What do the physical costs of pregnancy mean for the abortion debate?

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"My pregnancies were not separate from me," writes Charlotte Shane in the latest issue of Harper's Magazine. "The growth would be impossible without my organic matter; nothing about it occurred without incorporating the material of me." And this awareness of pregnancy's power of physical coercion, its "protracted invasion, debilitation and deadly hazard," brought with it a certain moral knowledge: The realization that she was pregnant "came with the understanding that I had the right not to be."

Three weeks ago I promised a series of columns on the pro-choice arguments that have assumed particular importance in the wake of the Supreme Court's Dobbs decision. The first installment covered the argument over whether exceptions to abortion restrictions can fully protect the life of the pregnant woman when it's threatened. This essay picks up where that one left off, with arguments like Shane's — which suggest that regardless of whether an unwanted pregnancy is life-threatening, it still constitutes a form of bondage, bodily torment, trauma or transformation that the law should not require a woman to endure.

Shane's essay is just one recent example of this theme. In May, Irin Carmon wrote for New York magazine about her own pregnancy in the context of the leaked draft of the Dobbs decision, setting the transformations involved even in an "easy" pregnancy, and the much more severe burdens that many pregnant women bear, against Justice Samuel Alito's emphasis on the physical development of the first-trimester fetus and embryo. My colleague Pamela Paul made a similar case around the same time, arguing that to expect unwillingly pregnant women to "just" have the baby — and, say, give it up for adoption — is actually to make a radical physical and psychological demand.

The interpretation of pregnancy in these kind of arguments — as a process in which a woman's body isn't just occupied but is taken over, put to use — has an ideological tilt, but it rests on clear biological realities. Here, from a book on the maternal transformation, is a vivid portrait of one part of that process, in which Harvey Kliman, a Yale research scientist, explains how the placenta goes to work on behalf of the newly conceived embryo:

The whole placenta is like a grappling hook swung overhead and cast into the body of the mother. It branches into smaller and smaller hooks, or blood vessels, all designed to draw nutrition from the mom into the fetus. … Under a microscope, Kliman shows me a piece of a woman's uterine lining that, to the naked eye, looks like a slice of fine prosciutto. With a ghostly white arrow he shows how certain placental cells — "They're very aggressive," he says — actually leave the placenta proper and migrate into the tissue of the mother, where they attack her arteries like starved wolves.

The author of this passage, I should mention, is my wife.

So the book of nature absolutely offers support for portrayals of pregnancy as an invasion "commandeering" the female body for a reproductive purpose. Indeed, the dystopia that has influenced pro-choice protest recently, Margaret Atwood's "The Handmaid's Tale," can be seen as a political elaboration of this cellular dynamic — with the commandeering force a literal commander, one of the male leaders of Gilead, raping the enslaved handmaid and imposing his reproductive cells into her flesh.

The Atwood dystopia is extreme enough to be self-undermining as an analogy for Georgia or Texas or Utah today. But the limits of the novel don't change the reality of its biological inspiration — the "invasion" Shane describes. It's true, as she puts it, "there is no process equivalent to pregnancy," no transformative and punishing biological experience that's as commonplace and as inherently sex-segregated. It's true, therefore, that a society that asks women to continue with unwanted pregnancies asks them to do something unique simply by virtue of their being women.

It's true that the physical responsibility for new life is not shared equally between the parties to a sexual encounter, that men perform the same consensual act as women and yet don't get pregnant. It's true that legal abortion offers itself as one potential rectification of this inequity, one clear way to resolve the problem for female equality that biology creates.

And it's true that if you assume a fetus or embryo has no significant moral standing, no meaningful claim to personhood, then abortion can seem like a straightforward form of rescue, akin to removing a unique female disability or curing a disease.

So for those who are uncertain about abortion, who are at least open to the claims made on behalf of human life in utero, I want to raise three questions about the idea of unwanted pregnancy as an experience so harrowing and so unfair that it automatically justifies that life's elimination.

The male default

The first question is about where interpreting pregnancy this way takes feminism in its relationship not just to abortion but to womanhood itself.

Consider that while pregnancy is unique, even just the female capacity to become pregnant has its own unique physical requirements, which are themselves entirely unchosen, a result of a process of maturation rather than a voluntary sexual act. At puberty and cyclically thereafter, even absent the grappling hooks of the placenta, an adult woman inherently experiences forms of vulnerability, transformation and pain that are inequitably distributed between the sexes.

One feminist response to this reality seeks redress and justice by demanding that society organize itself more fully around female vulnerability and mutability, rather than treating the feminine as a weird exception to a male default. But making abortion a core right, an essential measure of female progress toward equality, pushes in the opposite direction: It implies that the male experience is normative, the male body is the neutral human form and the male citizen the desirable default, whose rights and freedoms femaleness can approach only through subtraction, termination. It offers women equality, but at a price, abortion, that men still don't have to pay.

Of course these institutions can theoretically support any female choice, for childbearing or for abortion, just as a pro-choice politics can be supportive of mothers who choose to carry unwanted pregnancies to term.

But even though liberal policy is often more generous in this regard than conservative policy, the cultural default to abortion still has a powerful influence. There is a reason that Planned Parenthood performs more than 100 abortions for every adoption referral that it makes, a reason that liberal states tend to have higher abortion rates, a reason Silicon Valley is so enthusiastic about abortion rights. In the prevailing logic of liberal America, unplanned pregnancy represents danger and disorder, and abortion, safety and normalcy and restoration — with the source of disorder simply cut away.

