October 1995By Patricia Wesley
Patricia Wesley, M.D., is a practicing psychiatrist and Assistant Clinical Professor of Psychiatry at the School of Medicine at Yale University.
Real Choices: Offering Practical, Life-Affirming Alternatives to Abortion. By Frederica Matthewes-Green. Multnomah. 257 pages. No price given.
Real Choices is the product of research conducted by Frederica Matthewes-Green of the National Women's Coalition for Life. To answer her question, "How could we live without abortion?" she surveyed 1,800 prolife pregnancy centers to find out why women contemplated abortion as a solution to an unwanted pregnancy, and what supports they would have needed to carry the pregnancy to term. (Pro-choice organizations were invited to participate, but refused.) She also held small group discussions with post-abortion women in seven cities across the U.S., seeking similar information.
Women turn to abortion for multiple social, psychological, and economic reasons: They fear disruption of their school or career plans, they feel emotionally or financially unable to rear a child, the father of the child does not support the pregnancy, they cannot endure the idea of adoption, they are ashamed of being pregnant, and so forth. Many of these reasons overlap, and it was often difficult to pinpoint one primary reason.
One of the more interesting findings emerged from the discussion groups. Many of these women sought abortion to please another person, in the often futile hope of preserving an important relationship. Boyfriends and mothers were often the most vigorous promoters of abortion.
These women often had their first abortion -- a good number had several -- as teenagers. Their economic dependency, cognitive immaturity, and normal developmental inability to appreciate the future consequences of their actions made these very young women especially vulnerable to pressure from the powerful people around them -- whether that power was real or perceived. They told Matthewes-Green they felt "forced" into abortion. These self-reports are compatible with Wanda Franz's research on adolescents who have had abortions. She showed that, compared with older women, teens are more likely to feel they were coerced into abortion, and are more likely to experience subsequent psychological distress.
Matthewes-Green locates abortion in the wider cultural and historical context in which it must be located to be fully understood.
She identifies all the familiar culprits, whose mischief we are at last beginning to appreciate: the sexual revolution, the feminist movement, female careerism, the devaluation of motherhood, the irresponsible or discarded father, and a welfare system that encourages illegitimacy. Abortion is an integral part of this cultural web: It is the result of these changes, and at the same time, the engine that drives them.
Matthewes-Green correctly emphasizes that there are no babies, born or preborn, without mothers, and that if prolifers want the babies to live, they must genuinely care for and support the mother, both emotionally and practically.
Matthewes-Green thinks that while most Americans dislike legal abortion, and believe that abortion kills a baby, they are reluctant to make it illegal, or so they tell the pollsters. For Matthewes-Green this indicates that prolifers have lost the political battle, and would do better to turn their energies elsewhere, namely, to giving women "real choices." However, the results of polls are notoriously dependent on how questions are phrased, the order in which they are asked, and other nuances; moreover, when poll questions specify the particular reasons for abortions, the vast majority of Americans would make the vast majority of abortions illegal. Thus it is not clear that the political battle is lost.
In her closing pages, Matthewes-Green asserts that the battle over abortion is primarily cultural, not political: "In this project we have tried to identify and seek solutions for the cultural pressures that lead toward abortion . Nothing in these pages concerns strategies to make abortion illegal. The present, legal status has been assumed. We have not gloated [?] over ways to restrict 'a woman's choice'; instead, we have sought ways to expand her choices with adoption, marriage, shelter, employment, and every other resource available."
There is much that is right in Matthewes-Green's book, but much that is wrong too. For starters, what about her belief that the 4,400 women who get abortions every day in America really don't want to? Or her belief that abortion creates lasting, significant psychological problems for the women who have them?
The women Matthewes-Green spoke with are not necessarily representative of all post-abortion women -- and to be fair, she makes no such claim. Her informants were selected from women attending post-abortion counseling centers, who, by definition, were experiencing psychological distress over their abortions.
But what about the post-abortion women who do not seek such counseling, and with whom Matthewes-Green did not speak? Is it possible that some, or many, of them, while they may have some mild regret or guilt around anniversary dates, are nonetheless reasonably content with their decision to abort their child, and exhibit no discernible symptoms or signs of psychic damage? Is Matthewes-Green's view that women want abortion "as an animal, caught in a trap, wants to gnaw off its own leg" applicable to such women?
