Roos Kruimer 11034998 Master’s Thesis Word Count: 18,287 08/01/2019
“I thought… If I can survive this, I can survive anything”:
Women’s lived experiences of abortion in the Netherlands.
Supervisor: prof. dr. Sarah Bracke Reader: Myra Bosman
Acknowledgements
This whole thesis would not have been possible without my partner in crime, Ana, who dragged me to the library every day and gave me angry looks when I was procrastinating. Marit, for being the unwavering calm presence who always knew how to pull me out of my daily breakdowns by making me laugh. I want to thank Lubo, my sunshine, who listened to my whining and never, ever, stopped encouraging and supporting me. I’m so grateful to AJ, my love, who let me into her home and sat with me to write for days at a time. My mum, who (almost) always answered her phone and listened to me, and generously made up for my broken Dutch in the translations.
I am so grateful to Sarah for the motivating pep talks, as well as her beautifully thorough feedback that pointed me in the right direction. Myra, my lovely reader, who was encouraging about my topic before the proposal and very kindly agreed to read my work despite also supervising her own students.
Finally, I extend my gratitude to my eleven wonderful interviewees who shared their time, stories, and homes with me. This project never would have been possible without them.
Abstract
This thesis seeks to analyse a group of women’s recollections of their experiences with abortion. It explores and applies Foucault’s concept of biopower in order to highlight the use of contraception provision or lack thereof to control the number of a population. Along with a historical background of the history of abortion in the Netherlands, an overview of the laws and some of the discourses around it is given. A purposive sampling method was used, and 11 women who had abortions in the past five years in the Netherlands took part in semi-structured interviews lasting half an hour to an hour in different parts of the country. Findings show that women in heterosexual relationships carry the majority of the responsibility of birth control, and the failure thereof is taboo and is seen as a failure of character. The results chapters are divided into three themes, all of which tie theory to the experiences of the interviewed sample. The first explores contraception, fertility, and the responsibility of avoiding pregnancy. The second concerns their experiences in the clinics, the physical pain when taking the abortion pill, and their feelings of invasion of privacy in the clinics. The last chapter explores the direct influence of the legislative landscape on their experiences, e.g. with the mandatory 5-day waiting period, going through a GP, and not being close to any clinics. The project concludes that there is a difficulty in tending to every person’s needs in designing abortion policy because women’s experiences and needs vary so much. Moreover, women’s views on abortion are not fixed, and whether or not they already have children can have an impact on their decision-making process and potential feelings of regret.
Table of Contents Acknowledgements 1 Abstract 2 Table of Contents 3 1. Introduction 5 1.1 Rationale 6 1.2 Closed clinics 8 1.3 Significance 8
2. The story of abortion in the Netherlands 10
2.1 Historical background 10
2.2 Contemporary state of abortion 12
3. Theoretical framework 14
3.1 Factors influencing experience with abortion 14
3.1 Mandatory waiting period 14
3.2 Distance travelled to access clinics 16
3.3 Emotional experience and recovery 16
3.2 Undesired pregnancy and gender: theorising contraception and abortion discourse 17
3.3 Bodily integrity and agency 19
3.4 Biopower and religion 20
3.4.1 Biopower and the reproductive body 22
4. Methodology 25
4.1 Methods & Materials 26
5. Discourses on Contraception, Fertility, and the Burden of Responsibility 29
5.1 Use of contraception 30
5.2 Delaying pregnancy 31
5.3 Straying from normative ideas about pregnancy 33
6. In the Clinic: Privacy, Pain, and Care in the Hands of Women 36
6.1 During the procedure: privacy and pain 37
6.2 Pain & care (in the hands of women) 40
7. Policy: General Practitioners, Waiting periods, and Availability of Clinics 44
7.1 The general practitioner: comfort and obstacle 44
7.2 The mandatory waiting period 46
7.3 Availability of Clinics 47
8. Discussion & Concluding Remarks 51
9. Works cited 58
Appendix I: Recruitment message 65
Appendix II: Participant consent form 66
1. Introduction
Although abortion has officially only been legal in the Netherlands since 1984, women were seeking abortions through formal and informal channels for centuries before that (Treffers, 2006). Although the medical process is relatively easy and well regulated, the public debate around abortion continues to show some division, even 35 years after the implementation of the Wet Afbreking Zwangerschap (WAZ). The Netherlands is therefore quite an interesting case study when looking at the phenomenon of abortion, due to its state of both legality and accessibility, and the low rates at which people seek them which fluctuates between 5 and 7 out of 1000 women of reproductive age, which is largely due to the widespread use of contraception since the beginning of the 1960s until the end of the 1980s (Ketting & Visser, 1994). This same study found that it was also a combination of the encouragement of family planning services, economic growth, improvement in education, decreasing influence of organised religion, and the transition from an agricultural to an industrial society. All of these factors lead to abortion being seen as a last resort, where people primarily rely on contraceptive services.
Nevertheless, the experience can be difficult for many people, both emotionally, physically, and financially. Although anti-abortion activists often argue that women who undergo the procedure are immediately attached and face immediate regret, the reality is that many women are quite certain about their decisions but nevertheless may have some emotional difficulty with it. Kimport (2012) theorises that this can attributed largely to social disapproval, loss of romantic relationships, and head versus heart conflict. Physically, as will be presented in this research, the experience can be unpleasant as well. The abortion pill has often been shown to come alongside a myriad of unpleasant side effects, such as headaches, lower back pains, diarrhea, and vomiting. It also has a relatively high rate of failure (3.3%) when compared to the surgical vacuum aspiration procedure (1.5%) (Rademakers et al, 2001). Financially, undergoing abortion can provide
problems due to the days of work women potentially have to miss. This is closely tied to having a mandatory waiting period, whereby people have to come in for two appointments rather than just one. Moreover, abortion in the Netherlands is only free for residents with a BSN number. This leaves migrant and refugee women, as well as women with insecure residency status out of the social safety net. In their case, an abortion costs between €380 and €940 , depending on the procedure. 1
1.1 Rationale
The aim of this research is to explore the history and context of abortion in the Netherlands, and to both uncover and unpack the link between the contemporary policies and the experiences of women who have undergone abortions. This centers around the whole process of undergoing an abortion in the Netherlands, particularly with relation to having to go through a general practitioner in order to get a referral, long waiting times for abortion clinics, the national mandatory 5-day waiting period, and the low availability of abortion clinics in 2017 and 2018 after the closure of clinics in major cities. Furthermore, this project explores women’s emotional experiences throughout the process, as well as the potential impact it left and whether or not they sought emotional help afterwards by making use of state safety nets. This 'emotional experience' will be uncovered using retrospective narratives on the participants' part, by using their memories and recollections of the process and tying them to theory in the discussion chapter. The research explores the reasons as to why macro-level decisions are made about abortion and its availability, as well as the mechanisms that take shape behind these processes. This includes things like organised religion and its influence, neoliberalism and the liberalisation of civil rights, and the process of biopower and control over a population.
