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Feminism, Self-Estrangement, and the "Disease" of Pregnancy
by Mary Krane Derr, M.S.W.

Feminists have long expressed concern with women's estrangement from their bodies when they deviate from male norms of desirability. Stark manifestations of this devaluation is obvious in women's distaste for their body image, not because they "have unattractive bodies, but because they see themselves inaccurately . . . and tend to dislike their bodies as they dislike themselves," according to a 1984 study.[1] When women use the male norm, especially the lean, muscular form, as the ideal, and see themselves as a deviation and therefore inferior to that standard, they find special distress from additional real or imagined fat or softness on their bodies.

An extreme reaction to the fat is the disorder anorexia nervosa, which vividly illustrates the radical disjuncture between women's perceptions and the realities of their bodies. Anorexia nervosa reveals the violence some women can inflict on themselves because they "grotesquely distort" their looks. The distortion is inextricably bound up with severely deficient self-esteem, which results from a sense that one is inferior. The psychiatrist Hilde Bruch suggests that "quite normally it is alarm over body changes that seems to precipitate the anorexia." What most see as "normal development and changes" the female anorexic interprets as "fatness." Puberty may end her secret "dream of growing up to be a boy." Consider the case of Joyce:

She was troubled about seeing her body change. From childhood on, she felt it was not "nice" to look like a woman, that her tissues would bulge . . . She wanted to have a body as good as it could possibly be, which meant to her to be thin. She brought her weight down to seventy pounds, taking inordinate pride in being so slim, with no curves, and in having achieved this herself . . . Now she feels that her slenderness makes her look more like a man, and she wants to be equal to men, in particular to prove that she has the same stamina . . . The extreme thinness is one way of proving her strength.[2]

Anorexia nervosa is psychopathological behavior involving over-control of eating for weight reduction, and phobias concerning changes in bodily appearances. About one out of every 250 adolescent girls are afflicted to some degree, and 60% of those suffering the disorder are females ages 11 to 60 [3]

Although only so many women go to such extremes, untold numbers share the negative attitudes toward the female sex and the belief that a woman can acquire value only through a self-destructive process of identification with men. Frequently this self-deprecation has been acute in pregnancy, which biologically and socially represents the most critical and indisputable difference between male and female. The self-disparagement internalized by women tends to arise in those who most fully accept the societal dictum that they are inferior because not male, with its corollary that they acquire value only insofar as men find them valuable.

As prominent French feminist Simone De Beauvoir observed in her landmark 1950s book, The Second Sex, "Women who are primarily interested in pleasing men . . . are distressed to see themselves deformed, disfigured. . . Pregnancy seems to them no enrichment, but a diminution of the ego."[4]

The early twentieth-century dancer Isadora Duncan's account of her pregnancy exemplified de Beauvoir's claim.

The child asserted itself more and more. It was strange to see my beautiful marble body softened and stretched and deformed. . . . More and more my lovely body bulged under my astonished gaze . . . Where was my lovely, youthful Naiad form? Where my ambition? My fame? I felt miserable and defeated."[5]

More recently, a contemporary woman responded similarly in Our Bodies, Ourselves: "When I found out I was pregnant, I was frightened and angry that my body was out of control . . . that my sexual parts were alien and my enemy. I felt I was being punished for my femaleness." [6]

Yet this book was another landmark book for feminism, one published on the thesis that women should have knowledge of their bodies and regard them positively. For example, it states: "prenatal care is a form of preventive medicine, for when we are pregnant, we are not sick."[7] One contributor revealed the attitude that helped her to cope with the stresses attending pregnancy:"It was like premenstrual tension. I was a little nauseous. But it's amazing, once I realized I was pregnant, the symptoms were tolerable, because they are not signs of sickness, but life-producing."[8] The contrast between their chapter on abortion and the remainder of the book is remarkable.

During the 1970s feminist literature like Adrienne Rich's Of Woman Born moved pregnancy away from a disease that "extinguished an earlier self." It reclaimed the female reproductive function from the medical establishment and healed women's alienation from their pregnant bodies, insisting that giving birth was a natural, healthy physiological process rather than a pathology.[9]

Such an attitude precludes the notion that fetus and woman operate at cross purposes, at least in the physiological sense. Feminist writings continued to contribute enormously to positive attitudes toward pregnancy. Yet, at the same time, the advocacy for abortion was providing a disconcerting counter-point.

