Newborn babies at a hospital in Kolkata. Photo: Dibyangshu Sarkar/AFP/Getty Images
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Why is it still controversial to say that women should make the decisions about childbirth?

Rebecca Schiller’s All That Matters is a brief but important book.

The task was to endure the most bizarre experience of my life, the feeling, painless, of someone yanking all of your organs out. I am a vessel, only. I am something to be pillaged. I am a cabinet, a pantry door. I am lying naked on a table in a cold room under bright lights, my arms splayed out to form a T, and a team of people are gathered around my body, peering in.

A Birth Story, Meaghan O’Connell, quoted in Rebecca Schiller’s All That Matters

How much choice should a woman have in childbirth? Should she lie there, passive, while others slit her open and root around for the prize? Should she grit her teeth while her perineum is cut and those around her tell her what a “good girl” she is? Should she go it alone, fearing intervention more than pain itself? Who gets to decide? The answer provided by Rebecca Schiller’s All That Matters is straightforward: she should decide, always.

It’s a simple statement but also one that is deeply controversial. When we think about choice in childbirth, we have in the back of our minds the ultimate deal-breaker: no one wants an unhappy labour but “a healthy baby is all that matters.” A woman should have the right to choose except in all those instances when she shouldn’t. Schiller’s is the first book I’ve read which dares to challenge this head-on:

I want to say that a healthy baby is not all that matters and that, resoundingly, it all matters. This is the story of women, of why they matter too, and the things that happen when they are pushed to the bottom of a hierarchy in birth.

There are no ifs or buts. “It is,” writes Schiller, “challenging and uncomfortable to accept that if we respect women’s autonomy in pregnancy, they may not always make what we consider to be the right decisions for their baby.” We have to do it anyway, not simply on the basis that most women will do the things that meet with our approval, but that she is the guardian of her own foetus. The two are not, as Schiller puts it, “competing entities.” We owe it to the woman who “nourishes and sustains the foetus inside her womb, with all the risks to her own health and life that that brings with it” to respect her humanity.  

Schiller’s detailed, passionate study of birth rights looks at women from a broad range of countries, some wealthy, some poor. As such it puts paid to the glib assumption that choice in childbirth is merely a concern for the privileged, fussing over mood music and aromatherapy candles, while the rest of the world would be happy to slum it with a no-frills hospital labour. It is not so simple. Choice in childbirth is about a woman’s identity, her culture, her sense of self and her right to be treated as a person in her own right. The alternative to a pregnant woman’s own choice is not necessarily “the right choice”; it is merely someone else’s choice. While that someone else may have knowledge that a pregnant woman does not, his or her choice can still be influenced by misogyny, racism and class prejudice. It is a choice which cannot fully take into account the inner life, needs and fears of an individual woman about to give birth.

The most shocking sections of the book focus on choice – or lack of it – not in developing countries but in the US. The world’s largest economy has a maternal death rate of 28 per 100,000 (for the UK it is 8, while for Sweden it is 4) while the infant mortality rate is more than three times higher than that of Finland or Japan, despite considerably more spending on healthcare. Amnesty International calls US maternal healthcare “a human rights failure”. While much of this can be put down to broader failings within the US healthcare system, plus the impact of economic and racial inequalities (African-American women are four times more likely to die of pregnancy-related causes than their white counterparts), it is striking that this is happening in a country which seems increasingly obsessed with protecting “the unborn child” – albeit not from the impact of poverty or racism on the mother, but from the mother herself.

Schiller describes how a study run by the organisation National Advocates for Pregnant Women found that between 1973 and 2005 413 pregnant women in the US were either arrested or subjected to forced interventions; between 2005 and 2013 that number was 380. Cases included women being arrested for drinking alcohol in pregnancy, charged with feticide following miscarriage or stillbirth and accused of “appropriating a child whilst in utero” by moving to a different state to the one in which the father lived. The NAPW’s Lynn Paltrow “points to a direct link between this massive upswing in punitive measures for pregnant women and what the Guttmacher Institute describes as a “seismic shift” in the number of US states using legal measures to restrict or remove the right to abortion.” Establishing “foetal personhood” legitimises the control of women’s bodies and choices; what it does not do, as the statistics on infant and maternal mortality show, is make the US a safe place for mothers and babies. You could be forgiven for thinking that that control of female flesh is the end in itself; whether mothers and babies live or die is not even a secondary concern. It’s of no concern at all.

All That Matters is a brief but important book, written at a time when here in the UK we are witnessing an increased number of “benevolent” attacks on women’s bodily autonomy. As Schiller makes abundantly clear, the current onslaught against pregnancy and abortion rights – the way in which the erosion of one set of rights implicitly supports the erosion of the other – requires a united front. We cannot fight tooth and nail for the right to choose not to be pregnant while leaving the destiny of those who choose to remain pregnant to chance. If we do not respect what pregnancy is and does – what it takes from a woman and what she brings to it – then how can we understand the impact of denying her an abortion? If we create a false distinction between the foetus and the woman who sustains it, what is to stop us from swooping in to protect this supposedly independent person? Whether we are denying a woman an abortion, imprisoning her for taking drugs in pregnancy or forcing her to have a caesarean against her will, in each case we are treating her as less than human. It is not a price worth paying, at least not by anyone who values human life once it is outside of the womb, too.

