Women’s experiences matter – this simple truth is at the core of Natalie Kimball’s brilliant new exploration into the tragic history of unwanted pregnancy and abortion in highland Bolivia over the past sixty years. As Kimball so eloquently argues in her book An Open Secret: The History of Unwanted Pregnancy and Abortion in Modern Bolivia, Bolivian women’s intimate experiences with unwanted pregnancy and abortion matter for three reasons. Most broadly, they shaped reproductive policies and services in highland Bolivia between 1952 and 2010, the years her study analyzes. These experiences also reveal the “deeply ambivalent attitudes about women, and about sexuality more broadly” in urban Bolivia. But, most importantly, as Kimball writes, “women’s experiences matter simply because they occur” (3).
Take the story of Marcela (Kimball changed all names for privacy), a married mestiza woman who had two abortions at the ages of twenty-six and thirty. With her husband, she had four living children (she had abortions after her second and third children). Although at first, Marcela cited economic reasons as the impetus behind terminating her pregnancies, she later described the sexual abuse she received at the hands of her husband as the primary reason. “‘I argued with my husband,’” Marcela told Kimball, because he had chided her for getting pregnant in the first place. Marcela responded to her husband, “‘I didn’t ask you [for sex], you looked for me, I mean, you use me.’” Marcela then described to Kimball what she saw as the ubiquity of her experience: “‘I think many women experience this in Bolivia because men use us sexually. . . . There’s a lot of machismo, for that reason; yes, I’ve aborted two times.’” (135). It is stories like that of Marcela’s that fill the book and give it a rich empirical and emotional basis.
The backbone of this book draws from well over one hundred oral history interviews with women who experienced unwanted pregnancy and abortion, as well as conversations with activists, medical professionals, and government officials. Kimball complements these rich sources with an impressive analysis of medical records, demographic reports, and governmental policy. With care and deep humility, Kimball details her oral history methods and experiences, without ever losing sight of the women she spoke with. Writes Kimball, “When, during the course of an interview, a woman wept about her experience with pregnancy or the loss of a loved one, I responded as a human being rather than a historian, abandoning my prepared questions to express empathy and to ask if she had individuals to whom she could turn for support.” These are not “deviations from the script,” contends Kimball, but rather “inevitable expressions of our humanity and individuality as researchers” (31).
So what did Kimball find? Since the mid-twentieth century, four main features have shaped urban Bolivian women’s experience with unwanted pregnancy and abortion. As a country with a high percentage of Indigenous people, Bolivian reproductive politics have been shaped by competing national and international interests that have tied population policies to political and economic goals. In the second half of the twentieth century, as Bolivia transitioned through revolutionary and military regimes, Indigenous women’s bodies were central to policymakers’ views on the future of the Bolivian nation. Whether marking Indigenous women as inferior reproducers due to their inability to mother children properly (read: as white and western), or inferior reproducers because they had too many children during the overpopulation “scare” of the Cold War era, various political regimes on multiple levels viewed controlling Indigenous women’s reproduction as crucial to “modernizing” the country.
Bolivia’s Indigenous population also shaped Kimball’s second finding, that Bolivian women, both Indigenous and mestiza, relied on various, and at times overlapping, medical systems to help regulate their fertility. Women turned toward Indigenous cosmologies and medical systems and western, biomedical institutions for care during childbirth, after an abortion or miscarriage, or to regulate their fertility. Yet the presence of “medical pluralism” didn’t mean that the state and its official health institutions were the key regulatory structure surrounding women’s termination of unwanted pregnancies. In fact, Kimball’s third point is that “most women’s experiences with pregnancy and fertility regulation occurred outside the bounds of the state” (5). This was, in part, because of a “double discourse” on sexuality and reproduction in which most Bolivians condemn abortion in public but tacitly support their own access, or that of their loved ones, to the procedure. Patriarchal mores and practices – including domestic and sexual violence – religiosity, and pronatalism all affect the public side of this coin. In the end, this double discourse mirrors public policy in that changes to public healthcare and the selective and infrequent repression of abortion have created an environment where women have access to safer abortions, yet the procedure remains illegal.
Kimball’s book joins a growing historiography that has centered women’s lived reproductive experiences in the histories of sexuality, public health, and gender. These books, often centered on non-U.S. contexts, have pushed back on the idea that “choice” is the best rhetorical framework with which we can explain and thus advocate for women’s reproductive decision-making processes. A “rights-based” framework disregards the structural and interpersonal factors that always surround a woman’s reproductive decision. And thus I found Kimball’s fourth point her most powerful. Most women she spoke with expressed a “deep ambivalence” toward both unwanted pregnancy and abortion. Their experiences, writes Kimball, “highlights the error of making assumptions about the ways in which women feel about, and make choices regarding, their reproductive lives” (114). “Choice,” in other words, does not provide an adequate framework for discussing these women’s reproductive decisions, and they did not understand their actions within its discursive structure. Kimball calls for a “reevaluation of the language with which reproductive rights activists and other sectors speak about abortion more broadly” (114). Here, Kimball’s analysis dovetailed beautifully with Lara Friedenfelds’s recent work on miscarriage, in which she argues that the U.S. abortion debate, centered on “choice” versus “life” has erased the reality of “the frequent miscarriage of wanted pregnancies” (8).
This beautifully written book is a must-read for anyone interested in gender equality and reproductive justice. It serves as a model for how to write a book with sensitivity and rigor, defining the politically fraught topics of abortion and unwanted pregnancy “as human experiences” (250). It is a powerful reminder that what is at stake – women’s lives – is not something that should be up for political debate.