Talking about the Babies: Saying “Things We Cannot Say”

“[A]bortion is, in the ordinary motherhood-type way, the concern of women who are taking responsibility for the lives of their children” (Judith Arcana).

“You’ve written on your chart that you feel guilty,” I say to the patient I am screening. “Can you tell me more about that? Why do you feel guilty?”

“I feel guilty because I am killing my baby,” she answers. “That’s why I feel guilty.”

The first time an abortion patient said this to me, I was completely unprepared for it. Although I was a long-time pro-choice activist, a Ph.D. who had studied feminist theory, and a former abortion patient myself, nothing in my experience had prepared me to talk with a woman about killing babies. “Oh, no,” I said to her as gently as I could. “It’s not a baby—it’s just tissue.” That was wrong.

This past year, when the reports emerged of the conditions in the Philadelphia abortion clinic run by Dr. Kermit Gosnell, pro-choice activists tended to focus on Gosnell’s record of poor medical care (especially that he was doing illegal abortions), the state’s failure to respond to many complaints about Gosnell’s practice (including several filed by other physicians), the two women who died while under his medical care, and the racial and class politics that shaped his patient base (that is, that many of his patients were poor and recent immigrants, which certainly made it harder for them to expect and demand quality medical care).

At one point in an on-line discussion among pro-choice activists and abortion providers, one of our colleagues asked us to consider why we were not discussing the babies. In addition to the women, several infants were born alive in Gosnell’s clinic when their mothers’ abortions did not go as planned and then were killed. In at least one case, one of Gosnell’s employees reports, a baby born during an abortion-procedure-gone-wrong lay on a counter moving and breathing for almost twenty minutes before someone severed its spine and killed it. Why, our activist friend asked us, weren’t we talking about the dead babies?

The short answer is that it is hard for abortion providers and activists to talk about babies in the context of abortion. We all know that an unborn child dies in each abortion. And the majority of abortion care workers accept responsibility for our roles in these deaths. We have, for various reasons, determined for ourselves that having a part in these deaths is an important—and ethical—thing for us to do. At the same time, we realize that while our work brings us in direct contact with death on a regular basis, the majority of people (even those who identify as “pro-choice”) are uncomfortable talking about death. Add to this the way abortion-rights opponents have long invoked death to condemn abortion, and you have a perfect recipe for silencing people.

About three years ago, one of my physician colleagues broke this silence, speaking and writing about how it felt to be performing an 18-week abortion and suddenly feel her own 18-week fetus move. She writes that she cried. She also calls on abortion-rights advocates to have honest conversations about abortion and death, no matter how uncomfortable we might feel, because to avoid these conversations is to seem uncaring and out of touch with our patients and our society. We might start these honest conversations by asking what differentiates these two 18-week unborn babies? The short answer—which is both incredibly simple and very complicated—is that the unborn baby moving inside the physician/mother is being carried by someone who has chosen to complete her pregnancy and deliver a living child, and the other unborn baby is being carried by someone who, for reasons that we may or may not understand, has decided that she cannot complete her pregnancy. In other words, the life or death of the unborn baby is determined by the mother’s decision about whether she wants to share her body with another being; since that being is inside her, the decision is hers.

I do understand that this distinction can feel unsatisfying to many people, no matter what their stance on keeping abortion legal, and if the pregnancies in question were 24 weeks along, rather than 18, the relationship between abortion and death would be even more important for us to consider.

And what about death and abortion and the babies allegedly born-then-killed in Gosnell’s clinic? Suddenly the question of the mother’s decision about her pregnancy becomes more complex because the baby is no longer in her body. In other words, while she is pregnant, her decision to have an abortion is like any other woman’s. How does this change when the unborn baby is no longer unborn—no longer inside her body?

I’ve talked with two wise people about this question. One said to me, “when the baby is inside the mother’s body, its death is birth control; after it is outside the woman’s body, its death is something else—maybe population control.” He went on to suggest that we are, as a society, a lot more comfortable with birth control than with population control and that we might even consider the latter to be immoral.

The other wise person I spoke with suggested that we think about it another way. The pregnant woman went to Dr. Gosnell to ensure that she would not have her baby. She knew the baby would die. He did exactly what she asked, although not in the way (we presume) that she expected him to do it.

Certainly, the act of deliberately killing a living, breathing person is considered wrong in our society, and neither of these people contradicts that, but both challenge us to rethink this question, to place it in broader contexts of our social mores and expectations. At the very least, both suggest that we need to be able to have honest conversations about babies and death if we expect to be honest in our abortion-rights advocacy.

So what would it sound like if abortion-rights advocates were to speak openly and honestly about the death of unborn babies?

* First, we would need to acknowledge that having an abortion is a concern of motherhood. Even those of us who are not comfortable saying “babies” and “abortion” in the same sentence can remind people that an abortion decision is always made by someone who is (or is becoming) a mother. We tend to define pregnant women as moms almost immediately. When a friend learned she was pregnant with her first baby, we all expected her husband to come through with a Mother’s Day gift, even though she was not yet showing. (Luckily for him, he did!) Another friend tells me how, as soon as she had a positive pregnancy test, the staff at her doctor’s office started calling her “mother,” as in, “OK, mother, step up on the scale, so we can check your weight.” In the U.S., pregnant equals mother, and that means that every abortion is a mother’s act.

* Second, we should never deny that abortion kills an unborn child. When the topic comes up, a simple “yes, I know—and so do women who have abortions” will often suffice. Several years ago, the director at the clinic where I worked was on a radio show talking about second trimester abortion. A caller said, “you can’t tell me it’s not a baby. And you can’t tell me that the baby won’t die!” Yes, she said calmly, it is a baby and yes, it is killed. Women know this, and they have abortions anyway. This is exactly why abortion is complicated, like many of life’s challenges. We must remember, though, that complicated does not necessarily mean wrong.

If someone says, “so-and-so had an abortion. I can’t believe she would murder her baby!” we should resist the is-it-a-baby-yet argument. Instead, we should model what we hope others might say. For example: “I had no idea she was going through that. I hope she feels supported by those who love her.” This redirects the conversation from the killing to love. Hopefully, no matter how we feel about abortion, we can agree that those we care for deserve support when they are meeting a challenge.

* Third, we should acknowledge similarities between miscarriage and abortion. Doctors call miscarriage “spontaneous abortion” and a chosen abortion “elective abortion”; in other words, both are abortions. One happens whether the woman wants it to or not; the other happens at her request. Otherwise, they are remarkably similar, both emotionally and physically. When I give talks about elective abortion, I often use the phrase “when a pregnancy ends.” This draws attention to the commonalities among pregnant women and their various pregnancy experiences.

* Finally, we should never again tell a pregnant woman how to think about her pregnancy and her abortion decision, as I did in the example that opens this post. We should honor each woman’s relationship to her unborn child and her decision regarding its life and use the language she uses to discuss it. Once I really understood this, a clinic conversation that began with killing a baby might go something like this:

“I feel guilty because I am killing my baby.”

“OK. Let’s talk about how you are going to cope with knowing that you have killed your baby. What do you believe happens to us when we die?” From this point, the woman and I could have an honest conversation about how she understood her abortion decision within the context of her own life circumstances, beliefs, and ethics.

Women have always known that pregnancy means a baby and abortion means the baby will die. When women care enough about the lives of their children—born and unborn—and about their own lives to make that decision, we owe them the respect and support that honesty conveys.