Although feminists have struggled to heal women's alienation from their bodies, many have at the same time held fast to disparaging notions about female biology. They have sought greater power in the public sphere largely by concentrating on measures which enable women to forego childbearing, most notably in legalized abortion. In this way they have capitulated to the idea that women's distinctive physical powers are the source of, rather than the rationalization for, their inferior social status. Certainly, any arguments that abortion is necessary to achieve equality are based on this premise -- that female biology requires technological manipulation in order to avoid an inherently inferior status.

Tessa Weare wrestled with this dispiriting irony during her pregnancy, and wrote about it in a British feminist book:

There is tendency amongst women to reject aspects of our bodies that can be used against us. . . I've experienced this attitude mostly from feminists. . . Quite often I found that because they'd rejected that potential in themselves, they rejected it in me too. Some treated me with pity, others with amazement that I'd voluntarily chosen to increase my own oppression. . . My disappointment at these reactions tended to increase my rejection of my body as "me." I found it hard to accept my body growing round, heavy and "fat," as people insisted on calling it. My sexuality was connected to being "sylph-like." [10]

Yet, at the same time, the idea of loathing the womb was receiving feminist criticism. Mary O'Brien noted that

Feminists are increasingly aware that reproduction is the central issue for women, and that the problems of women's inferiority are not biologically but culturally determined. It is not the act of childbearing nor the task of child-rearingwhich stamps women as inferior, but the value which male-dominant society has given to these necessary activities of social life." [11]

For more than two decades feminists challenged the negative value the patriarchy applied to the female aspects of reproduction. Yet many did not question their own construction of unwanted pregnancy as a disease when this construction figured prominently in the arguments in favor of abortion legalization. Arguing convincingly that pregnancy is not a pathological condition, pro-choice feminists reverted to the language of disease they disdained to characterize unwanted pregnancies.

Although pregnancy is not a 'sickness,' it seems that it must be cast as a very heavy disability in order to justify abortion. Casting an unwanted pregnancy as a deviant condition that profoundly disrupts the victim's existence and utterly violates her bodily integrity supplies a compelling justification to end it. Therefore, motherhood can come to represent "the annihilation of women" [12], and the slogan becomes, "A woman's right to abortion/Is akin to her right to be." [13] Making unwanted pregnancy pathological not only addresses salient features of a crisis pregnancy experience. It also appeals to the common tendency of woman "to see her body in illness as a 'spoiler,' the enemy of her intellect, career, relationship, or whatever else is being disrupted by the illness."[14] Another woman, the veteran of two abortions, concludes,"God, woman's body is a drag."[15]

Once an effective corrective to the interpretation of pregnancy as disease, feminist rhetoric had abandoned its championship of pregnancy as a healthy state so pro-choice rhetoric could sell. When Dr. Bernard Nathanson worked for NARAL (at the time, the National Association to Appeal Abortion Laws; currently the National Abortion and Reproductive Rights Action League in the United States), his colleagues referred to the fetus as "a parasite" or "the aggressor."[16] These words evoke the militaristic language of a public health campaign, for example "the war on cancer." Dr. Natalie Shainess, who testified against abortion limits in New York State, insisted, "Medically, physicians recognize that pregnancy is a kind of parasitism. A parasite can commit murder." [17]

Myrna Lamb's 1969 play, "But What Have You Done for Me Lately?" explicitly expresses similar feelings about pregnancy. The drama depicts the reactions of a man in whom a pregnant uterus was forcibly implanted, clarifying for him the anger, desperation, and anguish of a woman when she faces the same dilemma:

Why should I give this . . . this thing representation?" he cries. "It is nothing to me. I am not responsible for it or where it is nor do I wish to be. I have a life, an important life. I have work, important work . . . and this mushroom which you have visited upon me in your madness has no rights, no life, no importance to anyone, certainly not to the world. It has nothing. It has no existence . . . A tumor. A parasite. This has been foisted upon me?and then I am told that I owe it primary rights to life?My rights are subsidiary! This insanity! I do not want this thing in my body! It does not belong there. I want it removed. Immediately. Safely." [l8]

The pregnant uterus he finds in him was implanted by a woman he once impregnated and abandoned. She remembers what it was like to have that unwanted disease and speaks for all women like her who are deprived of the surgery that would cure the unwanted pregnancy:

Our work suffered. Our futures hung from a gallows. Guilt and humiliation and ridicule and shame assailed us. Our bodies. Our individual unique familiar bodies, suddenly invaded by strange unwelcome parasites, and we were denied the right to rid our own bodies of these invaders by a society dominated by righteous male chauvinists of both sexes who identified with the little clumps of cells and gave them precedence over the former owners of the host bodies. [l9]

Perhaps it is not too far-fetched to suggest that the attitude towards the female body expressed here has some noteworthy resonances with that manifested in anorexia nervosa. For the woman who experiences a crisis pregnancy also sees the unwelcome emergence of distinctively female physiological processes as a dire threat to all that would render her a worthy human being. In order to remain "equal to men," in order to retain "a body as good as it can possibly be," she must prove her strength through the violent negation of this indisputable difference between the sexes that so threatens her.

