FWIW I had an abortion

The below text was written in the first few days of May 2022 immediately following the leaked Dobbs v. Jackson Supreme Court decision (which eventually overturned the 1973 Roe v. Wade decision).

A shortened version of this text was published with Journal of Medical Ethics Blog.

FWIW, I had an abortion last year. 

I was 30 years old, with a stable job, in a healthy committed relationship. It wasn’t a hard decision, and I don’t regret it (even remotely).

What was hard was the shame society tried to make me feel. From the mandatory 24-hour waiting period, to the forced ultrasound, to the protesters shouting at me, to my own father maintaining that abortions are always “sad”. I haven’t told him about mine. I know that telling him my story could help persuade him, but until now I’ve wanted to sway him on principle. 

The world has tried to make me feel like I was bad for choosing to end my pregnancy, but with Roe v. Wade and Planned Parenthood seeming to be destined to be overturned, I’m finally seeing that my story has a place in all of this.

I had a medical abortion. It should have been available to me from the comfort of my home. There is no medical reason I needed to be in a clinic. But I live in a place that has sought to decrease the number of abortions by making them harder to get. While the FDA has deemed it safe to prescribe medical abortions remotely, I live in one of 29 states that legally requires in-person visits for these services (per the Kaiser Family Foundation). So, in the middle of a pandemic, I spent  6 hours of a work day in a crowded clinic. 

The clinic I went to was the only one within an hour drive (it  would not have been reachable via any form of public transportation). The building was surrounded by 15-foot walls so that they women inside didn’t have to look at the constant presence of protesters. There are no windows in the clinic for this same reason. When I walked out of the clinic there was a person with a megaphone and a ladder shouting at me that I “didn’t have to do this”. The protesters surrounded the driveway both times I had to go to the clinic. I’m quite confident they are always there. The staff were clearly over-worked. Can you imagine going to work in that environment everyday? Everyday driving by the faces of people who scream at you that you’re a murderer? There is no doubt in my mind that the nurses and staff at that clinic are under-paid.

In contrast, across the street was a stunning new building with inviting floor to ceiling windows. It is not hidden behind any walls. There are no protestors outside. And had a large sign saying it is a “women’s center”. It is not, however, a healthcare facility. It is a “crisis pregnancy center” that uses manipulative tactics to convince pregnant persons out of getting abortions. The actual abortion clinic is hard to find – both their website and the worker on the phone repeatedly warned me not to mistakenly drive into the “women’s center” across the street – a mistake that had clearly been made by many people trying to visit the abortion clinic.

Everything about the abortion clinic seemed engineered to make me feel badly about being there.  

But how could I dare to get pregnant? Sex is not only enjoyable, but it is a meaningful way my partner and I connect to each other. I’m very grateful for my body, and the things it allows me to enjoy- hiking, rock climbing, biking, yoga, eating, and yes, sex. Sex comes with risks, but so do all of the activities I enjoy with my body. Reasonable risks are part of life. When I rock climb, I take reasonable precautions to prevent death or injury. Does that mean I’m guaranteed not to suffer unintended consequences? Certainly not. Does that mean that I’ll never climb “just for fun”? Certainly not. I know that there are risks to many of the activities I enjoy, and accidents happen.

That being said, I’m not, nor was I when I got pregnant, on any internal form of birth control. My partner and I use a combination of the calendar method and condoms to prevent pregnancy. I can hear the gasps of horror at *my* irresponsibility, but let me suggest that this moral outrage is misguided.  

I was on hormonal birth control for nearly 10 years. I never liked it, but I thought I had to do it. I thought that it was my job to ensure I didn’t conceive an unwanted child, so I had to subject my body to daily doses of hormones that changed my body and my moods. We’ve known about the link between mood changes and the pill since the original clinical trials reported the side effects included “crying spells” and “irritability” (Oreskes, 2019). These were not enough to suggest the pill might be unsafe, and it was found to successfully prevented pregnancy. So drug administrations across the globe approved the pill as “safe” and started prescribing it to millions and millions of women. To this day depression is the most common reason people give for discontinuing use of the pill (McDermott, 2016).

Despite the long history of reports of depression and mood changes associated with the pill, many still claim that we lack “hard data” to prove the connection (Oreskes, 2019). What is counted as “hard data” are things like diagnostic codes and prescription records, and what gets dismissed are the self-reports of millions of women worldwide collected over decades (Oreskes, 2019). I didn’t know any of that when, after a decade, I finally decided that I needed a break from the pill. The change in my energy levels and moods was so remarkable I can barely believe I lived like that for almost 10 years. I, for one, will never go back on the pill.

I’ve also tried non-hormonal IUDs. After a somewhat unpleasant insertion procedure, I expected my body to adjust to the new presence. It never did. For a full year of my life, I experienced continual mild discomfort, exacerbated by movement (especially twisting). The years of training in feminist philosophy were finally kicking in: Why in the name of preventing pregnancy was I putting my body through so much? Why was I expected to be in continual discomfort? I got my IUD removed. 

I wish I could boldly say I didn’t try again, but I got another IUD inserted a few months later. After three months of experiencing the same discomfort as I had previously, I again had my IUD removed. I will not try another internal form of birth control.

