Expertise and Scottish abortion practice: understanding healthcare professionals’ accounts

Abstract

Current UK abortion law has been subjected to extensive feminist critique because of the relationships that it constructs between healthcare professionals (HCPs) and women with unwanted pregnancies. The law allows HCPs to opt out of abortion provision on the grounds of conscience, implying that it is not something which they have an automatic duty to provide to their patients. It also gives doctors the authority to decide whether an abortion can legally take place, thus suggesting that women’s reproductive decisions should be regulated by medical ‘experts’. However, little is known about how HCPs who are involved in twenty-first century UK abortion provision define their relationships with their patients in practice. My thesis makes an important empirical contribution by responding to this gap in the literature and exploring the subjectivities which these HCPs construct for themselves and their pregnant patients. I address this issue by analysing Scottish HCPs’ interview accounts of their involvement in (or conscientious objection to) abortion provision, using conceptual tools provided by Science and Technology Studies (STS) and feminist theory. I begin by utilising HCPs’ discussions of the practice of ‘conscientious objection’ as a means of exploring how they define the boundaries of their professional responsibilities for abortion provision. I then move on to address HCPs’ accounts of their interactions with women requesting abortion, and analyse how they define legitimate or ‘expert’ knowledge in this context. A key conclusion of the thesis is that HCPs do concede some authority to women with unwanted pregnancies; this is revealed by their reluctance to suggest that they have the right to prevent individual women from accessing abortion. At the same time, I argue that the legitimacy granted to pregnant women by HCPs is limited. My analysis reveals that, in constructing knowledge claims about the use of abortion, HCPs co-produce troubling definitions of femininity, socio-economic class, age and ethnicity. I develop a strong critique of this process, and highlight its potential implications for women’s experiences in the abortion clinic. However, I conclude that this situation cannot be addressed by simply attacking the practices of HCPs as individuals. Rather, it is necessary to understand and critique the limitations of the discursive context in which HCPs are working, because this context shapes the subjectivities available to pregnant women and HCPs.