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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Andy Burnham and Sadiq Khan are both slippery self-mythologisers – so why do we rate one more than the other?

Their obsessions with their childhoods have both become punchlines; but one of these jokes, it feels to me, is told with a lot more affection than the other.

Andy Burnham is a man whose policies and opinions seem to owe more to political expediency than they do to belief. He bangs on to the point of tedium about his own class, background and interests. As a result he’s widely seen as an unprincipled flip-flopper.

Sadiq Khan is a man whose policies and opinions seem to owe more to political expediency than they do to belief. He bangs on to the point of tedium about his own class, background and interests. As a result he’s the hugely popular mayor of London, the voice of those who’d be proud to think of themselves as the metropolitan liberal elite, and is even talked of as a possible future leader of the Labour party.

Oh, and also they were both born in 1970. So that’s a thing they have in common, too.

Why it is this approach to politics should have worked so much better for the mayor of London than the would-be mayor of Manchester is something I’ve been trying to work out for a while. There are definite parallels between Burnham’s attempts to present himself as a normal northern bloke who likes normal things like football, and Sadiq’s endless reminders that he’s a sarf London geezer whose dad drove a bus. They’ve both become punchlines; but one of these jokes, it feels to me, is told with a lot more affection than the other.

And yes, Burnham apparent tendency to switch sides, on everything from NHS privatisation to the 2015 welfare vote to the leadership of Jeremy Corbyn, has given him a reputation for slipperiness. But Sadiq’s core campaign pledge was to freeze London transport fares; everyone said it was nonsense, and true to form it was, and you’d be hard pressed to find an observer who thought this an atypical lapse on the mayor’s part. (Khan, too, has switched sides on the matter of Jeremy Corbyn.)

 And yet, he seems to get away with this, in a way that Burnham doesn’t. His low-level duplicity is factored in, and it’s hard to judge him for it because, well, it’s just what he’s like, isn’t it? For a long time, the Tory leadership’s line on London’s last mayor was “Boris is Boris”, meaning, look, we don’t trust him either, but what you gonna do? Well: Sadiq is Sadiq.

Even the names we refer to them by suggest that one of these two guys is viewed very differently from the other. I’ve instinctively slipped into referring to the mayor of London by his first name: he’s always Sadiq, not Khan, just as his predecessors were Boris and Ken. But, despite Eoin Clarke’s brief attempt to promote his 2015 leadership campaign with a twitter feed called “Labour Andy”, Burnham is still Burnham: formal, not familiar. 

I’ve a few theories to explain all this, though I’ve no idea which is correct. For a while I’ve assumed it’s about sincerity. When Sadiq Khan mentions his dad’s bus for the 257th time in a day, he does it with a wink to the audience, making a crack about the fact he won’t stop going on about it. That way, the message gets through to the punters at home who are only half listening, but the bored lobby hacks who’ve heard this routine two dozen times before feel they’re in the joke.

Burnham, it seems to me, lacks this lightness of touch: when he won’t stop banging on about the fact he grew up in the north, it feels uncomfortably like he means it. And to take yourself seriously in politics is sometimes to invite others to make jokes at your expense.

Then again, perhaps the problem is that Burnham isn’t quite sincere enough. Sadiq Khan genuinely is the son of a bus-driving immigrant: he may keep going on about it, but it is at least true. Burnham’s “just a northern lad” narrative is true, too, but excludes some crucial facts: that he went to Cambridge, and was working in Parliament aged 24. Perhaps that shouldn’t change how we interpret his story; but I fear, nonetheless, it does.

Maybe that’s not it, though: maybe I’m just another London media snob. Because Burnham did grow up at the disadvantaged end of the country, a region where, for too many people, chasing opportunities means leaving. The idea London is a city where the son of a bus driver can become mayor flatters our metropolitan self-image; the idea that a northerner who wants to build a career in politics has to head south at the earliest opportunity does the opposite. 

So if we roll our eyes when Burnham talks about the north, perhaps that reflects badly on us, not him: the opposite of northern chippiness is southern snobbery.

There’s one last possibility for why we may rate Sadiq Khan more highly than Andy Burnham: Sadiq Khan won. We can titter a little at the jokes and the fibs but he is, nonetheless, mayor of London. Andy Burnham is just the bloke who lost two Labour leadership campaigns.

At least – for now. In six weeks time, he’s highly likely to the first mayor of Greater Manchester. Slipperiness is not the worst quality in a mayor; and so much of the job will be about banging the drum for the city, and the region, that Burnham’s tendency to wear his northernness on his sleeve will be a positive boon.

Sadiq Khan’s stature has grown because the fact he became London’s mayor seems to say something, about the kind of city London is and the kind we want it to be. Perhaps, after May, Andy Burnham can do the same for the north – and the north can do the same for Andy Burnham.

Jonn Elledge edits the New Statesman's sister site CityMetric, and writes for the NS about subjects including politics, history and Daniel Hannan. You can find him on Twitter or Facebook.