Abortion. We need to talk about it. I know, sometimes it seems as if we talk of little else, so perhaps I should say we need to talk about it differently. Not as something we all agree is a bad thing about which we shake our heads sadly and then debate its precise degree of badness, preening ourselves on our judiciousness and moral seriousness as we argue about this or that restriction on this or that kind of woman. We need to talk about ending a pregnancy as a common, even normal, event in the reproductive lives of women—and not just modern American women either, but women throughout history and all over the world, from ancient Egypt to medieval Catholic Europe, from today’s sprawling cities to rural villages barely touched by modern ideas about women’s roles and rights. Abortion takes place in Canada and Greece and France, where it is legal, performed by medical professionals, and covered by national health insurance, and also in Kenya, Nicaragua, and the Philippines, where it is a crime and a woman who terminates a pregnancy takes her life in her hands. According to anthropologists, abortion is found in virtually every society, going back at least 4,000 years. American women had great numbers of abortions throughout our history, when it was legal and when it was not. Consider this: At the beginning of the nineteenth century effective birth control barely existed and in the 1870s it was criminalized— even mailing an informational pamphlet about contraceptive devices was against the law and remained so until 1936. Yet the average number of births per woman declined from around 7 in 1800 to around 3.5 in 1900 to just over 2 in 1930. How do you think that happened?
We need to see abortion as an urgent practical decision that is just as moral as the decision to have a child—indeed, sometimes more moral. Pro-choicers often say no one is “pro-abortion,” but what is so virtuous about adding another child to the ones you’re already overwhelmed by? Why do we make young women feel guilty for wanting to feel ready for motherhood before they have a baby? Isn’t it a good thing that women think carefully about what it means to bring a child into this world—what, for example, it means to the children she already has? We tend to think of abortion as anti-child and anti-motherhood. In media iconography, it’s the fetus versus the coat hanger: that is, abortion kills an “unborn baby,” but banning it makes women injure themselves. Actually, abortion is part of being a mother and of caring for children, because part of caring for children is knowing when it’s not a good idea to bring them into the world.
We need to put abortion back into its context, which is the lives and bodies of women, but also the lives of men, and families, and the children those women already have or will have. Since nearly 1 in 5 American women end their childbearing years without having borne a child (compared with 1 in 10 in the 1970s), we need to acknowledge that motherhood is not for everyone; there are other ways of living a useful, happy life.
We need to talk about abortion in its full human setting: sex and sexuality, love, violence, privilege, class, race, school and work, men, the scarcity of excellent, respectful reproductive health care, and of realistic, accurate information about sex and reproduction. We need to talk about why there are so many unplanned and unwanted pregnancies—which means we need to talk about birth control, but also about so much more than that: about poverty and violence and family troubles, about sexual shyness and shame and ignorance and the lack of power so many women experience in bed and in their relationships with men. Why is it such a huge big deal to ask a man to wear a condom? Or for a man to do so without being asked? Why do so many women not realize they are pregnant until they are fifteen or twenty or even twenty-five weeks along, and what does that say about the extraordinary degree of vigilance we demand women exercise over their reproductive systems? And speaking of that vigilance, what about the fact that some 16 percent of women, according to a Brown University study, have experienced reproductive coercion in at least one relationship— a male partner who used threats or violence to control a woman’s contraception or pregnancy outcomes—with a remarkable 9 percent experiencing “birth control sabotage,” a male partner who disposed of her pills, poked holes in condoms, or prevented her from getting contraception. One-third of the women reporting reproductive coercion also reported partner abuse in the same relationship. Behind America’s high rate of unintended pregnancy—almost half of all pregnancies—and high rates of abortion lies a world of hurt.
We need to talk about the scarcity of resources for single mothers and even for two-parent families, and the extraordinary, contradictory demands we make upon young girls to be simultaneously sexually alluring and withholding: hot virgins. We need to talk about blood and mess and periods and pregnancy and childbirth and what women go through to bring new life into the world and whether deep in our hearts we believe that those bodies mean women were put on Earth to serve and sacrifice and suffer in a way that men are not. Because when we talk about abortion as a bad thing, and worry that there’s too much of it, sometimes we mean there’s too much unwanted pregnancy and that women and men need more and better sex education and birth control, and sometimes we mean there’s too much poverty, especially for children and their mothers, but a lot of the time we mean a woman should have a good cry, and then do the right thing and have the baby. She can always put it up for adoption, can’t she, like Juno in the movie? And that is close to saying that a woman can have no needs, desires, purpose, or calling so compelling and so important that she should not set it aside in an instant, because of a stray sperm.
