What Does It Mean to Have a “Real Choice” about Abortion?

Lara Freidenfelds

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What does it mean to have a “real choice” about abortion?

I am writing this book review as the Supreme Court hears arguments over Mississippi’s law banning abortion after 15 weeks of gestation, and it could seem like the wrong time for arguing the subtleties of this question. Abortion may become flat-out illegal throughout the American South in less than a year. If that happens, too many Americans will know exactly what it means to have no choice.

But looking forward, supporters of legal and readily available abortion care should keep talking about the myriad of circumstances that lead people to consider abortion to figure out how to come together in support of pregnant people, their choices, and their lives.

In No Real Choice: How Culture and Politics Matter for Reproductive Autonomy, sociologist Katrina Kimport shares the stories of women who considered abortion but did not follow through. The stories, selected from her interviews with 58 women, are important testaments to the many layers of deprivation and ill treatment that stand between American women and their ability to choose when to have a child, even in a moment when abortion remains tenuously legal.

Most strikingly, Kimport’s interviewees inevitably faced multiple barriers to ending a pregnancy. Sylvia, for example, wanted to have her tubes tied after having a child, but her doctor refused on the grounds that she might change her mind later. She and her boyfriend used contraception, but she got pregnant anyway. She thought about an abortion, since she worried she couldn’t support two children, and her boyfriend did not want to become a parent. But she didn’t have insurance, and paying for an abortion out-of-pocket would make it hard to afford rent. She recalled an earlier difficult miscarriage, and feared an abortion would be painful and maybe dangerous. And she thought abortion was irresponsible and immoral. She did not want to have a baby, but she didn’t feel like she could choose abortion.

For Kendra, a condom broke, the hospital emergency room refused to give her emergency contraception, and seven weeks later she confirmed she was pregnant. Following two previous abortions, she had had many conversations about abortion and God’s will with her mother and brother and had promised God that she would not have another. So, as much as she kept revisiting the possibility of aborting, she kept her pregnancy.

Maria had recently left an abusive relationship and moved to a new state when she found herself pregnant. She wanted an abortion, but all of her family members opposed it, and her current boyfriend told her it was her problem and he would not help. She was clinically depressed, unable to afford either depression medication or an abortion procedure, and overwhelmed by the Louisiana requirement of two clinical visits to obtain an abortion. So she stayed pregnant.

All the women Kimport interviewed were low-income or poor, and most were Black. While half lived in Louisiana, a “red” state with some of the most conservative abortion laws in the country, half lived in Maryland, a “blue” state with relatively permissive laws. And yet, in practice, abortion was not a choice for significant numbers of women in both states. While our attention has recently been focused on Texas’s extreme “bounty hunter”-style antiabortion law and Mississippi’s all-out ban after 15 weeks, Kimport found that legal access was no guarantee of practical access.

While Kimport tells women’s stories holistically, she introduces them in thematic chapters that emphasize specific kinds of barriers to abortion care. She examines laws and health financing that make abortion clinics hard to find and abortions unaffordable. She looks at the influence of family members, who often argued against choosing abortion, sometimes offering to pay for an abortion and then abruptly withdrawing their support. She considers the influence of misinformation and confusion, leading women to mistakenly conclude that they were not eligible for the procedure.

One of the understudied, and perhaps surprising, factors Kimport addresses is women’s fear and concern about the physical and emotional impact of the procedure itself. For example, Ebony had endured an incredibly painful previous abortion, and was unwilling to go through the procedure without heavy sedation, which the clinics in her area did not offer because they did not have anesthesiologists on staff. Pamela recalled the emotional fallout after a previous abortion following a romantic breakup and feared she would fall into depression if she aborted again. Melissa was pressured into an abortion as a teenager, and associated clinic-based abortion with coercion. Madison, perhaps influenced by antiabortion propaganda, distrusted the hygiene practices of the local abortion clinic. Khadijah had suffered previous obstetric violence and coercion and was nervous about how she’d be treated.

Historically, much of abortion discourse has been about women’s “desperation” and willingness to risk everything for an abortion. Some women did, in fact, take mortal risks to obtain abortions when it was criminalized, and historians such as Leslie Reagan have memorialized those who died. I think many Americans still believe that women ought to be forced to take some risk of injury to obtain an abortion – that it shouldn’t be an “easy out.” Kimport’s interviewees force readers to confront this implicit assumption in the abortion debate. They do not accept the risk of injury as appropriate “payment” in suffering for obtaining an abortion.

Another moving and perhaps unexpected chapter documents the stories of a small number of women who did not abort because they decided they were happy to be pregnant. Kimport shows how poor women may feel obliged to consider abortion because their pregnancies are seen as “irresponsible” or illegitimate. As she concludes, reproductive justice demands that their choices be respected, too.

Two of the chapters in No Real Choice address antiabortion belief and rhetoric and its influence on the women Kimport interviewed. Kimport shows how pro-life and religious arguments against abortion are implicitly, yet often deeply, held by her interviewees, including the perception of the fetus as a child from conception, the idea that women who have sex are automatically responsible for the children thereby conceived, and the belief that God intended the pregnancy and should not be second-guessed.

These beliefs certainly do inhibit women from obtaining abortions. Kimport views these cultural and religious beliefs as analogous to structural barriers imposed to restrain women’s choices. I am not so comfortable with this framing, for several reasons.

First, Kimport regards these ideas as historically recent and imposed on women by the pro-life movement, and especially its white Evangelical base. She writes about how pro-life rhetoric has “polluted pregnancy decision making” (p. 28). The pro-life movement has certainly had a large and demonstrable impact. But it’s hard to identify a prelapsarian “pure” version of pregnancy decision-making uninfluenced by religion or culture. Ambivalence about abortion long predated Roe v. Wade (see, for example, Abortion in Early Modern Italy). If anything, Kimport’s concept of “reproductive autonomy,” by which she means completing a pregnancy solely when a person is actively looking forward to bearing a child and otherwise safely preventing or terminating it, is a very historically specific concept dependent upon a recent confluence of technology and ideas. And the concept of maternal self-sacrifice certainly did not originate in the modern pro-life movement.

In particular, much of the history of Black American experiences of childbearing has yet to be written and is urgently needed. That history must include the relationship of Black women to the Black church in America. Historians need to do this work so that future sociologists can better contextualize Black women’s reproductive experiences and decisions in the present. Surely Black women’s narratives of childbearing are shaped by Black history and faith, and not just white Evangelical discourse.

Discussion of religious ideas in the book is also vexed by the difficulty of a secular interpretation of informants’ faith-based explanations for their thoughts and actions. When early anthropologists wrote about faraway people and “their gods,” informants were unlikely to read their analyses and take issue with them. But Kimport is writing about fellow Americans. I found it jarring when Kimport consistently wrote about a woman and “her god” when speaking of the Judeo-Christian “God.” I don’t blame her for making that choice, since I would never insist that someone genuflect to my God. But it points up the awkwardness of being an ethnographer in your own culture, and in particular, an ethnographer who regards religious belief as, in some sense, “just culture,” or perhaps even “just ideology,” and heavily politically-inflected ideology at that.

I came away from the book appreciative that Kimport had collected and shared so many moving and important stories of women whose voices are otherwise unlikely to be heard. My discomfort clarified for me the importance of bringing together secular and faith-based voices and perspectives in support of reproductive justice, as the Religious Coalition for Reproductive Choice has sought to do. In the current climate, reproductive justice demands nothing less.

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Featured image caption: My body my choice sign at a Stop Abortion Bans Rally in St Paul, Minnesota. (Courtesy Wikimedia)