It is also obvious that people understand the concept of reproductive choice differently according to their circumstances. Choice to a family that struggles to decide whether to spend its pitiful income on food or shelter means something different than it does to a family that struggles to decide whether to take a holiday in Europe or Asia. But then, the concept of ‘struggle’ means something different in these circumstances, too, and we feel no need to find a new word for that.
Nevertheless, the pressure to replace the C-word with ‘Reproductive justice’ is mounting. Reproductive justice, we are told, is an essential shift because it goes ‘beyond choice’ and redefines what we stand for. For groups such as Sistersong, ‘reproductive justice is not a label — it’s a mission. It describes our collective vision: a world where all people have the social, political and economic power and resources to make healthy decisions about gender, bodies, sexuality, reproduction and families for themselves and their communities. And it provides an inclusive, intersectional framework for bringing that dream into being.’
It is wrong to see this as an irrelevant semantic squabble or, simply, a distraction from the many attacks on abortion access in the US. For this is a debate that has serious consequences.
What’s in a name?
In January 2013, the Planned Parenthood Federation of America (PPFA) was the first major institution to distance itself publicly from support for choice. For those who live outside the US, the PPFA is a colossus in birth-control care, providing contraception and abortion to tens of thousands of US residents.
PPFA’s decision to distance itself from choice was presented as a matter of ‘messaging’ rather than an ideological shift: a response to research that showed that the pro-life/pro-choice framework for abortion failed to resonate with the general public. PPFA said it was responding to polling and focus groups that had shown that views on abortion are nuanced and context-specific in a way not captured by the label ‘pro-choice’. Its poll of 1,000 voters had shown that: 40 per cent said the morality of abortion ‘depends on the situation’; 25 per cent said it was always morally unacceptable; and 16 per cent said it was always acceptable. In short, for most people, the rightness or wrongness of an abortion depends on circumstances. These poll results, as some commentators have observed, do not support stepping away from a pro-choice identity.
The poll data shows simply that voters see the complexity of abortion in a way that is not reflected in rhetoric, especially that of politicians for whom abortion tends to be a matter of abstract principle, reasoning and belief. For most people, abortion is not a matter of politics; it is considered in the context of a person’s life. This is why abortion doctors treat so many women who say that they think that abortion is ‘wrong’ but their abortion is ‘right’ – or, at least, not as wrong as any other decision would be.
This is neither a new discovery nor difficult to understand. Considering abortion as a political matter is different to considering whether to have one – or even considering whether you think your friend should have one. Individual abortions are not statements of belief but medical procedures to solve problems. You do not have an abortion to demonstrate that you are pro-choice any more than you decide to have a baby because you are pro-life. In this case, the personal is not political.
It does not take a doctorate in sociology or psychology to understand why the polarised, political rhetoric that wraps round the public discussion of abortion in the US alienates people. Nor should advocates need advice from top-flight communications consultants to know that the way we discuss issues needs to change constantly if people are to understand what we mean. This much we know from experience.
Ironically, the pro-choice language we use today came from the need to adjust our message to make it more nuanced and inclusive. In the 1980s, ‘the right to choose’ replaced calls for ‘abortion on demand’ as we accepted that the key issue was a woman’s personal freedom to make a decision whether to have or not to have a child. We recognised that, for some women, what mattered was the demand to not have an abortion, or not to be sterilised because they were coerced into procedures that other women were denied.
The matter of ‘Who decides?/Whose choice?’ also applied to the use of new reproductive technologies, as questions were asked about who should and should not be permitted to use them. The Eighties was a decade when technical advances in in-vitro fertilisation (IVF) began to offer the hope of pregnancy to infertile married couples, but assisted conception was denied to single women and lesbians. This was also a time when some governments allowed, and even promoted, coercive sterilisation, while in other countries voluntary sterilisation was not a contraceptive option. (In France, for example, vasectomy remained unlawful until 2001.) It was clear to us then that a woman’s choice – her right to decide and not her doctor’s or her government’s – should be at the heart of what we fought for.
Naturally, in the 1980s, there was also opportunist support for the language of reproductive choice. There were some who felt that the A-word was best left unspoken, and the rallying cry of ‘abortion on demand’, which had been chanted so enthusiastically on the demonstrations of the 1970s, sounded strident in the less-radical 1980s. Even before the existence of a sophisticated communications industry, we knew that messaging mattered.
