For I will restore health to you, and your wounds I will heal, says the Lord, because they have called you an outcast.
—Jeremiah 30:17
Sitting in a stuffy, cramped conference room, I watched silently as a group of Christians, United Methodists specifically, debated their denomination’s stance on abortion. The room was packed with antiabortion activists wearing matching neon-orange T-shirts. Only elected delegates were allowed to speak in the session, but the presence of this activist group certainly made a statement. In the middle of this discussion, one of the delegates, an older white man from the United States, proposed an amendment to the existing language that, if approved, would alter the denominational position to approve of abortion only in instances when the pregnant person’s physical life was threatened. The official position at the time acknowledged the “tragic conflicts of life with life” that necessitate abortion, a carefully worded and nuanced phrase.1 This delegate’s proposal was articulated precisely and narrowly: the only circumstance in which an abortion could be morally justifiable was when death was imminent.
To my great relief, the amendment lacked the necessary support from a majority of delegates and failed in committee that year, but still, that scene haunts me. I have no doubt that future delegates will attempt again and again to modify the denomination’s position until they are successful in narrowing the language to permit abortion only in cases of life endangerment. More than that, though, I’m still grappling with the bone-chilling realization that some of my Christian siblings believe that the only time a pregnant person’s well-being matters is if they are facing certain death.
At the time of this denominational debate, my advocacy work focused primarily on the goal of lowering rates of maternal mortality through preventive measures like expanding voluntary access to a variety of contraceptive methods. I knew that pregnancy was a life-threatening condition for many women around the globe. The statistic at the time was that every two minutes, somewhere in the world a woman died from complications during pregnancy or childbirth. In fact, during the course of that General Conference, a delegate from Sierra Leone approached the debate floor for a point of personal privilege to request prayers for a woman who had died in childbirth earlier that day in her hometown. The stark reality of “tragic conflicts of life with life” was palpable in the room. We bowed our heads to pray for this woman who had died and for her baby who was now motherless, but what actions were we willing to take to end this needless suffering and preserve the full lives of pregnant people?
One of the guiding verses of my advocacy work is from the Gospel of John, when Jesus says, “I came that they may have life, and have it more abundantly” (10:10). We are created for more than mere survival. Abundant life is joy filled and fear-free, full of opportunity and hope, and it is just as much about the well-being of our communities as it is about the state of our individual lives. The two are intertwined. What I have learned from advocates in the reproductive justice movement is that all human beings have a fundamental right to conditions necessary for thriving as individuals, families, and communities. When a pregnancy conflicts with any aspect of a person’s well-being, we ought to ask, How are we called to respond to the conditions that interfere with a person’s ability to experience abundant life?
In 1973, the Supreme Court took on a very similar question regarding the status of a pregnant person’s well-being. Most people are familiar with Roe v. Wade, which ruled that abortion was legal before viability under the right to privacy, but another lesser-known Supreme Court decision issued the same day was Doe v. Bolton. This case challenged an existing abortion law in Georgia that required before any procedure the approval of three doctors and a special committee to confirm that a pregnancy would “seriously and permanently” injure the pregnant person, or that the fetus had serious anomalies, or that the pregnancy was the result of rape or incest. The Supreme Court decision ruled that the restrictions were unconstitutional, that a person could access an abortion after viability for health reasons, and that “health” included the physical, emotional, psychological, and familial well-being of a pregnant person. This understanding of health reflected the definition adopted by the World Health Organization in 1948 that health was “a state of complete physical, mental, and social well-being” and “not merely the absence of disease or infirmity.”2
Abortion opponents push back against this language because of how all-encompassing it is. The reality is that pregnancy and birth can lead to any number of complications that impact a person’s health and well-being, and many of the experiences I share in later chapters will expound on this truth. For this chapter, I have included two stories that illustrate how pregnancy can put a person’s health and well-being at risk and how access to abortion is lifesaving—in the greatest sense of the word—in these types of circumstances.
“No one has maternity leave for abortions or miscarriages, even if you have healing to do. Why do we let the system get away with it?”
“My story is going to be a little confusing,” Sarah warned me. I smiled, unfazed. None of the abortion stories I’d heard had been straightforward or simple. But she was right. I hadn’t yet heard a story quite as complex as hers.