By the way, no form of birth control is perfect. Methods like implants and IUDs are 99% effective, while the commonly used birth control pills are around 91% effective, and condoms are around 85% effective (Planned Parenthood). There is always a risk of pregnancy with most heteronomrative penetrative sex. It is also worth mentioning that all reversible forms of birth control (such as implants, IUDs, birth control shots, and the pill) place the burden of pregnancy prevention entirely on the partner who has a uterus. I find the notion that sex is shared, while pregnancy prevention burdens only fall on one partner to be a degrading experience. I do not need to live my life in continual emotional distress or physical discomfort to prevent the possibility of an unwanted pregnancy. I use methods of pregnancy prevention whose burdens and responsibilities can be shared, and I only choose partners who are willing to share that burden.

When we act as if promoting birth control is the solution to the abortion debate, we assume that it is good for most women to be on birth control. Of course, some women don’t experience the negative side effects I did from internal forms of birth control, but I don’t think it should be an expectation that women should either never have penetrative sex or be in continual distress or discomfort in the name of ‘risk mitigation.’. There is nothing bad or wrong about a woman who wants to have sex even though she has chosen not to be on birth control.

We’re also assuming that abortions are something that should be prevented at the expense of the well-being of women. We expect women to live worse lives so that some abortions might not happen.

It is worthy of note at this moment that there were studies in the 1990s of hormonal birth control for men (NYTimes). While the male pill was found to be highly effective at preventing pregnancy it was never approved because it was found to cause “weight gain, acne, irritability, mood swings” – all side effects well known to be associated with the pill in women. The clear double standard that has resulted from systematic patriarchy means that these experiences are different for the groups we’ve socially labeled “men” and “women”. While we also know that there are not two biologically distinct groups of humans “men” and “women” (e.g. Nature, 2015), and that humans who are “men” or “women” or neither might get pregnant, this social double standard is the reason for my decision to use the word “women” in these contexts.

At the time I got pregnant, I’d been using the combination of fertility awareness and condoms to prevent pregnancy for about 4 years.

I’m not bad for getting pregnant, and frankly I refuse to let the world tell me that I am. The patriarchy has been telling me my body is bad and wrong for as long as I can remember. I’m not thin enough, I’m too thin, my hair isn’t right, I’m not dressing correctly, I shouldn’t enjoy sex, but I should enjoy sex. It took a lot of work for me to enjoy my body, and to enjoy sharing my body with my partner. I am an embodied creature and experiencing my body as an enjoyable place to be is not something I will apologize for.

I know my cycle extremely well. Currently, I’ve got data going back about 4 years. I took a pregnancy test 3 days after my missed period and had scheduled my abortion later the same afternoon I found out I was pregnant. Due to scheduling difficulties, and the 24-hour waiting period in my state, my abortion appointment was about one week after my missed period–about as soon as someone possibly could have gotten such an appointment in my state.

After my forced and medically unnecessary trans-vaginal ultrasound, the nurse tried to tell me I was 6 weeks pregnant. I will never forget this moment. In states such as Texas, the nurse would have ostensibly been telling me they could no longer legally perform an abortion for me, despite the fact that it had only been 5 weeks since my last period.

The doctor couldn’t have been more wonderful. An old white man offering the only abortions for hundreds of miles in the upstate of South Carolina. He told me not to listen to anyone about a ticking clock, and that I could get pregnant into my 40s. He was the only person who made me feel like a person that day. He gave me my pills and sent me on my way.  

The strongest emotion I felt during my abortion process, or have felt since, is feminist rage at how we treat women. The idea that I went through all of that, and paid $500 out of pocket, to be given a couple pills and sent home was infuriating. The idea that I owe the world my perpetual pain, or discomfort, or the use of my body against my will in any way, just seems some plainly immoral.

I have also begun to feel that the way we talk about (and defend) the rights of pregnant persons to seek an abortion overlooks my story. I did not get my abortion because my life was in danger- as far as I know I could have carried a baby to full term with nothing other than the normal side effects. I did not get my abortion because I couldn’t afford to care for a baby – as a tenure -track philosophy professor I have an extremely stable job and a fine salary to support a child. I did not get my abortion because it would have prevented me from getting an education – I already have a terminal degree. I did not get an abortion because I was in an abusive or unsupportive relationship – my partner is good to me and would make an incredible parent. I’m tired of the defense of abortion that relies on the idea that there are good and bad reasons to get abortions.

I can understand why the conversation has evolved along these lines. 74% of women cite education, work, or ability to care for existing children as the reason for their abortion, 73% cite inability to afford taking care of the baby, and 48 % cite relationship problems (Guttmacher Institute). What is less clear to me is why we’re so invested in monitoring the reasons a person doesn’t want to carry, birth, or care for a child. The imagined pregnant person who is flippantly getting abortions late in a pregnancy doesn’t exist, so why has so much of the debate focused on the kinds of exceptions that should be carved out for person’s seeking abortions after some arbitrarily determined period of time? 

