Ever since an anti-abortion group released a series of sting videos targeting Planned Parenthood's fetal donation practices last summer, the little-known area of fetal tissue research has been thrust into the national spotlight. The highly edited videos allege that the women's health organization illegally sells aborted fetuses for profit. Planned Parenthood responded by saying that it is standard practice to seek reimbursement for costs associated with fetal tissue donation, and that neither the organization nor the patient benefits financially from it. The videos caused a frenzy among anti-abortion Republican lawmakers — including Sen. Ted Cruz, who said the videos were proof that Planned Parenthood was "selling baby parts" — and fueled a federal effort to defund the organization. However, eight states have declined to investigate Planned Parenthood due to lack of evidence of any wrongdoing, 12 state investigations have turned up nothing, and one grand jury even indicted the creators of the deceptive videos.

But fetal tissue research is still under attack. Republicans have launched a special House Committee to probe those who conduct fetal tissue research, which abortion rights activists and university officials say could threaten the lives of researchers, graduate students, administrative and support staff, and health-care providers at institutions that research or work with fetal tissue. Scientists and researchers have been procuring and studying fetal tissue for years. Though it may sound like an obscure area of science, you've probably been affected by the products of fetal tissue research in some way during your lifetime. As the government continues to debate the merits of this area of research, here are 12 things you should know:

1. Human fetal tissue comes from aborted fetuses. A human embryo becomes a fetus nine weeks after conception (the 11th week of pregnancy). For scientific purposes, human fetal tissue or organs can be acquired from either a miscarriage (which is called a spontaneous abortion), an ectopic pregnancy, or an induced abortion. But according to a Congressional Research Service reporton fetal tissue, fetal tissue from induced abortions is preferred for medical research. Spontaneous abortions and ectopic pregnancies are often unpredictable and can pose serious health risks to a woman, so "fetal tissue collected under these circumstances is often not suitable for research purposes."

2. Fetal tissue is hard to replace in research. Researchers use fetal tissue for a variety of reasons. They produce cell cultures from the tissue that can be stored in laboratories for long periods of time. According to the CRS report, these "[c]ultured cells mimic many of the properties that they have in a living body, and therefore can be used as a model for researchers studying basic biological processes." Carrie Wolinetz, the associate director for science policy at the National Institutes of Health, explained why fetal tissue is so useful to scientists and researchers in a December article in Nature. "Fetal tissue is a flexible, less-differentiated tissue," she said. "It grows readily and adapts to new environments, allowing researchers to study basic biology or use it as a tool in a way that can't be replicated with adult tissue."

This tissue can't simply be replaced by a computer model or simulation program either. "If we want to study a process, it's best to study the real thing," Johns Hopkins University School of Medicine professor Akhilesh Pandey told the Baltimore Sun. He has used fetal tissue to study cancer for more than a decade. "Models can be insufficient in mimicking what we want to study. Even today we don't understand all the biological processes. We can make a little bit of skin in the lab or cartilage, but not organs. For that, there is more complicated interplay."

3. Fetal tissue has been used in medical research since the 1930s. Though it's causing a stir today, human fetal tissue research has been a staple in the medical and scientific community for almost 100 years, and "virtually every person in this country has benefited" from its research, wrote Alta Charo, a leading bioethicist and professor of law and bioethics at the Wisconsin School of Law and School of Medicine & Public Health, in the New England Journal of Medicine. "Every child who's been spared the risks and misery of chickenpox, rubella, or polio can thank the Nobel Prize recipients and other scientists who used such tissue in research yielding the vaccines that protect us (and give even the unvaccinated the benefit of herd immunity). This work has been going on for nearly a century, and the vaccines it produced have been in use nearly as long."

