Provision: an interview with Dr Kamala Emanuel
Dr Kamala Emanuel, an experienced women’s health practitioner who has been providing abortions since the late 1990s, began her interaction with abortion clinics on the other side of the fence, as a protestor.
‘My first ever political activity was standing outside the abortion clinic in Tweed Heads with a bunch of other people with signs,’ Dr Emanuel admits. ‘I was there with my mum, and we wanted to save babies.’
Dr Emanuel’s voice rises here, her pitch indicating how silly she now feels about this idea of anti-abortion protestors trying to save the innocent souls of unborn children – this is clearly no longer her position today.
‘We actually didn’t like the way other people were harassing the women going in, and we both decided never to do that again.’
This conservative start is quite an anomaly in Dr Emanuel’s career since. Today, she is a well-known voice in socialist politics, having run for the Socialist Alliance for the seat of McConnell in the 2017 Queensland election. Her platform was based on legalising abortion and making it freely available in the public health system, as well as addressing climate change.
So what makes someone go from physically protesting abortions to training to provide them herself?
‘In the middle of my medical degree, I had conversations with people about things like women’s liberation and poverty, and the environment and so forth. And I shifted quite a lot, and came to embrace the idea that we actually need, women actually need, to achieve our rights. We’ve still got a long way to go,’ Dr Emanuel says.
When she speaks, her passion for this issue is very evident, and I can almost imagine her political awakening, not dissimilar to my own (although I was a teenager when feminism first revolutionised my way of thinking). I know it must have been a difficult transition to unpick her long-held beliefs, and consider the world through this different lens – a lens that takes the onus off the individual and instead looks at our societal structures and systems that rely on inequality to serve the mainstream and oppress the marginalised.
‘A lot of things changed for me in a relatively short period. My whole identity had been constructed around my Christian beliefs. I saw myself as a Christian before anything else – gender, class, race, nationality, age or whatever,’ Dr Emanuel says. ‘When, from a scientific point of view, I could no longer believe in the tenets of the evangelical Christianity to which I had adhered (primarily the literal resurrection of Jesus and the existence of God), I had to be honest with myself and give it up. But I didn’t want to. I remember a period in which I felt as if I’d been torn into a million pieces and was waiting for the dust of myself to settle, to find out what remained of who I am.’
This change, of course, affected Dr Emanuel’s views on a wide range of issues, abortion rights being one of the last that she contended with. Although it was one of the more challenging issues to grapple with, reproductive rights were ultimately what she decided to dedicate her life to.
‘I’d reached a point where I believed I could respect whatever reproductive choice a woman was making, and wanted to be part of providing technically excellent, compassionate and dignified care.’
Perhaps one of the most frustrating things for women’s health practitioners to reckon with is the political pressure put upon a service that they feel should not be political – a woman’s right to control her body.
Part of what motivates Dr Emanuel is the anger she feels at the way the medical institution controls women’s bodies, and how that power imbalance is reified by the structures of the industry.
‘I actually really think there is a need for us, from whatever position we occupy, to try to dismantle the unequal power between doctors and patients and between women and men,’ Dr Emanuel says. ‘And that’s what made me decide, yep, I’m going to provide abortions, that’s what I’m going to do. And I haven’t always been in situations where I’ve been able to provide abortions, but that has always been work that I have sought.’
This is a bold step for a woman who is already pushing boundaries just by practising medicine, which is still a male-dominated field. In some ways, the prestige associated with being a doctor is negated by choosing to work exclusively on women’s health.
Why does this dissonance exist, between the noble field of medicine, and the provision of abortions, or contraceptive services for women? Why is there still such societal distaste for women’s rights to control their wombs and what occupies them?
Growing up in Australia, I can reflect on the education I was provided on my reproductive capabilities, and notice how the uterus, ovaries and vagina were all discussed and referred to as being somehow separate from the woman.
Periods are something we ‘get’, or ‘have’, not something we ‘do’. There is a squeamishness towards this essential part of a woman’s reproductive cycle that means that as young women, we are taught to fear our period becoming public knowledge, through a leak onto our clothes or from the discovery of pads and tampons in our school bags.
