Construction of Women in Abortion Services
By Maxine Lattimer
The following paper was given as part of a day of discussion for
staff and students at Kent University Women's Studies Centre held
in the Autumn Term 1997. The day was about reproductive choice
and was organised by Ellie Lee, a student at Kent University and
Co-Ordinator of Pro-Choice Forum.
This paper is based on my PhD research which centres on an ethnographic
study of two private abortion charities. I conducted participant
observation fieldwork during 1995 and 1996 at the pregnancy advisory
bureaux of these two organisations, an important part of which
involved my sitting in on women's pre-abortion counselling sessions
which they received as part of their initial consultation. I also
interviewed bureau staff including counsellors, administrative
staff, managers and medical staff. The research focuses on the
way in which a set of cultural meanings surrounding abortion impact
upon women who have abortions in contemporary Britain, particularly
terms of their decision-making and their 'abortion stories' or
the public accounts of their decision as presented during their
counselling sessions. It also looks at how these cultural constructions
impact upon those who are engaged in providing abortions i.e.
the organisations and staff at my fieldwork sites. I have conceptualised
these cultural ideas around abortion as a set of 'hegemonic discourses',
using a Foucauldian understanding of discourse (1) and drawing
on Gramsci's concept of 'hegemony' to talk about the ideological
dominance of particular discourses (2).
The research explores the hegemonic ideas contained in what I
have called the 'moral' discourse of abortion, which includes
constructions of abortion, sexual behaviour and motherhood. These
constructions contain contradictory and confusing messages, and
it is clear that women faced with an unplanned or unwanted pregnancy
are caught up in a clash of cultural expectations and ideals that
they cannot live up to. Ideas about sexual spontaneity as well
as human and contraceptive failure lead to such pregnancies, but
they are perceived to be entirely preventable by responsible sexual
behaviour and the use of contraception. As a result they are a
source of shame and embarrassment. Abortion is the only solution
if a woman wishes to end the pregnancy. Unplanned and unwanted
pregnancies do not live up to ideals of 'proper' motherhood and
many women feel no desire to become a mother and have no maternal
feelings. If women do 'irresponsibly' continue the pregnancy in
less than ideal circumstances that are not 'fair' to the child
then they are open to criticism, for example single mothers who
stay at home and are dependant on state welfare (3), mothers who
work and leave their children with childminders (4), or teenage
mothers, who were even the subject of one of 'The Health of the
Nation' targets in 1992 (5).
But if women opt for an abortion they are also open to censure
by a society that says motherhood is good, abortion is bad, but
that babies should only be born in the 'right' circumstances.
Whatever choice women make they are stigmatised. Abortion can
be seen as both a proscribed and prescribed course of action in
this 'moral' discourse, and this is the dilemma that women face.
Abortion is proscribed act according to negative constructions
of abortion, entirely avoidable and preventable according to constructions
of sexual behaviour, and an act antithetical to the ideals of
self-sacrificing motherhood. At the same time abortion is also
a prescribed course of action according to these same constructions.
Abortion is undertaken to avoid mothering in culturally inappropriate
circumstances and thus is a moral act of responsibility and fairness
to the unborn child and the rest of society. Women act against
certain hegemonic ideas by having an abortion and in doing so
they conform to other hegemonic expectations of 'proper' motherhood.
I have written elsewhere about the way in which many of the hegemonic
ideas contained in this 'moral discourse' are also embedded in
the law regulating abortion in Britain (6). In this paper I would
like to look at the way in which women are constructed in abortion
services, focusing in particular on the pre-abortion counselling
provided at my fieldwork sites, and at women's own use of this
counselling session to construct themselves and explain their
decision. Sally Sheldon (7) has written about the way in which
abortion is controlled by the medical profession and distinguishes
between: 'technical control', that is the medical monopoly over
the performance of legal abortions; 'decisional control', in that
the doctor decides who has access to abortion; 'paternalistic
control', in which even a sympathetic doctor imposes his/her own
views; and 'normalising control', as the doctor has access to
details of the woman's private world and from this produces an
authorised account of her reality. In the organisations where
I conducted my fieldwork, that is the private charitable sector
of abortion provision as opposed to N.H.S. services, medical control
manifested itself in rather different ways. Such organisations
do play a major role in the provision of abortions through private
clients and a growing number of N.H.S. contracts
Technical control of abortion was still in the hands of doctors
since they actually performed the procedure, though nurses and
midwives at the nursing homes played a big role in attending to
the women's medical needs, particularly for late term prostaglandin
abortions and early RU486 medical terminations. Technically, decisional
control still rested with doctors since they had the final say
and their signatures were necessary for the 'blue form' to be
completed, without which the abortion could not legally be performed.
