A lot of commentary is springing up over this article in last September’s Glamour magazine. (The article is not available online; the link above is a badly-scanned PDF that seems to be missing at least two pages, but you can still get the gist of it. Another article is here.)

The article describes a network of abortion clinics in the Pittsburgh area, informally calling themselves “the November Gang” (the group first formed in November, 1989). The clinics provide the normal range of women’s health services, but put a special emphasis on allowing women, in pre-abortion counseling sessions, to discuss their emotional and spiritual state, and their feelings about their abortion decision. They use a set of questions and prompt-words on a written questionnaire to encourage women to identify areas of concern, and then offer a non-guided discussion of any issues the women do identify. For the many women who are not ambivalent about their decision, they simply offer standard medical information; for others, they respond to concerns the women raise, offer a sympathetic ear, and engage in counseling-style discussions to help the women come to their own resolutions.

The approach is different from ordinary informed-consent procedures in that it incorporates a counseling component specifically aimed at helping women process their feelings about their decision, and resolve concerns or ambivalence they may feel. It also sometimes includes partners of the pregnant women, which most abortion counseling does not. And it often includes explicitly religious or spiritual discussion - guided by the patient, not the counselor - which is unusual in a medical decision-making setting. In one reported exchange, the woman says:


“‘I’m killing my baby’ . . . ‘Will God forgive me?’ In response, [the counselor] gently asks her, ‘Do you think there are any things that God considers completely unforgivable?’ [She] thinks for a moment and shakes her head no.”

A much-remarked exercise the clinics use is to allow women to write their feelings or messages on pink paper hearts, which are then posted on the walls of the clinic. Some of the messages are quite poignant:


“I’m doing this on the day I gave birth first child. I love you even though I know in my heart I can’t keep you. But the memory of you will make me strong….” It’s signed, “All my love, the mom you’ll never meet.”

“I have a lot of goals to fulfill, and with a child right now, those goals would be impossible. We all have freedom of choice, and my choice is to wait until I want a child and am married-not now. I am only 20 years old.”

“To my little angel, Please understand that you are better off in the hands of God than mine at this moment…. You are and forever will be beautiful and pure. I smile when I think of you, even if I cry. You have given me reason to be strong and wise and responsible. You will always be my baby. I will see you in heaven, sweetheart. I love you’.”

There also an album where partners and family members of patients can write their own feelings, and the clinics sometimes arrange personal observances that would be unusual or discouraged at other facilities, such as viewing of the aborted remains and even informal “baptisms” or prayers in the procedure rooms.

The overall intent is to acknowledge the powerful and complex significance of abortion in the lives of women, and the fact that abortion may often evoke mixed emotions, and to allow women feeling concerns, or wanting closure for their conflicted feelings, an opportunity to express those feelings. The clinics offer encouragement to do so, and provide several means of expression and discussion, without ever imposing their own decisions on the women or invalidating the choices they make. One clinic director puts it this way:


Nine times out of 10, estimates November Gang member Tammy Sobieski, owner of four WomanCare Centers in Florida, her clients are sure about what they’re doing, but that doesn’t mean they simply want to come in for their procedures and leave as quickly as possible. Sobieski says, “They just want to
tell their story and have someone listen without going, `You’re wrong or `Have you really thought about this?’”

The strong impression I get is that these clinics are doing their best - in unusual, and innovative ways - to offer women as full and as honest a range of services as possible, without assuming either that women must be fully unconcerned and unconflicted about their decisions to be authentic and justified in them, or that women need to be second-guessed or cross-examined in the decisions they make. Obviously, they are entering very sensitive areas, and doing so without established practices or counseling models to guide them, but their practice seems largely driven by the needs and interests their own patients have expressed over time, and seems quite reasonable.

It seems to me, in fact, an honest and sensitive way of addressing the complexity of abortion decisions while supporting women in retaining the power and authority to make those decisions in their own way. Naturally, that doesn’t sit well with the anti-choice crowd. Instead of applauding the offer to women to express and process their conflicted feelings - which, presumably, would only be to the good for an anti-choicer, even if they didn’t approve of a final decision of abortion in principle - the general response, currently gaining traction among right-wing bloggers, is shock and horror that women can actually decide to have an abortion after having thought about it.

