Commentary Abortion

What We Can Learn From “Pro-life” Patients

Stigma Shame and Sexuality Series

To me the abortion experiences of prolife women can offer us insight into understanding internalized stigma. They remind us of the empathy we must harness to improve abortion care for all women, especially those with the least access to social support.

This post is by Kate Cockrill, and is part of Tsk Tsk: Stigma, Shame, and Sexuality, a series hosted by Gender Across Borders and cross-posted with Rewire in partnership with Ipas.

Over the years that I have been working in abortion research and care, I have heard many compelling stories about prolife patients. Feminist blogger Joyce Arthur gave some exposure to these stories in her 2007 Daily Kos piece entitled “The Only Moral Abortion is My Abortion.” Occasionally the story of the “prolife” patient is presented as a conundrum for counselors. What do we do when a woman thinks that having an abortion is the same as killing a baby? But more often than not, the “prolife” patient story becomes another sign of prochoice losses in the culture war over abortion. The patient is painted as the abortion-version of Benedict Arnold: hypocritical, a backstabber, a turn-coat.

I offer a different perspective. To me the abortion experiences of prolife women can offer us insight into understanding internalized stigma and the relationship between an individual’s conscience and their behavior. They remind us of the empathy we must harness to improve abortion care for all women, especially those with the least access to social support.

The following is the story of one prolife woman I met in my research. Her story has helped me to better understand the social and emotional experience of abortion for prolife women. Amanda was a 25- year-old student living with her husband and four children in a two-bedroom apartment. Early on in our conversation, she told me she was opposed to abortion.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

I don’t believe in killing a baby, you know. It’s living, no matter if it just, you know, just happened, or nine months from now.  You know the whole entire time it’s a living, growing thing. It’s, you know, it’s life so I don’t think that it’s, nothing like that should be taken lightly. It’s not just something you can pay money and just feel like, ‘Get rid of it.” And that’s how I feel about it.

In the past, she had protested outside of abortion clinics.

Yeah, with our church (we would) hold signs out, you know. We try to, I don’t know, to let people know that it’s okay to do other things. There’s other options then abortion, you know. Some women have more courage than others. Some women can go full term and have a baby and give it up for adoption because there are lots of women who, you know, can’t have kids and it is great to be able to give it to a family that, you know, will be able to love it and take care of it…I’m just not that strong. 

Tragically, Amanda had become pregnant with her youngest child as a result of a traumatic rape. She had considered abortion for that pregnancy but when she arrived at the clinic and saw the ultrasound she changed her mind.

I went to the abortion clinic in [small southern town] and walked in, paid the money, went and had an ultrasound, and the lady asked me if I wanted to look… I was real scared to look. And I went ahead and looked anyways and it was Jessie, and she was moving around and it freaked me out. I left and I didn’t go back. I walked out and that was it, and I had Jessie. She’s my seventeen-month-old.

When she became pregnant for the fifth time, Amanda and her husband had a difficult decision to make.

You know, sometimes we’ll eat peanut butter and jelly sandwiches for a whole week, you know, I mean, just with four kids, it’s a lot of people to take care of and feed. And it’s even harder, ‘cause when I get pregnant I’m out of work.

I asked her if there were any good reasons to have an abortion.

No, not really. I mean, my reason would be selfish. My reason for having an abortion would be selfish because it would be for myself and, you know, the rest of the kids in my house you know, to kill one life… But the more kids you have, the less attention they get, you know, the less care that you can really see yourself giving to them, or more tired. I feel like I can’t please all of them right now. I already feel like I’m going crazy, you know like, “I love you, I love you, I love you, I love you.”

Amanda expected judgment because of her decision.

I won’t tell anybody what I’m doing because I just don’t feel like I should be bashed for my decision. It’s my life and it will never happen again, so.

But she still had harsh words for other women who have abortions, especially more than one.

You know, like I say that I don’t believe in abortion, I don’t think it’s right…I don’t think that women should be able to keep coming back to an abortion clinic. I don’t think that you should be able to come back two or three times and be able to just continue to have abortions.

When we talked about abortion policy, Amanda did not think abortion should be illegal. But she was in favor of every other abortion restriction we discussed: waiting periods, age limits, mandatory counseling and prohibiting federal funding for abortion.

