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The Rhetoric of Fetal Rights in the
American Homebirth Debate
Suzan Steeman (5777038)
Thesis Advisor: Manon Parry
American Studies – University of Amsterdam
suzansteeman@gmail.com
Introduction
The Reduced Role of the Mother in Pregnancy and Birth
1
[ 1 ] ‘By Women for Women’
The Origins of the Homebirth Movement in America
6
[ 2 ] ‘Visualizing the Fetus’
The Rhetoric of Fetal Rights in the American Abortion Debate
19
2.1 Who Killed Junior
21
2.2 The Silent Scream
33
2.3 Too Many Aborted
39
[ 3 ] ‘Improving Birth’
The Rhetoric of Rights and the Current Homebirth Debate
46
Conclusion
63
1
[ Introduction ]
The Reduced Role of the Mother in Pregnancy and Birth
In 2012, the World Health Organization (WHO) published a report on trends in maternal mortality between 1990 and 2010. The maternal mortality rate in the United States of 12 per 100 000 live births is higher than the rates in other Western countries like Australia (7), Japan (5), the Netherlands (6), and Spain (6). Additionally, in contrast to many other countries, the maternal mortality rate in the US has increased between 1990 and 2010.1 The American Centers for Disease Control and Prevention (CDC) has also published some shocking conclusions on the pregnancy mortality rate in America. These show that black women in America are more likely to die from pregnancy-related causes than white women, with the pregnancy-related mortality rate for black women at 34.8 deaths per 100 000 live births.2 According to the CDC approximately half of the maternal deaths are preventable.3
Why is America lagging behind so many other Western countries? What is causing these high rates of maternal mortality and complications? A major factor is the increasing medicalization of both pregnancy and birth. The sociological concept of medicalization was developed in the 1970s to critique how the medical profession takes control of behaviors that are not abnormal or necessarily limited to medical factors.4 Critics of medicalization see the high cesarean rate, and the high rates of induction and other medical interventions, as proof of unnecessary medicalization.5 Scholars have argued that the medical world has wrongfully interfered with the natural process of pregnancy and birth and that because of that, a technocratic model of birth now prevails. In this technocratic model, medical viewpoints have the most authority.6 This model is opposed to the holistic model of birth,
1
World Health Organization, UNICEF, UNFPA and The World Bank ‘Trends in maternal mortality: 1990 to 2010,’ published by the World Health Organization (2012) pp.32-36
2 Centers for Disease Control and Prevention ‘Pregnancy Mortality Surveillance System,’ page last reviewe on March 7, 2013 at: http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PMSS.html#5
3
Amnesty International ‘Deadly Delivery – The Maternal Health Care Crisis In The USA,’ London: Amnesty International Secretariat (2010) p.3
4
White, K. ‘An Introduction to the Sociology of Health and Illness,’ London: Sage (2003) p.42 5
Kukla, R. and Wayne, K. ‘Pregnancy, Birth, and Medicine,’ in: The Stanford Encyclopedia of Philosophy (Spring 2011 Edition), Edward N. Zalta (ed.) p.2; Katz Rothman B, (1978) ‘Childbirth As Negotiated Reality’. In: Symbolic Interaction, Vol. 1, No. 2, pp. 126-129; Johanson R., Newburn M. and MacFarlane, A. ‘Has The Medicalisation Of Childbirth Gone Too Far?’ In: British Medical Journal, Vol. 324, No. 7342 (2002) pp. 892-893.
6 Davis-Floyd, R.E. ‘The technocratic body: American childbirth as cultural expression,’ in: Social Science &
2
which is often connected to homebirth, and in which the mother and fetus are conceptualized as one and the mother’s intuition controls the process.7
An indication for the over-medicalization of birth is the high rate of hospital delivery. In 2010, 98.8 percent of all births in America occurred in a hospital.8 This figure has remained high since the 1960s, when the proportion of hospital births first reached 96 percent.9 Around the same time that the hospital delivery rate rose to its highest point, critics called for a more natural birth with less medical interventions. Some of these critics came together in the homebirth movement.10 Although the number of hospital births has been very high for the last fifty years, homebirths are on the rise, and in 2009 were at the highest level since 1989. Between 2004 and 2009, the amount of
homebirths increased from 0.56 percent to 0.72 percent (29,650 births).11 This increase was mostly driven by non-Hispanic, married, white women above 35. Midwives attended 62 percent of these homebirths.12
Critics of the medicalization of pregnancy and birth argue that continual, technological intervention in pregnancy is often based on no established medical grounds, and that these interventions often go against the findings of major WHO research and guidelines for best
practices.13 Two technological interventions that are commonly used in the US although they are not always necessary are labor induction and cesarean section (C-section). According to the American College of Obstetricians and Gynecologists (ACOG) labor induction is recommended when the health of the fetus or mother is at risk and they define it as “the use of medications or other methods to bring on (induce) labor.”14 According to data from the U.S. Census Bureau, the induction rate of births of all gestational ages in America has more than doubled in less than twenty years’ time, the amount of induced birth rose from 9.6 percent in 1990 to 23.1 percent in 2008.15 A study showed that often times induction cases are categorized as elective and therefore not necessary.
7 Davis-Floyd (1994) p.1136 8
MacDorman, M.F., Mathews, M.S., Declercq, E. ‘Homebirths in the United States, 1990–2009,’ NCHS Data Brief, Number 84 (2012) p.2
9 Devitt, N. ‘The Transition from Home to Hospital Birth in the United States, 1930-1960,’ In: Birth and the
Family Journal, Volume 4, Issue 2 (1977) p. 47
10
Martin, J.A., Hamilton, B.E., Ventura, S.J., Osterman, M.J.K., Kirmeyer, S., Wilson, E.C. and T.J. Mathews ‘Births: Final Data for 2010,’ in: National Vital Statistics Reports, Volume 60, Number 1 (2011) p. 9 11
MacDorman et al. p.1 12
MacDorman et al. p.2 13 White p.142.