An unspoken myth of the anti-choice movement is that women who choose abortion are just deluded, and if they “really knew what they were doing” they wouldn’t have the values and interests they do, or make the decisions they do (if they really knew what they were doing, of course, they would have the values and interests the anti-choice movement has, and make the decisions anti-choicers approve of). (This explains the weird insistence among anti-choicers on showing women in abortion clinics sonograms of the fetus - on the apparent presumption that women don’t know what one looks like, or didn’t realize they were actually carrying one. It also explains the almost giddy response among right-wingers to the recent development of 3-D sonograms. If anybody develops Surroundsound sonograms, we’re going to have to round up the Christian Coalition and hose them down to prevent mass hysteria.) The fact that women can have conflicting feelings about abortion, think about them, and then decide to have an abortion in full knowledge of what it means to do so has left some right-wingers staggering in horrified disbelief:


“If only they knew it was a human life they were destroying. If they only knew, they wouldn’t – they couldn’t – go through with the abortion. But they do know.”

- Evangelical Outpost

They Know

The most disturbing aspect of this article is the realization that they know. They know what it is that they are killing. Despite their efforts to claim that it is just another body part, they know. . . . They know that there is a much greater moral significance than merely removing a “clump of cells”. . . . [W]e try to believe that the pro-abortion rights view is merely mistaken, in that they do not realize what a human fetus is. We wish to believe that if we just trained them to realize that there is a real, vulnerable, defenseless, human being growing inside of them, that they would realize what abortion actually does. But the truth is, as hard as it seems, is that they already know.

- Imago Dei

[I]t’s clear that these women know exactly what they’re doing. They know that they’re killing the baby inside them . . . .

- letters from babylon

(emphases original)

Surprise! They know.

Expecting that anyone who sees what she sees will then believe what she believes, letters from babylon almost comically concludes:


Apparently the facts don’t speak for themselves.

Women have always known what is going on inside their bodies; they have always known the conflict that abortion can represent. They have always dealt with the possibilities - of family, of injury or death, of fulfillment, of poverty, of happiness, of lost dreams and closed options, of pride, of shame and rejection, of new beginnings, of struggle and desperation, of so many things - inherent in any pregnancy. They have always known what they were choosing, and what they were giving up, both in completing a pregnancy and in aborting it. The right wing has never acknowledged that. What women have asked for is the right to weigh that balance, and make those decisions, for themselves - not have someone else’s values and hopes imposed on them, and their decisions made for them. The right wing has never been willing to grant them that. And women know . . . they know full well . . . what has been done to them by those who have taken, and would still take away their authority over their own lives and bodies.

But what does this new approach reveal about the abortion decision? What should we think about that? (Read on.)



What exactly is the issue here? Does the fact that some women (a small minority, according to those who have worked with them) have conflicted feelings about abortion somehow invalidate their choices to have an abortion, or the justification for abortion in general? Is there something about the particular ways the women profiled in these articles approach the abortion decision that indicts abortion itself?

Abortion and Personal Conflict

Most women who have an abortion will have children at some point in their lives; any pregnancy thus represents a possible child that a woman might, conceivably, accept, and the possibility of many negative consequences as well. Terminating a pregnancy would quite naturally not be as uncomplicated a medical decision as choosing most other common surgical procedures, simply because it represents rejecting something that, in other circumstances, that woman is likely to want. In contrast, nobody ever wants appendicitis or cancer - choosing surgery to end these conditions is never a choice between something you might want now or might want at some other point in your life.

In some cases, these alternatives can be starkly opposed: a pregnant teenager, with the most important period in her life just before her and no emotional or other resources to raise a child, might strongly desire to terminate a pregnancy at that time, but just as strongly desire to carry one to term at a later point in her life. She may feel great relief at terminating her pregnancy at the wrong time of life, and great happiness in carrying it to term later. At times, the choice may be more finely balanced, and the decision harder: a woman who is otherwise ready to have a family, but finds herself uncertain whether her partner is committed, whether she is with the right partner, or who simply hadn’t planned on the pregnancy right at that time, may feel that her opportunity for a family has arrived but the circumstances aren’t quite right; similarly, she may want to have a child but not have a stable home or financial situation, and thus would carry the pregnancy to term if her external situation were different. In this case, this woman may feel regretful about terminating a pregnancy she would have accepted under other circumstances, but still feel it was the right decision given the circumstances that did exist.

It is unrealistic and disrespectful not to expect women to have complicated feelings about a complicated decision. But, it is vital to note that all people have conflicted feelings about many important decisions in their lives: who to marry, whether and when to have children, when to buy a house, whether to invest in a risky stock, what career to pursue. They often are unsure of their decisions, they often wish they had had a wider range of options, or that circumstances had not required the decision they felt they had to make. They may even feel regret at their decision, thinking in retrospect that it was the wrong one.

