Abortion and Ideological Agency in the American Medical Sphere

Hubbs – A Contentious Practice 1

A Contentious Practice:

Abortion and Ideological Agency in the American Medical Sphere

Christine Hubbs

200311512

ANTH 343 – Medical Anthropology

Term Paper

Dr. Marcia Calkowski

December 3rd, 2013

Introduction

The American biomedical sphere is not the rational system it purports to be. Medical procedures are understood from a wide variety of viewpoints, and this allows some issues to become so contentious that they blatantly challenge the idea that biomedicine exists apart from the social world. Abortion is one of the United States’ most visible instances of medical contention. By employing the research question of why the medical procedure is so contentious, this paper will highlight some of the predominant themes that arise from discussion of abortion. A description of the social factors which inform the procedure will first contextualize this analysis. Two loose topics, gender and personhood, will be explored to outline the ways in which Americans attempt to make sense of the procedure. Finally, an analysis of the “values” Americans employ, as well as the ways in which the medical system itself is constructed, will highlight the ideological ambiguities present in the abortion debate. This paper argues that abortion is contentious partially because American people desire both a standardized medical system and a medical sphere which reflects back to them a portion of themselves. Whether one supports, vilifies, or altogether ignores the availability of the procedure, abortion is a moral touchstone at the centre of a much larger attempt of Americans to navigate their medical sphere while retaining their ideological agency.

An Overview of Abortion

There is a notion in the United States that abortion is a fringe procedure (Erdreich 2009: 69), but in reality, it is far more common than this discourse suggests. An estimated 25% of American pregnancies end in elective abortion, and roughly 35% of women have had one at some point of their lives (Torr 2006: 12). While age and poverty-levels do come into play, there is no stereotypical abortion recipient (Darney and Stewart 2006: 54).

Abortion in the United States is far from easily-accessible. Facilities are not evenly spread across the country, and 87% of American counties lack abortion providers altogether (Erdreich 2013: 48). The average abortion costs between $300 and $900, a price which rises by an additional $100 per week after the twelfth week of pregnancy (Erdreich 2013: 169). Women in areas devoid of abortion care may have to travel extensively for the procedure (Joffe 2009: 5), and many states have legislation which requires mandatory ultrasounds and counselling. Very little of this, if any, is covered by insurance (Erdreich 2013: 169). The financial circumstances of a prospective abortion recipient figure greatly in her medical experience.

The history of abortion in America is fraught with contention. Abortion became legal in 1973 with the infamous Roe v. Wade case, when America’s highest court found that the Fourth Amendment right to personal privacy protects the availability of the procedure (Torr 2006: 10). While this means first-trimester abortion cannot be outright banned, individual states are permitted to impose stringent regulations (Torr 2006: 11). Parental notification, spousal consent, waiting periods, and even mandatory viewing of the ultrasound are requirements many states have adopted with public support in an effort to curtail abortion numbers (Joffe 2009: 14). It may seem strange that such public interest has been taken in the regulation of a medical procedure, but some claim that abortion was always more of a political issue than a health one (Crandall 2006: 60). America is considered unique in the extent to which abortion ideology figures in domestic politics (Joffe 2009: 6, 9).

Coupled with structural restrictions is the intense controversy which defines how abortion is understood. The abortion debate commonly centers on whether it should be normalized within the medical system or outright banned, but the enactment of these opinions can become problematic. Since Roe, eight people in the abortion-providing community have been murdered because of their profession, and others have been threatened and stalked; abortion clinics have been picketed, vandalized, and firebombed; and, opponents of the procedure have videotaped patients entering clinics (Joffe 2009: xi). Those who support legal abortion employ the rhetoric that doctors are expected to “provide medical care in a war zone” (Erdreich 2013: 153), and a reluctance to provide statistics for abortion-related injuries suggests “bad medicine is glossed over in the name of choice” (Crandall 2006: 65). Abortion is clearly much more than a procedure to terminate pregnancy; it is a multivocal symbol, something which expresses meanings beyond itself (Ohnuki-Tierney 1984: 157). It is through this lens that the question of why abortion has become such a contentious medical procedure is explored.

Gender and Reproduction

It is not feasible to analyze the issue of abortion without discussing gender. Those who undergo the procedure are biologically female, and such is how they are defined within the medical system (Allen and Wiley 2013: 149). The biomedical emphasis on reproductive capacity seems to leave little room for gender as a social construct, yet ideas of gender roles constructed around reproduction are implicit. Some highlight that reproduction in America is highly romanticized, and for women “having a child is considered one of the most natural and biological impulses” (Erdreich 2013: 180). Because the nuclear family is seen as “the cornerstone of American society”, choosing not to have a child challenges one’s ascribed gender identity (Erdreich 2013: 180). Some feel that a woman’s social role is tied to childbearing, so a childless woman is inherently contentious (Allen and Wiley 2013: 165). While this may be true, it should be noted that many American men choose to remain childless as well (Erdreich 2013: 224). The issue of abortion in the United States is not informed solely by the idea that women should have children.

Notions of female identity discussed in American biomedicine are informed by much more than biology. While people may understand medicine as scientifically based, “even the most self-evident ‘givens’ of sexual embodiment belong not to some ubiquitous human nature but to the shifting world of cultural meanings” (di Leonardo and Lancaster 1997: 1). Emily Martin claims antiquated ideas of female reproduction are present in today’s medical practice (Larkin and Robbins 2007: 255). The idea that the female eggs “wait patiently” for the male sperm (Allen and Wiley 2013: 150) is coupled with the adage that “menstruation is the uterus crying for lack of a baby” (Larkin and Robbins 2007: 255), and such ideas are part of what inform medical practitioners’ knowledge of female health. The way people perceive the body itself reflects society (Laqueur 1997: 221). Michel Foucault views the body as something constructed by discourse, or the ways in which the surrounding society discusses, understands, and presents it (Shilling 2003: 65). In this light, the idea of the female body becomes subject to the dominant views of American culture (Shilling 2003: 65). While this is not to devalue the individual, this idea highlights that the female body has become a site for political discourse (Laqueur 1997: 219), of which abortion is one of the foremost debates.

