The Unfinished Revolution

SHANNON STETTNER

I did choose life—mine.

Sonya Renee Taylor

In August 2014, Colleen MacQuarrie and I hosted an interdisciplinary conference called “Abortion: The Unfinished Revolution,” at the University of Prince Edward Island.1 The decision to hold the conference in Charlottetown was political. As pieces in this collection indicate, anti-abortion activists in PEI had, over the years, done a tremendous job of eliminating abortion from the island’s hospitals, keeping the service inaccessible to women in need.2 Anti-abortion activists in Canada, proud to have eliminated access to abortions in PEI, referred to the province as a “life sanctuary.” In response, by holding the conference in Charlottetown, we symbolically brought abortion to the island. In addition to academics who travelled from around the globe, contingents of activists came from nearby provinces, especially New Brunswick, where, only a few weeks earlier, Fredericton’s Morgentaler Clinic had announced its impending closure. This gathering of academics, long-time activists, and individuals newly committed to the cause was, and still is, an encouraging sign for women in Canada. So, of course, was Premier Wade MacLauchlan’s announcement, on 31 March 2016, that the province of Prince Edward Island would make abortion services available by the end of that year. This victory reflects the work of a dedicated contingent of pro-choice and reproductive justice advocates in the Maritimes, who have been motivated by the continued lack of access and by women’s abortion experiences, such as those described in the research of Colleen MacQuarrie and her colleagues.3

In the weeks following the conference, pro-choice and reproductive justice activists in New Brunswick responded to the closure of the Morgentaler Clinic by forcing provincial politicians to accept abortion access as a major issue in the September 2014 provincial election. Through an intense social media campaign, pickets and protests, and petitions, activists forced abortion onto the agenda and ultimately contributed to the defeat of the incumbent anti-abortion premier, David Alward, of the Progressive Conservative Party.4 In November, the new Liberal premier, Brian Gallant, announced the demise of regulation 84-20, the long-standing “two-doctor” rule, according to which provincially funded abortions could be performed only by an OB-GYN specialist and only after the abortion had been certified as medically necessary by two medical doctors.5 New Brunswick serves as an exemplar of the importance of women’s voices and activism supporting reproductive rights: safe and accessible abortion can be an election issue, and more and more we see women around the world making it one.

The political climate in New Brunswick and Prince Edward Island, as elsewhere, shows us that women’s voices count and that the language we employ when discussing abortion matters. Talking about abortion is not easy. Abortion is more than a word. It operates as a concept, an action, and a set of knowledges that must be situated within its broader social, economic, and political contexts. Abortion requires us to make choices. The authors in this collection have commented on the idea of “choice,” explicitly and implicitly, and on its meanings in women’s lives, as well as on the strategic choices we make as activists, as academics, as women, and as allies.

Some authors in this collection envision choice more narrowly, as referring specifically to the decision to terminate a pregnancy. As noted in the introduction, the language of choice is often inadequate when used to explain women’s experiences, because it suggests that all women operate within the same structural and cultural frameworks when making their decisions. In this collection, both Clarissa Hurley and “Dr. James,” for example, see problems with the term. As Hurley observes, “‘Choice’ implies that desire trumps circumstance, while I believe the opposite is frequently true.” She continues, “Unfettered choice cannot exist in a world that remains judgmental, unaccommodating, and punitive to unpartnered pregnant women and mothers.” James, meanwhile, highlights other limits to the term choice, noting that simplifying the abortion issue to one of choice and autonomy minimizes the complexity and depth that many women explore when making a decision about their pregnancy. Significantly, he also observes, “Choice implies a proactive decision (‘If I get pregnant, I’m having an abortion’), whereas, for many women, the choice to have an abortion is reactive.” We must continue to struggle with the language we use when talking about abortion because that process of struggle, in and of itself, is transformative.

Here, alternative framings—like those offered by reproductive justice advocates and socialist feminists, among others—hold value, for they allow us to conceive of choice more broadly. Carolyn Egan and Linda Gardner, for example, explain that, in the view of the Ontario Coalition for Abortion Clinics, which adopted a socialist feminist framework when it formed in 1982, to have a genuine choice women must also have “safe and effective birth control services in their own languages and their own communities, decent jobs, paid parental leave, child care, the right to live freely and openly regardless of their sexuality, an end to forced or coerced sterilization, employment equity, and, of course, full access to free abortion.” Although socialist feminism and the movement for reproductive justice differ in certain respects, their adherents share a revolutionary perspective, according to which achieving equity for women presupposes a fundamental transformation of the social, economic, and political structures on which the culture of patriarchy rests. I would thus argue that our understanding of the history of reproductive rights in Canada would benefit from a more detailed exploration of the relationship between these two movements.

