Wednesday, October 26, 2011

The Limits of Abortion as a Health Issue

Earlier this year we had a blogswarm for world health day "Abortion is a Health Issue Not a Crime."  I never finished my post, partly because I am have deep reservations about "Abortion is a Health Issue" (which is what the post ended up being about).  I'm posting it today as part of a week of pro-choice posts in the run up to the release of NZ's abortion statistics on the 28th.  I'm posting three posts this week, and I realised they have a theme - the importance of keeping "Trust women, and all pregnant people"* at the centre of any struggle for any abortion rights.


In 2004, a woman in New Zealand was told she was not allowed in abortion when she was diagnosed with a heart condition in the 21st week. She was told it was too late in the pregnancy and that she did not meet the criteria. She died after the baby was still-born.  Of course access to abortion is a health issue - women die when they don't have access to abortion. Abortion is a health issue, because women die when they don't have access to safe abortion.

But abortion is not only a health issue or even mostly a health issue.  Abortion is about autonomy, freedom, survival and social relationships.  The slogan "Abortion is a Health Issue" suggests a strategy which narrows the lens and focuses our struggle for abortion away from these wider issues.  Now I'm uncomfortable about this because autonomy is the core of why I support abortion rights.  But on top of that I think this strategy may have fish hooks - the discourse of 'health' may not be as useful for us as it first appears.

First off, abortion as a health issue appears to be an area where anti-abortion people are actively taking the abortion struggle. Incrementalism - the anti-abortion tactic of making things just a little bit worse -  is based on a facade of treating abortion as a health issue.  Whether it's 'informed consent' (those are heavily sarcastic scare quotes in case you can't tell) or states putting in ridiculous regulations about the height of the ceilings in the abortion clinic.  Anti-abortionists are actively interested in fighting abortion as a health issue.

On one level this is quite a strange position for anti-abortionists to take - because the science is really heavily not on their side. The only reason they manage to even engage with health is they take conveniently ignore that by the time someone is seeking an abortion they are choosing between continuing pregnancy and abortion - and abortion is safer than bringing a pregnancy to term.

I may think that anti-abortionists are have to be some combination of: lying, deluded, misogynists, who are incapable of argument, reason, empathy, compassion or logic.  But they have a goal, and there has to be a reason they do the things that they do (besdies the fact that they're lying, deluded, misogynists, who are incapable of argument, reason, empathy, compassion or logic).  There are some areas that they deliberately try to avoid: the reality of women's experiences, women's autonomy, and who should be the decision-maker.  They know these are losing strategies for them and they will just say 'but what about the baby' to try and distract from the fact that they don't want to talk about any of these things.

But they are prepared to talk about health? Why is that?

By talking about abortion and health we're bringing in a discourse that already exists, and those discourses can serve anti-abortionists purposes as much as ours.  Take their incrementalist demand for parental notification/consent for under 16 year olds.  At the moment abortion is treated as exceptional within the health system.  For other medical decisions children are legally treated as unable to consent, and parents have to give their consent.  Those who are trying to punish young girls, can use normal health practice and rhetoric about involving the family, and parents' responsibility for children's health to support their cause.**

The existing discourse about health serve anti-abortionists purposes as much as they serve ours. They can play on the idea that 'health' means there is one right decision and that people are not well equipped to make decisions about their own health. Discourses of health in our society are not about autonomy and liberation. They are moral discourses that are based on an ideal way of being. In order to be healthy you must do some things (exercise, eat certain foods) and not do other things (smoke, eat other foods). In health discourses people are not treated as competent decision makers, but people who have to be persuaded to adopt a limited array of behaviours.

Women can go through the process of being certified as needing an abortion under the mental health provisions in this country, and not realise it, and not realise how restrictive the laws are. One of the reasons for this, is because we're so used to gatekeepers to get access to health procedures, diagnoses, and pharmaceuticals, that talking to so many doctors seems normal.

The existing models and meanings for health are not the sort of abortion services I am fighting for. As Anna Caro points out: "The whole way our medical system’s set up seems antithetical to anyone’s autonomy." The slogan of last year's pro-choice demo was 'No More Jumping Through Hoops'. But for many people jumping through hoops is part of engaging with the medical system (The End is Naenae has an example of how much work, and how many gate keepers there can be to get what you need. Amanda W has a great post on second shift for the sick).

There were many brilliant posts written as part of the blogswarm. I think talking about abortion and health is a really important way of connecting with some people we need to connect to.  But focusing on abortion and health is an incredibly risk strategy.  I wished we lived in a world where discourses of health were always discourses of autonomy and liberation - but we don't. So we have to always keep the autonomy and liberation of women (and all pregnant people) at the centre of our demands around abortion.

* 'Women, and all pregnant people' is a phrase I'm trying out. I'm struggling to talk about abortion in a way that acknowledges that not all people who get pregnant identify as women and also acknowledges that the politics of abortion are about misogyny and the struggle for freedom of women as a class.  I welcome ideas and feedback

** I think there are two answers to that - .  The first is that children should have control over their own health care before the age of 16 and the law in general should change.  And the second is that abortion is specifically different from other health care.  However, I think this demonstrates the problem of trying to argue abortion as a health issue.  Either you are also trying to change the nature of the health system - or you're also arguing that abortion should be treated differently.


  1. I like "women and all pregnant people'.

  2. "I may think that anti-abortionists are have to be some combination of: lying, deluded, misigoynists, who are incapable of argument, reason, empathy, compassion, or logic"
    That is a pretty strong insult. I take it you don't know personally as friends any pro-lifers. I sugest you should as it might change your opinions.

    I could argue that pro-choicers are incapable of empathy as they show no empathy for the fetus/unborn. I agree on occasion pro-lifers may appear to lack empathy, but if you hold their view the women must undergo some suffering so that the fetus/unborn can live, not having no empathy whatsoever with women.

    A 2009 UMR poll showed 45% of New Zealanders morally disaprove of abortion (link ). Now not all 45% may fit into what you consider "anti-abortionists" and want it illegal, but it does raise the question as to what portion of New Zealands population would be considered "incapable of argument, reason, empathy, compassion or logic"