Feminist reflections on miscarriage, in light of abortion
This paper highlights some of the personal, cultural, and philosophical challenges facing pro-choice feminists who miscarry in the United States. In light of the acrimonious debate over abortion, and the pressure to assign moral personhood to the beings lost in miscarriage, I offer suggestions for how we might mourn our losses without solidifying pro-life/anti-abortion politics. I outline a relational model of pregnancy and pregnancy loss that recognizes physical interrelation and dependency of an embryo/fetus on a woman, yet attaches as little or as much emotionality to that connection as each individual woman deems fit.
In 2006, and again in 2007, I suffered the miscarriages of two wanted and painstakingly planned pregnancies. In the aftermath of each, I found myself unprepared, as do many women who miscarry, for the devastation I would feel. In my attempts to cope, I sought solace in the written testimony of other women who had miscarried, in the medical statistics that reassured me I still had a [End Page 1] strong chance of carrying another pregnancy to term, in the experiences of friends and colleagues who had dealt with miscarriage and other reproductive difficulties, and in the expertise of counselors who helped me process my thoughts and feelings. While each of these avenues was helpful in its own right, I still found myself struggling with a persistent confusion. I was having trouble conceptualizing and naming exactly what I had lost, and was having trouble squaring my losses with my pro-choice politics. This paper explores some of those difficulties, and situates them within debates over abortion and personhood in the United States. I claim that failure to recognize the prevalence of miscarriage, and particularly the sorrow that often accompanies it, runs counter to feminist pro-choice politics. I then suggest that a relational model of pregnancy can help reconcile feelings of sorrow after a miscarriage (a.k.a. spontaneous abortion) with a commitment to keeping elective abortion legal.
Pregnant pro-choice feminists, coping with the termination of a desired pregnancy, often find it difficult to conceptualize and mourn our losses. Most of the self-help literature on miscarriage encourages us to call the embryos/fetuses our "babies" and to conceptualize our miscarriages in terms of their death. For those, like me, who have staunchly defended the use of precise prenatal terms—embryo until eight weeks, fetus thereafter until birth—the recommendation to name the lost being as a baby can be simultaneously disquieting and compelling. I, for instance, had always maintained a firm distinction between prenatal fetuses and postnatal infants, to help defend my belief that abortion of prenatal beings is a decision best left to the women who sustain and carry them;1 yet, after my miscarriages, my confidence in the terms embryo and fetus began to slip away. Somehow these terms were starting to feel too cold, too detached, to name and reference beings about which I had been so excited and hopeful. I began to find the notion that I had lost "babies" oddly comforting, in spite of worries that I was being unwittingly swayed by the "other side" to which my pro-choice politics had been so long positioned.
Even some of the most helpful literature contains implicit critiques of the embryo/fetus vs. baby distinction. Marie Allen and Shelly Marks's book, Miscarriage: Women Sharing Stories from the Heart, for instance, suggests that the experiences of women who miscarry are invalidated when referenced as "fetal" or "embryonic" losses. These terms, they claim, convey the message that these are "not really babies yet" and, for the woman who miscarries, invalidate "the reality of her baby and the legitimacy of her loss" (Allen and Marks 1993, 12). In their list of recommendations on how best to care for a woman who has [End Page 2] miscarried, they suggest: "Say the words 'baby' and 'died' rather than 'fetus' or 'is no longer viable'" (228). Of course, prior to my miscarriages, the pro-life/anti-abortion implications of such suggestions would have raised my hackles. But after my miscarriages, something about these suggestions felt oddly comforting. I had, after all, felt that my experiences had been generally discounted, and the legitimacy of my grief called into question after each loss. Could the source of these feelings be the fact that I was "only" referring to the lost beings as embryos or fetuses?2 And did my conflicted feelings signal an inconsistency in, or at least a challenge for, pro-choice feminism?
Although I did not arrive quickly at clear answers to these questions, I eventually recognized that the dichotomy I struggled with might be unique to a culture—U.S., specifically, arguably Western in general—in which debates over reproduction have focused almost solely on the moral status of fetuses, to the relative exclusion of women who make possible their development. Determination of what "they" were—embryos/fetuses or babies—had become central to my efforts to mourn the losses. My own shifting identity, my dashed hopes and expectations, my changing body, became peripheral and inconsequential to such efforts. In keeping with our culture's fascination with fetuses, and relative disinterest in the women who grow them, I was repeating the trend that feminists have struggled against for decades; I was colluding in the fallacy that Mary Mahowald, in her essay "As If There Were Fetuses without Women," calls "the fallacy of abstraction, that is, consideration of an object [a fetus] as if it exists without a context" (Mahowald 1995, 199).3
Most examples of this fallacy take place within what are known as the "personhood" debates. These debates contain various attempts to define what does or does not make a prenatal being part of the moral community of "persons," namely beings having or deserving a right to life, or at least a right not to be killed. Feminists have worked hard to challenge pro-life/anti-abortion writers who claim that a prenatal being is a "person" in the moral sense, either by denying that the criteria for personhood are present in fetuses (Warren 2006),4 or by denying that the presence of any such criteria outweighs the rights of the women pregnant with them (Thomson 1971; Steinbock 2003). Most of these feminist efforts have concentrated on negating either the claim that prenatal beings are persons, or that they have a right to life that outweighs a woman's freedom to choose whether to continue a pregnancy. And while negation of these claims has been critically important (given the fierce threats to reproductive freedom before and even after Roe v. Wade), the pressing need for arguments against [End Page 3] pro-life/anti-abortion rhetoric within this structure has yielded few conceptual alternatives to the person vs. nonperson dichotomy.