4. It continues to play a critical role in research today. Renate Myles, chief of the National Institute of Health's news media branch, told Cosmopolitan.com via email that human fetal tissue "continues to have an essential role in the pursuit of a vaccine for Ebola and new therapeutics for HIV/AIDS." Myles adds that it is "also a critical resource for researchers studying retinal degeneration, pregnancy loss, human development disorders such Down syndrome, and early brain development, with relevance to autism and schizophrenia." In fact, new fetal tissue research recently revealed information about the Zika virus that is considered a public health emergency by the World Health Organization. Little is known about the virus, and restrictions on fetal tissue research may interfere with learning about the disease.

5. Researchers get fetal tissue from several places: abortion providers, tissue banks, or a company supplier. Some researchers acquire fetal tissue from "abortion clinics at their own institutions, or from tissue banks maintained by some universities," reports the New York Times, and "[m]any buy the tissue from companies that act as middlemen." Despite what the controversy generated by the videos suggests, Nature reports that only a "handful of [Planned Parenthood] clinics in two states supply fetal tissue for research," and the Times reports that abortion providers are paid "small fees" — which providers say are reimbursement costs —for fetal tissue specimens. In response to the controversy, however, Planned Parenthood stopped seeking reimbursement for fetal tissue in the few offices where it was collected.

The companies that process the tissue then sell it to researchers for higher prices, sometimes charging up to thousands of dollars for a vial. But even this is not illegal. The founder of one major fetal tissue supplier told the Times that the increased prices reflect the high costs associated with extracting cells or tissue, storing them, and shipping them. StemExpress founder Cate Dyer said that isolating certain fetal cells can "take millions of dollars of equipment" and can cost "thousands of dollars" without a guarantee that it will work. However, the Times also notes that the suppliers "exist in a gray zone, legally," as "[f]ederal law says they cannot profit from the tissue itself, but the law does not specify how much they can charge for processing and shipping."

6. The federal government has supported the use of fetal tissue for medical research for decades. The National Institute of Health has supported fetal tissue research since the 1950s. In 2014, the National Institute of Health funded grants and projects for human fetal tissue research up to $76 million to more than 50 universities, including Harvard, Stanford, and MIT.

7. There are numerous restrictions on federal funding of human fetal tissue used in research. After abortion was legalized in 1973, there was a national debate on the ethics of fetal tissue donation and use in research. The government appointed a committee to assess the ethics of collecting and donating fetal tissue, which led to regulations that said that patients cannot be offered money or compensation to undergo an abortion and ensured that researchers "will have no part in any decisions as to the timing, method, or procedures used to terminate a pregnancy."

In 1993, President Bill Clinton signed the NIH Revitalization Act into law, which also made it illegal to profit from the sale, purchase, or transfer of human fetal tissue used for transplants. The law does, however, allow for reasonable payments for the reimbursement of costs associated with the "transportation, implantation, processing, preservation, quality control, or storage of human fetal tissue." The law also requires that a woman consent to an abortion before she can be asked about fetal tissue donation, and she has no say in how the tissue will be used once donated. While Clinton's regulations apply only to federally funded fetal tissue transplant research, Charo explained that "most clinics and most researchers try to follow the same federal rule, even when it is not required, because it has kind of become a standardized practice."

8. Most states have laws regulating fetal tissue donation. Every state has adopted its own version of the Uniform Anatomical Gift Act, a framework created in 1968 to regulate the donation of human tissue, organs, and body parts. According to a report by the Guttmacher Policy Review, 38 states and Washington, D.C., have "UAGA laws that explicitly treat fetal tissue the same way as other human tissue, permitting it to be donated by the woman for research, therapy or education." The UAGA laws in 12 remaining states don't have language specific to fetal tissue, "neither allowing nor disallowing the donation of fetal tissue." In addition to the UAGA, the Guttmacher report says that some states have specific statutes in line with federal guidelines that prohibit profiting from sale and procurement of fetal tissue or require patient consent before donation.