1 This information is not verifiably publicly available, and was only given upon request when calling the number of
The goal of this research project is to in some way contribute to the literature on this topic. Although the concept of abortion has been discussed, theorised, and studied at length throughout many fields (e.g. medicine, psychology, law), these numbers outweigh qualitative studies on the lived, embodied reality for the people who choose to undergo it. Therefore, the goal is that this project can contribute in some way to the body of literature on abortion by providing accounts of people’s experiences that are inherently affected by policy. For this exploratory research, the research question is therefore present below:
“How did women experience their abortions in the Netherlands in the last five years?”
It would be ideal if the growing body of scientific literature on contraception and abortion would eventually inform policy decision, in order for it to cater more to people’s desires and needs. This is particularly the case with the mandatory 5-day waiting period between consulting a general practitioner and being able to go to a clinic. This is one of the central focuses of the research, because (as will be shown in the literature), this is a sensitive point of debate between anti- and pro-abortion activists. Moreover, this law provides as interesting point of analysis by contrasting what the government and policymakers deem to be important, and what the patients undergoing the procedure deem important. By finding out the purpose of these waiting periods, I explore how individuals felt about it and whether or not they felt that it helped or hindered them. What is noteworthy about abortion policy is that it is all enforced on a single body. The people who undergo abortions experience it very directly, as their bodies are the locus of both policy and discourse. The focus of the interview questions and research is therefore how they experienced the different ways in which discourse and policy affected their embodied experience. Therefore, the theoretical framework explores the notion of bodily integrity with relation to abortion. It analyses different theories with regards to who primarily has ownership over the body, and to what extent outside factors can affect personal, embodied experiences. This will allow this research to be a part of the canon of literature about bodily integrity and
autonomy, as well as to analyse how women perceive the Dutch government’s control over women’s bodies before, during, and after their abortions. This is especially relevant in the Netherlands, which is one of the countries where women can legally still have late-term abortions at 24 weeks, although this is only permissible if there is a serious medical need for, otherwise the abortions can be performed without a medical need for it until 22 weeks (Gezondheid, 2019). On the surface, the policy may seem very liberal. However, due to it being subsidised by the government, people seeking abortions are dependent on this institution that holds a monopoly over both abortion provision and the legislation that accompanies it.
1.2 Closed clinics
On the 8th of November 2017, a court in Den Haag declared the nationally operating abortion organisation CASA bankrupt. As a result of this, the doors of clinics in Leiden, Den Haag, Houten and Goes closed indefinitely, although their services were still performed in Amsterdam, Rotterdam, and Maastricht. CASA performed half of all abortions in the country. People seeking help there for matters relating to contraception, abortion, and menopause, approximately 100 per day, were referred to other clinics in the country (Naber, 2017). This also means that the 150 employees working at these clinics lost their jobs, and had to reapply when the new ones opened. CASA was running seven out of seventeen abortion clinics in the Netherlands at the time, all of which closed. At the same time, the rental contract for the building on the Sarphatistraat finished, and the building had to be emptied. Amsterdam was therefore left without an abortion clinic indefinitely. This chaos created a sense of insecurity for women seeking abortions in this time. People were forced to stay pregnant for longer, as waiting times doubled for the clinics that were still open (van Kempen & Sevil, 2017). This situation provided an extra layer of adversity for people seeking these services, and an analysis of participants’ experience with this will be explored in depth in chapter 7.
1.3 Significance
The control over women’s fertility has been the locus of violence and exhaustive regulation for many centuries. Even at the time of writing, a multitude of laws being passed around the world restricting people’s right to abortion, or even criminalising ending an undesired pregnancy. It is difficult to escape the framework of the politicisation of the discourse on abortion, but it is important to try to share experiences and stories in order to normalise the process and detach it from the polarised public opinions about it. This relates to the polarisation of the debate in that women's individual experiences are overlooked, and reduced to a stance in a binary political debate. Nevertheless, the debate should not be viewed as a binary opposition of supporting or condemning abortion. As some participants demonstrate in this research, there is more nuance than is usually presented in mainstream media, as is usually the case with political debates. As is demonstrated in the results chapters, the women taking part in this project did not seem to care much for the polarised debate about abortion policy. They were simply people seeking a medical service, rather than taking a political stance within a debate. This is translated through the use of interview questions rooted in their experiences, or memories and recollections thereof, as well as very limited discussion about abortion in a national, as well as international context. In this project I therefore highlight the significance of this experience to the people who underwent the procedure. Rather than going along with the debate about ethics and the definition of ‘life’, this project recognises that the desire to end a pregnancy is an existing reality for many women. The process of abortion left many of them with a range of emotions, from sadness to shame to pride to gratitude. Nevertheless, all of them stood behind their decisions and expressed relief with regards to the ease with which they had access to these health services.
2. The story of abortion in the Netherlands
2.1 Historical background
For approximately 200 years from the beginning of the 1600s until the end of the 1700s, the purposeful termination of a pregnancy was deemed wrong, in some cases “worse than homicide” (De Bruijn, 1979). The reason for this was because of the deeply spiritual beliefs present in a large proportion of the society in that time. Abortion was seen as infanticide, which was worse than homicide primarily due to the fact that women were ignoring the will of God (which was assumed to be for the baby to live), as well as betraying their offspring and being disloyal to their own “flesh and blood” (De Bruijn, 1979). Religious consensus at the time promoted a discourse that by undergoing an abortion or induced miscarriage, a woman was withholding the act of being baptised from her child, and as a result these unbaptised children were castigated to hell. Deliberate pregnancy termination was, at this time, observed as a sin as well as a felony. Nevertheless, by the turn of the 19th century a public debate emerged that attempted to pinpoint the difference between a life with a soul, and a life without a soul. This debate helped further the cause for ending pregnancies, as this nuance between the two kinds of life allowed for a difference in punishment between the
two crimes. The ending of a “ bezield" life was penalised and tried in a court as a murder, whereas the ending of an “ onbezield” life resulted in a confinement to exile. The difference between these two interpretations of life was identified at precisely two weeks after conception. Another century later, nuance in thinking about the life of a foetus and ownership thereof was exacerbated, in secular as well as religious schools of thought as can be seen in my translation of an excerpt from 1910 from the Wereldvrede, a monthly Christian paper: “Neo-malthusianism has drawn much attention to the fact that mankind should be lord and master over his reproduction” (de Bruijn, 1979). This was one of the telling signs of a change in the social conceptions of morality and ethics, one diverging away from its roots in religion, to an ethical code being attached to biopolitics and a controlled population comprised of docile bodies, which will be explored in depth in section 3.4 of this chapter. Neo-Malthusian thinking brought with it a changing discourse and discussion surrounding the need for population control, particularly through birth control and family planning services. This line of thinking was observed especially in Protestant Christian practice, who at the time were the largest religion in Dutch society, therefore heavily influencing how people perceived abortion and the need for family planning.
