Pediatric Group Decries Outdated Double Standard on Fetal Pain

By Randall K. O’Bannon, Ph.D. NRL Director of Education &Research

Editor’s note. This appears in the March digital edition of National Right to Life News. Please share this editorial—and all of the remainder of the content in this 42-page issue with your family and friends. If they are not currently receiving  the monthly NRL News and/or the Monday through Saturday National Right to Life News Today, they can sign up for both at one time at

“Medicine’s double standard of acknowledging pain capability in wanted premature babies while denying it in unwanted unborn babies of the same gestational age is unconscionable”–Conclusion of American College of Pediatricians statement

Science has been uncovering more and more evidence of the ability of unborn children to experience pain but has anyone in the medical establishment been listening?  A statement issued this past January shows that the doctors who are a part of the American College of Pediatricians (ACPeds) have been.

After examining the recent evidence, “ACPeds advocates the need for in-utero, neonatal, and pediatric pain prevention, mitigation, and treatment. Medicine’s double standard of acknowledging pain capability in wanted premature babies while denying it in unwanted unborn babies of the same gestational age is unconscionable.”

ACPeds acknowledges that there have been some in the past who have argued that children under the age of two are “neurologically immature” and thus incapable of fully experiencing pain. Those denying the pain of unborn children or neonates argue this requires both a fully mature sensory and emotional or conscious capacity. But the ACPeds statement says such a test is no longer either scientifically or ethically tenable.

As recently at the late 1980s, as ACPeds points out, it was the consensus that babies, in the womb or even recently born, did not feel pain, so that surgical procedures on neonates were generally performed without anesthesia. 

But a “landmark”  paper published in the November 1987 issue of the New England Journal of Medicine  by KJ Anand of Harvard Medical School and PR Hickey challenged that assumption. * They wrote that these children had the necessary anatomical structures to transmit pain signals and displayed the physiological and behavioral responses that were clear indicators of experiencing pain and even remembering previous painful events.  

Based on their findings, Anand and Hickey recommended that these children be given local and general anesthesia during invasive procedures.

The science since that time has only confirmed and extended those insights. ** Stress hormone levels were shown to be elevated when unborn children at 18 weeks gestation (the statement does not make clear whether these are dates from fertilization or standard pregnancy dating from the mother’s last menstrual period) were stuck in the abdomen with needles for in-utero blood transfusions. 

Nociceptive responses (measurable anatomical and physiological responses of the body to hurtful stimuli) point to a much earlier experience of pain in developing unborn children. *** 

The ACPeds statement notes, “Relying on connections to the cortex for the existence of pain is also refuted by clinical evidence in adults suggesting that neither ablation nor stimulation of the primary somatosensory cortex alters pain perception.” The statement immediately adds that those who would rely upon full connection and cortical development for proof of the reality of early fetal pain ignore how infants with missing or minimal cortexes (anencephalic and hydranencephalic babies) react and respond when exposed to painful or consoling stimuli.

Which leads to this powerful conclusion: “Taken together, the findings of these studies suggest that definitions of pain which hinge on possessing a mature conscious capacity requiring cortical functioning and connectedness, are outdated.”

ACPeds says, “It is unethical to intentionally harm an innocent human being irrespective of the individual’s ability to perceive pain,” adding that now “a large body of scientific evidence demonstrates that painful or noxious stimulation adversely affects immature human beings, both before and after birth.”

You don’t have to be a pro-lifer for the ACPeds’ conclusion, stated earlier, to very much resonate with you, just an ordinary caring human being: “Medicine’s double standard of acknowledging pain capability in wanted premature babies while denying it in unwanted unborn babies of the same gestational age is unconscionable.” 


* Anand, KJS, Phil D, Hickey PR. Pain and its effects in the human neonate and fetus. NEJM. 1987; 317: 1321-1329.

** Some of this evidence is summarized and cited in National Right to Life’s fact sheet “Pain of the Unborn” found here:   

*** For more on this research, see the January 2020 NRL News.