As I attempted to situate my miscarriages within the frameworks of the personhood debates and in the context of feminist struggles for reproductive autonomy, I was disappointed to find few feminist philosophical publications on the topic. I had hoped that other feminist philosophers might offer conceptual clarity on how my confusions had roots in patriarchal thinking, and I expected to find illuminating proposals on how to transform my private sadness into more liberating forms of feminist thought. Yet, to my dismay, I found hardly anything written on the topic at all—a rather shocking find, given that an estimated one in five pregnancies ends in miscarriage. Linda Layne, feminist anthropologist, offers an explanatory account for this silence in her book, Motherhood Lost: A Feminist Account of Pregnancy Loss in America (2003). She claims:
Because anti-abortion activists base their argument on the presence of fetal, and even more important, embryonic personhood, feminists have studiously avoided anything that might imply or concede such a presence. The fear, in the context of pregnancy loss, is that if one were to acknowledge that there was something of value lost, something worth grieving in a miscarriage, one would thereby automatically accede the inherent personhood of embryos and fetuses.(240)
In my case, the fear that I would betray pro-choice efforts and concede personhood by acknowledging my sorrow and mourning the loss, impeded my healing and intensified my confusion. Given that I had become so attached, and, dare I say, loved5 these early beings so strongly, how could I consistently hold that they, or any other being at the same stage of development, could justifiably be terminated? I had come to associate the terms embryo and fetus not only with beings that a woman might choose to terminate, but also with beings about which one does not necessarily care.6 And this association led to further unnecessary steps: I then universalized my feelings of devastation and sadness—assuming that all other women who miscarry must have felt as I had about my losses—and committed the naturalistic fallacy, unnecessarily deriving an "ought" from an "is" in thinking that my devastation betrayed a deep level of connection that one ought to feel toward a miscarried fetus.
But, of course, the fact that an individual woman like me, for instance, might care about the prenatal being she sustains, does not imply that all women care about such beings. Likewise, the fact that I did care about the beings I was sustaining need not imply that I, or any other woman, ought to care about the [End Page 4] prenatal beings she or I might sustain. I had felt a tension between my firm belief that it would have been justifiable to terminate the lives of my fetuses (had I autonomously chosen to do so) and my extreme sorrow at their termination. But this tension was clearly resting on some unnecessary associations.
There is no correct or singular way to cope with miscarriage. Women who miscarry have widely different responses to the experience: some find it life-changing and mourn for years; others experience it as a momentary setback in their plans, or even as a relief. Yet recognition of such diversity need not preclude discourse on the topic, and feminist ethicists should, I believe, weigh in on the issue much more than we have thus far done. The disturbing lack of public discussion about miscarriage can add to the sense of isolation that women who miscarry feel, and it may also have the unintended consequence of weakening pro-choice efforts.
In the United States, our silence on this topic has been facilitated by a culture that knows and says very little about miscarriage. Allen and Marks claim that there are two main factors contributing to this general silence and ignorance. One is "society's pervasive lack of awareness about the emotional impact of miscarriage." The other is our inability to experience the "baby" (as these authors label it) through our senses of "sight, sound, smell, or touch, as the real, whole, and unrepeatable human beings they were" (6). While I certainly do not take all of Allen and Marks's claims uncritically, I believe these two categories are useful starting points for analyzing our relative silence.
In terms of the first, in U.S.-American culture,7 women are often encouraged to keep the news of their pregnancies quiet, until it is "safe" to go public (i.e., until the likelihood of miscarriage has decreased, or until prenatal testing confirms that the fetus is not likely to have developmental or chromosomal abnormalities). So most of us find ourselves dealing with our losses in private, sharing the news only with those who knew about the pregnancy in the first place.8 Those who have shared news of the pregnancy, and then must reveal the miscarriage, find themselves dealing with the fact that often "relatives, friends, and coworkers pretend that nothing happened" (Layne 2003, 69). There are few rituals through which family and friends can express sympathy over miscarriage, and few accepted terms of condolence. In fact, there is little in the way of established etiquette at all, aside from things one should typically avoid saying, such as "It's probably for the best," or chalking the loss up to "nature's way" or "God's plan," or attempting to console with, "Well, at least you can try again."9 Also, there is no industry built up around such loss; Linda Layne notes, "At the level of popular culture, one of [End Page 5] the clearest indications of the culturally sanctioned nonexistence of these events [miscarriages] is the fact that there are no greeting cards for such occasions" (68). Allen and Marks lament the fact that women who miscarry often feel unsafe or frightened to express their feelings, and cultural silence about the facts and frequency of miscarriage exacerbates this: "Without documented and available information on normal and actual emotional reaction to miscarriage, the woman who has miscarried is literally stunned by her feelings" (18). While it would be a mistake to assume that all women who miscarry want to talk, receive cards, participate in memorial services, seek counseling, or join support groups, the fact that these might rarely be considered says something about the extent to which our culture is aware of, or deems important, the grief that is often associated with miscarriage. And even if this silence were partly indicative of our society's lack of consensus about the moral status of embryos and fetuses, any possible resolution of this status surely need not precede improved methods for supporting women in their grief.
