The horrific shootings at a Colorado Springs Planned Parenthood demonstrate the power of words when it comes to the abortion debate. If you keep hammering home that unspeakably barbaric acts are being performed at Planned Parenthoods across the country and that the government refuses to stop them, don’t be surprised when a deeply troubled person decides to take matters into his own hands.
But even beyond potentially inspiring acts of violence against abortion providers, the right has been winning the war of abortion rhetoric for a long time, ever since the initial coup of labeling opposition to abortion “pro-life.” And now phrases such as “selling baby parts” or “harvesting of brains,” no matter how demonstrably false, are interminably affixed to Planned Parenthood.
But there’s a new movement afoot to reclaim how we talk and think about abortion from a pro-choice perspective. As Rebecca Traister recently noted in New York Magazine,
“After decades of treating abortion as a third rail to be gingerly sidestepped, with downcast eyes and sighing exhortations about tragic rarity, at least some on the long-ambivalent left have decided that fight for better access to abortion is an issue on which they can actually win.”
Part of that struggle is doing away with language that stigmatizes abortion and allows its continued marginalization as a health care services. And no phrase better captures the power of words to define and limit abortion than the labeling of all but so-called necessary abortions as “elective.” It’s a distinction that’s being used with stunning success across the country as opponents of abortion, emboldened by success in limiting abortion coverage under the Affordable Care Act, move to end insurance coverage of “elective” abortions.
State after state has banned insurers from covering most “elective” abortions—which can be broadly defined as abortions outside of the Hyde Amendment parameters of rape, incest or the life of the woman. Half of all states now prevent health plans participating in insurance exchanges from covering most abortions; Louisiana and Tennessee don’t allow exchange plans to cover abortions for any reason. And eight states ban all private health plans from covering abortion unless a woman would die. This means that a woman who wants to terminate a pregnancy for any number of reasons—a severe fetal deformity, a risk to her health, or the desire not to have a child—will have to pay for it out of pocket or forgo the abortion. It also means that millions of newly insured young and low-income women are denied abortion coverage.
At the heart of these limits lies a distinction between indicated, or necessary, abortion and “elective” abortion that dates back to the first half of the twentieth century, when there were only two kinds of abortion: illegal or therapeutic. Therapeutic abortions were those performed legally by a physician to save a woman’s life if she had a health condition, such as heart disease or tuberculosis, which was considered incompatible with pregnancy. Doctors sometimes stretched the indications to provide an abortion for a woman they felt “deserved” it, such as a sickly poor woman who already had a large family or a woman who had been raped, but they made that judgment based on a patriarchal code that presumed that women were primarily mothers, that they should have at least three or four children, and that abortion for “social” reasons was immoral.
In the early 1960s, a German measles epidemic and the introduction of thalidomide, both of which caused severe fetal deformities, spurred an increase in therapeutic abortions. At the same time it was becoming more common for doctors to provide abortions for single women under the justification that their mental health was threatened by having a child out of wedlock. Looking to legitimize therapeutic abortions that were already being done while reigning in any movement toward abortion “on demand,” an influential law institute recommended that in addition to life endangerment, abortion be legalized for serious threats to a woman’s physical or mental health, in cases of severely deformed fetuses, and for rape and incest, setting the parameters for justifiable abortion.
A dozen or so states broadened the indications for legal abortion along these lines before Roe v. Wade made it a moot point in 1973. But the frame that abortion was only justified in cases of an extraordinary threat to women stuck around, partially because the medical community, afraid of political blow-back, failed to take a leadership role in the abortion debate. The American Medical Association and the American College of Obstetricians and Gynecologists didn’t begrudgingly approve of abortions for “social” reasons until 1970. And while both organizations dropped the term “therapeutic” abortion, as Nancy Aries noted in the American Journal of Public Health, “the concept of medical indication remained” and “most insurance companies only reimbursed for abortions that were performed for medical indications.”
Never eager to pay for procedures that they didn’t have to, health insurers were happy to shuttle all but medically justified abortions into the “elective” bucket along with things like plastic surgery. A survey of insurers done before passage of the ACA by Guttmacher found that 87 percent covered “medically necessary or appropriate abortions,” but the Kaiser Family Foundation found that only 30 to 50 percent covered elective abortions.
The distinction between necessary and “elective” abortion, however, is more rhetorical than medical, argue Elizabeth Janiak, a doctoral candidate at the Harvard School of Public Health, and Dr. Alisa Goldberg of Harvard Medical School in the journal Contraception. They say it’s impossible to distinguish between elective and indicated abortion “either in a medical or a social sense” and that the phrase “elective abortion” should be “eliminated from scientific and medical discourse.”
According to Janiak and Goldberg, elective abortion is “variably defined, misrepresents the complexity and multiplicity of indications for abortion, and perpetuates stigma.” They note the phrase has no clear medical meaning but “imparts moral judgment.” They say that for many patients, obtaining an abortion is essential to their wellbeing for a variety of reasons and that “women who chose abortion for social and emotional reasons often state that they have no choice at all.” The distinction between different types of abortion is not only “impossible to operationalize” but implies a broad consensus where none exists:
Is termination of a pregnancy with trisomy 21 ‘elective’ or ‘indicated’? … Is an abortion in a 13-year-old who wants to finish middle school ‘elective’ or ‘indicated’? … A woman living in poverty who prioritized buying her daughter’s asthma medication over her contraceptive pills? How much risk of harm must a woman face if she does not obtain the abortion in order for that abortion to be classified as ‘indicated’?
“The phrase is misleading because it falsely categorizes some abortion as necessary and some as unnecessary,” Janiak told Salon. “It’s a very slippery term whose definition changes over time and context.”
But it’s a term that’s taken on a definite political meaning as frivolous or immoral abortion. In arguing for additional limits on abortion under the ACA, Rep. Virginia Foxx (R-NC) asserted earlier this year that “hard-earned taxpayer dollars are now being used to pay for elective abortions.” The Washington Post and other media outlets now routinely use “elective” abortion to mean all non-Hyde abortions. In Rhode Island, some 9,000 ACA enrollees are slated to lose abortion coverage as the result of a rule that requires at least one ACA plan in each state to ban “elective” abortion.
As Janiak and Goldberg note, the “primary rhetorical function of the phrase ‘elective abortion’ is to disparage women who reject pregnancy per se … as compared to women who have elected to terminate a specific pregnancy for a reason other than not wanting to be pregnant.”
“Within the broader cultural discourse, ‘elective abortion’ has taken on the meaning ‘morally unworthy’,” says Janiak. “I really believe that if researchers, doctors and public health professionals stop using the term, it can clarify to the public that there aren’t two types of abortion.”