Juno Carey, a pseudonym, is a midwife practitioner who has worked in an abortion clinic in the UK for the last eight years. She lives with her wife and their three children – the baby’s at home when I meet her, along with Carey’s sister, who’s looking after him. Carey is tidy and serene, the woman you’d single out in a playground if you needed a tissue, or a hairbrush, or some nice word on a bad day.
She has written a book about abortion that is not at all serene, but deeply knowledgable, full of conviction and not even trying to keep the peace. I’m not sure I’ve ever read a book so plain in its thinking and descriptions – of the women and their situations, of what abortion care looks like and the dilemmas, sensitivities and practicalities in a terrain that is discussed so much by those who oppose it, and shrouded in silence by those who support it. I wouldn’t say Carey’s tone was ever celebratory, but what often comes over in her anonymised stories is the sheer blissful relief of no longer having to be pregnant when you didn’t want to be, and the tight bond of gratitude that exists between patients and medics. We probably don’t talk about that enough.
It was just as Roe v Wade, which conferred a constitutional right to abortion, was overturned in the US that Carey was driving to her sister’s and heard a phone-in on LBC. A professor was talking about abortion, she remembers, describing the process of a termination in some detail from a position of absolute ignorance. He asserted as fact, she says, various kinds of protocols – that nurses never let you see the ultrasound, for instance – that don’t exist. “I’ve never called in to a phone-in, it would make me too anxious. Confrontation is not my thing. I wasn’t phoning in to argue with him, I just wanted to say: that’s not true. You need to hear from women. You need to hear from experts. It is dangerous, all this misinformation.”
So she called in, and the act of giving some basic detail about abortion out loud became the inspiration for her book. “Juno Carey” is a pseudonym partly for this reason – she doesn’t relish, or seek, confrontation. But the necessity also underlines a new(ish) reality: if she wrote this book under her real name, she would be trolled online by an international community of anti-abortion activists, most likely for the rest of her life, or certainly for so long that it would be impossible to do her job.
I cannot remember a time in my life when reproductive rights have been so precarious. In the US, 25 million women now live in a state where abortion is illegal. Women across the country are afraid to use period-tracker apps; women in Missouri aren’t allowed to get a divorce while they’re pregnant, so now that abortion is illegal, they’re living in an extraordinary state of semi-serfdom. In the UK, women are afraid to use period trackers, or if they aren’t, they should be. In England and Wales, there have been up to 60 criminal inquiries into procurement of abortion since 2018, according to reports, compared with almost none in the century and a half before.
If prosecuted, the women’s defences will probably rest on what term they thought their pregnancy was at. If they were using a period tracker, that could be used as evidence against them. In Poland, Malta and Austria, abortion is part of the criminal code, while in Germany, most women are made to go through ridiculous hoops before access to abortion services will be considered, such as mandatory counselling with a three-day cooling-off period. In Hungary, women are made to listen to the foetal heartbeat. Carey writes: “The void that we have created by failing to talk openly about abortion has been filled instead by those who oppose it.”
Brought up in London, Carey’s dad worked in advertising and her mum was a lefty. One set of grandparents were staunch Daily Mail readers, while her other grandmother was a boho single parent. Carey was much more emollient than political – “caring, I’d say”, her sister chips in. After five years in midwifery, she started work at an abortion clinic and was astonished by how little she knew. In her midwifery training, abortion was not mentioned, she said. “Which is bizarre, because you’re treating women every day, and a lot of these women will have had a termination in the past. It may not be medically relevant, but it might be relevant to how they’re responding to being in a hospital setting, or having surgery. I didn’t even realise that it was absent from the curriculum until I went to the clinic. It was just never spoken of.”
She describes in the book her first experience of assisting in a surgical abortion, relatively late-term at 20 weeks. “It was almost unbearably distressing to see and recognise body parts,” she writes. Carey is unflinching on this: to do her job, you have to come to terms with the fact that you’re ending what would otherwise become a life, and you feel that quite viscerally at the start. “It is very difficult, I did feel faint,” she says. “But I had that exact same feeling when I saw my first birth. So it’s not necessarily that it was particularly gruesome, or traumatising. It was a reaction to something that I’d never seen before, that I know a lot of people won’t ever see, and will stick with me for ever.”
The vast majority of abortions happen much earlier, and only 13% are carried out surgically – the rest are so-called medical abortions, where you take two drugs – mifepristone and misoprostol – usually a few days apart, to pass the pregnancy at home.
Carey says women vary enormously in how much they want to know about the procedure. “Some people really want detail, they want to know exactly what instruments will be used, what will happen to the remains. Some women say: ‘I don’t want to know anything,’ and I have to say: ‘I have to tell you some things, because I need you to consent. I’ll keep it as brief and as vague as I can, but I do need you to understand what it is.’”
Even those in the profession, Carey says, rarely talk about the procedures outside work, partly out of respect for squeamishness, but also because many women never talk about what their abortion was like, either. So there’s an omertà that runs from the patients to the medics, facing outwards and sometimes facing each other, and all that silence “can be preyed upon”, Carey says, “by people who use it to suggest: ‘They’re not telling you what happens because it’s so awful.’ That’s not it: we’ll tell you if you ask. It’s not a secret.”