Dr. Elizabeth Karlin, an abortion provider, asserts, "Nine out of ten women who come into my office have often repeated this sentence: 'I would never have an abortion.' When they face me and I ask them why they're crying, my patients who are minutes away from having an abortion say, 'I don't believe in abortion.'" [20] She uses this assertion as an example of how society marginalizes women by inducing them to have such emotions; that women who have such emotions may be being marginalized by being abandoned to abortion is an idea she does not explore.

The abortion that negates the pregnancy can be deemed an act of self-destruction, an act that radically estranges a woman from "her body, herself." Daphne de Jong, a New Zealand feminist, argues that the demand for abortion at will is a symptom of "self-hatred and total rejection not of the sex role but of sex identity." She asserts that "the womb is not the be-all and end-all of women's existence. But it is the physical center of her sexual identity, which is an important aspect of her self-image and personality." When a woman rejects the womb's function, or regards it as a "handicap, a danger, or a nuisance," she rejects a "vital part of her personhood." [21]

When this contradiction is grappled with, the term most frequently applied is "ambivalence". Those that most vociferously defend abortion have still taken note of this phenomenon. Barbara Ehrenreich, for example, complains that the women's movement has "sustained losses from a fifth column who took to wallowing in the 'ambivalence of abortion.' What next . . . second thoughts about suffrage?" [22]

This attitude has impaired sorely needed inquiry into a subject of vital importance to women. It has caused much trepidation and pain to people who, despite their commitment to abortion, have found that their own rhetoric neglects and even contradicts important features of women's reproductive experience. K. Kaufmann describes her own anguish at this discovery:

Why did both my abortions leave me bitter and angry in ways I could not, at that time, understand or explain to myself, let alone other people? I did and still do define myself as a feminist. I believe absolutely in the fundamental right of all women to control our bodies. Why did I feel the need to hide my pregnancies and abortions? Why did the abortions hurt so much?

. . . (T)here seemed to be a contradiction between everything I had ever read or thought about abortion and the lived experience, an enormous gap between the impassioned rhetoric of the political and moral arguments both for and against abortion, and the bloody reality of one scared woman screaming on a table. . . For (feminists like me), an experience which is supposed to affirm their right and power to choose, to define and use in their own terms their sexuality and creative energy, instead exposes how limited and illusory their choices are." [23]

Linda Bird Francke, who has had an abortion and interviewed a large number of women about theirs for The Ambivalence of Abortion, echoes this sentiment: "Having an abortion is not as simple as some advocates have led women to believe. It is a shock to the system, the womb in particular." She suggests that "a woman's womb is her emotional core, and during an abortion it is tampered with." Francke finds it amazing that she allowed herself to do just that, since she is "so neurotic about life that I step over bugs rather than on them." She "spends hours planting flowers and vegetables in the spring even though we rent out the house and never see them." She, who makes sure her children are vaccinated, inoculated, and filled with Vitamin C, wonders how she "could so arbitrarily decide that this life shouldn't be. . . More to convince himself than me," her husband had argued, "It's not a life. It's a bunch of cells smaller than my fingernail."

Francke seems to have remained unconvinced even after her abortion: "But any woman who has had children knows that certain feeling in her taut, swollen breasts, and the slight but constant ache in her uterus that signals the arrival of a life." She marveled that she "would march myself into blisters for a woman's right to exercise the option of motherhood," but discovered in the waiting room that "I was not the modern woman that I thought I was." [24]

Experiences like Francke's painfully attest to the truth of Adrienne Rich's characterization of abortion as a "deep, desperate violence inflicted by a woman upon, first of all, herself." [25] Perhaps the willingness, even the insistence, on the right of women to do such violence to themselves is inextricably bound up, like the self-negating behavior of anorexics, in a severe lack of self-esteem. Numerous observers of women's abortion experiences have noted many of these women display traits that indicate such an estrangement from their bodies. One observed among many women "an absence of personal strength." He saw "the women repeatedly display an unreadiness to assert themselves, to claim fair and fond consideration from their men. Instead, they are uncannily submissive."[26]

