Because most philosophies that frown on reproduction don't survive.

Thursday, October 25, 2012

The Problem with the "Pregnancy is Work" Argument For Abortion

Over at The Atlantic, Ta-Nehisi Coates reprints a post that he wrote two years ago which he considers to be a strong argument for the unrestricted "right to choose" abortion. This argument is basically that pregnancy is hard and sometimes dangerous work, and that women should thus not be forced to do it if they don't choose to.
Like most people, I have deep problems with the termination of life -- and that is what I believe abortion to be. Still a decade ago, I learned that those problems were abstract, and could not stand against something as tangible and imposing as death.

My embrace of a pro-choice stance is not built on analogizing Rick Santorum with Hitler. It is not built on what the pro-life movement is "like." It's built on set of disturbing and ineluctable truths: My son is the joy of my life. But the work of ushering him into this world nearly killed his mother. The literalism of that last point can not be escaped.

Every day women choose to do the hard labor of a difficult pregnancy. It's courageous work, which inspires in me a degree of admiration exceeded only by my horror at the notion of the state turning that courage, that hard labor, into a mandate. Women die performing that labor in smaller numbers as we advance, but they die all the same. Men do not. That is a privilege.
He says that since writing this, his feelings have only become more one sided on this issue:
I no longer have "deep problems" with the termination of fetal life. I don't think it's my place. I don't think I have much right to any qualms. I will never be pregnant. I will never be subject to the many biological functions that precede pregnancy and the ones that follow. I cannot know what it is to subject my body to such a process for the benefit of another. I don't believe everyone's opinion should be weighed equally. Some people carry more than others.
The thinking here seems to be that the work of being pregnant is so great that only those who have experienced it (or could) can really have an understanding of what it means. Now my first thought was: If one sees pregnancy as the big dividing line here, are women who have been pregnant more or less likely to support the "right to choose"? I consulted the General Social Survey to see if I could find out. Sure enough, all the data one needs is in there. I focused in on the question ABANY: "Please tell me whether or not you think it should be possible for a pregnant woman to obtain a legal abortion if: g. The woman wants it for any reason?" This is part of a series of questions in the survey which ask whether abortion should be legal for any reason (this question) and if it should be legal in certain specific situations (not able to afford another child, doesn't want more children, serious health problem for the mother, etc.) I filtered my data to look at women only and then I broke the data out by the number of children the woman had. The results are interesting, and basically what I expected:
Bold numbers are percentages, regular text represents absolute numbers.
Women who do not have any children (I'm not able to filter on whether they may have experienced miscarriages or abortions, but in general this should be the group of those with the least experience of pregnancy) are the most likely to support abortion on demand. Women who have experienced pregnancy (and the new life which it represents) are less likely to support abortion on demand. I tried separating the data out for married women and never-married women, but the views are almost exactly the same.

But what about the most extreme "hard case" situations? I pulled similar data for two questions in the survey dealing with pregnancy in cases of rape and pregnancies that severely threaten the health of the mother. As in the population as a whole many more women support abortion being legal in these situations. This table shows support for abortion being legal in cases of rape:
This one shows responses to the following question: "206. Please tell me whether or not you think it should be possible for a pregnant woman to obtaina legal abortion if: The woman's own health is seriously endangered by the pregnancy?"
This last is somewhat different from the others in that support for legal abortion in cases of serious health risk to the mother is virtually the same among women who have 0, 1 or 2 children, but then falls off progressively among women with three or more children. I tried splitting this out by how often she attends religious services, but while women who attend religious services weekly or more than once a week are much less likely to support abortion in cases of serious health risk than women who seldom or never attend religious services, the shape of the pattern is similar with women with 0, 1 or 2 children having fairly similar opinions and then increasing opposition to abortion as the number of children goes up from three.

While this doesn't mean that pregnancy isn't a unique and difficult experience, it seems to show that experiencing pregnancy does not make women more likely to support the "right" to "terminate a pregnancy". Indeed, it appears that pregnancy generally makes women less likely to support abortion. If, as Coates suggests, we left the question up to the veterans of pregnancy, abortion would be restricted more than it currently is.


Jenny said...

