Abortion, contraception, pregnancy: how women’s bodies became a battlezone

According to a draft proposal obtained by Vox in May, and confirmed by a report in the Wall Street Journal in August, the Trump administration is preparing to overhaul the mandate and allow any employer to seek a moral or religious exemption from the requirement. That could mean that millions of women who currently receive contraception for free would have to start paying for it. For many who already struggle to pay for rent and food, birth control is something they may have to give up.

Not everyone sees this as a concern. Donna J Harrison, executive director of the American Association of Pro-Life Obstetricians and Gynaecologists, applauds the likely change.

Such moves also stoke the flames of debate around the question: if women have reduced access to contraception, will abortion rates increase?

Many public-health experts argue that as contraceptive use increases, abortions decrease; after all, both offer means of achieving fertility control. Others, however, say that the increased use of contraception leads to higher abortion rates. (There’s no science to back this claim.)

For Cicely Marston, associate professor of social science at the London School of Hygiene and Tropical Medicine, it’s very simple: “If you are really genuinely anti-abortion then it makes sense to increase access to contraception to as many people as possible.”

Not everyone who has an abortion feels the relief Renee experienced. When 16-year-old Georgette Forney saw the fetus she had had aborted carried away in a stainless steel container, she didn’t know that it would take almost two decades before she found closure. This came when she held a memorial service for Elizabeth, the name she gave to her baby.

“It was healing,” she says from her home in Pennsylvania. “It was a profound way to attack all the pain and take authority over it and own it.” It was also the beginning of her work for a ministry dedicated to ending abortion and her search for more women to speak out about regretting their abortions.

To that end, Forney believes abstinence is the only method to prevent unwanted pregnancy; she doesn’t believe in birth control. “I want abortion to really become unthinkable and unnecessary,” she says.

The things that stop women accessing family planning in India are well documented. But as well as the economic, political and infrastructural obstacles, there’s another kind – the kind that spreads via word of mouth.

Data from India’s latest National Family Health Survey shows that just 1.5 per cent of married women of reproductive age use IUDs – less than a quarter of the equivalent figure in the US.

Experts blame the unpopularity of IUDs in India on myths surrounding their use. These include the belief that an IUD “can go to your brain and make you crazy” or that it “can go to your neck and you can choke and die”, says peer educator Ankita Rawat, who works with young people in New Delhi to improve access to contraception.

I ask Poonam Muttreja if she’s ever come across such rumours. She wobbles her head as if she’s heard it all before. “The fact people are full of myths and misconceptions irritates the hell out of me,” she says. “They are plucked from the sky.”

Nine years ago, when she was 28, Geeta Devi was sterilised at the nearest hospital to her village, about 25 km away. She’d had two sons and, on the advice of the local health worker, it was “time”. She wasn’t driven by the financial incentive ($20 for undergoing the procedure) but rather by her husband’s unwillingness to go for what she called the “chop” (a vasectomy), because of the time off he’d need from his work as a labourer. The operation, he said, would make him weak, meaning he couldn’t tend to the fields. And time off work could be detrimental to the family’s income.

At her mud-brick home in Sampla, a village in Rohtak district in the northern Indian state of Haryana, she wishes men would overcome their fear of vasectomy-induced weakness. “They insist that we get sterilised but men should come forward and take responsibility.”

Many men also believe that sterilisation will reduce their libidos and make sex less pleasurable. (There’s no science to back this claim.)

The government recognises the need to get the onus for family planning off of women – especially in the absence of a wide range of contraceptive options – and increase the popularity of male sterilisation. In its National Health Policy, the government sets an aim of increasing male sterilisation at least six-fold. But how it will reach this goal remains to be seen.

“Men do not take responsibility for family planning – they think it’s the business of women,” Muttreja says. “Family planning is not a women’s issue, it’s a people’s issue. [Men] have to take… more responsibility than women because they have all the agency.” Women, she argues, lack the authority or opportunity to make decisions about childbearing, let alone asking their husbands to get sterilised.

“Women can’t negotiate contraception. It’s something they have to keep to themselves because often even if a woman suggests her husband to wear a condom, she’s seen as promiscuous,” she says.

Sarah Hodges agrees. “No one opts in for sterilisation. These are women who don’t have choice over most things in their life.”