But, crucially, there was no mistaken view that talking about ‘reproductive choice’ would make it easier to build support for abortion. We knew that those who opposed abortion would remain as much opposed to it as a choice as they were opposed to it as a demand. This was not seen as a change of labels, it was not a branding exercise; it was a reposing of a principle. A specific commitment to choice was important because it captured what we stood for, and it captures what we stand for now.
What choice means
Support for reproductive choice in our movement has traditionally implied support for the decision-making capacity of the person who is the subject of that decision. The concept of reproductive choice is rooted in the liberal concept of autonomy: the idea that each individual should be free to follow their own life plan according to their beliefs, convictions and their conscience (provided others are not harmed).
In relation to abortion, support for reproductive choice means a woman being able to make a decision for herself about what she wants to do. In making a choice about the future of her pregnancy, she engages in an act of moral self-governance. She decides for herself, according to her own conscience, what is right for her. The fact that it is she who decides what is right for her – and not anyone else - is important in itself, regardless of whether she is able to follow through her choice.
This does not mean we ignore the very real issues of access to resources and services, or the inequalities caused by socioeconomic conditions, the need for structural change. It does not mean that we ignore the impact of race or class. The point is this: life is full of decisions, and it is who makes them that matters. This is not an exclusive class-based, ethnically specific framework; it is as true for economically disadvantaged women and women of colour as it is for WASP university graduates. It is as true for women in Pakistan as it is for women in Britain. Claiming that choice ‘does not matter’, or is irrelevant, to a group of women because, for example, they are economically or culturally excluded, is both patronising and degrading. It implies they have no interest in making these moral choices for themselves, and perhaps no capacity to do so.
We may not be able to provide women with the social and economic resources to live their preferred lives. But we should not add to women’s burdens by refusing to acknowledge the importance of what they do have; what some people call agency, others call decision-making capacity, and some of us call choice. Affirming the value of choice is a precondition for creating the circumstances in which it can be exercised. If a person has no concept that they might make a choice, they cannot determine what resources are required for them to exercise that choice.
As I explained in the journal Conscience recently: ‘Making a choice is, in itself, a demonstration of a freedom of sorts – the freedom to influence and take responsibility for what happens next. Our lives are made richer if we can direct them according to our personal values and convictions – even if our lives are not made richer by the options available to us. A “rock” and a “hard place” can be equally uncomfortable even when you have chosen which to sit on. The point is this: life is full of decisions, and it is who makes them that matters.’
Moral philosophers, from Kant to the recently deceased Ronald Dworkin, have acknowledged that there is a special quality to moral decision-making (such as that involved in abortion). Making decisions is part of what it means to be human. We may have no control over what we ‘are’, in the sense that our nationality and background may be set, but we do have some choice about what we ‘do’.
Socially constructed value systems do not predetermine all the decisions we take, although they can shape them. People in similar situations make different choices based on their values. The abject poverty that drives one woman to have an abortion may drive another to decide to have a child that she places for adoption. A diagnosis of Down’s syndrome may compel one woman to end her pregnancy, while another decides to embrace the child as ‘special’. The fact that a woman is black, or poor, or alone, or stigmatised, clearly will influence her decision – but it does not take away her capacity to decide, to make a choice.
Law professor Emily Jackson spells it out in her book, Regulating Reproduction: Law, Technology and Autonomy: ‘The decision to have an abortion… is made because, for a variety of reasons, this particular woman does not want to carry a pregnancy to term. That she is not in control of these reasons should not lead us to ignore her deeply felt preference even if we recognise that social forces may shape and constrain our choice. Our sense of being the author of our own actions, especially when they pertain to something as personal as reproduction, is profoundly valuable to us.’
Our ability to make moral judgements, decisions and choices is part of what makes us whole, competent human beings. It is what differentiates us from animals that act on instinct and habit. To take the capacity to make reproductive choices away from women is to take away their moral agency – it is to deny their humanity. As Jackson says, ‘we cannot believe all our preferences are not ours without our sense of self effectively collapsing’.
It follows that if people say they no longer identify themselves as part of a pro-choice movement, then we need to consider very carefully what is being implied here.
What it means to give up on choice
For example, what should we make of the decision of the American group, Physicians for Reproductive Choice and Health (PRCH), which, in the wake of the PPFA decision, announced it would change its name to Physicians for Reproductive Health? In its own words, it did so ‘to more accurately reflect how our doctors think about their work and the full range of care they provide’.