I still remember catching a bus with boys from a local private school, who would raid our bags for sanitary items, and then scribble on them with red textas and throw them out the bus windows at passing cars. Those boys couldn’t think of anything more gross than a pad or tampon – they would squeal as they unwrapped the items from their liners, and toss them from person to person, revelling in the pseudo intimacy of touching something that was intended to then touch female genitals.
I learned to fear my body from my first sexual education class. I feared that this onset of reproductive power, the moment my body would betray me by bleeding, would limit me through this act – no swimming for a week, no praying in my Muslim household, no speaking about it in front of my male relatives.
This fear was extended as I grew older. For years, I was told to fear ever becoming pregnant. Pregnancy would steer me off the correct path for an unwed young woman, I was told by every piece of culture I consumed. It was a message repeated at me from the books I read, where young, unmarried women were shunned and turned out of their homes for being pregnant. It was a message reinforced by news stories about teenage mothers, depicted as wayward and unable to care for a child, continue their education or contribute to society.
But just as pregnancy was feared and maligned in young women, outside the bounds of a societally approved marriage, our solution to crisis pregnancies was equally maligned. The only thing worse than a teenage mother was a teenager who had an abortion.
Despite the fact that our inability to terminate unwanted pregnancies has been the historical cause of so much suffering – women forced to give birth and have their children taken for adoption immediately, young mothers’ homes in the UK hiding pregnant girls in shame, attempts at self-terminating pregnancies resulting in death – now that we have medically safe methods of abortion, the stigma still continues.
Dr Emanuel can remember her early days practising as a GP and seeking education on how to provide abortions. It was a hard road, and one mostly travelled alone, despite the historical gains that had so recently been made.
‘By the time I was starting out, the trail had already been blazed as far as regards working as a GP with a focus on women’s health. In Newcastle, there was the Hunter Working Women’s Centre, and in inner western Sydney, the Leichhardt Women’s Health Centre. Leichhardt had, I believe, been set up in the early days of the women’s health movement that grew out of the feminist radicalisation of the 1970s. It may have been the first of its kind in Australia – certainly one of the first,’ Dr Emanuel says. ‘So, one element of starting out was an awareness of taking part in a movement to empower women as patients, to approach healthcare as a partner. I felt a strong connection with the ethos of dismantling some of the unequal power that exists in our whole society, from a little space in the institution of medicine, with its patriarchal history. That was extremely satisfying.’
But even with this strong foundation, there were very few paths available when it came to gaining the technical skills required to provide abortions and after-care.
‘As a medical student, intern and resident, there was no opportunity to learn in the university or public hospital system of Newcastle where I trained and first worked and lived,’ Dr Emanuel says. ‘So, early on, when it came to pursuing work focused on abortion provision, I felt somewhat isolated. I’m not sure whether that was a typical experience. I had strong women peers who it was great to have connections with. But although there were pathways to working in women’s health that involved GP training, sexual health medicine and/or obstetrics/gynaecology training, without a clear path directly into abortion care, it felt like I was on my own in the path to get the skills for the work I wanted to do.’
This was further exacerbated by the fact that many GP practices created additional barriers for the provision of abortions, even when it was legal in the state.
‘Some GPs are told by the owners of the practice where they work – whether as trainees, or as independent practitioners – that they are not allowed to provide medical abortions. It may be an attempt by anti-abortion practice owners to enforce their views. It may be a concern that if the practice gets known as being a place where abortion is offered, there will be some kind of retribution organised by people who oppose abortion.’
There is a religious undertone to the anti-abortion movement, of course. There is a focus on the innocence of a child, and the erroneous assumption that a foetus within the early stages of pregnancy is the equivalent of a living, breathing child. There is also the continuation of the devaluing of women’s lives, a trope that has been present in both Judeo-Christian religions and in secular western society for centuries.
A woman seeking an abortion is not worthy of the life she is seeking to protect – her own. Instead, from the moment of conception, the life inside her is more important than hers – it is pure despite her sins.
Ironically, a woman’s life is only truly valuable when she is still inside the womb – once in the world, her body is again a vessel for society’s opinions, not her own choices.
