Nicci Gerrard 

Damned if you do…

One in three women has had an abortion and 92 per cent of us agree with the right to choose. So why are we still ashamed to talk about its effect on our lives?
  
  


'It was as if I had failed somehow.'
'I didn't think it was wrong, but I wish, I really wish, it hadn't happened.'
'I thought: how could I let this happen to me; this kind of thing happens to other people.'
'People think you're careless, irresponsible, immoral - not like them.'
'I couldn't talk.'
'It was a secret.'

In this country between 30 and 40 per cent of women have an abortion; one in three. Two hundred thousand women every year have a pregnancy terminated. They are in their teens, their twenties, their thirties, their forties; they are single women and married ones; childless or with a family.

It is a common experience, although we don't talk of it as common or normal - in fact, we usually don't talk about it at all. It has been legal for over 30 years, and only eight per cent of the population think that it should not be. These eight per cent are outside of the pragmatic argument about time limits and doctors' rights not to perform terminations - for them, all abortion is wrong, a form of murder incomprehensibly legitimised by society.

The fact is, abortion has gradually but steadily increased over the last decade, and in spite of protests by the anti-abortion lobby there is no sign that we will ever return to the back-street days. Abortion, like contraception, is part of the fabric of modern society; the means by which contemporary women take control of their fertility and their lives. Perhaps it is time, finally, to think of it in the same way that we think of contraception: as a necessary and helpful intervention, as a way of making women equal, as a positive sign that women are taking control of their lives. Abortion is the way we live now.

Yet we continue to argue about abortion, hold passionate moral opinions, worry over the rights and wrongs of it. And this perpetual, unresolved anxiety is actually reflected in the law, for in this country each woman who chooses a termination must, in a sense, argue her case, and persuade two doctors to ratify her decision. While, in the last 30 years, abortions have increased and become, bit by bit, more publicly acceptable, the language with which we talk about them has remained stubbornly the same. Rather than speaking of the 'foetus' we talk about the 'unborn child', a phrase coined by anti-abortion-groups. This phrase, along with the posters like that of a tender, curled foetus held in the palm of a hand, implicitly brands all women who have an abortion as murderers. We use an emotional and judgmental vocabulary of shame and guilt, directed almost exclusively at the woman. To have an abortion is 'the lesser of two evils'; a woman has been 'careless' or 'irresponsible' or 'selfish'; she should have known better; she shouldn't have got carried away; this will be a lesson.

Good women don't have abortions. Bad girls do. And there is a sense that these bad girls - feckless girls who've had too much sex, with too little care - should suffer for their mistakes. Abortions shouldn't be too easy.

In the United States the rhetoric is far more extreme and the direct action more violent. Three weeks ago anti-abortionists won the right to publish on the internet what amounts to a hit-list of doctors who provide terminations for pregnant women. The site is known as the 'Nuremberg Files' (because, for the anti-abortionists, abortion amounts to a Holocaust of unborn babies); abortions are called 'Satan's food source'. The doctors are 'baby butchers'. Those performing terminations are not just the target of this wrenched, pornographic language but of death threats and physical abuse. Seven have been murdered in the past 10 years.

If David Paintin had lived in the United States, he too would presumably be named butcher and murderer, and his name posted on the site. He is the Emeritus Reader of Obstetrics and Gynaecology at St Mary's, London, a courteous, grey-haired man who for 27 years - until his retirement from the front line in 1990 - performed hundreds, thousands, of terminations. Now he lives in a lovely house in the countryside, reads books about shipbuilding, tends his pretty garden - and remains tirelessly active in the abortion reform campaign and radical in his unblinking commitment to the rights of women to choose.

Paintin's father was a Methodist minister, and he himself used to be a religious man. Now he calls himself an 'almost atheist' and a humanist. In 1956, when he was just starting out as a young and idealistic doctor, he worked with Dougal Baird in Aberdeen, where abortion was only a civil offence. Here they came across the poor and exhausted wives of fishermen, who had more children that they could cope with and who were often at breaking point. 'The women needed abortions,' says Paintin. 'Doctors could do them more safely. It was a utilitarian kind of ethics - no firm, fixed rules, but a practical approach.' He has provided women with terminations ever since. Most of them were early ones (a good 80 per cent of abortions are pre-12 weeks gestation). Some were later. Only a small fraction of one per cent take place after 24 weeks - because a woman had thought she was menopausal, infertile, because she is scared, in denial, in ignorance and terror and swamping panic. 'But yes, I would do those too if a woman requested it and persuaded me that she was justified in her request.'

When I wince at the thought of an abortion this late on, he says firmly: 'In my opinion a foetus is not a person in the way a woman is. Personhood is conferred by the woman giving birth. It is an act. It has no ethical status until it is independent and breathing air.' He smiles dryly, and adds: 'I am well aware that this is a position that some people feel very uncomfortable with.'

