Health

I was six weeks and two days gone when I found out I was pregnant. I had just gotten back from covering the US midterms in such a sickeningly frantic way that I hadn’t had time to think about the changes going on in my body, but the signs were there: a creeping nausea that felt like seasickness, breasts as sore as swollen pimples, sheer exhaustion that willed me into bed for three days upon my return.I had reasoned this was a normal response to a week spent shuttling across hundreds of miles, working 21-hour days on the abortion beat in the fury of election season.If I had wanted an abortion at that stage of my pregnancy, I would have already lost that right in 15 US states. On 24 June 2022, five months before I discovered my pregnancy, the US supreme court had undone the constitutional right to abortion, curtailing the rights of some 22-million women of reproductive age as easily as untying a shoelace.An influx of bans and restrictions quickly followed suit. Old laws sprang back into action, some of which had been written in the Victorian era – before women had the right to vote or had a legal protection against being raped within marriage. New laws were introduced, too, although their content – including murder charges for people who have abortions, and allowing members of the public to track anyone down like a bounty hunter, clearing the way for them to sue for “aiding and abetting” abortions – felt equally antiquated.I’ve driven across America’s varied terrain as a reporter throughout this tidal wave, bearing witness to a monumental assault on women’s rights. I have faced, head on, the fury that comes from anti-abortion extremists for daring to write about abortions. And I have seen the dogged organization and jubilance of those who have protected abortion rights in their states after months of pounding on doors, rain or shine.None of it has changed the way I’ve reported the news. It’s our job as journalists to see what is happening, not what we want to see. But covering this beat, especially while pregnant, has changed my depth of vision. To see this assault up close and personal is to see it for what it is: not a journey to protect life; but to stifle, suppress and suffocate freedom.I am not one of those people who loves the experience of being pregnant. I’m not excited about birth; I don’t believe it will be magical. I’ve been lucky enough to be healthy throughout my pregnancy but I miss being able to put my own socks on and being able to bend over with ease; I miss playing sports; I miss getting a full night’s sleep.I have, at the best of times, felt complicated emotions when it comes to learning to love the thing inside me, and all the changes in my body that come with it. I’m a fiercely independent person, and I have a tendency towards wanting to control my body and what happens to it. I’ve often fixated on the idea that I can undo bad experiences in my life by bolstering my health. In that vein, I have raced in a mini-triathlon, learned to do clap pushups and lifted heavy weights at the gym.Early in pregnancy, as double the amount of blood began to flood my body like an enemy army, ramping up my blood pressure, I felt I no longer knew myself. I felt trapped in my new body, denied all my usual escape routes. I realized I wouldn’t be able to compete in the New York City half marathon, an event I was looking forward to. I was used to running regularly, now speed-walking to the station felt like a humiliatingly difficult ordeal. My old stress relievers became suddenly out-of-bounds.These are all small things. But small details about a person matter. Small things make a person who she is, and influence how she interacts with a life-changing, all-consuming, body-throttling experience like pregnancy.Here in America, where abortion is now banned or severely restricted in 20 US states every person I report on is as complicated as me.It’s July, and I am hurtling across Kansas City in a rental car covering a monumental vote. In just a few days, Kansas will be the first state to directly ask its people if they want to protect abortion rights under the new status quo.Republicans are wide-eyed and hopeful: recent polls suggest people in Kansas, a ruby-red midwestern state, have far more complicated feelings about abortion restrictions than the rest of the country. While lots of American voters do not want more abortion restrictions, in Kansas, in 2022, polling analysis by the New York Times suggests they might be equally split. Nonetheless, it is currently a safe haven for abortion rights in the midwest, where a slew of bans have come down since Roe was overturned. If voters restrict abortion rights in the coming week, a refuge for millions who want access to abortion may soon be lost.I found Christy McNally – a former science teacher, a grandmother and dog lover – through a friend of hers who was working at the Johnston county Republican party. McNally is soft-spoken and sweet. She is the kind of person you feel would stop to pick up a stranger in the middle of a storm and take them where they needed to go.One night, before we speak on the phone, she sends me a photo of her meeting Bill Clinton in 1996. Back then, she was lobbying for an abortion bill aiming to criminalize doctors for performing a dilation and extraction procedure. These procedures are a rarity in the grand scheme of abortion care, because most abortions happen in the first 12 weeks of pregnancy, when simpler, less invasive options are available. Dilation and extraction in the third trimester, which anti-abortion advocates often reference, accounts for less than 1% of abortions each year and is used primarily in cases where the pregnancy is incompatible with life or puts the pregnant person at risk.The language used by the National Right to Life Committee around that bill in the 1990s was deliberately emotive and included a newly invented term: “partial-birth abortion”.Despite the fact