A Critical Feminist Discursive Analysis of Abortion Dynamics in Canada (2020) PDF

A critical feminist discursive analysis of dynamics shaping abortion in Canada: Implications for nursing. Margaret Lebold RN MScN & Judith A. MacDonnell RN PhD York University, School of Nursing, 4700 Keele Street, Toronto, Ontario, Canada. Cite as: Lebold, M. & MacDonnell, J. A...

A critical feminist discursive analysis of dynamics shaping abortion in Canada: Implications for nursing. Margaret Lebold RN MScN & Judith A. MacDonnell RN PhD York University, School of Nursing, 4700 Keele Street, Toronto, Ontario, Canada. Cite as: Lebold, M. & MacDonnell, J. A. (2020). A critical feminist discursive analysis of dynamics shaping abortion in Canada: Implications for nursing. Witness: The Canadian Journal of Critical Nursing Discourse, Vol 2(2), pp 76-91. https://doi.10.25071/2291-5796.76 Abstract The advent of “the abortion pill” (Mifegymiso) in 2015 has shaped the contemporary context of access to abortion in Canada. In this paper, we highlight findings of a literature review that uses a gender and intersectional lens and critical discourse analysis to explore contemporary abortion access and implications for nursing. The discursive dynamics influencing nurses’ understandings of abortion, that is, the contexts in which some discourses are privileged over others yet often operate at the unconscious level to influence everyday knowledge and practices, are important to discern to work towards social justice goals. Findings suggest that normative and contradictory features of discourses such as women’s health, motherhood, and abortion access are relevant. Given the relative silence of abortion in nursing literature and prevailing gender normativity in nursing, there are compelling reasons to apply a critical feminist lens to deepen nurses’ understandings and critical reflection about abortion. There are implications for current education, research, and nursing practice. Keywords: abortion access, critical feminist, motherhood, critical discourses, Mifegymiso, literature review This is a pivotal time in the history of Nurses are ethically mandated to support the women’s health in Canada with the advent of holistic health of diverse individuals and “the abortion pill” (Mifegymiso) in 2015. communities (Canadian Nurses Association, Reproductive health, including access to 2017). With the arrival of the abortion pill the abortion, are well documented as relevant to landscape of abortion in Canada has changed, women’s health in a Canadian context (Greaves ostensibly making abortion more accessible in & Whynot, 2014). Although abortion rights are Canada. It seemed important and timely, protected in Canada, abortion access continues therefore, to examine the literature to better to be contested (Saurette & Gordon, 2015). understand the broad and contextual dynamics Corresponding Author: Margaret Lebold, PhD Student, York University, School of Nursing, 4700 Keele Street, Toronto, Ontario, Canada [email protected] 76 shaping contemporary abortion access in Canada abortions without necessitating surgical facilities and implications for nursing. In undertaking the (Winikoff & Sheldon, 2012). Many abortion literature review, we gathered a range of advocates pushed for access to mifepristone for perspectives, including international and years, but, due to the lengthy and costly interdisciplinary research; however, for the medication approval process in Canada, purpose of the critical discourse analysis we combined with the country’s relatively small focused mainly on the contemporary Canadian population size, Mifegymiso’s submission to context and drew upon some American policy Health Canada took many years to materialize, literature. finally being approved in 2015, with initial distribution commencing in 2017 (CBC News, In Canada, where abortion rights have 2019; Winnikoff & Sheldon, 2012). Since 2019, been achieved since 1988, and the abortion Mifegymiso is now available in at least one part debate “closed”, there is however, recent of each province/territory, although individual evidence and media awareness of attempts to ease of access still varies significantly1 (Action erode Canadian women’s sexual and Canada for Sexual Health and Rights, 2019a; reproductive rights. For example, in May 2019 CBC News, 2019). This is not to say that in Ontario, three Members of Provincial procuring Mifegymiso for people who need Parliament (MPPs) spoke at an anti-abortion abortion is now simple. In fact, medical rally and vowed “to make abortion unthinkable oversight remains common pre- and post- in [their] lifetime” (Clementson, 2019). During abortion, although, guidelines around the the COVID-19 pandemic, fears about abortion necessity of ultrasounds pre-abortion have access heightened and concern arose across recently become more flexible (National North America, about whether governments Abortion Federation, 2020). would consider abortion an essential service during the pandemic, or whether pregnant By applying a critical feminist lens in people would be forced to maintain unwanted this literature review about abortion in the pregnancies (Action Canada for Sexual Health contemporary context, we uncover and Rights, 2020; Peters, 2020). contradictions and challenges to commonly held assumptions about abortion, and counter- Successful and tireless work by discourses to dominant discourses that shape the advocates set the foundation for increasing contemporary abortion context in Canada. In abortion accessibility in Canada in the latter half doing so, we illustrate the value of a critical of the current decade (Stettner, 2016a). Given feminist lens in generating complex Canada’s vast geography, along with mounting understandings about discursive dynamics (i.e., evidence from other countries that medical dominant and non-dominant discourses shaping abortion could assist more people who need abortion) that are needed for nurses. The abortions gain physical access, a major focus of discursive dynamics influencing our abortion-related research in recent years (2015- understanding of abortion, that is, the contexts in present) was connected with advocacy efforts to which some discourses are privileged over access the long-awaited “gold-standard” others, yet often operate at the unconscious level abortion pill: mifepristone/misoprostol, known to influence our everyday knowledge and as “Mifegymiso” in Canada (CBC News, 2019; practices, are important to discern to work Winikoff & Sheldon, 2012). This abortion pill towards social justice goals. We suggest that was first made available in France and China in such complex understandings of discursive the 1980s, and proved to be a discreet method of dynamics are important to discern, for example, abortion, allowing women to gain access to how some dominant discourses prevail while 1 Access was also facilitated by the parallel removal of previously mandatory pre-abortion ultrasound requirement that advocates claimed was sometimes nearly equally difficult to obtain as abortion, particularly in rural and Northern Canadian communities (Zingel, 2019). WITNESS VOL. 2(2) 77 others are marginalized, and how these have underlying inequalities (Fairclough, 1995; Smith impacts for what knowledge is available. 