I ask him to describe methods of termination, and he does so carefully and unemotionally. There are two basic ways of having an abortion. The first is with drugs, so that labour is induced - an experience much closer, clearly, to giving birth to a baby, and which some women choose precisely in order to participate in the process and to feel a kind of bereavement and closure at the end of it; some even hold the foetus before relinquishing it. The other method is suction. The foetus is pulled out, by a suction canular if it is pre-12 weeks or, later, by dilatation and evacuation. The earlier the easier, both for the doctors and for the woman. 'Some larger foetuses,' says Paintin dispassionately, 'have to be destroyed and pulled out bit by bit; limb by limb.'

He does not gloss over what an abortion consists of, but he does say, unequivocally, that it is actually a good thing. It is the price we pay for women's freedom.

Although it is impossible to know exactly how many women had abortions before the 1967 Act made it legal, it has been reasonably calculated that the Act simply replaced illegal with legal abortions, and serious risk with reason able safety. The graph that shows the rate of abortion over the subsequent years is a pretty steady, gradual increase - with the odd blip here and there, caused by things like the Pill scare and the post-Aids emphasis on condoms (a fallible method of contraception). So, in 1971, there were 94,570 abortions in England and Wales; 10 years later this number had risen to 128,581; in 1999 the number stood at 183,250.

Women are more likely to have abortions in their twenties than teens, thirties and forties. Most women (well over 60 per cent) say they got pregnant because of contraceptive failure. Every form of contraception is unreliable, especially those that require daily management (like the Pill) or are event-led (the slippery cap or splittable condom). If you have regular sex using contraception, then you are not 'irresponsible' if you get pregnant, simply one of the unlucky ones.

Four times more single women than married ones have abortions. Paintin believes this is because married women are more accepting of their role as 'wife'. Single women, he says, are more intolerant of contraceptive failure. And as employment becomes more available for women, the rates of abortion go up. A professional single woman will plan motherhood - and if we have a problem with that image of an ambitious middle-class person ruthlessly putting her career in front of her unborn child, that's because we are still in thrall to the notion of abortion as something which mops up our shameful mistakes.

Abortion is absolutely linked to social conditions. You can see the mirror image of the professional choosing to delay parenthood if you look at the socially and economically deprived. A survey conducted in Tayside recently compared rates of teenage pregnancy and abortion among women ranging from the very poor to the affluent. The most deprived teenagers were a shocking seven times more likely to get pregnant than their privileged peers. But they were several times less likely to have an abortion. Politicians and social commentators may call this behaviour irresponsible and condemn it. But actually these teenagers - who often come from broken families, live in rundown estates, leave school with few or no academic qualifications and have little sense of purpose or hope - are conforming to the adult role models they see around them and behaving in the way that is expected of them. For many girls, becoming a mother makes them into a woman; parenthood is a transition into desired adulthood.

Those who criticise them are really thinking about their own privileged daughters, who have achieved at school and whose life would be thrown off course by having a baby at 16 or 17.

Most women who choose to have a termination are not in extreme circumstances. They are most likely to be in their twenties and to want an abortion for 'social' reasons. There are no 'average' cases, but there are exemplary ones: Louise (let's call her) lives in the north of England. She is a professional single woman in her mid-twenties and two years ago she had an abortion. Eight months later she had a second one. The first pregnancy was a result of a 'one-night thing' with an old friend, shortly after a long-term relationship had ended. She was on the Pill: 'I never considered having it. I didn't tell him, he still doesn't know - but I talked to two friends, who came along with me. I went to the clinic when I was seven or eight weeks pregnant, and had the termination at nine weeks.

'I never thought of it as a baby. I didn't think I was killing my baby and I still don't. I wasn't in a relationship. I couldn't provide the stability I would want to give my children, and that I had myself when I was a child. I didn't feel I was doing anything wrong, but I did feel upset. In the waiting room I sat there with all these other women - I'd thought they'd all be in their late teens, but every kind of woman was there, all of us going through the same thing, and we all sat there and stared at each other, and I wondered what their stories were. It was all done pretty quickly. I was out again after five or six hours. And it was such a relief. But I kept very quiet about it. It's a private thing, and I did feel as if I'd been invaded. I thought of it like cancer - I know it's completely different. But when you really don't want to be pregnant and it's growing inside you, well, I had completely lost control for a while.'

Louise's second pregnancy happened eight months later. 'I was in a relationship. We were using condoms. I never had evidence that it had split; maybe he didn't tell me. It was much worse this time. I said after the first: "It's never going to happen again", and to have it happen again, it was horrendous. I told my boyfriend, and he said: "It's up to you." That made it more difficult, because he was involved, and the decision wasn't so completely obvious. But I didn't want a baby. I wanted my job, my life. I didn't tell my friends about it this time round. I suppose I felt ashamed that it had happened again. At seven weeks I had the termination.