Abortion has been legal across the United States for more than four decades. More than a million abortions are performed every year—some 55 million since 1973, when Roe v. Wade became the law of the land. A few facts: By menopause, 3 in 10 American women will have terminated at least one pregnancy; about half of all US women who have an abortion have already had a prior abortion; excluding miscarriages, 21 percent of pregnancies end in abortion. Contrary to the popular stereotype of abortion-seeking women as promiscuous teenagers or child-hating professionals, around 6 in 10 women who have abortions are already mothers. And 7 in 10 are poor or low-income. Abortion, in other words, is part of the fabric of American life, and yet it is arguably more stigmatized than it was when Roe was decided. Of the seven Supreme Court justices who made up the majority in Roe, five were nominated by a Republican president. These men were hardly radicals: Potter Stewart, nominated by President Eisenhower, had dissented in the court’s 1965 landmark decision, Griswold v. Connecticut, which struck down that state’s ban on the sale or use of contraceptives even by married couples; in two separate decisions he upheld prayer and Bible readings in public schools. Warren Burger, Richard Nixon’s choice for Chief Justice, went on to rule in favor of laws criminalizing “sodomy” in Bowers v. Hardwick (1986) on the grounds that historically homosexuality had been viewed as heinous and wrong. What made these staid, gray-haired gentlemen permit abortion virtually on demand in the first six months of pregnancy?
To understand that, we have to see what those men saw. In the law, they were witnessing a rapid evolution toward increased personal freedom, and in particular increased freedom for women: These were the years when feminism was a true grassroots movement, one that achieved remarkable success in a very short time, knocking down hundreds of laws and regulations, challenging centuries of tradition and custom, and expanding women’s rights and opportunities in almost every area of life. Ten million women were taking birth-control pills, and two-thirds of all Catholic women were using some form of contraception. Women were pouring into colleges and the workforce. The year before the Roe decision, the Senate had passed the Equal Rights Amendment and sent it to the states for ratification.
In tandem with these huge social shifts, elite views were changing on abortion. Doctors had helped criminalize abortions after the Civil War as part of their effort to professionalize medicine by marginalizing midwives and lay healers. Now significant numbers of them saw abortion bans as a constraint on their right to care for their patients: Barring malpractice, there was no other circumstance in which a doctor had to defend his professional decisions as a matter of law. There had always been a little wiggle room in state abortion laws, because doctors were still permitted to perform them for “therapeutic” reasons—to save a woman’s life, for example. But what did that mean, exactly? An amicus curiae brief in Roe from the American College of Obstetricians and Gynecologists and several other medical groups observed that “a woman suffering from heart disease, diabetes or cancer whose pregnancy worsens the underlying pathology may be denied a medically indicated therapeutic abortion under the statute because death is not certain.” Meanwhile, the definition of “therapeutic” was being quietly expanded—for women with money, connections, and luck. Certain psychiatrists were willing to bend the rules by certifying abortion-seeking patients as mentally ill or suicidal (of course, you had to pay them for this service, and know how to find them in the first place). Beginning in the late 1940s, hospitals in many states set up abortion committees to which a woman seeking to terminate her pregnancy could appeal. It was a humiliating process, which could involve multiple physical examinations and interrogations by unsympathetic doctors. For some women, the price of an abortion was sterilization. But it meant that some small fraction of middle-class white girls and women were able to obtain legal abortions, especially if they happened to be related to one of the doctors on the committee.
As a matter of public discussion, abortion was coming out of the shadows. In 1962, Sherri Chessen Finkbine was granted a legal abortion because she had taken Thalidomide, a sleeping medication her husband had brought back from a trip to Europe that, she belatedly discovered, had resulted in the births of thousands of babies with disastrous deformities. When the abortion was canceled after a newspaper article about her situation created an uproar, Finkbine publicly went to Sweden and terminated her pregnancy there. Her story was featured on the cover of Life magazine and helped break the silence around abortion. But it did more than that. It presented an abortion-seeking woman as sympathetic, rational, and capable. Finkbine was not a college student or low-income single mother to be either pitied as a victim or scorned as a slut. She was a white, middle-class married mother of four, well known as Miss Sherri on the local version of Romper Room, a popular children’s television show. In the early 1960s, epidemics of rubella, which is linked to birth defects, had the same effect: Americans had to listen to respectable white women unapologetically demanding the right to end their pregnancies. At the same time, Americans had to face the fact that illegal abortion was already common.