2007). Critical discourse analysis can rupture otherwise taken for granted discourses, by Methodology: Critical Feminist and showing how there is a link between language Intersectional Lens and social practices and the ways knowledge is regulated (Fairclough, 1995). We foreground The purpose of this literature review was gender identities and make visible how what we to identify dynamics including normative understand of abortion is constructed through discourses that influence contemporary access to gendered discourses. While we centralize gender abortion in Canada with a goal of understanding in this literature review, we also think about how implications for nursing. To do so, we purposely additional “axes of difference” or take a broad and critical scope when exploring intersectionalities, such as class, race, and access, expanding the confines of more typical sexuality (Hankivsky, 2007) are relevant to the nursing and health services abortion research to lives of diverse people who have abortion. We draw from literature in nursing, women's studies, also pay attention to how diverse, intersectional and social sciences. abortion discourses and the experiences they represent are eclipsed by dominant ways of We use a critical feminist and knowing. intersectional lens (Kagan et al., 2010) to examine social, political, economic, cultural, and At any time, there are many discourses historical forces, including dominant discourses circulating and embedded in texts such as the about women’s health, motherhood, and literature reviewed here. These discourses are abortion access that shape abortion. Like Kagan always contextualized by shifting historical, et al. (2010), we draw from critical social theory political, economic, social, and cultural to apply our critical feminist worldview that dynamics such that any analysis is necessarily recognizes that knowledge is “created within a partial (Lazar, 2007). Thus, we identify our socio-political context and shaped by power approach to apply a gender and intersectional dynamics” and “values subjugated ways of being lens and point to selected discourses for the and knowing” (p. 69). Our priorities are to purposes of this analysis and how they operate affirm multiple ways of knowing and amplify and relate to one another and with what traditionally silenced ways of knowing, towards impacts. We note that the available literature is awareness and action-oriented material changes broad but limited with respect to nursing (Kagan et al., 2010, 2014). We take a feminist research, especially in a Canadian context. Our approach that assumes that gender matters, that analysis offers insight into the Canadian context, knowledge is constructed, and that knowledge is but we recognize that there may be particular gendered (Hankivsky, 2007). Our position is that impacts for diverse people across Canada in gender and gendered social dynamics operate relation to the impacts of these discursive and have meaning in the lives of people who dynamics on abortion access and in relation to have abortions. Our approach also uses an nursing practice. The key is that these dominant “intersectional theory [that] posits that gender is and counter dynamics are potentially in play in distinct from but interacts with other social all contexts in which nurses practise and in features like social class or race/ethnicity such which abortion access is enabled or restricted for that their effects are mutually constitutive rather individuals or groups. Our analysis points to the than separate” (Pederson et al., 2014, p. 28). need to illuminate these dynamics. Critical discourse analysis focuses on Critical feminist discourse is a specific ways of knowing that are privileged or area of critical discourse analysis that is “guided marginalized in particular contexts and examines by feminist principles and insights in theorising how discourses reinforce power structures and and analysing the seemingly innocuous yet WITNESS VOL. 2(2) 78 oppressive nature of gender as an omni-relevant about abortion and implications for nursing? category in many social practices” (Lazar, 2007, Looking at nondominant ways of knowing and p. 143). Critical feminist discourse analysis is drawing out underrepresented perspectives particularly useful in identifying the subtle, (Kagan et al., 2010), we looked at how contemporary, and often taken-for-granted ways challenging dominant gender norms can disrupt in which gender assumptions and power our assumptions and understanding of abortion dynamics are discursively enacted (Lazar, 2007). (MacDonnell, 2014). Although a critical feminist discourse analysis can be critiqued for being too abstract, it is a Angie Deveau’s own abortion story methodology that moves us in an emancipatory offers such a disruption to common discourses direction (Lazar, 2007). It is a move away from about motherhood. She shares: the descriptive exploration of texts, to critical … I will always have a “what if” in the ones that focus on subtleties embedded in back of my head. Honestly, I think the contemporary discourses (Smith, 2007). It is in “what if” feeling is less my critical feminist discourse that we find romanticizing the notion of having opportunity for reflection and consideration another child and more my imagining about abortion discourse. my life and emotions spiraling even further out of control (Deveau, 2017, p. Four gendered discourses (women’s 44). health, motherhood, access, and nursing) emerged for us as relevant through a critical review of the literature on abortion access and Deveau’s story takes a feminist-mothering, or, were chosen for the purpose of this analysis. We matricentric form (Green, 2018), centralizing her began with a critical feminist analysis and as we personal wellbeing in a way that differs from identified discourses, we determined that a common public abortion discourses centered critical discourse analysis was helpful. We around abortion rights. As Angie’s story selected these discourses through an iterative, demonstrates, to understand, we need to have reflexive and recursive process of discussion in more complex and intersectional renderings of which we examined the forces shaping understanding of abortion. understandings (Lazar, 2007; Smith, 2007) of abortion access beyond the taken for granted Interrogating the Notion of Abortion as a challenges associated with abortion access. The Women’s Health Issue discourses about abortion from the critical literature pointed to contradictions and counter Reported abortions over the last few discourses, especially when we looked at these years suggest that 100,000 abortions take place in relation to each other through critical feminist each year in Canada2 (CIHI, 2017), and while and intersectional lenses. We juxtaposed Canadian contexts are central in this paper, we dominant and nondominant abortion discourses recognize that this