However, those doctors who worked in the private charitable sector
had actively chosen to be involved in abortion provision and consequently
supported women's abortion requests and interpreted the law liberally
to allow women to make their own choices. There was little evidence
of paternalistic control from doctors, except in terms of contraceptive
advice. Doctors tended to pursue the issue of future birth control
vigorously as this was seen to be crucial in order to prevent
further unwanted pregnancies. Normalising control continued but
this function was largely fulfilled by the counselling session
at the pregnancy advisory bureaux I attended. Doctors' part in
the consultation tended to be brief, routine and focused on purely
medical issues. They performed an internal examination or scanned
the woman to determine the gestation of the pregnancy, enquired
about her medical history, took a blood sample and asked about
future contraception, providing a prescription if necessary. They
signed the form HSA, usually only checking that the woman was
sure and that the decision was her own.
Women were rarely if ever refused an abortion and no attempt was
ever made to dissuade them from their choice, however the organisations
were constrained by the law and the necessary paperwork that had
to be completed as staff commented: 'I know it's a vague area
but obviously we can't just let a woman come in and say 'I don't
want to be pregnant, that's it', because of the legal side of
it.' Therefore women had to be questioned about their 'private
world' and their decision. It was the job of counsellors to obtain
this information and write an short account on the woman's notes
for the doctors who could then determine the clause under which
the woman could be granted an abortion. Women were 'assessed'
and 'processed' in this way. Although the counsellors at these
bureaux were 'gatekeepers', they saw themselves more as advocates
for the women they counselled The information they gathered and
notes they made were meant to sanction the woman's request for
an abortion. By presenting her decision in an acceptable way so
that the two doctors would be able to sign the legal forms and
allow her to have the operation they helped the client to achieve
her goal. These counsellors believed themselves to be very pro-choice
and pro-women. Indeed most would be dismayed at the suggestion
that they were 'gatekeepers' or had such power as this was totally
against their counselling persona and stated aims of sympathy
and support. And also their goal of relating to clients as another
woman and the feminist, 'sisterhood' side to their work which
focuses on empowerment and abortion as a shared experience with
Thus there was both an advocacy side to counsellors' gatekeeping
in which they helped women get what they wanted, but at the same
time a paternalistic side in which the counsellor 'knows best'.
Counselling was not just a bureaucratic procedure undertaken to
comply with the law. Counsellors had their own agenda based on
sincerely held and altruistic ideas about such counselling being
for the woman's 'own good', so really 'it's for them'. These counsellors
believed that any woman should have the right to have an abortion
if she wishes. However, they felt that they did have the right
to insist that the woman talk about her decision during the counselling
session, or at least had the opportunity to do so, because it
was for her 'own good'. It was assumed that the reason why a woman
would not want to talk was because she had been affected by the
stigma attached to abortion, or because she was 'bottling up'
or denying her feelings. Therefore it was for her own sake that
she should explore them at this stage to prevent trauma later.
The questions asked were posed in the framework of an egalitarian,
'person-centred' model of counselling. This very popular model
stresses the special relationship between client and counsellor,
who acts towards client with empathy and acceptance, is non-judgmental
and expresses 'unconditional positive regard' for the client.
Such counselling aims to be non-directive and to create an 'atmosphere
of freedom' so that the client can become 'self-actualising'.
The kind of control exercised by counselling is difficult to define
and locate since it extends beyond a framework of medical control
and operates on the level of emotions and care for the woman.
The control exercised by counselling is not decisional but 'experiential'.
