneuploidies, an abnormal number of chromosomes in cells, and they are rarely compatible with life. Aneuplodies cannot be prevented—this would require gene-editing of embryos, which is not currently possible.

There are a variety of other lesser causes of miscarriage, such as uterine abnormalities, thrombophilias, immunological and immunogenetic causes, and acute maternal infections. Certain lifestyle factors have been implicated in increasing the risk of miscarriage, including smoking, alcohol and caffeine consumption, and obesity, and finally increasing maternal age is also a factor.

Killing vs Letting Die

Some pro-lifers have claimed induced abortions are far morally worse than miscarriages, and that this justifies concentrating efforts on fighting induced abortion. The problem with this claim is that even if there is a moral distinction between deliberate killing (induced abortion) and letting someone die (miscarriage), it’s not clear that this matters. To explore this, let’s assume there is a moral difference—that it is far worse for someone to deliberately kill someone rather than letting them die, say by failing to rescue them. The issue for pro-lifers is that as far as they are concerned, it seems that induced abortions are also a case of letting die—they are not directly involved in killing themselves, and so they are bystanders with respect to induced abortions and miscarriages. Unless pro-lifers wish to make nebulous claims about induced abortions contributing to more evil in the world, it seems there is no good reason to prioritise opposing induced abortions over miscarriages on the grounds of moral evil.

Here Thomas Pogge sheds some light on the issue, stating that with regard to induced abortions ‘we are responsible for helping to bring these deaths about by participating in maintaining and enforcing a legal system that, by permitting abortions, foreseeably results in these extra deaths’ (Pogge 2010, p. 127). Citizens in the United States prior to 1860 were all responsible for laws permitting slavery, irrespective of whether they owned slaves themselves. Similarly, all citizens in a democracy permitting induced abortion bear some moral responsibility for these deaths. So if induced abortions are morally worse than miscarriages and all citizens bear some responsibility for them, this is a strong reason to oppose it.

In ethics, the killing vs letting die distinction is widely debated. Intuitively, most of us feel there is something worse about deliberate killing compared to allowing someone to die, but it is difficult to pin this down. Philosophers are very good at coming up with counter-examples to accounts of this difference. We take the approach of looking at a comparison that is as analogous as possible (on the pro-life view) to most induced abortions and miscarriages: the deliberate killing of a newborn baby who could be expected to live a normal life, and allowing a newborn with a fatal and incurable chromosomal disorder to die. It seems clear that letting the newborn die in this case may not be morally problematic at all, while killing a newborn baby is always gravely wrong. We conclude that similarly, it is far worse morally to deliberately kill a fetus than to fail to save it.

Conclusion

Even though the number of deaths are much higher for miscarriages than induced abortions, they both represent tens of millions of deaths of morally valuable human beings, according to the pro-life position. If we allow that our moral obligations with regard to these deaths are influenced by what can be done to prevent them, and that induced abortions are morally worse than miscarriages, then it seems reasonable for pro-lifers to concentrate on opposing induced abortions. If we consider prenatal deaths by preventable causes, induced abortion is by far the most preventable cause of death.

It is important, however, for pro-lifers not to ignore miscarriages. Although much medical research is dedicated towards the problem, the scale of deaths means the issue should be discussed widely in pro-life circles and consideration given to what might be done.