Consensus on Abortion?

A Pro-Choice “Extremist” Critiques the Global Search for Consensus on Abortion

Review of: The Human Drama of Abortion: A Global Search for Consensus
By Aníbal Faúndes and José S. Barzelatto, Vanderbilt University Press, Nashville, 2006. 200 pp.

Written by two distinguished doctors from Chile, this book is an important contribution to the abortion debate, but not without its flaws. Having witnessed the horrors of illegal, unsafe abortion in their own countries, the authors make a compelling pro-choice case. Their recounting of the facts about illegal and unsafe abortion around the world clearly demonstrates the tragic (and unnecessary) human, social, and economic costs of unsafe abortion.

The authors summarize the main causes of unwanted pregnancies as follows: women’s lack of power over their sexual activity; women’s lack of education, including inadequate and inaccurate knowledge of contraceptive methods; limited access to effective contraception; and the absence of social support for pregnant women and their children (pg. 124). The most common reasons for abortion, which the authors state are “fairly constant worldwide” are: absence of the father, financial constraints, inability to provide good parenting, interference with life prospects, conflict with prevailing social norms related to sex and marriage, health concerns, and lack of social support (pg. 55).

Of most interest are the authors’ proposed solutions for ending the abortion carnage, and for seeking a consensus within the abortion debate. Some idealism and faulty assumptions undermine the authors’ assessment, but their conclusions are thoughtful and still have value. They believe it’s possible to reach an “overlapping consensus” on abortion, by having a dialogue to identify common values and positions, and understand the roots of any differences (pg. 164). Although the authors seem aware that differences between the pro-choice and anti-choice positions reflect two irreconcilable world views, I do not feel they convincingly address this fundamental schism in a way that would really make a difference in reducing unsafe abortion.

The authors recognize that one of the most important ways to prevent unsafe abortion is to reduce the need for abortion in the first place. Both legal and moral prohibition have failed miserably, both throughout history and throughout the world today. The authors’ sensible prescriptions—already tried and true—are to prevent unwanted pregnancies by making contraception more accessible, empowering women, and providing better social support for mothers to raise their kids. Their suggestions to help reduce unsafe abortion include improving women’s status in society, decriminalizing abortion, and improving access to legal abortion.

But most of those in opposition to legal abortion are adamantly against the very things that would most effectively reduce unwanted pregnancies and unsafe abortions. This opposition is largely religiously-based and intransigent. The Catholic Church and other fundamentalist religious groups are the key players, especially where the toll of illegal and unsafe abortion is highest—Africa, Latin America, and parts of Asia. The authors do concede all this, but fail to adequately address how to overcome it. Instead, the authors cite a document called the "Genval Consensus" as religion’s next best hope for solving the problem of unsafe abortion. This United Nations report summarizes a meeting between theologians and scholars in 1994 in Belgium. The report's thoughtful conclusion was:

“Decriminalization of abortion, therefore, is a minimal response to this reality [danger of unsafe abortion] and a reasonable means of protecting the life and health of women at risk. … The view of any particular religious tradition should not be imposed on others.” (pg. 94)

These are very good and noble sentiments, but unfortunately, they were spoken from an academic ivory tower. Most of those who oppose abortion on religious grounds are highly conservative and will brook no compromise on the matter. They simply will not tolerate legal abortion, or the full emancipation of women. And all too often, they are eager to impose their beliefs on the rest of the world, or at least on all citizens of countries where they dominate. For proof, one need only look to the persistent existence of anti-abortion laws in Africa and Latin America, and the strident activism of anti-choice forces everywhere who protect or implement such laws. Yet Faúndes and Barzelatto calls the Genval Consensus the “mainstream of current religious thought” indicating that a “dialogue among religions that will identify common purposes is possible.” Yes, among liberals, of course! But liberal religious beliefs have never been the problem—it’s fundamentalism that is the intractable foe of women’s equality and safe abortion access.

An even deeper cause of opposition to abortion is patriarchy. The majority of modern cultures still want to cast women into a childbearing role, and keep women in an inferior position, socially and politically. This explains why religious groups are against contraception, the empowerment of women, and even better social support for mothers. One might think that motherhood would be highly valued and strongly supported by those opposed to legal abortion, but such is generally not the case. In a patriarchal society, women and children apparently do not “need” any direct social support, because it’s the sole responsibility of husbands and fathers to take care of them (and their prerogative not to). Faúndes and Barzelatto point to research in developing countries that shows the model of gender dominance can be shifted through educational programs that target males during childhood and adolescence (pg. 131). This is a hopeful sign that patriarchy is not necessarily inevitable, if society is willing to make a concerted effort to counteract it. In the meantime however, much of the world is still strongly patriarchal. This begs the question of how realistic it is to hope for significant improvement in abortion access through an “overlapping consensus.”

