No Place Like Home
The Rhetoric of Fetal Rights in the American Homebirth Debate
Suzan Steeman (5777038) Thesis Advisor: Manon Parry American Studies – University of Amsterdam
[ CONTENTS ]
Introduction
The Reduced Role of the Mother in Pregnancy and Birth 1
[ 1 ] ‘By Women for Women’
The Origins of the Homebirth Movement in America 6
[ 2 ] ‘Visualizing the Fetus’
The Rhetoric of Fetal Rights in the American Abortion Debate 19 2.1 Who Killed Junior 21 2.2 The Silent Scream 33 2.3 Too Many Aborted 39
[ 3 ] ‘Improving Birth’
The Rhetoric of Rights and the Current Homebirth Debate 46
Conclusion 63
Bibliography 66 No Place Like Home? Suzan Steeman (5777038)
[ Introduction ]
The Reduced Role of the Mother in Pregnancy and Birth
In 2012, the World Health Organization (WHO) published a report on trends in maternal mortality between 1990 and 2010. The maternal mortality rate in the United States of 12 per 100 000 live births is higher than the rates in other Western countries like Australia (7), Japan (5), the Netherlands (6), and Spain (6). Additionally, in contrast to many other countries, the maternal mortality rate in the US has increased between 1990 and 2010.1 The American Centers for Disease Control and Prevention (CDC) has also published some shocking conclusions on the pregnancy mortality rate in America. These show that black women in America are more likely to die from pregnancy-related causes than white women, with the pregnancy-related mortality rate for black women at 34.8 deaths per 100 000 live births.2 According to the CDC approximately half of the maternal deaths are preventable.3 Why is America lagging behind so many other Western countries? What is causing these high rates of maternal mortality and complications? A major factor is the increasing medicalization of both pregnancy and birth. The sociological concept of medicalization was developed in the 1970s to critique how the medical profession takes control of behaviors that are not abnormal or necessarily limited to medical factors.4 Critics of medicalization see the high cesarean rate, and the high rates of induction and other medical interventions, as proof of unnecessary medicalization.5 Scholars have argued that the medical world has wrongfully interfered with the natural process of pregnancy and birth and that because of that, a technocratic model of birth now prevails. In this technocratic model, medical viewpoints have the most authority.6 This model is opposed to the holistic model of birth,
1 World Health Organization, UNICEF, UNFPA and The World Bank ‘Trends in maternal mortality: 1990 to 2010,’ published by the World Health Organization (2012) pp.32-36 2 Centers for Disease Control and Prevention ‘Pregnancy Mortality Surveillance System,’ page last reviewe on March 7, 2013 at: http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PMSS.html#5 3 Amnesty International ‘Deadly Delivery – The Maternal Health Care Crisis In The USA,’ London: Amnesty International Secretariat (2010) p.3 4 White, K. ‘An Introduction to the Sociology of Health and Illness,’ London: Sage (2003) p.42 5 Kukla, R. and Wayne, K. ‘Pregnancy, Birth, and Medicine,’ in: The Stanford Encyclopedia of Philosophy (Spring 2011 Edition), Edward N. Zalta (ed.) p.2; Katz Rothman B, (1978) ‘Childbirth As Negotiated Reality’. In: Symbolic Interaction, Vol. 1, No. 2, pp. 126-129; Johanson R., Newburn M. and MacFarlane, A. ‘Has The Medicalisation Of Childbirth Gone Too Far?’ In: British Medical Journal, Vol. 324, No. 7342 (2002) pp. 892-893. 6 Davis-Floyd, R.E. ‘The technocratic body: American childbirth as cultural expression,’ in: Social Science & Medicine Volume 38, Issue 8 (1994) p.1126-1128
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No Place Like Home? Suzan Steeman (5777038) which is often connected to homebirth, and in which the mother and fetus are conceptualized as one and the mother’s intuition controls the process.7 An indication for the over-medicalization of birth is the high rate of hospital delivery. In 2010, 98.8 percent of all births in America occurred in a hospital.8 This figure has remained high since the 1960s, when the proportion of hospital births first reached 96 percent.9 Around the same time that the hospital delivery rate rose to its highest point, critics called for a more natural birth with less medical interventions. Some of these critics came together in the homebirth movement.10 Although the number of hospital births has been very high for the last fifty years, homebirths are on the rise, and in 2009 were at the highest level since 1989. Between 2004 and 2009, the amount of homebirths increased from 0.56 percent to 0.72 percent (29,650 births).11 This increase was mostly driven by non-Hispanic, married, white women above 35. Midwives attended 62 percent of these homebirths.12 Critics of the medicalization of pregnancy and birth argue that continual, technological intervention in pregnancy is often based on no established medical grounds, and that these interventions often go against the findings of major WHO research and guidelines for best practices.13 Two technological interventions that are commonly used in the US although they are not always necessary are labor induction and cesarean section (C-section). According to the American College of Obstetricians and Gynecologists (ACOG) labor induction is recommended when the health of the fetus or mother is at risk and they define it as “the use of medications or other methods to bring on (induce) labor.”14 According to data from the U.S. Census Bureau, the induction rate of births of all gestational ages in America has more than doubled in less than twenty years’ time, the amount of induced birth rose from 9.6 percent in 1990 to 23.1 percent in 2008.15 A study showed that often times induction cases are categorized as elective and therefore not necessary.
7 Davis-Floyd (1994) p.1136 8 MacDorman, M.F., Mathews, M.S., Declercq, E. ‘Homebirths in the United States, 1990–2009,’ NCHS Data Brief, Number 84 (2012) p.2 9 Devitt, N. ‘The Transition from Home to Hospital Birth in the United States, 1930-1960,’ In: Birth and the Family Journal, Volume 4, Issue 2 (1977) p. 47 10 Martin, J.A., Hamilton, B.E., Ventura, S.J., Osterman, M.J.K., Kirmeyer, S., Wilson, E.C. and T.J. Mathews ‘Births: Final Data for 2010,’ in: National Vital Statistics Reports, Volume 60, Number 1 (2011) p. 9 11 MacDorman et al. p.1 12 MacDorman et al. p.2 13 White p.142. For instance, the WHO advices a cesarean rate of 15 per cent, while in America one third of all births are cesareans. From: Grady, D. ‘Caesarean Births Are at a High in U.S.,’ New York Times, originally published on March 23, 2010 at: http://www.nytimes.com/2010/03/24/health/24birth.html?_r=0 14 ACOG Frequently Asked Questions ‘Labor Induction,’ originally accessed on June 14, 2013 at: http://www.acog.org/~/media/For%20Patients/faq154.pdf?dmc=1&ts=20130616T0925383120 15 U.S. National Center for Health Statistics, ‘VitalStats,’ August 2010
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No Place Like Home? Suzan Steeman (5777038)
Researchers explain these elective inductions by pointing to “health care providers' and new parents' desire to control the timing of delivery.”16 Between 1996 and 2009 the rate of C-sections increased 60 percent, and by 2010, 32.8 percent of all births in America were cesarean deliveries.17 This means that America has one of the highest C-section rates of the industrialized world.18 Obviously, the increase in maternal mortality shows that the high cesarean rate has not improved the outcomes of maternal health, while it has also not resulted in significant improvement in neonatal morbidity and mortality.19 Instead, experts say that with each subsequent cesarean, the risks to the mother increase and that cesarean delivery involves major abdominal surgery, which is associated with higher rates of surgical complications and re-hospitalization for both the mother and the newborn.20 Medical professionals have for a long time denied that this rise in induction and C-section was due to medicalization. They provided other causes such as the rising rate of multiple births, more obesity in pregnant women, and the older age of women giving birth.21 However, both the number of multiple births and the average age of birthing women stopped rising around 2003 while the cesarean rate kept increasing. This means that both of these cannot be the cause for the high rate. The same point has been made for obesity in pregnant women since research has shown that the relationship between maternal weight and cesarean rate cannot be ascertained directly.22 Additionally, mothers have been blamed for requesting elective C-sections. For example, a spokesperson of the American College of Obstetricians and Gynecologists (ACOG) claimed this was the case.23 The idea existed that pregnant women were not willing to attend natural-childbirth classes and therefore chose to request a C-section. Another ACOG spokesperson claimed that he had performed elective cesareans because women were too afraid of the labor-pains.24 However, the idea that mothers are asking for C-sections has also been debunked. The ACOG indicates that only 2,5 percent of all births in the US are cesarean delivery at maternal request, which means it is an
16 O’Callaghan, T. ‘Too Many C-sections: Docs Rethink Induced Labor,’ in: Time Magazine, originally published on August 2, 2010 at: http://www.time.com/time/health/article/0,8599,2007754,00.html#ixzz2WC13RsL8 17 Martin et al. p.2 18 Grady 19 Blanchette, H. ‘The Rising Cesarean Delivery Rate in America What Are the Consequences?’ in: Obstetrics & Gynecology, Vol.118, No.3 (2011) p.1 20 Menacker, F., Hamilton, B.E. ‘Recent Trends in Cesarean Delivery in the United States,‘ National Center for Health Statistics Data Brief, No.35 (2010) 21 Ibid. 22 Vireday, P. ‘Cesarean Rates: Debunking the Mother-Blaming,‘ originally published on April 1, 2013 at: http://wellroundedmama.blogspot.nl/2013/04/cesarean-rates-debunking-mother-blaming.html 23 Grady 24 Kotz, D. ‘A Risky Rise in C-Sections‘ US News, originally published on: March 28, 2008 at: http://health.usnews.com/health-news/managing-your-healthcare/sexual-and-reproductive- health/articles/2008/03/28/a-risky-rise-in-c-sections
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No Place Like Home? Suzan Steeman (5777038) even smaller percentage of the amount of C-sections.25 A survey among 1600 women who had had a cesarean, included only one woman who requested the procedure without medical reasons.26 This implies that it is in fact the management of birth that has caused the increasing rate of C-sections. Certain interventions, such as labor induction and continuous fetal monitoring, are associated with cesarean delivery.27 A poll among ACOG members showed that 29 per cent claimed they performed more cesareans because they feared lawsuits.28 Additionally, planning a cesarean is much less time- consuming for physicians than attending a natural birth. There are also financial incentives for physicians to provide a C-section because insurance companies pay more for cesareans than for vaginal births.29 By blaming mothers, medical professionals have failed to take responsibility for the increasing, unnecessary medicalization of birth. By blaming mothers, these physicians have, together with institutions such as ACOG, framed their position in this debate in such a way that it seems like they only care about what is in the best interest of the baby and the mother. When in fact they are most concerned about time-efficiency and avoiding malpractice suits. Since the 1960s, the homebirth movement has tried to reverse some of the results of medicalizations by offering homebirth as an alternative to the medicalized birth that takes place in hospitals. Organizations of midwives and their supporters make up an important part of the homebirth movement. They promote ‘natural’ childbirth, defining birth as a normal process and not as a dangerous activity, and thereby challenging the status quo of hospital delivery. Since the rise of the movement, homebirth has been a controversial issue, and a heated debate has arisen between these proponents of homebirth and their opponents, who are mostly affiliated to the medical profession. The aim of this thesis is to explore this homebirth debate and the arguments that are used by both opponents and proponents. A central component of this research is ‘the rhetoric of fetal rights.’ Fetal rights arguments build on the personification of the fetus and are often in conflict with women’s rights. Users of the rhetoric of fetal rights try to prove the personhood of the fetus, in order to grant the fetus certain rights. The rhetoric is regularly used in the abortion debate and is
25 ACOG Committee Opinion Number 559 ‘Cesarean Delivery on Maternal Request,’ originally published April, 2013 at: http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/ Cesarean_Delivery_on_Maternal_Request 26 Childbirth Connection ‘Why Is the National U.S. Cesarean Section Rate So High?’ (2012) originally accessed on June 27, 2013 at: http://www.childbirthconnection.org/article.asp?ck=10456 27 Ibid. 28 Grady 29 McConnell, C. ‘Take away the incentives for too many c-sections,’ Crosscut, originally published on August 6, 2009 at: http://crosscut.com/2009/08/06/health-medicine/19144/Take-away-incentives-for-too-many- csections/
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No Place Like Home? Suzan Steeman (5777038) often at variance with a woman’s right to choose an abortion and her right to control her reproductive life. With each of the next three chapters I explore the role played by the rhetoric of fetal rights play in the current homebirth debate in the United States. In 1987, feminist scholar Rosalind Petchesky analyzed the representation of pregnant women in contemporary culture and concluded that women were absent while their fetuses were the primary object on display. She concluded: “we have to restore women to a central place in the pregnancy scene. To do this, we must create new images that recontextualize the fetus, that place it back into the uterus, and the uterus back into the woman’s body and her body into its social space.”30 This had to be done because by then, the fetus had become the main figure in pregnancy and this had negative consequences for women. Women were treated as less important and their wishes and autonomy were not taken into account. Fetal imagery shows this treatment very clearly as the mother is often absent. Here I analyze whether the homebirth movement has succeeded in this task and how they have addressed the rhetoric of fetal rights. The rhetoric of fetal rights has its origins in the abortion debate, where it has been used in everything from court cases to advertisement campaigns. An important prerequisite of this rhetoric is the image of the fetus, which has been made possible by rapid advances in medical visualizing technologies since the 1960s. Photographic and ultrasound images of prenatal life have since then been widely available and have become part of the American public consciousness.31 Feminist scholars, including Petchesky, have argued that the availability of fetal images has helped construct the notion of fetal personhood because the images have made it possible to literally present the fetus as separate from the mother. This means that at the same time as the fetus became more visible, the mother became more transparent.32 Although the ultrasound image can only be made when the woman is present, she is not the central figure that is being looked at. Instead, the central figure is the fetus. The fetus becomes the more interesting, primary, and autonomous patient while the mother is simply a vessel.33 In some cases the mother has even been framed as posing a threat to her unborn child.34 In 1973 the American College of Obstetricians and Gynecologists formally designated fetology as a separate specialty. Since then, fetal medicine has also contributed to a reimagining of the maternal-fetal relationship, increasingly seen as one of two individual patients: the mother and
30 Petchesky, R. ‘Fetal Images: The Power of Visual Culture in the Politics of Reproduction,’ In: Feminist Studies Volume 13, Issue 2 (1987) p.287 31 Boucher, J. ‘The Politics of Abortion and the Commodification of the Fetus,’ In: Studies in Political Economy, Volume 73 (2004) pp. 69; Dubow, S. ‘Ourselves Unborn,’ Oxford University Press (2011) p.113 32 Nash, M. ‘From ‘bump’ to ‘baby’: Gazing at the foetus in 4d,’ in: Philament 10 (June 2007) p.13 33 Petchesky p.268 34 Petchesky p.272
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No Place Like Home? Suzan Steeman (5777038) the fetus.35 Technology has provided physicians and parents with more information about the fetus, and while both are medically surveilled and managed, the two separate patients are put in opposition to each other, with the mother supposed to subjugate her rights for the sake of the fetus.36 Recently, 3D and 4D ultrasounds have become increasingly popular in medical as well as commercial settings, providing a more vivid representation of the developing fetus.37 By showing the behavior of the fetus its image as a person is reinforced. Viewers can identify what they see, and associate it with images of babies and small children.38 Petchesky argued that fetal images epitomize the distortion inherent in all photographic images. These images “have the tendency to slice up reality into tiny bits wrenched out of real space and time.” 39 Photographs can make what they portray seem credible simply because it can be seen, they appear to be capturing literal reality and possess the appearance of objectivity. In Western culture, the visual is seen as an embodiment of the truth because when something can be seen it must real. But accepting an image as just that, the truth, means obscuring the fact that it has been constructed and is grounded in a context of historical and cultural meanings. An image is never just an image, as the saying goes, it can say more than a thousand words.40 On top of this perceived objective truth inherent to photographs, fetal images have obtained an aura of scientific authority because of their connection to medical technologies.41 Images retrieved from ultrasounds are culturally seen as accurate, incontrovertible, and inherently authoritative knowledge.42 This has to do with the authority physicians possess, which in turn can be connected to the medicalization of pregnancy and birth. These have increasingly become medical events in which physicians are seen as experts who know what is best. Therefore, ultrasound images of the fetus are easily accepted as the truth while the feelings of the mother are regarded as subjective and of less importance.43 Political economist Joanne Boucher argues that in the public portrayal of the fetus as it is represented in the commercial culture, references to the maternal body are suppressed, while at the same time its embeddedness in complex technologies and artifice is masked.44 Today, when you see
35 Dubow (2011)p.113 36 Nash p. 6 & pp.10-11 37 Wiseman, C.S. Kiel, E.M. ‘Picture Perfect: Benefits and Risk of Fetal 3D Ultrasound,’ in: the American Journal of Maternal/Child Nursing, Volume 32 (2007) pp.102-104 38 Zechmeister, I. ‘Foetal Images: The Power of Visual Technology in Antenatal Care and the Implications for Women's Reproductive Freedom,’ in: Health Care Analysis, Volume 9, Issue 4 (2001) p.393 39 Petchesky p.268 40 Zechmeister p.391-392; Petchesky p.269 41 Boucher p.69 42 Browner and Press ‘The Production of Authoritative Knowledge in American Prenatal Care,’ in: Medical Anthropology Quarterly, Vol. 10, No. 2 (1996) pp.142 & 152-153 43 Zechmeister p.392 44 Boucher p.70
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No Place Like Home? Suzan Steeman (5777038) an ultrasound image of a fetus, you recognize it as nothing other than a fetus. You do not see any references to the mother, you literally see straight through her, and you do not realize that it is not an actual photograph but a technologically constructed portrayal of the fetus. This is probably because the fetal imagery has become so well known in Western culture.45 The personification of the fetus through ultrasound is performed in two different ways. First it is performed by those who portray the fetus as a person, these are the physicians and commercial providers of ultrasounds. Second, those who interpret the fetus as a person also play an active role in personifying the fetus, they are most likely to be the prospective parents. In either case, the fetus is a passive participant in its own personification. Indeed, the ability to make the fetus visual at an increasingly early stage has paved the way for the fetal rights rhetoric to be used in the abortion debate because fetal imagery is framed as if it “proves” personhood. In turn, personhood “implies the possibility of creating a legal person with civil rights already before the baby is born.”46 Ultimately, the boundaries between fetus and baby are blurred because of fetal images.47 This is helpful for the anti-abortion movement because when the fetus is recognized as a legal person, their argument that abortion is murder becomes much more potent. Opponents of abortion argue that the fetus should have human rights and therefore abortion should be illegal, while proponents of abortion rights emphasize the rights of women to determine the outcome of unintended pregnancy. The anti-abortion movement has picked up on this visualization and personification of the fetus. The fact that about 400 000 people attended the March for Life on January 25 2013, to protest against abortion on the 40th anniversary of its legalization, shows that it is still one of the most controversial topics in the United States today.48 Forty years after the Roe v. Wade Supreme Court decision legalized abortion, it is still hotly debated in the public, political, and private domain. In this thesis I will show how the rhetoric of fetal rights developed in the abortion debate and how it has emerged in the homebirth debate. In the chapter 1, I will take a closer look at the origins of the contemporary homebirth movement. I trace its roots in the second wave of feminism of the 1970s and argue that this has subsequently had implications for its goals and methods. For instance the central role the movement grants to women and their rights originates in feminism. In chapter 2, I will explore the rhetoric of fetal rights in the abortion debate. I will analyze the visual by looking at three examples of material used by anti-abortion organizations. I will illustrate that the theory of the personification of the fetus can be recognized in each of these examples, and discuss
45 Petchesky p.; Boucher p.70; 46 Zechmeister p.394 47 Petchesky p.272 48 Giokaris, J. ‘March For Life 2013 Shows Most Americans Disagree With Republicans On Abortion,’ New York Times, originally published on January 28, (2013)
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No Place Like Home? Suzan Steeman (5777038) what implications this has had for the abortion debate. Finally, in chapter 4, I will analyze how the current homebirth debate reflects the importance of the rhetoric of fetal rights.
