During my recent visit to Vassar College I discovered the publication “Beyond Choice- Reproductive Freedom in the 21st Century” by Alexander Sanger. I had been following the “culture war over reproductive freedom” which had begun in Trinidad and Tobago, between the pro-choice group, ASPIRE and various pro-life groups, fuelled by the stance taken in the draft National Gender Policy on the issue of Abortion.

I was immediately attracted to the book because of the cover art - Gustav Klimt’s 1917 version of Adam and Eve. Eve, although the smaller of the two figures, has been given prominence in all of her voluptuousness. Indeed, it was easy to miss Adam altogether in the background. But what made the publication even more appealing was the observation that it was authored by a male who was either predicting or advocating for Reproductive Freedom in the 21st century—almost 100 years after the right to contraceptive use was fought and won.

The blurb on the dust cover gave an explanation for the male authorship- Alexander Sanger, when he wrote the book in 2004, was the Goodwill Ambassador for the United Nations Population Fund and Chair of the International Planned Parenthood Council. He was also the grandson of Margaret Sanger, renowned family planning advocate who had fought in the courts for women’s right to contraception during the early part of the 20th century.

I could hardly wait to discover how Sanger’s proposal to move “beyond choice” would break the deadlock between pro-choice and pro-life. The polarization between these two groups has not helped the cause of women, but rather it has been used in many countries on the political hustings to garner votes.

I hoped to get some insights or answers to the question: Who or what body could claim the moral, legal and ethical authority to decide on the choices that a woman could make on becoming pregnant? Was it the state or nation, the scientist, medical practitioner, the legal fraternity, family planning associations, religious organisations, women’s organisations, parents of pregnant teens, husbands, the pregnant woman? Can there be a solution that satisfies these multiple perspectives?

Reproductive freedom has always been enjoyed by males as their birthright, along with the many other freedoms bestowed on them, freedoms for which women have had a long history of struggle and which continues for many—e.g. the right to vote, to have access to higher education, to use contraception.

Interestingly, underpinning all the arguments used largely by the masculine hegemony to deny these rights, including the right of access to higher education, was the necessity to protect women’s reproductive function. Not to do so, would threaten the continued existence of the species, Homo sapiens. And although the current restrictive abortion laws force women to resort to termination methods which result in either sterility, the impairment of the female reproductive organs or maternal death, the protection of women’s reproductive function through access to safe abortions has not featured prominently in the debate. From the male perspective, reproductive freedom for women would result in infidelity, promiscuity and prostitution, the sentiment, which also informed the law preventing the use of contraception by women during the early part of the 20th century. A law, which was eventually overturned due to the efforts of Margaret Sanger.

In the court, she cited two cases in which she was personally involved: her mother whom she remembered as being either pregnant, nursing or in ill health and who had 11 children and 7 miscarriages and Sadie Sachs whom she had nursed back to health following complications of a self-induced abortion but who subsequently died as a result of yet another self-induced abortion.

As had been the tradition, before the advent of safe terminations, women with unwanted pregnancies like Sadie Sachs resorted either to ‘back alley” abortionists or self-induced abortions using herb concoctions, turpentine, Lysol, rolling down stairs, inserting slippery elm, or knitting needles. Contraceptive use was seen as solution to the maternal morbidity and mortality that resulted from multiple pregnancies and unsafe termination practices.

Although condoms were already in use during the period of Margaret’s struggle, they were not meant to be used as a means of contraception but to protect males from contracting venereal diseases from prostitutes. Therefore husbands were not allowed to use them with their wives to prevent pregnancy. A woman had no right to “copulate without fear of pregnancy.” And even though Margaret Sangar’s fight was precisely to allow women to “copulate without the fear of pregnancy”, a privilege which up to now was exclusive to males and infertile females, she chose to highlight in the courts the health risks associated with multiple pregnancies. Pregnancy, she argued, should be treated in the same way as a disease.

Disease was re-defined to mean an alteration of the body or of some organ. It was argued that pregnancy was “an alteration of the state of the body”, and must therefore be classified as a disease. Physicians (mostly males) could now prescribe birth control to prevent this disease.

