An Open Letter on the Importance of Reproductive Choice


See here for further discussion of “choice” and reproductive justice language.

I want to thank Jodi Magee for her response article on how Physicians for Reproductive Health continues to “absolutely support the right to choose,” despite having dropped the word “choice” from its name. In the United Kingdom, we are the poorer because no organization quite like hers exists.

For us, reproductive health is now pretty mainstream. Our Royal College of Obstetricians and Gynecologists (RCOG) has a faculty dedicated to it. But we have no mainstream, national organization with professional clout and profile that stands up for a woman’s right to choose.

Maybe this is why I’m alarmed when I read the arguments that the concept of reproductive “choice” is passé and that we should instead adopt a language of health and justice. And maybe this is why I must seem pedantic, mulish, and annoyingly intransigent.

For me, it is more than a matter of semantics. “Choice” means something specific. As I tried to explain in my essay,Remaking the case for a woman’s right to choose,” 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. As the Daily Telegraph noted in 1967, bishops, peers, and doctors supported the abortion bill because it “will give doctors the freedom to make the best choice for the mother, her established family and the embryo within her” (emphasis added).

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. A doctor can agree to an abortion because she believe her patient’s fetus is at severe risk of a serious abnormality, but not because her patient does not want to have a child who has Down syndrome.

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. It’s a fragile and tenuous framework in which competent and capable women must claim they “cannot cope” with a child.

“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. Long-acting contraceptives are promoted heavily because doctors agree they are “better,” and are concerned that women continue to choose less effective methods. 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.

To borrow again from O’Brien:

To be pro-choice is to dedicate oneself … to making the legal, political, social, and economic changes necessary to ensure that this true freedom of choice is available to each person. Choice does not negate social justice; indeed, we believe that true freedom of choice compels us to advocate for policies that ensure that everybody, regardless of their situation, has equal access to safe, compassionate, and comprehensive reproductive health-care options.

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.

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  • cjvg

    Choice at its core recognizes that competent adults (who happen to be women) can and should always be allowed to make their own choices!

    Why should decision on your body, which so intimately impact the core of what and who you are, the thing that ties you to this world and holds your essence, who’s ownership ultimately defines you and your options, should always be yours!

    If your body and the use of your body is owned by the state or another person, you have no rights at all except those that they magnanimously let you have!