However, the 20th century saw a rise in legal cases of convictions of infanticide due to the punishability by law of abortion in 1911. In 1911, a law from 1886 was amended in order to make abortion not only a “crime against life, but also against public morality” (Ketting & Schnabel, 1980). Under the previous law, it was necessary for a conviction to prove that the foetus was still alive at the time of the operation, which proved to be close to impossible and resulted in a very low number of convictions. However, this was amended in 1911 and caused a swift rise in the number of convictions. Still, these convicted women often only represented a very small proportion of the actual terminated pregnancies. As Foucault said: women are not “docile bodies” (1975), and they rebelled against this law at every possible turn, when necessary. This was done in many different ways: some women chose to go to their general practitioners, some went to unofficial or illegal abortion doctors, and women of higher classes went to Belgium, where it was easier to get an abortion. This privilege, however, was not afforded to everyone. Toward the end of the 1960s public social
discourse around abortion started to be underway. At the time, many hospitals had what was called “abortion commissions”, to decide whether or not an abortion would be permitted. Soon after, in 1971, the first ‘illegal’ abortion clinic opened, het Mildredhuis, but was never disallowed by the authorities due to an implicit gedoogbeleid. In these decades, the second wave of feminism fought for the right to abortion in the Netherlands, such as the group Dolle Mina. This was achieved with the implementation of the Wet Afbreking Zwangerschap (WAZ) in 1984, which stated that people may undergo abortions by licensed doctors in a clinic or hospital, after a mandatory period of five days (Historiek, 2019).
2.2 Contemporary state of abortion
In this project, abortion is regarded as a secondary option for birth control, with the primary choice being contraception. This is due to the difficulty of obtaining it, both in terms of formal access and in terms of the pain and recovery time required. Due to abortion being a difficult procedure due to the associated taboo, many women choose not to disclose anything even to the people closest to them in their personal networks due to the social stigma attached to it (Chor et al, 2019). There are three types of abortion provided in the Netherlands. The first is the medical abortion, also known as the abortion pill, which can be done until 8 weeks of pregnancy. These can be acquired at a clinic, which is fortunately completely anonymous. The added advantage is also that it can be taken at home, for people to feel more comfortable. The second type is the vacuum suction abortion, zuigcurettage, which is available until 12 weeks. Finally, there’s surgical abortion, which has the disadvantage that it has to be done in a hospital, meaning that there is no anonymity for the patient. Nevertheless, this is completely legal until the foetus is able to live on its own outside of the carrier’s body, which is around 22 weeks, although abortions will also be performed until 24 weeks if there a medical need for it or a serious threat to the mother’s or baby’s health (Gezondheid, 2019). In theory, the procedure could be delivered relatively easily, but it has long been “subject to legal proscription and administrative control” (Schur, 1968). This idea is still reiterated in a multitude of articles, even over fifty
years after the publication of Schur’s article (Guillaume & Rossier, 2018). Research into the topic shows that illegality of abortion does not actually result in lower rates of abortion. Restrictive abortion policy or even illegality does not deter people from seeking them in a statistically significant way (Medoff, 2002), but rather makes people seek them through unofficial channels often resulting in injury and even death (Schur, 1968; Unnithan & Zordo, 2018). Moreover, a study from 2014 found that in the U.S., states that do not fund abortion through Medicaid observe “significantly” higher rates of postpartum depression than states that do fund abortion through Medicaid (Medoff, 2014). Restrictive abortion policy often affects low-income people the most, as they do not have the economic or social capital to work around the law (Ely & Murshid, 2017). Due to the historical construction of race, ethnicity and social class are often highly correlated. Low-income people people of colour in the U.S. are most heavily impacted by restrictive abortion policy, and African-American teens show higher trends in unintended and teenage pregnancies than their white counterparts (Coles et al, 2010). It can therefore be seen that discourses on abortion are not only gendered, but also racialised and classed. The debate and feminists’ fight for abortion concerns people from a range of social classes, as well as across different ethnicities. Abortion is a matter of gender equality, and access to comprehensive reproductive care is an important right that has influence over may other aspects of one’s life (Francis et al, 2017).
3. Theoretical framework
The first half of this chapter will explore some of the factors that can have an influence on people’s experiences when seeking an abortion. This includes the mandatory waiting periods, which the Netherlands has as well, long distances travelled to get to a clinic, and emotional reactions after the experience. All of these things are politicised and gendered, and this chapter will explore how these factors set the tone for the qualitative research. Moreover, the second half of this chapter will explore how factors contributing to the availability of abortion are influenced by biopower. This section of the chapter will delve into how reproduction, and by extension women’s bodies, are subject to control in order to control a population’s numbers. All of this will be incorporated into the findings chapters, either by using it as assumptions to ask participants questions or, in the case of biopower, to use as a lens to analyse the purpose of certain laws.
3.1 Factors influencing experience with abortion
3.1 Mandatory waiting period
Mandatory waiting periods are often employed as a way to prevent patients from making rash decisions, and to make sure that they are 100% positive about their decision to have an abortion. According to experts, waiting periods for abortion serve no medical purpose, but are instead mechanisms intended to make abortion less accessible (Boonstra & Nash, 2014; Joyce et al, 2009). In the Netherlands, there is a mandatory national waiting period of five days between the first appointment at the general practitioner, and the appointment at the abortion clinic (Ministerie van Algemene Zaken, 2018). This is applied in all cases, unless
the patient is under 16 days late from the date that they should have had their last menstruation. The 5-day waiting period has been enforced since the implementation of the Wet Afbreking Zwangerschap (WAZ) in 1984 (Treffers, 2006). This came with one key disadvantage: prolonging an already undesired pregnancy. A national study by the state secretary of public health, well-being, and sports advised the withdrawal of this law (Treffers, 2006).