The second category—diminished or lack of experience of the embryo/fetus through the five senses, or what we might call the problem of tangibility—compounds the difficulty of conceptualizing and communicating the cause of one's sadness to the rest of one's community. Women who miscarry, Allen and Marks claim, suffer from a lack of "evidence" to support their feelings. In early miscarriage, they note, there is "no evidence of the reality of her baby—a kick, a visibly pregnant belly, knowledge of the sex or identity of her baby, or a corpse to show for her loss" (15). They continue:
This lack of evidence of any baby aids her denial of the loss as well as her confusion. The baby is nebulous. The loss is nebulous. Her ability to grieve, which has been defined as the slow realization of loss, is seriously impaired. She has first to validate that there was a baby before she can mourn and then say good-bye to him or her. It's difficult to grieve what is no more visible than air.(15–16)10
The women in Allen and Marks's collection who felt misunderstood and lonely often insist that their loss was not "nothing," not something from which they could easily pick up and move on. This was their "baby" or their "child," they insist. Layne notes that this insistence is picked up by miscarriage and stillbirth support groups, who often urge grieving parents to conceptualize their loss as that of a "baby" and to give the baby a name (224–29). The rationale is that this helps equate pregnancy losses to those of other losses more publicly recognized and memorialized in our culture. [End Page 6]
Interestingly, to make this link and to compensate for the lack of tangible evidence, women who miscarry are encouraged to connect "things," that "belonged" to the embryo/fetus. Support groups suggest collecting and displaying material mementos in order to aid mourning and healing. Layne notes:
Most members of our society deal with this challenge, and the threat that these liminal beings [prenatal ones] present, by pretending that such an event did not happen and that these betwixt-and-between beings never existed. This tendency contributes to additional and unnecessary suffering for those who have a pregnancy loss. In order to combat this tendency, many members of pregnancy-loss support groups often adopt the opposite strategy. They work to transform the dangerous ambiguity of that which they lost into power, and … they marshal the efficacy of things for this task.(142)
These things may be clothes, blankets, symbolic handprints or footprints, cribs, journals, toys—whatever might serve as a physical reminder of the lost being. "Clothing is one of the most frequently mentioned items in these accounts, which is understandable given how important clothing is as a marker of humanness, of personhood" (Layne 2003, 112). Layne claims, "the later the loss, the more 'baby things' (and personhood) an embryo/fetus/child is likely to have" (105).11 The link that thereby emerges between "things" and "personhood" is noteworthy. In Western consumerist communities, the acquisition and ownership of things is one of the ways in which a being's participation in a moral community is often recognized. Layne claims, "Through the buying, giving and arranging of things, American middle-class women and their social networks begin to actively construct babies-to-be as 'real,' that is, as 'individuals who count'" (105). Whether the connection between things and personhood is forged intentionally or not, memorializing the loss in this way can translate into a conceptualization of the miscarriage as loss of a "person," evidenced by the things that belonged to it. But, of course, while the desire to memorialize by way of "things" or "belongings" is certainly understandable, and can offer great comfort to some women and their families, the political effects of doing so may not be entirely neutral.12
Allen and Marks explicitly recommend that the lost being of a miscarriage be called a "baby," partly because they felt that their own losses were viewed and experienced as "unreal." They introduce their collection by noting that prior to their individual miscarriages in 1987, there were very few books on miscarriage at all, and clear distinctions were drawn between grief over miscarriage and grief over stillbirth: "Stillbirth was referred to as the 'death of a baby.' Miscarriage, on [End Page 7] the other hand, was referred to as the 'loss of a dream.' What did that say about our babies? Were they hallucinations? We felt that our babies and our losses were not valid and our grief was not justified next to babies and losses that were verifiable as 'real'" (3).13 Allen's and Marks's feelings that their losses were not considered "real" diminished their ability to cope, they claim, and provided the impetus for their collection: "We knew that if other women felt as we did, there was a great need for the education of society on the emotional impact of miscarriage. Someone needed to delve into the secret places in the hearts and minds of these women and make it known that they are suffering and in need of care" (4). This contention, that women who miscarry need further support, certainly needs no further qualification. When there are so few public means for recognizing and acknowledging miscarriage losses, it can begin to feel as if grief is not warranted, as if one is silly or overly sentimental for mourning for an extended period of time. But extending claims about the "reality" and "personhood" of these beings requires additional consideration, and poses a unique challenge for the pro-choice feminist who miscarries and feels sadness about the loss.14
The implicit suggestion in the self-help literature seems to be that when one loves or cares about an embryo or fetus, that love and care are better acknowledged, made "real," with the term baby. But we can, I believe, acknowledge and address parents' feelings that their "realities" have been discounted, while qualifying their insistence that their loss is only "real" when articulated as the loss of a "baby." That is, we ought not use the terms real loss and real baby interchangeably. It is perfectly consistent to acknowledge that parents' loss is real in the sense that they seem to want most—a loss over which their grief is deemed understandable, justifiable, and that warrants public recognition and consolation—without having to concede that the embryo or fetus was a "real person" in the sense that pro-life/anti-abortion advocates who claim personhood from the moment of conception might want. In doing so, there is no need to deny claims to personhood either; rather, we can simply recognize that this either/or dichotomy puts women in an unnecessary bind. The important task, it seems, is not to determine whether the embryo/fetus is "real" and a "person," but to listen to why a woman might feel the need to insist on categorizing it as such, in the first place. In doing so, we can interpret the pleas of the women who insisted that they had lost a baby/child not simply as a metaphysical insistence about the beings they may have lost, but perhaps, alternatively, as an insistence that their pain be recognized, socially, as a loss that is significant and worthy of grief. [End Page 8]
One of the instruments used, perhaps unwittingly in most cases, to raise parental attachment to the notion that the embryo/fetus is "real" (in the sense of visible and verifiable), and, thereby, a "person" in the moral sense, is the sonogram or ultrasound. In the past two decades, reliance on sonograms during pregnancy has increased significantly, and the photos printed from them, along with the ways in which they are interpreted, may effectively lend credence to the pro-life/anti-abortion claim that personhood begins before birth. Carolyn McLeod, one of the few feminist philosophers to explicitly address miscarriage in her book Self-trust and Reproductive Autonomy, worries about the trends in physicians' interpretations of sonograms, which might solidify agency-ascription (and perhaps thereby personhood) to fetuses.
