Reproductive choice or reproductive justice?
For me,
it is more than a matter of semantics. “Choice” means something specific. As I
tried to explain in an earlier piece, personal, individual “choice” in
reproductive decision-making is something special and particular. It relates to
the matter of who can make a decision, which refers to the agency and autonomy
of individuals. When we talk about reproductive choices, we refer to the
private matters that each of us must be able to resolve for ourselves. This is
more than health, and extends even beyond equality and justice.
Perhaps
here in the UK, some of us feel the importance of reproductive choice because
none of us have ever known it. Regardless of our wealth, education, or
standing, none of us can have a legal abortion in Britain because we decide,
personally and for ourselves, that it is right.
British
abortion law and practice has never acknowledged
women’s reproductive choice. Our legislation was drafted in the 1960s to
create conditions under which abortion could be delivered safely and regulated
closely for the public good—that it should be a right
for women was not even discussed. (Law professor Sally Sheldon
documents this well in her 1997 book Beyond Control: Medical Power and
Abortion Law). Our parliament, courts, and medical professionals have
never accepted that women have the capacity to decide about abortion for
themselves at any stage in pregnancy. Instead the law offers a legal defense
for a doctor who decides an abortion is best for a woman’s health.
That
legacy of medical patronage remains today. Even now, an abortion is unlawful
unless two doctors certify “in good faith” that it meets grounds relating to a
woman’s health.
This
means we have a law that allows for the protection of the health of the
pregnant woman but denies her the right as a person to decide on her
own reproductive destiny. A doctor can agree to an abortion because the
woman’s health will be damaged by her pregnancy, but not because she simply
does not want a baby.
Our law
works for women because our doctors frame unwanted pregnancy as a medical
health issue. They say that denying an abortion is bad for mental health, or
that statistically birth is riskier than abortion. And of course this is true.
But any “pro-choice” doctor will tell you he or she finds this demeaning and
degrading.
“Choice”
cannot simply be folded into the fabric of health, because not all of the
choices we need to defend are those that accord with our views of
health—sometimes they are just about what people want.
It has
been argued that abortion is seldom a matter of choice; choices are never
“truly free,” but are shaped by circumstances. But consider this: A pregnant
woman who gets a prenatal Down syndrome diagnosis, is offered an abortion, and
is struggling to decide her pregnancy’s future may feel she has “no choice” as
to her decision. But she has a different sense of “no choice” than a woman
who literally has no choice, because such an abortion would be
illegal. The one thing worse than having to decide between two things you don’t
want is not being able to decide at all.
Jon
O’Brien of Catholics for Choice put it well when he explained how our
circumstances, our access to resources, give context to our decisions but do
not fix them for us:
Choice,
at its core, recognizes that oppression influences, but does not dictate, our
choices. By grounding itself in the idea that each person has a right to bodily
autonomy, to determine the course of his or her reproductive life regardless of
circumstance, choice respects individual conscience.
This is
important because not all women in the same circumstances will want the same
thing. It is important because the decisions that we make express what we feel
and who we are.
We, each
of us, make decisions according to our values, and this is
important to us. The decision a woman makes about not being able to bear
another child because it will impoverish her family may not feel like a
“choice,” but it is a decision of a different order to a decision by
her doctor that she cannot bear another child regardless of what she wants.
It matters who takes the decision. Agency is everything—even
when the outcome of the decision is the same. A woman who decides her poverty
means she must have an abortion is in a different situation than a woman who is
told she must have one. Society removes personal decisions from those who are
not competent to make them; when decisions about abortion are taken away from
women, the status of competent, rational adults is taken away too.
The value
that doctors accord to choice—that is, to woman’s autonomy—shapes the way we
are treated. When you value a woman’s choice, you respect her right to
make a decision you think is wrong, perhaps a less-than-healthy choice, but one
that is nevertheless hers and not yours. Here in the UK, we increasingly see
people’s choices narrowed because someone else decides what is right for them.
Emergency contraception is under-promoted and overpriced, lest women should
choose to rely on it too much. Regulatory guidance tells us that
women should leave our abortion clinics with a method of
contraception, regardless of what the woman wants.
Choice
does not necessarily have to be in a name. But it needs to be at the core of
our values, because respect for women’s capacity to decide really does matter.
For the
first time in decades, in the UK we are starting to engage a new generation
campaigning for choice. The notion that people should, and can, have the
freedom to make destiny-changing decisions for themselves is a very big idea.
It needs a very big voice, and we’re glad to hear Jodi Magee say Physicians for
Reproductive Health is still part of the choir.
This article was originally written by Ann Furedi, bpas Chief Executive, for RH Reality Check
