Pro-choice doctor on abortion and Israeli law: In this case, the story is complicated

Frederica Mathewes-Green, a longtime friend of GetReligion and its founders, began her transformation into a pro-life activist in 1976, after reading a piece called “What I Saw at the Abortion” in Esquire. Read it and I predict you can tell the passage that grabbed her and would not let go.

We never quite know the potential of one honest essay or journalism feature to move a person’s conscience. This leads me to “I Found the Outer Limits of My Pro-choice Beliefs” by Chavi Eve Karkowsky, a specialist in maternal-fetal medicine, writing for The Atlantic.

Karkowsky remains resolutely pro-choice in her sympathies, as reflected in how she describes pro-lifers protesting at late-term abortion facilities as “screaming at [women] not to do what they have already spent days or weeks weeping about.” It’s odd that pro-lifers — diverse people who often protest in silence, pray the rosary, have calm conversations with women and offer to help them bring their babies to term — apparently can only scream in their mass-media appearances. 

But I digress. Karkowsky’s new awareness of these outer limits emerges from a time of working in Israel, after her husband took a job there. Israel’s laws on abortion are more permissive than those in the United States, although they also require taking the decision to a Termination of Pregnancy Committee (va’ada), as Karkowsky explains:

In this majority-Jewish country with deep socialist roots, abortion law has never been constructed around the idea of a woman’s power over her own body, or around the value of fetal life. The basics of abortion law were passed in the 1970s, and were largely built around demographic concerns in a tiny collectivist country that, at the time, was almost continually at war. Though changes have been made, those foundational laws still prevail. In Israel, terminations of pregnancy, regardless of gestational age, must go through a committee, a va’ada. Without its assent, an abortion is officially a criminal offense. But here’s the surprise: In the end, more than 97 percent of abortion requests that come before the committee are approved.

The va’ada can approve abortions for specific reasons spelled out by the law: if the woman is over 40, under 18, or unmarried; if the pregnancy is the result of rape, an extramarital affair, or any illegal sexual relationship, such as incest; if the fetus is likely to have a physical or mental defect; if continuing the pregnancy would endanger the woman’s life or cause her mental or physical harm. Some of these rationales, such as rape and incest, are familiar from the U.S. abortion debate. Other justifications, such as those involving the woman’s age or marital status, bespeak a certain amount of social engineering, and may strike Americans as odd matters for the law to take into account.

Karkowsky describes herself as homesick for Roe v. Wade, which sounds ghoulish for a moment, but her explanation makes it warmer and — how to put this? — almost pro-natal:

Of all the American things I’m homesick for, it turns out the biggest one is Roe v. Wade. I miss U.S. abortion law terribly. In some part, that’s because it’s familiar. But it’s also because the structure of American law, if practiced as constitutionally legislated, works for most patients, most of the time — ethically, emotionally, and medically. The arrangement of U.S. abortion rights means that terminations center on a woman’s choice, but also that there’s a point in a pregnancy when abortion is off the table, except in the most dire of circumstances. And that means there’s a point in the pregnancy when everybody can relax, when we start to comfortably call the fetus a baby, when we can embrace the joy that accompanies a healthy, desired pregnancy.

In Israel, because abortion is never off the table, that relaxed time in a pregnancy never fully arrives. Telling women all their legal options is still part of my job. I am ethically required to have these difficult conversations about late abortion. I can honor that minimal obligation, though I never imagined I’d have so much trouble meeting it. When I return to the United States, what I’ll take back with me is this itchy strangeness of having to figure out where I stand.

Karkowsky worries about the effects of her essay in The Atlantic, and again her perception of pro-life activists is heartbreaking:

I was almost not brave enough to write this piece. In the United States, there are only two sides to abortion, and there is outrage on both. Anti-abortion activists will say that I’m a murderer, or an accessory to murder, because of the work I do.

I also hesitated for the opposite reason: Any time a pro-abortion-rights provider admits to any doubts, her ambivalence may be used to limit abortion care. One expert I interviewed for this piece said, “If you write how hard it is to counsel about abortions, please know this: Somewhere, someone will use that to stop women from getting the procedures that they need.” After that, I couldn’t write for weeks.

But there needs to be a way to talk about all the places in the middle of the abortion debate, where most Americans’ beliefs actually lie.

This essay is no breakthrough pro-life moment, but it could represent a slight and encouraging doubt in Karkowsky’s pro-choice thinking. Her struggling with this matter in writing is commendable, and may it lead to more honesty, understanding and change in our divided culture. At the very least, it’s an example of an alternative voice appearing in an elite, important publication.

Art: Detail from the cover of “Information for Girls with an Unplanned Pregnancy,” a booklet by the State of Israel’s Ministry of Health.

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