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No Place Like Home? Suzan Steeman (5777038)
[ 1 ] ‘By Women for Women’
The Origins of the Homebirth Movement in America
In order for me to be able to discuss the homebirth debate and the role of the homebirth movement in contemporary America, it is important to discuss its past. With this chapter I will loosely chronologically describe where the roots of the homebirth movement lie. It is difficult to pinpoint the origins of the movement down to an exact moment in time although it is clear that it has its origins lay in the women’s health movement of the 1970s. I will look at several issues that were increasingly contested and problematized in America and that were connected to the medical world to analyze both these movement more thoroughly. Additionally, I will show what kinds of solutions were proposed, by women for women. The homebirth movement was a response to the increasing medicalization of both pregnancy and childbirth and to the rise of the second wave of feminism. In 1992, sociologist Peter Conrad provided a broad definition of medicalization that will be used throughout this chapter: “medicalization describes a process by which nonmedical problems become defined and treated as medical problems, usually in terms of illnesses or disorders.”49 Furthermore, the medical profession is often mandated to provide some type of treatment and this creates a negative connotation for some.50 Indeed, scholars and feminists have been critical of the expanding influence of the medical profession because they believe it undermined the position of the patient.51 It is important to emphasize the fact that medicalization is not a response to biological facts but rather a social and institutional process.52 Medicalization occurs when a medical frame or definition has been applied to understand or manage a problem.53 The consequences of medicalization of pregnancy and childbirth were presented to American women in different ways at different times and their reactions have been comparably different. In any case, since pregnancy is seen as an illness and the pregnant woman as sick, women have become increasingly passive and dependent upon the medical
49 Conrad, P. ‘Medicalization and Social Control,’ In: Annual Review of Sociology, Vol. 18, (1992), p. 209 50 Conrad pp.210-212 51 Davis-Floyd R. ‘Birth as an American Rite of Passage,’ Berkeley (CA): University of California Press (2003) 52 Kukla & Wayne p.2 53 Conrad p.211
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No Place Like Home? Suzan Steeman (5777038) profession for a safe outcome of pregnancy.54 Medicalization can be confirmed when the fact is taking into account that virtually no woman received care prior to delivering at the beginning of the twentieth century and that nearly all women receive such care today.55 Contrastingly, even though a biomedical representation of pregnancy and childbirth would come to structure viable understandings and experiences during the twentieth century, childbirth had been a social affair that took place at home since the American colonial days. Then, midwives mostly attended births and they were outside the jurisdiction of the medical world.56 However, during the late eighteenth and in the nineteenth century the medical profession started to lay hold of the practice and birth became a more pathological affair that was managed by men. The medicalization of maternity care went together with the reduced appreciation of midwives and the increasing dominance of male physicians.57 At the start of the twentieth century, medical control over birth was consolidated as physicians wanted to respond to criticism on the high infant and maternal mortality rate. The popularity of the twilight sleep movement in 1914 and 1915 reflects how some women felt about these developments. This movement saw the freedom for every woman to choose a painless birth as a feminist issue. This basically meant whether or not to take narcotics and amnesiacs during labor. This medication put the woman in a ‘twilight sleep,’ which then resulted in a painless, or rather unconscious, labor. These efforts can be seen as an attempt by women to gain control over the birthing process, although they did have to rely on physicians to provide the medication.58 Initially, the movement was successful and the use of anesthesia during labor was met with increased popularity. Because this medication could only be provided in hospital, its popularity caused the traditional home labor and midwives to lose ground and the medical profession to take a stronger hold of birth.59 In 1930, the American Board of Obstetrics and Gynecology was established to provide guidelines to hospitals with which to judge the capabilities of staff members and general practitioners. At this time the number of specialists, such as anesthetists, was growing and as a result women expected more from doctors and hospitals.60 As a consequence, medical advances succeeded in tempering the fear many women had of given birth by the 1940s, the experience was
54 Cahill , H.A. ‘Male Appropriation and Medicalization of Childbirth: an Historical Analysis,’ In: Journal of Advanced Nursing, Volume 33, Issue 3 (2001) pp.337-339 55 Barker, K.K. ‘A Ship upon a Stormy Sea: the Medicalization of Pregnancy’ in: Social Science & Medicine, Volume 47, Issue 8 (1998) p.1068 56 Barker p.1074; Schrom Dye, N. ‘History of Childbirth in America,’ in: Signs Volume 6, Issue 1 (1980) pp.98- 101 57 Cahill pp.337-341 58 Schrom Dye pp.100-101 & pp.106-107 59 Walzer Leavitt, J. ‘Birthing and Anesthesia: The Debate over Twilight Sleep,’ in Signs Volume 6, Issue 1 (1980) p.148 & p.159 60 Wertz, R.W. and Wertz, D. ‘Lying-In: A History of Childbirth in America, Expanded Edition,’ New York: Schocken Books (1977) pp.159-160
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No Place Like Home? Suzan Steeman (5777038) regarded more positively, and with less fear. On the other hand, interventions such as heavy anesthesia that caused a mother to not be conscious during most of the birth were met with resistance. Twenty years after the twilight sleep movement, the struggle for control over the birthing process was framed in the opposite way, promoting consciousness instead of twilight sleep.61 Medical understandings of birth and pregnancy became hegemonic and physicians saw both as dangerous processes that required routine medical assistance to prevent disaster.62 Some women desired a more natural birth and a stronger say in the process. Doctors and hospitals did not like the threat the idea of natural childbirth formed to their autonomy and incorporated some of the wishes women had into their practice in order to stay in control. Often, this incorporation was quite limited and interventions still took place, which shows that the physicians stayed in control. With only 12 percent of all births taking place at home by 1950 and that amount dropping to 4 percent by 1960, birth had successfully been moved into the hospital under the supervision of physicians by the middle of the 20th century.63 However, pain control methods required the laboring woman to be confined to bed. This further isolated her since her family was not allowed to visit and the confinement made it impossible for her to contact with familiar, supportive people.64 By the 1960s, as a result of the physician’s ongoing control, hospital delivery posed a time of alienation for many women. This could be alienation from the body, as well as from family and friends, from the community, and possibly even from life itself.65 After the first half of the twentieth century, women yet again set out to regain control over their bodies and births. However, pregnancy and birth were not the only issues that concerned women at that time. During the 1960s, President Johnson had introduced new health care programs in order to improve access to health care, especially for the poor. Around that time, many grassroots organizations surfaced in the United States. Civil Rights, anti-war, and other movements were fighting the suppressing social control they were faced with and mobilized for radical change.66 They critiqued inequality, discrimination, homophobia, and class inequality in the American society. The second wave of feminism arose together with these movements. The health care system was one of the
61 Schrom Dye p.108 62 Barker p.1074; Wertz & Wertz p. 164 63 Devitt, N. ‘The Transition from Home to Hospital Birth in the United States, 1930-1960,’ In: Birth and the Family Journal, Volume 4, Issue 2 (1977) p. 47 64 McCool, W.F., Simeone, S.A. ‘Birth in the United States: an Overview of Trends Past and Present,’ in: The Nursing Clinics of North America 37(4) (2002) p.738 65 Wertz & Wertz pp. 173-179 66 Reagan, L.J. ‘When Abortion was a Crime. Women, Medicine and Law in the United States, 1867-1973,’ University of California Press (1997) p.217; Kline, W. ‘Bodies Of Knowledge: Sexuality, Reproduction, and Women's Health in The Second Wave,’ Chicago: The University of Chicago Press (2010) p.13
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No Place Like Home? Suzan Steeman (5777038) major concerns of feminists who together formed the women’s health movement.67 It is helpful to now first take a closer look at the women’s health movement because that is where the homebirth movement has its origins. Both movements came forth out of the second wave of feminism and both tried to challenge the status quo in the medical world because they argued that equality would not be achieved if women were not in control of their own bodies. However, the homebirth movement tried to challenge medicine’s monopoly of childbirth in particular and promote a more natural model of birth. Within the women’s health movement, individuals had widely divergent goals. However, the demand for improved health care for all women and an end to sexism in the health system united them all.68 Activists of the women’s health movement believed the health care consumers, especially women, were not taken into account in deliberations about how to provide health care services and they raised questions on the power relationships between physicians and patients. A main criticism on physicians, hospital administrators, and other actors in the medical world was that they were putting profits above people. The medical knowledge of usually male doctors was often in conflict with the woman’s own knowledge of her body.69 Until then, issues of women’s health were dominated by the existing scientific paradigm that was based on a male model. This failure to recognize sex and gender as relevant in scientific research can be explained by the historical exclusion of women from virtually the entire public realm. In science, women were excluded from participation but also ignored as subjects of research because a patriarchal model dominated the field.70 One of the more central issues the women’s health movement focused on was women’s reproductive rights. More specifically, on decriminalizing abortion and increasing women’s access to birth control and safe abortion.71 Abortion became the key issue for feminist organizations during the 1960s because its prohibition epitomized the suppression of women. By 1960, abortion was illegal in every state, except for ‘therapeutic’ abortions performed to save a woman’s life. However, there was no consensus in the medical world on the conditions that mandated a therapeutic abortion.72 Hospitals had therapeutic abortion committees that decided whether an abortion would be permitted or not. These committees usually consisted of men who decided on issues of female
67 Morgen, S ‘Women Physicians and the Twentieth-Century Women’s health movement in the United States,’ In: (Eds. E.S. More, E. Fee and M. Parry) Women Physicians and the Cultures of Medicine. Baltimore: Johns Hopkins University Press (2009) p.162 68 Nichols, F. H. ‘History of the Women’s health movement in the 20th Century,’ In: Journal of Obstetric, Gynecologic, & Neonatal Nursing, Volume 29, Issue 1 (2006) p. 56; Morgen p.162 69 Morgen p.163 70 Sechzer, J. A., Griffin, A., & Pfafflin, S. M. ‘Women’s health and paradigm change’. In: Annals of the New York Academy of Sciences, 30, (1994) p.3 71 Morgen p.160 72 Reagan p.5
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No Place Like Home? Suzan Steeman (5777038) reproduction, and therefore denied female autonomy, and maintained a repressive system. Additionally, for women in the women’s health movement the criminal status of abortion was a fundamental feature of the subordination of women.73 Despite its illegal status, women received abortions every year. The risk of dying from an abortion was closely linked to race and class, mortality data shows the racial inequalities in access to safe abortions. While childbirth was becoming safer and accounted for a smaller percentage of maternal mortality, abortion-related deaths increased. This rise can be connected to the illegality of abortion because when skilled practitioners performed abortions, the mortality rate was lower than that of childbirth.74 In order to battle these conditions women organized to support reform legislation. One of the earlier examples of these organization is the Society for Humane Abortion (SHA). This organization proclaimed abortion as a right, demanded repeal of abortion laws, and declared that the decision to have an abortion was a private matter between the patient and her physician. The SHA was the first to frame the problem of abortion in terms of a woman’s right to control her reproduction.75 On January 22, 1973, the United States Supreme Court recognized that the constitutional right to privacy encompasses a woman’s right to choose abortion in the court-case Roe v. Wade. 76 For the first time, the state recognized women’s role and rights in reproductive policy.77 At the same time as the struggles for legal abortion were going on, several groups tried to raise women’s consciousness about the way they were treated in the medical world and challenge the unequal relationship between mostly male physicians and female patients. The goal of consciousness-raising was to encourage women to listen to one another and to construct knowledge about women’s experience.78 One of the most successful examples of this consciousness-raising is the book Our Bodies, Ourselves compiled by the Boston Women's Health Book Collective. In 1969, as the women’s movement was gaining momentum and influence, twelve women met in Boston to discuss their own experiences with the medical world and share their knowledge about their bodies. Eventually, their discussions and subsequent research resulted in a teaching course and a course booklet entitled Women and Their Bodies. During these courses the attending women wanted to work towards
73 Reagan p.173 & pp.214-217 74 Reagan pp.211-214 75 Reagan pp.223-224 76 Schuetz, J. ‘Communicating the Law: Lessons from Landmark Legal Cases,’ Long Grove: Waveland Press (2007) pp. 282-304 77 Reagan p.244 78 Kline (2010) pp. 11-13; Wells S. ‘Narrative Forms in Our Bodies Ourselves’. In: More, Fee, Parry (Ed.), Women Physicians and the Cultures of Medicine. Baltimore: Johns Hopkins University Press (2008) p. 187; Morgen (2009) pp.163-164 For more on the narrative forms in Our Bodies, Ourselves I recommend reading Wells’ entire chapter.
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‘consciousness-raising,’ this concept was already quite popular within the women’s movement. It can be described as a process in which sharing of personal stories led to a “click” or a sudden recognition that sexism lay at the root of their struggles. They found a discrepancy between their personal experiences and what they learned in school or from professional sources such as doctors, nurses, and medical journals. The group wanted experiential knowledge to be at the core of medicine and engage in collective self-education.79 Their knowledge was gathered through the different teaching courses the Boston Women's Health Book Collective had previously organized. There was such a high demand for the booklet and course that the authors decided to distribute the book commercially. In 1973, Simon & Schuster published an expanded edition that was renamed Our Bodies, Ourselves, and was a book “by women for women.”80 This book is a good example of the feminist philosophy taking a concrete form. The ideas of the authors of Our Bodies, Ourselves, reflect the more general ideas of the women’s health movement. In the preface of Our Bodies, Ourselves, the authors explain how they experienced their potential power as “a force for political and social change.”81 They describe how they as individual women were unsatisfied with the way they were treated in the medical world and decided they should be able to alter this treatment themselves. The book provides knowledge about women’s health and sexuality but in a different way than conventional literature had done so far. The chapters are ordered in such a way to tell the story of a normal life, from birth to death. However, for a large part the book relies on experiential knowledge and made this into a central component of their interpretation of health. The aim was to tell a much more human narrative than medical textbooks did at that time.82 The text consists of general information, integrated with personal stories about women’s experience with the medical world. One woman writes
All of a sudden my body told me to push. I kept shouting to everyone around me, “I have to push, I have to push.” They all said, “That’s impossible. You were just five centimeters dilated an hour ago.” Nonetheless, I had to push! Controlling that urge was the most difficult part of my labor. For about five contractions I panted and blew and sweated for all I was worth. Why weren’t they letting me trust my body? It was ghastly. Until, just when I was sure I couldn’t control the urge to push one more minute, the doctor appeared in the doorway. He took one look at me. “Push,” he said, “go ahead and push.” I was too happy at that moment to ask where he’d been until then.83
79 Kline p. 13 80 Boston Women's Health Book Collective ‘Our Bodies, Ourselves’ New York: Simon & Schuster (1973) pp. 1-3 81 Ibid. 82 Wells p.194 83 Boston Women's Health Book Collective p.202
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This quotation clearly shows the message of the book, as well as the women’s health movement. It outlines that a woman’s own feeling can be opposite to what she is told by medical professionals. This particular woman felt she was ready to push her baby out but she was made to wait for a doctor to arrive to allow her to. This unequal relationship between physicians and laboring women is exactly what the women’s health movement wanted to change. According to the authors, women who read Our Bodies, Ourselves were equipped with tools to challenge the medical hierarchy. Another way to battle the issues American women were faced with in the medical world was through establishing women’s clinics. These would serve to empower the women they served. In the 1970s, feminist women’s health centers opened their doors all over the country and these clinics epitomized the feminist philosophy.84 These centers were often founded by feminist health activists who had no professional medical training because they were meant to be an alternative for the established hospitals and clinics. These alternative health care providers believed that the routine passages of a woman’s reproductive life were over-medicalized, they wanted women to take over control from physicians in areas such as childbirth, family planning, and menopause. The women’s health centers were meant for all women and therefore offered free, low-cost, or sliding-scale services for their services.85 Evidently, an important concept for the women’s health movement was empowerment. This concept described the main goal the movement wanted to achieve, for women to take control over their own bodies and not be dependent, passive receivers of the autonomy of physicians and other health care providers. Proponents of homebirth or midwifery have used the medicalization of both mother and baby as an important argument for their cause. Just like the more general women’s health movement, the homebirth movement also believed empowerment of women was necessary. The American homebirth movement is an alternative health belief system that promotes a model of pregnancy and childbirth that is contradictory to the conventional biomedical model. The main ideas of the homebirth movement is that childbirth is, above all, a natural and therefore normal event, that the mother and not the physician should be in control, and that interventions should not be standard. Because of this, proponents believe, it is very possible to let a birth occur at home, as in history. Only when medical conditions or complications are involved,, medical interventions can be necessary.86 The movement was shaped by formally constituted organizations of local, national, and international scope, health care professionals sympathetic to the movement's
84 Geary, M.S. ‘An Analysis of the Women’s Health Movement and its Impact on the Delivery of health Care within the United States,’ In: Nurse Practitioner, Volume 20, Issue 11 (1995) p.29 85 Morgen pp.163-164 86 O'Connor, B.B. ‘The Home Birth Movement in the United States,’ In: The Journal of Medicine and Philosophy, Volume 18, Issue 2 (1993) p.147 & p.150
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No Place Like Home? Suzan Steeman (5777038) position and aims, parents who choose homebirth, and midwives who serve as principal birth- attendants and are meant to support and not manage the birth.87 Advocates of a less medicalized and more natural childbirth found refuge in organizations such as ASPO/Lamaze. French obstetrician Ferdinand Lamaze was the inspiration for this organization and for many supporters of natural birth. In his book Painless Childbirth: Psychoprophylactic Method, Lamaze vowed that a prepared birth could be a painless birth.88 He asked women to respond actively to labor contractions with a set of pre-learned, controlled breathing techniques. With the Lamaze method women were in control of birth and the doctor was part of her ‘team.’ After the method was introduced in America in 1959, it quickly became popular. In 1960, ASPO/Lamaze was founded by strong believers in the method’s benefits. Organizations like this one were meant to change childbirth practices by advocating choice for expectant mothers and fathers during childbirth and by preparing them for birth through childbirth education.89 Childbirth- preparation classes were booming just like books, articles and films on the subject.90 This idea of gaining control over one’s body was popular among educated, middle-class women and posed somewhat of a threat to traditional birthing methods.91 However, according to Our Bodies, Ourselves physical preparation was not enough. The authors claimed women needed to engage in discussions among themselves in order to find support outside the medical community and rely more on experiential knowledge.92 Although statistics show that homebirth was decreasingly common in the United States, some women were choosing this alternative. The New York Times of March 20, 1973 discussed the revival of “the ancient art of midwifery” in California.93 The authors ascribed this revival to the wish some parents had for a natural childbirth, a shortage of doctors, particularly in rural areas, and the desire of some women’s liberationists to avoid male obstetricians. The article continues by stating that doctors oftentimes do not want to attend homebirths because they are too time-consuming, they consider it “sub-standard medical practice,” and because they fear malpractice suits. In the same article, physician Dr. Whitt says he does attend homebirth simply because there is a demand for them. A spokesperson of a hospital in San Francisco explained that the hospital is trying to lure women away from the idea of having homebirths by providing a more “homey atmosphere.”94 This
87 O'Connor p.151 88 Melzack, R. ‘The Myth of Painless Childbirth,’ in: Pain, Volume 19, Issue 4 (1984) p.321 89 Nichols p. 57; Lamaze International ‘About Lamaze: History,’ originally accessed on June 2, 2013 at: http://www.lamazeinternational.org/History 90 Boston Women's Health Book Collective p.183 91 Wertz & Wertz p.194 92 Boston Women's Health Book Collective p.183 93 New York Times ‘Use of Midwives Revived in California’ March 20 (1973) 94 Ibid.