As Jessica Danforth has observed, the concept of reproductive justice, which evolved in the United States, initially met with some resistance in this country. Danforth was extremely critical of the pro-choice movement in Canada and what she experienced as an apparent reluctance to fully adopt a reproductive justice (RJ) framework, arguing that “actualizing RJ beyond a hot, new buzz word still has a long way to go and it has to start with being honest about where we are at and what’s really going on in terms of racism, sexism, classism, white supremacy, homophobia, transphobia, ableism and more—not just systemically, but what we ourselves are complicit in as well.”6 Since Danforth wrote, in 2010, the movement for reproductive justice has gained ground in Canada, but hers is a criticism that we must ponder as we move forward, especially now that RJ has gained increased prominence among Canadians organizing around the abortion issue. As is clear from Karen Stote’s chapter in this volume, the movement for reproductive justice is fundamental to improving the lives of women in Canada, especially those who have been racialized and marginalized..

Advocates of RJ consider access to abortion essential to achieving reproductive justice, seeing the issue as linked to matters of racial inequity, economic justice, youth issues, violence, religious intolerance, immigrants’ rights, disability rights, and imperialism.7 Although the issue of abortion access may not be the central or most important component of reproductive justice, RJ advocates acknowledge that it is appropriate to focus on a particular aspect of RJ, provided that such work is undertaken within an RJ framework: “We may not be able to work on every issue, but we can ask ourselves: How does my work support or undermine the work of others in this movement?”8 As I indicated in the introduction, what a RJ framework means and how that materializes is something that many of us who are new to RJ are only beginning to envisage as a possibility, much less comprehend. What we do know is that reproductive justice necessitates a reorientation of how we conceptualize and discuss abortion.

The main goals of this collection were to provide a space for voices speaking out on abortion to be heard and to explore questions about abortion and the issues of choice (the abortion decision, language choices, and movement strategy choices) with the hope that these conversations will continue beyond the covers of this book. To survive and to be relevant, the movements for reproductive autonomy, reproductive justice, and abortion rights—however these are labelled and conceptualized—must continue to evolve. This collection raises a number of important areas of discussion, but many additional issues and conversations await exploration. I hope to persist in encouraging dialogue around the shame, silence, stigma, and secrecy that continues to surround abortion. Not only do we need to speak openly about abortion, but as Danforth and others argue, we must also talk about the oppressions that continue to frame women’s lives and determine the choices they can or cannot make. I believe that overcoming the shame and stigma surrounding abortion is essential in the fight to overcome reproductive oppression. As I and others in this volume have expressed, if we eliminate the shame and stigma of abortion, if we reach a point where women can talk openly about their abortion experiences without fear of being judged or harassed, the anti-abortion movement will lose much of the power that it currently possesses.9 RJ activists work on the premise that incorporating abortion within the social, economic, and environmental contexts in which women live will help to better connect abortion to women’s lives, reducing the isolation, shame, and stigma often associated with it.10 Abortion, then, is not a dramatic or defining reproductive moment, but one life decision among many that women make over the course of their lives.

Eliminating the isolation of abortion as a single issue and overcoming the silence that surrounds abortion will destabilize opponents. I want to be clear, though, that the onus is not on women to stop anti-abortion harassment and violence. The anti-abortion movement maintains strength and relevancy in part because a few powerful elements (such as media and government) permit it. As Jane Cawthorne notes in her contribution to this collection, the media insist on giving equal weight and equal time to both sides of the issue despite the fact that those opposed to abortion are a minority in Canada and have been for decades. More importantly, those opposed to abortion access for women often employ misogynist materials and messages. Their use of words and images constitute hate speech and should not be tolerated.11 There are extreme elements in the anti-abortion movement that engage in violence and terrorism and as long as they are given equal space, women will continue to receive the message that their health care choices are shameful, selfish, and immoral.