does not comprehensively that we found in the literature in order to better reflect the experiences of people globally. understand how particular discourses operate Worldwide, 45% of all abortions are considered and dominate and to illuminate alternative, more unsafe, and these abortions are known to happen inclusive discourses through this critical feminist largely in countries where women have few and intersectional lens. To do so, we explored abortion rights (Ganatra et al., 2017; World some of the limitations of these normative Health Organization (WHO), 2018). Attitudes discourses and illuminated more inclusive ones. about abortion and access vary significantly We asked: What are the normative discourses across the world, including some countries 2 Approximately 85,000 abortions were reported in Canada in 2018, however, given variable reporting requirements, abortion data may not adequately capture or approximate the total number of medical and surgical abortions completed in Canada (CIHI, 2018). WITNESS VOL. 2(2) 79 where abortion is either less or more normalized critically needed (Mitchell, 2019). As well, the than in Canada (Purcell, 2015). cis-normative construction of mutually exclusive gender binary categories (male/female) continue Critical feminist perspectives examine to pervade the literature on abortion, for the social, political, economic, cultural, and example, “women who have abortions.” historical aspects of a given situation. They However, recognizing that people of various consider the ways in which people are situated genders may require abortions, Lowik (2018) diversely, based on social factors, and how implores clinicians to use more inclusive systems and structures of power, laws, and language; language such as: “anyone policies reinforce long-held positions of experiencing an unplanned or unexpected oppression and privilege (Hankivsky, 2020). In pregnancy”, “pregnant people”, and “people our review, it was evident that much of the who have abortions.” current abortion literature has a critical spin and reflects both challenges and progress for women At the same time, it is relevant to locally and globally. The commonly described recognize both the historical abortion advocacy material and social impacts of abortion are work taken on by many cisgender women, and indeed critical (for example, the financial, social, that cisgender women are the single-most likely and navigation aspects of abortion). The fact that gender group to necessitate abortions. In this these impacts are even known is a product of paper, therefore, drawing from Ross and women’s research and women’s advocacy Solinger (2017) and similar to Mitchell (2019), (Begnell & Durey, 2014). Thinking broadly we use women who have abortions when talking about contexts, gender, power, and about historical references and events or intersectionality, we aim to understand the referencing others’ work who talk specifically contemporary experiences of people needing about women. When referring to contemporary abortion more fully by turning to the social, groups of people who have abortions we strive legal, and critical literature, and by exploring to use people who have abortions and language implications for nursing. suggested by Lowik (2018). It must be noted upfront, that a Juxtaposing Abortion Language and persistent gap remains in our ability to Motherhood understand diversely situated people who have abortions in Canada. Noticeably, the experiences Examining varied conceptualizations of of people who have abortions still largely motherhood can inform a deeper understanding represent the experiences of a non-diverse of abortion. Abortions are often framed as being racial/ethnic (i.e., White) and gender groups “resistance” to a traditional pronatalist view of (i.e., cisgender women). However, there is motherhood aligned with a White, middle-class, evidence of more recent inclusion of some heteronormative, nuclear family model in which increased racial/ethnic diversities (Cano & a “real woman” bears children (DiLapi, 1989; Foster, 2016; Foster et al., 2017; Mitchell, 2019; Green, 2019; Jones et al., 2008). Women who Vogel et al., 2016) and some attention to choose abortion are deemed to be “abandoning” Muslim women’s experiences (Wiebe et al., their fertility and femininity (Abrams, 2015). 2011) in the recent Canadian abortion literature. Such normative views, aligned with the “institution of motherhood” (Green, 2019; Historically, abortion has fallen under O’Reilly, 2004) are embedded in all social the rubric of “women’s health.” Notwithstanding institutions such as the health and legal systems robust recent clinical guidance for trans- such that women are often stigmatized, and in inclusive abortion care (Lowik, 2018), research many instances outside of Canada, abortion exploring the abortion experiences of remains illegal (Abrams, 2015). Women who transgender and non-binary folks remains challenge motherhood ideologies based on WITNESS VOL. 2(2) 80 maintaining patriarchal authority over women’s conceptualizations of gender, reproduction, and lives can self define motherhood and what it family (Lowik, 2018). means to be a “good mother” (Green, 2018; MacDonnell, 2006). Access to Surgical and Medical Abortion A range of mothering practices shift In our view, what is typically known dominant motherhood ideas and are instead about abortions among health care providers, are aligned with feminist mothering practices, for the many barriers people face to obtaining an example, through resisting imposed expectations abortion; in other words, “physical access.” In of motherhood, such as self-sacrificing Canada, these barriers are namely the noticeable behaviour (Green, 2018). The few studies that geographic barriers and the associated materials explore mothers’ experiences with abortion and impacts, such as those required to travel to suggest that women considered their abortion see an abortion provider—e.g., related costs decisions in relation to relationship concerns, such as: travel/gas, hotel, childcare, lost work including abuse, and delayed motherhood until time—all of which are particularly pronounced they could raise children in healthy relationships among young women of low socioeconomic and/or prioritized their conditions and those of status (Cano & Foster, 2016; Sethna & Doull, their existing children (Jones et al., 2008; Wiebe 2013). People living in rural settings have long- et al., 2012). faced, and continue to face, the impacts of significant systemic challenges to abortion Contradictions about motherhood persist access, including inadequate health care staffing as women across social locations often face poor and provider unwillingness to perform/provide conditions for mothering. Even as traditional abortion care (Action Canada for Sexual Health motherhood is lauded as the desirable social job and Rights, 2019a, Cano & Foster, 2016; of women in a traditional context, it is often Dressler et al., 2013; Norman et al., 2013). devalued. It is unpaid work and there are limited resources and supports for mothers to