by Ani O'Brien

I am pro-choice. That means exactly what you think it does: I support women’s right to choose to terminate a pregnancy should she not want to go through with it. But it also means a whole lot more than just that.

There is a false binary that I want to challenge in this opinion piece and I suspect both sides will resist me. That is the binary of pro-life versus pro-choice. It is quite clear that I am fundamentally in disagreement with the core premise of the pro-life side, but there is a whole lot that the other side expects me to blindly agree with just because I am not anti-abortion. I am pro-choice, but I am pragmatic. I am not dogmatic about restricting access to abortion, but I am also not dogmatic about forcing everyone to celebrate and facilitate abortions.

Here’s what being pro-choice means to me.

First of all, my support for access to abortion comes with caveats. I do not support abortions up until birth unless the pregnancy becomes unviable (eg. the foetus cannot live outside the womb) or the mother’s life is endangered. In fact, I think that abortions should be performed as early as possible when they are required, for the good of all involved.

I also hold the somewhat (bizarrely) unpopular opinion that although women should have the right to access abortions, they should not be used as a slightly late contraceptive. Abortions are nothing to celebrate either. Most women who have an abortion suffer from at least some short term distress, for others the distress is long term. This is not a reason to restrict access, but it does remind us that this is not just like any other medical procedure. Whether due to social, emotional, mental, or physical impacts, it is a big deal to make the choice and to go through with it. I find the celebratory vibes of American-style pro-choice rallies very distasteful. Likewise, I find it silly that they promote the notion that the day before a baby’s due date they are somehow not human, but the moment they are born they are.

I am pro-choice, but I am a realist and I take the matter seriously. I like the old Clinton saying that “abortions should be safe, legal, and rare”.

A second way that being pro-choice is more than just support for access to abortion is that I support women who choose other options too. Discussing the option of seeing a pregnancy through and either keeping the baby or putting it up for adoption, are framed as somehow regressive but surely we should discuss and support the full spectrum of choice? For me, fully-informed awareness of all options is fundamental to women being able to make choices about their bodies and their futures.

Perhaps even more controversially, I believe it is important to respect the choice of medical professionals who object and exclude themselves from performing or assisting with abortions. It is a matter of moral and spiritual importance for many people including medical professionals and no one should be forced or coerced to be involved in something that they object to on such a moral level.

I actually started thinking about what choice means in the context of the fraught abortion debate thanks to an article I read by Alex Penk from Ethos. It is called Respect for conscience is a right not an “obstruction”. Ethos is an organisation interested in conscience, goodwill, common humanity, and they say they come from a “Christian starting point which motivates all that we do, but we’ll work with people of any faith or none.”

I suspect they would call themselves pro-life and that we would have many issues on which we hold differing perspectives. However, I found Penk’s analysis of both abortion legislation and end of life legislation from the perspective of freedom of conscience very interesting.

Alex Penk sets the legal foundation for the right to protect one’s conscience:

Legal protections for conscience start from the recognition that no-one should be required to act against their most important beliefs. As medical ethicists point out, these beliefs are integral to a person’s sense of identity, so integral that violating them causes moral injury. Conscience is also protected, they say, because it is a precondition of good medical practice; it reflects the reality that doctors are not mere service providers but skilled professionals who exercise reasoned moral judgment about complex situations.

That’s why freedom of conscience is correctly treated as a fundamental human right, protected by the New Zealand Bill of Rights Act 1990.

Despite this, the emerging attitude of activists and officials treats conscience rights as an impediment to “consumers” accessing a “service”.

The language used in the last sentence is both accurate and problematic. Yes, we are all “consumers” in our health service and women seeking abortions are “consumers” accessing a “service”, but I argue that in the case of abortions we have to allow for some nuance. There are few situations were we really have to contend with moral arguments of life and death. Abortion and euthanasia are the two most obvious examples. I contend that it is wrong for us to hide from the true nature of the issues with sanitised language of “consumers” and by pretending that this is a matter just like any other medical procedure. It is not. Abortion should be treated sensitively so as to ensure that everyone is looked after, especially the woman at the centre of it.

Alex Penk and Ethos are concerned that the Ministry of Health are running roughshod over the conscience rights of medical professionals in their earnestness to ensure access to abortion. He points to the recently released review of the Contraception, Sterilisation and Abortion Act and the following excerpt:

“Failure to reduce the impact of conscientious objection on abortion service provision contributes towards the overall inequity in accessing abortion services around the country.”

Penk also objects to the use of the word “manage” in the review in relation to objecting medical staff. I sympathise with this perspective. The idea that a doctor who has conscientiously objected to performing or assisting abortions can be “managed” into doing so is simply coercion. This is anti-choice and creates a clash of rights.

To be pro-choice, in my view, is to understand the high stakes of an issue loaded with emotion, morality, and spirituality, and be open to the various perspectives and decisions that are available. First and foremost, of course, are the choices of the pregnant woman. She should be free to make her choice without coercion and with a full understanding of the support she is entitled to in any outcome. For example, if she is seeking an abortion only because she feels unable to provide for the baby, but otherwise wants to continue with the pregnancy, she is entitled to all the information available about financial support, legal rights, and charitable organisations. On the other hand, if she is being coerced into continuing a pregnancy by someone in her life whose beliefs she does not share, she is entitled to support to get to the outcome she actually wants.