Sanders et al. (2016) found that women in Utah, where the waiting period is 72 hours, frequently had to travel much further to the abortion clinic than to their general consultation. ⅔ of those surveyed reported negative feelings toward their three-day waiting period, due to needing to take time off work, lost wages, cost of transportation, and having to disclose their abortion to people close to them, which they would not have had to do without the waiting period. Roberts et al. (2016) also based their research in Utah, and they concluded that most women were not conflicted when seeking an abortion and followed through despite a mandatory waiting period (=86%). 8% of them did not wish to have an abortion as a result of the follow-up appointment. They deem the waiting period unnecessary. Karasek et al. (2016) support this, showing that a 24-hour waiting period in Arizona led to unforeseen expenses which negatively affected their ability to pay for other things (e.g. bills and food). This waiting period is shown to have a stronger negative impact on women of lower income, as they do not have the resources to navigate it as easily. A very small minority of women (<8%) found the waiting period helpful and viewed it positively. Lupfer and Silber (1981) showed, from a survey of 400 women who have had abortions in Tennessee, that less than 70% of them could name a single benefit of mandatory waiting periods. All of these studies are conducted in the U.S., because abortion has the combination of being legalised by the federal government but having a lot of variation (and difficulty caused by it) depending on the state. A waiting period is only present in nine European countries (Guillaume & Rossier, 2018), compared to 34 out of 50 U.S. states that mandate counselling before an appointment at an abortion clinic (Guttmacher Institute, 2019). This is why research is more present and developed in the U.S. in this regard.
3.2 Distance travelled to access clinics
Research shows that people suffering from intimate partner violence are willing to travel greater distances in order to be able to undergo abortions. The study by Upadhyay et al. (2017) clearly advises that restrictive abortion policy be repealed in order to facilitate abortions to women suffering from domestic violence. This once again shows that people looking to undergo an abortion will go to great lengths for it, as supported by Unnithan & Zordo (2018). Nevertheless, Shelton et al. (1976) concluded that greater distance decreases the chance of people getting abortions, mostly in lower-income and other minority women. A higher density of abortion clinics increases the number of abortions performed, although this study was conducted in the U.S. and therefore should not be generalised to the Netherlands without critical evaluation. Therefore, it will be interesting to see if the participants’ experience reflects this. Of course, the studies conducted in the U.S. will apply very differently to the Netherlands, due to the massive difference in distances that one can travel within the country.
3.3 Emotional experience and recovery
Due to the strong polarisation of political opinions on this topic, there is also a polarisation of discourses regarding women’s emotional experiences after an abortion. There a is contested myth that all women feel regret afterward, also dubbed “post-abortion syndrome” but this idea is mostly promoted by anti-abortion activists starting in the 1960s in the U.S. by Crisis Pregnancy Centers (CPCs) (Stotland, 2003). A more nuanced analysis of this can be seen in Katrina Kimport’s ethnographic work with 21 women who have undergone abortions (2012). She problematises our categorisation of feelings post-abortion into either ‘relief’ or ‘regret’, with little nuance between the two. Kimport’s conclusion can also be seen in some women interviewed for this thesis, which is that many women feel mere ‘ambivalence’; neither relief nor regret. She further identifies three sources of emotional difficulty with abortion, namely “social disapproval, loss of romantic relationships, and head versus heart conflict” (Kimport, 2012). However, as is supported with data
from chapter 5, I suggest adding one more dimension to this based on my research, namely the influence of whether or not the women have already had children.
Studies mostly support that the notion that ‘undergoing an abortion is traumatising for patients’ is politically constructed, in order to justify implementing more conservative abortion policy (Stotland, 2003; Gold & Nash, 2007; Kelly, 2014). Both anxiety and depression are as prevalent in women who have undergone abortions, as ones who have been denied ones (Foster et al, 2015) and those who have not had experiences with abortion. Nevertheless, a meta-analysis of 36 studies between 1995 and 2011, found that a little over a third of them (n=16) reported positive correlations between at least one mental disorder and abortion. Only one of the studies showed worse outcome for childbearing (Belieni & Buonocore, 2013). On the other hand, Biggs et al (2017) showed that after 5 years, women denied an abortion showed much higher rates of anxiety than women who were provided one. They also reportedly showed symptoms of lower self-esteem, lower life satisfaction, and symptoms of depression. Charles et al. (2008) summarise this divided debate well by ranking studies into this topic based on methodological quality, and found that in the studies they rated as “excellent” yielded mostly neutral findings, with “few, if any, differences between women who had abortions and their respective comparison groups in terms of mental health sequelae”. Therefore, a certain neutrality will be employed to frame the questions asked to participants about their mental recovery, especially taking into account the amount of time that has passed since their abortions.
3.2 Undesired pregnancy and gender: theorising contraception and abortion discourse
There is a general consensus of acceptance, or at least ‘tolerance' of the availability of abortion in the Netherlands, which is strengthened by a legal framework. Nevertheless, there are still divided opinions about the ethics of it in the media, as well as in personal interactions in everyday life. Still, Dutch people in general reproduce a discourse of acceptance of the option of abortion, as can be seen in many different forms of media. On the one hand, an individual’s ability to make sovereign decisions over his/her bodies is both
written and reinforced in the constitution, but it is also one of the cornerstones of the nation’s strongly liberal economy which emphasises the individual’s rights and ability to make financial and personal decisions uninterrupted by the government. Any attempts to reduce the freedom of decision over one’s pregnancy status in the Dutch public sphere are often considered “deviant, patronising, and inappropriate” (Scharwächter, 2008). On the other hand, there is a combination of free speech, religious freedom, and far-right political extremism that creates contrasting discourses, condemning the freedom to end an unwanted pregnancy (van der Aa, 2019). In general, the stigma around abortion emerged due to its challenge of three traditional “feminine” ideals: perpetual fecundity; the inevitability of motherhood; and instinctive nurturing (Kumar, Hessini, & Mitchell, 2009). This research does not explicitly state being tied to a certain context as the journal it was published in tries to take an international perspective, nevertheless Ellen Mitchell is employed at the Amsterdam Medical Center and wrote alongside Kumar and Hessini, which provides some influence of the Dutch context. This stigma reveals itself in a myriad of ways, including but not limited to popular and medical discourses, individual conversations in personal networks and communities, government discourses, and institutional mechanisms.