raise A critical feminist perspective children, including family-hostile work illuminates the contexts of abortion access: how environments with even fewer resources people come to experience abortion access is available to those raising children on the about how they navigate the social, familial, margins (Bogart & Lee, 2020; DiLapi, 1989; community, and political contexts unique to Medoff, 2016; Rippeyoung, 2013). them—and equally, how individuals, situated differently, have resisted such contexts. Thus, Coincidingly, anti-abortion discourses abortion access can also be about agency and are at the centre of the reinforcement of structures of control permitting—or denying— traditional views of femininity and sexuality. agency. It is important to acknowledge that Discourses about who is fit to be a mother have women have been controlling their bodies since long persisted, often with consequences for time immemorial, and women have found ways those who mother despite being seen as unfit to to have abortions even when officially restricted mother, and similarly for those who are seen as (Boston Women’s Health Book Collective, fit to mother but who choose not to (Bourgeois, 2011; Ehrenreich & English, 1973/2010). The 2014). These gendered discourses of advent and accessibility of the abortion pill is motherhood and femininity work to limit access radical in that it allows for autonomous self- to abortion (Bourgeois, 2014). Reinforced administration and at-home abortion, rejecting messages about femininity and motherhood also the contemporary and dominant biomedical have implications for trans-men and non-binary ways in which abortion was once, up until very people who have been long excluded from recently, only accessible through direct provider conversations about both abortion and parenting, intervention (for example, vacuum aspiration reflecting narrow and persisting abortions in clinic or hospital settings) (Paynter WITNESS VOL. 2(2) 81 et al., 2019). abortion protests whereby anti-abortion language was often used with intensity—toward Even today, licensed providers largely women on their way to have an abortion. In remain gatekeepers to traditional, safe, abortion recognition of these verbal (and sometimes access—necessitating that providers examine physical) threats at abortion clinics, many issues of power in their relationships with people provinces have now enacted “bubble zones” thus seeking abortion care (Paynter et al., 2019)— restricting protesting around clinics however, the gendered dynamics, such as those (Bellefontaine, 2018; CBC News, 2018). described by McPherson (2003), may prevail in However, despite the restrictions imposed on nurses’ unexamined assumptions about their abortion protesting and the bubble zones values and practices (MacDonnell, 2014). enacted, anti-abortion discourses have Additionally, nursing has a history that is increasingly found ways into more public gendered and has operated in traditional power spaces—for example, on university campuses, hierarchies. Scholars who have studied nursing on advertising space on public transit buses, and have noted that the profession maintains in online environments (Eaton, 2018; gendered normativity, and where nursing may Endemann, 2019; Mallick, 2017; Saurette & still adhere to historical roles as passive, Gordon, 2015). This demonstrates the ways in complacent and “do-gooders” (McPherson, which broad and far-reaching public and online 2003; Traynor, 2017). Gendered discourses spaces are being sought to convey anti-abortion shape professionalism, respectability, and dialogue as policies change and technologies authority as McPherson (2003) has suggested. evolve. Meanwhile, spaces exist where frank abortion discourse is omitted. The omission of Impacts of Normative Discourses that Shape the term abortion from Ontario’s current (and all Abortion preceding) sexual health curriculums is evidence of such an omission (Action Canada for Sexual Discourses form norms and are often Health and Rights, 2019b). Likewise, the used to maintain the status quo of power and omission of abortion education and training in control among dominant groups, and without nursing and medicine has received recent critique, often reinforce binaries (Daley & attention (Paynter et al., 2019). Yet, by pointing MacDonnell, 2011). Used to ultimately out the gaps, opportunities to challenge such influence political outcomes, discourses work by silences are also made visible and may compel shaping and persuading audiences of, for us to action (Paynter et al., 2019; Saurette & example, select sets of values, “appropriate” Gordon, 2015). emotional responses, and ideologies (Saurette & Gordon, 2015). The more normalized and The way abortion discourses are commonplace discourses are, the more likely framed and discussed has much to say about they are to become imbedded in policy which how people understand abortion, their rights, health care providers may reaffirm, for example, and needs. Many discourses are subliminal, and through the common pathologization of certain it takes a lens of marginalization to illuminate groups of people (Saurette & Gordon, 2015). how these normative discourses are enacted and Given their status as minority gender groups, the implications of such discourses. A discourse women and non-binary people are no strangers analysis performed by Saurette and Gordon to the many everyday discourses that attempt to (2013) on anti-abortion dialogue in Canada control their behaviours and beliefs. found that abortion language has shifted over the course of the past 40 years—taking on more Historically, the most visible anti- “pro-woman”/pro-feminist similarities in order abortion discourses occurred in public, at to appeal to, and perhaps to conceal, anti- WITNESS VOL. 2(2) 82 abortion sentiments in similarly-worded, but discourses and are likely to subscribe to many differently-intentioned terms. For example, such discourses, because they dominate. “pro-family” and “women’s care clinics” are Furthermore, nurses represent these social terms commonly used among common-day norms, and nursing is a site where norms are anti-abortion agencies (Ibrahim, 2018; Saurette enacted (McPherson, 2003). People in non- & Gordon, 2013). Yet, even in traditional dominant positions can often internalize caring spaces of nursing, the ways abortions are dominant discourses, which can in turn, affect commonly discussed can also be critiqued. self-blame and decision-making. The phrase the medical necessity of abortion, is an example of a Discourses often reflect the maintenance phrase reflecting social norms in health care that of structural powers that represent the state’s can serve to reinforce structures of power and interests, and are often enacted by self-regulated privilege and eclipse underlying structures of health care providers where there is a sense they oppression. A persistent focus on the medical have authority to decide what is best, even if it necessity of abortion, draws attention to the may undermine people’s own knowledge and medical aspect of abortion, while