Sarah had been traveling with her spouse, a professional musician, on tour throughout Europe and Canada. With the constant upheaval and numerous changes in time zones, she didn’t think too much when her period was late. After returning home to the United States, they moved to their new home in Brooklyn, where Sarah started a new job. She also finally got her period, but the bleeding continued for more than a week, much longer than a typical period. On the eighth day of bleeding, while at work teaching a class, she felt something shift in her body. She rushed to the bathroom, where she had what she guessed was a miscarriage, and then returned to her classroom, trying to compartmentalize what just happened. That evening, she took a pregnancy test. It was positive.
Sarah didn’t have an opportunity to seek medical care immediately. She had plans to go out of town early the next morning for a wedding. “That’s what we do as clergy,” she said. “We participate in these life cycle events and put ourselves last.” The day she flew home, she was still bleeding, and she went straight to urgent care, wearing the same dress she’d worn to the ceremony. A blood test confirmed that she did have high levels of pregnancy hormones in her system, but the ultrasound did not detect a pregnancy. Based on the test results and her symptoms, the doctors determined that most likely she was having a miscarriage and that the bleeding would continue for some time, but it would stop eventually.
Sarah continued to bleed for weeks, and she suspected something else was going on medically. Not knowing her way around her new neighborhood in Brooklyn, she went to the hospital closest to her apartment. She was on Medicaid at the time, and the facility wasn’t well resourced. Many of the patients getting treatment there had no insurance. Getting test results took longer than Sarah expected. Based on her symptoms, the doctors guessed that she might have an ectopic pregnancy, a potentially life-threatening condition in which a fertilized egg implants and grows somewhere other than in the uterus, typically inside the fallopian tube, where the embryo gets “stuck” on its way to the uterus. Ectopic pregnancies occur in about one in fifty pregnancies, and they are the main cause of first-trimester maternal deaths.3 One of the major difficulties in treating ectopic pregnancies is that there is no way to detect that one has occurred without surgical intervention.
Before resorting to surgery, the doctors suggested a less invasive treatment first. They would inject Sarah with a low dose of chemotherapy called Methotrexate, which slows down the growth of cells and is often effective in treating most early ectopic pregnancies. “I had this fleeting thought of ‘Is this an abortion?’” she said. “I would be terminating the pregnancy, which is illegal in some states. I wasn’t sure if this was in alignment with Jewish law and if I should consult with someone.” In the moment, though, she told herself, This is just an injection, and she was desperate for her bleeding to stop. She agreed to the treatment.
Her bleeding still didn’t stop. Sarah began experiencing other symptoms that were endangering her health. She decided to seek a second opinion and scheduled an appointment with a gynecologist, who discovered that Sarah had a large cyst on her ovary that needed to be removed immediately. The doctor referred her to another hospital, one better resourced than the first she’d visited, for emergency surgery that same day. Five weeks after her bleeding began, Sarah finally got the medical care she needed to end the ectopic pregnancy that had implanted in her fallopian tube. During her operation, the surgeon also removed an ovarian cyst that was five centimeters in diameter and was near the point of rupture. In the end, they had to make six incisions in Sarah’s abdomen in order to remove the cyst, the damaged fallopian tube, and part of one ovary. She had been pregnant for twelve weeks. “A fertilized egg is tiny, and a uterus is made to accommodate the growth of the embryo,” she explained. “The fallopian tube is not. And it’s not built to be split open and stitched up again.”
Though her surgeon had talked through the possibilities of what they might find, when Sarah woke up from the procedure, she didn’t know exactly what they had found. All she knew was that she was in agonizing pain from the incisions and the intubation. But she also felt an overwhelming sense of gratitude and awe for the people who had provided her medical care. She was grateful that her care was covered by her Medicaid insurance. “Otherwise, I would have gone bankrupt,” she said.
She later shared with me that this entire experience illustrated to her how classism and systemic racism impact access to health care, given the stark differences between her two hospital visits: “Going to that first hospital really opened my eyes as to how low the level of care is for people who are uninsured or underinsured. It’s not just luck that I had Medicaid and could go to a better hospital.”