'I didn't have sex for a long time after that. It felt like the end with my boyfriend; I didn't know what to say to him. The door seemed closed. Now - well, I'm never going to be someone who hasn't had an abortion. It's always going to be there. Somehow I felt that these things happen to other women; people who aren't careful, risk-takers. It made the notion of control fragile. Things can happen to you, however careful you are. I know there are some women who experience terrible guilt. I didn't feel that. I think abortions should be available for women like me. I don't think we should feel ashamed. I feel I made the right decision, but I wish it hadn't happened.'

For someone like Louise it was implacably her decision. She had lost control of her life, and by having a termination was regaining it. Every so often a man will try to stop his partner having an abortion, and we enter a jungle of moral issues. Should men have any legal rights over the potential child? Over the bundle of cells inside a woman's body?

A few weeks ago one such case hit the headlines. Stephen Hone claimed the right, as a potential father, to stop his girlfriend, Claire Hansell, having an abortion. He claimed the unborn child as his - his to care for and bring up. But she got to the clinic before he got to the court. There is no middle ground between these two positions, no compromise possible between a woman choosing to be in control of her fertility, body and life, and a man insisting on joint responsibility and rights (ironically, the kind of responsibility that women often urge men to take after the baby is born).

There is a myth that the one-in-three women who have abortions every year don't care, take the decision lightly - that they have casual, unprotected sex and then casual terminations. Even women who have had abortions somehow manage to hold this view of the 'others'. For some women, says one health professional, there are three reasons to have an abortion: rape, incest and me. And from this notion of the feckless, uncontrolled woman comes our disapproval of the 'easy' abortion - the hundreds of thousands of morning-after pills sold over the counter; the walk-in clinics; the swelling numbers; the lack of guilt. Women must be made to confront what they've done.

There's no evidence that the decision is reached lightly. I've never met a woman who was casual or light-hearted about it. Ann Furedi, spokesperson for the British Pregnancy Advisory Service, says that many women who assume they would have a termination if the situation arose suddenly find themselves ambivalent when it does; and women who have always sworn they would never have an abortion find they cannot go through with their pregnancy. 'For a woman, it is startling to think that, if nothing is done, in nine months she will have a child and her life will be dramatically changed. Motherhood is no longer an abstract or philosophical idea but a reality. It is hugely important not to dismiss the moral issues of abortion, but yet to put them in the context of a woman's own particular circumstances. It is an insult put about by the anti-abortion lobby that women are somehow unaware that a foetus is a potential child.'

Furedi feels that abortion should be easy, the easier the better. The experience should be as forgettable as possible. 'That is not trivialising it. Society should trust women more to make the appropriate choices and moral judgments. It's horrific that some people seem to feel that if we don't regulate abortion tightly, then everyone will have one; the floodgates will open. We don't need these laws. Women and their doctors should be trusted a bit more.'

It is a legal and medical requirement to give counselling to a woman seeking an abortion, both to help her consider her options beforehand, and, if she wants, to give her post-abortion counselling. David Paintin says that most women who come to the clinics know already what they want to do, and have already talked to someone (partner, husband, family, friends or doctor). 'There is not a single study that shows that post-abortion counselling helps a woman,' he says. 'Counselling feeds some kind of fantasy we have that the woman should be saved.'

Rachel, who has been a counsellor for several years and has seen 'several thousand' women both before and after their abortions, more or less agrees. Women talk through their options with her beforehand, but usually, she says, they have already decided what it is they want to do. 'Usually they know what they want. They are grown-ups, moral beings. They don't want to sit in front of me explaining themselves in-depth.'

She goes on: 'Quite a lot of women absolutely know what they want, but feel bad about it, or anxious about what social attitudes towards them will be. I am not confident even now, with abortion so widely used, that women feel it's OK to want an abortion without feeling guilty. They say: "Am I some sort of monster that I feel all right about this?" '

'She isn't a monster, of course. She's like all of us. She's Everywoman. Sometimes women come in and say: "I can't believe how many people are out there in the waiting room." It's not a complaint; they feel such relief that they aren't alone.'

Maxine Lattimer is a health worker who sat in on counselling sessions with women seeking abortions over several weeks. The women she listened to were white, black, married, unmarried, middle and working class, articulate and sure, nervous and emotional. One of them had been raped by her husband, who wanted her to give him a child. Several already had children. One was about to return to work after her first baby. One was about to go to college. None of them was 'ready'. Many of them felt the need to justify themselves to the counsellor. They tried to find the right words to explain themselves. They didn't want to feel guilty for something they thought was right.'

