It isn’t long into reading Juno Carey’s book that you realise it also serves as a meditation on women and shame. A former NHS midwife who moved into abortion provision (first in clinics then on aftercare helplines), Carey (not her real name) was asked how she could do both, but in her view: “The gap between helping women deliver babies and helping them terminate unwanted pregnancies no longer seems wide to me.” As the title says, it is “a necessary kindness”, another way of aiding pregnant women. While acknowledging the complexities, Carey seeks to demystify abortion – the fact of it, the need for it, the processes of it – to rid it of the long, painful history of judgment, blame and misogynistic juju, and stress its rightful function in a civilised society. Abortion, she asserts, is healthcare.
This is a timely book for driving home the sociopolitical urgency of safeguarding reproductive freedoms. In 2022, the US supreme court overturned the 1973 Roe v Wade decision (which made abortion a constitutional right), leading to sweeping bans and restrictions across the nation. Other countries, including Malta and the United Arab Emirates, operate bans or restrictions. Despite law changes, it’s still complicated to access abortion in Northern Ireland. In the UK, abortion is technically illegal: only accessible if two doctors grant approval and certain criteria are met. While a free parliamentary vote on decriminalisation is expected soon, women (procuring late abortions) have recently been prosecuted using an 1861 law.
Carey writes evocatively of the stigma, guilt and secrecy that, even today, engulfs abortions – a culture of silence that makes women feel abnormal and alone. Roughly one in three women will have an abortion, more than will get a tattoo (about one in four). Carey emphasises the wide range of these women, at different ages and stages of life. Some are young and not ready for motherhood. Others are trafficked, raped, abused, or are victims of domestic violence. Some terminate longed-for pregnancies because of foetal abnormality. Others can’t afford another child, or simply don’t want one. And on and on: so many women requiring abortions, for myriad complex reasons. Carey writes: “I now believe almost anyone could undergo the procedure under certain circumstances.” Still, women would frequently turn up at her clinic fully expecting to be shamed.
The passages dealing with Carey’s work in abortion clinics are as valuable as they are sometimes daunting to read. She outlines different types of termination: medical (pills), and surgical, with local or general anaesthetic (later terminations are carried out at hospital). As her clinic dealt with surgical terminations, she witnessed late abortions (when foetuses are too big to be removed whole), writing: “It was almost unbearably distressing to see and recognise body parts.” Elsewhere, one patient died of undetected ectopic pregnancy-related issues. Another woman, who was too late for an abortion, killed herself after giving birth. Carey feels patients deserve “full transparency” about the procedure and risks but is clear that the vast majority proceed without problems. In 2021 in England and Wales, there were almost 215,000 terminations, and no abortion-related deaths.
Carey believes that radical transparency, including women feeling free to tell their stories, is vital, otherwise the vacuum will be filled by those who stridently oppose abortion. She points to protests and gatherings outside abortion clinics and the fight for buffer zones so that vulnerable patients don’t find themselves besieged with guilt-inducing entreaties or graphic, inaccurate, scaremongering leaflets. Just as with some people on March for Life demonstrations, Carey observes that “street counsellors” outside clinics are frequently paid by wealthy organised international groups that are buoyed by their success in America.
Carey covers many other topics, including how some hospitals view abortion clinics; the desperate and deadly history of illicit, dangerous “backroom” abortions (the knitting needles and the coat hangers); the ongoing opposition – British MP Jacob Rees-Mogg stated in 2022 that abortion is a “cult of death”, refusing to support termination even in cases of rape. Also, the good news: the countries decriminalising abortion; and how the pandemic helped facilitate UK legislation for telemedical abortion (“pills by post”), made permanent in 2022.
Along the way, Carey, a mother in a same-sex relationship, touches on her personal struggles to conceive with IVF but stresses this did not seem contradictory with her abortion work: “I wanted to be pregnant and they didn’t: it was as simple as that.” A Necessary Kindness emerges as a frank, comprehensive and often moving book. It makes you aware of the fragility of reproductive agency across the globe and in the UK. It’s a powerful insider account that opens a door into a long-hidden world in which secrecy and shame have been weaponised against women for too long.
• A Necessary Kindness: Stories from the Frontline of Abortion Care by Juno Carey is published by Atlantic Books (£17.99). To support the Guardian and Observer order your copy at guardianbookshop.com. Delivery charges may apply