The more exceptions there were to the criminalization of abortion, the more glaringly unfair and hypocritical the whole system was seen to be. By the time Roe came to the court, well-off, savvy women could flock to New York or several other states where laws had been relaxed and get a safe, legal termination; poor women, trapped in states that banned abortion, bore the brunt of harm from illegal procedures. There was a racial angle, too: Not only did women of color, then as now, have far more abortions than whites in proportion to their numbers, they were much more likely to be injured or die in botched illegal procedures. According to the Centers for Disease Con- trol and Prevention, from 1972 to 1974, the mortality rate due to illegal abortion for nonwhite women was 12 times that for white women. The injustice of a patchwork system, in which a simple medical procedure could leave a woman dead or in- jured based purely on where it took place, was obvious.
Women were speaking up, too, about their abortions. In 1969 feminists invaded and disrupted the New York state legis- lature’s “expert hearing” on abortion (the experts consisted of fourteen men and a nun). Women talked about ending their pregnancies in public speak-outs. In 1972 the first issue of Ms. magazine carried a statement headlined “We Have Had Abor- tions” that was signed by more than fifty prominent women, including Gloria Steinem, Nora Ephron, Billie Jean King, Lee Grant, and Lillian Hellman. In Chicago, the Jane Collective began by connecting women with an illegal provider and ended up performing abortions themselves. And if you assume the churches were united against abortion, think again: Begin- ning in 1967, the Clergy Consultation Service founded by the Rev. Howard R. Moody, a Baptist, along with Lawrence Lader, Arlene Carmen, and others, helped thousands of women across the country find their way to safe illegal abortions. In the years leading up to Roe, legalization of abortion under at least some circumstances was endorsed by the Union for Reform Judaism, the Southern Baptist Convention, the National Asso- ciation of Evangelicals, the United Methodist Church, the Presbyterian Church USA, the Episcopal Church, and other mainstream denominations.
Because so much of this history has been forgotten—what, the Southern Baptists supported legalization?—we tend to see Roe as a bolt out of the blue. But to the Supreme Court—and to the public, a majority of which supported liberalization—the ruling ratified and expanded social changes that were already under way. At the time, what its supporters saw as its chief effect was to transform an operation that was commonplace, criminal and sometimes extremely dangerous into an operation that was commonplace, legal, remarkably safe—and becoming ever safer: “Deaths from legal abortion declined fivefold between 1973 and 1985 (from 3.3 deaths to 0.4 deaths per 100,000 procedures),” reported the American Medical Association’s Council on Scientific Affairs, reflecting increased physician education and skills, improvements in medical technology, and, notably, the earlier termination of pregnancy. The mortality rate for childbirth from 1979 to 1985 was more than ten times higher than that from abortion in the same period.
Today the real-life harms Roe was intended to rectify have receded from memory. Few doctors remember the hospital wards filled with injured and infected women. The coat-hanger symbol seems as exotic as the rack and thumbscrew, a relic waved by gray-haired “radical feminists,” even as anti-abortion advocates use rare examples of injury and death to paint all abortions as unsafe. They seized on the horrifying case of Dr. Kermit Gosnell, who ran a filthy Philadelphia “clinic” where a teenage girl administered anesthesia, a patient died and others were injured, fetuses were aborted well into the third trimester, and the ones who survived had their spines “snipped.” You wouldn’t know from their reporting that what Gosnell was doing was completely against the law; he was found guilty of three acts of first-degree murder on May 13, 2013. Using deceptively edited secretly videoed encounters, abortion opponents tar all abortion clinics as inhumane “mills” staffed by callous, greedy people—transferring the century-old taint of the criminal “abortionist” to legitimate providers. Yet paradoxically, abortion opponents deny that when abortion was illegal it was both widespread and sometimes (though not always) dangerous. Look, they say, in 1960, Mary Steichen Calderone, medical director of Planned Parenthood, herself said there had been “only 260 deaths” in 1957. (They don’t mention that she also said it was likely that there were one million abortions a year—almost as many as today, in a much smaller population— and this was in the supposedly staid and moral 1950s, before the sexual revolution or the women’s movement.) Years ago I debated a leader of Massachusetts for Life who pooh-poohed the health risks of recriminalizing abortion: Thanks to suction machines and antibiotics (which illegal providers would all have access to) illegal procedures would be reasonably nonfatal. So there it is. Legal abortion: very dangerous. Illegal abortion: remarkably safe!