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No Place Like Home? Suzan Steeman (5777038) article shows that by then there was a growing dislike for impersonal care women received in hospitals and that by some, this was recognized as a reason for change. Apparently, the idea of natural births was resonating with American women, as hospitals sought for ways to respond to this need. An article in the Washington Post in 1977, described the growing number of midwives in the United States and the revival of homebirths as a national phenomenon. The author attributes this “boom in the ancient practice of midwifery” mostly to “sophisticated urban and suburban couples” who turn to midwifery as a way to go against the “depersonalization of institutionalized childbirth” in hospitals. The medical community is said to be shocked and the author claims that law and health officials are trying to curb the growth.95 An important figure in the homebirth movement is Ina May Gaskin. In 1971, she founded the Farm Midwifery Center, near Summertown, Tennessee where she helped women birth their baby in a non-medical environment. Her 1977 book, Spiritual Midwifery, caused quite a stir. Gaskin combined the communitarian birthing systems with the technical expertise of Western obstetrics. She is said to have knowledge of technology, biomedicine, homeopathy, and herbs but also a great repertoire of skills. The authoritative knowledge of birth of community midwives like Gaskin had mostly grown out of their collective experience. Midwives themselves write down, publish and spread much of their authoritative knowledge which is referred to as “the cohering and globalizing of midwifery”.96 In 1975, Suzanne Arm’s book Immaculate Deception was published. In this book, she presented a critique on the standard American obstetric practice after talking to mothers, obstetricians, nurses, and midwives. The New York Times reviewed the book and describes it as “remarkable,” “timely,” “valuable,” and “essential reading for any woman who plans to have a baby in an American hospital.” According to the author, birth had become such a medical specialty that it was by then more often seen as the “consummation of the obstetrician’s skill than as the normal procreative function of a woman’s body.” 97 Additionally states that the since the infant mortality rate in America is higher than in fifteen other, smaller, and less medically-advanced countries, something must be wrong with the American way of birth because. Still, she claims, discussion of the American obstetrical record is rare at that time. Arm’s book is such an important addition because it challenges the hospitalization of birth. With her book, Arms shows that among both physicians and parents, the conviction prevails that:
95 Meyer, E.L. ‘Midwifery on Increase,’ In: The Washington Post November 22 (1977) 96 R. Davis-Floyd and C. Sargent ‘Introduction,’ in: Medical Anthropology Quarterly Volume 10, Issue. 2 (1996) p. 117 97 Wilson, J. ‘Immaculate Deception: Doing What Doesn’t Always Come Natural,’ in: New York Times, June 22 (1975)
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Giving birth in a hospital is the safest, quickest, and easiest, and that medical interference with technology and drug can somehow “improve” the birth process. Beyond that, is a belief that homebirth must always be dangerous, and that midwives are nothing more than incompetent substitutes for the real thing, an obstetrician.98
This belief is in line with the broader critique of the homebirth movement. Supporters of the movement wanted to show that birth is a natural process, that the woman is not a patient, and that she has a right to choose the circumstances in which she gives birth does not coincide with the medicalization of pregnancy and birth.99 Medicalization was criticized by the homebirth movement because over the course of the twentieth century, it gave physicians more and women less control over pregnancy and childbirth. During the 1960s and 1970s, supporters of this movement tried to challenge the status quo in the medical world in different ways, and this status quo mostly existed of men. Fighting inequality between men and women is often linked to feminism. In many ways this fundamental starting point is also at the basis of the women’s health movement and the homebirth movement. Overall, the movements sought to empower women.
98 Ibid. 99 Ibid.
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[ 2 ] ‘Visualizing the Fetus’
The Rhetoric of Fetal Rights in the American Abortion Debate
Over the years, anti-abortion advocates have tried to empower the fetus instead of the woman. In 1973, the United States Supreme Court legalized abortion. The Supreme Court ruled that abortion should fall under a woman’s right to privacy and that abortion should therefore be legal and available for all women. During the court case the respondents (Wade) used the rhetoric of fetal rights in order to strengthen their anti-abortion case. They wanted the court to accept the idea that life begins at conception because then they could argue that if the law protects all life, it should also protect the life of the fetus in the mother’s womb and abortion should then be illegal. During the hearings, visual imagery, such as pictures of the development of the fetus, was used to support the respondents’ case. 100 The legalization of abortion after Roe v. Wade meant a victory for pro-choice advocates but it is also a key historic moment for the anti-abortion movement because of the backlash it caused. Immediately after the Roe v. Wade ruling, anti-abortion supporters called for its repeal and now, forty years later, that call has only intensified. Since 1973, there have been multiple court cases in which fetal rights were part of the reasoning. In 1975, for instance, there was the Edelin trial in Boston. In this trial dr. Kenneth Edelin was prosecuted for manslaughter after performing an abortion even though by then, abortion had been legal for two years. In this case, the respondents claimed the fetus was no other than a human being, both under the law and under the microscope.101 Then, in 1981, Jessie Mae Jefferson became the first American woman to have a court-ordered C-section when temporary custody of her unborn child was granted to the Department of Human Resources.102 These cases were based on the decision that fetal rights are more important than the rights of the mother. In this chapter, I want to take a closer look at the anti-abortion movement and some of the propaganda that has been used to advance the anti-abortion cause. I have chosen three examples of promotion material used by anti-abortion supporters and will describe and examine these examples
100 More information about the Roe v. Wade court case and an analysis of both the briefs of both the petitioner’s and the respondents can be found in Schuetz, J. ‘Communicating the Law: Lessons from Landmark Legal Cases,’ Long Grove: Waveland Press (2007) pp. 277-304 101 Dubow pp.97-98 102 Dubow p.117
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No Place Like Home? Suzan Steeman (5777038) in order to illustrate the role the fetal rights argument has played at different times, and the argument of the anti-abortion movement throughout the years. Each of the examples I discuss in this chapter were initiated, endorsed, or supported by the National Right to Life Committee (NRLC). The NRLC is the leading anti-abortion organization in America. President of Kalamazoo (MI) Right to Life Robert N. Karrer described the emergence of the NRLC in the 1960s as “the effort of ordinary people who established grassroots committees and small groups in the late 1960s.”103 However, Karrer himself discredits the claim that ordinary people caused the emergence of the NRLC by showing that the organization has a much more institutionalized background. The origins of the NRLC date back to 1966 when the United States Catholic Conference (USCC) started paying more attention to the abortion issue. At the National Conference of Catholic Bishops of 1967, it was decided to spend $50,000 on battling the wave of legislation that had somewhat liberalized abortion. It was at this conference that the NRLC was established and this quickly became the front-running organization of the anti-abortion movement. However, the organization quickly lost its ties with the Catholic Church in order to appeal to a broader audience. Thereafter, small, independent right-to-life committees throughout the country were established and followed the examples the NRLC set.104 Although, prior to Roe v. Wade, abortion had been illegal for over 100 years, abortions were available at that time. These were illegal abortions as well as abortions performed for therapeutic reasons. Around the time the NRLC emerged, movements to decriminalize abortion also began to make headway and feminists framed abortion as a right.105 After Roe v. Wade several separate anti-abortion organizations incorporated into the NRLC to better engage in “educational, charitable, scientific and political activities.”106 Today, the official NRLC’s website effaces the early years previous to this incorporation and starts counting its existence since 1973. It states that “since 1973 the organization has grown to represent over 3000 chapters in all of the United States.” Today, the ultimate goal of the NRLC is “to restore legal protection to innocent human life.”107 The fact that the NRLC says “restore,” indicates that they believe Roe v. Wade dismissed the legal protection of this “innocent human life” even though the ruling did not attend to this issue. The abortion controversy is their primary interest because in their eyes, the fetus epitomizes innocent human life and needs to be protected because it cannot protect itself.
103 Karrer, R.N. ‘The National Right to Life Committee: Its Founding, Its History, and the Emergence of the Pro- Life Movement prior to Roe V. Wade,’ in: The Catholic Historical Review, Volume 97, Issue 3 (2011) p. 539 104 Karrer pp.527-539 105 Reagan pp.13-14 106 Karrer p.554 107 National Right to Life Committee ‘Mission Statement,’ originally accessed on May 22, 2013 at: http://www.nrlc.org/missionstatement.htm
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Throughout the years, anti-abortion activists have used different kinds of material to promote their cause and put the fetus center stage. I will discuss three examples of these different materials: a booklet containing a comic, a short film and a billboard campaign and accompanying websites, each was supported by the NRLC in some way.
[ 2.1 ] Who Killed Junior
Shortly after the Supreme Court decision in Roe v. Wade in 1973, the NCRL published a booklet titled Who Killed Junior? It was part of the organization’s anti-abortion publicity campaign but it is unclear whether it was available for a wide audience and what kind of response it received.108 The booklet consists of a comic and a few informative pages. It is an early example of both the personification of the fetus and the use of the rhetoric of fetal rights in anti-abortion promotion material. Because of personification, the fetus is seen as a person with its own feelings and rights that need to be protected. The comic itself is 14 pages long and depicts the development of a fetus, Junior, from the moment of its conception to when it is three months old and in danger of abortion. Each separate image entails another week of Junior’s ‘life,’ supplemented by commentary such as “first week: fertilized egg enters the womb of the mother. A new life begins to develop.” The other seven pages provide informational images and texts. The front cover of the booklet simply shows the title (figure 1) while the back cover shows a photo of several dead babies (figure 2). The image on the back cover is accompanied by the words:
Figure 1 Figure 2
108 The website where I found the booklet an from which all the images are derived, specializes in comics that deal with “problems” and supplies the following information about Who Killed Junior: “Earliest known mass- produced anti-abortion hand-out from Right To Life, then a two month old organization, formed directly after the Roe V Wade Supreme Court decision.” Ethan Persoff ‘Who Killed Junior,’ originally accessed on March 18, 2013 at: http://www.ep.tc/junior/
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One morning’s work in an abortion hospital. Is this Nazi Germany in 1943? No – it is our America in 1973. Unbelievable but true – the same evil that we Americans fought against in W.W. II has started here in America! Human beings thrown in a garbage pail to die!”
This reference to Nazi Germany is probably meant to shock readers and although it isn’t mentioned anywhere else in the booklet it might have been an effective strategy to include it on the back cover as a way to directly clarify its position in the abortion debate. Additionally, comparing abortion to genocide probably easily debunked the practice without needing much more information. Each of the pages of the comic consists of a lot of information, statements, and apparent facts. However, it is interesting to notice that the comic is not very explicit about when ‘life’ starts exactly, even though the NRLC would later be much clearer about this.109 The first page of the comic shows the first week of the pregnancy. The commentary says that “a new life begins to develop” and the picture shows an egg-shaped form hurtling into what is said to be the womb but simply look like a transparent sac (figure 3). This explicit mentioning of ‘beginning to develop’ makes it reasonable to believe that the NRLC did not yet suppose life started immediately after conception. However, the question mark accompanying the egg might imply that they did think the fetus is already capable of wondering about his whereabouts and must then possess some degree of consciousness. In week two, on the next page, no major changes have occurred. However, the commentary does clarify that “a new life” is receiving nourishment which is probably meant to point out that it is alive (figure 4). On the page depicting the third to fourth week, the egg shows the first indicators of human life: eyes, eyebrows, and a heart. The commentary emphasizes the major developments are underway by stating that the spinal cord, brain, lungs, stomach, liver, and kidneys are forming and that the heart is beginning to pump (figure 5). In the fourth week the depiction of the fetus starts to resemble a baby, or even a person, due to the arms and legs that have been added to the egg-form (figure 6).
109 On their official website the NRLC states: “The life of a baby begins long before he or she is born. A new individual human being begins at fertilization, when the sperm and ovum meet to form a single cell.” National Right to Life Committee ‘When Does Life Begin?’ originally accessed on March 27, 2013 at: http://www.nrlc.org/abortion/wdlb/wdlb.html; National Right to Life Committee ‘Fetal Development,’ originally accessed on March 27, 2013 at: http://www.nrlc.org/abortion/facts/fetaldevelopment.html
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Figure 3
Figure 4
Figure 5
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Figure 6
Figure 7
Figure 8
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The term ‘baby’ is first introduced on page labeled “sixth to eighth week” and this is also the first time that the NRLC truly recognizes Junior as a responsive person as the commentary says “baby responds to tickling” (figure 7). It is of course not possible for a fetus to get tickled inside the womb, but pointing out that he is able to respond to tickling indicates that he is alert and receptive. Also, tickling is very innocent and contrasts with the harsh implications of an abortion we will see further on in the comic. The expression on his face, he is smiling, indicates that Junior is experiencing positive emotions. In this depiction he looks like a happy little baby. On the page representing the eighth week, the fetus gets called by his name for the first time. Additionally, he gets his own set of fingerprints with the text stating that “Junior has all his fingers and toes complete – even his fingerprints which are the same now as they will be when is eighty years old!” (figure 8). The claim that Junior’s fingerprints will remain the same until he is eighty years old helps indicate that his life is no less important than the life of an eighty-year-old. According to the commentary the “baby” is able to clutch things with his hands. Although it remains unclear what kind of things an eighth week old fetus could get a hold of, the purpose must be to make clear that the fetus is a person with human capabilities. The next page represents the eleventh and twelfth week of the pregnancy and the commentary emphasizes the fact that Junior can feel pain and that all body system are working (figure 9). In 2005, the American Medical Association (AMA) published a clinical review on fetal pain. The authors concluded that no research had ever been able to prove that a fetus can experience pain before the third trimester.110 This means that the claim that Junior can experience pain was unsupported by medical evidence and was just meant to dramatize abortion. Fetal pain was used by anti-abortion activists to evoke compassion for the fetus.111 Also in the eleventh and twelfth week, we see Junior formulating a thought for the first time as he thinks “time for me to get going soon” (figure 9). Even though there are still some 26 weeks left before this pregnancy reaches full-term, Junior is apparently ready to leave. Then, at three months the commentary reads that Junior has been fully formed and that he only has to grow further. But, the image on this page shows an alarmed Junior who is hearing his mother and her doctor discussing “how to kill him” (figure 10).
110 Lee, S.J., Ralston, H.J., Drey, E.A., Partridge, J.C., Rosen, M.A. ‘Fetal Pain a Systematic Multidisciplinary Review of the Evidence,’ in: Journal of the American Medical Association, Volume 294, No. 8 (2005) p.952 111 Dubow p.164
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Figure 9
Figure 10
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A 12-week old fetus is said to weigh approximately 12 grams which means Junior is nowhere near ready to get going soon.112 During the Edelin trial in 1975, several expert testified that they did not believe a fetus had any chance of survival outside the womb at twenty-four weeks. A professor emeritus of pathology at Harvard Medical School stated that a fetus become viable around the 28th week of gestation.113 This again shows that anti-abortionists wanted to convince the audience of the fact that abortion was immoral by arguing that fetuses were fully developed and alive from a very early stage, even though medical evidence shows this is not the case. Here, addressing both fetal pain and viability help solidify the argument that abortion is murder. An important conclusion that can be drawn from the comic is that the NRLC probably wanted to try to convince its public of the fact that a fetus is aware of its surroundings, can feel pain, and experience emotions as early as the end of the first trimester. Although it was not mentioned explicitly, the personhood argument was already being used. For instance, it is indicated by all the different kinds of facial expressions Junior has. He is portrayed while he is smiling, looking puzzled or worried and, as he gets aborted, the expressions on his face show that he is experiencing pain (figure 11). Also, the portrayal of Junior as able to ‘hear’ his mother and her doctor talking and capable of formulating thoughts helps illustrate his responsiveness and alleged personhood (figure 9 and figure 10). Another observation that can be made when looking at the comic is about the role the mother plays. The first page mentions that the fertilized egg has entered the mother’s womb, the womb remains the same shape and size throughout the whole comic and this implies that the mother isn’t a very active participant in the pregnancy. Feminist scholars have argued that ultrasound imagery separate mother and fetus, and I would argue that this comic does the same.114 The pregnancy has become externalized as we are looking inside the womb as spectators standing on the outside. The only time a depiction of the mother is shown, is when she makes the decision to abort Junior. This is the only time an action is attributed the mother, when she and her doctor discuss how to kill her baby and when the question is subsequently raised on how mothers murder their babies. In the commentary to the comic the mother is only mentioned in passive ways. Women in a general sense get some more attention in the rest of the booklet, albeit in a negative way when they are referred to as “foolish” (figure ). On a further page, the silhouette of a pregnant woman is shown, but this woman does not have a face or any other significant features, she is not granted an active role in the debate over abortion (figure ).
112 Baby Centre ‘Average Fetal Length and Weight Chart,’ originally accessed on June 10, 2013 at: http://www.babycentre.co.uk/e1004000/average-fetal-length-and-weight-chart 113 Dubow p.94 114 Nash, M. ‘From ‘bump’ to ‘baby’: Gazing at the foetus in 4d,’ in: Philament 10 (2007) p.6
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Literature in which fetal images have been analyzed has suggested that the mother is often not depicted in these images, the fetus gets described as floating in space, independent from the woman.115 Already in early examples of public fetal imagery the fetus was represented as primary and autonomous. A good example of this is a 1965 photo-essay in Life Magazine called Drama of Life Before Birth. This essay described the development of the fetus. Pivotal to this article were photos taken from the book A Child is Born made by Swedish photographer Lennart Nilsson (see figure 11 for one of these photos).116 In the article different stages of the development of the fetus are described, accompanied by Nilsson’s photos. The photograph clearly shows what scholars mean when they discuss “the floating fetus.” There is absolutely no reference made to the mother and the area surrounding the amniotic sac resembles outer space. However, Nilsson’s photos often did not represent what the article claimed, they were extreme enlargements of mostly dead fetuses. Scholar Karen Newman explains that the a fetus Nilsson photographed was only two-and-a-half inches, while it looks much bigger on the photos he published. She describes that extreme enlargements that focus on the hands and face of the fetus served to dramatize abortion.117 The fact that human features were so distinguishable made them strongly resemble human babies and attributed to the personification. The fact that the article’s text referred to the fetus as “baby” and “person” also helped this process.118 It is possible that the
Figure 11
115 Newman, K. ‘Fetal Positions: Individualism, Science, Visuality,’ Stanford University Press (1996) pp.8-12 116 Nilsson, L. ‘Drama of Life Before Birth,’ Life Magazine, Vol.58, no. 17, (1965) 117 Newman p.10 118 Newman p.10; Petchesky p.263
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No Place Like Home? Suzan Steeman (5777038) makers of Who Killed Junior were inspired by the Life Magazine article, although the comic looks a lot more simplified than the photos, and Junior is attributed with much more capabilities than Nilsson’s fetus. Still, in both instances the fetus is portrayed as separate from its mother and resembles the depiction of a child from an early stage onward. The next five pages deal with the different ways in which a fetus can be aborted, or in the words of the commentary, “murdered.” The commentary on the first of these pages asks and answers the question “how are babies murdered by their own mothers?” Junior is shown looking puzzled, a question mark hanging above his head. The commentary then explains that there are four different ways and that all of these “are cruel and inhuman” and that no matter what way Junior will go, “he will suffer” (figure 11). On the next pages, each of the four ways get discussed and visualized (figure 13). We first see Junior being vacuumed out in little pieces, in the second way Junior is sliced to pieces, in the third he is surgically removed by the physician to later be experimented on or “burned or drowned to death”, and finally Junior is “burned to death” with a salt solution injected into the amniotic sac. There is nothing scientific about the portrayals of the different abortion methods, for instance, the second method makes it seem as though the mother is being stabbed with a long knife in order to abort Junior, and on the next page the doctor’s hand is simply grabbing Junior by his feet to pull him out. Additionally the commentary next to the images is very explicit and non-medical. For instance, Junior is compared to dirt that gets cleaned up by a vacuum cleaner, and the doctor is said to “just slice the baby to pieces.” However, the aim must not have been to educate the audience about the technical side of abortion but simply to invoke disapproval of the procedure in general and compassion for the fetus in particular. This is done by making Junior look frightened, surprised, or in pain in each of the four images. It seems as though he is definitely be aware of what is happening to him.