In North America especially, physicians and sonographers often relate to the fetus of the ultrasound image as though it were an active, independent, and socialized agent (Mitchell and Georges 1998). For example, they describe fetal movement as "'playing,' 'swimming,' 'dancing,' 'partying,' and 'waving'" (108). They make comments about the fetus's personality, such as its shyness or cooperativeness (McLeod 2002, 109).
Physicians and sonographers who offer these descriptions are not necessarily motivated by pro-life/anti-abortion politics, and we cannot assume that they are aiming, consciously or unconsciously, to ascribe moral personhood to the fetus; they might simply be responding to the vast majority of their patients who delight in envisioning their fetus's unique attributes and personality. Nevertheless, the resultant risk of this growing trend could be further entrenchment of the notion that embryos/fetuses ought to be considered "persons" very early in the pregnancy.15
Layne notes, "Sonogram photos and scraps from fetal monitors are frequently saved by bereaved parents and utilized as evidence to prove to others that a "baby" existed" (Layne 2003, 97). And by way of a survey conducted by Share (the largest pregnancy-loss support group in the United States), Layne interprets these images as having a "reality making function" for parents and others (41). Respondents to the survey claimed:
"We need to remember her as a real person we were holding. This is our proof"; "Although I get no great comfort from her pictures, I do have them put away for when I do feel the need to see she existed"; "on those days when you feel like it really never happened and people are treating you like you never had a child, you do have a picture to remind yourself you did have a child."
As with the collection of baby "things" mentioned earlier, however, few distinctions appear to be drawn between (1) the need for social recognition of the loss, and (2) the metaphysical status of the embryo/fetus. Without due emphasis on the former, questions about the latter can easily become central in attempts to cope with the loss. This, of course, might account for my own, and others', strong need to search for an appropriate "name" or term for the lost beings, and to lean toward the more socially acceptable term baby.
Of course, it would be a mistake to condemn increased use of sonogram technology outright for these trends. Aside from the vast medical benefits of using them early in pregnancy, printed sonogram pictures can function as important reminders and reassurances about the connection parents felt to their embryo/fetus, particularly for those who felt that their losses were ignored, discounted, or misunderstood. It would be disrespectful to dismiss these parents as just confused or directing their grief inappropriately, simply because they cherish an image that may have political implications beyond the scope of their grief. Rather, the solution to this apparent tension lies neither in banning the technology nor in condemning the parents who cherish the images, but in finding alternative ways to interpret these pictures and alternative stories to attach to them. When women who miscarry insist that their sonogram images comfort them and make "real" their losses, this can be recognized as partial commentary, at least, on the extent to which their losses have felt "unreal" and invisible in the culture in which they live; again, this need not be framed entirely as a metaphysical claim about the prenatal being that died or failed to develop. And as physicians continue to rely on sonograms for monitoring the development of a pregnancy (as they will most likely continue to do), they can be cautioned about the potentially negative effects of ascribing communicative agency to the fetus, such as claims that it is "waving" to the camera when its arm moves.
To address the problematic effects of these trends, McLeod recommends some "fairly radical changes in obstetrical practice." The changes would require
a shift toward what I call woman-centered obstetrics, in which fetuses are constructed in relation to pregnant women and some respect is given for women's embodied knowledge of pregnancy. Granted, in some obstetrical contexts it may be appropriate to view fetuses as separate (e.g., in fetal surgery); however, overall, they should not be defined as separate or independent entities. During ultrasound scanning, sonographers and physicians should try to avoid descriptions which suggest that they are self-sustaining beings.(McLeod 2002, 159–60) [End Page 10]
This recommendation highlights the problem that has been exacerbated by "either/or" terminology (fetus vs. baby) and by the notion that one must ascribe allegiance to one or the other side of the personhood debates. When these become forced dichotomies, fetuses are more easily conceptualized as "growing" on their own, without sufficient attention to the person growing, sustaining, and developing them. Both Layne and McLeod suggest that a "relational" model of maternal–fetal development offers a solution to the fact that our culture at large, including Western obstetrics, focuses on fetuses more than on the women who sustain and develop them. McLeod claims: "We need a model of pregnancy as a relation, but not one that is so exact that it cannot accommodate varying degrees to which women view their fetuses as parts of them" (McLeod 2002, 160). Such a model must be flexible enough to respect the autonomy (as McLeod argues), and uniqueness, of all women—from the woman whose entire identity is willingly enmeshed with that of the prenatal being she sustains, to the one who considers the pregnancy akin to hosting an unwelcome invader.17
Feminist ethicists have embraced such a model with respect to elective abortion, and it behooves us to extend this model to spontaneous abortion, or miscarriage, as well. In "Abortion through a Feminist Ethics Lens" (1994) Susan Sherwin claims:
Women's personal deliberations about abortion include contextually defined considerations reflecting her commitment to the needs and interests of everyone concerned—including herself, the fetus she carries, other members of her household, etc. Because there is no single formula available for balancing these complex factors through all possible cases, it is vital that feminists insist on protecting each woman's right to come to her own conclusions … theoretically dispassionate philosophers and other moralists should not expect to set the agenda for these considerations in any universal way.(315)
The "conclusions" here are those by which a woman decides what the pregnancy means to her, for her, and potentially for others in her life. On the basis of these, she may decide to end a pregnancy, or to continue it. In either case, she has constructed a particular relationship, with moral and emotional significance: one that has meaning for her. Sherwin reminds us: "Fetuses develop in specific pregnancies which occur in the lives of particular women…. Their very existence is relational, developing as they do within particular women's bodies, and their principal relationship is to the women who carry them" (Sherwin 1994, 319). This reminder helps account for the apparent paradox that the loss of some pregnancies (whether elective or spontaneous) can be devastating, while others [End Page 11] are experienced as inconsequential or a relief; none of these experiences need be judged the "wrong" way to conceive of the embryo/fetus or the pregnancy. It is the woman's conception of the pregnancy and her relationship to the embryo/fetus that determines its moral and emotional significance. On a relational model, Sherwin notes, "fetuses are morally significant, but their status is relational rather than absolute" (319). Attempts to determine the "abstract metaphysical criteria of personhood" ignore a crucial consideration: "[p]ersonhood is a social category, not an isolated state" (ibid.).