One of the saddest stories Carey writes about is of a girl from Northern Ireland, who arrived at the clinic with her mother, thinking she was within the 24-week time limit for a termination, but turned out to be over it. She describes this awful, poignant scene, the mother trying to put a brave face on the inevitable (“it’ll be a Christmas baby”), while the girl wrestles with the realisation that her life has changed. The frustration of being powerless to help is quite rare, but there have been countless situations where Carey has had to learn that she’s “not there to solve everything. Admitting that is half the training.” Women come in with a pregnancy that’s the result of rape, and “you want to insert yourself into their lives and fix it all, especially at the beginning,” she says.
Now, having seen what it takes to prosecute a rape, and the vanishingly small likelihood of a conviction, she’s not even sure that she’d recommend anyone to report it. “You realise over time that they’re not coming to you to solve everything,” she says. “They just need to hear: ‘I’ve heard you, I believe you, let’s sort this one thing out that I can do, then here’s who can help with the rest.’”
She has unearthed sex trafficking, once involving a patient who “almost didn’t realise what she was disclosing” when she straightforwardly answered a question by saying she didn’t know who’d made her pregnant, it could have been one of multiple men and she didn’t know any of their names. “I’m sure she would have known that it wasn’t nice. And that she wasn’t consenting. But I don’t think she had a grasp of the fact that this entire network of illegal activity had happened, and she was a victim of it. I can almost guarantee that there have been trafficking cases that I have not picked up. I can only ask the questions and probe. I’m not an investigator. Sometimes, when I write down what a woman has said to me, I think: ‘There are six different triggers for a safeguarding referral form here.’”
Secrecy and stigma are “not the same, but they rely on each other, they feed off each other,” Carey says, and whether you’re talking about abortion or sexual violence, the common thread is that “discussion needs to start actually involving the women”.
She segues to a “very different issue” with the same discursive distortions: “My brother-in-law is trans, and he was saying exactly the same thing: all these conversations happen, between politicians, sports bodies, commentators, but where are the voices of people living those lives?”
While the issues are different, there is a massive – and new – crossover between anti-abortion and anti-trans activism, a lot of it funded by the same rightwing cadres. This is particularly pronounced in the US, but you can see the same issues being linked in the UK, with the lawyer Paul Conrathe bringing an anti-trans test case one year (Keira Bell v the Tavistock) and an anti-abortion test case the next. Conrathe has been active all this century representing pro-choice, from the Society for the Protection of Unborn Children to a 2001 case of a man trying to prevent his ex-partner from having an abortion.
This has a real world impact: Carey is sure that trans men are having to present as women in order to get abortions. “I’ve dealt with maybe three trans people over thousands of women that I’ve seen, and that seems statistically unlikely, to me: people present in the way that they think they need to present, in order to walk in to an abortion clinic. They think that, if they mention that they’re trans, it becomes a trans issue. Which is sad, because we do have the capacity to focus on you as a whole person.”
Carey had both her children – her daughter is five – through IVF while she was working at the clinic, and “I think people thought I would find that difficult,” she says. “I was a gay woman, paying thousands of pounds a month to have IVF, I then miscarried, and still had to go to work and look after women. I got pregnant again, after a struggle, and was there with this growing bump, facing women who were at exactly the same gestation as me. But I just didn’t find that difficult. I’m not jealous that you’re pregnant, when I’m trying to get pregnant. I’m not judging you for not wanting to be pregnant, when I am pregnant.”
“You can keep trying to separate women into different groups,” she says. “Pitting women against each other, as if we’re at two separate ends of some reproductive spectrum … but we’re all in the same boat.”
Indeed. We all need control over the lives we want to live, the families we want to have and when we want to have them, and I’d argue that is the foundational autonomy in a person’s life. When Roe v Wade was overturned, a lot of people – decent people – worried that it was just the beginning of the assault on women’s rights, from a newly empowered fundamentalist conservatism. But I thought, not really: it’s the beginning and the end. If you can’t choose whether or not to be a mother, you can’t choose anything.
Next month MPs will get a free vote on decriminalising abortion in the UK, which, if it passes, would put a stop to the recent surge in prosecutions for abortions over the 24-week time limit. “I’ve heard people saying that decriminalisation will lead to more late-term abortions, or more abortions,” says Carey. “That can’t be true because most of the women I see aren’t even aware that abortion is in the criminal statute.” Abortion, she says, “is a life-altering decision. It doesn’t matter how easy or not easy you make it. People will drive through the night, they will sleep in their cars, they will do anything to get the treatment they need. So many arguments aren’t borne out by the reality, and it’s all because these women aren’t heard.”
• A Necessary Kindness: Stories from the Frontline of Abortion Care by Juno Carey is published by Atlantic (£16.99). To support the Guardian and Observer order at guardianbookshop.com. Delivery charges may apply
• This article was amended on 14 March 2024. An earlier version said that all trainee midwives did not cover the topic of abortion, when this was meant to refer to Juno Carey’s training. It was further amended on 17 March 2024. An earlier version said that women in Germany had to undertake a mandatory three-day counselling course before having an abortion. In fact, most women in Germany have to undertake counselling with a three-day “cooling-off period” before an abortion can take place.