For women, pregnancy rights are human rights because they play a fundamental role in defining whether our bodies are seen to exist for us or for others. This has an impact not just on abortion rights, but on other areas concerning female bodily autonomy, such as rape legislation and the sex trade. What happens to a pregnant woman reflects what happens to all women, even those who never conceive. If she cannot say “no, this is where I start and others end”, why should any other woman? Hard-won rights are being eroded at a frightening pace and the foetus – I will not call it “unborn child” – is being used as a weapon by those who claim to have its best interests at heart. Female bodies are not merely a means to an end. We do not exist solely for others, neither for men nor for foetuses. Even if we are made to feel it, we are never just “a vessel … something to be pillaged … a cabinet, a pantry door”. And this is what is meant when we talk about women having a right to choose – not the right to choose anything, but the right not to be subject to another’s choices over what should happen to our most intimate selves and the babies whom only we can choose to birth and love.

Glosswitch is a feminist mother of three who works in publishing.

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Why Angela Merkel's comments about the UK and US shouldn't be given too much weight

The Chancellor's comments are aimed at a domestic and European audience, and she won't be abandoning Anglo-German relationships just yet.

Angela Merkel’s latest remarks do not seem well-judged but should not be given undue significance. Speaking as part of a rally in Munich for her sister party, the CSU, the German Chancellor claimed “we Europeans must really take our own fate into our hands”.

The comments should be read in the context of September's German elections and Merkel’s determination to restrain the fortune of her main political rival, Martin Schulz – obviously a strong Europhile and a committed Trump critic. Sigmar Gabriel - previously seen as a candidate to lead the left-wing SPD - has for some time been pressing for Germany and Europe to have “enough self-confidence” to stand up to Trump. He called for a “self-confident position, not just on behalf of us Germans but all Europeans”. Merkel is in part responding to this pressure.

Her words were well received by her audience. The beer hall crowd erupted into sustained applause. But taking an implicit pop at Donald Trump is hardly likely to be a divisive tactic at such a gathering. Criticising the UK post-Brexit and the US under Trump is the sort of virtue signalling guaranteed to ensure a good clap.

It’s not clear that the comments represent that much of a new departure, as she herself has since claimed. She said something similar earlier this year. In January, after the publication of Donald Trump’s interview with The Times and Bild, she said that “we Europeans have our fate in our own hands”.

At one level what Merkel said is something of a truism: in two year’s time Britain will no longer be directly deciding the fate of the EU. In future no British Prime Minister will attend the European Council, and British MEPs will leave the Parliament at the next round of European elections in 2019. Yet Merkel’s words “we Europeans”, conflate Europe and the EU, something she has previously rejected. Back in July last year, at a joint press conference with Theresa May, she said: “the UK after all remains part of Europe, if not of the Union”.

At the same press conference, Merkel also confirmed that the EU and the UK would need to continue to work together. At that time she even used the first person plural to include Britain, saying “we have certain missions also to fulfil with the rest of the world” – there the ‘we’ meant Britain and the EU, now the 'we' excludes Britain.

Her comments surely also mark a frustration born of difficulties at the G7 summit over climate change, but Britain and Germany agreed at the meeting in Sicily on the Paris Accord. More broadly, the next few months will be crucial for determining the future relationship between Britain and the EU. There will be many difficult negotiations ahead.

Merkel is widely expected to remain the German Chancellor after this autumn’s election. As the single most powerful individual in the EU27, she is the most crucial person in determining future relations between the UK and the EU. Indeed, to some extent, it was her intransigence during Cameron’s ‘renegotiation’ which precipitated Brexit itself. She also needs to watch with care growing irritation across the EU at the (perceived) extent of German influence and control over the institutions and direction of the European project. Recent reports in the Frankfurter Allgemeine Zeitung which suggested a Merkel plan for Jens Weidmann of the Bundesbank to succeed Mario Draghi at the ECB have not gone down well across southern Europe. For those critics, the hands controlling the fate of Europe are Merkel’s.

Brexit remains a crucial challenge for the EU. How the issue is handled will shape the future of the Union. Many across Europe’s capitals are worried that Brussels risks driving Britain further away than Brexit will require; they are worried lest the Channel becomes metaphorically wider and Britain turns its back on the continent. On the UK side, Theresa May has accepted the EU, and particularly Merkel’s, insistence, that there can be no cherry picking, and therefore she has committed to leaving the single market as well as the EU. May has offered a “deep and special” partnership and a comprehensive free trading arrangement. Merkel should welcome Britain’s clarity. She must work with new French President Emmanuel Macron and others to lead the EU towards a new relationship with Britain – a close partnership which protects free trade, security and the other forms of cooperation which benefit all Europeans.

Henry Newman is the director of Open Europe. He tweets @henrynewman.

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