For instance, the WHO advices a cesarean rate of 15 per cent, while in America one third of all births are cesareans. From:
Grady, D. ‘Caesarean Births Are at a High in U.S.,’ New York Times, originally published on March 23, 2010 at: http://www.nytimes.com/2010/03/24/health/24birth.html?_r=0
14
ACOG Frequently Asked Questions ‘Labor Induction,’ originally accessed on June 14, 2013 at: http://www.acog.org/~/media/For%20Patients/faq154.pdf?dmc=1&ts=20130616T0925383120 15 U.S. National Center for Health Statistics, ‘VitalStats,’ August 2010
3
Researchers explain these elective inductions by pointing to “health care providers' and new parents' desire to control the timing of delivery.”16
Between 1996 and 2009 the rate of C-sections increased 60 percent, and by 2010, 32.8 percent of all births in America were cesarean deliveries.17 This means that America has one of the highest C-section rates of the industrialized world.18 Obviously, the increase in maternal mortality shows that the high cesarean rate has not improved the outcomes of maternal health, while it has also not resulted in significant improvement in neonatal morbidity and mortality.19
Instead, experts say that with each subsequent cesarean, the risks to the mother increase and that cesarean delivery involves major abdominal surgery, which is associated with higher rates of surgical complications and re-hospitalization for both the mother and the newborn.20
Medical professionals have for a long time denied that this rise in induction and C-section was due to medicalization. They provided other causes such as the rising rate of multiple births, more obesity in pregnant women, and the older age of women giving birth.21 However, both the number of multiple births and the average age of birthing women stopped rising around 2003 while the cesarean rate kept increasing. This means that both of these cannot be the cause for the high rate. The same point has been made for obesity in pregnant women since research has shown that the relationship between maternal weight and cesarean rate cannot be ascertained directly.22
Additionally, mothers have been blamed for requesting elective C-sections. For example, a spokesperson of the American College of Obstetricians and Gynecologists (ACOG) claimed this was the case.23 The idea existed that pregnant women were not willing to attend natural-childbirth classes and therefore chose to request a C-section. Another ACOG spokesperson claimed that he had performed elective cesareans because women were too afraid of the labor-pains.24 However, the idea that mothers are asking for C-sections has also been debunked. The ACOG indicates that only 2,5 percent of all births in the US are cesarean delivery at maternal request, which means it is an
16
O’Callaghan, T. ‘Too Many C-sections: Docs Rethink Induced Labor,’ in: Time Magazine, originally published on August 2, 2010 at: http://www.time.com/time/health/article/0,8599,2007754,00.html#ixzz2WC13RsL8 17
Martin et al. p.2 18
Grady
19 Blanchette, H. ‘The Rising Cesarean Delivery Rate in America What Are the Consequences?’ in: Obstetrics &
Gynecology, Vol.118, No.3 (2011) p.1
20
Menacker, F., Hamilton, B.E. ‘Recent Trends in Cesarean Delivery in the United States,‘ National Center for Health Statistics Data Brief, No.35 (2010)
21 Ibid. 22
Vireday, P. ‘Cesarean Rates: Debunking the Mother-Blaming,‘ originally published on April 1, 2013 at: http://wellroundedmama.blogspot.nl/2013/04/cesarean-rates-debunking-mother-blaming.html 23 Grady
24
Kotz, D. ‘A Risky Rise in C-Sections‘ US News, originally published on: March 28, 2008 at: http://health.usnews.com/health-news/managing-your-healthcare/sexual-and-reproductive-health/articles/2008/03/28/a-risky-rise-in-c-sections
4
even smaller percentage of the amount of C-sections.25 A survey among 1600 women who had had a cesarean, included only one woman who requested the procedure without medical reasons.26 This implies that it is in fact the management of birth that has caused the increasing rate of C-sections. Certain interventions, such as labor induction and continuous fetal monitoring, are associated with cesarean delivery.27 A poll among ACOG members showed that 29 per cent claimed they performed more cesareans because they feared lawsuits.28 Additionally, planning a cesarean is much less time-consuming for physicians than attending a natural birth. There are also financial incentives for physicians to provide a C-section because insurance companies pay more for cesareans than for vaginal births.29
By blaming mothers, medical professionals have failed to take responsibility for the
increasing, unnecessary medicalization of birth. By blaming mothers, these physicians have, together with institutions such as ACOG, framed their position in this debate in such a way that it seems like they only care about what is in the best interest of the baby and the mother. When in fact they are most concerned about time-efficiency and avoiding malpractice suits.
Since the 1960s, the homebirth movement has tried to reverse some of the results of medicalizations by offering homebirth as an alternative to the medicalized birth that takes place in hospitals. Organizations of midwives and their supporters make up an important part of the
homebirth movement. They promote ‘natural’ childbirth, defining birth as a normal process and not as a dangerous activity, and thereby challenging the status quo of hospital delivery. Since the rise of the movement, homebirth has been a controversial issue, and a heated debate has arisen between these proponents of homebirth and their opponents, who are mostly affiliated to the medical profession.
The aim of this thesis is to explore this homebirth debate and the arguments that are used by both opponents and proponents. A central component of this research is ‘the rhetoric of fetal rights.’ Fetal rights arguments build on the personification of the fetus and are often in conflict with women’s rights. Users of the rhetoric of fetal rights try to prove the personhood of the fetus, in order to grant the fetus certain rights. The rhetoric is regularly used in the abortion debate and is
25 ACOG Committee Opinion Number 559 ‘Cesarean Delivery on Maternal Request,’ originally published April, 2013 at:
http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/ Cesarean_Delivery_on_Maternal_Request
26
Childbirth Connection ‘Why Is the National U.S. Cesarean Section Rate So High?’ (2012) originally accessed on June 27, 2013 at: http://www.childbirthconnection.org/article.asp?ck=10456
27 Ibid. 28 Grady 29
McConnell, C. ‘Take away the incentives for too many c-sections,’ Crosscut, originally published on August 6, 2009 at: http://crosscut.com/2009/08/06/health-medicine/19144/Take-away-incentives-for-too-many-csections/
5
often at variance with a woman’s right to choose an abortion and her right to control her
reproductive life. With each of the next three chapters I explore the role played by the rhetoric of fetal rights play in the current homebirth debate in the United States.
In 1987, feminist scholar Rosalind Petchesky analyzed the representation of pregnant women in contemporary culture and concluded that women were absent while their fetuses were the primary object on display. She concluded: “we have to restore women to a central place in the pregnancy scene. To do this, we must create new images that recontextualize the fetus, that place it back into the uterus, and the uterus back into the woman’s body and her body into its social
space.”30 This had to be done because by then, the fetus had become the main figure in pregnancy and this had negative consequences for women. Women were treated as less important and their wishes and autonomy were not taken into account. Fetal imagery shows this treatment very clearly as the mother is often absent. Here I analyze whether the homebirth movement has succeeded in this task and how they have addressed the rhetoric of fetal rights.