Right after the surgery, Sarah had wanted to go to the mikve, a ritual bath that many Jewish women visit monthly after menstruation as well as after reproductive experiences like birth, miscarriage, and abortion. Mentally and physically, however, she was not ready. After some time when she sensed she was close to having her first postsurgery period, Sarah forced herself to go. “I wanted this visit to the mikve to be different from the regular monthly purification ritual,” she told me. When she got there, Sarah needed to share about her ectopic pregnancy and abortion with the mikve attendant, who responded compassionately and offered Sarah many blessings. Once Sarah entered the waters of the mikve, she described it as feeling like she was going through the abortion experience all over again. “I cried. I lost it. I kept asking ‘why’ questions. Why me? Why this? Why is this a necessary part of life?” she asked. “Questioning is a stage of grief, and I had questions with no answers.”
After her visit to the mikve came the ritual of Yizkor, which involves lighting a candle that burns for twenty-four hours and calling to memory those who have passed. Yizkor is practiced four times throughout the religious calendar and then again on the anniversary of a loved one’s death. After Sarah’s abortion, the first Yizkor coincided with the week of what would have been her due date (since an ectopic pregnancy is not viable, there is no due date associated with it). “I was not ready for that. I don’t think you’re ever ready for these ritual moments in Judaism. They don’t have flexibility. It meant that I had to do some work to get myself there,” she remembered. In her role as clergy, Sarah was in charge of leading her community through these ritual services and memorial prayers even in the midst of coping with her own grief. When I commented on how hard that must have been, she responded, “It’s a gift to be able to create space and support people in their healing.”
When the first anniversary of Sarah’s abortion came, she expected the day to bring back intense feelings of grief, but to her surprise, it didn’t. “I already felt like I had made my abortion a part of myself. I didn’t feel the trauma anymore. It amazed me that a year after the abortion, I already felt I had done the healing work I needed to start speaking and advocating,” she shared. Prior to her ectopic pregnancy, Sarah was engaged in advocacy work for reproductive freedom, in part because of experiences that took place in her extended family, but now she had her own story to tell of why access to abortion is essential health care.
Sarah told me, “I never thought I was pregnant. I just felt like I had lost a pregnancy.” She never got to decide if she would continue the pregnancy or not. When I asked her if she considered what happened to her an abortion, she was adamant that it was. Her major cause of concern now is the real possibility that she may need to access the same kind of abortion care again in the future. The biggest risk factor for having an ectopic pregnancy is already having had one.
You might be wondering why Sarah would have this fear of not getting the care she needs. Her life and health were clearly at risk. Wouldn’t any physician perform the necessary abortion procedure she would need to preserve her life? Unfortunately, that is not the case everywhere. In some rural areas, the only available hospital is associated with the Catholic Church. All of these facilities are subject to the Ethical and Religious Directives for Catholic Health Care Services, under which an ectopic pregnancy cannot be treated through “direct abortion.” This means that treatments like the ones Sarah received—the injection and the surgery—would be unavailable to patients there. Religiously affiliated hospitals and providers are permitted legally to deny medical care under religious refusal clauses. Proponents of these exemptions argue that they are protected under the right to religious liberty in the Constitution. Legal arguments based on “religious freedom” have been successful in upholding these refusals. In multiple instances in recent years, the Supreme Court has sided in favor of restrictions to reproductive care and denial of services to LGBTQ+ individuals under this premise. But for people like Sarah, access to abortion is essential to their religious freedom. Under Jewish law, abortion is not just permissible but actually mandated in some instances. In Sarah’s case, even under the narrowest interpretation of Jewish law, her religion demanded that she end the pregnancy to preserve her own life.