Figure 12
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Figure 13
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After representing abortion methods in these ways, the comic turns to the abortion debate more generally. The next page shows three women holding signs with slogans such as “It’s my body!” The commentary next to this image states: “Some foolish women say “I have a right to my own body” – this is not true – God has the first right over our body – no woman has a right to interfere with a life god has created” (figure 114). This refutes the feminist argument of the women’s health movement that a woman has the right to her own body. It is instead in line with the idea that fetal rights are more important than a woman’s right to choose. The next page builds upon this argument, stating that no woman has a right over her baby’s body because the baby is a separate human being. It also makes the claim that God’s law should be placed over civil laws (figure 15). Before expanding the religious argument the commentary speaks to teenage girls directly on the next page while claiming that an abortion is not like having your tonsils taken out but that it means killing another human being. This message is reinforced by an image of a small baby (or the fetus) with a long knife cutting through it (figure 16). The commentary on the final pages of the booklet make it clear that God played an important role in the debate at the time Who Killed Junior was published. Three more pages are dedicated to what the bible says about life in the womb and this is then used as an objection to abortion, even though none of the quoted bible passages actually mention abortion. The final page is filled with information about abortion, such as studies that claim “abortions are more than twice as dangerous as childbirth,” and “more than one third of mothers of aborted babies have mental problems later.” Furthermore, the statement is made that there are “scrupulous doctors” who will say an abortion is the easy way out but they “are more concerned with you money that your life or the life of your baby.”
Figure 14
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Figure 15
Figure 16
Figure 17
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On the inside of the cover, information is given for when “you are in trouble,” including the number for the National Pregnancy Hotline, the promise that there are over 1000 agencies “who will help you,” and information on the distribution of the comic (figure 17). This hotline and the agencies must have been affiliated with the NRLC or at least have the same negative attitude towards abortion. This booklet demonstrates the rhetoric of fetal rights well because it depicts the fetus as a person and only pays negative attention to the role of the mother. Junior is depicted as an innocent, conscious victim of abortion that should be protected from this cruelty.
[ 2.2 ] The Silent Scream
The fetus is portrayed in a similar way in the 1984 film 28-minute long The Silent Scream. The Silent Scream was directed by Jack Duane Dabner and narrated by Bernard N. Nathanson, an obstetrician and one of the founders of the National Association for the Repeal of Abortion Laws (NARAL). He also previously performed abortions and himself claims to have “presided over 60 000 deaths.”119 Nathanson said that since the introduction of the ultrasound gave him the possibility to see the fetus inside the womb, he radically changed his thoughts on the issue. In 1974 he argued “there is no longer serious doubt in my mind that human life exists within the womb from the very onset of pregnancy.”120 Although the film shows some informative material about the ultrasound technology and the development of the fetus, the most important and powerful part is the alleged ultrasound depiction of an abortion in progress. During this depiction Nathanson emphasizes the fact that the fetus can be seen moving around, that it is responsive, and aware of what is happening around him. The film derives its name from the moment right before the actual abortion starts, at this point Nathanson claims that we can see the fetus let out a “silent scream”. The Christian organization American Portrait Films produced the film in 1983 and it has since been distributed to schools, churches, state and federal legislators, and anyone who wanted to rent it.121 Today, the entire film can be found on YouTube and on www.silentscream.org.122 A 1985 survey found that 42% of 2,500 Americans said that they had either seen, heard of read about The Silent
119 Imber, J.B. ‘Review of: Aborting America by Bernard N. Nathanson,’ in: The Hastings Center Report, Vol.10, No.3 (1980) p.45 120 McCombs, P. ‘The 'Scream' of Bernard Nathanson; The Obstetricians Odyssey, From Abortion King to Anti- Abortion Activist,’ in: The Washington Post, March 24 (1985) 121 Petchesky p.265; McCombs 122 I have seen the film through www.silentscream.org, unless mentioned otherwise, all quotations in part 2.2 are taken from this film
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Scream.123At the suggestion of President Reagan every member of Congress also received a copy of the film, because he hoped "if every member of Congress could see this film, that Congress would move quickly to end the tragedy of abortion."124 In 1985 the NRLC stated in their newsletter that they vigorously supported the film which they described as “incredible” and “extraordinary”. Its promotion was said to be one of the NRCL’s highest priorities because the organization believed that it was the most newsworthy item in the abortion debate. One of the efforts they made was to make sure that every television network received a tape of the Silent Stream. They claimed that every network showed clips of The Silent Scream.125 The organization’s president John Wilke said the following:
[The Silent Scream] represents the most powerful breakthrough for the right to life movement since the election of President Ronald Reagan. This extraordinary documentary of the death of a 12-week preborn child is changing the very vocabulary of the abortion debate, The National Right to Life Committee has been, and will continue to be, in the forefront of publicizing and distributing this compelling drama.126
The first few minutes of The Silent Scream serve as an introduction for what we are going to be looking at. Nathanson explains how new technologies such as ultrasound imaging and electronic fetal heart monitoring have made it possible for the science of fetology to develop. Fetology is a branch of medicine that is concerned with the study and treatment of the fetus in the uterus. In 1973 the American College of Obstetricians and Gynecologists formally designated fetology as a separate specialty. Since then fetal medicine has contributed to a reimagining of the maternal-fetal relationship, this is now seen as one that constitutes two, individual patients.127 While we see a woman undergo an ultrasound, Nathanson explains its medical uses. He claims that “those technologies […] have convinced us, that beyond question, the unborn child is simply another human being; another member of the human community, indistinguishable in every way from any of us.” This early statement clarifies the common thread of the film, its makers want to convince viewers of the fact that fetus is a human being. At the end of the introduction,
123 Coleman, B.C. ‘AMA Committee Criticizes 'Silent Scream' And Pro-choice Film As Biased,’ Associated Press, December 5, 1985 124 McCombs; McPherson, W. ‘Abortion And Other Images Of Horror,’ in: The Washington Post, February 19 (1985) 125 Andrusko, D. ‘NRLC Vigorously Promotes “The Silent Scream,”’ the reprinting of an article that appeared in 1985 in National Right to Life News, originally accessed on April 23, 2013 at: http://www.nationalrighttolifenews.org/news/2011/02/nrlc-vigorously-promotes-%E2%80%9Cthe-silent- scream%E2%80%9D/#.UXZVt5hTB_Y 126 Ibid. 127 Dubow p.113
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Nathanson continues to praise the technology, he says that this film will show “abortion from the victim’s vantage point,” and that “for the first time we are going to watch a child being torn apart, dismembered, disarticulated, crushed, and destroyed by the unfeeling steel instruments of the abortionist.” At this relatively early moment, Nathanson already refers to the fetus as “a human being,” “a member of the human community,” “the victim,” and “a child.” This is an important feature of his rhetoric that he keeps up throughout the entire film. Nathanson only uses the term ‘fetus’ when he is quoting a segment from a medical textbook. All other times he chooses words such as “child in its prenatal stage of life,” “little person,” “absolutely identifiable human being,” “our second patient,” or “living defenseless tiny human being” to refer to the fetus. In the next shot, Nathanson is standing next to six models of a pregnant woman’s pelvis section which depict the development of a “child in its prenatal stage of life”. The camera zooms in on the models to show that each model represents a different stage of the pregnancy, from four to twenty-eight weeks old. Nathanson explains that “there is no revolutionary or dramatic change in the form or in the substance of this person throughout this developmental stage.” He then takes the model of the twelve-week old “little person” in his hands to show that it is already a “fully formed, absolutely identifiable human being” and that all “his human functions are indistinguishable from any of ours”. What Nathanson+ does here, is in line with the way Who Killed Junior was set up. The different phases of prenatal development are described while the emphasis is put on the fact that the fetus develops human functions at a very early stage. This description and the different ‘names’ Nathanson gives the fetus, help personify the fetus. After walking us through the different development stages, Nathanson shows us a citation from Williams Obstetrics, a book which he describes as the “standard textbook used throughout every medical school in the United States.” This is the only time he uses the word “fetus.” According to Nathanson, the preface of Williams Obstetrics acknowledges the fetus as the second patient of obstetrics and even though the chosen citations do not say anything about abortion, Nathanson uses them as a way to confirm his message. He explains that “traditional medical ethics and precepts command us (physicians) that we must not destroy our patients, that we are pledged to preserve their lives.” However, even though Nathanson describes the fetus as the second patient of obstetrics he does not pay much attention to the first patient: the woman. Just like in Who Killed Junior the position of the mother and woman is a secondary subject. In the first minutes of the film we see a happy mother-to-be enjoying the benefits of the ultrasound technique. Further on when the fetal models are discussed the uterus is described as being “this muscle surrounding the child.” No other reference is made to the woman or mother until we approach the end of the film when Nathanson claims that the woman who had her abortion filmed for this occasion was a feminist who was
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No Place Like Home? Suzan Steeman (5777038) strongly for abortion. He then claims that she was so moved by what she saw at the editing session that she never again discussed the subject of abortion. In the film, women are named the victims of abortion, just like the unborn children. Nathanson says that: They [women] have not been shown the true facts of what an abortion really is. Women in increasing numbers, hundreds, and thousands, even tens of thousands have had their wombs perforated, infected, destroyed, women have been sterilized, castrated, all as a result of an operation of which they have had no true knowledge.
Nathanson then takes it upon himself to inform women of the dark sides and dangers of abortion. Like we have seen in the previous chapter, the technocratic model of pregnancy and birth has made it possible for the medical expert to impose his authority onto women. The Silent Scream shows how ultrasonography can reduce the role of the woman because as we are looking at the footage from the ultrasound, we are literally looking through her. Again, like in Who Killed Junior, the fetus is seen as floating independently in space as a second patient that has its own rights that need to be protected.128 In one shot we see Nathanson wearing a white lab coat while in all the other shots he wears a grey suit, it seems the lab coat is meant to confirm his medical authority as he speaks about the technicalities of an abortion. Of course, most viewers have no idea of how an abortion works and are likely to believe whatever Nathanson tells them in his role as a lab-coat-wearing expert. Compared to Who Killed Junior, the anti-abortion movement has clearly moved away from framing their argument in a religious way and now approaches abortion in a medical-technical way.129 Nathanson is standing behind a table on which instruments and the model of the twelve-week old fetus are exhibited and walks the viewer through each step of the abortion procedure, indicating which instrument is used for what. As he explains the procedure the footage of him applying the instruments to the model gets interspersed with footage of an actual abortion. An operating room can be seen with a woman in stirrups, two nurses can be recognized while the abortionist has his back turned to the camera. The material does not show the abortion explicitly but as the abortionist is seen almost aggressively carrying out the abortion, it is clear that the procedure is uncomfortable and accompanied by blood loss (the sheet underneath the woman is turning red) and pain (the woman’s feet are shaking violently in the stirrups). Although Nathanson explains the procedure very matter of factly, his choice of words gives off a very grim undertone. For instance, when he speaks of tearing the child apart and of crushing the head and then removing its contents. The visuals of the
128 Nash p. 13 129 Petchesky p.264
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No Place Like Home? Suzan Steeman (5777038) film also help deliver this undertone, as Nathanson speaks of crushing the head the camera zooms in on the model right before the instruments snaps. After this scene, Nathanson’s narrative is accompanied by ultrasound footage of the twelve- week induced abortion. The focus first lies on clarifying what we are meant to see on the ultrasound and pointing out where the fetus is in the image. This is necessary because without his expertise narrative it would be hard to decipher what we see happening on the screen. Of course this means that the narrative is guiding the interpretations of the film. The “child” is said to be moving around “its sanctuary rather serenely and quietly while its mouth is receiving its thumb”. Then, the abortionist’s instrument appears in the image, at which point the child is said to be rearing away from it. Nathanson tries to convince viewers of the fact the agitated and violent movements the fetus makes during the procedure imply that the fetus is trying to “get away” from the physicians’ instruments. He states that up to now the child had been “simply floating around in the womb,” but now “its movements” have become “much more purposeful”. As the abortion starts, Nathanson argues that the fetus’s mouth is wide open because it is “threatened imminently with extinction.” He explains that the child is letting out a “silent scream.” Nathanson then says that fetus is experiencing fear and he emphasizes this point by stating the child’s heartbeat is speeding up because it senses aggression in its “sanctuary”. The film immediately negative reactions from leading neurologists and physicians, who indicated that at twelve weeks, it is virtually impossible for the fetus to feel pain or experience fear. They stated that fetal movement is reflexive in nature, and not purposeful. Planned parenthood attacked The Silent Scream by saying it shifted the focus of the abortion debate away from compassion for the health and needs of the woman to an exaggerated concern for the fetus.130 Furthermore they believed the film was full of “scientific, medical, and legal inaccuracies, misleading statements, and exaggerations”.131 In 1985, shortly after the film was released, Planned Parenthood convened a panel of medical experts to review and critique the video. Because they believed the film could “propagate harmful myths that could endanger women’s health and the constitutional right to choose abortion and jeopardize the lives and careers of abortion providers.”132 Additionally “experts in ultrasonography and film technology concluded that the videotape of the abortion was deliberately slowed down and subsequently speeded up to create an impression of hyperactivity.”133
130 Planned Parenthood Federation of America ‘The Facts Speak Louder: Planned Parenthood’s Critique of “The Silent Scream,”’ published by the Katharine Dexter McCormick Library (1985) 131 Dubow p.160 132 Planned Parenthood Federation of America p.1 133 Planned Parenthood Federation of America p.3
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Petchesky has argued that the film is an image, of an image, of an image with a narrative that tells viewers what to believe. She claims the film should not be judged by how well it portrays medical evidence, but instead by the moral message it tries to convey.134 The film continues with some figures on the number of abortions taking place in America and its financial costs. This narrative is told over images of what seem to be dead children in buckets and on tables. The narrative is trying to imply that these are aborted fetuses, that look just like regular babies. Nathanson speaks of an “abortion industry” and says that clinics are being franchised like fast food chains. He says he wants this film to become part of the informed consent for any woman before she undergoes an abortion. Nathanson closes his narrative with the following accusation:
I accuse NARAL (pointing finger at the camera), I accuse Planned Parenthood, and all its co- conspirators in the abortion industry of a consistent conspiracy of silence of keeping women in the dark with respect to the true nature of abortion and I challenge all those purveyors of abortion to show this real time videotape or one similar to it to all women before they consent to abortion.
He says that what America is dealing with is mostly a social problem and that violence should not be sought as a resort. Instead Nathanson wants to “find a solution compounded equally of love and compassion and in decent regard to the overriding priority of human life.” Ending with such a heartfelt resolution makes pro-choice activists seem like pro-violence and anti-love. With The Silent Scream the rhetoric of fetal rights was firmly secured as an argument in the abortion debate. The “live footage” shows the fetus in what is said to be “real-time.” Clarifying that it displays movement and is responsive to what is happening in his surroundings, makes it easier for anti-abortion activists to argue that abortion means killing something that is alive. Although The Silent Scream was quickly debunked by experts after its release, it has nonetheless played an important part in the anti-abortion movement and has helped visualize and strengthen the fetal rights argument.135 In the film, medical hegemony is reaffirmed because medical technologies have been able to give a view inside the wombs. At the same time the woman is portrayed as a passive receiver of these medical advances. Additionally, she is described as a victim of abortion while her rights are not discussed. The next example also portrays the fetal rights argument but focuses less on the idea of life in the womb, and more on the idea of life that is lost in an abortion.
134 Petchesky, pp.266-267 135 Petchesky pp. 264-265; Boucher p. 69
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[ 2.4 ] Too Many Aborted
In June of 2003 the NRLC published the following statement in their newsletter:
The genocide threat to African-Americans continues to be one of the most significant problems facing Black Americans. Tragically, black women have an abortion rate three times higher than white women and many abortion clinics are located in predominately black areas. Since 1973, over 14 million black babies have been aborted, which is equal to the combined populations of eight mid-western states. The number of abortions in the African- American Community is even more frightening when it is compared to the total number of deaths from all other causes combined. Since 1973, about 8 million African-Americans have died from heart disease, diabetes, auto accidents, cancer, aids, etc.136
With this statement, the NRLC suggests that black Americans are disproportionally affected by abortion, that this group is being discriminated against, and that a genocide is taking place. This idea is central to the third example I will be looking at. Recently, some have framed abortion as a violation of the civil rights of African-Americans. Different organizations and individuals have attacked abortion with this argument and I will show how this fits into the rhetoric of fetal rights. The Outreach Department of the NRLC includes Black Americans for Life (BAL) and they are working together with other anti-abortion African-American groups and individuals “to help Black Americans recognize the threat of black genocide posed by abortion.”137 In 2003, Stop Black Genocide flyers and bumper stickers were produced. Although the webpage of the NRLC that provides information on BAL states that the BAL “works closely with a variety of groups to provide outreach to the black community and to help save black babies” it is not clear how active the BAL has been in recent years.138 One of the chapters that is currently planning a new campaign, is Arkansas Black Americans for Life (ABAL). The group is working together with the Radiance Foundation. The Radiance Foundation calls itself an “educational life-affirming organization.”139 It is their vision to “inspire people to embrace their intrinsic value and live a life of meaning.”140 The founder
136 National Right to Life Committee ‘Black Genocide,’ NRLC Online News Bulletin, June 2003, originally accessed on May 16, 2013 at: http://www.nrlc.org/news/2003/NRL05/black_genocide.htm 137 Ibid. 138 National Right to Life Committee ‘Black Americans for Life,’ originally accessed on May 16, 2013 at: http://www.nrlc.org/outreach/BAL.html 139 The Radiance Foundation ‘Our Vision and Mission,’ originally accessed on May 23, 2013 at: http://www.theradiancefoundation.org/our-story/our-vision-mission/ 140 Ibid.
