The Abortion Rights Movement Must Rethink Its Strategy The Abortion Rights Movement Must Rethink Its Strategy In the face of an aggressive assault by the right, the abortion rights movement should abandon its defensive stance and advocate fully integrating abortion into the country’s healthcare system. Demonstrators march in support of Planned Parenthood in St. Louis, Missouri, May 30, 2019. (Saul Loeb / AFP/Getty Images)

The American right is winning the battle over abortion rights. In fact, they have been winning for a long time. Since the late 1970s, conservatives have worked to build a well-funded, militant anti-abortion movement that that includes white nationalists, religious extremists, and pro-life feminists. Now, the end of the legal right to abortion appears terrifyingly imminent. The recent onslaught of proposed bills that would ban abortion from some point between conception and twelve weeks into pregnancy in Alabama, Arkansas, Iowa, Kentucky, Mississippi, Missouri, Louisiana, North Dakota, and Ohio are part of the right’s intensifying effort to challenge Roe v. Wade at the U.S. Supreme Court, now controlled by a conservative majority that could very well overturn the decision.

There is far from a consensus on the feminist left about how to respond, but many feminists have turned to the reproductive justice framework both to explain the failures of the mainstream reproductive rights movement and to suggest a corrective. Faced with the powerful right-wing movement that uses abortion as a wedge issue, the reproductive justice framework goes beyond just a focus on abortion rights to include social justice issues like poverty, immigration, and incarceration. However, if the left wants to win—which would mean, among other things, guaranteeing the right to an abortion—it must find a political strategy that can make the reproductive justice agenda a lived reality. In other words, the left must fight back against the anti-abortion right and, at the same time, expand the struggle beyond abortion rights by advocating for the right to healthcare and fully integrating abortion into the mainstream healthcare system.

The reproductive justice framework emerged in the 1990s in response to national debates over the Clinton administration’s proposed healthcare reforms. Black feminists in the reproductive rights movement objected to the concessions that the Democrats were making to the right, isolating reproductive rights from other social justice issues by failing to push for a reformed healthcare system that guaranteed comprehensive reproductive healthcare, including abortion. “Reproductive justice” was born as it became clear that the never-ending negotiations and compromises with the right over abortion had resulted in a limited and politically short-sighted vision for reproductive freedom.

More specifically, the reproductive justice framework charges that the “pro-choice” discourse narrows the scope of the debate about reproductive health. The framing of the “pro-choice” position as based on a right to privacy ignores the public, social context in which people have or decide to not have children—from the discriminatory, expensive private healthcare system itself to the state-sponsored sterilization abuse of poor women to the structural forces of poverty and racism. Reproductive justice, by contrast, integrates abortion into a broader, anti-racist, gender-affirming understanding of reproductive freedom that understands that people who can get pregnant have a right to have children in a safe and healthy environment as much as they have the right not to have children.

From the reproductive justice perspective, the pro-choice framework is also politically shortsighted. It gives the right the opportunity to use the logic of choice to both undermine accessibility to abortion services and stymie the expansion of universal government programs. For example, with the 1976 Hyde Amendment, the right blocked public funding for abortions through public services like Medicaid and the Indian Health Service. The reasoning was that if pregnant people could choose to abort, then people who disagree with that choice should be able to choose not to contribute to it in taxes: choices for all. With the same logic, the right has used abortion to derail attempts to create a more robust public insurance option, first in the 1990s and again in 2010. Today, there is neither equitable access to healthcare nor abortion access for an increasing number of people.

Yet, to address the current crisis, the mainstream pro-choice movement needs to do more than just change its perspective. It needs to change its strategy. The American Civil Liberties Union (ACLU), Planned Parenthood, the National Organization of Women (NOW), and NARAL have fought a seemingly endless legal battle for decades. The leaders of these mainstream groups claimed their gradualist strategy would ultimately triumph without prompting anti-abortion backlash. But when there are more than seven states with just one remaining abortion clinic, when the last clinic in Missouri appears on the brink of closing, and with the Louisiana abortion now on the Supreme Court’s docket, this argument is no longer convincing.

Many socialists argue that the liberal feminism of the large, non-profit and non-governmental organizations (NGOs) that dominate reproductive politics does not go far enough. They are right. But the problem is not only ideological, it is also structural. The majority of healthcare in the United States is provided through private insurance companies, non-profit religious hospitals, and for-profit hospitals. Abortion was never fully integrated into this system once legalized in 1973. Moreover, many private and religious institutions do not perform abortions; more than 90 percent of abortions take place in free-standing clinics. And these clinics, their funding networks, and their legal support are typically run by non-profits that receive federal Title X funding. In short, non-profits and NGOs have taken on the role of providing direct community services that neither the mainstream healthcare system nor the state provides.

The NGOs that provide important services like abortion occupy a vulnerable place within the healthcare system; as a result, their political activity is heavily circumscribed. Because their goal is to maintain their limited funding from the public sector within individual states and from private sector donors, their political activity must be palatable to politicians and philanthropists. To maintain a sustainable level of congressional support over time, their advocacy must be ideologically palatable to the most conservative elements of the Democratic Party in particular, and, if they are lucky, the most moderate Republicans. What emerges is a strategy focused, above all else, on ensuring partisan political support.