The aim of the Dutch government is to avoid abortion as much as possible, by offering affordable and educated access to contraceptive healthcare (Ketting & Visser, 1994). However, perhaps in part due to the patriarchal institution of medicine and healthcare, the biotechnological options of contraception are both limited, and almost entirely aimed at people with uteruses. This concerns in particular long-term and reversible birth control in the case of heterosexual sex. In the United States, women on average spend three decades controlling their fertility in order to avoid pregnancy (Boonstra et al, 2006). Many researchers in mostly Western contexts have found that the burden of birth control in heterosexual relationships, even in long-term committed relationships, falls on the woman (Fennell, 2011; Fields, 2008; Reich & Brindis, 2006; Weber, 2012). This uneven burden can, for example, be seen in the fact that women are often the only ones present in fertility counselling appointments (Shih et al, 2013). Therefore, the time, money, stress, and effort
women undergo in order to maintain the avoidance of pregnancy constitutes unpaid labour, what Bertotti (2013) called fertility work. Bertotti maintains that although the biotechnological options for long-term contraception are almost exclusively aimed at women, the attention and financial burden could be more evenly distributed in heterosexual relationships. One of the consequences of this division of labour is that when contraception fails and/or undesired pregnancy occurs, this is viewed as a failure on the woman’s part for not effectively avoid the pregnancy. The burden of either terminating a pregnancy or raising an unplanned child ends up falling on the woman, even though there were two people equally involved in sexual activity. In the Netherlands, in 2012 59,6% of women between 15 and 49 years old used some form of contraception, and for 79% of them it is important to avoid pregnancy (Picavet, 2012), meaning that over half of all Dutch women of this age perform some kind of fertility work, and four fifths of them actively do not wish to get pregnancy. This framework will be used and explored in more depth in chapter 5, wherein the participants’ experiences with fertility work and pregnancy will be examined.
3.3 Bodily integrity and agency
Bodily integrity is the “cornerstone of all other liberties”. One of the important philosophers of classical liberalism argued the following “[o]ver himself, over his own body and mind, the individual is sovereign” (Neff, 1991). Nevertheless, a woman’s right to bodily integrity is globally influenced by external forces, be they governmental or institutional: “a woman’s right to decide is balanced against the state’s right to interfere with her decision in furtherance of its own policies” (Neff, 1991). Importantly, the right to bodily integrity works in tangent with reproductive freedom, and the ability to decide if someone wants children or how many children they want to have. Bodily integrity with relation to abortion means more than mere noninterference on the state’s behalf, it means that they must ensure an environment where the decision to terminate a pregnancy is a viable option (Francis et al, 2017). Therefore, it is important to look at how individual agency can be negotiated even when restricted by forces outside of one’s control.
On the one hand, the argument can be made that a state authority that forces a woman to undergo a pregnancy without the ability to choose to terminate it is violating her bodily integrity. On the other hand, a state such as the Netherlands that permits and funds abortion but almost completely controls the process may also be restricting people’s bodily integrity, although in very different ways. Although they comply with Francis et al.’s notion of bodily integrity by creating an environment where undergoing abortion is possible, there are other ways that they may breach it. For example, by enforcing a mandatory 5-day waiting period people may have passed the time to have an abortion via the pill, and may be forced to undergo a surgical abortion against their will. The body can be said to be ‘fluid’, meaning that “it is defined with reference to the malleable components of subjectivity” (Herring & Wall, 2017). The boundaries of the body and its integrity are malleable, and for the purposes of this project an embryo will be seen as an extension of one’s body. According to Herring & Wall, the embryo “continues to be a site of integration of a person’s body and that person’s subjectivity.” (2017). This allows to provide an analysis wherein the foetus is merely an extension of its carrier’s body, as opposed to being an individual autonomous subject. Therefore, this project operates on the assumption that the person experiencing a pregnancy should have complete and independent control over what should happen to the embryo they are carrying. However, the reality is that most people do not have this liberty. In many places in the world, our bodily integrity is violated and manipulated by and for the benefit of institutions and greater forces outside our control. This is what biopower is, which leads into the next section that will explore how the creation of the nation-state came in tangent with the advent of biopower, and how this in turn can affect our bodily integrity.
3.4 Biopower and religion
“It was essential that the state knew what was happening with its citizens’ sex, and the use they made of it, but also that each individual be capable of controlling the use [she] made of it.”
(Foucault, 1978)
At its core, biopower can be defined as the discipline and “subjugation of bodies and the control of populations” (Foucault, 1978, p. 140). Biopower has two arms, one being the discipline of the body, and the other being the regulation of populations. Nevertheless, these institutions are not enough to discipline bodies, rather, enforcement by the institutions serves to create a new social norm, whereby people start to regulate themselves and each other, and the state apparatuses (medical, imperial, judicial) are for the most part regulatory. Moreover, according to Foucault, the implementation of biopower was crucial to the development of capitalism. This makes sense when considering the need for docile, subjugated bodies to be inserted into the production line, as well as a consumer population. It can therefore be said that since the development of biopower, and consequently capitalism, women’s bodies have been the nexus of control, due to them bearing children that go on to contribute to both the population in terms of numbers, as well as the labour force. This is done through influence over institutions and the discourses they in turn proliferate. For the purposes of this project, biopower is understood as regulatory mechanisms over the body, particularly in the arena of sexual reproduction. A starting point of control over the number of a population starts with birth, which is where regulation over women’s bodies starts. It is important to understand the mechanisms behind policy decisions concerning fertile bodies, because these regulations do not appear out of nowhere. They are targeted and have
a purpose, whether it is to cause a population to grow rapidly as will be demonstrated with the section about Sylvia Federici’s writing, or whether it is to keep birth rates stagnant, or to prevent unplanned births.
As explored earlier, biopower as control over the number of a population mainly articulated itself through religion in the Netherlands, especially in tangent with rising popularity of neo-Malthusian ideology. Biopower, Foucault argues, enables social control to be exerted through conceptions of sexuality, namely on the levels of the body as well as the population (Foucault, 1978). In the case of the Netherlands, this articulated itself through the institution of organised religion in the seventeenth and eighteenth century, around the time of the creation, development, and maintenance of the nation-state. Moreover, Foucauldian analysis can also be applied to the Netherlands when looking at the decreasing political power of the sovereign with the rise of the nation-state, although that of France was abolished as a result of the moderate revolutions between 1789 and 1792 (Vovelle, 1987). Shortly thereafter, in response to the 1848 revolutions, the Netherlands transitioned to a constitutional monarchy, whereby the monarch must act in line with a written constitution (Wintle et al., 2019). This is different from an absolute monarch, such as King Louis XVI of France, whose powers were not restricted to a pre-established legal framework. This section will outline how women’s bodies have always been at the nexus of biopower. Moreover, it will trace how the goals of biopower, and the force it exerts through governmentality, has shifted depending on the requirements from a population by a government. The definition of biopower is extensive, but facilitates our understanding of the way different institutions can be used by a government to control the number of a population through the control over sexual behaviour.