9. A growing number of states are curbing the ability to use donated fetal tissue for research — and some have outright banned the donation of fetal tissue. Several states — including a handful in which the UAGA explicitly allows for fetal tissue donation — have banned fetal tissue research. This means that even fetal tissue legally donated from abortions cannot be used for medical research. And according to the Guttmacher Institute, amid the furor over Planned Parenthood, five states —  South Dakota, Indiana, Florida, Idaho and Arizona — have declared an outright ban on fetal tissue donation this year, becoming "the first [laws] to ever ban the donation of fetal tissue." According to Guttmacher director of public policy Heather Boonstra, the new donation bans supersede any existing UAGA laws that may have allowed fetal tissue donation. In South Dakota, conducting fetal tissue research is now considered a felony, and Indiana's ban on fetal tissue donation requires that aborted fetuses be cremated or buried. In total, Guttmacher says that eight states now have laws that ban fetal tissue donation and/or ban fetal tissue research. 

These laws are a preview of what's to come. Guttmacher reports that similar bans have passed in at least one chamber of four other states, and since the Planned Parenthood videos emerged, 28 states have introduced legislation targeting fetal tissue research.

10. The anti-abortion debate has stalled fetal tissue research before. After Roe v. Wage legalized abortion in 1973, the Guttmacher Policy Reportnotes, "antiabortion leaders in Congress seized on fetal tissue research as a weapon in the war against abortion." The debate led to a temporary moratorium on federal funding of fetal tissue research until a bioethics committee laid out some ethical guidelines about fetal tissue used in federally funded research. The moratorium was lifted in 1975 and the use of fetal tissue in the research community flourished until 1988, when the Reagan administration put a moratorium on all federal funding of fetal tissue transplant research. A bipartisan ethics commission was again set up to decide on the ethics of fetal tissue transplantation. This commission concluded that using fetal tissue from aborted human fetuses was ethical. However, Reagan went against the commission's recommendations and continued the moratorium. Private funding continued and so "the work went on, it just went on more slowly, and went on, of course, in other countries," Charo explained. President Clinton signed an executive order lifting the moratorium in 1993.

11. Several anti-abortion conservatives previously supported fetal tissue research. Though they now oppose fetal tissue research, Sen. Leader Mitch McConnell; Reps. Lamar Smith, R-Texas, Fred Upton, R-Mich.; and former Sen. Rick Santorum, R-Pa., all voted to lift the moratorium on fetal tissue research in the 1990s. MSNBC notes that then-Republican minority leader former Sen. Bob Dole "even declared during the 1992 debate that lifting a ban on such research 'is the true pro-life position.'"

12. The current attacks on fetal tissue research pose a serious threat to medical breakthroughs around the world. Many researchers are seeing a steep drop in fetal tissue supply, have suspended their research entirely, or, as in the case of Brigham and Women's Hospital in Boston, "no longer accepts applications from researchers seeking fetal tissue from abortions performed there," reports the New York Times. Dr. Arthur Caplan, head of the Division of Medical Ethics at New York University's Langone Medical Center, told Nature that the abortion controversy "absolutely puts fetal tissue research at risk" because it deters young scientists from entering a field "where funding is uncertain and physical threats are a real possibility." The American Congress of Obstetricians and Gynecologists is distressed by Congress's ongoing investigation into fetal tissue researchers and procurement companies. In a statement condemning the hearings, the organization wrote: "Unfortunately, some state and federal politicians are working hard to obstruct — or even criminalize — fetal tissue research, limiting the ability of America's leading scientists and researchers to develop new vaccines and medicines to prevent and treat disease." If politicians continue to interfere with this research, the ACOG warns that "fetal tissue research bans will stymie U.S.-based medical progress, leaving us to rely on other countries to develop medicines for our own patients." 

This article has been updated to clarify why fetal tissue supply companies may increase prices when selling tissue. 

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Prachi Gupta

Prachi Gupta is an award-winning journalist and former senior reporter at Jezebel. She won a Writers Guild Award for her investigative essay “Stories About My Brother.” Her work was featured in The Best American Magazine Writing 2021 and has appeared in The Atlantic, The Washington Post Magazine, Marie Claire, Salon, Elle, and elsewhere. PrachiGupta lives in New York City.