Matthewes-Green asserts that abortion does violence to a woman's deepest identity. While there is much that is instinctively appealing in such a view, why then do American women subject themselves to such a trauma 1.5 million times a year? Is it, as she says, because the culture offers only the miserable alternative of abortion, and that with more "real choices" more women would choose life? Or do women get abortions because, rather than seeing abortion as a violation of their deepest feminine identity, they believe, or have been culturally conditioned to believe, that abortion is in fact an affirmation of women's power -- and a quick and seemingly cost-free way out of a crisis pregnancy to boot? And yes, with the repeat abortion rate approaching 50 percent, abortion has become an easy way out of the unanticipated consequences of sexual freedom.
Remember that for several decades the courts, the media, the medical associations, and many of the religious elites have been teaching women that abortion is a legal medical procedure, with perhaps no more moral significance than an appendectomy -- despite a lot of anguished mewling from these same quarters about abortion as a "tragic" choice. With these institutional imprimaturs firmly in place, abortion has become normative in vast reaches of our country, not just legally permissible but morally acceptable. As one of Matthewes-Green's informants reported, her husband told her that since the Supreme Court said abortion was O.K., who was she to have any qualms? Such cultural approval goes far -- if not always all the way -- to assuage any guilt post-abortion women might otherwise feel. Maybe the women who do suffer psychological distress are the ones who know right from wrong, despite what the AMA says.
Some years ago, then Surgeon General C. Everett Koop called for long-term, controlled, prospective studies of the psychological effect on women of all the results of mating -- childbirth, spontaneous miscarriage, elective abortion, sterility. Such a study, if it is ever done, may provide more complete information than we now have on if, how, and under what circumstances abortion harms women. Such a study poses daunting methodological problems, however. For example, how can we determine the relationship between "event" and outcome? Is it the abortion itself that causes psychological difficulties for some women, or is it something about the psychological make-up of the woman that causes abortion to be traumatic? Or both, acting together in complex ways? Prolifers better not assume that such research will necessarily yield the kind of unequivocal answers they would like.
Through the dedicated work of Vincent Rue, David Reardon, and many others, we know that abortion brings grievous psychological harm to some, and perhaps many, women. Matthewes-Green is correct in celebrating and encouraging the work of crisis pregnancy centers. Nonetheless, prolife strategy cannot be based on the psychological harm abortion does to women, nor can we retreat to the crisis pregnancy centers and forget about politics. Slavery was not ended because it harmed the psychological equilibrium of slaveholders -- though in some instances it did. And abortion will not end because some women suffer unfortunate side effects. It will end because people don't want babies killed anymore.
I suspect the main reason so many women have abortions is simply because abortion is legal, available, and cheap. People use whatever is at hand to get out of a crisis -- and abortion is most certainly at hand. Just check your Yellow Pages. If we can make abortion illegal, unavailable, and expensive (especially via large malpractice judgments against back-alley abortionists), we will see both abortions and unwanted pregnancies drop. This was amply demonstrated by the Minnesota parental-notification law which, while it was in effect, was associated with a significant drop in both teen pregnancy and abortion rates. Abortion is the "solution" for the problem -- unwanted pregnancy -- it helps create. The best way to help women avoid unwanted pregnancy and the trauma of abortion is to make abortion illegal.
Matthewes-Green does not fully appreciate that politics and culture are intertwined, and that public policy can penetrate deeply into the human heart. Laws do change behavior; when behavior changes, hearts, minds, and ultimately culture may follow. When men and women no longer have abortion as a seemingly easy "out," they may modify their sexual practices, and we may see a restoration of the sexual responsibility that is crucial to a humane and responsible society, and that was swept away by the upheavals of the last few decades.
We live in a nation founded on the principle that all human lives should be equal before the law, and equally deserve its protection. The prolife position has been primarily and properly based on the fact that the unborn are alive and human, and deserve a place under that protective umbrella. The prolife movement must never abandon that rationale. If we hope to restore protection to the unborn, we must continue to build on the bedrock of the American dream of "life, liberty, and the pursuit of happiness" -- and the first of these is life. That philosophical bedrock, and not shifting psychological data, or appealing but unproven theories about how abortion violates a woman's deepest nature, provides the only fully coherent basis for the prolife project. Contrary to Matthewes-Green, we must never "assume" the legal status of abortion. Like it or not, we're in politics for good.
As former Pennsylvania Governor Bob Casey puts it -- and he knows something about persisting in the face of adversity -- "Press on!"