The right wing has, for months, demanded that progressives talk about the Gosnell case. I’ve held off, because a) he hadn’t been convicted and b) before you can talk about Gosnell, you have to talk about absolutely everything else.
After all, unsafe illegal abortion is the raison d’être for the movement to legalize abortion.
Sometimes women get pregnant, and they don’t think they can have the baby.
Maybe it’s an ectopic pregnancy, and having the baby would kill both. Perhaps a complication (gestational diabetes, preeclampsia, infection, depression) will threaten the woman’s health. Sometimes women are raped and become pregnant, and carrying the pregnancy would be additional trauma. The incest taboo is stronger than the cultural drive to reproduce.
More simply, the woman could lack the resources to raise another baby, and the exorbitant cost of pregnancy would deprive her existing children. Or having this baby before she’s ready could preclude her from having a baby that she can give a better life. You’re not in her shoes, so it’s hard for you to say.
Regardless of the specifics, sometimes women get pregnant, and they don’t think they can have the baby. If any good comes from the Gosnell case, it will be to recenter reproductive policy around this existential fact of human condition.
There are a handful of strategies that can address the problem. These strategies have unfortunately formed coalitions, which have reified into competing tribes of “Pro-Choice” and “Pro-Life”. The political result has been the election of irrational tribal adherents (almost exclusively on the right) who blunder into strategic errors, creating “Pro-Life” policies that will increase infant mortality.
As there are 3 parts to the problem, there are 3 strategies to solve it. There is a fourth false strategy, which fails to address the problem.
(1) Sometimes women get pregnant, and (2) they don’t think they can (3) have the baby.
1. Create the technology to prevent pregnancy; educate women on that technology. The ancient Greek techne means both “tools” and “know-how”. Margaret Sanger’s American Birth Control League (1921) established the infrastructure to provide the education; once it became Planned Parenthood (1942), it invested in the research to create the tools.
If women only get pregnant once they think they can have a baby, the problem is solved.
2. Allow women to terminate a pregnancy safely and accessibly. Access to abortion exists within a movement spectrum determined by cost and knowledge, rather than as a legislative fact wherein legalization solves all the issues. The success of the National Association for the Repeal of Abortion Laws (what NARAL stood for in 1969) resulted in the 1973 Roe v. Wade ruling, which increases the accessibility of safe abortions. Planned Parenthood’s decision to provide abortions (1973-1990) removes a number of cost barriers.
If pregnant women have options, they aren’t forced to have a baby they can’t take care of.
3. Convince women that they can have the baby. If all pregnant women think they are capable of having a baby, the problem is solved. There are two approaches to this. The first is to make it easier to have a baby by offering (1) free pre-natal care, (2) free post-partum care, (3) paid maternity and paternity leave, (4) free day-care/pre-K, and (5) tax credits for parents.
Crisis Pregnancy Centers offer the second approach. The problem is that they’re lying to women! They don’t do any of the above (or even make referrals to them); they just coerce women into believing (rightly or wrongly) that they can have a baby. CPCs temporarily address the emotional state of a woman, but do longterm and widespread social harm by exacerbating the problem we’re trying to solve.
4. Criminalize abortions. This is a false strategy, and impotent against the existential dilemma. Since women are people, they are capable of controlling their actions and terminating a pregnancy. As universally shown, abortion bans don’t result in fewer abortions.
This strategy exists to make patriarchy feel better about itself. It says “sure, women are getting abortions, but they’re bad women–their suffering makes us holier.”
The coalition problem
Compared to most of the world, America has trouble assisting women who are pregnant and don’t think they can have the baby. A large reason is the coalition politics that have developed around the four strategies to address it.
Strategies 1 and 2 have been comparatively stymied in America. Birth control is cheaper in Europe, and abortion more accessible; as a result, Europe has far fewer women who find themselves pregnant and scared. It’s so bad, in fact, that strategy 3 is basically hopeless.
The Democratic Party finally coalesced around making it easier to be the parent of a young child–how much more “family values” can you get?–and the proposal was laughed out of Washington. The gynecological guarantees of Obamacare (birth control, STI treatment, post-partum care) will drastically reduce the abortion and infant mortality rates, and the Catholic Church responded to them more unequivocally than they did to Stalin’s religious purges. Why? Because our reproductive politics aren’t rational; they’re tribal.
The “Pro-Life” tribe hates abortion, and they’ve dedicated themselves to opposing it. They’re a tense but strong coalition of conservative Catholics, Mormons, evangelicals, terrorists, and hustlers. Catholic opposition to birth control keeps them from employing the first strategy; strategy 3 involves direct public expenditures, so the evangelicals think that it’s communism.
That means that criminalizing abortion is the only strategy that will galvanize the “Pro-Life” tribe. The hustlers among them exploit that for personal advancement, but it does nothing to help pregnant women. Invariably, tribal loyalty demands that politicians say crazy and inhumane things about all women, but particularly rape survivors.