Counselling staff felt that they sometimes needed to be 'cruel
to be kind' and make the process harder for the woman to ensure
that she had thought carefully about her decision and would make
the 'right' choice for her, as one counsellor explained: 'It's
just prodding, maybe being a bit more challenging and saying 'it's
such an important decision that you have to think about it. It
may be cruel, it may be a horrible thing, you may not like me
for this but I have to challenge it and you have to face it. Because
in order to make the right decision, you have to think about it.'
They can easily make the wrong decision if they're going to deny
it, don't want to think about it, and they can be aggressive and
say 'I don't want to justify this, I just want it, just do it'.
I can understand them wanting to do that but sometimes the best
thing is to make it a bit harder for them because it's one of
the most important decisions they'll ever make in their life.
They can't go back.' Counsellors also felt that it was important
to challenge women who were reluctant to 'take responsibility'
for their decision. One counsellor told me: 'I won't let someone
get away with saying 'I have no choice'. Because they do have
a choice and if they wanted the child then they would find a way
to have it.'
Many staff were adamant that blanket provision of counselling
as part of the consultation procedure was necessary to pick up
women who 'need' counselling, even though they may not realise
it themselves or may deny that they need it. They cited stories
about the post-abortion problems women had as a result of not
talking about their decision beforehand to justify their current
practice of providing pre-abortion counselling, and pointed out
the dangers of allowing women to opt out of this. As a receptionist
told me: 'I think it's really dangerous the idea of getting rid
of counsellors all together because often the women that say they
don't need counselling are the ones that desperately do. And already
it seems that there are more people coming back for post-abortion
counselling because they hadn't had enough time with the counsellor
in the first place, or they weren't counselled at all.'
Counsellors also acted out of a sense of professional obligation
to care for their client's psychological well-being, and an important
part of this was the detection of ambivalence in clients. As part
of their training counsellors were taught to interpret body language,
thus their special skills and experience gave them insights and
allowed them to spot ambivalence this way, as one counsellor explained:
'They can be very hunched up, very closed and sort of slumped,
don't have eye contact and say 'Yes, I'm very sure about my decision'.
But they're not really saying that and so it's just for me to
say to them gently 'Well you're saying that but I'm not really
hearing that' or 'I get the feeling that (you're not), would you
like (to talk about it)?' Counsellors considered looking for ambivalent
feelings in clients to be as part of their professional responsibility
rather than gatekeeping or policing. They felt that they had certain
obligations to their client and this included a moral obligation
to point out a lack of congruence between what was said verbally
and body language if it seemed to imply ambivalence. They needed
to be challenging to the woman and point out any ambivalence that
appeared to be there, perhaps making it harder for her if necessary
in order to prevent feelings being denied, to stop the 'wrong'
decision being made and so protect the client from possible depression
As part of their professional identities, counsellors would see
it as their job to provide a decent level of counselling care
whether the woman wanted the service or not. This was part of
doing a good job as a counsellor, providing a quality service,
and whether the woman resented or appreciated their efforts was
unimportant. Counsellors tended to see their role as in contrast
with that of the doctors and counselling as a movement away from
the medicalisation surrounding abortion. However, their introduction
could be seen as an extension of this medicalisation in that they
represent yet another 'professional' engaged in policing yet another
aspect of women's behaviour, their mental health now, with counselling
to prevent post abortion trauma. Both doctors and counsellors
act as a 'professional' third party there to provide help for
women in their decision making.
Women were also keen to use the counselling session to explain
and justify their decision for themselves, and construct themselves
as 'deserving' in their request. Often women do not want to continue
with a pregnancy because they themselves want to mother in different,
more 'appropriate' circumstances at a later stage in life, or
do not wish to become mothers at all. Women may want to pursue
goals other than motherhood in their lives and continuing the
pregnancy would mean giving up these things. However, women find
it difficult to present their choice to abort in terms of what
they want for themselves and their lives, as this seems 'selfish'.
