If abortion is a morally neutral act and does not endanger women's health, why bother to prevent the need for it? After all, the cost of a first-trimester abortion is comparable to the cost of a year's supply of birth control pills-and abortion has fewer complications and less medical risk for women than some of the most effective methods of contraception. This question has plagued advocates of choice since abortion was legalized. It has intensified in the face of antiabortion moralism about sex and responsibility, in the continued stigmatization of women who have abortions and in the increasingly expressed mantra that "there are simply too many abortions in the U.S." Frustration has led some advocates of legal abortion to dig in their heels and insist that any talk about preventing abortions denigrates women as moral decision-makers, misunderstands the reasons women have abortions, retreats from principled support for the right of women to choose abortion without government interference and tacitly lends credence to the contention that abortion is almost always morally wrong.
At the evidence level, some worry that the emphasis on prevention as a solution violates a core belief that good facts make good ethics. Demographers and social scientists are more than skeptical of claims by the group Democrats for Life (DfL) that we can reduce abortions by 95 percent in 10 years if we modestly increase economic support for women who face unintended pregnancies. The critics note that the level of increased support suggested by this interest group compares unfavorably with the level of support currently afforded to women in European countries-and the rate of abortions in those countries, while lower than that in the US, comes nowhere near the 95/10 goal DfL espouses.
Tactically, there is concern that an explicit goal of working to prevent the need for abortions or to reduce the incidence of abortion undermines efforts to demonstrate that those opposed to abortion are extremists. Are we buying into the antichoice movement's framing of the issue? Ellie Smeal, president of the Feminist Majority, noted that "while we're talking about all this, we could be putting the right wing on the defensive. We have to put the dying and suffering of women who don't have access to safe abortion onto the table."
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Further exasperation ensues when efforts to prevent unintended pregnancy, and thus also reduce the abortion rate, are cast as a "common-ground" approach with both "sides" in agreement. In reality, the organizations most identified with opposition to legal abortion are at best only marginally interested in reducing unintended pregnancy through contraceptive use; they are focused instead on abstinence for those who are unmarried and are divided on contraception in marriage. Many legislators who are opposed to legal abortion have discovered the hard way that embracing contraception diminishes their support from hard-line antiabortion groups. A case in point is Robert Casey, the prolife Democrat running for Republican US senator Rick Santorum's seat in Pennsylvania. Casey has attempted to temper his antiabortion position by supporting a wide range of measures that would reduce the need for abortion. A progressive Democrat, he supports more economic support for low-income and poor women who become pregnant and for children and families. He also supports contraception, including emergency contraception for adults over the counter. As a result, Casey has gone from prolife Catholic poster boy to the whipping boy of antiabortion groups.
Prolife Democratic congressman Tim Ryan, who has led the effort for recognition of prolife Democrats in the party, was dealt a blow when the group he is most closely associated with, Democrats for Life, refused to endorse his Reducing the Need for Abortion and Supporting Parents Act. The group's executive director, Kristen Day, said the bill had become a problem for them because "when you start talking about contraception, people are very committed to one side or the other." Day noted that her group was concerned only with helping women who had already become pregnant avoid abortion. Perhaps most sadly, the bill was introduced at a press conference at which the only "antiabortion" group willing to stand beside the prolife Ryan and prochoice Rosa DeLauro was the Catholic Alliance, which claims to be a progressive Catholic group challenging right-wing Catholicism. The Catholic Alliance was represented by Sister Sharon Dillon, who distanced herself from the bill by saying that as a Catholic group, her organization could not support the measures in the bill that provided support for contraception.
There is, of course, widespread support among abortion-rights advocates for contraception. Indeed, the country's Planned Parenthood affiliates have prevented more abortions by providing family planning than have groups like Priests for Life and the American Life League, who remain adamantly opposed to abortion and refuse to support contraception, the best hope for reducing the need for abortion. Why should prochoice groups accept the rhetoric of common ground on preventing the need for abortion, when the facts show that their counterparts in the antiabortion movement are unwilling to support contraception? Why should they, like Hillary Clinton, express respect for those in the antiabortion movement who actually are part of the problem?
Frankly, we shouldn't. But our commitment is not with antichoice leaders and groups. Our commitment is to women and to the vision of a just society that motivates our work. Our allies are those legislators who share substantially in that vision, including those who are far less accepting of a moral view that is broad enough to encompass the decision to have an abortion. Our link is to the vast majority of Americans who want abortion to be legal, but find it morally, not just practically preferable to work to avoid its need.
So we definitely should not let any one or all of the above obstacles keep us from strongly supporting efforts to reduce the need for abortion. And we should not have an ounce of ambivalence about publicly declaring ourselves to be committed to ensuring that public policy include a focus on lowering abortion rates without restricting women's freedom.
This takes us back to the very first sentence of this essay. Is abortion a morally neutral act? Is it, as some have said, an unambiguous moral good? This is where we go limp and get tongue-tied. Why, people ask us-if abortion is such a good thing; if it results in women coming to terms with their moral autonomy, making good choices for their lives, acting in the interests of society and their existing and future children-do we want to reduce the need for it? Simply put, the movement as a whole and most of our leaders find it difficult to acknowledge publicly that we have spent our lives, our passion, fighting for something that both is central to human freedom and autonomy and ends a form of human life.
