Dr Rishita Nandagiri, Fellow at the London School of Economics and Political Science, writes
In early May 2022, it was leaked Draft opinion of the US Supreme Court calling for Roe v. Wade to be overturned was quickly met with an avalanche of outrage over the continued assault on abortion and reproductive rights. The leaked opinion has drawn attention to abortion in the United States and worldwide, sparking and reinvigorating debates and fears about abortion access, legality and safety.
On June 24thuthe The US Supreme Court overturned it. This was not unexpected after the opinion was leaked, particularly to abortion activists and SRHRs who are fighting to protect abortion rights on many fronts, such as, more recently, Texas SB-8 bill. The official news was met with disappointment and despair, especially as some states moved to outright ban abortions.
In the wake of the leaked opinion and after the crisis, I was struck by how many conversations were based on images or frames of lack security, with many remembering it Roe years ago characterized by fear, death and/or ill health or challenge hangers and “street abortions.”
The hanger is a powerful symbol of unsafe abortion and reflecting entrenched gender, racial and class inequalities, used to denote the devastating impact of abortion restrictions. Abortion restrictions undoubtedly raise barriers to access and exposure to risk, disproportionately felt by those marginalized by class, race, ethnicity, sexuality or other factors. These restrictions affect not only those seeking abortion but it can have a chilling effect on providers and the entire “abortion ecology” of support and care delivery.
However, the advent of abortion pills and self-administration – especially when supported by feminist collectives, telephone lines, escort networks or another constellations of actors – significantly challenges the understanding of abortion safety, the actors involved and its connection to legality. Importantly, much of this challenge has come from feminist networks and collectives in the Global South, prompting us to re-examine these enduring images of ‘pant hangers’ and ‘backstreet abortions’. Indeed, as many have argued, this is a moment for transnational solidarity and knowledge sharing – and there is much to learn from abortion and reproductive justice organizing in the Global South.
Medical abortion pills and self-administered abortion (SMA) have shifted perceptions of safety away from a narrow medico-legal understanding (ie, legalized, in a clinical setting, by a licensed or legally recognized practitioner). Definitions of abortion safety have shifted from a binary understanding of safe/unsafe in a risk spectrum representing a range of methods, risk profiles, and legal settings that affect abortion safety and outcomes. THE new WHO guidelines consider safety as linked to quality of care, explicitly considering the changes brought about by medical abortion. Abortion can be effectively self-performed outside a health facility, and providing services with minimal supervision can greatly improve access (and privacy, convenience, and acceptance) to abortion without compromising biomedical safety standards or efficacy. her.
In mine ongoing research on abortion safety and care pathwaysI believe that despite the recognition of a wide range of factors and supports, sites and methods (approved or not), theories of safety remain largely within medico-legal frameworks. These current definitions and approaches still fail to be adequately taken into account social and political contexts of the lives of abortion seekers that shape perceptions and experiences of ‘safety’ and ‘danger’. This is because ‘safety’ and ‘risk’ are also socially constructed, evolving over time and context.
For example, even in settings where abortion is less legally restrictive such as India, the stigma of abortion can increase social risks and reputation and instead of exposure to risk through seeking abortion through formal settings, and abortion seekers instead turn to self-management as a way to enable their need for privacy. Similarly, in settings such as Chile where access to abortion is currently legally restricted, evidence suggests that Women value privacy, dealing with legal risks in addition to social taboos and fears of social punishment. Age and marital status, especially in settings where premarital sexual activity is prohibited, may also play a role how much is the confidentiality precious within abortion tracks in care and the types of delays they face. As these – and many other studies – highlight, safety is socially constructed and prioritized in ways that seek to protect the social standing and reputation of abortion seekers.
The links between legality and security are further complicated by SMA. In some contexts, SMA falls into a legal gray area – in Texas, USA, for example, the murder charges against Lizelle Herrera for self-inducing abortion were rejected as self-administration was not a criminal act. Apparently reported to authorities by the hospital she attended, Lizelle’s safety was compromised not by her self-management, but by a combination of criminal abortion laws and increased surveillance. The hospital, instead of a “safe” place for health care, becomes a place of surveillance and hostility for abortion seekers.
As well as challenging the idea that all illegal abortions are automatically unsafe, the SMA also raised questions about WHERE bears the burden of the risk(s). As governments increasingly enact anti-abortion laws, a range of formal and informal actors (e.g. feminist networks, doulas, escort groups, pharmacists, hotlines, etc.) have been organized to provide information and care, some times across borders. These actors are increasingly exposed to social and legal risks due to their work on medical abortion, as evidenced by the prosecution of activists Justyna Wydrzyńska for “help with an abortion” in Poland where an almost complete ban on abortion applies from 2021.
As feminist activists face a wave (again). gender attacks, of which anti-abortion is only one plank; It is important to consider how risk and safety are both social and biomedical and legal. These risks (or the lack of them) affect care seekers and care providers in intersectional ways, requiring an intersectional approach to abortion and broader reproductive care, one located in reproductive justice. This approach focuses on the needs of care seekers, broadens understanding of what the “minimum standards” are for a “safe” abortion environment, and possibly explains a broader set of conditions (governmental perceptions and accounting for safety and risk) that people face. seeking and providing abortion care. It thus enables a reimagining of abortion itself – one that centers autonomy, agency and collective care. As we resist constant assaults on bodily autonomy and regressive moves to limit it further, it is these iterations of reproduction, justice, safety and care that we must rebuild and resist, where it cannot be compromised and not can be compromised.
This blog post builds on ongoing work by Rishita Nandagiri on the theory of safety and risk in abortion and reproduction, some of which has previously been presented in Abortion laboratories (2018) and seminars (2022).
Author description:
Dr. Rishita Nandagiri (she/her) is a fellow at the London School of Economics and Political Science where her research focuses on abortion and reproduction in the Global South. He has previously published research on self-administered abortion, structural violencethe role(s) of community health mediators in abortionand to voluntary family planning. 2020-2021 was one ESRC Postdoctoral Fellow. She tweets at @rishie_ and co-runs (with Joe Strong) Zero Pressure abortion book club.
Please note that blog posts are not peer-reviewed and do not necessarily reflect the views of SRHM as an organization.