excluding the agency. In the contemporary context, discourses social, economic, and personal, gendered, and such as abortions should be rare still perpetuate, intersectional necessities of abortion (Kaposy, and can imply that abortions are occurring more 2009). Such discourses have been critiqued for often than they should, creating false goals or centering biomedical access-focused solutions, misguided priorities for providers to reduce to the exclusion of long-term outcomes for abortion rates, or to accept abortions on health and wellbeing. This is not to say that conditional bases, instead of improving access to access to abortion is never medically necessary, abortions (Stettner, 2016b; Weitz, 2010). but rather that greater attention ought to be paid to the social necessities of abortion, for Working closely beside medicine, while example—the structural realities and challenges nurses have resisted, they have often upheld of childrearing today—and why and how these gatekeeping and decision-making powers at structures are reinforced. Medoff’s (2016) different points over time, reinforcing overtones research implies the importance of connecting of middle-class values, often undermining maternal health with reproductive health and people’s own agency and knowledge (Kagan et exploring these issues together3. Employing al., 2014; McPherson, 2003). Such impositions, discourses that focus on the social necessity of including ideas as abortions should be rare, can abortion, expands attention to abortion beyond a operate in ways that restrict which people are medical need (Kaposy, 2009; Medoff, 2016). seen as fit to have children, for example, enacting social and political discourses to ensure Nurses themselves, are immersed in a low abortion rates. The result is often discourses gendered profession and within it discourses of that promote certain “acceptable” forms of birth passivity and powerlessness often circulate control much more widely and openly than other (Traynor, 2017). Historically, nurses could not available options (Carson, 2018). And, although be married, could not be lesbian, and ought to be the advent of the abortion pill in Canada “proper” women, able to follow directions represents a turn towards abortion self- provided by male superiors, and always “nice management versus control, (Paynter et al., rather than clever” (McPherson, 2003; Traynor, 2019), reproductive gatekeeping and control 2017, p. 81). Historically, nursing was a continue (Mitchell, 2019). profession for women, and remains to this day, a profession taken up largely by cisgender women Both health care providers and those in (Traynor, 2017). With this, there is an larger society are immersed in broader social expectation that nurses will uphold traditional 3 This is related to the broader concept of reproductive justice, explored in detail elsewhere (see: Ross & Solinger, 2017). WITNESS VOL. 2(2) 83 feminine morality and shy away from who have faced scrutiny for having an abortion stigmatized topics, to thereby maintain their because they are wrongly perceived to have “maternal” position relative to the patient, and as choice, when in fact, they may have little viable part of the doctor-nurse “parental team” choice available. For example, discourses that (McPherson, 2003). Paynter et al. (2019) criticize abortion for reasons due to sex selection describe the ways in which physicians, who, and fetal anomaly can place further limitations until recently, held exclusive authority to and guilt on women who already live in perform abortions, often obscured nursing’s tremendously sexist and ableist social networks significant contribution in the provision of (Vogel, 2012). For this reason, abortion abortion care. advocates suggest that all abortions need to be valid—that women do not deserve additional From this frame of reference of nurses intense scrutiny in their lives in addition to the as upholders of middleclass assumptions of possible ongoing oppressions they face values and morality, we explore two other terms everyday, a truth with particular salience for common in abortion discourse: elective abortion women of colour and marginalized women who and choice. Although the term elective abortion may face disproportional social pressures to is common, from a critical feminist perspective have abortions, and who would likely receive is misleading (Lippman, 2014). To many people, unreasonably more scrutiny from such a ban abortions are not generally considered elective (Vogel, 2012). Yet, dialogue about banning sex but rather necessary, by people who are selection is vast, and even medical doctors have unexpectedly pregnant, for any number of social, written about their hopes that inequality found in economic, or cultural reasons (Lippman, 2014). sex selection abortion studies will be used to In other words, many people’s diverse develop policies “aimed at eliminating the positions—or intersectionalities—make practice of prenatal sex selection in Canada” abortions a non-negotiable necessity. The term (Yasseen III & Lacaze-Masmonteil, 2016, p. elective abortion has the effect of suggesting— 640). It is important to realize that sex selection perhaps imposing—that high levels of social bans would do little to eliminate the root causes privilege are available to all people; that all and perpetuation of sexist and gender-biased people, without pause, could have a child, when, social norms that work to promote the this more accurately reflects a decontextualized maintenance of one gender over another (Vogel, understanding of people’s, and especially 2012). In a similar way, it is relevant to consider mothers’ roles and responsibilities. For example, the many socioeconomic realities of people’s women often express current life scenarios that lives, and that proceeding with a pregnancy with necessitate their need for an abortion, for a known fetal anomaly may be considered the example, to care for children, to attend to school right choice for some, while for others, abortion or work priorities, or to care for family crises may be the necessary choice. Much depends on (Janiak & Goldberg, 2016). It is key to note too, varying pre-existing oppressions and barriers, or that some women have been denied elective supports and privileges, in people’s lives. A childbearing—indeed, women in Canada have feminist approach accepts the limitations of been forced to have abortions (e.g., Indigenous choices, and thereby centralizes personal and women), raising questions about who exactly subjective reproductive decisions (Saurette & gets to define abortion as “elective” (Boyer & Gordon, 2015). Bartlett, 2017). Implications for Nurses In a comparable way, discourses that focus on abortion as a choice, although often In this paper, we have shown how used in a choice-as-good (e.g., “client choice”), reflection and careful attention to the value of a can reinforce gendered messages and the critical and intersectional lens renders complex maintenance of structures of power and control. understandings of abortion that are valuable for Saurette and