3.4.1 Biopower and the reproductive body
Foucault’s analysis, however, can be critiqued to be very male-centric. As women were overwhelmingly excluded from the labour market, they were neither bodies in the machinery of production nor part of the consumer population due to their nonexistent income. For this, Sylvia Federici (2004) writes
about women’s entanglement with a rise in control of fertility in society during the development of capitalism. The context she describes in during the beginning of the advent of modern capitalism in Europe, termed primitive accumulation of capital, to which expansion of control over the (mostly expansive) growth of a population was crucial. She revisits the Marxist concept of primitive accumulation of capital through exploitation of labour (Roberts, 2017), namely the transition from feudalism to capitalism, and explores it using a feminist lens in order to take into account women’s experiences during that time. Federici argues, however, that biopower was kickstarted by the population crises of the 16th and 17th centuries. Due to a rapidly declining population and increasing age of birth, the growth of population was taken into state hands. However, Federici notes that this was in particular done by implementing violent disciplinary methods to discourage women’s control over their own reproduction (“reproductive crimes”). From the mid-16th century onward, there was enormous concern with increasing the population in order to provide bodies for labour and armies to bring power to a nation. This was particularly seen in Protestant Reformers who were the leading religion in the Netherlands at the time. In France and England, for example, there was a “premium on marriage and penalised celibacy” in order to promote and encourage childbearing in the fertile population (Federici, 2004). Most importantly perhaps, the male doctor entered the delivery room in tangent with the marginalisation of the midwife. This was justified by stating that female doctors were more likely to commit “infanticide”. This, Federici states, was the beginning of the prioritisation of the foetus’ life over that of the mother.
These things show that by implementing mechanisms of biopower, women’s bodies, fertility and consequent sexual behaviour are often vulnerable targets. As Foucault notes, this enforcement of regulation is done through the often violent arm of the state. Violence, or the threat thereof, was used from the 16th century onward to control the sexual behaviour of women, by punishing deviant or non-reproductive behaviour. The remnants of this can still be seen today in many parts of the world where people, especially women, are fighting for reproductive justice. Although cultural contexts vary, stigma surrouding women’s deviant sexual
behaviour (such as non-reproductive sex, or a lack of desire to bear children) is seen throughout the world (Kumar et al, 2009; Link and Phelan, 2001) . It has been shown time and time again that the key to population growth at replacement level, improving gender equality, and a reproductively healthy female population is information about and control over their reproductive health. It is necessary to remember, however, that biopower did not cease after modernisation. Guillaume & Rossier (2018) write that abortion has been a “key tool in certain population policies”, such as in Bulgaria in the early twentieth century and foceful abortions in China in the 1970s.
One Foucaultian conecpt that provides a good basis for analysis for the position that women seeking abortion find themselves in is his understanding and description of ‘power’. To him, power is neither “a group of institutions and mechanisms that ensure the subservience of the citizens” nor “a general system of dominance exerted by one group over another” (p. 92). Power, for the purposes of this thesis, does not assume total, unquestioned forced through policy implementation by the patriarchal state. Observing power in this way does not allow the subjugated population to have agency nor control over their situations: “Where there is power, there is resistance, and yet, or rather consequently, this resistance is never in a position of exteriority in relation to power.” (p.95). Moreover, according to Federici (2004), women have always taken their reproduction into their own hands, even in the face of strong and often violent repression. Power is therefore multidimensional and -directional, exerted from and against all actors in the sphere in which they operate. The ‘debate’ or public discussion around abortion and birth control in the Netherlands is a constant exchange of power between all parties involved in it, whether they are politicians and journalists who shape discourse in mainstream media, lawmakers, healthcare providers, activist groups, or even a 16-year old girl who makes the choice to have an abortion for the first time. Power is everywhere. As is be presented throughout the course of this project, the participants exert power by subverting the social norm expected from them. This analysis of power enables the participants’ actions to be seen as a form of resistance, but in a way that does not rob them of their agency and individuality.
4. Methodology
In order to investigate people’s experiences, a qualitative approach was taken. This means that ethnographic material was collected by the researcher in the form of interviews, which was then in turn processed through coding into concise, accessible data. This qualitative approach allowed for a more nuanced and in-depth understanding of individual people’s experiences with abortion. Through this method, the sample of participants were able to express how they felt and thought about certain aspects of their experiences, as well as the things that they valued in life and how they made decisions based on those values. Individual interviews were conducted in a location of the participant’s choosing, using a semi-structured interview style. I first made a public post in English in the Facebook group “AUC Girls”, a women-majority network of students and alumni of my old university. This message stated the purpose and motivation for my research, the kind of participants I was looking for, as well as what they could expect from me in the research. From this post I got one respondent, Imani. After some reflection I realised I was asking for quite a lot from my participants without explicitly offering any reward, as well as that I was excluding Dutch-speaking women by writing only in English. Therefore, I made a similar post on the Facebook group “Amsterdam Durft te Vragen” in Dutch, as well as many other inquiry-based Facebook groups in both Dutch and English, offering a €15 compensation per interview (Appendix I). This allowed me to find the remainder of my participants, although many of them kindly refused the payment in the end. All of the interviews were conducted in the period of April and the first two weeks of May 2019. Although most of the participants were Dutch and living in Amsterdam for different reasons, I also travelled to Almere, Leiden, Rotterdam, and Haarlem to interview people living there. Each interview lasted between half an hour and an hour. As can be seen in the recruitment message in Appendix I, there were no specific criteria that were requested of participants. The only requirement for them to be interviewed was that they must have had an abortion in the past five years. Nevertheless, as will be explored in the discussion chapter, the participants that then responded to my
messages and were willing to be interviewed tended to follow a pattern. Nine of the eleven women interviewed were young at the time of their abortion, ranging between seventeen and twenty-two. As will be shown in the results chapters, the women who had their abortions young were less likely to feel doubt or regret, which could explain why their were more prominent in the research as they were more willing to talk about their experiences.
4.1 Methods & Materials
Due to the sensitive nature of this topic, it was important to take the ethics seriously. This was done to protect the participants’ privacy, as well as to be able to work in line with the research done before this. Therefore, a consent for was made outlining the aims of the project, as well as participants’ rights throughout their participation. This included things like the right to withdraw at any point, as well as the fact that all of their identifying information would be altered. During the pilot interview it became apparent that giving them the consent form to sign felt too professional and rigid, creating a bit of tension in the atmosphere (Appendix II). Therefore, for every interview conducted after that the consent form was sent to the participants the day before the interview, as well as being repeated to them in the recording before the interview. Several decisions were made to make the participants feel as comfortable as possible during the interview. First, a semi-structured interview format was chosen to create the feeling of a casual conversation. Some basic guiding questions were prepared beforehand derived from the macro and micro questions, and the rest was left to the flow of the conversation (Appendix III). This allowed me to look more interested, rather than having to constantly look at notes on a piece of paper to see which question to ask next (Bryman, 2012). Second, all participants were invited to pick a meeting spot of their choosing. In our correspondence I made it clear that I was willing to travel to meet them, but that they could pick a spot where they would feel most comfortable. I met most participants were in cafés close to their homes, so that they would not have to travel too far. When this was the case, they were offered a drink. Other participants offered for me to meet them at
their house, which created a sense of camaraderie and equality between me and the interviewees, as they were in the place they felt most comfortable. For example, Safiye was sitting in her living room, and I interviewed her over a cup of tea and a cigarette.