Staff spoke about women's reasons for choosing abortion and felt
that most did so for themselves rather than others: 'There's a
small percentage of women that feel they don't want to have an
abortion but are forced into it, for financial reasons or their
partner just won't support them and is definitely going to leave
them if they don't have an abortion. But in the end most of the
women make the decision for themselves, and if they really want
to go ahead obviously they wouldn't come. If they really want
to be pregnant and could cope with it, then they cope with it
whatever's going on in their life really because they don't want
to have an abortion.' Women continue to have their abortions every
year to resolve unplanned and unwanted pregnancies but remain
uneasy about their choice, as one client in counselling said:
'ethically I'm not that happy with it, but it's the right think
to do'. Abortion is often described as 'the lesser of two evils',
as 'wrong, but the right thing to do'. Thus women tend to appeal
to aspects of the moral discourse to justify their abortion decision,
both in their public abortion stories and their private justifications:
'It's to make themselves feel better and society's put them in
that situation where they need an excuse for it, which you shouldn't
really. The excuse is 'my partner's left me', whatever.'
The 'moral abortion' is when women choose abortion for the 'right'
reasons that fit with cultural ideals. Abortion is undertaken
by women to avoid 'bad' parenting, and out of a sense of 'fairness'
and 'responsibility' to the unborn child and to others such as
partners or parents. Thus abortion becomes a moral act of self-sacrifice.
This idea of abortion as a selfless act motivated by a 'maternal
ethic' fits in with societal expectations about motherhood as
a self-sacrificing state of being, and femininity, with women
as carers and nurturers. Women emphasise that their choice to
abort is made for 'good' reasons that are not 'trivial', nor is
their choice made simply out of 'convenience' or for themselves
alone. They present their choice in an acceptable way, using reasons
that will be understood and sympathised with. Anthropologist Heather
Paxson (8) also found that the Athenian women she interviewed
'describe abortion as an unhappy but necessary and even moral
recourse that enables them to avoid having children outside of
marriage and to 'properly' raise the children they already have
- in other words, to be 'good' mothers'. She found that 'because
abortion has been used by women to limit family size, and since
women do not generally consider foetuses to be 'persons' in their
own right, abortion is not structurally opposed to the ideals
When sitting-in on women's counselling sessions I found that ideas
about 'good' motherhood were extremely influential in their accounts.
These ideas were expressed in terms of 'responsibility' and 'fairness'
to the unborn child and also with regard to existing children
in terms of devoting enough time to them. Women talked about the
'right' way to bring up children which involved looking after
the child themselves rather than paying for childcare, a prospect
that was therefore impossible for single working women. Having
a child that was 'planned' and 'wanted' was very important. They
spoke about 'proper' motherhood and pregnancy maintaining that
they wanted to 'do it properly', 'eat right', 'be sober' and generally
take care of themselves and the baby. For many women this was
not the 'right' time in their lives, they felt 'too young' and
wanted to be 'settled down' before having children. Many were
very concerned to avoid single parenthood, saying that they did
not want a 'fatherless child' and wanted to be 'in a family' when
they had children. Financial security was also important to give
any child a 'proper start' in life, and to 'bring a child into
the world' without this was 'not right'.
One counsellor spoke about how important it was to women that
they had children in the 'right' circumstances. However, many
women emphasised that they were unable to continue with the pregnancy
because of reasons beyond their control such as their financial
state, rather than admitting that they simply preferred to mother
in more 'appropriate' circumstances: 'Some women will say 'If
I had more money I would keep the child'. Sometimes you feel that
is the case but at other times you feel they're just saying that
as a reason to justify their having a termination. 'I can't have
it, I'm living on my own'. 'A one bedroomed flat' they often say,
'Good relationship but we live in an one bedroomed flat'. And
you can't point out that really babies are better in the parents'
room for the first two years anyway so you can hear them in the
night. But it is an excuse very often to make them feel better
I think. Better to say that they can't. Some of them can say 'I
don't want it', others have to fish around for reasons, others
really do have reasons. (So) financial circumstances is often
given as a reason but you do wonder really whether it is that.
It's really that they hadn't planned to have a child at this stage
and they want everything to be right then. They've got a set idea,
a life plan, and they need to have a steady partner and get married
perhaps, with a steady relationship, two years in that, and then
children afterwards. If anything goes against that then they will
consider a termination quite honestly.'