A theme that often crops up in the book is the disconnect between the public condemnation of abortion, and the private acceptance of abortion when it impacts one’s own life, or when it suits one’s political purposes. Both Faúndes and Barzelatto have stories to illustrate this. Barzelatto, representing the World Health Organization, once had a meeting with a high official in the Ministry of Health in a Muslim country. The official began the meeting with a 20-minute lecture on the evils of induced abortion, even though the meeting had nothing to do with abortion. At the end of this diatribe, the official asked Barzelatto if WHO could help his country expand a national program on menstrual regulation, which is actually a type of early abortion. Barzelatto realized it had been “politically and religiously mandatory for my host to separate menstrual regulation from later abortion, and it was equally clear that his government would never accept any similarity between the two procedures.” (pg. 12-13). Faúndes’ story is about a physician colleague, a strict, anti-abortion Catholic who often spoke publicly on the evils of abortion and how it could never be justified under any circumstances. One night Faúndes received a phone call from this colleague, who requested an abortion for his 15-year old daughter. The colleague said she had been gang-raped at a party, and needed the abortion because otherwise “she would have no future, no hope of a ‘normal’ family, no chance of happiness.” Since his daughter’s period was only two weeks late, and the circumstances extreme, the colleague believed an early abortion to be completely justified (pg 69). (Faúndes helped arrange it, of course.)

I’ve written myself about the not-uncommon phenomenon of anti-choice women having abortions. In terms of Faúndes’ and Barzelatto’s book however, what’s most intriguing about this disconnect is that the authors themselves fall prey to it, although much less so than the average anti-choice hypocrite. This really serves to demonstrate just how deep the ambivalence and unease to abortion actually runs.

Faúndes describes being a medical intern in the 1950’s in Chile, when the prevailing culture in medicine was to treat women who had abortions as criminals. He says:

“Women had to pay for yielding to the pleasures of sex without assuming the responsibility of motherhood. The presumption was that (1) she had wanted to have sex, (2) she had enjoyed it, (3) she had not prevented the pregnancy because she was irresponsible, and (4) her reasons for not wanting to continue the pregnancy were selfish. At first I bought into this line of thought, but as I began to listen to the women’s stories, it became increasingly clear that in almost every case, some or all of the four presumptions listed above were incorrect. My initial condemnation of these women shifted to understanding and compassion.” (pg. 63)

In a few spots in the book, the authors point out that the majority of people in the world believe that abortion is “morally justified under certain circumstances” and should be “legally allowed under certain circumstances.” In the end, they too adopt this framework, even though Faúndes himself admitted that “in almost every case,” the moral presumptions about why women have abortions are wrong, which he says led him to a position of understanding and compassion.

But the understanding and compassion in the statement “abortion is morally justified under certain circumstances” is highly limited and qualified. Whose morals are we talking about, and who gets to decide whether they are justified? The statement actually puts us squarely into the anti-choice camp. We can’t trust women to make a morally justified decision, so someone else has to decide for them. Accordingly, Faúndes and Barzelatto assert that a consensus on abortion should have the following “ethical basis”: Women can have abortions on request until the 12th week of pregnancy. Between 12 and 22 weeks, a “strong justification” is needed, which would depend on the circumstances and the local culture, but would include at least a risk to the woman’s life, very severe fetal malformation, and pregnancy as a result of rape or incest. After 22 weeks, abortion should only be permitted if the pregnancy threatens the life of the woman, or in cases of lethal fetal abnormalities where the fetus cannot survive after birth (pg. 109).