The people most staunch in their support for abortion and at the same time most familiar with it as a daily practice are the doctors and nurses who are abortion providers. The clinic personnel also provide insight into the question of dealing with the contradictions. Nurse Sallie Tisdale wrote an article for Harper's magazine which discusses this:

Privately, even grudgingly, my colleagues might admit the power of abortion to provoke emotion. But they seem to prefer the broad view and disdain the telescope. Abortion is a matter of choice, privacy, control. Its uncertainty lies in specific cases: retarded women and girls too young to give consent for surgery, women who are ill or hostile or psychotic. Such common dilemmas are met with both compassion and impatience: they slow things down. We are too busy to chew over ethics. One person might discuss certain concerns, behind closed doors, or describe a particularly disturbing dream. But generally there is to be no ambivalence." [27]

Yet she also expresses poetically the feelings she has on the biological reality:

"How can you stand it?" Even the clients ask. They see the machine, the strange instruments, the blood, the final stroke that wipes away the promise of pregnancy. Sometimes I see that too; I watch a woman's swollen abdomen sink to softness in a few stuttering moments and my own belly flip-flops with sorrow." [28]

In fact, the widespread nature of these feelings was noted in the American Medical News (published by the American Medical Association, the United States' largest organization of doctors), in reference to workshops of the National Abortion Federation, an association of American abortion clinics: "The discussions . . . illuminate a rarely heard side of the abortion debate: the conflicting feelings that plague many providers who are seeking to balance the rights and needs of patients with the reality of terminating pregnancies. . . . The notion that the nurses, doctors, counselors and others who work in the abortion field have qualms about the work they do is a well-kept secret." [29]

The disparity between positive perceptions of female biology and abortion practice was also noted in a soul-searching book by a doctor who has been practicing abortion since before legalization:

It can't be pure coincidence that the three surgical procedures most frequently performed on the female patient are hysterectomy, abortion and cesarean section -- all of them assaults on the uterus, the maternal end organ. Somehow, it seems that the manipulation, removal and "cleaning" procedures that the womb is subject to arise from an attitude that it's expendable -- what one feminist friend of mine calls the 'We Don't Have It You Don't Need It" school of medicine.' [30]

The societal dictum that portrays women as deviations from and inferior to the male norm could prompt lack of self-esteem. The feminists who describe pregnancy as healthy only when it is wanted reinforce the dictum and exacerbate the problems that plague many pregnant women. Germaine Greer links this devaluation of the female to the casting of pregnancy as a pathological condition. She suggests that if the "management of childbearing in our society had actually been intended to maximize stress, it could hardly have succeeded better." Childbearers "embark on their struggle alone" while the rest of us "wash our hands of them." Elizabeth Fox-Genovese concurs, arguing that the community has abandoned its role in bearing or rearing children. Greer starkly sketches what we have made of pregnancy: "From conception, pregnancy is regarded as an abnormal state which women are entitled to find extremely distressing." It is not "viewed simply as a natural, but rather peculiar, condition, but as an illness, requiring submission to the wisdom of health professionals and constant monitoring, as if the fetus were a saboteur hidden in its mother's stomach." [31]

Feminists have rightly defined the alienation of women from their bodies as a critical social justice concern. Misogyny remains so entrenched in our society partly because it forces its way into that most private and individual aspect of women's lives: their experiences of their own bodies. Women squander tremendous amounts of energy berating themselves for their failure to meet impossible and destructive standards of physical "perfection." Unless they learn to accept and love their bodies instead, women will behave as patriarchy intends for them to behave; to blame themselves for problems whose real source is a society which denigrates the non-male.

Women are robbed of their greatest source of empowerment when they are compelled to experience their unique physical capacities as disease processes. Instead, women must regard these capacities as normal, healthy bodily features deserving of respect, accommodation, and celebration. Pregnancy is not some sort of debilitating, life-threatening parasitic infection which peculiarly curses their sex. It is rather "an arduous but normal exercise of life-giving power. . . which men can never know." [32] The fetus is not the antagonist of the woman; they are mutual participants in a "primordial, prototypical, and physically concrete form of sociality and interdependence." [33]

Such a transformed understanding of gestation can give women the confidence to demand proper recognition of pregnancy as a truly indispensable contribution that they, and only they, can make to human life. Indeed, women must make this demand if they wish to achieve full liberation. If feminists are to heal women's estrangement from their bodies, they must not think of pregnancy as disease, even when it occurs in tremendously unsupportive contexts. When they accept this construction of pregnancy, they only perpetuate the female tendency to lash out at the self rather than challenge societal conditions that deny the worthiness of the self.