4.2 Data collection and processing
All of the interviews were recorded on my phone after obtaining participants’ consent, transcribed using the online software Transcribe.com, printed out, and coded using an open coding technique, meaning that they were coded and analysed by being grouped into themes that emerged after reading the transcriptions once, with each group given a label to summarise its contents (Bird, 2005). While reading the interview transcripts with the research questions in mind several emergent categories became apparent, including some diverging away from the original research questions. These smaller categories were grouped into three overarching themes essential for answering the research question. The themes that emerged were in particular fertility work, and the burden they felt of avoiding pregnancy as well as the way they felt about failing to avoid a pregnancy. This theme also allowed me to place their experiences in a wider discourse about gender and contraception, as well as how they placed themselves within discourses about pregnancy. The second theme is broader, which is their experiences in the clinics and with their abortions. For many participants who underwent the vacuum aspiration procedure, their experiences in the clinics influenced how they looked back on the experience as a whole. As for the participants who used the abortion pill, this theme contains their physical as well as emotional experience both before and after the procedure. Finally, the last theme is explicitly about how policy decisions and in particular the clinics’ protocols influenced their experience. This section in particular covers the ways they felt about the mandatory five-day waiting period, getting a referral from a general practitioner, the period in which clinics were closed due to bankruptcy, and one story about a woman who disclosed that she had experienced intimate partner violence at home and her disappointing experience with the caregivers at the abortion clinic.
One thing of note is that the women were, on average, interviewed a while after their abortions. Some, as in the case of Emma, had their abortions as recently as three weeks before the interview. Others, as was the case with Samiya and Renske, had had their abortions six or seven years before the interview. This is significant because the data collected therefore consist not of an objective, measurable or even impartial reality. The data consists entirely of memories, both emotional and more factual. Nevertheless, the aim of this is to compile how they experienced their abortions meaning that the only “reality” I am looking to observe is their recollection of the events, as well as their emotional reaction to it now. It is imperative to be aware of the limits of memories - primarily when asking about numerical or other details that people do not generally pay a lot of attention to. For example, there was an attempt to compile an analysis of how long the women had to stay in the clinics on average. It surprised me that a significant majority of the participants were completely unable to even estimate how long they had been in the clinic from beginning to end. This could be attributed to many things, such as the impact of being unconscious due to the anaesthesia as well as the unfamiliar and, in some cases, emotional nature of the events at hand. Moreover, their perceptions of the transpired events could have been influenced over time, due to either changes in culture and discourse, or merely the fact that they are exposed to different kind of opinions or news stories.
5. Discourses on Contraception, Fertility, and the Burden of Responsibility
When young women start going through puberty or become sexually active, there is a certain discourse they become entangled in about the need to control their fertility. Many young women start using the birth control pill or other contraceptive methods which they, and they alone, are responsible for. Very consistently, all of the participants were very proactive about their use of birth control, and used the abortion method as a last resort. This also supported the assumption going into the study, as the process of undergoing an abortion is quite unpleasant, and extremely difficult for some. Therefore, many of them avoided getting pregnant primarily through the use of birth control. Although there was a lot of variation in the methods that they chose, they primarily used the birth control pill or tracking cycles naturally. Almost all of the participants used some kind of birth control, and the ones who did not had their personal reasons not to. For example, Renske suffered from anorexia when she was younger and was led to believe by her doctor that she would not be able to bear children. Safiye had been on many forms of birth control but did not like the way it affected her body. For most of the interviewees, their use of contraception was ineffective, even though they had access to both information and health-related services in order to acquire the means to prevent pregnancy. A study by Treffers (1967) showed that abortion in Amsterdam is not caused by “lack of knowledge of good contraceptives, but by ineffective practice of contraception”. Although this study was conducted primarily in Amsterdam and over four decades ago, the findings from the participants support this idea. Nevertheless, no generalisations can be made about this. For example as will be explored later, Mabel was using a condom with her partner, which failed, and she then took the morning-after pill and still became pregnant. This is a very rare case of two forms of contraception failing, rather than ineffective use by the consumers themselves. This section attempts to explore and analyse the ways in which the interviewed women navigate and use
different contraceptive methods. This leads into the following subsection, wherein it will be shown that most of them use contraception to control in order to delay pregnancy for a later time in their lives. Finally, I will analyse how they saw the abortion as a last resort, whether they felt burdened by the responsibility of avoiding pregnancy, and finally the feelings of failing to do so. This will be tied to wider normative discourses, which dictate that it is the woman’s role in a heterosexual relationship to avoid pregnancy, and a failure to do so is seen as a failure of character.
5.1 Use of contraception
In the selection of participants in long-term relationships, most of the women had plans for long-term forms of birth control. I categorise “long-term” birth control as any form of contraception that lasts longer than a day, which includes things like the pill, the IUD, or the implant. Short-term contraception in this case would be condoms, which very few people in steady, long-term relationships use in Amsterdam (Matser et al, 2014). Only one of the participants, Mabel, was using a condom with her long-term partner. The remaining women in relationships used either the pill, or natural fertility tracking. However, all of them completely took the responsibility of controlled fertility into their own hands. The difficulty with this, is that a few of the participants took their birth control quite lightly, citing that undesired pregnancy “happens to others, not to me”. In this sense, there was a feeling of exceptionalism with relation to pregnancy. Many of them used contraception irregularly, or were in a liminal period of switching between different methods to find one right for them. They consistently articulated a discourse of both being taught to or wanting to control their own fertility, but not expecting pregnancy if birth control were to fail, as Safiye (who was in a long-term relationship at the time) demonstrates below:
“[my boyfriend and I] went to Antwerp for a weekend, and before that I was on birth control, and it was a month before the trip that I quit because the hormones were fucking
everything up. So I actually had an appointment to talk to my GP about birth control, but then at that time I also had the natural cycles app to check it. It wasn’t the day [that I was ovulating] or something, and of course you never think “this is going to happen to me”. Me? No! Other people? Of course!”