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No Place Like Home? Suzan Steeman (5777038) of The Radiance Foundation is Ryan Bomberger, as a guest speaker at the National Right to Life Committee Convention in June 2013 he will talk about the right-to-life cause as the human rights issue of today and connect it to the history of civil rights in America.141 Together with many different anti-abortion groups like ABAL, The Radiance Foundation has launched the abortion awareness campaign Too Many Aborted142. The following is the mission statement of the accompanying website
TooManyAborted.com educates the public about abortion’s impact on the black community via accurate and documented statistics, historical perspectives, thought-provoking videos, and personal testimonies. We strongly encourage adoption and provide connections to local resources. Through speaking events and media campaigns, we expose the distortion and destruction of Planned Parenthood and its abortion allies.143
The campaign focuses on the abortion rate among black Americans and consists of billboards, a website, and other promotional material.144 The billboards feature a photograph of an African-American infant and proclaimed the message “Black Children are an Endangered Species” (figure 16). It seems strange that the term “endangered species” was chosen to define the problem, this makes it seem as though the campaign deals with a breed of animals that is on the brink of extinction. Only the reference to the campaign’s website helps clarify the point of the billboards. A
Figure 19
141 National Right to Life Committee ‘News Today: 100 Different Reasons to attend the NRLC Convention,’ last edited May 22, 2013 at: http://www.nationalrighttolifenews.org/news/2013/05/100-different-reasons-to- attend-the-nrlc-convention-in-dallas-june-27-29/#.UZ31bKJTB_Y 142 Throughout the rest of the text I will simply say Too Many Aborted when I refer to what is on the website 143 Too Many Aborted ‘Vision & Mission,’ originally accessed on May 22, 2013 at: http://www.toomanyaborted.com/about/vision/ 144 Too Many Aborted website ‘About Us,’ originally accessed on May 20, 2013 at: http://www.toomanyaborted.com/about/
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No Place Like Home? Suzan Steeman (5777038) few months later billboards with the same picture were put up but these carried the words “Black and Unwanted.”145 The campaign’s website is said to reveal “facts” about abortion and consists of articles and videos on different topics such as “abortion as genocide,” “choice kills,” and “the truth about Roe v. Wade.” One of the main claims is that abortion is the “number one killer” of African-Americans “outnumbering all other causes of death combined.” These other causes of death include diabetes, cancer, and accidents.146 Calling abortion a killer implies that this organization sees the fetus as a person. Indeed, on another page abortion is described as the killing of “an innocent human life.”147 This framing of the fetus as an innocent victim is similar to the rhetoric of fetal rights used in Who Killed Junior and The Silent Scream. Additionally, Too Many Aborted refers to abortion as a human rights issue. However, they do not mean that the option for abortion is a human rights issue but instead that the prevention of abortion is a human rights issue. Indeed, the Guttmacher institute has shown that the abortion rate for black women is almost five times higher than that of white women. However, this is due to the fact that these women have more unwanted pregnancies which in turn can be explained by their poor economic status and lack of access to contraception and education.148 Too Many Aborted does not attend to these explanations at all but instead tries to turn a civil rights rhetoric into an argument against abortion, framing abortion as an eugenicist plot disguised as voluntary reproductive choice. Like Nathanson did in The Silent Scream, Too Many Aborted refers to the “abortion industry.” This makes it seem as though there are financial gains to obtain by offering abortion. While Nathanson claimed that this is the case, Too Many Aborted states there are ideological reasons for offering certain people abortions. They state that this abortion industry has its origins in the “birth control industry.”149 According to Too Many Aborted.com, Family Planning organizations are the largest players in this “industry that profits from deception and destruction.”150 Furthermore, the campaign attacks Margaret Sanger, who is called “the mother of Planned Parenthood,” and is accused of having a “negative eugenic birth control philosophy.”151 Margaret Sanger is indeed responsible for establishing Planned Parenthood. In 1916, she and her sister opened the first birth
145 146 Too Many Aborted ‘Number-One-Killer,’ originally accessed on June 14, 2013 at: http://www.toomanyaborted.com/wp-content/uploads/2013/02/NUMBER-ONE-KILLER-2013-FB.jpg 147 Too Many Aborted ‘The Truth (in Black & White),’ originally accessed on June 13, 2013 at: http://www.toomanyaborted.com/truth-in-black-and-white/ 148 Cohen, S.A. ‘Abortion and Women of Color: The Bigger Picture,’ Guttmacher Policy Review, Volume 11, Number 3 (2008) p.2 149 Ibid. 150 Too Many Aborted ‘About Us,’ originally accessed on May 16, 2013 at: http://www.toomanyaborted.com/about/ 151 Too Many Aborted ‘The Mother of Planned Parenthood,’ originally accessed on June 13, 2013 at: http://www.toomanyaborted.com/sanger/
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No Place Like Home? Suzan Steeman (5777038) control clinic in Brooklyn, New York. This clinic provided contraceptive advice to poor women.152 At that time, selling contraceptives was illegal under the presupposition that it encouraged obscenity.153 Although she was arrested because of the work she did, Sanger founded the Birth Control Review, a scientific journal devoted to contraception and the American Birth Control League that would later become Planned Parenthood.154 Too Many Aborted analyzes statements Sanger made but these are not put into their proper context. For instance, the Negro Project is under scrutiny for being a racist program aimed at “eliminating” black Americans. This project was initiated by Margaret Sanger in 1939 to promote contraceptive use among African-Americans in urban and rural areas. Although she had advised to consider input from African-American family planning advocates, this did not happen. The Negro Projects became one of the most controversial Family Planning programs.155 Although the program no longer exists, Too Many Aborted still uses it to criticize planned parenthood, saying that “the intent of Sanger’s Negro Project is firmly intact. Nearly 40% of all African-American pregnancies end in induced abortion. This is by design.” On their website they describe the Negro Project as a program designed “to eliminate the ‘unfit.’” However, this was not Sanger’s aim. Planned Parenthood aims to empower women not control them. Too Many Aborted does not give women in general and African-American women in particular, much credit. The campaign frames women as active partakers of a genocide against the black race. This terrible accusation is not explicitly made but the ideas of the campaign do imply it. On the other hand, Too Many Aborted blames the “industry” behind abortion for seducing black women into having abortions and this makes it seem as though they do not believe women themselves are able to responsibly make the decision to have an abortion and need to be protected. This again is in line with both Who Killed Junior and The Silent Scream, which both portrayed women as passive participants of the pregnancy and victims of abortion. The billboard campaign of Too Many Abortion first started in Atlanta, Georgia in February of 2010. There, Georgia Right to Life (GRTL) sponsored 80 billboards. In 2010, Catherine Davis of GRTL said that if black women had not had abortions, “we would be 59 million strong.”156 An important note to make is that GRTL promotes the message of fetal personhood and campaigns for “effective
152 Planned Parenthood ‘History & Successes,’ originally accessed on June 24, 2013 at: http://www.plannedparenthood.org/about-us/who-we-are/history-and-successes.htm#Sanger 153 Tone, A. ‘Black Market Birth Control: Contraceptive Entrepreneurship and Criminality in the Gilded Age,’ in: The Journal of American History, Vol.87(2), pp.437-439 (2000) 154 Planned Parenthood 155 Parry, M. ‘Broadcasting Birth Control: Mass Media and Family Planning,’ Camden, NJ: Rutgers University Press (forthcoming 2013) p.55 156 Joyce, K. ‘Is Abortion “Black Genocide?” in: Collective Voices, Volume 6, Issue 12 (2011) p.9
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No Place Like Home? Suzan Steeman (5777038) legal protection for all human beings from the moment of fertilization until natural death.”157 Its president George Becker believes the personhood of all human life should be the biblical anti- abortion strategy for the twenty-first century.158 Obviously, Too Many Aborted also believes in personhood as it refers to aborted fetuses as “members of the African-American community.” The organization has created a website dedicated to personhood (www.personhood.net) and on this website video-ads about different issues concerning personhood have been published. One of these issues is the abortion rate among black Americans. The 30 second video Black Genocide shows Alveda King, the niece of civil rights leader Martin Luther King Jr.,director of the African-American outreach department of Priests For Life and one of the most visible advocates of the “abortion is black genocide” rhetoric.159 She has clearly wanted to capitalize on her uncle’s legacy. Priests for Life claimed that they are the new civil rights movement and that the civil rights of black babies are violated because they are being discriminated against before they are even born.160 In the video, King speaks of the genocide that is affecting the black community in America. She explains that over 14 million children have already been killed and she wants people to “help restore our dream by restoring the dignity of human life.”161 King has also endorsed Too Many Aborted and the website cites her asking the following question: “how can the dream survive if we murder our children?”162 Evidently she is trying to make abortion come across as an equally important issue as the civil rights battle her uncle fought for. King compared abortion to slavery when she said that “every aborted baby is like a slave in the womb of his or her mother. The mother decides his or her fate.”163 The civil rights rhetoric lends itself well for the anti-abortion case, in both instances personhood is under scrutiny and therefore Too Many Aborted has also focused on civil rights and claimed that “unborn babies are the most marginalized minority.”164 They attack large civil rights groups such as the National Association for the Advancement of Colored People, the Urban League, and the Congressional Black Caucus. They are accused of having done nothing to address the
157 Georgia Right to Life ‘About Us,’ originally accessed on May 21, 2013 at: http://www.grtl.org/?q=node/107 158 Personhood.net ‘About Us,’ originally accessed on May 21, 2013 at: http://www.personhood.net/index.php?option=com_content&view=article&id=160&Itemid=301 159 Joyce p.8 160 Priests for Life ‘MLK's niece preaches anti-abortion decisions,’ last edited on September 14, 2011 at: http://www.priestsforlife.org/articles/3763-mlks-niece-preaches-anti-abortion-decisions 161 Personhood.net ‘Black Genocide’ (video) originally accessed on May 23, 2013 at: http://www.personhood.net/index.php?option=com_wrapper&view=wrapper&Itemid=592 162 Too Many Aborted website ‘Endorsements,’ originally accessed on May 23, 2013 at: http://www.toomanyaborted.com/about/endorsements/ 163 Ros, L.J. ‘Trying to Hijack the Civil Rights Legacy: What's Behind the Anti-choice "Freedom Rides",’ in: Conscience (2011) 164 Too Many Aborted website ‘Civil Rights Gone Wrong,’ originally accessed on May 24, 2013 at: http://www.toomanyaborted.com/civil-rights-gone-wrong/#/
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No Place Like Home? Suzan Steeman (5777038) abortion epidemic among black Americans and instead supporting organizations such as Planned Parenthood. An article on the website reads:
How is it that these so-called “leaders” advocate the destruction of black life, the number one killer in the African-American community, and call it “Reproductive Freedom?” Most black “civil rights” groups speak of empowerment. Death doesn’t empower the black community. These groups decry health disparities. Yet, they ignore the most deadly one plaguing urban America—abortion. […] These groups speak of political influence through the power of the vote. Abortion has eliminated over 15 million black voters since 1973. That’s real voter suppression.165
Clearly, Too Many Aborted believes these groups are not truly defending the civil rights of African- Americans. It challenges the efforts the groups made to empower the black community by pointing to the fact that abortion does not empower but “destructs” them. What is interesting is that with this civil rights approach you would expect women to take up a more important role. However, it is the unborn black children that this campaign and its supporters sees as the victims here.166 The rhetoric of black genocide has capitalized on the history of African-Americans in the United States. Referring to civil rights is seems to be the next step in the rhetoric of fetal rights. After claiming that abortion is a discriminating plot against black Americans, referring to civil rights is a logical response. Of course, a prerequisite is that the fetus is seen as a person because civil rights can only be attributed to actual persons. The civil rights of the woman or mother are not discussed by the anti-abortion advocates. She is either regarded as a murderer or a fool, and complicit in the plot against the black community.167 Opponents of abortion have succeeded in creating a discourse, that gives the fetus new meaning as a human “life,” and labels abortion murder. Furthermore, the anti-abortion movement has projected a fetal “voice” to compete with and discredit the voices of real, live women. The fetus
165 Ibid. 166 On a political level, abortion has also been compared to slavery. These comparisons are similar to the way Congressman Huelskamp expressed his anti-abortion conviction in a speech at the 2012 Values Voter Summit. He claimed that the biggest war that was being waged “against our liberties” was the war against the unborn. He continued by saying that besides slavery, abortion is “the other darkest stain in our nations character”. He then compared pro-abortion groups to pro-slavery forces and attacked the Obama administration for funding Planned Parenthood that he said was “created for the sole purpose of killing children that look like mine. Earlier in his speech Huelskamp said he had adopted four children, each of the either Black, Hispanic, Native- American. The whole speech can be found on YouTube at: http://www.youtube.com/watch?v=5I-sFQbvDss NBC News ‘GOP Rep. calls Planned Parenthood 'racist' baby killers,’ originally accessed on May 23, 2013 at: http://firstread.nbcnews.com/_news/2012/09/14/13863666-gop-rep-calls-planned-parenthood-racist-baby- killers?lite 167 Joyce p.9
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No Place Like Home? Suzan Steeman (5777038) has been used to skirt the debate away from women.168 Here we have seen the fetal rights rhetoric evolve from a religious concept to a medically-approved message and finally to a human rights issue. Still, each of the examples carries with it the moral message that abortion is wrong. Anti-abortion advocates have found how effective the fetal rights rhetoric is to make this message more convincing and have stuck to it. Currently, their ultimate goal is to see the fetus granted with personhood because once this is established they automatically get a better fighting position to oppose abortion. In each of the examples discussed in this chapter, the fetus played a central role. I argue that the dismissal of the woman in the fetal imagery and the rhetoric of fetal rights in the abortion debate, coincides with the dismissal of the woman in the medical world that was discussed in the previous chapter. Although an abortion obviously affects a woman she has not been granted much attention in any of the mentioned campaigns. This shows that the sexism that feminists were trying to overcome in the 1960s and 1970s still exists today.
168 Reagan p.248
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[ 3 ] ‘Improving Birth’
The Rhetoric of Rights and the Current Homebirth Debate
The results of medicalization have for a large part been accepted and internalized. Most pregnant women voluntarily undergo surveillance in the form of prenatal testing and ultrasound, and do this because they are made to feel responsible for their unborn child. Many see information derived from technology as inherently authoritative knowledge. Additionally, these technologies are culturally regarded as being accurate, incontrovertible, and making a pregnancy more real.169 Scholars have argued that three negative effects of medicalization can be uncovered within American maternal care. First, medicalization has made pregnancy and birth seem like inherently high-risk, pathological processes which should be undertaken with expert help and surveillance. Second, with physicians becoming the primary managers of reproduction, women are reduced to playing passive roles in their own pregnancies and births. And third, pregnancy in general and birth in particular have become more stressful and alienating for women.170 However, some women are battling against the American health care system, because they believe it does not take women’s wishes into account. One of the groups in which these women unite is the homebirth movement. At the same time, the services of midwives are heavily criticized by opponents of homebirth, while the amount of medical interventions during childbirth keeps increasing.171 In this chapter I would like to argue that both the proponents and the opponents of homebirth use a rhetoric of rights to defend their cause. However, while the opponents base their argument on fetal rights and the safety of the child, the proponents have framed the freedom to choose a homebirth or fewer interventions as a human right. In what follows I will show where this framing comes from, how these groups frame their argument, and how these ideas play out in the public debate. I will trace the rhetoric of human rights in childbirth back to the end of the 1990s and then illustrate how it developed in the subsequent twelve years.
169 Browner & Press pp.152-153 170 Kukla & Wayne p.2 171 Martin et al. show that in 2009 the cesarean rate of all births in America was 32.9 percent. The amount of cesarean sections rose nearly 60 percent from 1996 to 2009. Martin, J.A., Hamilton, B.E., Ventura, S.J., Osterman, M.J.K., Kirmeyer, S., Wilson, E.C. and T.J. Mathews ‘Births: Final Data for 2010,’in: National Vital Statistics Reports, Volume 61, Number 1 (2012) p. 9
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The first instance of the rhetoric of rights in childbirth I want to discuss is not mainly associated with American maternal care but it is a relevant starting point since it lays out the basis for the rhetoric that was later used by homebirth activists. The Averting Maternal Death and Disability program (AMDD), part of the Mailman School of Public Health at Columbia University, has recognized maternal health as a basic human right since its founding in 1999.172 The organization focusses mainly on developing countries but also stresses the need for universally available emergency obstetric care services because these could help prevent most maternal and newborn deaths.173 Lynn Freedman, the current director of AMDD, wrote extensively about the connection between human rights and (maternal) health. In an article in the Journal of Gynecology & Obstetrics, she claimed that human rights are international standards that have been negotiated and accepted by governments as binding upon them. They can therefore provide a framework for human well- being in an increasingly globalized world. She states that this formal commitment between countries all over the world, is the first reason why human rights are important to maternal health care.174 She cites two articles of the Universal Declaration of Human Rights to indicate that human rights can be connected to maternal health care:
- All human beings are born free and equal in dignity and rights. (Art. 1) - Everyone is entitled to all the rights and freedoms...without distinction of any kind, such as race, color, sex, language, religion, political or other opinion, national or social origin, property, birth or other status. (Art. 2)175
Freedman explains that dignity should be a core value of maternal health care because “dignity is also a function of the way in which individuals, communities, and whole societies engage in the process of obtaining and maintaining a standard of health.”176 She then explains why maternal deaths are not the same as ‘other deaths.’
It is not simply that women’s lives and health are devalued; it is the intersection of such gender discrimination with imbalances of power by race ethnicity, class and age, within households, across societies, and between countries, that shapes the patterns of maternal
172 Averting Maternal Death and Disability program ‘About Us,’ originally accessed on May 31, 2013 at: http://www.amddprogram.org/d/content/about-us 173 Averting Maternal Death and Disability program ‘AMDD Evolution,’ originally accessed on June 19, 2013 at: http://www.amddprogram.org/d/content/amdd-evolution 174 Freedman, L.P. ‘Using Human Rights In Maternal Mortality Programs: From Analysis To Strategy,’ in: International Journal of Gynecology & Obstetrics, 75 (2001) p.53 175 Freedman p.54 176 Freedman p.55
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mortality. […] There are factors that put some women at risk to start with, including unwanted pregnancy because of lack of access to contraception (a human rights violation) or because of violent, forced intercourse (also a human rights violation).177
Freedman sees maternal deaths as a profound deprivation of human dignity, and explains that prevention deaths should be seen as a basic human right because many of its causes are rooted in other human rights violations. She refers to three treaties that contain provisions most directly relevant to maternal mortality and states that the United States has failed to ratify any of these treaties.178 The International Covenant on Economic, Social and Cultural Rights was ratified by the United Nations (UN) General Assembly in 1966 and encompasses every individual’s right to health. The Convention on the Elimination of All Forms of Discrimination Against Women, was adopted by the UN General Assembly in 1979, and is often described as an international bill of rights for women.179 The United Nations Convention on the Rights of the Child, is a human rights treaty that grants rights to children and was agreed upon in 1989.180 All of these three treaties were drafted by the UN, this gives a reference to these treaties more value because the UN is an influential institution when it comes to human rights. An interesting note to make is that the AMDD wants emergency obstetric care services to be universally available while in America, some frame the rhetoric of human rights in childbirth in such a way to support less medical interventions. How then can this idea of maternal health care as a human right be linked to the advocates of natural birth and homebirth in the United States? In 2009, the American College of Nurse-Midwives (ACNM) published the study Staying Home to Give Birth: Why Women in the United States Choose Home Birth. This study sheds some light on the reasons American women have for choosing homebirth. A survey of 160 women who had had a planned homebirth resulted in 508 separate statements about why each woman chose a homebirth. The researchers organized these statements into 26 themes. The five most common were ‘‘safety and better outcomes,’’ ‘‘intervention-free,’’ ‘‘negative previous hospital experience,’’ ‘‘control,’’ and ‘‘comfortable environment.’’181 Only fourteen women explicitly mentioned “birthing rights.” The fact that most of these women did not yet frame their decision as a human right, suggests that this rhetoric was not yet influential. It is also possible that it is mostly homebirth advocates that use the
177 Freedman p.54 178 Freedman p.53 179 United Nations Division of the Advancement of Women ‘Overview of the Convention,’ originally accessed on June 24, 2013 at: http://www.un.org/womenwatch/daw/cedaw/ 180 UNICEF ‘Convention on the Rights of the Child,’ originally accessed on June 24, 2013 at: http://www.unicef.org/crc/ 181 Boucher, D., Bennett, C. McFarlin, B. and Freeze, R. ‘Staying Home to Give Birth: Why Women in the United States Choose Home Birth,’ in: Journal of Midwifery & Women’s Health Volume 54, No.2 (2009) p.121
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No Place Like Home? Suzan Steeman (5777038) rhetoric of human rights in childbirth, and parents may prefer more personal explanations. Advocates of birth rights use the human rights rhetoric because it gives added weight to their argument. Mere personal reasons might not be as convincing as the human rights frame. The study shows that individual women are more likely to describe the choice between homebirth and hospital birth as a personal matter, although the themes in the study do draw on the rhetoric of human rights as they suggest that women who choose a homebirth want to exercise control over the birth as they have less trust in hospitals.182 In 2010, Hungarian woman, and mother, Anna Ternovszky took Hungary to the European Court of Human Rights (ECHR) when she was pregnant with her second child. She did this because she was not allowed to choose to give birth at home. She won the case. From that moment on, each European Union member state has to comply with the Ternovszky decision. This means that they must ensure that “pregnant women have a genuine choice to birth outside the hospital if they so choose.”183 The Court determined this issue lay within the right to privacy, just as the American Supreme Court did in Roe v. Wade in 1973. The fact that the ECHR considered the case to be a human rights issue had major implications for the rhetoric of human rights in childbirth. Advocates of homebirth have seen this court case as a turning point in the homebirth debate and use it as an argument to promote their cause. In America, the American College of Obstetricians and Gynecologists (ACOG) has expressed that they do not recommend homebirth. In 2011, the ACOG published a committee opinion in which they reiterated their previously expressed opposition to homebirth. Allegedly, the ACOG already published a statement to express their opposition to homebirth in 2008. However, the only statement the ACOG currently provides is the one they released in 2011.In this committee opinion, the ACOG states that they believe “the safest setting for labor, delivery and the immediate post- partum period is in the hospital, or a birthing center within a hospital complex.”184 According to ACOG, women are free to make their own decision in the matter as long as they are informed about the fact that “planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth.”185 However, this increased risk was found in a meta-analysis of research on home and hospital births by Wax et al. in 2010. However, this analysis has been widely contested by scholars and organizations such as the National Association of Certified Professional Midwives (NACPM). Some of the academics whose research was included in
182 Boucher et al. (2009) pp.123-125 183 Hayes-Klein, H. ‘Bynkershoek Conference Papers: Human Rights in Childbirth Conference,’ The Hague: Bynkershoek Publishing (2012) p.17-18 184 American College of Obstetricians and Gynecologists Committee Opinion number 476 ‘Planned Home Birth,’ February (2011) 185 ACOG Opinion number 476
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No Place Like Home? Suzan Steeman (5777038) the meta-analysis have argued that the article is “deeply flawed.”186 The NACPM states that the methodology of the Wax article is heavily flawed, that his conclusions are in direct conflict with a “growing international body of quality research that demonstrates the safety of homebirths,” and that “his alarmist conclusions will only serve to support the increased use of medical interventions in childbirth that have consistently been shown to cause more harm than good to women and infants.”187 A study published on Medscape shows that the Wax article contains many errors and paradoxical results. This study advises prospective parents to not take the conclusions of the Wax article to heart because they are made on the basis of combined results of too disparate researches.188 The ACOG never responded to the criticism the Wax article generated. Rather, they reaffirmed their 2011 committee opinion in 2013. Either way, the ACOG committee opinion has been regarded as an important and influential voice in the debate on homebirth.189 In a resolution the policy-making body of the American Medical Association (AMA) stated they support the statement the ACOG made in 2008 in which was stated that the hospital was the safest setting for birth. Furthermore, the AMA proposed to develop model legislation “in support of the concept that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG.”190 Although the ACOG states they “respect the right of a woman to make a medically informed decision about delivery,” their conviction that a hospital is the safest setting for birth implicitly entails the opinion that choosing a homebirth means voluntarily risking the safety of the unborn child and the mother herself.191 The ACOG does not totally reject homebirth and it also attends to a woman’s ‘freedom’ to choose. However, in their statement, the ACOG does make homebirths seem less safe than hospital birth by calling the latter “the safest setting”.192 Two major professional medical associations have clarified their position in the homebirth debate. Both do not support homebirth simply because they believe it is a less safer location for birth. To support their opinion, both rely on heavily contested. They have nevertheless sustained their negative stance
186 Horton, R. ‘Offline: Urgency and concern about home births,’ in: The Lancet, Volume 376, Issue 9755 (2010) p.1812 187 National Association of Certified Professional Midwives Press Release ‘RE: Maternal and Newborn Outcomes in Planned Home Birth Vs. Planned Hospital Births: A Meta-Analysis, Wax JR, Lucas FL, Lamont M, et al.,’ July 6 (2010) 188 Michal, C.A., Janssen, P.A., Vedam, S., Hutton, E.K., De Jonge, A. ‘Planned Home vs Hospital Birth: A Meta- Analysis Gone Wrong,’ published online on April 1 (2011) at: http://www.medscape.com/viewarticle/739987 189 Hunter, A. ‘Are Home Births Dangerous?’ ABC News, published online on July 11, 2008 at: http://abcnews.go.com/Health/story?id=5340949&page=1#.UcloCzs3Crg 190 American Medical Association ‘H-245.971 Home Deliveries ,’ originally accessed on June 25, 2013 at: http://www.ama-assn.org/resources/doc/hod/a08resolutions.pdf 191 ACOG Committee Opinion number 476 192 Ibid.
