The Medical Right Falls Hard for Ultrasounds -- At the Expense of Women's Health

You've already met the Religious Right. Now meet its offspring, the Medical Right -- ideologically motivated pseudo-medical organizations that are shaping reproductive health care policy and practice to conform to their unscientific beliefs about "the beginning of life."

The Religious Coalition for Reproductive Choice has been tracking these organizations on our online Medical Right Watch. Our latest report -- "UltraLove: The Medical Right Falls Hard for Ultrasound, Despite Lack of Evidence" -- describes the anti-abortion movement's multimillion-dollar immersion into the non-medical use of ultrasound equipment and questions the ethics of using medical diagnostic technology to persuade women to continue a pregnancy. Lost in the craze for non-medical ultrasound imagery is the potential risk to the developing fetus and the impact on vulnerable pregnant women, who are largely left to fend for themselves in sorting out potential health threats, the sufficiency of the exams, and their own personal needs.

The "Fetal Photo" Craze

To get a sense of the "fetal photo" craze, look at the mammoth right-wing "family values" organization, Focus on the Family. It began its Option Ultrasound Program in 2004, investing $4.2 million in a single year to pay for training and ultrasound equipment for crisis pregnancy centers. As of December 2007, the program manager reported that 363 ultrasound machines had been placed in centers and trainings held in 48 states. The National Institute of Family & Life Advocates in Virginia, a Medical Right organization, collected $731,000 in 2006 to provide training and counseling to crisis pregnancy centers that are adding ultrasound equipment. Heartbeat International, which claims 1,100 affiliates, says 460 of its affiliates are now equipped with ultrasound capability.

Anti-abortion advocates for the non-medical use of ultrasound imaging (also called sonography or sonograms) on pregnant women have two basic strategies. One is to equip the estimated 2,500-3,500 crisis pregnancy centers across the country with ultrasound machines, in some cases garnering government aid to pay for them. The other is to pass laws under the guise of "informed consent," which would require abortion clinics and doctors to conduct ultrasounds on pregnant women before providing abortion services. Some of these proposed laws go so far as to require that women view the images.

So-called crisis pregnancy centers offer free sonograms as bait to draw women into their office and claim that ultrasound images are highly effective in dissuading women from abortion. Focus on the Family claims that "research shows" that 89 percent of women considering abortion change their minds after having an ultrasound and counseling at a crisis pregnancy center. Other claims rely upon anecdotal stories, reprinted in anti-abortion literature, of women at crisis pregnancy centers who change their minds when they see the ultrasound. These stories and statistics have no scientific basis or support. No reliable study has measured the effect of ultrasound on a woman's decision whether or not to bear a child, according to a search of academic and medical literature and inquiries to research organizations, including The Guttmacher Institute. In fact, the opposite may be the case. Reports from abortion clinics indicate that women who have an ultrasound do not change their minds about having the procedure.

Medical Consequences of Ultrasound Imaging

Although ultrasound imaging is generally considered safe and is important in dating pregnancy (especially in a medication or "pill" abortion regimen using RU-486 or Mifeprex), determining the position of the fetus and whether there are multiple fetuses, ectopic pregnancy or fetal abnormalities, there are risks. The professional organization for sonography, The American Institute of Ultrasound in Medicine (AIUM), rejects non-diagnostic uses as does the U.S. Food and Drug Administration, which regulates the equipment, although no action has been taken against crisis pregnancy centers and there is little evidence of regulatory oversight.

In objecting to the purchase of ultrasound equipment by actor Tom Cruise for personal use in monitoring partner Katie Holmes' pregnancy, the AIUM reaffirmed its statement of "prudent use" that "strongly discourages the non-medical use of ultrasound for psychosocial or entertainment purposes. The use of either two-dimensional (2D) or three-dimensional (3D) ultrasound to only view the fetus, obtain a picture of the fetus, or determine the fetal gender without a medication indication is inappropriate and contrary to responsible medical practice." The statement, published in the January 2006 "Sound Waves," was endorsed by the American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine, and several other medical organizations.

AIUM also opposed the operation of portrait studios that make "keepsake" fetal sonograms. In 2004, the FDA warned against the "keepsake" non-medical uses of fetal ultrasound, calling it "risky business." "Expectant women and their families need to know that the long-term effects of repeated ultrasound exposures on the fetus are not fully known. In light of all that remains unknown, having a prenatal ultrasound for non-medical reasons is not a good idea," according to the FDA magazine.

Harm from excessive fetal exposure to ultrasound or at high frequencies has been the subject of some laboratory studies. In 2004, the FDA noted that fetal ultrasound scanning is considered safe, but "can't be considered completely innocuous." The FDA wrote: "(U)ltrasound is a form of energy, and even at low levels, laboratory studies have shown it can produce physical effects in tissue, such as jarring vibrations and a rise in temperature." A study released in 2006 found disruption of the normal migration of brain cells in fetal mice, which, if it occurred in humans, could potentially cause autism, mental retardation, epilepsy and learning disabilities. Additionally, studies of humans exposed to ultrasound have shown possible adverse effects in growth retardation, dyslexia, delayed speech development.

Even Focus on the Family's aggressively anti-abortion Physicians Resource Council issued a statement on the use of Doppler ultrasound in the first trimester in 2005, cautioning that it should only be used in "a case in which the mother is considering the option of abortion but might be more inclined to choose life after hearing the sound of the fetal heart."

Who's Administering the Sonography?

Another concern arises from the operation of fetal sonography by untrained or inexperienced operators who fail to diagnose or inform a woman about a serious condition. "Failure to diagnose" a fetal sonogram leads to a large number of medical malpractice claims. While the NIFLA advises pregnancy centers that ultrasound can be performed only by trained personnel and by a doctor's recommendation, first-hand accounts by crisis pregnancy center workers indicate that physicians may be distant participants in the process, if involved at all. A first-hand story carried online by Heartlink, the Focus on the Family ultrasound website, describes a center in which an impatient woman sought an ultrasound. The story describes how a sonographer extended herself to come from home to do it. "The sonographer never knows what she'll see when she does a scan ... This window into her womb showed her a darling little 14 week, 1 day old, bouncing, dancing baby," the article reports. Nowhere in the piece is the slightest indication of a doctor ordering the ultrasound or interpreting it.

Aside from liability issues, a survey published in the Journal of Ultrasound Medicine highlighted another potential problem: patients who forgo medical and diagnostic ultrasounds because they have had a non-medical ultrasound. A majority of those surveyed -- obstetricians and radiologists in Maine -- found this to be a worry. Majorities also believed that non-medical ultrasounds might leave fetal anomalies undetected and give patients false reassurances. More than one-third believed that licensing boards should discipline those conducting the non-medical ultrasounds.

With these concerns, why does the Medical Right staunchly support ultrasound technology for non-medical uses? At its core, ultrasound relies on the same fetal imagery that has roiled the anti-abortion community from the outset - whether "The Silent Scream" or giant fetus posters hoisted outside abortion clinics. In this high-tech culture, the Medical Right hopes that ultrasound will be the digital magical potion that will end abortion, but their premises, ethics and evidence are distinctly un-sound.

For the complete report, "UltraLove: Medical Right Falls Hard for Ultrasound, Despite Lack of Evidence," visit the Religious Coalition for Reproductive Choice's Medical Right Watch.

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