IOnly after reading Juno Carey’s book do you realize that it also serves as a meditation on women and shame. Carey (not her real name), a former NHS midwife who ended up in abortion provision (first in clinics and then through aftercare helplines), was asked how she could do both, but according to her: “The gap between helping women childbirth and helping them terminate unwanted pregnancies no longer seems broad to me.” As the title says, it is “a necessary kindness”, another way to help pregnant women. While acknowledging its complexity, Carey seeks to demystify abortion—its fact, its necessity, its processes—to rid abortion of its long, painful history of judgment, blame, and misogynistic juju, and to emphasize its rightful function in a civilized society. According to her, abortion is health care.
This is a timely book to highlight the sociopolitical urgency of securing reproductive freedoms. In 2022, the U.S. Supreme Court overturned the 1973 Roe v Wade decision (which made abortion a constitutional right), leading to sweeping bans and restrictions across the country. Other countries, including Malta and the United Arab Emirates, have bans or restrictions. Despite changes in the law, accessing abortion in Northern Ireland is still complicated. In Britain, abortion is technically illegal: only available if two doctors give permission and certain criteria are met. Although a free parliamentary vote on decriminalization is expected soon, women (who perform late-term abortions) have recently been prosecuted under an 1861 law.
Carey writes evocatively about the stigma, guilt, and secrecy that engulf abortions to this day—a culture of silence that leaves women feeling abnormal and alone. About one in three women will have an abortion, more than a tattoo (about one in four). Carey emphasizes the wide range of these women, at different ages and stages of life. Some are young and not yet ready for motherhood. Others are trafficked, raped, abused or victims of domestic violence. Some end a long-awaited pregnancy due to a fetal abnormality. Others cannot afford a second child, or simply do not want one. And on and on: so many women need abortions, for countless complex reasons. Carey writes, “I now believe that almost anyone could undergo the procedure under certain circumstances.” Yet women regularly came to her clinic expecting to be shamed.
The passages about Carey’s work in abortion clinics are as valuable as they are sometimes intimidating to read. She outlines different types of terminations: medical (pills) and surgical, with local or general anesthesia (later terminations are performed in hospital). While her clinic was performing surgical terminations, she witnessed late-term abortions (when fetuses are too large to be removed whole). She wrote: ‘It was almost unbearably painful to see and recognize body parts.’ Elsewhere, one patient died from undetected ectopic pregnancy-related problems. Another woman, who was overdue for an abortion, committed suicide after giving birth. Carey believes patients deserve “full transparency” about the procedure and its risks, but it’s clear the vast majority go off without a hitch. In 2021, there were almost 215,000 cancellations in England and Wales no abortion-related deaths.
Carey believes that radical transparency, where women feel free to tell their stories, is crucial, otherwise the vacuum will be filled by those who strongly oppose abortion. She points to protests and rallies outside abortion clinics and the fight for buffer zones so that vulnerable patients are not bombarded with guilt or explicit, inaccurate, fear-mongering leaflets. As with some people at March for Life demonstrations, Carey notes that “street counselors” outside clinics are often paid by wealthy organized international groups backed by their success in America.
Carey covers many more topics, including how some hospitals view abortion clinics; the desperate and deadly history of illegal, dangerous backroom abortions (the knitting needles and the coat hangers); the continued opposition – British MP Jacob Rees-Mogg declared in 2022 that abortion is a ‘cult of death’ and refused to support its termination, even in cases of rape. And then the good news: the countries that decriminalize abortion; and how the pandemic has facilitated the UK’s telemedical abortion (“pills by post”) legislation, which became permanent in 2022.
Along the way, Carey, a mother in a same-sex relationship, talks about her personal struggle to get pregnant with IVF, but insists that this did not seem to contradict her abortion work: “I wanted to be pregnant and she didn’t: it was that simple It.” A necessary kindness emerges as a candid, comprehensive and often moving book. It raises awareness of the fragility of reproductive organs around the world and in Britain. It is a powerful insider account that opens the door to a long-hidden world where secrecy and shame have been used against women for too long.