Margaret realized that if she were to succeed in getting the court to legalise the use of contraception by women, she would need the support of males and physicians to whom feminists (women’s rights) and class (poor women) arguments would not be appealing.

Therefore the issues she fought for were women’s health and the right of physicians to practice medicine in order to prevent disease. She had argued that making birth control legal and under the control of the physician would allow women to plan and properly space their children and that this would benefit not only the women and children, but also society at large. It would afford women the opportunity to contribute to the economy and the workplace.

The downside of this victory was that birth control and giving birth became medicalised and out of the hands of midwives. On the other hand, it elevated the control of reproduction by women, from a crime to a fundamental component of the constitutional right to privacy under which citizens made decisions on marriage and childbearing without the interference of government. Although this right was initially applicable only to married women it was later extended to unmarried women as well.

The constitutional “right to privacy” was used eight years later in the USA to debate the rights to reproductive freedom for women in Roe vs. Wade, which although it resulted in legalising abortion did not translate into reproductive freedom. The passing of a number of laws and bills eroded and continue to erode this freedom. These have included:

• the “partial-birth abortion” bill which restricts the procedure used for foetus greater than 20 weeks
• the “abortion non-discrimination” act which prohibits taking action against health care providers who do not abide by the existing laws
• the excessive, unreasonable demands being made of abortion-providers
• the “child custody protection” act which demands that the parents of the pregnant individual must make the decision
• the“ period of waiting” and “anti-abortion counseling” that must take place
• the “gag” rule which requires that no abortions be performed in order to receive federal funds
• the “unborn victim of violence” act which establishes the foetus as a legal person.

The most recent passing of the law in South Dakota, banning all abortions except for the case of a “sodomized, religious virgin” effectively overturns the Roe vs. Wade decision. Enacting laws restricting abortion in order to promote population growth as is purported for the case of S. Dakota, erodes the “freedoms” for which women have fought. It is not impossible to find ways to eliminate the economic childbearing penalty thus allowing females to pursue educational and employment opportunities and to be mothers without compromising either role. One way of achieving this would be to get males more involved in child rearing.

Recent research carried out by ASPIRE in Trinidad and Tobago indicate a figure of 4,000 cases of attempted abortion reaching the hospitals and an estimate of over 10,000 abortions taking place annually.

While it is legal to have an abortion in the case of incest, rape and if the mother is at risk, any abortion, even if it is being carried out for reasons covered by the current law, is treated as an illegal act. Safe termination of unwanted pregnancies is therefore carried out in private hospitals at a cost that can only be afforded by upper and middle-income women. Women in the low-income bracket continue to use the methods used in Sadie’s time with a few variations: cytotec instead of herbal concoctions, cassava instead of elm stick and coat hangers instead of knitting needles. These are the women more in need of these services, since they are less educated, less healthy, less empowered to take control of their lives and therefore more likely to face the situation of an unwanted pregnancy.

The proposed National Gender policy is attempting to move beyond the stalemate brought about by the absolutist arguments of pro-choice and pro-life, The position of the pro-choice is that either there is the “right to privacy” or not, while the position of pro-life is that either the unborn child is a “legal person protected by the constitution” or not. One focuses on the rights of the women to decision-making and health care, while the other focuses on the unborn child.

Unfortunately, there has been insufficient debates on and questioning of the biological and social and ethical issues surrounding reproductive freedom—it has now become imperative to do so in order to determine the desirability of allowing females the right to reproductive freedom.

In order to make any progress we need to start by first acknowledging that reproductive freedom for women is not solely a moral issue; it requires ethical consideration. We need to debunk the myth that women seeking abortions are promiscuous, sinful, self-seeking, single women. Reasons for terminations range from failed contraception to exposure to teratogens, genetic abnormalities, and teenage and menopausal pregnancies. Allowing such pregnancies to go to term can have detrimental effects not only on the mother but also on the offspring and hence the future generation.