Religiously affiliated medical facilities are not the only barrier to necessary reproductive health care, including abortion. There are also ill-informed politicians like Ohio Republican state lawmaker Rep. John Becker, who spread dangerous misinformation about reproductive health and pregnancy. In December 2009, Becker consulted a lobbyist for the Right to Life Action Coalition of Ohio to craft a bill that would prevent insurance companies from covering abortion procedures, except for ectopic pregnancies that could be “reimplanted” into the uterus. Astoundingly, Rep. Becker admitted he never did any research to confirm if this was a medically sound procedure. If he had, he would have found nothing to back his claim because it is absolutely not medically sound. He said, “I heard about [the procedure] over the years. I never questioned it or gave it a lot of thought.”4 These dangerous political stunts mechanized by antiabortion politicians like Rep. Becker are exactly why Sarah knows she cannot move to a state like Ohio. Sarah pointed out not only that he spread dangerous misinformation but also that he demonstrated a complete lack of compassion and sensitivity to the people who, like her, have experienced ectopic pregnancies and would have done anything to make such a procedure possible.
Sarah told me that she wants to be a parent. She would have been overjoyed if that pregnancy had been viable. Despite her surgery, she is still hopeful that one day she will have a healthy pregnancy, but she is also mindful of the reality that she might need another abortion in the future to save her life again. She told me, “I wouldn’t wait until my life was in danger to protect my health. I am putting myself first. I’m only going to live in a place where I can get the care that I need, which restricts the kinds of communities I am able to serve. But communities in other places need advocates and clergy who are compassionate too.”
Sarah is right. Every community needs people of faith advocating for abortion care as essential health care and lifting up the fact that unhindered access to comprehensive reproductive health care both upholds human rights and protects our constitutional right to religious freedom. As I reflected on my conversation with Sarah, I thought about another woman I spoke with who lives in Mississippi, a state notoriously hostile toward reproductive freedom. Her story brings us face-to-face with the struggle of accessing abortion care in a place where reproductive rights are on the chopping block every legislative session.
Names have been changed to protect the family’s privacy.
“I don’t have any regrets about my abortion. I never feel like a member of our family is missing. It would have been nice to have a third child, but I don’t have any guilt or lingering sadness that we didn’t have the one that came to us that third time.”
In 2011, the citizens of Mississippi prepared to vote on a state constitutional amendment touted by antiabortion activists that defined “personhood” as beginning at the moment of fertilization when sperm and egg connect. If adopted, the amendment would have outlawed abortion outright, but it also had the potential to impact much more than that. Access to certain forms of contraception and infertility treatments like in vitro fertilization would have been threatened too. “It was so extreme and ridiculous,” Alexandra told me. She hadn’t been political in the past, but this proposed constitutional amendment pushed her to take action. She knew she had to do her part to stop it from becoming state law. She got connected with reproductive freedom activists on the ground and joined an online community of parents working against the amendment, which ultimately failed. What Alexandra didn’t realize was that her advocacy work at the time would prepare her for an expected reproductive decision she would need to make just a few years later.
In 2007, four years before the Mississippi personhood amendment was proposed, Alexandra was in the middle of a long, grueling labor with her first child. She described the experience to me as a dark night of the soul, a time of not only physical exhaustion but also spiritual crisis. “I felt like I was in hell, and I was never going to get out of it,” she told me. “I was not spiritually equipped to descend into that underworld.” At 3:00 a.m., Alexandra mustered up her remaining strength to give one last push that brought her baby boy Henry into the world. Exhausted and depleted from labor, she fell into a much-needed deep sleep as the nursing staff tended to her newborn son. Four hours later, they woke her up abruptly. Something was wrong with Henry, they told her. There was possibly a complication with his heart, and he would need to be airlifted to the closest hospital with a NICU immediately. Alexandra and her husband, Bryan, would have to follow in an ambulance. The drive was over a hundred miles.
Doctors in the NICU diagnosed Henry with neonatal alloimmune thrombocytopenia (NAIT), a rare blood-related disorder that causes a fetus or newborn to have a low platelet count. It is a condition only detected after birth, and it’s potentially fatal, as she would later learn. While a medical team monitored her baby carefully in the NICU, Alexandra recovered from the birth a few floors away in the maternity ward. Thankfully, Henry responded well to treatment, and four days after his birth, he was released from the hospital. After a frightening and traumatic beginning to their parenting journey, Alexandra and Bryan were grateful that their baby boy was well enough to bring him home.