Lately these kind of questions have surfaced in a new way in the controversies over transgenderism, and especially over the practice of medically suspending a different biological transformation — not pregnancy but puberty itself. On that question feminism seems more doubtful and divided than about abortion. But there are currents linking the two debates, and where there are reasonable feminist doubts about adolescent transgender interventions, there might also be reasonable doubts that a right to abortion is the essential solution to the physical and psychological burdens of unintended pregnancy — as opposed to a right to receive care and support, with an ultimate goal of reconciliation.

The burden and the gift

From the perspective of Shane's essay, of course, the idea that a woman might be reconciled to the burdens of an unsought pregnancy is just the same oppression with a velvet glove. But in actual experience such reconciliation happens all the time — which raises the second issue with the depiction that Shane and others offer of the pregnant woman's predicament. Their argument deliberately isolates the traumatic aspects of childbearing, the better to cast them as a disease or a form of trauma, from the radical gift that pregnancy provides.

For evidence of this reality, it's worth taking up a work that's often cited in pro-choice argument, a research project and 2020 book called "The Turnaway Study," which tried to compare the life experiences of women who wanted an abortion but were denied one, because of legal cutoff dates, with those of women who obtained one.

The findings that the pro-choice side highlights include a relative absence of regret among women who had abortions, on the one hand, and the physical burdens and socioeconomic challenges borne by women who carried their pregnancies to term on the other. On the first point, a frequent pro-life rejoinder is that there was considerable attrition in the study and that women who regretted their abortions may have been more likely to drop out. On the second point, the study's finding seems undeniable: For individual women, bearing and rearing children creates real physical risks and imposes real financial costs. (How much legal abortion reduces such risks in the aggregate, across society as a whole, is a question the last column in this series will take up.)

But the other notable finding from the project is the absence of long-term psychological trauma among most of the women who were denied an abortion. As the author, Diana Greene Foster, writes, there is initial distress when the abortion can't be obtained, but not thereafter:

… once the pregnancy was announced, the baby born, and the unknown fears and expectations realized or overcome, the trajectory of mental health symptoms seems to return to what it would have been if the woman had received an abortion. I admit I was surprised about this finding. I expected that raising a child one wasn't planning to have might be associated with depression or anxiety. But this is not what we found over the long run. Carrying an unwanted pregnancy to term was not associated with mental health harm.

The absence of such distress doesn't prove anything about the rights or wrongs of abortion itself. But it undermines the claim that the harms from undesired pregnancy are so absolute as to simply settle the abortion debate. If enduring an unwanted pregnancy were a form of state-imposed brutality so severe that it automatically legitimated abortion no matter what the moral status of the fetus, you would expect that extremity to have far more significant psychological effects.

So if you can read "The Turnaway Study" as a vindication of the pro-choice position, you could also read its research as a vindication of an alternative, care-centered, pro-life mode of feminism. At the very least, it offers evidence that some of the core problems of unintended pregnancy, like the obstacles to female flourishing generally, are actually problems of resources, health care and emotional support, rather than some irreducible form of trauma that only abortion can relieve.

Does this mean that the Republican Party stands ready to offer those necessary resources? No, emphatically not. But American possibilities are not determined by one party's hypocrisies and failings. To liberals reading this who think, maybe it would be nice to imagine a pro-life feminism, but sadly what we have is the awful GOP, I am not arguing that you should vote for Herschel Walker or submit to the rule of Donald Trump. I am arguing instead, however quixotically, that liberalism and feminism should themselves become more anti-abortion, that blue America has it within its own power to create a world more fully welcoming to life.

If men could get abortions …

My exhortation, obviously, is a man's exhortation about a woman's issue, and all of the arguments I'm making here carry that inherent presumption, since they're based on analysis of a human reality that I can observe, even intimately, but never actually share.

Which brings me to the last question I want to raise about the argument that pregnancy's harrowing elements justify abortion. Some of that argument's power derives from exactly this gulf between male and female experience, via the implication that there is only a question about abortion, only a debate in the first place, because men don't get pregnant and don't know what it's like.

Of course many men are already pro-choice, even zealously so, and many women, including women who have experienced both unintended and dangerous pregnancies, are firmly pro-life.

But still that line has some truth to it. Just from human history, we know that patriarchal societies like pre-Christian Rome have deployed both abortion and infanticide largely for the sake of male convenience, not out of any modern regard for women's rights. In the modern world, abortion has been deliberately turned to misogynist, anti-female ends — as in the dramatic, society-warping use of sex-selective abortion in developing regions of the globe.

So if pregnancy somehow imposed itself physically on men, if we felt threatened by the biological transformation that Charlotte Shane so powerfully describes, there's no question a self-interested patriarchy could find reasons to not only justify abortion but celebrate it.

In other words, yes, of course, the more men's own bodies were directly implicated and affected by the abortion debate, the stronger the masculine incentives to defend or champion abortion might become.

But the great ambition of feminism has always been to right the wrongs of patriarchal power, not merely to match its most self-interested maneuvers. Its aim has been to champion a vision of society free from all forms of oppression and deliberate violence, not just to establish a gender-neutral or gender-reversed equivalent of whatever men in power would impose.