Gordon (2015) write about women WITNESS VOL. 2(2) 84 contemporary nursing. Reflection is warranted visible and which are overshadowed in nursing about how nursing is implicated in motherhood, discourses about nursing activism for policy abortion discourses, and abortion access in change. These findings support the call made by everyday practice, research, and education. Paynter et al. (2019) for the inclusion of abortion Nursing itself is situated in historical and curriculum, along with opportunities for nursing gendered underpinnings that continue to have students to participate in abortion care, and impacts to nursing practice today, for example, provide opportunities for deep reflection on the through heteronormative tendencies, nurses, as assumptions and knowledges that we take for well as all people who are working in relation to granted. Together, this critical discourse analysis discourses, may internalize dominant discourses, and Paynter et al. (2019) can be read as openings not necessarily having spent time to understand towards more visible and emancipatory abortion the complexities of abortion access. advocacy by nurses (Begnell & Durey, 2014). It fits well within other calls for emancipatory Taking nursing into consideration, we nursing research practice and education (Kagan show contradictions that exist in our own field; et al., 2010, 2014; MacDonnell, 2014). and highlight dominant discourses and silences through exemplars, to build an understanding about how abortion discourses and silences take shape in nursing, and how these may influence Conclusion care. In sharing this literature, and writing about abortion in nursing, we are indeed contradicting In this review, using a critical feminist normative discourses and resultant silences that perspective, we have highlighted some ways can operate in nursing and show how a critical interdisciplinary abortion literature disrupts and feminist lens can help illuminate these. challenges several of the normative ways of Therefore, we suggest that abortion discourses— thinking about abortion. We first looked at whether subtle or not—have implications for women’s health and raised questions about nursing. We present literature that exemplifies inclusivity and taken for granted discourses and how discourses work and may influence the assumptions about motherhood. By looking at ways in which nurses interact with patients who women’s health in relation to abortion, we have abortions; how these discourses affect the uncovered the need to disrupt the discourse of ways in which abortion is presented and taught women’s health in favour of a more inclusive in nursing school (Paynter et al., 2019); and the rendering, in which people—not just women— extent to which abortion research is explored in have abortions. Then, we looked at gender in nursing. relation to abortion access and discourses to uncover several limitations of abortion in We find there remains a stigma about contemporary Canadian nursing contexts, doing research at the intersection of nursing, shedding light on the gendered dynamics, the mothering, and abortion. To share this kind of history of the profession, and the silences in knowledge in nursing is a contradiction to the nursing. traditionally conceptualized role of the nurse. The consequence is, of course, that the operation Although there is some nursing of normative discourses of motherhood and literature examining abortion, recent nursing abortion remain largely understudied in nursing. literature draws attention to the enhanced There is a need to set the context for where educational opportunities to study abortion and nursing and abortion intersect and we would for increased participation of nurses as primary suggest there are implications across many providers in abortion provision (Paynter et al., domains of nursing—for example, normative 2019). Little is known in the current Canadian practices about what is taught and what is not in nursing literature about the experiences of nursing education and what topic areas are made people who have abortions, although earlier nursing research found that women’s WITNESS VOL. 2(2) 85 experiences with abortion are complex and contextual, influenced by, among other factors, social discourses about abortion and mothering (McIntryre et al., 2001). Our analysis builds on McIntyre et al. (2001) and Paynter et al. (2019) and suggests attention to both dominant and counter-dominant discourses and gender roles of nurses deepens abortion scholarship. In this context, there is a need for more nursing research using a critical feminist lens and critical discourse analysis to better understand the particular ways that discourses impact abortion access for diverse groups—including research focused on the experiences of Black, Indigenous, and People of Colour and gender diverse people. In tandem, we argue for a continued application of critical feminist perspectives in education to deepen nurses’ reflection and understandings and appreciation of the socially dynamic, gendered, and intersectional experiences of people who have abortion. How people understand and make meaning of abortion in the context of their lives amidst the discourses that shape contemporary abortion has implications for all people and nurses who support them. Ethical Permissions Ethical permissions from York University’s Ethics Review Board were provided for ML’s MScN thesis (STU 2017-165). Acknowledgements I (ML) would like to thank the Canadian Nurses Foundation for providing support for my MScN thesis through the Agnes Campbell Neill scholarship (2017-2018). WITNESS VOL. 2(2) 86  References Boston Women’s Health Book Collective. (2011). Our bodies, ourselves (Rev. ed.). Abrams, P. (2015). The bad mother: Stigma, Simon & Schuster. abortion and surrogacy. Journal of Law, https://www.ourbodiesourselves.org/publi Medicine, & Ethics, Summer, 179–191. cations/our-bodies-ourselves-2011/ https://doi.org/10.1111/jlme.12231 Bourgeois, S. (2014). Our bodies are our own: Action Canada for Sexual Health and Rights. connecting abortion and social policy. (2019a). Access at a glance: Abortion Canadian Review of Social Policy, 70, 22- services in Canada. 