This attitude is deeply ingrained in the medical institution, according to Dr Emanuel, so much so that even if a woman requires an abortion due to a spontaneous miscarriage, she may be refused in some Australian states.
‘The textbook treatment of someone who’s having a spontaneous miscarriage, if they’re still bleeding and it’s not complete, is to offer them either wait and see and let your body do it, or surgery, or medication to help the uterus sufficiently empty more quickly. And they’re all reasonable things to choose, but the textbook approach is the pregnant person gets to decide,’ Dr Emanuel explains.
But until recently, abortion was illegal in Queensland, where she practises, and the attitude towards women’s health was mired in anti-abortion rhetoric.
‘It’s “oh well, we don’t do that here. Unless you’re bleeding too much, just take the pain relief and go away”.’
Present in this thinking is the ongoing stigmatisation of women’s bodies, and the reinforcing of pain and fear as the natural outcomes of our reproductive systems. Just as we’re made to fear falling pregnant when society deems us unsuitable for raising children, we’re made to fear our inability to conceive when we are finally allowed to actively attempt pregnancy.
A miscarriage is a feared outcome, and infertility signifies a failure as a woman. There is no way to keep our wombs separate from public opinion, and no way to take control of our sexuality and reproductive rights without judgement.
This lack of autonomy extends even to the use of contraception. Dr Emanuel remembers some of her early patients, all of whom came from different walks of life and who had found their way to her clinic through different pathways but who were ultimately seeking some control in a situation of crisis.
One patient that particularly sticks in her mind is a woman in her early middle-age, who had made the choice not to use contraception, knowing that abortion was an option should she have an unwanted pregnancy. This woman had made an informed decision – she knew she infrequently had penetrative sex with men, and that the possible side effects of the contraceptive choices that were available outweighed her risk of pregnancy. Yet, despite having considered this deeply and made a choice for her own body, to seek an abortion having deliberately chosen not to take contraceptive measures is largely seen as grossly irresponsible by our society.
For Dr Emanuel, this case is particularly important because it reinforces the need for us to review the way we talk about contraception, especially in relation to abortion.
‘Most people would prefer to avoid crisis pregnancy, and termination of pregnancy does have real (though few) risks and costs. But contraception is not without risks and costs – whether these are the risks of pregnancy or the risks of heart attack, blood clot, stroke, depression, suicide, menstrual pain or acne. And it seems to me that we need to be better at recognising that contraception is voluntary – and of course do everything to offer good care, information and access to ensure that people can find and use what’s best for them.’
The overwhelming problem at the crux of how we address reproductive rights is the constant moralising of women’s decisions. Contraception is good, but abstinence is better, and abortion is always wrong – the result of irresponsibility on the woman’s part, with no mention of the man who inevitably contributed to the pregnancy.
It is this moralising that means that abortion providers play multiple roles.
‘I feel as though my role in relation to abortion has several facets. There’s the obvious one – the direct care of patients that I’ve spoken of. Then there’s my activist role, as a feminist, something I’d do regardless of whether or not I was a doctor or abortion provider, a political campaigner as a woman and feminist, believing excellent care is our right,’ Dr Emanuel says. ‘And then as a doctor, I have a role teaching other doctors, in the hope of provoking a self-critical approach to judgementalism and bias, and looking for ways to be at least professional and better yet, compassionate, when it comes to working with women and pregnant people facing a crisis pregnancy.
‘I would extend this to contraception too, and the recognition that there is no one-size-fits-all when it comes to contraception, and what matters is not what we do in our personal lives, what contraceptive decisions we make or think we might make in someone else’s position – it’s their values, experiences and framework that we should be supporting with information to facilitate decision-making that’s best for them.
‘And finally, there’s a role as an abortion and contraception provider, in contributing to the public debates about abortion and contraception, from a technically accurate and well-informed perspective.’
These positions are not lightly held, and require a commitment that goes beyond medical training, and instead speaks to the overarching issue of gender equality, women’s bodily autonomy, and the role that medicine can play in empowering patients. Dr Emanuel is one woman, making a big impact in abortion provision – in the decades that she has been practising, some legal reform has already taken place. Now, the battle is one of cultural norms and expectations. In this, she is not fighting alone.