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No Place Like Home? Suzan Steeman (5777038) toward homebirth. A possible explanation for this could be the fact that the medical world does not want to lose the authority they have in the field of pregnancy and birth to midwives and other birth attendants. A 2009 research on perceived risks of homebirth among physicians and midwives is supportive to this idea. It showed the incongruity between philosophies of midwives and physicians. Physicians often base their opinions on the safety and acceptability of home delivery on anecdotal data and perception, rather than on scientific evidence. They only witness cases that need to be transferred to the hospital and therefore have negative connotations with homebirth. At the other side of the fence, midwives experience hostile conduct of physicians when the accompany laboring women to the hospital.193 It seems both midwives and physicians oppose each other’s practices. Again, a critical difference is that midwives see birth as something natural, where physicians recognize it as a pathological process. In 2012, the NACPM, the American College of Nurse-Midwives (ACNM), and the Midwives Alliance of North America (MANA) released a consensus statement with recommendations to try to overcome these differences and establish the idea of birth as a normal process.194 The organizations represent midwives, albeit in slightly different ways. The NACPM is an organization of Certified Professional Midwives (CPM) that aims to increase women’s access to midwifery.195 According to their essential documents, they see it as the goal of midwifery to “support and empower the mother and to protect the natural process of birth.” 196 Furthermore they strive to minimize technological interventions, and claim that “the best research demonstrates that out-of-hospital delivery is a safe and rational choice for healthy women, and that the out-of-hospital-setting provides optimal opportunity for the empowerment of the mother and the support and protection of the normal process of birth.”197 The ACNM represents certified nurse-midwives (CNMs) and certified midwives (CMs) and claims to set standards for “midwife excellence” and have the woman “at the core” of their practice.198 The MANA is “dedicated to high quality, empowering, women-centered maternity care as exemplified by the midwifery model of care” and “values each woman’s autonomy in making
193 Cheyney, M., Everson, C. ‘Narratives of Risk. Speaking Across the Hospital/Homebirth Divide’ In: Anthropology News Volume 50, Issue 3 (2009) pp.7-8 194ACNM, MANA & NACPM ‘Supporting healthy and normal physiologic childbirth: a consensus statement by ACNM, MANA, and NACPM’. Released on: June 5 (2012) p.1 195 According to their website a CPM is “a knowledgeable, skilled and independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM). CPM is the only international credential that requires knowledge about and experience in out-of-hospital birth.” NACPM ‘What is CPM?’ originally accessed on June 19, 2013 at: http://www.nacpm.org/what-is-cpm.html 196 National Association of Certified Professional Midwives ‘Essential Documents of the National Association of Certified Professional Midwives,’ (2004) 197 Ibid. 198 American College of Nurse-Midwives ‘About ACNM,’ originally accessed on June 19, 2013 at http://www.midwife.org/About-ACNM
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No Place Like Home? Suzan Steeman (5777038) informed choices that affect her body, pregnancy, labor, birth, and parenting style”199 The consensus statement these organizations released in 2012 was intended for health care professionals and policymakers. This statement identifies key benchmarks for safe, healthy, and normal physiologic childbirth and reflects the ideologies of the organizations. They refer to the current, widespread application of technological interventions that lack scientific evidence for a primarily healthy birthing population and call for less unnecessary interventions. They claim that the use of obstetric interventions in labor and birth has become the norm in the United States, and cite data that reveals that half of all pregnant women receive synthetic oxytocin to induce or augment labor, and that one third of women deliver their babies via a C-section.200, According to the consensus statement, the three organizations believe a normal physiologic labor and childbirth is “one that is powered by the innate human capacity of the woman and fetus.”201 This means that technological interventions should not be the starting point when thinking about births. Women and fetuses should be trusted to be capable of handling the birth without these interventions. The consensus statement contains recommendations for policy, education, and research to promote normal physiologic childbirth including:
• Introduction of policies into hospital settings to support normal physiologic birth; • Comprehensive examination and dissemination of the evidence and care practices supportive of normal physiologic birth; • Midwifery care as a key strategy to support normal physiologic birth • Increasing the midwife workforce and enhancing regulations and funding strategies to support their practice; • Competency-based, inter-disciplinary education programming for maternity health care clinicians and students on the application of care that promotes normal physiologic birth; • Development of a future research agenda on short and long-term effects of normal physiologic birth.202
199 Midwives Alliance of North America ‘About us,’ originally accessed on June 19, 2013 at: http://www.mana.org/about-us/mission-goals 200 ACNM, MANA & NACPM Consensus Statement p.1 The website ‘Netdoctor’ provides some basic information on synthetic oxytocin: “Syntocinon injection contains a synthetic version of the naturally-occurring hormone oxytocin, it is used to induce labour for medical reasons, or if labour has not started naturally. The dose of the medicine is adjusted until the contractions produced are in a similar pattern to that of normal labour. Synthetic oxytocin can also be used to stimulate labour that has started naturally, but is considered too weak to push out the baby. In this case the medicine strengthens the contractions of the uterus. After the baby has been born, Syntocinon may be given to stimulate contractions that help push out the placenta and prevent heavy bleeding.” Netdoctor ‘Syntocinon,’ originally accessed on May 15, 2013 at: http://www.netdoctor.co.uk/pregnancy/medicines/syntocinon.html 201 ACNM, MANA, and NACPM Consensus Statement p.1 202 ACNM, MANA, and NACPM Consensus Statement p.4
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The arguments made by these organizations correlate with those of the homebirth movement in the 1960s and 1970s. Both then and now, the pregnant woman is put center stage by proponents of homebirth, while empowerment of women lies at the core of the ideologies. Additionally the organizations believe that allowing no unnecessary interventions that interrupt the normal physiologic processes has the potential to enhance the best outcome for the mother and.203 This is also in line with the ideas of the early homebirth movement in which midwives like Ina May Gaskin emphasized the natural characteristics of birth. The consensus statement contrasts the ACOG committee opinion in that it is opposed to too much technological interventions. It emphasized the process, which should be normal physiologic birth, while the ACOG put emphasis on the outcome: a healthy child and mother. In a way these three organizations seem to want to meet the ACOG halfway because they do not necessarily debunk hospital birth but propose that there are ways to improve it. Where the ACOG committee opinion briefly attended to a woman’s right to choose, this statement does not take rights into account. In the 2012 documentary Freedom For Birth, Hungarian midwife Ágnes Geréb argues that the freedom in a country can be measured by the freedom of choice regarding giving birth. Geréb was prosecuted in Hungary for her work as a midwife, and her story is the main thread running through the documentary, which is part of the One World Birth project. This project was initiated by Toni Harman and Alex Wakeford and Freedom For Birth is the first film in a series of seven. The couple felt they had had no control over the birth of their daughter and wondered where the problems lay exactly and what the solutions might be. They travelled through Europe and North America to speak to experts such as obstetricians, midwives, psychologists, and academics in order to find out more about the problems surrounding birth today.204 Harman and Wakeford describe the case of Ágnes Geréb as “the worst of what is happening with birth today.”205 Nonetheless, they believe this story entails hope for a future in which all women are free to choose the kind of birth they want. In the film, they state that today, birth “has been stolen by a powerful institutionalized system that is born of fear, a system that inherently believes that birth is dangerous, and must be managed and controlled by modern technology.”206 They conclude that the main issue is the violation of a woman’s basic human right to retain control over her body. The One World Birth project describes itself as “a movement for change” because in so many countries there is no “freedom for birth.” The issue of women who are coerced into opting for interventions by doctors
203 Ibid. 204 One World One Birth ‘About’ originally accessed on May 15, 2013 at: http://www.oneworldbirth.net/about/ 205 Freedom For Birth (campaign video) originally accessed on May 15, 2013 at: http://www.youtube.com/watch?feature=player_embedded&v=0-U_6AM6EVs 206 Ibid.
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No Place Like Home? Suzan Steeman (5777038) without full understanding of the consequences, is an important issue the filmmakers want to fight against. Their goal is to restore birthing women as the decision-makers in childbirth.207 In the documentary, Anna Ternovszky describes why she decided to appeal to the European Court of Human Rights when the Hungarian state did not allow her to have a homebirth. Furthermore, it shows Ternovszky attending the Human Rights in Childbirth Conference held in The Hague on Human Rights Day, 10 December 2012. This conference was organized by the grassroots network Human Rights in Childbirth, which wants to ensure that “the birthing woman is the decision-maker during childbirth and the recognition that she is in the best position to determine what support she needs for the safe and healthy birth of her baby.”208 Considering the principles of the conference, it makes sense that The Hague was chosen as the location. The International Court of Justice, a principal organ of the United Nations, is located there and the organizers probably wanted to address the importance of the issues they were dealing with.209 The attendants of the congress came from fifty different countries and their professions ranged from lawyers to doctors to midwives to academics.210 They did not aim to decide what kind of birth is best, instead they wanted to attend to what they saw as a the fundamental issue of Human Rights in childbirth, and retaining control over one’s body.211 In the introduction to the Conference Papers, lawyer and director of the Bynkershoek Institute’s Research Center for Reproductive Rights (RCRR) Hermine Hayes-Klein explained that the conference was intended to explore the theoretical and practical significance of the Ternovszky decision. On its website, the RCRR uses a quote of Margaret Sanger about free motherhood to clarify their position and explain that they are devoted to exploring issues of “empowered maternity.”212 These are issues associated with “access to birth control and abortion, the ability to choose the timing of conception and the father of the baby, health care and meaningful support during pregnancy and childbirth, surrogacy, the legal ethics of reproductive technologies, women’s authority and control over the process of labor and delivery, and the economics of motherhood.”213
207 Freedom For Birth (web version) originally accessed on May 15, 2013 at: http://www.youtube.com/watch?feature=player_embedded&v=D7c8UxbT7CU 208 Human Rights in Childbirth ‘Information for the Press,’ originally accessed on June 2, 2013 at: http://www.humanrightsinchildbirth.com/about/press 209 International Court of Justice ‘The Court,’ originally accessed on June 26, 2013 at: http://www.icj- cij.org/court/index.php?p1=1 210 Human Rights in Childbirth ‘Conference 2012,’ originally accessed on June 2, 2013 at: http://www.humanrightsinchildbirth.com/hric-conferences/past-hric-conferences/conference- 2012/participants 211 One World One Birth ‘About’ originally accessed on May 15, 2013 at: http://www.oneworldbirth.net/about/ 212 Bynkershoek Institute ‘Bynkershoek Research Center for Reproductive Rights,’ originally accessed on June 7, 2013 at: http://www.bynkershoek.eu/activities/bh-research/bhr-reproductive-rights/ 213 Bynkershoek Institute ‘Bynkershoek Research Center for Reproductive Rights,’ originally accessed on June 7, 2013 at: http://www.bynkershoek.eu/activities/bh-research/bhr-reproductive-rights/
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The RCRR believes all these are tied to the legal and economic status of women in their society and that more research is needed to find out what this status is and how it can be altered. Their focus lies on securing civil and human rights for women. Hayes-Klein poses the argument that women in America do not have a say in their birthing process. She argues that American women face many hurdles if they want a non-medical birth, and that these hurdles are often not for reasons of safety or health, but because of money and power.214 In the same volume, Ina May Gaskin writes of the American maternity care industry that “processes more than four million births each year” and spends more money per capita on maternity care than any other country. 215 Still, she claims, America produces the highest maternal mortality rate among countries of high economic status, and statistics of the WHO and the CDC support this claim.216 Gaskin points to the monopoly doctors hold over birth, and argues the necessity of human rights advocates to defend the rights of mothers and families. She writes:
The furor over home birth has continued over the last four decades, and unfortunately, it has distracted attention from the very real problems in US maternity care—our high and increasing rates of cesarean operations, induced labors, maternal mortality, the restrictions placed on vaginal births after cesarean, the small number of midwife assisted births, and the lack of a system for accurately counting and reviewing the causes for maternal deaths and near-misses.217
Gaskin’s words are in line with the recommendations of the consensus statement of the NACPM, the ACNM, and the MANA. By pointing to the commotion that homebirth has caused over the years and then contrasting this to the many things she thinks are wrong with American maternity care system, she succeeds in pointing out that it is this system that is at fault and not women or midwives. This is different from the ACOG committee opinion that affirmed their belief in the medical system and called this the “safest” option. In recent years organizations have been established to protest against the limitations put on women to exercise control over their birthing experience. In 2012, the first Rally to Improve Birth was held, organized by ImproveBirth.org. The founder of this organization states that ImproveBirth.org is not simply about natural birth vs. medicated birth or about hospital birth vs.
214 Hayes-Klein, H. (ed.) p. 19 215 Gaskin, I.M. ‘Letter to the Conference,’ in: Hayes-Klein, H. (ed.) ‘Bynkershoek Conference Papers: Human Rights in Childbirth Conference,’ The Hague: Bynkershoek Publishing (2012) p.26 216 World Health Organization, UNICEF, UNFPA and The World Bank ‘Trends in maternal mortality: 1990 to 2010,’ published by the World Health Organization (2012) pp.32-36; Centers for Disease Control and Prevention ‘Pregnancy Mortality Surveillance System,’ originally accessed on June 16, 2013 at: http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PMSS.html#5 217 Gaskin (2012) p.26
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No Place Like Home? Suzan Steeman (5777038) home birth or birth center birth. Instead it wants women to be able to make safer and more informed decisions about their care and their babies’ care. The organization argues that women can only be treated with dignity and compassion if they are given full and accurate information about their care options, including the potential harms, benefits, and alternatives.218 The rhetoric of human rights in childbirth is used in the following way:
We believe that women have the right to be respected as the decision-makers on their bodies and, by extension, their babies. Unfortunately, this right is not a reality in many parts of the country. Part of our ongoing advocacy work is to inform and support women in accessing their human and legal rights to make decisions about their bodies, babies, and births.219
Here, the woman is put center stage, similar to the consensus statement of the NACPM, the ACNM, and the MANA, and the Human Rights in Childbirth Conference. All three use the rhetoric of rights to authorize this central role attributed to women. ImproveBirth.org adds that the care provided should be catered to the individual, her wishes should be taken into account. The organization is a strong supporter of evidence-based maternity care. According to ImproveBirth.org evidence-based maternity care is the opposite of what is now routine maternity care. It means that physicians are honest and clear about all the possible options a birthing woman has in her birthing experience. For this information medical professionals need to rely on current medical evidence that has proven what is most beneficial to mothers and babies. Currently, the focus of medical and nursing education lies too much on what can go wrong and not on treating birth like a normal process.220 It is interesting to see that ImprovingBirth.org does not wholly reject the medical profession but that it mostly criticizes it. The organizations explains that a birthing woman is likely to believe what her doctor or nurse tell her because she credits them with authority and knowledge. However, they say, these medical professionals cannot always be trusted to give full disclosure. An example they give to support this claim is the high C-section rate in America. They point out that research show that less than 15 percent of all births need to be C- section, while the rate in America is 33%. The ACOG has shown that ImproveBirth.org has a solid point when they stated that homebirth is associated with more risks than hospital birth. Even though the research they relied on was highly contested, they stuck to their opinion. All of this is in
218 Improving Birth ‘Why We Do It,’ originally accessed on June 1, 2013 at: http://www.improvingbirth.org/why-we-do-it/ 219 Ibid. 220 Improving Birth ‘What is Evidence-based Maternity Care?’ originally accessed on June 27, 2013 at: http://www.improvingbirth.org/the-evidence-shows/
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No Place Like Home? Suzan Steeman (5777038) line with what Barbara Katz Rothman wrote about the medical world in her letter to The Human Rights in Childbirth Conference. She described that medicine has a talent for “creating feelings of safety,” even if these are not grounded in scientific research.221 The first Rally to Improve Birth was held in 2012 and consisted of events in 110 cities, in 46 states. Activists took to the streets of cities such as Atlanta and Los Angeles carrying signs reading “know your options,” “evidence-based birth,” “birth matters,” “respectful maternity care,” “fewer inductions,” “dignity in birth” (see figure 19 and figure 20). The commentator of a video coverage of the New York City rally states that the protesters are gathered to raise awareness to the lack of evidence-based maternity care in the United states and “those holding signs are calling this the most overlooked and underreported women’s rights issue in decades. Saying it is time that women have the right to choose how and where they birth their babies.” The coordinator of the New York City rally said that a major issue they want to battle is the fact that a lot of what happens in the birthing environment and maternity care itself is opinion-based, or fear-based and not evidence-based.222 The website Mommyish was ranked one of the 50 Best Websites of 2012 by Time Magazine. It describes its writers as people who take parenting and not themselves, seriously and states they are “a site for parents who are tired of mommy blogs.”223 A contributor to the website posted a reaction to the Improve Birth rally in Fort Wayne with the title “Apparently Labor Day Is The Time To Demonstrate For VBAC On Street Corners”. The author writes that according to their website Improving Birth is about “reducing the levels of C-sections, informing mothers about VBAC and promoting natural, unassisted birth as much as possible.”224 She explained she accidently passed by the rally and was not pleased with what she saw. According to her, protesters too clearly stated which birth is better, to oppose this she says that “as long as there is a happy baby every choice is acceptable.” Her perspective is often posed as a counterargument to the rhetoric of human rights in childbirth. It states that a healthy baby should be the goal and when you focus on how to get there you are losing sight of what is important. This particular author says that “we at Mommyish support, even encourage, sharing personal stories” however, she states this rally went too far in promoting
221 Katz Rothman, B. ‘Letter to the Conference,’ in: Hayes-Klein, H. (ed.) ‘Bynkershoek Conference Papers: Human Rights in Childbirth Conference,’ The Hague: Bynkershoek Publishing (2012) p.51 222 YouTube video ‘Improving Birth Rally for Change NYC Labor Day 2012,’ published on November 13, 2012 at: http://www.youtube.com/watch?v=3TibPvLb1ZA 223 Mommyish ‘About ,’ originally accessed on June 1, 2013 at: http://www.mommyish.com/about/#ixzz2Uxj7DQKt 224 Cross, L. ‘Apparently Labor Day Is The Time To Demonstrate For VBAC On Street Corners,’ on: Mommyish, originally published on September 3, 2012 at: http://www.mommyish.com/2012/09/03/labor-day-vbac- demonstration-improving-birth-868/
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No Place Like Home? Suzan Steeman (5777038) deeply personal decisions as if there is only one right way.225 Coordinator for the Improving Birth National Rally for Change in Fort Wayne Lindsey Gillespie posted a reaction to the article at the Mommyish website. She stated that they do not promote unassisted birth but are pushing for improvements in maternity care.226 A photo of the Fort Wayne rally also reveals that the demonstrators did not solely focus on VBACs but also called for evidence-based birth and fewer inductions and C-sections (figure 21).
