Category Archives: reproductive justice

On being a pro-choice midwife.

IMG_0339

My favourite puntastic tote bag from Education for Choice.

I am totally pro-choice – I believe in the right of the pregnant individual to make decisions about their pregnancy, including deciding if they wish their pregnancy to continue. And if they don’t want it to continue, to be able to access safe abortion on demand at any point up full term – something we don’t currently have.

People have expressed surprise that I hold these pro-choice views and yet I am training to be a midwife. But to me they are completely in line with providing person-centred care – something we midwives are supposed to be all over. What could be more person-centred than trusting that the pregnant person is the one who gets to decide if they want the pregnancy to continue? Their body, their choice, right?

In line with the Abortion Act of 1967, abortion is currently legal up until 24 weeks of pregnancy in Scotland, England and Wales. (Abortion is only legal beyond this point if there is a grave danger to the pregnant person’s life or risk of serious permanent injury, or if the baby would likely be born with significant mental or physical disability). Two doctors also have to agree that more damage would be done to the pregnant person’s mental and/or physical health if they were to continue with the pregnancy than if they had the abortion. The act also includes a clause that anyone with a conscientious objection to abortion does not have be involved in administering this procedure, which has generally been understood to mean that those health professionals are not obliged to be involved in the procedure. So this clause protects those seeking abortions from accessing care from those whose moral objection may impact on their ability to care for them sensitively, as well as allowing health professionals exemption from doing something that is against their morals.

This is a kind of backstory as to why I am so unsettled by the recent news that two midwives are going to the supreme court to try and defend their right *not* to allow abortions to those who want them. Not just their right to not be involved in the actual procedure (which is already in place), but to argue that to even co-ordinate a ward when the procedure takes place contravenes their human rights. To essentially limit access to a legal procedure on a structural level because of their moral objection to abortion. As BPAS warns; “It would be grossly unjust if an interpretation of conscientious objection was allowed to stand which would disrupt services to the point that those committed to helping women were unable to do so”. If those coordinating maternity services can claim that they have a right to prevent abortions happening under their watch, those health professionals who want to provide abortions may be prevented from doing so which will essentially prevent those seeking to end their pregnancies from accessing a procedure that is not only necessary but also legal.

If the supreme court rules that these two midwives are right to interpret the conscientious objection clause to mean they are within their rights to refuse to have any part to do with any part of abortion provision – including co-ordinating the service that provides the abortion – then there will be a precedent that can be used to further limit access to safe legal abortion. And it is the safe, legal abortions that will be limited, not the need for abortion, or the number of abortions that people will seek out by any means necessary. What is person-centred about that?

LINKS:

Education for Choice  – supports young people’s right to informed choice on abortion.

Abortion Rights – the national (UK) pro-choice campaign.

British Pregnancy Advisory Service (BPAS) 

The Cissexist Language of Midwifery Care and Reproductive Justice.

I started trying to write a post on the way my pro-choice views on abortion intersect positively with my midwifery practice, but I realised that first I needed to address the way that the language of midwifery care and reproductive justice is cissexist. Lauren Rankin spells it out when she says

We must acknowledge and come to terms with the implicit cissexism in assuming that only women have abortions. Trans men have abortions. People who do not identify as women have abortions. They deserve to be represented in our advocacy and activist framework. Honestly, I am guilty of perpetuating that harmful myth, both in my rhetoric and framing. I often frame abortion restrictions as misogynistic attacks meant to control women’s reproductive lives, and that is true. But abortion restrictions also affect the lives of people who aren’t women, and they hinder trans men and gender-non-conforming people and others who were Designated Female at Birth (DFAB) from accessing abortion care, as well.

Lauren Rankin, Not Everyone Who Has an Abortion Is a Woman – How to Frame the Abortion Rights Issue

I went to a training day on abortion activism (run by Abortion Rights) last year, attended by feminists and anarchists involved or interested in grassroots activism and campaigning. And it was refreshing to talk about “people wanting/needing abortions” without the discussion stalling when the other people in the conversation couldn’t understand why we weren’t saying women, or worse refuting the fact that it’s not only women getting pregnant (radfems, I’m looking at you again). And yet even though the space we made challenged the cissexism of typical reproductive justice dialogue, the cissexist language was still was inescapable. The news clips we watched, the stats on how many abortions are performed in the UK each year all talk about women and women only. The statistics we have for UK abortion rates take into account every registered abortion, but they do not record the person’s gender because it is assumed they are women. These statistics we quote, that “1 in 3 women will have an abortion by the time they are 45 years old”… these statistics implicitly misgender all those people who are not women who have abortions.

The same happens in midwifery. Language misgenders, both implicitly and explicitly. Because, on both an individual and systematic level, the possibility of trans men and non binary people becoming pregnant is either not considered or wilfully ignored; all language is inherently cissexist.  As midwives we talk constantly about “the woman” (or worse, “the lady”) as though it had not even occurred to us that not everyone who is pregnant is a woman, or that these people do not exist, or that they are such a small minority that it is ok for our language to erase them.

It is not ok. But everyone does it. I am even finding myself doing it.

A couple of weeks into my training I started to realise I wasn’t imagining it, midwifery lecturers were constantly talking about “the woman” and as students we were picking it up too. I queried it, explaining that I realised we said “the woman” rather than  “the patient”, because midwifery is about providing care through a normal physiological event (pregnancy and birth) rather than treating illness. But what about those people who aren’t women who are pregnant..? After clarifying that I didn’t mean cis men who have a developing embryo implanted in their abdominal cavity(!), the lecturer told me there hadn’t been any non binary people or trans men who had accessed midwifery care in our city and this seemed to suggest my point was moot. I didn’t believe her (because I imagine there must have been people who were not women, but were read as such by staff who didn’t feel safe/comfortable/have the energy to come out) but the discussion moved on.

Aside from the obvious problem of potentially misgendering (implicitly or explicitly) individuals accessing maternity care by talking only about women, there is the further problem that the language we use shapes the way we think and the way we see the world. By talking only about women, we are conditioning ourselves to think only in terms of women, to assume womanhood of everyone in our care. It is both habit-forming and world-shaping. When I started my training I always said “pregnant person” but everything I read, everything I am taught is saying “women”, and I am starting to slip up, to give up, and it’s not good enough.

I want people of all genders to be able to access midwifery care if they need it, without worry that they will be misgendered. I want NHS midwifery staff to have awareness raising sessions so they understand what is meant by trans, non binary, cissexist, misgendering. I want to rid policies and guidelines of their cissexist language. I want space on the paperwork we fill in at initial midwifery booking appointments to have space to ask about the person’s gender so we don’t simply assume they are all women.

In the same way that there seems to be a slow but sure shift away from heteronormative language in midwifery care (as both policies and practitioners start to talk about “partners” rather than “husbands/fathers”) I want to see a shift away from cissexist language. A lot of the times when we are talking generally and we say women, we can instead more accurately say “people who menstruate”, “people with uteruses”, “people who are pregnant”, “people needing abortions”. Instead of saying “she” we can say “they”. We can find new ways to convey meaning.

And don’t tell me it’s too hard – it can’t be any harder than having to navigate a maternity service designed for women when you are not a woman – which is what we are essentially asking of some people unless we sort this out.