The rhetoric of fetal rights has its origins in the abortion debate, where it has been used in everything from court cases to advertisement campaigns. An important prerequisite of this rhetoric is the image of the fetus, which has been made possible by rapid advances in medical visualizing technologies since the 1960s. Photographic and ultrasound images of prenatal life have since then been widely available and have become part of the American public consciousness.31
Feminist scholars, including Petchesky, have argued that the availability of fetal images has helped construct the notion of fetal personhood because the images have made it possible to literally present the fetus as separate from the mother. This means that at the same time as the fetus became more visible, the mother became more transparent.32 Although the ultrasound image can only be made when the woman is present, she is not the central figure that is being looked at. Instead, the central figure is the fetus. The fetus becomes the more interesting, primary, and autonomous patient while the mother is simply a vessel.33 In some cases the mother has even been framed as posing a threat to her unborn child.34
In 1973 the American College of Obstetricians and Gynecologists formally designated fetology as a separate specialty. Since then, fetal medicine has also contributed to a reimagining of the maternal-fetal relationship, increasingly seen as one of two individual patients: the mother and
30
Petchesky, R. ‘Fetal Images: The Power of Visual Culture in the Politics of Reproduction,’ In: Feminist Studies Volume 13, Issue 2 (1987) p.287
31 Boucher, J. ‘The Politics of Abortion and the Commodification of the Fetus,’ In: Studies in Political Economy, Volume 73 (2004) pp. 69; Dubow, S. ‘Ourselves Unborn,’ Oxford University Press (2011) p.113
32
Nash, M. ‘From ‘bump’ to ‘baby’: Gazing at the foetus in 4d,’ in: Philament 10 (June 2007) p.13 33 Petchesky p.268
6
the fetus.35 Technology has provided physicians and parents with more information about the fetus, and while both are medically surveilled and managed, the two separate patients are put in
opposition to each other, with the mother supposed to subjugate her rights for the sake of the fetus.36 Recently, 3D and 4D ultrasounds have become increasingly popular in medical as well as commercial settings, providing a more vivid representation of the developing fetus.37 By showing the behavior of the fetus its image as a person is reinforced. Viewers can identify what they see, and associate it with images of babies and small children.38
Petchesky argued that fetal images epitomize the distortion inherent in all photographic images. These images “have the tendency to slice up reality into tiny bits wrenched out of real space and time.” 39 Photographs can make what they portray seem credible simply because it can be seen, they appear to be capturing literal reality and possess the appearance of objectivity. In Western culture, the visual is seen as an embodiment of the truth because when something can be seen it must real. But accepting an image as just that, the truth, means obscuring the fact that it has been constructed and is grounded in a context of historical and cultural meanings. An image is never just an image, as the saying goes, it can say more than a thousand words.40
On top of this perceived objective truth inherent to photographs, fetal images have obtained an aura of scientific authority because of their connection to medical technologies.41 Images
retrieved from ultrasounds are culturally seen as accurate, incontrovertible, and inherently
authoritative knowledge.42 This has to do with the authority physicians possess, which in turn can be connected to the medicalization of pregnancy and birth. These have increasingly become medical events in which physicians are seen as experts who know what is best. Therefore, ultrasound images of the fetus are easily accepted as the truth while the feelings of the mother are regarded as
subjective and of less importance.43
Political economist Joanne Boucher argues that in the public portrayal of the fetus as it is represented in the commercial culture, references to the maternal body are suppressed, while at the same time its embeddedness in complex technologies and artifice is masked.44 Today, when you see
35
Dubow (2011)p.113 36
Nash p. 6 & pp.10-11
37 Wiseman, C.S. Kiel, E.M. ‘Picture Perfect: Benefits and Risk of Fetal 3D Ultrasound,’ in: the American Journal
of Maternal/Child Nursing, Volume 32 (2007) pp.102-104
38
Zechmeister, I. ‘Foetal Images: The Power of Visual Technology in Antenatal Care and the Implications for Women's Reproductive Freedom,’ in: Health Care Analysis, Volume 9, Issue 4 (2001) p.393
39
Petchesky p.268 40
Zechmeister p.391-392; Petchesky p.269 41 Boucher p.69
42 Browner and Press ‘The Production of Authoritative Knowledge in American Prenatal Care,’ in: Medical
Anthropology Quarterly, Vol. 10, No. 2 (1996) pp.142 & 152-153
43 Zechmeister p.392 44 Boucher p.70
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an ultrasound image of a fetus, you recognize it as nothing other than a fetus. You do not see any references to the mother, you literally see straight through her, and you do not realize that it is not an actual photograph but a technologically constructed portrayal of the fetus. This is probably because the fetal imagery has become so well known in Western culture.45 The personification of the fetus through ultrasound is performed in two different ways. First it is performed by those who portray the fetus as a person, these are the physicians and commercial providers of ultrasounds. Second, those who interpret the fetus as a person also play an active role in personifying the fetus, they are most likely to be the prospective parents. In either case, the fetus is a passive participant in its own personification. Indeed, the ability to make the fetus visual at an increasingly early stage has paved the way for the fetal rights rhetoric to be used in the abortion debate because fetal imagery is framed as if it “proves” personhood. In turn, personhood “implies the possibility of creating a legal person with civil rights already before the baby is born.”46 Ultimately, the boundaries between fetus and baby are blurred because of fetal images.47 This is helpful for the anti-abortion movement because when the fetus is recognized as a legal person, their argument that abortion is murder becomes much more potent. Opponents of abortion argue that the fetus should have human rights and therefore abortion should be illegal, while proponents of abortion rights emphasize the rights of women to determine the outcome of unintended pregnancy.
The anti-abortion movement has picked up on this visualization and personification of the fetus. The fact that about 400 000 people attended the March for Life on January 25 2013, to protest against abortion on the 40th anniversary of its legalization, shows that it is still one of the most controversial topics in the United States today.48 Forty years after the Roe v. Wade Supreme Court decision legalized abortion, it is still hotly debated in the public, political, and private domain.
In this thesis I will show how the rhetoric of fetal rights developed in the abortion debate and how it has emerged in the homebirth debate. In the chapter 1, I will take a closer look at the origins of the contemporary homebirth movement. I trace its roots in the second wave of feminism of the 1970s and argue that this has subsequently had implications for its goals and methods. For instance the central role the movement grants to women and their rights originates in feminism. In chapter 2, I will explore the rhetoric of fetal rights in the abortion debate. I will analyze the visual by looking at three examples of material used by anti-abortion organizations. I will illustrate that the theory of the personification of the fetus can be recognized in each of these examples, and discuss
45 Petchesky p.; Boucher p.70; 46 Zechmeister p.394
47
Petchesky p.272
48 Giokaris, J. ‘March For Life 2013 Shows Most Americans Disagree With Republicans On Abortion,’ New York
8
what implications this has had for the abortion debate. Finally, in chapter 4, I will analyze how the current homebirth debate reflects the importance of the rhetoric of fetal rights.
9
[ 1 ]
‘By Women for Women’
The Origins of the Homebirth Movement in America
In order for me to be able to discuss the homebirth debate and the role of the homebirth movement in contemporary America, it is important to discuss its past. With this chapter I will loosely
chronologically describe where the roots of the homebirth movement lie. It is difficult to pinpoint the origins of the movement down to an exact moment in time although it is clear that it has its origins lay in the women’s health movement of the 1970s. I will look at several issues that were increasingly contested and problematized in America and that were connected to the medical world to analyze both these movement more thoroughly. Additionally, I will show what kinds of solutions were proposed, by women for women.