Figure 20: Rally to Improve Birth Atlanta, Georgia227
225 Ibid. 226 Reaction to article on Mommyish website by Lindsey Gillespie at: http://www.mommyish.com/2012/09/03/labor-day-vbac-demonstration-improving-birth-868/ 227 ImprovingBirth.org Atlanta, GA, Facebook page, originally accessed on June 1, 2013 at: https://www.facebook.com/ImprovingBirthNationalRallyForChangeAtlantaGa
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Figure 21: Rally to Improve Birth Los Angeles, California228
Figure 21: Rally to Improve Birth Fort Wayne, Indiana229
228 YouTube Video still ‘Improving Birth - The National Rally for Change, September 3, 2012 Los Angeles’, originally published on September 4, 2012 at: http://www.youtube.com/watch?v=IWH-6LEwYoI 229 ImprovingBirth.org Fort Wayne, IN, Facebook page, originally accessed on June 1, 2013 at: https://www.facebook.com/improvingbirthfortwayne
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In the rest of the chapter I will take a look at the other side of the spectrum in the homebirth debate and find out in what way the opponents defend their position. Amy Tuteur is a well-known advocate of hospital birth and calls herself The Skeptical OB. She has her own website on which she posts blogs and she is also a contributor to the opinion section of the website of Time Magazine. On her website and in her posts she refers to herself as Dr. Amy. Her homepage describes her as an obstetrician-gynecologist who graduated from Harvard College in 1979, and Boston University School of Medicine in 1984. Her name and explicitly mentioned medical background, give her website and the blogs she posts more authority because it establishes her as a medical expert. Tuteur takes an extremely negative position in the homebirth debate, which makes her website an interesting resource for anti-homebirth material. However, the language Tuteur uses is far from professional, she aggressively attacks proponents of homebirth by calling them ignorant and selfish. In one entry she states that she “parodies” homebirth advocates, who she says try to fill their “narcissistic need” for attention by “having a homebirth.”230 In another blog post she calls midwives “uneducated, untrained birth junkies.”231 In the same post she argues that people like Ina May Gaskin are the ones that see women as machines because they say that every woman is able to have a vaginal birth without complications. According to Tuteur, it is Gaskin who does not acknowledge there are many variations of pregnancy experiences, complications and outcomes, not medical professionals. I believe Tuteur takes such an outspoken, negative stance in the homebirth debate because it is the easiest way to counter some of the arguments proponents of homebirth have made. The rhetoric of rights in childbirth is strong because it is hard to say that you do not want women to have rights, therefore Tuteur opts for the argument that choosing homebirth is selfish and dangerous. In a 2012 blog post, Tuteur addresses fathers “whose wives are trying to convince them to give their approval to homebirth.”232 She explains that homebirths are dangerous because emergency health care for the baby is not at hand, she then asks men to stand up to their wives because they “may be the only person standing between your baby and brain damage or death.”233 Tuteur effaces the wishes of women by saying that they have been seduced by midwives and she wants men to suppress their wives wishes in order to protect the unborn child. Clearly, Tuteur is not trying to enhance the empowerment of women. Reactions to her blog posts show that some of her
230 Tuteur, A. ‘Extreme Homebirth,’ The Skeptical OB, originally published on May 29, 2013 at: http://www.skepticalob.com/2013/05/extreme-homebirth.html 231 Tuteur, A. ‘Ina May, What’s the Perinatal Mortality Rate for Aardvarks?’ The Skeptical OB, originally published on May 28, 2013 at: http://www.skepticalob.com/2013/05/ina-may-whats-the-perinatal-mortality- rate-for-aardvarks.html 232 Tuteur, A. ‘The doubtful father’s guide to homebirth,’ The Skeptical OB, originally published on February 9, 2012 at: http://www.skepticalob.com/2012/02/doubtful-fathers-guide-to-homebirth.html 233 Ibid.
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No Place Like Home? Suzan Steeman (5777038) reader also do not see the merits of empowerment. In reaction to one Tuteur’s blogs, a woman stated that she did not understand what was important about having confidence in your body:
I really don't understand this idea that women need confidence in their bodies. Why do they need this? Having confidence in your body, to me, translates to expecting that everything will go smoothly. That kind of thinking a) doesn't actually do anything to help produce good outcomes and b) undermines confidence in their care providers, which is what they will actually need in the event that something does go wrong.234
This woman obviously values the medical world and the technological model of birth more than her own experience and body. Other women reacted to this post saying they had enough reason to not have confidence in their bodies. Most of Tuteur’s articles revolve around discrediting midwives and reaffirming the authority of the medical profession. Like the author of the Mommyish article she prefers putting emphasis on the outcome and not the process and she attacks advocates of homebirth or natural birth for doing the exact opposite.235 This is an effective strategy because no one would disagree about the fact that the health of the baby is very important. and the popularity of the website shows many people agree with her views. Although the critique Tuteur has on homebirth and midwives can be seen as aggressive and unprofessional, hers is not the only negative voice. As said, the ACOG expressed their reluctance to support homebirth in previous committee opinions and in 2013 the American Academy of Pediatrics (AAP) concurs with this opinion in a policy statement. They affirm that “hospitals and birthing centers are the safest settings for birth in the United States,” although they do respect “the right of women to make a medically informed decision about delivery.” 236 Furthermore, the AAP wants to provide high-quality care to all newborn infants, regardless of the circumstances of his or her birth. According to the AAP, pediatricians need to be prepared to inform mothers who are considering a homebirth about the associated risks. The ACOG committee opinion is referred to to support these risks, no mention is made of the many critiques the Wax article generated.237 Both sides of the debate emphasize evidence-based maternal health care because they believe this is in the best interest of both mother and child. However, for one side this means that homebirth and less medicalized birth can be safe and that the mother should be the one that decides, while the other side argues that the medical world knows what is best. Introducing human
234 Ibid. 235 Tuteur, A. ‘Dr. Amy’s 6 steps to a joyful birth’ The Skeptical OB, originally published on May 16, 2013 at: http://www.skepticalob.com/2013/05/dr-amys-6-steps-to-a-joyful-birth.html 236 American Academy of Pediatrics ‘Policy Statement: Planned Home Birth,’ in: Pediactrics, Volume 131, Number 5, (2013) p.1016 237 American Academy of Pediatrics p.1017
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No Place Like Home? Suzan Steeman (5777038) rights in childbirth seems to be a helpful approach for proponents of homebirth. It is hard to argue with human rights. This is a similar tactic that was used by anti-abortion advocates in the abortion debate. Claiming that the fetus is a person with rights that should be protected made their case much more viable because then they could frame abortion as murder. Now, proponents of homebirth have taken up a rights rhetoric of their own. They try to restore the mother to a central place in birth by pointing to the fact that choice in childbirth should be regarded as a human right.
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[ Conclusion ]
In the introduction of this thesis I quoted feminist scholar Rosalind Petchesky, who proposed the following in 1987: “we have to restore women to a central place in the pregnancy scene. To do this, we must create new images that recontextualize the fetus, that place it back into the uterus, and the uterus back into the woman’s body and her body into its social space.” It seems the homebirth movement could have helped achieve this and I believe they did make an effort. With this research I have tried to find out to what extend Petchesky’s proposal has been realized and what role the rhetoric of fetal rights played in restoring women to a central place in birth. I have shown that the homebirth movement responded to the rhetoric of fetal rights by framing their own cause as a rights-issue as well. In recent years, issues concerning maternal health and maternal mortality have increasingly been framed as rights-issues. In 2010, Amnesty International published the report Deadly Delivery – The Maternal Health Care Crisis in the USA. The main premise of this report was that health is a human right. More specifically, the report argued that America spends more money on health care than any other country in the world, and that the costs for hospitalization related to pregnancy and childbirth are the highest of all areas of medicine. Despite this, the risk of dying of pregnancy-related complications is greater for American women than for women in 40 other countries including 24 other industrialized nations. Furthermore, the report states that in the United States, more than two women die every day from pregnancy-related causes.238 Amnesty International sees the issue of maternal mortality and pregnancy-related complications as a violation of basic human rights, including the rights to life, to non-discrimination, and to the highest attainable standard of health. 239 The emphasis of the recommendations in the report is on quality health care for all on the grounds of equality and non-discrimination. Amnesty International believes the American government should take responsibility and help provide a coordinated, comprehensive system of maternal health care for all Americans regardless of their income.240 With this thesis, I have shown that, while the anti-abortion advocates framed abortion as a violation of fetal rights, homebirth advocates increasingly framed birth as a human rights issue.
238 Amnesty International ‘Deadly Delivery – The Maternal Health Care Crisis In The USA,’ London: Amnesty International Secretariat (2010) p.1 For the report, Amnesty International USA (AIUSA) did their own research but also relied on statistics from the Centers for Disease Control and Prevention (CDC) and other research. 239 Amnesty International (2010) p.3 240 Amnesty International (2010) pp.4-10, Page 9 and 10 of the Amnesty International report list ten key recommendations to the US government for improvement of the current situation.
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Homebirth activists seized the high maternal mortality rate in the United States to show that medicalization of pregnancy and birth had not been beneficial to the outcomes. I believe their rights in childbirth rhetoric is in line with the more general feminist ideology that revolves around women’s rights, and that was introduced in the 1960s and 1970s. From the second half of the twentieth century onward, homebirth has been unpopular in America. Since the 1960s, the amount of women that gives birth at home has been roughly the same, fluctuating around 1 percent. Giving birth in a hospital is the obvious choice for women in America and only a few see a home delivery as a responsible alternative. Birth and pregnancy are mostly treated as if they are a dangerous, instead of natural, processes. Together with the increasingly high rate of technological interventions such as cesarean sections and labor induction, the amount of hospital births demonstrates that birth in America has been medicalized. Despite of this, the American health care system has been criticized for its poor state of maternal health by organizations such as Amnesty International. The fact that the United States has a much higher ratio of maternal mortality than other Western countries makes it clear that medicalization has not necessarily paid off. Women have called for more ‘natural’ births as a response to medicalization of pregnancy and birth and they have united in the homebirth movement to promote their cause. Supporters of this movement believe the mother and not the physician should be the one that is in control during childbirth. Additionally, homebirth is presented as the alternative to the overmedicalized birth that hospitals offer. Although the homebirth-statistics show that the homebirth movement has not been very successful in moving birth from the hospital into the home, it is clear that as early as the 1960s, women were standing up for their rights to be in control of their birth, and to decide whether or not to give birth in a hospital. They claimed that births with less interventions were safer and served to empower the birthing woman. How did these arguments evolve into the human rights issue that birth is framed as in the current homebirth debate? I propose that proponents of homebirth support their argument by focusing on the rights of the birthing woman as an answer to the fetal rights rhetoric that has been an effective strategy for anti-abortion advocates in the abortion debate. In many anti-abortion campaigns, abortion is framed as murder of innocent life. Anti- abortion activists have tried to show that the fetus is a person that needs to be protected. In some campaigns, abortion is compared to slavery, and discrimination in the times of the Jim Crow laws and framed as the new civil rights issue. Ultimately, many anti-abortionists want to grant the fetus ‘personhood’ in order to create a legal person and make abortion illegal once again. Recently, a rhetoric of rights has also risen to the surface in the homebirth debate. I believe this is a response the rhetoric of fetal rights in the abortion campaign and an effort to no longer
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No Place Like Home? Suzan Steeman (5777038) focus on the fetus but on the mother instead. Midwives and other supporters of homebirth have organized in different organizations to promote birth as a human rights issue. They argue that the freedom to choose where and how a woman gives birth to her child is a basic human right. The rhetoric of choice in birth as a human right is a new strategy for advocates of midwifery and homebirth. Non-Hispanic, married, married, white women above 35 account for most of the homebirths that take place in the United States today, and many are also active in the homebirth movement. They organize in groups like ImproveBirth.org. With this thesis I have shown that a rhetoric of rights is popular among advocates with divergent interests. It seems that simply trying to convince the public that your position is the better one (pro-hospital birth or pro-homebirth, for or against abortion-rights) did not bear enough progress. Using a ‘rights- approach’ makes an argument much stronger because it is a hard rhetoric to fight against. Framing something as a rights-issue forces opponents to say whether or not they support those rights. Then, if they do not support them, they must want to suppress them which is then quickly interpreted as a violation which is hard to justify. Finally, I would like to argue that the fetus has not been placed back into the mother, I’d even say that since 1987, it has been portrayed and seen as a person even more. On the other hand, an effort has been made to restore the role of the mother in the birthing process. Medicalization has been attacked by proposing that choice in birth is a basic human right. Calling the freedom to choose how a woman gives birth a human right puts the woman center stage, instead of the fetus. The fact that homebirths are on the rise and reached the highest level since 1989 might reveal that progress is being made. Time will tell what the effects will be of framing choice in childbirth a human right. Perhaps the amount of homebirths will continue to rise, and more women will desire a natural birth and the saying no place like home will prove to be true. On the other hand, there is the possibility that women keep believing the medical profession knows what is best and keep relying on the technological model of birth that is dominant today.