these abortions are most commonly performed at a time when the scientific consensus agrees fetuses feel no pain, and often when life is not viable outside the womb, lobbyists switched to a graphic depiction of the procedure, which requires forceps to pass a fetus through the birth canal, in an attempt to foster anti-abortion sentiment.People outside the US often ask me how a country shifts to having no federal right to abortion. This is how: by evoking emotion that humanizes the fetus at all costs – often on shaky scientific grounding – while diminishing the humanity of the person delivering it. Eventually, these ideas are repeated enough, and become part of the mainstream. Today in America, federal judges refer to “unborn children”, “killing” and “personhood” when talking about abortion care even in the earliest stages of pregnancy.In 1996, the bill McNally lobbied Clinton over had no chance of passing. But in 2022 that rhetoric – of broken limbs, fetal pain and the murderous intent of those who perform and seek out abortions – already sat comfortably in the US vernacular.It is also this language that activates a lot of the anti-abortion advocates I have met during my reporting, who do not see themselves as radical. McNally tells me she believes abortions should be allowed in medical emergencies (she has a friend whose fetus had no skull). She also supports exceptions for rape and incest. When I probe, I can see McNally is conflicted on abortion: there are very particular, intimate circumstances where the case for abortion has won her over, but mostly, outright bans are appealing to her. To me, she most wants to talk about abortions in the third trimester – the most unusual, and incredibly rare type of abortion – as do most anti-abortion advocates I speak to.But the vast majority of bills that have been passed since Roe v Wade was overturned don’t target late-term abortions. Almost every single ban is instead a full ban on abortion with limited exceptions.Those limited exceptions are rarely enacted, because doctors are too scared to intervene. I have talked to women who were denied abortions after they were told their fetuses had no skulls – precisely because of the types of restrictions that would surely come if this referendum in Kansas were to pass.Perhaps most American people, including Republicans, know and care about this. In August 2022, 59% of Kansans voted to protect abortion rights in a state where, just a decade earlier, the abortion doctor George Tiller had been murdered. At the watch party on the night of the vote, the room interrupted in cheers, screams and tears as the result was read out.Nearing the end of the night, I noticed an older man happily perched on the corner of the stage, cradling his drink and looking a little giddy. His name was James Quigley. He was a 72-year-old Republican and a retired doctor, and he looked like he wanted to have his say.“Abortion is a much more nuanced issue than anti-choice individuals would have you think,” Quigley told me.“It is deeply personal, sometimes tragic, but also sometimes a liberating decision – and we should trust women, their physicians, and their God on that.”At some point during my pregnancy, I realized that I was no longer considered a full, complete, messy human – one with autonomy, quirks and desires. At best, what I wanted was important only in proportion to my ability to protect my pregnancy. At worst, people saw me as a container for a child.I was frequently advised that from now on, I should not “take any risks”, which, of course, is ridiculously unhelpful advice. “I just don’t see why you would [take any],” one friend told me – seemingly unaware that to leave your house in the morning is a risk. To drive at 28mph on a stressful day when you’re late for an appointment, instead of at 25mph, is a risk. Going for a run is a risk – but so is choosing to forgo exercise.I have found being treated like a child in this way difficult. I don’t have to listen to any of these people, but the experience of constantly being told what to do is tiring; usually becoming an adult means we get to make our own calculations over what’s best for us, pregnant or not.For many pregnant people in America, this is no longer the case. By accident of birth, circumstance, or both, they live in a state that now limits their opportunity to end a pregnancy. If they’re rich, and unafraid, they might travel for care. But often, they don’t have the money, or can’t get the time off work, or can’t spend the numerous days and thousands of dollars to travel to another state for care. Their personhood has been reduced beyond all measure, in defense of the potential person living inside them.In March, I reported on the case of a South Carolina woman who was arrested a year after allegedly taking pills to end her pregnancy. On the police report, her offense was listed simply as: “abortion”.Pregnancy now converts legal behavior for everyone else, into a potential charge of child abuse, or child neglect, or attempted murder just for women – as the CEO of a charity explained it to me at the time.It is hard for me not to feel that viscerally, in a context where I have sometimes had to decide whether it’s worth it for me to go to report in a state with a total abortion ban, where I know miscarriage could make me a crime suspect, or result in me being denied healthcare. Other people don’t get to make that choice, they just live there.In a country where drinking alcohol, overexerting yourself in a yoga class, or hanging out the top of a truck while someone drives fast is not a crime, it could become illegal just for pregnant people. Teenagers whose grade point averages don’t satisfy judges are told they are too immature to have abortions; but not to raise a child. This is not rhetoric: politicians have spoken brazenly about manipulating laws not meant for abortion to police proper conduct in pregnancy since Roe was overturned.Reporting on this while pregnant means I’ve sometimes found it hard not to feel anger when I should have been feeling happy. At our first ultrasound appointment, at six weeks and five days, I struggled to feel joy when the nurse played the “fetal heartbeat” to me and my husband.Watching the zigzags bounce up and down on the screen in a dimly lit room, and seeing my husband’s face light up, I suddenly felt indignant. At that point, our “baby” was barely a yolk sac and some villi. Still, in many places it had more rights than me.