People who say 'she should have thought' generally harbour another, puritanical shadow-thought: 'she shouldn't have had sex'. As Ann Furedi says, it is difficult to 'manage' sexuality and 'contain' it. For most of us, sex is spontaneous, passionate and abandoned. Better contraceptive use and more sex education are to be welcomed, but we will continue to take risks and make mistakes.

The English do not deal well with sex; we treat it as both smutty and salacious. Men and women find it hard to negotiate sexual relationships. We tend (no matter how we behaved when we were younger) to think that teenagers really shouldn't be having sex at all.

Moreover, there's a puritanical unease about women's bodies, perhaps a distaste for the messiness of all the female processes. Women bleed, evacuate their eggs monthly, have coils implanted in them; they conceive, their bodies swell, they have foetuses sucked out of their wombs. It's not very natural, is it? Is this why it's kept so quiet, remaining a secret, a guilt, a stigma, a shame: the great A-word, unspoken.

British Pregnancy Advisory Service: 08457 304030

Why I had my abortion

Chantal was 19 when she discovered she was pregnant. When she first found out, she didn't know what to do or how to feel. She told her boyfriend, whom she'd been going out with for about six months, and he simply said it was up to her. 'He didn't cuddle me, though, or tell me everything would be all right.' After a week she built up the courage to tell her parents, who reacted well, discussed it with her, and didn't push her towards her decision. She rang the family planning clinic, told them she wanted an abortion and was booked in for an appointment. She begged her boyfriend to come with her but he refused. He had started to become very distant. Chantal felt she could only really talk to her mother and to her best friend. Her mother went with her to the hospital. Later Chantal split with her boyfriend. She says that without her mother she doesn't know what she would have done. Now she is feeling much more confident about her life, and has a new boyfriend. They are saving up, and want to have a baby together soon.

Liz was 18 when she became pregnant. She had a place at university 'and my whole life was ahead of me'. She and her boyfriend decided not to tell their parents and to arrange an abortion as quickly as possible. But when their friends began to gossip they told their parents. His wanted her to keep the baby. Hers were 'so understanding' about her decision to have an abortion. Looking back, she says she doesn't know 'how I could possibly have thought I'd get through it without them. They agreed with my decision completely and tried to support me.' She was 10 weeks pregnant by the time of the abortion and had 'lots of different feelings about the baby', even though she knew she wasn't going to keep it. She found herself thinking about its sex, what it would look like. Her boyfriend started seeing someone else during this period, 'and everyone apart from my parents seemed to think it was so easy and straightforward to have an abortion. On the day of the operation she was very scared, and 'totally alone. I can honestly say that was the lowest point of my whole life. I felt so lonely, as if no one understood. When I came round from the operation, I thought: "What have I done?" I had such regrets and this terrible pain in my stomach. I was an emotional wreck. My ex-boyfriend and my friends couldn't understand why I was so depressed.' When she started university, however, she felt happy again, although she dreaded relationships for a year. She thinks she made the right decision - 'although it was one of the most awful experiences of my whole life. When I decide to have children I hope I'll be a good mother and that I'll have something to offer them. In the meantime I want to focus on my degree and enjoy being young.'

Carla was 30, with three children, all boys, aged seven, 20 months and 10 months. Carla had miscarried seven times after the eldest. Her husband was going to have a vasectomy after the third child but they had to wait a long time and the hospital kept putting him off. Her eldest son had a heart problem so he needed a lot of attention. The youngest had been in hospital recently with suspected meningitis. Initially Carla thought she had missed her period because of stress. She was very shocked when she found out she was pregnant. At first she decided she would keep the baby, but then thought about the children she had already. The two babies were a lot of work and the eldest would get even less attention if she had another child. It was not fair on them. Carla said she was now feeling positive and would look forward to the future with the three children she has - at least she does have them, she says. Some women can't have children at all.

From case studies conducted by Alison Hadley of Brook and Maxine Lattimer of the British Pregnancy Advisory Service

Abortion in Britain and the USA

1967 Abortion Act passed making abortion legal in England, Wales and Scotland.

1973 The US Supreme Court legalises abortion in the first three months across the US.

1982 Pro-life militant kidnaps an abortion doctor and his wife and holds them for eight days before releasing them unharmed.

1998 Dr Barnett Slepian is shot and killed, bringing the number of abortion doctors murdered in the States to seven.

2000 Abortions in England rise by 20 per cent after Millennium celebrations.

In Britain, abortion is a non-party political issue. The US has 47 pro-life senators and 34 pro-choice senators. Attorney General John Ashcroft is opposed to abortion.

President Bush said in his inaugural speech: 'I will lead our nation toward a culture that values life - the life of the elderly and sick, the life of the young and the life of the unborn.'

Resarch by Kim Bunce and Kirsty Buttfield

 

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