Alexandra shared just how much she and Bryan fell in love with their baby and how taking care of him together deepened their love for each other. They knew they wanted to grow their family in the future, but they worried about the potential risks. When would they be ready emotionally for what might happen with another pregnancy and birth? What health complications might arise the second time around, and how would they handle them? When she brought her concerns to her doctors, she told me that they did not discourage her from a future pregnancy. They reassured her that they would be prepared to handle any potential health complications and intervene early if necessary. She would likely need to deliver by cesarean section, they told her, but there was no reason for Alexandra to believe that a healthy pregnancy and delivery was out of reach.
Six years after Henry’s birth, Alexandra and Bryan were expecting their second child. They’d moved to a new town, and Alexandra found a new ob/gyn. She shared with me that when she was looking for a new provider, she chose her doctor in part because he had been a vocal opponent to the proposed “personhood” amendment. After learning of Henry’s NAIT, her physician said that he wanted to take every necessary precaution to avoid these same complications. About midway through her pregnancy, Alexandra took a blood test that confirmed her fetus was at risk of the same blood disorder that Henry had at birth.
Her doctor was taking no chances and prescribed her a weekly regimen of intravenous immunoglobulin, which is made up of antibodies collected from thousands of blood donors. Alexandra told me that it’s referred to as “liquid gold” because of its high cost; a single treatment can run a patient thousands of dollars. Since it also requires several hours to be administered, many patients have to spend the night at the hospital, an additional cost. Alexandra was fortunate to have health insurance and financial resources to receive this treatment weekly, but even so, it was a hardship for her family. For months she had to spend one night every week at the hospital, which was hard on her family and especially disruptive to her young son. “I didn’t realize I was signing up for this,” she said. “We were on a roller coaster, and we just had to keep riding it.”
The plan had been for Alexandra to make it to thirty-eight weeks before having a scheduled C-section, but in her third trimester, she developed preeclampsia, a potentially dangerous and even fatal condition that can cause significant damage to the liver and kidneys of a pregnant person. She shared that as part of her treatment for the NAIT her fetus might have, she had to take steroids, which likely contributed to her preeclampsia. She was also grieving the death of her best friend, who had passed away suddenly. At thirty-six weeks, Alexandra delivered her second son, Charlie, by C-section, thankfully without additional complications. The hospital staff were vigilant in checking the newborn for any sign of NAIT, but the intense treatments during Alexandra’s pregnancy worked as expected. Charlie was perfectly healthy.
Caring for a new baby and raising a child with special needs (Henry had been diagnosed with autism spectrum disorder) were rewarding but exhausting. Alexandra said that it was challenging to make time for anything else, including doctor’s appointments for herself. Any parent would be overwhelmed with caring for two young children, but Alexandra has the additional challenge of living with attention deficit hyperactivity disorder (ADHD), which increases feelings of worry and overwhelm and makes accomplishing tasks difficult. While she knew that she needed to be on some kind of contraceptive, she did not have the mental bandwidth to take care of it. Bryan and Alexandra used condoms, a contraceptive method that is typically about 85 percent effective.5 In 2016, three years after Charlie’s birth, Alexandra discovered she was pregnant for a third time.
In most areas of her life, Alexandra is indecisive. “Unless I have a strong preference, I don’t have a preference,” she explained. But when the pregnancy test was positive, she had an immediate, absolute knowledge that she could not continue this pregnancy. She had just weaned Charlie, and she could not imagine going through the ordeal all over again, spending all of those nights at the hospital receiving treatments and possibly ending up with preeclampsia a second time. Her boys needed her. Her husband needed her. She needed to take care of herself, and she knew she needed an abortion. “I couldn’t believe those words were coming into my mind,” she recalled. Even though she had advocated for the pro-choice cause, she never imagined being in a position of needing an abortion herself. But she was firm in her decision. She told her husband that she was pregnant and that she couldn’t have this baby.
Alexandra turned to the network of advocates she had gotten to know in 2011 when she advocated against the personhood amendment. Offers of support poured in. “I knew if I had any problems, I had people I could ask for help,” she told me. She had joined a mothers’ group on Facebook and read a post from a Unitarian Universalist minister about abortion and miscarriage. The minister shared an insight that Alexandra found helpful: “You’re allowed to tell this spirit or soul, ‘I’m sorry. You can’t come right now. This is not the right time.’” That gave her an even greater sense of peace about her decision to end the pregnancy.
