Operating Under a Broken System: On Legitimate Abortions and Forced Triage


Cross-posted with permission from the Abortion Gang blog.

Coverage of Representative Todd Akin’s “legitimate rape” comments have ignited a media storm. It’s clear that Akin’s remarks are more than just misinformation about reproductive health, and that they could have devastating and divisive policy implications for abortion rights and access. Akin’s comments have also sparked a conversation about abortion exceptions, “legitimate” reasons to have an abortion, or if we should even be talking about those reasons.

What do we know about abortion exceptions? We know that they make it harder for anyone to get an abortion, including each person who falls under exceptions such as rape, incest, or threat to the person’s life. Many of us in the reproductive health, rights, and justice movements have written about and fought against the concept of “legitimate” or “acceptable” reasons to have an abortion. Of course we agree that no one should differentiate between an individual’s circumstances surrounding an abortion decision. But that doesn’t mean that we, and by extension, our movement, don’t also play into labelling some abortions as more necessary, important, or worthy of funding than others.

This happens most noticeably at the policy level. We fight for legislation that grants military insurance coverage for abortion in cases of rape instead of fighting for military insurance to cover abortion regardless of if it was an instance of rape or not. When state legislators try to ban later abortions, we trot out stories of people who’ve needed later abortions for fetal anomalies, not those who need later abortions for less sympathetic reasons. And, more recently, the progressive media is aghast that the GOP platform includes an anti-abortion amendment that doesn’t give an exception for rape, when really, shouldn’t we be up in arms that there is an anti-abortion amendment, period?

We see this manifest in a different way in direct service organizations. Our work as abortion fund volunteers is grounded in the belief that each person has a human right to bodily autonomy and to health care access. We trust that a person has the ability to make their own abortion decision, and we do not honor one person’s experience over another. But we also recognize that despite our commitment to providing non-judgmental and compassionate services, we are human–we hold to our own beliefs, or our organization’s beliefs, about who is more deserving of or more in need of our assistance. Even as we are actively trying to shed ourselves of placing more or less value on one person’s experience, we cannot ignore that we have and will continue to make exceptions for those with more difficult circumstances and less access to services.

Abortion funds operate under hostile climates with limited financial resources. That leaves many of us asking difficult questions: who most deserves our limited financial assistance? This is the reality we live in. We know some of us will give more funding to a person who is the survivor of sexual assault instead of someone who is not, or to a person who is having a later abortion because of a fatal fetal anomaly than someone who is having a later abortion because she took a longer time coming to the decision to have an abortion. Why? Because we don’t have enough money to help every individual, and we want our time and money to go to the people who “really need it”: those who are the most marginalized and therefore have the slimmest chances of accessing services on their own. No matter how much we try to get out of the paradigm that some people deserve our help more than others, the reality is that we have to prioritize, to triage. As a result, whether we like it or not, we are complicit in the exceptionalization of certain abortions.

We live and work in a country where abortion providers and grassroots reproductive justice organizations like abortion funds are becoming more and more scarce. With few funding and staff to operate, we are forced to limit the populations we serve to those we deem most in need of care. What we need to constantly keep in mind is how we are deciding who is most in need of help, and reevaluating how that fits in with our values. Are we ok with only helping certain kinds of people who need abortions? Can we strategize for a future in which we don’t have to make these tough decisions? How can we get there?

Creating our own exceptions and hierarchy of abortion situations is a necessary evil. It isn’t ideal, and it’s not what we strive for, but it is a reality of a broken system and a reflection of little time, and scarce funding, not to mention a hostile political climate. We did not choose this system, we can’t blame ourselves for operating in a way that allows us to function and sustain ourselves. But we also must ask tough questions about how we, as abortion funders and pro-choice activists, engage in abortion exceptionalism, and keep each other accountable for figuring out answers that reconcile our values with the difficult circumstances in which our organizations operate. We can fight for military insurance to cover abortion as a result of rape as long as we are also fighting to repeal the Hyde amendment. We can provide more funding to a cancer patient who needs an abortion as long as we are also figuring out ways to increase the amount of money we give people who aren’t in dire situations. As much as we critique abortion exceptionalism, we need to examine and acknowledge when we are complicit in it as well.

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  • angela-quattrano

    outcry about fetal anomalies or risk to the mother’s health or life compared with calls for “rape and incest” exceptions. While we of course need to remove restrictions (as well as so many other issues with women’s reproductive health), by saying nothing about the risk to the mother’s health or life we enable those who are against abortion by denying the realities of risk. Women do die in pregnancy and childbirth, and often the risk cannot be quantified until it is too late.

    Ideologues should not be practicing medicine and playing games with women’s lives.

  • give-em-hell-mary

    The Dems and pro-choice folks must force MSM, clergy, ob/gyns and political candidates to address childbirth’s frequent grisly and deadly immediate and years-delayed complications that repulse husbands into divorce and bankrupt everyone with medical debt.  My learning of this ugly truth has taken years of searching because most mothers seem too cowed to share this with other family members, let alone the public.  And ob/gyns only post their successes on their walls for litigation reasons.  I began to get clues when I was a nasty Catholic anti-choice know-it-all teen.  My high school friends whispered about older friends’ husbands being totally repulsed by their pregnancy stretch marks.  Then a pretty 19-year-old military wife introduced herself to me with:  “Pardon me! — I just had a baby and every time I laugh, I pee!”  When I became fed-up with abuse and insults from my anti-choice family, Fay Wattleton’s mentioning of “women’s bodily integrity” intrigued me.  Bookstores, libraries and early internet searches added scary puzzle pieces, but chance encounters, off-hand comments and obits of young mothers connected many pieces.  A human rights activist/face cancer patient told me her cancer was weaponized by the hormones of her last pregnancy 15 years ago.  A co-worker’s sister’s lethal breast cancer was caused by her new daughter, and the grief caused by her death then killed her husband, leaving their young kids orphans!  My boss lost a young widower neighbor to foreclosure because he lost his job taking care of his infant twins whose birth killed their mother!  And I’ve barely scratched the surface of the deadly domino miseries caused by “wanted” pregnancies.

  • ljean8080

    having a baby does not give you cancer.would you call those kids killers?

  • colleen

    having a baby does not give you cancer.would you call those kids killers?

    No, but I would certainly  call the folks who would deny a pregnant woman lifesaving  treatment for cancer ‘killers’.

  • crowepps

    The ‘baby’ can actually BE a cancer when one egg is fertilized by two sperm and results in a molar pregnancy.

    Hydatidiform moles are abnormal conceptions with excessive placental development. Conception takes place, but placental tissue grows very fast, rather than supporting the growth of a fetus.

    Complete hydatidiform moles have no fetal tissue and no maternal DNA. A single sperm duplicates and this duplicated sperm fertilises an empty ovum, or, two sperms fertilise an empty ovum (dispermic fertilisation). An empty ovum is a maternal egg which has no functional maternal DNA.

    Partial hydatidiform moles have a fetus or fetal cells. They are triploid in origin, i.e. one set of maternal haploid genes and two sets of paternal haploid genes. They almost always occur following dispermic fertilisation of a normal ovum (fertilisation of one egg by two sperm).

    Malignant forms of GTD are very rare. About 50% of malignant forms of GTD develop from a hydatidiform mole.

    http://en.wikipedia.org/wiki/Gestational_trophoblastic_disease

    Note the phrase “The treatment for hydatidiform mole consists of the evacuation of pregnancy.”  Got to be careful not to use loaded words like ‘abortion’ even when talking about an invasive cancer so the ProLife fanatics won’t insist the woman die pointlessly.