For many years after Roe, abortion opponents talked a lot about the need to overturn the decision, and worked hard to elect officials who would install anti-abortion justices on the Supreme Court. So far, they have not seen that dream realized. But they have been shockingly successful in making abortion hard to get in much of the nation. Between 2011 and 2013, states enacted 205 new restrictions—more than in the previous ten years: waiting periods, inaccurate scripts that doctors must read to patients (abortion causes breast cancer, mental illness, suicide), bans on state Medicaid payments, restrictions on insurance coverage, and parental notification and consent laws. In Ohio, lawmakers have taken money from TANF, the welfare program that supports poor families, and given it to so-called crisis pregnancy centers (CPCs) whose mission is to discourage pregnant women from having abortions. (That’s right: Embryos and fetuses deserve government support, not the actual, living children they may become.) Twenty-seven states have passed laws forcing clinics into expensive and unnecessary renovations and burdening them with medical regula- tions intended to make them impossible to staff. Largely as a result, between 2011 and 2013 at least 73 clinics closed or stopped performing abortions. When these laws have been challenged in court, judges have set aside some of them, but not all. The result: In 2000, according to the Guttmacher Institute, around one-third of American women of reproductive age lived in states hostile to abortion rights, one-third lived in states that supported abortion rights, and one-third lived in states with a middle position. As of 2011, more than half of women lived in hostile states. Middle-ground states, such as North Carolina, Ohio, and Wisconsin, have moved in an anti-choice direction. Only twenty-three states could be said to have a strong commitment to abortion rights. In 2013, only one state, California, made abortion easier to obtain.
What this means is that although abortion has been legal for four full decades, for many women in America it might as well not be. It is inaccessible—too far away, too expensive to pay for out of pocket, and too encumbered by restrictions and regulations and humiliations, many of which might not seem to be one of those “undue burdens” the Supreme Court has ruled are impermissible curbs on a woman’s ability to terminate a pregnancy, but which, taken together, do place abortion out of reach. It would be nice to believe that no woman is deterred from an act so crucial to her future by having to wait a mere twenty-four hours between state-mandated counseling and the actual procedure, but what if the waiting period means two long round trips from your rural home to a distant city while trying to juggle work and child care, and because the clinic has to fly in a doctor from out of state, the twenty-four hours actually means a week, and that puts the woman into the second trimester but the clinic only does abortions through twelve weeks? What about the teenage girls who must tell their parents in order to get an abortion and can’t bear to do so until it’s too late? (Thirty-eight states currently require parental involvement in a minor’s decision to have an abortion.) What about low-income women who live in one of the thirty-three states without Medicaid abortion coverage? What if, while she is putting together the $500 for a first-trimester abortion, a low-income woman goes over into the second trimester, and now the abortion costs $1,000? It is as if a woman has a right to vote, but the polling place is across the state and casting a ballot costs two weeks’ pay, and as if she has a right to be a Jew or a Muslim or a Buddhist, but her place of worship is a four-hour bus ride away, and before she can go to services she has to listen to a fundamentalist Christian sermon warning her that if she doesn’t accept Jesus as her personal savior she’s going straight to hell. We would never accept the kinds of restrictions on our other constitutional rights that we have allowed to hamper the right to end a pregnancy.
How has this happened?
One answer is that the Republican Party, home base of the organized anti-abortion-rights movement, has won a lot of elections. The midterm elections in 2010 were crucial: The GOP won the House of Representatives and, even more important, in twenty states it had “trifectas”—control of both statehouses and the governorship. By 2013 it had twenty-four. Democrats, by contrast had only fourteen. (It’s important to note that not all Democratic politicians are pro-choice, especially in red states. In 2014, Louisiana’s bill that requires doctors at abortion clinics to have hospital admitting privileges, a measure that could close three out of the state’s five clinics, was written by a Democrat, Katrina Jackson.)
But there’s a deeper, more troubling answer. The self- described pro-life movement may not represent a numerical majority—only 7 to 20 percent of Americans tell pollsters they want to ban abortion—but what it lacks in numbers it makes up for in intensity, dedication, cohesion, and savvy. It is the closest thing we have right now to a mass social movement. It works in multiple ways at once—through its own organizations, electoral politics, abstinence-only sex education in the public schools, the Catholic and fundamentalist/evangelical churches, public protests like the annual March for Life in Washington, DC, and “sidewalk counseling” in front of clinics. It reaches all the way from a terrorist fringe that it regularly disowns but that has very effectively discouraged doctors from performing abortions to popular radio and TV haranguers like Bill O’Reilly and Rush Limbaugh to respectable journals like National Review and the Weekly Standard. Indeed, it is hard to think of American conservatism today without its opposition to abortion. You would never know that Ayn Rand and Barry Goldwater were pro-choice, and that in 1967, the governor of California, Ronald Reagan, signed what was then the most liberal abortion law in the nation. Some of this hostility to abortion is surely for political reasons: Right-wing Christians vote. But the fact that opposition to abortion is de rigueur even for mainstream Republicans like Mitt Romney shows the movement’s power.
