Unbearable, p.1
Unbearable, page 1
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To my daughters
INTRODUCTION
Four days after the Supreme Court overturned Roe v. Wade, I arrived hot and resentful to a Manhattan hospital for a thirty-three-week ultrasound.
There was no particular reason for the scan, no diagnosed concern, just an impersonal risk calculus driven by the fact that I was over thirty-five. This would be my second child, and admittedly some jadedness had set in. And I was more than a little distracted. For a dozen years, I’d reported on the legal, medical, and personal struggles over reproduction, and on the Supreme Court specifically. So much of my work had been leading up to this explosive decision, which was already throwing people’s lives into chaos.
And yet. Visible on the screen suddenly was a face that had so far eluded us, a shockingly clear delineation: an upturned nose, pouting lips, hanging open at that moment. We gazed at her in quiet, intimate surprise. “She’s looking more like a person now,” I murmured to my husband.
The ultrasound tech had been merry, cracking jokes to leaven the presumption of anxiety. Hearing me, she grew somber. She turned and spoke directly to the fetus enlarged on the screen, which is to say she spoke over me. “You were a person from day one,” she told the image reassuringly.
Her words were instantly familiar to me from my reporting on the fetal personhood movement, which puts the rights of a developing embryo or fetus on par with, or in practice above, the pregnant person, who is rendered a mere incubator. Over the years, I had spent hundreds of hours in conversation with anti-abortion activists, read countless books and briefs, even once ridden around New Mexico with the so-called Truth Truck, the image of a bloody fetus emblazoned on it.
I knew that the ultrasound itself could be a tool for vital healthcare but also a political weapon. Feminist critics had noticed early on how the popular use of ultrasound images suggested the fetus was floating in the ether, wholly apart from a woman’s body. Eventually, anti-abortion activists tried to use this technology’s power to try to talk abortion seekers out of their decisions by passing laws that forced them to look at their ultrasounds. It usually didn’t work, suggesting that the ultrasound simply confirmed whatever the pregnant patient already knew. Now, with the overturning of Roe v. Wade, the movement could claim its biggest legal victory in generations.
Even knowing all this, sitting there with jelly slicked across my abdomen, the amplified thrum of my fetus’s heartbeat filling the room, I was astonished. I could have snapped at this stranger in a white coat, inches away from me, that nobody had asked for her opinion on either of us. That I was a person before and after I became pregnant, and on that day, too. But I held my tongue. I reminded myself the tech had no power to enforce her opinion, just to irritate me. Whatever I’d had to say, I’d just said in print a few weeks earlier, when Justice Samuel Alito’s draft opinion in Dobbs had leaked.
In the fall of 2021, the nation’s highest court had begun considering whether Mississippi could ban abortion at fifteen weeks. To bless the law would mean throwing out about a half-century of precedent establishing a right to privacy. The court went much further than Mississippi had initially dared to demand, allowing all abortion bans without exception. In his draft opinion—leaked in May 2022 and nearly identical to what would be the final ruling a month later—Alito quoted at length the text of the Mississippi law, an emotionally freighted recitation of week-by-week fetal development—heartbeat, hair, fingernails, and so on. The sentence in that leaked document that really set me off quoted from the law: “At twelve weeks the ‘unborn human being’ has ‘taken on the human form in all relevant respects.’ ”
I started writing. My response began with “I, too, have taken on the human form in all relevant respects, although I couldn’t find mention of it in Alito’s draft opinion. At five or six weeks’ gestation of this pregnancy, my second, my heart began to pump an extra 40 or 50 percent blood volume, leaving me dizzy and breathless; at eight weeks, the waves of nausea were near-unbearable, though I wasn’t among those whose illness requires them to be hospitalized for IV fluids; at ten weeks, I, too, had fingernails, but they were breaking thanks to gushing hormones; at 11 weeks, I was still short of breath and gripped by a fatigue that felt like a hand pressing down on my chest. So far, I am having an easy pregnancy, and I chose it.”
Alito and his fellow justices in the majority had their calendar of humanity, but I had one, too—the successive toll of what pregnancy and birth does to you, in excruciating detail. The revelation of my piece—maybe even a revelation to me—was not simply that human reproduction can be scary or unpleasant, though it can certainly be that. I had had the privilege to choose both my pregnancy and its course. I recast Alito and the legislature’s selective account to demand that everyone understand what the bare minimum of the law was forcing pregnant and potentially pregnant people to bear, in all its gruesomeness and gravity. It was a cry against ignorance, an assertion of humanity, and a call for solidarity, regardless of our circumstances or our decisions.
But it was only the beginning of what needed to be said. At the time Dobbs was decided, according to how the census framed it, more than 80 percent of women had given birth at least once by the end of their reproductive years. It’s safe to assume an even greater number have been pregnant, though I could find no data on it. And yet what is clear to me from my years of reporting and my own experiences is how incomplete our story of American reproduction has been, how much has been unexpressed, hidden, or taken for granted, and not just by the Alitos of the world.