I think one reason that women with more children would be less likely to support abortion would be that they have learned to put pregnancy in perspective. Although while pregnant it seems interminable, pregnancy doesn't really last all that long. The first time seems like it is never going to end. After you've done it three or four times, you can temper your legitimate feelings of "UGH will this ever end" with the intellectual knowledge of "Yes and soon."

Anonymous said...

I recently had my first. Although pro-life, I feared pregnancy and delivery before I experienced it. I had all sorts of assumptions about how hard and sacrificial it was, some of this precisely because of this pro-choice argument. Granted, some women really do suffer, and the first trimester wasn't a picnic. But after having experienced pregnancy and delivery in it's entirety now, I am more pro-life than ever, and these stats don't surprise me at all. Never has it been so clear to me that a baby is a human being worthy of protection and also never has it been so clear to me that even on the bad days, pregnancy is a healthy state the female body is equipped for, not a disease... and yes, a very temporary state. Also, my husband did his fair and equal share of carrying the responsibilities of the pregnancy, including doing exhausting - truly exhausting - support during labor.

Rebekka said...

I've seen this (abortion because of health risk) once after the fact where I work, which is on a hematology ward, and live in dread of ever having to face it again. Lymphoma patients get different types of chemotherapy than people with solid tumors, and they get it in insanely high doses and in combination of four or five drugs at once. So it's not like these breast cancer patients you hear about who bring a pregnancy to term while on chemo. And since lymphomas are so malignant you can't wait to start treatment. And the chemotherapy causes thrombocytopenia, to the point that if you are a fertile woman you are put on hormones to completely suppress menstruation to prevent serious blood loss. So pregnancy is absolutely contraindicated, because when the chemo kills the baby, you are in grave risk of bleeding to death from miscarriage. You have to apply for permission to abort after 12 weeks here but this is definitely a case where abortion would be allowed all the way up to viability.

I think a lot of health risk grounds are "health risk" but definitely not all of them - and to be honest, I really don't know how I would tackle it if I had a patient who was pregnant, and part of that would definitely be having to explain to my coworkers why I refuse to have anything to do with an abortion even when I very much understand the absolutely desperate situation.

Anonymous said...

Rebekka...but in a very grave case such as you described is the Catholic Church against abortion? This seems to me the most extreme of all scenarios, one of a few types of scenarios where "for the health" of the mother is actually meaningful and real, and not just some notation jotted down by a physician to justify the abortion.

Rebekka said...

If I understand it correctly (and someone correct me if I'm wrong), it's not wrong to accept lifesaving reatment even if the baby will likely die as a result. Your intention is everything. It's like when we give morphine to the dying - it's wrong to do it to it in order to hasten death, but ok to put up a morphine drip to ease pain even if it shortens the patient's life.

As far as I am aware, this means that it's ok to get chemo while pregnant (indeed not always fatal to the baby) and then have to get a d + c, but not ok to get a d + c and then chemo.

But the case I'm talking about I really don't know what the answer is - it's about as gray as you can get. And chances of running into a patient who is in this situation and Catholic are microscopic, so my dilemma has mostly to do with my own participation in the situation.

bearing said...

Here's a philosophical political question.

Catholic moral teaching is that the principle of double effect makes it licit for a mother to seek necessary medical treatment that foreseeably will result in the death of her unborn child, as long as the death of the child is not intended. It's not okay, however, to directly and intentionally cause the death of the unborn child as the means of saving the mother.

Obviously as Catholics we have an obligation to seek legal protection for the unborn in all cases of so-called "elective" abortions. It seems evident to me (though not to all pro-life folks) that it's a step forward to affirm laws that ban most abortions (right now, thanks to RvW, only late-term ones) even if those laws contain exceptions such as for rape or for certain risks to the mother's life or health.

Someday we can hope that the rape exception will also fall, but here's a question:

Could we licitly accept a legal end-game in which abortion remained legal in the case of risks to the mother's life?