The anti-abortion movement has made abortion a lot harder to get in many states, but even more important, it has reframed the issue. It has placed the zygote/embryo/fetus at the moral center, while relegating women and their rights to the periphery. Over time, it has altered the way we talk about abortion and the way many people feel about it, even if they remain pro-choice. It has made abortion seem risky, when in fact it is remarkably safe—twelve to fourteen times safer than the alter- native, which is continued pregnancy and childbirth. It has made people think the abortion of viable fetuses happens all the time when in fact it is illegal in most states except for serious medical reasons, and happens very rarely: According to the Guttmacher Institute, only 1.5 percent of abortions occur after twenty weeks’ gestation. (The Supreme Court has said twenty-four weeks is the threshold of viability.) It has made practices that are virtually unknown in the United States, like sex-selective abortions, seem routine and clinics like Dr. Gosnell’s seem typical.
Most of all, abortion opponents have made ending a pregnancy shameful, even for women who don’t believe a fertilized egg or a lentil-sized embryo is a child. It is hard now to believe, or even remember, that for a brief moment in the 1970s (let alone when abortion was an illegal but common practice), it was permissible not to consider your abortion a personal tragedy and failure. You were not automatically a callous, superficial person if you felt nothing but relief that you were no longer pregnant, and you were not a monster if you said so.
Nowadays, we take it for granted that having an abortion is a sorrowful, troubling, even traumatic experience, involving much ambivalence and emotional struggle, even though studies and surveys consistently tell us it usually is not. Even pro-choicers use negative language: Hillary Clinton called abortion “a sad, even tragic choice to many, many women.” True as far as it goes, but you’ll notice she didn’t add, “and for many others, a blessing and a lifesaver.” For decades, the Democratic Party mantra has been “safe, legal, and rare,” with the accent on the rare. Among hardcore opponents, the language is completely over the top: Abortion is a Holocaust, providers are Nazis, the womb is the most dangerous place on Earth for a child, the Democratic Party is the Party of Death.
As long as abortion has been legal, pro-choice activists have complained that abortion opponents have stolen the language of morality and used it to twist public opinion. Who can be against “life,” after all? Or responsibility, family, babies, motherhood? But it’s not just opponents who paint abortion as awful and tormented. Pro-choicers do so too.
We may roll our eyes when abortion opponents contrast the anguish of abortion with the joys of unwanted babies, and the selfishness of women who end their pregnancies with the nobility of women who keep theirs whatever the difficulty, but over time it seeps in. So defensive has the pro-choice community become since the 1970s, when activists proudly defended “abortion on demand and without apology,” that in 2013 Planned Parenthood announced that it was moving away from the term “pro-choice,” which was itself a bit of a euphemism: Choose what? In mass-media messaging you’re likely to hear about “defending Roe,” even though only 62 percent of Americans (and only 44 percent of those under thirty) know what Roe is. When abortion opponents at the Susan G. Komen Foundation canceled its grants in 2012, Planned Parenthood’s response emphasized that “More than 90 percent of Planned Parenthood health care is preventive, including lifesaving cancer screenings, birth control, prevention and treatment of STDs, breast health services, Pap tests, and sexual health education and information.” True, this cautious approach won the day—Komen was forced to restore the grants, and the anti-choice faction left the organization. But was there no room for Planned Parenthood to add, “Yes, we perform abortions, and we are proud to offer that service to women who make the decision not to bear a child at that time, because abortion is a normal part of health care”?
It’s not just our leaders and spokespeople at major organizations who unwittingly participate in what’s been rather uneuphoniously called the “awfulization” of abortion. Anywhere you look or listen, you find pro-choicers falling over themselves to use words like “thorny,” “vexed,” “complex,” and “difficult.” How often have you heard abortion described as “the hardest decision” or “the most painful choice” a woman ever makes, as if every single woman who gets pregnant by accident seriously considers having a baby, only a few weeks earlier the furthest thing from her mind and for very good reason? Or more accurately, as if every accidentally pregnant woman really should seriously consider having that baby—and if she doesn’t at least claim she thought long and hard about it and only reluctantly and sadly realized it was impossible, she’s a bad woman who thinks only of her own pleasure and convenience.