On a relational model of pregnancy (and of pregnancy loss), as I conceive it, a woman and her fetus are physically connected beings, but there are contingent and severable aspects of this connection. One can conceptualize, name, and define a woman and her embryo/fetus as physically connected to each other, while still recognizing the variability in women's emotional and intellectual connections to their fetuses. We can conceptualize a woman and her embryo/fetus as interrelated on a physical level, while still recognizing the severability of that relationship, attaching as little or as much emotional significance to the relationship as each woman deems fit. Such a model recognizes that the bodies of the woman and her embryo/fetus interlock physically, but that the woman's attachment to the embryo/fetus on an emotional level can be strong, weak, or changing, depending on her circumstances, and on the extent to which she elects to attach moral and emotional significance to it. Such a model, I believe, appreciates the dependence of the embryo/fetus on the woman, and the ways in which the woman and embryo/fetus are growing and developing together. But it also allows for individual variation on how each woman herself thinks and feels about her embryo/fetus.
Allen and Marks claim: "A woman who is pregnant exists in a deep and intimate state of symbiosis with the baby in her womb. They are fused. Her baby is, quite literally, a part of her mentally, physically, and emotionally" (Allen and Marks 1993, 13). While the model I advocate recognizes the potential for such symbiosis on all of these levels, it does not assume that any such symbiosis must have emotionally positive significance for every woman, or that it is static throughout a pregnancy. Some women who feel deeply conflicted or ambivalent about a pregnancy at the beginning, conceptualizing the embryo/fetus as something unwelcome or invading their bodies, may feel deeply attached to it later on. And others, who feel deeply attached from the beginning, may feel the need to forge an emotional separation if it is determined that their fetus will die in [End Page 12] utero, or that termination of the pregnancy is deemed requisite, such as in the case of discovery of severe developmental abnormalities.18
There is considerable precedence for relational thinking about pregnancy and women's connections to their fetuses. Rebecca Kukla commends the significance of work done by Patrice DiQuinzio, Margrit Shildrick, Donna Haraway, Elizabeth Grosz, and particularly that of French feminists Hélène Cixous and Luce Irigaray, who "claim the shifting, permeable, expandable, unresolvable boundaries of the feminine and/or maternal body as a positive identity" (Kukla 2005, 224). Haraway and Grosz, she notes, "have reclaimed the failure of distinctions between self and other" (224); Cixous, she claims, "embraces the elasticity and spatial perplexity of the maternal bodies in all their forms" (225); and Irigaray "has embraced the apparent capacity of the female/maternal body to be unindividuatable, both one and two at once" (225). Their work celebrates the imprecision of fetal–maternal boundaries, instead of viewing imprecision as a deficit or weakness of the pregnant and/or lactating body, and, as Kukla claims, there is an indisputably important "theoretical and political place for writing that refuses to take the leaky, disorderly, extendable, unstable body as the defective or problematic counterpart to some mythical well-bounded, impenetrable, static masculine body" (225).
Yet Kukla also worries about the extent to which these accounts of the maternal body ultimately serve a liberating purpose, in the context of existing political power structures that threaten a woman's right to exercise control over her body. Under the current climate of renewed threats to Roe v. Wade in the United States, and backlash against reproductive rights of all sorts, feminists must tread carefully when advancing theoretical claims that may be interpreted to deny the existence of any clear distinctions or boundaries between the pregnant woman and her embryo/fetus. This, I believe, is a crucial cautionary note, particularly as feminists work to negotiate the following interlocking projects: on the one hand, we must be able to recognize pregnancy losses as potentially morally significant, and offer greater support to those women who are deeply affected by their miscarriages; on the other hand, we must frame our political positions so that we recognize each individual woman's right to embrace or to reject development of a fetus in her own body. As Kukla reminds us, we must be able to recognize the potential fluidity of maternal boundaries, but also to "ensure a stable body and agency strong enough to resist boundary crossings that are violating rather than liberating" (Kukla 2005, 226). [End Page 13]
My own either/or angst about whether to name my losses as babies or fetuses would have been eased had I adopted a more relational model; the importance of finding a name for each "being itself" that I lost might thereby have diminished. Part of this angst was based on the notion that I had to determine whether the lost beings were persons (babies) in the moral sense. But this worry rested on a failure to recognize that "personhood is a relational concept" (Sherwin 1994, 320), that the moral and emotional significance of these beings were conceptually (as well as physically) shaped by me, in the context of my life. On a relational reconceptualization, then, my losses could be understood more holistically, not merely as the death of developing beings, but also as the loss of my hopes and expectations, as well as fluids and tissue, that I built up in the pregnancy. My miscarriages on this model become "pregnancy losses," not merely embryonic/fetal losses, with a much fuller conception of pregnancy than that of containing, housing, or carrying an embryo/fetus.19
The physical miscarriage, after all, involves not only the loss of embryonic/fetal tissue, but also of supporting blood and tissue, rendering the boundaries between "what" is lost (parts of the woman or parts of the embryo/fetus) fuzzy to begin with. Books about pregnancy remind us in meticulous detail how pregnancy "weight gain" is distributed: blood volume increases 40–50 percent; nutrient, protein, and fat are "stored"; and changes in breasts, uterus, placenta, umbilical cord, and amniotic fluid cause weight increases, making a relatively small proportion of pregnancy weight gain attributable to the weight of the "actual" fetus "itself." Yet the dearth of literature on miscarriage seems to signal that, in terms of pregnancy, we care more about the accumulation of such weight during pregnancy than we do about its loss. We fail to recognize that all of this physical matter—which belongs both to the woman and the fetus—is eventually lost in the process. A relational model of pregnancy might accommodate the variety of ways in which a woman may experience her loss, and also the ways in which a woman is, physically, losing aspects of her "own" body.