Underlying the statement that “abortion is morally justified under certain circumstances” are several unquestioned assumptions on the part of the authors. First, they sometimes speak of the “rights of the fetus” – as if fetuses have rights, or at least should have rights. But at no time do the authors present any evidence for such a thing. Instead, they simply presume that fetal rights exist as a valid competing claim against the woman’s rights, especially after viability. I have argued (in my article “The Fetus Focus Fallacy”) that whatever the fetus might be, and whatever its moral status, are completely subjective issues that are irrelevant to the abortion debate. Many people care a lot about fetuses, but others don’t place much importance on them. The wide varety of personal opinion on the value of fetuses—ranging from "just a clump of cells" to a "full human being"—means that it's impossible to arrive at any true (or just) social consensus on the status of the fetus. I would argue that the more we value fetuses, the more we ignore or downgrade the rights of women. Placing value on fetuses simply masks our distrust and disrespect for women—as explained in my article "Let No Fetus Defeat Us!"

The only person who can rightfully make a determination of fetal value is the pregnant woman herself (if she wants to). In an egalitarian society where women are truly empowered, women would be trusted to act responsibly on behalf of their fetuses, whether that means having an abortion or getting pre-natal care. There would be no compulsion to second-guess women, or treat them like amoral children in need of protection from themselves.

Further, concerns around fetal viability are a red herring. If we can trust women and their doctors to make pregnancy decisions before viability, why should that change after viability? Is that the point at which legislators suddenly become more knowledgeable and skilled in medicine than doctors? Or is it because all pregnant women lose control of their senses after the 22nd week of pregnancy? In fact, post-viability abortions are rare because they are only needed in the most extreme or desperate circumstances. That makes legal restrictions on late abortion wrong and counter-productive. Not only do they obstruct access to critical medical care for the most vulnerable women, they put an official stamp of moral disapproval on those women and the doctors who help them. If a woman wants or needs an abortion after 22 weeks, and her doctor agrees, then it’s nobody’s business but theirs.

This conclusion might be unsettling to some, which brings me to another unquestioned assumption on the part of the authors. Although Faúndes has found that women have understandable reasons for abortion “in almost every case,” he believes that only “certain” abortions are morally justified. Setting aside this puzzling contradiction, let’s look at the women who request abortion for supposedly “morally unjustified” reasons. What would these reasons be? Let’s keep in mind that they cannot be the reasons cited by the pregnant woman herself, to whom a requested abortion is always justified, by definition. Unfortunately, Faúndes and Barzelatto do not give us any clues about “morally unjustified” abortions. We must turn to anti-choice people to discover these reasons. Only they seem to know about the many women who have abortions “casually” for the sake of “convenience.” According to them, some women have abortions on impulse, stopping by the clinic on their way to the hairdresser. Teenage girls often get abortions so they’ll fit into their prom dress. Other women selfishly want to continue living their fun but shallow life, uninterrupted by dirty diapers. A few women even show up at abortion clinics totally guilt-free, even having the nerve to chat and laugh while relaxing casually in the waiting room. Most troubling of all perhaps, is that some women just don’t want to have children.

What’s wrong with these women, anyway? And are we right to believe that forced motherhood will cure their apparent neuroses and other evil inclinations?

Of course, I’m being facetious. Both the “casual” abortion and the “irresponsible, selfish” woman are the mythical creations of the anti-choice movement. These myths gain traction in society at large, because patriarchy says that women naturally want to be mothers and must be mothers, which makes women who have abortions “unnatural” or “immoral.” That’s why women who simply don’t want to have babies are lumped in with the “irresponsible, selfish” sort.

For the sake of argument, let’s suppose there are some irresponsible women having casual abortions for reasons we would all find morally reprehensible. I’m even willing to admit there might be a few of those—women aren’t perfect after all. But do we really think it’s appropriate for a teenage girl to have a baby when all she cares about is fitting into her prom dress? Do we really want a callous and shallow woman to be a mother of an innocent baby she doesn’t want and will probably abuse?

The deeper question is whether we have the right to morally judge any woman or her decision, regardless of our own gut feelings. Morals are a personal thing, and what seems right for one person might be anathema to the next. Besides, it's not illegal to be irresponsible and selfish, generally speaking, so how can we exercise a legal veto over such behaviour in pregnant women—let alone judge it? Doing so is the very definition of paternalism—the refusal to treat women as adults, including not letting them take responsibility for their own decisions and their own mistakes. Paternalism also lies behind the assumption that some abortions are not morally justified, because this implies it would be more moral to force women to have babies they don't want. No reasonable pro-choice person can agree with this.