It should not be beyond us to respect the choices of women (whatever they may be) and medical professionals (also whatever they may be). Every woman in New Zealand should have access to safe and legal abortions. “Legal” is sorted and “safe” depends mostly on access. Access is impacted by the number of medical professionals qualified to perform abortions meeting the demand of the number of women needing them. This is where the anxiety around “managing” objecting medical staff comes from. I would rather that our system ensured access by bringing the woman to the service than force someone to perform a procedure they morally object to in order to bring the service to her. By this I mean, for women in remote areas, for example, we should fund transport and accommodation as necessary to get her to a larger town or city where she can get an abortion.

“Rare” is where I lose the pro-choice crowd. They question why it needs to be rare if there is nothing morally wrong with abortions. Why shouldn’t they be proud of having had four abortions by the age of 21?

This leads us to confront the truths and conflicting beliefs that make this one of the most fundamental moral divisions of modern society. In my view, the way in which the pro-choice side has set out to pretend that there isn’t an inconvenient question to be answered about when life begins is wrong. Likewise, the way in which the pro-life side frames an abortion in the early weeks of pregnancy as murder akin to killing someone with your bare hands is also wrong. See, I told you both sides would not be happy with me.

Perhaps it is not possible, but I would like us to be able to find a moral middle ground. Or at least a middle ground of tolerance. In this mythical place we would understand that life does begin at conception. We would acknowledge that the way we observe and celebrate the phases of growth in planned pregnancies demonstrates that we do believe in the existence of life from the beginning. Abortion is a decision to end that life. However, unlike the pro-life side that see the point of conception as a light switching on that remains on until we die, I see it as a dimmer switch. A small, barely perceptible flicker of light is ignited at conception and over the gestation period that light grows brighter until it bursts forth into the world kicking and screaming. We then need to determine at what point the light is too bright to be snuffed out without incurring moral injury. The tricky thing is that just as it is impossible to know the exact second that the sun is risen, there is no obvious point at which to draw the line.

Personally, I have decided the line should exist based on the ability of the foetus to feel pain and be cognisant. This too is problematic though! Most medical professionals and relevant organisations agree that fetal pain perception is not likely before 24 weeks of gestation. This is based on current knowledge of fetal brain and nervous system development. However, as with many aspects of fetal development, this remains a complex and controversial issue, with differing opinions on the precise moment when a fetus can feel pain. While early abortions (before 12 weeks) are generally considered painless for the fetus due to incomplete development of the nervous system, later abortions (after 24 weeks) raise more questions about pain perception, though consensus still suggests that pain is unlikely in the earlier stages of pregnancy.

Around 20 weeks, the fetus begins to have more developed sensory capabilities, including hearing and possibly touch. However, while sensory input is possible then, cognitive awareness (the ability to interpret or understand these stimuli) remains undeveloped at this stage as the necessary brain structures for cognition, including complex thought processes, are not yet sufficiently developed.

In New Zealand, abortions are accessible on demand up to 20 weeks. Abortion is still legal after 20 weeks but requires two qualified medical practitioners to consult on whether it is clinically appropriate. New Zealand law does not specify an upper time limit for abortion. However, abortions after 20 weeks are rare and typically involve complex medical, ethical, or personal considerations. These procedures are usually carried out in hospitals or specialist clinics.

As I said, in my view, the earlier the better. I personally, would prefer an upper limit in the 12-16 week range with the exception of unviable pregnancies or threat to the mother’s life. This is simply because it fits with my own individual moral negotiations around pain and cognisance.

There is a morality issue with how we frame information and education around abortion too. I believe that we must teach young women (and, by extension, young men) that abortions should be prevented by responsible contraception use. Abortion should be framed as a big deal, a big decision. However, we should also teach them that terminating pregnancy is the choice some women will make.

Pro-choice is complex. Well, my version is anyway. There are lots of grey areas and really challenging moral questions.

There are other big moral and social issues attached to the topic of abortion too. I won’t get into them today, but I do want to flag that there are much wider societal issues driving modern narratives around sex and relationships. Louise Perry has written and presented extensively about them in a way that is somehow compatible with feminism (the proper kind that knows what a woman is) and more traditional views around sex, relationships, and forming families. I can’t recommend her enough.

I will be utterly amazed if anyone has made it this far through this opinion piece without disagreeing with me at least once. Do tell me if you are a unicorn who agrees exactly with my morality equation for abortion! But I expect that everyone who reads this will have their own parameters and thresholds, and that these will inform how they negotiate with their own conscience and beliefs. What I am interested in most of all, is how despite our vast spectrum of moral positions we not only create laws and systems but also tolerate our differences socially.

I am looking forward to reading an array of perspectives in the comments so please share your views. I am not a woman who says men cannot have opinions on these things, so you blokes are welcome too. It is like any issue where we have an opinion but it doesn’t directly affect us, if we want to have productive and respectful conversation we are respectful of those it does affect.

Originally published on Change My Mind.