Determinants of Ethical Concern With Multifetal Pregnancy Reduction Among U.S. Women of Reproductive Age [17G

Abstract

INTRODUCTION: Multifetal pregnancy reduction (MFPR) is recognized by the American College of Obstetricians and Gynecologists and the American Society of Reproductive Medicine to be a challenging ethical decision. This study explores the determinants of ethical concern with MFPR among U.S. women of reproductive age. METHODS: Data were obtained from the National Survey of Fertility Barriers (Wave 1, 2004-2007), a random digit dialing telephone survey of 4,794 women aged 25-50. Logistic regression was performed to determine the relationship between ethical concern with MFPR and religion, obstetric history, history of infertility, and history of infertility treatments. RESULTS: Only 14.7% of respondents had no ethical concerns with MFPR, while 44.3% expressed serious concerns. Serious ethical concerns were less likely among women with a history of abortion (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.31-0.58) or with no religious affiliation (OR 0.47, 95% CI 0.31-0.70). Serious ethical concerns were more common among women with a history of multiple gestation (OR 3.30, 95% CI 1.44-7.56) or who attend a weekly religious service (OR 1.55, 95% CI 1.16-2.08). After adjustment, religiosity remained a significant determinant of having serious ethical concern with MFPR (OR 1.18, 95% CI 1.12-1.24). History of infertility and its treatment had no significant association with ethical concerns about MFPR. CONCLUSION: A majority of U.S. women have ethical concerns with MFPR. While religiosity is a significant determinant of this concern, infertility and infertility treatments are not. The overall high level of ethical concern with MFPR underscores the importance of minimizing multiple gestations during infertility treatment.