For the sake of justice and compassion, we cannot judge pregnant women. Only they truly understand their circumstances and personal capacities. Only they are experiencing the pregnancy; only they must sacrifice their freedom and bodies for nine months to host and birth the baby, as well as the next 20 years of their lives to raise that child. It’s their bodies and their lives at stake—which is a cliché nowadays, but one that should never lose its powerful meaning. A pregnant woman has to live with the decision she makes, and the consequences of it. That’s why an abortion decision is nobody’s business but hers—regardless of her reasons, and regardless of the length of gestation.

The only factor that should legitimately limit access to abortion is the willingness and ability of the abortion provider. We often do a disservice to them as well. Doctors are professionally trained to deliver medical care and help their patients. If we can trust their medical discretion in other areas, there’s no reason not to trust their medical discretion when it comes to abortion. All doctors are subject to codes of ethics, and medical policies and regulations, such as providing informed consent to patients. Medical bodies already monitor doctors for possible unethical or criminal behaviour, so there’s no reason to single out abortion care. Abortion is a necessary medical treatment for women, and no required medical care should ever subject doctors to possible criminal prosecution. We do not need any legal restrictions at all on abortion, just like we don’t need them for doing appendectomies. In fact, the wide variety of abortion laws throughout the world is hard proof that such laws have nothing to do with the health of women; instead they are cultural and political products of religious patriarchy. As proven by Canada, the only democratic country in the world that has no laws against abortion, we can trust doctors and women to act responsibly without the need for any regulation.

A final unquestioned assumption on the part of the authors sorely needs to be addressed. In discussing the basis for an overlapping consensus on abortion, the authors state:

“The public debate has been dominated by two extreme views: one that maintains that women always have the right to decide the fate of the fetus as a part of their bodies and one that maintains that the rights of the fetus, from the time of fertilization, always override the rights of the pregnant woman. We believe that most people disagree with both of these two extremes and that there is a already a narrow but significant overlapping consensus with respect to abortion (1) Nobody likes the idea of having an abortion, or of other people having abortions, but virtually everyone agrees that abortion is morally justified under certain circumstances. (2) There are too many avoidable abortions. (3) Unsafe abortion is a major public health problem.” (pg. 166)

Well, I guess this makes me an “extremist.” The odd thing is, I don’t disagree with the overlapping consensus as stated here, except to add the caveat, that even if someone thinks a particular abortion is morally unjustified, that’s irrelevant, because there should be no legal restrictions on abortion anyway. I also don’t disagree with any of the nine points the authors subsequently list as a guide to the dialogue (pg.167-169). But I do question the authors’ stated commitment to “gender equity” and women’s right to “true control over their sexual lives” when they actually believe the abortion decision should be taken away from women after only 12 weeks of pregnancy (with no recognition that many women are unable to access early abortion services for reasons beyond their control).

What bothers me most about this passage, however, is the total lack of justification for using the word “extreme” when talking about a strong pro-choice view. In the abortion wars I’m familiar with, the extremists are the ones who bomb clinics and shoot doctors in the name of “pro-life.” Extremists are those who deny human rights and dignity for half the world’s population on the basis of biology. Extremists are those who don’t care when women die from unsafe abortion, because they label such women “murderers” who deserve their fate. Those are the extremists I know. On the other hand, those who advocate full equality and respect for women—backed up by evidence, logic, and ethical arguments—are not extremists by any stretch of the imagination. The use of the word "extreme" in this context is an insult, a dismissive caricature of the nuanced views of most pro-choice campaigners. The most “extreme” pro-choice people I know work in abortion clinics. They got that way by developing a profound respect, compassion, understanding, and trust for the women they serve. They put the woman first, making sure her needs are listened to and met, and by doing so, they’ve saved the lives of more fetuses than the protesters outside their doors ever will.

So, is it possible to reach an “overlapping consensus” on abortion? Maybe, if fundamentalist religion loses its sway in the world. There are many progressive and thoughtful people working hard to advance abortion rights and improve access, so there’s bound to be some successes, and hopefully steady progress in the years to come. Even though I’m an “extremist,” I appreciate that positive change must usually come in slow increments. For example, in a country with a strict abortion ban, an amendment that allows abortion in cases of rape or incest is a huge step forward, one that may serve to increase popular support for abortion rights in general. But we should always keep our eye on the prize. The solution advocated by Faúndes and Barzelatto is a compromise that doesn’t fully respect women’s autonomy, while pretending to. True justice demands nothing less than full equality for women, sexual and reproductive freedom for all, and the repeal of all abortion laws and restrictions.