Chapter 7: The Price of Motherhood
As an obstetrician, my brain continually provided me with helpful information about all the different ways I could die. I was absolutely certain that I would die of an amniotic fluid embolism or some other horrible way, like Smita Patil had died a few years ago. If not, then there was always DIC, thromboembolism, meningitis due to spinal anesthesia, or postpartum hemorrhage.
The frightening and numbing realization that you are no longer in control of your body and are completely dependent on someone else to do the right thing is a feeling that never really leaves you. And anyone who hasn’t experienced this helplessness can never truly understand what it feels like on the deepest level.
The frightening and numbing realization that you are no longer in control of your body and are completely dependent on someone else to do the right thing is a feeling that never really leaves you.
Given all this knowledge, it makes me angry when someone starts talking about “father’s rights.”
Sure, buddy, the day fathers die during pregnancy and childbirth and we start measuring father mortality, that’s the day we can start having this conversation. Until then, fatherhood is just a privilege and a responsibility.
“But why abortion?” People used to ask me when I co-founded the Asia Safe Abortion Partnership.
What they probably meant was, of all the ways to use your expertise, make money, and serve women, why would you choose this uncomfortable and difficult topic?
I always told them that in some ways I didn’t make it my life’s purpose or my career. It chose me.
During ObGyn’s residency, surgical abortions and second trimester abortions were simply part of everyday work. I never saw what we did for women as anything special or amazing.
But as a practicing gynecologist in the outside world and a slowly evolving feminist, when I saw the absolute relief and joy on the faces of the women on the ward at the London Hospital where they had performed early termination of pregnancy (TOP) with mifepristone in 1999, I realized that this was incredibly important work.
I also worked in an early pregnancy unit at UCH when a longed-for pregnancy sometimes brought bad news. I saw these women experience very different emotions at the end of their pregnancy. I discovered my growing interest in women’s health and human rights issues through taking various courses offered. During my stay in London, I attended a special course on dealing with victims of sexual assault. A few years later, I enrolled in the first-ever summer course at Johns Hopkins University on “Prison Health Management.” My final submission paper can be found in the appendices.
In the public debate, contraception and abortion continue to be portrayed as opposites, as if to say, “If you have contraception, why would you ever need an abortion?”
But this is a false dichotomy – a logical fallacy in which only two mutually exclusive options are presented as if they were the only possibilities, and all other potential alternatives or middle paths are ignored.
In the public debate, contraception and abortion continue to be portrayed as opposites, as if to say, “If you have contraception, why would you ever need an abortion?” But this is a false dichotomy.
Although contraception reduces unwanted pregnancies, it does not eliminate them. Every spacing method – like pills, IUDs, condoms, implants – has a margin of error, whether due to human error or inherent to the method. There are documented cases of women becoming pregnant even after hysterectomies or tubal ligation.
After all, the two imperatives of life are: survival and reproduction.
An average woman in modern times has about 400 menstrual cycles between the ages of 10 and 50. Not everyone may ovulate, but even if it’s only 300, that’s a huge number of times one could get pregnant compared to the current desire for one or even zero children.
The emergency contraceptive pill (ECP) is often promoted as a miracle pill, but it also has its limitations. The greatest effect occurs within 12 hours, the effect wears off after 72 hours. It doesn’t work as well when ovulation has already occurred and is less reliable for women over a certain body weight.5 These nuances rarely make it into public discussion, leaving women to blame.
Even with perfect contraception, an abortion will always be necessary because pregnancies do not exist in a vacuum. Even a planned and wanted pregnancy can become unwanted due to changing circumstances. A relationship may fail, a partner may become abusive or leave or die, finances may collapse, or the pregnant person’s health may change overnight.
And of course the many hundreds and thousands of pregnancies that occur due to rape and incest do not exactly fall into the realm of perfect contraception. In fact, as stealthing (where the male partner secretly removes the condom just before penetration) increases, the risk of unwanted pregnancy increases, even in negotiated encounters.
To view abortion as merely a “substitute” for a rare event of failed contraception is to ignore the messy and dynamic terrain of real life.
The real choice is not contraception or abortion, but whether we build systems that recognize women as full human beings with the right to change, adapt, and choose, or whether we continue to act as if biology and patriarchy should work together to determine their fate.
The truth is that there will never be a world in which abortion is not necessary at all, because human lives and relationships are too complex, too fragile, and too unpredictable.
The real choice is not contraception or abortion, but whether we build systems that recognize women as full human beings with the right to change, adapt, and choose, or whether we continue to act as if biology and patriarchy should work together to determine their fate.
Every advance in reproductive technology, contraception, emergency pills, legal abortion and medical abortion pills removes one obstacle, but society immediately puts another in its way – stigma, inequality, fines or outright criminalization.
On the other hand, despite pregnancy tracking, compulsory institutional delivery and “respectful” maternity care programs, women in many countries still do not receive the full dose of TT or at least four antenatal visits, are severely anemic, malnourished, die in the delivery room and in the postpartum period, suffer from postpartum depression, are exposed to increasing violence during the delivery of a girl, and are at significantly higher risk of being killed by their partner.
Women pay a high price for becoming mothers, but also for choosing not to become mothers.
Hmm…it’s almost like the systems hate women.
Excerpted with permission from “A Is For Abortion” by Dr. Suchitra Dalvie, published by Beeja House.
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