28 SEPTEMBER 1974, Page 4


Sir: John Linklater (Spectator, September 21) is quibbling if he thinks there is any moral difference between abdominal hysterotomy (*min i-Cesarian'), which may result in short-lived extra-uterine fetal survival, and other types of abortion, performed before fetal viability.

Dr Linklater observes: "some 10,000 larger babies are being aborted annually by Cesarian Section", which he equates with the Lane Report's "large fetuses which had reached the stage of legal (or actual) viability". He confuses the fact that, strictly speaking, abdominal hysterotomy is only necessary to perform very late abortions, with the fact that fetal viability supervenes rather late in pregnancy. The passage of twenty-eight weeks since last menstrual period (LMP) entails a legal presumption of fetal viability; premature babies born earlier than that have been known to survive under intensive care; but certainly no fetus born under twenty weeks since LMP (halfway through a full-term pregnancy) is currently viable (although the time may come!)

Thus although 11,768 (22 per cent), 12,681 (15 per cent), 10,960 (9 per cent) and 7,986 (5 per cent) abdominal hysterotomies were performed in England and Wales in the years 1969, 1970. 1971 and 1972, respectively, the corresponding numbers and proportions of abortions performed after nineteen weeks since LMP were 1,421 (2.6 per cent), 1,093 (1.3per cent), 1,160 (0.9per cent) and 1,206 (0.8 per cent). I do not wish to minimise the distress occasioned by even such less frequent events. Dr Linklater and I would at least 'agree that, from the pregnant woman's point-of-view, abdominal hysterotomY is a barbaric practice. Although this operation represented only 11 per cent of all legal abortions performed in England and Wales in 1968-72, it was associated with about 40 per cent of the notified deaths. And in 1970, 1971, and 1972, 75 per cent of abdominal hysterotomies were accompanied by sterilisation: 35 per cent, 38 per cent and 40 per cent of abdominal hysterotorriies were performed before thirteen weeks since LMP, when (but for sterilisation) much safer techniques are available.

Philip Kestelman 10 Carston Close, London SE12