“That’s not actually a heartbeat, you know?” I told my husband as soon as the nurse left the room. I felt like a killjoy. This was supposed to be an intimate moment. But all I could think about was the many US states that had brought “fetal heartbeat bills” in recent years. Those were now a legal reality, banning abortions at a point when I did not yet know I was pregnant.At six weeks, a fetus has not yet developed a heart. It has developed a small cluster of cells that may eventually turn into a heart – if the pregnancy is healthy – and the noise is the electrical activity coming from those cells. This is amazing, sure, but it’s not a heartbeat. There is no heart, no chambers, no blood pumping.In these early stages of pregnancy – between four and 12 weeks – pregnancy tissue removed in an abortion looks, first, like something that comes out of your nose; then tiny little egg whites; then more like a sprawling jellyfish. I know this because I worked with doctors to publish photos of what pregnancy tissue looks like after it’s extracted in an abortion before 12 weeks of pregnancy. I have seen early abortions performed at a clinic, and looked at the tissue directly after.Still, to point out what early abortion tissue looks like is often met with rage, sometimes with confusion and disbelief. In a way, I understand this. I wanted to report this story precisely because it goes against the grain of the pregnancy images we are shown. So many pregnancy images show the fetus through a microscope, or make it seem more humanized: when you look at images of early fetal development online, or even scientific imagery provided in textbooks, the depictions are very human-like. Even the perspective on an ultrasound can be misleading, highlighting the fetus in black and white so features are more visible, and showing the growing form in contrast to the tiny surrounding container of the amniotic sac.After I published this story, angry readers sent me ultrasound images; graphic descriptions of what fetuses look like in miscarriage; and videos of early fetal development under microscope. Some sent me the Guardian’s own coverage of Lennart Nilson’s photos of the earliest stages of life, taken in 1965. That imagery shows a nascent embryo, which first forms around 11-12 weeks, at a time when, if you view the fetus through a macro lens, you will see the early beginnings of a trunk and head developing.These are all different perspectives of life – neither I nor any single person can determine which is right. Different perspectives don’t have to discount one another. Sometimes, they just add to the knowledge we draw upon to make decisions about the world. I see it as my job as a journalist to give people more of this information, so they can make more informed decisions.I understand that images are incredibly powerful; I often come back from my scans feeling bursts of excitement; rare moments when I feel ready. I also understand the way in which personifying my pregnancy helps me to connect with it. Early on, my husband and I debated for a long time whether or not to find out the sex. Still feeling detached and confused about the changes going on inside me, I reasoned that knowing more might help me to feel more connected. It has.Later in my pregnancy, I have paid attention to when the little kicks come – sometimes after I eat raspberries, or drink orange juice, or when I have a chocolate bar. “He loves sugar!” I tell my husband – although I actually have no idea what the correlation is.I have also reported on the stories of people who do not feel this way about kicks or scans. One woman, Samantha Casiano, told me every new kick was a reminder of the inevitable moment when her baby would die, after she was refused an abortion in the state of Texas, despite her pregnancy not being viable.I can imagine how the descriptions of whether her fetus is now the size of a mango, or a cantaloupe, might bring on horror and fear. I can’t imagine what it must be like to be bombarded with this imagery after being told you no longer have agency over your own body.Carrying many perspectives can be helpful. It’s not my job to tell you what to believe, or even what to feel – just to let you know that these images are factual, and the lens you choose to put on them is yours, not mine.When I think about the decisions a person who wants an abortion has to make in places where it is banned, I think about the hormones that have cascaded through my body like a tornado during pregnancy.One day was so bad I had to call my friend to come over and console me while I cried for hours in my living room. That was a day when every decision I made felt certain to result in the sky falling in on me: the offending decision was over whether to buy a more expensive bar of soap, that smelled nicer. One day, I cried after a friend gave me a batch of her maternity clothes. I was in my 16th week of pregnancy, and increasingly feeling like nothing was my own. I wanted to go home to London. I worried about losing my career. I was watching my body balloon up in real time, and worried about looking at myself after pregnancy and not knowing who I was any more.Recently, when I couldn’t sleep at 4am, I read a book about the first month postpartum. The author used the word “capacious” to describe the vagina after birth. Even though I knew the word, I felt a need to Google it. “She rummaged in her capacious handbag,” was the sentence example returned to me in the search. I cried again.The changes the body goes through during pregnancy are not small. But in an abortion context obsessed with a very particular kind of religious morality, the changes a body goes through in a pregnancy sometimes feel like an afterthought.When 22-year-old Chloe tells me about being forced to deliver a baby at 37 weeks that did not go on to live, I feel a crushing sense of empathy for her. It is her struggles with her body image that she finds difficult, precisely because it is seen as so unimportant.