Last night I watched the latest episode of Call The Midwife on catch up. CTM has been my hands-down favourite TV show since it first aired. As any of you who have watched it will know, it is far away from being mere feel-good Sunday night entertainment — it is a living social history document, a fearless one that details the harsh realities of life for women in the mid-twentieth century.
The current series has been absolutely masterful in it’s oh-so-subtle signposting of the stunning plot twist in the penultimate episode: you don’t see it coming, although looking back you realise that the clues were there all along, building to a crescendo. But, then, aren’t there a lot of things in life we only see with hindsight?
It is set this time in 1964: a time when advice on contraception was hard to come by even for married women, and next to impossible for unmarried ones to access; unwed mothers were shamed, stigmatised, and often disowned; abortion was still illegal. Three separate heartbreaking stories of botched illegal, or ‘backstreet’ abortions have been featured, starkly highlighting the difficult and often dangerous predicament women found themselves in as a result of an unwanted pregnancy, and the desperate need for a change in the law that would allow women access to safe, discreet termination of pregnancy — women were literally dying for it.
These storylines left me hugely conflicted. On the one hand I want to celebrate, stand up for, and defend the greater rights, greater safety, and reproductive autonomy that I and my fellow women in the UK now have thanks to the change in the law that came about in 1967. I want to thank those who made it possible … but …
and there is a ‘but’ … because I am looking back at the situation from a distance of 50 years down the track, and things have changed.
Now I see legal abortion, the very thing that was intended to bring greater safety and choice to women, being used as a tool of social engineering, in a way that very subtly co-opts a woman’s ‘right to choose’ and seeks to steer it towards one particular, socially-approved course of action; it also discriminates against another already marginalised and vulnerable group of people.
Now there is a new reality on the block — prenatal screening technology. Back in 1967 there were no prenatal screening tests, or ultrasound scans: pretty much all the midwife could tell you about your baby before birth was what she could feel with her hands or hear with her ears. When abortions were carried out in the years following, it was because the mother’s circumstances made it impossible or undesirable for her to carry or raise any child at that time.
In the 1980s the first tests were introduced that could detect certain ‘conditions’, most notably Down’s Syndrome, in the unborn child. Nowadays more and more women are opting to terminate planned and wanted pregnancies, not because of their circumstances, but because of a particular genetic characteristic of the foetus identified during the screening process — in other words, selective abortion. With the advent of NIPT (Non-invasive Prenatal Testing) we have the potential to analyse the whole foetal genome, however, detecting Down’s Syndrome remains the primary focus of the screening programme. Or should I say, detecting Down’s Syndrome in order to offer the mother a timely termination of pregnancy: because the tests are never marketed as an opportunity for mother and hospital to prepare and plan for the delivery of a baby with an extra chromosome, and they are seldom recommended to expectant women in this way.
Down’s Syndrome is a spontaneously occurring chromosomal difference that renders the person with it perfectly capable of living a good and fulfilling life: capable of learning and educational achievement, of self-awareness and self-determination, of the full range of human emotions, capable of enjoying a wide range of activities and hobbies, often of holding down a job, and most definitely capable of forming positive relationships with others. Down’s Syndrome does cause some degree of learning disability, most commonly mild to moderate in nature, and it does come with an increased likelihood of certain physical characteristics, and certain medical conditions — but most of these are treatable or manageable today. Call The Midwife itself has featured three actors with Down’s Syndrome, two of whom have been centre-stage as fully-fledged characters, indeed Daniel Laurie makes regular appearances as ‘Reggie’.
When Down’s Syndrome is identified in a pregnancy, expectant mothers are often given unduly negative and outdated information, a worst-case-scenario of disaster-movie proportions, and are strongly urged to terminate. Sometimes the push towards termination begins even before the diagnosis has been confirmed. I faced this pressure myself, but I was lucky — when I declared that I wasn’t prepared to consider a termination, my consultant left it at that. There is testimony from many other women who were not so lucky: who found that terminations had been booked for them without their consent on the assumption that that is what they would want, or who, even after they had expressed a commitment to continue their pregnancy, were still repeatedly offered a termination, some even when they arrived for induction of labour carrying baby clothes and a car seat. For every one of those who resisted this pressure how many crumbled after having their judgement questioned and undermined in this way at such a vulnerable time? We hear often about the plight of women still denied abortion: we never hear the stories of women coerced into it against their will or better judgement, but it does happen.
How many of us are truly, completely, pro-choice? How many would support selective abortion on the grounds of the baby’s sex? I suspect most would reject this as discriminatory.
This is why I am so conflicted — because it is impossible to be completely pro-choice if you are anti-discrimination. I might support a woman’s right to seek a termination if something in her own circumstances makes it undesirable to carry or raise ANY child, but I cannot support her right to terminate a previously wanted baby simply because it has Down’s Syndrome, as, whatever you believe about ‘a woman’s right to choose’, the fact remains that selective abortion is an act of discrimination, albeit it a legally-sanctioned one.
It is an act of discrimination that has repercussions for those already born and living with the condition. Once people with Down’s Syndrome come to be seen as ‘disposable’, as a ‘problem’ that can be solved by abortion, then society will no longer see the need to make provision for, or even accept, people with it, believing instead that that they need not, should not, exist. Research will stop, services will disappear, the discrimination and stigma that people with Down’s Syndrome already experience at the hands of others will only get worse. Forced sterilisation and compulsory euthanasia are the spectres that lurk at the far end of this pathway.
Some places are already waking up to the idea that selective abortion is discriminatory. Some states in the US have tried to ban abortion carried out solely on the grounds of Down’s Syndrome, whilst the Netherlands have excluded all anomalies on the 23rd chromosome (the sex chromosome) from NIPT screening as this discriminates against people with intersex conditions. This was achieved by intense lobbying from LGBTQI advocacy groups. Abortion is not always a simple issue of women’s rights. It is an issue of human rights: and there are times when women’s rights intersect with, and conflict with, the human rights of other population groups, most notably those of Disabled people.
This is why I am so conflicted about the issue of abortion. I am not completely anti-abortion per se — I would never want to see a return to the dark reproductive days my grandmother and mother lived through, the days of gin and hot baths and ‘miscarriages’ procured by means of knitting needles, crochet hooks and Daz washing powder. But one thing I very definitely am is anti-discrimination: we should all have the right to live free from that. Which is why I can never, in good conscience, be completely pro-choice, because that would mean being pro-discrimination.