The homebirth movement was a response to the increasing medicalization of both
pregnancy and childbirth and to the rise of the second wave of feminism. In 1992, sociologist Peter Conrad provided a broad definition of medicalization that will be used throughout this chapter: “medicalization describes a process by which nonmedical problems become defined and treated as medical problems, usually in terms of illnesses or disorders.”49 Furthermore, the medical profession is often mandated to provide some type of treatment and this creates a negative connotation for some.50 Indeed, scholars and feminists have been critical of the expanding influence of the medical profession because they believe it undermined the position of the patient.51 It is important to emphasize the fact that medicalization is not a response to biological facts but rather a social and institutional process.52 Medicalization occurs when a medical frame or definition has been applied to
understand or manage a problem.53 The consequences of medicalization of pregnancy and childbirth were presented to American women in different ways at different times and their reactions have been comparably different. In any case, since pregnancy is seen as an illness and the pregnant woman as sick, women have become increasingly passive and dependent upon the medical
49 Conrad, P. ‘Medicalization and Social Control,’ In: Annual Review of Sociology, Vol. 18, (1992), p. 209 50 Conrad pp.210-212
51
Davis-Floyd R. ‘Birth as an American Rite of Passage,’ Berkeley (CA): University of California Press (2003) 52 Kukla & Wayne p.2
10
profession for a safe outcome of pregnancy.54 Medicalization can be confirmed when the fact is taking into account that virtually no woman received care prior to delivering at the beginning of the twentieth century and that nearly all women receive such care today.55
Contrastingly, even though a biomedical representation of pregnancy and childbirth would come to structure viable understandings and experiences during the twentieth century, childbirth had been a social affair that took place at home since the American colonial days. Then, midwives mostly attended births and they were outside the jurisdiction of the medical world.56 However, during the late eighteenth and in the nineteenth century the medical profession started to lay hold of the practice and birth became a more pathological affair that was managed by men. The
medicalization of maternity care went together with the reduced appreciation of midwives and the increasing dominance of male physicians.57 At the start of the twentieth century, medical control over birth was consolidated as physicians wanted to respond to criticism on the high infant and maternal mortality rate. The popularity of the twilight sleep movement in 1914 and 1915 reflects how some women felt about these developments. This movement saw the freedom for every woman to choose a painless birth as a feminist issue. This basically meant whether or not to take narcotics and amnesiacs during labor. This medication put the woman in a ‘twilight sleep,’ which then resulted in a painless, or rather unconscious, labor. These efforts can be seen as an attempt by women to gain control over the birthing process, although they did have to rely on physicians to provide the medication.58 Initially, the movement was successful and the use of anesthesia during labor was met with increased popularity. Because this medication could only be provided in hospital, its popularity caused the traditional home labor and midwives to lose ground and the medical profession to take a stronger hold of birth.59
In 1930, the American Board of Obstetrics and Gynecology was established to provide guidelines to hospitals with which to judge the capabilities of staff members and general practitioners. At this time the number of specialists, such as anesthetists, was growing and as a result women expected more from doctors and hospitals.60 As a consequence, medical advances
succeeded in tempering the fear many women had of given birth by the 1940s, the experience was
54
Cahill , H.A. ‘Male Appropriation and Medicalization of Childbirth: an Historical Analysis,’ In: Journal of
Advanced Nursing, Volume 33, Issue 3 (2001) pp.337-339
55
Barker, K.K. ‘A Ship upon a Stormy Sea: the Medicalization of Pregnancy’ in: Social Science & Medicine, Volume 47, Issue 8 (1998) p.1068
56 Barker p.1074; Schrom Dye, N. ‘History of Childbirth in America,’ in: Signs Volume 6, Issue 1 (1980) pp.98-101
57
Cahill pp.337-341
58 Schrom Dye pp.100-101 & pp.106-107
59 Walzer Leavitt, J. ‘Birthing and Anesthesia: The Debate over Twilight Sleep,’ in Signs Volume 6, Issue 1 (1980) p.148 & p.159
60 Wertz, R.W. and Wertz, D. ‘Lying-In: A History of Childbirth in America, Expanded Edition,’ New York: Schocken Books (1977) pp.159-160
11
regarded more positively, and with less fear. On the other hand, interventions such as heavy anesthesia that caused a mother to not be conscious during most of the birth were met with
resistance. Twenty years after the twilight sleep movement, the struggle for control over the birthing process was framed in the opposite way, promoting consciousness instead of twilight sleep.61
Medical understandings of birth and pregnancy became hegemonic and physicians saw both as dangerous processes that required routine medical assistance to prevent disaster.62 Some women desired a more natural birth and a stronger say in the process. Doctors and hospitals did not like the threat the idea of natural childbirth formed to their autonomy and incorporated some of the wishes women had into their practice in order to stay in control. Often, this incorporation was quite limited and interventions still took place, which shows that the physicians stayed in control. With only 12 percent of all births taking place at home by 1950 and that amount dropping to 4 percent by 1960, birth had successfully been moved into the hospital under the supervision of physicians by the middle of the 20th century.63 However, pain control methods required the laboring woman to be confined to bed. This further isolated her since her family was not allowed to visit and the
confinement made it impossible for her to contact with familiar, supportive people.64 By the 1960s, as a result of the physician’s ongoing control, hospital delivery posed a time of alienation for many women. This could be alienation from the body, as well as from family and friends, from the community, and possibly even from life itself.65 After the first half of the twentieth century, women yet again set out to regain control over their bodies and births.
However, pregnancy and birth were not the only issues that concerned women at that time. During the 1960s, President Johnson had introduced new health care programs in order to improve access to health care, especially for the poor. Around that time, many grassroots organizations surfaced in the United States. Civil Rights, anti-war, and other movements were fighting the suppressing social control they were faced with and mobilized for radical change.66 They critiqued inequality, discrimination, homophobia, and class inequality in the American society. The second wave of feminism arose together with these movements. The health care system was one of the
61
Schrom Dye p.108 62
Barker p.1074; Wertz & Wertz p. 164
63 Devitt, N. ‘The Transition from Home to Hospital Birth in the United States, 1930-1960,’ In: Birth and the
Family Journal, Volume 4, Issue 2 (1977) p. 47
64
McCool, W.F., Simeone, S.A. ‘Birth in the United States: an Overview of Trends Past and Present,’ in: The Nursing Clinics of North America 37(4) (2002) p.738
65 Wertz & Wertz pp. 173-179 66
Reagan, L.J. ‘When Abortion was a Crime. Women, Medicine and Law in the United States, 1867-1973,’ University of California Press (1997) p.217; Kline, W. ‘Bodies Of Knowledge: Sexuality, Reproduction, and Women's Health in The Second Wave,’ Chicago: The University of Chicago Press (2010) p.13
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major concerns of feminists who together formed the women’s health movement.67 It is helpful to now first take a closer look at the women’s health movement because that is where the homebirth movement has its origins. Both movements came forth out of the second wave of feminism and both tried to challenge the status quo in the medical world because they argued that equality would not be achieved if women were not in control of their own bodies. However, the homebirth movement tried to challenge medicine’s monopoly of childbirth in particular and promote a more natural model of birth.