“I’ve gained a ton of weight. And you know, I don’t know what to do about it,” she told me in a recent phone call. “If I ask anybody for help, people will probably just tell me, you should go work out. It sucks, a lot,” she says.On a reporting assignment last winter, I sat in a doctor’s office nextdoor all day while they saw clients. One woman came in, her face flooded with tears, already knowing the doctor couldn’t help – the state had a total ban. The woman was too poor to afford another child, and too poor to travel out of state to get an abortion.This is not unusual, the doctor told me: people still need abortions all the time. The conflict for the doctor has become what to do. Help, and you risk losing your license, or going to jail. Don’t help, and the patient might be failed at a time when one doctor’s decision could change their lives forever.One doctor told me about a single weekend during which she saw two infected pregnant women on her emergency shift when she checked in. One had gone into sepsis; the second patient eventually hemorrhaged, although she did not die. The doctors, one on the prior shift, and one at another hospital, had ignored them both – too scared to intervene, because administering an abortion was legally risky.They are not wrong to be scared. I’ve documented the consequences for doctors who stick their heads above the parapet: one was fined thousands for speaking out about a 10-year-old rape victim forced to travel to her state for care, another was publicly chased from her job.Working on those stories, I’m often told by people denied abortions that they feel America should be described as pro-birth, rather than pro-life. States have no intention of cleaning up the mess after an abortion has been denied, just to stop it happening in the first place.This exact scenario unfolded for Samantha Casiano, the Texas woman who was forced to deliver her baby with ancephaly. Her baby was breech – for which people are often offered a C-section, to reduce pain and severe complications. Casiano was not offered this, and found the entire birthing experience traumatic. “Your baby is going to pass away so we don’t need to do all that,” the doctors told her.“I felt degraded,” Casiano told me. “There was a lot of things I felt like wouldn’t have happened in a normal pregnancy, but with me, it’s like they were like, ‘OK, let’s just get this over with,” she said.She was made to carry the pregnancy for 13 weeks, knowing her daughter wouldn’t survive – just so, in her eyes, the doctors could “get it over with”.Mostly, the impacts of abortion bans don’t fall on people who are sick; or who have wanted pregnancies; or medically complicated pregnancies. They fall on people who want abortions because giving birth doesn’t fit with school work, with work-work, with raising the children they already have. They fall on people with few economic options, further entrenching inequality along race and class lines. Sometimes, they fall on people in domestically violent relationships. Other times, on people who know they won’t make good parents.These are all complicated reasons why someone might not be ready to have a child. In America, they aren’t good enough reasons to justify an abortion, but what happens after the abortion is denied?I recently moved back to England to give birth and be closer to family for a while. Here, I have often felt that people like to exaggerate America’s differences with the UK, because it helps deflect from our own very sordid political realities. “At least we’re not America,” people often say with a wink and a nod, often bypassing shattering political moments like Brexit, the story of a young Black boy being murdered, or our own legacy of slavery.These are the assurances I am sure people may feel reading this article: that the rest of the world is nothing like America when it comes to abortion.That may be true, but our prime minister has abstained every time he has been asked to vote on abortion since he became an MP; this includes voting to stop protesting outside of abortion clinics and to legalize abortion in Northern Ireland. In the UK, our chancellor of the exchequer has called to cut the time that abortions are legal in half, from 24 weeks to 12. Our health minister said that protesters outside clinics could just be trying to “comfort” women.This is the UK, too: where a woman was this month sentenced to two years in prison for taking abortion pills after the legal limit.As I write this, two weeks before my due date, I don’t know whether to feel hope or despair. Nor do I know what to make of America’s complicated abortion landscape, where people have repeatedly shown at the ballot box that they do not want abortion restrictions; that they are willing to oust politicians who want to bring them; and that they will continue to find innovative ways to continue to protect abortion.It’s a strange dynamic to see play out in a country where people are so obsessed with freedom. Because this is, at its core, an issue of freedom, as well as an issue of equality and fairness. When you curtail abortion – whether it is an abortion you agree with or not – you fundamentally alter someone’s right to make choices about their own chequebooks, their bodies and their families.I’m glad I had a choice, but I still burn with rage at how normal it has become in America for people not to. More