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.
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.