Within the women’s health movement, individuals had widely divergent goals. However, the demand for improved health care for all women and an end to sexism in the health system united them all.68 Activists of the women’s health movement believed the health care consumers, especially women, were not taken into account in deliberations about how to provide health care services and they raised questions on the power relationships between physicians and patients. A main criticism on physicians, hospital administrators, and other actors in the medical world was that they were putting profits above people. The medical knowledge of usually male doctors was often in conflict with the woman’s own knowledge of her body.69 Until then, issues of women’s health were dominated by the existing scientific paradigm that was based on a male model. This failure to recognize sex and gender as relevant in scientific research can be explained by the historical exclusion of women from virtually the entire public realm. In science, women were excluded from participation but also ignored as subjects of research because a patriarchal model dominated the field.70
One of the more central issues the women’s health movement focused on was women’s reproductive rights. More specifically, on decriminalizing abortion and increasing women’s access to birth control and safe abortion.71 Abortion became the key issue for feminist organizations during the 1960s because its prohibition epitomized the suppression of women. By 1960, abortion was illegal in every state, except for ‘therapeutic’ abortions performed to save a woman’s life. However, there was no consensus in the medical world on the conditions that mandated a therapeutic abortion.72 Hospitals had therapeutic abortion committees that decided whether an abortion would be permitted or not. These committees usually consisted of men who decided on issues of female
67
Morgen, S ‘Women Physicians and the Twentieth-Century Women’s health movement in the United States,’ In: (Eds. E.S. More, E. Fee and M. Parry) Women Physicians and the Cultures of Medicine. Baltimore: Johns Hopkins University Press (2009) p.162
68
Nichols, F. H. ‘History of the Women’s health movement in the 20th Century,’ In: Journal of Obstetric,
Gynecologic, & Neonatal Nursing, Volume 29, Issue 1 (2006) p. 56; Morgen p.162
69 Morgen p.163
70 Sechzer, J. A., Griffin, A., & Pfafflin, S. M. ‘Women’s health and paradigm change’. In: Annals of the New York
Academy of Sciences, 30, (1994) p.3
71 Morgen p.160 72 Reagan p.5
13
reproduction, and therefore denied female autonomy, and maintained a repressive system. Additionally, for women in the women’s health movement the criminal status of abortion was a fundamental feature of the subordination of women.73 Despite its illegal status, women received abortions every year. The risk of dying from an abortion was closely linked to race and class, mortality data shows the racial inequalities in access to safe abortions. While childbirth was becoming safer and accounted for a smaller percentage of maternal mortality, abortion-related deaths increased. This rise can be connected to the illegality of abortion because when skilled practitioners performed abortions, the mortality rate was lower than that of childbirth.74
In order to battle these conditions women organized to support reform legislation. One of the earlier examples of these organization is the Society for Humane Abortion (SHA). This
organization proclaimed abortion as a right, demanded repeal of abortion laws, and declared that the decision to have an abortion was a private matter between the patient and her physician. The SHA was the first to frame the problem of abortion in terms of a woman’s right to control her reproduction.75 On January 22, 1973, the United States Supreme Court recognized that the constitutional right to privacy encompasses a woman’s right to choose abortion in the court-case Roe v. Wade. 76 For the first time, the state recognized women’s role and rights in reproductive policy.77
At the same time as the struggles for legal abortion were going on, several groups tried to raise women’s consciousness about the way they were treated in the medical world and challenge the unequal relationship between mostly male physicians and female patients. The goal of
consciousness-raising was to encourage women to listen to one another and to construct knowledge about women’s experience.78
One of the most successful examples of this consciousness-raising is the book Our Bodies,
Ourselves compiled by the Boston Women's Health Book Collective. In 1969, as the women’s
movement was gaining momentum and influence, twelve women met in Boston to discuss their own experiences with the medical world and share their knowledge about their bodies. Eventually, their discussions and subsequent research resulted in a teaching course and a course booklet entitled
Women and Their Bodies. During these courses the attending women wanted to work towards
73 Reagan p.173 & pp.214-217 74 Reagan pp.211-214 75 Reagan pp.223-224 76
Schuetz, J. ‘Communicating the Law: Lessons from Landmark Legal Cases,’ Long Grove: Waveland Press (2007) pp. 282-304
77 Reagan p.244
78 Kline (2010) pp. 11-13; Wells S. ‘Narrative Forms in Our Bodies Ourselves’. In: More, Fee, Parry (Ed.), Women
Physicians and the Cultures of Medicine. Baltimore: Johns Hopkins University Press (2008) p. 187; Morgen
(2009) pp.163-164
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‘consciousness-raising,’ this concept was already quite popular within the women’s movement. It can be described as a process in which sharing of personal stories led to a “click” or a sudden recognition that sexism lay at the root of their struggles. They found a discrepancy between their personal experiences and what they learned in school or from professional sources such as doctors, nurses, and medical journals. The group wanted experiential knowledge to be at the core of
medicine and engage in collective self-education.79 Their knowledge was gathered through the different teaching courses the Boston Women's Health Book Collective had previously organized. There was such a high demand for the booklet and course that the authors decided to distribute the book commercially. In 1973, Simon & Schuster published an expanded edition that was renamed Our
Bodies, Ourselves, and was a book “by women for women.”80
This book is a good example of the feminist philosophy taking a concrete form. The ideas of the authors of Our Bodies, Ourselves, reflect the more general ideas of the women’s health
movement. In the preface of Our Bodies, Ourselves, the authors explain how they experienced their potential power as “a force for political and social change.”81 They describe how they as individual women were unsatisfied with the way they were treated in the medical world and decided they should be able to alter this treatment themselves. The book provides knowledge about women’s health and sexuality but in a different way than conventional literature had done so far. The chapters are ordered in such a way to tell the story of a normal life, from birth to death. However, for a large part the book relies on experiential knowledge and made this into a central component of their interpretation of health. The aim was to tell a much more human narrative than medical textbooks did at that time.82 The text consists of general information, integrated with personal stories about women’s experience with the medical world. One woman writes
All of a sudden my body told me to push. I kept shouting to everyone around me, “I have to push, I have to push.” They all said, “That’s impossible. You were just five centimeters dilated an hour ago.” Nonetheless, I had to push! Controlling that urge was the most difficult part of my labor. For about five contractions I panted and blew and sweated for all I was worth. Why weren’t they letting me trust my body? It was ghastly. Until, just when I was sure I couldn’t control the urge to push one more minute, the doctor appeared in the doorway. He took one look at me. “Push,” he said, “go ahead and push.” I was too happy at that moment to ask where he’d been until then.83
79 Kline p. 13
80 Boston Women's Health Book Collective ‘Our Bodies, Ourselves’ New York: Simon & Schuster (1973) pp. 1-3 81
Ibid. 82 Wells p.194
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This quotation clearly shows the message of the book, as well as the women’s health movement. It outlines that a woman’s own feeling can be opposite to what she is told by medical professionals. This particular woman felt she was ready to push her baby out but she was made to wait for a doctor to arrive to allow her to. This unequal relationship between physicians and laboring women is exactly what the women’s health movement wanted to change. According to the authors, women who read Our Bodies, Ourselves were equipped with tools to challenge the medical hierarchy.
Another way to battle the issues American women were faced with in the medical world was through establishing women’s clinics. These would serve to empower the women they served. In the 1970s, feminist women’s health centers opened their doors all over the country and these clinics epitomized the feminist philosophy.84 These centers were often founded by feminist health activists who had no professional medical training because they were meant to be an alternative for the established hospitals and clinics. These alternative health care providers believed that the routine passages of a woman’s reproductive life were over-medicalized, they wanted women to take over control from physicians in areas such as childbirth, family planning, and menopause. The women’s health centers were meant for all women and therefore offered free, low-cost, or sliding-scale services for their services.85
Evidently, an important concept for the women’s health movement was empowerment. This concept described the main goal the movement wanted to achieve, for women to take control over their own bodies and not be dependent, passive receivers of the autonomy of physicians and other health care providers. Proponents of homebirth or midwifery have used the medicalization of both mother and baby as an important argument for their cause. Just like the more general women’s health movement, the homebirth movement also believed empowerment of women was necessary.