It is also a labor intensive and financially costly approach due to constant right-wing attacks. The possibility of enraging a powerful anti-abortion right makes politicians more likely to compromise, and yet electing sympathetic politicians to retain funding is crucial. NGOs must therefore narrow the scope of their arguments in defense of abortion and their scope of political activity. But this disadvantages many activists on the ground operating with different strategies—and a more expansive notion of what reproductive justice means.

Take Planned Parenthood, for example. At first glance, organizations like Planned Parenthood appear to be leading the movement for abortion rights. However, their dominance in reproductive politics obscures the real relationship between abortion access and reproductive justice. It also truncates debates about what it will take to win full reproductive justice.

Planned Parenthood has increasingly de-emphasized the abortion care they provide despite the fact that this care is the reason that they are vulnerable to right-wing attacks in the first place. They consistently downplay the proportion of abortion services they provide relative to other services in response to inflated right-wing statistics. They emphasize instead other services like pap smears, contraception, and STD screenings to shield themselves from the public perception that they are just an abortion clinic. Planned Parenthood’s attempts to de-escalate its increasingly dangerous confrontations with the right sends a contradictory message to its political supporters. Planned Parenthood is the defender of abortion rights, but it too often shies away from offering an unapologetic defense of those rights.

An additional challenge is the right’s attempt to claim feminist politics as their own, especially in the absence of a more robust, feminist defense of abortion. The right has taken advantage of the left’s relative weakness on abortion to coopt the language of reproductive justice, formulating the idea of “pro-life feminism.” The anti-abortion right has distanced itself from the explicit, anti-woman misogyny of yore and instead moved toward a pro-woman philosophy of “care” for abortion “survivors” and their “unborn children,” emphasizing the emotional toll abortion takes and the unjust circumstances in which women are forced to have abortions. The right has also seized on the idea that feminist leftists are the true racists who want to kill Black children in the womb, here coopting the concerns of Black feminists regarding sterilization abuse.

It is a cruel twist of fate that the right can claim this territory. But it is important to understand why. The rhetorical and strategic conservatism of the leading reproductive rights NGOs has prevented them from adequately challenging the right’s multipronged attack on the legitimacy of abortion. To many in the United States, it is no longer clear why abortion is a basic right and how it is connected to other experiences of gender oppression, like pressuring women to take long-acting contraceptives or to undergo sterilization procedures for lack of options, or sexual violence.

In 1997, Dorothy Roberts, a pioneering reproductive justice scholar and author of Killing the Black Body, argued that “Black women’s experiences” demand “not only a rejection of the singular preoccupation with abortion rights, but also a reassessment of the meaning of abortion rights and its place in a broader vision of reproductive freedom.” But where the non-profit world has rejected a singular preoccupation with abortion rights, it has done so at the expense of the latter, equally important, proposition. More than twenty years later, a new generation must put forward strategies that use the reproductive justice framework to challenge the right by demanding more, not less. In practice, this means both asserting that abortion access is not a sufficient condition for reproductive justice and acknowledging its centrality to the right’s political program.

The right sees abortion as a wedge issue. They have used restrictions on abortion to divide people who need access to reproductive healthcare by gender, class, and race. They have successfully targeted poor women by restricting public funding for abortions and militated against the expansion of public insurance for everyone. Racist proponents of population control find themselves in the happy situation of having reinforced the vulnerability of poor women to state surveillance. That the poor of reproductive age depend on access to public insurance means that their healthcare is siloed away from the rest of the healthcare system. This situation is ripe for manipulation and abuse. The testimonies of poor women that have been abused are rarely believed because their seemingly unique dependence on the state is seen as a result of their ignorance or incompetence; they will never be reliable witnesses because their use of public insurance hurts their credibility to begin with. The same rules that apply in the private sector do not apply to them.

The left, in contrast has not used abortion to press for more expansive demands. It should, and there are several ways the left can use abortion to undermine the structural conditions of reproductive injustice. A Medicare for All bill that guarantees abortion as a right and overturns restrictions on federal abortion funding would go a long way toward shrinking class differences in access to abortions, prenatal care, and other forms of pregnancy support. Medicare for All is also an opportunity to codify a reproductive healthcare bill of rights because it gives everyone a stake in the rights they have as patients. It would thus diminish the power of the state to intervene in poor women’s reproductive decisions.

Integrating abortion care into hospitals and regular Ob-Gyn services would also improve the quality of reproductive healthcare. If people can seek abortion care from their regular Ob-Gyn, then patients can receive care from someone who knows their medical history and who can provide them with the widest range of services and options. Reproductive healthcare would be streamlined, and the right would be deprived of one of its most important battlegrounds, the symbolic vortex and place of convergence for the anti-abortion movement: clinics. Free-standing clinics are politically and physically vulnerable to attacks, putting the women who use their services on the frontlines of the national fight over abortion rights. This situation is extraordinarily violent. Today, a normal part of what it means to go to the doctor at a clinic from New York City to Missouri means facing down right-wing violence in the form of harassment, physical intimidation, and clinic invasions. Reproductive justice is not possible in a world where this violence continues.

The challenge is to make abortion a central issue by fighting for abortion access as part of a broader movement for reproductive healthcare reform. The left cannot move toward an alternative vision of reproductive justice and avoid confronting the right on abortion at the same time. And the non-profit sector is not up to the task of taking the lead. What is needed in addition are independent and democratic political organizations that build support for universal policies, not by shying away from abortion, but by emboldening women to use creative and escalating tactics to secure their rights.

Lillian Cicerchia is a PhD candidate in political philosophy at Fordham University in New York. She is also a member of New York City for Abortion Rights.