Allowing these harmful and hateful voices to continue has other effects, including contributing to the decline in abortion providers. As a consequence, we need to encourage medical students to become providers. Historically, we know that physicians performed abortions prior to legalization because of the risks women faced when they either attempted to self-abort or sought help from untrained individuals. We also know that since abortion has been legally available, we have moved away from the generation(s) of physicians who could spot the consequences of attempted abortions.12 Additionally, health care professionals who engage in abortion work confront the stigma of that work, stigma that makes them targets both at an individual level and within a health care system that keeps abortion care separate from other forms of health care delivery; sufficient provider support, then, becomes a part of addressing the provider shortage.13 In this volume, Dr. James highlights the effort it took on his part to opt into provider training given that most medical schools provide minimal abortion-related training. Activists need to collaborate with and support organizations like Medical Students for Choice in their efforts to ensure sufficient physician training. The failure of medical schools to provide adequate abortion education is an issue that deserves more attention. Not only are doctors ill-equipped to recognize the signs of illegal abortion attempts, but the fact that medical students need to opt into abortion training suggests that it is not a medically necessary service, which sets the stage for what is often labelled “conscientious objection.” Few other professions would allow members to refuse to perform key components of their job. There should be no exception for abortion, which is not to say that all doctors need to provide abortions, but if they cannot recognize the signs of incomplete abortions, if they cannot offer their patients a full spectrum of care, and if they choose not to refer their patients to pro-choice providers in their stead, they are inflicting their personal beliefs on their patients—and that is intolerable.

As long as women’s bodies—and abortion—remain medicalized, as long as physicians remain the gatekeepers to abortion procedures, women will continue to endure reproductive oppression. Here the question of the involvement of others in the provision of abortion services is relevant. Can physicians be supplemented (and in some cases replaced) by nurses, abortion doulas, midwives, or others?14 Ultimately, anti-abortion ideologies have no place in the health care practices related to abortion.15 The need to address these issues—provider shortage and insufficient training, provider stigma, so-called conscientious objection, and the potential role of other technicians—takes on a certain urgency when one considers the statistics put forth by Canadians for Choice to illuminate the provider shortage in stark terms—in spring 2012, the total number of providers in Canada was 134, with the provincial and territorial breakdown as follows: Nunavut, 1; Yukon, 1, Northwest Territories, 2; British Columbia, 23; Alberta, 4; Saskatchewan, 3; Manitoba, 4; Ontario, 36; Québec, 54; New Brunswick, 3; Prince Edward Island, 0; and Newfoundland and Labrador, 3.16 These numbers take on increased significance when one considers that, according to 2015 data from Statistics Canada, women account for 18.1 million (or 50.4%) of Canada’s population.17 What these numbers mean, then, is that there are 134 abortion providers for 18.1 million women who will all experience roughly thirty years of fertility during the course of their lifetime.

In addition to rethinking who can provide abortions, the imbalance in fertility responsibility needs to be addressed. Currently, the responsibility for fertility falls unevenly on women’s shoulders. But how do we incorporate men into discussions (and decisions), honouring their voices and feelings, without ceding control? Women must retain control of the final decisions, yet, as Dr. James notes, until we figure out how to involve men effectively, women will continue to bear the brunt of fertility responsibilities and decisions—which includes the emotional and financial costs, as well as the shame and stigma, associated with abortion.

Issues of fertility play out in other ways, too. There is an enormous disconnect between the advertised effectiveness of birth control and the level of contraception failure. Moreover, the people overwhelmingly responsible for using contraception, women, feel disconnected and alienated from it. Women of colour have a long history of being critical of various hormonal contraceptives.18 Increasingly, studies suggest that young women are disenchanted with hormonal birth control (whether because of side effects or lifestyle choices) and that this dissatisfaction leads to a reliance on less effective forms of contraception.19 Rather than push hormonal contraception on women, especially at the time of termination, the medical profession and those who care about lowering the abortion rate need to think carefully about why women increasingly do not like using hormonal contraceptives and look for alternatives that better resonate with them. Shannon Dea’s harm-reduction model can be applied to this issue. It is neither productive nor accurate to label women as contraceptively irresponsible: not only does it relieve men of responsibility for birth control, but such energies would be better directed to actualizing more effective and safer forms of birth control.

Understanding women’s fertility needs will ultimately help us to improve women’s abortion experiences. Where, when, and how abortions take place impact a woman’s experience, often negatively.20 Medical technology like RU-486 allows for early abortion to occur at home, which is, for many women, more comfortable than a clinic or hospital. In July 2015, Health Canada approved the sale of RU-486, which should be available late in 2016; theoretically, this will alleviate some of the barriers to access faced by women in the Maritimes, the North, and rural Canada.21 But medical abortions do not eliminate the need for surgical interventions or solve the lack of support for women who choose abortion. Several narratives in this collection highlight the isolation experienced by women who undergo abortions; often partners, friends, and family members are not allowed to accompany patients because of safety concerns or privacy issues. If we are looking for the best abortion experience, the option of having a supportive person with them throughout the procedure should be available to women. Furthermore, certain practical measures, like better enforcement of injunctions against clinic harassers, would also go a long way to improving abortion experiences.