33. https://www.actioncanadashr.org/resource https://crsp.journals.yorku.ca/index.php/cr s/factsheets-guidelines/2019-09-19- sp/article/view/38700/35108 access-glance-abortion-services-canada Boyer, Y. & Bartlett, J. (2017). External review: Action Canada for Sexual Health and Rights. Tubal ligation in the Saskatoon Health (2019b). Statement on Ontario’s sex-ed Region: The lived experience of curriculum. Aboriginal women. https://www.actioncanadashr.org/news/20 https://www.saskatoonhealthregion.ca/Do 19-03-19statement-ontarios-sex-ed- cumentsInternal/Tubal_Ligation_intheSas curriculum katoonHealthRegion_the_Lived_Experien Action Canada for Sexual Health and Rights. ce_of_Aboriginal_Women_BoyerandBart (2020). Joint statement on essential lett_July_22_2017.pdf abortion care during COVID-19. Canadian Institute for Health Information https://www.actioncanadashr.org/news/20 (CIHI). (2017). Induced abortion reported 20-03-20-joint-statement-essential- in Canada in 2017 [Data set]. abortion-care-during-covid-19 https://www.cihi.ca/en/induced-abortions- Bellefontaine, M. (2018, April 4). Alberta to reported-in-canada-in-2017 introduce ‘safe zones’ around abortion Canadian Institute for Health Information clinics. CBC News. (CIHI). (2018). Induced abortion reported https://www.cbc.ca/news/canada/edmonto in Canada in 2018 [Data set]. n/alberta-to-introducesafe-zones-around- https://www.cihi.ca/en/search?query- abortion-clinics-1.4605302 all=abortion&Search+Submit Begnell, P. & Durey, R. (2014). Creating lasting Canadian Nurses Association (CNA). (2017). change: Advocacy for gender- Code of ethics for registered nurses. transformative health promotion. In L. https://www.cna-aiic.ca/html/en/Code-of- Greaves, A. Pederson, & N. Poole (Eds.), Ethics-2017-Edition/files/assets/basic- Making it better: Gender transformative html/page-1.html health promotion (pp. 212–224). Canadian Scholars’ Press/Women’s Press. Cano, J. K. & Foster, A. M. (2016). “They made me go through like weeks of appointments and everything”: Documenting women’s experiences seeking abortion care in Yukon territory, Canada. Contraception, Bogart, N. & Lee, V. (2020, May 18). Child 94(5), 489–495. care restrictions preventing some from https://doi.org/10.1016/j.contraception.20 going back to work as economy reopens. 16.06.015 CTV News. Carson, A. (2018). Feminism, biomedicine and https://www.ctvnews.ca/health/coronaviru the ‘reproductive destiny’ of women in s/child-care-restrictions-preventing-some- clinical texts on the birth control pill. from-going-back-to-work-as-economy- Culture, Health & Sexuality, 20(7), 830– reopens-1.4944380 843. WITNESS VOL. 2(2) 87  https://doi.org/10.1080/13691058.2017.13 https://doi.org/10.1371/journal.pone.0067 84852 070 CBC News. (2018, February 1). Safe zones Eaton, A. (2018 Sep 15). Graphic anti-abortion around abortion clinics now in place. protests have no place on campus. The CBC News. Varsity. https://www.cbc.ca/news/canada/ottawa/o https://thevarsity.ca/2018/09/15/op-ed- ttawa-abortion-clinic-safezone-police- graphic-anti-abortion-protests-have-no- 1.4510607 place-on-campus/ CBC News. (2019, April 4). Abortion pills Ehrenreich, B., & English, D. (2010). Witches, replace demand for surgical termination midwives, & nurses: A history of women of pregnancy at Victoria Clinic. CBC healers (2nd ed.). Feminist Press. (Original News. work published 1973) https://www.cbc.ca/news/canada/britishco Endemann, E. (2019, April 25). Anti-abortion ad lumbia/mifegymiso-abortion-pill- on Ottawa bus angers two councillors. 1.5083852 Ottawa Citizen. Clementson, L. (2019, May 9). ‘We pledge to https://ottawacitizen.com/news/local- make abortion unthinkable in our news/anti-abortion-ad-onottawa-bus- lifetime’: PC MPP Sam Oosterhoff. CBC angers-two-councillors News. Fairclough, N. (1995). Critical discourse https://www.cbc.ca/news/canada/hamilton analysis: The critical study of language. /oosterhoff-abortion-1.5129494 Longman. Daley, A. E. & MacDonnell, J. A. (2011). Gender, sexuality and the discursive representation of access and equity in health services literature: Implications for Foster, A. M, LaRoche, K. J., El-Haddad, J., LGBT communities. International DeGroot, L. & El-Mowafi, I. M. (2017). Journal for Equity in Health, 10(40), 1- “If I ever did have a daughter, I wouldn’t 10. https://doi.org/10.1186/1475-9276-10- raise her in New Brunswick:” Exploring 40 women’s experiences obtaining abortion care before and after policy reform. Contraception, 95(5), 477–484. Deveau, A. (2017). Timeline of a maternal https://doi.org/10.1016/j.contraception.20 breakdown: A feminist mother’s blog post 17.02.016 about her abortion experience. In E. R. M. Ganatra, B., Gerdts C., Rossier C., Ronald Lind & A. Deveau (Eds.), Interrogating Johnson Jr., B., Tunçalp, Ö., Assifi, A., Pregnancy Loss: Feminist Writings on Sedgh, G., Singh, S., Bankole, A., Abortion, Miscarriage, and Stillbirth (pp. Popinchalk, A., Bearak, J., Kang, Z., & 40–46). Demeter Press. Alkema, L. (2017). Global, regional, and DiLapi, E. M. (1989). Lesbian mothers and the subregional classification of abortions by motherhood hierarchy. Journal of safety, 2010–14: Estimates from a Homosexuality, 18(1-2), 101–121. Bayesian hierarchical model. The Lancet, https://doi.org/10.1300/J082v18n01_05 390(10110), 2372–2381. Dressler, J., Maughn, N., Soon, J. A., & https://doi.org/10.1016/S0140- Norman, W. V. (2013). The perspective of 6736(17)31794-4 rural physicians providing abortion in Greaves, L., & Whynot, E. (2014). Promoting Canada: Qualitative findings of the BC women’s hospitals as a site for change. In Abortion Providers Survey (BCAPS). L. Greaves, A. Pederson, & N. Poole PLOS ONE, 8(6), 1–5. (Eds.), Making it better: Gender- WITNESS VOL. 2(2) 88  transformative health promotion (pp. Kagan, P. N., Smith, M. C., Richard Cowling 225–239). III, W., Chinn, P. L. (2010). A nursing Green, F. J. (2018). Empowering mothers and manifesto: an emancipatory call for daughters through matroreform and knowledge development, conscience, and feminist motherliness. Journal of the praxis. Nursing Philosophy, 11, 67–84. Motherhood Initiative, 9(1), 9–20. https://doi.org/10.1111/j.1466- https://jarm.journals.yorku.ca/index.php/ja 769X.2009.00422.x rm/article/view/40475%20 Green, F. J. (2019). Practicing matricentric feminist mothering. Journal of the Motherhood Initiative, 10(1&2), 83–99. https://jarm.journals.yorku.ca/index.php/ja Kagan, P. N., Smith, M. C., & Chinn, P. L. rm/article/view/40555 (2014). Introduction. In P. N. Kagan, M. C. Smith & P. L. Chinn (Eds.), Philosophies and Practices of Emancipatory Nursing: Social Justice as Praxis (pp. 1–17). Routledge. Kaposy, C. (2009). The public funding of Hankivsky, O. (2007). More than age and abortion in Canada: Going beyond the biology: Overhauling lifespan approaches concept of medical necessity. Medicine, to women’s health. In M. Morrow, O. Health Care, and Philosophy, 12(3), 301– Hankivsky, & C. Varcoe (Eds.), Women’s 311. https://doi.org/10.1007/s11019-008- health in Canada: Critical perspectives 9164-9 on theory and policy (pp. 64–90). Lazar, M. (2007). Feminist critical discourse University of Toronto Press. analysis: Articulating a feminist discourse Hankivsky, O. (2020). Using intersectionality to praxis. Critical Discourse Studies, 4(2), understand who is most at risk for 141–164. COVID-19. Pursuit. https://doi.org/10.1080/174059007014648 https://pursuit.unimelb.edu.au/articles/usi 16 ng-intersectionality-to-understand-who-is- Lippman, A. (2014). Foreward. In S. Patterson, most-at-risk-of-covid-19 F. Scala & M. K. Sokolon (Eds.), Fertile Ibrahim, H. (2018, July 31). Anti-abortion ground (pp. xiii-xv). McGill-Queen’s centre reopens next door to Clinic 554. University Press. CBC News. Lowik, A. J. (2018). Trans-inclusive abortion https://www.cbc.ca/news/canada/new- services: A manual for providers on brunswick/right-to-life-clinic- operationalizing trans-inclusive policies 554abortion-1.4768481 and practices in an abortion