Like me, most pregnant people who are seeking an abortion want to get them as early as possible. However, pregnant people get abortions after 15 weeks for a variety of reasons (per NPR and Kaiser Family Foundation). For instance, many didn’t know they were pregnant (they might have been on birth control and didn’t always get their periods, or only get “irregular” periods). Many cited the high cost of abortions (which usually cost $500-600). And many pregnant persons struggle to get the money together to not only pay for the procedure, but all the other indirect costs associated with obtaining abortions in many states today. For example, clinics are often far away, and mandatory waiting periods may mean individuals need to make multiple visits. Similarly, getting time off work, transportation, and the need to obtain childcare all increase the cost and burden on those seeking to obtain an abortion, and are frequently cited reasons for delaying abortions. Of course, there are other reasons a pregnant person might seek an abortion after 15-weeks, but it worth noting that many are forced into this situation only by the restrictive abortion laws that many states have put in place.

If 92% of abortions occur in the first 13 weeks of pregnancy (CDC, 2021), and most of the reasons women report delaying abortion have to do the restrictions imposed on abortion access by the pro-life community, we need to be arguing for better access to abortion not just to birth control. Even if the concern for the developing baby goes up as a pregnancy goes along, why wouldn’t we be trying to make early access to abortion easier not harder?

It took a lot – a meticulous knowledge of my cycle, a flexible work schedule, a supportive partner, a lack of existing dependents, etc. – for me to be able to get my abortion as soon as I did. Medically speaking my abortion was easy – a rough day of having my period. My body and my ovulation cycle rebounded immediately. I wish we could live in a world where that was the experience for every person who wanted an abortion. Not everyone who seeks an abortion will have the privileges that I had that allowed my experience to be so (relatively) smooth. All this is to say that even if we buy into the idea that there can be some time-frame after which states can prohibit non ‘medically necessary’ abortions, I think we need to spend less time discussing the reasons people might get abortion and more time making them easier to access.

I’m tired of the memes about how abortions are about health or economics or education. They can be about those things. But mine wasn’t. Mine was about choosing to build my life and my family in a way that made sense for those of us involved. Mine was about creating a life I enjoyed and controlled. I’m so lucky and grateful for the opportunity to love my life.

My understanding of my experience has also been shaped in dialogue with my partner. My partner is a political and legal philosopher, whose work focuses on dignity. He argues that the decisions that grant us the right to an abortion before the point of viability (Roe vs. Wade and Planned Parenthood vs. Casey), and the decisions that prohibit laws against same-sex intercourse (Lawrence v. Texas), and protect same-sex marriage (Obergefell v. Hodges) all rely partially on the idea that making actions illegal causes “dignitary harms” that are beyond those of the legal penalties associated with them. Criminalizing behaviors associates non-trivial shame and stigma with those behaviors. Thus, when governments criminalize abortion, it treats pregnant persons seeking an abortion (or medical practitioners providing them) as criminals worthy of condemnation. 

The social pressure to feel shame is something I have continually felt since my abortion. Every day when I come to my office and look at the flyer advertising a local crisis pregnancy center of the kind discussed above posted on my colleagues’ door I’m reminded that I should feel bad about myself.

And you want to know what is making me the saddest today? Even when Roe and Casey are gone, and when I live in a state where (most?) abortions will be illegal, I won’t lose the ability to get another abortion should I ever want or need one. My privilege would (likely) protect me. It is my neighbors who are already struggling, who have already been hurt more by our racist and classist systems, who will be harmed more once again. I can’t stop that. And isn’t that the worst of it? Those with power repeatedly harming the most powerless and marginalized in society.

My abortion is by no means the hardest or saddest thing that has happened to me. My experience is, however, a worthy part of the ongoing conversation. I’m tired of feeling like I can’t admit to my abortion. What I’m coming to understand is that telling some people that their stories are less important, their perspectives are less worthy, is part of how we perpetuate social oppression. Part of the dignitary harm that has been done to me is that I’ve been made to feel as if I cannot or should not tell my story. Philosophy (my home academic discipline) has a long history of excluding narrative  – we seek rational persuasion- just as I have with my father. Yet, moral motivation requires more than rational justification, and what qualifies as rational justification is shaped by the dominant social forces in any group. 

We don’t believe the voices of women on birth control who tell us it causes depression or mood swings. We believe the men. Or maybe we do believe the women, but we think that although it is worth their suffering to prevent abortions, it isn’t worth the same suffering in men. 

The reality is that moral and legal reasoning is continuously full of contradictions and  irrationality. What is accepted has more to do with social power than rationality. What stories we tell, what stories we listen to, and what counts as a ‘good reason,’ are all shaped by what we deem socially worthy. I had wanted to persuade my father that abortions weren’t always “sad” using reason because I looked down on the value of my own story. I felt it was illogical to use my story to highlight the moral failings of our thinking on abortion. But the more I’ve thought about it, the more I’ve realized this is a repetition of the suppression of voices society doesn’t want to hear. My abortion didn’t save my life or allow me to finish school. It just let me live a life I wanted. And, for whatever reason, that isn’t supposed to be enough. 

So for what it’s worth, that is my story. I had an abortion last year, and it changed how I saw the world. Maybe it can change yours too. 

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