The phrase ‘pro-choice’ has been primarily associated with a movement to allow women the legal right to choose an abortion.  The rationale behind this movement is grounded in the belief that a woman has absolute ownership over her body and unborn baby.  This post is not about abortion and I do not necessarily embrace the entire pro-choice movement as the concept of foetal rights introduces complexities for me.  I would however like to explore the meaning of pro-choice outside the abortion realm and what it means in the larger scale of a woman’s rights over her fertility and her body as a whole.

There have been several high profile cases where a woman has become pregnant in unusual (and some may say inadvisable) circumstances, whether naturally or with medical assistance. Michelle Duggar’s 19th baby, Josie, born three months prematurely. ‘Octomom’ Nadya Suleman.  This post in particular was prompted by coverage of  72 year old Rajo Devi Lohan who is now dying following an IVF pregnancy and birth which resulted in a healthy baby but severe maternal complications.

What enraged me about this coverage was the suggestion by a psychiatrist working for Fox News that a 72 year old woman was probably not ‘of sound mind’.   This is pure nonsense.  (Just ask my grandmother who completed a MEd last year at the grand old age of 77).  Lohan’s decision-making process was clearly heavily influenced by a cultural perception where she felt it was better to die than to be barren for the rest of her life.  This may be a difficult leap of logic for Westerners, but it does not make it an insane decision.  The same is true for Suleman or the Duggars.  In fact, one could argue in this age of media attention and poor employment prospects, their fertility choices were a calculated risk –  they both have greatly improved their earning potential and all their babies have thankfully survived.

Yet there is an immense amount of judgement attached to fertility choices.  Women are attacked for remaining childless, for only having one baby, for having more than two babies.  There are perhaps valid reasons for questioning these choices when the women then require resources from the community to support the children (The UK’s financial welfare system for example or even the question of global resources).  However I suspect these are a smokescreen.  The real outrage is directed at women claiming ownership of their own fertility rights.  Indeed not having enough or having too many babies is often specifically called ’selfish’ by the less sisterly among us.

These sentiments, the idea of a woman being selfish or of unsound mind hark back to decades of women being considered hysterics and hussies, incapable of making a rational decision about their body.  They are frequently directed at women who opt for home births, for example.  Meanwhile, men may reproduce as responsibly or irresponsibly as they choose and at worse are a ‘cad’ or a ‘player.’  Single mothers struggling to raise their children are pilloried in the Daily Mail/Fox yet the fathers are quickly forgotten.  A woman who abandons her children is an atrocity while a man who does the same is just shrugged away.

The truth is, fertility is a human right.  Why do we reproduce?  As the child-free contingent point out, it is probably illogical.  It’s a poor financial choice, it’s bad for global resources and it is a massive responsibility.  However it is a natural drive.  Even having one baby could be termed selfish, but it is necessary for the continuation of the species and it is something that many women want for reasons which might be instinctive, spiritual and all-encompassing.  It is rarely a choice of pure logic.

What is concerning is that society has repressed our reproductive rights.  It is difficult to survive on one salary with several children.   The US in particular offers little in the way of maternity leave or benefit and mothers are pressed to return to work as soon as possible.  We are effectively slaves as we have sold our freedom to reproduce – we are expected to raise our children in an appropriately consumerist way and this requires a certain level of wealth.  SAHMs are often called lazy, yet they’re doing something perfectly natural and normal – raising their children as generations have done.

Being pro-choice means that you accept a woman has full ownership of her reproductive organs and the way she chooses to use them.  You may not approve of her choices but criticising a woman for having several children or for being too young or too old to have children is as offensive and unpleasant as criticising a woman for having an abortion.  Why do we allow so many others to curtail our choices?  More worryingly, laws are in place to prevent certain kinds of birth in some states.  Though some may consider home birth risky and unassisted birth downright dangerous, if you are pro-choice, surely you accept that a woman may have her reasons for making a choice that you do not approve of and that it is ultimately her absolute right to birth her child however she wants.  There is far wider debate in this sphere.  Whether women should have a choice to smoke or drink alcohol or go abseiling in pregnancy.  Whether women should have a choice to reproduce when under the legal age for sexual intercourse (after all, why do we allow an arbitrary age which changes from region to region to dictate a behaviour encouraged by nature?).  This is why I cannot categorically say I am pro-choice as I do believe an unborn child should be granted certain protections.