* * *
THIS BOOK seeks to tell a fuller story by tracing the lives of five very different women living in an America that, in crucial and devastating ways, refuses to recognize their full personhood.
Their stories make clear how deeply linked different experiences of reproduction are. For much of American history and medicine, artificial categories of good and bad pregnancies—celebrated or stigmatized, wanted or unwanted, medicalized or “natural,” healthy or unhealthy, planned or unplanned—have obscured the true complexities of people’s lives. Good women, it is assumed, embrace pregnancy under approved circumstances and comply with doctors’ orders. They are happy to be delivered of a healthy baby without asking too many questions or making too many demands. If life takes a different course, even if you try to do everything “right,” you will be punished.
These categories have been used to pit people—above all, women—against each other who should share a common cause, which is safety, health, and above all autonomy over our lives.
What’s wrong with pregnancy in America is not simply a matter of right versus left, or even simply male control of female bodies, although that sometimes, maybe often, describes what is happening. Two of the women whose stories are traced in this book live in New York City, one of the bluest places in America. For some, the person inflicting the harm was another woman. Nor is it enough to simply say that what these women needed was “a choice.” As the Black-woman-led reproductive justice movement has powerfully demonstrated, a choice isn’t a choice when it’s made before a bare cupboard. “Choice” makes it sound like you’re on a casual shopping trip through life, as if all options are equally accessible and rewarded for everyone, until, of course, you need any kind of community or government support. And “choice” doesn’t encompass messiness like not being able to be pregnant when you desperately want to be, or a pregnancy you desire but wish came under different circumstances.
To be pregnant anywhere means being handed a script you did not write. It is a biological script, laying out the unstable particulars of what your body is and will become, how a microscopic speck does or doesn’t grow, the form and function it all takes on as it saps your nutrients and reshapes your bones, all the way to how and when it leaves you. Even biology, though, is shaped by ever-changing forces far outside your body. In America, where you live and who you are determines so much of who will care for you, and where, and how. The expectations of your behavior, what you consume and what you are told to avoid, what laws and authorities delineate when your body is yours and when it isn’t. Whether you will lose your freedom or your children for something that wouldn’t be a crime if you weren’t pregnant. Nature alone cannot explain why your pregnancy will be fundamentally shaped by giving birth in one hospital over another, or what race you or even your partner are, whether you have health insurance, or what kind it is, or whether you live on one side of a state line or another.
Being pregnant in America, whether it brings joy, consternation, or some ambivalent jumble, means navigating a system that boasts some of the most advanced medical technology and research in the world, but, that in more and more places, cannot provide basic prenatal care or even a hospital labor and delivery ward—and unlike most of the rest of the world, all but abandons you afterward. In America, the language of choice will be used to punish anyone who makes a mistake or doesn’t have access to perfection. Any notion of choice will be functionally undermined if, like most pregnancies, yours is actively managed according to a one-size-fits-all medical script that treats your needs and d
Being pregnant in America means inheriting a legacy of racist reproductive control in which Black women’s childbearing was alternately monetized or punished, where their bodies were the unwilling foundation of American gynecology and obstetrics, and where disproportionate policing, debilitation, and death persist in pregnancy. It means the fetishization of certain babies and certain women’s reproduction—mainly white women with means. But no matter who you are, or what privileges you enjoy, nothing can guarantee your personal safety or security, especially if you diverge from the script.
All of this was true before Dobbs. But the Supreme Court’s decision banning abortion was both clarifying—for those who hadn’t already known all of this—and accelerating. Clarifying because anyone who thought it wouldn’t affect them or someone like them was quickly proven wrong. Accelerating because without the legal bulwark of reproductive privacy or freedom, there is even less to prevent the surveillance, suspicion, and isolation of anyone who can become pregnant.
The end of Roe v. Wade, allowing about half of American states to enact abortion bans almost overnight, has already brought unimaginable pain. It has also exposed how broken the existing system already is, shaped as it is by the same values that animate abortion bans: The desire to control reproduction using every imaginable tool, from coercion to criminalization. The systemic misogyny, paternalism, and racism. The prioritization of potential life over existing life above all else, driven either by conviction or legal cowardice or both. The crass reality that money can often, if not always, buy you a way out. Being pregnant in America, it is ever clearer, means bearing the consequences of separating one form of reproductive care, abortion, from everything else—whether you need one or not.
Even in the face of all of this, and at the cost of personal pain and sacrifice, there are still brave and committed people who are willing to risk almost everything to make pregnancy in America better. They have helped me see that it doesn’t have to be like this, and to imagine a better reality. You’ll meet some of them in this book.
* * *
MY GRANDMOTHER, a mother of five, used to say a woman was at her strongest when pregnant. By the time I got pregnant for the first time in the fall of 2019, she was no longer on the earth. My job had repeatedly exposed me to everything that could go wrong in a pregnancy. Now I wished so much I could have asked my grandmother what she meant. Even when welcomed and uncomplicated, pregnancy felt like a loss of control, a self-effacement that left you perilously closer to death.