More than anything, though, the “Pro-Life” tribe defines itself in opposition to the “Pro-Choice” tribe.
The coalition that mobilized to overturn American abortion bans labeled itself as pro-choice. Within the historical cultural context, being “pro-choice” meant that the coalition was identified with sexual revolution and women’s liberation; in contemporary terms, the coalition has expanded to include LGBT rights and transnational feminism. To be “pro-choice” now signifies that “I’m the type of person who protests the Saudi driving ban and marches in the Pride Parade”.
And I am that type of person! But I need to form legislative coalitions with people who aren’t. Thus, comprehensive sex education is harder to pass when it’s something that the “pro-choice” tribe wants, just as background checks are harder to pass when “the gun control crowd” wants them.
Because any time a reporter quotes me, j-school tells him that he’s obligated to also quote an anti-choicer.
A brief history on abortion in America
I promise that I’m getting to Gosnell. But we need to reach a consensus on history first.
In the pre-industrial era, women terminated pregnancies mainly through consuming abortifacients they got from midwives*. In 19th century America, as (male) surgeons began to replace (female) midwives as the experts on women’s reproductive health, men would perform surgical abortions in unsterilized and coercive conditions.
Being unsafe, this practice was outlawed. However, the prohibition did nothing to address the problem: women were still getting pregnant without thinking they could have the baby. As a result, demand for illegal abortion was just as high as it had been for legal abortion.
With the advent of modern medicine after the second World War, it became possible for obstetricians to perform surgical abortions safely, albeit illegally. These procedures were very expensive, since they were a risk to the practitioner. For a time, “safe illegal abortion providers” operated alongside “unsafe illegal abortion providers”, with access to safe abortion being contingent on money and connections.
Simultaneously, Planned Parenthood clinics became more and more widespread. None of these clinics provided abortion.
Starting in the 1960s, states began to permit abortions in cases of rape, incest, and the health of the mother. These permissions were a result of lobbying from the “safe illegal abortion providers”, but had the unintended consequence of introducing moral dessert into the policy equation. In essence, states were determining which women ought to have an abortion, and which women should be punished with having a child they don’t think they can raise.
In 1973, SCOTUS determined in Roe v. Wade that doctor-patient confidentiality trumps the states’ ability to ban abortion. The Roe decision made it legal nationwide for doctors to provide surgical abortions.
Roe didn’t immediately change any practices or availability; “safe legal abortion providers” were now operating alongside “unsafe legal abortion providers”. Safe abortion was still expensive, and women still needed connections to tell them which providers are safe. In 1976, Kermit Gosnell went into practice in Philadelphia as an unsafe legal abortion provider.
Over the course of the next two decades, Planned Parenthood became a “safe legal abortion provider”. In 1970, with abortion legal in New York, Planned Parenthood of Syracuse became the first Planned Parenthood affiliate to provide abortion. After Roe, more affiliates follow suit.
Planned Parenthood’s entrance into the abortion landscape changed the practice. As a nationally-recognized brand, unconnected women quickly learned to trust Planned Parenthood over providers like Gosnell. Additionally, with 60 years of experience providing health care to low-income women, Planned Parenthood was able to make abortion more affordable.
At some point, Planned Parenthood became synonymous with abortion, culminating with so many attempts to remove funding for cancer screenings and rape prevention and prenatal care from communities in Ohio and around the country.
So what does any of this have to do with Gosnell?
It’s hard to talk about Gosnell (clearly!) because he’s the Loch Ness monster: the last remaining unsafe illegal abortion provider.
Or are there more Gosnells? New Gosnells? My assumption is that desperate women are more likely to get black market misoprostol, but I can’t put myself in their shoes–they’re not likely to be reproductive justice activists.
Perhaps every other year, an independent abortion provider makes the news for facing criminal charges or ethics violations. Are they Gosnell, or is a local prosecutor grandstanding for the press (and for contributions from the “Pro-Life” tribe)?
Clearly, the focus on Planned Parenthood by medical inspectors and anti-choice protesters was the main element that kept Gosnell in business. The tribal response from the Right–that all abortion providers are just like Gosnell–means that they won’t change anything.
The Gosnell case shows that our discourse is broken. The “Pro-Life” tribe is completely divorced from the reality that their ban-shame-and-protest tactics have been sending women to unsafe conditions.The “Pro-Choice” tribe is unable to communicate to the press that Kermit Gosnell is the reason that abortion was legalized in the first place.
It’s an opportunity, though, to reframe policy around the only goal that makes any sense: to reduce the number of women who get pregnant, and don’t think they can have the baby.
* As long as I’m taking the wide-angle historical perspective, I have to mention that the Malleus Maleficarum of 1486 labeled these midwives as witches. The how-to manual for medieval witch hunts considered the following as magical spells: contraception, sex education, abortion. Yes, I’m implying that the anti’s think Planned Parenthood is a witch.