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The recent ANNALS reflection entitled On Abortion and Autonomy: A Letter to My Unborn Daughter provides a unique perspective on the Dobbs ruling. The differences between those who identify as “pro-choice” and those who identify as “pro-life” has led to conflict, outrage, and even violence. Is there a way physicians on each side of the chasm can build a bridge between these two diametrically opposed viewpoints? One way to begin is to acknowledge the truths that each side brings to the table. The “pro-choice” side highlights the fact that throughout history up to the present day, women have been a mistreated group with little power and limited ability to make decisions about what is best for them. They emphasize the fact that women experience profoundly more, if not all, the harmful and, at times, life threatening physical, emotional, financial, and social effects of pregnancy and childbirth. To this side, it is a matter of the ethical principle of autonomy why women should have the right to abortion. The “pro-life” side highlights the biological fact that pregnancy is the process whereby a distinct and separate living human being is growing and developing inside a woman’s uterus beginning at the time of conception. To this side, the growing human’s right to life takes precedence over a woman’s right to end the pregnancy.
There are many intelligent, well-meaning physicians in both camps. What are the are ways that physicians of good will from both viewpoints can work together to support women’s autonomy, protect women’s health, AND respect the life of the developing human? The following might be ways to start:
1) Make unwanted pregnancies rare.
a. Improve sex education
i. Teens and young adults must know sexual activity has consequences. Abortion is not a free pass.
ii. Men and boys must take and bear responsibility for their roles in creating a pregnancy.
b. Media must “desexualize”. Similar to how cigarette smoking was once romanticized in print media, TV, and movies, the media has a role in not portraying sexual activity as “cool”, fun, and risk free.
2) No woman should feel the need to abort for financial, educational, or social reasons.
a. There should be financial support for pregnant women and those with young children.
b. All women should have maternity and family leave available to them.
c. There should be affordable child care available for anyone who wants or needs it.
d. Schools, including colleges and universities, should have adequate support so pregnant students and new mothers can continue their educations.
e. There must be adequate mental health services for women before, during, and after pregnancy.
I agree with Dr. Krinsky’s assessment that her daughter is one of the “lucky kids” - starting with the fact that her mom is giving her the opportunity to “grow up”. I also share Dr. Krinsky’s wish that she grows up to “have compassion and humility, to care about people and respect their bodies and decisions”, and I would add “from conception to natural death”.