The phrase pregnancy loss need not be amended in order to acknowledge the variability in women's feelings and thoughts about their fetuses. Loss, whether intentional or unintentional, need not be restricted to those experiences about which a woman is upset or grief stricken. Although the term loss typically accompanies emotions of sadness or regret (e.g., loss of a loved one, loss of a job, even loss of one's wallet), it does not always do so. One of the most celebrated forms of loss in our culture is weight loss; it is loss about which we congratulate one another and even celebrate. Some pregnant women look forward to this [End Page 14] loss, while others mourn it deeply. Likewise, to some, the loss of the placental organ is an event that inspires reverence and ritual; to others, it is spiritually or culturally neutral. So the extent to which weight loss associated with pregnancy—whether it be loss of fluid, supporting organs, or an embryo/fetus—can be deemed desirable or undesirable remains highly circumstantial and even culturally specific. Furthermore, we need not assume that feelings of grief or sadness indicate that the pregnant woman experienced a symbiosis with the embryo/fetus on a mental or emotional level. Sometimes crying, sadness, and depression after a miscarriage might be attributable more to the loss of control a woman feels over her body or over her plans for the future, than grief over the death of the embryo/fetus itself.20
It is not a misnomer, I believe, to call both the fetus and the pregnant woman "developing beings," and to recognize that termination of the fetus involves termination of many other developing processes within the pregnant woman's body. A relational model accounts for the fact that the boundaries between a woman and her embryo/fetus are, both literally and figuratively, more fluid than we often recognize. But this model allows an individual woman to determine, to an extent, what those boundaries are, certainly on an emotional level, and ultimately on a physical level as well.
This model has the added benefit of helping feminists identify links between women who undergo elective abortions and those who undergo spontaneous abortions (miscarriages), without denying that vastly different intentions, motivations, and emotional connections might be present in the relationship between a woman and her embryo/fetus in each individual circumstance. My second miscarriage was completed with administration of Mifepristone, a form of "the abortion pill," rather than with a D&C (Dilation and Curettage).21 Never having had an elective abortion, I developed both empathy and anger at how much more difficult it might have been to take this pill under the cloud of shame that our society heaps on women who electively abort, had my abortion been "intentional." As the days of the "miscarrying"—of heavy bleeding and severe cramping—went on, I became increasingly angry at the protestations I had heard over providing home access to this drug, such as, "If we let people take it home with them, it trivializes abortion; it makes it too easy." Anyone who had launched such protestations clearly had no personal experience with the drug's effects and probably had not talked to anyone who had. The cramps were, even with heavy pain medication, at points agonizing. And I just could not even fathom how anyone, upon visiting the bathroom every half hour and watching large [End Page 15] clumps of blood fall into the toilet, could allege that this was thereby a trivialized process. If anything, the slow methodical dripping of blood and dropping of tissue from my body made the process more intense and more traumatic than I would ever have expected.22
Pregnancies develop and terminate under a wide variety of circumstances, and through unique relationships between a woman and her embryo/fetus. In order to respect each individual woman, who must explore what this relationship means to her, our primary aim should be to offer her support, not to categorize her choices into acceptable and unacceptable ones. Supporting women who abort electively does not imply disrespect for pregnant women and/or the lives that are developing with them; likewise, supporting women who abort spontaneously (miscarry) does not imply disrespect for the movement to ensure women's rights of reproductive choice. In extending both forms of support, we allow women to define and name what it is that they need, either in making decisions about whether to continue their pregnancies and/or in coping with the emotions that accompany their terminations (whether intended or unintended). A relational model that recognizes the uniqueness of each woman's feelings and circumstances is important not just for the melding of pro-choice feminism with the diverse experiences of miscarriage, but also for the melding of pro-choice feminism with the experiences of pregnancy and elective abortion.
More feminist philosophical work on the topic of miscarriage should ultimately help strengthen feminist pro-choice efforts, not weaken them. Layne suggests that if we fail to do feminist work on the topic of pregnancy loss, we have effectively "surrendered the discourse of pregnancy loss to antichoice activists" (239). A study conducted by Kristin Luker in the mid-1980s revealed "that one-third of the pro-life activists … reported some form of 'parental loss,' such as infertility, a miscarriage, or the death of an infant or child, whereas only 6 percent of the pro-choice activists reported such a loss" (cited in Layne 2003, 50). While this difference, Layne notes, might simply be attributable to the fact that pro-life advocates tend to produce more children, the study also suggested that "the experience of a pregnancy loss was important to the decision of some to become active in the pro-life movement" (50). Given that approximately 20 percent of all pregnancies end in miscarriage, and that these numbers may rise as women delay childbearing, there is reason to worry about swelling in the ranks of pro-life/anti-abortion support, if we do not offer greater support to women who miscarry. As Roe v. Wade is put into an increasingly precarious [End Page 16] position, feminists simply cannot afford to lose any pro-choice women by failing to listen, communicate, embrace and/or comfort them when they miscarry.23
Kate Parsons is associate professor of philosophy and director of the Center for Ethics at Webster University in St. Louis. Her current research focuses on ethics of the family, feminist philosophies of the body, and theories of identity related to gender, race, and class.
