The far-stretching reach of Mississippi's personhood amendment

On 8 November the Mississippi electorate voted against an amendment to the Bill of Rights in their state Constitution which would have redefined life as beginning at the moment of fertilisation — the so-called 'personhood amendment' (Proposition 26).

In short, Proposition 26 sought the redefinition of person so as 'to include every human being from the moment of fertilisation, cloning or the functional equivalent thereof' (1).

While many media sources have labelled the proposal the 'anti-abortion' amendment, the consequence of redefining personhood from the moment of fertilisation stretched far beyond the arena of abortion, and well into the area of reproductive health and assisted reproduction.

Several forms of birth control have mechanisms of action which inhibit the implantation of a fertilised egg onto the lining of the uterus, such as the intrauterine device, the morning after pill, the progesterone-only 'mini-pill' and even traditional contraceptive pills (where one mechanism of action is the alteration of the uterus lining and inhibition of implantation of any fertilised egg following breakthrough ovulation).

The personhood amendment would have outlawed any of these contraceptive methods within the state of Mississippi. This would have happened within a state which currently has the highest number of teen pregnancies and unplanned pregnancies in the country (2). Moreover, there was no indication that appropriate concurrent public health programmes or advocacy work would have been introduced to address the obvious ramifications of the amendment.

Furthermore, IVF techniques are far from efficient: not only do very few embryos implant, the procedure most often produces more than one fertilised egg. Thus, the amendment would have restricted the freezing of fertilised eggs for future use and the destruction of any unused fertilised eggs.

The consequences of this in terms of limiting stem cell and reproductive research are also clear: if a fertilised egg is granted the status and protection of personhood, then there can be no research carried out on the egg or its constituent parts.

Several commentators (3) have raised the interesting question of what would happen in the situation of natural miscarriages (an all too common and distressing aspect of pregnancy) — would the women in those circumstances have to undergo investigation to ensure that there was no foul play at work following the loss of life?

As the amendment was voted down by a majority of 58 percent to 42 percent, one may ask why the story is still of interest. The reason is two-fold: (i) some believe that had the vote passed, it would have reopened a national-level discussion on abortion, and (ii) the proposed amendment to the Mississippi law is just one such proposal, support for the same amendment is currently being sought in at least 14 other US states.

While proponents of the amendment argued that it would not affect any medical care outside of abortion, the vague wording of the amendment (reflected in the division it caused amongst the normally united conservative anti-abortion camp) and basic scientific knowledge of IVF procedures and stem cell research would clearly suggest otherwise.

At least two national medical organisations produced statements in response to Proposition 26. The American Society for Reproduction Medicine spoke in support of the outcome, praising the people of Mississippi for not accepting 'this dangerous measure that would have endangered access to reproductive health care' (4).

'[Proposition 26] has wide-reaching implications that will impact access to women's health, including treatment for cancer, infertility treatment, birth control options, and pregnancy termination', wrote the American Congress of Obstetricians and Gynaecologists in a more lengthy statement. 'This proposal unnecessarily exposes women to serious health risks and significantly undermines the relationship between physicians and our patients' (5).

State-by-state proposals of this nature will act to widen the already disparate access to reproductive health care in the US, as well as severely limiting associated research. While the amendment may not have passed this November in this particular state, it will be interesting to see whether the US Government acts now to open national legislative discussion surrounding the implications of the personhood initiatives and pre-emptively safeguard reproductive health and assisted reproduction technologies and research.