setting. Janiak, E., & Goldberg, A. B. (2016). http://www.fqpn.qc.ca/main/wp- Eliminating the phrase “elective content/uploads/2017/12/FQPN-Manual- abortion”: Why language matters. EN-Web.pdf Contraception, 93(2), 89–92. MacDonnell, J. (2006). Exploring matrices of https://doi.org/10.1016/j.contraception.20 mothering and feminisms: Understanding 15.10.008 mothering discourses for lesbian health Jones, R. K., Frohwirth, L. F., & Moore, A. M. advocates through life histories. Journal (2008). “I would want to give my child, of the Association for Research on like everything in the world”. Journal of Mothering, 8(1, 2), 298–310. Family Issues, 29(1), 79–99. https://jarm.journals.yorku.ca/index.php/ja https://doi.org/10.1177/0192513X073057 rm/article/view/5034 53 WITNESS VOL. 2(2) 89  Findings of the British Columbia Abortion Providers Survey. PloS ONE, 8(6), e67023. https://doi.org/10.1371/journal.pone.0067 MacDonnell, J. (2014). Enhancing our 023 understanding of emancipatory nursing: A O’Reilly, A. (2004). Introduction. In A. O’Reilly reflection on the use of critical feminist (Ed.), Mother matters: Motherhood as methodologies. Advances in Nursing discourse and practice (pp.11–26). Science, 37(3), 271–280. Association for Research on Mothering. https://doi.org/10.1097/ANS.0000000000 Paynter, M., Norman, W. & Martin-Misener, R. 000038 (2019). Nurses are key members of the Mallick, H. (2017, January 13). After anti- abortion care team: Why aren’t schools of abortion ads on buses, what’s next?: nursing teaching abortion care? Witness: Mallick. The Toronto Star. The Journal of Critical Nursing https://www.thestar.com/news/gta/2017/0 Discourse, 1(2), 17–29. 1/13/after-antiabortion-ads-on-buses- https://doi.org/10.25071/2291-5796.30 whats-next-mallick.html Pederson, A., Poole, N., Greaves, L., Gerbrandt, McIntyre, M., Anderson, B., & McDonald, C. J., & Fang, M. L. (2014). Envisioning (2001). The intersection of relational and gender-transformative health promotion. cultural narratives: Women’s abortion In L. Greaves, A. Pederson, & N. Poole experiences. Canadian Journal of Nursing (Eds.), Making It Better: Gender- Research, 33(3), 47–62. Transformative Health Promotion (pp. McPherson, K. (2003). Bedside Matters: The 17–41). Canadian Scholars’ transformation of Canadian nursing, Press/Women’s Press. 1900–1990. Oxford University Press. Peters, J. W. (2020, April 20). How abortion, Medoff, M. (2016). Pro-choice versus pro-life: guns and church closings made The relationship between state abortion Coronavirus a culture war in America. policy and child well-being in the United New York Times. States. Health Care for Women https://www.nytimes.com/2020/04/20/us/ International, 37(2), 158–169. politics/coronavirus-protests-democrats- https://doi.org/10.1080/07399332.2013.84 republicans.html 1699 Purcell, C. (2015). The sociology of women’s Mitchell, K. (2019). "It was everyone's abortion experiences: Recent research and judgement": Experiences seeking abortion future directions. Sociology Compass, in Southern Alberta (2007-2017). 9(7), 585–596. [Master’s thesis, University of https://doi.org/10.1111/soc4.12275 Lethbridge]. University of Lethbridge Research Repository. https://opus.uleth.ca/bitstream/handle/101 33/5411/MITCHELL_KATELYN_MA_2 Rippeyoung, P. L. F. (2013). Governing 019.pdf?sequence=3 motherhood: Who pays and who profits? National Abortion Federation. (2020). Clinical Canadian Centre for Policy Alternatives. Policy Guidelines for Abortion Care. https://www.policyalternatives.ca/sites/def https://5aa1b2xfmfh2e2mk03kk8rsx- ault/files/uploads/publications/reports/doc wpengine.netdna-ssl.com/wp- s/Governing%20Motherhood.pdf content/uploads/2020_cpgs_final.pdf Ross, L. & Solinger, R. (2017). Reproductive Norman, W. V., Soon, J. A., Maughn, N. & Justice: An introduction. University of Dressler, J. (2013). Barriers to rural California Press. induced abortion services in Canada: WITNESS VOL. 2(2) 90 Saurette, P. & Gordon, K. (2013). Arguing Exploring Canadian women’s knowledge abortion: The new anti-abortion discourse of and interest in mifepristone: results in Canada. Canadian Journal of Political from a national qualitative study with Science, 46(1), 157–185. abortion patients. Contraception, 94, 137– https://doi.org/10.1017/S00084239130001 142. 76 https://doi.org/10.1016/j.contraception.20 Saurette, P. & Gordon, K. (2015). The changing 16.04.008 voice of the anti-abortion movement: The Weitz, T. A. (2010). Rethinking the mantra that rise of “pro-woman” rhetoric in Canada abortions should be ‘safe, legal, and rare’. and the United States. University of Journal of Women’s History, 22(3), 161– Toronto Press. 172. Sethna, C. & Doull, M. (2013). Spatial https://doi.org/10.1353.jowh.2010.0595 disparities and travel to freestanding Wiebe, E., Najafi, R., Soheil, N., Kamani, A. abortion clinics in Canada. Women’s (2011). Muslim women having abortions Studies International Forum, in Canada: Attitudes, beliefs, and 38(Complete), 52–62. experiences. Canadian Family Physician, https://doi.org/10.1016/j.wsif.2013.02.001 57, e134–138. Smith, J. L. (2007). Critical discourse analysis Wiebe, E., Chalmers, A., & Yager, H. (2012). for nursing research. Nursing Inquiry, Delayed motherhood: Understanding the 14(1), 60–70. experiences of women older than age 33 https://doi.org/10.1111/j.1440- who are having abortions but plan to 1800.2007.00355.x become mothers later. Canadian Family Stettner, S. (2016a). A brief history of abortion Physician, 58, e588–95. in Canada. In S. Stettner (Ed.), Without apology: Writings on abortion in Canada Winnikoff, B., & Sheldon, W. (2012). Use of (pp. 31–76). AU Press Athabasca medicines changing the face of abortion. University. International Perspectives on Sexual and https://www.aupress.ca/app/uploads/1202 Reproductive Health, 38(3), 164–166. 57_99Z_Stettner_2016- https://www.guttmacher.org/journals/ipsrh Without_Apology.pdf /2012/09/use-medicines-changing-face- abortion World Health Organization. (2018, Feb 19). Stettner, S. (2016b). Without apology: An Preventing Unsafe Abortion. introduction. In S. Stettner (Ed.), Without https://www.who.int/en/news-room/fact- apology: Writings on abortion in Canada sheets/detail/preventing-unsafe-abortion (pp. 3-30). AU Press Athabasca Yasseen III, A. S. & Lacaze-Masmonteil, T. University. (2016). Male-biased infant sex ratios and https://www.aupress.ca/app/uploads/1202 patterns of induced abortion. CMAJ, 57_99Z_Stettner_2016- 188(9), 640–641. Without_Apology.pdf https://doi.org/10.1503/cmaj.160183 Traynor, M. (2017). Critical resilience for Zingel, A. (2019, April 25). Removal of nurses: An evidence-based guide to ultrasound requirement could improve survival and change in the modern NHS. access in remote communities to abortion Routledge. drug. CBC News. Vogel, L. (2012). Sex-selective abortions: No https://www.cbc.ca/news/canada/north/ab simple solution. CMAJ, 184(3), 286-288. ortion-pill-ultrasound-access-1.5110044 https://doi.org/10.1503/cmaj.109-4097 Vogel, K., LaRoche, K. J., El-Haddad, J., Chaumont, A., & Foster, A. M. (2016). WITNESS VOL. 2(2) 91