One of the tenets of qualitative research is to ask open-ended questions without guiding the participant toward any sort of answer.  In my interview with Amanda, we explored her beliefs but I did not ask her to confront or explain her ambivalence or conflicted feelings. This style of interaction enabled me to see Amanda in the way she saw herself: against abortion but having one anyway. From her perspective abortion is always wrong and some abortions are more wrong than others. She felt good about her commitment to her family and simultaneously selfish for extinguishing the life that was growing inside her. She did not see herself as a victim. She just hoped God would forgive her.

Although I label Amanda “prolife” I am aware that women’s negative attitudes toward abortion and even abortion policy are not static. The boundaries of prochoice and “prolife” are notoriously hard to define.  It makes sense that “prolife patients” would espouse contradictory values in light of their own abortion experience. Amanda was no different.  Though she expressed condemnation of abortion and other patients throughout the interview, she showed a change of heart when I asked if she would protest abortion in the future.

I would, I would go out there with [prolife protestors] but I would… be able to have a sign that said that I want everybody to choose, you know, what they want to do. I would never go out there and just say don’t have abortion. Not any more.

At ANSIRH we recently collected data from over 600 women who have had abortions in the US. Our preliminary analyses of the data suggest that the most common type of stigma women experience is internalized stigma (eg. guilt, self-hatred and shame). More women internalize their stigma than experience direct forms of stigma like judgment from others, the loss of a relationship, gossip or abuse. Unfortunately, women who have negative attitudes toward their own abortion are likely to come from communities with similarly harsh views and therefor may be the least likely to seek support from others.

Stories about “prolife” women who turn their backs on their abortion providers have some truth. Having worked in abortion care, I know that not all patients are grateful or well-mannered. Some women can be downright abusive. But if we expect the “other side” to move from judgment to empathy on the issue of abortion, then we should expect no less from ourselves. Focusing on the outrageous behavior of a few “prolife patients” does nothing to support the very women who may be at the most risk of stigma and isolation. At the same time it furthers a mythology that adds fuel to the culture wars that are harmful to all of us. By seeking an understanding of these women we blur the political lines and expand the potential of our movement.

When I think about “prolife” patients, I think about Amanda and how she battled her conscience to do what she believed was right for her family. I don’t expect her to join the movement for abortion rights. Though I am glad those rights were there for her when she needed them. I mostly hope she has found peace with her decision and moved forward with her life.

Kate Cockrill  is the Stigma Project Director at Advancing New Standards in Reproductive Health, at the University of California San Francisco.

Roundups Law and Policy

Gavel Drop: Republicans Can’t Help But Play Politics With the Judiciary

Jessica Mason Pieklo & Imani Gandy

Republicans have a good grip on the courts and are fighting hard to keep it that way.

Welcome to Gavel Drop, our roundup of legal news, headlines, and head-shaking moments in the courts.

Linda Greenhouse has another don’t-miss column in the New York Times on how the GOP outsourced the judicial nomination process to the National Rifle Association.

Meanwhile, Dahlia Lithwick has this smart piece on how we know the U.S. Supreme Court is the biggest election issue this year: The Republicans refuse to talk about it.

The American Academy of Pediatrics is urging doctors to fill in the blanks left by “abstinence-centric” sex education and talk to their young patients about issues including sexual consent and gender identity.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

Good news from Alaska, where the state’s supreme court struck down its parental notification law.

Bad news from Virginia, though, where the supreme court struck down Democratic Gov. Terry McAuliffe’s executive order restoring voting rights to more than 200,000 felons.

Wisconsin Gov. Scott Walker (R) will leave behind one of the most politicized state supreme courts in modern history.

Turns out all those health gadgets and apps leave their users vulnerable to inadvertently disclosing private health data.

Julie Rovner breaks down the strategies anti-choice advocates are considering after their Supreme Court loss in Whole Woman’s Health v. Hellerstedt.   

Finally, Becca Andrews at Mother Jones writes that Texas intends to keep passing abortion restrictions based on junk science, despite its loss in Whole Woman’s Health.

Culture & Conversation Human Rights

Let’s Stop Conflating Self-Care and Actual Care

Katie Klabusich

It's time for a shift in the use of “self-care” that creates space for actual care apart from the extra kindnesses and important, small indulgences that may be part of our self-care rituals, depending on our ability to access such activities.