Of course, both could be true. “The woman’s body, with its potential for gestating, bringing forth and nourishing new life, has been through the ages a field of contradictions,” wrote Adrienne Rich in her 1976 classic Of Woman Born. (Not everyone who becomes pregnant identifies as a woman, but rigid ideas about womanhood and pregnancy constrict everyone.) That body, Rich continued, is “a space invested with power, and an acute vulnerability; a numinous figure and the incarnation of evil; a hoard of ambivalences, most of which have worked to disqualify women from the collective act of defining culture.”
Much of what Rich described had been imposed from the outside. It fell to feminists to imagine how to define pregnancy’s meaning from within. Rich’s fellow second-wave feminist Shulamith Firestone categorically declared that pregnancy, which she hoped might be soon replaced by technological reproduction, “is barbaric.” Rich called that view “shallow and unexamined.” But what would come instead?
Years of reporting on abortion in America hadn’t prepared me for what might happen when you actually wanted to be pregnant and had so far avoided catastrophe. By then, I could recite the litany of prohibitions, mainly what to eat and what not to, and the counterarguments to not eating or doing those things. But there were deeper, fundamental questions of how this pregnancy would go, starting with who would care for my body and the one I was gestating. Having made my “choice” and been lucky enough to see it made reality, I found I would still have to keep fighting off incursions from the outside that treated me as less than a person. I wasn’t the only one to be surprised by that.
* * *
A LITTLE over a year after that post-Dobbs ultrasound, I spread a blanket on the patchy grass of a local park and held my damp-haired second baby on my lap. New York still smelled mustily of late summer, lingering into the fall’s new beginnings. That day, a few loosely connected families had gathered before our kids were about to start public preschool together. They were roaming the playground in our sightline.
Someone who knew me asked how this book was going, and someone who didn’t asked a polite follow-up, asking what it was about. I hesitated. I was still struggling with the hugeness of this story. I hadn’t yet figured out what had to be in a story about pregnancy in America when almost anything could. And anyway, it was a preschool meet-and-greet half full of strangers. It didn’t feel like the moment for a soapbox.
But I named the title, and noticed the fathers tilt a bit, casting a careful eye to their partners. Did I imagine it, the alertness to triggers?
“The way you’re treated when you’re pregnant…” I paused, searching for a word that would be honest without circumscribing too much. “Like you’re a child.” I needn’t have worried.
“Like an animal,” replied one mother instantly.
“Like a child-animal,” said Maggie Boyd vehemently.
I knew who she was already, but from Instagram, so I cagily pretended not to. The ceramicist and artist who had made the gleaming green tiles beneath the counter at the new coffee shop, etched with shapes my older child liked to trace with her fingers as we waited: an undulating mermaid, a star. In person, Maggie was warm and whimsical and unguarded, with wide blue eyes and delicate features. Soon she was skipping among the kids, gamely sticking pretzels in her mouth to pretend to be a walrus.
The sudden rawness of that moment in the park stayed with me. It was, for the most part, a group of people with education and access, people who had options, who were used to asking for something better, whatever better looked like to them, and even getting it. If some of the luckiest, best-prepared women in America had a shudder of recognition at the phrase child-animal when recalling some of their most vulnerable and meaningful experiences—if I did, too—what hope was there for people who didn’t have all that going for them?
But that was the point, too, I came to realize. Privilege could insulate you from a lot, but pregnancy had a way of humbling everyone. And people like me who are used to the system bending to their will might suddenly learn what it feels like to be treated like a child-animal. When I’d met with the writer and sociologist Tressie McMillan Cottom that summer and marveled at the stories spilling out about disrespectful care from people who expected better—mostly but not all white, well-off women—she remarked that in America, pregnancy and birth could “pierce the class veil,” a glimpse at a world they might otherwise never see, but that is all too common for so many others.
It would take some time to learn, and to be astounded by, what Maggie was referring to when she said child-animal. I would also have my breath taken away by how her experience intertwined with that of another woman in New York, Christine, whom she had never met. Both helped me get closer to understanding what has gone terribly wrong with pregnancy in America.
In the strictest sense, what they went through had nothing to do with the Supreme Court banning abortion. They both lived in New York City, a place that has long held itself out as a refuge for abortion seekers from hostile states. We liked to congratulate ourselves in New York, but somehow the largest, wealthiest city in the country, with its world-class hospitals and universities, is also a place with a starker racial disparity in maternal mortality than Alabama. Both my personal experiences and my reporting had suggested to me that when it came to pregnancy care, bigger and richer didn’t always mean better for everyone. And anyway, as I’d glimpsed for myself in the ultrasound room, purportedly cosmopolitan New York City is hardly exempt from a worldview that treats you, at best, as secondary when you get pregnant.
