Who Stands to Lose in the Fight Over Abortion?

Jill B. Delston argues that when abortion rights come under attack, all obstetric care hangs in the balance.

Even if you never want and never have an abortion, a prohibition against abortion can spell disaster for you and your family. The erasure of bodily autonomy in the face of the alleged personhood of a fetus puts all pregnant people—along with their babies—in significant danger.

Abortion opponents often invoke the moral status of the fetus to make their case. Since the fetus is a person, or is alive, or has the full range of rights enjoyed by all human beings, abortion is wrong. However, as others have pointed out, the value of the fetus is not enough by itself to justify the impermissibility of abortion. 5,000 American citizens will die this year if they do not get a kidney transplant. Yet the government does not come to your door to demand you offer these sick individuals the use of your organs, even though they will die if you do not. Their valuable lives are not offered as a justification for the government to take away your right to keep your kidney because you are thought to have a say in the matter; that say is your bodily autonomy. To justify something as strong as the prohibition on abortion, it is not enough to say the fetus is valuable—even as valuable as an autonomous, rational adult—nor enough to say that it has a right to life. Abortion prohibitions require something stronger: that your bodily autonomy may be overridden to serve the fetus’ interests. Of course, this argument clearly prohibits anything that would cause the death of the fetus, like abortion. But the same argument about the moral status of the fetus also leads to overriding the bodily autonomy of the pregnant person in less familiar ways. It prohibits any action that doesn’t protect the perceived interest of that fetus, and that includes much more than just abortion.

For example, suppose you are pregnant and your doctor thinks bed rest is required for the health of your fetus. Many doctors recommend bed rest when issues of preterm birth arise, in spite of the risks it presents, such as bone density loss, blood clots, depression, anxiety, job loss, and putting other children in the home at risk. (Never mind that there is no evidence for the effectiveness of bed rest and major medical organizations oppose it.)

If doctors or governments can argue that you are putting your fetus at risk by not following recommendations—whatever those recommendations are—then they have the basis they need to take away your bodily autonomy. Bed rest is likely to increase, not decrease risks of preterm birth. It’s also likely to lead to a host of conditions that can increase morbidity or mortality for you. No matter: your fetus is a person, and its right to life eclipses these threats to your life and your health. That means you give up rights to make decisions that now fall to your doctor or your government during the gestation of the full moral person inside you. That’s precisely what happened to Samantha Burton when a judge effectively imprisoned her at a hospital and ordered her to undergo whatever her doctors prescribed to prevent a possible miscarriage, including bed rest.

Or suppose your doctor thinks an episiotomy or a C-section is required during delivery. Many doctors perform these procedures against the stated preferences of those who are pregnant (and against medical guidelines). Again, your fetus’ rights trump your decision about what is to happen with your body. So, if someone thinks you are putting your fetus in danger by rejecting a C-section, or slowing down your labor unnecessarily by refusing an episiotomy, they can override your decision. In a world that rejects abortion rights due to the moral standing of the fetus, someone who is pregnant doesn’t have the power to decide in these situations at all. For that reason, doctors don’t have to ask them what they want if doctors think they are protecting the fetus. In fact, doctors often don’t ask: a significant portion of those receiving such interventions report having no choice. This is likely why these interventions are so common. Episiotomies are almost never medically indicated and C-sections rarely are. In the United States, C-sections make up about a third of all births, but are medically indicated for at most 10 percent of pregnancies.

Remember, the moral status of the fetus is taken to override the pregnant person’s right to bodily autonomy. This leads many doctors to ignore the wishes of pregnant people—why shouldn’t they? But those wishes are an important source of information. At the very least, medical providers who ignore them aren’t accountable to those wishes, and so don’t have to do the work of ensuring that the procedures they carry out are effective or necessary. This is, in part, why doctors perform so many medically unnecessary episiotomies and C-sections. Maybe it should be as simple as, “mother knows best.” But even if parents don’t know best, they provide a helpful check on the unfettered discretion of doctors, as well as hold those doctors accountable.

Perhaps you are okay giving up your decision-making, bodily autonomy, and medical power of attorney during your pregnancy because doing so would be in the best interest of the fetus. You want to, or at least are willing to be a martyr to your fetus. But ignoring the interests of pregnant people in the doctor’s office in favor of their fetuses is ignoring that fetus’ best advocate. Bed rest, C-sections, and the other common interventions I just discussed are not just likely to increase maternal morbidity and mortality; they are also likely to increase neonatal morbidity and mortality. For example, neonatal mortality is twice as high in C-section births as in vaginal births. When we wrest control of medical decisions from pregnant people, we hurt babies.

Let’s face it: abortion was never about the moral personhood of the fetus. If it were, we wouldn’t see the same attitudes and actions restricting contraception before the fetus even exists. But we do: doctors often subject patients to irrelevant and unnecessary tests before refilling a birth control prescription. Abortion is about medical sexism: a gendered hierarchy in the medical context that justifies controlling the behavior of women and all people with uteruses. That medical sexism justifies the removal of the rights you have over your medical decisions. And medical sexism is a threat to you, regardless of your position on abortion. So, please don’t sacrifice your bodily autonomy on the altar of anti-abortion views. And while you’re at it, please don’t sacrifice mine.

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Jill B. Delston is associate teaching professor of philosophy at the University of Missouri-St. Louis and the author of Medical Sexism: Contraception Access, Reproductive Medicine, and Health Care.