Issue link: https://maltatoday.uberflip.com/i/1318996
3 LETTERS & EDITORIAL maltatoday | SUNDAY • 13 DECEMBER 2020 Mikiel Galea Letters & Clarifications Outdated research cited THIS newspaper has provided me with ample space to air my views as a pro- choice doctor so it is entirely reasonable for Louisa Houlton (6 December, 2020), a psychologist by profession, to ex- pound her own opposing views. I must however take her to task for citing outdated research that ascribes neurological function to the foetus in the first half of pregnancy. I quote from research presented by the Royal College of Obstetricians and Gynaecol- ogists titled 'Fetal Awareness: Review of Research and Recommendations for Practice' [1]: "In reviewing the neuroanatomical and physiological evidence in the foe- tus, it was apparent that connections from the periphery to the cortex are not intact before 24 weeks of gestation and, as most neuroscientists believe that the cortex is necessary for pain perception, it can be concluded that the foetus can- not experience pain in any sense prior to this gestation. After 24 weeks there is continuing development and elabora- tion of intracortical networks such that noxious stimuli in newborn preterm infants produce cortical responses. Such connections to the cortex are necessary for pain experience but not sufficient, as experience of external stimuli requires consciousness. Furthermore, there is in- creasing evidence that the foetus never experiences a state of true wakefulness in utero and is kept, by the presence of its chemical environment, in a con- tinuous sleep-like unconsciousness or sedation. This state can suppress higher cortical activation in the presence of intrusive external stimuli. This observa- tion highlights the important differenc- es between fetal and neonatal life and the difficulties of extrapolating from observations made in newborn preterm infants to the foetus." On one point we do agree: prenatal stress affects newborns in ways we are only now beginning to understand. I wonder if your readers would care to walk for just one day in the shoes of a woman who finds herself pregnant, perhaps in a domestic violence situa- tion, or without the financial means to support her extended family, or perhaps a migrant, or having been given the dreadful news that her fetus has a fatal abnormality. Can you imagine how much stress that would cause? No, Ms Houlton, in Malta we do not universally provide "good healthy sex- ual education for all". Schools in Malta promote abstinence as pregnancy pre- vention, when there is overwhelming evidence of its lack of efficacy. Neither is contraception free nor consistently available. Moreover, some pharmacists cite conscientious objection to dispensing emergency contraception, and renege on their duty of care to refer women appropriately. Malta is an island where a woman who makes a decision based on her own needs, regardless of her personal rea- sons for doing so, as well as anyone who helps her, may face criminal proceed- ings, and the latter, if a medical doctor, may also end up having their license revoked. Notwithstanding what most middle aged, mostly male (as well as a smatter- ing of medical doctors) may believe, I would never impose my personal pro- choice beliefs on others. What gives you the right to impose your anti-choice beliefs on all residents in Malta? [1] Royal College of Obstetricians and Gynaecologists. (2010). Fetal Awareness: Review of Research and Recommenda- tions for Practice. [Online]. Available: https://www.rcog.org.uk/en/guide- lines-research-services/guidelines/fetal- awareness---review-of-research-and-rec- ommendations-for-practice/ Prof. Isabel Stabile FRCOG., Ph.D St Julian's