Pregnancy is not caregiving

In this post, Christie Hartley (Georgia State University) and Ashley Lindsley-Kim (University of British Columbia) discuss their recently published article in the Journal of Applied Philosophy  in which they argue against the claim that the feminist commitment that all persons are owed care could obligate pregnant persons to gestate unwanted fetuses.

Is pregnancy a kind of caregiving? This might seem initially plausible since it is through pregnancy that essential fetal needs are met. Furthermore, at least in some societies, it is commonly thought that pregnancy is a labor of love or that continuing a pregnancy is a way of caring for another. Yet, it is a mistake to think of pregnancy in this way, that is, as a kind of caregiving. Understanding why is crucial for thinking well about the ethics and politics of abortion.

Let’s start with caregiving, which involves providing material or emotional care for another or oneself. Examples of the former include feeding, bathing, or dressing someone; examples of the latter include comforting or simply listening to another. Both types of caregiving are social practices and, as such, involve patterns of behavior that are part of a society or a group’s culture and that emerge or follow from a society or a group’s values and beliefs. Pregnancy, by contrast, is not a social practice. It’s a progressive biological condition characterized by numerous nonvoluntary changes in a female’s body. Some of these changes help maintain and support fetal development; others prepare the body for birthing and breastfeeding. While essential fetal needs (e.g., the fetus’s need for oxygen, nutrients, waste disposal) are met through pregnancy, these needs are not met through social practices.

This is not to deny that cultures have values and beliefs about pregnancy that result in social practices related to pregnancy or that pregnancy is implicated in our social lives. Regarding social practices, pregnant persons often engage in self-care for their pregnancy by, for example, consuming extra calories, or they engage in practices related to supporting fetal development by taking prenatal vitamins or avoiding certain foods. Many pregnant persons also develop a social relationship with their fetus during gestation and express a caring attitude towards their fetus. All these things influence how pregnant persons think about and respond to their pregnancy.

Yet, we should not conflate pregnancy with caregiving. Consider some important differences. Intentionally ceasing material caregiving does not involve some kind of physical intervention, such as surgery or medical care. And, for those who engage in material caregiving, when they are meeting their own needs – by eating, taking medication, etc. – they are not necessarily affecting others (at least, when they are not pregnant). These differences have to do with the fact that material caregiving lacks the distinctive kind of physical intertwinement and entanglement that characterizes pregnancy. Indeed, as the fetus comes into existence, it is necessarily integrated with the pregnant person. From the beginning of a pregnancy, when a fertilized egg implants in the uterine wall, the fetus’s internal entanglement is established. Continued development requires considerable integration with the pregnant person, in addition to the physical expansion of the pregnant person’s body.

Indeed, this kind of considerable physical intimacy is necessary for fetal development, and it is different from other types of intimacy in two important ways. First, this kind of invasive relation poses especially significant risks to a pregnant person’s health and wellbeing. A pregnant body undergoes physiological and anatomical changes – such as weight gain, fluid retention, ligament laxity, hormonal changes, and compression of soft tissues and nerves – which can be painful and debilitating. Additionally, a pregnancy person’s cardiac output increases, putting stress on the heart and putting them at persistent higher risks for cardiovascular disease and premature death for the rest of their lives. Second, physically invasive intimacy fundamentally concerns bodily integrity, and persons have a morally weighty interest in its protection. We are our bodies in an important sense, and pregnancy changes how a person’s body functions, how a person’s internal systems operate, and how a person is internally organized. Moreover, successfully carrying a fetus to term requires birthing, whether a birth is vaginal or cesarean. This is a physically traumatic end to a fetus’s invasive physical integration with a gestating person and, all by itself, raises concerns about forced pregnancy given the importance of bodily integrity.

Comparing pregnancy and material caregiving leads us to ignore the distinctive ways in which a person’s bodily integrity is at stake in pregnancy and not in caregiving. Of course, we certainly do not intend to minimize the demandingness of caregiving or its costs. We hold caregiving to be socially necessary, valuable work that can be demanding and costly and that we have a shared, moral obligation to provide. Yet, analogizing pregnancy to material caregiving suggests that pregnant persons have far more agency over what occurs in the progressive condition of pregnancy than they do. Further, considering pregnancy as a form of caregiving suggests that pregnant persons may have a moral obligation to gestate. This perpetuates the pernicious view that those who can gestate must use their bodies in the sexual and reproductive service of others. This threatens to naturalize sex-based caregiving.

In today’s political climate, thinking of pregnancy as a kind of caregiving is especially dangerous. The U.S. Supreme Court overruled Roe v. Wade in Dobbs vs. Jackson Women’s Health Organization (2022) and held that the U.S. Constitution does not confer a right to abortion. At this time, 12 U.S. states have almost completely banned the practice, and Florida, Iowa, Georgia, and South Carolina have banned abortion at about 6 weeks. Other states have taken measures to protect the practice and make it more accessible. In states with restrictive abortion bans, pregnant persons are legally required to gestate and, then, legally required to birth. This forces pregnant persons – overwhelmingly women – to be in the forced service of the state. Given the importance of caregiving duties, the suggestion that pregnancy is a form of caregiving provides support for such sexual servitude.