The American homebirth movement is an alternative health belief system that promotes a model of pregnancy and childbirth that is contradictory to the conventional biomedical model. The main ideas of the homebirth movement is that childbirth is, above all, a natural and therefore normal event, that the mother and not the physician should be in control, and that interventions should not be standard. Because of this, proponents believe, it is very possible to let a birth occur at home, as in history. Only when medical conditions or complications are involved,, medical
interventions can be necessary.86 The movement was shaped by formally constituted organizations of local, national, and international scope, health care professionals sympathetic to the movement's
84 Geary, M.S. ‘An Analysis of the Women’s Health Movement and its Impact on the Delivery of health Care within the United States,’ In: Nurse Practitioner, Volume 20, Issue 11 (1995) p.29
85
Morgen pp.163-164
86 O'Connor, B.B. ‘The Home Birth Movement in the United States,’ In: The Journal of Medicine and Philosophy, Volume 18, Issue 2 (1993) p.147 & p.150
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position and aims, parents who choose homebirth, and midwives who serve as principal birth-attendants and are meant to support and not manage the birth.87
Advocates of a less medicalized and more natural childbirth found refuge in organizations such as ASPO/Lamaze. French obstetrician Ferdinand Lamaze was the inspiration for this
organization and for many supporters of natural birth. In his book Painless Childbirth:
Psychoprophylactic Method, Lamaze vowed that a prepared birth could be a painless birth.88 He asked women to respond actively to labor contractions with a set of pre-learned, controlled
breathing techniques. With the Lamaze method women were in control of birth and the doctor was part of her ‘team.’ After the method was introduced in America in 1959, it quickly became popular. In 1960, ASPO/Lamaze was founded by strong believers in the method’s benefits. Organizations like this one were meant to change childbirth practices by advocating choice for expectant mothers and fathers during childbirth and by preparing them for birth through childbirth education.89 Childbirth-preparation classes were booming just like books, articles and films on the subject.90 This idea of gaining control over one’s body was popular among educated, middle-class women and posed somewhat of a threat to traditional birthing methods.91 However, according to Our Bodies, Ourselves physical preparation was not enough. The authors claimed women needed to engage in discussions among themselves in order to find support outside the medical community and rely more on experiential knowledge.92
Although statistics show that homebirth was decreasingly common in the United States, some women were choosing this alternative. The New York Times of March 20, 1973 discussed the revival of “the ancient art of midwifery” in California.93 The authors ascribed this revival to the wish some parents had for a natural childbirth, a shortage of doctors, particularly in rural areas, and the desire of some women’s liberationists to avoid male obstetricians. The article continues by stating that doctors oftentimes do not want to attend homebirths because they are too time-consuming, they consider it “sub-standard medical practice,” and because they fear malpractice suits. In the same article, physician Dr. Whitt says he does attend homebirth simply because there is a demand for them. A spokesperson of a hospital in San Francisco explained that the hospital is trying to lure women away from the idea of having homebirths by providing a more “homey atmosphere.”94 This
87
O'Connor p.151
88 Melzack, R. ‘The Myth of Painless Childbirth,’ in: Pain, Volume 19, Issue 4 (1984) p.321 89
Nichols p. 57; Lamaze International ‘About Lamaze: History,’ originally accessed on June 2, 2013 at: http://www.lamazeinternational.org/History
90 Boston Women's Health Book Collective p.183 91 Wertz & Wertz p.194
92
Boston Women's Health Book Collective p.183
93 New York Times ‘Use of Midwives Revived in California’ March 20 (1973) 94 Ibid.
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article shows that by then there was a growing dislike for impersonal care women received in hospitals and that by some, this was recognized as a reason for change. Apparently, the idea of natural births was resonating with American women, as hospitals sought for ways to respond to this need.
An article in the Washington Post in 1977, described the growing number of midwives in the United States and the revival of homebirths as a national phenomenon. The author attributes this “boom in the ancient practice of midwifery” mostly to “sophisticated urban and suburban couples” who turn to midwifery as a way to go against the “depersonalization of institutionalized childbirth” in hospitals. The medical community is said to be shocked and the author claims that law and health officials are trying to curb the growth.95
An important figure in the homebirth movement is Ina May Gaskin. In 1971, she founded the Farm Midwifery Center, near Summertown, Tennessee where she helped women birth their baby in a non-medical environment. Her 1977 book, Spiritual Midwifery, caused quite a stir. Gaskin
combined the communitarian birthing systems with the technical expertise of Western obstetrics. She is said to have knowledge of technology, biomedicine, homeopathy, and herbs but also a great repertoire of skills. The authoritative knowledge of birth of community midwives like Gaskin had mostly grown out oftheir collective experience. Midwives themselves write down, publish and spread much of their authoritative knowledge which is referred to as “the cohering and globalizing of midwifery”.96
In 1975, Suzanne Arm’s book Immaculate Deception was published. In this book, she presented a critique on the standard American obstetric practice after talking to mothers, obstetricians, nurses, and midwives. The New York Times reviewed the book and describes it as “remarkable,” “timely,” “valuable,” and “essential reading for any woman who plans to have a baby in an American hospital.” According to the author, birth had become such a medical specialty that it was by then more often seen as the “consummation of the obstetrician’s skill than as the normal procreative function of a woman’s body.” 97 Additionally states that the since the infant mortality
rate in America is higher than in fifteen other, smaller, and less medically-advanced countries, something must be wrong with the American way of birth because. Still, she claims, discussion of the American obstetrical record is rare at that time. Arm’s book is such an important addition because it challenges the hospitalization of birth. With her book, Arms shows that among both physicians and parents, the conviction prevails that:
95 Meyer, E.L. ‘Midwifery on Increase,’ In: The Washington Post November 22 (1977)
96 R. Davis-Floyd and C. Sargent ‘Introduction,’ in: Medical Anthropology Quarterly Volume 10, Issue. 2 (1996) p. 117
97 Wilson, J. ‘Immaculate Deception: Doing What Doesn’t Always Come Natural,’ in: New York Times, June 22 (1975)
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Giving birth in a hospital is the safest, quickest, and easiest, and that medical interference with technology and drug can somehow “improve” the birth process. Beyond that, is a belief that homebirth must always be dangerous, and that midwives are nothing more than incompetent substitutes for the real thing, an obstetrician.98
This belief is in line with the broader critique of the homebirth movement. Supporters of the movement wanted to show that birth is a natural process, that the woman is not a patient, and that she has a right to choose the circumstances in which she gives birth does not coincide with the medicalization of pregnancy and birth.99
Medicalization was criticized by the homebirth movement because over the course of the twentieth century, it gave physicians more and women less control over pregnancy and childbirth. During the 1960s and 1970s, supporters of this movement tried to challenge the status quo in the medical world in different ways, and this status quo mostly existed of men. Fighting inequality between men and women is often linked to feminism. In many ways this fundamental starting point is also at the basis of the women’s health movement and the homebirth movement. Overall, the movements sought to empower women.
98 Ibid.
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[ 2 ]
‘Visualizing the Fetus’
The Rhetoric of Fetal Rights in the American Abortion Debate
Over the years, anti-abortion advocates have tried to empower the fetus instead of the woman. In 1973, the United States Supreme Court legalized abortion. The Supreme Court ruled that abortion should fall under a woman’s right to privacy and that abortion should therefore be legal and available for all women. During the court case the respondents (Wade) used the rhetoric of fetal rights in order to strengthen their anti-abortion case. They wanted the court to accept the idea that life begins at conception because then they could argue that if the law protects all life, it should also protect the life of the fetus in the mother’s womb and abortion should then be illegal. During the hearings, visual imagery, such as pictures of the development of the fetus, was used to support the respondents’ case. 100 The legalization of abortion after Roe v. Wade meant a victory for pro-choice advocates but it is also a key historic moment for the anti-abortion movement because of the backlash it caused. Immediately after the Roe v. Wade ruling, anti-abortion supporters called for its repeal and now, forty years later, that call has only intensified.
