Is a “choice” a bad frame for childbirth?

There is an article in the UK newspaper the Telegraph, about Sheila Kitzinger, and her thoughts about a new UK plan to ensure all women have choice when it comes to where they give birth. From a US perspective, the plan is pretty radical. The choice includes home birth, a birth center attended by midwives and a traditional hospital setting.

Kitzinger supports the plan, but criticizes the language of choice:

“Choice comes from the language of advertising – it is what happens in supermarkets,” she said. “The idea is one of free choice but in fact the products at eye level are displayed to have the greatest impact on the consumer; it is the same with maternity.”

“Childbirth experts are often blamed for raising women’s expectations but I think you have to look further. I think the problem is a consumerist agenda. We are geared up to competition, to test everything; nowadays, we see birth as a performance,” she said.

Sound familiar to anyone?

Reproductive justice activists have long critiqued the reproductive rights movement for using the consumer based “choice” framework. They argue that not everyone has the same “choice” largely due to social and economic factors.

Moving from choice to justice has been a way to move the reproductive rights framework to a broader philosophy that incorporates the reality that many women do not have a choice–and their socio-economic situation, their race, their religion, etc don’t allow them to make these decisions.

One of the reasons “choice” is so popular, though, is that it removes judgment. If I say I am pro-choice, I’m not saying I like abortion or promote it, but that I value the right of every individual to decide. Same thing with birth. If the UK government supports every woman having a choice, they are not saying that homebirth is good, or hospital birth bad, but that every person should be able to decide.

But “choice” still ignores that there are factors that influence us, often that we don’t have control over. Those factors could be doctor’s opinions, family pressures, economic circumstances, access issues, cultural barriers. This is another place where the reproductive justice and birth activist movements find commonality–“choice” isn’t working too well for either movement.

Reproductive rights folks have latched onto “justice” as a frame instead. Reproductive justice works toward a world where all people have the resources and support they need to make decisions about family creation. I think birth activism fits neatly into that framework, which is part of the reason I write about how these issues overlap.


4 thoughts on “Is a “choice” a bad frame for childbirth?

  1. ecohumanist January 12, 2010 / 6:02 am

    choice also distracts you from the fact that some institutions have more power and means than others to influence women’s decisions…

  2. Annie @ PhD in Parenting January 12, 2010 / 6:29 pm

    I believe that society should provide us with choice. I believe that individuals should make informed choices. I believe those who seek to maliciously influence people to make bad choices should be punished. I know that sounds a lot simpler than it is.

  3. k. emvee January 14, 2010 / 7:52 pm

    I have also heard it brilliantly argued (and I’m not about to do it justice) that framing reproductive rights in the choice framework is what enabled the Roe v. Wade decision to even exist in the first place. That it was precisely the act of placing abortion on the table as a consumer right (as opposed to a social justice right) and a choice that enabled women (albeit and admittedly largely white, middle class women) to see it in terms of a medical service essentially no different from any other rather than in terms of morality. That this act gave women agency over their own bodies in a way that human rights and social justice language would not have at the time. Of course I’m kicking myself now because I can’t for the life of me remember where I heard or read that to link back to a source.

    But I’ve long wondered what would happen if the birth movement fully co-opted the language of choice in the way the reproductive rights movement has and whether that would change fact that midwives of all stripes are sorely underutilized resources in the US. Perhaps the UK will be a living case study for us about this.

    By the way, do you have sources you could link to about these views from the reproductive justice movement? I think most of the time reproductive justice activists are right on in their view and critique of things and I’d love to read some of these sources.

  4. radicaldoula January 19, 2010 / 12:08 pm

    k. emvee–you’re right. It was the choice framework–actually even more narrowly based on the idea of “privacy” that won us the Roe vs. Wade decision. It was based on the principle of right to privacy between a doctor and their patient.

    Unfortunately we only have the constitution to work with when it comes to the justice system, so the arguments available to us are pretty narrow.

    But the problem with the Roe vs. Wade win is how hard it is to defend. “Privacy” says absolutely nothing about access, so low-income women are sold up the river when it comes to abortion access (and the same would be true for alternative birth access). Not to mention young women (parental consent/notification laws), women in the military and those living on military bases or with government insurance, etc, etc.

    Privacy hasn’t given us a very strong leg to stand on.

    For more information about reproductive justice, check out this website:

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