In 2000, the US Food and Drug Administration (FDA) approved the drugs misoprostol and mifepristone to end pregnancy within the first ten weeks – also known as medical abortion. Many people thought that the reproductive revolution had finally arrived.

It was believed that the drugs, which have been shown to be highly effective and safe, would dramatically increase women’s access to abortion. But the excitement was premature. The approval of the pills came with tight restrictions on how they can be distributed – only in clinics, medical offices and hospitals, and only by or under the supervision of a doctor certified to prescribe them, and only to patients who have signed an FDA-approved patient agreement. Those restrictions, the FDA says, are to ensure the safe use of mifepristone.

After the FDA restrictions came state restrictions. In Arkansas, for example, a law was implemented in 2015 requiring providers to counsel patients that medical abortion may be reversed if a woman is given a high dose of progesterone after taking the pills. (There’s no science to back this claim.)

As restrictions on abortion increase, it’s no surprise that women are trying to find their own answers. In fact, Google data shows a surge in searches for the topic of self-induced abortion in the US in 2011 – the same year that marked a steep increase in anti-abortion legislation on a state level.

Increasingly, women are turning to the internet to procure the pills, like they are in many other parts of the world where abortion is illegal or highly restricted.

“How can it be that in a country like Ethiopia, which has poor health infrastructure, you can buy the pills for $5 and just use them?” says Elisa Wells, who in 2014, along with two colleagues, began the Plan C campaign, a website dedicated to giving American women reliable information about medical abortion. “The idea that women have better access to abortion there than women in the US is crazy,” she says.

Wells believes the online revolution could “upend” the system and break down barriers for women. “No longer do you have to find a clinic near you, which is disruptive to your normal life, or far away… you could just get it online and do it from the convenience of your home. You no longer have to walk through the gauntlet of protestors, who are so stigmatising – there’s no need for women to be subjected to that.”

Donna Harrison, from the American Association of Pro-Life Obstetricians and Gynaecologists, is firmly against women obtaining abortion pills online – or at all. She says it’s far more dangerous than surgical abortion, despite studies showing that both procedures, if done correctly, are incredibly safe.

For women looking to procure the pills online, the main concerns – aside for deciphering which websites are fakes – are legal. “We have seen in recent years women who’ve been arrested and sometimes convicted for seeking abortions outside the legal system,” says Elizabeth Nash from the Guttmacher Institute.

“We have to ensure that women can do this safely without the threat of legal prosecution. Ultimately what would be wonderful is if women could access healthcare when they need and not have to use a clandestine process.”

Two years after FDA approval in the US, India followed suit, allowing registered medical practitioners to provide medical abortion at up to seven weeks, in accredited facilities. In 2003 it extended the law to allow these providers to prescribe the drugs in other settings, meaning that women could get the pills over the counter with a prescription. The idea was to deter women from seeking unsafe abortions and ultimately reduce the harm and deaths that these can cause.

But again, the law may say one thing but it plays out differently on the ground. Research shows that over 70 per cent of sales of these drugs take place without prescription, and pharmacists often fail to explain to women how to take the pills or offer traditional medicine instead.

“Traditional or alternative drugs… often lead to complications or incomplete abortion. Often the clients are so poor that they can’t afford the combination of drugs and they don’t want to go to the hospital even if it’s free,” says Rajib Acharya, statistician and demographer at the Population Council in India, a research organisation focused on health issues.

And there remain other major barriers to the uptake of medical abortion, including cost, ignorance and stigma.

At the end of the day many women, Muttreja believes, will still seek out the quack down the road because they fear being seen at the pharmacy. “Do women actually have the courage to go to a pharmacy which is always [run by] a man and ask them to give her medical abortion tablets?” she asks.

Despite their vast physical distance apart and differences in language, culture and so much more, women like Sanathoi and Renee are both part of the story of the monumental challenges women face today: how to manage their bodies in a world where their sexual and reproductive health and rights are increasingly under attack.

Back in New Delhi, Vidya’s mother is slouched by her bed on a stool, sweat dripping down her forehead. Intermittent power cuts temporarily stop the rotting fans and make the already unbearable heat even worse.

“She has brought great shame on the family,” she says, shaking her head as the nurse stands by. Vidya has heard it all before; she doesn’t contradict her mother. In fact, she barely flinches. “Yes, I plan for marriage at the end of the year,” Vidya says, staring into the distance. Silently, she is wheeled off for the procedure.

* Some names have been changed

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