As a chronically ill, chronically poor person, I have feelings about when, why, and how the phrase “self-care” is invoked. When International Self-Care Day came to my attention, I realized that while I laud the effort to prevent some of the 16 million people the World Health Organization reports die prematurely every year from noncommunicable diseases, the American notion of self-care—ironically—needs some work.

I propose a shift in the use of “self-care” that creates space for actual care apart from the extra kindnesses and important, small indulgences that may be part of our self-care rituals, depending on our ability to access such activities. How we think about what constitutes vital versus optional care affects whether/when we do those things we should for our health and well-being. Some of what we have come to designate as self-care—getting sufficient sleep, treating chronic illness, allowing ourselves needed sick days—shouldn’t be seen as optional; our culture should prioritize these things rather than praising us when we scrape by without them.

International Self-Care Day began in China, and it has spread over the past few years to include other countries and an effort seeking official recognition at the United Nations of July 24 (get it? 7/24: 24 hours a day, 7 days a week) as an important advocacy day. The online academic journal SelfCare calls its namesake “a very broad concept” that by definition varies from person to person.

“Self-care means different things to different people: to the person with a headache it might mean a buying a tablet, but to the person with a chronic illness it can mean every element of self-management that takes place outside the doctor’s office,” according to SelfCare. “[I]n the broadest sense of the term, self-care is a philosophy that transcends national boundaries and the healthcare systems which they contain.”

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

In short, self-care was never intended to be the health version of duct tape—a way to patch ourselves up when we’re in pieces from the outrageous demands of our work-centric society. It’s supposed to be part of our preventive care plan alongside working out, eating right, getting enough sleep, and/or other activities that are important for our personalized needs.

The notion of self-care has gotten a recent visibility boost as those of us who work in human rights and/or are activists encourage each other publicly to recharge. Most of the people I know who remind themselves and those in our movements to take time off do so to combat the productivity anxiety embedded in our work. We’re underpaid and overworked, but still feel guilty taking a break or, worse, spending money on ourselves when it could go to something movement- or bill-related.

The guilt is intensified by our capitalist system having infected the self-care philosophy, much as it seems to have infected everything else. Our bootstrap, do-it-yourself culture demands we work to the point of exhaustion—some of us because it’s the only way to almost make ends meet and others because putting work/career first is expected and applauded. Our previous president called it “uniquely American” that someone at his Omaha, Nebraska, event promoting “reform” of (aka cuts to) Social Security worked three jobs.

“Uniquely American, isn’t it?” he said. “I mean, that is fantastic that you’re doing that. (Applause.) Get any sleep? (Laughter.)”

The audience was applauding working hours that are disastrous for health and well-being, laughing at sleep as though our bodies don’t require it to function properly. Bush actually nailed it: Throughout our country, we hold Who Worked the Most Hours This Week competitions and attempt to one-up the people at the coffee shop, bar, gym, or book club with what we accomplished. We have reached a point where we consider getting more than five or six hours of sleep a night to be “self-care” even though it should simply be part of regular care.

Most of us know intuitively that, in general, we don’t take good enough care of ourselves on a day-to-day basis. This isn’t something that just happened; it’s a function of our work culture. Don’t let the statistic that we work on average 34.4 hours per week fool you—that includes people working part time by choice or necessity, which distorts the reality for those of us who work full time. (Full time is defined by the Internal Revenue Service as 30 or more hours per week.) Gallup’s annual Work and Education Survey conducted in 2014 found that 39 percent of us work 50 or more hours per week. Only 8 percent of us on average work less than 40 hours per week. Millennials are projected to enjoy a lifetime of multiple jobs or a full-time job with one or more side hustles via the “gig economy.”

Despite worker productivity skyrocketing during the past 40 years, we don’t work fewer hours or make more money once cost of living is factored in. As Gillian White outlined at the Atlantic last year, despite politicians and “job creators” blaming financial crises for wage stagnation, it’s more about priorities:

Though productivity (defined as the output of goods and services per hours worked) grew by about 74 percent between 1973 and 2013, compensation for workers grew at a much slower rate of only 9 percent during the same time period, according to data from the Economic Policy Institute.