My sincere thanks go to Carolyn McLeod, Sheila Hwang, Britt-Marie Schiller, and Karla Armbruster for their helpful feedback on this paper.
1. I conceptualize this belief as both feminist and pro-choice. While there are those who claim to be feminists and pro-life/anti-abortion, I believe this pairing makes sense only on an individual, and not a political, level. In other words, I believe it is perfectly consistent for a person to be a feminist and personally opposed to abortion, but that it is inconsistent with feminist politics for a person to claim that other women should be denied the right to choose whether to terminate their pregnancies, at least within the first trimester.
2. In my own miscarriages, the first was technically the loss and death of an embryo that had developed a beating heart that later ceased. The second miscarriage took place at the fetal (rather than embryonic) stage in terms of weeks, but not in terms of development. Although I was chemically pregnant the second time, the gestational sac was empty (sometimes called a "blighted ovum"). These distinctions, of course, further complicated the issue of how to name and conceptualize my losses.
3. Mahowald's essay concentrates primarily on the ethics of fetal tissue transplantation, but her claim extends to the Western abortion debates in general.
4. In "The Moral Significance of Birth" (1989), Mary Anne Warren addresses the criticisms that, unfairly, made her 1973 claims infamous in some circles. She counters the suggestion that by denying that criteria for personhood are met in fetuses, her view implies the moral permissibility of infanticide. She argues, "Birth is morally significant because it marks the end of one relationship and the beginning of others" (62), thereby providing a means to differentiate morally between late-term abortion and infanticide.
5. It is interesting to consider whether love requires reciprocity, the existence of two sentient, if not conscious, beings, and whether I felt something more appropriately called hope, affection, attachment, etc. But exploration of this question is outside the scope of this paper.
6. This worry came from the assumption that willingness to terminate a being's life contradicts caring for it. But, as I will note later, some might argue that caring for a being with severe impairments could require terminating its life. [End Page 17]
7. This essay will focus primarily on U.S.-American culture with respect to miscarriage, but Layne and others have done fascinating comparative work on the ways in which miscarriage and miscarried fetuses are regarded in other societies. See Layne, pp. 62–64, especially.
8. Linda Layne states: "It should also be noted that women who miscarry may inadvertently collude in the silence-making by their decision not to reveal their pregnancy until after the first trimester (i.e., until after the greatest risk of pregnancy loss has passed) (cf. Reinharz 1987: 234)" (Layne 2003, 70).
9. Ingrid Kohn and Perry-Lynn Moffitt list "The Five Worst Comments You Might Hear: (1) It happened for the best; (2) Don't worry, you can have another baby; (3) You didn't really know the baby, so it's not like losing a child who has lived with you for a while; (4) I know exactly how you feel; (5) What are you going to do now?" Following this, they list "The Five Best Comments You Might Hear: (1) I'm so sorry. I know how much you wanted to have that baby; (2) It's okay to cry; (3) Would you like to talk about it? (4) Is there anything I can do for you? (5) May I call you back in a few days to see how you are doing?" (Kohn and Moffitt 2000, 157–58). And Layne reminds us that even hurtful comments often come from sympathetic intentions: "From time to time I give public lectures on my work on pregnancy loss and questions from the audience are frequently from those who know someone who has had a loss and want advice on what to say or do. In these cases, it is clearly not a lack of sympathy or goodwill that is the problem but the absence of acceptable cultural scripts for how to behave in such circumstances" (Layne 2003, 69).
10. Of course, this is not the case in all miscarriages. Some women who miscarry outside of a hospital are able to see the embryo or fetus, either in parts or fully intact, after expulsion. But this visibility is still typically limited to the woman who miscarries and/or to a partner or close friend who is with her in the process. Friends and family do not typically see the embryo or fetus itself.
11. Author's emphasis.
12. Layne also notes that women often "feel trapped in a liminal social position" (Layne 2003, 60) after miscarriages. Because pregnancy often represents the stage of "limbo" before one enters into the status of "motherhood," women who miscarry are at a loss over whether to call themselves "mothers," as well.
13. Miscarriage is pregnancy loss before twenty weeks gestation, and stillbirth is pregnancy loss after twenty weeks gestation. Most support books published in the past few decades recognize this medical distinction, but do not attempt to rank women's grief over the latter as worse than grief over the former. [End Page 18]
14. Although most of Allen and Marks's book focuses on articulating, analyzing, and justifying the profound grief of women who miscarry, they do include a short qualification of their project: "Although the women in our study felt grief, and while we discuss the usefulness of expressing and working through grief, we realize the potential for inverting the overall problem we have described. Women who don't or didn't grieve their miscarriages may begin to feel guilty, abnormal, or alone. We are not implying that to grieve is smarter, better, more sensitive or aware, or in vogue. Whether we feel our miscarriages are deaths or blessings, both, or something else altogether, our feelings are okay" (Allen and Marks 1993, 10).
15. Layne notes that many feminists have critiqued the role of sonograms "for their role in the construction of fetal personhood at the expense of maternal personhood, particularly in the context of abortion politics." But, she says, "To date, no one has examined the impact that obstetrical imaging technologies have on pregnancies that end without a live birth" (Layne 2003, 100–101). Also, Rebecca Kukla notes that while ultrasound technicians talk to the fetus and the parent(s) "in ways that playfully presume its independent and individualized agency," some also counter parental interest in individualizing the fetus, especially with nonwhite patients. These technicians suggest that it is less important to know the sex of the fetus, than it is to have confirmation that the fetus is healthy. "Thus technicians … use the images that they control in order to help canonize an image of a fungible public fetus, unindividuated even by sex, and they also facilitate the forging of a personalized relationship with this fetus by presenting it to its parents as a humanized interlocutor" (Kukla 2005, 114).