In this segment, Safiye articulates her frustration with the pressure to constantly be monitoring and controlling her fertility. The birth control pill comes with a myriad of unpleasant side effects from weight gain to depression, and it makes sense that she would not want these things imposed on her. She therefore resorted to a phone application in order to track her fertile days, an alternative many of the interviewed participants took. However, this method allows for a lot of human error if used improperly, and comes with advantages and disadvantages like all other forms of birth control. For example, although it does not require any unfamiliar or synthetic hormones in the body, natural family planning requires constant monitoring, strong commitment, and abstinence for a large proportion of the menstrual cycle (Pérez, 1998). Still, during this time she was in a long-term committed relationship, and when talking about the way in which she got pregnant she never mentioned her partner or what he was doing to prevent a pregnancy, or if he was even part of the discussion. Once again, even though heterosexual intercourse in these scenarios consists of both men and women together, the responsibility of avoiding pregnancy is almost completely on the woman, because failure comes with consequences more dire for her than him.
5.2 Delaying pregnancy
When looking at abortion as a contraceptive method, many of them had very clear reasons as to why they did not wish to be pregnant, consistent with their reasons for using birth control: they simply did not want to be mothers (at this time in their lives). The reasons were varied: Samiya had just started a new job that she was passionate about, Mabel thought she was too young and felt as though her boyfriend would not be fit
to be a father, and Sofie was too busy with her studies to accommodate a child. Most of the participants therefore described that they used birth control not to avoid pregnancy permanently, but rather as a mechanism to control exactly when they wanted to have children. In every case this had to do with financial instability, insecure living or relationship situations, or simply because they felt that they were too young to have children. In the following quote, Sofie exemplifies this sentiment:
“I was 20 at the time. I was living in Amsterdam, just practically speaking I was thinking “this isn’t going to work.”. I wasn’t with my partner anymore and I didn’t want to be. I really love children, but maybe in 10 years when my life is going well. I was also only getting student loans and didn’t have an income, you know? It just wouldn’t have worked.”
In line with the Netherlands’ model of abortion, caregivers try to prevent it as much as possible in the future by talking about future contraception with the patient, often during the first consultation with the GP and then again during the appointment at the clinic. Again, the responsibility is placed on the woman to avoid pregnancy in the future, as none of the patients were even offered the option of, for example, a vasectomy for their long-term male partner. When undergoing the vacuum aspiration procedure, many of the participants chose to have an IUD placed in their uterus, as they felt it would be simple, long-term, and they would be under anaesthesia anyway so they would not have to worry about the pain. Most of them found it easy, efficient, and appreciated the fact they would not have to feel any additional pain. This demonstrates how many of the participants were forward-thinking with their birth control, and how they used it as a long-term mechanism to delay pregnancy.
5.3 Straying from normative ideas about pregnancy
Continuing in a similar line of thinking, even though women are encouraged to actively control their fertility, it is still expected that they want to give birth later on whether they want to or not. This was explored in an earlier chapter, where Kumar & Mitchell (2009) demonstrate that the inevitability of motherhood is a traditional “feminine” ideal, and going against this comes with a strong stigma. Women are responsible for their fertility, but there are still normative discourses in place about how they should be controlling it. Most of the women did want to have children later in life, but for the ones who do not fit into this pattern seeking permanent sterilisation can be very difficult, as Lieke demonstrates below:
“I never wanted kids. Never. And I always had difficulty with contraception in a lot of ways, so from the time I was 22 I wanted to get sterilised. I went to my doctor three times to ask him to tie my tubes, but he wouldn’t let me get them tied until I was 30. That’s eventually why I got pregnant too. This would have been avoided so easily if he’d just let me get my tubes tied.”
The trouble here is that not only are her complaints about her body not taken seriously by a (male) medical professional, but this dismissal of her desires actually caused her to get pregnant and have to undergo multiple abortions. Moreover, it is clear that her personal choice not to have children is very difficult to make a reality, due to the social deviance of the idea that not all women want to have children (Guillaume & Rossier, 2018). For the participants who already had children, having an abortion was more of a dilemma than for those who did not yet have children of their own. From what they said during interviews, the interviewed mothers (in this case Samiya and Emma) stated their difficulty in getting a late abortion due to their
knowledge of the development of a foetus. At the time of her most recent abortion, Emma already had two children. Her line of thinking is highlighted below:
“I think that when you go to the toilet it all just comes out. I don’t want anything traumatising. When I found out, I was 5 weeks pregnant. If I had been 11 or 12 weeks, I wouldn’t get rid of it. That’s against my principles, I think that’s too far along. In the past I had abortions easily and didn’t think about it. Still, I think even 7 weeks is too far along. At that point they’re already developing, isn’t that piteous (zielig)? At 12 weeks it already has arms and legs!”
Her use of the phrase “it’s against my principles” is interesting in this context. It shows that Emma’s feelings about abortion are not as binary as the public debate often seems to be, as was discussed in the introduction chapter. For Emma’s personal code of ethics, she would not want to have an abortion after the 7th week of pregnancy, regardless of her ability to take care of the baby, due to her feelings of compassion for it at that point. Nevertheless, for the first few weeks of pregnancy she would have no strong feelings toward the baby, which is an interesting piece of information for this research. The same feelings were present in Samiya, which also articulated that due to her knowledge of pregnancy after having had children, she would not want to have an abortion after a certain point. What these two women have in common is that they both had repeated abortions, have multiple children, and are older than thirty. This shows that people’s opinions about abortions are not static, and can change depending on the course of their lives. Moreover, these abortions for them were difficult afterward, as they already knew what it was like to give birth. Samiya in particular stated that she would often look at her children and wonder what it would be like to have another sibling. This is an addition I propose to Kimport’s framework on regret after abortion (2012), which leaves
out experience with pregnancy. For these women, this was clearly a source of potential regret, as well as a reason for them to take time to very consciously make a decision about what they wanted to do.
This chapter provides an insight into how women of all ages are entangled into gendered discourses about their fertility, as well as the burden of fertility work. Long-term reversible contraception was found mostly in the participants who were in long-term relationships, as supported by Matser el at (2014). Nevertheless, many of them used birth control improperly, or were in between different methods when their pregnancy happened, due to a feeling of exceptionalism about pregnancy (“pregnancy happens to other people, not to me”). Finally, using contraception to delay pregnancy in order to raise a child in better circumstances was the norm in both the participants and the normative discourses they positioned themselves in. However, Lieke demonstrated that going against the norm of eventually desiring children can cause difficulties, exemplified by her doctor’s refusal to “let her” be sterilised. These discourses are strongly gendered, and cause a feeling of disappointment at the failure to produce the behaviours expected of them.