We cannot imagine coercing a woman to continue a pregnancy that is unsupportable. At the same time, there is something valuable about encouraging public policy and personal decision-making that start from a presumption in favor of life. We interpret life broadly. We say we are in favor of legal abortion because it protects women's lives. We do not mean just their physical lives; we mean their capacity to live full, free and happy lives. Why, then, should we think that a presumption in favor of life is inappropriately applied to fetal life? Why do we insist that because the fetus is not a person in any theological, scientific, legal or sociological sense, it does not deserve our consideration? Do not people want to know if those of us who advocate a moral right to choose an abortion also approach all aspects of life with wonder and awe? Can we totally separate our attitude toward the justifiable taking of non-personal life in abortion from the other principles of protecting life that have become crucial to our survival as civilized human beings?
A modern sensibility about an expanded definition of respect for persons and life became common in the last part of the 20th century. The war in Vietnam was almost over, and we thought we had learned a lesson about peace and justice. Women and racial minorities had their rights recognized. These advances now seem illusory as we see the way in which our country and other countries have morally distanced themselves from massive slaughter in war and in tribal and ethnic conflict. We see the continuing disregard for the lives and aspirations of the poor and marginalized people among us. We are not just committed to the lives of persons; we are committed to being persons who respect many forms of life. We want to behave in ways that honor even non-human life-animals and plants included. We respect the environment, which is essential to our survival. We seek laws that ensure that human tissue and body parts are treated respectfully even as they are used to further the health and well-being of all. We insist that human subjects not be experimented upon. We speak out against the torture of one person, even if it would save the lives of many others, and we are horrified that this principle is not universally accepted. It is foolish to think that these sentiments and values do not or should not affect the way in which we and the American people think about the fact that abortion necessarily results in the ending of potential human life. To think that we should remain inured to these instincts would tragically diminish our humanity and make us less worthy public leaders.
Although it would be unjust to place on women's reproductive decisions the moral burden of upholding absolutely a presumption in favor of life, it is important that we express our belief that the ability to create and nurture and bring into the world new people should be exercised carefully, consciously, responsibly and with awe for our capacity to create life. That is one reason why we must commit ourselves to working to make abortion unnecessary, and be willing to use those words. We must not flinch when Hillary Clinton says abortion should be "safe, legal and rare." We must applaud prochoice members of congress like Rosa DeLauro, who says: "We must create an environment that encourages pregnancies that can be carried to term." Such statements are not made in a vacuum; they are not the idiosyncratic thoughts of Catholics who have some creepy obsession with fetuses. They are part of thoughtful attempts to balance respect for a woman's right to make the choice about when to bring a new child into the world with a deep presumption that life, even the life of non-persons, is worthy of respect. And they should be based on our values, on the desire not to better "message" abortion rights, but to respect the moral sensibilities of American women.
We have been on the defensive so long that we are like lionesses ready to rip out the throat of anyone who attacks our cubs-and women are our cubs! Yet the vast majority of American women act as if they do not want to need abortions. How many times have we heard a woman say, "I missed my period; I hope I am not pregnant; I don't want to have to have an abortion"? According to the latest figures, 89 percent of women who are at risk of unintended pregnancy use contraception. They represent 48 percent of the 3.1 million women annually who have unintended pregnancies. The 11 percent of women at risk for pregnancy who are not using contraception account for the remaining 52 percent of unintended pregnancies.
They know there is no fully satisfying outcome to undesired pregnancy. The choice to have a child one is not prepared to parent or cannot afford, give a child up for adoption or have an abortion is a grim one. Women are strong and they cope well with these lousy choices. An unwanted child can become loved and cared for; an adoption, although painful, can be viewed as a generous gift; an abortion today may enable better parenting or a more fulfilled life without children in the future. Unwanted children can also remain unwanted and uncared for, though, and both adoption and abortion can result in lifelong sadness. For those who are prochoice, this second set of outcomes of unintended pregnancies is inconsistent with our vision of a just and caring society. Women should not end up having children they do not want and cannot care for, nor should they end up having abortions they would have preferred not to have.
Why then do we get so caught up, so tongue-tied when we are asked if we want to prevent abortion? We spend countless hours trying to find the most nuanced way of answering this question. We worry that some woman will be hurt if we acknowledge the moral ambiguity of abortion. Yes, words are important, but so is vision. Should we say there are too many abortions in the US? I doubt it. Which abortion tipped the balance from just enough to too many? It's a little bit like Goldilocks and the Three Bears: too hot, too cold, just right. Which woman should not have had an abortion? What reason was frivolous? Our heads spin! We believe we are on thin ice if we say we want to reduce the number of abortions. Is there an ideal number of abortions? An arbitrary rate that is acceptable? Are some women irresponsible? Should we set an annual number and then stop performing abortions once we have hit that number? Does every woman who reaches puberty get an abortion chit which can only be redeemed once in a lifetime?
There is nothing unusual about moral complexity. Women-and men-live with it every day. It is what it means to be a human person. We are in favor of a woman's right to decide when she will give the gift of life; after all, gifts must be freely given. We love life and want to act in its interest, and so we are in favor of supporting women's own desire not to become pregnant when they do not wish to bring a child into the world, we strongly support the right of every woman to continue a difficult but wanted pregnancy, and we will do everything we can to support her economically and emotionally.
The reality is that we could use a lot of government involvement in supporting women's moral agency. One of the most touching phrases in the Roe v. Wade decision was the recognition that women should not be isolated in their pregnancies. Government has washed its hands of pregnancy-it will not pay for abortion, it provides inadequately for contraception and sexuality education, and it certainly does not provide for women, children and families. It is time to change that. A moral discourse that calls on individuals to act toward the creation of life responsibly cannot be separated from a call of social justice for measures, like those included in the Ryan-DeLauro bill, that contribute to a sense that it is not women alone who are responsible for respecting life, but government as well.