A Necessary Kindness (eBook)

Introduction

I CAN SAY without hesitation that I love my job. I understand that my devotion to my work will come as a surprise to many. I first trained and worked as a midwife, and I loved that too. The journey that led me to my work at an abortion clinic was an unexpected one, but it is one that many midwives have made before me and since. The gap between helping women deliver babies and helping them terminate unwanted pregnancies no longer seems wide to me; it is a spectrum of reproductive care, and we need both, and much more. Now, more than ever, the stories of those who have had abortions, and the stories of those who provide them, need to be heard and understood.

On Friday 24 June 2022, the supreme court in the United States overturned the decades old Roe v. Wade decision, which had federally legalized abortion in America since 1973, paving the way for sweeping abortion bans all over the country that removed many people’s reproductive rights overnight. I read the news on my phone – the judgment had been leaked a week before but the dreaded confirmation had just been announced – as I sat in an IVF clinic reception, waiting to find out if I had been successful in conceiving my second child. ‘Holy shit,’ I whispered to myself, and my stomach dropped. I hadn’t really believed that it would go this far. I could instantly envisage the horror that my fellow workers in abortion care in the United States would be feeling but could only imagine the fear that women must be feeling. I knew what this would lead to. People who do not want to be pregnant will not simply accept being trapped by their bodies and forced to carry that pregnancy to term. They will make long and torturous journeys if they can afford them, and if they can’t, then they will find another way, one that could potentially kill them.

We are lucky to have access to abortion in the UK, but we should not assume that our reproductive rights are safe here. Contrary to the assumptions of many, there is no right to abortion codified in law in this country. In fact, abortion is still illegal here. Under the 1861 Offences Against the Person Act (OAPA) it is a crime to ‘procure a miscarriage’ or help another person to do so. This law remains in force to the present day. Treatment is facilitated only by the 1967 Abortion Act, which provides exemptions if certain conditions are met and if two doctors give their approval. But as long as the OAPA remains on the statute books, both doctors and patients face potential prosecution. And anti-abortion activists have shown their willingness to press for prosecutions if a practitioner does not correctly fill out the requisite paperwork. This is intended to have a ‘chilling’ effect on medical professionals taking part in abortion care, and there is some evidence to suggest that this is working. A study published in 2018 found that the threat of criminal sanction created an atmosphere of ‘fear and insecurity’ and one doctor interviewed for the study said that ‘All of the negative light that’s been shone on abortion … to see if doctors are breaking the law. I think those things are deterrents to junior doctors going into the field and wanting to get training.’1

Patients too are not protected, in law or in practice, from being prosecuted for having an abortion.

Since I started writing this book, prosecutions of women for procuring abortions, under the 1861 OAPA, has picked up pace in the UK. For context, and as a measure of how antiquated the law with which these women are being criminalized is, it also prohibits ‘destroying or damaging a building with gunpowder’ and ‘impeding a person endeavouring to save himself from a shipwreck’.

In June 2023 a woman was given a twenty-eight-month prison sentence for procuring drugs to induce an abortion after the pregnancy had progressed beyond the legal limit. She was ordered to serve half this sentence in custody, despite having other young children and the judge’s acknowledgement that she was racked by guilt and suffering depression. A letter to the judge signed by the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives asked him not to give a custodial sentence in this case, as it would deter other women from seeking medical care for fear of prosecution. The judge called the letter ‘inappropriate’.2

In August 2023, a twenty-two-year-old woman was also put on trial for procuring an abortion and became the fourth woman that year to be prosecuted under the 1861 law. There were only three prosecutions in the more than 160 years prior to that.3 The fresh zeal with which these women are being pursued by the Crown Prosecution Service should ring alarm bells.

Abortion provision is, I believe, a normal health service that every civilized society offers to its citizens, so that they can exercise full autonomy over their bodies and their lives. We have seen the effects of hundreds of years of illegal, restricted or inaccessible abortion all over the world. These barriers lead to women suffering and dying from unsafe and unregulated illegal procedures, administered by themselves or by often unscrupulous physicians. In her memoir about her abortion in 1960s France, Annie Ernaux writes that ‘knowing that hundreds of other women had been through the same thing was a comfort to me’, but what she is referring to is a self-administered abortion with a long knitting needle. We know that, without other options, women have tried to end their pregnancies with coat hangers, by throwing themselves down flights of stairs or with dangerous quantities of illegal drugs.

One of the immediate effects of the 1967 Abortion Act, which legislated for abortion provision for the first time in England, Wales and Scotland, was to drastically reduce the number of deaths from unsafe abortions. In the decade immediately after the act was brought in, the proportion of maternal deaths due to abortion dropped from 25 per cent to 7 per cent. During 1961 to 1963, 160 deaths were recorded as due to abortion; during 1982 to 1984, there were 9.4 And in 2021 there were zero deaths from abortion in the UK.

In the ‘best case’ scenarios, women don’t acquire a lethal illegal abortion but are instead forced to carry their pregnancies to term, with all the life-changing and, in some cases, deeply traumatic consequences of that. But abortion care is an area of women’s rights and healthcare that is still dangerously taboo in this country, and around the world.

I have worked in several clinics over my career, in a major city and a rural town. I have been the first point of consultation for abortion patients, have worked in surgical recovery at the clinic and, in recent years, have worked remotely on the clinic’s aftercare phoneline. In my time as a midwife practitioner working in abortion clinics, I have seen that abortion involves many contradictions. One such contradiction is that, though it is portrayed as something extreme by its omnipresent opponents, it is actually incredibly common – far more so than I think most people realize, even the patients themselves. One in three women in the UK will have an abortion in their lifetime, and these figures are broadly similar across the world – depending on, of course, the restrictions on and accessibility of abortion provision in those countries. In the United States before Roe v. Wade was overturned, around one in four women would have a termination in their lifetime.

More people in this country will get an abortion than a tattoo (one in four), and more people will need treatment for an unwanted pregnancy than they will for hay fever (also one in four). But most likely you don’t know, or think you don’t know, anyone who has had an abortion. If you do, I wonder if they have spoken to you at length about that experience. If I didn’t work in abortion care, I don’t know if the women in my life who have had terminations would have told me. I wonder if it would have come up organically in conversation, or if they would have felt comfortable revealing it to me. These days we speak openly with our friends about losing our virginity or our experience of childbirth, and we can even joke darkly about STIs we have caught. But we have not been very good at facilitating conversations about abortion. And I see that reality every day in my consultation room. Women sitting opposite me who are scared, who are ashamed, and who imagine themselves to be almost entirely unique – and therefore alone – in going through this process. But they are not. If you have thirty women in your life – your friends and family, your colleagues and acquaintances – then you likely know ten people who have had or will have an abortion. Maybe you are one of them.

The void that we have created by failing to talk openly about abortion – who really has one and why – has been filled instead by those who oppose it. They have predominantly filled it with prejudice and misinformation, and in many areas of the world, their efforts are paying off. As we have seen, access to abortion has been dramatically curtailed in the United States, with many states drip-feeding increasingly draconian anti-abortion legislation through their systems, and there is currently no end in sight to the stripping away of reproductive rights there. Those rights are under siege in Europe too, with Poland – an EU member state – bringing in an almost total ban on abortions when its supreme court ruled that abortions for fetal abnormalities, which make up 98 per cent of terminations in the country, were unconstitutional.5

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