Multiple pregnancy, fetal reduction and selective termination.

The avoidance of twin or higher-order multiple pregnancies is in the best interest of families, medical practitioners and health services, given the health hazards and costs associated with higher-order multiples. This commentary explores the background to and ideas in the paper by Legendre et al., (2013), which makes the case for separate consideration of the various issues around selective termination of a multiple pregnancy and fetal reduction. The exploration does so mainly within the context of UK law and practice, but has international relevance. The responsibilities of health professionals for putting many of these women in the difficult position of having to make a decision about selective termination or fetal reduction is critically reviewed. The imperative must be for health professionals to reduce the need for women to have to make these difficult choices. In these circumstances, I argue that the differences in motivation and emotional burden between the two situations may be less clear cut, and are less salient, in practice than Legendre et al. conclude from their theoretical approach to the issues.