Since 1973, there have been multiple court cases in which fetal rights were part of the reasoning. In 1975, for instance, there was the Edelin trial in Boston. In this trial dr. Kenneth Edelin was prosecuted for manslaughter after performing an abortion even though by then, abortion had been legal for two years. In this case, the respondents claimed the fetus was no other than a human being, both under the law and under the microscope.101 Then, in 1981, Jessie Mae Jefferson became the first American woman to have a court-ordered C-section when temporary custody of her unborn child was granted to the Department of Human Resources.102 These cases were based on the
decision that fetal rights are more important than the rights of the mother.
In this chapter, I want to take a closer look at the anti-abortion movement and some of the propaganda that has been used to advance the anti-abortion cause. I have chosen three examples of promotion material used by anti-abortion supporters and will describe and examine these examples
100 More information about the Roe v. Wade court case and an analysis of both the briefs of both the
petitioner’s and the respondents can be found in Schuetz, J. ‘Communicating the Law: Lessons from Landmark Legal Cases,’ Long Grove: Waveland Press (2007) pp. 277-304
101 Dubow pp.97-98 102 Dubow p.117
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in order to illustrate the role the fetal rights argument has played at different times, and the argument of the anti-abortion movement throughout the years.
Each of the examples I discuss in this chapter were initiated, endorsed, or supported by the National Right to Life Committee (NRLC). The NRLC is the leading anti-abortion organization in America. President of Kalamazoo (MI) Right to Life Robert N. Karrer described the emergence of the NRLC in the 1960s as “the effort of ordinary people who established grassroots committees and small groups in the late 1960s.”103 However, Karrer himself discredits the claim that ordinary people caused the emergence of the NRLC by showing that the organization has a much more
institutionalized background. The origins of the NRLC date back to 1966 when the United States Catholic Conference (USCC) started paying more attention to the abortion issue. At the National Conference of Catholic Bishops of 1967, it was decided to spend $50,000 on battling the wave of legislation that had somewhat liberalized abortion. It was at this conference that the NRLC was established and this quickly became the front-running organization of the anti-abortion movement. However, the organization quickly lost its ties with the Catholic Church in order to appeal to a broader audience. Thereafter, small, independent right-to-life committees throughout the country were established and followed the examples the NRLC set.104 Although, prior to Roe v. Wade,
abortion had been illegal for over 100 years, abortions were available at that time. These were illegal abortions as well as abortions performed for therapeutic reasons. Around the time the NRLC
emerged, movements to decriminalize abortion also began to make headway and feminists framed abortion as a right.105
After Roe v. Wade several separate anti-abortion organizations incorporated into the NRLC to better engage in “educational, charitable, scientific and political activities.”106 Today, the official NRLC’s website effaces the early years previous to this incorporation and starts counting its existence since 1973. It states that “since 1973 the organization has grown to represent over 3000 chapters in all of the United States.” Today, the ultimate goal of the NRLC is “to restore legal protection to innocent human life.”107 The fact that the NRLC says “restore,” indicates that they
believe Roe v. Wade dismissed the legal protection of this “innocent human life” even though the ruling did not attend to this issue. The abortion controversy is their primary interest because in their eyes, the fetus epitomizes innocent human life and needs to be protected because it cannot protect itself.
103
Karrer, R.N. ‘The National Right to Life Committee: Its Founding, Its History, and the Emergence of the Pro-Life Movement prior to Roe V. Wade,’ in: The Catholic Historical Review, Volume 97, Issue 3 (2011) p. 539 104 Karrer pp.527-539
105 Reagan pp.13-14 106
Karrer p.554
107 National Right to Life Committee ‘Mission Statement,’ originally accessed on May 22, 2013 at: http://www.nrlc.org/missionstatement.htm
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Throughout the years, anti-abortion activists have used different kinds of material to promote their cause and put the fetus center stage. I will discuss three examples of these different materials: a booklet containing a comic, a short film and a billboard campaign and accompanying websites, each was supported by the NRLC in some way.
[ 2.1 ] Who Killed Junior
Shortly after the Supreme Court decision in Roe v. Wade in 1973, the NCRL published a booklet titled
Who Killed Junior? It was part of the organization’s anti-abortion publicity campaign but it is unclear
whether it was available for a wide audience and what kind of response it received.108 The booklet consists of a comic and a few informative pages. It is an early example of both the personification of the fetus and the use of the rhetoric of fetal rights in anti-abortion promotion material. Because of personification, the fetus is seen as a person with its own feelings and rights that need to be
protected. The comic itself is 14 pages long and depicts the development of a fetus, Junior, from the moment of its conception to when it is three months old and in danger of abortion. Each separate image entails another week of Junior’s ‘life,’ supplemented by commentary such as “first week: fertilized egg enters the womb of the mother. A new life begins to develop.” The other seven pages provide informational images and texts.
The front cover of the booklet simply shows the title (figure 1) while the back cover shows a photo of several dead babies (figure 2).
The image on the back cover is accompanied by the words:
108 The website where I found the booklet an from which all the images are derived, specializes in comics that deal with “problems” and supplies the following information about Who Killed Junior: “Earliest known mass-produced anti-abortion hand-out from Right To Life, then a two month old organization, formed directly after the Roe V Wade Supreme Court decision.” Ethan Persoff ‘Who Killed Junior,’ originally accessed on March 18, 2013 at: http://www.ep.tc/junior/
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One morning’s work in an abortion hospital. Is this Nazi Germany in 1943? No – it is our America in 1973. Unbelievable but true – the same evil that we Americans fought against in W.W. II has started here in America! Human beings thrown in a garbage pail to die!”
This reference to Nazi Germany is probably meant to shock readers and although it isn’t mentioned anywhere else in the booklet it might have been an effective strategy to include it on the back cover as a way to directly clarify its position in the abortion debate. Additionally, comparing abortion to genocide probably easily debunked the practice without needing much more information.
Each of the pages of the comic consists of a lot of information, statements, and apparent facts. However, it is interesting to notice that the comic is not very explicit about when ‘life’ starts exactly, even though the NRLC would later be much clearer about this.109 The first page of the comic shows the first week of the pregnancy. The commentary says that “a new life begins to develop” and the picture shows an egg-shaped form hurtling into what is said to be the womb but simply look like a transparent sac (figure 3). This explicit mentioning of ‘beginning to develop’ makes it reasonable to believe that the NRLC did not yet suppose life started immediately after conception. However, the question mark accompanying the egg might imply that they did think the fetus is already capable of wondering about his whereabouts and must then possess some degree of consciousness.