Do the doctors who belong to this organisation really believe that choice is incidental, and that it is sufficient to commit to reproductive health? This seems unlikely. The organisation formally known as PRCH was (and presumably PRH still is) made up of good doctors who, presumably, would say their views haven’t changed. However, saying you support women’s reproductive health is just not the same as saying you support women’s choice. Especially when you are a doctor.
Every day, doctors find themselves frustrated by patients who choose to ignore recommendations and interventions that would improve their health, who choose to continue to smoke, drink, take drugs and overeat. Reproductive-health doctors are similarly frustrated by people who continue to choose to practise unsafe sex despite education about the consequences. Some 14-year-old girls refuse to choose the most effective contraceptives and then choose to become mothers, even where it seems obvious that delaying motherhood would be better not just for them, but for their future families, too.
In these circumstances, the value accorded to the woman’s autonomy – that is, her choice – is not merely a matter of labelling that can be stripped out of the garment as you would cut an annoying brand tag from a shirt. Support for the woman’s choice determines the kind of service she receives. To be a doctor for women’s choice privileges respect for women’s autonomy above all. To be a doctor for reproductive health can mean something very different.
Where will the doctors in PRH stand when faced with the controversies about women who base their reproductive decisions on issues that are nothing to do with reproductive health at all? I know what a doctor in PRC
H will say about a 35-year-old woman who chooses to have an abortion because she prefers to delay starting her family. That doctor will support her patient’s choice. But if the doctor is only interested in her patient’s reproductive health? Given the increase in risks with maternal age, I’m not so sure what she’ll say in the above situations.
Our reproductive choices do not always accord with what is best for us, any more than our choices in other areas. But still our choices should be ours to make.
A declaration for choice
It is simply wrong to say that evidence shows that a commitment to reproductive choice is out of touch with public opinion. Even if it were, it would be our task to put this right.
In Europe and the US, there is ample evidence to suggest that people see pregnancy decisions as serious, complex, deeply personal and context-specific. Even among the most conservative of thinkers, there seems little desire to compel women to have children they do not want. If this does not accord with their perception of what it means to be pro-choice, then it suggests that serious public education is needed to put that right.
In September 2012, the secular UK abortion provider British Pregnancy Advisory Service (bpas) and the international Catholic advocacy group, Catholics for Choice (CfC) jointly hosted a colloquium of activists, doctors, lawyers and academics from across the world to discuss the meaning of a commitment for choice. It seemed to some a surprising alliance, but both organisations had found that they had a similar core commitment: a commitment to personal autonomy that manifested as commitment to reproductive choice.
The outcome was a declaration of what it means to be pro-choice. To those who wish to drop the C-word: with what, in this declaration, do you disagree?
The London Declaration of Pro-Choice Principles is a simple statement of what it means to be pro-choice. To renounce ‘reproductive choice’ is to renounce more than a label: it is to renounce what this movement stands for and it is to renounce what all women need.
LONDON DECLARATION OF PRO-CHOICE PRINCIPLES
We believe in a woman’s autonomy and her right to choose whether to continue or end a pregnancy. Every woman should have the right to decide the future of her pregnancy according to her conscience, whatever her reasons or circumstances. A just society does not compel women to continue an undesired pregnancy.
We recognise that support for choice in itself is not enough. Access to abortion is an integral part of women’s reproductive healthcare, and we believe in the right to receive this. Women need access to resources and services, including the counsel of the professionals, friends and family they choose to involve. Legal, political, social and economic changes are necessary to allow the exercise of reproductive choice, and a commitment to such changes is part of a commitment to choice.
We express solidarity with those who provide abortion care, and we recognise the moral value of their work. We recognise and respect that some healthcare personnel may choose not to provide abortions, but we believe it is ethically imperative for them to ensure that a woman receives a referral to a willing provider.
We believe there is a profound moral case for freedom of reproductive choice. We are committed to explaining why abortions are necessary and why women are competent to make decisions and act on them responsibly.
To be pro-choice is to be committed to the right of women to make their own reproductive decisions and to:
- Strive to create the conditions in which reproductive choice may be exercised.
- Support reproductive autonomy.
- Advocate for legal frameworks that allow autonomous decision-making.
- Educate the public and policymakers globally about the value of reproductive autonomy.
Women are the only ones who can make the right decision for themselves. This is the very essence of what it means to be pro-choice.
Ann Furedi is chief executive of bpas, the British Pregnancy Advisory Service.