It was the perfect ornament for Christmas, she thought — the photograph from the doctor of those little circles, those early cells dividing.
Tina Mody followed every moment when she became pregnant two years ago. The in vitro fertilization process meant she knew when the egg met the sperm, and when the cells implanted in her uterus. She tracked the morphology of the embryo, its size and shape, thrilled when all looked perfect.
This is my daughter, she thought. She named her Maya.
On her way to her 16-week pregnancy appointment, she started bleeding. She lost her beloved Maya in the emergency room. Then she had to have a surgical evacuation procedure to remove the placenta before she bled out.
“I can’t tell you exactly when I pinpoint the moment that I think Maya is a person,” said Mody, a pharmacist. “Because to me and my wife, we think so much of her as the hopes and the dreams that we want in this child.”
“To us, she is alive. She was alive,” she said.
The question of life and when it begins seems so much bigger than the fights she hears about it now in abortion politics, she said. Mody and her wife started a foundation, Maya’s Wings, to work to eliminate preventable pregnancy loss and improve health outcomes for mothers and babies. She also believes that individuals “have the right to choose, in discussion with their provider” whether to have an abortion.
“It really is a very personal decision on how we perceive life to begin. And that is really the crux of this debate we are having,” she said. “It is not black and white.”
America’s fight over abortion has long circled a question, one that is broad and without consensus:
When does life begin?
In the months since the Supreme Court overturned Roe v. Wade, it has become unavoidable, as activists and politicians try to squeeze concrete answers from an eternal question of human existence.
Lawmakers and judges from Arizona to South Carolina have been reviewing exactly which week of development during pregnancy the procedure should be allowed. Some states draw the line at conception, or six weeks or 15 or around 40. Many others point to viability, the time when a fetus can survive outside the uterus. The implication is that after the determined time, the developing embryo or fetus is a human with rights worth protecting.
Public opinion reflects the range and complexity of belief. Most Americans support the right to an abortion, but within limits, and they disagree on what those limits should be. But almost uniformly across gender, politics and religion, they believe that how long a woman has been pregnant should matter in determining whether the procedure is legal. Over half of American adults say the statement “human life begins at conception, so a fetus is a person with rights” describes their views at least somewhat well, according to the Pew Research Center.
The search for answers
The question of when life begins can be confusingly broad in what it is asking. In biological terms, when is an organism an organism? Or philosophically, what makes a human a person? And spiritually, what is the relationship between the body and soul?
Amander Clark, president-elect of the International Society for Stem Cell Research, has examined the question for years as a stem cell biologist.
The question is complicated, she said.
“From the biologist point of view, I’d need to say life of a mammalian organism begins at fertilization,” she said. “But if the question is, when is a human a human being, to me that is very different.”
For generations, the mystery of human life has been wrestled by philosophers and scientists, felt by mothers and midwives. Every culture and time has determined its own answers.
Ancient Chinese medicine spoke of two essences joining together, of mother and father, blood and semen, to generate a child who is intertwined with the mother until birth. Jewish communities have long pointed to life beginning with a baby’s first breath, recalling the Genesis story of God breathing the breath of life, or the soul, into the first man.
The Western perspective has been largely shaped by Christianity, a religion that was literally born from a pregnant woman who, as the biblical story goes, carried a divine child when an angel told her that was God’s plan. From the faith’s earliest days, many theologians have seen the soul as something God creates and puts into a body in utero, although they have differed on when, exactly, this “ensoulment” occurs.
Creation and biology
The scientific revolution, from Charles Darwin’s theory of evolution to reproductive science, disrupted centuries of thought on human life.
Nick Hopwood, a professor at the University of Cambridge, has spent years researching the history of reproduction. The question of when life begins may be inherited from the idea of ensoulment, and the idea that you can pinpoint a moment when that happens, but by the 20th century many biologists rejected the question as “not a good question,” he said.
“The egg is alive, the sperm is alive, the cells from which they develop are alive; it is a continuum,” he said. “There might be slightly more acceptance of the question ‘When does a life begin?’ And then different biologists might point to different stages.”
Scientific consensus around conception emerged in the 1870s, when a German scientist watched through a microscope as the nuclei of sea urchin sperm and egg fused. It was during this period that Pope Pius IX shifted the Catholic Church’s centuries-long view of a later fetal ensoulment to conception.
