Navigating ethical demands in feminist abortion research
In 2007 a watershed reform legalized abortion in Mexico’s capital, making it one of just three places in the heavily Catholic region of Latin America where the procedure is permitted. The abortion reform represented the culmination of decades of activism through which feminists sought to strategically reposition abortion in public discourse from a religious sin to a matter of women’s rights and citizenship. While first-trimester abortion services are now available on demand and free of cost through a new public program of the Mexico City Ministry of Health, the procedure remains criminalized elsewhere across the country. In this ‘fragmented’ abortion landscape (De Zordo, Mishtal, and Anton 2017), where political, legal, and moral contestation over abortion is ongoing, conducting ethnographic research on Mexico City’s new public-sector abortion program presented a series of unanticipated ethical demands and challenges. In this essay, I focus on two ethical binds I encountered during my research, related to the politically charged environment of my fieldwork site and topic and my subject position as a pro-choice feminist researcher. My discussion illuminates the difficulties inherent in feminist abortion research in a context of recent legalization and sustained anti-abortion sentiment.
My subject position as a feminist and an anthropologist collided as I struggled to reconcile my observations with patient narratives and to accurately interpret their answers.
The protestors who congregated weekly outside of the small community abortion clinic where I conducted the bulk of my fieldwork were a constant reminder that the work being carried out inside was deeply controversial, and that my association with it made my presence in the small bustling neighborhood morally suspect. I learned that the local antiabortion movement had engaged in a variety of attempts to criminalize the public abortion program and its staff in order to stamp out this new element of public health care in Mexico’s capital. Along with intercepting patients on their way to the clinic to dissuade them from seeking abortion, activists released a series of sensational media accounts about patients who were allegedly suffering from ‘postabortion syndrome’, a pseudo medical affliction invented by the antiabortion movement.
I struggled to accept that the trust I gained incrementally with personnel and patients within clinic walls seemed to preclude the formation of certain relationships outside of them. I resorted to smiling politely or simply averting my gaze as I shuffled past the protestors to make it to the clinic in time for patient intake each morning. Engaging the protestors, I soon learned, would render me suspicious in the eyes of clinic staff and abortion patients, who were their regular targets. Given the divisiveness of abortion in the context of the neighborhood, and in Mexico City more broadly, it became clear that in order to conduct the study I had envisioned, I would have to clearly align myself against the antiabortion movement. While I had initially hoped to incorporate the perspectives of protestors and the broader community in which the clinic was situated, I decided to relinquish certain aspects of my study given the deeply controversial character of abortion in this context.
Navigating ethical conflicts inside the abortion clinic was no less complicated. There, I walked a tightrope in seeking to earn the trust of both abortion providers and patients, populations that seemed locked in opposition in the paternalistic environment of Mexico’s public health system. Based on my prior research in private abortion clinics in the United States, I had expected abortion providers to embrace feminist constructions of abortion as a woman’s right. I was surprised by the at-times harsh treatment of abortion patients, whom clinical staff routinely chided for being ‘irresponsible’ in their sexual lives and for wasting valuable state resources in the form of public abortion care, particularly if they returned for a second abortion. After a few months, the staff allowed me to participate in patient intake. My observations in the counseling office facilitated a quick rapport with clinic personnel, who began to treat me as part of the clinical team. It also afforded me a new analytical vantage on clinical encounters in the public abortion program, and deeper insight into the perspectives and daily frustrations of the staff.
Yet, I grew increasingly apprehensive about my role in perpetuating a culture of medical paternalism, and about the implications of brusque treatment for the well-being of patients. I also feared that my association with clinic personnel would distance me from patients, who might be less inclined to offer uncensored evaluations of the care they received, even in the private space of an interview. As a foreign anthropologist with no medical training, however, it would have been inappropriate for me to question the staff about their bedside manner. While in certain cases patients directly challenged staff and critiqued the treatment, more often women reported high quality care, praising the free services and the relative ease of access to abortion. To my surprise, patients tended to accept clinical scolding as a paternalistic expression of care and an apt response to their decisions to terminate their pregnancies, about which many women harbored moral misgivings. My subject position as a feminist and an anthropologist collided as I struggled to reconcile my observations with patient narratives and to accurately interpret their answers. Moreover, I grappled with the ethical implications of my complicity in the unforgiving treatment of patients as I sat through dozens of counseling sessions.
To work my way out of this ethical bind, I strove to offer nonjudgmental support and to demonstrate respect in my interactions with patients in the clinic and in private interviews, and to emphasize that my research was separate from the work of the clinic. I also strove to better understand the perspectives of clinical staff, the motivations behind their gruff treatment of patients, and the local context in which abortion held different meanings for both providers and patients than it does in the United States. Interviews and conversations with staff helped me to appreciate that, from their perspective, clinical scolding grew from a profound sense of responsibility they felt to protect their patients and the public health of Mexican society more broadly. In my writing, I am endeavoring to make sense of the authoritarian style of care offered in the clinic, and also how patients assimilate medical paternalism while claiming their right to abortion.
Researching a controversial topic such as abortion poses unique challenges, particularly in a context of the recent legalization of, political backlash against, and ongoing stigma of abortion. In Mexico City, researching abortion entailed learning to navigate a politically charged fieldwork site and understanding which individuals I could and could not engage with. My fieldwork also demanded that I suspend my own understandings and expectations about appropriate abortion care in order to fully appreciate the local perspectives, frustrations, and moral reservations that abortion provoked among clinic workers and women seeking to terminate their pregnancies in this context. The ethical, political, and emotional hurdles I encountered in my research underscore the political and moral contestation that continues to ensnare abortion in contemporary urban Mexico. The lessons I learned in the process can inform feminist investigations of abortion in a variety of contexts.
About the author
Elyse Ona Singer is a postdoctoral fellow at Brown University in the Population Studies and Training Center. She holds a PhD in cultural anthropology from Washington University in St. Louis, where she also earned a certificate in women, gender, and sexuality studies. Broadly, Elyse’s research examines reproductive governance, gender, citizenship, and bioethics amidst shifting moral regimes of life and death in contemporary Mexico. Her scholarship appears in Medical Anthropology Quarterly and Culture, Medicine, & Psychiatry, and has been funded by the National Science Foundation, the Wenner-Gren Foundation, and the American Association for University Women.
De Zordo, Silvia, Joanna Mishtal, and Lorena Anton. 2017. A Fragmented Landscape: Abortion Governance and Protest Logics in Europe. New York: Berghahn.