Doctors as Gatekeepers: An Essay on Reproductive Rights

The message sent by the series of radical abortion bills being passed in America in 2019 is clear; a woman’s entitlement to make decisions about her own body is still questioned and denied. Unfortunately, it is not just US politicians that hold these views. Reproductive rights remain a controversial subject for debate. Once a woman becomes pregnant, she loses her right to self-determination, to make informed choices about her own body, to be an autonomous citizen. This article will look at the Abortion Act 1967, which is the law governing abortion in Great Britain. It will be demonstrated that women under law do not have a right to choose, and this right was not given when the Act was passed because of negative views of women. The ‘rape exception’, which anti-choice proponents say is sufficient to strike the right balance will also be criticized.

The Woman at the Mercy of the Doctor

The law in England and Wales is not as liberal as it is perceived. Abortion still constitutes an offence under law and a ‘right to choose’ has never been recognized. What the Abortion Act has done is establish defenses to protect medical professionals from liability when performing abortions, which apply if certain criteria are fulfilled. Doctors have therefore become the gate-keepers of abortion, and despite the permissive clinical practices, at the end of the day a woman cannot legally have an abortion without two medical professionals allowing her to.

It is not the fault of the doctor that they are in this position of authority and it is incredibly positive that professional guidance recognizes patient autonomy. The NHS guidelines unambiguously state that the decision to have an abortion is the pregnant woman’s alone. Why is it then that the law is not in line with this? In the 1960s, the status of womanhood was such that it was politically easier to argue that doctors, as well-respected professionals, should have the authority to decide rather than women, who do not enjoy the same heightened status. Despite differing stances on whether abortion should be permissible, one point was clearly agreed upon; that it was inappropriate for women to be granted decision-making authority on this topic. While this view has been challenged and is considered outdated, it still informs the law.

Why were women not recognized as able to make their own decisions when the Abortion Act was passed? This was largely because of paternalistic assumptions about a woman’s capacity and worthiness, with a particular argument standing out: that the irresponsible and immoral woman does not deserve decision-making authority. The pregnant woman loses her right to self-determination because she was careless, ignorant or promiscuous as she engaged in sexual activity for purposes other than procreation. In the abortion debate, both the responsibility to avoid pregnancy and the blame rest entirely on the woman as if pregnancy is brought about by asexual reproduction. This ignores two realities: one, that contraception is not 100% effective and two, that pregnancy can be a result of forced sex or malicious interference with contraceptive methods. Both circumstances will be examined in the subsequent sections.

Contraception: A Woman’s Responsibility

That the responsibility to prevent pregnancy rests on women is made evident by the inequality of contraception options available. The following facts are listed on the NHS website. At the moment, the only contraceptive methods available to men are condoms or a vasectomy. The male contraceptive injection was tested and found to be effective in 98.4% of men, but the study was terminated early as it was decided that the risk of side effects in the study outweighed the benefits. The most common side-effects of the male contraceptive injection will sound familiar to women on hormonal contraception: acne, impact on libido, injection site pain, emotional disorders, muscle aches. Contrast this with the female contraceptive injection side-effects: headaches, acne, hair loss, decreased sex drive, mood swings, weight gain. Not to mention one of the listed ‘disadvantages’ of another form of widely available female contraception, the combined pill: it has been linked to an increased risk of blood clots and breast cancer and other serious health conditions.

The answer to women is this: if you do not wish to endanger your physical and mental well-being, rely on condoms. Unfortunately, male condoms when used correctly, are 98% effective, meaning that there is a chance a woman could become pregnant despite using contraception. Therefore, arguments that it is the irresponsible and immature woman that falls pregnant, as advocated when passing the Abortion Act, cannot stand. And it is regrettable that preventing pregnancy is deemed almost exclusively a woman’s responsibility. This is not to argue that were contraception 100% effective, the legitimacy of abortion would no longer be up for debate. It is highlighted to demonstrate how society still considers pregnancy a woman’s responsibility, and will villainize the pregnant woman regardless of all the care she has taken to avoid it. In the construction of womanhood informing the Abortion Act, she is still the Irresponsible, the Undeserving.

The Rape Exception

Anti-choice advocates try to get around this debate by allowing the law to have mercy on the woman who was sexually assaulted and raped, permitting abortion under this circumstance. But this brings an entirely new hurdle to the debate: the standard of proof. How will a woman satisfy the law enforcer that she was impregnated against her will? How will she prove the attack if there are no marks, the condom that was intentionally pre-torn, the birth control that was meddled with? How will she prove that her partner removed his condom mid-intercourse, a prevalent practice called ‘stealthing’?


Reproductive freedom is a political decision and indicative of women’s status within society. A society that denies women authority over their bodies is a society that sanctions inequality and second-class citizenship. A society which retains an outdated framework, informed by outdated and wholly inappropriate constructions of womanhood, is similarly blameworthy. Let women be the gatekeepers of their own bodies. Listen to women, respect women, trust in women.

Article by BWV volunteer Nicoletta Bakolas.

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