Some women even prefaced their abortion request with anti-abortion
sentiments then proceeded to construct themselves and their circumstances
as exceptional and justified, a practice that bureau staff found
extremely annoying. As one of the receptionists explained: 'People
say 'Well, I don't believe in abortion but because of my circumstances,
blah, blah, blah'. I suppose it's denying that they're actually
going through (it). When they've been inundated with 'what you're
doing is wrong', it's their way of coping with it.' She described
one extreme case of 'distancing' in which the woman simply could
not accept that she was having an abortion and 'rang up saying
the weirdest things about having a miscarriage but it wasn't a
complete miscarriage. She came in and had a pregnancy test and
it was still positive. She was just trying to tell herself that
she was having a miscarriage and that when she went into the clinic
it was just 'finishing it off' (to) justify what she's doing.
It's sad that you have to go to those lengths isn't it?' Many
women also appealed to aspects of the negativity surrounding abortion
in order to justify their actions by emphasising how hard the
decision had been and the guilt they felt, to show that they were
'paying' for their choice.
In contrast, other women spoke about their abortion choice in
purely practical terms, stressing the 'inconvenience' of the pregnancy
and saying 'I want to get rid of it' or 'I just don't want it'.
As a receptionist commented to me: 'A lot of women talk about
not having money, having too many children. But you get quite
a few women who are quite honest with themselves as well and say
they just don't want to be pregnant'. In her opinion 'this is
what's wrong with the whole thing. You get women who say 'I couldn't
possibly carry on with this pregnancy because I'm poor or I'm
working and so on'. And I just think well why are you dressing
it up? You don't want to be pregnant. There are genuine cases
of situations where women feel forced into things but I don't
think that that's the majority. I think we do have a choice at
the end of the day and the choice is to continue the pregnancy
or not. We're never going to get any further on issues like abortion
because we help it along.'
However, these women were still constrained by the legal framework
in which they must justify their request for abortion under the
terms of the 1967 Act and provide specific reasons. Many women
were aware of the need to 'make a case' in order to obtain their
abortions and this affected their 'abortion stories' or public
presentations of their choice. As staff pointed out 'It's the
law that they can't come in and say, 'I just don't want to be
pregnant' and that's it. You need more than that. The counsellor
has to say 'Well, is it financial then?' Often women who spoke
about their abortion decision in this way went on to describe
themselves as 'selfish' and 'cold-hearted' for having no feelings
about the pregnancy, and almost all had a strong concern for secrecy
taking on-board ideas about abortion being a shameful act to be
kept quiet. Thus the legal, medical and service framework, and
women themselves with their need own to explain and justify their
decision to abort, act to reinforce and maintain the hegemonic
ideas contained in the 'moral' discourse.
(1) Foucault, M. (1972) The Archaeology of Knowledge and The Discourse
on Language. New York, Pantheon
(2) Gramsci, A. (1971) Selections from the Prison Notebooks. London,
Lawrence and Wishart.
(3) Dennis, N. and Erdos, G. (1992) Families without fatherhood,
London: Institute of Economic Affairs Health and Welfare Unit.
Davies, J., Berger, B., and Calson, A. (1993) The family: is it
just another lifestyle choice?, London: Institute of Economic
Affairs Health and Welfare Unit.
(4) Silva, E. B. (ed.) (1996) Good Enough Mothering? Feminist
Perspectives on Lone Mothering, London: Routledge.
(5) Department of Health (1992) 'The Health of the Nation: a strategy
for health in England', London: HMSO.
(6) Lattimer, M. (1998) 'Hegemonic discourses embedded in British
abortion law: dominant ideas vs. women's reality' in Lee, E. (ed.)
Abortion Law and Politics Today, London: Macmillan.
(7) Sheldon, S. (1997) Beyond Control: Medical Power and the Abortion
Law, London: Pluto Press.
(8) Paxson, H. (1997) A 'Necessary Evil': Abortion and Maternal
Morality in Urban Greece', unpublished paper presented at the
Annual Meeting of the American Anthropological Association, Washington