1. Sanford, Linda T. and Mary Ellen Donovan, Women and Self-Esteem, Anchor Press/Doubleday, Garden City, New York, 1984, pp 369-70.

2. Bruch, Hilde, The Golden Cage, Harvard University Press, Cambridge, Massachusetts, 1978, pp 65ff.

3. Levenkron, Steven, Treating and Overcoming Anorexia Nervosa, Warner Books, New York, 1983.

4. De Beauvoir, Simone, The Second Sex, transl. H.M. Parshley, Knopf, New York, 1957, p. 50.

5. Ibid.

6. Boston Women's Health Collective, Our Bodies, Ourselves, Simon and Schuster, New York, 1976, p. 222. A different form of the same quotation was included in The New Our Bodies, Ourselves, published in 1984, p. 292.

7. Ibid., page 252.

8. Ibid., page 257-58.

9. Rich, Adrienne, Of Woman Born, Norton, New York, 1976, pp. 166-67.

10. Weare, Tessa, "Round in a flat world" Women's Health: A Spare Rib Reader, ed. Sue O'Sullivan, Pandora Press, London, 1987. pp 360-64.

11. O'Brien, Mary, "The politics of hysteria: man, media, and the test-tube baby,", Canadian Women's Studies, Summer 1979, p. 61. Emphasis in original

12. Allen, Jeffner, "Motherhood: the annihilation of women," Women and Values, ed. Marilyn Pearsall, Wadsworth, Belmont, California, 1986, p. 91-101.

13. Boston Women's Health Collective, The New Our Bodies, Ourselves, Simon and Schuster, New York, 1984, p. 315.

14. Sanford, Linda T. and Mary Ellen Donovan, Women and Self-Esteem, Anchor Press/Doubleday, Garden City, New York, 1984, pp 370-71.

Francke, Linda Bird, The Ambivalence of Abortion, Random House, New York, 1978.

Nathanson, Bernard, Aborting America, Doubleday, New York, 1979, p. 220. Dr. Nathanson was a pioneering abortion doctor, but is currently an active abortion opponent.

Shainess, Natalie, quoted by James T. Burtchaell in Rachel Weeping, Harper and Row, San Francisco, 1984, p. 196.

Lamb, Myrna, "But what have you done for me lately?,", in Woman and Sexist Society, ed. Vivian Gornick and Barbara K. Moran, Basic Books, New York, 1971, p. 10.


Karlin, Elizabeth, "What Shall I Wear?", Progressive, October, 1994.

de Jong, Daphne, "Feminism and Abortion", Sisterlife, Spring 1986, p. 5.

Ehrenreich, "The Next Wave", Ms., July/August 1987, pp. 166ff. See also her "The heart of the matter", Ms., May 1988, pp. 20-21.

Kaufmann, K. "Abortion: a woman's matter", Test-Tube Women ed. Rita Ardittain, Renate Duelli Klein, and Shelley Minden Pandora Press, London, 1984, pp. 213-34.

Francke, Linda Bird, The Ambivalence of Abortion, Random House, New York, 1978.

Rich, Adrienne, Of Woman Born, Norton, New York, 1976, p. 269.

Burtchaell, James T., Rachel Weeping, Harper and Row, New York, 1982, p. 7.

Tisdale, Sallie, "We do abortions here: A nurse's story", Harpers Magazine, October, 1987.


Gianelli, Diane M. "Abortion providers share inner conflicts," American Medical News, July 12, 1993.

Abortion: A Doctor's Perspective, A Woman's Dilemma. Don Sloan, M.D. with Paula Hartz. Donald I Fine, Inc., New York, 1992, p. 178.

Greer, Germaine, Sex and Destiny, Harper and Row, New York, 1984, p. 7.

Callahan, Sidney, "Abortion and the sexual agenda," Commonweal, April 25, 1986, pp. 232-38.

Cahil, Lisa Sowle, "Abortion, autonomy, and community," pp. 261-76 in Abortion: Understanding Differences, ed. Sidney Callahan and Daniel Callahan (New York: Plenum Press, 1984).

Originally printed in Feminism and Non-Violence Studies Journal, Vol. 1, Issue 1, Winter 1995. Reprinted with permission.