I think there are a few grounds for this:

(a) the populace at large has no clue how to deal with the subtleties of double effect and ends vs. means;

(b) enforcement would be a nightmare, as it would be very hard for the criminal justice system to distinguish between medical treatment causing an intended fetal death and medical treatment causing an unintended fetal death;

(c) the notion that it matters *how* you cause the death of an unborn baby, such that physically-less-invasive or physically-less-risky procedures might have to be foregone in favor of more invasive or risky ones, is arguably going to be seen as religious-enough to violate public perception of appropriate state neutrality towards religion. Thus it may never be accepted as a matter of law.

Note that not everything that's immoral, even widely believed immoral, is illegal -- often because the attempt to enforce a law against such things might be impossible without creating a privacy nightmare. I'm wondering if the situation of "abortions deemed medically necessary to save a mother's life" -- might be one such.

If that were to happen, the task for life advocates would be to educate physicians and patients about the morality of the various possible actions in such sad circumstances.


Rebekka said...

I think that (b) is maybe not as difficult as it would seem, but perhaps I'm being naive. It's not exactly easy to kill a fetus, you pretty much have to mean it, or you're doing something risky for the mother - surgery or radiation or systemic chemotherapy on a drastic scale. I guess there are some really immoral physicians out there, but it would be nearly impossible to justify giving someone high dose methotrexate, for example, without all the diagnostics and biopsies that show they are in need of the treatment.

I could imagine that there would be some sort of medical ethics committee that doctors would inform when they were in a situation where they needed to treat a patient in a manner that would have the unintended effect of ending a pregnancy. We do this already in Denmark with, for example, medications not approved for general use. Also abortions after the 12th week have to be approved by the Abortion Board (Abortnævnet) - which does actually give refusals occasionally. This would provide legal exceptions without the need for review after the fact and relieve the burden of the whole criminal justice element both for the health care people and the justice system.

I think that (a) is probably the hardest one to get around.

Brandon said...

Could we licitly accept a legal end-game in which abortion remained legal in the case of risks to the mother's life?

I would say yes, for reasons (a) and (b) (in any stable social situations in which they are true). (This is pretty much my own view: I don't think it's ever morally right, but I think there are sharp practical limits to what the law can enforce in these sorts of cases without overstepping reasonable bounds.)

Even in a situation in which one could get around (a) and (b), I think there's an excellent argument that these sorts of cases would require a good deal of leniency in how the laws were structured -- laws need to take into account the difficulty of choices people are actually being faced with. (I think it was Anatole France, or someone like that, who somewhere made the sarcastic comment that the laws of France were perfectly fair because they gave the same sharp punishments to all people who stole bread and slept under bridges no matter whether they were rich or desperately poor. There's a good argument that laws perfectly fine in themselves can sometimes be unjust contextually by simply failing to take into account the difficulties people face in real life.)

sdecorla said...

Not sure if anyone is still reading this thread, but I just had to comment. I have actually had the opposite experience from what is described here: being pregnant did not change my pro-life views, but it made me FAR more sympathetic to the pro-choice position.

Before I experienced pregnancy myself, I honestly could not wrap my head around the pro-choice position at all. When I first learned about abortion at age 10, I was horrified by it and instantly pro-life, and that feeling had nothing to do with religion.

And then I had three children. My first pregnancy got me fired from my job, my second pregnancy almost killed me, and my third pregnancy almost ended my marriage (long stories, all).

I also became more aware of all the many, many things that can go wrong during pregnancy, some of which can kill the woman or seriously damage her health. Yes, the pregnancy itself is temporary, but the damage to a woman’s health can be permanent. I know that technically, “pregnancy is not a disease,” but it can cause diseases, some of which ONLY occur during pregnancy (like preeclampsia, which I had, and which caused me to develop pretty severe health anxiety for awhile and even panic attacks). I was completely ignorant about most of these conditions before I became pregnant myself. I honestly think the pro-life movement downplays them.

At the end of the day, I am still pro-life, because the bottom line is that the unborn child is still a human being, and I still think the humanity of the unborn child outweighs any other concerns. But I *completely* understand where the pro-choice side is coming from. Experiencing pregnancy made me “put it in perspective” as well, but for me, I realized it was a much, much bigger deal than I ever imagined.

I guess you could say that before I was ever pregnant, both my heart and my head were pro-life. Now, my head is still pro-life, but my heart is wavering.