In week two, on the next page, no major changes have occurred. However, the commentary does clarify that “a new life” is receiving nourishment which is probably meant to point out that it is alive (figure 4). On the page depicting the third to fourth week, the egg shows the first indicators of human life: eyes, eyebrows, and a heart. The commentary emphasizes the major developments are underway by stating that the spinal cord, brain, lungs, stomach, liver, and kidneys are forming and that the heart is beginning to pump (figure 5). In the fourth week the depiction of the fetus starts to resemble a baby, or even a person, due to the arms and legs that have been added to the egg-form (figure 6).
109 On their official website the NRLC states: “The life of a baby begins long before he or she is born. A new individual human being begins at fertilization, when the sperm and ovum meet to form a single cell.” National Right to Life Committee ‘When Does Life Begin?’ originally accessed on March 27, 2013 at:
http://www.nrlc.org/abortion/wdlb/wdlb.html; National Right to Life Committee ‘Fetal Development,’ originally accessed on March 27, 2013 at: http://www.nrlc.org/abortion/facts/fetaldevelopment.html
23
Figure 3
Figure 4
24
Figure 6
Figure 7
25
The term ‘baby’ is first introduced on page labeled “sixth to eighth week” and this is also the first time that the NRLC truly recognizes Junior as a responsive person as the commentary says “baby responds to tickling” (figure 7). It is of course not possible for a fetus to get tickled inside the womb, but pointing out that he is able to respond to tickling indicates that he is alert and receptive. Also, tickling is very innocent and contrasts with the harsh implications of an abortion we will see further on in the comic. The expression on his face, he is smiling, indicates that Junior is experiencing positive emotions. In this depiction he looks like a happy little baby.
On the page representing the eighth week, the fetus gets called by his name for the first time. Additionally, he gets his own set of fingerprints with the text stating that “Junior has all his fingers and toes complete – even his fingerprints which are the same now as they will be when is eighty years old!” (figure 8). The claim that Junior’s fingerprints will remain the same until he is eighty years old helps indicate that his life is no less important than the life of an eighty-year-old. According to the commentary the “baby” is able to clutch things with his hands. Although it remains unclear what kind of things an eighth week old fetus could get a hold of, the purpose must be to make clear that the fetus is a person with human capabilities.
The next page represents the eleventh and twelfth week of the pregnancy and the commentary emphasizes the fact that Junior can feel pain and that all body system are working (figure 9). In 2005, the American Medical Association (AMA) published a clinical review on fetal pain. The authors concluded that no research had ever been able to prove that a fetus can experience pain before the third trimester.110 This means that the claim that Junior can experience pain was unsupported by medical evidence and was just meant to dramatize abortion. Fetal pain was used by anti-abortion activists to evoke compassion for the fetus.111
Also in the eleventh and twelfth week, we see Junior formulating a thought for the first time as he thinks “time for me to get going soon” (figure 9). Even though there are still some 26 weeks left before this pregnancy reaches full-term, Junior is apparently ready to leave. Then, at three months the commentary reads that Junior has been fully formed and that he only has to grow further. But, the image on this page shows an alarmed Junior who is hearing his mother and her doctor discussing “how to kill him” (figure 10).
110
Lee, S.J., Ralston, H.J., Drey, E.A., Partridge, J.C., Rosen, M.A. ‘Fetal Pain a Systematic Multidisciplinary Review of the Evidence,’ in: Journal of the American Medical Association, Volume 294, No. 8 (2005) p.952 111 Dubow p.164
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Figure 9
27
A 12-week old fetus is said to weigh approximately 12 grams which means Junior is nowhere near ready to get going soon.112 During the Edelin trial in 1975, several expert testified that they did not believe a fetus had any chance of survival outside the womb at twenty-four weeks. A professor emeritus of pathology at Harvard Medical School stated that a fetus become viable around the 28th week of gestation.113 This again shows that anti-abortionists wanted to convince the audience of the fact that abortion was immoral by arguing that fetuses were fully developed and alive from a very early stage, even though medical evidence shows this is not the case. Here, addressing both fetal pain and viability help solidify the argument that abortion is murder.
An important conclusion that can be drawn from the comic is that the NRLC probably
wanted to try to convince its public of the fact that a fetus is aware of its surroundings, can feel pain, and experience emotions as early as the end of the first trimester. Although it was not mentioned explicitly, the personhood argument was already being used. For instance, it is indicated by all the different kinds of facial expressions Junior has. He is portrayed while he is smiling, looking puzzled or worried and, as he gets aborted, the expressions on his face show that he is experiencing pain (figure 11). Also, the portrayal of Junior as able to ‘hear’ his mother and her doctor talking and capable of formulating thoughts helps illustrate his responsiveness and alleged personhood (figure 9 and figure 10). Another observation that can be made when looking at the comic is about the role the mother plays. The first page mentions that the fertilized egg has entered the mother’s womb, the womb remains the same shape and size throughout the whole comic and this implies that the mother isn’t a very active participant in the pregnancy. Feminist scholars have argued that ultrasound imagery separate mother and fetus, and I would argue that this comic does the same.114 The pregnancy has become externalized as we are looking inside the womb as spectators standing on the outside.
The only time a depiction of the mother is shown, is when she makes the decision to abort Junior. This is the only time an action is attributed the mother, when she and her doctor discuss how to kill her baby and when the question is subsequently raised on how mothers murder their babies. In the commentary to the comic the mother is only mentioned in passive ways. Women in a general sense get some more attention in the rest of the booklet, albeit in a negative way when they are referred to as “foolish” (figure ). On a further page, the silhouette of a pregnant woman is shown, but this woman does not have a face or any other significant features, she is not granted an active role in the debate over abortion (figure ).
112 Baby Centre ‘Average Fetal Length and Weight Chart,’ originally accessed on June 10, 2013 at: http://www.babycentre.co.uk/e1004000/average-fetal-length-and-weight-chart
113 Dubow p.94
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Literature in which fetal images have been analyzed has suggested that the mother is often not depicted in these images, the fetus gets described as floating in space, independent from the woman.115 Already in early examples of public fetal imagery the fetus was represented as primary and autonomous. A good example of this is a 1965 photo-essay in Life Magazine called Drama of Life
Before Birth. This essay described the development of the fetus. Pivotal to this article were photos
taken from the book A Child is Born made by Swedish photographer Lennart Nilsson (see figure 11 for one of these photos).116
In the article different stages of the development of the fetus are described, accompanied by Nilsson’s photos. The photograph clearly shows what scholars mean when they discuss “the floating fetus.” There is absolutely no reference made to the mother and the area surrounding the amniotic sac resembles outer space.
However, Nilsson’s photos often did not represent what the article claimed, they were extreme enlargements of mostly dead fetuses. Scholar Karen Newman explains that the a fetus Nilsson photographed was only two-and-a-half inches, while it looks much bigger on the photos he published. She describes that extreme enlargements that focus on the hands and face of the fetus served to dramatize abortion.117 The fact that human features were so distinguishable made them strongly resemble human babies and attributed to the personification. The fact that the article’s text referred to the fetus as “baby” and “person” also helped this process.118 It is possible that the
115 Newman, K. ‘Fetal Positions: Individualism, Science, Visuality,’ Stanford University Press (1996) pp.8-12 116
Nilsson, L. ‘Drama of Life Before Birth,’ Life Magazine, Vol.58, no. 17, (1965) 117 Newman p.10
118 Newman p.10; Petchesky p.263