On the day of the first appointment (Mississippi requires two: one for in-person abortion counseling and then another, at least twenty-four hours later, for the procedure), Bryan stayed home with their two boys while a friend accompanied Alexandra to what is now the state’s only abortion clinic, Jackson Women’s Health Organization. Known to many as the “Pink House” for its bright pink exterior, the clinic is a constant target for antiabortion protesters. Because Alexandra had been to the building before as an advocate defending their work, she was prepared to face whoever might try to stand in her way of receiving abortion care. “I had a sense of how I had to shield myself energetically so that none of the shame [the protesters] wanted to put in me got in,” she said.
Alexandra sat with the other patients that day as they went through a state-mandated class about abortion. When she went in to get her ultrasound, Alexandra was so early in her pregnancy that it was undetectable, and she had to return a full week later. Though delaying her second appointment was unexpected and, in her case, a minor inconvenience, Alexandra credits the clinic for their caution: “They weren’t going to give me medication I didn’t need. They’re not just here to make money.” After a somewhat difficult week of waiting, Alexandra returned to the clinic—this time on her own—and after detecting her pregnancy through the ultrasound, she got the prescription she needed for her medication abortion, which she needed to fill at a local pharmacy. She briefly wondered if she ought to travel to a nearby town where no one would recognize her. The prescription cost $400, an expense their family could cover, which she recognizes as a rare privilege. She went home, read the instructions several times, and took the medication.
The process of the abortion itself was not difficult for Alexandra physically or emotionally. She’d already been through childbirth twice. She said, “Having years and years to develop my sense of my own bodily autonomy is what informed me to make that decision to end the pregnancy that much more easily.” But what did prove difficult was the realization that she could not share what she had gone through freely with her loved ones. Her parents, who are conservative Christians, still do not know about the abortion to this day because Alexandra knows they would not be able to handle it. She said, “I’m an open person, and it takes a lot of work for me not to be. I’m not used to having to shield things.” Having to hold this secret carries its own kind of pain and grief.
It’s not only her parents that Alexandra is worried about. She wonders what her obstetrician would think if he knew about her abortion. Even though her doctor spoke out against the personhood amendment, she is still not sure how he would react to finding out she’d had an abortion herself. “When you’re in a place like Mississippi, when you’re not in a safe environment, you never really know how someone is going to respond,” she shared. Sometimes she wonders what would have happened if she had complications with her medication abortion. What kind of care would she have gotten at the local hospital when she disclosed her abortion? Afterward, when Bryan scheduled an appointment to have a vasectomy, his doctor actually tried to talk him out of going through with it. He thought to himself, This guy doesn’t know what we’ve just been through.
Having an abortion only solidified Alexandra’s commitment to the work of justice: “I said to Spirit, I am ready to do this work. What can I do? Use me as you see fit.” Today she continues to advocate for reproductive freedom and human rights in Mississippi. Once at a march organized by Black Lives Matter, some white antiabortion protesters were being disruptive during a moment of silence meant to honor the Black victims of police violence. People in the crowd were becoming visibly upset in response to their shouting. Then Alexandra noticed that the cord connected to their speaker was within arm’s reach. Wordlessly, she pulled the plug. She said, “It was one of those moments when you know God or Spirit puts you there to use you.”
Because of their access to abortion care when they needed it, both Sarah and Alexandra have been able to grow and move forward, incorporating their abortion experiences into the ways that they move throughout the world. Sarah continues to serve as a congregational leader, and she is hoping to share her abortion experience through poetry and song that she will write one day. Alexandra has embraced her role as an advocate in her community and continues to explore the ways that she can support movements for justice. For each of them, the decision to have an abortion was an act of self-compassion and an affirmation that their lives were sacred and worth saving in every sense of the word. This is what abundant life looks like.
We ought not expect anyone to justify or apologize for the preservation of their well-being when we know that a life of abundance is the desire and intention of the most Holy for each of us. Access to abortion is essential for our collective flourishing. Even when these decisions are painful and hard, they are ultimately life-giving.