16. Sometimes pregnancy-loss support groups encourage parents who did not get sonograms of their own to obtain substitutes, in the form of photocopied images of a fetus at the same gestational age at which theirs died (Layne 2003, 136).
17. McLeod's use of "relational" is explored in considerable detail in her book Self-trust and Reproductive Autonomy (2002), and she situates the term within the rich feminist literature on autonomy. For McLeod, self-trust is relational "in the sense of being socially constituted" (6). The extent to which a woman might trust herself, and make decisions autonomously, she argues, must be evaluated relationally, that is, in the contexts of the social forces (particularly coercive or oppressive ones) that shape her life. Adequate development of justified self-trust and autonomy, she claims, requires "a supportive social environment" and nonoppressive conditions (McLeod 2002, 130; Chapter 6). My use of the term relational does not conflict with this, but my focus is slightly different. I simply intend to capture the ways in which a woman and her fetus are conceptualized and connected, and to [End Page 19] acknowledge that there are both necessary and contingent aspects of these connections.
18. Consider the importance of respecting women who make the often difficult decision to terminate a pregnancy, after discovering such abnormalities. One woman writes: "She was my daughter and we terminated her life because we loved her so much that we cold [sic] not bear for her to suffer so innocently" (Minnick, Delp, and Ciotti 2000, 106). Another shares: "I felt like such a split personality because part of me wanted to love feeling the baby move and the other part of me cringed at hating the baby for putting my family through this. I felt like I had a 'thing' or some kind of 'creature' inside me, not a precious baby. I just wanted it to be gone; this baby whom I wanted and for whom I waited so long. I felt like it was consuming me from the inside out. In the week or so before the termination I became preoccupied with how I could possibly grieve for a baby I was choosing to kill. To my mind, grief is a healing process and eventually brings peace. I did not see how I was entitled to such peace" (Minnick, Delp, and Ciotti. 2000, 105).
19. One woman claims, "I hate that term 'miscarriage.' It's like a football that's being tossed to you and you don't quite catch it" (Allen and Marks 1993, 14). Another says, "I did not like the word miscarried. It implies that I did not know how to carry my baby in my womb" (Layne 2003, 10). Distaste for this word might be partially explicable in cultural context: "In the United States we tend to understand moral stature and worldly success to be the result of purposeful, individual effort, a reproductive 'failure' like pregnancy loss is often understood by women to be somehow their fault. Although physicians routinely reassure women post facto that there was nothing they could have done to cause their loss, this message contradicts all of the morally laden messages they have received throughout the pregnancy regarding their personal responsibility for the well-being of their child" (Layne 2003, 19). Other possible causes for this feeling include messages from the women's health movement that we should have and exert greater control over our pregnancies, and the myth of meritocracy that pervades U.S.-American culture (Layne 2003, 19).
20. For instance, "a woman told us in a comfortable tone of voice that she was glad she miscarried, she never made any emotional attachment to her baby, she didn't think of it as a baby, her miscarriage was 'meant to be,' and it had no impact on her life at the time of her interview. This woman also said, 'I cried. It didn't really hit me for a week. Then I felt sad and upset…. I always feel I have to be in control. I don't think I knew how to feel'" (Allen and Marks 1993, 52). [End Page 20]
21. I was given the option either of scheduling a D&C and handling things "surgically," or of going home with pills to prompt the miscarriage "medically." My obstetrician, probably unsure of my politics and about how I might react to the implications of the "medical" option, simply told me how the medicine might work. She mentioned that the pharmacist might ask me questions about whether I'd received proper advice and guidance about the medication, and warned me that s/he might be hesitant to fill the prescription. In the haze of dealing with all of this bad news, it didn't occur to me that this advice was out of the ordinary. It was only when I got home, thought more carefully about my obstetrician's advice, about the pharmacist's avoidance of my gaze, and about the strangely familiar name of the medication, that I realized I had obtained "the abortion pill." I was shocked to realize that I was about to take a medication that had been, and still was, highly controversial, and for which I had signed Planned Parenthood and NARAL petitions for years.
22. It would be a mistake to assume, however, that the "surgical" option of the D&C is always or necessarily less traumatic. Although in surgery one is under anesthesia, some women feel violated and torn after the procedure. One woman shares: "I felt I had been vandalized, like someone had broken in and ransacked me. It's like having something ripped from you. When it's done by D&C, it feels brutal and violent, like a vacuum cleaner sucking the life out of you. A very special, loved part of my own body was torn out of me" (Allen and Marks 1993, 14).
23. Under their heading "What Felt Helpful," Allen and Marks offer some advice for supporting women who miscarry—advice that can, I believe, be embraced easily by the pro-choice feminist: "People who invited the women to talk or who simply listened without judgment, belittlement of the loss, or pointing to 'the brighter side' were helpful. When others acknowledged the women's miscarriages as losses and responded with compassion and acceptance, relationships felt healing and were remembered with deep appreciation" (Allen and Marks 1993, 117). Layne also suggests that we can work to develop "feminist rituals of pregnancy loss" that do not focus, as most support groups do currently, "on concretizing and sacralizing the personhood of the baby" (Layne 2003, 247). Instead, "[f]eminist rituals might focus on the woman and provide scripted ways for friends, relatives, and colleagues to offer support, acknowledge her loss, reaffirm her connections to others, and her sense of belonging and identity" (247).