None of this invalidates the decision made. Decisions sometimes bring conflict with them; many decisions are made between undesirable options, in which the final choice can only be one that one would prefer not to have made at all. These are not only valid decisions, they are necessary and inescapable acts of responsible adulthood in a complicated world. Still less does any of this invalidate the very possibility of choice in the contentious area. If it is perfectly natural to have to face the complex consequences of complex decisions, it is absurd to argue that one may not be allowed to make difficult decisions because they may cause conflicted feelings.

Yet this is just what anti-choicers imply in highlighting the conflicts experienced by (some, few) women facing an abortion decision. Having been humiliated in their fraudulent claims of a psychopathological “Post-Abortion Syndrome,” anti-choice bloggers are now jumping on evidence not of psychological trauma, but of simple mixed feelings among women choosing abortion as something that somehow impugns abortion itself.

What these feelings demonstrate, of course, is merely that abortion is one of the complicated decisions people sometimes face, one that offers alternatives that may be neither wholly good nor wholly bad, and which women may therefore make with regret at the necessity of the decision itself. If abortion is immoral because some women feel conflicted about it, then buying a car is immoral because some people feel buyer’s remorse, getting married is immoral because some people get divorced, and dieting is immoral because some people crave dessert. Alternatively, we can recognize that responsible people make difficult decisions knowing that (as so shocks the right-wingers currently hyperventilating over this issue) the decisions are not always clean and easy, and that that fact is both a function of, and evidence of, the maturity and competence of the decisionmakers.

Abortion and the Personalized Fetus

What is striking about the statements and messages quoted in the article is the highly personal way in which the women having abortions relate to the fetus they are aborting. The fetus is often addressed as a child, and the pregnant woman and her partner refer to themselves as “mother” and “father.” This certainly does conflict with the somewhat sanitized image of abortion often presented by the pro-choice movement. Do these feelings and expressions on the part of these women belie the pro-choice rhetoric that drives the abortion-rights struggle? If women do feel this way about the fetuses they are carrying, or, more to the point, if this is the “appropriate” or “correct” way to feel about them, does this invalidate abortion as a procedure?

Certainly the right wing would like to think so. This is the significance of their professed shock that anyone feeling this way could still choose abortion. In particular, since personalizing the fetus clearly acknowledges it as a “human being,” these women’s behavior is incomprehensible if one assumes that abortion is obviously wrong if the fetus is a “human being,” or that no one would choose abortion if they realized this was true. Some commentators say this explicitly:


I am amazed that the complete recognition of what they’re doing doesn’t stop these women from having abortions.

- letters from babylon

If only we could convince them that the “fetus” is a person. If only they knew it was a human life they were destroying. If they only knew, they wouldn’t – they couldn’t – go through with the abortion.

- Evangelical Outpost

What this misses is two things: (a) a standard, and important, line of argumentation in the abortion debate that defends abortion without relying on questions of whether the fetus is a “person” or not; and (b) a distinction between how women think or feel about the fetus and its actual moral status.

First, although much discussion of abortion turns on arguments about whether the fetus is a “moral person,” has rights, or in other ways has the moral standing to claim equal weight against the moral interests of the woman whose body it occupies, this is not the only approach to the issue. In the interests of space, I’ll merely summarize here, but the argument is that, even granting for argument’s sake that the fetus is a full person with all rights and claims that its mother might herself make does not invalidate her right to have it aborted. No person has the right to occupy the body of another person against their will, and demand that that person not only devote themselves to keeping the first person alive, but also willingly take the considerable risks to health imposed on doing so, and furthermore abandon any of their own plans or commitments that might conflict with that other person’s interests. If this is true, then the fetus does not have any such claim on a pregnant woman - whether or not she became pregnant voluntarily, whether or not it is a high or low risk pregnancy, or under any other circumstances. And this holds good even if the fetus has all the rights and privileges of any other moral person - because those rights and privileges do not, for any person, extend to taking over and occupying another person’s body, even if you need it to live.

So, if this argument holds, the abortion debate does not turn on whether or not the fetus is a person (still less, in the - deliberately or ignorantly - sloppy terminology of the anti-choice movement, a “human being”), and surely does not turn on whether or not pregnant women think of it or address it as a person. This position is also reflected in the pro-choice (but not, of course, the corresponding anti-choice) rhetoric: “It’s My Body” encapsulates perfectly the governing principle even in the extreme case that the fetus is granted all the rights and standing of the pregnant woman.

