Poverty is the Commonest Reason For Abortion: This is not a choice
The BMJ is correct to use its platform to highlight the harrowing experiences of MP Creasy(1) so as to raise awareness and stop those that seek to wage a secret campaign of intimidation. However with the privilege of this platform comes the responsibility not to inadvertently engage in misrepresentation. The article conflates the extreme and deplorable actions of individuals with the "prolife movement". No one on either side of the debate endorses the use of harassment or intimidation of women, which is singularly unacceptable. Last week the Lancet published a piece highlighting the toll of gender-selective abortion, with an estimated 23 million missing girls worldwide between 1950 and 2017 due to this egregious practice(2). However the article was careful not to align this nefarious conduct with the “pro-choice” movement, which would be a gross misrepresentation. Similarly it is inaccurate to portray the rebarbative actions of a minority of individuals as a component of the “prolife” campaign.
The well-written and moving BMJ piece also tellingly describes abortion as a "women's right to chose". However the evidence has consistently shown that the vast majority of women request abortions due to a lack of financial resources(3,4). A Guttmacher Institute study reported that 73% of women cited this as the motivating factor for abortion(4). Under these circumstances there is no way abortion can be called a “choice”. Indeed the Guttmacher institute went on to expressly state in the wake of their study that
“Qualitative data from in-depth interviews portrayed women who had had an abortion as typically feeling that they had no other choice, given their limited resources and existing responsibilities to others”(5)
It is in many ways an affront to suggest to women, who are compelled to have an abortion out of poverty and an inability to afford childcare; that they have "chosen” their abortion. It is sadly ironic that in the same issue that the BMJ calls for greater socio-economic diversity in medicine(6), it then only engages in the abortion debate from the vantage point of the privileged. As the journal recognises doctors tend to come from affluent backgrounds and thus can fail to empathise and relate to women who literally have to “choose” between abortion and sufficient financial resources to survive or continue the pregnancy with a precarious and uncertain future. This may be inconceivable for the privileged but the evidence suggests that this is a reality for many, if not the vast majority of women who seek termination of pregnancy(3,4). 75% of women requesting abortion in the US are in poverty or in the low income bracket(7). The poorest 12% of women account for almost 50% of abortions and the poorest 30% for 75% of abortions(8). Abortion cannot be a solution for poverty; thereby surreptitiously allowing those in authority to abdicate responsibility of tackling socio-economic inequality. The BMJ has shown commendable leadership and been at the forefront of the campaign to eradicate period poverty(9) but has been much less vocal at the scourge of poverty which suffuses the issue of abortion. Abortion may be a right in the UK but it is clearly not a choice.
1. Eaton L. A woman's right to choose: five minutes with . . . Stella Creasy. BMJ. 2019 Nov 7;367:l6424
2. Uzoigwe CE Does the first assault on women's rights occur in utero? Lancet. 2019 Nov 2;394(10209):1614
3. Chae S, Desai S, Crowell M, Sedgh G. Reasons why women have induced abortions: a synthesis of findings from 14 countries. Contraception. 2017; 96:233-24
4. Finer LB, Frohwirth LF, Dauphinee LA, Singh S, Moore AM. Reasons U.S. women have abortions: quantitative and qualitative perspectives. Perspect Sex Reprod Health. 2005; 37:110-8
6. Godlee F. Inequality matters : BMJ 2019;367:l6489
9. Rimmer A. BMA calls for end to period poverty. BMJ. 2018 Jun 26;361:k2811
Competing interests: No competing interests