It is important to remember that abortion experiences do not end with the procedure. As abortion rights advocates, we have often failed to support women post-abortion. Along with and as part of the process of reducing shame and stigma surrounding abortion, we need to provide better support to those women who require it. Some advocates argue that women only need support because of the anti-abortion messages that have bombarded us for decades.22 Certainly women would experience less guilt or stress or sadness if they stopped receiving messages that they are horrible human beings for having an abortion, but, as shown by several pieces in this collection, abortion is a complicated issue for many people, and sometimes women have abortions when, under different circumstances, they would have preferred to continue the pregnancy. Ultimately, working within an RJ framework, we hope to reach a point where women can decide on abortion without feelings of regret or shame. Until then, we need to accept—and honour—that some women struggle with abortion and need to be supported, regardless of the underlying cause(s) of their struggles.

Changing abortion experiences also necessitates changing the way we talk about abortion. Laura Gillespie’s essay challenges us to better control how abortion is framed. She calls on us to move from a reactive position to a defining one. Similarly, Katha Pollitt, in 2014, issued a call to redefine abortion as a positive social good.23 Ultimately, we need to stop apologizing for abortion. As Erin Mullan and Dr. James contend in this volume, abortion is most often a parental decision made out of love and consideration. It is also a remarkably common, even ordinary, reproductive decision that women make every day.

Becoming more aware of language has far-reaching consequences. Activists, the media, and others often use the term pro-choice in reference to those who advocate for safe and legal abortion. As we have seen repeatedly in this collection and as is abundantly clear in external criticisms of the concept, the notion of “choice” is problematic. We need to be more conscious, moving forward, of the costs and limitations of the word. As noted, a number of organizations and activists are abandoning the “pro-choice” label, but should we do so entirely? There is a generation of activists who very much identify with the term and spent their lives fighting to see the decriminalization of abortion, and we need to recognize their contributions while at the same time acknowledging the need for continued activism, especially in the United States.24 Pro-choice is also a term that resonates publicly; especially within the larger general public who are not inclined toward activism, the “pro-choice” label is an easy and comfortable, if problematic, shorthand. Speaking from the perspective of a historian, I propose that retaining the term makes sense because it has historical resonance—at least when discussing almost half a century of abortion rights activism. But for those of us concerned with the implications of language choices, it becomes increasingly difficult to use pro-choice because historically, the pro-choice movement has excluded the experiences and concerns of racialized women. We need, then, to continue the conversation about the term—what it means and how it is, and is not, applicable.

Connected to this issue of terminology is the need to build better linkages between generations of activists; between academic and front-line activists; between the different groups advocating for reproductive choice, freedom, and justice; and between the resolutely pro-choice and those not quite as comfortable with abortion. Many segments of the population feel alienated from the pro-choice movement because of its largely white, middle-class nature and its overwhelming failure to articulate demands for broader structural changes in Canadian society. Indeed, it is the very middle-class and white nature of the pro-choice movement that makes it so resistant to change or self-reflection. Looking inward and questioning our positions is extremely difficult, especially when it reveals that we are complicit, tacitly or not, in the perpetuation of privilege and power. For those of us who choose to involve ourselves in struggles to ensure that women have access to abortion, the suggestion that we are complicit in undermining the rights of racialized women to make choices is incredibly difficult to face and hard to comprehend.25 But in order to move forward and to make real change, we have to acknowledge that “the regulation of reproduction and exploitation of women’s bodies is both a tool and a result of systems of oppression based on race, class, gender, nation and sexuality.”26 So building linkages and partnerships necessitates engaging in self-reflection and self-awareness, educating ourselves on what it means to be an ally, and truly listening to the needs of other people.

The pieces in this collection have addressed different perspectives (choice, reproductive justice, harm reduction) that might provide useful arguments at different times. Debate on reproductive rights occurs at different levels—interpersonal, familial, social, and institutional (e.g., university, church, the media, and government). At stake in all these debates are views of women and their roles. In Canada, many of us have come to see the promise of reproductive justice as an organizing framework, although many of us still have much to learn from the powerful examples of women of colour in the United States, Canada, and elsewhere. We need to adopt more fully the RJ framework, which situates abortion in the broader context of human rights, thus combatting reproductive oppression by framing abortion as a social justice issue.27 As well, many of the pieces in this collection point to the need to continue to listen to women’s stories about their abortion experiences; only by talking openly and often about abortion will we move to a place where abortion is normalized, removed from the shame, secrecy, and silence that has, for too long, characterized abortion in Canada. To that end, the voices in this collection are transformative, and they will be made more powerful as they are supplemented by additional voices. Muriel Rukeyser, a poet, once asked, “What would happen if one woman told the truth about her life?” and offered an answer: “The world would split open.” Now is the time for us to tell the truth about our abortions—without apology.