The language we use to talk about a pregnant person’s right to decide whether to continue a pregnancy is full of false binaries: pro-choice versus pro-life, bodily autonomy versus fetal personhood, moral versus immoral. These dualities unnecessarily divide us and prevent deeper conversations about the unique status of pregnancy within our society.
An either-or mentality creates a situation of separate but unequal laws for pregnant people that violate both the human right to bodily autonomy and the guarantee of equal protection under the law.
We, as nurses, midwives and health researchers, know that using a both-and mentality instead of an either-or mentality makes space for multiple truths and nondichotomist positions concerning the decision to continue or terminate a pregnancy. A both-and approach is a hallmark of Black feminism and one that assumes multiple outcomes, multiple discussions or multiple futures as we work together to address the urgent reproductive health crisis in our country.
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The primary issue in the Dobbs v. Jackson Women’s Health Supreme Court case is whether or not Mississippi’s 15-week, previability abortion ban is constitutional. When Roe v. Wade was argued, however, the word “viability” was never uttered. Court documents show how a Supreme Court clerk suggested that viability be settled upon as a legal compromise. That compromise attempted to mark to a point in time at which, in the prescient words of Justice Thurgood Marshall, “the State’s interest in preserving the potential life of the unborn child overrides any individual interests of the woman.”
The binary status of viability and nonviability means that the rights of pregnant people are time-sensitive. As we’ve learned from the experiences of countless marginalized groups, rights that do not apply to all individuals at all times are not rights, but conditional benefits that are inequitably distributed. The emphasis in the abortion debate on viability distracts us from the human rights argument that asserts that bodily autonomy, including the decision to continue or terminate a pregnancy, rests squarely with the pregnant person at all times and in all circumstances.
The whipping of Black enslaved people who were pregnant is a noted instanceof the false dichotomy of promoting survival of the fetus at the expense of the pregnant person’s humanity and autonomy. To protect these fetuses, the enslaved people’s stomachs lay in holes dug into the ground while the rest of their bodies were exposed for punishment. Repeatedly, lawmakers and law enforcers have justified the primacy of fetal rights to restrict bodily autonomy and enforce separate, distinct laws over the bodies and decisions of pregnant people—especially pregnant people of color.
The push for fetal personhood developed alongside, and is in many ways tied to, scientific advances in perinatal-neonatal medicine that enabled the fetus to survive (with extensive technological life support) outside the uterus at earlier and earlier gestations. In this way the fetus and pregnant person became separate entities, and separate patients in a health care setting.
Abortion binaries exist not only in legal settings, but in social discourse. For decades, a majority of adults in the United States has agreed that abortion should be legal in all or most cases. However, heterogeneity in views on abortion, particularly across religious affiliations and political ideologies, provide evidence of more nuanced beliefs within groups. Therefore, representations of individuals as either “pro-life” or “pro-choice” do little to identify the granular detail behind an individual’s attitudes, beliefs and behavior.
These binary beliefs provide little context around people’s life circumstances and the communities in which they belong. Our recent research identified obstetric, women’s health and neonatal nurses’ attitudes around abortion. We found that on a five-point scale (i.e., strongly or moderately proabortion, or strongly or moderately antiabortion, or unsure) that used 14 questions to measure abortion attitudes, one third of the participants ended up in the unsure category. They were neither proabortion or antiabortion. This category also included the largest percentage of those who identified as Christian.
Among nurses who took the survey and reported having had an abortion, nearly one quarter were in the unsure category and 10 percent vocalized antiabortion attitudes, indicating that people's attitudes about abortion are not necessarily indicative of their behavior. This may be evidence of internalized abortion stigma. A lack of concordance between attitudes and actions is neither new nor problematic, but instead points to the importance of meeting people where they are, and respecting their expertise and ability to know exactly what is best of them and their families.
Moving away from binaries and polarities allows us to instead focus on language that helps create physical and social environments that ensure equitable reproductive health for all, a healthy pregnancy for all who choose parenthood, and a safe childhood for all. Research suggests that many people who had an abortion wanted to continue the pregnancy and parent the child but made the choice to have an abortion because they felt they could not adequately or ethically raise a child. They often cited circumstances specific to a lack of resources, whether human, money, space or time.
Often, these circumstances could have been ameliorated by enhanced social services, legal protections for pregnant people, paid parental leave and universal childcare, but instead pit the needs of the fetus against the needs of the parent. Policies that are centered in reproductive justice can address the biggest threats to life and livelihood; namely poverty, health care barriers, racism and environmental hazards. Meeting these needs could reduce the need for abortion.
Regardless of the decision of the Supreme Court, we as health care providers and researchers must do a better job allowing for complexity. What do pregnant people want and need? Are we implementing policies that provide financial security, high-quality health care and the social support necessary for those that desire to grow their family while simultaneously ensuring safe, respectful and stigma-free abortion services are readily accessible?
With the future of safe and legal abortion in the hands of the Supreme Court, we affirm that bodily autonomy as manifested in abortion is a human right, and at the same time, we must improve health care and social services for all people who choose parenthood, especially those historically marginalized.