From this point of view, it makes perfect sense that women - especially conflicted or ambivalent women - would think of the fetus they are carrying as a “baby” or a person, yet still choose to abort it and be justified in doing so. The choice they are making - for this conflicted minority - is between accepting that fetus as a baby - a child they will bear and, likely, raise - or terminating it and rejecting a mother/baby relationship with it. To the extent that they are inclined to carry the pregnancy, they are predisposed to think of the fetus as a baby, and, when they choose not to carry the pregnancy, to think of that decision as rejecting a baby that might have been. This, as we have seen above, says nothing about whether that decision is justified; it just tells us something about their emotional state in making it. They are entitled to feel however they may; one wishes them success in making the decision that works out best - emotionally and practically - for them, but the fact that that decision may be emotionally fraught does not invalidate the decision, neither for that woman herself nor in general.

Now, as regards the actual moral status of the fetus (assuming, that is, that this is a significant issue in the abortion debate - as the argument I outlined above does not assume), that is even less impacted by the particular perspective, or emotional state, of women making personal decisions about abortion. The agonized moaning about “they knew . . . they knew” from right-wing bloggers seems very over-wrought in respect of the actual importance of the feelings or beliefs of the women having abortions.

These women’s statements and language regarding their fetuses tells us little, either about abortion in general or even about their own decision-making. Most obviously, what these women think about the fetus is not determinative of what is true about it from a moral perspective; supportive counseling practice would acknowledge their personal perspectives on the issue without requiring that we agree with them. But, if one did believe that the moral status of the fetus is relevant to the morality of abortion, then one’s personal belief that the fetus is a person would presumably provide some disincentive to having an abortion. This still does not mean that nobody who held those beliefs could not choose abortion: one could feel that the moral status of the fetus was an important factor, but not the only factor to take into account (as apparently did the woman who told her fetus “you will be better off in the hands of God”); one could feel that there were equally-strong conflicting principles in play; or, one could feel that one was, knowingly, making a bad choice but hoping to attone for it (as apparently did the woman who asked if “God will forgive me”). In addition, the statements may not express any particular belief about the moral status of the fetus at all. Some women may refer to a fetus as a “baby” because that is language commonly used in pregnancy; some may address it in personal terms as a way of expressing their feelings toward it, but not with an implication that they regard it as a person (people commonly do this with pets, their cars, their computers, and, for many men, their penises).

In short, the language women use toward the fetus implies nothing about what we are supposed to believe about its moral status. It may or may not imply that they themselves “know” (i.e., believe) that the fetus is a moral person or even a distinctly personal entity. Furthermore, that some women may feel that the fetus is a person does not preclude their choosing abortion in the face of that knowledge. Still further, the fact that women choose to abort what they believe is a moral person does not require that they have knowingly committed an immoral act by their own lights (though this could be the case). All in all, it hardly justifies the self-righteously judgmental rhetoric of the anti-choice wing:


“This is the most selfish of decisions–they are not ignorant, they are not to be pitied–they are narcissistic.”

“They already know that they’re in really big trouble before their Maker”

“[O]nly the most inhumane women would proceed despite [having seen an ultrasound of her fetus].”

- letters from bablyon [in the comments]

Finally, none of this justifies the conclusion the anti-choice wing seeks to drag out of this story: that abortion should be outlawed, and that some clinics are dealing with the fact that abortion decisions can be complicated proves that abortion should be outlawed. I can’t see why providing better abortion services constitutes an argument against abortion, but at any rate, nothing in the fact that abortion decisions may be complicated even remotely implies that they should not be made. That is the bottom line in this issue.

Abortion remains as necessary and as justified as ever. That some treatment modalities are being developed that better reflect the range of patient approaches to the procedure is only to the good. That there is such a range no more invalidates abortion as a procedure than does the ambivalence and hesitation many patients feel over cancer surgery invalidate that treatment. It is probably fair to say that some abortion-services providers have often been too caught up in the politics of the abortion debate, and its attendant yes/no rhetoric, to respond to the ambivalence and nuances of their patients’ feelings about the procedure - and who could blame them? But that some clinics are developing a fuller approach to patient care only adds to the benefits abortion provides to women in need. The idea that allowing those women to speak honestly and openly about their needs would be grounds for denying them that service could only come from the right wing.