Popular discourse today often references “the moment” of conception, but fertilization is a complex biological process. A woman’s ovary releases an egg, which moves down the fallopian tube, a duct whose cells interact with incoming male sperm cells and change a sperm cell’s composition so it can fuse with the egg.
The cell begins to divide, and after several days it has become a ball of about 100 cells, of which a fraction give rise to the human embryo.
For about 14 days after conception, this growing group of cells can divide into separate entities, leading to twins or triplets. That possibility largely ends at implantation, when biochemical interactions allow the cells to attach to the wall of the uterus. Then, a specialized process called gastrulation begins, when the embryo cells begin to differentiate into systems to organize the body.
The discovery of DNA reshaped ideas about what made a person an individual. Fertilization, when a human gets its genome, has become a modern kind of ensoulment, said Scott Gilbert, professor emeritus of biology at Swarthmore College, a co-author of a prominent textbook on developmental biology.
“It is a creation story myth, it is an origin story,” he said. “The female myth, the myth of birth, is replaced by the male myth of fertilization.”
During fertilization, he said, the two cells’ membranes dissolve to share genetic material to create a one-cell entity called a zygote. In the process of natural development, scientists estimate that up to or around two-thirds of zygotes do not result in a live birth. Many fertilized eggs do not implant, and after that some pregnancies naturally fail.
Development is a progressive continuum as cells realize unique purposes, systems interact and body parts grow. Pivotal moments include fertilization, embryonic cell differentiation, or cardiac or brain activity. The entire process takes about 40 weeks, until birth. Key phases for heart development occur in the first few weeks, along the way and at the end. At birth, the baby’s first breath changes its cardiac anatomy.
For years in the United States, a focal point has been 23 or 24 weeks of development, called viability, when the fetus may be able to survive outside the uterus. Around the time of the Roe decision in the 1970s, available technology meant that viability was around 28 weeks.
What defines a person?
Dr. Brendan B. Mitchell is an obstetrician-gynecologist and the medical director for Advice and Aid Pregnancy Centers in Overland Park, Kansas, which opposes abortion and provides support for pregnant women.
He struggles with what he feels is inconsistency in how society values premature babies versus developing fetuses. Doctors work hard to save babies born at 23 or 24 weeks, and people spend millions of dollars to help patients born prematurely, he said, but in some places it is legal to terminate a pregnancy at that time.
“That point of viability is getting constantly pushed back,” he said. “What defines that person as a person or a life — is it what their parents think?”
In biology, scientists research how humans develop not as persons, but into independent organisms. There is less attention to what else is happening during that same 40-week period: the state of pregnancy.
Pregnancy is a woman “making a new organism with her body,” said Elselijn Kingma, a professor at the King’s College London who specializes in pregnancy through both science and philosophy.
It is a unique state where one organism grows, as part of itself, a fetus that will eventually detach and become its own, independent organism, she said. It is a state “where the other person can only exist by grace of the constant provision and nourishment of another,” she said.
It does not follow that a fetus is not an organism before birth or that a pregnant human should be allowed to treat the fetus as any other body part, Kingma said.
“That is just not a relationship we really have space for, like our law and our morality, they all assume that we have separate bodies,” she said. “That’s the really tricky question: What does morality demand? And then, what can the law enforce, and what can society demand, in that unique state of intertwinement?”
A social choice
The search for answers pushes past science. It is tied to a society’s values, a person’s sense of self and a cultural understanding of what it means to be human. Spiritual thinkers and philosophers say it requires social choice, and an interrogation of our ethics.
In the United States, there has long been a unique focus on the individual, and individual freedoms, often instead of the community or ecosystem. For the question of a new human life, that has led to an either/or priority on the pregnant woman or the developing baby.
“We think we are having a debate in the United States about when life begins, but we are not,” said Agustín Fuentes, an anthropologist at Princeton University. “We are having a debate about when society is going to decide that the person counts. And not only when the person counts, but which person counts more.”
As someone who studies biological societies and human evolution, he grows frustrated at the individual focus, which he sees as atypical for the human species.
“We should be asking questions about our community. What is best not for an individual but for a society, for mothers, for families, for communities,” he said.
If everyone agrees the ultimate goal is to maximize health, a different set of questions arises, he said.
“How do we create and foster the healthiest possible outcomes for individuals and for communities; it can’t just be either/or,” he said.
This article originally appeared in The New York Times.
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