Women in the English National Health Service facing pre-viability second trimester pregnancy loss through foetal death, premature labour or termination of pregnancy for foetal anomaly find themselves in a particular trajectory of care. This usually involves the requirement to labour and birth the foetal body and may involve undergoing feticide in cases of termination. Drawing on ethnographic research investigating women's experiences of second trimester pregnancy loss, I argue that the determining factor affecting care trajectories for the pregnant body is the biomedically diagnosed status of the foetal body. Foetal size, non-viability and the potential for live birth during terminations all structure the healthcare options for the woman facing pregnancy loss in the second trimester. As such, the diagnostic classification of the foetal body in the context of gestational time determines the medical care afforded to the pregnant body. This results in specific consequences for women, whose experiences of, and choices around, second trimester pregnancy loss are constrained by diagnostic and classificatory decisions around the status of the foetal being before legal viability.
In English law, the conventional view is that human personhood is produced by live birth, kinship is produced by relations between persons, and corpses are produced on the death of persons, which are then buried or cremated. Beings produced by human pregnancy which do not fit these discursive categories are classified as 'pregnancy remains', have no personhood or kinship, and their disposal is regulated as human tissue. However, this paper argues that the governance of the dead, born, foetal body in England, in fact, produces forms of foetal personhood, through the regulation of the material dead bodies of foetuses and babies. Furthermore, the assignment of responsibility for disposal and post-mortem decisions to kin of the dead foetal being also produces a relational form of foetal personhood. The examination of second-trimester pregnancy loss in England through fieldwork with women who have experienced foetal death, premature labour, and termination for foetal anomaly before 24 weeks' gestation reveals how governance of the dead, born, foetal body in England is incoherent.It also illustrates the effects of this incoherence on parental choices about the range of actions available after pregnancy loss in relation to the material body of the foetal being or baby.
The article extends Robson and Walter’s concept of hierarchies of loss by describing further factors which afford differential social legitimacy to death-related losses. Drawing on our separate research with women in England who have experienced pre-viability pregnancy loss through different types of miscarriage and termination for foetal anomaly, we note that closeness of relationship to the object of loss does hierarchise pregnancy loss. However, other relational elements are also implicated, including ontological positions on what it was which was lost, in relation to other individually and socially experienced losses. Hierarchies are both imposed and agentially used by those who are implicated. This wider analysis extends the concept of hierarchies of loss so it can include experiences which do and do not involve grief and bereavement, and experiences of social recognition alongside those where loss is disenfranchised, marginalised, or ungrievable.
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