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[ Bibliography ]
ACOG FAQ ‘Labor Induction,’ originally accessed on June 14, 2013 at: http://www.acog.org/~/media/For%20Patients/faq154.pdf?dmc=1&ts=20130616T09253831 20
ACOG Committee Opinion Number 559 ‘Cesarean Delivery on Maternal Request,’ April (2013)
American College of Obstetricians and Gynecologists Committee Opinion number 476 ‘Planned Home Birth,’ February (2011)
ACNM, MANA & NACPM ‘Supporting healthy and normal physiologic childbirth: a consensus statement by ACNM, MANA, and NACPM’. Released on: June 5, 2012 p. 1
American Academy of Pediatrics ‘Policy Statement: Planned Home Birth,’ in: Pediactrics, Volume 131, Number 5, (2013) p.1016
American College of Nurse-Midwives ‘About ACNM,’ originally accessed on June 19, 2013 at http://www.midwife.org/About-ACNM
American College of Obstetricians and Gynecologists Committee Opinion number 476 ‘Planned Home Birth,’ February (2011)
American Academy of Pediatrics ‘Policy Statement: Planned Home Birth,’ in: Pediatrics, Volume 131, Number 5, (2013) p.1016-1020
American Medical Association ‘H-245.971 Home Deliveries ,’ originally accessed on June 25, 2013 at: http://www.ama-assn.org/resources/doc/hod/a08resolutions.pdf
Andrusko, D. ‘NRLC Vigorously Promotes “The Silent Scream,”’ originally accessed on April 23, 2013 at: http://www.nationalrighttolifenews.org/news/2011/02/nrlc-vigorously-promotes %E2%80%9Cthe-silent-scream%E2%80%9D/#.UXZVt5hTB_Y
Amnesty International ‘Deadly Delivery – The Maternal Health Care Crisis In The USA,’ London: Amnesty International Secretariat (2010)
Averting Maternal Death and Disability program ‘About Us,’ originally accessed on May 31, 2013 at: http://www.amddprogram.org/d/content/about-us
Averting Maternal Death and Disability program ‘AMDD Evolution,’ originally accessed on June 19, 2013 at: http://www.amddprogram.org/d/content/amdd-evolution
Baby Centre ‘Average Fetal Length and Weight Chart,’ originally accessed on June 10, 2013 at: http://www.babycentre.co.uk/e1004000/average-fetal-length-and-weight-chart
Barker, K.K. ‘A Ship ipon a Stormy Sea: the Medicalization of Pregnancy’ in: Social Science & Medicine, Volume 47, Issue 8 (1998) pp. 1067–1076
66
No Place Like Home? Suzan Steeman (5777038)
Blanchette, H. ‘The Rising Cesarean Delivery Rate in America What Are the Consequences?’ in: Obstetrics & Gynecology, Vol.118, No.3 (2011) p.1
Boston Women's Health Book Collective ‘Our Bodies, Ourselves’ New York: Simon & Schuster (1973)
Boucher J. ‘The Politics of Abortion and the Commodification of the Fetus,’ In: Studies in Political Economy, Volume 73 (2004) pp. 69
Boucher, D., Bennett, C. McFarlin, B. and Freeze, R. ‘Staying Home to Give Birth: Why Women in the United States Choose Home Birth,’ in: Journal of Midwifery & Women’s Health Volume 54, No.2 (2009) pp.119-126
Browner, C. H. and Press, N. ‘The Production of Authoritative Knowledge in American Prenatal Care,’ In: Medical Anthropology Quarterly, Vol. 10, No. 2 (1996) pp. 141–156
Bynkershoek Institute ‘Bynkershoek Research Center for Reproductive Rights,’ originally accessed on June 7, 2013 at: http://www.bynkershoek.eu/activities/bh-research/bhr-reproductive- rights/
Cahill, H.A. ‘Male Appropriation and Medicalization of Childbirth: an Historical Analysis,’ In: Journal of Advanced Nursing, Volume 33, Issue 3 (2001) pp. 334–342
Centers for Disease Control and Prevention ‘Pregnancy Mortality Surveillance System,’ page last reviewed on March 7, 2013 at: http://www.cdc.gov/reproductivehealth/ MaternalInfantHealth/PMSS.html#5
Cheyney, M., Everson, C. ‘Narratives of Risk. Speaking Across the Hospital/Homebirth Divide’ In: Anthropology News Volume 50, Issue 3 (2009) pp.7-8
Childbirth Connection ‘Why Is the National U.S. Cesarean Section Rate So High?’ (2012) originally accessed on June 27, 2013 at: http://www.childbirthconnection.org/article.asp?ck=10456
Cohen, S.A. ‘Abortion and Women of Color: The Bigger Picture,’ Guttmacher Policy Review, Volume 11, Number 3 (2008) p.2
Coleman, B.C. ‘AMA Committee Criticizes 'Silent Scream' And Pro-choice Film As Biased,’ Associated Press, December 5, 1985
Conrad, P. ‘Medicalization and Social Control,’ In: Annual Review of Sociology, Volume 18 (1992) pp. 209-232
Cross, L. ‘Apparently Labor Day Is The Time To Demonstrate For VBAC On Street Corners,’ on: Mommyish, originally published on September 3, 2012 at: http://www.mommyish.com/2012/09/03/labor-day-vbac-demonstration-improving-birth- 868/
Davis-Floyd, R.E. ‘The technocratic body: American childbirth as cultural expression,’ in: Social Science & Medicine Volume 38, Issue 8 (1994) pp.1125–1140
Davis-Floyd, R. and Sargent, C. ‘Introduction’ In: Medical Anthropology Quarterly Volume 10, Issue 2 (1996) pp. 111-120
67
No Place Like Home? Suzan Steeman (5777038)
Davis-Floyd, R. ‘Birth as an American rite of passage,’ Berkeley (CA): University of California Press (2003)
Devitt, N. ‘The Transition from Home to Hospital Birth in the United States, 1930-1960,’ In: Birth and the Family Journal, Volume 4, Issue 2 (1977) pp. 47–58
Dubow, S. ‘Ourselves Unborn: A History of the Fetus in Modern America,’ Oxford University Press (2011)
Ethan Persoff ‘Who Killed Junior,’ originally accessed on March 18, 2013 at: http://www.ep.tc/junior/
Freedman, L.P. ‘Using Human Rights In Maternal Mortality Programs: From Analysis To Strategy,’ in: International Journal of Gynecology & Obstetrics, 75 (2001) pp.51-60
Freedom For Birth (campaign video) originally accessed on May 15, 2013 at: http://www.youtube.com/watch?feature=player_embedded&v=0-U_6AM6EVs
Freedom For Birth (web version) originally accessed on May 15, 2013 at: http://www.youtube.com/watch?feature=player_embedded&v=D7c8UxbT7CU
Galton, F. ‘Eugenics: Its Definition, Scope, and Aims,’ in: American Journal of Sociology, Vol.10, No.1 (1904) pp.1-25
Gaskin, I.M. ‘Letter to the Conference,’ in: Hayes-Klein, H. (ed.) ‘Bynkershoek Conference Papers: Human Rights in Childbirth Conference,’ The Hague: Bynkershoek Publishing (2012) pp.26-27
Geary, M.S. ‘An Analysis of the Women’s Health Movement and its Impact on the Delivery of health Care within the United States,’ In: Nurse Practitioner, Volume 20, Issue 11 (1995) pp.24-35
Georgia Right to Life ‘About Us,’ originally accessed on May 21, 2013 at: http://www.grtl.org/?q=node/107
Giokaris, J. ‘March For Life 2013 Shows Most Americans Disagree With Republicans On Abortion,’ New York Times, originally published on January 28, (2013)
Grady, D. ‘Caesarean Births Are at a High in U.S.,’ New York Times originally published on March 23, 2010 at: http://www.nytimes.com/2010/03/24/health/24birth.html?_r=0
Hayes-Klein, H. ‘Bynkershoek Conference Papers: Human Rights in Childbirth Conference,’ The Hague: Bynkershoek Publishing (2012)
Horton, R. ‘Offline: Urgency and concern about home births,’ in: The Lancet, Volume 376, Issue 9755 (2010) p.1812
Human Rights in Childbirth ‘Information for the Press,’ originally accessed on June 2, 2013 at: http://www.humanrightsinchildbirth.com/about/press
Human Rights in Childbirth ‘Conference 2012,’ originally accessed on June 2, 2013 at: http://www.humanrightsinchildbirth.com/hric-conferences/past-hric conferences/conference-2012/participants
68
No Place Like Home? Suzan Steeman (5777038)
Hunter, A. ‘Are Home Births Dangerous?’ ABC News, published online on July 11, 2008 at: http://abcnews.go.com/Health/story?id=5340949&page=1#.UcloCzs3Crg
Imber, J.B. ‘Review of: Aborting America by Bernard N. Nathanson,’ in: The Hastings Center Report, Vol.10, No.3 (1980) p.44-45
Improving Birth ‘Why We Do It,’ originally accessed on June 1, 2013 at: http://www.improvingbirth.org/why-we-do-it/
Improving Birth ‘What is Evidence-based Maternity Care?’ originally accessed on June 27, 2013 at: http://www.improvingbirth.org/the-evidence-shows/
ImprovingBirth.org Atlanta, GA, Facebook page, originally accessed on June 1, 2013 at: https://www.facebook.com/ImprovingBirthNationalRallyForChangeAtlantaGa
ImprovingBirth.org Fort Wayne, IN, Facebook page, originally accessed on June 1, 2013 at: https://www.facebook.com/improvingbirthfortwayne
Johanson R., Newburn M. and MacFarlane, A. ‘Has The Medicalisation Of Childbirth Gone Too Far?’ In: British Medical Journal, Vol. 324, No. 7342 (2002) pp. 892-895.
Joyce, K. ‘Is Abortion “Black Genocide?” in: Collective Voices, Volume 6, Issue 12 (2011) pp.8-9
Karrer, R.N. ‘The National Right to Life Committee: Its Founding, Its History, and the Emergence of the Pro-Life Movement Prior to Roe V. Wade,’ In: The Catholic Historical Review, Volume 97, Issue 3 (2011) pp. 527-557
Katz Rothman, B. ‘Childbirth As Negotiated Reality,’. In: Symbolic Interaction, Volume 1, No. 2 (1978) pp. 124-137
Katz Rothman, B. ‘Letter to the Conference,’ in: Hayes-Klein, H. (ed.) ‘Bynkershoek Conference Papers: Human Rights in Childbirth Conference,’ The Hague: Bynkershoek Publishing (2012) pp.50-52
Kline, W. ‘Bodies Of Knowledge: Sexuality, Reproduction, and Women's Health in The Second Wave,’ Chicago: The University of Chicago Press (2010)
Kotz, D. ‘A Risky Rise in C-Sections‘ US News, originally published on: March 28, 2008 at: http://health.usnews.com/health-news/managing-your-healthcare/sexual-and- reproductive-health/articles/2008/03/28/a-risky-rise-in-c-sections
Kuehn, B.M. ‘CDC Promotes Care Before Conception,’ in: The Journal of the American Medical Association Volume 295, Issue 22 (2006) 2591-2592.
Kukla, R. and Wayne, K. ‘Pregnancy, Birth, and Medicine,’ in: The Stanford Encyclopedia of Philosophy (2011), Edward N. Zalta (ed.) p.2
Lamaze International ‘About Lamaze: History,’ originally accessed on June 2, 2013 at: http://www.lamazeinternational.org/History
69
No Place Like Home? Suzan Steeman (5777038)
Lee, S.J., Ralston, H.J., Drey, E.A., Partridge, J.C., Rosen, M.A. ‘Fetal Pain a Systematic Multidisciplinary Review of the Evidence,’ in: Journal of the American Medical Association, Volume 294, No. 8 (2005) pp.947-954
MacDorman, M.F., Mathews, M.S., Declercq, E. ‘Homebirths in the United States, 1990–2009,’ NCHS Data Brief, Number 84 (2012) p.2
Martin, J.A., Hamilton, B.E., Ventura, S.J., Osterman, M.J.K., Kirmeyer, S., Wilson, E.C. and T.J. Mathews ‘Births: Final Data for 2010,’ in: National Vital Statistics Reports, Volume 61, Number 1 (2012) p. 9
McCombs, P. ‘The 'Scream' of Bernard Nathanson; The Obstetricians Odyssey, From Abortion King to Anti-Abortion Activist,’ in: The Washington Post, March 24 (1985)
McConnell, C. ‘Take away the incentives for too many c-sections,’ Crosscut, originally published on August 6, 2009 at: http://crosscut.com/2009/08/06/health-medicine/19144/Take-away- incentives-for-too-many-csections/
McCool, W.F., Simeone, S.A. ‘Birth in the United States: an Overview of Trends Past and Present,’ in: The Nursing Clinics of North America 37(4) (2002) pp.735-746
McPherson, W. ‘Abortion And Other Images Of Horror,’ in: The Washington Post, February 19 (1985)
Melzack, R. ‘The myth of painless childbirth,’ in: Pain, Volume 19, Issue 4 (1984) pp.321–337
Menacker, F., Hamilton, B.E. ‘Recent Trends in Cesarean Delivery in the United States,‘ National Center for Health Statistics Data Brief, No.35 (2010)
Meyer, E.L. ‘Midwifery on Increase,’ In: The Washington Post, November 22 (1977)
Michal, C.A., Janssen, P.A., Vedam, S., Hutton, E.K., De Jonge, A. ‘Planned Home vs Hospital Birth: A Meta-Analysis Gone Wrong,’ Medscape, published online on April 1 (2011) at: http://www.medscape.com/viewarticle/739987
Midwives Alliance of North America ‘About us,’ originally accessed on June 19, 2013 at: http://www.mana.org/about-us/mission-goals
Mommyish ‘About ,’ originally accessed on June 1, 2013 at: http://www.mommyish.com/about/#ixzz2Uxj7DQKt
Morgen, S. ‘Women Physicians and the Twentieth-Century Women’s health movement in the United States,’ In: (Eds. E.S. More, E. Fee and M. Parry) Women Physicians and the Cultures of Medicine. Baltimore: Johns Hopkins University Press (2009) pp. 160-183
NACPM ‘What is CPM?’ originally accessed on June 19, 2013 at: http://www.nacpm.org/what-is- cpm.html
Nash, M. ‘From ‘bump’ to ‘baby’: Gazing at the foetus in 4d,’ in: Philament 10, (2007) pp.1-25
National Association of Certified Professional Midwives Press Release ‘RE: Maternal and Newborn Outcomes in Planned Home Birth Vs. Planned Hospital Births: A Meta-Analysis, Wax JR,
70
No Place Like Home? Suzan Steeman (5777038)
Lucas FL, Lamont M, et al.,’ July 6 (2010)
National Association of Certified Professional Midwives ‘Essential Documents of the National Association of Certified Professional Midwives,’ (2004)
National Right to Life Committee ‘Mission Statement,’ originally accessed on May 22, 2013 at: http://www.nrlc.org/missionstatement.htm
National Right to Life Committee ‘When Does Life Begin?’ originally accessed on March 27, 2013 at: http://www.nrlc.org/abortion/wdlb/wdlb.html
National Right to Life Committee ‘Fetal Development,’ originally accessed on March 27, 2013 at: http://www.nrlc.org/abortion/facts/fetaldevelopment.html
National Right to Life Committee ‘Black Genocide,’ NRLC Online News Bulletin, June 2003, originally accessed on May 16, 2013 at: http://www.nrlc.org/news/2003/NRL05/black_genocide.htm
National Right to Life Committee ‘Black Americans for Life,’ originally accessed on May 16, 2013 at: http://www.nrlc.org/outreach/BAL.html
National Right to Life Committee ‘News Today: 100 Different Reasons to attend the NRLC Convention,’ last edited on May 22, 2013 at: http://www.nationalrighttolifenews.org/news/2013/05/100-different-reasons-to-attend the-nrlc-convention-in-dallas-june-27-29/#.UZ31bKJTB_Y
NBC News ‘GOP Rep. calls Planned Parenthood 'racist' baby killers,’ originally accessed on May 23, 2013 at: http://firstread.nbcnews.com/_news/2012/09/14/13863666-gop-rep-calls- planned-parenthood-racist-baby-killers?lite
New York Times ‘Use of Midwives Revived in California’ March 20 (1973)
Newman, K. ‘Fetal Positions: Individualism, Science, Visuality,’ Stanford University Press (1996)
Netdoctor ‘Syntocinon,’ originally accessed on May 15, 2013 at: http://www.netdoctor.co.uk/pregnancy/medicines/syntocinon.html Nichols, F.H. ‘History of the Women’s health movement in the 20th Century,’ In: Journal of Obstetric, Gynecologic, & Neonatal Nursing Volume 29, Issue 1 (2000) pp. 56-64
Nilsson, L. ‘Drama of Life Before Birth,’ in: Life Magazine, Vol.58, no. 17, (1965)
O’Callaghan, T. ‘Too Many C-sections: Docs Rethink Induced Labor,’ in: Time Magazine, originally published on August 2, 2010 at: http://www.time.com/time/health/article/0,8599,2007754,00.html#ixzz2WC13RsL8
O'Connor, B.B. ‘The Home Birth Movement in the United States,’ In: The Journal of Medicine and Philosophy, Volume 18, Issue 2 (1993) pp. 147-174
One World One Birth ‘About’ originally accessed on May 15, 2013 at: http://www.oneworldbirth.net/about/
Parry, M. ‘Broadcasting Birth Control: Mass Media and Family Planning,’ Camden, NJ: Rutgers
71
No Place Like Home? Suzan Steeman (5777038)
University Press (forthcoming 2013)
Personhood.net ‘About Us,’ originally accessed on May 21, 2013 at: http://www.personhood.net/index.php?option=com_content&view=article&id=160&Itemid =301
Personhood.net ‘Black Genocide’ (video) originally accessed on May 23, 2013 at: http://www.personhood.net/index.php?option=com_wrapper&view=wrapper&Itemid=592
Petchesky, R. ‘Fetal Images: The Power of Visual Culture in the Politics of Reproduction,’ In: Feminist Studies, Volume 13, Issue 2 (1987) pp. 263-292
Planned Parenthood Federation of America ‘The Facts Speak Louder: Planned Parenthood’s Critique of “The Silent Scream,”’ published by the Katharine Dexter McCormick Library (1985)
Planned Parenthood ‘History & Successes,’ originally accessed on June 24, 2013 at: http://www.plannedparenthood.org/about-us/who-we-are/history-and- successes.htm#Sanger
Priests for Life ‘MLK's niece preaches anti-abortion decisions,’ last edited on September 14, 2011 at: http://www.priestsforlife.org/articles/3763-mlks-niece-preaches-anti-abortion-decisions
The Radiance Foundation ‘Our Vision and Mission,’ originally accessed on May 23, 2013 at: http://www.theradiancefoundation.org/our-story/our-vision-mission/
Reagan, L.J. ‘When Abortion was a Crime. Women, Medicine and Law in the United States, 1867 1973,’ University of California Press (1997)
Ros, L.J. ‘Trying to Hijack the Civil Rights Legacy: What's Behind the Anti-choice "Freedom Rides",’ in: Conscience (2011)
Schuetz, J. ‘Communicating the Law: Lessons from Landmark Legal Cases,’ Long Grove: Waveland Press (2007) pp. 282
Schrom Dye, N. ‘History of Childbirth in America,’ in: Signs Volume 6, Issue 1 (1980) pp.97-108
Sechzer, J. A., Griffin, A., & Pfafflin, S. M. ‘Women’s health and paradigm change’. In: Annals of the New York Academy of Sciences, 30, (1994) pp.2-20
Sunshine, P. ‘The Neonatal Intensive Care Unit Today,’ From an NIH Symposium on October 7, 1985, p.31
Tone, A. ‘’ Black Market Birth Control: Contraceptive Entrepreneurship and Criminality in the Gilded Age,’ in: The Journal of American History, Vol.87(2), pp.437-459 (2000)
Too Many Aborted ‘About Us,’ originally accessed on May 16, 2013 at: http://www.toomanyaborted.com/about/
Too Many Aborted ‘Vision & Mission,’ originally accessed on May 22, 2013 at: http://www.toomanyaborted.com/about/vision/
Too Many Aborted ‘The Truth (in Black & White),’ originally accessed on June 13, 2013 at:
72
No Place Like Home? Suzan Steeman (5777038)
http://www.toomanyaborted.com/truth-in-black-and-white/
Too Many Aborted ‘Number-One-Killer,’ originally accessed on June 14, 2013 at: http://www.toomanyaborted.com/wp-content/uploads/2013/02/NUMBER-ONE-KILLER- 2013-FB.jpg
Too Many Aborted ‘The Mother of Planned Parenthood,’ originally accessed on June 13, 2013 at: http://www.toomanyaborted.com/sanger/
Too Many Aborted website ‘Endorsements,’ originally accessed on May 23, 2013 at: http://www.toomanyaborted.com/about/endorsements/
Too Many Aborted website ‘Civil Rights Gone Wrong,’ Originally accessed on May 24, 2013 at: http://www.toomanyaborted.com/civil-rights-gone-wrong/#/
Tuteur, A. ‘Extreme Homebirth,’ The Skeptical OB, originally published on May 29, 2013 at: http://www.skepticalob.com/2013/05/extreme-homebirth.html
Tuteur, A. ‘Ina May, What’s the Perinatal Mortality Rate for Aardvarks?’ The Skeptical OB, originally published on May 28, 2013 at: http://www.skepticalob.com/2013/05/ina-may-whats-the- perinatal-mortality-rate-for-aardvarks.html
Tuteur, A. ‘Dr. Amy’s 6 steps to a joyful birth’ The Skeptical OB, originally published on May 16, 2013 at: http://www.skepticalob.com/2013/05/dr-amys-6-steps-to-a-joyful-birth.html
Tuteur, A. ‘The doubtful father’s guide to homebirth,’ The Skeptical OB, originally published on February 9, 2012 at: http://www.skepticalob.com/2012/02/doubtful-fathers-guide-to homebirth.html
United Nations Division of the Advancement of Women ‘Overview of the Convention,’ originally accessed on June 24, 2013 at: http://www.un.org/womenwatch/daw/cedaw/
UNICEF ‘Convention on the Rights of the Child,’ originally accessed on June 24, 2013 at: http://www.unicef.org/crc/
U.S. National Center for Health Statistics, ‘VitalStats,’ August 2010
Vireday, P. ‘Cesarean Rates: Debunking the Mother-Blaming,‘ originally published on April 1, 2013 at: http://wellroundedmama.blogspot.nl/2013/04/cesarean-rates-debunking-mother blaming.html
Walzer Leavitt, J. ‘Birthing and Anesthesia: The Debate over Twilight Sleep,’ in Signs Volume 6, Issue 1 (1980) pp.147-164
Wells, S. ‘Narrative Forms in Our Bodies Ourselves’. In: More, Fee, Parry (Ed.), Women Physicians and the Cultures of Medicine. Baltimore: Johns Hopkins University Press (2008) pp. 184-204
Wertz, R.W., Wertz, D. “Lying-In: A History of Childbirth in America, Expanded Edition,” New York: Schocken Books (1977)
White, K. ‘An Introduction to the Sociology of Health and Illness,’ London: Sage (2003)
73
No Place Like Home? Suzan Steeman (5777038)
Wilson, J. ‘Immaculate Deception: Doing What Doesn’t Always Come Natural,’ in: New York Times, June 22 (1975)
Wiseman, C.S. Kiel, E.M. ‘Picture Perfect: Benefits and Risk of Fetal 3D Ultrasound,’ in: the American Journal of Maternal/Child Nursing, Volume 32 (2007) pp.102-109
World Health Organization, UNICEF, UNFPA and The World Bank ‘Trends in maternal mortality: 1990 to 2010,’ published by the World Health Organization (2012)
YouTube video ‘Improving Birth Rally for Change NYC Labor Day 2012,’ published on November 13, 2012 at: http://www.youtube.com/watch?v=3TibPvLb1ZA
YouTube Video (still) ‘Improving Birth - The National Rally for Change, September 3, 2012 Los Angeles’, originally published on September 4, 2012 at: http://www.youtube.com/watch?v=IWH-6LEwYoI
Zechmeister, I. ‘Foetal Images: The Power of Visual Technology in Antenatal Care and the Implications for Women's Reproductive Freedom,’ in: Health Care Analysis, Volume 9, Issue 4 (2001) pp. 387-400
74