The Regulatory Environment, Medical Practices and Experiences of Multifetal Pregnancy Reduction: A Comparative Case Study of Italy and Japan

My dissertation examines how the regulatory environment of abortion and medically assisted reproduction (MAR) shapes the practices and experiences of multifetal pregnancy reduction (MFPR), a procedure to eliminate one or more fetal lives in multiple pregnancies. As the incidence of multiple pregnancy is significantly higher in MAR-induced pregnancies, MFPR is usually performed in the context of MAR, in which people intend to initiate pregnancy and achieve live birth; however, the procedure involves, at least partially, voluntary elimination of a fetal life.

Drawing on the literature of medical sociology and science and technology studies (STS), the study takes a comparative perspective on Italy and Japan. The two countries have responded to the issue of MAR-induced multiple pregnancies in two diverging ways. In Italy, the restrictive MAR legislation has limited measures to prevent multiple pregnancies during MAR treatments but made MFPR legal. In contrast, the Japan’s self-regulation of MAR by the professional associations has focused on preventing multiple pregnancies while leaving MFPR in a legal vacuum.

The study investigates how medical professionals and patients navigate ethical, legal and other sorts of dilemmas of MFPR against the regulatory backgrounds of each country. It pays particular attention to how the risks and benefits of each option are laid out, assessed, interpreted and negotiated during and outside of the consultation between the provider and the recipient, when they choose different methods of MAR and, in case of multiple gestation, make decisions about MFPR. The study employs in-depth interviews with gynaecologists, embryologists, psychologists and patients as well as their partners.

Using the case of MFPR, the study will add to social studies of reproduction. Existing studies have mostly investigated in a single reproductive event (e.g., abortion, infertility) in isolation. Yet, it is crucial to understand reproduction policies more holistically, that is, how regulation of one aspect of reproduction may affect another. Furthermore, this study will contribute to making the voices of MFPR patients heard and their difficult decision-making processes visible, which are crucial for regulatory choices.