Sarah Catt: when we've stopped pointing the finger let's ask ourselves how much we care

Sarah Catt faces an eight year jail sentence after taking abortion medication purchased over the internet to end her pregnancy at 39 weeks. I don’t know if she had any idea that she was putting her life and her liberty at risk when she did this. There is speculation as to both her motivation and her mental state, but the only fact of the matter is that for some reason the idea of giving birth to a living baby, which she almost certainly would have done within just a couple of weeks, was intolerable to her.

Speculation about whether she is a monster or just desperately ill and unhappy will, no doubt, be rife. Arguments will rage to and fro about whether she should have received such a long sentence. Others will ask whether the current time limit for abortion is right, whether there should be time limits at all or whether our focus should be on doing everything we can to make abortion as accessible as possible, as early as possible. Some people will say that this case demonstrates an argument for taking abortion out of the sphere of criminal law altogether, others that this proves we need legal limits on abortion provision because we simply cannot trust women not to go running around choosing late term abortions.

For me this case is so unusual that I’m not sure if it can helpfully inform debates about abortion law. They say that hard cases make bad law and this is probably a case in point.

If we can draw any lessons from this it might be about the support that we can provide to those women who consistently struggle to control their fertility, to choose and use an appropriate contraceptive method, and to manage relationships. There are many reasons why women who feel negative or at least ambivalent towards pregnancy still get pregnant repeatedly including complex personal circumstances. Easy as it is to blame individual women for making bad decisions (we rarely blame their partners) we also have to ask ourselves whether sometimes repeat unintended pregnancies do highlight a shortfall in services. Did Sarah ever seek or was she ever offered any support to think about her fertility, to clarify her own feelings about pregnancy and parenthood and to make informed choices about future relationships and contraceptive use?

Did she have the emotional and practical support she needed after she placed a child for adoption? Or did that process contribute to her belief that it was better to go through the potential pain and danger of labouring alone to have a stillbirth, than to give birth safely and retain the option of placing the baby for adoption? When she was turned down for abortion after 24 weeks did anyone offer her the opportunity to think about ‘what next?’ Did anyone offer to help her talk to her husband and think through the possible consequences (good and bad) of having this conversation in terms of her safety, their relationship and the future of their family?

When a healthy woman with a healthy pregnancy seeks abortion after the legal time limit, it is likely that her circumstances and her feelings about the pregnancy are pretty desperate. For good or ill, a woman in this situation cannot have an abortion after 23 weeks and 6 days. What do we offer these women to address the circumstances they find themselves in, in which continuing the pregnancy is intolerable? Are they made aware of the dangers both medical and legal of trying to induce an abortion themselves? Is there anything we can offer to make the next 16 weeks of pregnancy tolerable, safe and manageable for them...let alone the next 20 years of parenthood?

I don’t know what kind of support is available to the handful of desperate women who are turned away from abortion because they’re just too late. Later abortion is a divisive issue, but whatever anyone feels about it, we must all feel some duty of care towards women who want one, but can’t have one.

It's women's lives stoopid

Many people will be whooping at delight that Melinda Gates is defying the hierarchy of the Catholic Church to promote and fund provision of contraception to women around the world. I’m whooping myself because we all know that women of all faiths and cultures want access to modern contraceptive methods and there is currently a massive global unmet need for them. It’s great that she has presented her view on this as one of social justice and interesting that she has linked this to the ethos of her convent education. We know that nuns are not always uncritical mouthpieces for the Vatican. In fact US Bishops have recently been ordered by the Vatican to whip their nuns into line for focussing on ‘radical feminist themes’. Historically, there is even evidence of nuns providing women with safe abortion. It’s a shame that Gates’ teachers never taught her this bit too.


Because the thing that is significantly missing from Gates’ pronouncements on contraception is a recognition that abortion too is a matter of women’s health and of social justice? While Gates hopes to generate $4bn to fund family planning services, no money is going to go towards provision of safe abortion or advocating for governments to reform restrictive abortion laws. For Gates, abortion is a step too far morally. Maybe she hopes that with good contraceptive coverage this problem will disappear, but we all know this is wishful thinking. Maybe she thinks that if she doesn’t mention abortion she can hold back the rage of the Catholic establishment –even win them round. Both of these are wishful thinking too. 


By ignoring abortion or presenting it as morally distinct from contraception - as she does - it reinforces a separation that serves women badly. It undermines the efforts of those who are trying to reform restrictive laws in their own countries, it marginalises those who do provide abortions, and maintains the invisibility of the ordinary women who have abortions each year (44 million in 2008).  It even risks limiting contraceptive options for women, as the anti-choice lobby draws our energy into debates about which drugs are abortifacient as opposed to contraceptive. We know that women everywhere have abortions - whether they are poor women in rural areas with no access to contraception, or middle class women in Europe whose contraception has failed. Catholic women are no more immune to the dilemma of an unintended pregnancy than any other women. Like all women when they know that they simply cannot continue a particular pregnancy, they will defy their religious leaders and the law of the land. They will risk excommunication, prison, and even their lives to get the abortion they have decided is the right thing for them. For some reason these women, their bodies and their lives are not a legitimate focus of social justice.


The same ear-covering ‘la la la la la I can’t hear you’ attitude is often on display in the maternal health field. Despite that fact that 13% of maternal deaths are due to unsafe abortion – a higher proportion in some regions – many in the maternal health field don't address this cause. Despite many of the women dying from pregnancies they would rather have ended, some funders and policy makers in maternal health field avert their eyes. Even as doctors pick up the pieces of unsafe abortions around the world and families bury their dead, abortion remains, at best, peripheral to the maternal health agenda.


It is only when we join up all the dots, that we will really start to improve and save women's lives. That means advocating for, and funding, comprehensive and accurate sexual health education for all young people; access to the full range of modern contraceptive methods and sexual health services for all; safe, legal and accessible abortion as a necessary safety net when things go wrong; and comprehensive ante-natal, maternity, emergency obstetric and post-partum care. Separating these things out or picking and choosing which to address to accommodate the personal morality or preferences of law makers and funders, or hoping that doing so will minimise the opposition will mean that women continue to die wholly preventable deaths.


So please funders, don’t leave out abortion  - it’s women’s lives stoopid.