It’s no wonder we don’t sleep. The Centers for Disease Control and Prevention (CDC) has been sounding the alarm for some time. The American Academy of Sleep Medicine and the Sleep Research Society recommend people between 18 and 60 years old get seven or more hours sleep each night “to promote optimal health and well-being.” The CDC website has an entire section under the heading “Insufficient Sleep Is a Public Health Problem,” outlining statistics and negative outcomes from our inability to find time to tend to this most basic need.

We also don’t get to the doctor when we should for preventive care. Roughly half of us, according to the CDC, never visit a primary care or family physician for an annual check-up. We go in when we are sick, but not to have screenings and discuss a basic wellness plan. And rarely do those of us who do go tell our doctors about all of our symptoms.

I recently had my first really wonderful check-up with a new primary care physician who made a point of asking about all the “little things” leading her to encourage me to consider further diagnosis for fibromyalgia. I started crying in her office, relieved that someone had finally listened and at the idea that my headaches, difficulty sleeping, recovering from illness, exhaustion, and pain might have an actual source.

Considering our deeply-ingrained priority problems, it’s no wonder that when I post on social media that I’ve taken a sick day—a concept I’ve struggled with after 20 years of working multiple jobs, often more than 80 hours a week trying to make ends meet—people applaud me for “doing self-care.” Calling my sick day “self-care” tells me that the commenter sees my post-traumatic stress disorder or depression as something I could work through if I so chose, amplifying the stigma I’m pushing back on by owning that a mental illness is an appropriate reason to take off work. And it’s not the commenter’s fault; the notion that working constantly is a virtue is so pervasive, it affects all of us.

Things in addition to sick days and sleep that I’ve had to learn are not engaging in self-care: going to the doctor, eating, taking my meds, going to therapy, turning off my computer after a 12-hour day, drinking enough water, writing, and traveling for work. Because it’s so important, I’m going to say it separately: Preventive health care—Pap smears, check-ups, cancer screenings, follow-ups—is not self-care. We do extras and nice things for ourselves to prevent burnout, not as bandaids to put ourselves back together when we break down. You can’t bandaid over skipping doctors appointments, not sleeping, and working your body until it’s a breath away from collapsing. If you’re already at that point, you need straight-up care.

Plenty of activities are self-care! My absolutely not comprehensive personal list includes: brunch with friends, adult coloring (especially the swear word books and glitter pens), soy wax with essential oils, painting my toenails, reading a book that’s not for review, a glass of wine with dinner, ice cream, spending time outside, last-minute dinner with my boyfriend, the puzzle app on my iPad, Netflix, participating in Caturday, and alone time.

My someday self-care wish list includes things like vacation, concerts, the theater, regular massages, visiting my nieces, decent wine, the occasional dinner out, and so very, very many books. A lot of what constitutes self-care is rather expensive (think weekly pedicures, spa days, and hobbies with gear and/or outfit requirements)—which leads to the privilege of getting to call any part of one’s routine self-care in the first place.

It would serve us well to consciously add an intersectional view to our enthusiasm for self-care when encouraging others to engage in activities that may be out of reach financially, may disregard disability, or may not be right for them for a variety of other reasons, including compounded oppression and violence, which affects women of color differently.

Over the past year I’ve noticed a spike in articles on how much of the emotional labor burden women carry—at the Toast, the Atlantic, Slate, the Guardian, and the Huffington Post. This category of labor disproportionately affects women of color. As Minaa B described at the Huffington Post last month:

I hear the term self-care a lot and often it is defined as practicing yoga, journaling, speaking positive affirmations and meditation. I agree that those are successful and inspiring forms of self-care, but what we often don’t hear people talking about is self-care at the intersection of race and trauma, social justice and most importantly, the unawareness of repressed emotional issues that make us victims of our past.

The often-quoted Audre Lorde wrote in A Burst of Light: “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”

While her words ring true for me, they are certainly more weighted and applicable for those who don’t share my white and cisgender privilege. As covered at Ravishly, the Feminist Wire, Blavity, the Root, and the Crunk Feminist Collective recently, self-care for Black women will always have different expressions and roots than for white women.

But as we continue to talk about self-care, we need to be clear about the difference between self-care and actual care and work to bring the necessities of life within reach for everyone. Actual care should not have to be optional. It should be a priority in our culture so that it can be a priority in all our lives.