The aim of moralists is to ensure the enactment of laws that will promote common morals and values in society, but when these laws impact on the capacity of humans to reproduce and evolve, not only are they likely to fail, but in addition they can have dangerous consequences for the well-being of society. As has been demonstrated worldwide, restrictive laws that invade the private spheres of persons are largely ineffective, therefore it is highly likely that the State would be unsuccessful if what it proposes interferes ideologically or economically with women’s access to reproductive choice.

The expertise of Biologists and Sociologists should be enlisted to define terms used in the debate e.g. embryo, foetus, person. When exactly can we term the foetus, a person? Biologists have argued that it can be termed a person when it has the capacity to survive independently of the mother. Because of improved technologies, the age of the foetus at which it can command the rights of personhood has shifted from 28 weeks to 20 weeks.

The concept of “foetal harm” should not only be framed in terms of the pregnant female, but must include male battering of pregnant females, male exposure to toxins in the workplace, as well as producing second-hand smoke all of which result in “foetal harm.”

The myths on human reproduction perpetuated by masculinist Biology and which may influence the position taken by each group needs debunking. Females have been studied by Biologists mainly in terms of their reproductive function, linking this to their sexuality. However a number of studies including those of Kinsey et al. and Donald Symons have refuted this link.

Data obtained from studies on the influence of hormones on female sexual desires and orgasm, which suggested that the oestrous was the only period when females participated or should participate in sex was challenged, since in other studies many women reported peaks of sexual desire just before, just after, and even during menstruation with only 6-8% reporting increased sexual desire at ovulation.

Sexual activity must be seen as important not only for procreation, but also as the means by which Nature is able to survive and evolve. The downside of linking female reproduction with sexuality is that it leads to the “slippery slope” fallacy that if women were granted reproductive freedom, it would lead to greater promiscuity and the downfall of society. Indeed this was precisely the argument used to deny women the rights to use contraception. History has shown that that reasoning was flawed—gaining the right to use contraceptives did not turn these women into prostitutes; the right to reproductive freedom is much less likely to do so.

“Paternal uncertainty” has been a fear that haunted the majority of males. While women can be pretty certain who fathered her child, it is not so certain for the male who carries the fear of parenting a child that is not his own. Biology, with its powerful tool of DNA fingerprinting could now allay this fear. We need to enlighten males however that the right to contraception and abortion does not equate with women’s freedom to have sex and that pregnancy is not the sole determinant of unfaithfulness.

Natural selection will favour women with reproductive rights since these women would have a better chance of surviving childbirth, maintaining their fertility and passing on their genes. This right must be seen as beneficial to men and women and society, since both sexes have an equal role to play in human and social evolution.

New developments in reproductive technologies, e.g. cloning and stem cells, bring an added dimension to reproductive freedom, which needs analysis and discussion for inclusion in the debate. Scientists are now able to control the reproductive process—with the advent of contraception and IVF, no longer is the uniting of sperm and egg a “divine act” it has now become a “human act.”

It is difficult to imagine our Heavenly Father giving us the capacity to produce hundreds of offspring, when it is only possible to bring a small fraction of this to fruition during our reproductive lives or that He allows the uniting of a sperm and egg, many of which later aborts in a natural process. Natural selection is a wasteful process; therefore exercising some control instead of leaving it to chance or nature may be a more efficient process.

It can be argued that reproductive freedom is an ethical right in that it helps to preserve human life by allowing women the choice to have children who are “wanted” and who will survive and have children in turn.

When the State denies women the freedom of making decisions about her body and her life; when it lacks confidence in women’s ability to make choices, which would be in the best interest of society and humanity, then it continues to send the message that they are lesser beings. The decision to have or not have a child should rest squarely with the pregnant female, empowered through education and with access to unbridled consultation and expert advice.

In charting the way forward we need to consider the interest of society. Both pro-life and pro-choice can start the process by coming together to identify goals in common These might be inter alia to reduce the number of abortions, improve the overall and economic status of women and find acceptable alternatives to current abortion procedures. We need to reframe the abortion debate, shifting the emphasis from right to privacy, women’s equality, autonomy and bodily integrity to issues of promoting the welfare of children, family and public health. The former could be achieved by ensuring that every child is a “wanted” child, the latter by eliminating the negative consequences of unsafe abortion practices.