How Abortion Protects Us From the Choices We Can’t Make

There’s so much about pregnancy and abortion people don’t choose—like ectopic pregnancies, or spontaneous miscarriages, or pregnancy as a result of sexual abuse.

Hadley Duvall waits to speak on the first day of the Democratic National Convention at the United Center in Chicago on Aug. 19, 2024. (Brendan Smialowski / AFP via Getty Images)

Like many other feminists and reproductive rights advocates, I was thrilled to hear speakers at the Democratic National Convention say the word “abortion,” speaking up on behalf of reproductive freedom. But I realized I tensed up whenever someone spoke in terms of protecting women’s “decisions” about pregnancy. This isn’t because I disagree or don’t think every person—including all those with the capacity for pregnancy—should have the right to make decisions about their bodies and lives. Rather, it is because I worry that this language (and its close relative, “choice”) unintentionally reinforces the profoundly misleading idea that pregnancy is something human beings can completely control through deliberate and informed decision-making. 

The fact is that there is a lot about pregnancy that happens in the absence of any decision at all, or in spite of the decisions people make. This is the result of biology, and it is something we do our best to manage and cope with. Many of the women and men who spoke at the DNC made this clear:

  • DNC speaker Hadley Duvall of Kentucky described a different kind of hell that she did not choose. She did not decide to become pregnant at age 12 as the result of sexual abuse by a stepfather. 
  • Kate Cox and her husband decided to expand their family and have a third child. They, did not, however, decide to have a pregnancy in which they would learn that the fetus was not viable and had no chance of surviving. Their fetus had a genetic anomaly that in their case was fatal. 
  • Kaitlyn Joshua did not decide to have a miscarriage. But her pregnancy, like 15-20 percent of all pregnancies, ended in a pregnancy loss. Such losses occur to people who have wholeheartedly, unambivalently, 100 percent decided to get pregnant and have a baby. 
Vice President Kamala Harris embraces Kate Cox, a Texas woman who was denied an abortion, as she arrives to deliver remarks on reproductive rights at the University of Maryland on June 24, 2024, in College Park, Md., on the two-year anniversary of the Dobbs decision. (Kevin Dietsch / Getty Images)

Speakers at the DNC covered a lot of territory but certainly not all of it. Examples of pregnancies and pregnancy outcomes that defied people’s decisions abound. 

For example, the decision not to become pregnant is famously one that is flouted by bodies determined to do otherwise. No contraceptive is 100 percent effective. As a result, women who decide not to get pregnant and engage in careful and conscientious use of contraception sometimes still become pregnant.  

And no woman who decides to become pregnant chooses to have an ectopic pregnancy, where the fertilized egg implants in a fallopian tube. In such cases, the fertilized egg has no chance of fully developing into a baby but does have a significant likelihood of causing the woman’s death if she is unable to terminate that pregnancy. 

But it is precisely because there is so much about pregnancy and its biological processes that we cannot actually control, that will not bend to our most heartfelt wishes and careful choices, that we must ensure that the law—something we can control—does not cruelly add to the experience of powerlessness, pain and loss.

So while families may not “decide” to experience infertility, the law should not prevent them from making the decision to address that problem through avenues like IVF. The Alabama Supreme Court, however, ruled this year that frozen embryos, necessary for IVF treatment, are “extrauterine children” who may not be “killed.” The result is that a fertility treatment that can bring about hope instead of hell has for many, been delayed and even stopped. Project 2025, would nationalize this, calling on conservatives “to protect the unborn in every jurisdiction in America.”

For women and girls like Hadley Duvall, the availability of legal abortion can help ameliorate the trauma and pain caused by the sexual abuse and pregnancy over which they had no decision-making power. As Duvall put it, “I can’t imagine not having a choice, but today, that’s the reality for many women and girls across the country because of Donald Trump’s abortion bans.” 

While going through a miscarriage she did not decide to have, she was denied the right to make healthcare decisions that would have safeguarded her life and reduced her pain and suffering. 

Kate Cox, the Texas mother who was denied an abortion by that state’s Supreme Court, exercised one of the tenuous rights she still had—the right to travel so that she could obtain the abortion care she needed in another state. That abortion ended her ordeal and preserved her future fertility. Her announcement at the convention that she is pregnant again was met with cheers.

Kaitlyn Joshua recounted how two hospitals in her home state of Louisiana denied her the care she needed during the miscarriage because of that state’s abortion bans. “I was in pain, bleeding so much my husband feared for my life,” she said. “No woman should experience what I endured, but too many have.” So while going through the miscarriage she did not decide to have, she was denied the right to make healthcare decisions that would have safeguarded her life and reduced her pain and suffering. 

We must not make the mistake of overestimating the extent to which our decisions will determine the complex and often uncontrollable biological process called pregnancy. At the same time, we should never underestimate the importance of electing candidates and supporting policies that protect people’s ability to make and carry out decisions over those aspects of pregnancy that they can control. Anything less is an affront to the dignity and freedom everyone, including those who have the capacity for pregnancy, deserves.

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About

Lynn M. Paltrow is a lawyer and the founder of Pregnancy Justice, formerly National Advocates for Pregnant Women.