I think these questions are worth asking.  Being ‘pro-choice’ is not as simple and as clear cut as it appears.

I’m coming to the end of the final module of my MBA. I started on that path ten years ago as a bright-eyed 21 year old software developer with vague notions of one day being a powerdressing consultant. It’s been a long, long process with several pauses during which I had two babies, completed a BA in theatre at a bricks and mortar university then moved across the world and had a third baby.

I accelerated the MBA over the last two years and decided to pick a specialism in healthcare and the life sciences. It turned out to be a serendipitous choice. My home birth revitalised a rabid interest in birth matters and the life science specialism allowed me to combine my birth and management studies into a dissertation on how the NHS might cope with managing doulas.

So now I find myself at a crossroads. Home-educating and breastfeeding are part of my life and I’m more t-shirts and piercings than shoulderpads. But I want to keep studying, keep going, keep learning and I want to be challenged. I also want to be in a position to make positive changes in the world.

Here’s the thing.. my impression is that the only qualification which counts is MD. (Please, PLEASE challenge me on this. I’d welcome a debate!)

Personally, I adore midwives. I’ve met several over the last year or so who are among the wisest people I have ever met. They are on top of the latest evidence, constantly learning, reading, gaining experience and absorbing knowledge. They have the emotional intelligence, spiritual intuition AND the science.

Yet if we’re playing ‘birth top trumps’ the midwife always loses out to the doctor.

And in American society, the doctor is king. They can deliver babies, cut people open, prescribe medicine, make diagnoses and declare deaths. They get a cracking salary. They can also make all sorts of pronouncements that are often ‘the voice of experience’ rather than coming from any kind of evidence.

And many will say fair enough, they went to medical school for a long time.

And this is where I hit a snag.

I would quite like to go to medical school. I would love to learn about cell biology and anatomy and all that stuff. I’m a good student. I’ve juggled motherhood and studying in various fields for years.

Yet the barriers are massive. They’re almost insurmountable if you have young children. “It’s about stamina.” I hear. You have to go full time. You can’t do med school part time. You have to be dedicated. It has to be your number one priority. Your spouse will have to deal with the funny hours. You won’t see your children. You need to do it early in life or you’ll never pay off the debts etc. etc. etc.

I ask why? Why can’t you learn more slowly? Why all the macho stamina stuff? Why is it a study course tailored to young, childless people? Why is the med-school recruitment target audience made up of people who have not yet had a baby or even much life experience out of academia? At my school, the ‘clever girls’ were groomed to be doctors following a straight, clear path from school. And well done to them. It’s not an easy path. They were smart figuring out what they wanted to do before children. But some of us needed a little more time to figure out what we want to do – then find it’s too late.

Things are changing slowly in the UK – St George’s for example offers a fast track course aimed at getting older students in and trained. There are post-bacc courses in the US too. But there are no part time med schools. You have to dedicate yourself to it entirely. You can do law or business part time. You can do a PhD part time. But medicine is different. Why?

Now I’m not suggesting that doulas or midwives are second best. They’re a different thing entirely. And there are some massively influential ones – Peggy Simkin, Ina May Gaskin etc. etc. But they don’t carry as much weight in the medical world as they should. Hospitals NEED more doctors like Dr Biter who is rightly all over the news at the moment. Doctors who have PERSPECTIVE and are aware of why natural birth is important and when they should let it take its course. Doctors who carry weight with their peers. Who have the same level of education and authority.

But that education is not easily available to women with children. Especially women who are reluctant to put their children into full time day care.

There’s a feminist issue here. Why should wanting to care for your children preclude you from accessing that education? Why shouldn’t women with children study and gain the experience to become peers with doctors? So many mothers become doulas or even midwives yet for a hands-on mother to become an OB/GYN is difficult to the point of near-impossibility.

And doulas and midwives will always be ‘put in their place’ beneath the OB/GYNs. The patriarchy is stifling.

How can mothers get their voice and experience heard when we’re always told we’re ‘not as good’ or ‘not as clever’ or ‘not as educated’ or ‘don’t carry as much authority’ as the wise doctor and we don’t even have a chance to access the education?