Gender may figure greatly in how Americans understand social identity, but it is certainly not the only contributing factor. Many also operate under the assumption that the body is less important than the mind. There is the notion that “liberalism postulates a body that, if not sexless, is nevertheless undifferentiated in its desires, interest, or capacity to reason” (Laqueur 1997: 229). The body can therefore be considered a container for the rational person, and rational people ostensibly have equal potential. This places the idea that identity depends on a person’s reproductive capacity in jeopardy, because it stands at odds with Americans’ dualistic conception of the body and person (Lock 2002: 95). These contradictions regarding gender become particularly delicate in the discussion of abortion, for on the one hand fertility is still largely constructed as the woman’s “purpose” (Allen and Wiley 2013: 164), but on the other, ideas of individualism, equality, and privacy form the notion that the woman’s body should be inviolable (Erdreich 2013: 179).

While gender, the body, and female reproduction cannot be wholly extracted from discussion of abortion, the medical practice itself and its surrounding discourse must be viewed as something larger than a feminist issue. It is true that only women who are biologically capable of reproduction can undergo the procedure, but it is also true that people of all gender roles, ages, and statuses form the wider social world in which abortion takes place. One American abortion provider emphasized that safe access to abortion “is a reflection of our society’s values… egalitarianism and freedom in general” (Erdreich 2013: 224).

Questions of Personhood

The concept of personhood is highly visible amidst the contention about abortion, and the patient’s experience is no exception. Generally speaking, some consider the entrance to the biomedical sphere an instance wherein a person’s identity is modified. Erving Goffman postulates that patients are depersonalized when they enter a medical institute, because it is necessary for them to put aside their normal identity and adopt the specific role of the patient – complete with normative behaviours, attire, and responses – for the overall medical structure to function (Gambino 2013: 53). While this idea has been criticized for its reifying and fatalistic tone (Gambino 2013: 53), it eloquently highlights the discomfort people may feel when they enter a clinic and essentially grant strangers access to their body. This does not mean that the patient’s constitution as a person is drastically changed, but rather that her personhood has the potential to become exaggeratedly context-dependant.

It is crucial to note that not only are patients treated in a standardized way in biomedicine, but that these standards do not always reflect what the average American considers empirical knowledge. How a patient is treated by doctors is often determined by the legal system, and increasingly by politicians (Joffe 2009: 71). The medical standards for abortion vary from state to state, yet some areas – such as Texas – have introduced so many abortion regulations that many patients are unable to receive the medical procedure they feel they are entitled to (Erdreich 2013: 88). In addition to this, how medical experts are permitted to discuss abortion with a patient may be limited because of the ideological rhetoric required, such as South Dakota’s mandate that an abortion cannot occur until a woman’s doctor stresses she is “terminating the life of a whole, separate, unique, living human being” (Joffe 2009: 3). Such statements confer to the patient that her abortion casts her in a negative light, something which undoubtedly affects her view of the procedure. While the medical sphere and the legal system which regulates it are by no means completely hegemonic, they do play a strong role in the patient’s subjective medical experience.

Much of how the average abortion recipient’s personhood is constituted, in terms of how the social world views her and how she views herself, is also informed by social opinion. Talcott Parsons claims the individualistic Americans are more concerned with a patient’s inability to fill her social role rather than with her suffering, and the patient is expected to deal with her medical issues independently (1963: 23). The experience of suffering itself is a social product (Baer, Singer, and Susser 2003: 7), which suggests that some of the emotions an abortion recipient feels may be encouraged by the social world she occupies. Since diagnosis “bears heavily on the kind of person one is taken to be, both in and out of the clinic” (Buchbinder 2011: 458), the way a person’s medical procedure is viewed can result in the discourse that “certain types of people are seen as more deserving of treatment” (Buchbinder 2011: 459). Stigma, a situation in which a person cannot achieve “full social acceptance” (Joffe 2009:3), is frequently associated with the abortion recipient. Goffman’s view of social stigma is that those who bear the brunt of it develop “a spoiled identity”, in that the stigma continues to define the stigmatized socially even after whatever situation encouraged it is over (Joffe 2009: 3). An abortion recipient may face direct stigmatization from others; antiabortionists sometimes cluster around clinics to see who enters, seeking to “out” recipients to their communities (Joffe 2009: 116), and many who picket abortion clinics protest that the procedure can be equated with genocide (Erdreich 2013: 178).

When an American woman considers an abortion, she is aware that her actions are politically and socially charged no matter what she ultimately decides. Even those who undergo the procedure with no regrets sometimes state they should feel guilty, because that is what they consider the normative response (Joffe 2009: 136). The rhetoric that abortion is selfish and immoral, while commonly found within groups who oppose it, is noted by providers to also be a dominant mentality among abortion recipients (Joffe 2009: 137). This becomes problematic because patients may feel stigmatized even in situations where nobody but clinic staff is aware of their procedure (Erdreich 2013: 88). While Americans say everyone has the right to personal integrity (Borgmann and Weiss 2006: 24), in practice it seems that many are unsure how this concept applies to medical issues. Meanwhile, even when demoralizing tactics on the part of government and society do not work, the patient may still internalize cultural messages about themselves and take on stigma regardless of how they perceive their supposed medical rights (Joffe 2009: 114).